Types of processing according to SanPiN
There are different levels and methods of disinfection (see tab.), but not all experts appreciate these techniques, and are often limited simple rinsing.
| Type of processing | Purpose of the processing method | When to apply |
|---|---|---|
| Hygiene treatment of the hands of medical personnel: washing with soap and water |
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| Hygienic treatment of hands using an antiseptic |
|
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| Surgical treatment of the hands of medical staff | The purpose of the surgical treatment of the hands of medical personnel:
|
|
HYGIENIC PROCESSING of the hands of medical staff: an algorithm
The goal with this method is to remove any visible contaminants, as well as transient microflora. This is necessary in order to exclude the possibility of transferring such microflora to other health workers and patients.
3 requirements for hygienic hand washing according to SanPin:
- Before starting, the doctor must remove jewelry and watches - a large number of microbes accumulate under them;
- The nails of a specialist should be cut short, the presence of varnish on them is undesirable.
- The sleeves of the medical gown must be tucked up 2/3 so that they do not interfere.
SanPiN requirements suggest thorough lathering. After that, they are washed with running warm water, and the procedure is repeated. This is due to the fact that with a single wash, dirt and harmful microorganisms are removed only from the skin of the hands. When the doctor rinses the soap with warm water, the pores open, allowing the remaining germs to be removed.
RULES OF SANITARY PROCESSING
Processing the hands of medical personnel: an algorithm
The mechanical technology according to this algorithm of actions allows minimizing contamination with various dangerous bacteria and dirt without the use of additional devices. This method is used before / after eating and visiting the toilet, before performing procedures on the patient.
To use this method you will need:
- a clean cloth to dry the skin;
- liquid soap, preferably without a sharp perfumed smell. It is important that all processing steps are hygienic, so soap with a closed dispenser is suitable for the procedure.
The technique itself consists of several basic techniques:
- one palm rubs against the other with smooth movements;
- in turn, the palm of one hand rubs the hands and the back of the palm of the other;
- the fingers of one are connected to the interdigital spaces of the other, internal surfaces fingers are processed with up and down movements;
- the palm is going to the lock, while the bent fingers of one hand rub the palm of the second;
- rotational friction, which cleans the surfaces of the hands and wrists;
- in a circular motion, the palm of one hand touches the fingertips of the other, after which they change.
Washing method with soap and water
Washing with soap and water - basic way prevention of the spread of nosocomial infections, which allows you to stop the further transmission of pathogens of dangerous diseases.
When washing, employees often miss brush areas:
- thumbs;
- spaces between fingers
- fingertips, which are most often contaminated with dangerous microorganisms to a greater extent, because most of the actions are performed by them.
At frequent use soap, it is important to follow the basic principles of skin care.
Hand processing algorithm
The processing of the hands of medical personnel is shown in the diagram below.
Hand sanitizing requirements. Hygienic washing technique
The types of processing of the hands of medical personnel, specific technological methods, are determined by the purpose of the forthcoming processing and the types of services, works, and activities to be carried out.
The main technological methods for processing the skin of the hands of personnel and the requirements for the rules for carrying out are established in section 12 of chapter I SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities":
- hygienic washing is carried out for the purpose of mechanical removal, washing away of dirt and transient microflora;
- hygienic treatment is carried out in order to reduce the number of transient microflora by at least 95% of the original;
- surgical treatment is carried out in order to destroy the resident and transient microflora up to 100%.
Attention: guidelines for the disinfection of the skin, approved. Ministry of Health of the Russian Federation December 18, 2003 N 11-7 / 16-09, as well as the WHO Guidelines "WHO guidelines for hand hygiene in medical institutions. World Health Organization, 2009", it is recommended to use solid or liquid soap for hygienic washing of the hands of personnel without antimicrobial additives.
Use for liquid soap dispensers or other devices (dispensers) that allow mechanical feeding; for soap bars - small individual packaging, or soap dishes with a magnetic suspension, allowing it to dry between uses. Be guided in the choice of soap by the preferences of medical personnel, including those associated with the incidence of dermatitis and allergic reactions.
The staff is obliged to monitor the condition of their hands (the presence of scratches, cracks, macerations), nails (shortly trimmed to the level with the fingertips and microcracks on the surface), not to use false nails and varnish, remove bracelets, watches, rings before hand treatment.
The technique of hygienic hand washing is carried out before preparing, distributing and eating food; after performing "dirty" procedures (cleaning the premises, changing clothes for the sick, going to the toilet) and any other contamination of the hands.
When washing hands hygienically with soap and water, you should:
- 1. Moisten hands with warm water ( hot water increases the risk of dermatitis).
- 2. Lather wet hands with enough soap to cover the entire surface of the hand. Lather with the resulting soap foam water faucet.
- 3. Wash hands for about 40-60 seconds, alternately wiping the palmar surfaces, the back surfaces of the hands with a change in their position; the inner surfaces of the fingers, interlacing and bending their fingers, thumbs in a circular motion, in the direction forward and backward, and ending with rubbing the palms with the fingertips of the opposite hand in a circular motion.
- 4. Give Special attention treatment of subungual zones, nails, periungual ridges and interdigital zones.
- 5. Rinse soap suds thoroughly from hands and faucet, avoiding splashing water, contact with faucet and sink.
- 6. Dry your hands with a disposable towel (or personal use towel). Use the same towel to close the tap. To prevent the occurrence of contact dermatitis, it is recommended to thoroughly rinse and dry your hands when washing with water and soap, and at the end of the work shift, use softening and moisturizing hand skin care products.
It is not recommended to use electric hand dryers, as it is impossible to permanently remove residues detergent and desquamated epithelium (there is no such important function of the towel as rubbing the skin), as well as due to the inevitable swirl of air containing polluting particles.
Social Hand Treatment Standard
Target: removal of dirt and transient flora from the contaminating skin of the hands of medical personnel as a result of contact with patients or objects environment; ensuring the infectious safety of the patient and staff.
Indications: before distributing food, feeding the patient; after visiting the toilet; before and after patient care, unless the hands are contaminated with the patient's bodily fluids.
cook: liquid soap in disposable dispensers; clock with a second hand, paper towels.
Action algorithm:
1. Remove rings, rings, watches and other jewelry from your fingers, check the integrity of the skin of your hands.
2. Wrap the sleeves of the robe on 2/3 of the forearm.
3. Open the faucet with a paper towel and adjust the water temperature (35°-40°C), thereby preventing hand contact with microorganisms located on the faucet.
4.
Wash your hands with soap under running water up to 2/3 of the forearm for 30 seconds, paying attention to the phalanges, interdigital spaces of the hands, then wash the back and palm of each hand and rotational movements of the base of the thumbs (this time is enough to decontaminate the hands at a social level if the surface of the skin of the hands is lathered thoroughly and do not leave dirty areas of the skin of the hands).
5. Rinse your hands under running water to remove soap scum (hold your hands with your fingers up so that the water runs into the sink from your elbows, without touching the sink. The phalanges of your fingers should remain the cleanest).
6. Close the elbow valve by moving your elbow.
7. Dry your hands with a paper towel, if there is no elbow tap, close the edges with a paper towel.
Standard "Processing of hands at a hygienic level"
Target:
Indications: before and after performing invasive procedures; before putting on and after removing gloves, after contact with body fluids and after possible microbial contamination; before caring for an immunocompromised patient.
cook: liquid soap in dispensers; 70% ethyl alcohol, watch with second hand, warm water, paper towel, container for safe disposal (CBU).
Action algorithm:
1. Remove rings, rings, watches and other jewelry from your fingers.
2. Check the integrity of the skin of the hands.
3. Wrap the sleeves of the robe on 2/3 of the forearm.
4. Open the faucet with a paper towel and adjust the water temperature (35°-40°C), thereby preventing hand contact with microorganisms. located on the crane.
5. Under a moderate stream of warm water, lather your hands vigorously until
2/3 forearms and wash your hands in the following sequence:
- palm on palm;
Each movement is repeated at least 5 times within 10 seconds.
6. Rinse your hands under running warm water until the soap is completely removed, holding your hands so that your wrists and hands are above elbow level (in this position, water flows from a clean area to a dirty one).
7. Turn off the faucet with your right or left elbow.
8. Dry your hands with a paper towel.
If no elbow faucet is available, close the faucet with a paper towel.
Note:
- in the absence of the necessary conditions for hygienic hand washing, you can treat them with an antiseptic;
- apply to dry hands 3-5
ml of antiseptic and rub it on the skin of the hands until dry. Do not dry your hands after handling! It is also important to observe the exposure time - hands must be wet from the antiseptic for at least 15 seconds;
- the principle of surface treatment "from clean to dirty" is observed. Washed hands should not touch foreign objects.
1.3. Standard "Hygienic treatment of hands with antiseptic"
Target: removal or destruction of transient microflora, ensuring the infectious safety of the patient and staff.
Indications: before injection, catheterization. operation
Contraindications: the presence of pustules on the hands and body, cracks and wounds of the skin, skin diseases.
cook; skin antiseptic for the treatment of hands of medical personnel
Action algorithm:
1. Decontaminate hands at a hygienic level (see standard).
2. Dry your hands with a paper towel.
3. Apply 3-5 ml of antiseptic on the palms and rub it into the skin for 30 seconds in the following sequence:
- palm on palm
- right palm on the back of the left hand and vice versa;
- palm to palm, fingers of one hand in the interdigital spaces of the other;
- the back of the fingers of the right hand along the palm of the left hand and vice versa;
- rotational friction of the thumbs;
- with the tips of the fingers of the left hand gathered together on the right palm in a circular motion and vice versa.
4. Ensure that the antiseptic is completely dry on the skin of the hands.
Note: before using a new antiseptic, it is necessary to study the guidelines for it.
1.4. Sterile Gloving Standard
Target: ensuring the infectious safety of the patient and staff.
- gloves reduce the risk of occupational infection when in contact with patients or their secretions;
- gloves reduce the risk of contamination of the hands of personnel with transient pathogens and their subsequent transmission to patients,
- gloves reduce the risk of infection of patients with microbes that are part of the resident flora of the hands of healthcare workers.
Indications: when performing invasive procedures, in contact with any biological fluid, in case of violation of the integrity of the skin, both of the patient and the medical worker, during endoscopic examinations and manipulations; in clinical - diagnostic, bacteriological laboratories when working with material from patients, when performing injections, when caring for a patient.
cook: gloves in sterile packaging, safe disposal container (SDF).
Action algorithm:
1. Decontaminate your hands at a hygienic level, treat your hands with an antiseptic.
2. Take gloves in a sterile package, unfold.
3. Hold the right hand glove by the lapel with your left hand so that your fingers do not touch the inner surface of the lapel of the glove.
4. Close the fingers of the right hand and insert them into the glove.
5. Open the fingers of the right hand and pull the glove over them without breaking its lapel.
6. Insert the 2nd, 3rd and 4th fingers of the right hand, already wearing a glove, under the lapel of the left glove so that the 1st finger of the right hand is directed towards the 1st finger on the left glove.
7. Hold the left glove vertically with the 2nd, 3rd and 4th fingers of the right hand.
8. Close the fingers of your left hand and insert them into the glove.
9. Open the fingers of the left hand and pull the glove over them without disturbing its lapel.
10. Straighten the lapel of the left glove by pulling it over the sleeve, then on the right with the help of the 2nd and 3rd fingers, bringing them under the tucked edge of the glove.
Note: If one glove is damaged, you must immediately change both, because you cannot remove one glove without contaminating the other.
1.5. Standard "Removal of gloves"
Action algorithm:
1. With the fingers of your right hand in a glove, make a lapel on the left glove, touching it only on the outside.
2. With the fingers of your left hand in a glove, make a lapel on the right glove, touching it only from the outside.
3. Remove the glove from the left hand, turning it inside out.
4. Hold the glove removed from the left hand by the lapel in the right hand.
5.
With your left hand, take the glove on your right hand by the lapel with inside.
6. Remove the glove from the right hand, turning it inside out.
7. Place both gloves (left inside right) into the KBU.
The composition of the cleaning solution
3. Load the fully disassembled medical devices into washing solution for 15 minutes, having previously filled the cavities and channels with the solution, close the lid.
4. Treat each item with a ruff (gauze swab) in the cleaning solution for 0.5 minutes (pass the cleaning solution through the channels).
5.
Place the medical supplies in the tray.
6. Rinse each product under running water for 10 minutes, passing water through the channels, cavities of the products.
7. Carry out a quality control of the pre-sterilization cleaning with an azopyram test. Control is subjected to 1% of simultaneously processed products of the same name per day, but not less than 3-5 units.
8. Prepare a working solution of the azopyram reagent (the working reagent should be used for 2 hours after preparation).
9. Apply the working reagent with a “reagent” pipette to medical devices (on the body, channels and cavities, places of contact with biological fluids).
10. Hold medical devices over cotton or tissue, observing the color of the dripping reagent.
11. Evaluate the result of the azopyram test.
Ear care standard
Target: observance of the patient's personal hygiene, disease prevention, prevention of hearing loss due to sulfur accumulation, instillation of a medicinal substance.
Indications: serious condition of the patient, the presence of sulfur in the ear canal.
Contraindications: inflammatory processes in the auricle, external auditory canal.
Prepare: sterile: tray, pipette, tweezers, beaker, cotton swabs, napkins, gloves, 3% hydrogen peroxide solution, soap solution, containers with disinfectant solutions, KBU.
Action algorithm:
1. Explain the procedure to the patient, get his consent.
3. Prepare a container with soap solutions.
4. Tilt the patient's head in the direction opposite to the treated ear, substitute the tray.
5. Dampen the washcloth in warm soapy water and wipe the auricle, dry with a dry cloth (to remove dirt).
6. Pour into a sterile beaker, preheated in a water bath (T 0 - 36 0 - 37 0 C) 3% hydrogen peroxide solution.
7. Take a cotton turunda with tweezers in your right hand and moisten it with a 3% hydrogen peroxide solution, and with your left hand pull the auricle back and top to align the ear canal and insert the turunda with rotational movements into the external auditory canal to a depth of no more than 1 cm for 2 - 3 minutes.
8. Insert dry turunda with light rotational movements into the external auditory canal to a depth of not more than 1 cm and leave for 2-3 minutes.
9. Remove the turunda with rotational movements from the external auditory canal - the removal of secretions and sulfur from the auditory canal is ensured.
10. Treat the other ear canal in the same sequence.
11. Remove gloves.
12. Place used gloves, turundas, wipes in KBU, tweezers, beaker in containers with disinfectant solutions.
13. Wash and dry your hands.
Note: when processing the ears, cotton should not be wound on hard objects, injury to the ear canal is possible.
Action algorithm:
1. Explain to the patient the purpose of the procedure, get his consent.
2. Decontaminate hands at a hygienic level, put on gloves.
3. Spread an oilcloth under the patient.
4. Pour warm water into the basin.
5. Expose the patient's upper body.
6. Moisten a napkin, part of a towel or a cloth mitten in warm water, lightly squeeze out excess water.
7. Wipe the patient's skin in the following sequence: face, chin, behind the ears, neck, arms, chest, folds under the mammary glands, armpits.
8. Dry the patient's body in the same sequence with the dry end of the towel and cover with a sheet.
9. Treat the back, live, hips, legs in the same way.
10. Trim your fingernails.
11. Change underwear and bedding (if necessary).
12. Remove gloves.
13. Wash and dry your hands.
Action algorithm:
1. Wash the head of a seriously ill person in bed.
2. Give your head an elevated position, i.e. put a special headrest or roll up a mattress and tuck it under the patient's head, lay an oilcloth on it.
3. Tilt the patient's head back at neck level.
4. Place a bowl of warm water on a stool at the head end of the bed at the level of the patient's neck.
5.
Moisten the head of the patient with a jet of water, lather the hair, massage the scalp thoroughly.
6. Wash your hair from the front of your head back with soap or shampoo.
7. Rinse your hair and wring it dry with a towel.
8. Comb your hair with a fine comb daily, short hair should be combed from roots to ends, and long hair is divided into strands and combed slowly from ends to roots, being careful not to pull them out.
9. Put a clean cotton scarf over your head.
10. Lower the headrest, remove all care items, straighten the mattress.
11. Place used care items in a disinfectant solution.
Note:
- a seriously ill patient (in the absence of contraindications) should be washed once a week. The optimal device for this procedure is a special headrest, but the bed must also have a removable backrest, which greatly facilitates this time-consuming procedure;
- women comb their hair daily with a fine comb;
- men's hair is cut short;
- a fine comb dipped in a 6% vinegar solution combs out dandruff and dust well.
Ship delivery standard
Target: providing physiological administration to the patient.
Indication: used for patients on strict bed and bed rest when emptying the intestines and bladder. cook: disinfected vessel, oilcloth, diaper, gloves, diaper, water, toilet paper, disinfectant container, KBU.
Action algorithm:
1. Explain to the patient the purpose and course of the procedure, obtain his consent,
2. Rinse the vessel with warm water, leaving some water in it.
3. Separate the patient with a screen from others, remove or fold the blanket to the waist, place an oilcloth under the patient's pelvis, and a diaper on top.
4. Decontaminate hands at a hygienic level, put on gloves.
5. Help the patient turn on his side, bend his legs slightly at the knees and spread them apart at the hips.
6. Move your left hand from the side under the sacrum, helping the patient raise the pelvis.
7. With your right hand, move the vessel under the patient's buttocks so that his perineum is above the opening of the vessel, while moving the diaper to the lower back.
8. Cover the patient with a blanket or sheet and leave him alone.
9. At the end of the act of defecation, slightly turn the patient to one side, holding the vessel right hand, remove it from under the patient.
10. Wipe the anal area toilet paper. Place the paper in the vessel. If necessary, wash the patient, dry the perineum.
11. Remove the vessel, oilcloth, diaper and screen. Change the sheet if necessary.
12.
Help the patient to lie down comfortably, cover with a blanket .
13.
Cover the vessel with a diaper or oilcloth and take it to toilet room.
14.
Pour the contents of the vessel into the toilet bowl, rinse it with hot water .
15.
Immerse the vessel in a container with a disinfectant solution, discard gloves in
KBU.
16.
Wash and dry your hands.
Dedicated liquid
9. Record the amount of liquid drunk and injected into the body on the record sheet.
Injected fluid
10. At 6:00 am the next day, the patient submits the registration sheet to the nurse.
The difference between the amount of liquid drunk and the daily amount of the night is the value of the body's water balance.
The nurse must:
- Ensure that the patient can perform a fluid count.
- Ensure that the patient has not taken diuretics for 3 days prior to the study.
- Tell the patient how much fluid should be excreted in the urine normally.
- Explain to the patient the approximate percentage of water in food to facilitate the accounting of the introduced liquid (not only the water content in food is taken into account, but also the parenteral solutions introduced).
- Solid foods can contain 60 to 80% water.
- Not only urine, but also vomit, feces of the patient are subject to accounting for the amount of excreted fluid.
- The nurse calculates the number of entered and withdrawn nights per day.
The percentage of fluid excretion is determined (80% of the normal amount of fluid excretion).
amount of urine excreted x 100
Removal percentage =
amount of fluid injected
Calculate the water balance accounting using the following formula:
multiply the total amount of urine excreted per day by 0.8 (80%) = the amount of night that should normally be excreted.
Compare the amount of excreted fluid with the amount of calculated fluid in the norm.
- The water balance is considered negative if less liquid is released than calculated.
- The water balance is considered positive if more liquid is allocated than calculated.
- Make entries in the water balance sheet and evaluate it.
Result evaluation:
80% - 5-10% - excretion rate (-10-15% - in the hot season; + 10-15%
- in cold weather;
- positive water balance (>90%) indicates the effectiveness of treatment and convergence of edema (reaction to diuretics or unloading diets);
- negative water balance (10%) indicates an increase in edema or an ineffective dose of diuretics.
I.IX. Punctures.
1.84. Standard "Patient preparation and medical instruments for pleural puncture (thoracentesis, thoracentesis).
Target: diagnostic: study of the nature of the pleural cavity; therapeutic: the introduction of drugs into the cavity.
Indications: traumatic hemothorax, pneumothorax, spontaneous valvular pneumothorax, respiratory diseases (croupous pneumonia, pleurisy, pulmonary empyema, tuberculosis, lung cancer, etc.).
Contraindications: increased bleeding, skin diseases (pyoderma, herpes zoster, burns chest, acute heart failure.
Prepare: sterile: cotton balls, gauze pads, diapers, needles for intravenous and s / c injections, puncture needles 10 cm long and 1 - 1.5 mm in diameter, syringes 5, 10, 20, 50 ml, tweezers, 0, 5% solution of novocaine, 5% alcohol solution of iodine, alcohol 70%, clip; cleol, adhesive plaster, 2 x-rays of the chest, sterile container for pleural fluid, container with disinfectant solution, referral to the laboratory, anaphylactic shock kit, gloves, CBU.
Action algorithm:
2. Seat the patient, stripped to the waist, on a chair facing his back, ask him to lean on the back of the chair with one hand, and put the other (from the side of the pathological process localization) behind his head.
3. Ask the patient to slightly tilt the trunk in the direction opposite to where the doctor will perform the puncture.
4. Pleural puncture is performed only by a doctor, a nurse assists him.
5. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.
6. Treat the intended puncture site with 5% alcohol solution of iodine, then with 70% alcohol solution and again with iodine.
7. Give the doctor a syringe with a 0.5% solution of novocaine for infiltration anesthesia of the intercostal muscles, pleura.
8. A puncture is made in the VII-VII intercostal space along the upper edge of the underlying rib, since the neurovascular bundle passes along the lower edge of the rib and intercostal vessels can be damaged.
9. The doctor inserts a puncture needle into the pleural cavity and pumps out the contents into a syringe.
10. Substitute a container for the extracted liquid.
11. Release the contents of the syringe into a sterile jar (test tube) for laboratory testing.
12. Give the doctor a syringe with the collected antibiotic for injection into the pleural cavity.
13. After removing the needle, treat the puncture site with a 5% alcohol solution of iodine.
14. Apply a sterile napkin to the puncture site, fix with adhesive plaster or glue.
15. Perform a tight bandage of the chest with sheets to slow the exudation of fluid into the pleural cavity and prevent the development of collapse.
16. Remove gloves, wash and dry hands.
17. Used disposable syringes, gloves, cotton balls, wipes, put in the KBU, puncture needle in a container with disinfectant.
18. Monitor the patient's well-being, the state of the bandage, count his pulse, measure blood pressure.
19. Escort the patient to the room on a stretcher, lying on his stomach.
20. Warn the patient about the need to stay in bed for 2 hours after the manipulation.
21. Send the received biological material for analysis to the laboratory with a referral.
Note:
When removing more than 1 liter of fluid from the pleural cavity at once, there is a high risk of collapse;
Delivery of pleural fluid to the laboratory should be carried out without delay in order to avoid the destruction of enzymes and cellular elements;
When the needle enters the pleural cavity, there is a feeling of "failure" into the free space.
1.85. Standard "Preparation of the patient and medical instruments for abdominal puncture (laparocentesis)".
Target: diagnostic: laboratory study of ascitic fluid.
Therapeutic: removal of accumulated fluid from the abdominal cavity with ascites.
Indications: ascites, with malignant neoplasms of the abdominal cavity, chronic hepatitis and cirrhosis of the liver, chronic cardiovascular insufficiency.
Contraindications: severe hypotension, adhesive process in the abdominal cavity, severe flatulence.
Prepare: sterile: cotton balls, gloves, trocar, scalpel, syringes 5, 10, 20 ml, wipes, jar with a lid; 0.5% solution of novocaine, 5% iodine solution, alcohol 70%, container for extracted liquid, basin, test tubes; a wide towel or sheet, adhesive plaster, a kit for helping with anaphylactic shock, a container with a disinfectant solution, a referral for research, dressings, tweezers, CBU.
Action algorithm:
1. Inform the patient about the upcoming study and obtain his consent.
2. On the morning of the examination, give the patient a cleansing enema until the effect of "clean water".
3. Immediately before the manipulation, ask the patient to empty the bladder.
4. Ask the patient to sit on a chair, leaning on its back. Cover the patient's legs with oilcloth.
5. Decontaminate your hands hygienically, treat them with a skin antiseptic, put on gloves.
6. Give the doctor a 5% alcohol solution of iodine, then a 70% alcohol solution to treat the skin between the navel and pubis.
7. Give the doctor a syringe with a 0.5% solution of novocaine for layer-by-layer infiltration anesthesia of soft tissues. A puncture during laparocentesis is made along the midline of the anterior abdominal wall at an equal distance between the navel and the pubis, retreating 2-3 cm to the side.
8. The doctor cuts the skin with a scalpel, pushes the trocar through the thickness of the abdominal wall with drilling movements with his right hand, then removes the stylet and ascitic fluid begins to flow through the cannula under pressure.
9. Place a container (basin or bucket) in front of the patient for fluid flowing from the abdominal cavity.
10. Type in a sterile jar 20 - 50 ml of liquid for laboratory testing (bacteriological and cytological).
11. Place a sterile sheet or wide towel under the patient's lower abdomen, the ends of which should be held by a nurse. Tighten the abdomen with a sheet or towel covering it above or below the puncture site.
12. With a wide towel or sheet, periodically tighten the patient's anterior abdominal wall as fluid is removed.
13. After the end of the procedure, the cannula should be removed, the wound should be sutured with a skin suture and treated with a 5% iodine solution, and an aseptic dressing should be applied.
14. Remove gloves, wash and dry hands.
15. Put the used tools in a disinfectant solution, put gloves, cotton balls, syringes in the KBU.
16. Determine the patient's pulse, measure blood pressure.
17. Transport the patient to the room on a stretcher.
18. Warn the patient to stay in bed for 2 hours after the manipulation (to avoid hemodynamic disorders).
19. Send the received biological material for analysis to the laboratory.
Note:
When carrying out the manipulation, strictly observe the rules of asepsis;
With the rapid withdrawal of fluid, collapse and fainting may develop due to a drop in intra-abdominal and intrathoracic pressure and a redistribution of circulating blood.
1.86. Standard "Preparation of the patient and medical instruments for spinal puncture (lumbar)".
Target: diagnostic (for the study of cerebrospinal fluid) and therapeutic (for the introduction of antibiotics, etc.).
Indications: meningitis.
cook: sterile: syringes with needles (5 ml, 10 ml, 20 ml), puncture needle with mandrel, tweezers, wipes and cotton balls, tray, nutrient medium, test tubes, gloves; manometric tube, 70% alcohol, 5% alcohol solution of iodine, 0.5% novocaine solution, adhesive plaster, KBU.
Action algorithm:
1. Inform the patient about the upcoming procedure and obtain consent.
2. The puncture is performed by a doctor under conditions of strict observance of the rules of asepsis.
3. Escort the patient to the treatment room.
4. Lay the patient on the right side closer to the edge of the couch without a pillow, tilt the head forward to the chest, bend the legs as much as possible at the knees and pull them to the stomach (the back should arch in an arc).
5. Put your left hand under the patient's side, with your right hand hold the patient's legs to fix the position given to the back. During the puncture, another assistant fixes the patient's head.
6. A puncture is made between the III and IV lumbar vertebrae.
8. Treat the skin at the puncture site with 5% iodine solution, then with 70% alcohol solution.
9. Draw a 0.5% solution of novocaine into the syringe and give it to the doctor for infiltration anesthesia of soft tissues, and then a puncture needle with a mandrel on the tray.
10. Collect 10 ml of cerebrospinal fluid in a test tube, write a referral and send to the clinical laboratory.
11. Collect 2-5 ml of cerebrospinal fluid in a culture tube for bacteriological examination. Write a referral and send the biological material to the bacteriological laboratory.
12. Give the doctor a manometric tube to determine the CSF pressure.
13. After removing the puncture needle, treat the puncture site with a 5% alcohol solution of iodine.
14. Apply a sterile napkin to the puncture site, seal with adhesive tape.
15. Lay the patient on his stomach and take him on a stretcher to the ward.
16. Lay the patient on the bed without a pillow in the prone position for 2 hours.
17. Monitor the patient's condition during the day.
18. Remove gloves.
19. Place syringes, cotton balls, gloves in the KBU, place the used tools in a disinfectant solution.
20. Wash and dry.
1.87. Standard "Preparation of the patient and medical instruments for sterile puncture".
Target: diagnostic: bone marrow examination to establish or confirm the diagnosis of blood diseases.
Indications: diseases of the hematopoietic system.
Contraindications: myocardial infarction, attacks bronchial asthma, extensive burns, skin diseases, thrombocytopenia.
cook: sterile: tray, syringes 10 - 20 ml, Kassirsky's puncture needle, glass slides 8 - 10 pieces, cotton and gauze balls, forceps, tweezers, gloves, 70% alcohol, 5% alcohol solution of iodine; adhesive plaster, sterile dressing material, KBU.
Action algorithm:
1. Inform the patient about the upcoming study and obtain his consent.
2. Sternal puncture is performed by a doctor in a treatment room.
3. The sternum is punctured at the level of the III-IV intercostal space.
4. The nurse assists the doctor during the manipulation.
5. Invite the patient to the treatment room.
6. Have the patient undress to the waist. Help him lie down on the couch, on his back without a pillow.
7. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.
8. Treat the anterior surface of the patient's chest, from the collarbone to the gastric region, with a sterile cotton ball moistened with 5% iodine solution, and then 2 times with 70% alcohol.
9. Perform layer-by-layer infiltration anesthesia of soft tissues with 2% novocaine solution up to 2 ml in the center of the sternum at the level of III-IV intercostal spaces.
10. Give the doctor a puncture needle of Kassirsky, setting the shield-limiter on the 13 - 15 mm tip of the needle, then a sterile syringe.
11. The doctor pierces the outer plate of the sternum. The hand feels the failure of the needle, taking out the mandrin, a 20.0 ml syringe is attached to the needle and 0.5 - 1 ml of bone marrow is sucked into it, which is poured onto a glass slide.
12. Dry the slides.
13. After removing the needle, treat the puncture site with 5% alcohol solution of iodine or 70% alcohol solution and apply a sterile bandage, fix with adhesive tape.
14. Remove gloves.
15. Dispose of used gloves, syringes and cotton balls in the KBU.
16. Wash your hands with soap and dry.
17. Escort the patient to the room.
18. Send the slides with a referral to the laboratory after the material has dried.
Note: Kassirsky's needle is a short thick-walled needle with a mandrel and a shield that prevents the needle from penetrating too deep.
1.88. Standard "Preparation of the patient and medical instruments for joint puncture".
Target: diagnostic: determination of the nature of the contents of the joint; therapeutic: removal of effusion, washing of the joint cavity, introduction of medicinal substances into the joint.
Indications: diseases of the joints, intra-articular fractures, hemoarthritis.
Contraindications: purulent inflammation of the skin at the puncture site.
Prepare: sterile: puncture needle 7-10 cm long, syringes 10, 20 ml, tweezers, gauze swabs; aseptic dressing, napkins, gloves, tray, 5% alcohol solution of iodine, 70% alcohol solution, 0.5% novocaine solution, test tubes, KBU.
Action algorithm:
1. The puncture is performed by a doctor in the treatment room in strict compliance with the rules of asepsis.
2. Inform the patient about the upcoming study and obtain his consent.
3. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.
4. Ask the patient to sit comfortably in a chair or take a comfortable position.
5. Give the doctor a 5% alcohol solution of iodine, then a solution of 70% alcohol to treat the proposed puncture site, a syringe with a 0.5% solution of novocaine for infiltration anesthesia.
6. The doctor with his left hand covers the joint at the puncture site and squeezes the effusion to the puncture site.
7. The needle is inserted into the joint and the effusion is collected with a syringe.
8. Pour the first portion of the contents from the syringe into the test tube without touching the walls of the laboratory test tube.
9. After the puncture, antibiotics and steroid hormones are injected into the joint cavity.
10. After removing the needle, lubricate the puncture site with a 5% alcohol solution of iodine and apply an aseptic dressing.
11. Place the used syringes, wipes, gloves, gauze swabs in the CBU, the puncture needle in the disinfectant.
12. Remove gloves, wash and dry hands.
I.XII. "Preparation of the patient for laboratory and instrumental methods of research."
Standard "Preparing the patient for fibrogastroduodenoscopy"
Target: provide high-quality preparation for the study; visual examination of the mucous membrane of the esophagus, stomach and duodenum
Prepare: sterile gastroscope, towel; research direction.
EGD is performed by a doctor, a nurse assists.
Action algorithm:
1. Explain to the patient the purpose and course of the upcoming study and obtain his consent.
2. Conduct psychological preparation of the patient.
3. Inform the patient that the study is carried out in the morning on an empty stomach. Avoid food, water, medicines; don't smoke, don't brush your teeth.
4. Provide the patient with a light dinner the night before no later than 18 hours, after dinner the patient should not eat or drink.
5.
Make sure that the patient removes removable dentures before the examination.
6. Warn the patient that during the endoscopy he should not speak and swallow saliva (the patient spits saliva into a towel or napkin).
7. Escort the patient to the endoscopy room with a towel, medical history, referral to the appointed time.
8. Accompany the patient to the ward after the examination and ask him not to eat for 1-1.5 hours until the act of swallowing is fully restored; no smoking.
Note:
-
remedication s / c is not carried out, because. changes the state of the organ under study;
- when taking material for a biopsy - food is served to the patient only in a cold form.
Standard "Preparing the patient for colonoscopy"
Colonoscopy - This is an instrumental method for examining high-lying sections of the large intestine using a flexible endoscope probe.
Diagnostic value of the method: Colonoscopy allows direct
It is possible to prevent the spread of diseases and germs with the help of such a simple procedure as hand sanitization. Hand sanitizing levels depend on the person's level of exposure to the potential hazard, as well as their professional activities. The rules of such disinfection should be familiar not only to every professional medical worker, but also to a simple layman.
Types of microflora
What is the method of hand treatment? The levels of hand cleaning depend on the tasks and jobs that the healthcare professional performs. Since it is not possible to completely cleanse the skin of pathogenic bacteria, it must be disinfected on an ongoing basis. For general information, it is necessary to give a basic classification of microflora:
It should be noted that on the skin of the hands there are the most problematic areas, which are quite problematic to clean from such contaminants. These include the ridges near the nails and the space under the nails, as well as the spaces between the fingers.
The first methods of processing hands appeared and began to be used in the middle of the 19th century. So, at first, a phenol solution was used for disinfection. Currently, it is customary to practice somewhat different methods.
Classification of skin disinfection methods
So, how exactly is the classification of such a procedure as hand treatment carried out? Hand processing levels are represented by three types of manipulations:
- Normal processing.
- Hygienic treatment.
- Surgical treatment.
Let's analyze the features of each method in a little more detail.
First stage
Ordinary washing is the simplest and most affordable method of cleansing. Its task is to eliminate dirt and a number of bacteria carried from dirty surfaces and infected people. Medical professionals wash their hands before starting work, after receiving a patient, changing clothes, and also after moving to another office or to another place of work. The procedure can be used:
The effectiveness of a simple wash is no more than 70 percent with a double repetition and no more than 40 percent with a single wash. Before the procedure, it is recommended to remove all jewelry and watches, and thoroughly rub the cleanser into the skin, then rinse completely and repeat the manipulations. The soap used should not contain additional flavors or dyes, it should be neutral.
Second step
Hand sanitizing of medical staff is often carried out hygienic method. It is carried out, as a rule, in the following cases:
Such hygienic treatment involves two stages. At the first stage, a classic hand washing is carried out, at the second, disinfection is added with an alcohol-containing antiseptic.
Hygienic or medical treatment hands can be carried out using the following types of antiseptics:
- Bactericidal soap (in liquid form).
- Alcoholic solutions designed specifically for the treatment of the skin.
- bactericidal gel.
An alcohol-free product is applied to wet skin in an average amount of 3 to 5 milliliters. Alcohol-based products are used on dry skin, they need to be rubbed for about 15-20 seconds. It is allowed to add a small amount of glycerin or lanolin to the antiseptic to soften the skin and prevent it from drying out.
Third step
It is the third and most total method of disinfection. Its implementation is relevant for all participants in the surgical intervention. It is carried out according to the following algorithm:
- Hand washing. It lasts for 2 minutes, after treatment of the skin it is necessary to dry it with a sterile material.
- The use of an antiseptic. With its help, hands, wrists, and, if necessary, forearms are processed. There are special rules for the amount of its use, as well as the frequency of use.
It should be noted that the surgical treatment of hands can be carried out exclusively with antiseptics containing alcohol. These include the following drugs:
Treatment with significant contamination
Separately, it is necessary to touch on the question of how the hands of the medical staff are processed when the patient's blood gets on them. If the biological fluid has got directly on the skin, it is required to act according to the following algorithm:
- Remove the resulting contamination with a napkin.
- Cleanse skin with soap and water.
- Dry the affected area with a disposable sterile cloth.
- Twice to carry out the treatment with alcohol antiseptic.
If contamination has got on the surface of the glove, the procedure undergoes certain changes. They are represented by the following diagram:
- Removal of contamination from the material with a disinfectant wipe.
- Washing gloved hands with water.
- Removing gloves.
- Hand washing with soap, drying.
- Single use of antiseptic for the treatment of the skin of the hands.
There are also general rules hand treatment. They boil down to the following requirements and recommendations:
Types of drugs
How to choose the right hand sanitizer? When choosing one or another tool, use the following recommendations:
Of course, medical workers have specific documents prescribing how hand treatment should be carried out. Hand sanitizing levels determine the type of disinfectant used. For example, let us dwell in more detail on the means for surgical treatment:
- Alcohols. The optimal solution is ethyl 70%. Excellent help against gram-positive and gram-negative bacteria, affect individual viruses and fungi.
- Solutions based on iodine and alcohol - a wide spectrum of action. They help against bacteria, including causative agents of tuberculosis, spores, viruses, protozoa, and fungi.
- Iodophors. They help against rotoviruses, herpes, HIV infection, staphylococci and spores.
- Chlorhexidine. It has a narrower spectrum of action, targets gram-positive bacteria, certain categories of fungi.
Any involves preparation and direct decontamination (removal of contaminants). The hands of a nurse must be well-groomed, without inflammation, burrs and microcracks.
Nails should be neatly trimmed and unvarnished. The skin edge of the nail bed should not be cut due to the risk of microtrauma and inflammation. Artificial nails on the hands of a nurse are unacceptable. Before it startsfor manipulation, wrist watch and jewelry must be removed.
Preparing the nurse's hands for processing
- We remove watches and jewelry.
- We examine the hands for inflammation and skin damage.
- In the presence of wounds, inflammation of the skin, we inform the senior nurse.
- In the presence of small injuries and local inflammation, we seal the problem areas of the skin with adhesive tape and put on a fingertip.
Machining the hands of a nurse
Normal hand washing is carried out with liquid soap from the dispenser, and in case of its absence, with simple lumps. Manipulation rooms should be equipped with elbow-operated mixers.
After preparing the hands, we moisten them with warm water, lather the palms, the backs of the hands, the interdigital spaces and the nail beds.
Vigorously three hands together:
- palm on palm;
- right palm on the back of the left hand and vice versa;
- we interlock our hands with spread fingers and three inner surfaces of the fingers with up and down movements;
- we fold our hand into a fist and with the back of the fingers of one hand we three palm of the other hand (repeat for each hand);
- we clench our hand into a fist and embrace the finger of the other hand, three fingers in a circular motion - repeat with each finger on both hands;
- three palm of one hand with the fingertips of the other, then change hands.
Each action must last at least 30 seconds. After washing, we dry our hands with a disposable towel or cloth, which is immediately removed from circulation.
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Hygienic antiseptic treatment of the hands of a nurse
- Preparing hands for processing.
- Washing hands with antiseptic soap.
- Treatment of hands with water or alcohol antiseptic in accordance with the instructions for use. Drying with a towel after treatment with an antiseptic is NOT ALLOWED.
Surgical treatment of the hands of a nurse
- Hand preparation.
- Washing with ordinary or antiseptic soap - hands, wrists, forearms. Nails are treated with brushes.
- Drying hands with a sterile cloth.
- Application of an alcohol solution of a skin antiseptic, rubbing it into the skin until completely dry (water solutions of antiseptics are NOT APPLIED).
- Repeated application and rubbing of an alcohol antiseptic, followed by drying WITHOUT DRYING WITH A TOWEL.
- Putting on sterile gloves on dry hands.
1. Remove all rings from your hands (depressions on the surface of jewelry are a breeding ground for microorganisms).
2. Move the watch above the wrist or take it off.
3. Clean the areas under the nails with a nail cleaner under running water.
4. Apply 3-5 ml of liquid soap to your hands or lather your hands thoroughly with bar soap.
5. Wash your hands using the following technique:
Vigorous mechanical friction of the palms (repeat 5 times);
The right palm washes the back of the left hand with rubbing movements, then the left palm washes the back of the right hand (repeat 5 times);
Palm to palm, fingers of one hand in the interdigital spaces of the other (repeat 5 times);
The back of the fingers to the palm of the other hand (fingers interlaced - repeat 5 times);
Alternating rotational friction of the thumbs of one hand with the palms of the other, palms clenched (repeat 5 times);
Variable friction of the palm of one hand with the closed fingers of the other hand (repeat)
fig.6. Hand washing.
6. Rinse your hands under running water, hold them so that the wrists and hands are below the level of the elbows and to avoid contamination from touching the sink, bathrobe and other objects.
7. Turn off the faucet, holding it only with a paper towel, as it can be a source of contamination.
8. Dry hands with sterile gauze.
8. Thoroughly treat the skin of the hands for 2-3 minutes with 2 swabs moistened with 70% alcohol or an alcohol-containing skin antiseptic with a virucidal effect (at least one minute for each hand) or apply 5-8 ml of 70% ethyl alcohol to the palmar surfaces alcohol or an alcohol-containing skin antiseptic with a virucidal effect and rub into the skin for 2 minutes.
9. Throw away the used balls into a container for disinfection.
10. Put on gloves according to the algorithm of actions.
Use of protective clothing.
Bathrobes.
With the exception of operating rooms or dressing rooms, where sterile gowns are worn to protect the patient, the main purpose of gowns is to prevent the entry of infectious agents on the clothes and skin of personnel.
Beanies.
Medical caps securely cover the hair, preventing it from acting as a source of pollution.
Aprons.
Rubber and polyethylene aprons are necessary to protect the overalls and skin of personnel in case of the threat of splashing of blood and other and other biological fluids and secretions.
Masks.
Masks are necessary to avoid airborne transmission of microorganisms, as well as in cases where there is a possibility of liquid substances of the human body entering the nose or mouth. They are especially important when personnel work directly on a large wound surface, such as open surgical wounds or burns, or in procedures with infectious patients from whom the infection can be easily transmitted by airborne droplets.
Masks should be replaced every 3-4 hours (depending on the type of work performed) or when they are moistened during work. Masks must not be lowered around the neck, reused. All masks must completely cover the nose and mouth.
