Order 111 hand washing technique RK. Hand washing technique in medicine: sequence of movements. Regional routing scheme for preterm birth

On improving medical care for women during pregnancy, childbirth and the postpartum period and amending certain orders of the Ministry of Health and Social Development of the Samara Region

Accepted Ministry of Health of the Samara region.

In accordance with the Procedure for the provision of medical care in the field of “obstetrics and gynecology” (except for the use of assisted reproductive technologies), approved by order of the Ministry of Health of the Russian Federation dated November 1, 2012 N 572n, in order to provide affordable and high-quality medical care to women during pregnancy, childbirth and the postpartum period I order:
1. Provide chief doctors of state budgetary healthcare institutions of the Samara region with:
hospitalization of pregnant women, women in labor and postpartum for the provision of emergency and emergency medical care in accordance with Appendix 1 to this Order;
hospitalization of pregnant women with obstetric complications in accordance with Appendix 2 to this Order;
implementation by specialists of the clinical recommendations “Premature birth”, approved by the Russian Society of Obstetricians and Gynecologists dated December 5, 2013 N 769, and the regional routing scheme for premature birth in accordance with Appendix 3 to this Order;
implementation by specialists of clinical recommendations "Hypertensive disorders during pregnancy, childbirth and the postpartum period. Preeclampsia. Eclampsia", approved by the Ministry of Health of the Russian Federation dated September 23, 2014 N 15-4/10/2-7138, and the regional routing scheme for hypertensive disorders during during pregnancy, during childbirth and the postpartum period, preeclampsia, eclampsia in accordance with Appendix 4 to this Order;
implementation by specialists of an algorithm of actions in the event of obstetric bleeding in accordance with Appendix 5 to this Order.
2. Make the following changes to the order of the Ministry of Health and Social Development of the Samara Region dated September 18, 2008 N 1127 “On measures to prevent cases of maternal and infant mortality”:
clause 1.1 is declared invalid;
in paragraph 3.3, delete the words “Hospitalization scheme for pregnant women, women in labor and postpartum women (Appendix 4) and”;

Application
to Order No. 111 of January 30, 2015

Annex 1 “Providing medical care to pregnant women and women in labor during premature birth” and Annex 4 “Hospitalization scheme for pregnant women, women in labor and postpartum” shall be declared invalid.
3. Make the following changes to the order of the Ministry of Health and Social Development of the Samara Region dated July 18, 2011 N 930 “On measures to prevent cases of maternal mortality”:
paragraph 1 is declared invalid;
the attached clinical protocol “Bleeding in the postpartum period” is considered invalid.
4. Entrust control over the implementation of this Order to the management of the organization of medical care for women and children of the department of organization of medical care to the population (Ponomarev).
Minister
G.N.GRIDASOV

Routing scheme for pregnant women, women in labor and postpartum for emergency and emergency medical care Samara

1. To the maternity ward of the Samara Regional Clinical Hospital named after M.I. Kalinin (obstetric hospital group 3A):
1.1. Pregnant women and women in labor from 22 weeks of pregnancy, belonging to the high-risk group, from cities and districts of the region, except for the city of Samara and the territories assigned to the inter-district perinatal center of the State Budgetary Institution of Healthcare of the Samara Region "Tolyatti City Clinical Hospital No. 5".
1.2. Women giving birth at 22-33 weeks of pregnancy (subject to a living fetus and the possibility of transportation) from obstetric hospitals of the 1st group and obstetric hospitals of the 2nd group - GBUZ SO "Kinelskaya Central Bank for Hydrotherapy", GBUZ SO "Pokhvistnevskaya CDGiR", GBUZ SO "Novokuibyshevskaya" Central City Hospital", GBUZ SO "Chapaevskaya Central City Hospital".
1.3. Pregnant women and women in labor from 22 weeks of pregnancy from the Krasnoglinsky district of Samara.
1.4. During the cleaning of the maternity ward No. 20 of the State Budgetary Healthcare Institution of the Samara Region "Samara City Clinical Hospital No. 1 named after N.I. Pirogov" - women in labor at 22-33 weeks of pregnancy from the Kirov and Zheleznodorozhny districts of Samara.
1.5. During the scheduled cleaning of the maternity ward of the State Budgetary Institution of Healthcare of the Samara Region "Samara City Clinical Hospital No. 2 named after N.A. Semashko" - women in labor at 22-33 weeks of pregnancy from the Industrial District of Samara.
1.6. During the washing period of the State Budgetary Institution "Samara Regional Clinical Cardiological Dispensary" - pregnant and parturient women with cardiovascular diseases from all cities and districts of the region, except for the territories assigned to the interdistrict perinatal center of the State Budgetary Institution of the Samara Region "Tolyatti City Clinical Hospital No. 5" (excluding pregnant women and women in labor requiring specialized cardiac surgical care).
2. To the maternity ward of the Samara Regional Clinical Cardiology Dispensary (obstetric hospital of the 2nd group):
2.1. Pregnant women and women in labor with cardiovascular diseases from all cities and districts of the region.
2.2. During the scheduled washing of the maternity ward of the Samara Regional Clinical Hospital named after M.I. Kalinin - pregnant women and women in labor from 22 weeks of pregnancy, belonging to the high-risk group, from the territories of group A.
2.3. During the scheduled washing of the maternity ward of the Samara Region State Budgetary Institution "Samara City Clinical Hospital No. 2 named after N.A. Semashko" - pregnant women and women in labor from 22 weeks of pregnancy from the Sovetsky district of Samara.
2.4. Women giving birth at 34-36 weeks of pregnancy from the Neftegorsk Central District Hospital (subject to a living fetus and the possibility of transportation).
3. To the maternity ward No. 20 of the Samara Region Samara City Clinical Hospital No. 1 named after N.I. Pirogov (obstetric hospital of the 2nd group):
3.1. Pregnant women and women in labor from 22 weeks of pregnancy from the Kirovsky district of Samara, the Volzhsky district (part).
3.2. Women giving birth at 22-33 weeks of pregnancy from the Zheleznodorozhny district of Samara.
3.3. During the scheduled washing of the maternity ward of the State Budgetary Healthcare Institution "M.I. Kalinin Regional Clinical Hospital" - pregnant women and women in labor from 22 weeks of pregnancy from the high-risk group from the city of Otradny, districts - Elkhovsky, Kinelsky, Krasnoyarsky, Koshkinsky.
3.4. During the scheduled cleaning of maternity ward No. 21, pregnant women and women in labor from 22 weeks of pregnancy from the Oktyabrsky district of Samara, women in labor at 22-33 weeks of pregnancy from the Leninsky and Samara districts of Samara.
3.5. During the scheduled washing of the maternity ward of the Samara Region State Budgetary Institution "Samara City Clinical Hospital No. 2 named after N.A. Semashko" - pregnant women and women in labor from 34 weeks of pregnancy from the Industrial District of Samara.
3.6. During the scheduled cleaning of the maternity ward of the State Budgetary Healthcare Institution of the Samara Region "Samara City Hospital No. 10" - pregnant women and women in labor at 22-33 weeks of pregnancy from the Kuibyshevsky district of Samara.
3.7. Women giving birth at 34-36 weeks of pregnancy from the Krasnoyarsk Central District Hospital (subject to a living fetus and the possibility of transportation).
4. To the maternity ward No. 21 of the Samara Region Samara City Clinical Hospital No. 1 named after N.I. Pirogov (obstetric hospital of the 2nd group):
4.1. Pregnant women and women in labor from 22 weeks of pregnancy from Leninsky, Samara and Oktyabrsky districts of Samara.
4.2. During the scheduled washing of the maternity ward of the State Budgetary Healthcare Institution "M.I. Kalinin Special Clinical Hospital" - pregnant women and women in labor from 22 weeks of pregnancy from the Krasnoglinsky district of Samara.
4.3. During the scheduled washing of the maternity ward No. 20 of the Samara Region State Budgetary Institution "Samara City Clinical Hospital No. 1 named after N.I. Pirogov" - pregnant women and women in labor at 34 weeks of pregnancy or more from the Kirov district of Samara, the Volzhsky district (part).
4.4. During the scheduled cleaning of the maternity ward of the Samara Region State Budgetary Healthcare Institution "Samara City Hospital No. 10" - pregnant women and women in labor at 34 weeks of pregnancy or more from the Kuibyshevsky and Zheleznodorozhny districts of Samara.
5. To the maternity ward of the State Budgetary Healthcare Institution of the Samara Region "Samara City Clinical Hospital No. 2 named after N.A. Semashko" (obstetric hospital of the 2nd group):
5.1. Pregnant women and women in labor from 22 weeks of pregnancy from the Promyshlenny and Sovetsky districts of Samara.
5.2. During the scheduled washing of the maternity ward of the State Budgetary Healthcare Institution "M.I. Kalinin Special Clinical Hospital" - pregnant women and women in labor from 22 weeks of pregnancy from the high-risk group from the Kamyshlinsky, Klyavlinsky, Shentalinsky, Sergievsky, Chelno-Vershinsky, Isaklinsky districts.
5.3. Women giving birth at 34-36 weeks of pregnancy from the Sergievskaya Central District Hospital, Chelno-Vershinskaya Central District Hospital (subject to a living fetus and the possibility of transportation).
6. To the maternity ward of the State Budgetary Healthcare Institution of the Samara Region "Samara City Hospital No. 10" (obstetric hospital of the 2nd group):
6.1. Pregnant women and women in labor from 22 weeks of pregnancy from the Kuibyshevsky district of Samara, the Volzhsky district (part).
6.2. Pregnant women and women in labor at 34 weeks of pregnancy or more from the Zheleznodorozhny district of Samara.
6.3. During the scheduled washing of the maternity ward No. 21 of the Samara Region Samara City Clinical Hospital No. 1 named after N.I. Pirogov, pregnant women and women in labor at 34 weeks of pregnancy or more from the Leninsky and Samara districts of Samara.
6.4. During the cleaning of the maternity ward of the interdistrict perinatal center of the State Budgetary Institution of Health of the Samara Region "Novokuibyshevskaya Central City Hospital" - pregnant women and women in labor from the city of Novokuibyshevsk and Bolsheglunitsky districts, pregnant women and women in labor of average risk from the Bolshechernigovsky district.
TOgliatti
7. To the maternity ward of the interdistrict perinatal center of the State Budgetary Healthcare Institution of the Samara Region "Tolyatti City Clinical Hospital No. 5" (obstetric hospital group 3A):
7.1. Pregnant women and women in labor from 22 weeks of pregnancy, belonging to the high-risk group, from Togliatti, Syzran, Zhigulevsk, Oktyabrsk, Stavropol, Syzran and Shigonsky districts of the region.
7.2. Women in labor at 22-33 weeks of pregnancy (subject to a living fetus and the possibility of transportation) from the Syzran Central City Hospital, the Zhigulevskaya Central City Hospital, the Oktyabrskaya Central City Hospital, the Shigonskaya Central Regional Hospital, the Syzran Central Hospital Central Regional Hospital", GBUZ SO "Stavropol Central Regional Hospital".
7.3. Pregnant women and women in labor from 22 weeks of pregnancy from the Avtozavodsky district of Tolyatti.
8. To the maternity ward of the Samara Region Togliatti City Hospital No. 2 named after V.V. Banykin (obstetric hospital of the 2nd group):
8.1. Pregnant women and women in labor from 22 weeks from the Central and Komsomolsky districts of Tolyatti.
8.2. Pregnant women and women in labor at 34 weeks or more from the city of Zhigulevsk and Stavropol region.
8.2. Women giving birth at 34-36 weeks from the Koshkinskaya Central District Hospital (subject to a living fetus and the possibility of transportation).
9. To the maternity ward of the interdistrict perinatal center of the State Budgetary Healthcare Institution of the Samara Region "Syzran Central City Hospital" (obstetric hospital of the 2nd group):
9.1. Pregnant women and women in labor of low and moderate risk at 34 weeks or more in the cities of Syzran, Oktyabrsk, Syzran and Shigon districts.
9.2. Women giving birth at 22-33 weeks of pregnancy if it is impossible to transport them to a group 3A obstetric hospital from the city. Syzran, Oktyabrsk, Syzran and Shigonsky districts.
10. To the maternity ward of the interdistrict perinatal center of the State Budgetary Healthcare Institution of the Samara Region "Novokuibyshevskaya Central City Hospital" (obstetric hospital of the 2nd group):
10.1. Pregnant and postpartum women of low and moderate risk groups at 34 weeks or more from the city of Novokuybyshevsk, Bolsheglunitsky district.
10.2. Pregnant and parturient women of moderate risk group at 34 weeks or more from the Bolshenigovsky district.
10.3. Women giving birth at 22-33 weeks from the city. Novokuibyshevsk, Bolsheglunitsky, Bolshechernigovsky districts if it is impossible to transport to a group 3A obstetric hospital.
10.4. During the cleaning of the maternity ward of the interdistrict perinatal center of the State Budgetary Institution of Health of the Samara Region "Chapaevskaya Central City Hospital" of pregnant women and women in labor of low and moderate risk groups at 34 weeks or more from the city of Chapaevsk, Krasnoarmeysky district, moderate risk groups from Bezenchuksky, Pestravsky, Khvorostyansky, Privolzhsky districts.
11. To the maternity ward of the interdistrict perinatal center of the State Budgetary Healthcare Institution of the Samara Region "Chapaevskaya Central City Hospital" (obstetric hospital of the 2nd group):
11.1. Pregnant and postpartum women of low and moderate risk groups at 34 weeks or more from the city of Chapaevsk, Krasnoarmeysky district, moderate risk groups from Bezenchuksky, Pestravsky, Khvorostyansky, Privolzhsky districts.
11.2. Women giving birth at 22-33 weeks from the city of Chapaevsk, Krasnoarmeysky, Bezenchuksky, Pestravsky, Khvorostyansky, Privolzhsky districts if it is impossible to transport them to a group 3A obstetric hospital.
12. To the maternity ward of the interdistrict perinatal center of the Pokhvistnevskaya CBGiR (obstetric hospital of the 2nd group):
12.1. Pregnant women and women in labor of low and moderate risk at 34 weeks or more from the city of Pokhvistnevo, Kamyshlinsky, Klyavlinsky, Isaklinsky, Pokhvistnevsky districts.
12.2. Women giving birth at 22-33 weeks from the city of Pokhvistnevo, Kamyshlinsky, Klyavlinsky, Isaklinsky, Pokhvistnevsky districts if it is impossible to transport them to a group 3A obstetric hospital.
13. To the maternity ward of the interdistrict perinatal center of the State Budgetary Healthcare Institution SO "Otradnenskaya Central Bank" (obstetric hospital of the 1st group):
13.1. Pregnant and postpartum women of low and moderate risk group at 34 weeks or more from the city of Otradny, moderate risk group at 34 weeks or more from Borsky and Bogatovsky districts.
13.2. Women giving birth at 22-33 weeks from the city of Otradny, Borsky and Bogatovsky districts if it is impossible to transport them to a group 3A obstetric hospital.
13.3. Women giving birth at 34-36 weeks from the Kinel-Cherkasy region (subject to a living fetus and the possibility of transportation).
14. To the maternity ward of the State Budgetary Healthcare Institution SO Kinelskaya Central Bank of the city and district (obstetric hospital of the 2nd group):
14.1. Pregnant women and women in labor over 34 weeks of low and moderate risk groups from the city of Kinel and Kinelsky district;
14.2. Women giving birth at 22-33 weeks from the city of Kinel and Kinelsky district if it is impossible to transport them to a group 3A hospital.
GBUZ Territory15. GBUZ SO "Bezenchukskaya Central District Hospital" Pregnant women and women in labor (37 weeks or more) of low risk group, women in labor at 22-36 weeks in Bezenchuk district if it is impossible to transport them to hospitals of group 3a-216. GBUZ SO "Bor Central District Hospital" Pregnant women and women in labor (more than 37 weeks) of low risk group in the Bor region, women in labor at 22-36 weeks in the Bor region with impossibility of transportation to hospitals of the 3a-2nd group17. GBUZ SO "Bogatovskaya Central District Hospital" Pregnant women and women in labor (more than 37 weeks) of low risk group, women in labor at 22-36 weeks in the Bogatovsky district if it is impossible to transport them to hospitals of the 3a-2nd group18. GBUZ SO "Bolshechernigovskaya Central District Hospital" Pregnant women and women in labor (more than 37 weeks) of low risk group, women in labor at 22-36 weeks in the Bolshechernigovsky district if it is impossible to transport them to hospitals of the 3a-2nd group19. GBUZ SO "Kinel-Cherkassy Central District Hospital" Pregnant women and women in labor (more than 37 weeks) of low risk group, women in labor at 22-36 weeks in the Kinel-Cherkassy district (if transportation is impossible) to hospitals of the 3a-2nd group20. GBUZ SO "Koshkinskaya Central District Hospital" Pregnant women and women in labor (more than 37 weeks) of low risk group, women in labor at 22-36 weeks in the Koshkinsky district (if transportation is impossible) to hospitals of the 3a-2nd group21. GBUZ SO "Krasnoyarsk Central District Hospital" Pregnant women and women in labor (at a period of more than 37 weeks) of a low risk group, women in labor at a period of 22-36 weeks in the Krasnoyarsk, Elkhovsky districts (if transportation is impossible) to hospitals of the 3a-2nd group22. GBUZ SO "Neftegorsk Central District Hospital" Pregnant women and women in labor (at a period of more than 37 weeks) of a low risk group, women in labor at a period of 22-36 weeks in the Neftegorsk and Alekseevsky districts (if transportation is impossible) to hospitals of the 3a-2nd group23. GBUZ SO "Pestravskaya Central District Hospital" Pregnant women and women in labor (at a period of more than 37 weeks) of a low risk group, women in labor at a period of 22-36 weeks in the Pestravsky district (if transportation is impossible) to hospitals of the 3a-2nd group24. GBUZ SO "Privolzhskaya Central District Hospital" Pregnant women and women in labor (at a period of more than 37 weeks) of a low risk group, women in labor at a period of 22-36 weeks in the Privolzhsky region (if transportation is impossible) to hospitals of the 3a-2nd group25. GBUZ SO "Sergievskaya Central District Hospital" Pregnant women and women in labor (at a period of more than 37 weeks) of a low risk group, women in labor at a period of 22-36 weeks in the Sergievsky district (if transportation is impossible) to hospitals of the 3a-2nd group26. GBUZ SO "Khvorostyansk Central District Hospital" Pregnant women and women in labor (more than 37 weeks) of low risk group, women in labor at 22-36 weeks in the Khvorostyansky district (if transportation is impossible) to hospitals of the 3a-2nd group27. GBUZ SO "Chelno-Vershinskaya Central District Hospital" Pregnant women and women in labor (more than 37 weeks) of low risk group, women in labor at 22-36 weeks in the Chelno-Vershinsky district (if transportation is impossible) to hospitals of the 3a-2nd group28. GBUZ SO "Shentala Central District Hospital" Pregnant women and women in labor (more than 37 weeks) of low risk group, women in labor at 22-36 weeks in the Shentala region (if transportation is impossible) to hospitals of the 3a-2nd group
29. Hospitalization of postpartum women with postpartum septic complications and gynecological patients with purulent diseases:
29.1. For gynecological beds for patients with purulent diseases of the State Budgetary Healthcare Institution of the Samara Region "Samara City Clinical Hospital No. 1 named after N.I. Pirogov" - septic gynecological patients and postpartum women from the Samara, Zheleznodorozhny, Leninsky, Oktyabrsky, Kuibyshevsky districts of Samara, postpartum women from the territories group A.
29.2. For gynecological beds for patients with purulent diseases of the State Budgetary Healthcare Institution of the Samara Region "Samara City Clinical Hospital No. 2 named after N.A. Semashko" - septic gynecological patients and postpartum women from the Industrial, Krasnoglinsky, Kirov, Sovetsky districts of Samara, postpartum women from the territories of group B , septic gynecological patients from territories of groups A and B.
29.3. To the Department of Septic Gynecology of the Samara Region State Budgetary Institution "Tolyatti City Clinical Hospital No. 5" - from the cities of Tolyatti, Syzran, Zhigulevsk, Oktyabrsk, Stavropol, Shigonsky, Syzran districts.
The possibility of transportation during premature birth is determined after examination of the woman in labor by an obstetrician-gynecologist of the territorial maternity ward and is carried out when the uterine pharynx of the woman in labor is dilated less than 3 cm; acute tocolysis is performed during transportation.
1st group - GBUZ SO "Bezenchukskaya Central District Hospital", GBUZ SO "Borskaya CRH", GBUZ SO "Bogatovskaya CRH", GBUZ SO "Bolshechernigovskaya CRH", GBUZ SO "Kinel-Cherkasy Central District Hospital", GBUZ SO "Koshkinskaya CRH", GBUZ SO "Krasnoyarsk Central District Hospital", GBUZ SO "Neftegorskaya CRH", GBUZ SO "Pestravskaya CRH", GBUZ SO "Privolzhskaya CRH", GBUZ SO "Sergievskaya CRH", GBUZ SO "Khvorostyanskaya CRH", GBUZ SO "Chelno-Vershinskaya CRH", GBUZ SO "Shentalinskaya Central District Hospital", GBUZ SO "Otradnenskaya Central City Hospital".
List of territories of group A
1. Cities - Novokuybyshevsk, Chapaevsk.
2. Districts - Alekseevsky, Bezenchuksky, Bogatovsky, Bolsheglunitsky, Bolshechernigovsky, Borsky, Volzhsky, Kinel-Cherkassky, Krasnoarmeysky, Neftegorsky, Pestravsky, Pokhvistnevsky, Privolzhsky, Khvorostyansky.
List of Group B territories
1. Cities - Otradny.
2. Districts - Elkhovsky, Isaklinsky, Kamyshlinsky, Kinelsky, Klyavlinsky, Koshkinsky, Krasnoyarsky, Sergievsky, Chelno-Vershinsky, Shentalinsky.

Scheme of planned routing of pregnant women with obstetric complications of pregnancy

I. Hospitalization of pregnant women with obstetric pathology during pregnancy 22 weeks or more is carried out only in obstetric hospitals with maternity wards.
II. Planned hospitalization of pregnant women is carried out by referral from an obstetrician-gynecologist at the antenatal clinic during the daytime from 08.00. until 16.00.
III. If there are emergency indications for hospitalization, the pregnant woman is delivered by ambulance.
SAMARA
1. To the obstetric department of pathology of pregnant women of the Samara Regional Clinical Hospital named after M.I. Kalinin (obstetric hospital of group 3A):
1.1. Pregnant women belonging to the high-risk group from cities and districts of the region, except for the city of Samara and the territories assigned to the interdistrict perinatal center of the State Budgetary Institution of Healthcare of the Samara Region "Tolyatti City Clinical Hospital No. 5".
1.2. Pregnant women up to 22 weeks with clinical signs of threatened miscarriage with a history of recurrent miscarriage, fetal loss syndrome and after IVF - from cities and districts of the region, Krasnoglinsky, Kirovsky and Industrial districts of Samara, except for the territories assigned to the interdistrict perinatal center of the State Budgetary Institution of Healthcare of the Samara Region " Tolyatti City Clinical Hospital No. 5".
1.3. Pregnant women with clinical signs of obstetric pathology, having concomitant extragenital diseases of moderate and severe severity, in accordance with the order of the Ministry of Health and Social Development of the Samara Region dated December 22, 2014 N 2045 “On the provision of medical care to pregnant women, women in labor, postpartum women and gynecological patients.”
2. To the obstetric department of pathology of pregnant women of the Samara Regional Clinical Center for Family Planning and Reproduction:
2.1. Pregnant women up to 22 weeks with clinical signs of threatened miscarriage with a history of recurrent miscarriage, fetal loss syndrome and after IVF - from Kuibyshevsky, Samara, Leninsky, Oktyabrsky, Zheleznodorozhny, Promyshlenny and Sovetsky districts of Samara.
3. To the obstetric department of pathology of pregnant women of the Samara Regional Clinical Cardiology Dispensary (obstetric hospital of the 2nd group):
3.1. Pregnant women with clinical signs of obstetric pathology, with concomitant moderate and severe cardiovascular diseases, from all cities and districts of the region.
3.2. Pregnant women of moderate risk group from the Neftegorsk region.
4. To the obstetric department of pathology of pregnant women No. 18 of the Samara Region Samara City Clinical Hospital No. 1 named after N.I. Pirogov (obstetric hospital of the 2nd group):
4.1. Pregnant women from Kirovsky, Oktyabrsky, Leninsky, Samara districts of Samara, Volzhsky district (part).
4.2. Pregnant women of moderate risk group from Krasnoyarsk and Elkhovsky districts.
5. To the obstetric department of pathology of pregnant women of the Samara Region Samara City Clinical Hospital No. 2 named after N.A. Semashko (obstetric hospital of the 2nd group):
5.1. Pregnant women from Promyshlenny, Sovetsky, Krasnoglinsky districts of Samara.
5.2. Pregnant women of moderate risk group from Sergievsky, Shentalinsky, Chelno-Vershinsky districts.
6. To the obstetric department of pathology of pregnant women of the Samara Region State Budgetary Institution "Samara City Hospital No. 10" (obstetric hospital of the 2nd group):
6.1. Pregnant women from the Kuibyshevsky and Zheleznodorozhny districts of Samara, the Volzhsky district (part).
TOgliatti
7. To the obstetric department of pathology of pregnant women of the interdistrict perinatal center of the State Budgetary Healthcare Institution of the Samara Region "Togliatti City Clinical Hospital No. 5" (obstetric hospital group 3A):
7.1. Pregnant women from 22 weeks of pregnancy, belonging to the high-risk group, from Tolyatti, Syzran, Zhigulevsk, Oktyabrsk, Stavropol, Syzran and Shigonsky districts of the region.
7.2. Pregnant women up to 22 weeks with clinical signs of threatened miscarriage with a history of recurrent miscarriage, fetal loss syndrome and after IVF - from Tolyatti, Syzran, Zhigulevsk, Oktyabrsk, Stavropol, Syzran and Shigonsky districts of the region.
7.3. Pregnant women from the Avtozavodsky district of Tolyatti.
8. To the obstetric department of pathology of pregnant women of the Samara Region Togliatti City Hospital No. 2 named after V.V. Banykin (obstetric hospital of the 2nd group):
8.1. Pregnant women of low and moderate risk groups from the Central and Komsomolsky districts of Togliatti, Zhigulevsk, pregnant women of moderate risk group of Koshkinsky district.
CITIES (except Samara and Tolyatti)
9. To the obstetric department of pathology of pregnant women of the interdistrict perinatal center of the State Budgetary Healthcare Institution of the Samara Region "Syzran Central City Hospital" (obstetric hospital of the 2nd group):
9.1. Pregnant women of low and moderate risk from the city of Syzran, Oktyabrsk, Syzran and Shigonsky districts.
10. To the obstetric department of pathology of pregnant women of the interdistrict perinatal center of the State Budgetary Healthcare Institution of the Samara Region "Novokuibyshevskaya Central City Hospital" (obstetric hospital of the 2nd group):
10.1. Pregnant women of low and moderate risk from Novokuybyshevsk, Bolsheglunitsky district; pregnant women of moderate risk group from Bolshechernigovsky district.
11. To the obstetric department of pathology of pregnant women of the interdistrict perinatal center of the State Budgetary Healthcare Institution of the Samara Region "Chapaevskaya Central City Hospital" (obstetric hospital of the 2nd group):
11.1. Pregnant women of low and moderate risk groups from Chapaevsk, Krasnoarmeysky district, moderate risk groups from Bezenchuksky, Pestravsky, Khvorostyansky, Privolzhsky districts.
12. To the obstetric department of pathology of pregnant women of the interdistrict perinatal center of the Pokhvistnevskaya CBGiR (obstetric hospital of the 2nd group):
12.1. Pregnant women of low and moderate risk from the city of Pokhvistnevo, Kamyshlinsky, Klyavlinsky, Isaklinsky, Pokhvistnevo districts.
13. To the obstetric department of pathology of pregnant women of the interdistrict perinatal center of the State Budgetary Healthcare Institution SO "Otradnenskaya Central Bank" (obstetric hospital of the 1st group):
13.1. Pregnant and postpartum women of the low and moderate group from the city of Otradny, moderate risk group from the Borsky and Bogatovsky, Kinel-Cherkasy districts.
14. To the obstetric department of pathology of pregnant women of the State Budgetary Healthcare Institution SO "Kinel Central Hospital of the City and District" (obstetric hospital of the 2nd group):
14.1. Pregnant women of low and moderate risk from the city of Kinel and Kinelsky district.
Obstetric hospitals of the 1st group (rural areas)
GBUZ Territory15. GBUZ SO "Bezenchukskaya Central District Hospital" Low-risk pregnant women of Bezenchuksky district16. GBUZ SO "Bor Central District Hospital" Low-risk pregnant women of Bor district17. GBUZ SO "Bogatovskaya Central District Hospital" Pregnant women of the low group of Bogatovsky district18. GBUZ SO "Bolshechernigov Central District Hospital" Low-risk pregnant women of the Bolshechernigov region19. GBUZ SO Kinel-Cherkassy Central District Hospital" Low-risk pregnant women of Kinel-Cherkassy district20. GBUZ SO "Koshkinskaya Central District Hospital" Low-risk pregnant women of Koshkinsk district21. GBUZ SO "Krasnoyarsk Central District Hospital" Low-risk pregnant women in Krasnoyarsk and Elkhov districts22. GBUZ SO "Neftegorsk Central District Hospital" Low-risk pregnant women of Neftegorsk and Alekseevsky districts23. GBUZ SO "Pestravskaya Central District Hospital" Low-risk pregnant women of Pestravsky district24. GBUZ SO "Privolzhskaya Central District Hospital" Low-risk pregnant women of the Volga region25. GBUZ SO "Sergievskaya Central District Hospital" Low-risk pregnant women of the Sergievsky district26. GBUZ SO "Khvorostyanskaya Central District Hospital" Low-risk pregnant women of Khvorostyansk district27. GBUZ SO "Chelno-Vershinskaya Central District Hospital" Low-risk pregnant women of the Chelno-Vershinsky district28. GBUZ SO "Shentala Central District Hospital" Pregnant women of the low group of Shentala district
1. Cities - Tolyatti, Syzran, Zhigulevsk, Oktyabrsk.
2. Districts - Stavropol, Shigonsky, Syzran.

Regional routing scheme for preterm birth

Obstetric situation Gestational age Gestational ageRegular contractions (4 in 20 minutes) and opening of the uterine os less than 3 cm Up to 33 weeks. 6 days of pregnancy 34-36 weeks. 6 days pregnant1. Start RDS prevention. 2. Start tocolysis. 3. For obstetric hospitals of the 1st group and part of the hospitals of the 2nd group - transportation of the woman in labor to the next stage. For obstetric hospitals of the 1st group - transportation of the woman in labor to the hospital of group 3A - GBUZ SOKB named after. M.I. Kalinina For GBUZ SO "Syzran Central City Hospital" - transportation of a woman in labor to hospital group 3A of GBUZ SO "Togliatti City Clinical Hospital No. 5" - GBUZ SO "Kinelskaya Central Clinical Hospital", GBUZ SO "Pokhvistnevskaya Central City Hospital", GBUZ SO "Novokuibyshevskaya Central City Hospital", GBUZ SO "Chapayevskaya Central City Hospital" - transportation of a woman in labor to hospital group 3A of the State Budgetary Healthcare Institution SOKB named after M.I. Kalinin - For the State Budgetary Healthcare Institution SOKKD, the State Budgetary Healthcare Institution SO "TGB No. 2 named after. V.V. Banykin", GBUZ SO "SGKB No. 2 named after. ON THE. Semashko", GBUZ SO "Samara City Clinical Hospital No. 1 named after. N.I. Pirogov", GBUZ SO "Samara GB N 10" - delivery of birth in health care facility 1. Start tocolysis (during transportation - for obstetric hospitals of the 1st group) For obstetric hospitals of the 1st group - transportation of the woman in labor to hospitals of the 2nd group ( intermunicipal perinatal centers) For the State Budgetary Institution of Health Care "Kinel-Cherkassk Central District Hospital" - in the State Budgetary Institution of Health Care of the "Otradnenskaya Central City Hospital" For the State Budgetary Institution of Institution of Institution of the Secondary Institution "Koshkinskaya Central Regional Hospital" - in the State Budgetary Institution of Health Care Institution No. 2 named after V.V. Banykin For the State Budgetary Institutional Institution of Institution of Institution of the Secondary Institution "Sergievskaya Central Regional Hospital", State Budgetary Institution of Health Care of the "Sergievskaya Central District Hospital" "Chelno-Vershinskaya Central District Hospital" - in the State Clinical Hospital No. 2 named after N.A. Semashko For the GBUZ SO "Neftegorskaya CRH" - in the GBUZ "SOKKD" GBUZ SO "Krasnoyarsk Central District Hospital" - in the 20th maternity ward of the GBUZ SO "Samara City Clinical Hospital No. 1 named after N.I. Pirogov"Regular contractions (4 in 20 minutes) and dilation of the uterine pharynx 3 cm or more 1. For a hospital of the 1st group - call a mobile neonatological resuscitation team. 2. Delivery 1. Calling a neonatologist. 2. Delivery

Regional routing scheme for hypertensive disorders during pregnancy, childbirth and the postpartum period, preeclampsia, eclampsia

ICD-10 Class XV: pregnancy, childbirth and the puerperium Block 010-016: edema, proteinuria and hypertensive disorders during pregnancy, childbirth and the puerperium RoutingPre-existing essential hypertension complicating pregnancy, childbirth and the postpartum period 10.0 Initial consultation with specialists at the place of observation (generalist/GP, cardiologist, nephrologist) According to indications, further examination at the State Budgetary Healthcare Institution of the Regional Clinical Children's Hospital with a specialization in "cardiology" or the State Budgetary Institution of the Regional Clinical Clinical Hospital named after. M.I. Kalinina, majoring in nephrologyPre-existing cardiovascular hypertension complicating pregnancy, childbirth and the postpartum period 10.1Pre-existing cardiovascular and renal hypertension complicating pregnancy, childbirth and the postpartum period 10.3Pre-existing hypertension complicating pregnancy, childbirth and the puerperium, unspecified 10.9Maternal hypertension, unspecified 16Pre-existing renal hypertension complicating pregnancy, childbirth and the puerperium 10.2Pre-existing secondary hypertension complicating pregnancy, childbirth and the postpartum period 10.4Swelling caused by pregnancy 12.0 Outpatient observation by an obstetrician-gynecologistPregnancy-induced proteinuria 12.1 Observation in the day hospital of the antenatal clinic/one-day hospital in a 24-hour hospital or hospitalization in diagnostic beds of an obstetric hospitalPregnancy-induced edema with proteinuria 12.2Pregnancy-induced hypertension without significant proteinuria 13Pre-existing hypertension with associated proteinuria 11Preeclampsia (nephropathy) of moderate severity 14.0 Hospitalization in a 24-hour obstetric hospital of group 2-3A Calling the SAS team to the obstetric hospital of group 1Preeclampsia (nephropathy), unspecified 14.9Severe preeclampsia 14.1Eclampsia during pregnancy 15.0Eclampsia during childbirth 15.1Eclampsia in the postpartum period 15.2Eclampsia, not specified by date 15.9

Algorithm for actions of medical workers in the event of obstetric hemorrhage

In accordance with the identified risk factors, the obstetrician-gynecologist determines the optimal routing scheme for a pregnant woman, determines indications for prenatal hospitalization and a list of consultations with related specialists.
All patients at high risk for the development of massive blood loss are given birth as planned in obstetric hospitals according to the list specified in Appendix 1 to this Order.
At the prehospital stage (EMS, FAP), the main action for a patient with bleeding is transportation to the nearest medical facility with the possibility of surgical treatment.
Manipulations:
1. Catheterization of a peripheral vein. In the absence of a catheter, it is possible to provide venous access with a large-diameter needle.
2. Tranexamic acid 15 mg/kg IV once at a rate of 1 ml per minute.
3. Infusion of 250-500 ml of crystalloids intravenously over 15-20 minutes.
4. If hemorrhagic shock manifests itself, notify the receiving hospital and increase the intravenous infusion of crystalloids to 1 - 1.5 liters at a rate close to jet administration.
Providing venous access and conducting infusion therapy, administering antifibrinolytics, warming and other measures should not extend the transportation time to the stage of surgical bleeding control (carried out during transportation, among other things).
When a patient with bleeding (or suspected bleeding) is admitted to the emergency room of a hospital, it is necessary to conduct clinical, laboratory and functional studies as quickly as possible to assess the severity of blood loss and determine the need for surgical treatment. In case of a serious condition of the patient - hemorrhagic shock - all studies are carried out in an operating room and simultaneously with intensive therapy.
Algorithm of actions for postpartum hemorrhage:
at each stage, it is necessary to evaluate blood loss (including as a percentage of the blood volume) with subsequent recording in the medical documentation.
First stage:
Target:
- establish the cause of bleeding;
- take the necessary measures to stop bleeding;
- order the necessary examinations.
Diagnostics, bleeding control and infusion therapy are performed simultaneously with the organization of monitoring the patient’s condition.
Alert:
- call a second midwife, a second doctor - obstetrician-gynecologist;
- call an anesthesiologist-resuscitator, laboratory assistant;
- appoint a transfusiologist who must provide a supply of fresh frozen plasma and red blood cells;
- call the nurse on duty to deliver tests and blood components;
- designate one member of the duty team to record events, fluid therapy, medications, and vital signs;
- in case of massive bleeding, inform the administrator on duty, the transfusiologist of the healthcare facility and call an angiosurgeon, open the operating room.
All obstetric hospitals of the 1st and 2nd groups notify the SAS GBUZ "M.I. Kalinin Regional Clinical Hospital" about a case of massive obstetric hemorrhage.
Manipulations:
- catheterization of 2 peripheral veins, catheterization of the bladder, oxygen mask and monitoring of vital functions (blood pressure, pulse, respiration, oxygen saturation, diuresis), intravenous administration of crystalloid solutions.
Studies: clinical blood test (hemoglobin level, hematocrit, red blood cells, platelets), bedside test (Lee White method), hemostasiogram (fibrinogen concentration, PTI, APTT, if possible - thromboelastogram), determination of blood group, Rh factor.
Measures to stop bleeding:
First stage:
- manual examination of the postpartum uterus, removal of remnants of placental tissue and clots (once),
- external-internal massage,
- suturing ruptures of the soft birth canal,
- prescribing medications for the treatment of atony,
- correction of violations of hemostasis parameters.
Second stage: if bleeding continues:
- controlled balloon tamponade of the uterus,
- continuation of infusion-transfusion therapy is carried out depending on the amount of blood loss and the patient’s body weight.
Third stage: if previous measures are ineffective, bleeding may become life-threatening and require surgical treatment.
The initial step in surgical treatment is the application of B-Lynch compression sutures (during cesarean section) (Fig. 1) or vertical or square compression sutures (Fig. 2).
Rice. 1.
Compression seam according to B-Lynch
(during caesarean section)
Rice. 2. Vertical and square compression seams
Surgical treatment includes laparotomy with ligation of the uterine vessels or internal iliac arteries or hysterectomy. In each case, management tactics are determined by the clinical situation, the professional level of the doctor and the technical equipment of the institution.
- Ligation of uterine vessels. Applying ligatures to vascular bundles (ascending branch of the uterine artery and ovarian arteries).
- Ligation of the internal iliac arteries.
- Hysterectomy is most often used for massive postpartum hemorrhage, if surgical treatment is necessary, and is the last step if all previous surgical measures have not given the desired effect.
- Mandatory drainage of the abdominal cavity after performing surgical hemostasis.

Approve the attached changes that are being made to the procedure for issuing permission to conduct a clinical trial of a medicinal product for medical use, approved by order of the Ministry of Health and Social Development of the Russian Federation dated August 26, 2010 N 748n (registered by the Ministry of Justice of the Russian Federation on August 31, 2010, registration N 18317).

Minister
IN AND. SKVORTSOVA

APPROVED
by order of the Ministry of Health
Russian Federation
dated March 13, 2015 N 111n

CHANGES TO THE PROCEDURE FOR ISSUING PERMISSION TO CONDUCT A CLINICAL STUDY OF A DRUG FOR MEDICAL USE, APPROVED BY ORDER OF THE MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION DATED AUGUST 26, 2 010 G. N 748Н

1. In paragraph one of paragraph 5, the words “Ministry of Health and Social Development of the Russian Federation” should be replaced with the words “Ministry of Health of the Russian Federation”.

"2) a copy of the contract of compulsory life and health insurance of patients participating in a clinical trial of a medicinal product for medical use, concluded in accordance with the Standard Rules for compulsory life and health insurance of a patient participating in clinical trials of a medicinal product, approved by the Decree of the Government of the Russian Federation dated September 13 2010 N 714<*>, indicating the maximum number of patients participating in a clinical trial of a medicinal product for medical use;";

<*L>Collection of legislation of the Russian Federation, 2010, N 38, art. 4832; 2011, N 22, art. 3171; 2012, N 37, art. 5002.

b) add subparagraphs 3 and 4 with the following content:

"3) information about medical organizations in which clinical trials of a medicinal product for medical use are expected to be conducted (full and abbreviated names, organizational and legal form, location and place of activity, telephone, fax, e-mail address of the medical organization);

4) the expected timing of a clinical trial of a medicinal product for medical use."

"7) a document drawn up by the manufacturer of the medicinal product and containing the indicators (characteristics) of the medicinal product produced for clinical trials;

8) information on payments and compensation to patients (healthy volunteers, patients) involved in clinical trials of a medicinal product for medical use, bioequivalence studies and (or) therapeutic equivalence."

a) in paragraph one, replace the words “in paragraphs 6 and 7” with the words “in paragraph 6”, replace the words “Ministry of Health and Social Development of the Russian Federation” with the words “Ministry of Health of the Russian Federation”;

5. Add clause 8.1 with the following content:

"8.1. In case of obtaining permission to conduct an international multicenter clinical trial of a medicinal product or post-registration clinical trial of a medicinal product, the Department of the Ministry of Health of the Russian Federation responsible for issuing the permit:

1) within a period not exceeding five working days from the date of acceptance of the application for a permit and the documents specified in paragraph 7 of this Procedure:

checks the completeness and accuracy of the information contained in the documents submitted by the applicant. If the information contained in the materials submitted by the applicant is revealed to be unreliable, the Ministry of Health of the Russian Federation sends the applicant a request to clarify the specified information. This request can be submitted to the authorized representative of the applicant in person against signature, sent by registered mail or transmitted electronically via telecommunication channels. If this request is sent by registered mail, it is considered received after six days from the date of sending the registered letter;

decides to conduct an examination of documents to obtain permission to conduct an international multicenter clinical trial of a medicinal product or a post-registration clinical trial of a medicinal product and ethical examination or to refuse to conduct these examinations;

notifies the applicant in writing about the sending of documents for the specified examinations or about the refusal to send documents for examination, indicating the reasons for such refusal;

2) within a period not exceeding five working days from the date of receipt of the results of the examinations specified in paragraph three of subparagraph 1 of this paragraph: makes a decision to issue permission to conduct an international multicenter clinical trial of a medicinal product or a post-registration clinical trial of a medicinal product or to refuse to issue the corresponding permissions;

issues a permit to the applicant or notifies the applicant in writing of the refusal to issue a permit, indicating the reasons for such refusal."

Proper hand sanitization of healthcare workers is key to maintaining infection control. We will tell you about the hand washing technique, its features, and give you a step-by-step algorithm for washing your hands.

The main factor in the transmission and spread of infectious agents associated with the provision of medical care are the hands of medical personnel, the contamination of which occurs during manipulations or in contact with various objects of the hospital environment (surfaces of devices, instruments, patient care items, sanitary equipment, linen, clothing , medical products, dressings, medical waste, etc.).

On a note!
What are the advantages and disadvantages of hand treatment methods for healthcare personnel?

The effectiveness, practicality, and acceptability of hand sanitization depend on the method and associated hand sanitization conditions available in the healthcare organization.

To interrupt possible routes of transmission of microorganisms through hands and reduce the risk of infections associated with the provision of medical care, it is necessary to clean the hands of healthcare workers in all cases where there is a real or potential possibility of contamination.

trimmed nails,
lack of nail polish,
no artificial nails,
lack of jewelry and watches on hands.

The hands of healthcare workers are a major factor in the transmission of healthcare-associated infections (HAIs). In this regard, compliance with hand hygiene is a necessary measure and an important factor of infection control (IC) in a medical organization to maintain the safety of patients and health workers themselves.

Types of hand treatment

There are three types of hand treatment for employees of medical organizations:

household level (washing hands with soap and water without using antiseptics);
hygienic level (hand treatment using skin antiseptic);
surgical level (followed by putting on gloves).

Social level of hand handling

Hand hygiene

Hand treatment using antiseptic carried out in the following cases:

Hand treatment steps:

washing hands with soap and water;
hand disinfection with skin antiseptic.

Hand treatment algorithm using antiseptic:

wash your hands with soap and water (in accordance with the above hand washing algorithm);
Apply an antiseptic to your hands in an amount of at least 3 ml and thoroughly rub into the skin until completely dry, following the sequence of movements according to the EN-1500 standard (do not wipe your hands after applying the antiseptic).

To clean hands, use warm running water, liquid soap and antiseptics in bottles with an elbow dispenser, disposable towels or disposable napkins. Do not add liquid soap or antiseptic to a partially emptied bottle. Used as an antiseptic

In order to receive pin code to access this document on our website, send an SMS message with the text zan to the number

Subscribers of GSM operators (Activ, Kcell, Beeline, NEO, Tele2) will receive access to the Java book by sending an SMS to the number.

Subscribers of a CDMA operator (Dalacom, City, PaThword) will receive a link to download wallpaper by sending an SMS to the number.

The cost of the service is tenge including VAT.

2. Sending an SMS message to short numbers 7107, 7208, 7109 means full agreement and acceptance of the terms of service by the Subscriber.
3. Services are available to all Kazakhstan mobile operators..

6. The cost of the service when sending an SMS message to the short number 7107 is 130 tenge, 7208 is 260 tenge, 7109 is 390 tenge.
+7 727 356-54-16
8. The subscriber agrees that the provision of the service may be subject to delays caused by technical failures, overloads on the Internet and mobile networks.
9. The subscriber is fully responsible for all results of using the services.

Correspondents for the fragment
Bookmark
View bookmarks
Add a comment

1. General Provisions

3. The main factor in the transmission and spread of pathogens of nosocomial infections in medical organizations are the hands of medical personnel, the contamination of which occurs when performing manipulations or in contact with various objects of the hospital environment (surfaces of devices, equipment, patient care items, sanitary equipment, linen, clothing, medical products, dressings, medical waste, etc.).

5. There are three methods for treating the hands of employees of medical organizations:

washing hands with soap and water without using antiseptics;

2. Washing hands with soap and water without using antiseptics

1) before working with food, preparing and serving food;

3) after visiting the toilet;

4) before and after carrying out actions to care for the patient, when there is no direct contact with the patient (changing bed linen, cleaning the room, etc.);

SOP Hand Hygiene Program

The article provides an example of a Hand Hygiene Program SOP.

SOP “Hand Hygiene Program”

Base:

Order of the Chairman of the Committee for State Sanitary and Epidemiological Surveillance of the Ministry of Health of the Republic of Kazakhstan dated April 23, 2013 No. 111 “Methodological recommendations for the treatment of hands of employees of medical organizations of the Republic of Kazakhstan.”

Definition:

To ensure effective hand treatment, the following conditions must be observed: trimmed nails, no nail polish, no artificial nails, no jewelry or watches on the hands.

Resources:

For hand washing use:

warm running water;
liquid soap in bottles with dispenser;
disposable towels or disposable napkins.

Do not add liquid soap to a partially emptied bottle.

Documentation:

hand hygiene program;
instructions “Surgical treatment of hands”;
hand washing technique (photo).

Procedures:

There are three ways to clean the hands of employees of medical organizations:

1. Washing hands with soap and water without using antiseptics.

2. Hand treatment using antiseptic.

3. Surgical hand disinfection.

Washing hands with soap and water without using antiseptics

Hand washing with soap and water without using antiseptics is carried out in the following cases:

To wash your hands, use warm running water, liquid soap in bottles with a dispenser, disposable towels or disposable napkins. Do not add liquid soap to a partially emptied bottle.

Sequence of actions when washing hands:

2) wet your hands with water;

3) apply soap to wet hands;

4) carry out processing in accordance with the European standard EN-1500 (appendix to these guidelines);

6) throw the towel into a container or waste collection container.

Hand treatment using antiseptic

Hand treatment using antiseptic is carried out in the following cases:

Hand treatment using antiseptic consists of two stages:

washing hands with soap;
hand disinfection with skin antiseptic.

The sequence of actions when treating hands using an antiseptic:

1) wash hands with soap and water in accordance with these guidelines;

2) apply an antiseptic to your hands in an amount of at least 3 ml and thoroughly rub into the skin until completely dry, following the sequence of movements according to the EN-1500 standard (do not wipe your hands after applying the antiseptic).

Surgical hand disinfection

before any surgical interventions;
before major invasive procedures (for example, puncture of large vessels).

by o hand sanitization of medical staff

organizations of the Republic of Kazakhstan

4. To interrupt possible routes of transmission of microorganisms through hands and reduce the risk of nosocomial infections, it is necessary to disinfect the hands of employees of medical organizations in all cases where there is a real or potential possibility of their contamination.

hand treatment using antiseptic;

surgical hand disinfection.

2. Washing hands with soap and water without using antiseptics

6) in all cases where hands are clearly dirty.

7. To wash your hands, use warm running water, liquid soap in bottles with a dispenser, disposable towels or disposable napkins. Do not add liquid soap to a partially emptied bottle.

8. Sequence of actions when washing hands:

1) open the water tap;

4) carry out processing in accordance with the European standard EN-1500 (appendix to these guidelines);

5) dry your hands with a disposable towel or disposable napkin;

3. Hand treatment using antiseptic

9. Hand treatment using antiseptic is carried out in the following cases:

1) before and after performing invasive procedures;

2) before and after manipulations that damage the integrity of the patient’s skin;

3) before and after manipulations with wounds and catheters;

4) after contact with blood and other biological fluids, secretions of the patient;

6) before examining newborns .

10. Hand treatment using an antiseptic consists of two stages: hand washing with soap and water (according to point 8) and hand disinfection with a skin antiseptic.

11. Sequence of actions when treating hands using an antiseptic:

1) wash hands with soap and water in accordance with paragraph 8 of these guidelines;

12. To clean hands, use warm running water, liquid soap and antiseptics in bottles with an elbow dispenser, disposable towels or disposable napkins. Do not add liquid soap or antiseptic to a partially emptied bottle. Disinfectants approved for use in the Republic of Kazakhstan are used as an antiseptic.

4. Surgical hand disinfection

13. Surgical hand disinfection is carried out in the following cases:

1) before any surgical interventions;

2) before serious invasive procedures (for example, puncture of large vessels).

14. Surgical hand disinfection consists of three stages: mechanical cleaning of hands, disinfection of hands with a skin antiseptic, covering of hands with sterile disposable gloves.

15. When surgical disinfection of hands, the forearms are included in the treatment, warm running water, liquid soap and antiseptics in bottles with an elbow dispenser, sterile towels or sterile napkins are used.

16. During surgical disinfection, hands and forearms are washed with warm water and liquid soap, following the sequence of movements according to the EN-1500 standard, and dried with a sterile towel or sterile napkin. Then the nail beds and periungual folds are treated with disposable sterile wooden sticks soaked in an antiseptic solution. Brushes are not necessary. If brushes are still used, sterile soft brushes should be used, and brushes should only be used to treat periungual areas and only for the first treatment during the work shift.

After completing the mechanical cleaning stage, an antiseptic is applied to the hands in 3 ml portions and immediately rubbed into the skin, strictly following the sequence of movements according to the EN-1500 standard. The procedure for applying a skin antiseptic is repeated 2 times, the total antiseptic consumption is 10 ml, the total procedure time is 5 minutes.

After completion of the operation (procedure), gloves are removed, hands are washed with liquid soap and a nourishing cream or lotion is applied.

Medical order 111 RK

Order of the Ministry of Health and Social Development of the Republic of Kazakhstan No. 19 dated August 22, 2014 “On approval of the Instructions for the organization and implementation

April 6, 2015. Ministry of Investment and Development of the Republic of Kazakhstan. 111, Order of the Minister of Internal Affairs of the Republic of Kazakhstan dated.

Code of the Republic of Kazakhstan dated September 18, 2009 No. 193-IV “On the health of the people and the system. Law of the Republic of Kazakhstan dated November 16, 2015. 111-V (see previous edition); .

Ministry of Health of the Republic of Kazakhstan. Ministry of Health of the Republic of Kazakhstan. INN.

In pursuance of the Laws of the Republic of Kazakhstan dated June 7, 1999 N 389-1 “On Education”, dated May 19, 1997 N 111-1 “On the protection of the health of citizens in the Republic

MINISTRY OF HEALTH OF THE KOMI REPUBLIC ORDER dated February 3, 2000 N 2/33 ON AMENDMENTS AND ADDITIONS TO ORDERS OF THE MOH RK DATED 11.18.97 N 185 § 1, FROM 07.09.98 N 111-R AND ORDER.

March 28, 2014. Ministry of Health of the Republic of Kazakhstan. 111 Astana. Loading. . On orders of the Ministry of Health 759 on medical rehabilitation" and 44 on.

Recommendations for hand treatment of employees of medical organizations of the Republic of Kazakhstan Order of the Chairman of the Committee of State Sanitary and Epidemiological Surveillance of the Ministry of Health of the Republic of Kazakhstan dated April 23, 2013 No. 111.

Order dated July 23, 2012 No. 1001PR/111P/133PR. The order of the Ministry of Health of the Republic of Kalmykia dated.

Ministry of Health of the Komi Republic. Order. dated July 9, 1998 N 111-r. On approval of the level of unproductive costs when calculating the function of a medical position.

May 24, 2013. Instructions for hand hygiene for medical personnel - Duration: 2:23. NMITs DGOI named after. Dmitry Rogachev 61,510 views.

12 Oct 2016. Number of requests per 1 thousand population. III quarter 2016 – 1.3 per 1 thousand. In accordance with the order of the Ministry of Health of the Republic of Kazakhstan dated June 21, 2016.

7. For technical support of the SMS service, call the subscriber service of the RGL Service company by phone +7 727 269-54-16 during business hours (Mon, Wed, Fri: from 8:30 to 13:00, from 14:00 to 17:30; Tue, Thu: from 8:30 to 12:30, from 14:30 to 17:30) .

4. Service codes must be typed only in Latin letters.

during business hours (Mon, Wed, Fri: from 8:30 to 13:00, from 14:00 to 17:30; Tue, Thu: from 8:30 to 12:30, from 14:30 to 17:30) .

10. Using the services without reading these Terms of Service means the Subscriber automatically accepts all their provisions.

2. To ensure effective hand treatment, the following conditions must be observed: trimmed nails, no nail polish, no artificial nails, no jewelry or watches on the hands.

6. Hand washing with soap and water without using antiseptics is carried out in the following cases:

5. Sending an SMS to a short number other than 7107, 7208, 7109, as well as sending the wrong text in the SMS body, makes it impossible for the subscriber to receive the service. The Subscriber agrees that the Provider is not responsible for the specified actions of the Subscriber, and payment for the SMS message is not refundable to the Subscriber, and the service for the Subscriber is considered completed.

1. Before sending an SMS message, the Subscriber must read the Terms of Service.

order 111 of 04/23/2013 - Information and retrieval database Afn.kz order of the Ministry of Health of the Republic of Kazakhstan 111 of 04/23/2013 on the treatment of hands of medical employees.

By order. Chairman. Committee of State Sanitary and Epidemiological Surveillance of the Ministry of Health of the Republic of Kazakhstan from. April 23, 2013 No. 111 “On approval of methodological recommendations for cleaning the hands of employees of medical organizations. Republic of Kazakhstan". Illustrated instructions for.

April 2, 2014. . performance of official duties, employees and employees of the federal fire service of the State Fire Service or members of their families, approved by order of the Ministry of Emergency Situations of Russia dated April 23. 2013 N 280″ (Registered with the Ministry of Justice of Russia on April 24, 2014 N.

Approved. By order of the Chairman of the Committee. state sanitary

5 Oct 2017. The article provides methodological recommendations for the treatment of hands of employees of medical organizations of the Republic of Kazakhstan, approved by order of the Ministry of Health of the Republic of Kazakhstan dated April 23, 2013 No. 111.

Order No. 111 dated April 23, 2013. On the appointment of responsible persons for monitoring the conduct of public events.

03.08.2017, 111-P, On approval of the adjusted investment program of Lukoil-Energoseti LLC of the city of Kogalym in the field of heat supply for 2016-2019, Order of the Department of Housing, Communal Services and Energy of the Khanty-Mansiysk Autonomous Okrug - Ugra. 06/29/2017.

The Directory contains calculations for the distribution of orders and directives in accordance with Order of the Minister of Defense of the Russian Federation dated April 23, 2013 No. 333dsp. Ministry of Defense registration numbers in joint regulations are shown in bold. In connection with.

Orders of the Ministry of Sports of the Republic of Kazakhstan. 2018. Order No. 01-12/94 dated 04/03/2018 “On the assignment and confirmation of sports categories” · Order No. 01-12/74 dated 03/19/2018 “On the assignment and confirmation of sports categories” · Order No. 01-12/49 dated 02/20/2018 “On the assignment and confirmation of sports categories.”

Order of the Republic of Kazakhstan 111 dated 23. Dry your hands with an individual towel, preferably a disposable one. Surface finish: Smooth.

EUR / KZT - 400.2. RUB / KZT - 5.77. Ministry of Justice of the Republic of Kazakhstan · Legal information service free call 119.

Order of the Ministry of Health of the Republic of Kazakhstan 111 dated 23042013 on the treatment of hands of medical staff - take a free test on Aeterna Hand treatment of medical staff.

Hand washing with soap and water without the use of antiseptics is carried out in the following cases: 1) before working with food, preparing and serving food; 2) before meals Order of the Ministry of Health of the Republic of Kazakhstan No. 111 dated 23, Order of the Ministry of Labor of the Russian Federation 126 dated May 11, 2000.

Minister of Health of the Republic of Kazakhstan dated 5. medical services at the primary health care level, according to Appendix 2 to the order of the Ministry of Health of the Republic of Kazakhstan No. 479: 1) reception. individual card of a pregnant and postpartum woman according to form No. 111/u; . Wash your hands according to the hand washing technique.

Supervision of the Ministry of Health of the Republic of Kazakhstan dated April 23, 2013 No. 111 Guidelines for hand treatment

Orders of the Ministry of Health · Government programs. In accordance with subparagraph 2) of Article 6 of the Code of the Republic of Kazakhstan dated 18. 111. When assessing the effectiveness of anti-pediculosis measures. allocate for washing the hands of staff and do not use for other purposes.

Ministry of Health of the Russian Federation. improving hand hygiene standards and practices in healthcare, . (iv) simple hand washing or sanitizing should be done. 111. Neonatal department. An overall decrease in HAI rates (from 11 to 8.2 infections per 1000.

Ministry of Health. Republic of Kazakhstan. dated April 23, 2013. No. 111. Methodological recommendations.

The use of soap during hand washing removes most of the transient flora. Remove permanent stains from the deep layers of the skin.

27 Feb 2015. This order comes into force after ten calendar days. separate sink for hand washing and a sink for cleaning tools. 23. . 111. The composition of the children's department is provided.

Since 1969, Deputy Head of the Central Medical Laboratory, from 1970 to 1993 – Head of the Central Medical Laboratory of the Ministry of Defense of the Russian Federation and Chief Forensic Expert of the USSR Ministry of Defense - V.V. Tomilin.

344000, Rostov region, Rostov-on-Don, st. Lermontovskaya, 60

Before the start of the Great Patriotic War, there was no forensic medical examination within the structure of the Red Army. Expert questions in the interests of military justice were resolved by military pathologists and civilian forensic doctors.

681000, Khabarovsk region, Komsomolsk-on-Amur, Puteyskaya street, 91

630017, Novosibirsk region, Novosibirsk, Military town No. 1, bldg. 20

In March 1943, on the basis of the Directive of the General Staff of the Red Army (Noorg/6/133213), the Central Forensic Medical Laboratory of the Red Army (CSML) was created. The reorganization and placement of personnel was completed by June 1943.

443099, Samara region, Samara, st. Ventseka, 48

191124, St. Petersburg, St. Petersburg, Suvorovsky Ave., 63

620001, Sverdlovsk region, Ekaterinburg, st. Dekabristov, 85

681000, Khabarovsk Territory, Komsomolsk-on-Amur, military unit 63763 (for OSME),

680028, Khabarovsk region, Khabarovsk, st. Serysheva, 1

111 Main state center for forensic medical and forensic examinations of the Ministry of Defense of the Russian Federation

683015, Kamchatka region, Petropalovsk-Kamchatsky-15, st. Ammonal honeydew, 1, OSME

2) protocols for the diagnosis and treatment of diseases in accordance with Appendix 2 to this order;

5. Control over the implementation of this order is entrusted to the Vice Minister of Health of the Republic of Kazakhstan K. T. Omarov.

4. Recognize the order as invalid and. O. Minister of Health of the Republic of Kazakhstan dated December 30, 2005 No. 655 “On approval of periodic diagnostic and treatment protocols.”

program for reform and development of healthcare of the Republic of Kazakhstan for 2005-2010, approved by Decree of the Government of the Republic of Kazakhstan dated October 13, 2004 No. 1050, I ORDER:

preventive work of the Ministry of Health of the Republic of Kazakhstan (Ismailov Zh. K.), RSE "Institute for Healthcare Development" of the Ministry of Health of the Republic of Kazakhstan (Birtanov E. A.) ensure the implementation of activities in accordance with the approved plan.

1) dissemination of protocols for the diagnosis and treatment of diseases in accordance with the needs of medical organizations;

3) an action plan for the implementation of protocols for the diagnosis and treatment of diseases for 2008 in accordance with Appendix 3 to this order.

1) a list of protocols for the diagnosis and treatment of diseases in accordance with Appendix 1 to this order;

2. Committee for control in the provision of medical services of the Ministry of Health of the Republic of Kazakhstan (Musin E. M.), Department of Medical -

3. The heads of health departments of regions, the cities of Astana and Almaty (as agreed) and republican health care organizations must ensure:

Pursuant to paragraph 53 of the Action Plan for the implementation of the State

2) implementation of protocols for the diagnosis and treatment of diseases in accordance with the action plan approved by this order, from January 1, 2008.

5.1. All personal information about the User is stored and processed by the Owner in accordance with the terms of the Confidentiality Agreement. The owner undertakes to comply with the requirements of the legislation on the protection of personal data in accordance with the Federal Law of July 27, 2006 N 152-FZ (as amended on July 25, 2011) “On Personal Data.”

6.2. The Owner has the right, but not the obligation, to monitor for prohibited Content and may remove or move (without notice) any Content or Users in its sole discretion, for any reason or no reason, including (without limitation) the removal or removal of Content that, in the opinion of the Owner, violates the terms of this Agreement, the legislation of the Russian Federation and/or may violate the rights, cause harm or threaten the safety of other Users or third parties.

– promote criminal activity or contain advice, instructions or guidelines for committing criminal acts;

3.2.1. Comply with the provisions of the current legislation of the Russian Federation, this Agreement and other special documents approved by the Owner and regulating the relationship between the Owner and the User when using the resource.

4.2.2. These third parties and the Content of third parties are not checked by the Owner for compliance with any requirements (reliability, completeness, integrity, etc.). The Owner is not responsible for any information posted on third party sites that the User accesses through links posted on the resource, or Third Party Content, including, but not limited to, any opinions or statements expressed on third party sites or in Third Party Content persons

Advisory support for 3 months is included in the course price.

3.3.2. Upload, store, publish, distribute and make available or otherwise use any information and materials that:

1.1. This Agreement defines the terms of use of the resource “trade.su”, as well as the rights and obligations of its Users and the Owner.

Demonstrate or promote violence and cruelty or inhumane treatment of animals;

Order 111 of the Ministry of Health of the Republic of Kazakhstan 2013

Department of Allergology and Pulmonology

Department of Anesthesiology, Resuscitation and Intensive Care No. 1

Department of Radiation and Physical Methods of Diagnostics and Physiotherapy

Department of Nephrology and Gastroenterology

Patient Help Desk

Compulsory social health insurance

Rules for citizens to contact the emergency medical service

The staff of the maternity ward are happy to welcome you within the walls of our institution!

The obstetric service of the ShGMB is represented by the following divisions:

— birth block — 6 maternity rooms

— physiology department with 40 beds

— wards for pregnant women with pathology for 5 beds

— children's department with 40 beds

— neonatal pathology department with 5 beds

— department of anesthesiology and intensive care with 4 beds

— gynecology department with 20 beds;

— day hospital at the gynecology department with 7 beds.

— clinical and biochemical laboratory 24 hours a day

On the basis of the maternity ward, a course of obstetrics and gynecology of the Moscow Municipal Technical University named after. HA. Yasawi, together with the Department of Obstetrics and Gynecology, a Coordination Council was created.

The work of the obstetric service is carried out according to the orders:

1. Order of the Ministry of Health of the Republic of Kazakhstan No. 498 dated July 7, 2010 “On approval of the Rules for the provision of inpatient care in medical organizations for the protection of maternal and child health.”

2. Order of the Ministry of Health of the Republic of Kazakhstan No. 349 dated August 15, 2006. “On approval of sanitary and epidemiological rules and norms. Sanitary and epidemiological requirements for working conditions and medical support during infection control of nosocomial infections in medical organizations of the Republic of Kazakhstan.”

3. Order of the Ministry of Health of the Republic of Kazakhstan No. 626 dated October 30, 2009. “On the indications and rules for termination of pregnancy in the Republic of Kazakhstan”, other orders of the Ministry of Health of the Republic of Kazakhstan and the Department of Health, instructions and methodological recommendations regulating our section of work.

5. Resolution of the Government of the Republic of Kazakhstan No. 1472 dated December 6, 2011 “On approval of the Rules for the provision of inpatient care”

6. Order of the Ministry of National Economy of the Republic of Kazakhstan No. 194 dated March 12, 2015. Sanitary rules “Sanitary and epidemiological requirements for the organization and implementation of sanitary and anti-epidemic (preventive) measures to prevent infectious diseases”

7. Order No. 2136 dated December 15, 2009. “On approval of the rules for ensuring and receiving by citizens a guaranteed volume of free medical care.”

10. Order of the Ministry of Health and Social Development of the Republic of Kazakhstan No. 627 dated July 28, 2015 “On approval of the rules for reimbursement of costs to healthcare organizations from budgetary funds.”

11. Order No. 457 dated July 19, 2012. UZ SKO "On organizations of emergency surgical and gynecological care."

12. Order of the MZRK No. 452 dated July 3, 2012 Layouts and algorithms, assessment sheets for emergency conditions. “Algorithm for examining women of fertile age at the level of primary health care.”

13. Order No. 824 of November 1, 2013 “On monitoring of postpartum hemorrhage.”

14. Order of the Ministry of Health of the Republic of Kazakhstan dated June 9, 2011 No. 372 “On approval of the Regulations on organizations providing anesthesiological and resuscitation care to the population of the Republic of Kazakhstan.”

15. Order of the Ministry of Health of the Republic of Kazakhstan No. 111 dated April 23, 2013 “On approval of methodological recommendations for the treatment of hands of employees of medical organizations of the Republic of Kazakhstan.

16. Order of the Ministry of Health of the Republic of Kazakhstan dated September 1, 2010 No. 691 “On approval of action algorithms for emergency conditions.”

17. Order of the Ministry of Health of the Republic of Kazakhstan dated May 28, 2010 No. 388 “Criteria for the preventability of maternal and infant death.”

18. Order of the Ministry of Health of the Republic of Kazakhstan dated May 7, 2010 No. 325 “On approval of the Instructions for improving the regionalization of perinatal care in the Republic of Kazakhstan.”

19. Order of the Administration of the South Kazakhstan region dated September 11, 2017. No. 707 “Regulations on the regionalization of perinatal care.”

20. Order No. 131 of February 25, 2015 “On the organization and implementation of preventive work against particularly dangerous infections.”

21. Order of the Ministry of Health of the Republic of Kazakhstan dated June 9, 2011 No. 372 “On approval of the Regulations on organizations providing anesthesiological and resuscitation care to the population of the Republic of Kazakhstan.”

Composition of doctors working in the maternity ward.

Maintaining hygiene and cleanliness is the key to health in all areas of life. If we are talking about medicine, then cleanliness of hands should be an integral rule, because the life of both the entire medical staff and the patient depends on such a seemingly trifle. The nurse is responsible for ensuring that the condition of her hands is satisfactory and meets medical health standards. It is important to get rid of micro cracks, hangnails, clean your nails and remove any nails, if any. Why is this so important and what are the requirements?

In order for all personnel to comply with the European medical standard, it is important for each employee to be told about the existing requirements for disinfecting hands, instruments and other medical equipment. There are separate rules for hand care for nurses, these include the following requirements:

you cannot paint your nails or glue artificial ones
nails should be neatly trimmed and clean
It is not recommended to wear bracelets, watches, rings or any other jewelry on your hands, as they are sources of bacteria and germs

It was found that it is the lack of proper care among doctors and nurses that contributes to the development and rapid spread of nosocomial infectious pathogens throughout the clinic. Touching manipulation devices, devices, patient care items, test equipment, technical equipment, clothing, and even medical waste with unclean hands can negatively affect the health of the patient and everyone in the hospital for a long period of time.

To prevent the spread of microorganisms and reduce the risk of infection through hands, there are rules and means of disinfection. Any hospital employee must follow these recommendations, especially those who work closely with sources of infection and infected patients.

In medicine, several methods have been developed for disinfecting the hands of all medical staff:

Hand washing with soapy water and plain water, without the use of additional products
washing hands with antiseptic hygiene products
surgical disinfection standards

Cosmetological and folk remedies for hair care

However, there are rules for washing hands this way. It has been noticed that in frequent cases, after treating the skin of the hands, many bacteria remain on the inner surface and fingertips. To avoid this, you must follow the following recommendations:

First, you need to remove all unnecessary items: watches, jewelry, and other small items that contribute to the proliferation of microorganisms.
The next step is soaping your hands; you need the soap to penetrate all areas.
Rinse off the foam under running warm water.
Repeat the procedure several times.

When the washing procedure is performed for the first time, dirt and bacteria located on the surface of the skin are removed from the hands. When repeated treatment with warm water, the skin pores open and the cleansing goes deeper. It is useful to do light self-massage when soaping.

Cold water is less useful in this case, because it is the elevated temperature that allows soap or other hygiene products to penetrate deeply into the skin and remove the thick fat layer from both hands. Hot water will also not work; it can only lead to negative results.

Surgical rules for disinfection

Surgery is an area where neglect of hand hygiene rules can cost the patient’s life. Hand treatment is carried out in the following situations:

Before any type of surgery
During invasive procedures such as vascular puncture

Of course, the doctor and everyone assisting during the operation put on disposable sterile gloves on their hands, but this does not give the right to forget about hygienic means of protection and hand treatment.

Next, the usual hand cleaning is carried out again and three milligrams of an antiseptic are applied, and it is rubbed into the fabric and skin in a circular motion. It is advisable to carry out this entire process several times. A maximum of ten milligrams of antiseptic is used. The processing time takes no more than five minutes.

After the procedure or operation has been completed, the sterile gloves are thrown away, and the skin of the hands is washed with soap and treated with lotion or cream, preferably made from natural substances.

Modern methods of disinfection

Medicine is moving forward and disinfection techniques are improving every day. At the moment, a mixture is widely used, which includes the following components: distilled water and formic acid. The solution is prepared daily and stored in enamel containers. Immediately wash your hands with ordinary soap, and then rinse with this solution for a couple of minutes (the part from the hand to the elbow is treated for 30 seconds, the rest of the time the hand itself is washed). Hands are wiped with a napkin and dried.

Another method is disinfection with chlorhexidine, which is initially diluted with 70% medical alcohol (dosage one to forty). The processing procedure lasts about three minutes.

Iodopirone is also used for hygienic treatment of the hands of medical staff. The whole process follows a similar pattern: hands are washed with soapy water, then nails, fingers and other areas are disinfected with cotton swabs.

Ultrasound treatment. The hands are lowered into a special one through which ultrasonic waves pass. Processing lasts no more than a minute.

All methods are good, it’s just important not to neglect the general recommendations.

So, hand disinfection plays an important role in medicine. It is not enough to simply wash your hands with water. Hand treatment is carried out in different ways, different hygiene products are used, depending on the situation. Neglecting basic rules can lead to negative consequences that will affect not only patients, but also medical personnel.

Jun 22, 2017 Violetta Doctor