Sanitary- hygienic regimen in the surgical statsionari.Metody antiseptics. Care for patients in the preoperative period.
The provisions of the surgical department and its planning.
Modern surgical department - is a complex medical complex , whose activity is regulated by a common relevant sanitary norms. Surgical department recommended be placed in separate rooms facing the south, southeast or southwest. This orientation creates conditions for the separation of light chambers with natural sunlight, a sufficient dose of UV rays , which adversely affects a variety of infectious agents .
The main requirement for the surgical department - its isolation from other branches hospital. Zahalnohirurhichne department district and city hospitals consists of a reception office, chambers for patients ( hospital) , additional rooms (dining room , manipulation , nursing , etc.). Dressing and operational unit.
Admission department .
Admission department functioning by type changing rooms, where they spent roughing patients. Admission department consists of a desk , cabinet initial examination of patients, shower , bathroom, laundry cell toilet. In some hospitals in the admission department creates 1-2 diagnostic chamber and isolation for infectious patients. Browse patients spend on a couch covered with oilcloth , which after examining each patient wipe wipes moistened with disinfectant solutions. After examination of patients , the study of wounds and replacing bandages staff wash hands with warm running water and soap for 3 min and processing solutions hands bactericidal drugs ( 0.2% solution of chlorine bleach , 0.1% dezoksonu -1 , 760 ethanol , 0, 5% solution of chlorhexidine in 700 ethanol , sterylium et al. ).
in the emergency department patient conduct sanitization (hygienic shower and bathtub) , disguised in a hospital gown ( robe , underwear, slippers) . In urgent hospitalization of the patient is carried out sampling of blood, urine and other body fluids for analysis.
Surgical department .
Treat patients in a specially designed and equipped surgical wards (Fig. 1).
In large hospitals provide specialized departments for 3040 beds to assist patients with vascular , endocrine, pulmonary and others. pathology. To prevent transmission of purulent infection from one patient to the next , it is desirable to have a clean surgical department and the department of surgical infection. They need to be isolated from each other, have a separate inventory, equipment and staff. If you can not make a separate department for septic patients assign separate chamber and dressings . Under these conditions, it is important to cleanliness and order in the department . All the work plan so that the first operation is carried out , then perform clean bandaging of patients , and only after all - pus ligation (order dressings ).
In the composition of the surgery department includes wards for patients operations unit, dressing , handling and support facilities (toilet , bathroom, dining room , pantry , laundry room , staff, sterilization , etc.). . Chamber should be spacious , based 6,57,5 sq.m. area for each patient. In the House it is expedient to place 2-4 beds. Natural lighting should be such that the ratio of the area of windows to floor area was 1:6 ( Fig. 2).
Artificial lighting shall be provided with frosted shades chandeliers and table lamps for Invalids . The patient should have a comfortable bed , better functional (Fig. 3) or with a special headrest , side table, chair for visitors.
In the House needs to be cleaned , clean and quiet. Temperature range there should be within 18-20 ° C (Fig. 4).
Radio patients should listen with headphones , watch TV in the other room . For the most serious post-operative patients in the surgical ward or hospital equipped NICU with special equipment , a set of medicines, tools needed for the possible conduct of resuscitation . Patients who die are placed in special wards - wards.
Surgical department must be equipped with a central vodohanom (cold , heat, water), central heating , sanitation and forced-air ventilation. Hygienic Practice volume of air in the room up 27-30 m3, in natural or artificial ventilation in the room allows you to create a carbon dioxide concentration of less than 0.1% , air velocity should be 0,100,15 m / s in air humidity 50-55 %. These optimal conditions for normal human life . These parameters can be easily adjusted using the air conditioner. To contact the duty staff with patients on the wards should be sound and light alarm . Corridors should be spacious and comfortable. On the floor lay linoleum. in the surgical ward with a damp cleaning with the addition of antiseptics . Cleaning should be carried out twice a day. Wet cleaning chambers begin to remove dust from window sills , cabinets , ceilings , beds. This should open the window . Lying patients should be well covered . Cleaning should be carried out on windows and walls to the door. Wet cleaning furniture spend every day. The panels are cleaned every three days. The upper parts of the walls , ceiling , ceiling cleaned of dust at least twice a month. At the same time wipe the window frames and doors. Equally important is compliance with sanitary requirements in the dining room. Dishes are washed in two waters at a temperature of 70-90 ° C in a water bath or with the addition of mustard or special dish detergent . You can not use cookware with upholstered edges. Food waste is collected in special closed bucket. To keep the health unit in due course need to have specially marked buckets , dusters, mops. They can not be used for cleaning other rooms . Strict compliance with sanitary standards is the key to prevention of nosocomial infections.
His place is usually in the hallway near the chambers ( Fig. 5).
At another table sisters should be illuminated or audible alarm , telephone, desk lamp , etc. .
in the procedure room are :
1) Cabinets for drugs and sterile syringes labeled " domestic ", " for others " injection "," outdoor ", which closes with a key ;
2) a table for slut with sterile material and antiseptics ( 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.
Workplace sisters surgical unit should be kept in perfect order. The nurse must strictly adhere to the rules of personal hygiene, be clean , dressed in a clean robe, hat or scarf . When performing injections or intravenous infusions should be sure to use a mask and rubber gloves.
The provisions on the treatment of care of surgical patients
All work in the surgical department based on the principles of security and treatment regimen. The patient should be surrounded with attention and care from medical personnel. Hospitalized patients in the department accompanied by a nurse or nurse receiving department. Another nurse at the direction of the head of department or another surgeon places the patient in one of the chambers . All the terminally ill and those in need of urgent surgical care ( acute diseases of the abdominal cavity, abdominal trauma , chest , etc. . ) Delivered to the surgical department on a gurney . Patients who need immediate surgery, sent to the intensive care unit for preoperative preparation or directly to the operating room . All medical personnel should build a time under the regime of the surgery department (Table 2).
Exemplary adherence , order and discipline in the department and elevates the mood of the patient is self speedy recovery . All patients should adhere to hospital treatment, the recommendations of your doctor. They are familiar with the mode of the surgical department at the emergency department , which is painted in the map patient. For violations of patients discharged from hospital.
Diet surgical department
7.00 Elevation patients
7.00 - 7.30 Temperature measurement , hygienic gymnastics
7.30 - 8.00 Morning toilet, sampling of blood, urine and other biological substances for analysis. Housekeeping department
8.00 - 8.30 Distribution of drugs, perform manipulations and procedures
8.30 - 9.00 breakfast
9.00 -10.00 Bypass doctors
10.00 -14.00 Perform medical appointments , racking patients perform
operations , counseling patients
14.30 - 16.30 Rest of the day;
16.30 -17.00 temperature measurement
17.00 - 19.00 Visiting relatives
19.00 - 19.30 dinner
19.30 - 21.30 Distribution of drugs, perform nightly manipulations and procedures
preparing patients for surgery
21.30 - 22.00 evening dresses
22.00 -7.00 sleep
In the surgical ward leadership of nurses and nurses provides senior nurse , who immediately obeys the Head of the Department , performs his instructions on care and maintenance of patients and is solely responsible for the work of junior medical staff. Given the range of responsibilities for this position appoint people who have experience of working as a nurse for at least 3 years and are usually those who have certified the first category. Thus Nurse Surgical Department appoints and dismisses the Chief Physician Hospital on the recommendation of the head of the surgical department. As has been said, in her direct supervision is the nurses office. Work elder sister is very responsible .
Be ' Relations Nurse surgical department:
1. Conducts appropriate selection of nurses with regard to their psychological compatibility.
2. Makes nursing work schedules , timetables.
3. Provides normal operation department through timely replacement nurses and nurses who could not go to work due to illness or other reasons.
4. Follows the timeliness and clarity of execution ordered by physician .
5. Systematically department provides medications and medinstrumentariyem and other objects of care.
6. Follows the use , storage , distribution, copying mechanism and control of medicines , medical instruments and items of care.
Provides sanitary-epidemiological regime in office.
8. Follows rules for storage and accounting of narcotic drugs .
9. By order of the head of the organization department conducts individual posts about terminally ill .
10. Ensure the implementation of internal regulations department, adhering to the principles of health - protective regime .
11. Conducts monitoring compliance with food for patients, is a la carte food orders , according to the dietary tables, monitors the quality of prepared food and its distribution .
12. Keeps records of acceptance and discharge of patients , a report on the movement of patients in the department , reports on admission and outpatient department data on the availability of beds.
13. When writing out reports seriously ill relatives about the date and time of discharge or transfer it to another branch. If necessary, the patient appoints maintainer of the staff office and arranges transportation technicians state.
14. Under leadership of the head of department develops and oversees implementation of plans to improve the skills of nurses.
15. Participates in the Board of Nursing Hospital nursing conferences.
Requirements ward nurse surgical department:
A nurse in the department of maintenance patients department reports directly to residents in part of the routine work - older sister branch. It is responsible for the timely and proper execution of medical appointments , the quality of care for patients in wards or her assigned office ( dressings , manipulation ).
The post of ward nurse nurses appointed to the first level of accreditation.
Duties ward nurse surgical department:
1) hospitalized patients , checking correctness of their sanitization , review patient with the internal regulations ;
2 ) collecting material for the study (blood , urine , feces ) and send it to the lab ;
3) patients had to be ready to perform diagnostic tests ( endoscopy, radiography, ECG , etc. .) And support or transport them to various diagnostic rooms ;
4) faithful implementation of all doctor appointments, which are recorded in special letters of appointments ;
5) should be present on rounds physician reporting to him about all the changes in the condition of the patient during rotation ;
6) body temperature examination (morning and evening) and record temperature data sheet ;
7) blood pressure , rate of hartbeets , breathing, post this data doctor ;
8) surveillance of the wound ( bandage ) and discharge of drainage ;
9) careful and close supervision of the patient , if necessary, immediately giving him first aid ( CPR, indirect massage of the heart, stop bleeding) ;
10) monitoring compliance with patients assigned to diet , checking quality products that bring families;
11) control of the technological process ( nurses , cleaners ) and compliance measures for sanitation regime at the department ( prevention of pressure sores, skin care, oral patients , etc.)
12) carefully maintaining medical records , which includes a magazine for receiving and transferring duties and magazines. MEDICAMENTAL and portion requirements leaves medical appointments , temperature , etc. leaves .
For the diligent performance of duties surgical nurse in a short period of time it is necessary to examine a large section of general surgery , learn the basic surgical diseases , their diagnosis and treatment , especially the care of patients. Medical assistance is a sacred duty of every health worker , regardless of his level of education and profession. Inattention or unjustifiable failure to carry out his duties leading to legal liability.
The provisions of dressings . Dressings .
Requirements for dressings should be the same as the operating (light room , the ceiling of which shall be painted with oil paint , walls and floor are lined with tiles ).
The dressing is necessary to maintain cleanliness. Table for instruments and dressings cover as well as in the operating room.
Tools submit forceps . Ligation is carried out only by the tool. Instruments are sterilized in most dressings or surgical sterilization room block. Dressings should be provided with a central cold and warm water. The optimum temperature should be 18-20 ° C. The dressing should be no foreign objects , clothes, except for the dressing table , table for instruments and dressings , medicines and cabinets for tools and chairs for patients. In conducting dressings must consider the degree of purity of healing the sick. Patients with complications of purulent wounds bandaged last. At the end of the day with a damp clean dressings and irradiation with ultraviolet rays ( kvartsevaniya ). In major surgical wards usually has two dressings - for "clean " and " septic " patients.
Be ' Relations nrev ' yazuvalnoyi nurse :
1. Performs prescribed by a doctor - intern manipulations that are allowed to perform nurse .
2. Accompanies conducted seriously ill after manipulation to the House .
3. Strictly adhering to the rules of asepsis and antisepsis.
4. Prepares to sterilize and sterilize bandages and instruments in accordance with operating instructions.
5. Provides a systematic bacteriological control of dressings, instruments, placing Trans ' yazuvalnoyi .
6. Ensures the systematic replenishment , inventory, storage , and monitors expenditure of medicines, dressings , instruments and clothes .
7. Instructs nurses dressings and monitor its performance.
8. Keeps accounting records .
9. Systematically improve their professional skills.
10. Participates in health - educational work .
Infection control of surgical hospital.
In order to prevent festering disease and compliance with sanitary standards bacteriological laboratory sanitary station, which is subject to a medical institution, shall once in 15-20 days bacteriological control of air pollution ( operating, dressings, Chambers ), quality control, disinfection, treatment hands of personnel, material and sterility of surgical instruments.
Control of microbial contamination of the air in the operating room and surgical dressing conduct once a month. Air pollution in the House and dressings can be determined by sedimentation , filtration and method of shock wave air. Sedimentation principle of the method is that the bacteria that are in the air , settle on a horizontal surface. For this study, using Petri dishes with nutrient medium (2% agar ), which for 15 minutes are left open in predefined locations operating or dressings . Then the Petri dish is placed in an incubator for 24 h and counted the number of colonies that grew . Filtration method of investigation is to draw 10-40 liters of air through special absorbers with sterile fluid. The principle of the shock is that soaked through the apparatus air strikes the surface containing culture medium , resulting in bacteria trapped in it. Air samples were carried out using the apparatus Krotov .
The operating number of colonies of microorganisms on 1m3 of air should not exceed 500 hours and 1000 - during and after the operating . For dressings and preoperative may be no more than 1000 colonies in 1m3 of air to work. In addition, a sample volume of 250 liters of air should not be plazmokoahulyatsiynoho hemolytic staphylococcus .
Quality control of disinfection carried out suddenly, without the knowledge of the staff , 1-2 times a month. Sterile cotton swab moistened with sterile isotonic sodium chloride solution or 1% hyposulfite spend washout from 10 subjects , the area must be flush 200-300 cm3. Give a satisfactory assessment of disinfection in the absence of growth of E. coli , Proteus, Pseudomonas aeruginosa, Staphylococcus and Streptococcus .
Crops with it, usually held senior operating sister so that the staff did not know when and who he will be taken . Drill results should be discussed and spivstavlyatysya frequency of postoperative complications. This control improves the quality of handwashing staff and reduce the number of postoperative complications.
In addition to the mandatory daily monitoring the effectiveness of sterilization in an autoclave ( dressings , linen) using standard vials or sulfur is necessary every 10 days seeding with sterilized material. Particular attention should be given to the quality of sterilization of suture material. Crops of silk, catgut should be performed prior to sterilization and its in storage at least once in 10 days.
To control the sterility of hands of medical personnel , dressings and suture material eldest sister should be operating a special journal.
To identify and sanitation carriers of pathogenic organisms 1-2 times a year to all employees doing surgery department swabs from the nose and throat swabs special . Revealed carriers of pathogenic infections dignity without fail. In the absence of positive results from the treatment of chronic inflammatory diseases of the upper respiratory tract and oral cavity employees transferred to another job.
Pirogov one of the first thought | idea |, that infection of wounds caused | caused | the hands of the surgeon and his assistants, as well as through underwear and bed linen . To avoid | prevent , prevention | possible contamination of wounds he used to disinfect alcohol, lapis , iodine.
In 1847 based on a large private | personal | Experience | Research | Hungarian doctor | physician | obstetrician - gynecologist Ivan Zemelveys argued that the cause of postpartum sepsis - infection is entering his hands doctor | physician | during the internal investigation after | later | births . Introduce him | introduction | the practice of washing hands 10% bleach solution significantly reduced the number of specified complications .
The English Surgeon D. Lister , based on discoveries | Opening | L.Pastera and analysis of causes of death of patients after | later | operations, concluded that the cause of complications is | appear appear | bacteria. Developed a number of | a bench , a number of | methods of killing germs in the air as on the hands in the wound , as well as items pertaining to the | with the | wounds. As a means of | expense | killing germs he chose carbolic acid. Lister developed a system of measures to | intended | for killing germs in the wound , received | received | name antiseptic surgical method of operation ( 1867) .
Antiseptic, its types , characteristics
Antisepsis (Latin anti - against , sepsis - decay ). By the mid- nineteenth century, more than 80% of the operated patients died from various complications caused by wounds were suppurating . One of the first who suggested that infection occurs through wounds hand surgeon, his assistants , tools, clothes, Hungarian physician Ignaz was Zemelveys , who in 1847 first used for the treatment of the hands of medical personnel bleach to prevent puerperal sepsis. The great Russian surgeon NI Pi - linked Rogov suppurating wounds in the existence of a sort of sick miasma ( pollution ) and to treat wounds applied alcohol , iodine, lapis . Only in 1867 the British surgeon Joseph Lister, according to the teachings of Louis Pasteur of decomposition of organic matter due to the " germ " of air, came to the conclusion that the cause of septic complications and death in patients after surgery are microbes. As a means to kill germs in the wound D. Lister proposed and widely used carbolic acid. His name is linked to the development of a new method of antiseptic surgical operation.
Joseph Lister and his contemporaries at the " Antiseptic " understood the destruction of pathogens of purulent processes in the wound and all the objects of the external and internal environment in contact with the wound , with the help of chemicals. Subsequently, with the introduction into medical practice of sterilization, disinfection, chemotherapy, aseptic imagination of antiseptics changed.
And today when antiseptics should understand the complex health care measures aimed at eliminating the bacteria in the wound and the body as a whole.
There are mechanical, physical , chemical and biological antiseptic .
Mechanical surgery - a complex mechanical measures to destroy or wound infection in creating unfavorable conditions for its development.
Keep in mind that all household injuries are infected. Microorganisms trapped in the wound, held during adaptation and under favorable conditions multiply. Established in the early hours after injury ( 6-12 h) microbes are within the damaged tissue and only time through the lymph , blood vessels spread to healthy tissue. This is why this period is necessary to process a wound - wash it, remove blood clots, gangrenous tissue, foreign bodies. These wounds healed without complications. When festering wounds remove gangrenous tissue, revealing the festering race. After cleaning the wound of pus, necrotic tissue and the appearance of granulation (young connective tissue) impose secondary sutures.
Physical surgery - creating unfavorable conditions for growth and reproduction of microorganisms in the wound by physical properties of various drugs.
Most often used for this purpose hygroscopic dressings : gauze, napkins, turundas, drainage. However, be aware that the content of the wound quickly penetrates bandages and after 5-6 hours it loses suction feature. To extend and improve the suction dressings impregnated with extra hypertonic solution or antiseptic ointments hyperosmolar ( Nitacid , strep - tonitol , oflaksyn etc. .) , So you can replace the dressing after 12 hours. For better cleaning wounds commonly used drainage tube or rubber strips that are made of surgical gloves , because they can stand on their own content (passive selection) , and in conjunction with suction drainage pipes ( water , electric ) - active. The methods include natural antiseptic wound irradiation with ultraviolet lamps, ultrasonic, laser cutting . Thus not only achieve drying wounds, but also bactericidal action on the microflora . Often for drying wounds made special metal frame to which is mounted bulbs . Recently established special edition aeroterapevtychnyh units ( Ata ) with laminar flow of sterile air.
The use of such a facility provides the creation of a special environment that favorably affect the course of wound healing and delay the growth of microorganisms. In the absence of such equipment can treat open wounds with bandages method (the action of air, sunlight) .
Chemical and biological antiseptic
Chemical and biological antiseptic - This is a general antiseptic in which to kill germs in the wound or in the body as a whole using various chemical or biological means.
they are divided into preservatives and chemotherapeutic drugs.
Antiseptics - it's mostly non-specific antimicrobial agents actions. Antiseptic preparations can be used for local treatment of wounds in the form of solutions, powders , ointments , emulsions, for making bath ( for burns or other major wounds ) for the introduction of pus cavity through the drainage tube , for rehabilitation ( recovery ) of the whole body - internal rishnom the muscle , intravenously, intra- , intraosseous , and endolymphatic enterally ( orally or as an enema ).
The most common use of antiseptics such groups :
1. Group halides . Chloramine (Chloraminum) - white with yellow
white crystalline powder. It contains 25-29 % active chlorine, launched at the Ministry -
ing what is used as a disinfectant and deodorizing agent. its
used to treat infected wounds (washing , wetting ser-
twigs , turundas 1.5-2 % solution ), hand disinfection (0.25-0.5 % solution ), death
infection of non-metallic tools , handling care items HVO -
rhyme ( urinal , ships , etc.). , disinfecting excreta (feces , urine,
specimens (3-5 %).
Hloratsyd (Chloracidum) - a white crystalline powder, soluble in water, alcohol, as a 0.5% solution is used for the treatment of hand surgery , sterilization of catheters, drainage , irrigation of purulent cavities , treatment of infected wounds .
Chlorhexidine (Chlorhexidinum) - released as a 20% aqueous solution - 500 ml. There is a very effective remedy for gram-positive and gram -negative bacteria , stimulates the phagocytic action on fungi. 0.5% alcohol solution is widely used for the treatment of hand surgery , the surgical field , sterilization of surgical instruments . The aqueous solution hlorheksydy well - used in septic processes ( washing wounds , cavities , bladder , etc.). .
Alcoholic solution of iodine (SolutioYodi spirituosa). Iodine -old antiseptic. However, due to the irritant effect of iodine on the skin and mucous membranes , and the presence of toxic- allergic properties using it currently prohibited by order of the Minister of Healthcare of Ukraine.
The widespread use today are iodine - iodoform , they have antiseptic properties, do not create resistant strains of micro-organisms and have no side effects on the body.
Yodynol (Iodinoli) - an aqueous solution of 0.1% iodine , 0.3 % potassium yodytu and 0.9% polyvinyl alcohol. Yodynol used in the treatment of thermal and chemical burns , festering wounds, sore throats . However, remember that yodynol inhibiting the growth of streptococci, staphylococci relatively inactive and has no effect on gram-negative bacteria. Therefore, its use in surgery is limited.
Yodonat (Iodonati) - aqueous mixture of sodium alkyl sulfates with iodine. 1% solution of the drug, diluted 3 times with distilled water, is an effective way to handle the surgical field .
Yoddytseryn (Ioddicerinum) - iodine domestic product of the new generation has a strong fungicidal , antimicrobial and antiviral effect . Produced a solution . The main indication for use of the drug is a chronic inflammatory infection ( sores , ulcers , fistulas , etc. . ). The drug is used topically to swab turundas as flushing , irrigation and so on.
2. Oxidants. A solution of hydrogen peroxide (Solutio Hydrogenii peroxidi
diluta) 3% is used for washing wounds , cavities as an antiseptic
and deodorizing agent. The foam that forms on the surface of the wound, moreover, removes non-viable cells.
Potassium permanganate (Kalu hypermanganicum) - powder dark brown or reddish- purple in color , soluble in water. Applied 0.1-0.5 % aqueous solution for washing wounds, cavities, burn surface . It is a strong oxidant , has antibacterial and deodorizing properties. In a 2-5 % concentration is used as a means of tannic .
Boric acid (Acidum boricum) - a white crystalline powder, readily diluted in water, alcohol . 2% aqueous solution used for washing wounds , especially in the presence of blue- green sticks manure can be used as ointments, powders .
3. Dyes . Methylene blue (Methylenum coeruleum) - dark
green crystalline powder, poorly soluble in water, alcohol . Use -
stovuyut as 1-3% alcohol solution for burns, purulent dis -
Brilliant green ( Viride nitens). Applied 0.1-0.2 % alcohol solution purulent skin disease . Included in the fluid MV Novikova , which is used for processing micro traumas , skin rash.
Rivanola (Aethacridini lactas) - yellow crystalline powder, has antimicrobial antykokovu action, especially against streptococci, low toxicity, does not irritate the tissues. Used for treatment and the treatment of wounds , pleural lavage , abdominal and others. at concentrations of 0.05 % ( 1:2000 ), 0.1% ( 1:1000 ), 0.2% ( 1:500 ).
4. Formaldehyde . Causes dehydration mummification tissues ma -
Formalin (Formalinum) - aqueous solution of formaldehyde. Apply for disinfecting instruments (0.5% solution). Included in the triple solution ( formalin 20 grams , 10 grams of carbolic acid , sodium carbonate -30 g per 1000 ml of distilled water). In formalin vapors in special chambers to sterilize devices with optical system.
5. Salts of heavy metals. Mercury dichloride - mercuric chloride (Hydrargiri
dichloridum) - white powder, soluble in water, alcohol, an active anti-
septic tanks, on the other hand - quite toxic agent. Apply for zneza -
razhuvannya sick care items , gloves at a dilution of 1:1000 .
Reserve list and in a well- plugged bottles.
Oxidation of cyanide of mercury (Hydrargyci oxycyanidum) - strong antiseptic. At a concentration of 1:1000 cystoscope is used to sterilize instruments and other optical systems. 1:10 -1:20 Solutions 000 000 used in urological practice to flush the bladder , the eye - when blenoreyi , gonorrhea, conjunctivitis , and others.
Silver nitrate (Argenti nitras) - clear crystals , odorless , readily soluble in water, alcohol . At low concentrations has vyazhuchu , anti-inflammatory and bactericidal action. Used externally as a 2-10 % solution, ointment, lyapisnyh pencils.
6. Detergents . Tseryhel (Cerigelum) - a colorless viscous liquid with an odor of alcohol. It belongs to the group of cationic detergents and has a high surface activity . When applied to the skin forms a film is used as an antibacterial , antiseptic drug for the treatment of hand injuries.
Eton (Aethonium) - a white crystalline powder with a specific action, easily soluble in water and alcohol. Effective against streptococci, staphylococci and other microorganisms. At the same time , causing local pain relief , stimulates healing. Applied externally as 0,02-1 % solution.
Dioxidin (Dioxidinum) - green- yellow crystalline powder, odorless , bitter taste. It is readily soluble in water, has a broad antimicrobial spectrum . It as sensitive aerobes and anaerobes. For external use produced in the form of 1 %, 0.5 % aqueous solution for intravenous - 0.1 % solution.
Dimeksid (Dimeksidum) - clear liquid with a specific odor, well diluted with water or alcohol. The product has a strong bactericidal , anti-inflammatory , analgesic effect, increases the sensitivity of microorganisms to antibiotics. For external use using 10-30 % solution.
Chemotherapy drugs have a specific mechanism of action and spectrum . It usually inorganic ( sulfa drugs ) and organic ( antibiotic ) compounds are not only bactericidal but bacteriostatic effect.
1. Sulfa drugs . Streptocide (Streptocidum) - a white crystalline powder, poorly soluble in water. Used for the treatment of streptococcal , meningococcal , gonococcal and other infections. Internal use by 0.5-1.0 g 4-6 times a day.
Norsulfazola (Norsulfasolum) - more active drug than streptocide use in inflammatory diseases of staphylococcal etiology. Assign 0.5-1.0 g 4-6 h.
Sulfadimezin (Sulfadimesinum) - white powder, practically insoluble in water. One of the strengths of sulfonamides, rapidly absorbed, low toxicity, very active. Apply for streptococcal, pneumococcal, meningococcal and other infections.
Etazol (Aethazolum) - white yellowish powder. Practically insoluble in water, alcohol - soluble hard. Has a pronounced effect on streptococci, pneumococci, meningococci, gonococci, Escherichia coli, pathogenic anaerobic bacteria. The product has low toxicity, is quickly absorbed into the body. Assign 1.0 g 4-6 times a day. In severe cases etazol sodium is used in 10-20% solution (5.10 ml)
for intravenous infusion. Re-entry is recommended every 8 hours. The course of treatment is 7-10 days.
Bactrim (Baktrium) - combination product that contains two active ingredients: sulfa drugs sulfamethoxazole and trimethoprim. There are antibiotics. Produced also called Biseptol. Assign Table 2. (For adults), 2 times a day. The drug is rapidly absorbed, maximum concentration is kept for 7 h. Recently, the use sulfisoksazol and sulfamethoxazole.
2. Antibiotics (biological preservatives) - organic compounds produced during the life of organisms. There are a group of antibiotics:
Penicillin (Penicillinum) has a broad spectrum of activity against various microorganisms. Penicillin is dissolved in an isotonic solution of sodium chloride, 0.25 - 0.5% solution of novocaine. Rapidly absorbed and excreted, and therefore it must be entered every 4-6 hours. Recently, it is used less frequently because of penitsylinostiy-cal forms of bacteria. Prolonged use of penicillin may candidosis (fungal infection).
Group streptomycin. Streptomycin (Streptomycinum) has a pronounced effect on the various flora and especially in Mycobacterium tuberculosis. Enter intramuscularly at a dose of 500 000 to 1 000 000 IU 1-2 times a day.
Streptotsylin (Streptocillinum) - a mixture of benzyl penicillin and streptomycin, and therefore is a highly effective drug in mixed infections. Assign 1-2 times a day to 900 000 units.
Tetracycline. Tetracycline (Tetracyclinum) used for the prevention of postoperative complications, burns, various suppurative complications. Prescribe in pill form to 0.1-0.15 g 4-6 times a day. The maximum daily dose - 2 h can be used locally as a 1.2% ointment.
Oxytetracycline (Oxytetracyclinum) the structure and the action is close to tetracycline. Prescribe in tablets of 100 000-500 000 IU (0,10,5 d) to receive 3-4 times a day. The highest dose - 2 hours
Morfotsyklin (Morphocyclinum) is a synthetic drug that is easily soluble in water, its effect is similar to tetracycline. Use in cases where it is necessary to create a high concentration of antibiotic in the blood and tissues. Produced in bottles of 0.1, 0.15 g (100 000 and 150 000 IU) and injected 1-2 times a day intravenously with 20 ml of 5% glucose.
Doxycycline hydrochloride (Doxycyclim hydrochloridum) - a semi-synthetic drug oxytetracycline, a broad spectrum of activity, active in many resistant bacteria, but has no effect on Pseudomonas aeruginosa, Proteus, fungi, viruses. The drug is rapidly absorbed and slowly excreted from the body. Use it on the first day to 0.2 g once or 0.1 g every 12 hours. In the next few days - 0.1 grams per day.
Group aminohlyukozydiv. Monomitsin (Monomycinum) has a broad spectrum of activity. Active against microorganisms resistant to tetracycline, chloramphenicol, streptomycin. Enter intramuscular injection of 250 000 IU 3 times a day. Prolonged taking may be cochlear nerve, kidney damage.
Kolimitsyn or neomycin sulfate (Colimycinum sulfas) has a broad spectrum of activity. Used for treatment of purulent abdominal processes pleural cavities, septic wounds etc.. Resistance to microbes kolimitsynu develops slowly. Take 0.1, 0.25 g tablets 2-4 times daily or intramuscular injection of 0.5 g, 2 times a day.
Gentamicin sulfate (Gentamycini sulfas) has bactericidal activity against many gram-positive and gram-negative microorganisms, including - Proteus, E. coli, and others. Resistance develops slowly. The drug is rapidly absorbed, but has oto-and nephrotoxic effects. Available in vials and ampoules 0.08 (80 mg) and 0.04 (40 mg).
Amikacin (Amikacinum) - one of the most active antibiotics aminohlyukozydiv obtained semisynthetic route. It has a wide spectrum of action. Especially effective in relation to gram-negative infections. Apply for intramuscular or intravenous administration of 100 or 500 mg 2-3 times the rate of 10-15 mg / kg per day.
Antibiotics, macrolides in its structure with lactone ring.
Erythromycin (Erythromycinum) the spectrum of action similar to penicillin, but better tolerated. Take tablets of 0.1, 0.25 g (100 000 - 250 000 IU) every 4-6 hours. Daily dose - 2 g
Group chloramphenicol. Chloramphenicol (Laevomycetinum) - a synthetic broad-spectrum drugs. Prescribe in tablets 20-30 minutes before meals 3-4 times of 0.25 and 0.5 g capsules - 0,1, 0,25 and 0,5 g for intravenous infusion using 1% solution: Dissolve 0.25 or 0.5 grams of the drug, respectively, in 25 or 50 ml of water for injection. You can enter a drip of 5% glucose solution, 0.9% sodium chloride solution.
SYNTHOMYCINE (Syntomycinum) - the active substance is chloramphenicol. Applied externally as 01/05/10% emulsion for the treatment of septic, burn wounds, ulcers and so on.
Rifamycin group - a group of antibiotics derived natural and semi-synthetic method.
Rifamycin (Rifamycinum) has significant antibacterial activity, including strains resistant to other antibiotics. Active against tuberculosis. In high concentrations, acts on E. coli. Assign for intramuscular and intravenous infusion at a dose of 0.5-1.5 g, 2 times a day.
Cephalosporin group. The structure of these antibiotics - to 7-amino acid notsefalosporynova. They have a broad and significant antibacterial activity. Cephalosporins are divided into I, II, III, and IV generation (generation). Most commonly used:
Cefazolin (Cephazolinum). Available in a sodium salt. Enter the drug intramuscularly at a dose of 0.25-0.5 g diluted in isotonic sodium chloride or intravenous 5% glucose solution.
Cephalexin (Cephalexinum) has a pronounced effect on gram-positive and gram-negative bacteria. However ineffective against Proteus, Pseudomonas aeruginosa. Prescribe in tablets of 0.25-0.5 (daily dose - 1.2 g) 3-4 times a day.
Maksypym (Macsupimum) has a wide range and a pronounced effect against gram-positive and gram-negative pathogens both aerobic and anaerobic. Treatment maksypymom be started without waiting for the results of a sensitivity analysis. The usual dose for adults - 1 or 2 g every 12 hours.
Tien (Thienam) - B-lactam antibiotic with a broad spectrum of activity to Gram-positive and Gram-negative pathogens, both aerobic and anaerobic resistant to other antibiotics. Antibacterial spectrum tiyenamu much broader than any other antibiotic, which enables its use in the treatment of polymicrobial, mixed aerobic and anaerobic infections. Tien is produced in two forms: the first for intramuscular and intravenous injection. Vials containing 500 mg and 750 mg. Dissolved in 2 ml and 3 ml of water for injection or physiological sodium chloride solution. Assign 2-3 grams per day. Intramuscular formulation should not be used for intravenous administration.
The presence of a large number of antibiotics makes it possible to use them in different combinations. It should take into account the nature of their joint action. Today has developed special schemes compatibility antibiotics.
Errors and danger of antibiotic therapy. The main mistake of antibiotic therapy and the risk is the wrong choice.
Antibiotics should be based on the definition sensitivity of cultured microorganisms and held as monotherapy.
The combination of antibiotics is prescribed only in the presence of mixed flora. When prescribing broad-spectrum antibiotics can be observed allergic or toxic reactions and the development of dysbiosis.
You can not use antibiotics with an expired shelf life, and antibiotics were kept in violation of instructions. Before each appointment is necessary to determine sensitivity to antibiotics.
To do this, use the following tests:
Intradermal. The inner surface of the forearm internal rishnoshkirno 1000 ED administered antibiotic dissolved in 0.1 ml of isotonic sodium chloride solution. To control use the same amount of isotonic sodium chloride solution, but without antibiotic. In patients with hypersensitivity to antibiotic administration area observed hyperemia, edema, rash.
Prick via scarification. The inner surface of the forearm, after treatment with 70 ° alcohol, put one drop of investigational antibiotic, diluted with isotonic sodium chloride solution (1 IU per 1 ml in allergic history and 50 units per 1 ml in its absence) and spend scarification. Results evaluated as during internal noshkirnoyi sample.
Sublingual test. Patient with a small gauze ball are 1/4 -1 / 3 dose of study medication under the tongue. A positive reaction in 10-20 minutes. observed swelling frenulum of the tongue, buccal mucosa, lips.
A positive reaction of the antibiotic can not enter.
In patients with hypersensitivity to antibiotics may have allergic reactions such as rash, redness of the skin, dermatitis, urticaria, angioedema (angioedema), rhinitis, bronchitis and so on. When they occur should be abolished and prescribe antibiotics, antihistamines (diphenhydramine, suprastin, pipolfen, diazolin, ketotifen), in severe cases - hormones (hydrocortisone, prednisone, etc.)..
When using antibiotics without defining sensitivity in patients quite often antibiotic anaphylactic shock.
Anaphylactic shock antibiotic evident decrease in blood pressure, loss of consciousness, facial swelling, urticaria, sometimes vomiting, and diarrhea.
In severe cases, the observed respiratory disorders (dyspnea), intestinal bleeding, liver damage, brain edema, coma. Death may occur in the first minutes or hours after administration of antibiotics.
Treatment. The patient was urgently necessary to introduce 0.2% solution noradre Nalin, or 0.1% solution of epinephrine in a dose of 0.5-1 ml subcutaneously or intra-muscularly. In severe cases, intravenously administered 5 mg of norepinephrine in 500 ml isotonic sodium chloride solution, along with 75-100 mg hydrocortisone or prednisolone 50-100 mg, 1 ml of 1% solution mezatona, 10 ml of 10% calcium chloride solution. If laryngeal edema and an increase in dyspnea spend tracheal intubation, tracheostomy, artificial respiration, injected 10 ml of 24% solution eufillina, 1 ml of 2.5% solution dimedrol, diuretics (Lasix).
When using any antibiotic, especially at high doses, may occur toxic effects on individual organs and systems. Clinically, it can manifest disorders of hearing, vestibular apparatus, optic nerve, central nervous system, gastrointestinal tract, and others.
Candidiasis caused by yeast fungi of the genus Candida. Long-term use of antibiotics gives a normal relation between various representatives of the microflora (bacteria inhibited growth and multiplication of yeast fungi amplified). At that affects the mucous membranes, skin, internal organs (respiratory tract, gastrointestinal tract, genitourinary system, etc..).
Treatment. For the treatment of candidiasis prescribe antifungal drugs - nystatin 500 000 units (1 table.) 3-4 times daily or levorin 1 capsule (500 000 IU) 2-3 times a day, amphotericin 250 U / kg intravenously (particularly the drug effective in the treatment of fungal diseases which are treatable by other antifungal agents), hrizeofulvin. There are recent new antifungals - Nizoral and Diflucan (fluconazole).
Enzymes. Used in surgery and drugs are proteolytic (protein melted) action: trypsin, chymotrypsin, pancreatic ribonuclease, collagenase, elastolityn, terylityn et al. These drugs have the ability to melt necrotic tissue fibrynni formations thin viscous contents wounds, blood clots. Relatively healthy tissue, these enzymes are inactive. They are widely used for the treatment of purulent, necrotic wounds.
Volatile - preparations containing biologically active plant substances with antimicrobial expressed as bactericidal and bacteriostatic action. They are made from the leaves of eucalyptus, hypericum, makleyi, heart and other plants. Widespread use of such drugs as received Chlorophilipt, novoimanin, ekterytsyd, tincture of calendula, garlic and so on. They are used mainly for the treatment of septic wounds, rinse cavity and inhalation for respiratory diseases.
Basic principles of aseptic
Introduction aseptic opened a new era in the development of surgery. Today asepsis is one of the main foundations on which rests the modern surgery. With the development of aseptic surgery was possible to extend the range of surgeries, conduct transplantation of organs and tissues. Aseptic Technique was developed in the 80-90s of last century, E. Bergman and his student E. Shymelbushem.
Under aseptic (a - without, sepsis - decay) is meant a set of preventive methods aimed at preventing the ingress of microorganisms in the wound, creating bezmikrobnyh, sterile environment for the surgery through the use of organizational arrangements, technical, chemical and physical factors. Today aseptic surgical operation method combined with the use of different antiseptic preparations.
The main goal of asepsis is to destroy germs on all subjects, instruments, dressings, etc.., Which can contact with the wound or can be introduced into the body during examination or treatment. Keep in mind that everything that comes in contact with the wound must be clean and free from germs (sterile).
Sources and routes of infection in surgery
Airborne infection and its prevention. The importance of preventing suppuration in wounds is prevention airborne infection. Today proved that suppuration of surgical wounds is directly proportional to the degree of microbial contamination of the air operating.
When air infection should be understood microorganisms in the air and can get to the wound. The number of microbes in the air is proportional to its contamination. Fighting dust and air pollution in operating and dressing are the foundation of prevention of air infection. Of great importance in the fight against infectious contamination is timely cleaning of the operating room, air conditioning, UV light exposure, adherence to an antimicrobial treatment.
Under Drip infection should be understood microorganisms spread and transmitted to another person when talking, coughing and sneezing. To protect the wound from infection droplet masked. Keep in mind that when talking droplets of saliva can fly apart at a distance of 1.5-2 m and nursing staff can be a source of infection patients. In saliva gets infected in the presence of carious teeth, tonsillitis, purulent processes of the mouth, nose.
For the prevention of droplet infection is carried out a range of measures:
All patients, including medical professionals, with high fever, catarrhal symptoms from the respiratory tract into the operating permit no. All employees who are involved in transactions, regardless of position, should be examined periodically in ENT med-Line with mandatory bacteriological control roto-and nasopharynx.
In the presence of the examined pathogens in crops (batsylonosiyi) conduct appropriate treatment (sanitation).
It is mandatory to wear a mask that covers the mouth and nose. Today proved that mask with four layers of cheesecloth retains 90-94% of microorganisms. Mask of six layers holds up to 97% of bacteria. To reduce the penetration of droplets of saliva between layers of gauze pads should be placed further from wool.
Contact infection and its prevention. During the contact infection should be understood infected wounds through objects: gloves, tools, dressings, needles, etc.., Hand surgeon and his assistants. The main way to prevent infection is contact disinfection and sterilization, which was carried out by chemical and physical methods.
Implatatsiyna infection and its prevention .. Arises through suture, bone clamps, drainage and so on. listed in the sore and infected when executing or due to violations of sterilization.
According to the order of Ministry of Health of Ukraine ¹ 120 from 25.05.2000, for the purpose of prevention of HIV-infection and viral hepatitis B and C infection nozokominalnoyi all medical devices, tools that are used for a variety of manipulations and operations shall be subject to disinfection, and sterilization before sterilization processing .
Responsible for disinfection, and sterilization process before sterilization is the older sister of operating unit.
When disinfection is meant a set of measures aimed at the destruction of pathogenic and potentially pathogenic microorganisms to humans for tools, etc.. environment. All instruments (cannula, forceps, scalpels, catheters, bloodsto, clamps, scissors, etc..) After using them apart and immersed in a 3% solution of chlorine bleach solution bodefenu, mikrobaku 60 minutes if instruments contaminated with blood, it is immersed in 1% solution of sodium benzoate for 1 hour, or 4% hydrogen peroxide solution for 90 min. Disinfectant solution used once.
Before sterilization processing tools
Upon completion of the disinfection of medical instruments washed in running water over the sink to completely remove dirt disinfectant. Washed and disinfected medical instruments are soaked in hot (50-55 ° C) Pressure wash solution (detergent "Biolot", "Lotus" or the "Ari-el" - 5 grams of powder, 170 ml of 3% hydrogen peroxide solution in 825 mm of water) for 15 minutes at full immersion products. The temperature of the solution during soaking is not supported. Then wash in the working solution for 30 s to one instrument. Cleaned and washed medical instruments washed first under running water and then in distilled water. Medical instruments Washed up and dried in hot air oven at temperature of 85 ° C until complete disappearance of moisture.
Test with "hemotestom-m". First, prepare a working solution, which consists of a mixture of alkaline solution chromogen (reagent 1) and hydrogen peroxide (reagent 2). In the study tools put few drops of the working solution and wipe the surface of the product swab dipped in a solution. If there is any blood appears violet-blue color.
Test with azopiramom. Before checking quality cleaning tools, prepare a working solution by mixing equal amounts of azopiramu of 3% hydrogen peroxide solution (1:1). Working solution should be used within 1-2 hours, with the appearance of spontaneous pink color change it. In the study tools put few drops of the working solution and wipe the surface of the product swab dipped in a solution. In the presence of blood in the contaminated areas of instruments (products) appears violet color, which for a few seconds turns into pink, blue or brown. With azopiramu detect the presence of hemoglobin, peroxidase herbal, oxidizers (bleach, bleach, detergents, solvents, acids, and others. Bure color observed in the presence of the studied subjects rust and hlorokside. Studies conducted at room temperature (not above 25 oC ).
The sample preparation of "Torch 2". The product is a white powder, produced in plastic vials (1000 samples). For the tests on the remains of blood, prepare a working solution. Open the capsules (dispenser) and it poured 0.02 g product, which was dissolved in 10 ml of water. At the same time receive 0.2% solution of reagent F-2. In solution adds 1 ml of 3% hydrogen peroxide solution (ratio 1:10). In the studied object (tool) put a few drops of solution or wipe moistened swab. In the presence of blood drug solution F-2 becomes pink or cherry color. Time of observation - 5 min. The working solution was used for 30 min.
Phenolphathalein indicator test. Prepare a 1% solution of phenolphthalein and put on a piece of washed 2-3 drops. In the presence of detergent appears pink color.
When sterilization is meant a set of physical and chemical methods of complete disinfection of tools, appliances, machines, and other implements medical supplies. To do this, mainly used calcination, pasteurization, boiling, suhozharovyy method (160-200 ° C), autoclaving.
Calcination. This method of sterilization can be used in emergency situations when an urgent need to prepare some tools: needle holder, needles, clips, etc.. However, it should be remembered that the ignition is not achieved reliable disinfection, in addition, this method of sterilization instruments spoils.
Pasteurization - a method of decontamination of organic liquids using temperature 60-100 ° C, at which only kill vegetative forms of bacteria. it is used mainly in the manufacture of protein drugs, culture media by re-heating to 55-60 ° C for 30 min.
Boiling is now rarely used, except in small hospitals. Tools Used after disinfection and processing are placed in a special metal sterilizer with grid and lid tightly closed.
In sterilizer pour water and add sodium bicarbonate to produce 2% solution. The liquid is brought to a boil, immerse it has analyzed and compiled into a grid tools. When the water boils again, note the start time of sterilization. Upon completion of sterilization into the instruments are removed from the boiler (Fig. 24), the tools laid out on a sheet covered with a sterile tool table. Terms of sterilization include: metal tools - 20 min, rubber items - 10 min. Cutting tools better without adding soda to boil for 5 minutes, after cutting part wrapped with gauze. Boiling syringes and needles in hospitals admitting only in exceptional (military) situations. Healthcare professionals should be aware that this type of sterilization as boiling is not completely reliable because the viruses HIV, hepatitis and some bacterial spores can withstand even prolonged boiling.
Sterilization by steam under pressure. This method is mainly used to sterilize bandages, linen at a temperature of 120 132 ° C. Sterilization by steam under pressure is carried out in a special apparatus, autoclaves. The vapor pressure in the autoclave is controlled by a pressure gauge and a special safety valve through which automatically resets the surplus that can maintain adequate pressure and temperature inside the autoclave.
When the vapor pressure of 1 atm sterilization occurs at a temperature of 120 ° C, sterilization time - 45 min. When the vapor pressure of 1.5 atm in an autoclave temperature is increased to 127 ° C, the sterilization time is reduced to 30 minutes. At a pressure of 2 atm internal temperature reaches 132 ° C, and at the same time sterilization is 20 minutes.
Material for sterilization placed in special boxes (Bix) (Fig. 26), which is used for sterilization of various items and their subsequent storage.
Bix is usually round in shape and different capacity, made of stainless steel. Being closed with a lid and a special lock. Along the perimeter
Bix is a small hole through which enters into steam. To handle lock attached special Tags, which record the date of sterilization, material and its owner. Upon completion of the sterilization material is considered sterile for 72 hours. Now produce special sterile box (Bix) with antibacterial filters (KSPF) in which the shelf life of sterile material lasts up to 1 month. It should be remembered that if sterile slut opens its contents should be used within one day.
Sterilization of instruments, syringes performed under a steam pressure of 1.5 atm for 30 min. Rubber tubing, catheters, drains before sterilization to stand for 1 h in 1% solution of bleach or hloratsydu, dioxidin, washed with water and dried, wrapped in gauze and sterilized at a pressure of 1 atm 45 min. Recently, the use of rubber products only use single (drainage tubes, catheters, gloves) that are sterilized at the factory.
To assess the sterility of the material after autoclaving using different chemicals that alter its physical properties at 120-132 ° C (sulfur powder (117 ° C), antipyrine, Amidopyrine (110 ° C), resorcinol (119 ° C), benzoic acid ( 121 ° C), urea (132 ° C). Lately produce standard indicator tube and special Thermo indicator paper, which changes color depending on the temperature and exposure.
With no standard indicator made it their own. Matter is poured into a small test tube caulk a piece of gauze or cotton ball and place among the items to be sterilized. If the light has not changed (not melt, did not change color), the sterilization failed and the material can not be used.
Sterilization by dry heat (air sterilization). Metal tools better sterilized by dry heat. Dry heat cabinet work on electricity. Surgical instruments selected for the transaction, put on a metal grid and placed in the sterilizer (Fig. 27). Closet closed and include electric heaters.
10-15 minutes the temperature inside the cabinet reaches 160 ° C. With the controller, it can reach 200 ° C. The duration of sterilization depends on the temperature: at 160 ° C - 150 min, 180 ° C - 60 min, 200 ° C - 15 min .
To monitor sterilization in cabinets using chloramphenicol (melting point 150-160 ° C) sucrose and tartaric acid (180 ° C), hydroquinone, thiourea (over 180 ° C). Best-industrial indicator - sealed tube with powder of sucrose and tartaric acid, which at 180 ° C into a liquid. Dry heat sterilization cabinets installed in along with the operating rooms. In these cabinets can be sterilized several different sets of tools.
Gas sterilization. Used mainly for the sterilization of products from polymeric materials (endoscopes, plastic). The most common gas used for sterilization is ethylene oxide. This dangerous gas can explode, so it's easier to use a mixture of carbon dioxide, methyl bromide. Optical devices and their elements can be sterilized in formalin vapors. For this special airtight glass or plastic cylinder (camera) is placed at the bottom of formalin 2-3 tablets (paraform) or pour 10-20 ml of formalin. Sterilization is carried out during the day (Fig. 28).
Industry produces special gas sterilizers. Upon completion of the sterilization material is placed in the plenum.
Sterilization using solutions (chemical sterilization). Cutting instruments (scalpels, knives, scissors, razor blades, needles) and rubber products, which deteriorate when heated, can be sterilized in solution. To prepare tools usually use 96 ° ethanol. Tools pour alcohol two hours before surgery.
In some cases, for sterilization of rubber products (gloves, catheters, drains) use diotsyd (1:3000), 2% solution of chlorine bleach, no-vosept, rokal et al.
Radiation sterilization. With this method of sterilization using ultraviolet radiation or g-rays. With g-rays sterilized suture material, implants, catheters, etc.. Radiation sterilization is quite reliable. Objects can be stored in sealed sterile packaging for many months.
Control of sterilization
Control of sterilization material is made tools for performance manometer, thermometer, indicator substances that change their physical properties depending on the temperature and duration of sterilization and bacteriological method which is the most efficient and helps you determine the type of bacteria.
Crops sterility of surgical instruments. Surgical instruments using sterile tweezers reach a slut or a soft package and placed in a test tube full of nutrient medium. Exceptionally, in some cases, if all sterilized instruments in one pack large size (Needle Holders, ranorozshyryuvachi, etc.), conduct washed from the surface of the instrument sterile cloth moistened with sterile saline or sterile running water and place a napkin in a test tube with tiohlikolevym environment. Similar washings with other tools inoculated into tubes of medium Hottinhera and Saburo.
Sowing sterility catheters, rubber gloves and other rubber products and plastic. Sterility control probes, catheters, rubber gloves and other rubber products is carried out by fully immersing small products in the culture medium, from large cut small pieces (1-2 cm) and placed in a culture medium.
Drill results are available 48-72 hours. Such monitoring should be performed 1 time per month with appropriate registration.
Preparation hands before surgery
Medical personnel should carefully monitor the cleanliness of their hands, to avoid contamination. If there are abrasions, scratches, and especially purulent diseases to participate in the operation are absolutely prohibited. Not allowed manicure, nails should be cut short. Recommended overnight lubricate your hands with petroleum jelly, lanolin or hand cream.
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There are several traditional (classical) and modern treatment arms.
The most common is the traditional method Spasokukotsky-Kochergina. In two dry basins for washing hands pour 5 ml 96 ° alcohol and burn their surface. Then pour two pots
2 liters of distilled water and add 10 ml of pure ammonia (Fig. 29). In this solution to wash their hands using napkins alternately for 3 min. Pre-washing hands brushing is not required, it is performed only if contamination. Then dry your hands with a sterile towel or napkins for 5 min and treated with wipes soaked with 70 ° or 96 ° alcohol. Interdigital spaces and nail cuticles additional 5% alcoholic solution of iodine (yodonatom).
Method Fyurbrinhera is washing hands under running water with two brushes for 5 min each (Fig. 30). Then he wiped his hands sterile towels or towel and treated with 15% solution turns dichloro do mercury (mercuric chloride) for 3 min (rys.31). The tips of the fingers smeared with 5% alcoholic solution of iodine (yodonatom).
Method Alfeld. Of all the others, this method is used most often. Hands are washed two sterile brushes with warm running water
3 soap and water for 10 minutes, then wipe with a sterile towel and treated with 96 ° alcohol for 5 min, the nail bed smeared with 5% alcoholic solution of iodine (yodonatom).
With modern methods of treatment, there are several ways:
Treatment arms hlorheksydy Mr. (hibitalom). Hibital released as a 20% aqueous solution of 500 ml. Hand wash using 0.5% alcohol solution. For this preparation was diluted in 70 ° ethanol at a ratio of 1:40. After the usual hygienic hand washing with warm soapy water, wipe hands with a sterile towel and then treated twice for 3 min. wipes soaked in the solution. Additional treatment with alcohol and so on. needed.
Processing dehmitsydom. Apply 1% solution at a concentration dehmitsydu 1:30 (1 part drug and 29 of distilled water). Process as chlorhexidine.
Processing nadmurashy hands-tion acid. Method: 30% hydrogen peroxide (172 mL) and 85% formic acid (81 mg) in turn poured into a glass bottle, mix and place in a saucepan with cold water to 1-1.5 hours. After cooling, the solution was diluted with water (you can tap) to 10 liters. The solution should be used during the day. In five liters of working solution can wash their hands in 1011 people. Initially, the hands are washed 1 min with running water and soap (no brush), and then within a minute - in solution nadmurashynoyi acid (no napkins). After washing hands with one of the above methods of wiping dry with sterile towels, wear a sterile mask, gown and gloves (Fig. 32, 33).
Use rubber gloves allows for complete sterility hands during operation. Today gloves are widely used not only during operations, dressings, but when examining patients.
For the prevention of surgical infections it is important to regularly check for sterility hands of members of the operating team. To this end, once in 15-20 days before the operation took hold of the hands of surgeons and nurses in operating.
Methods of processing surgical field
Operative field - the scene of the surgeon should be free of microorganisms. Immediately before surgery shaved operative field with method Hrosiha-Filonchikova. Its essence is that the skin is treated with surgical field 4 times a antiseptics. Recently, most often used solution yodonate. It is cooked before surgery (ex tempore): 5% concentrated solution of dissolved yodonate boiled or sterile water at a ratio of 1:5.
First lubricate the skin surgical field is carried out after preliminary washing of gasoline or alcohol wipe twice with sterile swabs moistened with a solution of yodonatu. Second - before incision, after covering the patient with sterile sheets, and others - before suturing the skin and the fourth - after suturing the skin. In addition to these mandatory four treatments, skin surgical field should be lubricated each time changing clothes around the wound (pollution, widening the wound, etc.).
Sterilization of suture material
In surgery using various in their physical properties, chemical structure and source of the suture material: silk, cotton threads, synthetic threads, non-absorbable (nylon, polyester, Teflon, etc..) Synthetic filament, absorbable, with glycolic acid and Dekson, oktselon, polypropylene, metal, stainless steel, tantalum (paper clip, wire), and biological filaments that absorbable (catgut). Due to their different physical and chemical properties of suture materials sterilization methods may not be the same. Some kinds of (silk, cotton threads, polyester, etc.). Sterilized in an autoclave at a pressure of 1 atm for 20-30 minutes. Silk is often sterilized by the method of Kocher. The gist of it is this: after washing and drying the skeins of silk threads placed in jars with ground glass stopper for 24 h in air for degreasing and then at the same time - in 70 ° alcohol. Silk is then put in a pan, pour 0.5% solution of dichloride of mercury (corrosive sublimate) and boil for 10 minutes. Then, translated into sterile jars with ground glass stopper, filled with 96 ° alcohol, in which both preserve. Sterility check silk bacteriological method. Before using silk boiled for 2 min in 0.5% solution of mercury dichloride.
However, the surgery is the preferred silk, which is sterilized at the factory and stored in glass vials sealed. Today it has almost completely replaced by synthetic suture material.
Sterilization synthetic fibers like those that do not dissolve, and those that dissolve spend in boiling water for 20-30 minutes, or in a solution of mercuric chloride 1:1000 for 1-5 min. Then sterilize and store them in 96 ° alcohol in a glass jar with a tight ground-crusts. Metallic suture material (skobky stainless steel paper clip with tantalum clips, wire) are also sterilized by boiling in 2% sodium bicarbonate solution.
Sterilization of biological suture material that dissolves (catgut) is complex and requires special diligence because of the risk of contamination of its anaerobic microflora. It is carried out by chemical methods. Pre suture is placed for 24 h in air for degreasing and then sterilized by the method of Claudius, Gubareva or Sitkovskiy.
By using catgut Claudius in coils placed in an aqueous solution of iodine (1 g crystalline iodine, 2 g of potassium iodide and 97 g of water) for 9 days and then tested for bacteriological sterility method. If the material turns a sterile solution of cans drained and gut fill in 96 ° alcohol, in which it is stored. If non-sterile catgut appears, again pour water solution of iodine for 9 days and then tested for sterility.
Today has become widespread modification of catgut sterilization by AP Gubarev, which suggests using an alcohol solution of iodine. The duration of sterilization is reduced to 7 days.
The method allows to prepare catgut Sitkovskiy faster, but with much material deteriorates, becomes rough, brittle. In a jar with ground glass stopper poured crystalline iodine (40 g per 1 bank capacity of 3 liters and 60 g - 5 l). Zmotanyy catgut in the rings hung in the bank at the height of 6-7 cm from its bottom. Bank closed ground glass stopper and pour paraffin. Periodically, the bank will need to shake for a better distribution of iodine vapor between catgut. After 3-4 days of gut check for sterility (seeding) and in the absence of microorganisms it is transferred to a dry sterile bank where he stored hermetically zakrytymPered sterilization by dry catgut advisable to drop by 1-2 min in 2% solution of potassium iodide. After this treatment it is better to react to iodine vapor.
Given the complexity of sterilization should use catgut, made at the factory.
Sterilization of dressings and linen
The main type of dressings used in the operating room - white absorbent gauze. Cotton has limited application.
Preparation dressings. The gauze should be white, soft, hygroscopic and skim. Width factory -60-70 cm pieces of gauze surgical dressings prepared on a clean table, carefully washing hands. The basic rule compilation dressings optionally gauze inside edges to prevent the ingress of fine threads wound.
To prepare the surgery napkins in three sizes: large, medium and small. Great wipes up the pieces of gauze the size 40x60 cm, medium - 37.5 x30 cm, small - 20h15 cm Prepare them as follows: from
overall piece are 10-12 layers of cheesecloth and cut it with scissors along the lines specified in the diagram (Fig. 34). They are trained large napkins. The middle large piece also cut along the cross yarn gauze into three equal strips, which in turn is cut in half twice. These pieces 20h15 cm size used for making small napkins.
In this case, one end cut a strip width of 20 cm, which is prepared large napkins, on the other - a strip width of 5 cm, which is used for balls. The middle piece of gauze remaining, cut in half, once in the longitudinal, the second - in the transverse direction. From these pieces of prepared medium napkins. Large roll as follows: both circumcised edges to a depth of 5-6 cm inside the wrap, then again up the cheesecloth in half. Minimize average napkins begin with earthing three sides (cut edges): within a depth of 3-5 cm, then wipe up the first half along the transverse and then along the longitudinal threads.
In a piece of gauze, which make up a small napkin, all cut in the sides formed the edges, so they must be wrapped inside napkins. The first hill province of large parties in such a way that they went a little to each other, then the free edge of the smaller parties turning inward so that they faced each other, and finally up the napkin in half. For the same pieces of gauze prepare large, medium and small swabs (Fig. 35).
Great swab prepared as follows: trimmed edges gauze wrapped inside a depth of 5-6 cm and in the same direction twice comprise half. A strip formed length 60 and a width of 10 cm up almost
twice: the lower half should be 5-6 cm longer than the upper. Then swab up again in half. Free edge of the bottom layer of gauze wrapped in a tampon.
Average swab prepared as well: strip formed up along the transverse threads, and then, in longitudinal. Average swab can be made sister while real average napkins.
Drawing begins with a small swab into 1-2 cm from one short edge piece of gauze, and then into the hill with some measure at each other longer edge of re-assembling them in half lengthwise and transverse directions.
Balls are prepared with a piece of gauze 10x10 cm, making them twice and wrapping around the index finger to form a ball, inside which wrap the loose ends.
Preparation laundry. By operating clothes include gowns that are fastened behind, sheets, towels, linen napkins, hats and masks. Before operating sterilization sister integrity checks and makes clothes in her slut. Sheets up as follows: a narrow bend edge for width 50 cm, up to four times the length and loosely skochuyut starting from nezahnutoho end. Composite sheet so very convenient to deploy.
Dressing up the sleeves inside. Then it loosely skochuyut.
Towels and wipes up four times. Masks and caps are sterilized, usually alone or together with the material.
Putting clothes on Bix. Before styling Bix wipe the inside and outside with a tissue moistened with 0.5% solution of ammonia or a solution of 96% ethanol. Then push on the wall of a circular plate slut that closes the side holes cast and vystelyayut cover the bottom and sides Bix pelenkoyu, towel or sheet so that the edges hanging loosely from all sides. At the conclusion of linen and dressings to Bix be followed established procedure that allows you to quickly and easily find the desired object. Linen put in an upright position so that you can pull out slut any thing without affecting the others. Surgical dressings also placed so as to pack every package or you can pull apart. In the center of the tube is placed slut with sulfur or other substances to control sterility.
Depending on the power and purpose operating unit operating clothes, put her kits.
Laying stuff and clothes in this way, you start with a rough per transaction.
To handle every slut tied oilcloth label to indicate which content Binks, indicate the date of sterilization and name of the person who prepared the slut. Others make a pencil. Bix close lid, strengthen hook on a chain and tightly tied lace that she accidentally opened. In late check whether the open side hole slut.
Scalpels are zahalnohirurhichni and eye (Fig. 36a). The shape of the blades are divided into oval and pointed. For the length of the blade zahalnohirurhichni oval divided into large (50 mm blade) and medium (40 mm blade), and oval eye - on average (30 mm blade) and small (20 mm blade). Scalpels genital produce only medium size. Scalpel Handles zahalnohirurhichnyh flat surface of matte eye scalpels handles the cut square. Recently released scalpels for single users'
tion and b and with variable blade.
The shape of the blade distinguished: straight, curved on the plane (Cooper), bent over the edge. In addition, the scissors can be spiky, obtuse and with one sharp end length of 14, 17 or 25 cm
Scissors additional purpose scissors to remove the bandages, nail trimming, grooming, prescription and others.
Scissors with a button (Lister) (Fig. 38a) differ in that they have a curved blade on the edge of the 30 ° and at one end of a long blade portion is in the form of a flat button in order to bring it under the bandage without causing scratches or injury to the skin of the patient.
Nail scissors are straight and curved blade on the butt with a notch (Files for Nail)
Scissors for trimming hair with sharp ends
Prescription scissors - pointed, like a home, but they are among branshamy oval cutout that can be used for the maintenance of cortical plugs