Organization of an anti-epidemic regime in dressing rooms and treatment rooms. Operation of the dressing room in the surgical department Dressing room in the urology department

Purpose of a clean dressing room

Clean dressing room is intended for carrying out dressings after clean operations and for outpatient treatment a number of diseases and injuries. The following interventions are performed in the dressing room.

• 1. Surgical treatment of shallow soft tissue wounds, introduction of antibiotics into the tissue surrounding the wound, suturing.
• 2. Reduction of simple dislocations after anesthesia.
• 3. Treatment of limited I-II degree burns without signs of suppuration: toileting the burn surface, applying a bandage.
• 4. Catheterization or puncture Bladder at acute delay urine.
• 5. Reduction of the head or dissection of the pinching ring in case of paraphimosis.

In addition, in case of severe injuries and acute surgical diseases with critical condition Before transporting patients to the hospital, they are given emergency care in the dressing room.

• 1. Removal from terminal states: restoration of patency respiratory tract, external cardiac massage, artificial respiration, intravenous jet injection of plasma substitutes.
• 2. Temporarily stopping external bleeding using a tourniquet, applying a ligature or clamp to a bleeding vessel visible in the wound, tightly tamponade the wound with gauze napkins and suturing the skin wound over tampons.
• 3. Anti-shock measures for severe traumatic shock: novocaine blockades, transport immobilization for fractures of the bones of the limbs, pelvis, spine; jet infusion of plasma substitutes intravenously, especially before the upcoming long-term transportation.
• 4. Applying a sealing bandage when open pneumothorax; puncture or drainage of the pleural cavity for tension pneumothorax; alcohol-novocaine intercostal or paravertebral blockade for multiple rib fractures.
• 5. Catheterization of the bladder in case of damage or injury spinal cord; puncture of the bladder in case of rupture of the urethra and overflow of the bladder.

Equipment and facilities for a clean dressing room

The dressing room is equipped in a room with an area of ​​at least 15 m2 with natural illumination of 1:4. The requirements for covering the ceiling, walls and floor of the dressing room are the same as in the operating room. The same applies to cleaning the dressing room. For hand washing, two sinks with hot and hot mixer taps are installed in it. cold water.Equipment and fittings for dressing room may vary depending on local conditions, the predominance of one or another surgical pathology. Below is a sample list.

• 1. Dressing table - 1
• 2. Table for sterile materials and instruments - 1
• 3. Small tool table - 1
• 4. Gynecological chair - 1
• 5. Table for medicines and cutting instruments - 1
• 6. Screw chair - 2
• 7. Stands for bixes - 2
• 8. Enameled basins for hand treatment - 2
• 9. Basin supports - 2
• 10. Tool cabinet - 1
• 11. Cabinet for medicines - 1
• 12. Stand for hand operations - 1
• 13. Shadowless lamp with emergency lighting - 1
• 14. Germicidal lamp - 1
• 15. Bixes (sterilization boxes) different sizes - 4
• 16. Stand with bottle holder for intravenous infusions - 1
• 17. Electric boiler (sterilizer) - 1
• 18. Quadrangular basin with lid - 1
• 19. Sphygmomanometer - 1
• 20. Hemostatic tourniquets - 2
• 21. Mouth retractor, tongue holder - 1 each
• 22. Breathing tube (air duct) - 1
• 23. Forceps in a jar with disinfectant solution - 1
• 23.Scissors for cutting bandages - 1
• 24. Disposable intravenous infusion systems, sterile - 4
• 25. Hair clipper and razor - 1 each
• 26.Set transport tires - 1
• 27. Foot bath
• 29. Hand bath - 1
• 30.Hanger - 1
• 31.Plastic aprons - 3
• 32.Bucket for collecting dirty material - 1
• 33.Set surgical instruments, corresponding to the volume of operations and surgical work in the dressing room.

The medicine cabinet contains external agents and solutions for intravenous or subcutaneous administration. P A sample list of products for external use is as follows:

• 1. Iodonate - 300 ml
• 2. Alcohol iodine solution 5% - 300 ml
• 3. Ethyl alcohol - 200 ml
• 4. Ether or gasoline - 200 ml
• 5. Hydrogen peroxide - 300 ml
• 6. Furacilin 1:5000 - 500 ml
• 7. Synthomycin emulsion - 200 g
• 8. Vaseline oil sterile - 50 g
• 9. Ammonia (10% ammonia solution) - 500 ml
• 10.Degmicide - 1500 ml
• 11.Triple solution - 3000 ml

The following drugs are used as intravenous and injection drugs:

• 1. Glucose 40% solution in ampoules - 1 box
• 2. Poliglyukin in bottles - 5 bottles
• 3. Sodium chloride 0.85% solution - 1000 ml
• 4. Calcium chloride 10% solution in ampoules - 1 box
• 5. Novocaine 0.25% solution - 400 ml
• 6. Novocaine 0.5% solution - 800 ml
• 7. Novocaine 2% solution in ampoules - 2 boxes
• 8. Hydrocortisone in bottles - 4 bottles
• 9. Adrenaline 0.1% in ampoules - 1 box
• 10.Mezaton 1% in ampoules - 1 box
• 11.Diphenhydramine 1% in ampoules - 1 box
• 12.Caffeine 10% in ampoules - 1 box
• 13.Tetanus toxoid in ampoules - 1 box
• 14. Antitetanus serum in ampoules - 1 box
• 15. Various antibiotics in bottles - 30 bottles

Scroll medications can expand or contract depending on the nature and volume of work in the dressing room. There are medicines and dressing are also placed in a certain order. On the top shelf there is a quadrangular basin with cutting tools filled with a triple solution, a forceps in a jar with a triple solution, suture material in ampoules or jars, cups, jars with a stopper for alcohol, iodonate solution, iodine, cleol. Bandages, cotton wool, and plaster are placed on the bottom shelf.

Before starting work in the dressing room, a sterile table with instruments and materials is set up, the set of which varies depending on the volume of work of the dressing room.

An approximate list of tools in the dressing room is as follows:

• 1.Needle holder - 3
• 2. Various hemostatic clamps - 12
• 3. Surgical tweezers - 8
• 4. Anatomical tweezers - 8
• 5.Toothed tweezers - 5
• 6.Kontsang - 2
• 7.Plate hooks (Farabefa) - 4
• 8. Two- or three-pronged sharp medium hooks - 4
• 9.Button probe - 3
• 10. Grooved probe - 3
• 11. Trocar in the set - 1
• 12. Various syringes - 8
• 13.Clips for attaching surgical linen - 8
• 14. Kidney-shaped coxae - 6
• 15. Cups for novocaine solution - 6
• 16.Urethral rubber catheters of different sizes - 3
• 17. Urethral metal catheters - 2
• 18.Drainage tubes and microirrigators - 10
• 19. Surgical gloves - 6 pairs
• 20.Injection needles for syringes, different - 20

Cutting instruments and surgical needles are stored sterile in a quadrangular basin, filled with a triple solution: scalpels - 6, scissors - 6, different surgical suture needles - 10. To ensure emergency care in the dressing room it is necessary to have special sets of sterile instruments for tracheostomies.

Tracheostomy kit

• 1. Surgical tweezers - 1
• 2. Anatomical tweezers - 1
• 3. Plate hooks (Farabefa) - 2
• 4. Hemostatic clamps - 4
• 5. Needle holder - 1
• 6. 10 ml syringe - 1
• 7. Different needles for the syringe - 3
• 8. Single-prong tracheotomy hooks - 2
• 9. Tracheotomy dilator - 1
• 10.Tracheotomy tubes No. 3 and 4 - 2
• 11.Cup for novocaine - 1
• 12. Kidney-shaped coxa - 1

These sets of instruments are placed in a kidney-shaped basin and sterilized in a dry-heat oven. After sterilization is completed, it is convenient to leave the kits in the same cabinet, the door of which is kept closed and sealed. To perform an urgent operation, cutting instruments are added to these instruments by removing them from the triple solution: scalpel, scissors, surgical needles. The suture material used is ampoule material, which is always ready for use. Sterile balls, napkins, towels are taken directly from the bix. In some institutions, the tracheotomy set is placed in a bix and sterilized in an autoclave.

Immediately before an urgent operation (surgical treatment of a wound) or dressing, an individual instrument table is covered from a large sterile table, and if the dressing is to be small, then instead of the table, the instruments are taken into a sterile kidney-shaped basin - individually for each patient.

To close wounds, cleol or adhesive plaster dressings are widely used, which provides significant savings in dressing material. To fix a sterile napkin on a wound in outpatient surgery, it is convenient to use mesh-tubular bandages "Retelast", which are made in different sizes: No. 1 - for fingers, No. 2 - for the hand and foot, No. 3 and 4 - for the shoulder and lower leg, No. 5 and 6 - for the head and thighs, No. 7 - for the chest and abdomen.

Minor surgery. IN AND. Maslov, 1988.

»» No. 5 1996 Prevention of nosocomial infections consists of a set of measures aimed at breaking the chain of occurrence of the epidemiological process. One of the important sections of this complex is compliance with the sanitary-hygienic and anti-epidemic regime when carrying out various surgical procedures. Today the topic of our article is the organization of work in the dressing room. We will talk about the work of dressing rooms using the example of the State Clinical Hospital named after. S.P. Botkin.

Organization of work in dressing rooms. In accordance with the requirements of the current regulatory documents(SNiP 2.08.02-89) there should be two dressing rooms in the department (for clean and purulent dressings). However, in many medical institutions one dressing room is allocated. Therefore, it is especially important in the prevention of purulent-septic complications to strictly comply with the requirements of the sanitary-hygienic and anti-epidemic regime.

In the presence of one dressing, patients with purulent wounds must be prescribed procedures at the end work shift. Here are the basic requirements that must be strictly observed when performing dressing changes in the department:

All dressings and instruments should be stored in bags for no more than 3 days or in packaging paper (kraft paper) for no more than 7 days. When opening the bix, the shelf life of the dressing material is no more than 6 hours. There should be a mark on the box indicating the time of opening;

To carry out dressings, prepare a sterile table, which is covered with a sterile sheet in one layer, so that it hangs 15-20 cm below the surface of the table. The second sheet is folded in half and placed on top of the first. After laying out the tools (material), the table is covered with a sheet (folded in 2 layers), which should completely cover all the objects on the table, and is tightly fastened with clamps to the bottom sheet. The sterile table is set for 6 hours. In cases where the instruments are sterilized in individual packaging, there is no need for a sterile table or it is covered immediately before the manipulations. Dressings are carried out wearing a sterile mask and rubber gloves. All items from the sterile table are taken with forceps or long tweezers, which are also subject to sterilization. Forceps (tweezers) are stored in a container (jar, bottle, etc.) with 0.5% chloramine or 3% or 6% hydrogen peroxide. The chloramine solution is changed once a day. 6% hydrogen peroxide is changed after three days. Containers for storing forceps (tweezers) must be sterilized in a dry-heat oven every 6 hours;

Unused sterile material is set aside for re-sterilization;

After each dressing or manipulation, the couch (table for dressings) must be wiped with a rag moistened with a solution of approved disinfectants;

After each dressing (manipulation), the nurse must wash gloved hands with toilet soap (be sure to soap them twice), rinse with water and dry with an individual towel. Only after this procedure are the gloves removed and thrown into a container with a disinfectant solution;

Used dressings are collected in plastic bags or special marked buckets and, before disposal, are pre-disinfected for two hours with a disinfectant solution.

As a rule, in our hospital, in each dressing room there is a dry-heat cabinet, where nurses sterilize all metal instruments (trays, tweezers, jars, forceps, etc.). The operation of the drying oven is controlled using chemical tests: hydroquinone or tesourea at 180°. The dry-heat oven operates twice a day, and the operating mode is noted in the journal “Accounting for the operation of the dry-heat oven.” Dressings and rubber products in bags are sterilized in a central autoclave and delivered to all departments by specially designated vehicles.

Twice a day - in the morning before starting work and in the oven after finishing work - routine cleaning is carried out, combined with disinfection. For disinfection, a 1% chloramine solution is used. Once a week, a mandatory general cleaning is carried out: the room is cleared of equipment, inventory, tools, medicines, etc. A complex of disinfectant and detergent. The disinfectant solution is applied by irrigation or wiping to walls, windows, window sills, doors, tables and a bactericidal lamp is turned on for 60 minutes. Then all surfaces are washed with a clean rag dampened tap water, bring in disinfected furniture and equipment and turn on the bactericidal lamp again for 30 minutes.

Cleaning equipment specially designated for work in the dressing room (buckets, rags) are marked and after cleaning they are disinfected in a disinfectant solution for an hour.

A journal “Accounting for general cleaning” is kept in each office.

Since 1996, we have introduced in-hospital and laboratory control over the quality of cleaning, including in dressing rooms. It is conducted by an epidemiologist assistant according to a special schedule. In addition, bacterial tests are taken to test for sterility and cultures to test for air sterility.

The results of the control are heard at the council of senior nurses.

Control over the sanitary and epidemiological regime in the dressing room, as well as the work on training nurses, is carried out by the head nurses of the hospital and specialists from the epidemiological department of the hospital.

V.P. SELKOVA, Deputy Chief Physician for Sanitary and Epidemiological Issues and infectious diseases Moscow city clinical hospital them. S.P. Botkin
G.Yu. TARASOVA, Head of the Epidemiological Department of the City Clinical Hospital named after. S.P.Botkina

A dressing room is a specially equipped room for the production of dressings, examination of wounds and a number of procedures performed during the treatment process. Minor operations, often with purulent diseases(carbuncle, ), intravenous infusions, punctures, blockades, taking blood from a vein, etc. are also performed in the dressing room, if there is no special procedural room.

In large surgical departments there are two dressing rooms: “clean” and “purulent”. If there is only one, then both aseptic and infected wounds are bandaged in it. With good organization of work and strict adherence to asepsis, this does not pose a danger.

A spacious, bright room is allocated for the dressing room, the floor, ceiling and walls of which are covered with oil paint or tiles so that they can be easily washed. The dressing room is well ventilated, the temperature is maintained at least 18°, and impeccable cleanliness is maintained.

In the outpatient clinic of a rural medical station, at the paramedic-midwife station, there is a doctor’s (paramedic) office and a dressing room. In the dressing room of the paramedic-obstetric station (see), small ones are also performed (application of bandages and sutures for wounds, stopping bleeding, reduction of simple dislocations, splinting for bone fractures, opening of superficial abscesses, etc.); provide gynecological care to the extent permitted by midwives. To perform these manipulations, the dressing room must have the necessary set of instruments, splints for immobilizing fractures (dislocations) and medications.

In hospitals, dressing rooms are usually located in rooms isolated from other rooms (wards, operating unit). If the surgical department has one operating room for aseptic (clean) operations debridement wounds, removal of atheromas, foreign bodies, as well as purulent operations (opening of felon, carbuncle) are performed in the dressing room. After dressings, the dressing room can be used to examine patients, prepare them for surgery, etc.

The dressing room equipment consists of one or two tables (wooden or metal) for patients, several stools for seated patients, tables for sterile instruments and sterile dressings, glass cabinets for storing instruments, medicines and bandages, a washbasin with hot and cold water, stands for sterilizers, a heat source (electric stove), basins for removed bandages, bottles with disinfectant solutions, trays for dirty instruments. Anesthesia kits, a basin with diocide solution for hand treatment, containers with sterile dressings and dressings, trays for syringes and boiled brushes are also placed; install lighting fixtures and bactericidal lamps. In the dressing room you must have: with a capacity of 20, 10 and 5 ml, anatomical and surgical tweezers, straight and curved scissors, blunt and sharp hooks for spreading the edges of the wound, hemostatic clamps, scissors for removing bandages, both soft and hard (plaster), button and grooved probes, tourniquets, forceps, scalpels, needle holders, spatulas, catheters, .

Before starting work in the dressing room, the dressing nurse treats her hands in the same way as before the operation, covers the table with a sterile sheet, lays out the necessary sterile material and instruments on it, which she covers with a second sterile sheet. A doctor (paramedic) working in a dressing room receives everything he needs from a sterile table through a dressing nurse, who uses a sterile forceps.

Instruments are sterilized in the dressing room itself or in a separate room connected to the dressing room - in the pre-dressing room.

The equipment of the dressing room, in addition to the items listed in section 2, includes:

Operating and dressing table

Table with sterile instruments

Shadowless surgical lamp

And is excluded from the list of treatment rooms:

Table for IV injections

Container for sending blood tubes to the laboratory

Accessories for IV injections

Algorithm for preparing the treatment (dressing) room for work.

All preparatory work is carried out by a procedural (dressing) nurse at the beginning of the working day in casual overalls in the following order:

Working solutions are being prepared to disinfect syringes, needles, equipment, used balls, and gloves.

The surfaces of all work tables are wiped with a sterile rag soaked in a disinfectant solution.

The bactericidal irradiator is turned on for 60 minutes.

Bixes, craft packages delivered from the Central Distribution Center are placed on the utility table. Outside surface Bixov, before opening, is disinfected.

A table is set for non-sterile instruments and medications (ointments, syringes, etc.).

Algorithm for opening bix.

5.1. Before opening the box, the date and time of opening must be noted (on a special tag). ATTENTION! The period of use of sterile material after opening the bix is ​​no more than 24 hours.

5.2. A procedural (dressing) nurse, dressed in casual work clothes, thoroughly (for at least 1-2 minutes) washes her hands with warm running water, soaping twice, using liquid soap in a dispenser, soap shavings or soap in small packages (should lie on a wire rack dry) wipes with a clean towel or better with a disposable napkin. (The towel is changed every day.) Then carries out hygienic disinfection of hands with a skin antiseptic. (70g ethyl alcohol, 0.5% water solution Chlorhexidine bigluconate) by wiping with two sterile swabs with an antiseptic for 1 minute on each hand.

5.3. He opens a craft bag with sterile work clothes and puts them on in the following order: gown, cap, 4-ply gauze mask, rubber gloves.

5.4. Opens the lid of the container, takes the first sterile ball lying on the packaged tweezers on top of the lining diaper, moistens 70g with alcohol or antiseptic, and carefully treats the hands according to the scheme.

5.5. He takes tweezers from the soft packaging.

5.6. Using a sterile instrument, remove the paper thermal time indicator. The color of the indicator is compared with the standard: if it matches the standard, it is glued to the tag for the entire period of use of the indicator.

5.7. If the color of the indicator does not correspond to the standard, notify the head nurse, after finding out the reason, replenish the bix and send the bix for re-sterilization.

Algorithm for covering a sterile table in a dressing room.

6.1. The procedure for preparing the office for work is described in section 4.

6.2 as in paragraph 5.2; 5.3;

6.3. Opens the bix in accordance with clauses 5.4 – 5.7.

6.4.Using sterile tweezers, carefully unfolds the lining diaper so that its ends remain inside the bix.

6.5. Using tweezers, he takes out sterile packs (kraft bags) with balls (20-25 pcs) and individual packs for dressing from the bix.

Note: The tweezers are stored in a sterile jar with a disinfectant solution. (only the sterile ends of the tweezers should be in the solution up to the point where the hands touch, at least ¾ of the length). Sterile jars with disinfectant solution and tweezers should be changed after 6 hours. It is recommended to use a 1% aqueous solution of Chlorhexidine Bigluconate as a disinfectant for storing tweezers.

FEATURES OF ORGANIZING THE NURSING PROCESS IN SURGERY.

1. DEFINITION OF THE NURSING PROCESS.

NURSING PROCESS is a method of organizing and providing qualified nursing care to the patient.

2. STAGES OF THE NURSING PROCESS

A joint venture is a series of actions leading to a specific result and including 5 main stages.

FIRST STAGE – EXAMINATION OF THE PATIENT

SEQUENCING:

1) history taking: general information about the patient, history of the problem, risk factors; psychological data; sociological data (from medical history);

2) physical examination: blood pressure, heart rate, body temperature; Height Weight; identification of vision, hearing, memory, sleep, and motor impairments; examination of the skin and mucous membranes; examination of systems (musculoskeletal, respiratory, cardiovascular system, digestive, urinary);

3) laboratory and instrumental studies: as directed by the doctor.

The foundation of nursing assessment is the doctrine of the basic vital needs of a person.

NEEDS according to A. Maslow:

Physiological: eat, drink, breathe, excrete, maintain temperature (homeostasis)

Protection needs - to be healthy, clean, sleep, rest, move, dress, undress, avoid danger

Needs for belonging and love – communicate, play, study, work

Respect needs - to be a competent specialist, to achieve success, to be approved

Maslow later identified 3 more groups of needs:

Cognitive - explore, know, be able to, understand

Aesthetic – in beauty, harmony, order

The need to help others.

It is important to remember that the needs of each subsequent level become relevant only after the previous ones are satisfied!!

SECOND STAGE – IDENTIFYING THE PATIENT'S PROBLEMS AND FORMULATING A NURSING DIAGNOSIS.

CLASSIFICATION OF PROBLEMS:

PHYSIOLOGICAL – pain, suffocation, cough, sweating, palpitations, nausea, lack of appetite, etc.

PSYCHOLOGICAL – fear, depression, anxiety, fear, anxiety, despair, etc. Reflect the disharmony of someone who finds themselves in an unusual situation (shame when giving an enema, etc.).

SOCIAL – job loss, divorce, change in social status.

SPIRITUAL – loss of meaning in life, alone with illness, no friend.

PATIENT PROBLEMS are divided into EXISTING AND POTENTIAL.

EXISTING PROBLEMS - those that concern the patient in this moment. For example, fear of surgery, inability to independently move around the department and take care of oneself.

POTENTIAL PROBLEMS are those that may arise over time. In surgical patients, this is a violation of the mental state (the body’s reaction to premedication), pain, changes in the state of the body (T, blood pressure, blood sugar, bowel dysfunction) with concomitant diseases. As a rule, a patient may have several problems at once. In such cases, it is necessary to find out which of them are primary and require emergency intervention (increased blood pressure, pain, stress), and which intermediate ones are not life-threatening (forced position after surgery, lack of self-care).

The next task of the second stage is the formulation of the NURSING DIAGNOSIS.

NURSING DIAGNOSIS is a patient's health condition determined by a nursing assessment and requiring intervention by the nurse. In fact, these are problems that the nurse can prevent or resolve. Nursing diagnosis differs from medical diagnosis and is aimed at identifying the body's reactions to the disease. The diagnosis may change as the body's reactions change. The nursing diagnosis is formulated in PES format, where P is a problem..., E-...associated with..., S-...confirmed... (signs of a problem)

THIRD STAGE – PLANNING NURSING CARE. The nurse must formulate goals of care and develop a plan of action to achieve the goals.

Goals must be realistic and within the nurse's control!!

There are two types of goals:

SHORT TERM must be completed within short period time, usually 1-2 weeks. They are usually placed in acute phase diseases/

LONG-TERM are achieved in more than a long period time (more than 2 weeks). They are usually aimed at preventing relapses of diseases, complications, their prevention, rehabilitation and social adaptation, acquisition of knowledge about health.

FOURTH STAGE – IMPLEMENTATION OF NURSING INTERVENTIONS.

INDEPENDENT nursing intervention involves actions carried out by the nurse on his own initiative.

DEPENDENT nursing interventions are performed based on written orders and under the supervision of a physician.

INTERDEPENDENT nursing intervention involves the joint activities of the nurse with the doctor and other specialists (nutritionist, exercise therapy instructor).

Initiating the fourth stage of the nursing process, the nurse carries out two strategic directions:

Observation and control of the patient’s response to doctor’s prescriptions

Observe and control the patient's response to nursing actions. Both are recorded in the nursing record.

FIFTH STAGE – ASSESSMENT OF THE EFFECTIVENESS OF THE NURSING PROCESS

Its PURPOSE is to assess the patient's response, results and summarize. Assessment of the effectiveness and quality of care should be carried out by the senior and chief sister constantly and by the sister herself as self-monitoring at the end and beginning of each shift. If the goal is not achieved, then it is necessary to identify the reasons, deadlines for implementation, and make adjustments.

ORGANIZATION OF WORK IN THE SURGICAL DEPARTMENT.

The surgical hospital includes several main functional units: emergency department, operating room, surgical departments (urological, vascular surgery, neurosurgery, burns, etc.), dressing rooms, procedural departments.

SURGICAL DEPARTMENT: designed to accommodate patients during their surgical treatment. It consists of hospital wards, the office of the head of the department and doctors of the nursing station, treatment room, dressing rooms, sanitary facilities, utility rooms (cystoscopy, plaster room, etc.).

One of the main tasks of the department is to ensure prevention nosocomial infection(HAI), therefore all surgical patients are divided into “purulent, septic” (GSI), “clean, aseptic” and traumatological. The flows of these patients must be separated.

The wards contain special functional beds and minimal amount pieces of furniture (bedside table, chair for each patient, there is an alarm system for calling medical staff), which is easy to clean and disinfect.

The optimal number of beds in the wards is up to 4, and for burn patients and GSI – 2. The filling of the wards for burn patients is “simultaneous”. Beds must be accessible from all sides. The optimal air temperature in the rooms is 20-25*.

Cleaning of the department 3 times a day, incl. 1 time with disinfectants, in burn and medical examination wards - 3 times with disinfectants. After cleaning – air disinfection. When performing work in the wards for patients with GSI, personnel must wear gloves and protective equipment that is specially marked and has distinctive markings.

Change of bed linen once every 7 days and when soiled, collection of linen in waterproof containers, storage in a special room of the department for a maximum of 12 hours. Bedding (mattress, blanket, pillow) is subject to decontamination after discharge, transfer to another department or death of the patient, or contamination with biomaterial. Mattresses and pillows placed in tightly sewn hygienic covers can be disinfected by wiping or spraying the covers with a solution of a chemical disinfectant.

Treating the bed and bedside table with a disinfectant - after the patient is discharged, transferred to another department, before the patient’s admission.

General cleaning once every 7 days, in burn wards - and after the immediate discharge of patients, when repurposing wards.

ORGANIZATION OF THE WORK OF A NURSE IN THE SURGICAL DEPARTMENT.

The work of a nurse is based on knowledge and fulfillment of requirements regulatory documentation regulating compliance with sanitary and epidemiological regulations, organization of work and correct execution all manipulations within the competence of the nurse.

MAIN RESPONSIBILITIES OF A NURSE

The duties of a nurse include the following:

Strictly comply with internal labor regulations;

Carry out the procedures prescribed by the doctor accurately and in a timely manner;

Ensure the issuance, receipt, storage, control of expiration dates, consumption of medications, property necessary for work;

Timely complete the syndromic kits to provide medical care at emergency conditions;

Ensure the implementation of measures aimed at preventing nosocomial infections

News medical documentation according to established forms (logs of reception and delivery of duties, medical prescriptions, recording of medications, registration of admitted and discharged patients, temperature sheets etc.);

Constantly improve your qualifications and professional level.

ORGANIZATION OF WORK IN THE DRESSING ROOM.

DRESSING ROOM - a specially equipped room in a surgical hospital or outpatient facility for the production of dressings and minor surgical interventions.

IN surgical hospitals As a rule, clean and purulent dressings are created; in the presence of one dressing, dressings of purulent patients are carried out after clean. The dressing room equipment consists of dressing tables, cabinets with instruments and medications, a table with sterile material on which the most commonly used instruments and prepared sterile dressings are located. At the dressing tables there are basins on stands for used dressing material. In addition, the dressing room should have stands for blood transfusions and solutions, portable devices for giving oxygen and anesthesia. WORK PROCEDURE IN THE DRESSING ROOM

During dressing changes, entry to outsiders is prohibited;

The medical staff in the dressing room wears a gown, a waterproof apron (it is disinfected after each dressing), gloves, a mask, and a cap. Change of overalls - daily and when soiled. Changing gloves - after each dressing;

Medical instruments are disinfected using a virucidal regimen;

In dressing rooms intended for emergency care, a sterile table is available around the clock (the nurse is responsible for preparing sterile material and instruments!);

Once a day, the sterile material on the table is changed, even if the table has not been used;

For routine work, a sterile table is prepared to begin dressing changes each morning;

It is necessary to ensure the rapid removal of used dressings, which are collected in sealed containers and subsequently incinerated;

Purulent dressing room linen must have a special marking, because its use in a clean dressing room is unacceptable.

Dressing room cleaning (preliminary, current, final, general) and bacteriological control are carried out in the same way as in the operating room (see below).

ORGANIZATION OF WORK OF THE OPERATING BLOCK

An operating unit is a complex of specially equipped premises for performing operations and carrying out activities that support them. The operating unit should be located in a separate room or on a separate floor of a multi-story surgical building. It has operating rooms separated from each other to perform clean and purulent operations. In addition to the operating rooms, the operating block provides the following specially equipped rooms: preoperative room, sterilization room, blood transfusion room, anesthesia room, material room, plaster room, director's office, staff rooms, sanitary checkpoint.

The organization of the operation of the operating unit and the rules of behavior in it are strictly regulated. The fundamental principle in the operation of the operating unit is strict adherence to the rules of asepsis. There should be no unnecessary furniture and equipment in the operating room, the volume of movements and walking is reduced to a minimum, conversations are limited, and there should be no unnecessary people in the operating room. Persons with acute illnesses are not allowed to be in the operating room. respiratory diseases and purulent-inflammatory processes. Entrance to the operating room for personnel is through a sanitary inspection room, which is divided into 2 zones; personnel (if necessary) take a shower, put on a surgical suit, shoe covers, cap, mask and go to the preoperative room, where they wash and perform surgical hand antisepsis. Members of the surgical team wear a waterproof apron. Staff wear a sterile gown and gloves in the operating room. Change of clothing and personal protective equipment - after each operation. Change masks and gloves - every 3 hours with repeated surgical hand antiseptics.. If gloves are damaged - the same. Used for all members of the operating team special clothing, which differs in color from the accepted clothing in other departments of the hospital

The patient is delivered on a gurney in the operating room through the airlock. The gurney is disinfected after each patient. All instruments and devices brought into the operating unit must be disinfected.

In the operating room during planned operations First of all, clean operations are performed (on the thyroid gland, blood vessels, joints, for hernias) and only then operations associated with possible microbial contamination (cholecystectomy, gastric resection) are performed. After performing urgent (emergency) medical intervention for a patient with suppurative processes in the general(!) operating room, general dressing room, the following must be carried out: cleaning; final disinfection; disinfection air environment in accordance with the requirements of these Sanitary Rules.

There are some requirements for working in a purulent operating room: Additional requirements. Surgical instruments, dressings and linen are stored separately and under no circumstances are used for aseptic operations. The combination of work of personnel (nurses, orderlies) in a clean and purulent operating room is excluded. Used dressing material is burned.

FUNCTIONAL ZONES. To ensure sterility, special functional areas are allocated in the operating unit.

GENERAL SECURITY AREA: here are the offices of the manager, senior nurse, rooms for storing and sorting linen and tools.

A RESTRICTED ZONE, or technical zone, combines production premises to ensure the operation of the operating unit. There are equipment for air conditioning, vacuum installations, installations for supplying the operating room with oxygen, a battery substation for emergency lighting, and a darkroom for developing X-ray films. Material - a room for storing supplies of tools, suture material and medicines.

A HIGH SECURITY ZONE includes such premises as a sanitary inspection room, storage rooms for surgical instruments and devices, anesthesia equipment and medications, a blood transfusion room, rooms for the duty team, and a senior operating nurse.

THE STERILE MODE AREA combines the operating room, preoperative room and sterilization room.

CLEANING OF THE OPERATING UNIT is always carried out wet method. Exist the following types operating room cleaning:

Preliminary is carried out in the morning before starting work; all horizontal surfaces (floors, tables and window sills) are wiped with a damp cloth to collect dust that has settled overnight, bactericidal agents are turned on ultraviolet lamps for air disinfection;

The current one is carried out during the operation; the nurse collects all accidentally fallen balls and napkins from the floor, wipes away any blood or other liquid that has fallen on the floor;

Intermediate is done between operations; all material used during the operation is removed, the floor is wiped with a damp cloth;

The final one is carried out at the end of the operating day.

General surgery is carried out according to plan on a day free from surgery, once a week.

Dressing room- a specially equipped room for performing dressings and minor surgical procedures (suture removal, laparocentesis, therapeutic and diagnostic punctures, etc.). P. is deployed in hospitals and outpatient medical institutions, in surgical departments and offices (surgical, traumatological, urological). There are P. for so-called clean dressings and separate P. for patients with purulent-inflammatory diseases and complications. In departments with 100 beds, 2 dressing rooms with two tables in each should be organized.

The area of ​​the dressing area is determined based on 1 table 22 m 2 and for dressing rooms for 2 tables - 30 m 2. The room for P. is equipped taking into account the need for wet cleaning. The ceiling is painted with oil paint in gray-green or gray-blue color. The walls are lined with ceramic tiles of the same color to a height of at least 1.7-2 m from the floor, but better to the ceiling. The floor is covered with ceramic tiles or wide sheets of durable linoleum, the joints between which should be well coated with a special putty that does not allow water to pass through. The dressing room should have 2 separate basins for washing hands and for washing instruments with appropriate markings and hot and cold water mixer taps. The design of the heating system should not make wet cleaning difficult. The most convenient heaters are in the form of pipes located horizontally above each other at a distance of 25-30 cm from the wall, or solid panels. The optimal air temperature for P. is about 22°. P. windows are oriented to the north, northeast or northwest. For better natural light, the ratio of window (or window) area to floor area should be at least 1:4.

For artificial lighting lamps with a total power of at least 500 are mounted on the ceiling W by 50 m 2 premises that can be exposed wet cleaning. Additionally, a shadowless lamp is installed above the dressing table, creating an illumination of at least 130 OK. P. is equipped with air conditioning or supply and exhaust ventilation with a predominance of air flow, providing double air exchange per 1 h. It is also recommended to have mobile recirculation air purifiers (VOPR-0,

9 and VOPR-1.5 m), which are capable of 15 min work to reduce the dust content of the air and the number of microbes in it by 7-10 times. To disinfect the air, bactericidal irradiators are installed: ceiling-mounted (OBP-300, OBP-350) and wall-mounted (OBN-150, OBN-200). The lamps are placed at a distance of 2.5 m one from the other. In the presence of people, you can turn on only shielded lamps, but no more than 6-8 h. Preferably every 2-3 h work P. take a 10-minute break and turn on the bactericidal lamps. In purulent P., you should additionally have a bactericidal lighthouse-type irradiator or a mobile irradiator.

Special furniture is installed in the dressing room: a dressing table, big table for sterile material and instruments, a small mobile table for sterile instruments, a small table with a glass panel for antiseptic solutions, medical cabinet for tools, a cabinet for dressings and linen, a ladder stand, a hanger rack. Enameled basins and buckets with lids for used dressings are also required. An operating table of any model can be used as a dressing table (see.

Medical staff, working in the dressing room, must strictly follow the rules asepsis , change your robe, cap, and mask daily. In clean P., first of all, manipulations are performed that require strict asepsis (blockades, punctures, laparocentesis, etc.), then patients who were operated on the day before are bandaged. Secondly, the remaining clean dressings are performed and the sutures are removed.

In purulent P., first of all, patients with healing purulent wounds, then with significant purulent discharge and, last of all, patients with fecal

Dressings play an important role in the treatment of wounds. For this reason, it is necessary to strictly follow the rules for dressing wounds. There are general rules, and there are specific ones, depending on the type of damage.

General information about dressings

Dressing is medical procedure, which is indispensable in the treatment of wounds. Its main tasks:

• inspection of the wound surface;
• treatment of the damaged area and the skin around it;
• cleaning the wound;
• drug therapy;
• replacing an old dressing by applying a new one.

This is the general algorithm for the dressing procedure. It can be performed by a nurse in the dressing room in the presence of the attending physician. The latter may take responsibility for applying the bandage in particularly severe cases.

The frequency of wound dressing depends primarily on the extent of the damage and the healing process, as well as on the type of dressing itself:

• clean postoperative wounds are bandaged 1 week after surgery to remove the sutures;
• superficial injuries that heal under the scab are also rarely bandaged;
• purulent wounds are bandaged every 2-3 days if they do not show signs of getting wet;
• dry ulcers are also bandaged once every 2-3 days;
• wet-drying dressings, which are heavily saturated with purulent discharge, are changed every day;
• dressings that are soaked with the contents of the intestines or bladder are changed 2 to 3 times a day.

In the hospital, patients with clean wounds are first treated and only after them - with purulent ones.

General rules for applying a bandage

The specialist performing this manipulation must follow the general rules.

The main ones are:

1. Do not touch the wound. Under no circumstances should you touch the wound surface with your hands.
2. Disinfection. Before starting treatment, the nurse should wash and disinfect the patient’s hands and skin.
3. Sterility. This applies primarily to dressings and instruments.
4. Position. It is very important for an even application of the bandage that the affected part of the body is in the correct position.
5. Direction of bandaging. It is correct to perform this procedure from bottom to top and from left to right. You need to unwind the bandage with your right hand, and hold the bandage with your left hand, while straightening the bandage. If a limb is bandaged, you need to start the procedure in the direction from the edge of the wound to the center.
6. Correct selection of material. It is important that the bandage matches the size of the wound. So, its diameter should be slightly larger than the diameter of the damaged area.
7. Fixation. In order for the dressing to be firmly fixed, you need to bandage from the narrowest part to the widest. There is no need to make the bandage tighter than necessary.

It is important that the bandage is not too loose so that it falls off. At the same time, it should not be very tight, so as not to disrupt local blood circulation. To do this, soft pads are applied in places of compression.

Algorithm for dressing a clean wound

A wound in which there are no signs of infection is called clean: there is no pus or any pathological processes in it, it is granulated, there is no local increase in temperature, redness of the surrounding skin, etc. The main task of the doctor is to prevent infection in the future.

Indications for clean dressing postoperative wound are the following situations:

• if after surgical intervention a tampon or drainage was left in it and 1 to 3 days passed;
• the time has come to remove the stitches;
• if the bandage gets wet with blood or ichor.

To treat a clean wound, you need to prepare the following sterile equipment:

• 2 trays, one of which is intended for the use of dressings;
• dressing material: plaster, bandage, cleol;
• tweezers;
• medical mask and gloves;
• antiseptics for treating the hands of a nurse and the patient’s skin;
• clean cloth;
• saline solution for disinfecting used dressings and surfaces.

The dressing process is carried out in 3 stages: preparatory, main and final.

Stages of the procedure

The first stage is preparatory. The doctor performs the following manipulations:

1. Disinfects hands: washes them with soap and then treats them with antiseptic. Wears gloves and a mask.
2. Prepares the dressing table. To do this, the table is covered with a clean sheet, because the procedure is performed with the patient lying down.

After this, the next stage begins - the main one. In this case, the doctor or nurse performs the following manipulations (all dressing material is held with tweezers, not fingers!):

1. Removes the old bandage. Tweezers are used for this.
2. Inspects the wound. In this case, not only the visual inspection method is used, but also the palpation method to assess the condition of the skin of the suture.
3. Treats the skin around the wound. To do this, the nurse soaks a napkin in an antiseptic. In this case, the direction of the tweezers is from the edges of the wound to the periphery.
4. Performs seam processing. An antiseptic napkin is also used for this. This procedure is performed with blotting movements.
5. Apply a dry, clean cloth to the wound. After this, secure it with a bandage, plaster or cleol.

Finally, the last step is to completely disinfect used instruments, dressing materials and work surfaces.

Algorithm for bandaging a purulent wound

If the wound becomes infected, purulent discharge appears in it. In addition, the patient’s body temperature rises, and painful pulsating sensations appear in the wound. Indications for dressing are the following situations:

• the bandage becomes saturated with purulent contents;
• it's time for another dressing;
• the bandage has moved.

To carry out the procedure, it is necessary to prepare the following sterile instruments:

1. Trays. You will need 2 of them, one of which is intended for used tools and material. In addition, a table for tools is needed.
2. Dressing. In particular, cleol, plaster, bandage.
3. Tools for dressing: tweezers, scissors, probe, syringe, clamps, rubber drains (flat). You will also need medical gloves, an oilcloth apron and a mask.
4. Antiseptic solution. It is needed to treat the doctor’s hands and the patient’s skin.
5. Hydrogen peroxide solution.
6. Disinfection solution. It is needed for final surface treatment.
7. Clean cloth.

The procedure is performed by a doctor. As with the treatment of clean wounds, it also takes place in 3 stages.

Stages of dressing infected wounds

The preparatory stage is the same as when working with clean wounds: the doctor washes and treats his hands with an antiseptic, puts on a mask, gloves and an apron. The apron is additionally treated with a disinfectant solution. Then they are additionally washed with soap and treated with an antiseptic and the hands that are already wearing gloves.

After this, the main stage of the procedure begins, that is, treatment and dressing of the wound. The doctor performs the following manipulations (while all the dressing material is held with tweezers, not fingers!):

1. He takes off the old bandage. This should be done using tweezers.
2. Treats the wound. To do this, you need a napkin soaked in a solution of hydrogen peroxide.
3. Dries the seam. To do this, use a clean, dry cloth. The movements are of a wet nature.
4. Treats seams and skin. To do this, use napkins moistened with an antiseptic solution. They process the seam and skin near him.
5. Identifies the site of suppuration. To do this, the doctor palpates around the suture.
6. Removes stitches. In the area of ​​suppuration, the doctor removes no more than 1-2 stitches and widens the wound with a clamp.
7. Cleans the wound. To do this, use a cloth moistened with hydrogen peroxide, or a syringe with a blunt needle.
8. Dries the wound. To do this, the doctor takes a dry napkin.
9. Treats the skin around the wound. To do this, use a napkin with an antiseptic solution.
10. Inject sodium chloride solution into the wound. It can be administered in two ways: using drainage or turunda.
11. Apply a napkin soaked in an antiseptic solution to the wound.
12. Secures the napkin. A bandage is used for this.

After this, the doctor completely disinfects all work surfaces and instruments.