The purpose of the household level of hand treatment is the mechanical removal of most of the transient microflora from the skin (antiseptics are not used).
Such hand treatment is carried out:
- after visiting the toilet;
- before eating or before working with food;
- before and after physical contact with the patient;
- with any contamination of the hands.
Required equipment:
- Liquid dosed neutral soap or individual disposable soap in pieces. It is desirable that the soap does not have a strong odor. Open liquid or bar reusable non-personal soap quickly becomes infected with germs.
- Napkins measuring 15x15 cm are disposable, clean for getting your hands wet. The use of a towel (even an individual one) is not desirable, because it does not have time to dry out and, moreover, is easily seeded with microbes.
Hand treatment rules:
All jewelry, watches are removed from the hands, as they make it difficult to remove microorganisms. Hands are lathered, then rinsed with warm running water and everything repeats from the beginning. It is believed that during the first soaping and rinsing with warm water, microbes are washed off the skin of the hands. Under the influence of warm water and self-massage, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes are washed away from the opened pores.
Warm water makes the hand sanitizer or soap work more effectively, while hot water removes the protective fatty layer from the surface of the hands. For this reason, you should avoid using too much hot water for washing hands.
Hand treatment - the necessary sequence of movements
1. Rub one palm against the other palm in a reciprocating motion.
- Rub the back surface of the left hand with the right palm, change hands.
- Connect the fingers of one hand in the interdigital spaces of the other, rub the inner surfaces of the fingers with up and down movements.
- Connect the fingers into a “lock”, rub the palm of the other hand with the back of the bent fingers.
- Grasp the base of the thumb of the left hand between the thumb and index fingers right hand, rotational friction. Repeat on the wrist. Change hands.
- In a circular motion, rub the palm of the left hand with the fingertips of the right hand, change hands.
Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute.
It is very important to follow the described handwashing technique, since special studies have shown that during routine handwashing, certain areas of the skin (fingertips and their inner surfaces) remain contaminated.
After the last rinse, the hands are wiped dry with a napkin (15x15 cm). The faucets are closed with the same napkin. The tissue is discarded into a container with a disinfectant solution for disposal.
In the absence of disposable wipes, it is possible to use pieces of clean cloth, which, after each use, are discarded into special containers and, after disinfection, sent to the laundry. Replacing disposable wipes with electric dryers is impractical, because. with them, there is no rubbing of the skin, which means that there is no removal of detergent residues and desquamation of the epithelium.
In order to prevent nosocomial infections, the hands of medical workers (hygienic treatment of hands, treatment of surgeons' hands) and the skin of patients (treatment of the operating and injection fields, elbow folds of donors, sanitization of the skin) are subject to disinfection. Depending on the medical manipulation being performed and the required level of reduction of microbial contamination of the skin of the hands, medical personnel perform hygienic treatment of hands or treatment of surgeons' hands. The administration organizes training and monitoring of compliance with hand hygiene requirements by medical personnel.
To achieve effective washing and disinfection of hands, the following conditions must be observed: short-cut nails, no nail polish, no artificial nails, no rings, rings and other jewelry. Before processing the hands of surgeons, it is also necessary to remove watches, bracelets, etc. Clean cloth towels or disposable paper towels are used to dry the hands, and only sterile cloth ones are used when treating the hands of surgeons.
Medical personnel should be provided with sufficient effective means for washing and disinfecting hands, as well as hand skin care products (creams, lotions, balms, etc.) to reduce the risk of contact dermatitis. When choosing skin antiseptics, detergents and hand care products, individual tolerance should be taken into account.
Hygienic processing of hands.
Hand hygiene should be carried out in the following cases:
before direct contact with the patient;
after contact with the patient's intact skin (for example, when measuring the pulse or blood pressure);
after contact with secrets or excretions of the body, mucous membranes, dressings;
before performing various manipulations to care for the patient;
after contact with medical equipment and other objects in the immediate vicinity of the patient;
after treatment of patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment.
Hand hygiene is carried out in two ways:
hygienic handwashing with soap and water to remove contaminants and reduce microbial counts;
hand sanitizer to reduce microbial counts to safe levels.
Used for washing hands liquid soap using a dispenser. Dry hands with an individual towel (napkin), preferably disposable.
Hygienic treatment of hands with an alcohol-containing or other approved antiseptic (without prior washing) is carried out by rubbing it into the skin of the hands in the amount recommended by the instructions for use, paying special attention to the treatment of the fingertips, the skin around the nails, between the fingers. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.
When using a dispenser, a new portion of antiseptic (or soap) is poured into the dispenser after it has been disinfected, rinsed with water and dried. Preference should be given to elbow dispensers and dispensers on photocells.
Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In departments with a high intensity of patient care and a high workload on staff (intensive care units, etc.), dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by staff (at the entrance to the ward, at the bedside of the patient and etc.). It should also provide for the possibility of providing medical workers with individual containers (vials) of small volumes (up to 200 ml) with skin antiseptic.
2. PROCESSING OF HANDS OF MEDICAL PERSONNEL
Hand washing is a simple but very important method of preventing HCAI.PCorrect and timely processing of hands is the key to the safety of medical personnel and patients .
Hand preparation rules:
1.Remove rings, watches.
2.Nails must be cut short and no polish is allowed.
3.Roll the long sleeves of the robe over 2/3 of the forearm.
All jewelry, watches are removed from the hands, as they make it difficult to remove microorganisms. Hands are soaped, then rinsed warm running water and everything repeats from the beginning. It is believed that during the first soaping and rinsing with warm water, microbes are washed off the skin of the hands. Under the influence of warm water and self-massage during mechanical treatment, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes from the opened pores are washed off. Warm water contributes to a more effective effect of antiseptic or soap, while hot water removes the protective fatty layer from the surface of the hands. In this regard, you should avoid using too hot water for washing your hands.
When entering and leaving the intensive care unit or ICU, the staff should clean their hands with a skin antiseptic.
There are three levels of hand treatment:
1.Household level (mechanical processing of hands);
2.Hygienic level (treatment of hands using skin antiseptics);
3.Surgical level (a special sequence of actions when processing hands, increasing the processing time, processing area, followed by putting on sterile gloves).
1. Machining of hands
The purpose of the household level of hand treatment is the mechanical removal of most of the transient microflora from the skin (antiseptics are not used).
· after visiting the toilet;
· before eating or before working with food;
· before and after physical contact with the patient;
· with any contamination of the hands.
Required equipment:
1.Liquid dosed neutral soap. It is desirable that the soap does not have a strong odor. Opened liquid soap is quickly infected with microbes, so it is necessary to use closed dispensers, and at the end of the contents process the dispenser, only after processing fill it with new contents.
2.Napkins measuring 15x15 cm are disposable, clean for drying hands. The use of a towel (even an individual one) is not desirable, because it does not have time to dry out and, moreover, is easily seeded with microbes.
Hand treatment - the necessary sequence of movements:
1.Rub one palm against the other palm in a reciprocating motion.
2.Rub the back surface of the left hand with the right palm, change hands.
3.Connect the fingers of one hand in the interdigital spaces of the other, rub the inner surfaces of the fingers with up and down movements.
4.Connect the fingers into a “lock”, rub the palm of the other hand with the back of the bent fingers.
5.Grab the base of the thumb of the left hand between the thumb and forefinger of the right hand, rotational friction. Repeat on the wrist. Change hands.
6.In a circular motion, rub the palm of the left hand with the fingertips of the right hand, change hands.
HAND HYGIENE REGULATIONS
European standard EN-1500
Scheme 4
|
Palm to palm including wrists |
Right palm on the left back of the hand and left palm on the right back of the hand |
Palm to palm of hand with fingers crossed |
|
The outer side of the fingers on the opposite palm with crossed fingers |
Circular rubbing of the left thumb in the closed palm of the right hand and vice versa |
Circular rubbing of the closed fingertips of the right hand on the left palm and vice versa |
2. Hand hygiene
The purpose of hygienic treatment is the destruction of resident microflora from the surface of the skin of the hands with the help of antiseptics.
Such hand treatment is carried out:
· before putting on gloves and after removing them;
· before caring for a patient with a weakened immune system or when making rounds in the wards (when it is not possible to wash hands after examining each patient);
· before and after performing invasive procedures, minor surgical procedures, wound care or catheter care;
· after contact with body fluids (e.g. blood emergencies).
Required equipment:
2.Napkins measuring 15x15 cm are disposable, clean (paper or fabric).
3.Skin antiseptic. It is advisable to use alcohol-containing skin antiseptics (70% ethyl alcohol solution; 0.5% solution of chlorhexidine bigluconate in 70% ethyl alcohol, AHD-2000 special, Sterillium, Sterimax, etc.).
Hygiene treatment hands consists of two stages:
1 - mechanical cleaning of hands, followed by drying with disposable wipes;
2 - disinfection of hands with a skin antiseptic.
3 . Surgical treatment of hands
The goal of the surgical level of hand decontamination is to minimize the risk of violating operational sterility in the event of damage to gloves.
Such hand treatment is carried out:
· before surgical interventions;
· before serious invasive procedures (for example, puncture of large vessels).
Required equipment:
1.Liquid dosed pH-neutral soap.
2.Napkins size 15x15 cm disposable, sterile.
3.Skin antiseptic.
4.Disposable sterile surgical gloves.
Hand treatment rules:
Surgical treatment hands consists of three stages:
1 - mechanical cleaning of hands followed by drying,
2 - disinfection of hands with a skin antiseptic twice,
3 - closing hands with sterile disposable gloves.
In contrast to the above-described method of mechanical cleaning at the surgical level, the forearms are included in the treatment; sterile wipes, but hand washing lasts at least 2 minutes. After drying, the nail beds and periungual ridges are additionally processed with disposable sterile wooden sticks soaked in an antiseptic solution.
Brushes are not required. If brushes are still used, sterile, soft, disposable or autoclavable brushes should be used, and brushes should only be used on the periungual area and only for the first brushing of a work shift.
At the end of the mechanical cleaning stage, an antiseptic is applied to the hands in portions of 3 ml and, preventing drying, is rubbed into the skin, strictly observing the sequence of movements. 5 minutes .
Sterile gloves are put on dry hands only. If the duration of work with gloves is more than 3 hours, the treatment of hands is repeated with a change of gloves.
After removing the gloves, the hands are again wiped with a napkin moistened with a skin antiseptic, then washed with soap and moistened with an emollient cream.
Bacteriological control of the effectiveness of processing the hands of personnel.
The washings from the hands of the personnel are made with sterile gauze wipes 5 × 5 cm in size, moistened with a neutralizer. Thoroughly wipe the palms, periungual and interdigital spaces of both hands with a gauze cloth. After sampling, the gauze pad is placed in wide-mouth tubes or flasks with saline and glass beads and shaken for 10 minutes. The liquid is inoculated, incubated for 48 hours at a temperature of + 37 0 C. Accounting for the results: the absence of pathogenic and opportunistic bacteria (Guidelines 4.2.2942-11).
Dermatitis associated with frequent hand washing
Repeated hand washing may cause skin dryness, cracking and dermatitis in sensitive subjects. A healthcare worker suffering from dermatitis contributes to an increased risk of infection for patients due to:
· the possibility of colonization of damaged skin by pathogenic microorganisms;
· difficulties in adequately reducing the number of microorganisms in handwashing;
· tendencies to avoid handling hands.
Measures that reduce the likelihood of developing dermatitis:
· thoroughly rinsing and drying hands;
· use an adequate amount of antiseptic (avoid excess);
· usage contemporary and various antiseptics;
· obligatory use of moisturizing and emollient creams.
Skin microflora
Surface layer epidermis ( upper layer skin) is completely replaced every 2 weeks. Every day, up to 100 million skin scales are peeled from healthy skin, of which 10% contain viable bacteria. The microflora of the skin can be divided into two large groups:
1.Resident flora
2.Transient flora
1. Resident microflora are those microorganisms that constantly live and multiply on the skin without causing any diseases. That is, it is a normal flora. The number of resident flora is approximately 10 2 -10 3 per 1 cm 2. The resident flora is represented mainly by coagulase-negative cocci (primarily Staphylococcus epidermidis) and diphtheroids (Corinebacterium spp.). Although Staphylococcus aureus is found in the nose of approximately 20% of healthy people, it rarely colonizes the skin of the hands (unless it is damaged), but in a hospital setting it can be found on the skin of the hands medical personnel with no less frequency than in the nose.
The resident microflora cannot be destroyed by ordinary hand washing or even antiseptic procedures, although its numbers are significantly reduced. Sterilization of the skin of the hands is not only impossible, but also undesirable: because the normal microflora prevents the colonization of the skin by other, much more dangerous microorganisms, primarily gram-negative bacteria.
2. Transient microflora- These are those microorganisms that are acquired by medical personnel as a result of contact with infected patients or contaminated objects. environment. Transient flora can be represented by much more epidemiologically dangerous microorganisms (E.coli, Klebsiella spp., Pseudomonas spp., Salmonella spp. and other gram-negative bacteria, S.aureus, C. albicans, rotaviruses, etc.), including hospital strains of pathogens of nosocomial infections. Transient microorganisms remain on the skin of the hands for a short time (rarely more than 24 hours). They can easily be removed with normal hand washing or destroyed with antiseptics. As long as these microbes remain on the skin, they can be transmitted to patients through contact and contaminate various objects. This circumstance makes the hands of the staff the most important factor transmission of infection.
If the integrity of the skin is broken, then the transient microflora can cause an infectious disease (for example, panaritium or erysipelas). You should be aware that in this case, the use of antiseptics does not make hands safe in terms of infection transmission. Microorganisms (most often staphylococci and beta-hemolytic streptococci) remain with the disease on the skin until a cure occurs.
Filonov V.P., Doctor of Medical Sciences, Professor,
Dolgin A.S.,
CJSC "BelAseptika"
According to the World Health Organization (hereinafter - WHO), infections associated with the provision of medical care(hereinafter referred to as HCAI) - are a major patient safety issue, and their prevention should be a priority for medical institutions and institutions that are obliged to provide safer medical care.
Hand hygiene is a first line intervention that has proven effective in preventing HCAI and the spread of antimicrobial resistance.
The history of antiseptics is associated with the names of the Hungarian obstetrician Ignaz Philipp Semmelweis and the English surgeon Joseph Lister, who scientifically substantiated and put antiseptics into practice as a method of treating and preventing the development of suppurative processes, sepsis. So, Semmelweis, on the basis of many years of observations, came to the conclusion that puerperal fever, which gave high mortality, is caused by cadaveric poison transmitted through the hands of medical staff. He conducted one of the first analytical epidemiological studies in the history of epidemiology and convincingly proved that the decontamination of the hands of medical personnel is the most important procedure to prevent the occurrence of nosocomial infections. Thanks to the introduction of antiseptics into practice in the obstetric hospital where Semmelweis worked, the death rate from nosocomial infections was reduced by 10 times.
Practical experience and a huge number of publications devoted to the issues of processing the hands of medical staff show that this problem, even more than one and a half hundred years after Semmelweis, cannot be considered solved and remains relevant. Currently, according to WHO, up to 80% of HAIs are transmitted through the hands of healthcare workers.
Proper hand hygiene of healthcare workers is the most important, simplest, and least expensive way to reduce the incidence of HCAI, as well as the spread of antibiotic-resistant strains of pathogens, and to prevent the occurrence of infectious diseases in healthcare organizations.
Hand skin treatment includes a number of complementary methods (levels): hand washing, hygienic and surgical hand skin antisepsis, each of which plays a role in preventing infections.
It should be noted that all these methods to some extent affect the microflora of the skin of the hands - resident (permanent) or transient (temporary). Microorganisms of the resident flora are located under the surface cells of the stratum corneum of the epithelium; this is the normal human microflora. The transient microflora gets on the skin of the hands as a result of work and contact with infected patients or contaminated environmental objects, remains on the skin for up to 24 hours, and its species composition is directly dependent on the profile of the healthcare organization and is associated with the nature of the health worker's activity. Most often, these microorganisms are associated with HAIs, and are represented by pathogenic microorganisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), polydrug-resistant gram-negative bacteria, fungi of the Candida genus, clostridia.
The transient microflora is epidemiologically the most significant. So, if the skin is damaged, in particular during the use of inadequate methods of hand treatment (use of hard brushes, alkaline soap, hot water, excessively unreasonable use of hand washing instead of antiseptics), the transient microflora penetrates deeper into the skin, displaces the permanent microflora from there, disrupting its stability, which in turn leads to the development of dysbacteriosis. In this case, the hands of medical workers become not only a factor in the transmission of opportunistic and pathogenic microorganisms, but also their reservoir. Unlike resident, transient microflora is completely removed during antiseptic treatment.
Recommendations for hand hygiene are set out in the relevant WHO Guidelines. General recommendations to the hygiene of the hands of medical personnel are reduced to the following positions:
1. Wash your hands with soap and water when they are visibly soiled, stained with blood or other body fluids, or after going to the toilet.
2. If exposure to a potential spore-forming pathogen is high (suspected or proven), including cases of C. difficile outbreaks, handwashing with soap and water is the preferred measure.
3. Use alcohol-based handrub as the preferred routine antiseptic measure in all other clinical situations listed in step 4, unless hands are visibly contaminated. If alcohol-based hand rub is not available, wash your hands with soap and water.
4. Practice hand hygiene:
before and after contact with the patient;
before touching an invasive patient care device, whether or not you are wearing gloves;
after contact with body fluids or secretions, mucous membranes, damaged skin or wound dressings;
if, when examining a patient, you move from a contaminated area of \u200b\u200bthe body to an uncontaminated one;
after contact with objects (including medical equipment) from the immediate environment of the patient;
after removing sterile or non-sterile gloves.
5. Before handling medications or preparing food, perform hand hygiene using an alcohol-based hand rub or wash your hands with plain or antimicrobial soap and water.
6. Soap and alcohol-based hand sanitizer should not be used at the same time.
At the same time, WHO states that the highest frequency of compliance by medical workers with recommended hygiene measures is up to 60% at best. WHO experts identify the main factors associated with insufficient adherence to hand washing: the status of a doctor (compliance with hand hygiene is less common than that of nursing staff); work in intensive care, work in the surgical department; work in emergency care, work in anesthesiology; working during the week (compared to working on weekends); shortage of staff (surplus of patients); wearing gloves; a large number of indications for hand hygiene within an hour of patient care after contact with environmental objects in the patient's environment, for example, with equipment; before contact with environmental objects in the environment of the patient, etc.
Speaking about the three levels of hand treatment (hygienic washing, hygienic antiseptic, surgical antiseptic), it should be noted that their goal is not to replace each other, but to complement each other. Thus, hand washing allows mechanical cleaning from organic and inorganic contaminants and only partially remove transient microflora from the skin. At the same time, in healthcare organizations, for hygienic handwashing, soaps should be used that will cause the least harm to the skin, while providing maximum effect. These are liquid, pH-neutral soaps containing bactericidal and fungicidal components, as well as additives softening and moisturizing the skin. At the same time, it is necessary to pay close attention to the hand treatment technique and its duration, which should be 40-60 seconds, as well as the hand drying procedure. On the one hand, complete and proper drying of the skin of the hands after washing prevents the occurrence of dermatitis with the subsequent use of alcohol-containing antiseptics, and on the other hand, it is important condition proper decontamination. Currently carried out in different countries studies (including those by an accredited laboratory of CJSC "BelAseptika") show that microbiological contamination of the skin of the hands, after going to the toilet, washing hands and using an electric towel, does not decrease, but increases by 50%. Indicators of microbiological contamination of the skin of hands in persons who washed their hands after going to the toilet and used a paper (disposable) towel are reduced by almost 3 times, and in those who additionally apply antiseptic gel up to 10 times.
Therefore, the use of disposable paper towels for drying hands compared to electric towels is much more optimal in epidemiological terms. The additional use of antimicrobial hand gels is the most promising solution. This practice can provide both greater convenience, and protection of the skin of the hands, and the effectiveness of processing.
The procedure for conducting hand antisepsis in our country is currently defined by the Instruction "Hygienic and Surgical Antisepsis of the Skin of the Hands of Medical Personnel", approved by the Chief State Sanitary Doctor of the Republic of Belarus on September 5, 2001 N 113-0801 and fully complies with the international standard EN-1500.
Hygienic antisepsis of the skin of the hands aims to destroy the transient microflora of the skin.
At the same time, the treatment procedure itself includes applying an antiseptic to the hands in an amount of 3 ml and thoroughly rubbing into the palmar, back and interdigital surfaces of the skin of the hands for 30-60 seconds until completely dry, strictly following the sequence of movements according to the European processing standard EN-1500.
In order to make the right choice of drugs, which is often difficult due to the abundance of offers on domestic market, it is necessary to consistently take into account their key properties: the presence of a wide spectrum of antimicrobial activity, the absence of an allergic and irritating effect on the skin, registration as a drug, cost-effectiveness. At the same time, the use of alcohol-based antiseptics, the most effective against HCAI pathogens and compatible with the skin, is also recognized by WHO as the “gold standard”. The use of such antiseptics is one of the main key points in the hygiene of the hands of medical workers.
According to the Law of the Republic of Belarus "On medicines ah” antiseptics in our country are classified as medicines, and therefore undergo clinical trials confirming their safety and are produced at enterprises that have implemented and certified the Good Manufacturing Practice (GMP) system at the Ministry of Health. The water used for the production of antiseptic medicines is purified at reverse osmosis plants, and the finished antiseptic itself is microfiltered before bottling, which eliminates the presence of any infectious agents in it. It is this approach to ensuring the production of high-quality antiseptics that has made it possible today to reduce the exposure of hygienic antiseptics, compared to the previously accepted one. Currently, some drugs have been confirmed effective at 12 seconds hygienic antiseptics(Septocid-synergy, Septocid P+).
Along with this, the use of "aqueous" alcohol-free solutions of antiseptics in healthcare organizations is not as effective, convenient and safe. So, components such as triclosan, HOURS can cause allergic reactions. Guanidine film can contribute to the formation of biofilms in cases where the skin of the health worker's hands is unhealthy, there are signs of dysbacteriosis, violation of the integrity of the skin, the presence of infection. In addition, the 5-7 minute "stickiness" of the skin of the hands that occurs after the use of alcohol-free antiseptics also reduces the convenience of their use, especially when using gloves. Alcohol-containing antiseptics, according to WHO recommendations, are the most reliable in this regard. The concentration of alcohols (ethyl, isopropyl) in the range from 60% to 80% allows you to achieve maximum efficiency. In addition, the advantage of antiseptics over the usual 70% alcohol is that they contain special emollients that neutralize the drying effect of alcohols.
Surgical antisepsis of the skin of the hands ensures the destruction of transient microflora and reduces the amount of resident microflora to a subinfectious level and is carried out during medical procedures associated with contact (direct or indirect) with the internal sterile environments of the body (catheterization of central venous vessels, punctures of joints, cavities, surgical interventions, etc.). .d.).
In the process of professional activity of medical workers, the skin may lose its ability to perform a barrier function - it becomes irritated, dry and cracked. The most common staff reactions are contact dermatitis and allergic reactions. Experts believe that 2/3 of all skin problems are due to improper care behind the skin, including due to the application of alcohol-containing antiseptics on wet hands. Regular and intensive care on the skin using creams, lotions, balms at the workplace, such as for example: Dermagent C, Dermagent R, is a preventive measure against occupational dermatoses.
To ensure the prevention of HCAI in healthcare organizations, it is necessary to carry out targeted work to increase the adherence to hand hygiene among medical staff. The administration of the institution should pay special attention to conducting effective training of medical personnel using interactive technologies and ensuring the availability of alcohol antiseptics for medical workers at points of medical care.
Administration support and encouragement for good hand hygiene, development of an audit system for the use of alcohol-based hand rubs, and monitoring of hand hygiene compliance may be most effective in promoting adherence to handwashing among healthcare workers. Commitment to hand hygiene of the older generation of medical workers also influences the formation of commitment among young employees, interns and students.
Combining the efforts of medical workers, the administration of healthcare organizations, specialists from hygiene and epidemiology centers, teachers of educational institutions in the step-by-step implementation and formation of a sustainable hand washing practice, as well as their own example, will allow instilling a simple and effective practice of hand hygiene into everyday activities in the provision of medical care in real and future generations of health workers, thereby ensuring the stable safety of medical care.
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 environmental objects; 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 water faucet using 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 and 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 rotate the base of the thumbs (this time is enough to decontaminate the hands on a social level if the surface of the skin of the hands is lathered thoroughly and dirty areas of the skin of the hands are not left).
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 paper towel, in the absence of an 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, safe disposal container (SDF).
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 water. warm water until the soap is completely removed, holding the arms so that the wrists and hands are above the level of the elbows (in this position, water flows from the clean area to the 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:
- Without necessary conditions for hygienic washing of hands, 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. Take the glove for the right hand by the lapel with the left hand so that the fingers do not touch inner surface lapel 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, wring out excess water slightly.
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 ones are divided into strands and slowly combed from ends to roots, trying 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 "Preparation of the patient 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, chest burns, 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. Slip through left hand under the patient's side, hold the patient's legs with your right hand 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, asthma attacks, 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. Swipe psychological preparation 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
