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. Removal of the old bandage, toilet 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, moisten its strips, 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. With significant contamination of the skin around the wound, you can protect the wound surface with a sterile gauze cloth, thoroughly wash the entire limb with soap, and if the wound fester, then this procedure must be performed every dressing. After cleaning the skin, it is dried with gauze balls, and then treated with iodine with alcohol, iodinol or other coloring antiseptics. Cleanliness of the 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: removal of sutures, probing the suture area, ointment tamponade, washing of purulent cavities.
Withdrawal skin sutures may be performed by a nurse in the presence of a doctor. To do this, you need surgical tweezers, scissors and a small napkin. Tweezers pull on one of the ends of the threads, tied to the side of the seam line. After 2-3 mm of the subcutaneous part of the silk thread appears from the depth of the tissues 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. A cut ligature with a knot is easily removed with tweezers. Each removed seam is placed on a nearby unfolded small napkin, which, after removing the seams, is folded with tweezers and thrown into a basin with dirty material.
Removing metal brackets. To remove the staples, you must have a staple remover and a clip for Michel's brackets. Instead of a staple clamp, a curved Billroth forceps can be used. Having brought the jaw of the staple remover or clamp under the middle bent part of the bracket, by squeezing the tool, the bracket is straightened and, having first isolated one, then the other tooth from the skin, it is removed. When removing the bracket with two surgical tweezers, it is captured by both ends, unbent and the teeth are removed from the skin. After removing the sutures or staples, the line of sutures is treated with an antiseptic and stickers are made.
3. Protect the skin from discharge from the wound. Before applying a dressing 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 petroleum jelly, Lassar paste, and zinc ointment. With a spatula, the sister 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 size of which is 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 the 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 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 on weight with the help of her forceps. The surgeon gradually introduces the turunda with 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, syntomycin 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.
Contents of the article: classList.toggle()">toggle
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.
- Soaking 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:
Similar articles 
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 that, put on sterile gloves, as well as 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 suture 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 that, the thread is gently pulled out of the patient's body. Thus, all sutures are removed.
After the suture removal procedure, the surface of the wound and the places where the threads were located must be carefully treated 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.
Dressing care and dressing change frequency
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 in the process of healing the injury did not become infected, and did 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 funds 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, each surgical operation requires a 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 in treatment, after operations and various injuries. It protects the wound surface from external influences, infection and consists of five stages:
- Removing old bandages, if this is not the first dressing;
- Carrying out the necessary surgical actions;
- Treatment of damaged skin to prevent infection;
- Apply a clean, sterile dressing;
- Bandage fixing.
The most common cases are: bandaging of the 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 of the head or other important organs, such events can be very painful, so it is better to anaesthetize before starting the procedure.
Dressing preparation
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 the dressing rooms provided in each surgical department. First of all, before working in the room, a thorough cleaning and disinfection is carried out. After that, 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;
- Medications that are prescribed individually.
The main tools used in the dressing of various injuries:
- Medical forceps;
- Surgical scissors;
- Tweezers;
- clamp;
- Scalpel.
Dressing
All types of dressings are carried out in accordance with antiseptic rules. To avoid infection, foreign bodies should not enter the wound.
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. Young people healthy people the healing process is much faster.
Bandaging of the damaged area occurs until complete healing. The need for dressing disappears when the impact external factors will not affect the affected area. Up to this point, dressings should be done daily until wet spots appear on the bandages. This suggests that the healing process has not yet begun.
Important! Sometimes the dressing has to be changed outside the schedule. If it has weakened, got off its seat and does not perform its functions, it must be replaced. If the wound starts to hurt, then it is necessary to unbandage and examine. The cause of the 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
It is necessary 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 the bandages stick to the wound. Separating them without pretreatment is not recommended. First, the bandage must be cut with scissors. Adhering pieces of gauze are soaked with special solutions: sodium chloride or hydrogen peroxide. After some time, the adhering remnants of the dressing should themselves lag behind the edges of the scar.
They need to be removed along the scar. Pulling across the seams can cause pain. Moreover, a wound with unhealed sutures can open and bleed, and this will significantly slow down the process of tissue regeneration.
Remove the bandage with tweezers with a gauze ball, pressing down on the skin. When removing the last layer, care must be taken to ensure that the skin around the wound does not stretch behind it. If bleeding occurs, stop it with a clean gauze pad.
Damaged surface treatment
After removing the bandage, the affected area is treated 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. In the process, it is necessary to ensure that the liquid does not get inside. If the surface of the skin is stained, a sterile napkin is applied to the affected area, after which everything is washed with soap. After that, the skin should dry. The dry surface is treated with antiseptic preparations.
Clean skin around the injury prevents infection under the bandage, which can cause skin diseases.
After that, the seam is processed, for the processing of which the following medicines are used:
- Sodium chloride;
- manganese solution;
- Hydrogen peroxide;
- Chlorhexidine;
- Miramistin.
At home, processing can be done with the help of 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 purpose of the dressing is to prevent such deviations in the future.
Bandaging 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 ooze profusely;
- First dressing after surgery;
- It's time to remove the stitches.
After removing the old dressing and processing, a clean napkin soaked in antiseptics is applied. After that, it is wrapped with a clean bandage in several layers. The dressing 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.
Bandaging of a purulent wound
IN infected wounds arise purulent discharge. With purulent wounds a little more difficult. Often the patient has an increase in temperature, resulting in throbbing pain. Bandaging of such injuries is required in such cases:
- The dressing was soaked with pus;
- The bandage is deformed or shifted to the side;
- Another scheduled change.
As with dressing a clean wound, several procedures must be done.
First and most important point after removing the old dressing, disinfection and cleaning of the wound from purulent masses is carried out. Pus is removed with cotton swabs. Then the wound is cleansed with antibacterial and antiseptic substances. After the edge of the wound, they are smeared with iodine, and a gauze napkin soaked in hypertonic solution is applied to the wound. The affected area is wrapped with bandages, soaking each layer with an isotonic solution. After that, fixation is made.
Organization of work and sanitary and hygienic regime in the operating unit
What conditions must be met when entering the operating block?
ü you should enter in a special dressing gown 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 hat that completely covers the hair and a four-layer mask, shoe covers
600. It is allowed to enter the operating block ...
All persons, with special clothing
ü only persons whose presence in the operating room is necessary
601. Among the employees of the operating unit and surgical department preventive examination held …
o Once a year
1 time in ½ year
· 2 times per year
602. What are the zones of the operating block?
ü zone general regime
ü Restricted zone
ü zone strict regime
ü sterile area
603. Preoperative, anesthesia, washing belong to ...
zone of general regime
ü strict regime zone
Restricted zone
sterile area
604.In the operating room are ...
All items and equipment that may be needed in the operating process
ü only necessary items and equipment directly used in the operational process
605. Fixation of the patient to the operating table is performed ...
ü before introducing the patient into anesthesia, having previously warned him
After the patient has been put under anesthesia
606. Creation of unfavorable conditions in the wound for the development of microflora ensures …
ü careful attitude to fabrics
meticulous hemostasis
ü wound drainage (according to indications)
ü prevention of ischemia of the wound edges when tightening the sutures
607. In violation of vital functions during surgery under general anesthesia The surgeon must...
continue the operation while the anesthesiologist performs correction of 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 an operation?
All fabrics are recycled
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 a bacteriological examination of swabs from the surgical field, the surgeon's hands, instruments?
ü 1 time in 7 days
1 time in 14 days
· 1 time per month
611. What are the types of operating room cleaning?
ü preliminary
ü current
ü final
ü general
immediate
612. What does the preliminary 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 to the level of panels, ultraviolet irradiation of operating room air
quartzing of the operating room
613. How often is spring-cleaning operating room?
ü Once a week (specially allocated for this day)
1 time in 14 days
· 1 time per month
614. What does the 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 the walls to a height of 2 meters, quartzing the air
Wet cleaning with disinfectants of the operating room after removal of mobile equipment and medicines from it, air quartzization
removal from the floor of biological fluids spilled during the operation, treatment with disinfectants operating table, quartzization of air.
615. During general cleaning, equipment and mobile inventory of the operating room ...
ü removed from the operating room and treated with disinfectant solutions outside of it
Produce treatment with disinfectant solutions directly in the operating room
subjected to ultraviolet irradiation
29.23. Organization of work and sanitary and hygienic regime in the dressing room
In a clean dressing room, ...
dressing of clean postoperative wounds
ü blockade
ü puncture of cavities and joints that do not contain pus
Insertion of drains into the pleural cavity in case of pleural empyema
Bandaging of patients with intestinal and gastric fistulas
616. Purulent dressings are intended for ...
dressing of purulent wounds
ü puncture of abscesses and abscesses containing pus, opening of abscesses
Bandaging of postoperative wounds with the presence of tampons and drainage tubes for the outflow of blood or serous fluid
bandaging of patients with intestinal and gastric fistulas
introduction of drains into the pleural cavity in case of pleural empyema
617. The order of performing dressings in the presence of one dressing ...
ü clean dressings, then, dressings of purulent patients
ü bandaging of purulent patients, after careful cleaning of the dressing room, clean dressings are performed
618. A mat soaked with a disinfectant solution before a clean dressing room should be changed ...
· every day
ü at least 3 days later
at least every 5 days
619. A rug moistened with a disinfectant solution before a purulent dressing room should be changed ...
o every day
at least every 3 days
at least every 5 days
620. Medical staff constantly working in the dressing room changes work clothes:
o every day
· in one day
1 time per week
621. Preliminary cleaning of the dressing room involves ...
ü double treatment of horizontal surfaces (couch, instrumental tables, bix surfaces) with a disinfectant solution
ü treatment of the wall with a disinfectant to a height of at least 1 meter above a stationary tool table
Washing walls with disinfectants
washing the floor
622. During the current cleaning of the dressing room, the couch and the table on which the patients are laid are treated twice with disinfectants ...
ü after each dressing
As it gets dirty
in case of outflow of blood or inflammatory exudate 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
o Once a week
1 time in 10-14 days
624. Dressings are performed at night...
dressings are not performed
ü dressings are performed according to strict indications duty nurse
any dressings are performed around the clock
625. Bacteriological examination of air, swabs from horizontal surfaces in the dressing room are taken ...
o 1 time per month
in purulent dressings every day
1 time per week
626. Disinfection of air in the dressing room by ultraviolet irradiation is performed ...
at the beginning and at the end of the working day
ü at the beginning and at the end of the working day, every 2-3 hours of work
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?
sent for re-sterilization
used for dressings the next day
628. When a sterile instrument table is covered, a dressing sheet is placed in a dressing sheet ...
in 2 layers
ü in 4 layers
in 6 layers
629. A sterile instrumental dressing table is covered ...
ü every day after pre-cleaning
· in one day
As the instruments and dressings are used up
Chapter 24
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, sewn up tightly or with the presence of tampons and drainage tubes for blood outflow;
punctures of cavities and joints, in which purulent contents are not expected;
removal of sutures from healing wounds by primary tension(no signs of inflammation).
Purulent dressings are used for:
bandaging of purulent wounds;
punctures of abscesses and cavities containing pus;
opening of abscesses;
introduction of drains into the pleural cavity with pleural empyema;
bandaging of patients with intestinal and gastric fistulas.
If there is one dressing room, it should be placed in the center of the department. The order of performing dressings in it is determined by the degree of their asepticity. First, clean dressings are performed, and then dressings for purulent patients, followed by a thorough cleaning of the room and all equipment with disinfectant solutions.
The room under the dressing room should be spacious so that it is free to turn around with a stretcher. 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.
Finishing and sanitary-hygienic conditions in the dressing room are the same as in the operating unit.
The dressing room has a nurse and nurse. The number of nurses is determined in accordance with the number of dressing nurses. Responsible stages of dressing are carried out by the attending physician. Re-dressings superficial wounds at the direction of the doctor, a nurse can perform, periodically showing the patient to the doctor.
Before entering the dressing room for cleaning the soles of shoes, a rug soaked in a disinfectant is spread. In clean dressing rooms, the mat changes as it gets dirty, but at least every 3 days, in purulent dressing rooms - daily. Replaceable mat for 30 min. immersed in a disinfectant solution, and then sent to the laundry for washing with boiling.
All entering the dressing room must wear sterile masks. They enter the dressing room in working hospital clothes. Dressing staff (doctors, nurses, nurses) should change gowns, caps, masks daily. Personnel who are not constantly working in dressing rooms are allowed to enter them only to accompany the patient or participate in the dressing.
Work in the dressing room begins with a preliminary morning cleaning on the same principle as in the operating room. The tool table before covering it, the work table, couches, the surfaces of the bixes are wiped twice with 3% solution of chloramine or 1% solution of calcium hypochlorite with an interval of 15 minutes.
Sometimes morning cleaning takes a lot of time, since in the evening or at night it may be necessary to change the dressing, replace the fallen gastrostomy tube, and other manipulations. In the dressing room for this purpose, a "duty" sterilization box with dressings should be allocated. The nurses on duty take sterile instruments from the instrument table, opening the top sheet on it. After the dressing is completed, the duty personnel must clean up by putting the used tools in the intended place (a container with a detergent-disinfectant solution). Removed bandages, napkins and used dressings are thrown into a special bucket with a lid, designed to collect dirty materials.
Current cleaning is carried out during dressings. The surface of the couches and tables on which patients are laid is wiped with 1% calcium hypochlorite solution or 3% chloramine twice with an interval of 15 minutes after each of them.
After the end of the dressings, a 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 premises and equipment using a 1% calcium hypochlorite solution or a 3% chloramine solution.
Once a week, after the premises are emptied of inventory, equipment, tools, a general cleaning is carried out with detergents and disinfectants. For air disinfection, bactericidal lamps are switched on (Fig. 24.1).
Rice. 24.1. Disinfection of the dressing room: a - spraying the walls from the hydraulic console; b - wiping the walls
Once a month, a bacteriological examination of air, personnel hands, dressings, and instruments is carried out.
The dressing nurse should ensure that dressings can be performed at any time of the day or night. Before leaving work, she should leave the dressing in fully prepared to work, close the dressing room with a lock, transfer the keys to the dressing room and cabinets with tools 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 (abundant wetting of the wound, prolapse of the gastrostomy tube, etc.).
The principles of work in the dressing room should be known to all guard nurses, since during their duty it may be necessary to dress.
AIR DISINFECTION IN THE dressing room
The air in dressing rooms contains significantly more germs than the air in the operating room or other areas of the hospital. This is due to the fact that during the working day in the dressing room it happens big number people (medical staff, patients, students). In addition, with any dressing, the wound surface remains open for some time, in contact with air, tools and other items used in dressings. Especially many microorganisms contain the air of purulent dressing rooms, as well as dressing otolaryngological departments. The air microflora of these dressing rooms contains predominantly antibiotic-resistant microflora. Spreading by air and air-dust, this microflora creates the danger of secondary infection of the wound, layering on the infection already present in it and thereby contributing to the weakening of the body's defenses.
The main method of air disinfection in the dressing room is its irradiation with ultraviolet lamps. ultraviolet irradiation dressing 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 bactericidal lamps, and ventilate the room.
COVERING THE STERILE INSTRUMENT TABLE
The sterile instrumental table is covered 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 and pre-sterilized instruments and handed over for sterilization. They take off and fold separately the sheets with which the table was set for the previous day, put them in biks and hand them over to the sterilization room.
Before laying, the table is wiped twice with a rag with a disinfectant (3% chlorine solution lime, 1% solution of calcium hypochlorite). The dressing nurse washes her hands as if for an operation, puts on a sterile gown, gloves and covers the table with sterile sheets in 4 layers. Separately, on large towels, lays out tweezers, clamps, drainage tubes, distributing them into groups. In a cuvette, with a large napkin sent in, he lays out reusable syringes and needles, covering them with half of the same towel. Spreads 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 fastened in front and on the front half of the sides of the table, and large clips like Mikulich clips are attached at the corners. This is done so that, having unfastened the clothes clips from the front, it would be possible, holding the Mikulich clips, to lift the edge of the upper sheets and, wrapping them like an accordion on the table, open access to the tools (Fig. 24.2).
Rice. 24.2. Sterile instrumental dressing table: a - during dressing; b - in the interval between dressings
After dressings are completed, the top sheets are put in place and re-attached with clips. The date of the setting of the table is set daily, the label is fixed on the corner of the sheet under the clip.
After setting the instrument table, the dressing nurse can remove the sterile gown, remaining in sterile gloves, a regular gown and a mask.
ORDER OF PERFORMANCE OF BANDAGES
The order in which dressings are performed depends on the degree of their asepsis. In the presence of one dressing treatment of purulent wounds is carried out after clean manipulations, followed by a thorough treatment of the room and all equipment with disinfectant solutions.
Solutions for dressings are poured into a marked jar or glass and, if necessary, a ball or napkin is dipped into it with a tool, which must be moistened with a solution. Excess liquid is squeezed out with another tool (tweezers).
To lubricate the napkin with ointment, it is spread on the tool table at the bottom of the cuvette and the ointment is evenly spread over the gauze with a spatula. The ointment bandage should exceed the wound incisions by 2-3 cm, otherwise the bandage may shift during movements and a dry napkin will lie on the skin.
When dressing, you should “work with your eyes and tools”, without touching the wound and dressings with your fingers (apodactyly). You can not touch with your fingers and that part of the instrument, which will have to work in the wound.
For each patient separately in a sterile tray, the nurse prepares instruments, napkins, balls. Required Tools and she gives the materials to the doctor with a sterile forceps, Mikulich clamp or other long instrument (tweezers). These instruments are stored in a container 2/3 full of 6% hydrogen peroxide solution. Change of the tool, capacity and solution is made 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 nurse, working with gloves, removes the upper layers of the dressing from purulent wounds with tweezers.
The dressing nurse and the doctor, before dressing purulent patients, wash their hands twice with soap, treat with 0.5% alcohol solution chlorhexidine and put on sterile gloves.
After dressings are completed, gloved hands are treated with 1% calcium hypochlorite solution or 3% chloramine solution, removed from hands, leaving in one of these solutions for 1 hour. After that, the gloves are washed under running water, dried and sterilized in an autoclave at 1.1 atm (120 °C) for 45 minutes.
Pus that has fallen on the dressing table or on the floor, the nurse immediately wipes with a swab moistened with a disinfectant solution.
After the 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 the material used in the dressing process are dumped into a basin or bucket, which is placed near each dressing table. Between dressings, the nurse transfers the contents of the basins into a bucket with a lid and a foot pedal, and then takes it out for burning.
Containers in suctions must be marked. The containers and hoses of the electric pump are disinfected with 1% solution of calcium hypochlorite. When biological fluids are sucked out, dry disinfectants are placed in the suction tank based on the amount of fluid being sucked out (1:5).
BANDAGES IN THE ROOM
When bandaging in the ward, it is necessary to minimize the risk of secondary infection of the wound with the microflora contained in the air of the ward, and to prevent contamination of the ward air and objects in it with microorganisms from the patient's wound. The content of microorganisms in the air of the ward increases sharply during bedding, dry cleaning, and movement around the ward. Therefore, when preparing the ward for dressing, it is necessary to complete the morning cleaning and ventilate it. For the period of dressing, it is necessary to ask walking patients to leave the ward and prevent patients and excess personnel from walking on 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 in the form of an envelope. Long tweezers for the work of a dressing nurse are placed so that its upper part protrudes 2-3 cm beyond the sterile material covering the instruments and dressing material. This allows the nurse to take these forceps without disturbing the sterility of everything on the mobile instrument table.
The solutions used for dressing are poured into a cuvette or a barrel-shaped basin. There, either in a clean towel or in a lining, used tools can be folded.
Rice. 24.3. Mobile manipulation table
Rice. 24.4. Sterile tray with a set of instruments and dressing material for one dressing
