Organization of work in dressing rooms. Dressing room in surgical operating room
The dressing nurse is responsible for maintaining asepsis in the dressing room.
Depending on the profile of the department in a clean dressing room, novocaine blockades, diagnostic and therapeutic punctures of the chest and abdominal cavity, blood and drug transfusions. In clean dressing rooms, minor operations are often performed: applying skeletal traction, removing skin tumors and subcutaneous tissue, primary processing small wounds.
Treatment is carried out in purulent dressing rooms purulent wounds, puncture and opening of abscesses and other manipulations of patients with purulent infection including blood transfusions.
Personnel working in the dressing room, where both clean and purulent dressings are performed, must be especially careful and attentive so as not to confuse the instruments used to bandage clean and purulent patients.
Dressing duties nurse includes training of the nurse working in the dressing room on the rules of asepsis and antiseptics.
Rules of conduct in the dressing room
1. A strict order of dressings is established: clean first, for example, after plastic surgery, then conditionally clean, for example, after operations on the abdominal organs, and in last resort- purulent dressings.
2. Patients take off outerwear (pajamas, robe), stockings, socks in front of the dressing room, in a room specially designated for this, adjacent to the dressing room.
3. Medical personnel work in masks, clean hospital shoes, easy-to-clean shoes (leather, rubber, etc.), gowns with short sleeves or rolled up to the elbows, and a cap. At the entrance to the dressing room there should be a mat moistened antiseptic solution.
4. Infected dressing material is taken only with a tool, thrown into a bucket with a pedal lid and then destroyed.
Organization of work in the dressing room
The working day begins with an inspection of the dressing room. The dressing nurse checks whether the staff on duty used the dressing room at night. In case of emergency intervention or unscheduled dressing, the used and contaminated dressing material is put into buckets with lids, the used instruments, after washing, are soaked in an antiseptic solution. The nurse checks whether the floors and furniture have been wiped with a damp cloth, arranges containers with material, and installs the medications received from the pharmacy the day before.
The dressing nurse receives a list of all dressings for the day and sets their order. First of all, patients with a smooth postoperative course (removal of sutures) are bandaged, then those with granulating wounds.
Having made sure that the dressing room is ready, the nurse begins to treat her hands. First, she puts on a surgical uniform, carefully hides her hair under a headscarf or cap, trims her nails short, and puts on a mask. After cleaning her hands, the sister gets dressed. She takes a robe from the bix without touching the edges of the bix. Carefully unfolding it on outstretched arms, she puts it on, ties the sleeves of the robe with ribbons and hides the ribbons under the sleeve. He opens the bix and ties the strings of the dressing room nurse's robe at the back. After this, the nurse puts on sterile gloves and covers the instrument table. To do this, she takes out a sterile sheet from the box and lays it, folded in half, on the instrument table.
When air sterilizing in kraft paper, the nurse should first find out the sterilization date. Products sterilized in kraft paper can be stored for no more than three days. The instruments should be laid out in a certain order, which the dressing nurse chooses herself. Usually the instruments are laid out on the left side of the table, the dressing material is on right side, special instruments and drainage tubes are placed in the middle. Here the sister puts sterile jars for novocaine, hydrogen peroxide, furatsilin. The nurse leaves the right corner free for preparing stickers and bandages during dressing. The sister covers the instrument table with a sheet folded in half. Preparatory work must be completed by 10 o'clock.
1. Organization of dressings. The nurse calls patients from the wards, guided by a list compiled by the dressing nurse. Bedridden patients are transported on a gurney with a blanket and pillow taken from their bed. After transferring the patient to the dressing table, the gurney together
with a blanket and pillow taken outside the dressing room until the dressing is completed. It is much more convenient to work in a dressing room when there are two tables: while the surgeon is bandaging one patient, the nurse on the other is preparing the second patient - placing him on the table, removing top bandages. If it is not possible to organize two tables, it is necessary to have two gurneys in the dressing room so that the next patient can wait for the dressing, lying near the dressing room. It is unacceptable to use a gurney from the operating room. In the absence of two gurneys, dressings can be speeded up by alternating bedridden and walking patients. Walking patients take off their outer clothing and go to the dressing table. The ward nurse and nurse help the patient lie down on the dressing table, then cover him to the waist with a clean sheet. A doctor is present when changing the dressing; He personally performs particularly important procedures, as well as the first dressing.
Each dressing consists of five stages:
1) removing the old bandage and toileting the skin;
2) performing manipulations in the wound;
3) protection of skin and from wound discharge;
4) applying a new bandage;
5) fixation of the bandage.
1. Removing the old bandage, toileting the skin. A nurse unwinds the bandage. When removing the bandage, do not twist it, as the lower layers may become infected. Bandages soaked in blood or pus are not unwound, but cut with scissors to remove the bandages. To remove the adhesive plaster, its strips are moistened, and when peeling off, hold the skin with your hands. The surgeon performing the dressing removes the sticker with tweezers. To do this, the sister uses a forceps to hand him surgical tweezers. The old sticker is removed along the wound from one end to the other. Removing the bandage across the wound causes it to gape and hurt. When removing the bandage, hold the skin with a spatula, tweezers or a gauze ball, preventing it from reaching behind the bandage. A tightly adhered bandage is peeled off with a ball moistened with a solution of hydrogen peroxide or an isotonic solution of sodium chloride. It is better to remove old dried bandages from the hand and foot after soaking, if the condition of the wounds allows for manual or foot bath from a warm solution of cadium permanganate (1:4000). Before starting the procedure, the bath is treated with alcohol or washed hot water with synthetic detergents. Then pour into the bath warm water 38-40 °C and add a few drops of a 30% solution of potassium permanganate until an intense pink color is obtained. The limb is immersed for 5 minutes along with the bandage. After removing the bandage, the limb is removed from the water, the dressing material is grabbed with a forceps and thrown into the gas. The surgeon examines the wound and treats it. The bath is washed with hot water and synthetic detergents, washed with disinfectant solutions and stored dry.
If removing the bandage causes capillary bleeding, it is stopped by lightly pressing the bleeding area with a gauze ball.
After removing the sticker, the skin around the seam or wound is cleaned. Clean the wound with gauze or cotton balls, first dry and then moistened with technical ether. You can use warm water for cleaning. soapy water 0.5% solution ammonia. It is good to remove Lassara paste with balls moistened Vaseline oil. The skin is wiped starting from the edges of the wound to the periphery, and not vice versa. In this case, drops of liquid should not get into the wound. If the skin around the wound is significantly contaminated, you can protect the wound surface with a sterile gauze pad, thoroughly wash the entire limb with soap, and if the wound is festering, then this procedure must be performed every time the dressing is changed. After cleaning the skin, it is dried with gauze balls, and then treated with iodine with alcohol, iodinol or other coloring antiseptics. Clean skin around the wound is the first condition for successful treatment. In addition to cleaning, the treatment causes local hyperemia, which has a positive effect on trophism after surgical suture and speeds up healing.
2. Performing manipulations in the wound. When dressing, the following manipulations are performed: removing sutures, probing the suture area, ointment tamponade, washing purulent cavities.
Removal skin sutures can be performed by a nurse in the presence of a doctor. To do this, you need surgical tweezers, scissors and a small napkin. Using tweezers, pull on one of the ends of the threads, tied on the side of the suture line. After 2-3 mm of the subcutaneous part of the silk thread appears from the depths of the tissue white, in this place, a sharp jaw of scissors is brought under the thread and this thread is crossed at the surface of the skin. The cut ligature with a knot is easily removed with tweezers. Each removed seam is placed on a small unfolded napkin lying nearby, which, after removing the seams, is folded with tweezers and thrown into a basin with dirty material.
Removing metal brackets. To remove staples, you must have a staple remover and a Michel bracket clamp. Instead of a staple clamp, you can use a curved Billroth clamp. By bringing the jaw of the staple remover or clamp under the middle bent part of the staple, squeezing the tool, the staple is straightened and, having first isolated one, then the other tooth from the skin, it is removed. When removing the staple, use two surgical tweezers to grab it at both ends, unbend it, and remove the teeth from the skin. After removing the sutures or staples, treat the suture line with an antiseptic and apply stickers.
3. Protect the skin from discharge from the wound. Before applying a bandage to wounds with intestinal, biliary discharge (in the presence of intestinal, biliary, pancreatic fistulas), the skin around the wound must be protected from maceration and irritation. For this purpose, the skin around the wound is lubricated with Vaseline, Lassar paste, and zinc ointment. Using a spatula, the nurse applies a thick layer of paste or ointment to the skin from the edges of the wound and further for 3-4 cm and lets it dry.
4. Applying a bandage. For a postoperative aseptic suture it is sufficient aseptic dressing. It consists of a gauze napkin spread over the entire length of the surgical suture, which is covered with another layer of gauze, the dimensions of which are 3-4 cm larger. The gauze is glued around the periphery with cleol. The stitches on the face can be left without a sticker from the first day. A dry aseptic cotton-gauze dressing is used for fresh wounds, after removal of postoperative sutures. Bandages filled with tampons with hypertonic solution or ointments. If there is a drainage tube in the wound, then to bring it out, the bandage is cut, draining the drainage through the incision. The thickness of the cotton wool layer depends on the amount of discharge from the wound. Dimensions cotton-gauze bandage determined based on the size of the wound or postoperative suture with the expectation that its dimensions overlap the suture line by 3 cm. For long-term dressings, often over absorbent cotton wool Apply a layer of gray cotton wool to prevent the bandage from getting wet.
5. The bandage is fixed by bandaging, gluing or using a mesh-tubular bandage. The nurse, using a cotton swab dipped in cleol, lubricates the skin along the edges of the applied bandage to a width of 3-4 cm. The skin around the wound should be clean shaved and degreased with alcohol. After the cleol has dried, apply a piece of gauze on top, stretching it by the corners, which is 4 cm wider and longer than the applied bandage. The gauze is pressed tightly to the skin. Its non-glued edges are trimmed with scissors. When fixing with an adhesive plaster, the surgeon brings the edges of the wound together with his hands and holds them in the desired position, and the nurse tears off a strip of the required length from the roll of adhesive plaster, without touching the area of the plaster that lies on the wound with her hands. Usually 1-3 strips are glued. To prevent the wound from spreading, it is necessary to make strips of sufficient length, covering at least 10 cm of healthy skin. Thus, the total length of the strip is 20-22 cm. Two longitudinal strips are applied on top of the transverse strips parallel to the wound, retreating from the edge of the wound by 3-5 cm.
A properly applied bandage usually gives the patient relief. Even if dressing is accompanied by painful procedures and manipulations, the pain they cause quickly subsides.
It is necessary to pay attention to the patient’s complaints and increased pain after dressing. Most often they are associated with a tightly applied bandage, sometimes a skin burn due to careless use of iodine, but there may also be more serious reasons, for example, secondary bleeding with the formation of a bursting hematoma. At the end of the dressing, you need to make sure that the sticker is strong. When moving and dressing the patient, ward nurses and dressing room nurses help. The nurse must ensure that patients enter only when called and do not linger after changing the dressing.
After each dressing, the oilcloth located on top of the sheet is wiped with a disinfectant solution. If pus accidentally gets on the floor, the nurse immediately wipes the floor with a mop soaked in a disinfectant solution.
Dressings of patients with purulent wounds. Purulent dressings begin only after the dressing nurse checks that all clean dressings have been completed and that there are no purulent patients left undressed. When working with purulent patients, staff wear specially designated gowns, gloves and aprons. The nurse takes the patient to the dressing room, places an oilcloth under him, taking into account the possibility of pus spreading, places a kidney-shaped basin on the wound or places several layers of lignin or sterile cotton wool to prevent pus and rinsing fluids from getting from the wound onto the table. Before opening the abscess, the nurse shaves the hair in the area surgical field and, as directed by the doctor, places the patient in comfortable position. Dressings of purulent wounds, both primary and secondary (arising from suppuration of surgical and traumatic wounds) are of the same type. Treatment of purulent wounds and dressings, in particular, are based on an understanding general patterns currents purulent process, having three phases:
The inflammation phase, which includes two periods - vascular changes (hyperemia, edema) and wound cleansing;
Reparation phase (formation and maturation of granulation tissue);
The phase of epithelialization and reorganization of the scar.
After removing the bandage and cleaning the skin around the wound, the sister gives several dry gauze balls one after another. The pus is not wiped off, but the balls are lightly pressed onto the surface of the wound, like blotting paper. Used balls soaked in pus are thrown into a basin. As directed by the doctor, the nurse gives several balls moistened with hydrogen peroxide, and then again dry balls to drain the resulting foamy mass. Then, in the same way, the nurse gives the surgeon balls soaked in a furatsilin solution, and then dry balls to completely dry the wound.
If necessary, the dressing nurse prepares a gauze turunda. A dressing nurse takes a turunda 20-30 cm long by the edge with a forceps, wraps it around its jaws with tweezers and immerses it in a jar with a 10% sodium chloride solution, where she easily unwinds it and removes it after soaking. When removing the turunda, the nurse squeezes the excess solution into a jar using tweezers. After this, she fixes the free end of the turunda with tweezers and gives the tweezers to the doctor, who takes the turunda with his tweezers. To place the turunda and fill the cavity with it, the doctor must have a button-shaped probe. The sister holds the edge of the turunda suspended with the help of her forceps. The surgeon gradually introduces the turunda using a probe into purulent cavity, and at this time the sister continues to support her, intercepting her with a forceps in the right place. Several napkins, also soaked in this solution, are placed on top of the turunda with a hypertonic solution.
Currently, water-soluble ointments are actively used - levosin, levomekol, sorbilex, etc. Tampons with such ointments do not stick to the bottom of the wound and easily melt at a temperature of 37 °C. These ointments are used in the first phase of the purulent process, helping to cleanse wounds of non-viable tissue and suppress microflora. Used as a tampon soaked in ointment, or administered in an amount of 10-15 ml using a syringe through a catheter or microirrigator. In the presence of scanty purulent discharge and the appearance of granulations, i.e. in the second phase of the purulent process, it is necessary that the applied medicines reliably protected granulation tissue from superinfection and provided conditions for epithelization of wounds. Usually they use ointments that do not have an irritating effect: Vishnevsky ointment, vinylin (Shostakovsky balm), sea buckthorn oil, Kalanchoe, methyluracil ointment, solcoseryl gel, synthomycin emulsion, etc. The procedure for wetting turundas and napkins and presenting them to the doctor is the same. Foaming aerosols (cimesol, itosol) protect wound granulations well from damaging effects and promote the process of epithelization; when used, the antimicrobial drug of the aerosol almost completely remains on the surface of the wound, and thus a sufficient concentration is created. If excess granulations appear, the doctor is given a small cotton swab moistened with a solution of silver nitrate (lapis) to cauterize the granulations.
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In the treatment of any wound, including clean ones, proper dressings play an important role. Each type of injury requires special approach to carry out dressings and has its own characteristics of this important procedure.
In most cases, clean wounds are postoperative wounds that have undergone correct processing sutures and not having a purulent-inflammatory process.
General rules for applying a bandage
To carry out high-quality dressing of a clean postoperative wound, it is important to follow some rules, in particular:
Algorithm for dressing a clean wound
A wound that does not have any signs of infection is considered clean, that is, one in which there is no inflammation, suppuration, redness of the skin around the wound, and where normal healing processes are not disrupted.
If the wound is clean, the patient does not experience fever or severe painful sensations. The main task medical personnel If the patient has a clean injury, it is to prevent its possible infection.
Dressing of a clean wound occurs if there are indications, which are:
- Placement of a drainage tube or pack into the damaged area after surgery.
- Second day after surgery. In this case, dressing of the postoperative wound is carried out in order to assess the condition of the sutures and the surface of the future scar.
- Blotting the applied bandage with blood.
- The time has come when it is necessary to remove the stitches.
To carry out the dressing, you should prepare the following tools and materials:
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The process of dressing a clean wound is carried out in three stages. The first of which is preparatory, which consists of disinfecting hands, for which they must be thoroughly washed with soap and then treated with an antiseptic solution. After this, you should wear sterile gloves and a medical mask. Next, you need to prepare a dressing table, for which it is wiped with a disinfectant solution and covered with a clean sheet. Most dressings are performed with the patient lying down.
During the main stage of the procedure, the dirty dressing is removed from the wound, the injury itself and the skin around it are treated, and a clean dressing is applied.
It is important to remember that all manipulations at this stage must be performed using tweezers. Do not touch the wound or dressing material with your hands, even if you are wearing sterile medical gloves.
The algorithm for dressing a clean postoperative wound is as follows:
The last stage of dressing is the processing of the dressing table and all used instruments, as well as working surfaces.
Removing stitches
It is necessary to remove the sutures when the wound begins to actively heal and its edges grow together, but this should be done before a scar forms at the site of the injury.
It is important that the suture removal procedure is carried out by a doctor or qualified nurse in a hospital or clinic treatment room.
You should not carry out this procedure yourself at home, since there is a serious risk of infection in the wound remaining at the site of the removed suture material.
Before removing the sutures, they, as well as the skin in the places where they are applied, as well as on the surface of the healing wound and around it, are thoroughly treated with an antiseptic solution.
To carry out the procedure, it is necessary to prepare sterile instruments (tweezers and surgical scissors), as well as a tray for placing the removed suture material.
After processing, one of the ends of the seam is lifted with tweezers and retracted in the direction opposite to the seam. The seam should rise slightly above the surface of the wound. Then surgical scissors are passed under the thread, with the help of which the suture material is cut near the knot. After this, the thread is carefully pulled out of the patient's body. Thus, all applied sutures are removed. antiseptic solution to prevent possible infection. Then an antiseptic bandage made of sterile bandage or gauze is applied to the treatment area, which is secured with pieces of plaster.
Care of the dressing and frequency of dressing replacement
A bandage is applied to the wound immediately after the operation, suturing and complete treatment of the surfaces of the injury, the skin around it and the inserted threads.
The bandage is replaced the next day, while the doctor evaluates the condition of the sutured injury and the sutures applied.
If the wound is clean, without signs of inflammation or infection, it is treated with an antiseptic solution and a clean bandage is applied. Outside the treatment schedule, the dressing can be changed if the applied dressing material is saturated with blood or the dressing has shifted due to improper fixation.
Dressing of a clean postoperative wound in the future is carried out only if replacement is necessary, as well as on the day when the time comes to remove the suture material. If during the healing process of the injury it does not become infected and does not begin inflammatory process
, then the dressings are changed from the moment of the operation to the removal of the sutures only twice, with the exception of cases where the dressings are soaked in blood.
After the stitches are removed from the wound, in most cases the patient is discharged home, where he himself must continue to care for the bandage at home. At home, many people use various drugs and folk remedies
to speed up the healing process of a clean wound, as well as to prevent the formation of rough scars.
Many of the products are applied under a bandage or compress. In this case, the dressings are changed according to an individual schedule, taking into account the time of the next application of the drugs used. As a rule, every surgical operation requires dressing. Regardless of the wound, there are several stages of dressing, including not only bandaging, but also appropriate treatment with antibacterial and antiseptic drugs
. For this procedure, the surgery uses a special dressing room. All actions are carried out by a nurse in the presence of a doctor.
Why is dressing needed and what role does it play? Wound dressing is a very important procedure during treatment, after operations and various injuries. It protects the wound surface from external influences
- , infection and consists of five stages:
- Carrying out the necessary surgical actions;
- Treatment of damaged skin to prevent infection;
- Apply a clean, sterile dressing;
- Fixing the bandage.
The most common cases are: bandaging an arm, leg or head.
There are times when dressing a wound is very inconvenient. Then a regular patch comes to the rescue. In case of serious injuries to the head or other important organs, such activities can be very painful, so it is better to take pain relief before starting the procedure
Preparing for dressing
Before dressing, it is necessary to carry out a number of preparatory measures, which are usually done by sanitary workers. The procedure is performed in dressing rooms provided in each surgical department. The first step before work is to thoroughly clean and disinfect the room. After which the necessary surgical instruments and medications are prepared.
Medicines and materials that will be needed during the process of establishing a dressing:
- Sterile rubber gloves;
- Bandages;
- Cotton swabs;
- Gauze napkins;
- Clean towel;
- Patch;
- Ethanol;
- Hydrogen peroxide;
- Antiseptics;
- Medicines that are prescribed individually.
The main tools used in dressing various injuries:
- Medical forceps;
- Surgical scissors;
- Tweezers;
- Clamp;
- Scalpel.
Performing dressing
All types of dressings are carried out in accordance with antiseptic rules. To avoid infection, foreign bodies should not get into the wound.
The healing of sutures depends on many factors:
- From the rate of fluid outflow and scarring;
- Chronic diseases and pathologies of the patient’s body;
- Age category. In young people healthy people the healing process occurs much faster.
Bandaging the damaged area occurs until complete healing. The need for dressing disappears when the impact external factors will not affect the affected area. Until this point, it is necessary to do dressings daily until wet spots appear on the bandages. This suggests that the healing process has not yet begun.
Important! Sometimes the bandage has to be changed outside of the schedule. If it is weakened, has fallen out of its place and does not perform its functions, it needs to be replaced. If the wound begins to hurt, it means it needs to be unbandaged and examined. The cause of pain may well be an infection. Therefore, it is better to treat the wound with antibacterial substances, and then apply a clean sterile bandage.
Removing the old bandage
You need to remove the old bandage carefully, following a certain algorithm, so as not to damage the tissues that have already begun their recovery. It often happens that bandages stick to the wound. It is not recommended to separate them without pre-treatment. First, the bandage must be cut with scissors. Sticky pieces of gauze are soaked with special solutions: sodium chloride or hydrogen peroxide. After some time, the adhering remnants of the dressing material should themselves fall away from the edges of the scar.
They need to be removed along the scar. Pulling across the seams may cause painful sensations. Moreover, a wound with unhealed sutures can open and bleed, and this will significantly slow down the process of tissue regeneration.
Remove the bandage using tweezers with a gauze ball, pressing on the skin. When removing the last layer, you must ensure that the skin around the wound does not stretch behind it. If bleeding occurs, stop it with a clean gauze pad.
Treatment of damaged surface
After removing the bandage, begin treating the affected area with warm, soapy water, with the addition of ammonia in a ratio of 1:200. Cleaning is done around the wound with a cotton swab. During the process, it is necessary to ensure that liquid does not get inside. If the surface of the skin is dirty, apply a sterile napkin to the affected area, then wash everything with soap. After this, the skin should dry. The dry surface is treated with antiseptic preparations.
Clean skin around the wounds prevents infections under the dressing, which can cause skin problems.
After this, the seam is processed, for the treatment of which the following medications are used:
- Sodium chloride;
- Manganese solution;
- Hydrogen peroxide;
- Chlorhexidine;
- Miramistin.
At home, treatment can be done using calendula infusion.
Applying a new dressing to a clean wound
The term “clean wound” means the absence of infections, pus and other pathological disorders in the form of fever, irritation or redness around the injury. The point of bandaging is to prevent such deviations in the future.
Dressing of a clean postoperative wound is carried out under the following circumstances:
- If after surgical intervention a tampon or drainage remains in the wound;
- The bandaged wound began to bleed or secrete copious amounts of ichor;
- First dressing after surgery;
- It's time to remove the stitches.
After removing the old bandage and processing, apply a clean napkin soaked with antiseptics. After this, it is wrapped in several layers with a clean bandage. The bandage should cover at least 10 cm from the edges of the injury. Then it is securely fixed to prevent displacement, especially with head injuries in winter. This will prevent the penetration of various infections.
Dressing a purulent wound
IN infected wounds arise purulent discharge. With purulent wounds it is a little more difficult. Often the patient experiences an increase in temperature, resulting in throbbing pain. Bandaging of such injuries is required in the following cases:
- The dressing material was saturated with pus;
- The bandage has become deformed or moved to the side;
- Another scheduled dressing change.
As with dressing a clean wound, several procedures must be performed.
The first and most important point After removing the old bandage, the wound is disinfected and cleaned of purulent masses. Pus is removed using cotton swabs. Then the wound is cleansed with antibacterial and antiseptic substances. After the edges of the wound are coated with iodine, a gauze pad soaked in a hypertonic solution is applied to the wound. The affected area is wrapped in bandages, soaking each layer with an isotonic solution. After which fixation is made.
Organization of work and sanitary-hygienic regime in the operating unit
What conditions must be met when entering the operating room?
ü you should enter in a special robe or trousers and jacket
· it is allowed to enter the operating unit in street shoes and clothes with a cap, mask and shoe covers
ü Be sure to wear a cap that completely covers your hair and a four-layer mask and shoe covers
600.It is allowed to enter the operating unit...
· all persons, provided they have special clothing
ü only to persons whose presence in the operating room is necessary
601.Among the workers of the operating unit and surgical department preventive examination held …
ü once a year
· Once every ½ year
· 2 times per year
602.What are the zones of the operating block?
ü zone general regime
ü restricted area
ü zone strict regime
ü sterile area
603.Pre-operative, anesthesia, washing rooms refer to...
general regime zone
ü high security zone
· restricted area
· sterile area
604.In the operating room there are...
· all items and equipment that may be needed in the operating process
ü only necessary items and equipment directly used in the operating process
605. The patient is fixed to the operating table...
ü before introducing the patient into anesthesia, having previously warned him
after the patient has been put under anesthesia
606.Creating unfavorable conditions in the wound for the development of microflora provides...
ü careful treatment of fabrics
ü thorough hemostasis
ü wound drainage (according to indications)
ü prevention of ischemia of the wound edges when tightening sutures
607.If vital functions are impaired during surgery under general anesthesia the surgeon must...
· will continue to perform the operation while the anesthesiologist corrects vital functions
ü suspend the operation until the patient’s condition stabilizes, and, if necessary, change the volume surgical intervention
stop the operation
608.What is done with tissues removed during surgery?
All fabrics are recycled
ü all tissues are subjected to histological or cytological examination
· only part of the removed organ is subjected to histological examination, the rest is disposed of
609.What is done with the dressing material used during the operation?
· dispose of immediately
ü disposed of after soaking in an antiseptic solution
· subjected to special treatment for reuse
610. How often is bacteriological examination of swabs from the surgical field, surgeon’s hands, and instruments carried out?
ü once every 7 days
· Once every 14 days
· 1 time per month
611.What types of operating room cleaning exist?
ü preliminary
ü current
ü final
ü general
· direct
612.What does pre-cleaning of the operating room include?
ü treatment of horizontal surfaces with a disinfectant, ultraviolet irradiation of operating room air
· disinfectant treatment of horizontal surfaces, walls up to the level of panels, ultraviolet irradiation of operating room air
· quartzing of the operating room
613.How often is it carried out spring-cleaning operating room?
ü once a week (a day specially allocated for this)
· Once every 14 days
· 1 time per month
614.What does final cleaning of the operating room include?
ü wet cleaning with disinfectants of the operating room and the devices and instruments located in it, washing walls to a height of 2 meters, quartzing the air
· wet cleaning with disinfectants in the operating room after removing mobile equipment and medications from it, air quartzing
· removal of biological fluids spilled during surgery from the floor, treatment with disinfectants operating table, air quartzization.
615. When carrying out general cleaning, equipment and mobile equipment of the operating room ...
ü removed from the operating room and treated with disinfectant solutions outside of it
· carry out treatment with disinfectant solutions directly in the operating room
· exposed to ultraviolet irradiation
29.23. Organization of work and sanitary and hygienic regime in the dressing room
In a clean dressing room they perform...
ü dressing of clean postoperative wounds
ü blockade
ü puncture of cavities and joints that do not contain pus
· insertion of drainage into the pleural cavity for pleural empyema
· dressings of patients with intestinal and gastric fistulas
616. Purulent dressings are intended for...
ü dressing purulent wounds
ü puncture of abscesses and ulcers containing pus, opening of ulcers
· dressing of postoperative wounds with the presence of tampons and drainage tubes for the outflow of blood or serous fluid
ü dressings of patients with intestinal and gastric fistulas
ü insertion of drainage into the pleural cavity for pleural empyema
617. The order of performing dressings in the presence of one dressing ...
ü clean dressings, then dressings of purulent patients
ü dressings of purulent patients; after thorough cleaning of the dressing room, clean dressings are performed
618. A mat moistened with a disinfectant solution must be changed before a clean dressing room...
· every day
ü no less than every 3 days
· at least every 5 days
619. A mat moistened with a disinfectant solution should be changed before purulent dressing...
ü every day
· at least every 3 days
· at least every 5 days
620. Medical personnel constantly working in the dressing room change work clothes:
ü every day
· in one day
· 1 time per week
621.Preliminary cleaning of the dressing room involves...
ü double treatment of horizontal surfaces (couch, tool tables, surfaces of beams) with a disinfectant solution
ü treating the wall with a disinfectant to a height of at least 1 meter above the stationary instrument table
· washing walls with disinfectants
· mopping the floor
622. During the current cleaning of the dressing room, the couch and table on which the patients are laid are treated twice with disinfectants...
ü after each dressing
· as it gets dirty
· when blood or inflammatory exudate spills onto the couch
· at the end of the working day
623. General cleaning of the dressing room is carried out ...
· at the end of the working day, every day
ü 1 time per week
· Once every 10–14 days
624. At night, dressings are performed...
· dressings are not performed
ü dressings are performed according to strict indications charge nurse
· any dressings are performed around the clock
625. Bacteriological study of air, swabs from horizontal surfaces in the dressing room are taken ...
ü 1 time per month
· in purulent dressing rooms every day
· 1 time per week
626.Disinfection of air in a dressing room with ultraviolet irradiation is carried out ...
· at the beginning and end of the working day
ü at the beginning and end of the working day, every 2–3 hours of work
· the quartz lamp turns on only at the end of the working day and works all night
627.What is done with sterile instruments not used for dressings on the instrument table?
ü sent for re-sterilization
· used for dressings the next day
628.When covering a sterile instrument table, a dressing sheet is placed...
· in 2 layers
ü 4 layers
· in 6 layers
629. The sterile instrument and dressing table is set...
ü every day after preliminary cleaning
· in one day
as instruments and dressings are used up
Chapter 24. Organization of work and sanitary and hygienic regime in the dressing room
Dressing rooms for clean and purulent dressings are strictly separated, which should be located at different ends of the department and adjacent to the corresponding wards.
A clean dressing room is designed to perform:
puncture biopsy;
dressings of clean postoperative wounds, sutured tightly or with tampons and drainage tubes for blood outflow;
punctures of cavities and joints, in which purulent contents are not expected;
removing stitches from healing wounds primary intention(no signs of inflammation).
Purulent dressings are used for:
dressings of purulent wounds;
punctures of abscesses and cavities containing pus;
opening of abscesses;
insertion of drainage into the pleural cavity for pleural empyema;
dressings of patients with intestinal and gastric fistulas.
If there is one dressing room, it should be located in the center of the department. The order of dressings in it is determined by the degree of their asepticity. First, clean dressings are performed, and then dressings are performed for purulent patients, followed by thorough cleaning of the room and all equipment with disinfectant solutions.
The dressing room should be spacious so that you can easily turn around with a gurney. In dressing rooms with a small area, instead of a table that takes up a lot of space, you can install a couch (against the wall), and bandage bedridden patients on a gurney.
In the dressing room it is necessary to provide supply and exhaust ventilation, transoms or mesh windows, an air conditioning system is desirable. UV lamps are installed on the walls or under the ceiling.
The finishing and sanitary and hygienic conditions in the dressing room are the same as in the operating unit.
A nurse and a nurse work in the dressing room. The number of nurses is determined in accordance with the number of dressing nurses. The responsible stages of dressing are carried out by the attending physician. Repeated dressings superficial wounds
as directed by the doctor, the nurse can perform this, periodically showing the patient to the doctor.
Before entering the dressing room, a mat soaked in a disinfectant solution is laid out to clean the soles of shoes. In clean dressing rooms, the mat is changed as it gets dirty, but at least every 3 days; in purulent dressing rooms - every day. Replaceable mat for 30 min. immersed in a disinfectant solution, and then sent to the laundry for washing with boiling water.
Everyone entering the dressing room must wear sterile masks. They enter the dressing room wearing hospital work clothes. Dressing room staff (doctors, nurses, orderlies) must change gowns, caps, and masks daily.
Personnel who do not constantly work in dressing rooms are allowed to enter them only to accompany the patient or participate in dressing.
Work in the dressing room begins with preliminary morning cleaning according to the same principle as in the operating room. Before covering the instrument table, work table, couches, surfaces of the benches, they are wiped twice with 3% chloramine solution or 1% calcium hypochlorite solution with an interval of 15 minutes.
After finishing the dressings, final cleaning is carried out, similar to the same cleaning in the operating room. At least twice a day, wet cleaning is carried out with disinfection of the entire room and equipment using a 1% calcium hypochlorite solution or a 3% chloramine solution.
Once a week, after the premises have been emptied of inventory, equipment, and tools, general cleaning is carried out with detergents and disinfectants.
To disinfect the air, bactericidal lamps are turned on (Fig. 24.1).
Rice. 24.1. Disinfection of the dressing room: a – spraying the walls from a hydraulic remote control; b – wiping the walls
Once a month, a bacteriological examination of the air, personnel’s hands, dressings, and instruments is carried out. The dressing nurse must ensure that dressings can be carried out at any time of the day or night. Before leaving work, she should leave the dressing room in full readiness to work, lock the dressing room, hand over the keys to the dressing room and cabinets with instruments and solutions to one of the nurses on duty. During night duty, dressings should be prescribed according to special indications
, as well as in the event of circumstances requiring urgent dressing (excessive wetting of the wound, loss of the gastrostomy tube, etc.).
All guard nurses should know the principles of working in the dressing room, since during their duty it may be necessary to carry out dressing changes.
AIR DISINFECTION IN THE DRESSING ROOM The air in dressing rooms contains significantly more germs than the air in the operating room or other hospital rooms. This is due to the fact that during the working day in the dressing room there is big number
people (medical staff, patients, students). In addition, with any dressing, the wound surface remains open for some time, in contact with air, instruments and other objects used in dressings. The air of purulent dressing rooms, as well as dressing otolaryngological departments, contains especially many microorganisms. dressing room is carried out an hour before the start of work and at the end of the working day for 2-3 hours. It is advisable to take a 10-minute break every 2-3 hours of work, turn on the bactericidal lamps, and ventilate the room.
COVERING A STERILE INSTRUMENT TABLE
The sterile instrument table is repositioned daily in the morning after preliminary cleaning of the dressing room. Before cleaning, the remaining unused instruments are removed from the table, combined with used instruments that have undergone pre-sterilization cleaning, and handed over for sterilization.
The sheets with which the table was set for the previous day are removed and folded separately, placed in a bin and handed over to the sterilization room. Before setting the table, wipe it twice with a rag containing a disinfectant (3% chlorine solution
lime, 1% calcium hypochlorite solution). The dressing nurse washes her hands as if for an operation, puts on a sterile gown and gloves and covers the table with sterile sheets in 4 layers. Separately, lay out tweezers, clamps, and drainage tubes on large towels, distributing them into groups. In a cuvette, with a large napkin sent, he places reusable syringes and needles, covering them with half of the same towel. Lays out packs of napkins and other types of dressings. When the table is laid, the nurse covers it on top with sterile sheets in 4 layers. At the back and sides, the top sheet is tightly fastened with clothes clips to the bottom sheets, a few clips are attached to the front and on the front half of the sides of the table, and large clips such as Mikulicz clips are attached to the corners.
This is done so that, having unfastened the clothes clips in front, it would be possible, holding the Mikulicz clips, to lift the edge of the top sheets and, wrapping them like an accordion on the table, to open access to the tools (Fig. 24.2).
Rice. 24.2. Sterile instrument and dressing table: a – during dressing; b – during the break between dressings
Once the dressings are completed, the top sheets are put back in place and reattached with clamps.
The order of dressings depends on the degree of asepticity. If there is only one dressing room, treatment of purulent wounds is carried out after clean manipulations, followed by thorough treatment of the room and all equipment with disinfectant solutions.
Solutions for dressings are poured into a labeled jar or glass and, if necessary, using a tool, a ball or napkin is immersed in it, which needs to be moistened with the solution. Excess liquid is squeezed out with another instrument (tweezers).
To lubricate a napkin with ointment, spread it on the instrument table at the bottom of the cuvette and spread the ointment evenly on the gauze with a spatula. The ointment bandage should be 2-3 cm larger than the wound incisions, otherwise the bandage may move when moving and a dry cloth will lie on the skin.
When dressing dressings, you should “work with your eyes and tools” without touching the wound or bandages with your fingers (apodactylic). Do not touch with your fingers the part of the instrument that will have to work in the wound.
For each patient, the nurse prepares instruments, napkins, and balls separately in a sterile tray. Required Tools and she provides the materials to the doctor with a sterile forceps, Mikulicz clamp or other long instrument (tweezers). These instruments are stored in a container 2/3 filled with a 6% hydrogen peroxide solution. Instruments, containers and solutions are changed daily after their preliminary sterilization.
When dressing purulent patients, the dressing nurse, and, if necessary, the doctor, works in an oilcloth or cellophane apron, which after each dressing the nurse wipes with a rag soaked in a disinfectant solution (3% chloramine solution, 6% hydrogen peroxide, 1% calcium hypochlorite solution), disinfect hands.
The dressing room nurse, wearing gloves, removes the upper layers of the dressing from purulent wounds with finger tweezers.
Before bandaging purulent patients, the dressing nurse and the doctor wash their hands twice with soap and treat with 0.5% alcohol solution chlorhexidine and wear sterile gloves.
After the dressings are completed, gloved hands are treated with a 1% solution of calcium hypochlorite or a 3% solution of chloramine, removed from the hands, and left in one of these solutions for 1 hour. After this, the gloves are washed under running water, dried and sterilized in an autoclave at 1.1 atm (120 °C) for 45 minutes.
Any pus that gets onto the dressing table or the floor is immediately wiped off by a nurse with a swab soaked in a disinfectant solution.
After dressing is completed, the used instruments are placed in a disinfectant solution, and then subjected to pre-sterilization cleaning and re-sterilization.
Removed dressings, removed drainage tubes and material used in the dressing process are dumped into a basin or bucket, which is placed near each dressing table. In between dressing changes, the nurse transfers the contents of the basins into a bucket with a lid and a foot pedal, and then takes it out to be burned.
Containers in suction units must be marked. The containers and hoses of the electric suction are disinfected with 1% calcium hypochlorite solution. When suctioning biological fluids, dry disinfectants are placed in the suction container based on the amount of fluid being sucked out (1:5).
DRESSINGS IN THE ROOM
When dressing in the ward, it is necessary to minimize the risk of secondary infection of the wound by microflora contained in the air of the ward, and to prevent contamination of the air of the ward and objects in it with microorganisms from the patient’s wound. The content of microorganisms in the air of the ward increases sharply during bed changing, dry cleaning, and movement around the ward.
Therefore, when preparing the room for dressing, it is necessary to complete the morning cleaning and ventilate it. During the dressing period, you must ask walking patients to leave the room and prevent patients and unnecessary personnel from walking around it.
The materials necessary for dressing are delivered on a mobile sterile table on wheels or in a cuvette covered with two layers of a sterile towel, or in a sheet folded like an envelope.
Long tweezers for the work of a dressing nurse are placed so that the upper part of it protrudes 2-3 cm beyond the sterile material covering the instruments and dressings.
This allows the nurse to grab these tweezers without compromising the sterility of everything on the mobile instrument table.
