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Sanitary – hygienic regimen in the surgical statsionari

June 9, 2024

Sanitary- hygienic regimen in the surgicalnstatsionari.Metody antiseptics. Care for patients in the preoperative period.

The provisions of the surgical department and itsnplanning.

Modern surgical department – is a complex medicalncomplex , whose activity is regulated by a common relevant sanitary norms.nSurgical department recommended be placed in separate rooms facing the south,nsoutheast or southwest. This orientation creates conditions for the separationnof light chambers with natural sunlight, a sufficient dose of UV rays , whichnadversely affects a variety of infectious agents .

The main requirement for the surgical department – itsnisolation from other branches hospital. Zahalnohirurhichne department districtnand city hospitals consists of a reception office, chambers for patients (nhospital) , additional rooms (dining room , manipulation , nursing , etc.).nDressing and operational unit.

Admission department .

Admissionndepartment functioning by type changing rooms, where they spent roughingnpatients. Admission department consists of a desk , cabinet initial examinationnof patients, shower , bathroom, laundry cell toilet. In some hospitals in thenadmission department creates 1-2 diagnostic chamber and isolation forninfectious patients. Browse patients spend on a couch covered with oilcloth ,nwhich after examining each patient wipe wipes moistened with disinfectantnsolutions. After examination of patients , the study of wounds and replacingnbandages staff wash hands with warm running water and soap for 3 min andnprocessing solutions hands bactericidal drugs ( 0.2% solution of chlorinenbleach , 0.1% dezoksonu -1 , 760 ethanol , 0, 5% solution of chlorhexidine inn700 ethanol , sterylium et al. ).

in the emergencyndepartment patient conduct sanitization (hygienic shower and bathtub) ,ndisguised in a hospital gown ( robe , underwear, slippers) . In urgentnhospitalization of the patient is carried out sampling of blood, urine andnother body fluids for analysis.

Surgical department .

Treat patients in a specially designed and equippednsurgical wards (Fig. 1).

In large hospitals provide specialized departments forn3040 beds to assist patients with vascular , endocrine, pulmonary and others.npathology. To prevent transmission of purulent infection from one patient tonthe next , it is desirable to have a clean surgical department and thendepartment of surgical infection. They need to be isolated from each other,nhave a separate inventory, equipment and staff. If you caot make a separatendepartment for septic patients assign separate chamber and dressings . Undernthese conditions, it is important to cleanliness and order in the department .nAll the work plan so that the first operation is carried out , then performnclean bandaging of patients , and only after all – pus ligation (orderndressings ).

In thencomposition of the surgery department includes wards for patients operationsnunit, dressing , handling and support facilities (toilet , bathroom, diningnroom , pantry , laundry room , staff, sterilization , etc.). . Chamber shouldnbe spacious , based 6,57,5 sq.m. area for each patient. In the House it isnexpedient to place 2-4 beds. Natural lighting should be such that the ratio ofnthe area of windows to floor area was 1:6 ( Fig. 2).

Artificialnlighting shall be provided with frosted shades chandeliers and table lamps fornInvalids . The patient should have a comfortable bed , better functional (Fig.n3) or with a special headrest , side table, chair for visitors.

In the Housenneeds to be cleaned , clean and quiet. Temperature range there should be withinn18-20 ° C (Fig. 4).

Radio patientsnshould listen with headphones , watch TV in the other room . For the mostnserious post-operative patients in the surgical ward or hospital equipped NICUnwith special equipment , a set of medicines, tools needed for the possiblenconduct of resuscitation . Patients who die are placed in special wards -nwards.

Surgical department must be equipped with a centralnvodohanom (cold , heat, water), central heating , sanitation and forced-airnventilation. Hygienic Practice volume of air in the room up 27-30 m3, innnatural or artificial ventilation in the room allows you to create a carbonndioxide concentration of less than 0.1% , air velocity should be 0,100,15 m / snin air humidity 50-55 %. These optimal conditions for normal human life . Thesenparameters can be easily adjusted using the air conditioner. To contact thenduty staff with patients on the wards should be sound and light alarm .nCorridors should be spacious and comfortable. On the floor lay linoleum. in thensurgical ward with a damp cleaning with the addition of antiseptics . Cleaningnshould be carried out twice a day. Wet cleaning chambers begin to remove dustnfrom window sills , cabinets , ceilings , beds. This should open the window .nLying patients should be well covered . Cleaning should be carried out onnwindows and walls to the door. Wet cleaning furniture spend every day. Thenpanels are cleaned every three days. The upper parts of the walls , ceiling ,nceiling cleaned of dust at least twice a month. At the same time wipe thenwindow frames and doors. Equally important is compliance with sanitarynrequirements in the dining room. Dishes are washed in two waters at antemperature of 70-90 ° C in a water bath or with the addition of mustard ornspecial dish detergent . You caot use cookware with upholstered edges. Foodnwaste is collected in special closed bucket. To keep the health unit in duencourse need to have specially marked buckets , dusters, mops. They caot be usednfor cleaning other rooms . Strict compliance with sanitary standards is the keynto prevention of nosocomial infections.

Nursing post.

His place is usually in the hallway near the chambersn( Fig. 5).

At another table sisters should be illuminated or audiblenalarm , telephone, desk lamp , etc. .

procedure room

in the procedure room are :

1) Cabinets for drugs and sterile syringes labeledn” domestic “, ” for others ” injection “,”noutdoor “, which closes with a key ;

2) a table for slut with sterile material andnantiseptics ( alcohol hlorheksedyn , yodynol et al .)

3) Safe and potent drugs ;

4) refrigerator for intravenous solutions;

5) washed – lnyk with a towel ;

6) couch and chairs.

Workplacensisters surgical unit should be kept in perfect order. The nurse must strictlynadhere to the rules of personal hygiene, be clean , dressed in a clean robe,nhat or scarf . When performing injections or intravenous infusions should bensure to use a mask and rubber gloves.

The provisionsnon the treatment of care of surgical patients

All work in thensurgical department based on the principles of security and treatment regimen.nThe patient should be surrounded with attention and care from medicalnpersonnel. Hospitalized patients in the department accompanied by a nurse ornnurse receiving department. Another nurse at the direction of the head ofndepartment or another surgeon places the patient in one of the chambers . Allnthe terminally ill and those ieed of urgent surgical care ( acute diseasesnof the abdominal cavity, abdominal trauma , chest , etc. . ) Delivered to thensurgical department on a gurney . Patients who need immediate surgery, sent tonthe intensive care unit for preoperative preparation or directly to thenoperating room . All medical personnel should build a time under the regime ofnthe surgery department (Table 2).

Exemplarynadherence , order and discipline in the department and elevates the mood of thenpatient is self speedy recovery . All patients should adhere to hospitalntreatment, the recommendations of your doctor. They are familiar with the modenof the surgical department at the emergency department , which is painted innthe map patient. For violations of patients discharged from hospital.

Table 2

Diet surgical department

7.00 Elevationnpatients

7.00 – 7.30nTemperature measurement , hygienic gymnastics

7.30 – 8.00nMorning toilet, sampling of blood, urine and other biological substances fornanalysis. Housekeeping department

8.00 – 8.30 Distributionnof drugs, perform manipulations and procedures

8.30 – 9.00nbreakfast

9.00 -10.00nBypass doctors

10.00 -14.00nPerform medical appointments , racking patients perform

operations ,ncounseling patients

14.00-14.30ndinner

14.30 – 16.30nRest of the day;

16.30 -17.00ntemperature measurement

17.00 – 19.00nVisiting relatives

19.00 – 19.30ndinner

19.30 – 21.30nDistribution of drugs, perform nightly manipulations and procedures

preparingnpatients for surgery

21.30 – 22.00nevening dresses

22.00 -7.00nsleep

In the surgical ward leadershipnof nurses and nurses provides senior nurse , who immediately obeys the Head ofnthe Department , performs his instructions on care and maintenance of patientsnand is solely responsible for the work of junior medical staff. Given the rangenof responsibilities for this position appoint people who have experience ofnworking as a nurse for at least 3 years and are usually those who havencertified the first category. Thus Nurse Surgical Department appoints andndismisses the Chief Physician Hospital on the recommendation of the head of thensurgical department. As has been said, in her direct supervision is the nursesnoffice. Work elder sister is very responsible .

Be ‘ Relations Nurse surgical department:

1. Conducts appropriate selection of nurses withnregard to their psychological compatibility.

2. Makes nursing work schedules , timetables.

3. Provides normal operation department through timelynreplacement nurses and nurses who could not go to work due to illness or othernreasons.

4. Follows the timeliness and clarity of executionnordered by physician .

5. Systematically department provides medications andnmedinstrumentariyem and other objects of care.

6. Follows the use , storage , distribution, copyingnmechanism and control of medicines , medical instruments and items of care.

Provides sanitary-epidemiological regime in office.

8. Follows rules for storage and accounting ofnnarcotic drugs .

9. By order of the head of the organization departmentnconducts individual posts about terminally ill .

10. Ensure the implementation of internal regulationsndepartment, adhering to the principles of health – protective regime .

11. Conducts monitoring compliance with food fornpatients, is a la carte food orders , according to the dietary tables, monitorsnthe quality of prepared food and its distribution .

12. Keeps records of acceptance and discharge ofnpatients , a report on the movement of patients in the department , reports onnadmission and outpatient department data on the availability of beds.

13. When writing out reports seriously ill relativesnabout the date and time of discharge or transfer it to another branch. Ifnnecessary, the patient appoints maintainer of the staff office and arrangesntransportation technicians state.

14. Under leadership of the head of departmentndevelops and oversees implementation of plans to improve the skills of nurses.

15. Participates in the Board of Nursing Hospitalnnursing conferences.

Requirements ward nurse surgical department:

A nurse in the department of maintenance patientsndepartment reports directly to residents in part of the routine work – oldernsister branch. It is responsible for the timely and proper execution of medicalnappointments , the quality of care for patients in wards or her assigned officen( dressings , manipulation ).

The post of wardnnurse nurses appointed to the first level of accreditation.

Duties wardnnurse surgical department:

1) hospitalizednpatients , checking correctness of their sanitization , review patient with theninternal regulations ;

2 ) collectingnmaterial for the study (blood , urine , feces ) and send it to the lab ;

3) patients hadnto be ready to perform diagnostic tests ( endoscopy, radiography, ECG , etc. .)nAnd support or transport them to various diagnostic rooms ;

4) faithfulnimplementation of all doctor appointments, which are recorded in specialnletters of appointments ;

5) should benpresent on rounds physician reporting to him about all the changes in thencondition of the patient during rotation ;

6) bodyntemperature examination (morning and evening) and record temperature data sheetn;

7) bloodnpressure , rate of hartbeets , breathing, post this data doctor ;

8) surveillancenof the wound ( bandage ) and discharge of drainage ;

9) careful andnclose supervision of the patient , if necessary, immediately giving him firstnaid ( CPR, indirect massage of the heart, stop bleeding) ;

10) monitoringncompliance with patients assigned to diet , checking quality products thatnbring families;

11) control ofnthe technological process ( nurses , cleaners ) and compliance measures fornsanitation regime at the department ( prevention of pressure sores, skin care,noral patients , etc.)

12) carefullynmaintaining medical records , which includes a magazine for receiving andntransferring duties and magazines. MEDICAMENTAL and portion requirements leavesnmedical appointments , temperature , etc. leaves .

For the diligentnperformance of duties surgical nurse in a short period of time it is necessarynto examine a large section of general surgery , learn the basic surgicalndiseases , their diagnosis and treatment , especially the care of patients.nMedical assistance is a sacred duty of every health worker , regardless of hisnlevel of education and profession. Inattention or unjustifiable failure toncarry out his duties leading to legal liability.

The provisions of dressings .nDressings .

Requirements for dressings should be the same as thenoperating (light room , the ceiling of which shall be painted with oil paint ,nwalls and floor are lined with tiles ).

The dressing is necessary to maintain cleanliness.nTable for instruments and dressings cover as well as in the operating room.

Tools submitnforceps . Ligation is carried out only by the tool. Instruments are sterilizednin most dressings or surgical sterilization room block. Dressings should benprovided with a central cold and warm water. The optimum temperature should ben18-20 ° C. The dressing should be no foreign objects , clothes, except for thendressing table , table for instruments and dressings , medicines and cabinetsnfor tools and chairs for patients. In conducting dressings must consider thendegree of purity of healing the sick. Patients with complications of purulentnwounds bandaged last. At the end of the day with a damp clean dressings andnirradiation with ultraviolet rays ( kvartsevaniya ). In major surgical wardsnusually has two dressings – for “clean ” and ” septic “npatients.

Be ‘ Relationsnnrev ‘ yazuvalnoyi nurse :

1. Performsnprescribed by a doctor – intern manipulations that are allowed to perform nursen.

2. Accompaniesnconducted seriously ill after manipulation to the House .

3. Strictlynadhering to the rules of asepsis and antisepsis.

4. Prepares tonsterilize and sterilize bandages and instruments in accordance with operatingninstructions.

5. Provides ansystematic bacteriological control of dressings, instruments, placing Trans ‘nyazuvalnoyi .

6. Ensures thensystematic replenishment , inventory, storage , and monitors expenditure ofnmedicines, dressings , instruments and clothes .

7. Instructsnnurses dressings and monitor its performance.

8. Keepsnaccounting records .

9.nSystematically improve their professional skills.

10. Participatesnin health – educational work .

Infection control of surgical hospital.

In order to prevent festering disease and compliancenwith sanitary standards bacteriological laboratory sanitary station, which isnsubject to a medical institution, shall once in 15-20 days bacteriologicalncontrol of air pollution ( operating, dressings, Chambers ), quality control,ndisinfection, treatment hands of personnel, material and sterility of surgicalninstruments.

Control of microbial contamination of the air in thenoperating room and surgical dressing conduct once a month. Air pollution in thenHouse and dressings can be determined by sedimentation , filtration and methodnof shock wave air. Sedimentation principle of the method is that the bacterianthat are in the air , settle on a horizontal surface. For this study, usingnPetri dishes with nutrient medium (2% agar ), which for 15 minutes are leftnopen in predefined locations operating or dressings . Then the Petri dish isnplaced in an incubator for 24 h and counted the number of colonies that grew .nFiltration method of investigation is to draw 10-40 liters of air throughnspecial absorbers with sterile fluid. The principle of the shock is that soakednthrough the apparatus air strikes the surface containing culture medium , resultingnin bacteria trapped in it. Air samples were carried out using the apparatusnKrotov .

The operatingnnumber of colonies of microorganisms on 1m3 of air should not exceed 500 hoursnand 1000 – during and after the operating . For dressings and preoperative maynbe no more than 1000 colonies in 1m3 of air to work. In addition, a samplenvolume of 250 liters of air should not be plazmokoahulyatsiynoho hemolyticnstaphylococcus .

Quality controlnof disinfection carried out suddenly, without the knowledge of the staff , 1-2ntimes a month. Sterile cotton swab moistened with sterile isotonic sodiumnchloride solution or 1% hyposulfite spend washout from 10 subjects , the areanmust be flush 200-300 cm3. Give a satisfactory assessment of disinfection innthe absence of growth of E. coli , Proteus, Pseudomonas aeruginosa,nStaphylococcus and Streptococcus .

Crops with it, usually held senior operating sister sonthat the staff did not know when and who he will be taken . Drill resultsnshould be discussed and spivstavlyatysya frequency of postoperativencomplications. This control improves the quality of handwashing staff andnreduce the number of postoperative complications.

In addition to the mandatory daily monitoring theneffectiveness of sterilization in an autoclave ( dressings , linen) usingnstandard vials or sulfur is necessary every 10 days seeding with sterilizednmaterial. Particular attention should be given to the quality of sterilizationnof suture material. Crops of silk, catgut should be performed prior to sterilizationnand its in storage at least once in 10 days.

To control the sterility of hands of medical personneln, dressings and suture material eldest sister should be operating a specialnjournal.

To identify and sanitation carriers of pathogenicnorganisms 1-2 times a year to all employees doing surgery department swabs fromnthe nose and throat swabs special . Revealed carriers of pathogenic infectionsndignity without fail. In the absence of positive results from the treatment ofnchronic inflammatory diseases of the upper respiratory tract and oral cavitynemployees transferred to another job.

Pirogovnone of the first thought idea , that infection of wounds caused caused nthe hands of the surgeon and his assistants, as well as through underwear andnbed linen . To avoid prevent , prevention possible contamination of woundsnhe used to disinfect alcohol, lapis , iodine.

Inn1847 based on a large private personal Experience Research Hungarianndoctor physician obstetrician – gynecologist Ivan Zemelveys argued that thencause of postpartum sepsis – infection is entering his hands doctor physiciann during the internal investigation after later births . Introduce him nintroduction the practice of washing hands 10% bleach solution significantlynreduced the number of specified complications .

ThenEnglish Surgeon D. Lister , based on discoveries Opening L.Pastera andnanalysis of causes of death of patients after later operations, concludednthat the cause of complications is appear appear bacteria. Developed annumber of a bench , a number of methods of killing germs in the air as onnthe hands in the wound , as well as items pertaining to the with the nwounds. As a means of expense killing germs he chose carbolic acid. Listerndeveloped a system of measures to intended for killing germs in the wound ,nreceived received name antiseptic surgical method of operation ( 1867) .

Antiseptic,nits types , characteristics

Antisepsis (Latin anti – against , sepsis – decay ).nBy the mid- nineteenth century, more than 80% of the operated patients diednfrom various complications caused by wounds were suppurating . One of the firstnwho suggested that infection occurs through wounds hand surgeon, his assistantsn, tools, clothes, Hungarian physician Ignaz was Zemelveys , who in 1847 firstnused for the treatment of the hands of medical personnel bleach to preventnpuerperal sepsis. The great Russian surgeon NI Pi – linked Rogov suppuratingnwounds in the existence of a sort of sick miasma ( pollution ) and to treatnwounds applied alcohol , iodine, lapis . Only in 1867 the British surgeonnJoseph Lister, according to the teachings of Louis Pasteur of decomposition ofnorganic matter due to the ” germ ” of air, came to the conclusionnthat the cause of septic complications and death in patients after surgery arenmicrobes. As a means to kill germs in the wound D. Lister proposed and widelynused carbolic acid. His name is linked to the development of a new method ofnantiseptic surgical operation.

Joseph Lister and his contemporaries at the “nAntiseptic ” understood the destruction of pathogens of purulent processesnin the wound and all the objects of the external and internal environment inncontact with the wound , with the help of chemicals. Subsequently, with thenintroduction into medical practice of sterilization, disinfection,nchemotherapy, aseptic imagination of antiseptics changed.

And today when antiseptics should understand thencomplex health care measures aimed at eliminating the bacteria in the wound andnthe body as a whole.

There are mechanical, physical , chemical andnbiological antiseptic .

Mechanical surgery

Mechanical surgery – a complex mechanical measures tondestroy or wound infection in creating unfavorable conditions for itsndevelopment.

Keep in mind that all household injuries are infected.nMicroorganisms trapped in the wound, held during adaptation and under favorablenconditions multiply. Established in the early hours after injury ( 6-12 h)nmicrobes are within the damaged tissue and only time through the lymph , bloodnvessels spread to healthy tissue. This is why this period is necessary tonprocess a wound – wash it, remove blood clots, gangrenous tissue, foreignnbodies. These wounds healed without complications. When festering wounds removengangrenous tissue, revealing the festering race. After cleaning the wound ofnpus, necrotic tissue and the appearance of granulation (young connectiventissue) impose secondary sutures.

Physical surgery

Physical surgery – creating unfavorable conditions forngrowth and reproduction of microorganisms in the wound by physical propertiesnof various drugs.

Most often used for this purpose hygroscopic dressingsn: gauze, napkins, turundas, drainage. However, be aware that the content of thenwound quickly penetrates bandages and after 5-6 hours it loses suction feature.nTo extend and improve the suction dressings impregnated with extra hypertonicnsolution or antiseptic ointments hyperosmolar ( Nitacid , strep – tonitol ,noflaksyn etc. .) , So you can replace the dressing after 12 hours. For betterncleaning wounds commonly used drainage tube or rubber strips that are made ofnsurgical gloves , because they can stand on their own content (passive selection)n, and in conjunction with suction drainage pipes ( water , electric ) – active.nThe methods include natural antiseptic wound irradiation with ultravioletnlamps, ultrasonic, laser cutting . Thus not only achieve drying wounds, butnalso bactericidal action on the microflora . Often for drying wounds made specialnmetal frame to which is mounted bulbs . Recently established special editionnaeroterapevtychnyh units ( Ata ) with laminar flow of sterile air.

The use of such a facility provides the creation of anspecial environment that favorably affect the course of wound healing and delaynthe growth of microorganisms. In the absence of such equipment can treat opennwounds with bandages method (the action of air, sunlight) .

Chemical and biological antiseptic

Chemical and biological antiseptic – This is a generalnantiseptic in which to kill germs in the wound or in the body as a whole usingnvarious chemical or biological means.

they are divided into preservatives andnchemotherapeutic drugs.

Antiseptics – it’s mostly non-specific antimicrobialnagents actions. Antiseptic preparations can be used for local treatment ofnwounds in the form of solutions, powders , ointments , emulsions, for makingnbath ( for burns or other major wounds ) for the introduction of pus cavitynthrough the drainage tube , for rehabilitation ( recovery ) of the whole body -ninternal rishnom the muscle , intravenously, intra- , intraosseous , andnendolymphatic enterally ( orally or as an enema ).

The most common use of antiseptics such groups :

1. Group halides . Chloramine (Chloraminum) – whitenwith yellow

white crystalline powder. It contains 25-29 % activenchlorine, launched at the Ministry –

ing what is used as a disinfectant and deodorizingnagent. its

used to treat infected wounds (washing , wetting ser-

twigs , turundas 1.5-2 % solution ), hand disinfectionn(0.25-0.5 % solution ), death

infection of non-metallic tools , handling care itemsnHVO –

rhyme ( urinal , ships , etc.). , disinfecting excretan(feces , urine,

specimens (3-5 %).

Hloratsyd (Chloracidum) – a white crystalline powder,nsoluble in water, alcohol, as a 0.5% solution is used for the treatment of handnsurgery , sterilization of catheters, drainage , irrigation of purulentncavities , treatment of infected wounds .

Chlorhexidine (Chlorhexidinum) – released as a 20%naqueous solution – 500 ml. There is a very effective remedy for gram-positivenand gram -negative bacteria , stimulates the phagocytic action on fungi. 0.5%nalcohol solution is widely used for the treatment of hand surgery , thensurgical field , sterilization of surgical instruments . The aqueous solutionnhlorheksydy well – used in septic processes ( washing wounds , cavities ,nbladder , etc.). .

Alcoholic solution of iodine (SolutioYodi spirituosa).nIodine -old antiseptic. However, due to the irritant effect of iodine on thenskin and mucous membranes , and the presence of toxic- allergic propertiesnusing it currently prohibited by order of the Minister of Healthcare ofnUkraine.

The widespread use today are iodine – iodoform , theynhave antiseptic properties, do not create resistant strains of micro-organismsnand have no side effects on the body.

Yodynol (Iodinoli) – an aqueous solution of 0.1%niodine , 0.3 % potassium yodytu and 0.9% polyvinyl alcohol. Yodynol used in thentreatment of thermal and chemical burns , festering wounds, sore throats .nHowever, remember that yodynol inhibiting the growth of streptococci,nstaphylococci relatively inactive and has no effect on gram-negative bacteria.nTherefore, its use in surgery is limited.

Yodonat (Iodonati) – aqueous mixture of sodium alkylnsulfates with iodine. 1% solution of the drug, diluted 3 times with distillednwater, is an effective way to handle the surgical field .

Yoddytseryn (Ioddicerinum) – iodine domestic productnof the new generation has a strong fungicidal , antimicrobial and antiviralneffect . Produced a solution . The main indication for use of the drug is anchronic inflammatory infection ( sores , ulcers , fistulas , etc. . ). The drugnis used topically to swab turundas as flushing , irrigation and so on.

2. Oxidants. A solution of hydrogen peroxide (SolutionHydrogenii peroxidi

diluta) 3% is used for washing wounds , cavities as annantiseptic

and deodorizing agent. The foam that forms on thensurface of the wound, moreover, removes non-viable cells.

Potassium permanganate (Kalu hypermanganicum) – powderndark brown or reddish- purple in color , soluble in water. Applied 0.1-0.5 %naqueous solution for washing wounds, cavities, burn surface . It is a strongnoxidant , has antibacterial and deodorizing properties. In a 2-5 %nconcentration is used as a means of tannic .

Boric acid (Acidum boricum) – a white crystallinenpowder, readily diluted in water, alcohol . 2% aqueous solution used fornwashing wounds , especially in the presence of blue- green sticks manure can benused as ointments, powders .

3. Dyes . Methylene blue (Methylenum coeruleum) – dark

green crystalline powder, poorly soluble in water,nalcohol . Use –

stovuyut as 1-3% alcohol solution for burns, purulentndis –

Bathrooms skin.

Brilliant green ( Viride nitens). Applied 0.1-0.2 %nalcohol solution purulent skin disease . Included in the fluid MV Novikova ,nwhich is used for processing micro traumas , skin rash.

Rivanola (Aethacridini lactas) – yellow crystallinenpowder, has antimicrobial antykokovu action, especially against streptococci,nlow toxicity, does not irritate the tissues. Used for treatment and thentreatment of wounds , pleural lavage , abdominal and others. at concentrationsnof 0.05 % ( 1:2000 ), 0.1% ( 1:1000 ), 0.2% ( 1:500 ).

4. Formaldehyde . Causes dehydration mummificationntissues ma –

tion antiseptic.

Formalin (Formalinum) – aqueous solution ofnformaldehyde. Apply for disinfecting instruments (0.5% solution). Included innthe triple solution ( formalin 20 grams , 10 grams of carbolic acid , sodiumncarbonate -30 g per 1000 ml of distilled water). In formalin vapors in specialnchambers to sterilize devices with optical system.

5. Salts of heavy metals. Mercury dichloride -nmercuric chloride (Hydrargiri

dichloridum) – white powder, soluble in water,nalcohol, an active anti-

septic tanks, on the other hand – quite toxic agent.nApply for zneza –

razhuvannya sick care items , gloves at a dilution ofn1:1000 .

Reserve list and in a well- plugged bottles.

Oxidation of cyanide of mercury (Hydrargycinoxycyanidum) – strong antiseptic. At a concentration of 1:1000 cystoscope isnused to sterilize instruments and other optical systems. 1:10 -1:20 Solutionsn000 000 used in urological practice to flush the bladder , the eye – whennblenoreyi , gonorrhea, conjunctivitis , and others.

Silver nitrate (Argenti nitras) – clear crystals ,nodorless , readily soluble in water, alcohol . At low concentrations hasnvyazhuchu , anti-inflammatory and bactericidal action. Used externally as an2-10 % solution, ointment, lyapisnyh pencils.

6. Detergents . Tseryhel (Cerigelum) – a colorlessnviscous liquid with an odor of alcohol. It belongs to the group of cationicndetergents and has a high surface activity . When applied to the skin forms anfilm is used as an antibacterial , antiseptic drug for the treatment of handninjuries.

Eton (Aethonium) – a white crystalline powder with anspecific action, easily soluble in water and alcohol. Effective againstnstreptococci, staphylococci and other microorganisms. At the same time ,ncausing local pain relief , stimulates healing. Applied externally as 0,02-1 %nsolution.

Dioxidin (Dioxidinum) – green- yellow crystallinenpowder, odorless , bitter taste. It is readily soluble in water, has a broadnantimicrobial spectrum . It as sensitive aerobes and anaerobes. For externalnuse produced in the form of 1 %, 0.5 % aqueous solution for intravenous – 0.1 %nsolution.

Dimeksid (Dimeksidum) – clear liquid with a specificnodor, well diluted with water or alcohol. The product has a strong bactericidaln, anti-inflammatory , analgesic effect, increases the sensitivity ofnmicroorganisms to antibiotics. For external use using 10-30 % solution.

Chemotherapy drugs have a specific mechanism of actionnand spectrum . It usually inorganic ( sulfa drugs ) and organic ( antibiotic )ncompounds are not only bactericidal but bacteriostatic effect.

1. Sulfa drugs .nStreptocide (Streptocidum) – a white crystalline powder, poorly soluble innwater. Used for the treatment of streptococcal , meningococcal , gonococcal andnother infections. Internal use by 0.5-1.0 g 4-6 times a day.

Norsulfazola (Norsulfasolum) – more active drug thannstreptocide use in inflammatory diseases of staphylococcal etiology. Assignn0.5-1.0 g 4-6 h.

Sulfadimezin (Sulfadimesinum) – white powder,npractically insoluble in water. One of the strengths of sulfonamides, rapidlynabsorbed, low toxicity, very active. Apply for streptococcal, pneumococcal,nmeningococcal and other infections.

Etazol (Aethazolum) – white yellowish powder.nPractically insoluble in water, alcohol – soluble hard. Has a pronounced effectnon streptococci, pneumococci, meningococci, gonococci, Escherichia coli,npathogenic anaerobic bacteria. The product has low toxicity, is quicklynabsorbed into the body. Assign 1.0 g 4-6 times a day. In severe cases etazolnsodium is used in 10-20% solution (5.10 ml)

for intravenous infusion. Re-entry is recommendednevery 8 hours. The course of treatment is 7-10 days.

Bactrim (Baktrium) – combination product that containsntwo active ingredients: sulfa drugs sulfamethoxazole and trimethoprim. Therenare antibiotics. Produced also called Biseptol. Assign Table 2. (For adults), 2ntimes a day. The drug is rapidly absorbed, maximum concentration is kept for 7nh. Recently, the use sulfisoksazol and sulfamethoxazole.

2. Antibiotics (biological preservatives) – organicncompounds produced during the life of organisms. There are a group ofnantibiotics:

Penicillin (Penicillinum) has a broad spectrum of activitynagainst various microorganisms. Penicillin is dissolved in an isotonic solutionnof sodium chloride, 0.25 – 0.5% solution of novocaine. Rapidly absorbed andnexcreted, and therefore it must be entered every 4-6 hours. Recently, it isnused less frequently because of penitsylinostiy-cal forms of bacteria.nProlonged use of penicillin may candidosis (fungal infection).

Group streptomycin. Streptomycin (Streptomycinum) hasna pronounced effect on the various flora and especially in Mycobacteriumntuberculosis. Enter intramuscularly at a dose of 500 000 to 1 000 000 IU 1-2ntimes a day.

Streptotsylin (Streptocillinum) – a mixture of benzylnpenicillin and streptomycin, and therefore is a highly effective drug in mixedninfections. Assign 1-2 times a day to 900 000 units.

Tetracycline. Tetracycline (Tetracyclinum) used fornthe prevention of postoperative complications, burns, various suppurativencomplications. Prescribe in pill form to 0.1-0.15 g 4-6 times a day. Thenmaximum daily dose – 2 h can be used locally as a 1.2% ointment.

Oxytetracycline (Oxytetracyclinum) the structure andnthe action is close to tetracycline. Prescribe in tablets of 100 000-500 000 IUn(0,10,5 d) to receive 3-4 times a day. The highest dose – 2 hours

Morfotsyklin (Morphocyclinum) is a synthetic drug thatnis easily soluble in water, its effect is similar to tetracycline. Use in casesnwhere it is necessary to create a high concentration of antibiotic in the bloodnand tissues. Produced in bottles of 0.1, 0.15 g (100 000 and 150 000 IU) andninjected 1-2 times a day intravenously with 20 ml of 5% glucose.

Doxycycline hydrochloride (Doxycyclim hydrochloridum)n- a semi-synthetic drug oxytetracycline, a broad spectrum of activity, activenin many resistant bacteria, but has no effect on Pseudomonas aeruginosa,nProteus, fungi, viruses. The drug is rapidly absorbed and slowly excreted fromnthe body. Use it on the first day to 0.2 g once or 0.1 g every 12 hours. In thennext few days – 0.1 grams per day.

Group aminohlyukozydiv. Monomitsin (Monomycinum) has anbroad spectrum of activity. Active against microorganisms resistant tontetracycline, chloramphenicol, streptomycin. Enter intramuscular injection ofn250 000 IU 3 times a day. Prolonged taking may be cochlear nerve, kidneyndamage.

Kolimitsyn or neomycin sulfate (Colimycinum sulfas)nhas a broad spectrum of activity. Used for treatment of purulent abdominalnprocesses pleural cavities, septic wounds etc.. Resistance to microbesnkolimitsynu develops slowly. Take 0.1, 0.25 g tablets 2-4 times daily or intramuscularninjection of 0.5 g, 2 times a day.

Gentamicin sulfate (Gentamycini sulfas) hasnbactericidal activity against many gram-positive and gram-negativenmicroorganisms, including – Proteus, E. coli, and others. Resistance developsnslowly. The drug is rapidly absorbed, but has oto-and nephrotoxic effects.nAvailable in vials and ampoules 0.08 (80 mg) and 0.04 (40 mg).

Amikacin (Amikacinum) – one of the most activenantibiotics aminohlyukozydiv obtained semisynthetic route. It has a widenspectrum of action. Especially effective in relation to gram-negativeninfections. Apply for intramuscular or intravenous administration of 100 or 500nmg 2-3 times the rate of 10-15 mg / kg per day.

Antibiotics, macrolides in its structure with lactonenring.

Erythromycin (Erythromycinum) the spectrum of actionnsimilar to penicillin, but better tolerated. Take tablets of 0.1, 0.25 g (100n000 – 250 000 IU) every 4-6 hours. Daily dose – 2 g

Group chloramphenicol. Chloramphenicoln(Laevomycetinum) – a synthetic broad-spectrum drugs. Prescribe in tablets 20-30nminutes before meals 3-4 times of 0.25 and 0.5 g capsules – 0,1, 0,25 and 0,5 gnfor intravenous infusion using 1% solution: Dissolve 0.25 or 0.5 grams of thendrug, respectively, in 25 or 50 ml of water for injection. You can enter a dripnof 5% glucose solution, 0.9% sodium chloride solution.

SYNTHOMYCINE (Syntomycinum) – the active substance isnchloramphenicol. Applied externally as 01/05/10% emulsion for the treatment ofnseptic, burn wounds, ulcers and so on.

Rifamycin group – a group of antibiotics derivednnatural and semi-synthetic method.

Rifamycin (Rifamycinum) has significant antibacterialnactivity, including strains resistant to other antibiotics. Active againstntuberculosis. In high concentrations, acts on E. coli. Assign for intramuscularnand intravenous infusion at a dose of 0.5-1.5 g, 2 times a day.

Cephalosporin group. The structure of thesenantibiotics – to 7-amino acid notsefalosporynova. They have a broad andnsignificant antibacterial activity. Cephalosporins are divided into I, II, III,nand IV generation (generation). Most commonly used:

Cefazolin (Cephazolinum). Available in a sodium salt.nEnter the drug intramuscularly at a dose of 0.25-0.5 g diluted in isotonicnsodium chloride or intravenous 5% glucose solution.

Cephalexin (Cephalexinum) has a pronounced effect onngram-positive and gram-negative bacteria. However ineffective against Proteus,nPseudomonas aeruginosa. Prescribe in tablets of 0.25-0.5 (daily dose – 1.2 g)n3-4 times a day.

Maksypym (Macsupimum) has a wide range and anpronounced effect against gram-positive and gram-negative pathogens bothnaerobic and anaerobic. Treatment maksypymom be started without waiting for thenresults of a sensitivity analysis. The usual dose for adults – 1 or 2 g everyn12 hours.

Tien (Thienam) – B-lactam antibiotic with a broadnspectrum of activity to Gram-positive and Gram-negative pathogens, both aerobicnand anaerobic resistant to other antibiotics. Antibacterial spectrum tiyenamunmuch broader than any other antibiotic, which enables its use in the treatmentnof polymicrobial, mixed aerobic and anaerobic infections. Tien is produced inntwo forms: the first for intramuscular and intravenous injection. Vialsncontaining 500 mg and 750 mg. Dissolved in 2 ml and 3 ml of water for injectionnor physiological sodium chloride solution. Assign 2-3 grams per day.nIntramuscular formulation should not be used for intravenous administration.

The presence of a large number of antibiotics makes itnpossible to use them in different combinations. It should take into account thennature of their joint action. Today has developed special schemes compatibilitynantibiotics.

Errors and danger of antibiotic therapy. The mainnmistake of antibiotic therapy and the risk is the wrong choice.

Antibiotics should be based on the definitionnsensitivity of cultured microorganisms and held as monotherapy.

The combination of antibiotics is prescribed only innthe presence of mixed flora. When prescribing broad-spectrum antibiotics can benobserved allergic or toxic reactions and the development of dysbiosis.

You caot use antibiotics with an expired shelfnlife, and antibiotics were kept in violation of instructions. Before eachnappointment is necessary to determine sensitivity to antibiotics.

To do this, use the following tests:

Intradermal. The inner surface of the forearm internalnrishnoshkirno 1000 ED administered antibiotic dissolved in 0.1 ml of isotonicnsodium chloride solution. To control use the same amount of isotonic sodiumnchloride solution, but without antibiotic. In patients with hypersensitivity tonantibiotic administration area observed hyperemia, edema, rash.

Prick via scarification. The inner surface of thenforearm, after treatment with 70 ° alcohol, put one drop of investigationalnantibiotic, diluted with isotonic sodium chloride solution (1 IU per 1 ml innallergic history and 50 units per 1 ml in its absence) and spend scarification.nResults evaluated as during internal noshkirnoyi sample.

Sublingual test. Patient with a small gauze ball aren1/4 -1 / 3 dose of study medication under the tongue. A positive reaction inn10-20 minutes. observed swelling frenulum of the tongue, buccal mucosa, lips.

A positive reaction of the antibiotic caot enter.

In patients with hypersensitivity to antibiotics maynhave allergic reactions such as rash, redness of the skin, dermatitis,nurticaria, angioedema (angioedema), rhinitis, bronchitis and so on. When theynoccur should be abolished and prescribe antibiotics, antihistaminesn(diphenhydramine, suprastin, pipolfen, diazolin, ketotifen), in severe cases -nhormones (hydrocortisone, prednisone, etc.)..

When using antibiotics without defining sensitivity innpatients quite often antibiotic anaphylactic shock.

Anaphylactic shock antibiotic evident decrease innblood pressure, loss of consciousness, facial swelling, urticaria, sometimesnvomiting, and diarrhea.

In severe cases, the observed respiratory disordersn(dyspnea), intestinal bleeding, liver damage, brain edema, coma. Death maynoccur in the first minutes or hours after administration of antibiotics.

Treatment. The patient was urgently necessary tonintroduce 0.2% solutiooradre Nalin, or 0.1% solution of epinephrine in andose of 0.5-1 ml subcutaneously or intra-muscularly. In severe cases,nintravenously administered 5 mg of norepinephrine in 500 ml isotonic sodiumnchloride solution, along with 75-100 mg hydrocortisone or prednisolone 50-100nmg, 1 ml of 1% solution mezatona, 10 ml of 10% calcium chloride solution. Ifnlaryngeal edema and an increase in dyspnea spend tracheal intubation,ntracheostomy, artificial respiration, injected 10 ml of 24% solution eufillina,n1 ml of 2.5% solution dimedrol, diuretics (Lasix).

When using any antibiotic, especially at high doses,nmay occur toxic effects on individual organs and systems. Clinically, it cannmanifest disorders of hearing, vestibular apparatus, optic nerve, centralnnervous system, gastrointestinal tract, and others.

Candidiasis caused by yeast fungi of the genus Candida.nLong-term use of antibiotics gives a normal relation between variousnrepresentatives of the microflora (bacteria inhibited growth and multiplicationnof yeast fungi amplified). At that affects the mucous membranes, skin, internalnorgans (respiratory tract, gastrointestinal tract, genitourinary system,netc..).

Treatment. For the treatment of candidiasis prescribenantifungal drugs – nystatin 500 000 units (1 table.) 3-4 times daily or levorinn1 capsule (500 000 IU) 2-3 times a day, amphotericin 250 U / kg intravenouslyn(particularly the drug effective in the treatment of fungal diseases which arentreatable by other antifungal agents), hrizeofulvin. There are recent newnantifungals – Nizoral and Diflucan (fluconazole).

Enzymes. Used in surgery and drugs are proteolyticn(protein melted) action: trypsin, chymotrypsin, pancreatic ribonuclease,ncollagenase, elastolityn, terylityn et al. These drugs have the ability to meltnnecrotic tissue fibrynni formations thin viscous contents wounds, blood clots.nRelatively healthy tissue, these enzymes are inactive. They are widely used fornthe treatment of purulent, necrotic wounds.

Volatile – preparations containing biologically activenplant substances with antimicrobial expressed as bactericidal andnbacteriostatic action. They are made from the leaves of eucalyptus, hypericum,nmakleyi, heart and other plants. Widespread use of such drugs as receivednChlorophilipt, novoimanin, ekterytsyd, tincture of calendula, garlic and so on.nThey are used mainly for the treatment of septic wounds, rinse cavity andninhalation for respiratory diseases.

Basic principles of aseptic

Introduction aseptic opened a new era in thendevelopment of surgery. Today asepsis is one of the main foundations on whichnrests the modern surgery. With the development of aseptic surgery was possiblento extend the range of surgeries, conduct transplantation of organs andntissues. Aseptic Technique was developed in the 80-90s of last century, E.nBergman and his student E. Shymelbushem.

Under aseptic (a – without, sepsis – decay) is meant anset of preventive methods aimed at preventing the ingress of microorganisms innthe wound, creating bezmikrobnyh, sterile environment for the surgery throughnthe use of organizational arrangements, technical, chemical and physicalnfactors. Today aseptic surgical operation method combined with the use ofndifferent antiseptic preparations.

The main goal of asepsis is to destroy germs on allnsubjects, instruments, dressings, etc.., Which can contact with the wound orncan be introduced into the body during examination or treatment. Keep in mindnthat everything that comes in contact with the wound must be clean and freenfrom germs (sterile).n

Sourcesnand routes of infection in surgery

Airborne infection and its prevention. The importancenof preventing suppuration in wounds is prevention airborne infection. Todaynproved that suppuration of surgical wounds is directly proportional to thendegree of microbial contamination of the air operating.

When air infection should be understood microorganismsnin the air and can get to the wound. The number of microbes in the air isnproportional to its contamination. Fighting dust and air pollution in operatingnand dressing are the foundation of prevention of air infection. Of greatnimportance in the fight against infectious contamination is timely cleaning ofnthe operating room, air conditioning, UV light exposure, adherence to annantimicrobial treatment.

Under Drip infection should be understood microorganismsnspread and transmitted to another person when talking, coughing and sneezing.nTo protect the wound from infection droplet masked. Keep in mind that whenntalking droplets of saliva can fly apart at a distance of 1.5-2 m and nursingnstaff can be a source of infection patients. In saliva gets infected in thenpresence of carious teeth, tonsillitis, purulent processes of the mouth, nose.

For the prevention of droplet infection is carried outna range of measures:

All patients, including medical professionals, withnhigh fever, catarrhal symptoms from the respiratory tract into the operatingnpermit no. All employees who are involved in transactions, regardless ofnposition, should be examined periodically in ENT med-Line with mandatorynbacteriological control roto-and nasopharynx.

In the presence of the examined pathogens in cropsn(batsylonosiyi) conduct appropriate treatment (sanitation).

It is mandatory to wear a mask that covers the mouthnand nose. Today proved that mask with four layers of cheesecloth retains 90-94%nof microorganisms. Mask of six layers holds up to 97% of bacteria. To reducenthe penetration of droplets of saliva between layers of gauze pads should benplaced further from wool.

Contact infection and its prevention. During thencontact infection should be understood infected wounds through objects: gloves,ntools, dressings, needles, etc.., Hand surgeon and his assistants. The main waynto prevent infection is contact disinfection and sterilization, which wasncarried out by chemical and physical methods.

Implatatsiyna infection and its prevention .. Arisesnthrough suture, bone clamps, drainage and so on. listed in the sore andninfected when executing or due to violations of sterilization.

According to the order of Ministry of Health of Ukrainen№ 120 from 25.05.2000, for the purpose of prevention of HIV-infection and viralnhepatitis B and C infectioozokominalnoyi all medical devices, tools that arenused for a variety of manipulations and operations shall be subject tondisinfection, and sterilization before sterilization processing .

Responsible for disinfection, and sterilizationnprocess before sterilization is the older sister of operating unit.

Disinfection

Whenndisinfection is meant a set of measures aimed at the destruction of pathogenicnand potentially pathogenic microorganisms to humans for tools, etc..nenvironment. All instruments (cannula, forceps, scalpels, catheters, bloodsto,nclamps, scissors, etc..) After using them apart and immersed in a 3% solutionnof chlorine bleach solution bodefenu, mikrobaku 60 minutes if instrumentsncontaminated with blood, it is immersed in 1% solution of sodium benzoate for 1nhour, or 4% hydrogen peroxide solution for 90 min. Disinfectant solution usednonce.

Beforensterilization processing tools

Upon completionnof the disinfection of medical instruments washed in running water over thensink to completely remove dirt disinfectant. Washed and disinfected medicalninstruments are soaked in hot (50-55 ° C) Pressure wash solution (detergentn”Biolot”, “Lotus” or the “Ari-el” – 5 grams ofnpowder, 170 ml of 3% hydrogen peroxide solution in 825 mm of water) for 15nminutes at full immersion products. The temperature of the solution duringnsoaking is not supported. Then wash in the working solution for 30 s to oneninstrument. Cleaned and washed medical instruments washed first under runningnwater and then in distilled water. Medical instruments Washed up and dried innhot air oven at temperature of 85 ° C until complete disappearance of moisture.n

Test withn”hemotestom-m”. First, prepare a working solution, which consists ofna mixture of alkaline solution chromogen (reagent 1) and hydrogen peroxiden(reagent 2). In the study tools put few drops of the working solution and wipenthe surface of the product swab dipped in a solution. If there is any bloodnappears violet-blue color.

Test withnazopiramom. Before checking quality cleaning tools, prepare a working solutionnby mixing equal amounts of azopiramu of 3% hydrogen peroxide solution (1:1).nWorking solution should be used within 1-2 hours, with the appearance ofnspontaneous pink color change it. In the study tools put few drops of thenworking solution and wipe the surface of the product swab dipped in a solution.nIn the presence of blood in the contaminated areas of instruments (products)nappears violet color, which for a few seconds turns into pink, blue or brown.nWith azopiramu detect the presence of hemoglobin, peroxidase herbal, oxidizersn(bleach, bleach, detergents, solvents, acids, and others. Bure color observednin the presence of the studied subjects rust and hlorokside. Studies conductednat room temperature (not above 25 oC ).

The samplenpreparation of “Torch 2”. The product is a white powder, produced innplastic vials (1000 samples). For the tests on the remains of blood, prepare anworking solution. Open the capsules (dispenser) and it poured 0.02 g product,nwhich was dissolved in 10 ml of water. At the same time receive 0.2% solutionnof reagent F-2. In solution adds 1 ml of 3% hydrogen peroxide solution (ration1:10). In the studied object (tool) put a few drops of solution or wipenmoistened swab. In the presence of blood drug solution F-2 becomes pink orncherry color. Time of observation – 5 min. The working solution was used for 30nmin.

Phenolphathaleinnindicator test. Prepare a 1% solution of phenolphthalein and put on a piece ofnwashed 2-3 drops. In the presence of detergent appears pink color.

Sterilization

When sterilization is meant a set of physical andnchemical methods of complete disinfection of tools, appliances, machines, andnother implements medical supplies. To do this, mainly used calcination,npasteurization, boiling, suhozharovyy method (160-200 ° C), autoclaving.

Calcination. This method of sterilization can be usednin emergency situations when an urgent need to prepare some tools: needlenholder, needles, clips, etc.. However, it should be remembered that thenignition is not achieved reliable disinfection, in addition, this method ofnsterilization instruments spoils.

Pasteurization – a method of decontamination ofnorganic liquids using temperature 60-100 ° C, at which only kill vegetativenforms of bacteria. it is used mainly in the manufacture of protein drugs,nculture media by re-heating to 55-60 ° C for 30 min.

Boiling is now rarely used, except in small hospitals.nTools Used after disinfection and processing are placed in a special metalnsterilizer with grid and lid tightly closed.

In sterilizer pour water and add sodium bicarbonate tonproduce 2% solution. The liquid is brought to a boil, immerse it has analyzednand compiled into a grid tools. When the water boils again, note the start timenof sterilization. Upon completion of sterilization into the instruments arenremoved from the boiler (Fig. 24), the tools laid out on a sheet covered with ansterile tool table. Terms of sterilization include: metal tools – 20 min,nrubber items – 10 min. Cutting tools better without adding soda to boil for 5nminutes, after cutting part wrapped with gauze. Boiling syringes and needles innhospitals admitting only in exceptional (military) situations. Healthcarenprofessionals should be aware that this type of sterilization as boiling is notncompletely reliable because the viruses HIV, hepatitis and some bacterialnspores can withstand even prolonged boiling.

Sterilization by steam under pressure. This method isnmainly used to sterilize bandages, linen at a temperature of 120 132 ° C.nSterilization by steam under pressure is carried out in a special apparatus,nautoclaves. The vapor pressure in the autoclave is controlled by a pressurengauge and a special safety valve through which automatically resets the surplusnthat can maintain adequate pressure and temperature inside the autoclave.

When the vapor pressure of 1 atm sterilization occursnat a temperature of 120 ° C, sterilization time – 45 min. When the vapornpressure of 1.5 atm in an autoclave temperature is increased to 127 ° C, thensterilization time is reduced to 30 minutes. At a pressure of 2 atm internalntemperature reaches 132 ° C, and at the same time sterilization is 20 minutes.

Material for sterilization placed in special boxesn(Bix) (Fig. 26), which is used for sterilization of various items and theirnsubsequent storage.

Bix is usually round in shape andndifferent capacity, made of stainless steel. Being closed with a lid and anspecial lock. Along the perimetern

Bix is ansmall hole through which enters into steam. To handle lock attached specialnTags, which record the date of sterilization, material and its owner. Uponncompletion of the sterilization material is considered sterile for 72 hours.nNow produce special sterile box (Bix) with antibacterial filters (KSPF) innwhich the shelf life of sterile material lasts up to 1 month. It should be rememberednthat if sterile slut opens its contents should be used within one day.

Sterilization ofninstruments, syringes performed under a steam pressure of 1.5 atm for 30 min.nRubber tubing, catheters, drains before sterilization to stand for 1 h in 1%nsolution of bleach or hloratsydu, dioxidin, washed with water and dried,nwrapped in gauze and sterilized at a pressure of 1 atm 45 min. Recently, thenuse of rubber products only use single (drainage tubes, catheters, gloves) thatnare sterilized at the factory.

To assess thensterility of the material after autoclaving using different chemicals thatnalter its physical properties at 120-132 ° C (sulfur powder (117 ° C),nantipyrine, Amidopyrine (110 ° C), resorcinol (119 ° C), benzoic acid ( 121 °nC), urea (132 ° C). Lately produce standard indicator tube and special Thermonindicator paper, which changes color depending on the temperature and exposure.n

With no standardnindicator made it their own. Matter is poured into a small test tube caulk anpiece of gauze or cotton ball and place among the items to be sterilized. Ifnthe light has not changed (not melt, did not change color), the sterilizationnfailed and the material caot be used.

Sterilization byndry heat (air sterilization). Metal tools better sterilized by dry heat. Drynheat cabinet work on electricity. Surgical instruments selected for thentransaction, put on a metal grid and placed in the sterilizer (Fig. 27). Closetnclosed and include electric heaters.

10-15 minutesnthe temperature inside the cabinet reaches 160 ° C. With the controller, it cannreach 200 ° C. The duration of sterilization depends on the temperature: at 160n° C – 150 min, 180 ° C – 60 min, 200 ° C – 15 min .

To monitornsterilization in cabinets using chloramphenicol (melting point 150-160 ° C)nsucrose and tartaric acid (180 ° C), hydroquinone, thiourea (over 180 ° C).nBest-industrial indicator – sealed tube with powder of sucrose and tartaricnacid, which at 180 ° C into a liquid. Dry heat sterilization cabinets installednin along with the operating rooms. In these cabinets can be sterilized severalndifferent sets of tools.

Gasnsterilization. Used mainly for the sterilization of products from polymericnmaterials (endoscopes, plastic). The most common gas used for sterilization isnethylene oxide. This dangerous gas can explode, so it’s easier to use a mixturenof carbon dioxide, methyl bromide. Optical devices and their elements can bensterilized in formalin vapors. For this special airtight glass or plasticncylinder (camera) is placed at the bottom of formalin 2-3 tablets (paraform) ornpour 10-20 ml of formalin. Sterilization is carried out during the day (Fig.n28).

Industrynproduces special gas sterilizers. Upon completion of the sterilization materialnis placed in the plenum.

Sterilizationnusing solutions (chemical sterilization). Cutting instruments (scalpels,nknives, scissors, razor blades, needles) and rubber products, which deterioratenwhen heated, can be sterilized in solution. To prepare tools usually use 96 °nethanol. Tools pour alcohol two hours before surgery.

In some cases,nfor sterilization of rubber products (gloves, catheters, drains) use diotsydn(1:3000), 2% solution of chlorine bleach, no-vosept, rokal et al.

Radiationnsterilization. With this method of sterilization using ultraviolet radiation orng-rays. With g-rays sterilized suture material, implants, catheters, etc..nRadiation sterilization is quite reliable. Objects can be stored in sealednsterile packaging for many months.

Controlnof sterilization

Control of sterilization material is made tools fornperformance manometer, thermometer, indicator substances that change theirnphysical properties depending on the temperature and duration of sterilizationnand bacteriological method which is the most efficient and helps you determinenthe type of bacteria.

Crops sterility of surgical instruments. Surgicalninstruments using sterile tweezers reach a slut or a soft package and placed inna test tube full of nutrient medium. Exceptionally, in some cases, if allnsterilized instruments in one pack large size (Needle Holders,nranorozshyryuvachi, etc.), conduct washed from the surface of the instrumentnsterile cloth moistened with sterile saline or sterile running water and placena napkin in a test tube with tiohlikolevym environment. Similar washings withnother tools inoculated into tubes of medium Hottinhera and Saburo.

Sowing sterility catheters, rubber gloves and othernrubber products and plastic. Sterility control probes, catheters, rubber glovesnand other rubber products is carried out by fully immersing small products innthe culture medium, from large cut small pieces (1-2 cm) and placed in anculture medium.

Drill results are available 48-72 hours. Suchnmonitoring should be performed 1 time per month with appropriate registration.

Preparationnhands before surgery

Medical personnel should carefully monitor thencleanliness of their hands, to avoid contamination. If there are abrasions,nscratches, and especially purulent diseases to participate in the operation arenabsolutely prohibited. Not allowed manicure, nails should be cut short.nRecommended overnight lubricate your hands with petroleum jelly, lanolin ornhand cream.

Signature: Signature: a

There are several traditional (classical) and modernntreatment arms.

The most common is the traditional methodnSpasokukotsky-Kochergina. In two dry basins for washing hands pour 5 ml 96 °nalcohol and burn their surface. Then pour two pots

2 liters of distilled water and add 10 ml of purenammonia (Fig. 29). In this solution to wash their hands using napkinsnalternately for 3 min. Pre-washing hands brushing is not required, it isnperformed only if contamination. Then dry your hands with a sterile towel ornnapkins for 5 min and treated with wipes soaked with 70 ° or 96 ° alcohol.nInterdigital spaces and nail cuticles additional 5% alcoholic solution ofniodine (yodonatom).

Method Fyurbrinhera is washing hands under runningnwater with two brushes for 5 min each (Fig. 30). Then he wiped his handsnsterile towels or towel and treated with 15% solution turns dichloro do mercuryn(mercuric chloride) for 3 min (rys.31). The tips of the fingers smeared with 5%nalcoholic solution of iodine (yodonatom).

Method Alfeld. Of all the others, this method is usednmost often. Hands are washed two sterile brushes with warm running water

3 soap and water for 10 minutes, then wipe with ansterile towel and treated with 96 ° alcohol for 5 min, the nail bed smearednwith 5% alcoholic solution of iodine (yodonatom).

With modern methods of treatment, there are severalnways:

Treatment arms hlorheksydy Mr. (hibitalom). Hibitalnreleased as a 20% aqueous solution of 500 ml. Hand wash using 0.5% alcoholnsolution. For this preparation was diluted in 70 ° ethanol at a ratio of 1:40.nAfter the usual hygienic hand washing with warm soapy water, wipe hands with ansterile towel and then treated twice for 3 min. wipes soaked in the solution.nAdditional treatment with alcohol and so on. needed.

Processing dehmitsydom. Apply 1% solution at anconcentration dehmitsydu 1:30 (1 part drug and 29 of distilled water). Processnas chlorhexidine.

Processing nadmurashy hands-tion acid. Method: 30%nhydrogen peroxide (172 mL) and 85% formic acid (81 mg) in turn poured into anglass bottle, mix and place in a saucepan with cold water to 1-1.5 hours. Afterncooling, the solution was diluted with water (you can tap) to 10 liters. Thensolution should be used during the day. In five liters of working solution cannwash their hands in 1011 people. Initially, the hands are washed 1 min withnrunning water and soap (no brush), and then within a minute – in solutionnnadmurashynoyi acid (no napkins). After washing hands with one of the abovenmethods of wiping dry with sterile towels, wear a sterile mask, gown and glovesn(Fig. 32, 33).

Use rubber gloves allows for complete sterility handsnduring operation. Today gloves are widely used not only during operations,ndressings, but when examining patients.

For the prevention of surgical infections it isnimportant to regularly check for sterility hands of members of the operatingnteam. To this end, once in 15-20 days before the operation took hold of thenhands of surgeons and nurses in operating.

Methodsnof processing surgical field

Operative field – the scene of the surgeon should benfree of microorganisms. Immediately before surgery shaved operative field withnmethod Hrosiha-Filonchikova. Its essence is that the skin is treated withnsurgical field 4 times a antiseptics. Recently, most often used solutionnyodonate. It is cooked before surgery (ex tempore): 5% concentrated solution ofndissolved yodonate boiled or sterile water at a ratio of 1:5.

First lubricate the skin surgical field is carried outnafter preliminary washing of gasoline or alcohol wipe twice with sterile swabsnmoistened with a solution of yodonatu. Second – before incision, after coveringnthe patient with sterile sheets, and others – before suturing the skin and thenfourth – after suturing the skin. In addition to these mandatory fourntreatments, skin surgical field should be lubricated each time changing clothesnaround the wound (pollution, widening the wound, etc.).

Sterilizationnof suture material

In surgery using various in their physical properties,nchemical structure and source of the suture material: silk, cotton threads,nsynthetic threads, non-absorbable (nylon, polyester, Teflon, etc..) Syntheticnfilament, absorbable, with glycolic acid and Dekson, oktselon, polypropylene,nmetal, stainless steel, tantalum (paper clip, wire), and biological filamentsnthat absorbable (catgut). Due to their different physical and chemicalnproperties of suture materials sterilization methods may not be the same. Somenkinds of (silk, cotton threads, polyester, etc.). Sterilized in an autoclave atna pressure of 1 atm for 20-30 minutes. Silk is often sterilized by the methodnof Kocher. The gist of it is this: after washing and drying the skeins of silknthreads placed in jars with ground glass stopper for 24 h in air for degreasingnand then at the same time – in 70 ° alcohol. Silk is then put in a pan, pourn0.5% solution of dichloride of mercury (corrosive sublimate) and boil for 10nminutes. Then, translated into sterile jars with ground glass stopper, fillednwith 96 ° alcohol, in which both preserve. Sterility check silk bacteriologicalnmethod. Before using silk boiled for 2 min in 0.5% solution of mercuryndichloride.

However, the surgery is the preferred silk, which isnsterilized at the factory and stored in glass vials sealed. Today it has almostncompletely replaced by synthetic suture material.

Sterilization synthetic fibers like those that do notndissolve, and those that dissolve spend in boiling water for 20-30 minutes, ornin a solution of mercuric chloride 1:1000 for 1-5 min. Then sterilize and storenthem in 96 ° alcohol in a glass jar with a tight ground-crusts. Metallic suturenmaterial (skobky stainless steel paper clip with tantalum clips, wire) are alsonsterilized by boiling in 2% sodium bicarbonate solution.

Sterilization of biological suture material thatndissolves (catgut) is complex and requires special diligence because of thenrisk of contamination of its anaerobic microflora. It is carried out bynchemical methods. Pre suture is placed for 24 h in air for degreasing and thennsterilized by the method of Claudius, Gubareva or Sitkovskiy.

By using catgutnClaudius in coils placed in an aqueous solution of iodine (1 g crystallineniodine, 2 g of potassium iodide and 97 g of water) for 9 days and then testednfor bacteriological sterility method. If the material turns a sterile solutionnof cans drained and gut fill in 96 ° alcohol, in which it is stored. Ifnnon-sterile catgut appears, again pour water solution of iodine for 9 days andnthen tested for sterility.

Today has becomenwidespread modification of catgut sterilization by AP Gubarev, which suggestsnusing an alcohol solution of iodine. The duration of sterilization is reducednto 7 days.

The methodnallows to prepare catgut Sitkovskiy faster, but with much materialndeteriorates, becomes rough, brittle. In a jar with ground glass stopper pouredncrystalline iodine (40 g per 1 bank capacity of 3 liters and 60 g – 5 l).nZmotanyy catgut in the rings hung in the bank at the height of 6-7 cm from itsnbottom. Bank closed ground glass stopper and pour paraffin. Periodically, thenbank will need to shake for a better distribution of iodine vapor betweenncatgut. After 3-4 days of gut check for sterility (seeding) and in the absencenof microorganisms it is transferred to a dry sterile bank where he storednhermetically zakrytymPered sterilization by dry catgut advisable to drop by 1-2nmin in 2% solution of potassium iodide. After this treatment it is better tonreact to iodine vapor.

Given thencomplexity of sterilization should use catgut, made at the factory.

Sterilization ofndressings and linen

The main type ofndressings used in the operating room – white absorbent gauze. Cotton hasnlimited application.

Preparationndressings. The gauze should be white, soft, hygroscopic and skim. Width factoryn-60-70 cm pieces of gauze surgical dressings prepared on a clean table,ncarefully washing hands. The basic rule compilation dressings optionally gauzeninside edges to prevent the ingress of fine threads wound.

To prepare thensurgery napkins in three sizes: large, medium and small. Great wipes up thenpieces of gauze the size 40×60 cm, medium – 37.5 x30 cm, small – 20h15 cmnPrepare them as follows: from

overall piecenare 10-12 layers of cheesecloth and cut it with scissors along the linesnspecified in the diagram (Fig. 34). They are trained large napkins. The middlenlarge piece also cut along the cross yarn gauze into three equal strips, whichnin turn is cut in half twice. These pieces 20h15 cm size used for making smallnnapkins.

1-20 –

In this case,none end cut a strip width of 20 cm, which is prepared large napkins, on thenother – a strip width of 5 cm, which is used for balls. The middle piece ofngauze remaining, cut in half, once in the longitudinal, the second – in thentransverse direction. From these pieces of prepared medium napkins. Large rollnas follows: both circumcised edges to a depth of 5-6 cm inside the wrap, thennagain up the cheesecloth in half. Minimize average napkins begin with earthingnthree sides (cut edges): within a depth of 3-5 cm, then wipe up the first halfnalong the transverse and then along the longitudinal threads.

In a piece ofngauze, which make up a small napkin, all cut in the sides formed the edges, sonthey must be wrapped inside napkins. The first hill province of large partiesnin such a way that they went a little to each other, then the free edge of thensmaller parties turning inward so that they faced each other, and finally upnthe napkin in half. For the same pieces of gauze prepare large, medium andnsmall swabs (Fig. 35).

Great swabnprepared as follows: trimmed edges gauze wrapped inside a depth of 5-6 cm andnin the same direction twice comprise half. A strip formed length 60 and a widthnof 10 cm up almost

twice: the lowernhalf should be 5-6 cm longer than the upper. Then swab up again in half. Freenedge of the bottom layer of gauze wrapped in a tampon.

Average swabnprepared as well: strip formed up along the transverse threads, and then, innlongitudinal. Average swab can be made sister while real average napkins.

Drawing beginsnwith a small swab into 1-2 cm from one short edge piece of gauze, and then intonthe hill with some measure at each other longer edge of re-assembling them innhalf lengthwise and transverse directions.

Balls arenprepared with a piece of gauze 10×10 cm, making them twice and wrapping aroundnthe index finger to form a ball, inside which wrap the loose ends.

Preparationnlaundry. By operating clothes include gowns that are fastened behind, sheets,ntowels, lineapkins, hats and masks. Before operating sterilization sisternintegrity checks and makes clothes in her slut. Sheets up as follows: a narrownbend edge for width 50 cm, up to four times the length and loosely skochuyutnstarting from nezahnutoho end. Composite sheet so very convenient to deploy.

Dressing up thensleeves inside. Then it loosely skochuyut.

Towels and wipesnup four times. Masks and caps are sterilized, usually alone or together withnthe material.

Putting clothesnon Bix. Before styling Bix wipe the inside and outside with a tissue moistenednwith 0.5% solution of ammonia or a solution of 96% ethanol. Then push on thenwall of a circular plate slut that closes the side holes cast and vystelyayutncover the bottom and sides Bix pelenkoyu, towel or sheet so that the edgesnhanging loosely from all sides. At the conclusion of linen and dressings to Bixnbe followed established procedure that allows you to quickly and easily findnthe desired object. Linen put in an upright position so that you can pull outnslut any thing without affecting the others. Surgical dressings also placed sonas to pack every package or you can pull apart. In the center of the tube isnplaced slut with sulfur or other substances to control sterility.

Depending on thenpower and purpose operating unit operating clothes, put her kits.

Laying stuff andnclothes in this way, you start with a rough per transaction.

To handle everynslut tied oilcloth label to indicate which content Binks, indicate the date ofnsterilization and name of the person who prepared the slut. Others make anpencil. Bix close lid, strengthen hook on a chain and tightly tied lace thatnshe accidentally opened. In late check whether the open side hole slut.

SurgicalnInstruments

Cuttingntools

Scalpels are zahalnohirurhichni and eye (Fig. 36a).nThe shape of the blades are divided into oval and pointed. For the length ofnthe blade zahalnohirurhichni oval divided into large (50 mm blade) and mediumn(40 mm blade), and oval eye – on average (30 mm blade) and small (20 mm blade).nScalpels genital produce only medium size. Scalpel Handles zahalnohirurhichnyhnflat surface of matte eye scalpels handles the cut square. Recently releasednscalpels for single users’

tion and b and with variable blade.

The shape of the blade distinguished: straight, curvednon the plane (Cooper), bent over the edge. In addition, the scissors can benspiky, obtuse and with one sharp end length of 14, 17 or 25 cm

Scissors additional purpose scissors to remove thenbandages, nail trimming, grooming, prescription and others.

Scissors with a button (Lister) (Fig. 38a) differ innthat they have a curved blade on the edge of the 30 ° and at one end of a longnblade portion is in the form of a flat button in order to bring it under thenbandage without causing scratches or injury to the skin of the patient.

Nail scissorsnare straight and curved blade on the butt with a notch (Files for Nail)

Scissors forntrimming hair with sharp ends

Prescriptionnscissors – pointed, like a home, but they are among branshamy oval cutout thatncan be used for the maintenance of cortical plugs

nnnn