In the intensive care wards, as well as in the operating room, I strictly observe the sanitary-epidemiological and hygienic regimes.
Sanitary-anti-epidemiological and hygienic regimes are a whole complex of organizational, sanitary-hygienic and anti-epidemic measures that prevent the occurrence of nosocomial infection (HAI), purulent-septic processes, viral hepatitis and other infectious diseases, as well as measures aimed at preventing injuries, and, respectively, the possible infection of medical workers (based on the system of accounting and registration of injuries and emergencies associated with blood). To carry out preventive measures in case of an emergency, the treatment room has an emergency first aid kit, which includes:
Ø Alcohol 70%-100.0 ml.,
Ø Iodine solution 5%.
Ø Bactericidal plaster.
Ø Dressing material.
Ø Fingertips.
Ø Sterile distilled water.
Ø Tanks for pointing solutions.
Ø Disposable syringes (pipettes).
Actions of a medical worker in an emergency:
Ø in case of cuts and punctures immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% alcohol solution of iodine;
Ø in contact with blood or other biological fluids on the skin this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol;
Ø when blood and other biological fluids of the patient get on the mucous membrane of the eyes, nose and mouth: rinse the mouth with plenty of water and rinse with 70% ethyl alcohol solution , the mucous membrane of the nose and eyes are washed with plenty of water (do not rub);
Ø when blood and other biological fluids of the patient get on the dressing gown, clothes: remove work clothes and immerse in a disinfectant solution or in a bix (tank) for autoclaving;
Ø get started as soon as possible antiretroviral drugs for post-exposure prophylaxis of HIV infection.
Every Monday in our department general cleaning is carried out:
Daily routine cleaning is carried out twice a day.
After the transfer of the patient, all care items are processed: a tray, a vessel, bottles from under the drains. Processing of beds, mattresses, bedside tables, stools, oilcloths.
I disinfect used syringes, needles, systems in 2%
solution "Nick-Police" exposure 15 minutes. Stitching and cutting objects after processing are disposed of in a separate container;
I carry out disinfection and pre-sterilization treatment
instrumentation solution "Nika-Politsid" 2% exposure 15 minutes;
I carry out disinfection of anesthesia and respiratory equipment;
I carry out quartz treatment and ventilation of the wards;
I carry out a phenolphthalein and azopyram test for control
the quality of pre-sterilization cleaning of instruments with a record in the special. magazine.
Due to the high risk of occupational infection, in order to comply with the sanitary and epidemiological regime and safety regulations, we work in special clothes using a mask, gloves and goggles. modern technology hand treatment, all expendable materials disposable: this helps reduce the risk of developing nosocomial infections
In my work I am guided by the orders:
According to sanitary epidemiological mode:
1. Federal Law of March 30, 1999 No. 52-FZ “On the sanitary and epidemiological well-being of the population”.
2. Federal Law No. 157-FZ of September 17, 1998 “On Immunoprophylaxis of Infectious Diseases”.
3. Federal Law No. 38-FZ of March 30, 1995 “On the Prevention of Distribution in Russian Federation disease caused by the human immunodeficiency virus (HIV).
4. Decree of the Government of the Russian Federation of July 15, 1999 No. 825 “On approval of the list of works, the implementation of which is associated with a high risk of contracting infectious diseases and requires mandatory preventive vaccinations”
5. SanPiN 2.1.3.2630-10 "Sanitary epidemiological requirements to organizations engaged in medical activities"
6. SanPiN 2.1.7.2790-10 "Sanitary and epidemiological requirements for the management of medical waste"
9. SP 3.1.5.282-10 "Prevention of HIV infection"
10. SP 3.1.958-00 “Prevention of viral hepatitis. General requirements to the epidemiological surveillance of viral hepatitis.
11. SP 3.1.1.2341-08 "Prevention of viral hepatitis B".
12. SP 3.1.2.1108-02 "Diphtheria prevention".
13. SP 3.1.1.1117-02 "Prevention of acute intestinal infections".
14. SP 3.1.1.2137-06 "Prevention of typhoid fever and paratyphoid fever".
15. SP 3.1.1381-03 "Prevention of tetanus".
16. SP 3.1.1295-03 "Prevention of tuberculosis".
17. SP 3.1.2.1319-03 "Influenza Prevention".
18. SP 3.1.3.2352-08 "Prevention of tick-borne viral encephalitis".
19. Order of the Ministry of Health of the USSR dated March 23, 1976 No. 288 “On approval of the instructions on the sanitary and anti-epidemic regime of hospitals”.
20. Order of the Ministry of Health of the USSR dated April 14, 1979 No. 215 “On measures to improve the organization and improve the quality of specialized medical care patients with purulent surgical diseases.
21. Order of the Ministry of Health of the Russian Federation dated August 16, 1994 No. 170 “On measures to improve the prevention and treatment of HIV infection in the Russian Federation”.
22. Order of the Ministry of Health of the Russian Federation of September 30, 1995 No. 295 “On the Enactment of the Rules for Mandatory Medical Examination for HIV and the List of Employees individual professions, industries, enterprises, institutions and organizations that undergo a mandatory medical examination for HIV”
23. OST 42-21-2-85 "Sterilization and disinfection of products medical purpose(Methods, means and modes)”, approved by the Order of the Ministry of Health of the USSR dated 10.06.85 No. 770.
24. Order of the Ministry of Health of the Russian Federation of March 21, 2003 No. 109 “On the improvement of anti-tuberculosis measures in the Russian Federation”.
25. Order of the Ministry of Health of the USSR dated 16.08.89. No. 475 "On measures to further improve the prevention of AII incidence in the country."
26. Order of the Ministry of Health of the USSR dated July 12, 1989 No. 408 “On measures to reduce the incidence of viral hepatitis in the country”.
27. Order of the Ministry of Health of the Russian Federation dated November 26, 1998 No. 342 “On strengthening measures for the prevention of epidemic typhus and the fight against pediculosis”.
28. Order of the Ministry of Health of the Russian Federation dated April 24, 2003 No. 162 “On approval of industry standards. Patient management protocol. Scabies"
29. Order of the Ministry of Health and Social Development of the Russian Federation of April 12, 2011 No. 302n “On Approval of Lists of Harmful and (or) Dangerous production factors and work, during the performance of which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting mandatory preliminary and periodic medical examinations(surveys) of workers employed in hard work and at work with harmful and (or) hazardous conditions labor"
30. MU 3.1.2313-08 "Requirements for the disinfection, destruction and disposal of single-use injection syringes."
31. MU - 287-113 of December 30, 1998 "On disinfection, pre-sterilization cleaning and sterilization of medical devices"
32. Guidelines R.3.5.1904-04 "Use of ultraviolet germicidal radiation for disinfection of indoor air and surfaces".
33. Instructions for the use of disinfectants used in the work.
The work of the surgical department uses a fairly large amount of narcotic drugs used to relieve pain in patients in the postoperative period. In my work, I use normative documents:
Ø Order of the Ministry of Health of the Russian Federation No. 330 dated 11/12/1997. “on measures to improve the storage, prescribing and use of narcotic drugs and psychotropic substances”;
Ø Order No. 1008n "on the invalidation of some annexes to order No. 330";
Ø FZ-No. 3 dated 08.01.98. " the federal law on narcotic drugs and psychotropic substances”;
Ø Decree of the Government of the Russian Federation of 06.08.98. No. 892 "on approval of the rules for the admission of persons to work with narcotic substances and psychotropic substances";
Ø order No. 785 "List of medicines subject to subject-quantitative accounting in pharmacies (organizations), organizations wholesale trade medicines, medical institutions and private practitioners”;
Ø order No. 703 "addition to order 785";
Ø order No. 127 of the Ministry of Health of the Russian Federation of 03.28.03. “on the approval of instructions for the destruction of narcotic drugs, psychotropic substances included in lists 2 and 3 of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation, the further use of which in medical practice is recognized as inappropriate”;
Ø order No. 110 of the Ministry of Health of the Russian Federation dated 12.02.07. “On the procedure for prescribing and prescribing medicines, medical devices and specialized health food products”;
Ø order No. 747 "on approval" of the "instruction for accounting for medicines, dressings and medical products in medical and preventive health care institutions, consisting of the state. budget";
Ø Order of the Ministry of Health of the Russian Federation No. 245 dated 30.08.91. "On the norms of consumption of ethyl alcohol for healthcare, education and social security institutions";
Ø order No. 109 dated 12.02.07. “On making changes to the procedure for dispensing medicines approved by Order No. 785”;
Ø order No. 706n "Rules for the storage of medicines";
Ø p.p. No. 1148 "Rules for the storage of narcotic drugs and psychotropic substances"
Ø Government Decree No. 681 dated 06/30/1998 "on approval of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation."
Ø Decree of June 9, 2010 N 419 on the provision of information on activities related to the circulation of precursors of narcotic drugs and psychotropic substances, and the registration of operations related to their circulation
Ø By Decree of the Government of the Russian Federation of December 29, 2007 N 964, a list of potent substances for the purposes of Article 234 and other articles of the Criminal Code of the Russian Federation
All documents related to the circulation of narcotic drugs, psychotropic substances and their precursors, poisonous and potent substances must be filled out with the utmost care, corrections are not allowed.
Nurse, in addition to performing medical work and caring for the sick, maintains medical records.
1. Journal, or notebook appointments.
2. Journal of reception and transfer of duty.
3. A sheet of records of the movement of patients and hospital beds.
5. Register of medicines of list A and B.
6. Summary of the condition of the patients of the help desk.
7. Journal of accounting for expensive and acutely scarce drugs.
8. Journal of dressings.
9. Journal of copying materials and alcohol.
10. Journal of disinfection treatment of instruments.
I. Journal of pre-sterilization treatment of instruments.
12. Journal of general cleaning.
13. Journal of quartzization.
14. Register of post-injection complications. In addition, she must be able to fill out a statistical coupon (form No. 30).
15. Journal of emergency tetanus prophylaxis.
Journal or appointment book. The nurse prescribes the prescribed drugs, as well as the studies that need to be performed by the patient, in the prescription book, which indicates the full name. patient, room number, manipulations, injections, laboratory and instrumental studies. It duplicates the entry data in the appointment sheet. Be sure to put the dates and the signature of the nurse.
Journal of reception and transfer of duties. Most often, the transfer of duty is done in the morning, but it can also be done in the afternoon, if one nurse works in the first half of the day, and the second in the second half of the day and at night. The nurses receiving and handing over the duty go around the wards, check the sanitary and hygienic regime, examine the seriously ill and sign in the register of reception and transfer of duty, which reflects the total number of patients in the department, the number of seriously ill and feverish patients, the movement of patients, urgent appointments, the state of medical equipment, items care, emergencies. The journal must have clear, legible signatures of the nurses who accepted and passed the duty.
The nurse on duty in the morning fills out the “Patient Movement Record Sheet” (form No. 007y).
The ward nurse, checking the list of appointments, makes a "portion" every day (if there is no dietary sister). The portioner should contain information about the number of different dietary tables and types of unloading and individual diets. For patients admitted in the evening or at night, the portioner is made up by the nurse on duty. Information from ward nurses on the number of diets is summarized by the head nurse of the department, they are signed by the head of the department, then transferred to the catering department.
Register of medicines of list A and B. Medicines included in list A and B are stored separately in a special cabinet (safe). On the inside of the safe there should be a list of these medicines. Narcotics usually stored in the same safe, but in a special compartment. The safe also stores extremely scarce and expensive funds. Handing over the keys to the safe is recorded in a special register. To account for the consumption of medicines stored in a safe, special journals are kept. All sheets in these magazines should be numbered, laced, and the free ends of the cord should be sealed on the last sheet of the magazine with a paper sheet indicating the number of pages. This sheet is stamped and signed by the head of the medical department. To account for the consumption of each drug from list A and list B, a separate sheet is allocated. This magazine is also kept in a safe. Annual records of drug consumption are maintained by the head nurse of the department. The nurse has the right to administer a narcotic analgesic only after the doctor records this appointment in the medical history and in his presence. About the injection made, a mark is made in the medical history and in the prescription sheet. Empty ampoules from under narcotic analgesics are not thrown away, but are transferred together with unused ampoules to a nurse starting the next duty. When transferring duty, they check the correspondence of entries in the accounting log (the number of used ampoules and the balance) with the actual number of filled used ampoules. When using the entire stock of narcotic analgesics, empty ampoules are handed over to the head nurse of the department and new ones are issued in return. Empty ampoules from narcotic analgesics are destroyed only by a special commission approved by the head of the medical department.
The journal of accounting for acutely scarce and expensive funds is compiled and maintained according to a similar scheme.
Summary of the status of patients for the reference table. This summary is compiled daily by the night nurse, most often early in the morning, before the shift. It contains the names of patients, the numbers of their wards, as well as their state of health.
The dressing journal indicates the date, types of dressings, the number of patients who received dressings, and also puts a daily signature.
The journal for writing off alcohol and dressings is located in the surgical room or in the dressing room. This journal is numbered and laced, signed by the senior nurse and head of the department. To the attention of the nurse - the consumption of alcohol by order No. 245 of August 30, 1991.
Surgical office - 1200 g per 1 thousand people (1 person - 1.2 g of alcohol).
Oncology room - 1000 g per 1 thousand people (1 person - 1 g of alcohol).
Urologist's office - 1200 g per 1 thousand people (1 person - 1.2 g of alcohol). To apply a compress, 20-30 g of alcohol is required. Burn treatment - 20-40 g of alcohol.
Similarly, the consumption of cotton wool, bandages, furacilin is taken into account. Logs of disinfection treatment of instruments, pre-sterilization treatment of instruments are compiled and maintained to control the relevant activities (table).
Orders for work in the surgical room
Instruction on labor protection for a nurse at school. AGREED APPROVED. Chairman of the trade union director. Order. General provisions health and safety instructions for nurses. An employee hired by a school as a nurse must necessarily undergo a medical examination, special training, introductory safety briefing, primary briefing for a nurse - at the workplace, repeated briefing - at least once every 6 months, unscheduled (if conditions change) work of a nurse, safety violations, accidents).
Employees with a secondary medical education in their specialty are allowed to independently perform work. Persons who have studied the labor protection instructions for the school nurse, as well as the job description of the nurse at the school, are allowed to perform duties. The employee has the right to refuse the work entrusted to him if a situation has arisen that is dangerous for his personal health, or for the people who surround him, and the environment.
An employee is obliged to strictly comply with the requirements and internal regulations of a general educational institution: observe discipline; take care of equipment, tools, devices, medicines, materials and overalls; keep one's own clean workplace and territory; periodically undergo medical examinations. When performing the duties of a nurse at a school, exposure to harmful production factors is possible: electric shock when turning on electric lighting, using faulty electrical outlets; electric shock when working with a bactericidal quartz lamp, medical or other electrical equipment; violation of visual acuity in case of insufficient illumination of the workplace of a nurse; damage to the mucous membrane of the eyes due to failure to comply with the instructions and requirements for the use of bactericidal quartz lamps; injections, cuts in the provision of medical care to victims. It is forbidden to smoke and drink alcohol in the workplace. Fire safety regulations must be strictly observed. It is also necessary to observe the rules of personal hygiene: eat only in the dining room; perform work in perfectly clean overalls; when performing injections, use rubber gloves; one.
All employees of the department (office) are re-instructed at least as often as the knowledge of the personnel of the department (office) on safety measures according to the program. The results of the briefing are recorded in the appropriate journal, knowledge of this labor protection instruction for the nurse is checked. Maintaining the necessary sanitary and epidemiological regime in the surgical department is impossible without the following components They are contained in the RTM
The nurse is obliged to follow the instructions for labor protection in the medical office. The medical office of the institution must be equipped and equipped with tools in accordance with the approved list of equipment and tools for the medical office. For violation of the requirements of this instruction on labor protection for a nurse, a medical worker working at a school is held liable in accordance with the legislation of the Russian Federation. Occupational safety requirements for a nurse before starting work.
Before starting work in the medical office of the school, the nurse must put on clean overalls: a medical gown, a hat or scarf, a gauze bandage-mask. The overalls of the nurse must be clean and ironed, fastened with all buttons or tied.
Inspect the premises, make sure that the electric lighting in the medical and treatment rooms of the school is working. Ventilate the room of the medical office, treatment room. Check the integrity of electrical outlets and the serviceability of other electrical appliances. It is necessary to carefully check the availability of all drugs and serviceability medical equipment.
Before starting work, the nurse of the educational institution must thoroughly wash their hands with soap and water. Safety requirements during the work of a nurse. The school nurse is obliged to: Accurately and promptly follow the instructions of the doctor; be sensitive and attentive to sick children, monitor the personal hygiene of students; use equipment and tools professionally, accurately and carefully; Report all technical malfunctions to the director of the educational institution. It is forbidden for the school nurse to use medical equipment and devices for other purposes. To avoid injury and the occurrence of dangerous situations, the nurse must comply with the following requirements: do not leave switched on and operating equipment unattended; do not allow persons who have not undergone appropriate training to work with medical equipment; work only on serviceable medical equipment and serviceable tools; constantly monitor the expiration date of the drugs used; observe the rules of electrical safety and fire safety; do not perform work that is not part of your duties. Sterilize medical instruments only in specialized rooms (treatment room). When working with medical equipment, observe safety measures: do not connect to the electrical network and do not disconnect devices from it with wet and damp hands; do not violate the sequence of turning on and off the equipment, do not violate technological processes; strictly follow the instructions for using electrical appliances available in the medical office; do not leave unattended devices, quartz lamps, ovens, etc., turned on in the medical office;
Each student is required to undergo a safety briefing at the clinical base of the department, before starting training and conducting practical classes. Conducting practical classes at the clinical bases of the department, in the departments of the surgical profile. Safety instructions for working in the surgical department. File description: Added: 04/20/2016 Downloads: 1603 File status: available File public: Yes File uploaded: raulLAN44. Typical instruction on labor protection for personnel of operating units (approved by Job description nurses of the surgical department: This job description was developed and approved by them; - internal rules work schedule; — rules and regulations of labor protection, safety and fire protection; — 1st and 2nd surgical departments. Standard safety instructions for working in sterilization rooms (Approved by the Ministry of Health of the USSR on 14.10. Each student is required to undergo a safety briefing in the hospital. Before starting work in the hospital department, it is necessary to change clothes.
An instruction on labor protection for an obstetrician is urgently needed. To work in the gynecological department (hereinafter referred to as the "department"). Surgical instruments used in various HEALTH AND SAFETY INSTRUCTION Nursing post of the surgical department, Contents. Repeated briefing on labor protection should be carried out at least in time when working in the surgical department, in maternity, etc. Participates in surgical operations, provides members of the surgical team with the necessary tools, materials, equipment. Complies with internal regulations, fire safety and safety regulations.
This job description defines official duties, rights and responsibility (head of the department, deputy chief physician). Safety and fire safety rules at the workplace and in the department. Basic requirements, orders, instructions for infectious safety and prevention of nosocomial infections in a surgical hospital. Instructions for students on safety precautions when working in medical institutions in 2. Before starting work in the hospital department, you must change clothes. Dress code: medical gown, surgical suit, medical cap. All newly hired workers must undergo an introductory briefing on labor protection. The results are recorded in the entry log. My 422039-05 (technics for the collection and transport of surgical and biomaterials in microbiological laboratories) institutions). Instructions GBUZ SO *&SOKB N*.
The head of the department is obliged to develop safety instructions for each type of equipment, which must be approved by the administration of the health facility and agreed with the trade union committee.
Standard instruction on labor protection for department personnel, labor protection for a ward nurse (reception-quarantine. The job description of a nurse (nurse) is local act in which the activities of the department to which it is attached (surgical, radiological Compliance with safety precautions when working with equipment in the operating room. When working with electrical equipment, follow the operating rules and safety precautions set out in the instructions, which 9. Infections of the skin and subcutaneous tissue - only for obstetric and surgical hospitals, departments of neonatal pathology Instructions for safety precautions Obligations of the student in the surgical department: I. To ensure a safe environment for the patient in the hospital.
To protect yourself from injuries to your hands in the process of opening the ampoule, you must first file the ampoule with a nail file and then break off its nose with your fingers protected with gauze or cotton. Know the evacuation routes in case of fire, the procedure for emergency know how to use a powder fire extinguisher when necessary. During work, the nurse must follow the rules of personal hygiene, the requirements of the labor protection instructions for the school nurse, and be careful with medications. Occupational safety requirements at the end of the work of a nurse. Disconnect all electrical equipment from the electrical network.
Ventilate the medical office. Tidy up your workspace. Take off your overalls and hide them in the designated place. Tightly close the window, transom. Close the medical and treatment room with a key.
reachpriority.weebly.com
I.V.SHATKIN
Appendix No. 21
to the order of the Ministry
health care of the USSR
dated 23.09.1981 N 1000
www.zakonprost.ru
Organization of the work of the surgical department and the surgical room of the polyclinic
In our country, medical care is organized according to the territorial principle, however, with the development of insurance and private medicine, this principle, especially in relation to planned care, is beginning to change.
Organizations of surgical care
Feldsher-obstetric station - provides emergency first aid, carries out the prevention of diseases and injuries to residents of one or more rural settlements.
The district hospital provides emergency and urgent medical care for acute surgical diseases and injuries, carries out work on their prevention, manages the work of feldsher-obstetric stations located in this area of the district.
District hospital - provides surgical care to all patients with acute surgical diseases and trauma, conducts planned treatment of the most common surgical diseases (hernia, gastric ulcer, cholecystitis, etc.)
The regional hospital - in addition to the volume of care provided in district hospitals, provides specialized surgical care: urological, traumatological, oncological, etc.
City hospitals provide emergency and planned surgical care to residents of city districts.
Surgical departments of medical universities - in addition to providing surgical care, they conduct the scientific development of certain sections of surgery.
Scientific research institutes, in accordance with their profile, provide special surgical care, carry out the scientific development of surgical problems.
Inpatient surgical care is provided in three types of surgical departments: general, specialized and highly specialized (centers).
General surgical departments are organized as part of district and city hospitals. They provide the main types of qualified inpatient surgical care to a large part of the country's population. Various diseases are treated here, among which more than 50% are acute surgical pathologies and 20-40% are injuries and diseases of the musculoskeletal system.
Specialized departments are opened in regional and city hospitals and serve from 50 thousand to 3 million people. They are intended to provide patients with surgical care in the relevant specialty. The organization of specialized departments is based on similar principles that contribute to the concentration of patients on a certain basis:
* · for a disease of one organ system - departments of vascular surgery, lung surgery, proctological, urological, etc.;
* By nosological forms, taking into account localization - burn departments, surgery for genitourinary and osteoarticular tuberculosis, etc.;
* by sections of surgical pathology - oncological departments, emergency surgery, purulent surgery, etc.;
* by the peculiarities of the methods of operations - plastic surgery;
* by age characteristics — pediatric surgery.
General surgical departments are opened, as a rule, for 60 beds or more, specialized departments for 25-40 beds. A significant part of city and regional hospitals are clinical, as surgical clinics of medical institutes operate on their basis. Surgical beds are also available in special clinics of medical institutes that are not part of the city network, in research institutes subordinate to ministries and departments, and in institutes of the Russian Academy of Medical Sciences.
Organization of emergency and urgent surgical care. In cities, it is carried out according to the scheme: emergency medical care (health center or clinic) - surgical hospital. In the countryside: feldsher-obstetric station, district hospital - surgical department of the district hospital. Surgical departments have round-the-clock duty of surgeons, anesthesiologists and operating nurses to provide emergency surgical care.
ORGANIZATION OF THE WORK OF THE SURGICAL DEPARTMENT
Departments of the surgical profile should be located in the same building with the emergency room, the operating unit, the intensive care unit and the intensive care unit, since they are functionally dependent on each other. Ward departments are organized for 60 or more beds. According to SNiP (Building Norms and Rules, 1971), departments in new hospitals are planned from two impassable sections, which are separated by halls. The section should have 30 beds. The ward section provides for: a post for a nurse on duty (4 m 2), a treatment room (18 m 2), a dressing room (22 m 2), a dining room (with at least 50% of the number of beds), a room for sorting and temporary storage of dirty linen , cleaning items (15 m 2), bathroom (12 m 2), enema (8 m 2), restroom (men's, women's, for staff). Along with this, the department needs: the head's office (12 m 2), the staff's room (10 m 2 for each doctor, in addition to one additional 4 m 2), the head nurse's room (10 m 2), the hostess (10 m 2). The clinics provide offices for professors, associate professors, assistants and study rooms for 10-12 people.
Chamber - the main place of stay of the patient in a medical institution. In the wards of the surgical department, 7 m 2 is allocated per bed. Most of the wards in the section are planned for 4 beds, 2 - two-bed wards, 2 - one-bed wards. The optimal number of beds in the ward is 3. Before entering the ward, a gateway is planned, which is provided as a small front room, where there are built-in individual wardrobes for patients and an entrance to the toilet, with a washbasin, bath or shower. The rooms are equipped with beds of a metal structure, to which a transfusion stand and a skeletal traction device can be attached. Most beds should be functional. The interior of the room is complemented by a bedside table, a common table, chairs, and a waste paper basket. The temperature in the room should be at 20°C. Optimum air humidity is 50-60%, air mobility is about 0.15 m/s. Chambers should be well lit by natural light, windows should not be oriented to the north. The ratio of the area of windows and the floor should be 1:6. Provides general and local electric lighting. Each bed has a call system ward nurse.
The post of the ward nurse is placed in the corridor so as to provide a good overview of the wards. The post is located in the center of the section. It is equipped with cabinets for storing medicines, tools, care items and documentation (lists of medical appointments, handovers, etc.).
When placing patients, it is necessary to take into account the characteristics of the contingent, so clean and purulent departments should be allocated. This will make the treatment more effective, and most importantly, prevent complications.
Surgical departments should be provided with forced ventilation, and separate rooms with supply and exhaust ventilation or conditioned air. The premises of surgical departments are subject to wet cleaning, using disinfectants, twice a day: in the morning after the patients wake up and in the evening before bedtime. Once a month it is necessary to carry out general cleaning, with wet disinfection of mattresses and pillows. Air samples should be taken monthly for bacteriological examination.
The organization of work of medical personnel is regulated by the “Model internal regulations”, on the basis of which rules are drawn up for various institutions depending on their purpose. Each surgical department has a daily routine, which is aimed at creating rational working conditions for medical personnel and optimal conditions for the recovery of patients.
Special requirements are imposed on the personnel of the surgical department: the human qualities of the personnel are no less important than their qualities as specialists. It is necessary to impeccably follow the principles of medical deontology and ethics. Deontology (Greek deon - due, logos - teaching) - a set of ethical and organizational norms for the fulfillment by health workers of their professional duties. The main elements of deontology are aimed at creating a special psychological climate in the surgical department. The main function of the psychological climate in a surgical facility is to create conditions for the speedy, high-quality and reliable recovery of patients. Two main goals follow from this:
* Minimize the effect of factors slowing down and qualitatively worsening the process of patients' recovery;
* Maximize the extent to which patients perceive a healthier lifestyle.
WORK ORGANIZATION
SURGICAL DEPARTMENT OF THE POLYCLINIC
The polyclinic provides reception of patients with surgical diseases and treatment of those who do not need inpatient treatment. Most patients visit the department repeatedly for dressings and medical procedures.
The surgical department of the polyclinic should be located, if there is no elevator, on the first or second floor. This facilitates visiting them by patients with diseases of the lower extremities and the delivery of stretcher patients. With one working surgeon, the department should include: a doctor's office, a dressing room, an operating room, a sterilization room, and material rooms. With a large number of working surgeons, the operating room, sterilization room, material room can be shared, but the office and dressing room should be separate for each doctor. The surgeon's office should have a table, 2 stools, a couch for examining patients, which is best placed behind a screen, a negatoscope, etc.
The walls must be smooth and in all rooms at least two meters high must be painted with oil paint, the walls of the operating room must be covered with tiles. All rooms in the surgical department must have wash basins. Premises of the surgical room must be especially carefully protected from pollution. The contingent of patients changing during the reception, the delivery of patients in clothes contaminated after injuries contributes to the introduction of dirt into the surgical room. Therefore, it is necessary to frequently wipe the floors of offices and dressing rooms with a wet method, using antiseptic liquids that are devoid of an unpleasant odor. Wet current cleaning of the premises (floor, walls) should be carried out after each appointment. At the end day job The office is completely cleaned.
The work of a surgeon in a clinic is significantly different from the work of a surgeon in a hospital. Unlike a hospital surgeon, an outpatient surgeon has significantly less time for each patient and often lacks the ability to accurately distribute his work hours, especially where there is no separate trauma room. Appeal of patients for emergency surgical care (dislocations, fractures, injuries) requires stopping the current appointment and providing first aid to the victim, however, this does not relieve the surgeon from providing assistance to all other patients scheduled for an appointment.
The surgeon participates in consultations with doctors of other specialties, resolves issues of planned and emergency hospitalization of patients, issues of working capacity, employment. In addition to medical, advisory work, a polyclinic surgeon conducts a medical examination of certain groups of patients (varicose veins, thrombophlebitis, osteomyelitis, hernia, after surgery for gastric ulcers, etc., as well as disabled WWII), participates in preventive work on the site, in the work of engineering and medical teams. The polyclinic surgeon maintains contact with the hospital, where he sends patients, and also provides aftercare after discharge from the hospital. In some cases of emergency surgery, the doctor has to visit patients at home, where, in the absence of additional research methods, he is obliged to make the correct diagnosis and decide on the tactics of further treatment of the patient. An error in diagnosis and delay in providing the necessary assistance can lead to fatal consequences. To carry out this work, the surgeon must be the organizer of the medical and surgical process, implementing the principle of N.I. Pirogov on the importance of organization in medicine and surgery in particular.
The nature of the work of the surgical office requires that all personnel are well aware of their duties and master the methods of their work. The nurse of the surgical office should be knowledgeable in the field of asepsis and antisepsis, comply with her requirements in work and monitor compliance with them by other employees and patients, help the doctor in organizing the reception of patients. The nurse of the surgical department should be trained in the rules of cleaning, washing instruments, and the technique of preparing material for sterilization. She must skillfully help the doctor and nurse during certain manipulations (help with undressing, dressing, etc.). Be aware of the danger of violating the rules of asepsis (be able to open bottles with sterile linen, supply a sterilizer with instruments, a basin for washing hands, etc.).
When conducting a lesson in the surgical office of the polyclinic, students, together with the surgeon working in the office, receive primary and secondary patients, participate in their examination, get acquainted with the rules for filling medical documents(outpatient card, dispensary card, coupons and referrals) and selection of patients for hospitalization. The most interesting and thematic patients are dealt with in more detail with the teacher. In the course of admission, students get acquainted with the procedure for issuing and extending sick leave.
Thus, in the classroom in the clinic, students get acquainted with the contingent of patients that they do not see in the hospital, and also consolidate practical skills (bandaging, immobilization, injections, etc.).
ORDER of the Ministry of Health of the USSR dated September 23, 1981 N 1000 (as amended on December 22, 1989) “ON MEASURES TO IMPROVE THE ORGANIZATION OF WORK OF OUTPATIENT AND POLYCLINIC INSTITUTIONS”
Annex N 20
1. Surgical, otolaryngological, ophthalmological and neurological departments (offices) are organized as part of the city polyclinic.
2. The head of the department (office) is a specialist who has received special training in the relevant specialty.
3. Control over the work of the department (office) is carried out by the management of the polyclinic.
4. Doctors of departments (offices) work in contact with doctors - specialists of a different profile and, first of all, with general practitioners - district (territorial and shop medical districts).
5. Doctors of departments (offices) in their work are guided by this regulation, orders, instructions and instructions of the Ministry of Health of the USSR and current legislation.
6. The main tasks of departments (offices) are to carry out disease prevention measures, early detection of patients and their effective treatment in a polyclinic and at home according to their profile.
7. In accordance with these tasks, doctors of departments (offices) carry out:
– regular outpatient appointments according to the schedule approved by the administration of the polyclinic;
- dynamic observation and active treatment of patients until their recovery, remission or hospitalization;
- control over the timeliness of the implementation of diagnostic and therapeutic procedures by patients under supervision in this department (office);
- timely referral of patients, if indicated, to VTEC;
- consultations of patients in the directions of other doctors - specialists, incl. at home;
- timely identification of persons subject to medical examination according to the profile of this department (office), and taking them for dynamic observation;
– conducting an examination of temporary disability with the issuance of sick leave in accordance with applicable law;
— carrying out sanitary-educational work and hygienic education of the population.
8. The department (office) has the necessary space for placement, in accordance with sanitary and hygienic standards and requirements, as well as medical equipment, tools and inventory.
Head of the Main Department
medical and preventive care
I.V.SHATKIN
Appendix No. 21
to the order of the Ministry
health care of the USSR
dated 23.09.1981 N 1000
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| Order number issuing body | The year of publishing | Order name | ||
| 288, Ministry of Health of the USSR | 23.03.19. | "On the approval of the instructions on the sanitary and anti-epidemic regime of the hospital and on the procedure for the implementation by the bodies and institutions of the sanitary and epidemiological service of the state sanitary supervision of the sanitary condition of healthcare facilities" | ||
| 720, Ministry of Health of the USSR | 31.07.1978. | "On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections" | ||
| SanPiN 2.1.3.2630-10 | 08.05.2010 | "Sanitary and epidemiological requirements for organizations engaged in medical activities" | ||
| OST 42-21-2-85 of the Ministry of Health of the USSR, project No. 770 of the Ministry of Health of the USSR was introduced | 01.01.1986. 10.06. | Sterilization and disinfection of medical devices. Methods, means and modes» | ||
| 408, Ministry of Health of the USSR | 27.07.1989. | "On strengthening measures to reduce the incidence of viral hepatitis in the country" | ||
| 254, Ministry of Health of the USSR | 03.09.1991. | "On the development of disinfection in the country" | ||
| 342, Ministry of Health of the Russian Federation | 26.11.1998. | "On strengthening measures for the prevention of epidemic typhus and the fight against pediculosis" | ||
| 249, Ministry of Health of the Russian Federation | 09.08.1997. | "On the nomenclature of specialties of nursing and pharmaceutical personnel" | ||
| 170, Ministry of Health of the Russian Federation | 16.08.1994. | "On measures to improve the prevention and treatment of HIV infection in the Russian Federation" | ||
| 174-D, Ministry of Health of the Republic of Belarus | 30.01.2012. | "On emergency prevention of HIV infection" | ||
| SanPin 2.1.7.2790-10 | 09.12.2010 | « Sanitary and epidemiological requirements for the handling of medical waste " | ||
| SP. 3.1.5.2826-10 | 11.01.2011 | Sanitary and epidemiological rules "Prevention of HIV infection" | ||
| SP 1.3.2322-08 | 02.06.2009 | Sanitary regulations and norms "Safety of working with microorganisms of III-IV groups of pathogenicity and helminths" | ||
| Order No. 259-D of the Ministry of Health of the Republic of Belarus | 30.04.2003 | "On measures to prevent respiratory disease syndrome (SARS) in the Republic of Belarus". | ||
| Order No. 60-D of the Ministry of Health of the Republic of Belarus | 07.07.1996 | "On conducting a medical examination for HIV / AIDS." | ||
| SP 3.1.2825-10 | 30.12.2010 | Sanitary and epidemiological rules "Prevention of viral hepatitis A" | ||
| Order No. 36 of the Ministry of Health of the Russian Federation | 03.02.1997 | "On the improvement of measures for the prevention of diphtheria". | ||
| Order No. 678-D of the Ministry of Health of the Republic of Belarus | 19.10.2001 | "On the state of readiness of health care facilities and centers of the State Sanitary and Epidemiological Service for the occurrence of foci of HOI." | ||
| Order No. 139 of the Ministry of Health of the USSR | 02.03.1989 | "On measures to reduce the incidence of typhoid and paratyphoid fever in the country." | ||
| Order No. 475 of the Ministry of Health of the USSR | 16.08.1989 | "On measures to further improve the prevention of acute intestinal infections in the country." | ||
| Instruction of the Ministry of Health of the USSR | 24.03.1989 | "On the collection, storage and delivery of scrap medical products of single use from plastics". | ||
| M.U. 3.1. 2313-08 | 15.01.2008 | Guidelines"Requirements for the neutralization, destruction and disposal of injection syringes, single use." | ||
| Order No. 302N of the Ministry of Health of the Russian Federation | “On the procedure for conducting preliminary periodic medical examinations”. | |||
| Order No. 109 of the Ministry of Health of the Russian Federation | "Measures for the prevention of tuberculosis in the country". | |||
| Order No. 65 of the Ministry of Health of the Russian Federation | 01.06.1999 | "On preventive medical examinations." | ||
Disinfection methods:
1.Physical method (hot air, water vapor, fire, germicidal lamps).
2. Chemical method - the use of chemical disinfectants.
3. Mechanical method - knocking out, shaking out.
Pre-sterilization cleaning all medical devices, in order to remove protein, fat, mechanical contaminants, drugs.
Sterilization - a method that ensures the death of vegetative, spore forms and organisms. All products in contact with the wound surface, blood are sterilized (OST 42-21-2-85 was put into effect with the order of the Ministry of Health of the USSR No. 770 dated 10.06.85 "Sterilization and disinfection of medical devices. Methods, means, modes").
Every day before starting work, I prepare disinfectant solutions as follows:
Conditions for disinfection:
1) the presence of containers with a disinfectant;
2) full immersion in a disinfectant solution;
3) all containers with a disinfectant are marked and used for their intended purpose;
4) dilute the disinfectant using measuring utensils;
5) I attach a tag with a dilution mark to each container: date, signature of the nurse.
Currently, new highly effective disinfectants with a washing effect are used, which combine disinfection and pre-sterilization treatment of medical devices.
Storage of detergents and disinfectants is carried out in the container (package) of the manufacturer, provided with a label, on racks, in a specially designed place.
We have separate containers with working solutions of disinfectants used for processing various objects.
Containers with working solutions of disinfectants are equipped with tight-fitting lids, have clear inscriptions, labels indicating the agent, its concentration, purpose, date of preparation, expiration date of the solution.
When working with disinfectants, I observe all precautions, including the use of disinfectants personal protection specified in the instructions for use.
To control pre-sterilization cleaning I carry out:
1) azopyram test(alcohol solution of azopyram + 3% hydrogen peroxide solution, all in equal amounts, prepared before use) control for the presence of occult blood;
2) phenolphthalein test(1% phenolphthalein solution) control for the presence of detergent.
Sterilization I spend in the treatment room in a dry-heat cabinet, after preliminary disinfection and pre-sterilization treatment. Sterilization of instruments is carried out by the air method in a dry-heat cabinet at a temperature of 180 0 C, exposure 1 hour. To control the sterility of instruments, I use Vinar indicators, placing them at five points: four at the corners of the sterilizer, one in the middle. At the end of sterilization, the indicator changes color to dark brown, I save them and stick them in the sterilization control log.
Glove processing: for examination and carrying out any manipulations to patients, sterile gloves are used, for each individual. At the end of work, all gloves are disinfected (San Pin 2.1.3.2630-10). I immerse in one of the disinfectants for 1 hour, dispose of as class B waste.
Sterilization methods:
Table 5
Steam method
Bixes with a filter - shelf life - 20 days.
Without filter - 3 days.
Opened - 6 hours.
Each bix contains 3 tests - up, middle and down.
Table 6
chemical method
Composition of the emergency kit
According to order No. 174D of the Ministry of Health of the Republic of Belarus dated January 30, 2012. An emergency first aid kit for a medical worker in an emergency includes:
1. ethyl alcohol 70% - 50ml,
2. 5% alcohol solution of iodine - 20 ml,
3. adhesive plaster,
4. sterile cotton balls No. 20 - 1 pack.,
5. sterile gauze wipes No. 10 - 1 pack.,
6. sterile bandage - 1 pc.,
7. express tests for HIV - 2 pcs. -
store centrally, in a place that is generally accessible to health workers, including at night and on weekends.
As the material is used, replenishment of the first-aid kit should be carried out immediately.
1. Order of the Ministry of Health of the USSR No. 408 of 1989 "On measures to reduce the incidence of viral hepatitis in the country."
Epidemiology, clinic, diagnostics, treatment, outcomes, clinical examination of patients with viral hepatitis A, B, delta, etc.
Hepatitis A. Hepatitis A virus (HA) belongs to the family of picornaviruses, similar to enteroviruses. HA virus can survive for several months at 4 °C, several years at -20 °C, and several weeks at room temperature. The virus is inactivated by boiling.
Only one serological type of the HA virus is known. Of the determined specific markers, the most important is the presence of antibodies to the GA virus of the Ig M class (GA antivirus IgM), which appear in the blood serum at the onset of the disease and persist for 3-6 months. Detection of anti-HAV IgM indicates hepatitis A and is used to diagnose the disease and identify sources of infection in foci.
The antigen of the GA virus is found in the feces of patients 7-10 days before clinical symptoms and is used to identify sources of infection.
Antivirus GA IgG is detected from the 3-4th week of the disease and persists for a long time.
The source of infection are patients with any form of acute infectious process.
Forms of the disease: icteric, anicteric, subclinical, inapparent.
The transmission mechanism is fecal-oral. Its implementation occurs through the factors inherent in intestinal infections: water, "dirty hands", food products, household items. Human susceptibility to infection is universal. Immunity after an illness is long, possibly lifelong.
The incubation period is from 7 to 50 days, on average 15-30 days.
Preicteric period (prodrome period) - acute onset, fever up to 38 ° C and above, chills, headache, weakness, loss of appetite, nausea, vomiting, abdominal pain. There is a feeling of heaviness in the right hypochondrium. The tongue is coated, the abdomen is swollen, the liver reacts to palpation of the abdomen. The duration of this period is 5-7 days. By the end of the preicteric period, the urine becomes dark, the color of beer. The stool is discolored. Subicteric sclera appears. The II icteric phase of the disease begins.
Jaundice grows rapidly, a number of symptoms weaken, a feeling of heaviness in the right hypochondrium, weakness, loss of appetite persists. The size of the liver increases, it has a smooth surface, compacted. The spleen is enlarged. In the blood - leukopenia, a moderate increase in bilirubin, increased AlAT and AsAT. The icteric period lasts 7-15 days.
The period of convalescence is characterized by the rapid disappearance of clinical and biochemical signs of hepatitis.
There are no chronic forms of GA.
Anicteric forms of viral hepatitis A have the same clinical (with the exception of jaundice) and biochemical (with the exception of an increase in the level of bilirubin) signs.
Erased forms - those in which all clinical signs are minimally expressed.
Inaparant forms - asymptomatic carriage, which is detected by the appearance of ALT activity in the blood serum and the presence of anti-IgM and IgG.
The diagnosis is established on the basis of clinical data, as well as the detection in the blood serum of antibodies to the HA virus of the immunoglobulin class M (anti-HAV IgM) and class G (anti-HAV IgG) and an increase in the activity of ALT and AST and bilirubin in the blood.
Patients are subject to hospitalization in the infectious diseases department of the hospital. Recovery usually occurs within 1 - 1.5 months after discharge from the hospital.
HAV convalescents are observed in the office of infectious diseases, where they undergo medical examination once a month. Removed from the register after 3 months in the absence of complaints, normalization of liver size and functional tests.
Treatment, prevention
Mild forms of hepatitis A do not require medical treatment. It is enough to follow a diet, half-bed rest, drink plenty of water; with a moderate form, the introduction of detoxification agents is added: a 5% glucose solution is injected intravenously, a solution
Ringer 500 ml with the addition of 10 ml of a 5% solution of ascorbic acid.
Severe forms are extremely rare: more intensive infusion therapy may be required.
Preventive measures - the introduction of immunoglobulin according to epidemiological indications up to 3.0 ml. Data on immunoglobulin prophylaxis are entered into accounting forms No. 063 / y and 26 / y. It is allowed to administer the drug no more than 4 times at intervals of at least 12 months.
Persons who have been in contact with HAV patients are monitored (once a week for 35 days).
Hepatitis B (HB) is an independent disease caused by the hepatitis B virus, which belongs to the hepadnavirus family. Extremely stable in the external environment.
The source of hepatitis B is patients with any form of acute and chronic hepatitis B, as well as chronic "carriers" of the virus. The latter are the main sources of infection. The patient can be contagious as early as 2-8 weeks before the onset of signs of the disease.
The incubation period is 6-120 days.
Preicteric period. The disease begins gradually. Patients complain of loss of appetite, nausea, vomiting, constipation, followed by diarrhea. Often worried about pain in the joints, itching, increase
Transmission mechanism - parenteral:
Through damaged skin and mucous membranes;
Tranplaceptally;
With blood transfusions;
Sexually.
the size of the liver, sometimes the spleen. Leukopenia in the blood. The activity of the indicator enzymes AlAT and AsAT in the blood serum is increased. The duration of this period is from 1 day to 3-4 weeks.
The icteric period is long, characterized by the severity and persistence of the clinical symptoms of the disease, tends to increase. Jaundice reaches a maximum at 2-3 weeks. There is prolonged pain in the right hypochondrium, the liver is smooth, enlarged. In the blood: leukopenia, lymphocytosis, a significant increase in the level of bilirubin, an increase in ALT and AST in the blood serum.
Usually acute hepatitis B occurs in a moderate form, severe forms are frequent.
Fulminant (lightning) forms are rare.
Complications: hepatic coma, encephalopathy.
Chronic forms of hepatitis B are common.
The period of recovalescence is longer than in HAV, clinical and biochemical signs persist for a long time.
Specific methods of laboratory diagnostics are the presence of HBs antigen (HBSAg), which appears in the blood long before the onset of the disease clinic.
To delimit the state of HBsAg carriage from active infection, it is necessary to study anti-HBsIgM in the blood serum; the absence of such antibodies is characteristic of carriage.
The discharge of convalescents for hepatitis B is carried out according to the same clinical indications as for hepatitis A. The discharge of convalescents in whom the HBs antigen continues to be detected for a long time must be reported to the infectious disease doctor in the clinic and to the sanitary and epidemiological station of the district.
Outcomes of acute viral hepatitis:
Recovery;
Residual effects:
Protracted convalescence;
Posthepatitis hepatosplenomegaly.
The ongoing course of the infectious process:
Protracted hepatitis;
Chronic persistent hepatitis;
Asymptomatic carriage of the HBs antigen;
Chronic active hepatitis;
Cirrhosis of the liver;
Primary liver cancer.
Clinical examination
After discharge from the hospital, the patient is examined no later than 1 month later. Then he is examined after 3, 6, 9 and 12 months after discharge. Deregistration is carried out in the absence of chronic hepatitis and a double negative test for HBsAg, conducted with an interval of 10 days.
Treatment:
Detoxification therapy, depending on the severity of the condition;
Reaferon (recombinant alpha-2 interferon);
symptomatic treatment.
Prevention is aimed at actively identifying sources of infection, for this it is necessary to conduct a survey of the population for the carriage of viral hepatitis B, and, first of all, to examine people from risk groups.
At-risk groups
1. Donors.
2. Pregnant.
3. Recipients of blood and its components.
4. Personnel of blood service institutions, hemodialysis departments, surgery, biochemical laboratories, ambulance stations, intensive care units.
5. Patients at high risk of infection staff of hemodialysis, kidney transplant, cardiovascular and pulmonary surgery, hematology centers.
6. Patients with any chronic pathology who are in hospital for a long time.
7. Patients with chronic liver diseases.
8. A contingent of narcological and dermatovenerological dispensaries.
Prevention of occupational infections:
All manipulations during which hands may be contaminated with blood or serum are carried out with rubber gloves. During work, all injuries on the hands are sealed with adhesive tape. Masks should be worn to avoid blood splatter;
Frequent use of disinfectants should be avoided when cleaning hands. Surgeons should not use hard brushes to wash their hands;
In case of contamination of hands with blood, immediately treat them with a disinfectant solution (1% chloramine solution) and wash them twice with warm water and soap, wipe dry with an individual disposable napkin;
In case of contamination with blood, immediately treat the surface of work tables with a 3% solution of chloramine;
Medical workers who have contact with blood by the nature of their professional activity are subject to examination for the presence of HBsAg upon admission to work, and then at least once a year.
Prevention of hepatitis during treatment and diagnostic parenteral interventions
1. In order to prevent hepatitis B in all health facilities:
It is necessary to use disposable tools as much as possible;
Strictly follow the rules of disinfection, pre-sterilization cleaning and sterilization of medical equipment;
Case histories of people who carry HBsAg should be labelled.
2. OST of the USSR Ministry of Health of 1985 42-21-2-85
Sterilization and disinfection of medical devices.
Methods, means, modes:
Disinfection (methods, means);
Pre-sterilization treatment (stages);
Sterilization (methods, modes, means);
Cleaning products from corrosion.
3. Order of the Ministry of Health of the USSR No. 215 of 1979 "On measures to improve the organization and improve the quality of specialized medical care for patients with purulent surgical diseases."
The instructions for the organization and implementation of sanitary and hygienic measures, anti-epidemic regime in surgical departments, intensive care units are described.
4. Order of the Ministry of Health of the Russian Federation No. 295 of 1995 “On the Enactment of the Rules for Mandatory Medical Examination for HIV”.
The list of employees of institutions and organizations that undergo a medical examination for the detection of HIV infection during mandatory upon admission to work and periodic medical examinations:
Doctors, middle and junior medical staff for the prevention and control of AIDS, directly involved in the examination, diagnosis, treatment and care of persons infected with the immunodeficiency virus;
Doctors, middle and junior medical personnel of laboratories;
Scientists, workers of enterprises for the production of immunobiological preparations, whose work is related to the material containing the immunodeficiency virus.
Rules for conducting a mandatory medical examination for the detection of HIV infection.
1. Donors of blood, sperm and other biological fluids, tissues, organs are subject to mandatory medical examination.
2. The study of blood serum for the presence of antibodies to the immunodeficiency virus is carried out in 2 steps.
Stage I - the total spectrum of antibodies against antigens of the HIV virus is detected using enzyme immunoassay.
Stage II - immune blotting is carried out in order to determine antibodies to individual proteins of the immunodeficiency virus.
3. In case of detection of HIV infection among employees of certain enterprises (the list of organizations is approved by the Government of the Russian Federation), they are subject to transfer to another job that excludes the conditions for the spread of HIV infection.
List of indications for testing for HIV / AIDS in order to improve the quality of diagnosis.
1. Patients according to clinical indications:
Fever for more than one month;
Having an increase in lymph nodes of two or more groups for more than one month;
With diarrhea lasting more than one month;
With unexplained weight loss;
With prolonged and recurrent pneumonia or pneumonia not amenable to conventional treatment;
With subacute encephalitis;
With hairy leukoplakia of the tongue;
With recurrent pyoderma;
Women with chronic inflammatory diseases of the reproductive system of unknown etiology.
2. Patients with suspected or confirmed diagnosis for the following diseases:
Addiction;
Sexually transmitted diseases;
Kaposi's sarcoma;
Lymphomas of the brain;
T-cell leukemia;
Pulmonary and extrapulmonary tuberculosis;
Hepatitis B;
Cytomegalovirus infection;
Generalized or chronic forms of herpes simplex;
Recurrent shingles (persons younger than 60 years);
Mononucleosis;
Candidiasis of the esophagus, bronchi, trachea;
Deep mycosis;
Anemia of various origins;
Pregnant women - in the case of taking abortion and placental blood for further use as a raw material for the production of immunopreparations.
Compulsory HIV testing is prohibited.
Coding of patients when referring them for HIV testing:
100 - citizens of the Russian Federation;
102 - drug addicts;
103 - homo- and bisexuals;
104 - patients with venereal diseases;
105 - persons with promiscuity;
106 - persons staying abroad for more than one month;
108 - donors;
109 - pregnant women (donors of placental and abortion blood);
110 - recipients of blood products;
112 - persons who were in places of deprivation of liberty from risk groups;
113 - examined but clinically indicated (adults);
115 - medical staff working with AIDS patients or infected material;
117 - examined according to clinical indications (children);
118 - other (specify contingent);
120 - medical contacts with AIDS patients;
121 - heterosexual partners of HIV-infected people;
122 - homosexual partners of HIV-infected people;
123 - partners of HIV-infected people for intravenous drug injection;
126 - examination is voluntary;
127 - survey anonymous;
200 - foreign citizens.
5. Order of the Ministry of Health of the USSR No. 1002 of 04.09.87 "On measures to prevent infection with the AIDS virus."
Subject to verification:
Foreigners who arrived for a period of 3 months or more;
Russian citizens returning from foreign business trips lasting more than one month;
Persons from risk groups who received multiple transfusions of blood and its preparations, who suffer from drug addiction, homosexuals, prostitutes;
Citizens who have contacts with patients or virus carriers;
Those who wish to be tested.
6. Order No. 286 of the Ministry of Health of the Russian Federation of December 7, 1993 and Order No. 94 of February 7, 1997 “On improving the control of sexually transmitted diseases.”
For the first time in a patient's life with an established diagnosis of active tuberculosis, syphilis, gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, gardnerellosis, urogenital candidiasis, anourogenital herpes, genital warts, scabies, trachoma, mycosis of the feet, a notification is submitted (form No. 089 / y-93).
The notice is drawn up in each medical institution. The notice is written by a doctor. In the case of a diagnosis by paramedical personnel, patients should be referred to a doctor.
To carry out 100% coverage with serological blood tests for syphilis of patients admitted for inpatient treatment who applied to polyclinics for the first time in a given year - by the express method; tuberculosis, neurological, narcological patients, donors - classical serological reactions.
7. Order of the Ministry of Health of the Russian Federation No. 174 of May 17, 1999 "On measures to further improve the prevention of tetanus."
The most effective method of preventing tetanus is active immunization with tetanus toxoid (TT).
Protection against tetanus in children is created by immunization with DPT-vaccine or ADS-toxoid, in adults - with ADS-M-toxoid or AS-toxoid. The completed course of active immunization includes primary vaccination and the first revaccination. To prevent the occurrence of tetanus in case of injuries, emergency prophylaxis is necessary.
Drugs used for routine active immunization against tetanus:
DPT - adsorbed pertussis-diphtheria-tetanus vaccine containing 1 ml of 20 billion inactivated pertussis microbial cells, 30 units of diphtheria and 10 binding units of tetanus toxoid;
ADS-M - with a reduced content of antigens;
As - tetanus toxoid (in 1 ml 20 units).
Drugs used in emergency immunoprophylaxis of tetanus:
AC - adsorbed tetanus toxoid;
IICC - purified horse tetanus serum, one dose of PSS is 3000 IU;
PSHI - human tetanus immunoglobulin, one dose is 250 IU.
Emergency prophylaxis of tetanus is carried out with:
Injuries with violation of the integrity of the skin and mucous membranes;
Burns and frostbite II-IV degrees;
community-acquired abortions;
Childbirth outside medical institutions;
Gangrene of any type, carbuncles and long-term abscesses;
Animal bites.
Emergency prophylaxis of tetanus consists in the primary surgical treatment of the wound and simultaneous specific immunoprophylaxis. It must be carried out as early as possible and up to 20 days from the date of injury.
The introduction of drugs is not carried out:
Children who have documentary evidence of scheduled preventive vaccinations in accordance with age, regardless of the period that has elapsed after the next vaccination;
Adults who have a document confirming the completion of a full course of immunization no more than 5 years ago.
Only 0.5 ml of AC-toxoid is injected:
Children who have documented evidence of routine preventive vaccinations, without the last age-related revaccination;
Adults who have a document on the course of immunization more than 5 years ago;
Persons of all ages who received two vaccinations no more than 5 years ago, or one vaccination no more than two years ago;
Children from 5 months old, military personnel whose vaccination history is unknown.
Conducting active-passive tetanus prophylaxis:
When conducting active-passive prophylaxis of tetanus, 1 ml of AS is injected, then with another syringe into another part of the body, PSCI (250 IU) or after an intradermal IICC test (3000 IU);
Active-passive vaccination is carried out for people of all ages who received two vaccinations more than 5 years ago, or one vaccination two years ago;
Unvaccinated people, as well as people who do not have a documented warning about vaccinations.
To complete the course of immunization against tetanus in the period from 6 months to 2 years, 0.5 ml of AS or 0.5 ml of ADS-M should be revaccinated.
Emergency prophylaxis of tetanus in re-injury
Persons who, in accordance with their vaccination history, received only AS (ADS-M) during an injury, in case of repeated injuries, undergo emergency prophylaxis as previously vaccinated, but not more often than once every 5 years.
Emergency prophylaxis of tetanus in case of radiation-thermal lesions - 1 ml of AS and 250 PSCI are administered.
Conditions and technique for emergency tetanus prophylaxis
Considering that after the introduction of PSS and preparations containing tetanus toxoid, especially sensitive people may develop shock, each vaccinated person must be medically monitored for an hour after vaccination. Before the introduction of AS, the ampoule is shaken until a homogeneous suspension is obtained. An opened ampoule with AS or PSS can be stored, covered with a sterile cloth, for no more than 30 minutes.
The drug is drawn into the syringe from the ampoule with a long needle with a wide lumen. A different needle is used for injection. AS is administered in an amount of 1 ml. At the same time, 250 IU of PSCI is injected intramuscularly into another part of the body; in the absence of PSCI, 3000 MEPSS is administered.
Before the introduction of the PSS in without fail put an intradermal test with horse serum, diluted 1:100, to determine the sensitivity to horse serum proteins (the ampoule is marked in red). An intradermal test is not performed if the victim underwent a test with a diluted 1:100 anti-rabies gamma globulin within 1-3 days before the introduction of the PSS.
For setting the sample, an individual ampoule, sterile syringes and a thin needle are used. Serum diluted 1:100 is injected intradermally into the flexor surface of the forearm in an amount of 0.1 ml. Accounting for the reaction is carried out after 20 minutes. The test is negative if the diameter of the edema or redness at the injection site is less than 1 cm. With a negative skin test, PSS (from an ampoule marked in blue) is injected subcutaneously in an amount of 0.1 ml. If there is no reaction after 30 minutes, the remaining dose of serum is injected with a sterile syringe. During this time, the opened PSS ampoule should be closed with a sterile napkin.
Emergency prophylaxis by revaccination of AS
AS is administered in an amount of 0.5 ml in accordance with the instructions for the drug.
About all cases of post-vaccination complications that developed after the use of drugs containing tetanus toxoid, as well as after the introduction of PSS or PSCI (shock, serum sickness, diseases nervous system) medical staff immediately reports to the sanitary and epidemiological station.
8. Order No. 297 dated October 7, 1997 “On improving measures to prevent rabies in humans.”
In the Russian Federation, from 5 to 20 cases of human infection with rabies are registered annually. In order to improve the quality of anti-rabies care and improve measures to prevent rabies in humans, I order:
Organize centers for anti-rabies care on the basis of medical and preventive institutions that include a trauma department;
Conduct annual seminars for medical workers on anti-rabies assistance to the population and rabies prevention;
Organize mandatory preventive immunization against rabies for persons professional activity which is associated with the risk of infection with the rabies virus;
Exercise strict control over the availability of anti-rabies drugs and their storage conditions in health facilities;
Intensify awareness-raising work among the population, using the media and visual agitation.
Regulations on the anti-rabies help center
1. It is created on the basis of a medical facility, which has a trauma center or a trauma department.
2. The head of the Center is a traumatologist or a surgeon who has been trained in the organization and provision of anti-rabies care.
3. The activities of the Center are carried out in contact with health facilities, centers of the State Sanitary and Epidemiological Supervision, and the veterinary service.
The main tasks and functions of the center:
1. The Center provides coordinating, organizational, methodological, advisory and practical assistance to medical institutions in the provision of medical care to persons at risk of infection with the rabies virus.
2. Receiving and providing medical assistance to victims of bites, scratches, saliva by animals, persons at risk of infection with the rabies virus.
3. Organizes permanent seminars on training and retraining of specialists, anti-rabies assistance to the population.
4. Carries out communication and mutual information with the veterinary supervision authorities throughout the serviced territory on the issues of the epizootic state of the area.
5. Organizes and conducts sanitary and educational work on the prevention of rabies among the population.
Center rights:
Receive necessary information from healthcare facilities, centers of the State Sanitary and Epidemiological Surveillance, veterinary services;
Submit proposals to the health authorities on the improvement and improvement of anti-rabies activities, attract, if necessary, consultants of various profiles.
Instructions on the procedure for the work of a medical institution and centers of the State Sanitary and Epidemiological Supervision for the prevention of rabies diseases
First medical aid to persons who applied for bites, scratches, saliva of any animals, as well as persons who received damage to the skin and the ingress of foreign material on the mucous membranes when cutting and opening carcasses of animals, opening the corpses of people who died from hydrophobia, is provided by all healthcare facilities.
1. The course of therapeutic and prophylactic immunization is prescribed immediately and is carried out in trauma centers, and in their absence in surgical rooms or departments:
Thoroughly wash wounds, scratches, abrasions with a stream of water and soap (or any detergent), treat the edges of the wound with 70% alcohol or tincture of iodine, apply a sterile bandage. The edges of the wound inflicted on animals should not be excised or sutured during the first three days, except for injuries that require special surgical interventions for vital signs;
For extensive wounds, after preliminary local treatment of the wound, several leading sutures are applied;
In order to stop external bleeding, bleeding vessels are washed.
2. Emergency tetanus prophylaxis is carried out.
3. The victim is sent to the emergency room or surgical department of the hospital for the appointment and conduct of a course of anti-rabies vaccinations.
4. A telephone message is sent to each applicant and a written “emergency” notice is sent ( accounting form No. 058u) within 12 hours to the center of the State Sanitary and Epidemiological Supervision, emergency rooms.
5. In the absence of trauma centers, surgical rooms and departments are required to:
In the case of the initial appeal of the victim, provide him with first aid, promptly transfer a telephone message, send a written notice (registration form No. 058 / y) to the center of the State Sanitary and Epidemiological Supervision (station);
Fill in for each victim the "Card of those who applied for anti-rabies help" (registration form No. 045 / y) in two copies;
Prescribe and ensure that a course of anti-rabies vaccinations is carried out in accordance with current instructions, including on weekends and holidays;
Ensure hospitalization of the following categories of victims:
a) persons who have received severe and multiple bites and bites of dangerous localization;
b) persons living in countryside;
c) vaccinated again.
has not entered into force Edition from 15.11.2012
| Document name | ORDER of the Ministry of Health of the Russian Federation of November 15, 2012 N 922n "ON APPROVAL OF THE PROCEDURE FOR PROVIDING MEDICAL CARE TO ADULTS ON THE PROFILE "SURGERY" |
| Type of document | order, order, rules, standard |
| Host body | Ministry of Health of the Russian Federation |
| Document Number | 922N |
| Acceptance date | 01.01.1970 |
| Revision date | 15.11.2012 |
| Registration number in the Ministry of Justice | 28161 |
| Date of registration in the Ministry of Justice | 17.04.2013 |
| Status | has not entered into force |
| Publication |
|
| Navigator | Notes |
ORDER of the Ministry of Health of the Russian Federation of November 15, 2012 N 922n "ON APPROVAL OF THE PROCEDURE FOR PROVIDING MEDICAL CARE TO ADULTS ON THE PROFILE "SURGERY"
Annex 7
1. These Rules establish the procedure for organizing the activities of the surgical department, which is a structural unit medical organization.
2. The surgical department of a medical organization (hereinafter referred to as the Department) is created as structural subdivision medical organization.
3. The department is headed by the head, who is appointed and dismissed by the head of the medical organization in which the Department was created.
4. A specialist who meets the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and social development Russian Federation dated July 7, 2009 N 415n, majoring in surgery.
5. The structure and staffing of the Department are approved by the head of the medical organization in which the department was created, and are determined based on the volume of treatment and diagnostic work carried out and the bed capacity, taking into account the recommended staff standards, provided for in Appendix N 8 to the Procedure for the provision of medical care to the population in the profile "surgery", approved by this order.
6. The equipment of the Department is carried out in accordance with the standard of equipment provided for in Appendix No. 9 to the Procedure for the provision of medical care to the population in the profile "surgery", approved by this order.
examination room;
doctor's office;
wards for patients, including single rooms (isolator);
operating room or operating room;
dressing room;
dressing room (for purulent wounds);
procedural;
dressing (gypsum);
manager's office.
Zakonbase: In electronic document the numbering of paragraphs corresponds to the official source.
sisterly;
office of the head nurse;
storage room for medical equipment;
Room of the hostess;
buffet and distributing;
dining room
Room for collecting dirty linen;
shower room and toilet for medical workers;
showers and toilets for patients;
room for sanitation;
sanitary room.
8. The main functions of the Department are:
provision of specialized, including high-tech, medical care by performing operations using surgical (including microsurgical) methods based on medical care standards;
preparation and implementation of diagnostic procedures in stationary conditions;
Development and implementation in clinical practice modern methods diagnosis, treatment, rehabilitation and prevention of diseases and conditions requiring surgical treatment;
development and implementation of new medical technologies related to the treatment of patients with diseases in the profile of "surgery";
development and implementation of measures aimed at improving the quality of diagnostic and treatment work in the Department of Surgery;
Implementation of the rehabilitation of patients with diseases on the profile of "surgery" in stationary conditions;
carrying out examination of temporary incapacity for work;
Providing advice to medical specialists of other departments of the medical organization on the prevention, diagnosis and treatment of diseases and pathological conditions requiring surgical treatment;
maintaining accounting and reporting documentation, providing in due course reports on the activities of the Branch, the maintenance of which is provided for by the legislation of the Russian Federation.
9. The Department, in order to ensure its activities, uses the capabilities of the medical diagnostic and auxiliary units of the medical organization, within which the Department is organized.
10. The department can be used as a clinical base for medical educational organizations secondary, higher and additional professional education, as well as scientific organizations.
Appendix No. 8
to the Procedure for the provision of medical
assistance to the adult population on the profile
"surgery", approved by order
Ministry of Health
Russian Federation
dated November 15, 2012 N 922n