Basic orders, regulatory documents regulating the work of a nurse in a urological office. Documentation of the surgical department of the hospital List of documents in the surgical department

Order of the Ministry of Health of the USSR of September 23, 1981 No. 1000 "On measures to improve the organization of the work of outpatient clinics"

Order of the Ministry of Health of the USSR dated July 12, 1989 No. 408 "On strengthening measures to reduce the incidence of viral hepatitis in the country"

Order of the Ministry of Health of the USSR dated March 23, 0978 No. 288 "On approval of the instructions on the sanitary and anti-epidemic regime of the hospital"

Order of the Ministry of Health of the Republic of Belarus dated February 2, 1996 No. 60-D "On conducting a medical examination for HIV (AIDS)"

Order of the Ministry of Health of the Russian Federation of August 16, 1994 No. 170 "On measures to improve the prevention and treatment of HIV-infected patients in the Russian Federation"

Order of the Ministry of Health of the Republic of Belarus dated September 12, 2003 No. 585-D “On streamlining the examination for HIV infection”

Order of the Ministry of Health of the Russian Federation dated May 16, 2003 No. 205 "On amendments and additions to the order of the Ministry of Health of the Russian Federation dated January 1, 1997 No. 330 "Use and prescription of narcotic drugs""

Order of the Ministry of Health of the USSR dated January 29, 1987 No. 149 "On additional measures to strengthen the fight against drug addiction"

Order of the Ministry of Health of the USSR dated 06/02/1987 No. 747 "Instructions for accounting for medicines and dressings in medical facilities"

Order of the Ministry of Health of the USSR of August 30, 1991 No. 245 "On the standards for the consumption of ethyl alcohol in health facilities"

Order of the Ministry of Health of the Russian Federation of November 26, 1998 No. 342 "On strengthening measures for the prevention of typhus and the fight against pediculosis"

Order of the Ministry of Health of the RSFSR of December 19, 1994 No. 286 "On the procedure for admission to professional activities"

Order of the Ministry of Health of the Republic of Belarus dated December 20, 1996 No. 534-D "On measures for the development of medical prevention in the Republic of Belarus"

Order of the Ministry of Health of the Russian Federation of September 23, 2003 No. 455 "On improving the activities of health authorities and institutions for the prevention of diseases in the Russian Federation"

Order No. 36 of the Ministry of Health of the Russian Federation of February 30, 1997 "On improving measures for the prevention of diphtheria"

Order No. 475 of the Ministry of Health of the USSR of August 16, 1989 "On measures to further improve the prevention of acute intestinal infections in the country"

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"

Order of the Ministry of Health of the Russian Federation of March 14, 1996 No. 90 "On the procedure for conducting preliminary and periodic medical examinations"

Order of the Ministry of Health of the USSR dated May 30, 1986 No. 770 "On the procedure for conducting a general medical examination" (as amended on September 12, 1997)

Order of the Ministry of Health of the USSR dated June 10, 1985 No. 770 OST 42-21-2-85 "Methods, means, pre-sterilization cleaning regime, sterilization and disinfection of medical devices"

Order of the Ministry of Health of the USSR dated July 31, 1978 No. 720 "On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections"

Order of the Ministry of Health of the Republic of Belarus dated 06.02.1995 No. 105-D "On measures to reduce hepatitis and immunoprophylaxis against hepatitis B".

Order of the Ministry of Health of the Republic of Belarus dated 04.12.98 No. 740-D "On the organization of a hospital for replacing technologies (the introduction of a "hospital at home")"

Order of the Ministry of Health of the Russian Federation of May 23, 1995 No. 131 "Regulations on the certification of paramedical workers"

Order of the Ministry of Health of the Russian Federation of January 27, 1998 No. 25 "On strengthening measures to prevent influenza and other acute respiratory infections"

Order of the Ministry of Health of the Russian Federation of June 27, 2001 No. 229 "On the national calendar of preventive vaccinations and the vaccination schedule for epidemiological indications"

Order of the Ministry of Health of the Republic of Belarus dated 1996 No. 535-D "On strengthening measures to reduce the incidence of tick-borne encephalitis in the Republic of Belarus"

Order No. 675-U of the Ministry of Health of the Russian Federation of August 25, 1998 "On additional measures for the prevention of measles and whooping cough"

Order of the Ministry of Health of the Russian Federation of March 21, 2003 No. 117 "On the elimination of measles in the Russian Federation by 2010"

Order of the Ministry of Health of the Russian Federation of October 26, 1999 No. 386 "On additional measures for the prevention of mumps and measles"

the federal law RF "On Compulsory Medical Insurance of Citizens of the Russian Federation" dated 28.06.1991.

Order of the Ministry of Health of the Republic of Belarus dated 09.12.2004 No. 916-D "On the introduction of new forms of accounting documentation in institutions providing primary health care."

Order of the Ministry of Health and social development of the Russian Federation of November 22, 2004 No. 255 "On the procedure for providing primary health care to citizens entitled to receive a set of social services"

Order of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004 No. 256 "On the procedure for medical selection and referral of patients for san-resort treatment"

Order of the Ministry of Health and Social Development of the Russian Federation of April 11, 2005 No. 273 "On the aftercare (rehabilitation) of patients in a sanatorium"

SanPiN 3.1.5.2826 - 10 "Prevention of HIV infection"

SanPiN 2.1.3.2630 - 10 "Sanitary - epidemiological requirements to the treatment of medical waste"

Order of the Ministry of Health of the Russian Federation of November 20, 2002 No. 350 "On the improvement of outpatient care for the population."

Work organization nurse urological office

To fulfill my functional duties, I am guided by orders No. 1000 of September 23, 1981 "On measures to improve the organization of the work of outpatient clinics" and according to Appendix No. 47 to this order "On the functional duties of nurses."

The nurse works under the guidance of a urologist, chief and senior nurse of the polyclinic.

The outpatient work of a nurse in a urological office is as follows:

Workplace preparation.

Daily polyclinic reception of urological patients with a doctor, fulfillment of doctor's prescriptions.

Care of urological patients at home.

Work with a dispensary group of patients, where special attention is paid to the disabled and participants in the Second World War.

Preparation and participation in carrying out planned manipulations.

Daily bandaging of urological patients.

Preparation of dressing material for sterilization.

Sanitary and educational work.

Preparation for work of urological instruments.

Providing emergency assistance.

Invitation of D-patients for examination.

Work with outpatient cards.

Reception work

Before the start of the appointment, I prepare the office for work: I prepare forms for referrals, outpatient cards, and paste the test results into outpatient cards.

During the reception, I keep a register of admitted patients, record manipulations, fill out statistical coupons. In addition, I keep a log of the movement of dispensary patients, a log of hospitalization, a log of referrals for a consultation at the ROD, a log of sanitary and educational work. I write out referrals for examinations, consultations, hospitalizations.

I write down the manipulations in the manipulation journal, measure the temperature, examine for pediculosis, scabies, fill out the medical examination sheet in the outpatient card.

First of all, patients with acute urological diseases, patients with high fever, disabled people and participants in the Second World War, pregnant women are invited to the reception.

Cabinet equipment

The urological office has all the necessary equipment for receiving patients:

Germicidal lamps No. 2.

Sterile table No. 1.

Couch for examining patients.

Doctor's table with accessories for cystoscopy No. 2.

Medical cabinets for solutions and dressings.

Bixes, containers and containers for solutions.

Rack for containers.

Tanks for collecting class A and class B waste.

In the manipulation room, there are two sinks (for hands, for tools) with an elbow tap.

Tightly closed curbstones for solutions.

Gynecological chair.

Sanio air sterilizer.

Ultraviolet chamber for storage of sterile instruments "UFK 3".

Refrigerator single-chamber (sviyaga).

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 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 of antibodies to the HA virus in the blood serum 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 test 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, by the nature of their professional activity, have contact with blood, 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 observe the rules of disinfection, pre-sterilization cleaning and sterilization 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 products medical purpose.

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 organizing and carrying out 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 personnel for the prevention and control of AIDS, directly involved in the examination, diagnosis, treatment and care of people 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 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 of serological blood tests for syphilis in patients admitted to 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 carrying out 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 received only AS (ADS-M) in case of injury in accordance with their vaccination history, 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 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 institutions that have a trauma department;

Conduct annual seminars for medical professionals on anti-rabies assistance to the population and rabies prevention;

Organize mandatory preventive immunization against rabies for persons whose professional activities are 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;

To intensify awareness-raising work among the population, using the means mass media and visual propaganda.

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 coordination, 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. Carries out the reception and provision of 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 the necessary information from health facilities, centers of the State Sanitary and Epidemiological Supervision, 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, salivation by 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, and 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 (registration form No. 058u) is sent within 12 hours to the center of the State Sanitary and Epidemiological Supervision, trauma centers.

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 rural areas;

c) vaccinated again.

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Introduction

FamousPolishdoctorwrote:"Whomnottoucheshumanneed,whonothassoftnessincirculation,atwhomnot enoughstrengthwill,toeverywhereandsunewheredominateaboveyourselfthatletbetterelectsanotherprofessionforhenevernotbatchildrengoodmedicalworker."

SAKHALIN REGIONAL ONCOLOGICAL DISPENSARY is a medical institution that combines a hospital with 302 beds and a polyclinic.

Manages a medical institution - OVSYANNIKOV. V.G

Chief Nurse-ZHAROVTSEVA.N.A

The medical base of the oblonkodispanser includes

1-oncological-department of abdominal surgery-40 beds

2-oncological-department of head and neck tumors - 40 beds

3-oncological-department of oncogynecology -40 beds

4-oncological-department of thoracic surgery-30 beds

5-oncological-department of mammology-40 beds

6th department of chemotherapy - 30 beds

7- urological department -30 beds

8-radiological department

It should be noted that the ONCOLOGICAL DISPENSARY is the only one in the entire Sakhalin region and accepts patients from all regions. Oncology is a special "branch" of medicine and requires greater ethics in working with patients.

Today, the institution is a close-knit, qualified team capable of using the most high-tech medical equipment in treatment.

Health workers are able to provide medical care in many areas, not only within the walls of the hospital, but also in extreme conditions, during emergencies, during sports competitions at the federal level.

Surgicaldepartmenthospital deployed with 40 beds.

In the department, patients with pathology of the gastrointestinal tract, trauma with damage to the internal organs of the abdominal cavity and patients with purulent-septic diseases receive treatment.

Currently, the department is located on the 2nd floor of a 3-storey building. The department includes: 14 wards, of which 5 have 2 beds, the rest have 4, each equipped with a shower and toilet, a treatment room, a dressing room, 2 manipulation rooms, a sanitary room, a nurse's post, a head nurse's office, and at the other end of the corridor , there is a staff room and a buffet.

Branchcarries outthe followingfeatures:

Providing diagnostic, therapeutic and preventive care to patients with cancer;

Providing advice to doctors of other departments of a medical organization in resolving issues of diagnosis and provision of medical care to patients with oncological diseases;

Development and implementation of measures to improve the quality of medical and preventive work of the department;

Participation in the process of improving the professional qualifications of staff on the issues of diagnosis and provision of medical care to patients with oncological diseases;

Implementation in clinical practice modern methods diagnostics, treatment and rehabilitation of patients with oncological diseases;

Carrying out an examination of temporary disability;

Conducting conferences on the analysis of the causes of deaths in the treatment of patients with oncological diseases together with the pathoanatomical department;

Implementation of sanitary and hygienic and anti-epidemic measures to ensure the safety of patients and staff, to prevent the spread of nosocomial infection;

Maintaining accounting and reporting documentation, submitting reports on their activities to in due course, data collection for registers, the maintenance of which is provided for by law.

Dressingtoofficesurgicalbranches- it is mine workplace. For ease of cleaning, the floor is covered with ceramic-granite tiles, the walls are tiled, the ceiling and doors are painted with light-colored oil paint. There is a centralized supply of cold and hot water, heating, electricity and ventilation. Artificial lighting is provided by a fluorescent lamp located above the dressing table and lighting fixtures. The wiring is hidden and there is a ground loop. There are two sinks for washing hands and washing tools. Doors of cases and doors are covered with plastic.

Equipmentdressingcabinet: table for instruments and dressings - 1 pc. Ultralight - for storage of sterile instruments 1 pc., Dry-heat cabinet for sterilization of instruments 1 pc., Germicidal lamp - 1 pc.; tripod; Hemostatic tourniquets - 2 pcs.; Chairs and stools - 3 pcs.; Bench stands - 2 pcs.; operating table / gynecological chair - 1 pc.; tool cabinet - 1 pc.; medicine storage cabinet - 1 pc.; desktop - 1 piece; table for medical documentation - 1 pc.; tongs for collecting contaminated dressings - 2 pcs.; containers for disinfectant solutions - 8 pcs.; buckets for class A and B waste: dry white bag; medical yellow bag - 2 pcs.; mobile reflector lamp - 1 piece; aprons made of oilcloth and plastic - 4 pcs.; goggles - as a means of eye protection - 4 pcs.; disposable sterile gowns, gloves, hats, masks, shoe covers - in abundance; disposable sterile underwear - in abundance; ready sterile material - in abundance; containers for preparing working solutions of disinfectants, measuring containers for diluting disinfectants, brushes, ruffs - for processing tools, a bedside table for storing detergents and disinfectant detergents. Anti-shock and anti-AIDS first aid kits with instructions for their use, also, next to the office there is a sanitary room for dressing room, where there is cleaning equipment for current and general cleaning - buckets for washing floors and walls - 2 pcs, containers for processing furnishings, surfaces -2 pcs, mops for washing floors and walls - 2 pcs and containers for diluting disinfectants.

Toolsdressingcabinet: maskites; Volkman's spoons; disposable sets for pleural puncture; suture material, anatomical, surgical and pawl tweezers - 8 pcs.; hemostatic clamps - 8 pcs.; abdominal scalpels -3 pcs.; pointed scalpels - 2 pcs.; pointed scissors -2 pcs.; pointed eye scissors - 1 pc.; blunt-pointed scissors, curved along the plane, - 2 pcs.; lamellar hooks - 1 pair; general surgical needle holders - 2 pcs.; different surgical needles - 10 pcs.; forceps - 2 pcs.; long tweezers - 2 pcs.; bulbous and grooved probe - 1 pc.; kidney-shaped trays; different cuvettes - 5 pcs. Sterile disposable dressing trays with ready-made dressings are also available.

REQUIREMENTS FOR THE PLACEMENT OF THE EQUIPMENT OF THE DRESSING ROOM.

The room of the dressing room is conditionally divided into two zones: clean and conditionally clean.

In a clean area: a table with sterile instruments, a dry-heat cabinet, a cabinet for medicines and instruments are placed.

In a conditionally clean area: the rest of the equipment is placed, the nurse's work table, an operating and dressing table, a table with disinfectants, a sink, etc.

A RESPONSIBILITY.

The dressing nurse is responsible for:

1. lack of sanitary and hygienic regime in the dressing room.

2. safety of instruments, suture material, equipment.

3. violation of the rules of asepsis.

4. disruption and delay of dressings due to one's own fault.

5. lack of knowledge about the course of dressings.

Mydofficialresponsibilities:

In the dressing room, bandaging and monitoring of postoperative wounds are carried out, minor operations and punctures are performed. As well as:

1. Manipulations prescribed by the attending physician are performed, which are allowed to be performed by paramedical personnel.

2. Seriously ill patients are escorted to the ward after the manipulations.

3. Instruments and dressings are being prepared for sterilization.

4. Systematic sanitary and hygienic control of the dressing room is carried out.

5. Systematic replenishment, accounting, storage and consumption of medicines, dressings, instruments and linen is provided.

6. The junior medical staff of the dressing room is instructed and their work is controlled.

7. Regulatory medical documentation is maintained in accordance with the nomenclature of cases.

8. Collection, disinfection and disposal of medical waste is carried out.

9. Measures are being taken to comply with the sanitary and hygienic regime in the premises, the rules of asepsis and antiseptics, the conditions for sterilizing instruments, and the prevention of post-infectious complications, hepatitis, HIV infection. 10. Immediately inform your immediate supervisor about any accident that occurred at work, about signs of an occupational disease, as well as about a situation that poses a threat to life and health of people. If necessary, perform the functions of an operating room nurse when performing simple surgical interventions performed in the dressing room.

Volumeperformedwork.

My working day starts with a tour of the dressing room. I, as a dressing nurse, check 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 removed into buckets with lids (yellow bag - Class B waste), the used tools are soaked in a disinfectant solution.

I check whether wet cleaning has been carried out using disinfectants, I take sterile instruments from the CSO, arrange bixes with the material, and install the medicines received from the pharmacy the day before.

I get a list of all dressings for the day, set their order. First of all, I bandage patients with a smooth postoperative course (removal of sutures), then with granulating wounds. After making sure that the dressing room is ready, I proceed to the processing of the hands.

After processing the hands, I proceed to putting on a sterile gown. Opening the lid of the bix, I check the type of indicator. Taking the robe, I carefully unfold it, holding the edges of the collar on my outstretched arm with my left hand so that it does not touch the surrounding objects and clothes, I put the robe on my outstretched right hand. With this hand I take the left edge of the gate and put it on my left hand, stretching them forward and up. The assistant ties the ribbons on the robe from the back. Next, I tie the ribbons on the sleeves, as well as the belt, taking it by the free ends, without touching the dressing gown and hands. Then I put on sterile gloves.

When I put on a sterile gown and gloves, I proceed to prepare a sterile table. A sterile table is being prepared, which is covered with a sterile sheet in one layer, so that it hangs 15-20 cm below the table surface. The second sheet is folded in half and placed on top of the first. After laying out the tools (material), the table is covered with a sheet (folded in 2 layers), which should completely cover all objects on the table, and is tightly fastened with clips to the bottom sheet. The sterile table is covered for 6 hours. In cases where the instruments are sterilized in individual packaging, there is no need for a sterile table or it is covered immediately before manipulations.

Dressings are carried out in a mask, cap and sterile gloves, which are changed for each patient. All items from the sterile table are taken with forceps or long tweezers, which are also subject to disinfection and sterilization.

Analysis of work for the reporting period:

№ p.p.	Name:	Quantity:
	Pleural puncture
	Bandaging of postoperative patients
	Laparocentesis
	Opening of purulent parapractitis
	Opening panaritiums and phlegmons
	Opening of abscesses
	Applying compresses


	CHOLECYSTOSTOMY
	CYSTOSTOMES

2. Knowledge and skills of the certified specialty

During my work, I have mastered the following manipulations:

o Maintaining medical records.

ü Monitoring compliance with the rules of asepsis and antisepsis in the dressing room.

l Cleaning the dressing room.

b Preparation of linen, dressings, masks for sterilization.

b Preparation of surgical packings.

l Preparation of instruments and equipment for sterilization.

l Ensuring patient safety.

l Disinfection in the dressing room.

ü Participation in all types of punctures.

b Acquisition of sets of surgical instruments.

b Preparation of suture material.

b Imposition of all types of dressings.

l Provision of various methods of hemostasis.

b Providing assistance in terminal conditions.

l Modern methods of processing the surgical field.

b Performing various types of patient positioning on the operating table.

b Use of personal protective equipment.

b Preparation of disinfectants.

ü Supply of instruments during the operation and dressing.

b Collection and disposal. used materials and tools.

Manipulations are performed in a certain sequence: removing the bandage applied earlier; primary skin toilet around the wound; initial examination and toilet of the wound; re-examination of the wound; performing diagnostic or therapeutic procedures; re-toilet of the skin, bandaging.

The primary toilet of the skin is performed in order to remove blood, pus, etc. from the skin surrounding the wound (for wounds of the hairy areas of the body, hair is shaved off). The toilet is performed with gauze (or cotton) balls soaked in ethyl alcohol, etc .; the skin is treated in the direction from the edges of the wound to the periphery in order to protect it from contamination and infection.

When examining aseptic wounds with sutures, pay attention to the appearance of local signs of inflammation (hyperemia, edema, eruption of sutures, necrosis). In the absence of inflammation and necrosis, the wound along the suture line is lubricated with 5% alcohol solution of iodine or 1% alcohol solution of brilliant green, 3-5% potassium permanganate solution, chlorhexidine bigluconate solution and a dry aseptic dressing is applied from gauze napkins, which are fixed with an aseptic sticker, tubular or ordinary bandage.

In case of suppuration of the wound, the sutures are removed completely or partially, while paying attention to the nature of the discharge. When evaluating the wound process, the condition of the wound is of great importance. With the development of a putrefactive infection, the surface of the wound is characterized by dryness, lack of granulations, the presence of necrotic tissues, gray muscles; crepitation of tissues is rare, indicating the presence of gas in them. With an anaerobic infection, the edges of the wound are edematous, and finger pressure does not leave a trace in the edematous tissues, muscle swelling, traces of bandage depression, eruption of the stitches, crepitus are noted. The slightest suspicion of an anaerobic infection is an alarming signal and requires the necessary urgent measures.

Pleuralpuncture: My duties include assisting the doctor during the thoracentesis. The puncture of the pleural cavity is carried out with a diagnostic therapeutic purpose. The patient is placed in a comfortable sitting position, with the emphasis of the shoulder girdle on the back of the chair or lying on its side. Hands are treated with alcohol 70% or skin antiseptic "CLEAN", we put on sterile gloves. We treat the puncture site with iodine, alcohol using cotton balls. The doctor performs local anesthesia with a 0.5% novocaine solution. The fluid is aspirated using a disposable pleural puncture kit. After the procedure, the puncture site is treated and a sterile dressing is applied. The pleural contents are immediately sent to the laboratory in a special labeled jar.

ATdressingofficemeongoingnextdocumentation:

* Journal of registration and control of the operation of the bactericidal installation;

* Journal of accounting for general cleaning;

* Journal of sterilization;

* Journal of quality control of pre-sterilization cleaning (azopyramic and phenolphthalein samples);

* Journal of dressings;

* Journal of small surgical operations;

* Journal of biopsy;

* Journal of dressings and consumables;

* Journal of receipt of medicines from the head nurse;

* Journal of emergency situations.

Holdinganti-epidemicactivities.

The department has a dressing room for dressing clean and purulent wounds. To do this, it was necessary to single out the so-called clean and purulent dressings, first of all, clean dressings are carried out. After each dressing of patients with signs of suppuration or with purulent wounds, the sheet on the dressing table is replaced, so we use disposable underwear as soon as possible. Dressings are carried out according to the schedule, which is approved by the head of the department. The schedule is posted in a conspicuous place - on the office door.

Prevention of the development of postoperative purulent-septic infections consists of a set of measures aimed at breaking the chain of occurrence of the epidemiological process. One of the important sections of this complex is the observance of the sanitary-hygienic and anti-epidemiological regime in the dressing room.

WorksindressingofficewhichII'm doingdaily:

1. I process my hands, process them at a hygienic level, put on sterile clothes and open the Bix.

2. Using sterile tweezers (forceps), carefully unfold the lining diaper so that its ends remain inside the bix. The tweezers are stored in a sterile bag, in a sterile bix, the tweezers are changed after 1 hour.

3. The sterile table is covered for 6 hours of work.

4. For each patient, an individual dressing is covered. The set of styling depends on the dressing profile or minor operation.

5. After dressing, all used tools are placed in a container with a disinfectant for 30 minutes and closed with a lid.

6. After dressing each patient, the dressing table oilcloth is wiped with a rag moistened with a disinfectant solution.

7. Used balls, tampons are disinfected, after which they are collected in yellow disposable plastic bags, which, after filling, are sealed and removed from the disposal compartment.

8. After every 2 hours of intensive work, the dressing room is closed for 30 minutes for ongoing cleaning, ventilation and quartzing. At the same time, the sheet on the dressing table is replaced.

9. The work of the dressing room is carried out in accordance with the schedule approved by the head of the department, the schedule is posted on the door of the office.

10. In the treatment of surgical patients with drainage: all connecting tubes and jars for discharge are changed daily to sterile ones, used ones are disinfected; jars for the drainage system are not placed on the floor, they are tied to the patient's bed or placed next to it on a stand.

11. Sterile gloves change:

In case of contamination with blood or other discharge from the wound and with instrumental dressing - after each patient! Preliminary hygienic hand antisepsis is carried out.

The sterile dressing tray in the ward is only covered for one patient!

Asepsis is violated if, during dressing, a sterile napkin is moistened by pressing it against the neck of the vial or pouring from the vial. Pour the sterile solution into a glass or tray and dip the tissue into it. If the dressing is ointment, then the napkin should be put in a sterile tray and the ointment should be applied with a sterile spatula, then given to the doctor.

PREPARATION OF KITS FOR STERILIZATION IN A DRY CABINET.

The cabinet, before placing products into it, is wiped with a disinfectant solution twice, with an interval of 15 minutes.

Tools on the bars are placed in one row, with open locks no more than 10 pieces.

Stericons 180 degrees, are laid in each installation, for each lattice, 5 pieces in the middle and on the sides of the lattice.

Sterilization time is 60 minutes, after which the instruments are placed on the ULTRALIGHT-STERILE TABLE, which is also treated once a week with a disinfectant, distilled water and 6% hydrogen peroxide.

ALGORITHM FOR PREPARING BIKS FOR STERILIZATION AND TRANSPORTATION IN THE CSO.

Bix is wiped with a disinfectant solution twice with an interval of 15 minutes.

Beaks are lined with a large napkin, which should hang from the outside by 2/3 of the height of the beaks, put an indicator on the bottom. Products packed in calico or kraft paper are laid out vertically or on edge, the distance between the packages is equal to the thickness of the palm, so that steam can evenly penetrate between the products. We put an indicator at 132 degrees in the middle of the bix, cover the products with a large napkin and put another indicator on top, close the bix and attach a tag on the handle, which indicates the material laid in the bix. The bix windows are open, we deliver the biks to the CSO in two bags. When opening the bag, pay attention to the date of sterilization, the color of the indicator should be brown. Products in bix must be dry. WET PRODUCTS ARE NOT STERILE.

GENERAL REQUIREMENTS FOR THE ORGANIZATION OF THE STORAGE OF MEDICINAL PRODUCTS IN THE DRESSING ROOM ORDER-523 dated 03 07 1968. hospital dressing room organization

Storage medicines for external and internal use should be made on separate shelves, which should be marked appropriately from the pharmacy. ready-made with precise and clear designation on the label (internal, external).

PACKAGING, LOSSING, TRANSFERING, AS WELL AS REPLACEMENT OF LABELS IS PROHIBITED.

EXPIRY DATES OF MEDICINES MANUFACTURED IN THE PHARMACY:

Order of the Ministry of Health of the Russian Federation - 214 dated July 16, 1997.

Injection solutions in vials, hermetically sealed - 30-90 days.

Opened vials 6 hours.

Ointments for 10 days.

Hydrogen peroxide 10 days.

Potassium permanganate 10 days.

ALGORITHM OF ACTION IN ANAPHILACTIC SHOCK.

Anaphylactic shock - is a consequence of an allergic reaction of an immediate type, accompanied by a life-threatening violation of all body systems (respiratory, cardiovascular, nervous, endocrine, etc.). The development of shock is provoked by any drugs (antibiotics, sulfonamides, vitamins, etc.).

CLINICAL SIGNS:

Against the background or immediately after the administration of the drug (serum), etc.

There was weakness, dizziness.

Difficulty breathing, feeling short of breath.

Restlessness, feeling of heat all over the body.

Dry mouth, difficulty swallowing (sometimes vomiting)

The skin is pale, cold, moist.

Breathing is frequent, shallow.

· Systological pressure 90 mm Hg. and below.

In severe cases, depression of consciousness and breathing.

· Later convulsions appear, consciousness is obscured.

The skin is covered with itchy patches (urticaria).

NURSE TACTICS:

· Urgently call a doctor.

· Give the patient a stable lateral position, raise the foot end.

Give humidified oxygen.

Measure blood pressure, heart rate.

Prepare medicines from the anti-shock first aid kit.

FIRST AID KIT (ANTI-SHOCK KIT):

1 Adrenaline 0.1% -1.0

3 Isotonic solution 0.9% sodium chloride

4 Dropper

5 Syringes 5.0 10.0 20.0

6 Rubber harness

PROTECTION OF MEDICAL PERSONNEL FROM INFECTION.

COMPOSITION OF THE FIRST AID KIT IN EMERGENCIES WITH BLOOD.

1 Alcohol 70%-200 ml

2 Alcohol solution of iodine 5% 15 ml

3 sterile bandage 2 pcs

4 Sterile wipes 10 pcs

5 Bactericidal adhesive plaster 5 pcs

The first aid kit for HIV prevention should be stored in a separate labeled container.

INSTRUCTIONS ON THE ACTION OF A MEDICAL WORKER IN EMERGENCY SITUATION.

In order to avoid infection with parenteral viral hepatitis, HIV infection, you should follow the rules for working with piercing and cutting objects.

1. In case of cuts and injections, immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% iodine solution.

2. If blood or other biological fluids get on the skin, this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol.

3. If the patient's blood and other biological fluids get on the mucous membranes of the eyes, nose and mouth, rinse the mouth with plenty of water and rinse with 70% alcohol, rinse the mucous membranes of the eyes and nose with plenty of water, do not rub!!!

4. If blood and other biological fluids of the patient get on the dressing gown, clothes: take off work clothes and immerse in a disinfectant solution and in a bix for autoclaving.

5. Start taking antiretroviral drugs as soon as possible for post-exposure prophylaxis of HIV infection.

For the purpose of emergency prevention of HIV infection, azidomycin is prescribed for one month. The combination of azidomycin and lamivudine enhances antiviral activity and overcomes the formation of resistant stamps. If there is a high risk of contracting HIV infection (deep cut, visible blood on damaged skin and mucous membranes from patients infected with HIV), for the appointment of chemoprophylaxis, you should contact the territorial centers for the fight and prevention of AIDS.

Persons exposed to the threat of HIV infection are under the supervision of an infectious disease specialist for 1 year with a mandatory examination for the presence of a marker of HIV infection.

Personnel who had contact with material infected with the hepatitis B virus in different parts of the body according to the 0-1-2-6 months scheme, followed by monitoring of the hepatitis marker (at least 3-4 months after the administration of immunoglobulin). If the contact occurred in a previously vaccinated health worker, it is advisable to determine the anti-HBs in the blood serum. In the presence of an antibody concentration in the titer of 10 IU / l and above, vaccination is not carried out; in the absence of antibodies, it is advisable to simultaneously administer 1 dose of immunoglobulin and a booster dose of the vaccine.

Qualitativecontrolperholdingmanipulation

Qualitative indicators include the results of washouts from objects external environment held in the surgical department regularly throughout the year. Washouts determined the presence of opportunistic and pathogenic forms (Table No. 1), as well as the sterility of medical instruments and dressings (Table No. 2).

Table No. 1

Conclusion: during the year there was not a single positive result. The department carries out high-quality disinfection in accordance with SanPiN 3.1.5.2826-10, industry standard 42-21-2-85 and orders No. 288, No. 254.

Table number 2

Conclusion: During the year there was not a single positive washout for sterility, which indicates the high-quality processing and sterilization of medical instruments and dressings.

Table No. 3

Conclusion: during the year there was not a single positive result.

ATthe presenttimeforfulfillmentsanitary and anti-epidemicmode,Sosameforstreamliningworkintherapeutic and prophylacticinstitutionsoperatesleblowingthe documentsandorders:

W Industrystandard42-21-2 - 85 determining the methods, means and mode of disinfection and sterilization of medical devices.

W Order№1204 dated 11/16/87 "On the medical and protective regime in medical institutions."

W AtkazMOHUSSRfrom12.07.89 № 408 "On measures to reduce the incidence of hepatitis viruses in the country."

W Order№ 288 "O Sanitary and epidemiological regime of a medical institution.

W Federallaw“On the prevention of the spread in the Russian Federation of a disease caused by the human immunodeficiency virus (HIV infection) dated February 24, 1995.

W OrderMOHRFfrom26.11.98 G№ 342 "On strengthening measures for the prevention of epidemic typhus and the fight against pediculosis."

W OrderMOHUSSR№ 254 dated 09/03/1991 "On the development of disinfection in the country."

W OrderMOHRF№ 109 dated March 21, 2003 "On the improvement of anti-tuberculosis measures in the Russian Federation."

W OrderMOHRF№ 229 dated June 27, 2001 "On the national calendar of preventive vaccinations and the vaccination schedule for epidemic indications."

W SanPiN2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities."

W SanPiN2.1.7.2730-10 from09.12.10 of the year- "Sanitary and epidemiological requirements for the treatment of medical waste."

W SanPiN3.1.5.2826-10 from11.01.11 of the year- “Prevention of HIV infection”.

3. Health education activities

Work on medical prevention and promotion of a healthy lifestyle for the population is carried out on the basis of the order of the Russian Federation No. 455 of September 29, 2003. 4 hours of budgetary time are worked out for medical prevention of the population.

Various forms of work are used: conversations, design of health corners, sanitary bulletins, lectures.

I am supposed to work 44 hours a year on sanitary and educational work. The most convenient form of work is conversations. After each conversation, I make a note in the register for the conduct of sanitary and educational work. I constantly hold conversations not only with the patient, but also with their relatives to promote a healthy lifestyle.

One of the main goals of the work of a nurse is continuous improvement, observance of ethics and deontology in relation to patients and colleagues. The nurse should promote the preservation and promotion of health, encourage a healthy lifestyle. By virtue of his profession, instill in patients the rules of self-care, hygiene. The significance of these measures prevents chronic diseases and their complications. A study of the activities of paramedical personnel showed that this category of workers has sufficient work experience, highly qualified, great responsibility and independence.

Sanitary - educational work in the department I spend constantly. I form the need for patients to give up bad habits, motivation for recovery, the ability and skills to self-monitor their health, to provide first aid in case of exacerbation. Main topics of conversation:

v Varicose veins of the lower extremities.

v About the dangers of smoking.

v Proper intake of tablet medicines.

v Teaching patients how to care for a colostomy and how to change colostomy bags.

v Diet for diabetes mellitus.

Sanitary bulletins were issued in 2014 on the topics: “Prevention of hemorrhoids”, “Phlegmon” and others.

Conclusion

The hospital is constantly working to improve the skills of nursing staff. Every year, advanced training courses for nurses are held on the basis of the SBMK SAKHALIN BASIC MEDICAL COLLEGE. The main staff of nurses has qualification categories and work experience of more than twenty years.

Once a month, conferences are held on compliance with the sanitary and epidemiological regime in the department, processing of equipment and instruments, problems of providing first aid, etc.

Kindsraiseprofessionalqualifications

I improve my professional level by attending sister conferences, getting to know new technologies. The department holds monthly thematic conferences, where we are introduced to new protective equipment, innovations in dressings or equipment, etc. The department is constantly studying new orders and instructions, as well as classes on topics. For example:

§ Organization of the work of the dressing room. Bix laying, sterile table setting. Tool processing.

§ Types of desmurgy.

§ Technique for dressing postoperative wounds.

§ Care of stoma (intestinal). Features depending on the location of the overlay. Means for skin treatment.

§ Care of drainage tubes. Types of drains. The need to flush the drainage tubes.

§ Care of wounds: purulent and clean. Types of bandages.

The nurses of the department are fluent in the technique of central vein catheterization, all types of dressings, maintaining medical records, etc. All staff are instructed every six months with exams in sanitary and epidemiological regime. Continuous training is provided to familiarize functional responsibilities department employees.

self-education

In the modern world, there is a sufficient amount of professional literature that contains all the material that a medical worker needs to know. Thanks to this, self-education becomes accessible to a wide range of people. The development of communications, the media, the Internet, television allows you to perceive new information and use it in professional activities. Big choice medical journals for nursing staff: "nursing", "medical bulletin", "nurse", etc. provides the necessary information from which one can draw experience from other regions of Russia. Attending nursing conferences, seminars, talks is also an integral part of my self-education.

Planningwork

Every day in the department, the head of the department and the head nurse, before the start of the working day, hold planning meetings, at which the dressing plan for the day is specified, all current affairs are discussed, problems are identified and decisions are made to eliminate them.

Mentoring

I conduct training for junior medical staff in compliance with the rules of the sanitary and epidemiological regime, work with disinfectants, labor protection rules.

On the basis of the department, students of the medical school practice. I teach them dressings. I try to ensure that during the practice, future nurses receive the basic knowledge and skills of nursing.

Privateprofessionalplan

b Confirm qualification category majoring in Nursing.

ü Constantly improve your professional level of knowledge, skills and abilities through self-education, participation in hospital-wide, intra-departmental conferences, technical studies, seminars.

l Actively participate in the life of the department and the hospital.

ü Constantly use the library with medical literature on the specifics of the department, as well as read the magazines "Nursing", "Nursing".

ü Take an active part in the training of young professionals

Offers

According to the specifics of the work of the department, patients are admitted both planned and urgent. For postoperative patients and patients with limb amputation, functional beds, bed reusable and disposable underwear are needed.

For patients who have temporarily lost their motor function, individual wheelchairs and crutches are required.

An important role is played by the appearance of the employee, it is necessary to allocate medical gowns and suits.

1. Provide with disposable medical products, consumables in full.

2. Computerization of medical records.

3. Continue the planned work on the passage of studies, advanced training of the medical staff of the department.

4. Pay special attention to: improvement of working and rest conditions, moral and material encouragement of department employees.

5. Implement a program for the exchange of experience of nurses from other regions of the Sakhalin region.

Dressing nurse FISHCHUK E.B.

Senior Nurse IVANOVA S.N.

Chief Nurse ZHAROVTSEVA N.A.

Bibliography

1. Official website of the NB FGBUZ "YUOMTS FMBA of Russia".

2. Petrovskaya S.A. Desk book chief (senior) nurse. Moscow: Dashkov i K, 2007.

3. Yu.P. Lisitsyn "Guide to social hygiene and healthcare organization". 1987.

4. Handbook "Prevention of nosocomial infections in the work of nursing staff." 2010

5. Methodological letters and orders of the Ministry of Health of the USSR and the RSFSR, job description.

6. Barykina N.V., Chernova O.V. Nursing in surgery: workshop. Rostov n/a: Phoenix, 2007.

7. Dvoinikov S.I. Fundamentals of nursing. M.: Academy, 2007.

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Organization of dressing work

In any surgical department, it is necessary to deploy two dressing rooms: “clean” and “purulent”, placing them as isolated as possible from each other, from the wards and from service units. In departments specialized in the treatment of patients with proctological diseases, anaerobic infections and other diseases associated with massive environmental infection with highly pathogenic microorganisms, it is advisable to deploy a third dressing room for these groups of patients. Dressings in each of these dressing rooms should be made first in the "cleaner" patients, then in the "more purulent". Patients with putrefactive processes, intestinal fistulas, and anaerobic infections are bandaged last. This principle of operation ensures the longest possible preservation of aseptic conditions in the dressing room and prevents cross-infection between patients.

Instruments and sterile dressings in the dressing room are stored on the “sterile table”, located in the place farthest from the front door and dressing tables. The "sterile table" is closed at least once every 6 hours. The dressing nurse cleans her hands and puts on a sterile gown as in preparation for the operation, covers the table with two layers of sterile sheets, puts sterile instruments and dressings on it, and covers it with two layers of sterile sheets on top. The edges of the sheet are fixed with special linen clips, for which you can lift the top sheet without touching it and the contents of the table. An oilcloth label is attached to one of these clips, on which the date and time of the last table overlap and the signature of honey are indicated. the sister who made it. Instruments and dressing material are served from the “sterile table” by the dressing nurse with a sterile instrument (usually a forceps is used), which is stored separately in 6% hydrogen peroxide or on the “sterile table” itself, in the corner, on a specially laid diaper or oilcloth.

Currently, dressing rooms are additionally equipped with UV bactericidal chambers for storing sterile medical instruments. (Chamber "Ultra-light" is designed to store tools for 7 days).

The staff in the dressing room wears changeable gowns, caps, 4-layer gauze masks and disinfected (non-sterile) rubber gloves. In recent years, due to the increase in the incidence of viral hepatitis and HIV, the use of goggles or face shields is recommended. Before performing dressings, staff wash their hands under a tap with soap and water, then put on gloves. At the same time, the hands do not become sterile, therefore, manipulations in the wound are performed only with tools. Between individual dressings, gloved hands are washed under a tap with soap. If the gloves come into contact with blood or wound discharge, they must be replaced. Immediately after use, gloves are disinfected in accordance with OST 42-21-2-85. If it is necessary to perform manipulations with hands, they are prepared as before the operation, and sterile gloves are put on.

There should be two washbasins (sinks) in the dressing room: “for hands” and “for gloves”. Three labeled towels should hang next to each, which are changed every day: “for doctors”, “for a nurse”, “for a nurse”. This is due to the fact that, due to the production duties, the hands of the junior honey. personnel, as a rule, are more contaminated than the hands of nurses and doctors, and the requirements for cleanliness of the hands of a dressing nurse are the highest. In the "purulent" dressing room, oilcloth aprons are additionally put on, which the nurse wipes with a 3% solution of chloramine after each dressing.

The doctor performing the dressing should not approach the "sterile table". Tools and dressings are supplied from it only by the dressing sister. The doctor takes it from his sister's forceps without touching the latter. The used dressing material is collected in trays disinfected for 1 hour in a 3% chloramine solution and placed in a closed container (bucket with a lid), where it is poured with chloramine solution to a concentration of 6%, taking into account the volume of dressing material for 1 hour.

In the dressing room is carried out:

pre-cleaning is carried out before the start of the working day: horizontal surfaces are wiped with a disinfectant solution to collect dust that has settled overnight;

cleaning after each dressing: the surface of the dressing table and the floor around it are treated with a disinfectant solution;

daily final wet cleaning using a disinfectant solution, which is used to treat equipment, floors and walls to the height of human growth;

general cleaning is carried out once a week, during which all equipment and the room, including the ceiling, are washed using detergents and a 3% solution of chloramine.

All dressing rooms should be equipped with powerful (150-300 W) ultraviolet lamps, which should be treated for at least 2 hours a day. It is advisable to leave the UV lamps on for all non-working hours.

healthcare……………………………………………………2

2. Typical instructions for filling out primary forms

medical documentation of treatment and prophylactic

(Form No. 039-3/y)………………………………………….6

offices (form No. 028 / y)………………………………...7

hospital (form No. 008/y)………………………

2.5...2... Temperature sheet (Form No. 004/

y)…………...9

2.5...3... . "Statistical map of the retired

hospital "(form No. 066 / y)……………………

3. The procedure for filling out the "Consolidated record of the doctor

surgical department, office "……………………….... 11

Application…………………………………………………………...………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

List of used literature……………………………...……13

1. On approval of forms of primary medical

documentation of healthcare institutions. Order of the Ministry of Health of the USSR dated 04.10.1980 No.

No. 1030 (Extraction)

In order to streamline the maintenance and use of primary

medical documentation in healthcare institutions, bringing

medical documentation to a unified system of standards forms,

ensuring the completeness and reliability of information reflecting

activities of health care institutions.

APPROVE:

List and samples of forms of primary medical documentation

(appendix to the order).

I ORDER:

intradepartmental statistical reporting and streamlining accounting in

bodies, institutions and enterprises of the system of the Ministry

health care of the USSR" and other orders of the Ministry of Health

USSR, published before 1.10.80 in terms of approving the forms of primary

medical documentation, with the exception of orders of the USSR Ministry of Health,

which are approved for experimental work

temporary accounting forms, the period of application of which did not expire before 1.10.80

2. Typical instructions for filling out primary forms

medical documentation of treatment and prophylactic

institutions in the provision of surgical care.(without laboratory documents) Approved by the order of the Ministry

health care of the USSR No. 1030 dated 04.10.80 (Extract)

destination. Inpatient medical records

allow you to control the correct organization of the treatment process

and are used to issue reference material upon request

departmental institutions (court, prosecutor's office, examination, etc.).

Passport part, diagnosis of the sending institution and diagnosis,

established by doctors upon admission of the patient to the hospital

13. Journal of recording surgical interventions in the hospital f. 008/u.

14. Cards of an inpatient

15. Journal of registration of transfusion of transfusion media f. 009/u.

16. Journal of registration of narcotic and psychotropic drugs

17. Journal of verification of measuring instruments

18. Book of complaints and suggestions

20. Minutes of the meetings of the bonus commission

21. Minutes of production meetings and meetings

24.Schedule of work of the head nurse of the department

25. Plan of study of middle and junior medical personnel

26.Schedules for the medical examination by the staff of the department

27. Timesheets and work schedules of department employees

28. Requirements for obtaining medicines

29.Journal on the examination of the quality of work of middle and junior medical personnel

30. Journal of advanced training of nursing staff

31. Journal of subject-quantitative accounting and write-off of medicines

32. Journal of accounting for the consumption of alcohol

33. Journal of Humanitarian Aid

34. Journal of accounting for dressings

35. Journal of accounting systems

36. Journal of syringes

37. Journal of accounting for the sterilization of medical instruments

38. Journal of accounting for material assets

39. Journal of accounting of administrative rounds

40. Journal of quartzization

43. Journal of accounting for sanitary and educational work f. No. 38 / y.

44. Log of the movement of patients

45. Journal of blood sampling for HIV, HBS antigen

47. Journal of taking blood for alcohol

48. Journal of taking swabs into the tank. laboratory

49. Journal of examination of patients for pediculosis

50. Journal of accounting for azopyram samples

51. Journal of accounting briefing on labor protection and safety

52. Journal of daily control on labor protection and safety

53. Journal of safety knowledge testing for personnel with electrical safety group 1

54. Journal of entry to work and departure from work of employees of the department

55. Nomenclature of cases.

II. Indicators of performance and defects characterizing the activity of the 2nd surgical department of the hospital for 2 years

Name of indicators and methods of their calculation	Years 2013 2014
Performance indicators
1. Average number of bed days per year Number of bed days actually spent by patients in a year Number of average annual beds	307,2	298,7
2. Average duration of treatment Number of bed-days spent by patients per year Number of dropped out patients	7,3	7,3
3. Surgical activity (in %) ×100 Number of used patients from the department	46,6	46,9
4. Lethality (in%) ×100 Number of patients who left the department	2,6	1,77
5.Bed turnover Number of patients used (half the sum of admissions, discharges and deaths) Average annual number of beds		20,5
6. Postoperative mortality (in %) × 100 Number of all operated patients per year	6,9	3,9
Defect rates
1. Discrepancy between clinical and pathoanatomical diagnoses (in %) The number of discrepancies between clinical and pathoanatomical diagnoses (per year)×100 Number of autopsies of the deceased in the surgical department (per year)	6,25	4,3
2. Postoperative mortality in diseases requiring emergency surgical care (in % of the number of operations) The number of deaths from diseases requiring emergency surgical care× 100 Number of operated patients requiring emergency surgical care
3. Nosocomial purulent-septic infection - postoperative complications (in % of the number of operations) ×100 Number of operated patients

Indicators
Number of bed-days spent by patients per year
Number of average annual beds
Number of retired patients (discharged + deceased)
Number of operated patients per year
Number of patients used (half sum of admissions, discharges and deaths)
Number of patients who died per year
Number of deaths after surgery per year
Number of discrepancies between clinical and pathoanatomical diagnoses (per year)
The number of post-mortem autopsies of the deceased in the surgical department (per year)
The number of deaths from diseases requiring emergency surgical care
Number of operated patients requiring emergency surgical care
Number of postoperative complications (per year)

Calculation of indicators for 2013.

Performance indicators:

1. Average number of days of bed operation per year = 12288/40 = 307.2

2. Average duration of treatment =12288/1684=7.3

3. Surgical activity = (392/842) × 100 = 46.6

4. Lethality = (44/1684) × 100 = 2.6

5. Bed turnover =842/40=21

6. Postoperative mortality = (27/392) × 100 = 6.99

Defect indicators:

1. Discrepancy between clinical and pathoanatomical diagnoses =2/32×100=6.25

2. Postoperative mortality in diseases requiring emergency surgical care =(0/101)×100=0

3. Nosocomial purulent-septic infection - postoperative complications =(0/861)×100=0

ORDER No. 720 OF JULY 31, 1978 "ABOUT IMPROVING MEDICAL CARE TO PATIENTS WITH PURULENT SURGICAL DISEASES AND STRENGTHENING MEASURES TO FIGHT AGAINST HOSPITAL INFECTION"

Despite the progress made in the treatment of purulent wounds, the problem of surgical and nosocomial infections is of particular importance. Due to the economic instability in the country, a sharp deterioration in healthcare funding, a reduction in the bed network and the impossibility of providing full-fledged emergency medical care to surgical patients, an increase in the number of advanced cases of diseases requires a clear implementation of this order.

This order approved 4 instructions:

Instructions for the organization and implementation of sanitary and hygienic measures for the prevention of nosocomial infections in medical institutions (surgical departments, in wards and intensive care units and intensive care);

Instructions for bacteriological control of the complex of sanitary and hygienic measures in medical institutions (surgical departments, in wards and intensive care units);

Instructions for bacteriological examination to identify carriers of pathogenic staphylococcus and sanitation;

· instructions for cleaning and disinfection of devices for inhalation anesthesia and artificial lung ventilation.

In this order, due to the high frequency of allergic reactions, it is prohibited to treat the hands of the surgeon and the surgical field with tincture of iodine, it is recommended to replace it with iodine-containing solutions (solutions of iodonate, iodopyrone, and others). As an alternative for the treatment of the surgeon's hands and the operating field, Pervomur (C4 formulation, or a mixture of hydrogen peroxide and performic acid) and a 0.5% alcoholic solution of chlorhexidine bigluconate were proposed.

ORDER of the Ministry of Health of the Russian Federation No. 174 DATED 17.05.99 “ON MEASURES TO FURTHER IMPROVE THE PREVENTION OF TETANUS ”

As a result of mass immunization of the population, the incidence of tetanus has significantly decreased and in the last decade has stabilized at low rates - from 0.033 to 0.6 per 100 thousand of the population. Every year, about 70 cases of this infection are registered in the country, half of which are fatal.

As a result of targeted active immunoprophylaxis since 1975, neonatal tetanus has not been registered.

The most effective method of preventing tetanus is active immunization with tetanus toxoid (AS-toxoid). Protection against tetanus in children is usually obtained by immunization with DPT vaccine or DTP toxoid or AS toxoid.

After a completed course of immunization, the human body for a long period (about 10 years) retains the ability to rapidly (within 2-3 days) produce antitoxins in response to repeated administration of drugs containing AS-toxoid.

The completed course of active immunization includes primary vaccination and the first revaccination. To maintain immunity against tetanus at a sufficient level, it is necessary to revaccinate periodically at intervals of 10 years by a single injection of preparations containing AS-toxoid.

To prevent the occurrence of tetanus in case of injuries, emergency prophylaxis is necessary.

Emergency immunoprophylaxis is carried out differentially depending on the patient's previous immunization against tetanus by administering AS-toxoid and ADS-M-toxoid (emergency revaccination), or using active-passive immunization by simultaneously administering AS-toxoid and tetanus toxoid (PSS) or immunoglobulin ( PSCHI).

Emergency active-passive prophylaxis in previously unvaccinated people does not guarantee the prevention of tetanus in all cases, in addition, it is associated with the risk of immediate and long-term reactions, as well as complications in response to the introduction of PSS. To exclude the re-introduction of PSS in case of new injuries, persons who received active-passive prophylaxis must complete the course of active immunization by a single revaccination with AS-anatoxin or ADS-M-anatoxin.

Drugs used for routine active immunization against tetanus:

n Adsorbed pertussis-diphtheria-tetanus vaccine (DPT) containing 20 billion inactivated pertussis microbial cells, 30 flocculating units of diphtheria and 10 units of conjugated (EC) tetanus toxoid per ml.

n Adsorbed diphtheria-tetanus toxoid (ADS), containing 60 diphtheria and 20 EU tetanus toxoids in 1 ml.

n Adsorbed diphtheria-tetanus toxoid with a reduced content of antigens (ADS-M), containing 10 diphtheria and 10 EU tetanus toxoids in 1 ml.

n Adsorbed tetanus toxoid (AC) containing 20 EC per 1 ml.

Drugs used in emergency immunoprophylaxis of tetanus:

n Adsorbed tetanus toxoid (AS);

n Adsorbed diphtheria-tetanus toxoid with a reduced content of antigens (ADS-M);

n Tetanus toxoid horse serum purified concentrated liquid (PSS). One prophylactic dose of PSS is 3000 IU (international units);

n Human tetanus immunoglobulin (HTI). One prophylactic dose of PSCI is 250 IU.

Emergency prophylaxis of tetanus is carried out:

n in case of injuries with violation of the integrity of the skin and mucous membranes;

n with frostbite and burns (thermal, chemical, radiation) of the second, third, and fourth degrees;

n with penetrating damage to the gastrointestinal tract;

n for community-acquired abortions;

n for childbirth outside of medical facilities;

n with gangrene or tissue necrosis of any type, long-term abscesses, carbuncles;

n when bitten by animals and humans.

Emergency prophylaxis of tetanus consists in the primary surgical treatment of the wound and simultaneous specific immunoprophylaxis. Immunoprophylaxis for tetanus should be performed as early as possible and up to 20 days after injury, given the duration incubation period with tetanus.

The appointment of drugs for emergency immunoprophylaxis of tetanus is differentiated depending on the availability of documentary evidence of a prophylactic vaccination or data on immunological control, the intensity of tetanus immunity, and also taking into account the nature of the injury.

The introduction of drugs is not carried out:

n children and adolescents who have documented confirmation of scheduled preventive vaccinations in accordance with age, regardless of the period that has passed since the next vaccination;

n Adults with documentary evidence of having completed a full course of immunization no more than 5 years ago;

n persons who, according to emergency immunological control, have a tetanus antitoxin titer in blood serum above 1:160 according to TPHA, which corresponds to a titer above 0.1 IU / ml according to biological neutralization reaction - pH (protective titer).

Only 0.5 ml of AC-toxoid is injected:

n children and adolescents who have documented evidence of a course of routine preventive vaccinations without the last age-related booster, regardless of the date of the last vaccination;

n adults who have documented a full course of immunization more than 5 years ago;

n people of all ages who received two vaccinations less than 5 years ago, or one vaccine less than 2 years ago;

n children from 5 months of age, adolescents, military servicemen and those who have served in the army for a fixed period, whose vaccination history is not known, and there were no contraindications to vaccination;

n persons who, according to emergency immunological control, have a tetanus toxoid titer in the range of 1:20 - 1:80 according to the RGPA or in the range of 0.01 - 0.1 IU / ml according to the pH.

Instead of 0.5 ml AS, 0.5 ml of ADS-M can be administered if immunization with this drug is necessary.

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 test - PSS (3000 IU).

Active-passive prevention is carried out:

persons of all ages who received two vaccinations more than 5 years ago, or one vaccination more than 2 years ago;

unvaccinated persons, as well as persons who do not have documentary evidence of vaccinations;

Persons who, according to emergency immunological control, have a tetanus antitoxin titer of less than 1:20 according to RGPA or less than 0.01 IU / ml according to pH.

All persons who received active-passive tetanus prophylaxis should be revaccinated with 0.5 ml of AS or 0.5 of ADS-M to complete the course of immunization in the period from 6 months to 2 years.

For various reasons, children under 5 months of age who are not vaccinated are given only 250 IU PSS or (in the absence of PSS) - 3000 IU PSS.

Emergency prophylaxis of tetanus for repeated injuries:

Persons who, in case of injury, in accordance with their vaccination history, received only AS (ADS-M), in case of repeated injuries, undergo emergency prophylaxis as previously vaccinated in accordance with the rules, but not more often than 1 time in 5 years.

Contraindications to the use of specific means of emergency prophylaxis of tetanus:

1. The main contraindications to the use of specific prophylaxis of tetanus are:

n hypersensitivity to the respective drug;

n pregnancy (in the first half, the introduction of AS (ADS-M) and PSS is contraindicated, in the second half - PSS).

2. In persons who had contraindications to the administration of AS (ADS-M) and PSS, the possibility of emergency prophylaxis with the help of PSCI is determined by the attending physician.

3. The state of alcoholic intoxication is not a contraindication to emergency prophylaxis of tetanus.

After the introduction of PSS or drugs containing tetanus toxoid, in very rare cases, complications may develop: anaphylactic shock, serum sickness.

ORDER of the Ministry of Health of the Russian Federation No. 297 OF 07.10.1997 " ON THE IMPROVEMENT OF MEASURES TO PREVENT RABIES IN PEOPLE»

In connection with the aggravation in recent years in the territory of the Russian Federation of the epizootic situation for rabies, the threat of the spread of this infection among the population has significantly increased. The number of animal rabies cases has doubled in recent years, and the number of people injured by animals has more than doubled. In the Russian Federation, 5-20 cases of rabies among people are registered annually, in the Republic of Belarus 1-2 cases.

First aid for persons who applied for bites, scratches, saliva of any animals, as well as for persons who received damage to the skin and contact of infected material with mucous membranes when cutting and opening the carcasses of animals that died from rabies, or when opening the corpses of people who died from hydrophobia, render everything TREATMENT AND PREVENTIVE INSTITUTIONS.

TREATMENT AND PREVENTIVE INSTITUTIONS when addressing persons bitten, scratched, salivated by any animals, as well as persons who have received damage to the skin and contact of infected material with mucous membranes when cutting and opening the carcasses of animals that died from rabies, or when opening the corpses of people who died from rabies are required to:

Immediately provide first aid to the victim: wash the wounds, scratches, abrasions, saliva with plenty of water and soap (or any washing solution), treat the edges of the wound with 70% alcohol or tincture of iodine, apply a sterile bandage. The edges of the wound inflicted on the animal should not be excised or sutured during the first three days, except for injuries that require special surgical interventions for health reasons;

In case of extensive wounds, after preliminary local treatment of the wound, several leading sutures are applied;

In order to stop external bleeding, bleeding vessels are stitched;

Carry out emergency prophylaxis of tetanus in accordance with the instructions for its implementation;

Send the victim to a trauma center (or office), and in his absence - to the surgical office or surgical department of the hospital for the appointment and conduct of a course of anti-rabies vaccinations;

· Send a telephone message to each applicant and send a written “Emergency notice of an infectious disease” (registration form No. 058 / y) to the center of the state sanitary and epidemiological supervision, in the area of \u200b\u200bwhich the institution is located;

Inform every victim of possible consequences refusal of vaccinations and the risk of rabies, the timing of observation of the animal.

TRAUMATOLOGICAL POINTS (OFFICES), and in their absence SURGICAL ROOMS AND SURGICAL DEPARTMENTS SHOULD:

1. In the case of the initial request of the victim to provide him with first aid, promptly transfer a telephone message and within 12 hours send an emergency notice (registration form No.

2. Fill in for each victim the “Card of those who applied for anti-rabies help” (account form No. 045 / y).

3. Prescribe and ensure a course of anti-rabies vaccinations in accordance with the current instructions for the use of anti-rabies drugs, including without fail on Saturdays, Sundays and holidays in medical institutions that continuously receive patients around the clock.

4. Provide hospitalization of the following categories of victims for a course of vaccinations:

Persons who have received severe and multiple bites and bites of dangerous localization;

· Persons living in rural areas;

Revaccinated;

· Having burdened anamnesis (neurological, allergic, etc.).

5. Specify the course of vaccinations on the basis of a report from a veterinary institution on the results of animal observation or a report from the State Sanitary and Epidemiological Surveillance Center on the results of a laboratory study of a dead or killed animal.

6. Inform the centers of the state sanitary and epidemiological supervision:

In case of moving to another place of residence of the victim who has not completed the course of anti-rabies vaccinations;

In the event of a post-vaccination complication;

About vaccinated people who have not completed the course of vaccinations;

· About each case of refusal of anti-rabies vaccinations.

7. Send copies of all completed "Cards of those who applied for anti-rabies help" to the territorial centers of the State Sanitary and Epidemiological Supervision.

8. Ensure the continuity of the course of anti-rabies vaccinations, if possible with one series of vaccine.

9. To issue a refusal to provide anti-rabies assistance in the form of a patient's receipt, certified by the signatures of 2 doctors and the seal of the medical facility.

10. Issue and issue a certificate to the patient about the course of anti-rabies vaccinations, if he has a vaccination certificate, fill out the registration sheet.

11. Keep records of post-vaccination reactions and complications to the introduction of anti-rabies drugs.

12. Determine the need for anti-rabies drugs and submit requests for anti-rabies drugs in a timely manner.

Lecture 3. ASEPTICA

Asepsis - measures aimed at preventing the entry of microbes into the wound. Asepsis in Greek means: A - without, septicos - purulent. Hence the basic principle of asepsis says: everything that comes into contact with the wound must be free from bacteria, that is, it must be sterile. Any surgical intervention must be performed under sterile conditions, this applies not only to surgery itself, but also to traumatology, ophthalmic surgery, urology, endoscopy and other specialties. Therefore, knowledge of asepsis is mandatory for almost any medical specialty.

Microbes can get into the wound both from the inside and from the outside. An endogenous infection is an infection that is inside the body or on the skin and mucous membranes. Such an infection can get into the wound by contact, lymphogenous and hematogenous routes. Sources of endogenous infection are carious teeth, foci of chronic infection in internal organs - cholecystitis, bronchitis, pyelonephritis, etc.

The most important is an exogenous infection that enters the wound from the external environment. There are 3 ways of transmission of exogenous infection:

1. Airborne - the infection enters the wound from the air, with saliva splashes, when coughing, sneezing, etc.

2. Contact way - the infection enters the wound from objects in contact with the wound.

3. Implantation route - the infection enters the wound from materials left in the body or wound during surgery: drains, catheters, suture material, vascular prostheses, artificial materials, etc.

Airborne Infection Prevention

Prevention of airborne infection primarily depends on the proper organization of the surgical department, dressing rooms, and operating rooms. In the surgical department, the wards should have 2-4 beds, the area per 1 bed should be at least 6.5-7.5 square meters. Floors, walls, furniture in the wards should be easily cleaned and disinfected. In the conditions of small hospitals, like a district hospital, there is 1 surgical department, but at the same time it is necessary to separate “purulent” from “clean” patients, ideally to have 2 dressing rooms - for purulent and clean dressings. In dressing rooms it is necessary to work in dressing gowns, caps, masks.

Asepsis must be especially carefully observed in the operating unit. The operating unit should be separated from other parts of the hospital. The operating block consists of operating rooms, preoperative rooms, utility rooms for staff. In the operating room, the floor and walls should have a smooth surface, preferably tiles, which can be easily disinfected. The operating team before the operation completely changes into sterile overalls, students must visit the operating rooms in clean gowns, caps, masks, shoe covers, without woolen clothes, with neatly hidden hair. In the operating room, the rule of "red line" must be observed. Cleaning of operating rooms is carried out in a wet way. Distinguish:

pre-cleaning - before the operation;

current cleaning - carried out during the operation;

daily cleaning - after the end of the operation;

general cleaning - carried out once a week.

Air purifiers and bactericidal lamps are used to reduce bacterial contamination of the air in the operating room.

Prevention of contact infection

This section includes the processing of the hands of the surgeon and the operating field, the sterilization of surgical instruments, the sterilization of underwear and dressings.

Treatment of the surgeon's hands includes 2 stages: mechanical cleaning and disinfection. Mechanical cleaning consists in washing hands under running water with soap and a brush for 2-5 minutes. Hand disinfection can be done in several ways:

1. Until recently, the treatment of the surgeon's hands according to Spasokukotsky - Kochergin was most widespread: after washing, the hands are treated in 2 basins with a 0.5% solution of ammonia, for 5 minutes in each basin. Then the hands are wiped dry, and treated with 96% alcohol for 5 minutes. Due to the processing time, this method is currently rarely used.

2. Treatment of the surgeon's hands with chlorhexidine bigluconate: after washing, the hands are dried, treated twice for 3 minutes with napkins moistened with a 0.5% alcohol solution of chlorhexidine bigluconate.

3. Treatment of the surgeon's hands with a solution of pervomur (a mixture of formic acid and hydrogen peroxide): after washing, the hands are treated in a basin with a 2.4% solution of pervomur for 1 minute.

4. Treatment of the surgeon's hands according to the Davletov method: after washing, the hands are treated with Davletov's solution (a mixture of 0.1 normal hydrochloric acid solution and 33% alcohol).

5. Accelerated methods for processing the surgeon's hands: Brun and Alfeld methods using 96% and 70% alcohol.

After processing the hands by any method, the surgeon puts on sterile rubber gloves.

Treatment of the surgical field consists in hygienic treatment and disinfection of the skin in the area of surgical access. Hygiene treatment consists in washing the patient, shaving the hair in the area of the forthcoming surgical intervention.

Most often, disinfection of the surgical field is carried out according to Grossikh-Filonchikov: the surgical field is widely treated twice with 5% tincture of iodine, then twice with 70% alcohol solution, after which the surgical field is lined with sterile sheets.

In addition, the surgical field can be treated with iodonate, iodopyrone, 0.5% alcohol solution of chlorhexidine bigluconate.

Sterilization of surgical instruments consists of pre-sterilization treatment and sterilization itself.

Pre-sterilization treatment: instruments contaminated with blood after the operation are soaked in a washing solution, then washed under running water with a brush, rinsed in distilled water, and dried at a temperature of 85 degrees.

Sterilization:

Boiling: produced in special boiler sterilizers, with the addition of soda. Currently rarely used, mainly for the sterilization of rubber, vinyl chloride and silicone tubes, non-cutting instruments. Metal tools and glass products are boiled for 20 minutes, rubber products - 10 minutes.

Sterilization with dry steam: carried out in special dry-heat cabinets at a temperature of 180 degrees for 60 minutes.

Chemical method: small instruments (needles, scalpel blades) and plastic products can be sterilized in a 6% hydrogen peroxide solution for 360 minutes at 18 degrees, or for 180 minutes at 50 degrees.

Processing of endoscopes, catheters is carried out:

in steam-formalin chambers;

ethylene oxide (gas method);

solutions like "sideks";

triple solution.

Sterilization of surgical linen and dressings

Surgical linen and dressings are sterilized by autoclaving - in special biks, which are placed in autoclaves. Linen and material are sterilized at a temperature of 120 degrees under a steam pressure of 1.1 atmospheres for 45 minutes, or at a temperature of 132 degrees under a steam pressure of 2 atmospheres for 20 minutes.

Prevention of implantation infection

Suture sterilization

silk sterilization: Kocher method - silk skeins are washed in warm water with soap, dried, degreased in ether for 12-24 hours, then placed in 70% alcohol for 12-24 hours, after which they are boiled for 10 minutes. Stored in hermetically sealed jars in 96% alcohol, which is changed every 7 days.

sterilization of capron and lavsan: carried out by autoclaving.

sterilization of catgut: Sitkovsky's method - in iodine vapor; beam method - gamma irradiation.

sterilization of atraumatic ligatures: factory method by gamma irradiation.

Control of pre-sterilization treatment

In order to control for the presence of residues of the washing solution, amidopyrine or phenolphthalein tests are carried out, for the presence of blood residues - benzidine or ortho-toluidine tests. In the presence of residual cleaning solution or blood, a discoloration of the control solutions appears.

Sterilization control: based on color change of test indicators; on the effect of melting some chemical compounds; by direct thermometry; by bacteriological control.

During autoclaving, together with the products to be sterilized, sealed glass flasks with chemical compounds are placed in biks: urea powders, benzoic acid with fuchsin, which melt at temperatures above 120 degrees.

When sterilizing in dry-heat cabinets, thermal indicators are used that change color when the temperature reaches 180 degrees, or direct thermometry using thermometers built into sterilizers.

Control over the sterility of the suture material, dressing material, underwear, the hands of the surgeon and the surgical field is carried out by periodic crops of swabs or samples of the suture material - bacteriological control.

Lecture 4. ANTISEPTICS

One of the important sections of general surgery is the topic "Antiseptics". Without dwelling in detail on the history of antiseptics, it is only necessary to note that the founder of antiseptics is considered to be the English surgeon Lister, who proposed carbolic acid for treating wounds, the surgeon's hands and instruments.

So, antiseptic is a set of measures aimed at the destruction of microorganisms in the wound, in the pathological focus and in the body as a whole. Antiseptic agents can create either unfavorable conditions for the development of infection, or have a detrimental effect on microorganisms.

There are mechanical, physical, chemical, biological and mixed antiseptics. Let's consider each of them separately.

Mechanical antiseptic- this is the use of mechanical methods that contribute to the removal of foreign bodies from the wound, non-viable and necrotic tissues, which are a good breeding ground for microorganisms. In general, any accidental wound is considered infected, but not every wound suppurates. This is due to the fact that a certain concentration of microbes is necessary for the development of an infection in a wound: 100,000 microbial bodies per 1 g of tissue. This is a critical level of wound contamination.

However, an infection can develop in the wound even with a lower bacterial load, for example, with diabetes mellitus, anemia, general weakening of the patient, immune suppression, etc.

Therefore, any accidental injury must be treated. Thus, the main method of mechanical antisepsis is surgical debridement. Primary surgical treatment of the wound consists in excision of the edges and bottom of the wound. In this case, the microbial contamination of the wound is significantly reduced.

In addition, mechanical antiseptics include wound treatment with a jet of liquid. A jet of liquid under high pressure washes away foreign bodies, pus and microorganisms.

Mechanical antiseptics also include wound drainage with rubber strips and tubes, this is the so-called passive wound drainage, when pus from the wound flows by gravity, passively.

Application of methods of active drainage of wounds. In contrast to passive drainage, in this case, to improve the outflow from the focus, a vacuum source is used: an electric pump, a vacuum pump, a microcompressor, etc. There are two types of active drainage: first, active-aspiration drainage, when the drainage tube is connected to the suction; secondly, flow-aspiration drainage, when an antiseptic solution is injected into the focus through one tube, the other tube is connected to the suction, thus the focus is constantly irrigated.

Physical antiseptic is the application of physical factors. These include:

1. Application of a high-energy (surgical) laser. A moderately defocused laser beam evaporates necrotic tissues and pus. After such treatment, the wound becomes sterile, covered with a burn scab, after which the wound heals without suppuration.

2. The use of ultrasound - a sound with a frequency above 20 kHz causes the effect of cavitation, i.e. the action of high-frequency shock waves that have a disastrous effect on microorganisms.

3. The use of physiotherapy procedures - UVI, quartz treatment, UHF, electrophoresis, etc.

Chemical antiseptic- the use of chemicals that have a bactericidal effect (delaying the development and reproduction of microbes).

There are many chemical antiseptics, they are divided into the following groups:

I. Halogen group:

1. chloramine B: used for washing purulent wounds 1-2% solution, for hand disinfection - 0.5% solution, for current disinfection of premises - 2% solution;

2. iodine alcohol solution 5-10%;

3. iodine preparations: iodonate 1% solution, iodinol 1% solution, iodopyrone 1% solution.

II. Oxidizers:

1. Hydrogen peroxide solution. Upon contact with the wound, hydrogen peroxide decomposes with the release of oxygen, and abundant foam is formed. The antiseptic effect of hydrogen peroxide is explained both by a strong oxidizing effect and by mechanical cleaning of the wound from pus and foreign bodies;

2. Perhydrol - contains about 30% hydrogen peroxide, used to prepare a solution of pervomur;

3. Potassium permanganate ("potassium permanganate"): used for washing wounds 0.1% solution, for washing the mouth and stomach 0.01% solution.

Oxidizing agents are especially effective in anaerobic and putrefactive diseases.

III. Acids:

1. Boric acid - in the form of a powder, and in the form of a 4% solution for washing wounds. Especially effective for Pseudomonas aeruginosa.

2. Formic acid - used to prepare a solution of Pervomura (for treating the surgeon's hands).

3. Hydrochloric acid - 0.1% hydrochloric acid solution is part of Davletov's solution.

IV. Aldehydes:

1. formaldehyde;

2. lysoform;

3. formalin.

V. Phenols:

1. carbolic acid;

2. Ichthyol, used as an ointment.

VI. Alcohols: ethyl alcohol 70% and 96% solutions, for the treatment of wound edges, the treatment of the surgeon's hands and the surgical field.