Types of processing according to SanPiN
There are different levels and methods of disinfection (see table), but not all specialists appreciate these techniques, and are often limited to simple rinsing.
| Type of processing | Purpose of the processing method | When to use |
|---|---|---|
| Hand hygiene for medical personnel: washing with soap and water |
|
|
| Hand hygiene using antiseptic |
|
|
| Surgical treatment of the hands of medical staff | The purpose of surgical treatment of the hands of medical personnel:
|
|
HYGIENIC TREATMENT OF THE HAND OF MEDICAL STAFF: ALGORITHM
The goal with this method is to remove any visible contaminants, as well as transient microflora. This is necessary in order to exclude the possibility of transferring such microflora to other healthcare workers and patients.
3 requirements for hygienic hand washing according to SanPin:
- Before starting, the doctor must remove jewelry and watches - a large number of microbes accumulate under them;
- The specialist’s nails should be cut short, and it is undesirable to have varnish on them.
- The sleeves of the medical gown must be rolled up 2/3 so that they do not interfere.
SanPiN requirements require thorough lathering. After this, they are washed with running warm water and the procedure is repeated. This is due to the fact that with a single wash, dirt and harmful microorganisms are removed only from the skin of the hands. When the doctor rinses the soap with warm water, the pores open, allowing any remaining germs to be removed.
SANITARY RULES
Hand treatment of medical personnel: algorithm
Mechanical technology according to this algorithm of actions makes it possible to minimize contamination by various dangerous bacteria and dirt without the use of additional devices. This method is used before/after eating and visiting the toilet, before performing procedures on the patient.
To use this method you will need:
- a clean napkin that can be used to dry the skin;
- liquid soap, preferably without a strong perfumed odor. It is important that all stages of processing are hygienic, so soap with a closed dispenser is suitable for the procedure.
The technique itself consists of several basic techniques:
- one palm rubs against the other with smooth movements;
- in turn, the palm of one hand rubs the hands and back of the hand of the other;
- the fingers of one are connected to the interdigital spaces of the other, internal surfaces fingers are processed with up and down movements;
- the palm is gathered into a lock, while the bent fingers of one hand rub the palm of the other;
- rotational friction, which cleanses the surfaces of the hands and wrists;
- in a circular motion, the palm of one hand touches the fingertips of the other, after which they change.
Washing method with soap and water
Washing with soap and water - basic way prevention of the spread of nosocomial infections, which helps stop further transmission of pathogens of dangerous diseases.
When washing, employees often skip areas of brushes:
- thumbs;
- spaces between fingers;
- fingertips, which are most often contaminated with dangerous microorganisms to a greater extent, because most actions are performed by them.
At frequent use soap, it is important to follow basic skin care principles.
Hand processing algorithm
The hand treatment of medical personnel is shown in the diagram below.
Requirements for hand treatment of personnel. Hygienic washing technique
Types of hand treatment for medical personnel and specific technological techniques are determined by the purpose of the upcoming treatment and the types of services, work, and activities to be performed.
The basic technological methods for treating the skin of personnel’s hands and the requirements for the rules of implementation are established in section 12 of Chapter I of SanPiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities”:
- hygienic washing is carried out for the purpose of mechanical removal, washing away dirt and transient microflora;
- hygienic treatment is carried out with the aim of reducing the number of transient microflora by at least 95% of the original;
- surgical treatment is carried out with the aim of destroying resident and transient microflora up to 100%.
Attention: methodological recommendations on disinfection of skin, approved. Ministry of Health of the Russian Federation December 18, 2003 N 11-7/16-09, as well as the WHO Guidelines “WHO Guidelines for Hand Hygiene in Medical Facilities. World Health Organization, 2009”, it is recommended to use solid or liquid soap for hygienic hand washing of personnel without antimicrobial additives.
Use for liquid soap dispensers or other devices (dispensers) that allow for mechanical supply; for soap in bars - small individual packaging, or soap dishes with magnetic suspension, allowing it to dry between uses. When choosing soap, be guided by the preferences of medical personnel, including those related to the incidence of dermatitis and allergic reactions.
Personnel are obliged to monitor the condition of their hands (presence of scratches, cracks, macerations), nails (cut short to the level of the fingertips and microcracks on the surface), not to use false nails or varnish, and to remove bracelets, watches, and rings before treating hands.
Hygienic hand washing technique is carried out before preparing, serving and eating food; after performing “dirty” procedures (cleaning rooms, changing clothes for patients, visiting the toilet) and any other contamination of hands.
When washing hands hygienically with soap and water, you should:
- 1. Wet your hands with warm water ( hot water increases the risk of dermatitis).
- 2. Lather wet hands with enough soap to cover the entire surface of the hand. Lather with the resulting soap suds water tap.
- 3. Wash hands for about 40-60 seconds, alternately wiping the palmar surfaces, the back surfaces of the hands with a change in their position; the inner surfaces of the fingers, interlacing and bending their fingers, thumbs in a circular motion, in the direction forward and backward, and ending with rubbing the palms with the fingertips of the opposite hand in a circular motion.
- 4. Give Special attention treatment of subungual zones, nails, periungual ridges and interdigital zones.
- 5. Rinse soap suds thoroughly from hands and faucet, avoiding splashing water, contact with faucet and sink.
- 6. Dry your hands with a disposable towel (or personal use towel). Use the same towel to close the tap. To prevent the occurrence of contact dermatitis, it is recommended to thoroughly rinse and dry your hands when washing with water and soap; at the end of the work shift, use softening and moisturizing hand skin care products.
It is not recommended to use electric hand dryers, as it is impossible to permanently remove residues detergent and desquamated epithelium (there is no such important function of the towel as rubbing the skin), as well as due to the inevitable turbulence of air containing polluting particles.
Standard “Handwashing at a social level”
Target: removal of dirt and transient flora from contaminating skin on the hands of medical personnel resulting from contact with patients or objects environment; 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 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.
4.
Wash your hands with soap and water running water up to 2/3 of the forearm for 30 seconds, paying attention to the phalanges, interdigital spaces of the hands, then wash the back and palm of each hand and rotational movements of the base of the thumbs (this time is enough to decontaminate the hands at a social level if the surface of the skin of the hands is thoroughly soaped and does not leave dirty areas on the skin of the hands).
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 with a paper towel; if you don't have an elbow tap, seal 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 (SCU).
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 warm running water until the soap is completely removed, holding your hands so that your wrists and hands are above elbow level (in this position, the water flows from the clean area to the dirty area).
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:
- if there are no necessary conditions for hygienic hand washing, you can treat them with an antiseptic;
- apply to dry hands 3-5
ml of antiseptic and rub it 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. Take the right-hand glove by the lapel with your left hand so that your fingers do not touch the inner surface of the 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, lightly squeeze out excess water.
7. Wipe the patient’s skin in the following sequence: face, chin, behind the ears, neck, arms, chest, folds under the mammary glands, armpits.
8. Dry the patient’s body 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-toothed comb daily, short hair should be combed from roots to ends, and long hair should be divided into strands and combed slowly from ends to roots, being careful 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 "Patient Preparation and medical instruments to perform 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, shingles, burns chest, 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. Place your left hand under the patient’s side, and with your right hand hold the patient’s legs to fix the position given to the back. During the puncture, another assistant fixes the patient's head.
6. 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, seizures 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. Provide psychological preparation to the 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
Preventing the spread of diseases and germs is possible with such a simple procedure as hand washing. Levels of hand treatment depend on the level of contact a person has with potential hazards, as well as the professional activities they perform. The rules for such disinfection should be familiar not only to every professional medical worker, but also to the common man.
Types of microflora
What method is used to clean hands? Hand sanitization levels depend on the tasks and jobs performed by the healthcare worker. Since it is not possible to completely cleanse the skin of pathogenic bacteria, it must be disinfected on an ongoing basis. For general information, it is necessary to provide a basic classification of microflora:
It should be noted that there are the most problematic areas on the skin of the hands, which are quite problematic to clean from such contaminants. These include the ridges around the nails and the space under the nails, as well as the spaces between the fingers.
The first methods of hand treatment appeared and began to be used in the mid-19th century. So, initially, a phenol solution was used for disinfection. Currently, it is customary to practice somewhat different methods.
Classification of skin disinfection methods
So, how exactly is the classification of such a procedure as hand treatment carried out? Hand processing levels are represented by three types of manipulations:
- Normal processing.
- Hygienic treatment.
- Surgical treatment.
Let's analyze the features of each method in a little more detail.
First stage
Ordinary washing is the simplest and most affordable method of cleansing. Its job is to eliminate dirt and a range of bacteria carried from dirty surfaces and infected people. Medical professionals wash their hands before starting work, after seeing a patient, changing clothes, and moving to another office or place of work. For the procedure the following can be used:
The effectiveness of simple washing is no more than 70 percent when repeated twice and no more than 40 percent when repeated once. Before the procedure, it is recommended to remove all jewelry and watches, and thoroughly rub the cleanser into the skin, then rinse completely and repeat the manipulations. The soap used should not contain additional flavors or dyes; it should be neutral.
Second stage
Hand sanitization of medical staff is often carried out hygienic method. It is carried out, as a rule, in the following cases:
Such hygienic treatment involves two stages. At the first stage, classic hand washing is carried out, at the second stage disinfection is added using an alcohol-containing antiseptic.
Hygienic or medical treatment hands can be carried out using the following types of antiseptics:
- Antibacterial soap (liquid form).
- Alcohol solutions designed specifically for treating the skin.
- Bactericidal gel.
The alcohol-free product is applied to damp skin in an average amount of 3 to 5 milliliters. Alcohol-based products are used when the skin is dry; you need to rub them in for about 15-20 seconds. A small amount of glycerin or lanolin can be added to the antiseptic to soften the skin and prevent it from drying out.
Third stage
It is the third and most total method of disinfection. Its implementation is relevant for all participants in the surgical intervention. It is carried out according to the following algorithm:
- Hand washing. Lasts for 2 minutes, after treatment the skin must be dried with sterile material.
- Application of antiseptic. It is used to treat the hands, wrists, and, if necessary, the forearms. There are special standards for the amount of its use, as well as the frequency of use.
It should be noted that surgical treatment of hands can only be carried out with antiseptics containing alcohol. These include the following drugs:
Treatment for significant contamination
Separately, it is necessary to touch upon the issue of how the hands of medical staff are treated when the patient’s blood comes into contact with them. If biological fluid comes into direct contact with the skin, you must act according to the following algorithm:
- Remove the resulting contamination with a napkin.
- Clean skin with soap and water.
- Dry the affected area with a disposable sterile cloth.
- Treat with alcohol antiseptic twice.
If contamination gets on the surface of the glove, the procedure undergoes certain changes. They are represented by the following diagram:
- Removing contamination from the material using a disinfectant wipe.
- Washing gloved hands with water.
- Removing gloves.
- Hand washing with soap and drying.
- One-time use of an antiseptic to treat the skin of the hands.
There are also general rules hand treatment They boil down to the following requirements and recommendations:
Types of drugs
How to choose suitable hand sanitizers? When choosing a particular product, use the following recommendations:
Of course, medical workers have specific documents that prescribe how hands should be cleaned. Hand treatment levels determine the type of disinfectant used. As an example, let’s look in more detail at the means for surgical treatment:
- Alcohols. The optimal solution is ethyl 70%. They are excellent against gram-positive and gram-negative bacteria, and act on certain viruses and fungi.
- Solutions based on iodine and alcohol - a wide spectrum of action. They help against bacteria, including tuberculosis pathogens, spores, viruses, protozoa, and fungi.
- Iodophors. They help against rotaviruses, herpes, HIV infection, staphylococci and spores.
- Chlorhexidine. It has a narrower spectrum of action, targeting gram-positive bacteria and certain categories of fungi.
Any involves preparation and direct decontamination (removal of contaminants). The nurse's hands should be well-groomed, free of inflammation, hangnails and microcracks.
Nails must be neatly trimmed and not varnished. The skin edge of the nail bed should not be cut off due to the risk of microtrauma and inflammation. Artificial nails on a nurse's hands are not acceptable. Before it startsfor carrying out manipulations, wrist watch and jewelry must be removed.
Preparing a nurse's hands for treatment
- We take off watches and jewelry.
- We examine the hands for inflammation and skin damage.
- If there are wounds or signs of skin inflammation, we inform the senior nurse.
- If there are minor injuries and local inflammation, we cover the problem areas of the skin with an adhesive plaster and put on a finger guard.
Mechanical treatment of a nurse's hands
Normal hand washing is carried out with liquid soap from a dispenser, and in case of its absence, with a simple bar soap. Manipulation rooms must be equipped with elbow-controlled mixers.
After preparing your hands, moisten them with warm water, soap your palms, the backs of your hands, the spaces between your fingers and nail beds.
Vigorously three hands touching each other:
- palm on palm;
- right palm on the back of the left hand and vice versa;
- we clasp our hands with the fingers spread and the three inner surfaces of the fingers with up and down movements;
- fold your hand into a fist and use the back of the fingers of one hand to rub the palm of the other hand (repeat for each hand);
- clench your hand into a fist and grasp the finger of the other hand, three fingers in a circular motion - repeat with each finger on both hands;
- three palms of one hand with the fingertips of the other, then change hands.
Each action must last at least 30 seconds. After washing, we dry our hands with a disposable towel or a cloth one, which is immediately removed from circulation.
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Hygienic antiseptic treatment of nurse's hands
- Preparing hands for processing.
- Washing hands with antiseptic soap.
- Hand treatment with water or alcohol antiseptic in accordance with the instructions for use. Drying with a towel after treatment with an antiseptic is NOT ALLOWED.
Surgical treatment of nurse's hands
- Hand preparation.
- Wash hands, wrists, and forearms with regular or antiseptic soap. Nails are treated with brushes.
- Drying hands with a sterile cloth.
- Applying an alcohol solution of a skin antiseptic, rubbing it into the skin until completely dry (aqueous solutions of antiseptics DO NOT APPLY).
- Repeated application and rubbing of alcohol-based antiseptic, followed by drying WITHOUT TOWEL DRYING.
- Putting sterile gloves on dry hands.
1. Remove all rings from your hands (the indentations on the surface of jewelry are breeding grounds for microorganisms).
2. Move the watch above your wrist or remove it.
3. Clean the areas under the nails with a nail cleaner under running water.
4. Apply 3-5 ml of liquid soap to your hands or thoroughly lather your hands with bar soap.
5. Wash your hands using the following technique:
Vigorous mechanical friction of the palms (repeat 5 times);
The right palm washes the back of the left hand with rubbing movements, then the left palm washes the back of the right hand (repeat 5 times);
Palm to palm, fingers of one hand in the interdigital spaces of the other (repeat 5 times);
The back of the fingers to the palm of the other hand (fingers intertwined - repeat 5 times);
Alternating rotational friction of the thumbs of one hand with the palms of the other, palms clenched (repeat 5 times);
Alternating friction of the palm of one hand with the closed fingers of the other hand (repeat)
Fig.6. Hand washing.
6. Rinse your hands under running water, holding them so that your wrists and hands are below elbow level and to avoid contamination from touching the sink, robe and other objects.
7. Close the tap, handling it only with a paper towel, as it can be a source of contamination.
8. Dry your hands with a sterile gauze pad.
8. Thoroughly treat the skin of your hands for 2-3 minutes with 2 swabs moistened with 70% alcohol or an alcohol-containing skin antiseptic with a virucidal effect (at least one minute on each hand) or apply 5-8 ml of 70% ethyl alcohol to the palm surfaces alcohol or an alcohol-containing skin antiseptic with a virucidal effect and rub into the skin for 2 minutes.
9. Throw the used balls into a container for disinfection.
10. Put on gloves according to the action algorithm.
Use of protective clothing.
Robes.
With the exception of operating rooms or dressing rooms, where sterile gowns are worn to protect the patient, the main purpose of the gowns is to prevent the contact of infectious agents with the clothing and skin of personnel.
Hats.
Medical caps reliably cover the hair, preventing it from acting as a source of contamination.
Aprons.
Rubber and polyethylene aprons are necessary to protect the protective clothing and skin of personnel in the event of the threat of splashing blood and other biological fluids and secretions.
Masks.
Masks are required to avoid airborne transmission of microorganisms, as well as in cases where there is a possibility of liquid substances from the human body entering the nose or mouth. They are especially important when personnel are working directly on large wound surfaces, such as open surgical wounds or burns, or when performing procedures on infectious patients from whom infection can be easily transmitted through airborne transmission.
Masks should be replaced every 3-4 hours (depending on the type of work being performed) or when they become wet during work. Masks should not be lowered onto the neck or reused. All masks must completely cover the nose and mouth.
