The purpose of household hand treatment is to mechanically remove most of the transient microflora from the skin (antiseptics are not used).
A similar hand treatment is carried out:
- after visiting the toilet;
- before eating or working with food;
- before and after physical contact with the patient;
- for any contamination of 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. Opened liquid or bar reusable non-individual soap quickly becomes infected with germs.
- Napkins measuring 15x15 cm are disposable, clean for blotting hands. Using a towel (even an individual one) is not advisable, because it does not have time to dry and, moreover, is easily contaminated with germs.
Hand treatment rules:
All jewelry and watches are removed from hands, as they make it difficult to remove microorganisms. Hands are soaped, then rinsed with warm running water and everything repeats all over again. It is believed that the first time you soap and rinse with warm water, germs are washed off from the skin of your hands. Under the influence of warm water and self-massage, the pores of the skin open, so when repeated soaping and rinsing, germs are washed away from the opened pores.
Warm water makes the antiseptic or soap work more effectively, while hot water removes the protective fat layer from the surface of the hands. In this regard, you should avoid consuming too much hot water for washing hands.
Hand treatment - the necessary sequence of movements
1. Rub one palm against the other palm in a back-and-forth motion.
- Rub the back of your left hand with your right palm and switch 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.
- Place your fingers in a “lock” and rub the palm of your other hand with the back of your bent fingers.
- Cover 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.
- Rub the palm of your left hand in a circular motion with the fingertips of your right hand, switch hands.
Each movement is repeated at least 5 times. Hand treatment is carried out for 30 seconds - 1 minute.
It is very important to follow the described hand washing technique, since special studies have shown that during routine hand washing, certain areas of the skin (fingertips and their inner surfaces) remain contaminated.
After the last rinse, wipe your hands dry with a napkin (15x15 cm). The same napkin is used to close the water taps. The napkin is dumped into a container with a disinfectant solution for disposal.
In the absence of disposable napkins, it is possible to use pieces of clean cloth, which after each use are thrown into special containers and, after disinfection, sent to the laundry. Replacing disposable napkins with electric dryers is impractical, because... with them there is no rubbing of the skin, which means 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, disinfection of surgeons’ hands) and the skin of patients (treatment of surgical and injection fields, elbow bends of donors, sanitary treatment of the skin) are subject to disinfection. Depending on the medical procedure being performed and the required level of reduction in microbial contamination of the skin of the hands, medical personnel perform hygienic treatment of hands or treatment of the hands of surgeons. The administration organizes training and monitoring of compliance with hand hygiene requirements by medical personnel.
To achieve effective hand washing and disinfection, the following conditions must be observed: short-cut nails, no nail polish, no artificial nails, no rings, signet rings, etc. jewelry. Before treating surgeons' hands, it is also necessary to remove watches, bracelets, etc. To dry hands, use clean cloth towels or disposable paper napkins; when treating surgeons' hands, use only sterile cloth ones.
Medical personnel should be provided with sufficient quantities of 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 skin care products, individual tolerance should be taken into account.
Hand hygiene.
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 pulse or blood pressure);
after contact with body secretions or excreta, mucous membranes, dressings;
before performing various patient care procedures;
after contact with medical equipment and other objects located in close proximity to the patient;
after treating patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment.
Hand hygiene is carried out in two ways:
hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;
treating hands with a skin antiseptic to reduce the number of microorganisms to a safe level.
Used for hand washing liquid soap using a dispenser. Dry your hands with an individual towel (napkin), preferably disposable.
Hygienic treatment of hands with 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 in 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, washed with water and dried. Preference should be given to elbow dispensers and photocell dispensers.
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 with a high workload on staff (resuscitation and 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 patient’s bedside and etc.). It should also be possible to provide medical workers with individual containers (bottles) 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 hand washing is the key to the safety of medical personnel and patients .
Hand preparation rules:
1.Remove rings and watches.
2.Nails must be cut short and no polish is allowed.
3.Fold the long sleeves of the robe over 2/3 of your forearms.
All jewelry and watches are removed from hands, as they make it difficult to remove microorganisms. Hands are soaped and then rinsed warm running water and everything repeats itself from the beginning. It is believed that the first time you soap and rinse with warm water, germs are washed off from the skin of your hands. Under the influence of warm water and self-massage during mechanical treatment, the pores of the skin open, so when repeated soaping and rinsing, germs are washed away from the opened pores. Warm water contributes to a more effective effect of the antiseptic or soap, while hot water removes the protective fat layer from the surface of the hands. Therefore, you should avoid using too hot water when washing your hands.
When entering and exiting the intensive care unit or intensive care unit, personnel must treat their hands with a skin antiseptic.
There are three levels of hand treatment:
1.Household level (mechanical hand treatment);
2.Hygienic level (hand treatment using skin antiseptics);
3.Surgical level (special sequence of actions when treating hands, increasing treatment time, treatment area, followed by putting on sterile gloves).
1. Mechanical treatment of hands
The purpose of household hand treatment is to mechanically remove most of the transient microflora from the skin (antiseptics are not used).
· after visiting the toilet;
· before eating or working with food;
· before and after physical contact with the patient;
· for any contamination of hands.
Required equipment:
1.Liquid dosed neutral soap. It is desirable that the soap does not have a strong odor. Open liquid soap quickly becomes infected with microbes, so you need to use closed dispensers, and after finishing the contents, process the dispenser, and only fill it with new contents after processing.
2.Disposable, clean, 15x15 cm napkins for drying hands. Using a towel (even an individual one) is not advisable, because it does not have time to dry and, moreover, is easily contaminated with germs.
Hand treatment - the necessary sequence of movements:
1.Rub one palm against the other palm in a back-and-forth motion.
2.Rub the back of your left hand with your right palm and switch 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 your fingers into a “lock” and rub the palm of your other hand with the back of your bent fingers.
5.Cover the base of the thumb of the left hand between the thumb and index finger of the right hand, rotational friction. Repeat on the wrist. Change hands.
6.Rub the palm of your left hand in a circular motion with the fingertips of your right hand, switch 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 to destroy resident microflora from the surface of the skin of the hands using antiseptics.
Such hand treatment is carried out:
· before putting on gloves and after removing them;
· before caring for an immunocompromised patient or during ward rounds (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 (eg 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.).
Hygienic treatment hands consists of two stages:
1 - mechanical cleaning of hands followed by drying with disposable napkins;
2 - hand disinfection with skin antiseptic.
3 . Surgical treatment of hands
The purpose of the surgical level of hand cleaning is to minimize the risk of disruption of surgical sterility in the event of glove damage.
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.Wipes measuring 15x15 cm are disposable, sterile.
3.Skin antiseptic.
4.Disposable sterile surgical gloves.
Hand treatment rules:
Surgical debridement hands consists of three stages:
1 - mechanical cleaning of hands followed by drying,
2 - hand disinfection with skin antiseptic twice,
3 - covering 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, and itself hand washing lasts at least 2 minutes. After drying, the nail beds and periungual folds are additionally treated with disposable sterile wooden sticks soaked in an antiseptic solution.
It is not necessary to use brushes. If brushes are used, sterile, soft, single-use or autoclave-resistant brushes should be used only for periungual areas and only for the first brush of a work shift.
At the end of the mechanical cleaning stage, an antiseptic is applied to the hands in 3 ml portions and, without allowing drying, rubbed into the skin, strictly observing the sequence of movements. The procedure for applying a skin antiseptic is repeated at least twice, the total consumption of the antiseptic is 10 ml, the total procedure time is 5 minutes .
Sterile gloves are worn only on dry hands. If you work with gloves for more than 3 hours, hand treatment is repeated with a change of gloves.
After removing the gloves, hands are wiped again with a cloth moistened with a skin antiseptic, then washed with soap and moisturized with an emollient cream.
Bacteriological control of the effectiveness of personnel hand treatment.
Washings from the hands of personnel are carried out using sterile gauze wipes measuring 5x5 cm, soaked in a neutralizer. Using a gauze napkin, thoroughly wipe the palms, periungual and interdigital spaces of both hands. After sampling, the gauze pad is placed in wide-necked test tubes or flasks with saline solution and glass beads and shaken for 10 minutes. The liquid is inoculated and incubated for 48 hours at a temperature of + 37 0 C. Recording of results: absence of pathogenic and opportunistic bacteria (Guidelines 4.2.2942-11).
Dermatitis associated with frequent hand cleaning
Repeated hand cleaning may cause skin dryness, cracking and dermatitis in sensitive subjects. A healthcare worker suffering from dermatitis increases the 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 to reduce the likelihood of developing dermatitis:
· thoroughly rinsing and drying hands;
· using an adequate amount of antiseptic (avoid excess);
· usage modern and various antiseptics;
· mandatory use of moisturizing and softening creams.
Skin microflora
Surface layer epidermis ( upper layer skin) is completely replaced every 2 weeks. Every day, up to 100 million skin flakes are shed from healthy skin, of which 10% contain viable bacteria. Skin microflora can be divided into two large groups:
1.Resident flora
2.Transitory flora
1. Resident microflora- these are those microorganisms that constantly live and multiply on the skin without causing any diseases. That is, this is normal flora. The number of resident flora is approximately 10 2 -10 3 per 1 cm 2. The resident flora is represented predominantly by coagulase-negative cocci (primarily Staphylococcus epidermidis) and diphtheroids (Corinebacterium spp.). Despite the fact that Staphylococcus aureus is found in the nose of approximately 20% of healthy people, it rarely colonizes the skin of the hands (if it is not damaged), however, in hospital conditions it can be found on the skin of the hands medical personnel with no less frequency than in the nose.
Resident microflora cannot be destroyed by regular 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 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 be easily removed by regular hand washing or destroyed by using antiseptics. While 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 compromised, then transient microflora can cause an infectious disease (for example, whitlow or erysipelas). You should be aware that in this case, the use of antiseptics does not make your hands safe from the point of view of transmission of infection. Microorganisms (most often staphylococci and beta-hemolytic streptococci) remain on the skin during the disease until recovery occurs.
Filonov V.P., Doctor of Medical Sciences, Professor,
Dolgin A.S.,
CJSC "BelAseptika"
According to the World Health Organization (hereinafter referred to as WHO), infections associated with the provision of medical care(hereinafter referred to as HAIs) are a major patient safety issue, and their prevention should be a priority for medical institutions and institutions committed to providing safer medical care.
Hand hygiene is a first-line intervention that has proven effective in preventing HAIs 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 introduced antiseptics into practice as a method of treating and preventing the development of suppurative processes and sepsis. Thus, Semmelweis, based on many years of observations, came to the conclusion that puerperal fever, which had a high mortality rate, is caused 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 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 mortality rate from nosocomial infections was reduced by 10 times.
Practical experience and a huge number of publications devoted to the issues of hand treatment for medical personnel show that this problem, even more than one hundred and fifty 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.
Good hand hygiene among healthcare workers is the most important, simplest, and least expensive way to reduce the incidence of HCAIs, the spread of antibiotic-resistant pathogens, and 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 its role in preventing infections.
It should be noted that all these methods, to one degree or another, affect the microflora of the skin of the hands - resident (permanent) or transient (temporary). Microorganisms of resident flora are located under the surface cells of the stratum corneum of the epithelium; this is the normal human microflora. 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 activities. Most often, these microorganisms are associated with HAIs and are represented by pathogenic microorganisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), multidrug-resistant gram-negative bacteria, Candida fungi, clostridia.
Transient microflora is the most significant epidemiologically. Thus, when 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), transient microflora penetrates deeper into the skin, displacing permanent microflora from there, thereby disturbing its stability, which in turn leads to the development of dysbiosis. 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 microflora, transient microflora is completely removed during antiseptic treatment.
Recommendations for hand hygiene are outlined in the relevant WHO Guidelines. General recommendations Hand hygiene for medical personnel boils down to the following points:
1. Wash your hands with soap and water when they are visibly dirty, contaminated with blood or other body fluids, or after using the toilet.
2. When 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 an alcohol-based hand rub as the preferred routine antiseptic measure in all other clinical situations listed in point 4 unless hands are visibly contaminated. If an alcohol-based hand rub is not available, wash your hands with soap and water.
4. Perform hand hygiene:
before and after contact with the patient;
before touching an invasive device for patient care, whether you wear gloves or not;
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 the body to a non-contaminated one;
after contact with objects (including medical equipment) from the patient’s immediate environment;
after removing sterile or non-sterile gloves.
5. Before handling medications or preparing food, perform hand hygiene by using an alcohol-based hand rub or washing your hands with regular or antimicrobial soap and water.
6. Soap and alcohol-based hand sanitizer should not be used simultaneously.
At the same time, WHO states that the highest frequency of compliance by medical workers with recommended hygiene measures is, at best, up to 60%. WHO experts identify the main factors associated with insufficient adherence to hand hygiene: 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 (excess 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, such as equipment; before contact with environmental objects in the patient’s environment, etc.
Speaking about the three levels of hand treatment (hygienic washing, hygienic antiseptics, surgical antiseptics), it should be noted that their goal is not to replace each other, but rather to complement each other. Thus, hand washing allows you to 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 hand washing, soaps should be used that will cause the least harm to the skin, while simultaneously ensuring maximum effect. These are liquid, pH-neutral soaps containing bactericidal and fungicidal components, as well as skin softening and moisturizing additives. At the same time, it is necessary to pay close attention to the technique of hand treatment and its duration, which should be 40-60 seconds, as well as the procedure for drying hands. 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 an important condition proper decontamination. Currently carried out in different countries studies (including those by the accredited laboratory of JSC BelAseptika) show that microbiological contamination of the skin of the hands after visiting the toilet, washing hands and using an electric towel does not decrease, but increases by 50%. Indicators of microbiological contamination of the skin of the hands of people who, after visiting the toilet, washed their hands and used a paper (disposable) towel are reduced by almost 3 times, and for those who additionally use an 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 gels for hand skin care is the most promising solution. This practice can provide greater convenience, protection of the skin of the hands, and effectiveness of treatment.
The procedure for hand antisepsis in our country is currently determined 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 hand skin antiseptics are aimed at destroying transient skin microflora.
In this case, 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 observing the sequence of movements in accordance with the European treatment standard EN-1500.
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 action, the absence of allergic and irritating effects on the skin, registration as a medicine, and cost-effectiveness. At the same time, the use of alcohol-based antiseptics, which are the most effective against HAI pathogens and are compatible with the skin, is also recognized by WHO as the “gold standard”. The use of just such antiseptics is one of the main key points in hand hygiene of healthcare 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 by the Ministry of Health. The water used for the production of antiseptic medicines is purified in reverse osmosis units, and the finished antiseptic itself undergoes microfiltration 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 to hygienic antiseptics compared to previously adopted. Currently, some drugs have proven effectiveness at 12 seconds. hygienic antiseptics(Septotsid-synergy, Septotsid R+).
Along with this, the use of “aqueous” alcohol-free solutions of antiseptics in healthcare organizations is not so effective, convenient and safe. Thus, components such as triclosan and HOURS can cause allergic reactions. Guanidine film can contribute to the formation of biofilms in cases where the skin of a healthcare worker’s hands is unhealthy, there are signs of dysbacteriosis, damage to the integrity of the skin, or the presence of infection. In addition, the 5-7 minute “stickiness” of the skin of the hands that occurs after using alcohol-free antiseptics also reduces the ease of 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) ranging from 60% to 80% allows you to achieve maximum efficiency. In addition, the advantage of antiseptics over regular 70% alcohol is that they contain special softening components that neutralize the drying effect of alcohols.
Surgical antisepsis of the skin of the hands ensures the destruction of transient microflora and reduces the number 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, puncture of joints, cavities, surgical interventions, etc. .d.).
During the professional activities of medical workers, the skin may lose its ability to perform a barrier function - it becomes irritated, dry and cracked. The most common reactions among personnel are contact dermatitis and allergic reactions. Experts believe that 2/3 of all skin problems arise due to improper care skin care, including due to the application of alcohol-containing antiseptics to wet hands. Regular and intensive care skin care using creams, lotions, balms in the workplace, such as: Dermagent S, Dermagent R, is a preventive measure against occupational dermatoses.
To ensure the prevention of HAIs in healthcare organizations, it is necessary to carry out targeted work to increase the adherence to hand hygiene among medical staff. Particular attention by the administration of the institution should be paid to conducting effective training of medical personnel using interactive technologies and ensuring the availability of alcohol antiseptics for health workers at the point of medical care.
The most effective ways to promote adherence to hand sanitizing among health care workers may be through management support and encouragement for proper hand hygiene, development of a system for auditing the use of alcohol-based hand rubs, and monitoring of hand hygiene compliance. The commitment to hand hygiene of older generations of healthcare workers also influences the formation of commitment among younger employees, interns and students.
Combining the efforts of medical workers, the administration of health care organizations, specialists from hygiene and epidemiology centers, teachers of educational institutions in the step-by-step implementation and formation of sustainable hand washing practices, as well as our own example, will make it possible to instill simple and effective hand hygiene practices in everyday activities when providing medical care to real people. and future generations of medical workers, thereby ensuring sustainable safety of medical care.
Standard “Handwashing at a social level”
Target: removal of dirt and transient flora from contaminating skin of the hands of medical personnel as a result of contact with patients or environmental objects; ensuring infectious safety of patients and staff.
Indications: before distributing food, feeding the patient; after visiting the toilet; before and after caring for the patient, unless hands are contaminated with the patient's body fluids.
cook: liquid soap in dispensers for single use; clock with 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. Fold the sleeves of the robe over 2/3 of your forearms.
3. Open water tap using a paper napkin and adjust the water temperature (35°-40°C), thereby preventing hand contact with microorganisms located on the tap.
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 rotating 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 soaped thoroughly and dirty areas of the skin of the hands are not left).
5. Rinse your hands under running water to remove soap suds (hold your hands with your fingers up so that the water flows into the sink from your elbows, without touching the sink. The phalanges of your fingers should remain the cleanest).
6. Close the elbow valve using your elbow.
7. Dry your hands paper towel If there is no elbow tap, cover the edges with a paper towel.
Standard “Hand hygiene 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 on your hands.
3. Fold the sleeves of the robe over 2/3 of your forearms.
4. Open the water tap using a paper napkin and adjust the water temperature (35°-40°C), thereby preventing hand contact with microorganisms. located on the tap.
5. Lather your hands vigorously under a moderate stream of warm water 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. Close the tap with your right or left elbow.
8. Dry your hands with a paper towel.
If there is no elbow valve, close the valve using 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 onto the skin of your hands until dry. Do not wipe your hands after treatment! 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. Do not touch foreign objects with washed hands.
1.3. Standard “Hygienic treatment of hands with antiseptic”
Target: removal or destruction of transient microflora, ensuring infectious safety of the patient and staff.
Indications: before injection, catheterization. operation
Contraindications: presence of pustules on the hands and body, cracks and wounds of the skin, skin diseases.
cook; skin antiseptic for treating the hands of medical personnel
Action algorithm:
1. Carry out hand decontamination at a hygienic level (see standard).
2. Dry your hands with a paper towel.
3. Apply 3-5 ml of antiseptic to your 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 backs of the fingers of the right hand across the palm of the left hand and vice versa;
- rotational friction of the thumbs;
- with the fingertips of the left hand gathered together on the right palm in a circular motion and vice versa.
4. Ensure that the antiseptic on the skin of your hands dries completely.
Note: before you start using a new antiseptic, you need to study the guidelines for it.
1.4. Standard “Wearing Sterile Gloves”
Target: ensuring infectious safety of patients and staff.
- gloves reduce the risk of occupational infection when in contact with patients or their secretions;
- gloves reduce the risk of contamination of personnel’s hands 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 medical workers.
Indications: when performing invasive procedures, in contact with any biological fluid, in violation of the integrity of the skin of both 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 the patient.
cook: gloves in sterile packaging, safe disposal container (KBU).
Action algorithm:
1. Decontaminate your hands at a hygienic level and treat your hands with an antiseptic.
2. Take gloves in sterile packaging and unwrap them.
3. Grasp the right-hand glove by the lapel with your left hand so that your fingers do not touch inner surface glove lapel.
4. Close the fingers of your right hand and insert them into the glove.
5. Open the fingers of your right hand and pull the glove over them without disturbing its cuff.
6. Place the 2nd, 3rd and 4th fingers of the right hand, already wearing the 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 your left hand and pull the glove over them without disturbing its cuff.
10. Straighten the lapel of the left glove, pulling it over the sleeve, then on the right using the 2nd and 3rd fingers, bringing them under the folded 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. Using the gloved fingers of your right hand, make a flap on the left glove, touching only the outside of it.
2. Using the gloved fingers of your left hand, make a flap on the right glove, touching it only from the outside.
3. Remove the glove from your left hand, turning it inside out.
4. Hold the glove removed from your left hand by the lapel in your right hand.
5.
With your left hand, grab the glove on your right hand by the lapel with inside.
6. Remove the glove from your right hand, turning it inside out.
7. Place both gloves (the left one inside the right one) in the KBU.
Composition of the cleaning solution
3. Immerse completely disassembled medical devices in cleaning solution for 15 minutes, after filling the cavities and channels with the solution, close the lid.
4. Use a brush (gauze swab) to soak each item in the washing solution for 0.5 minutes (pass the washing solution through the channels).
5.
Place medical supplies in the tray.
6. Rinse each product under running water for 10 minutes, passing water through the channels and cavities of the products.
7. Carry out quality control of pre-sterilization cleaning with an azopyram sample. 1% of simultaneously processed products of the same type per day, but not less than 3-5 units, are subject to control.
8. Prepare a working solution of the azopyram reagent (the working reagent can be used for 2 hours after preparation).
9. Apply the working reagent with a “reagent” pipette to medical products (on the body, channels and cavities, places of contact with biological fluids).
10. Hold medical devices over cotton wool or tissue, observing the color of the reagent flowing off.
11. Evaluate the result of the azopyram test.
Standard "Ear Care"
Target: maintaining the patient’s personal hygiene, preventing diseases, preventing hearing loss due to the accumulation of sulfur, instilling a medicinal substance.
Indications: patient’s serious condition, presence of wax in the ear canal.
Contraindications: inflammatory processes in the auricle, external auditory canal.
Prepare: sterile: tray, pipette, tweezers, beaker, cotton pads, napkins, gloves, 3% hydrogen peroxide solution, soap solution, containers with disinfectant solutions, KBU.
Action algorithm:
1. Explain the procedure to the patient and obtain his consent.
3. Prepare a container with soap solutions.
4. Tilt the patient’s head in the direction opposite to the ear being treated and place the tray.
5. Moisten a napkin in warm soapy solution and wipe the ear, dry with a dry cloth (to remove dirt).
6. Pour 3% hydrogen peroxide solution into a sterile beaker, preheated in a water bath (T 0 – 36 0 – 37 0 C).
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 the dry turunda with light rotational movements into the external auditory canal to a depth of no more than 1 cm and leave for 2 - 3 minutes.
9. Remove the turunda with rotational movements from the external auditory canal - this ensures the removal of secretions and wax from the ear canal.
10. Treat the other ear canal in the same sequence.
11. Remove gloves.
12. Place used gloves, turundas, napkins in the KBU, tweezers, beaker in containers with disinfectant solutions.
13. Wash and dry your hands.
Note: when treating ears, cotton wool should not be wound onto hard objects, as injury to the ear canal may occur.
Action algorithm:
1. Explain to the patient the purpose of the procedure and obtain his consent.
2. Decontaminate your hands at a hygienic level and wear gloves.
3. Place 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 with the dry end of the towel in the same sequence and cover with a sheet.
9. Treat the back, thighs, legs in the same way.
10. Trim your fingernails.
11. Change underwear and bed linen (if necessary).
12. Remove gloves.
13. Wash and dry your hands.
Action algorithm:
1. Wash the hair of a seriously ill patient in bed.
2. Give your head an elevated position, i.e. place a special headrest or roll up the 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 of the bed at the level of the patient's neck.
5.
Wet the patient's head with a stream of water, lather the hair, and thoroughly massage the scalp.
6. Wash your hair from the frontal part of the 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. Place a clean cotton scarf on your head.
10. Lower the headrest, remove all care items, and straighten the mattress.
11. Place used care items in disinfectant solution.
Note:
- seriously ill patients should wash their hair (in the absence of contraindications) once a week. The optimal device for this procedure is a special headrest, but the bed should also have a removable backrest, which greatly facilitates this labor-intensive procedure;
- women comb their hair daily with a fine comb;
- men have their hair cut short;
- a fine-tooth comb dipped in a 6% vinegar solution is good for combing out dandruff and dust.
Standard "Vessel supply"
Target: providing physiological functions to the patient.
Indication: used by patients on strict bed rest and bed rest for bowel and bladder emptying. cook: disinfected vessel, oilcloth, diaper, gloves, diaper, water, toilet paper, container with disinfectant solution, 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 from others with a screen, remove or fold back the blanket to the lower back, place an oilcloth under the patient’s pelvis and a diaper on top.
4. Decontaminate your hands at a hygienic level and wear gloves.
5. Help the patient turn on his side, legs slightly bent at the knees and spread at the hips.
6. Place your left hand under the sacrum on the side, helping the patient lift the pelvis.
7. With your right hand, move the diaper under the patient’s buttocks so that his perineum is above the opening of the vessel, while moving the diaper towards the lower back.
8. Cover the patient with a blanket or sheet and leave him alone.
9. At the end of the bowel movement, turn the patient slightly to one side while holding the bedpan 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 and dry the perineum.
11.Remove the bedpan, oilcloth, diaper and screen. Replace the sheet if necessary.
12.
Help the patient 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, rinse it with hot water .
15.
Immerse the vessel in a container with disinfectant solution, discard gloves in
KBU.
16.
Wash and dry your hands.
Excreted liquid
9. Record the amount of fluid you drink and inject into your body on a record sheet.
Injected liquid
10. At 6:00 am the next day, the patient hands over the record sheet to the nurse.
The difference between the amount of fluid you drink and the daily amount at night is the amount of water balance in the body.
The nurse should:
- Ensure that the patient can perform a fluid count.
- Ensure that the patient has not taken diuretics within 3 days before 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 accounting for the administered fluid (not only the water content in the food is taken into account, but also the administered parenteral solutions).
- Solid foods can contain between 60 and 80% water.
- Not only urine, but also vomit and feces of the patient are taken into account.
- The nurse calculates the amount of input and output per night.
The percentage of fluid excreted is determined (80% of the normal amount of fluid excreted).
amount of urine excreted x 100
Excretion percentage =
amount of fluid administered
Calculate water balance using the following formula:
multiply the total amount of urine excreted per day by 0.8 (80%) = the amount of night that should be excreted normally.
Compare the amount of fluid released with the amount of normal fluid calculated.
- Water balance is considered negative if less fluid is released than calculated.
- The water balance is considered positive if more fluid is released than calculated.
- Make entries on 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 resolution of edema (reaction to diuretics or fasting diets);
- negative water balance (10%) indicates an increase in edema or ineffectiveness of the 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: introduction of drugs into the cavity.
Indications: traumatic hemothorax, pneumothorax, spontaneous valve pneumothorax, respiratory diseases (lobar 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 subcutaneous injections, puncture needles 10 cm long and 1 - 1.5 mm in diameter, syringes 5, 10, 20, 50 ml, tweezers, 0. 5% novocaine solution, 5% alcohol solution of iodine, 70% alcohol, clamp; cleol, adhesive plaster, 2 chest x-rays, sterile container for pleural fluid, container with disinfectant solution, referral to the laboratory, kit for assistance with anaphylactic shock, gloves, CBU.
Action algorithm:
2. Place the patient, undressed to the waist, on a chair facing the back of the chair, ask him to lean on the back of the chair with one hand and place the other (from the side of the pathological process) behind his head.
3. Ask the patient to slightly tilt their torso in the direction opposite to where the doctor will perform the puncture.
4. Only a doctor performs a pleural puncture; a nurse assists him.
5. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, and put on gloves.
6. Treat the intended puncture site with a 5% alcohol solution of iodine, then with a 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 and pleura.
8. The puncture is made in the VII - VII intercostal spaces 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 the syringe.
10. Place a container for the liquid to be removed.
11. Release the contents of the syringe into a sterile jar (test tube) for laboratory testing.
12. Give the doctor a syringe with a filled 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 and secure with adhesive tape or cleol.
15. Tightly bandage the chest with sheets to slow down the exudation of fluid into the pleural cavity and prevent the development of collapse.
16. Remove gloves, wash hands and dry.
17. Place used disposable syringes, gloves, cotton balls, napkins in the KBU, puncture needle in a container with disinfectant solution.
18. Monitor the patient’s well-being, the condition of the bandage, count his pulse, measure his blood pressure.
19. Escort the patient to the room on a gurney, lying on his stomach.
20. Warn the patient about the need to remain in bed for 2 hours after the procedure.
21. Send the obtained biological material for research to the laboratory with a referral.
Note:
When more than 1 liter of fluid is removed from the pleural cavity at a time, there is a high risk of collapse;
Delivery of pleural fluid to the laboratory must be carried out immediately to avoid the destruction of enzymes and cellular elements;
When a needle enters the pleural cavity, a feeling of “falling” into the free space appears.
1.85. Standard "Preparation of the patient and medical equipment for abdominal puncture (laparocentesis)."
Target: diagnostic: laboratory examination of ascitic fluid.
Therapeutic: removal of accumulated fluid from the abdominal cavity during ascites.
Indications: ascites, with malignant neoplasms of the abdominal cavity, chronic hepatitis and cirrhosis of the liver, chronic cardiovascular failure.
Contraindications: severe hypotension, adhesions in the abdominal cavity, severe flatulence.
Prepare: sterile: cotton balls, gloves, trocar, scalpel, syringes 5, 10, 20 ml, napkins, jar with lid; 0.5% novocaine solution, 5% iodine solution, 70% alcohol, container for extracted liquid, basin, test tubes; a wide towel or sheet, an adhesive plaster, a kit to help with anaphylactic shock, a container with a disinfectant solution, a referral for examination, dressing material, tweezers, KBU.
Action algorithm:
1. Inform the patient about the upcoming study and obtain his consent.
2. On the morning of the test, give the patient a cleansing enema until the effect of “pure water” is achieved.
3. Immediately before the procedure, ask the patient to empty his bladder.
4. Ask the patient to sit in a chair, leaning on its back. Cover the patient's legs with oilcloth.
5. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, and 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 to carry out 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 pubis, stepping 2-3 cm to the side.
8. The doctor incises the skin with a scalpel, pushes the trocar through the thickness of the abdominal wall with a drilling motion 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. Take 20 - 50 ml of liquid for laboratory testing (bacteriological and cytological) into a sterile jar.
11. Place a sterile sheet or wide towel under the patient’s lower abdomen, the ends of which should be held by the nurse. Cover the abdomen with a sheet or towel covering it above or below the puncture site.
12. Using a wide towel or sheet, periodically tighten the patient's anterior abdominal wall as fluid is removed.
13. After completing the procedure, you need to remove the cannula, close the wound with a skin suture and treat it with a 5% iodine solution, apply an aseptic bandage.
14. Remove gloves, wash hands and dry.
15. Place the used instruments in a disinfectant solution, place gloves, cotton balls, and syringes in the KBU.
16. Determine the patient’s pulse and measure blood pressure.
17. Transport the patient to the room on a gurney.
18. Warn the patient to remain in bed for 2 hours after the procedure (to avoid hemodynamic disorders).
19. Send the obtained biological material for testing to the laboratory.
Note:
When performing manipulations, strictly follow the rules of asepsis;
With rapid fluid withdrawal, collapse and fainting may develop due to a drop in intra-abdominal and intrathoracic pressure and redistribution of circulating blood.
1.86. Standard "Preparation of the patient and medical instruments for performing a spinal puncture (lumbar)."
Target: diagnostic (for studying cerebrospinal fluid) and therapeutic (for administering antibiotics, etc.).
Indications: meningitis.
cook: sterile: syringes with needles (5 ml, 10 ml, 20 ml), puncture needle with mandrel, tweezers, napkins 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 adherence to aseptic rules.
3. Take the patient to the treatment room.
4. Lay the patient on his right side closer to the edge of the couch without a pillow, tilt his head forward to his chest, bend his legs as much as possible at the knees and pull them towards the stomach (the back should arch).
5. Push it in 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. The puncture is made between the III and IV lumbar vertebrae.
8. Treat the skin at the puncture site with a 5% iodine solution, then with a 70% alcohol solution.
9. Fill a syringe with a 0.5% solution of novocaine 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 tube, write the directions and send to the clinical laboratory.
11. Collect 2-5 ml of cerebrospinal fluid into a test tube with nutrient medium 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 cerebrospinal fluid pressure.
13. After removing the puncture needle, treat the puncture site with a 5% alcohol solution of iodine.
14. Place a sterile napkin over the puncture site and cover with adhesive tape.
15. Place the patient on his stomach and take him on a gurney to the ward.
16. Place the patient on the bed without a pillow in the prone position for 2 hours.
17. Observe the patient’s condition throughout the day.
18. Remove gloves.
19. Place syringes, cotton balls, gloves in the CCU, place the used instruments in a disinfectant solution.
20. Wash and dry.
1.87. Standard "Preparation of the patient and medical equipment for sterile puncture."
Target: diagnostic: examination of bone marrow to establish or confirm the diagnosis of blood diseases.
Indications: diseases of the hematopoietic system.
Contraindications: myocardial infarction, attacks of bronchial asthma, extensive burns, skin diseases, thrombocytopenia.
cook: sterile: tray, syringes 10 - 20 ml, Kassirsky 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 the treatment room.
3. The sternum is punctured at the level of the III - IV intercostal space.
4. The nurse assists the doctor during the procedure.
5. Invite the patient into the treatment room.
6. Invite the patient to 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, and put on gloves.
8. Treat the front surface of the patient’s chest, from the collarbone to the gastric region, with a sterile cotton ball moistened with a 5% iodine solution, and then 2 times with 70% alcohol.
9. Perform layer-by-layer infiltration anesthesia of soft tissues with a 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 Kassirsky puncture needle, installing a limiter shield at 13 - 15 mm of the needle tip, then a sterile syringe.
11. The doctor pierces the outer plate of the sternum. The hand feels the failure of the needle; after removing 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 a 5% alcohol solution of iodine or a 70% alcohol solution and apply a sterile bandage and secure with an adhesive plaster.
14. Remove gloves.
15. Dispose of used gloves, syringes and cotton balls in the CBU.
16. Wash your hands with soap and dry.
17. Show the patient to the room.
18. Send the slides 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 protects the needle from penetrating too deeply.
1.88. Standard "Preparation of the patient and medical instruments for joint puncture."
Target: diagnostic: determining the nature of the contents of the joint; therapeutic: removing effusion, washing the joint cavity, introducing medicinal substances into the joint.
Indications: joint diseases, intra-articular fractures, hemoarthrosis.
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 a treatment room under conditions of strict adherence to aseptic rules.
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, and put on gloves.
4. Ask the patient to sit comfortably in a chair or assume a comfortable position.
5. Give the doctor a 5% alcohol solution of iodine, then a 70% alcohol solution to treat the intended puncture site, and a syringe with a 0.5% novocaine solution for infiltration anesthesia.
6. The doctor covers the joint at the puncture site with his left hand 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 test tube for laboratory testing.
9. After 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 bandage.
11. Place used syringes, napkins, gloves, gauze swabs in the KBU, puncture needle in the disinfectant solution.
12. Remove gloves, wash and dry your hands.
I.XII. “Preparation of the patient for laboratory and instrumental research methods.”
Standard “Preparation of 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; referral for research.
FGDS is performed by a doctor and 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. Eliminate food, water, medicines; do not smoke, do not brush your teeth.
4. Provide the patient with a light dinner the night before no later than 6 p.m.; 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 endoscopy he should not speak or swallow saliva (the patient spits saliva into a towel or napkin).
7. Take the patient to the endoscopy room with a towel, medical history, and directions to the appointed time.
8. Escort the patient to the room after the study and ask him not to eat for 1-1.5 hours until swallowing is completely restored; no smoking.
Note:
-
SC remedication is not carried out, because changes the condition of the organ being studied;
- when taking material for a biopsy, food is served to the patient only cold.
Standard “Preparation of the patient for colonoscopy”
Colonoscopy - This is an instrumental method for examining high-lying parts of the colon using a flexible endoscope probe.
Diagnostic value of the method: Colonoscopy allows you to directly
