Position of the dressing room. Carrying out dressings. Responsibilities of a nurse in the surgical department Step-by-step work in the dressing room of the surgical department

Organization of an anti-epidemic regime in dressing rooms and treatment rooms.

1. General provisions.

Responsibility for organizing and carrying out a set of measures to comply with the sanitary and anti-epidemic regime and prevent intra-hospital infections in departments (clinics) rests with senior nurses.

In accordance with the current regulatory documents of the Ministry of Health of Russia, in order to prevent occupational diseases (including nosocomial infections) and occupational injuries, each employee is given instructions on safe techniques and work methods, which is divided into: introductory (upon hiring), initial at work place and periodic (repeated).

Instruction of medical personnel in the workplace and communication of the provisions of these methodological recommendations is carried out under signature, upon hiring and subsequently once a year. The briefing must be recorded in a special journal.

In accordance with orders of the Ministry of Health of Russia dated 29.09.89, No. 000 and dated 14.03.96 No. 90, all persons hired to work in healthcare facilities are required to undergo medical examinations, laboratory and functional examinations.

2. Standard of equipment for the treatment room.

Nurse's desk - 1 piece

Chair – 1 piece

Chair for the patient (screw) – 1 piece

Table for IV injections – 1 piece

Medical couch – 1 piece

Medical cabinet for medicines, solutions, instruments - 1-2 pcs.

Medical instruments: hemostatic clamp - 4, forceps - 2, anatomical tweezers - 2, surgical scissors - 2, mouth retractor - 1, tongue holder - 1.

Instrument tables for storing sterile bix, packs with sterile balls, sterile tweezers and other instruments. (conditionally sterile table).

For storing alcohol, packaged medicines, disposable syringes, scissors, adhesive tape, and other items that cannot be sterilized. (not a sterile table).

Table (bedside table) for storing disinfectants and preparing their working solutions.

Containers for sending blood tubes to the laboratory.

A bedside table for storing detergents and disinfectants, rags, chemical indicators, test controls. Etc. -1–2 pcs.

Sink

Household refrigerator – 1 piece

Air sterilizer - 1 piece

Stands for intravenous drip infusions - 4-6 pcs.

Test tube racks – 2 pcs.

- containers for disinfection (1 piece each) (all containers must be marked, equipped with lids, sinks and used strictly for their intended purpose) for:

Disposable syringes

Rubber gloves

Used blood transfusion systems and blood substitutes

Used balls

- measuring containers for disinfectants and detergents - 2 pcs.

- container with disinfectant solution for tweezers

Kidney-shaped trays - 4 pcs.

Turn on the bactericidal lamp for 60 minutes.

After completing the 60-minute exposure, put on another clean gown, a second pair of rubber gloves, and rinse off the disinfectant solution with a sterile rag and clean tap water.

Complete the cleaning by disinfecting the floors with a disinfectant solution with the addition of detergents (exposure 60 minutes), followed by washing them with clean water and repeated ultraviolet irradiation of the room for 60 minutes.

Disinfect all cleaning equipment in a disinfectant solution for 1 hour, then rinse and dry.

At the end of the general cleaning, the nurse makes a note about its implementation in the “general cleaning” journal.

Labeled cleaning equipment for general cleaning and routine cleaning is stored separately.

9. Rules for the operation and operation of bactericidal lamps.

9.1. The bactericidal irradiator is equipped at a height that is easily accessible for its treatment (about 2 meters), so that the flow of rays is directed into a clean area.

9.2. Germicidal lamps that have served their guaranteed service life (in accordance with the passport from 3 to 5 thousand hours of operation) must be replaced with new ones. To do this, they must keep track of the operating time of each of them. As the lamps operate, it is necessary, after 1/3 of the nominal service life of the lamps has expired (for example, 1 thousand hours out of 3 thousand), to increase the initially set duration of irradiation by 1.2 times. (at a rate of 1 hour - by 12 minutes) and after 2/3 of the period - by 1.3 times (by 18 minutes). Accounting for the operating time of irradiators and changes in the duration of irradiation must be entered into the “log of registration and control of the operation of bactericidal irradiators”

9.3. Weekly (during general cleaning), the irradiator lamp is wiped from all sides from dust and fatty deposits with a sterile gauze cloth (the presence of dust reduces the effectiveness of air disinfection by 50%). To do this, you need to: unfold the napkin lengthwise, moisten it with 70% alcohol, throw one end of the napkin over the other side of the lamp, encircling it into a ring. Then hold both ends of the napkin with one hand and wipe the lamp lengthwise.

9.4. The lamp fittings are wiped with one of the disinfectants with the addition of 0.5% detergent, and then with clean distilled water.

10. Features of the anti-epidemic regime when performing injections.

IV, IM, subcutaneous injections can be performed in the treatment room and in the wards if necessary.

Before starting work, the requirements of clauses 5.1 and 5.2 are met.

Sterile rubber gloves are put on your hands.

Prepare 5 cotton balls moistened with 70% alcohol or other skin antiseptic.

Hands with gloves are treated with the first ball.

The syringe is assembled and the needle is capped.

The second ball treats the ampoule with the drug.

The ampoule is opened.

The medicine is drawn into the syringe and the needle is closed with a cap.

A pad (roller) with oilcloth is placed under the elbow.

An elastic tourniquet is applied to the shoulder (but not to the bare area) at a distance of 10 cm from the injection site.

The third ball is used to wipe the skin of the patient's elbow over an area of ​​at least 15x15 cm.

The fourth ball is used to wipe gloved hands again.

Venipuncture is performed.

The fifth ball presses the venipuncture site.

The used syringe is filled through a needle with a disinfectant solution, after which, without removing the needle, it is placed in a special marked container for disinfection.

Wipe the pillow, tourniquet and oilcloth with a rag soaked in a disinfectant solution.

Used balls are disinfected in a separate container, after which they are transferred to disposable yellow plastic bags, sealed and removed from the department for disposal.

10.1 To disinfect disposable syringes and balls, disinfectants supplied to health care facilities are used in accordance with the instructions.

After disinfection, disposable syringes are handed over to the senior medical officer. sister for subsequent processing, for disposal.

10.2 Disinfection of disposable systems for transfusion of solutions and blood, plastic containers for donor blood.

Before disinfection, a nurse, wearing gloves, cuts the system hoses in half with scissors into 15-20 cm fragments, plastic blood containers are also cut in half and immersed in a disinfectant solution. After exposure, they are placed in a yellow plastic bag for disposal.

10.3. Collection of sharp instruments (needles, feathers) after disinfection, are collected in a hard, puncture-proof sealed package.

10.3. Rubber gloves are removed and disinfected by soaking in a disinfectant solution. After which they are disposed of.

10.4. At the end of the procedures, routine cleaning and ultraviolet irradiation of the office are carried out, clause 8.1.

10.5. Injections at the patient's bedside.

Injections in the ward are given only to patients on bed rest.

The treatment room is equipped with a sterile tray in which the following is placed:

A disposable syringe filled with medicine, with a cap on the needle, 5 balls moistened with an antiseptic or alcohol.

The tray is covered on top with another sterile tray or sterile napkin.

An injection is performed at the patient's bedside, following the rules outlined above.

Used syringes and balls are placed in a tray and must be disinfected in the treatment room.

Reuse of the tray is allowed only after pre-sterilization treatment and sterilization.

11.Use of bottles with infusion solutions.

Before use, a bottle of a sterile drug used for several patients is marked with the date and time of opening. Use the bottle within 24 hours. When using a dropper bottle for one patient, the date and time are not set.

Disinfect the cap and stopper of the bottle with 70% alcohol or an antiseptic solution.

Draw the medicine into the syringe.

Between uses, close the bottle cap with a dry, sterile gauze ball; Before each repeated use of the drug, disinfect the stopper by wiping with 70% alcohol (antiseptic).

The remainder of the drug after the expiration date can be used for external use.

12. Documentation on the organization and control of compliance with the sanitary and anti-epidemic regime in the department.

- Each department maintains the following documentation on sanitary and anti-epidemic work:

Plan – schedule for medical examinations and laboratory tests.

Medical sanitary records for all employees.

Logbook for recording the results of monitoring the operation of air sterilizers.

Logbook for recording the quality of pre-sterilization treatment of medical devices.

Logbook for monitoring the operation of bactericidal irradiators.

Journal of general cleaning.

List of department employees subject to vaccination against viral hepatitis B.

Journal of nosocomial infections among patients and employees.

Logbook for recording emergency situations in the staff department.

Documentation

Logbook for registering the bactericidal installation and recording the operation of bactericidal lamps

1. Characteristics of bactericidal installations and lamps.

2. Accounting for the operation of bactericidal lamps.

Schedule

carrying out general cleaning of the treatment room

(name of division)

Magazine

taking into account the quality of pre-sterilization treatment

Magazine

Registering cases of nosocomial infections

in patients of the department

(name of department)

Magazine

registration of cases of intra-hospital infection among department staff

(name of department)

FEATURES OF ORGANIZING THE NURSING PROCESS IN SURGERY.

1. DEFINITION OF THE NURSING PROCESS.

NURSING PROCESS is a method of organizing and providing qualified nursing care to a patient.

2. STAGES OF THE NURSING PROCESS

A joint venture is a series of actions leading to a specific result and including 5 main stages.

FIRST STAGE – EXAMINATION OF THE PATIENT

SEQUENCING:

1) collecting anamnesis: general information about the patient, history of the problem, risk factors; psychological data; sociological data (from medical history);

2) physical examination: blood pressure, heart rate, body temperature; Height Weight; identification of vision, hearing, memory, sleep, and motor impairments; examination of the skin and mucous membranes; examination of systems (musculoskeletal, respiratory, cardiovascular system, digestive, urinary);

3) laboratory and instrumental studies: as directed by the doctor.

The foundation of nursing assessment is the doctrine of the basic vital needs of a person.

NEEDS according to A. Maslow:

Physiological: eat, drink, breathe, excrete, maintain temperature (homeostasis)

Protection needs - to be healthy, clean, sleep, rest, move, dress, undress, avoid danger

Needs for belonging and love – communicate, play, study, work

Respect needs - to be a competent specialist, to achieve success, to be approved

Maslow later identified 3 more groups of needs:

Cognitive - explore, know, be able to, understand

Aesthetic – in beauty, harmony, order

The need to help others.

It is important to remember that the needs of each subsequent level become relevant only after the previous ones are satisfied!!

SECOND STAGE – IDENTIFYING THE PATIENT'S PROBLEMS AND FORMULATING A NURSING DIAGNOSIS.

CLASSIFICATION OF PROBLEMS:

PHYSIOLOGICAL – pain, suffocation, cough, sweating, palpitations, nausea, lack of appetite, etc.

PSYCHOLOGICAL – fear, depression, anxiety, fear, anxiety, despair, etc. Reflect the disharmony of someone who finds themselves in an unusual situation (shame when giving an enema, etc.).

SOCIAL – job loss, divorce, change in social status.

SPIRITUAL – loss of meaning in life, alone with illness, no friend.

PATIENT PROBLEMS are divided into EXISTING AND POTENTIAL.

EXISTING PROBLEMS are those that concern the patient at the moment. For example, fear of surgery, inability to independently move around the department and take care of oneself.

POTENTIAL PROBLEMS are those that may arise over time. In surgical patients, this is a violation of the mental state (the body’s reaction to premedication), pain, changes in the state of the body (T, blood pressure, blood sugar, intestinal dysfunction) with concomitant diseases. As a rule, a patient may have several problems at once. In such cases, it is necessary to find out which of them are primary and require emergency intervention (increased blood pressure, pain, stress), and which intermediate ones are not life-threatening (forced position after surgery, lack of self-care).

The next task of the second stage is the formulation of the NURSING DIAGNOSIS.

NURSING DIAGNOSIS is a patient's health condition determined by a nursing assessment and requiring intervention by the nurse. In fact, these are problems that the nurse can prevent or resolve. Nursing diagnosis differs from medical diagnosis and is aimed at identifying the body's reactions to the disease. The diagnosis may change as the body's reactions change. The nursing diagnosis is formulated in PES format, where P is a problem..., E-...associated with..., S-...confirmed... (signs of a problem)

THIRD STAGE – PLANNING NURSING CARE. The nurse must formulate goals of care and develop a plan of action to achieve the goals.

Goals must be realistic and within the nurse's control!!

There are two types of goals:

SHORT TERM must be completed in a short period of time, usually 1-2 weeks. They are placed, as a rule, in the acute phase of the disease/

LONG-TERM are achieved over a longer period of time (more than 2 weeks). They are usually aimed at preventing relapses of diseases, complications, their prevention, rehabilitation and social adaptation, and acquiring knowledge about health.

FOURTH STAGE – IMPLEMENTATION OF NURSING INTERVENTIONS.

INDEPENDENT nursing intervention involves actions carried out by the nurse on his own initiative.

DEPENDENT nursing interventions are performed based on written orders and under the supervision of a physician.

INTERDEPENDENT nursing intervention involves the joint activities of the nurse with the doctor and other specialists (nutritionist, exercise therapy instructor).

Leading up to the fourth stage of the nursing process, the nurse implements two strategic directions:

Observation and control of the patient’s response to doctor’s prescriptions

Observe and control the patient's response to nursing actions. Both are recorded in the nursing record.

FIFTH STAGE – ASSESSMENT OF THE EFFECTIVENESS OF THE NURSING PROCESS

Its PURPOSE is to assess the patient's response, results and summarize. Assessment of the effectiveness and quality of care should be carried out by the senior and chief sister constantly and by the sister herself as self-monitoring at the end and beginning of each shift. If the goal is not achieved, then it is necessary to identify the reasons, deadlines for implementation, and make adjustments.

ORGANIZATION OF WORK IN THE SURGICAL DEPARTMENT.

The surgical hospital includes several main functional units: admission department, operating unit, surgical departments (urological, vascular surgery, neurosurgery, burns, etc.), dressing rooms, procedural departments.

SURGICAL DEPARTMENT: designed to accommodate patients during their surgical treatment. It consists of hospital wards, the office of the head of the department and doctors of the nursing station, treatment room, dressing rooms, sanitary facilities, utility rooms (cystoscopy room, plaster room, etc.).

One of the main tasks of the department is to ensure the prevention of nosocomial infections (HAIs), therefore all surgical patients are divided into “purulent, septic” (GSI), “clean, aseptic” and traumatological. The flows of these patients must be separated.

The wards contain special functional beds and a minimum number of pieces of furniture (bedside table, chair for each patient, there is an alarm system for calling medical staff), which is easy to clean and disinfect.

The optimal number of beds in the wards is up to 4, and for burn patients and GSI – 2. The filling of the wards for burn patients is “simultaneous”. Beds must be accessible from all sides. The optimal air temperature in the rooms is 20-25*.

Cleaning of the department 3 times a day, incl. 1 time with disinfectants, in burn and medical examination wards - 3 times with disinfectants. After cleaning – air disinfection. When performing work in the wards for patients with GSI, personnel must wear gloves and protective equipment that is specially marked and has distinctive markings.

Change of bed linen once every 7 days and when soiled, collection of linen in waterproof containers, storage in a special room of the department for a maximum of 12 hours. Bedding (mattress, blanket, pillow) is subject to decontamination after discharge, transfer to another department or death of the patient, or contamination with biomaterial. Mattresses and pillows placed in tightly sewn hygienic covers can be disinfected by wiping or spraying the covers with a solution of a chemical disinfectant.

Treating the bed and bedside table with a disinfectant - after the patient is discharged, transferred to another department, before the patient’s admission.

General cleaning once every 7 days, in burn wards - and after the immediate discharge of patients, when repurposing wards.

ORGANIZATION OF THE WORK OF A NURSE IN THE SURGICAL DEPARTMENT.

The work of a nurse is based on knowledge and compliance with the requirements of regulatory documentation regulating compliance with sanitary and epidemiological regulations, organization of work and the correct implementation of all manipulations within the competence of the nurse.

MAIN RESPONSIBILITIES OF A NURSE

The duties of a nurse include the following:

Strictly comply with internal labor regulations;

Carry out the procedures prescribed by the doctor accurately and in a timely manner;

Ensure the issuance, receipt, storage, control of expiration dates, consumption of medications, property necessary for work;

Timely complete the syndromic kits for providing medical care in emergency conditions;

Ensure the implementation of measures aimed at preventing nosocomial infections

Maintain medical documentation in accordance with established forms (logs of reception and delivery of duties, medical prescriptions, medication records, registration of admitted and discharged patients, temperature sheets, etc.);

Constantly improve your qualifications and professional level.

ORGANIZATION OF WORK IN THE DRESSING ROOM.

DRESSING ROOM - a specially equipped room in a surgical hospital or outpatient facility for the production of dressings and minor surgical interventions.

In surgical hospitals, as a rule, clean and purulent dressing rooms are created; in the presence of one dressing, dressings of purulent patients are carried out after clean. The dressing room equipment consists of dressing tables, cabinets with instruments and medications, a table with sterile material on which the most commonly used instruments and prepared sterile dressings are located. At the dressing tables there are basins on stands for used dressing material. In addition, the dressing room should have stands for blood transfusions and solutions, portable devices for giving oxygen and anesthesia. WORK PROCEDURE IN THE DRESSING ROOM

During dressing changes, entry to outsiders is prohibited;

The medical staff in the dressing room wears a gown, a waterproof apron (it is disinfected after each dressing), gloves, a mask, and a cap. Change of overalls - daily and when soiled. Changing gloves - after each dressing;

Medical instruments are disinfected using a virucidal regimen;

In dressing rooms intended for emergency care, a sterile table is available around the clock (the nurse is responsible for preparing sterile material and instruments!);

Once a day, the sterile material on the table is changed, even if the table has not been used;

For routine work, a sterile table is prepared to begin dressing changes each morning;

It is necessary to ensure the rapid removal of used dressings, which are collected in sealed containers and subsequently incinerated;

Purulent dressing room linen must have a special marking, because its use in a clean dressing room is unacceptable.

Dressing room cleaning (preliminary, current, final, general) and bacteriological control are carried out in the same way as in the operating room (see below).

ORGANIZATION OF WORK OF THE OPERATING BLOCK

An operating unit is a complex of specially equipped premises for performing operations and carrying out activities that support them. The operating unit should be located in a separate room or on a separate floor of a multi-story surgical building. It has separate operating rooms for performing clean and purulent operations. In addition to the operating rooms, the operating block provides the following specially equipped rooms: preoperative room, sterilization room, blood transfusion room, anesthesia room, material room, plaster room, director's office, staff rooms, sanitary checkpoint.

The organization of the operation of the operating unit and the rules of behavior in it are strictly regulated. The fundamental principle in the operation of the operating unit is strict adherence to the rules of asepsis. There should be no unnecessary furniture and equipment in the operating room, the volume of movements and walking is reduced to a minimum, conversations are limited, and there should be no unnecessary people in the operating room. Persons with acute respiratory diseases and purulent-inflammatory processes are not allowed to be in the operating room. Entrance to the operating room for personnel is through a sanitary inspection room, which is divided into 2 zones; personnel (if necessary) take a shower, put on a surgical suit, shoe covers, cap, mask and go to the preoperative room, where they wash and perform surgical hand antisepsis. Members of the surgical team wear a waterproof apron. Staff wear a sterile gown and gloves in the operating room. Change of clothing and personal protective equipment - after each operation. Change masks and gloves - every 3 hours with repeated surgical hand antiseptics.. If gloves are damaged - the same. All members of the operating team wear special clothing, which differs in color from the clothing accepted in other departments of the hospital

The patient is delivered on a gurney in the operating room through the airlock. The gurney is disinfected after each patient. All instruments and equipment brought into the operating unit must be disinfected.

In the operating room, when carrying out planned operations, first of all, clean operations are performed (on the thyroid gland, blood vessels, joints, for hernias) and only then operations associated with possible microbial contamination (cholecystectomy, gastric resection) are performed. After performing urgent (emergency) medical intervention on a patient with suppurative processes in the general(!) operating room and general dressing room, the following must be carried out: cleaning; final disinfection; disinfection of the air environment in accordance with the requirements of these Sanitary Rules.

There are some additional requirements for the procedure for working in a purulent operating room. Surgical instruments, dressings and linen are stored separately and under no circumstances are used for aseptic operations. The combination of work of personnel (nurses, orderlies) in a clean and purulent operating room is excluded. Used dressing material is burned.

FUNCTIONAL ZONES. To ensure sterility, special functional areas are allocated in the operating unit.

GENERAL SECURITY AREA: here are the offices of the head, head nurse, rooms for storing and sorting linen and instruments.

A RESTRICTED ZONE, or technical zone, combines production premises to ensure the operation of the operating unit. There are equipment for air conditioning, vacuum installations, installations for supplying the operating room with oxygen, a battery substation for emergency lighting, and a darkroom for developing X-ray films. Material - a room for storing supplies of instruments, suture material and medicines.

A HIGH SECURITY ZONE includes such premises as a sanitary inspection room, storage rooms for surgical instruments and devices, anesthesia equipment and medications, a blood transfusion room, rooms for the duty team, and a senior operating nurse.

THE STERILE MODE AREA combines the operating room, preoperative room and sterilization room.

CLEANING OF THE OPERATING UNIT is always carried out using a wet method. There are the following types of operating room cleaning:

Preliminary is carried out in the morning before starting work; all horizontal surfaces (floors, tables and window sills) are wiped with a damp cloth to collect dust that has settled overnight, and bactericidal ultraviolet lamps are turned on to disinfect the air;

The current one is carried out during the operation; the nurse collects all accidentally fallen balls and napkins from the floor, wipes away any blood or other liquid that has fallen on the floor;

Intermediate is done between operations; all material used during the operation is removed, the floor is wiped with a damp cloth;

The final one is carried out at the end of the operating day.

General surgery is carried out according to plan on a day free from surgery, once a week.

Dressing room- a specially equipped room for performing dressings and minor surgical procedures (suture removal, laparocentesis, therapeutic and diagnostic punctures, etc.). P. is deployed in hospitals and outpatient medical institutions, in surgical departments and offices (surgical, traumatological, urological). There are P. for so-called clean dressings and separate P. for patients with purulent-inflammatory diseases and complications. In departments with 100 beds, 2 dressing rooms with two tables in each should be organized.

The area of ​​the dressing area is determined based on 1 table 22 m 2 and for dressing rooms for 2 tables - 30 m 2. The room for P. is equipped taking into account the need for wet cleaning. The ceiling is painted with oil paint in gray-green or gray-blue. The walls are lined with ceramic tiles of the same color to a height of at least 1.7-2 m from the floor, but better to the ceiling. The floor is covered with ceramic tiles or wide sheets of durable linoleum, the joints between which should be well coated with a special putty that does not allow water to pass through. The dressing room should have 2 separate basins for washing hands and for washing instruments with appropriate markings and hot and cold water mixer taps. The design of the heating system should not make wet cleaning difficult. The most convenient heaters are in the form of pipes located horizontally above each other at a distance of 25-30 cm from the wall, or solid panels. The optimal air temperature for P. is about 22°. P. windows are oriented to the north, northeast or northwest. For better natural light, the ratio of window (or window) area to floor area should be at least 1:4.

For artificial lighting, lamps with a total power of at least 500 are mounted on the ceiling. W by 50 m 2 rooms that can be wet cleaned. Additionally, a shadowless lamp is installed above the dressing table, creating an illumination of at least 130 OK. P. is equipped with air conditioning or supply and exhaust ventilation with a predominance of air flow, providing double air exchange per 1 h. It is also recommended to have mobile recirculation air purifiers (VOPR-0,

9 and VOPR-1.5 m), which are capable of 15 min work to reduce the dust content of the air and the number of microbes in it by 7-10 times. To disinfect the air, bactericidal irradiators are installed: ceiling-mounted (OBP-300, OBP-350) and wall-mounted (OBN-150, OBN-200). The lamps are placed at a distance of 2.5 m one from the other. In the presence of people, you can turn on only shielded lamps, but no more than 6-8 h. Preferably every 2-3 h work P. take a 10-minute break and turn on the bactericidal lamps. In purulent P., you should additionally have a bactericidal lighthouse-type irradiator or a mobile irradiator.

Special furniture is installed in the dressing room: a dressing table, a large table for sterile material and instruments, a small mobile table for sterile instruments, a small table with a glass panel for antiseptic solutions, a medical cabinet for instruments, a cabinet for dressing material and linen, a ladder stand, a hanger -stand. Enameled basins and buckets with lids for used dressings are also required. An operating table of any model can be used as a dressing table (see.

Medical staff, working in the dressing room, must strictly follow the rules asepsis , change your robe, cap, and mask daily. In clean P., first of all, manipulations are performed that require strict asepsis (blockades, punctures, laparocentesis, etc.), then patients who were operated on the day before are bandaged. Secondly, the remaining clean dressings are performed and the sutures are removed.

In purulent P., first of all, patients with healing purulent wounds are bandaged, then with significant purulent discharge, and lastly patients with fecal

Dressings play an important role in the treatment of wounds. For this reason, it is necessary to strictly follow the rules for dressing wounds. There are general rules, and there are specific ones, depending on the type of damage.

General information about dressings

Dressing is a therapeutic procedure that is indispensable in the treatment of wounds. Its main tasks:

• inspection of the wound surface;
• treatment of the damaged area and the skin around it;
• cleaning the wound;
• drug therapy;
• replacing an old dressing by applying a new one.

This is the general algorithm for the dressing procedure. It can be performed by a nurse in the dressing room in the presence of the attending physician. The latter may take responsibility for applying the bandage in particularly severe cases.

The frequency of wound dressing depends primarily on the extent of the damage and the healing process, as well as on the type of dressing itself:

• clean postoperative wounds are bandaged 1 week after surgery to remove the sutures;
• superficial injuries that heal under the scab are also rarely bandaged;
• purulent wounds are bandaged every 2-3 days if they do not show signs of getting wet;
• dry ulcers are also bandaged once every 2-3 days;
• wet-drying dressings, which are heavily saturated with purulent discharge, are changed every day;
• dressings that are soaked with the contents of the intestines or bladder are changed 2 to 3 times a day.

In the hospital, patients with clean wounds are first treated and only after them - with purulent ones.

General rules for applying a bandage

The specialist performing this manipulation must follow the general rules.

The main ones are:

1. Do not touch the wound. Under no circumstances should you touch the wound surface with your hands.
2. Disinfection. Before starting treatment, the nurse should wash and disinfect the patient’s hands and skin.
3. Sterility. This applies primarily to dressings and instruments.
4. Position. It is very important for an even application of the bandage that the affected part of the body is in the correct position.
5. Direction of bandaging. It is correct to perform this procedure from bottom to top and from left to right. You need to unwind the bandage with your right hand, and hold the bandage with your left hand, while straightening the bandage. If a limb is bandaged, you need to start the procedure in the direction from the edge of the wound to the center.
6. Correct selection of material. It is important that the bandage matches the size of the wound. So, its diameter should be slightly larger than the diameter of the damaged area.
7. Fixation. In order for the dressing to be firmly fixed, you need to bandage from the narrowest part to the widest. There is no need to make the bandage tighter than necessary.

It is important that the bandage is not too loose so that it falls off. At the same time, it should not be very tight, so as not to disrupt local blood circulation. To do this, soft pads are applied in places of compression.

Algorithm for dressing a clean wound

A wound in which there are no signs of infection is called clean: there is no pus or any pathological processes in it, it is granulated, there is no local increase in temperature, redness of the surrounding skin, etc. The main task of the doctor is to prevent infection in the future.

Indications for dressing a clean postoperative wound are the following situations:

• if after surgery a tampon or drainage was left in it and 1 to 3 days passed;
• the time has come to remove the stitches;
• if the bandage gets wet with blood or ichor.

To treat a clean wound, you need to prepare the following sterile equipment:

• 2 trays, one of which is intended for the use of dressings;
• dressing material: plaster, bandage, cleol;
• tweezers;
• medical mask and gloves;
• antiseptics for treating the hands of a nurse and the patient’s skin;
• clean cloth;
• saline solution for disinfecting used dressings and surfaces.

The dressing process is carried out in 3 stages: preparatory, main and final.

Stages of the procedure

The first stage is preparatory. The doctor performs the following manipulations:

1. Disinfects hands: washes them with soap and then treats them with antiseptic. Wears gloves and a mask.
2. Prepares the dressing table. To do this, the table is covered with a clean sheet, because the procedure is performed with the patient lying down.

After this, the next stage begins - the main one. In this case, the doctor or nurse performs the following manipulations (all dressing material is held with tweezers, not fingers!):

1. Removes the old bandage. Tweezers are used for this.
2. Inspects the wound. In this case, not only the visual inspection method is used, but also the palpation method to assess the condition of the skin of the suture.
3. Treats the skin around the wound. To do this, the nurse soaks a napkin in an antiseptic. In this case, the direction of the tweezers is from the edges of the wound to the periphery.
4. Performs seam processing. An antiseptic napkin is also used for this. This procedure is performed with blotting movements.
5. Apply a dry, clean cloth to the wound. After this, secure it with a bandage, plaster or cleol.

Finally, the last step is to completely disinfect used instruments, dressing materials and work surfaces.

Algorithm for bandaging a purulent wound

If the wound becomes infected, purulent discharge appears in it. In addition, the patient’s body temperature rises, and painful pulsating sensations appear in the wound. Indications for dressing are the following situations:

• the bandage becomes saturated with purulent contents;
• it's time for another dressing;
• the bandage has moved.

To carry out the procedure, it is necessary to prepare the following sterile instruments:

1. Trays. You will need 2 of them, one of which is intended for used tools and material. In addition, a table for tools is needed.
2. Dressing. In particular, cleol, plaster, bandage.
3. Tools for dressing: tweezers, scissors, probe, syringe, clamps, rubber drains (flat). You will also need medical gloves, an oilcloth apron and a mask.
4. Antiseptic solution. It is needed to treat the doctor’s hands and the patient’s skin.
5. Hydrogen peroxide solution.
6. Disinfection solution. It is needed for final surface treatment.
7. Clean cloth.

The procedure is performed by a doctor. As with the treatment of clean wounds, it also takes place in 3 stages.

Stages of dressing infected wounds

The preparatory stage is the same as when working with clean wounds: the doctor washes and treats his hands with an antiseptic, puts on a mask, gloves and an apron. The apron is additionally treated with a disinfectant solution. Then they are additionally washed with soap and treated with an antiseptic and the hands that are already wearing gloves.

After this, the main stage of the procedure begins, that is, treatment and dressing of the wound. The doctor performs the following manipulations (while all the dressing material is held with tweezers, not fingers!):

1. He takes off the old bandage. This should be done using tweezers.
2. Treats the wound. To do this, you need a napkin soaked in a solution of hydrogen peroxide.
3. Dries the seam. To do this, use a clean, dry cloth. The movements are of a wet nature.
4. Treats seams and skin. To do this, use napkins moistened with an antiseptic solution. They treat the seam and the skin around it.
5. Identifies the site of suppuration. To do this, the doctor palpates around the suture.
6. Removes stitches. In the area of ​​suppuration, the doctor removes no more than 1-2 stitches and widens the wound with a clamp.
7. Cleans the wound. To do this, use a cloth moistened with hydrogen peroxide, or a syringe with a blunt needle.
8. Dries the wound. To do this, the doctor takes a dry napkin.
9. Treats the skin around the wound. To do this, use a napkin with an antiseptic solution.
10. Inject sodium chloride solution into the wound. It can be administered in two ways: using drainage or turunda.
11. Apply a napkin soaked in an antiseptic solution to the wound.
12. Secures the napkin. A bandage is used for this.

After this, the doctor completely disinfects all work surfaces and instruments.

Participation in the work of the surgical (dressing) room of the surgical department

Much surgical work is carried out in surgical rooms of clinics, outpatient clinics and dispensaries. It consists mainly of dressings and partly in small operations performed on the go (minor surgery). It is advisable that the outpatient room be isolated from the surgical department and served by special, at least non-surgical, personnel, since most of the work in the surgical office is purulent.

Three rooms are required for the surgical office. In the first room, patients are examined without damage to the integument and, if necessary, the patient undresses; the second room is a dressing room, where a patient with open injuries is bandaged and examined, and the third is an operating room.

The arrangement of the operating room and dressing room is simpler than in the corresponding rooms of the surgical department. There are sinks for hand washing in the dressing room and operating room; in the dressing room they put boilers for instruments; It is advisable to sterilize the material in a special, fourth room (sterilization room, also known as material) or outside the surgical room of the outpatient clinic.

In well-organized clinics, as well as in clinics of medical and sanitary units of enterprises, there is a trauma center or office in which emergency care for injuries is provided. Its design and equipment provide the ability to make a dressing, perform primary surgical treatment of the wound for minor injuries and apply a splint or plaster bandage.

In a small outpatient clinic, it is often necessary to carry out all the work in one room. At the same time, in one part of the room there is a table for the person conducting the reception, for the necessary entries in outpatient cards and writing out prescriptions, a table with dressings, instruments and medicines. In another part of the room there is a table for examining patients and stools for seated patients. Buckets and basins for dirty dressings are placed near them.

In a rural environment, at local medical centers, outpatient appointments, including surgical patients, are often carried out by a paramedic, and therefore he must know well the structure of the outpatient surgical room. The closer the outpatient surgery room gets to the dressing room, the better. The paramedic must not only know the structure of the dressing room, but also be able to properly organize it, providing all the necessary equipment.

We will indicate the necessary equipment: a table for bandaging patients, a table for instruments and dressings, 2-3 stools for sitting patients, a stool for the person conducting the reception, a washbasin with hot water, a bucket or basin for removing bandages, a vessel with boiled brushes for washing hands , soap plate. In addition, you need: a bottle with a disinfectant solution (for example, a solution of 1: 1000 sublimate), a box with sterile material, a tray with clean instruments, trays for dirty instruments, jars and bottles with ointments and disinfectant liquids. Necessary medications: iodine tincture, hydrogen peroxide, 2% soda solution, rivanol, sterile petroleum jelly, ointments (zinc, bismuth). Instruments are sterilized in the surgical office of the outpatient clinic or in the next room. All equipment must be easy to clean.

The organization and distribution of work depends on how many people take part in the work. If a nurse helps a paramedic, he examines patients and gives prescriptions; The sister bandages and bandages the sick, and the nanny monitors cleanliness and order and unbandages the sick. If a paramedic sees only a nanny, then the latter needs to be taught not only how to unbandage, but also how to apply simple bandages.

For fast and good work, it is necessary to properly establish the correct order of arrival of patients and fight the formation of queues. This works best if a certain number of patients are assigned to each hour, especially those who come for repeated dressings. Outpatient cards should be kept in order so that they do not get lost and do not have to be found. A well-organized reception of patients and order in the cards greatly facilitate the work.

After reviewing the outpatient card, the paramedic examines the patient. The nanny should put the patient to bed and help him undress. After interviewing and examining the patient, he is prescribed treatment and a paramedic or nurse makes a dressing.

Dressings should be organized according to the type of instrumental ones, and the necessary instruments (10-15 tweezers, 3-4 scissors, 1-2 probes, 1 scalpel, 1-2 hemostatic clamps, 2-3 spatulas) should be boiled in advance and lie in the tray. As they become dirty, the nanny should wash them over the sink and put them back in the boiler. With this organization of work, it is possible to quickly and correctly make many dressings during an appointment.

The paramedic must give advice to the patient on how he should behave, make notes on the outpatient card (diagnosis, course of the disease, treatment) and on the sick leave certificate, if the patient is insured, and provide the necessary certificates.

Dressing room equipment:

• 1) Table for instruments and dressings - 1 pc.;
• 2) Distiller - 1 pc.;
• 3) Germicidal lamp - 1 pc.;
• 4) Stands for long-term infusions - 2 pcs.;
• 5) Refrigerator for storing medicines, etc. - 1 pc.;
• 6) Hemostatic tourniquets - 2 pcs.;
• 7) Chairs or stools - 3 pcs.;
• 8) Bench stands - 2 pcs.;
• 9) Operating table / gynecological chair - 1 pc.;
• 10) Tool cabinet - 1 pc.;
• 11) Cabinet for storing medicines - 1 pc.;
• 12) Desk - 1 pc.;
• 13) Table for medical documentation - 1 pc.;
• 14) Nippers for collecting contaminated dressings - 2 pcs.;
• 15) Containers for disinfection solutions - at least 4 pcs.;
• 16) Garbage buckets: dry white bag; medical yellow bag - 2 pcs. ;
• 17) Mobile reflector lamp - 1 pc.;
• 18) Aprons made of oilcloth or plastic - 4 pcs.;
• 19) Glasses - as a means of eye protection - 4 pcs.;
• 20) Disposable sterile gowns, gloves, hats, masks, shoe covers - in abundance;
• 21) Disposable sterile linen - in abundance;
• 22) Ready-made sterile material - in abundance;
• 23) Containers for preparing working solutions of disinfectants, measuring containers for diluting disinfectants, a water thermometer, anti-allergenic disinfectants - alaminol, brushes, ruffs - for processing instruments.

Dressing room instruments:

• - Trays;
• - Tweezers;
• - Clamps;
• - Muskites;
• - Needle holders;
• - Volkmann spoons;
• - Probes;
• - Scissors for removing sutures;
• - Scalpels;
• - Fenestrated tweezers;
• - Regular scissors;
• - Disposable sets for pleural puncture;
• - Suture material.

The structure and staffing of surgical rooms and departments depend on the structure of the clinic, the number of calls per shift (depending on this, there are 5 categories of clinics - from 400 to 1200 calls or more), its functions and tasks, in particular on the patient population. According to the norm, the population's need for outpatient services is 12.9 visits per year per city resident and 8.2 per village resident, including 1.4 visits to surgical offices (departments).

The surgical office of a district clinic consists of two, less often one or three rooms. In one room, the surgeon receives, registers and examines patients; the second, connected to the first, is used as a dressing room. If the office is one-room, the doctor’s table and the couch for examining the patient are in one half of the room, and the dressing table is in the second, and they are separated by a screen.

If the office or department consists of three rooms, the middle one is equipped as a doctor’s office, where he receives patients, the other two, located on both sides, are equipped with a dressing room and an operating room, or (less often) two dressing rooms - a clean one and a purulent one.

In large clinics (city, regional, etc.), the surgical department has four or more rooms: a doctor’s office, two dressing rooms (clean and purulent), an operating room, a preoperative room, and sometimes also a sterilization room. This is already an surgical dressing block.

In the surgical room, which is combined with a dressing room, the distribution of patients with clean and purulent wounds and processes is achieved by establishing a priority in work: patients with clean wounds are bandaged and operated on first, and those with purulent processes second. If there are two dressing rooms (without an operating room), surgical treatment of fresh wounds, dressing of clean wounds, as well as operations on planned patients are performed in a clean room.

In those surgical departments that also have an operating room, planned operations and surgical treatment of fresh wounds are carried out in the operating room. The premises of the surgical office and department, in particular their dressing rooms and operating rooms, in their design features and interiors must comply with all the sanitary and hygienic requirements for similar premises in a surgical hospital.

Purpose of a clean dressing room

Clean dressing room is intended for carrying out dressings after clean operations and for outpatient treatment of a number of diseases and injuries. The following interventions are performed in the dressing room.

• 1. Surgical treatment of shallow soft tissue wounds, introduction of antibiotics into the tissue surrounding the wound, suturing.
• 2. Reduction of simple dislocations after anesthesia.
• 3. Treatment of limited I-II degree burns without signs of suppuration: toileting the burn surface, applying a bandage.
• 4. Catheterization or puncture of the bladder for acute urinary retention.
• 5. Reduction of the head or dissection of the pinching ring in case of paraphimosis.

In addition, in case of severe injuries and acute surgical diseases with a critical condition of patients, they are provided with emergency care in the dressing room.

• 1. Removal from terminal conditions: restoration of airway patency, external cardiac massage, artificial respiration, intravenous jet administration of plasma substitutes.
• 2. Temporarily stopping external bleeding using a tourniquet, applying a ligature or clamp to a bleeding vessel visible in the wound, tightly tamponade the wound with gauze napkins and suturing the skin wound over tampons.
• 3. Anti-shock measures for severe traumatic shock: novocaine blockades, transport immobilization for fractures of the bones of the limbs, pelvis, spine; jet infusion of plasma substitutes intravenously, especially before the upcoming long-term transportation.
• 4. Application of a sealing bandage for open pneumothorax; puncture or drainage of the pleural cavity for tension pneumothorax; alcohol-novocaine intercostal or paravertebral blockade for multiple rib fractures.
• 5. Catheterization of the bladder in case of damage, spinal cord injury; puncture of the bladder in case of rupture of the urethra and overflow of the bladder.

Equipment and facilities for a clean dressing room

The dressing room is equipped in a room with an area of ​​at least 15 m2 with natural illumination of 1:4. The requirements for covering the ceiling, walls and floor of the dressing room are the same as in the operating room. The same applies to cleaning the dressing room. For hand washing, two sinks with hot and cold water mixer taps are installed in it. Equipment and fittings for dressing room may vary depending on local conditions and the predominance of a particular surgical pathology. Below is a sample list.

• 1. Dressing table - 1
• 2. Table for sterile materials and instruments - 1
• 3. Small tool table - 1
• 4. Gynecological chair - 1
• 5. Table for medicines and cutting instruments - 1
• 6. Screw chair - 2
• 7. Stands for bixes - 2
• 8. Enameled basins for hand treatment - 2
• 9. Basin supports - 2
• 10. Tool cabinet - 1
• 11. Cabinet for medicines - 1
• 12. Stand for hand operations - 1
• 13. Shadowless lamp with emergency lighting - 1
• 14. Germicidal lamp - 1
• 15. Bixes (sterilization boxes) of different sizes - 4
• 16. Stand with bottle holder for intravenous infusions - 1
• 17. Electric boiler (sterilizer) - 1
• 18. Quadrangular basin with lid - 1
• 19. Sphygmomanometer - 1
• 20. Hemostatic tourniquets - 2
• 21. Mouth retractor, tongue holder - 1 each
• 22. Breathing tube (air duct) - 1
• 23. Forceps in a jar with disinfectant solution - 1
• 23.Scissors for cutting bandages - 1
• 24. Disposable intravenous infusion systems, sterile - 4
• 25. Hair clipper and razor - 1 each
• 26.Set of transport tires - 1
• 27. Foot bath
• 29. Hand bath - 1
• 30.Hanger - 1
• 31.Plastic aprons - 3
• 32.Bucket for collecting dirty material - 1
• 33. A set of surgical instruments corresponding to the volume of operations and surgical work in the dressing room.

The medicine cabinet contains external agents and solutions for intravenous or subcutaneous administration on different shelves. P A sample list of products for external use is as follows:

• 1. Iodonate - 300 ml
• 2. Alcohol iodine solution 5% - 300 ml
• 3. Ethyl alcohol - 200 ml
• 4. Ether or gasoline - 200 ml
• 5. Hydrogen peroxide - 300 ml
• 6. Furacilin 1:5000 - 500 ml
• 7. Syntomycin emulsion - 200 g
• 8. Sterile Vaseline oil - 50 g
• 9. Ammonia (10% ammonia solution) - 500 ml
• 10.Degmicide - 1500 ml
• 11.Triple solution - 3000 ml

The following drugs are used as intravenous and injection drugs:

• 1. Glucose 40% solution in ampoules - 1 box
• 2. Poliglyukin in bottles - 5 bottles
• 3. Sodium chloride 0.85% solution - 1000 ml
• 4. Calcium chloride 10% solution in ampoules - 1 box
• 5. Novocaine 0.25% solution - 400 ml
• 6. Novocaine 0.5% solution - 800 ml
• 7. Novocaine 2% solution in ampoules - 2 boxes
• 8. Hydrocortisone in bottles - 4 bottles
• 9. Adrenaline 0.1% in ampoules - 1 box
• 10.Mezaton 1% in ampoules - 1 box
• 11.Diphenhydramine 1% in ampoules - 1 box
• 12.Caffeine 10% in ampoules - 1 box
• 13.Tetanus toxoid in ampoules - 1 box
• 14. Antitetanus serum in ampoules - 1 box
• 15. Various antibiotics in bottles - 30 bottles

The list of medications may expand or narrow depending on the nature and volume of work in the dressing room. On a two-tier table, medications and dressings are also placed in a certain order. On the top shelf there is a quadrangular basin with cutting tools filled with a triple solution, a forceps in a jar with a triple solution, suture material in ampoules or jars, cups, jars with a stopper for alcohol, iodonate solution, iodine, cleol. Bandages, cotton wool, and plaster are placed on the bottom shelf.

Before starting work in the dressing room, a sterile table with instruments and materials is set up, the set of which varies depending on the volume of work of the dressing room.

An approximate list of tools in the dressing room is as follows:

• 1.Needle holder - 3
• 2. Various hemostatic clamps - 12
• 3. Surgical tweezers - 8
• 4. Anatomical tweezers - 8
• 5.Toothed tweezers - 5
• 6.Kontsang - 2
• 7.Plate hooks (Farabefa) - 4
• 8. Two- or three-pronged sharp medium hooks - 4
• 9.Button probe - 3
• 10. Grooved probe - 3
• 11. Trocar in the set - 1
• 12. Various syringes - 8
• 13.Clips for attaching surgical linen - 8
• 14. Kidney-shaped coxae - 6
• 15. Cups for novocaine solution - 6
• 16.Urethral rubber catheters of different sizes - 3
• 17. Urethral metal catheters - 2
• 18.Drainage tubes and microirrigators - 10
• 19. Surgical gloves - 6 pairs
• 20.Injection needles for syringes, different - 20

Cutting instruments and surgical needles are stored sterile in a quadrangular basin, filled with a triple solution: scalpels - 6, scissors - 6, various surgical suture needles - 10. To provide emergency care in the dressing room, it is necessary to have special sets of sterile instruments for tracheostomies.

Tracheostomy kit

• 1. Surgical tweezers - 1
• 2. Anatomical tweezers - 1
• 3. Plate hooks (Farabefa) - 2
• 4. Hemostatic clamps - 4
• 5. Needle holder - 1
• 6. 10 ml syringe - 1
• 7. Different needles for the syringe - 3
• 8. Single-prong tracheotomy hooks - 2
• 9. Tracheotomy dilator - 1
• 10.Tracheotomy tubes No. 3 and 4 - 2
• 11.Cup for novocaine - 1
• 12. Kidney-shaped coxa - 1

These sets of instruments are placed in a kidney-shaped basin and sterilized in a dry-heat oven. After sterilization is completed, it is convenient to leave the kits in the same cabinet, the door of which is kept closed and sealed. To perform an urgent operation, cutting instruments are added to these instruments by removing them from the triple solution: scalpel, scissors, surgical needles. The suture material used is ampoule material, which is always ready for use. Sterile balls, napkins, towels are taken directly from the bix. In some institutions, the tracheotomy set is placed in a bix and sterilized in an autoclave.

Immediately before an urgent operation (surgical treatment of a wound) or dressing, an individual instrument table is covered from a large sterile table, and if the dressing is to be small, then instead of the table, the instruments are taken into a sterile kidney-shaped basin - individually for each patient.

To close wounds, cleol or adhesive plaster dressings are widely used, which provides significant savings in dressing material. To fix a sterile napkin on a wound in outpatient surgery, it is convenient to use mesh-tubular bandages "Retelast", which are made in different sizes: No. 1 - for fingers, No. 2 - for the hand and foot, No. 3 and 4 - for the shoulder and lower leg, No. 5 and 6 - for the head and thighs, No. 7 - for the chest and abdomen.

Minor surgery. IN AND. Maslov, 1988.

The surgical department requires more attentive and thorough patient care, especially in the postoperative period. The nurse must monitor as closely as possible and have patience with patients throughout the day and night; The slightest changes in blood pressure, pulse, appearance can lead to permanent consequences.

The nurse's work schedule is rotating, every three days. The surgical department is staffed by operating rooms and shift nurses who report to the head of the department, operating unit or the head of the medical institution.

The surgical department nurse borrows:

The operating room nurse, together with the surgical team, prepares the operating room, the necessary instruments, dressings, and suture material. During the operation, provides the surgical staff with instruments. She also does everything necessary to ensure the infection safety of staff and patients, and monitors compliance with all aseptic rules. The absence of postoperative complications in patients depends on the quality of work of the operating room nurse.

The shift nurse keeps logs of reception and transfer of duty, various medical documentation (logs of quartzing, dressings, general cleaning, disinfection treatment and other similar ones).

A nurse's working day begins long before patients get up. Then he turns on the lights in the wards, greets the patients, and distributes thermometers. After measuring the temperature, collects thermometers, records the readings in the medical history, and gives injections according to the prescription log. In a department with seriously ill patients, a nurse treats the patients’ eyes, mouth, nose, helps them wash, and combs their hair. Sends tests to the laboratory. After distributing medications, he reminds patients about the necessary tests and informs them when and where they will take place. Her responsibilities include preparing for X-ray and ultrasound examinations, and she also warns about hunger before upcoming examinations. According to the doctor's indications, he gives enemas, compresses, and bandages. Gives seriously ill patients a comfortable position in bed and ventilates the room. The nurse on duty helps distribute food, feeds seriously ill patients if necessary, and monitors diet for all patients. When returning to duty, the nurse reports on the condition of the patients, all incidents during the shift, prepares a sterile table with instruments, and prepares dishes for analysis.

Rules for working in the dressing room.

Prevention of nosocomial 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 compliance with the sanitary-hygienic and anti-epidemic regime when carrying out various surgical procedures. Today the topic of our article is the organization of work in the dressing room. We will talk about the work of dressing rooms using the example of the State Clinical Hospital named after. S.P. Botkin.

Organization of work in dressing rooms. In accordance with the requirements of current regulatory documents (SNiP 2.08.02-89), the department must have two dressing rooms (for clean and purulent dressings). However, many medical institutions have one dressing room. Therefore, it is especially important in the prevention of purulent-septic complications to strictly comply with the requirements of the sanitary-hygienic and anti-epidemic regime.

If there is only one dressing, patients with purulent wounds should be scheduled for the procedure at the end of the work shift. Here are the basic requirements that must be strictly observed when performing dressing changes in the department:

All dressings and instruments should be stored in bags for no more than 3 days or in packaging paper (kraft paper) for no more than 7 days. When opening the bix, the shelf life of the dressing material is no more than 6 hours. There should be a mark on the box indicating the time of opening;

To carry out dressings, prepare a sterile table, which is covered with a sterile sheet in one layer, so that it hangs 15-20 cm below the surface of the table. 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 the objects on the table, and is tightly fastened with clamps to the bottom sheet. The sterile table is set 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 the manipulations. Dressings are carried out wearing a sterile mask and rubber gloves. All items from the sterile table are taken with forceps or long tweezers, which are also subject to sterilization. Forceps (tweezers) are stored in a container (jar, bottle, etc.) with 0.5% chloramine or 3% or 6% hydrogen peroxide. The chloramine solution is changed once a day. 6% hydrogen peroxide is changed after three days. Containers for storing forceps (tweezers) must be sterilized in a dry-heat oven every 6 hours;

Unused sterile material is set aside for re-sterilization;

After each dressing or manipulation, the couch (table for dressings) must be wiped with a rag moistened with a solution of approved disinfectants;

After each dressing (manipulation), the nurse must wash gloved hands with toilet soap (be sure to soap them twice), rinse with water and dry with an individual towel. Only after this procedure are the gloves removed and thrown into a container with a disinfectant solution;

Used dressings are collected in plastic bags or special marked buckets and, before disposal, are pre-disinfected for two hours with a disinfectant solution.

As a rule, in our hospital, in each dressing room there is a dry-heat cabinet, where nurses sterilize all metal instruments (trays, tweezers, jars, forceps, etc.). The operation of the dry-heat oven is monitored using chemical tests: hydroquinone or thiourea at 180°. The dry-heat oven operates twice a day, and the operating mode is noted in the journal “Accounting for the operation of the dry-heat oven.” Dressings and rubber products in bags are sterilized in a central autoclave and delivered to all departments by specially designated vehicles.

Twice a day - in the morning before starting work and in the evening after finishing work - routine cleaning is carried out, combined with disinfection. For disinfection, a 1% chloramine solution is used. Once a week, a mandatory general cleaning is carried out: the room is cleared of equipment, inventory, tools, medicines, etc. A complex of disinfectant and detergent is used as a disinfectant. The disinfectant solution is applied by irrigation or wiping to walls, windows, window sills, doors, tables and a bactericidal lamp is turned on for 60 minutes. Then all surfaces are washed with a clean rag moistened with tap water, disinfected furniture and equipment are brought in and the bactericidal lamp is turned on again for 30 minutes.

Cleaning equipment specially designated for work in the dressing room (buckets, rags) are marked and after cleaning they are disinfected in a disinfectant solution for an hour.

A journal “Accounting for general cleaning” is kept in each office.