Responsibilities of a nurse in the surgical department. Organization of the work of dressing rooms Organization of the work of the dressing nurse of the surgical department

Let's see how it goes bandaging according to approved standards.

The first stage is preparatory

The dressing room is being prepared for work: wet cleaning and bactericidal irradiation are carried out.
Before starting dressings in the office, the nurse performs according to approved standards.
The nurse puts on sterile work clothes. Hands are treated with a sterile swab or cotton ball moistened with a skin antiseptic.
Sterile bix is treated twice with a napkin with disinfectant and opened.
The dressing table is disinfected and covered with a sterile sheet (one-time or bix). A disinfected oilcloth or plastic wrap is placed on top of the sheet.

Direct dressings

We cut the old bandage with scissors, the ends of which are directed in the direction that is safest for the patient and the nurse. Waste material is dumped into a container with a disinfectant solution. Leave the napkin on the skin.
We take out the first clip from the individual packaging. With a cotton ball with an antiseptic solution, we toilet the skin area on which the dressing is performed.
We remove the napkin left from the old bandage from the skin and discard it in the disinfectant solution. The first tweezers are also immersed in a container with a disinfectant solution for used tools.
We take out the second tweezers, take a sterile ball with them, moisten it in an antiseptic and treat the wound.
If you need to remove the seams - we take out the third tweezers, scissors and remove the seams.
With the second and third tweezers we apply an aseptic bandage on the wound surface.
We fix the bandage with a bandage or cleol.
Waste materials and tools are immersed in containers with a disinfectant solution, closed with lids and exposed.
After each dressing, wipe the surface of the oilcloth with a rag soaked in a disinfectant solution.
used dressing material after disinfection is collected in special plastic bags yellow color(class B waste). After filling, the bags should be sealed tightly and removed from the compartment for disposal.
Every 2 hours, the dressing room should be subjected to current wet cleaning using a disinfectant, ventilation and bactericidal irradiation. In this case, it is necessary to replace the sterile sheet on the dressing table.

should be shared bandaging for clean and festering wounds. For this, the so-called clean and purulent dressings are isolated. If this is not possible, clean dressings are performed first. After each dressing of patients with signs of suppuration or with purulent wounds, the sheet on the dressing table is replaced. Therefore, it is better to use disposable underwear.

The nurse must carry out bandaging according to the schedule approved by the head of the department. The schedule is posted in a conspicuous place - on the office door, or near it.

JSC "Astana Medical University"
Department of Surgical Diseases №1
SRS
ON THE TOPIC OF:
PARTICIPATION IN THE WORK
dressing room
SURGICAL DEPARTMENT
Prepared by: Saparbekova
A.E 446 OM
Checked by: Khasenov R.E
Astana 2016

Plan

PLAN
Dressing room is..
Types of dressings in the surgical
department
Instruments in the dressing room
surgical department
The activity of the nurse in the dressing room

Dressing room is…

DRESSING IS…
specially equipped room for
performing dressings and minor surgeries
physical manipulations (removal of sutures,
laparocentesis
, medical and diagnostic punctures, etc.
p.) In the surgical department, usually
allocate clean and purulent dressings.

Conditions for dressing surgical department

CONDITIONS FOR DRESSING
SURGICAL DEPARTMENT
The dressing room should be light,
preferably with walls finished
tiled or painted with oil
paint. It must have good
ventilation, optimal temperature and
humidity. Need to ensure
cold and hot water supply, have
sink for washing hands and tools.
The area of the dressing room on 1 table should
be 22 m2.

Instruments in the dressing room of the surgical department

INSTRUMENTS IN THE dressing room
SURGICAL DEPARTMENT
Equipment
dressing room:
1) Table for tools and
dressing material - 1
PC.;
2) Distiller - 1 piece;
3) Germicidal lamp - 1
PC.;
4) Tripods for long
injections - 2 pcs.;
5) Refrigerator for
storage of medicinal
preparations, etc. - 1 pc.;

6) Hemostatic
harnesses - 2 pcs.;
7) Chairs or stools - 3 pcs.;
8) Stands-benches - 2 pcs.;
9) Operating table /
gynecological chair - 1
PC.;
10) Tool cabinet - 1
PC.;
11) Storage cabinet
medicines - 1 pc.;
12) Desktop - 1 piece;
13) Medical table
documentation - 1 piece;

14) Collection tongs
contaminated dressing room
material - 2 pcs.;
15) Tanks for disinfection
solutions - at least 4 pcs.;
16) Garbage pails: dry
white bag; medical
yellow bag - 2 pcs. ;
17) Mobile lamp reflector - 1 piece;
18) Oilcloth aprons or
plastic - 4 pcs.;

20) Disposable sterile
coats, gloves, hats,
masks, shoe covers - in abundance;
21) Disposable sterile
linen - in abundance;
22) Ready sterile
material - in abundance;
23) Tanks for
preparation of workers
disinfectant solutions
funds, measuring containers
for breeding
disinfection

Dressing room tools

INSTRUMENTATION OF THE DRESSING
OFFICE
-
Trays;
Forceps (anatomical and surgical)
clamps;
Kortsang
Maskites;
Needle holders;
Volkmann's spoons;
probes;
Scissors for removing seams;
scalpels;
The tweezers are fenestrated;
Scissors are ordinary;
Disposable sets for pleural puncture;
Suture material.

Layout of instruments and material on the dressing table

LOCATION DIAGRAM OF INSTRUMENTS AND MATERIAL ON
dressing table

"Clean" dressings

"CLEAN" dressings
punctures of bones, joints, soft tissues, and
also the spinal canal;
pleural punctures, because not always possible
anticipate the nature of the content
pleural cavity;
bandaging of fresh postoperative wounds;
removal of stitches;
dressing other clean wounds.

"Purulent" dressings

"PURULENT" dressings
In purulent dressings
set depending on
quantity and quality of purulent
detachable. Lastly
bandaged patients with fecal
fistulas and anaerobic wounds.
It is UNACCEPTABLE that one medical
sister worked in two dressing rooms at once
(clean and purulent).

opening of abscesses
introduction of a drain into the pleural cavity
with empyema, etc.
bandage patients with intestinal and
fecal fistulas.

Carrying out dressings

CARRYING OUT THE BANDAGES
The first stage is preparatory
The dressing room is being prepared for work:
wet cleaning and bactericidal irradiation.
Before you start dressing in the office,
the nurse is washing and sanitizing hands
according to approved standards.
The nurse puts on sterile work clothes.
Gloved hands are treated with a sterile swab or
cotton ball moistened with a skin antiseptic.
Sterile bix is processed twice with a napkin with
disinfectant and opened.
The dressing table is disinfected and covered
sterile sheet (single or bix). over
sheets are placed disinfected oilcloth
or polyethylene film.

Second
stage
1. Removal of the old bandage with its subsequent disinfection or
burning and toileting the skin around the wound (rubbing it
ether, then 96% ethyl alcohol and lubrication 5-10%
alcohol solution iodine).
2. Protecting the skin around the wound with sterile gauze from
secretions from it.
3. Performing manipulations in the wound (treatment of the scar 5-10%
alcohol solution of iodine, removal of sutures or probing in the area
scar, with purulent wounds - removal of pus with sterile wipes
from the wound, washing the wound with antiseptics, etc.).
4. Applying a new aseptic dressing. Scar after suture removal
lubricate with 5-10% alcohol solution of iodine and apply more often
just a dry aseptic bandage. After granulation treatment
or festering wound the skin around it is lubricated zinc paste(For
prevention of skin maceration) and apply a bandage with
antiseptics.

Third stage
Dirty instruments, rubber and glass
objects are disinfected in a 3% solution
Lysol for 30 minutes or in a 0.5% solution
ammonia for 3 hours. After disinfection, they
washed with soap in running water, then boiled in 2%
sodium bicarbonate solution 20 min. Better than them
be autoclaved. Dressing
she puts the material and operating linen in
biks, which the nurse takes to the autoclave for
sterilization. Each bix has its own address.

dressing room nurse job responsibilities

JOB DUTIES
DRESSING ROOM NURSES
organization of collection and disposal of medical waste.
Instructs junior medical staff
dressing room and controls its work.
Timely and correct management
medical records
Measures for the timely and
high-quality performance of medical diagnostic procedures:

Types of cleaning in the dressing room

TYPES OF CLEANING IN
dressing
preliminary
Current - every 2 hours
Final
(big)-after
manipulation
General - 1 time per
week

List of used literature

LIST OF USED
LITERATURE
Kuzin M.I. Antisepsis and asepsis from
N.I. Pirogov to the present day, M., 1999;
General Surgery, ed. W. Schmitt,
V. Hartig and M.I. Kuzina, vol. 1, p. 5, M.,
2005;
Struchkov V.I., Gostishchev V.K. And
Struchkov Yu.V. Purulent guide
surgery, p. 101, M., 1998

erythromelalgia

The disease was first described by Mitchell in 1878. The name comes from the Greek words erythros - red, melos - part of the body, algos - pain. It is believed that the development of the disease is due to a violation of the innervation of the vessels of the lower extremities. In patients, acute expansion of capillaries, arterioles, and veins occurs. Clinically, this is manifested by bouts of burning, throbbing pain in the feet, much less often in the legs and thighs. There is hyperemia of the skin, a sharp local increase in temperature, edema, hyperhidrosis. These symptoms usually occur in the evening or at night and are aggravated by heating the legs, walking, standing, mechanical irritation. Seizures can last up to several hours. The intensity of pain decreases with cooling (under the influence of cold water). With the progression of the disease, permanent trophic changes in the limbs appear (edema, dryness and peeling of the skin, brittle nails and changes in the bones). However, patients never develop trophic ulcers. The cause of erythromelalgia can be injuries, thermal effects (overheating or frostbite), diseases of internal organs. Quite often, such disorders occur in patients with syringomyelia, myelitis, multiple sclerosis, polycythemia, sometimes as an independent disease.

Treatment includes the appointment of vasoconstrictor drugs (caffeine-sodium benzoate, ephedrine hydrochloride, mezaton, ergotamine), painkillers (analgin), anticonvulsants (carbomazeggin), physiotherapy methods (carbonate baths are advisable). Sometimes, in order to interrupt the sympathetic vasodilating effects on the affected limbs, surgical intervention is used (transection of the posterior roots, resection of the lumbosacral sympathetic trunk).

Dressing room - a specially equipped room for the production of dressings, examination of wounds and a number of procedures performed in the process of treating a wound. Minor operations, more often with purulent diseases (carbuncle, panaritium), intravenous infusions, punctures, blockades, blood sampling from a vein, etc., are also performed in the dressing room, if there is no special procedural one.

In large surgical departments there are two dressing rooms: "clean" and "purulent". If there is only one dressing room, then both aseptic and infected wounds. With good organization of work and strict observance of asepsis, this does not pose a danger.

Under the dressing room, a spacious bright room is assigned, the floor, ceiling and walls of which are covered oil paint or tiles so that they can be easily cleaned. The dressing room is well ventilated, the temperature is maintained at no lower than 18°C, and impeccable cleanliness is maintained.

In the outpatient clinic of the rural medical district, at the feldsher-obstetric station, there is a doctor's office (paramedic) and a dressing room. In the dressing room of the feldsher-obstetric station (see), dressings and minor surgical operations are performed (bandaging and sutures in case of injury, bleeding arrest, reduction of simple dislocations, splinting for bone fractures, opening of superficial abscesses, etc.); provide gynecological care to the extent permitted by midwives. To perform these manipulations, the dressing room should contain the necessary set of tools, dressing material, splints for immobilizing fractures (dislocations) and medicines.

In hospitals, dressing rooms are usually located in rooms isolated from other rooms (wards, operating rooms). If there is one operating room in the surgical department for aseptic (clean) operations, surgical treatment of wounds, removal of atheromas, foreign bodies, as well as purulent operations (opening panaritium, carbuncle) are performed in the dressing room. After dressings, the dressing room can be used to examine patients, prepare them for surgery, etc.

The equipment of the dressing room consists of one or two tables (wooden or metal) for patients, several stools for sedentary patients, tables for sterile instruments and sterile dressings, glass cabinets for storing instruments, medicines and bandages, a washbasin with hot and cold water, stands for sterilizers, heat source (electric stove), basins for removed dressings, bottles with disinfectant solutions, trays for dirty instruments. They also place sets for anesthesia, tracheotomy, a basin with a diocide solution for treating hands, bixes with sterile dressings and gloves, trays for syringes, boiled brushes; install lighting fixtures, bactericidal lamps. In the dressing room, you must have: syringes with a capacity of 20, 10 and 5 ml, anatomical and surgical tweezers, straight and curved scissors, blunt and sharp hooks for diluting the edges of the wound, hemostatic clamps, scissors for removing bandages, both soft and hard (gypsum) , bellied and grooved probes, tourniquets, forceps, scalpels, needle holders, spatulas, catheters, suture material.

Before starting work in the dressing room, the dressing nurse treats her hands in the same way as before the operation, covers the table with a sterile sheet, lays out the necessary sterile material and tools on it, which she covers with a second sterile sheet. The doctor (paramedic) working in the dressing room receives everything he needs from the sterile table through the dressing nurse, who uses a sterile forceps.

Instruments are sterilized in the dressing room itself or in a separate room associated with the dressing room - in the pre-dressing room.

Registration log emergencies in the staff department.

Documentation

Journal of registration of a bactericidal installation and accounting of the operation of bactericidal lamps

1. Characteristics of bactericidal installations and lamps.

2. Accounting for the operation of germicidal lamps.

No. bacter.	current cleaning	spring-cleaning	number of working hours

Schedule

General cleaning of the treatment room

(name of division)

Magazine

taking into account the quality of pre-sterilization treatment

Magazine

Registration of cases of nosocomial infection

in patients of the department

(name of department)

Magazine

registration of cases of nosocomial infection among department staff

(name of department)

Dressing room - a specially equipped room for the production of dressings, examination of wounds and a number of procedures in the process of treating wounds. In the dressing room, injections, transfusions and minor surgeries can also be performed.

Dressing rooms in neurosurgical, gynecological, urological and burn departments have equipment corresponding to their profile.

The first dressing rooms appeared in the Moscow Hospital and St. Petersburg Marine Hospital built by the decree of Peter I. The dressing rooms were divided into clean and purulent ones by N.I. Pirogov.

Depending on the profile of the department in a clean dressing room, they produce: novocaine blockades, diagnostic and medical punctures chest and abdominal cavity. They also carry out blood transfusions and infusions of certain drugs. Often, small operations are performed in clean dressing rooms. Imposition of skeletal traction, removal of tumors of the skin and subcutaneous tissue, primary treatment of small wounds of patients admitted by ambulance.

Organization of the work of a purulent dressing room and features of care for patients with purulent pathology.

For patients with purulent wounds, a separate ward section is allocated, or separate wards in a separate wing of the department, as far as possible from the operating unit. A purulent dressing room is allocated separately for these wards, and all patients are served by separate personnel. If there is one dressing room, patients with purulent wounds are bandaged after "clean" dressings have been performed, with careful further treatment of the premises and equipment with disinfectant solutions.

In purulent dressing rooms, treatment of purulent wounds, puncture and opening of abscesses, and other manipulations with a patient with a purulent infection (including blood transfusion) are performed. It is unacceptable to call purulent dressings dirty, since in the treatment of purulent patients it is necessary to adhere to strict asepsis so that there is no additional infection of the purulent wound with microbes of the second patient. This secondary infection can cause severe complications(suppuration, sepsis, etc.). The staff working in the dressing room, where both clean and purulent dressings are made, must be especially careful and attentive so as not to confuse the instruments used in dressing clean and purulent patients. In a dressing room, overloaded with equipment and furniture, where there are many people every day, it is much more difficult to keep clean and tidy. The dressing nurse during dressings directs the work of the dressing room and requires the strictest observance of all asepsis rules.

A strict order of dressings is established: first clean (for example, after plastic surgery), and lastly - conditionally clean.

Disposal of dressings contaminated with purulent secretions (cotton wool, lignin, gauze) is carried out by burning.

dressing room- a specially equipped room for performing dressings and minor surgical procedures (removal of sutures, laparocentesis, therapeutic and diagnostic punctures, etc.). P. is deployed in hospitals and outpatient medical institutions, at surgical departments and offices (surgical, traumatological, urological). Allocate P. for the so-called clean dressings and individual 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 dressing room area is determined based on 1 table 22 m 2 and for dressing rooms on 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 preferably to the ceiling. The floor is covered with ceramic tiles or wide sheets of durable linoleum, the joints between which must be well coated with a special putty that does not allow water to pass through. The dressing room should have 2 separate barns for washing hands and for washing tools with appropriate markings and mixing taps for hot and cold water. The design of the heating system should not impede wet cleaning. The most convenient heaters are in the form of pipes located horizontally one above the other at a distance of 25-30 cm from the wall, or solid shields. The optimum air temperature for P. is about 22°. P.'s windows are oriented to the north, northeast or northwest. For better natural light, the ratio of the area of windows (or windows) to the floor area should be at least 1:4.

For artificial lighting on the ceiling, fixtures with a total power of at least 500 Tue at 50 m 2 rooms that can be subjected to wet cleaning. 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 inflow, providing a double air exchange in 1 h. It is also recommended to have mobile recirculating air cleaners (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. For air disinfection, bactericidal irradiators are installed: ceiling (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 not more than 6-8 h. Preferably every 2-3 h work P. take a 10-minute break and turn on bactericidal lamps. In purulent P., you should additionally have a bactericidal beacon-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 dressings and linen, a ladder stand, a hanger -rack. Enameled basins and buckets with lids for used dressings are also needed. An operating table of any model can be used as a dressing table (see Fig.

Medical equipment ). Before each dressing, the dressing table is covered clean sheets. A large instrumental and material sterile table is prepared daily at the beginning of the working day after the preliminary cleaning of P. Only the dressing sister opens it. All items from the table are taken with sterile long tweezers or forceps. Tools, dressings, vessels with antiseptic solutions should have their own strictly defined places on tables and cabinets, shelves in cabinets should be marked. The set of instruments and their number depend on the profile of the department or cabinet in which the dressing room is deployed.

Medical staff, working in the dressing room, must strictly follow the rules asepsis , daily change bathrobe, hat, mask. In clean P., first of all, manipulations are performed that require strict asepsis (blockades, punctures, laparocentesis, etc.), then the patients 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 last of all, patients with fecal

Dressings play an important role in the treatment of wounds. For this reason, the rules of wound dressing must be strictly followed. There are general rules, but there are specific ones, depending on the type of damage.

General information about dressings

Bandaging is a medical procedure that is indispensable in the treatment of wounds. Her main tasks:

examination of the wound surface;
treatment of the damaged area and the skin around it;
wound cleaning;
drug therapy;
replacement of the old bandage by applying a new one.

This is the general algorithm of 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 bandaging in particularly severe cases.

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

clean postoperative wounds are bandaged 1 week after surgery in order to remove the sutures;
superficial lesions that heal under the scab are also rarely dressed;
purulent wounds are bandaged every 2-3 days if they do not show signs of getting wet;
dry ulcers are also bandaged 1 time in 2-3 days;
wet-drying dressings, which are abundantly saturated with purulent secretions, are changed every day;
dressings that are soaked in intestinal contents or Bladder, change from 2 to 3 times a day.

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

General rules for bandaging

The specialist performing this manipulation must follow the general rules.

The main ones are:

Don't touch the wound. Under no circumstances should you touch the wound surface with your hands.
Disinfection. Before starting treatment, the nurse should wash and disinfect the hands and skin of the patient.
Sterility. This applies primarily to dressings and instruments.
Position. It is very important for the dressing to be evenly applied so that the affected part of the body is in the correct position.
Bandaging direction. Correctly perform this procedure in the direction from the bottom up and from left to right. The bandage should be unwound with the right hand, and the bandage should be held with the 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.
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.
Fixation. In order for the dressing to be firmly fixed, it is necessary to bandage from the narrowest part to the widest. Do not make the bandage tighter than necessary.

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

Clean wound dressing algorithm

A clean wound is one in which there are no signs of infection: there is no pus or any pathological processes, it granulates, there is no local increase in temperature, redness of the skin around it, 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 at the same time from 1 to 3 days passed;
the time has come for the removal of stitches;
if the bandage is abundantly wet with blood or ichor.

To treat a clean wound, it is necessary to prepare the following sterile instruments:

2 trays, one of which is intended for the use of dressings;
dressing material: plaster, bandage, cleol;
tweezers;
medical mask and gloves;
hand sanitizers nurse and skin of the patient;
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:

Disinfects hands: washes them with soap and then treats them with an antiseptic. Puts on gloves and a mask.
Prepares dressing table. To do this, the table is covered with a clean sheet, because the procedure is performed in the position of the patient lying down.

After that, 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!):

Removes old bandage. For this, tweezers are used.
Examines the wound. This applies not only to the method visual inspection, but also a palpation method for assessing the condition of the skin of the seam.
Carries out the treatment of the skin around the wound. To do this, the nurse moistens a napkin in an antiseptic. In this case, the direction of the tweezers is from the edges of the wound to the periphery.
Performs seam processing. For this, a napkin with an antiseptic is also used. This procedure is performed with blotting movements.
Apply a clean, dry cloth to the wound. After that, fix it with a bandage, plaster or cleol.

Finally, the last step is the complete disinfection of used instruments, dressing materials and work surfaces.

Purulent wound dressing algorithm

If the wound becomes infected, it appears purulent discharge. In addition, the patient's body temperature rises, pain pulsating character. Indications for dressing are the following situations:

the bandage is impregnated with purulent contents;
it's time for another dressing;
bandage has shifted.

For the procedure, it is necessary to prepare the following sterile instruments:

Trays. You will need 2 of them, one of which is for used tools and material. In addition, you need a table for tools.
Dressing. In particular, cleol, plaster, bandage.
Dressing tools: tweezers, scissors, probe, syringe, clamps, rubber drains (flat). You will also need medical gloves, an oilcloth apron and a mask.
Antiseptic solution. It is needed to treat the doctor's hands and the patient's skin.
Hydrogen peroxide solution.
Solution for disinfection. It is needed for final surface treatment.
Clean fabric.

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 disinfects his hands with an antiseptic, puts on a mask, gloves and an apron. The apron is additionally treated with a disinfectant solution. Then they additionally wash with soap and treat with an antiseptic and hands that are already wearing gloves.

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

He takes off the old bandage. You need to do this with tweezers.
Treats the wound. To do this, you need a napkin dipped in a solution of hydrogen peroxide.
Dries the seam. To do this, use a clean dry cloth. The movements in this case are of a wet character.
Treats the seam and leather. For this, wipes moistened with an antiseptic solution are used. They process the seam and skin near him.
Reveals the place of suppuration. To do this, the doctor performs palpation around the seam.
Removes stitches. In the focus of suppuration, the doctor removes no more than 1-2 stitches and expands the wound with a clamp.
Washes the wound. To do this, use a napkin moistened with hydrogen peroxide, or a syringe with a blunt needle.
Dries out the wound. To do this, the doctor takes a dry napkin.
Treats the skin around the wound. To do this, use a napkin with an antiseptic solution.
Introduces sodium chloride solution into the wound. It can be entered in two ways: with the help of drainage or turunda.
Puts a napkin soaked in an antiseptic solution on the wound.
Secures the napkin. For this, a bandage is used.

After that, the doctor conducts a complete disinfection of all work surfaces and instruments.

FEATURES OF THE ORGANIZATION OF 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

SP is a series of actions leading to a certain result and including 5 main stages.

FIRST STAGE - EXAMINATION OF THE PATIENT

SEQUENCING:

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

2) physical examination: blood pressure, heart rate, body temperature; Height Weight; detection of visual impairment, hearing, memory, sleep, motor activity; examination of the skin, mucous membranes; examination by systems (musculoskeletal, respiratory, CCC, digestive, urinary);

3) laboratory and instrumental studies: as prescribed by a doctor.

The foundation of nursing examination 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 - to communicate, play, study, work

Respect needs – to be competent, to achieve success, to be approved

Later, Maslow identified 3 more groups of needs:

Cognitive - to explore, to know, to 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 - IDENTIFICATION OF THE PATIENT'S PROBLEMS AND FORMULATION OF NURSING DIAGNOSIS.

CLASSIFICATION OF PROBLEMS:

PHYSIOLOGICAL - pain, choking, coughing, sweating, palpitations, nausea, lack of appetite, etc.

PSYCHOLOGICAL - fear, depression, anxiety, fear, anxiety, despair, etc. Reflect the disharmony of the person who got into an unusual situation (shame when setting an enema, etc.).

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

SPIRITUAL - loss of the meaning of life, one on one with the disease, no friend.

PATIENT PROBLEMS are divided into EXISTING AND POTENTIAL.

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

POTENTIAL PROBLEMS are those that may arise over time. In surgical patients, this is a violation mental state(reaction of the body to premedication), pain, changes in the state of the body (T, blood pressure, blood sugar, disruption of the intestines) with comorbidities. As a rule, the 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 syndrome, 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 as a result of a nursing examination and requiring intervention by a nurse. In fact, these are problems that a nurse can prevent or resolve. Nursing diagnosis differs from medical diagnosis and is aimed at identifying the body's response to a disease. The diagnosis can change as reactions in the body change. Nursing diagnosis is formulated in PES format, where P- problem ..., E- ... related to ..., S- ... confirmed ... (signs of a problem)

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

Goals must be realistic and within the competence of the nurse!!

There are two types of goals:

SHORT TERM should be completed in a short period of time, usually 1-2 weeks. They are usually placed in acute phase diseases/

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 refers to activities carried out by the nurse on her own initiative.

DEPENDENT nursing intervention is performed on the basis of a written prescription of a doctor and under his supervision.

INTERDEPENDENT nursing intervention involves joint activities nurses with a doctor and other specialists (nutritionist, exercise therapy instructor).

Leading the fourth stage of the nursing process, the sister carries out two strategic directions:

Monitoring and monitoring the patient's response to doctor's prescriptions

Observation and control of the patient's response to the performance of nursing activities. Both are recorded in the nursing history of the disease.

FIFTH STAGE - EVALUATION OF THE EFFICIENCY OF THE NURSING PROCESS

Its PURPOSE is to evaluate the patient's response, results and summarizing. Evaluation of the effectiveness and quality of care should be carried out by the senior and main sister constantly and by the sister herself in the order of self-control at the end and beginning of each shift. If the goal is not achieved, then it is necessary to identify the reasons, the timing of 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, procedural.

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

One of the main tasks of the department is to ensure the prevention of nosocomial infection (HAI), therefore, all surgical patients are divided into "purulent, septic" (GSI), "clean, aseptic" and trauma. The streams of these patients should be separated.

The wards are equipped with special functional beds and a minimum number of pieces of furniture (a bedside table, a 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 HSI - 2. The filling of the wards for burn patients is "one-time". Beds must be accessible from all sides. Optimum air temperature in the wards is 20-25*.

Office cleaning 3 times a day, incl. 1 time with disinfectants, in burn and CSI wards - 3 times with disinfectants. After cleaning - air disinfection. When performing work in the wards for patients with GSI, the personnel must wear gloves and a special protective cover, which is specially allocated and has a distinctive marking.

Change bed linen 1 time in 7 days and as it gets dirty, collection of linen - in a waterproof container, storage in a special room of the department for a maximum of 12 hours. Bedding (mattress, blanket, pillow) is subject to non-chamber processing after discharge, transfer to another department or death of the patient, contamination with biomaterial. Mattresses and pillows in tightly sewn hygienic covers can be decontaminated by wiping or irrigating the covers with a solution of a chemical disinfectant.

Processing the bed, bedside tables with a disinfectant - after the patient is discharged, transferred to another department, before the patient enters.

General cleaning 1 time in 7 days, in burn wards - and after a single discharge of patients, when reprofiling the wards.

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

The work of a nurse is based on the knowledge and implementation of the requirements of regulatory documentation governing the observance of the sanitary and epidemiological regime, the organization of work and the correct performance of all manipulations related to the competence of the medical profession.

MAIN RESPONSIBILITIES OF A NURSE

The duties of a nurse include:

Strictly observe the rules of internal labor regulations;

Accurately and timely carry out the procedures prescribed by the doctor;

Ensure the issuance, receipt, storage, control of expiration dates, expenditure of medicines, property necessary for work;

Timely complete the syndromic kits for medical care in case of emergency;

Ensure the implementation of measures aimed at preventing nosocomial infections

News medical documentation according to the established forms (logs for the reception and delivery of duty, medical appointments, accounting for medicines, registration of admitted and retired patients, temperature sheets, etc.);

Constantly improve your skills and professional level.

ORGANIZATION OF WORK IN THE dressing room.

DRESSING ROOM - a specially equipped room of a surgical hospital or an outpatient institution 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 dressing of purulent patients, they are carried out after clean. The dressing room equipment consists of dressing tables, cabinets with instruments and medicines, a table with sterile material, on which the most frequently used instruments and prepared sterile dressings are located. At dressing tables there are basins on stands for used dressings. In addition, the dressing room should have stands for transfusion of blood and solutions, portable devices to give oxygen and anesthesia. ORDER OF WORK IN THE dressing room

During dressings, outsiders are not allowed to enter;

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

Medical instruments are disinfected according to the virucidal regime;

In emergency dressing rooms, 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 was not used;

For planned work, a sterile table is prepared for the start of dressings every morning;

It is necessary to monitor the rapid removal of the used dressing, which is collected in sealed containers with subsequent incineration;

Linen of a purulent dressing room should have a special marking, because it is unacceptable to use it in a clean dressing room.

Cleaning of the dressing room (preliminary, current, final, general) and bacteriological control is carried out in the same way as in the operating room (see below).

ORGANIZATION OF THE WORK OF THE OPERATING UNIT

Operating block - a complex of specially equipped rooms 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-storey surgical building. It distinguishes separated operating rooms for performing clean and purulent operations. In addition to operating rooms, the following specially equipped rooms are provided in the operating block: preoperative room, sterilization room, blood transfusion room, anesthesia room, material room, plaster room, manager's office, staff rooms, sanitary checkpoint.

The organization of the work of the operating unit and the rules of conduct in it are strictly regulated. The fundamental principle in the work of the operating unit is the strictest observance of asepsis rules. 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, there should be no extra people in the operating room. Persons with acute respiratory diseases and purulent-inflammatory processes are not allowed to be in the operating room. The entrance to the operating room of the personnel is through the sanitary inspection room, which is divided into 2 zones; the staff (if necessary) takes a shower, puts on a surgical suit of shoe covers, a cap, a mask and goes to the preoperative room, where they wash and surgically sanitize their hands. Members of the surgical team wear a waterproof apron. The staff wears a sterile gown and gloves in the operating room. Change of clothes and PPE - after each operation. Change of masks and gloves - every 3 hours with repeated surgical hand antisepsis. If gloves are damaged - the same. For all members of the operating team, special clothing is used, which differs in color from the accepted clothing in other departments of the hospital

Delivery of the patient - on the gurney of the operating unit through the gateway. The wheelchair is disinfected after each patient. All devices, devices imported into the operating unit must be disinfected.

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

Some additional requirements are imposed on the order of work in a purulent operating room. Surgical instruments, dressings and underwear 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. The used dressing material is burned.

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

GENERAL ZONE: here are the offices of the head, the head nurse, rooms for storing and sorting linen and tools.

ZONE OF LIMITED MODE, or technical zone combines industrial premises to ensure the operation of the operating unit. There are air-conditioning equipment, vacuum units, installations for supplying the operating room with oxygen, an accumulator substation for emergency lighting, a photographic laboratory for developing X-ray films. Material - a room for storing stocks of tools, suture material and medicines.

The strict regime zone includes such premises as a sanitary inspection room, rooms for storing surgical instruments and devices, anesthesia equipment and medicines, a blood transfusion room, rooms for the duty team, and the senior operating nurse.

The STERILE REGIME ZONE combines the operating, preoperative and sterilization areas.

CLEANING OF THE OPERATING UNIT is always carried out with 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 (floor, tables and window sills) are wiped with a damp cloth to collect dust that has settled overnight, bactericidal ultraviolet lamps are turned on to disinfect the air;

The current one is carried out during the operation; the nurse collects all accidentally dropped balls, napkins from the floor, wipes the 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 is carried out at the end of the trading day.

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

Traumatology and orthopedics. E.P. Mezhenina, Yu.G. Zalozny. Second edition, enlarged. Kyiv. "Vishcha school." 1985

Leading specialists in the field of traumatology and orthopedics

Sikilinda Vladimir Danilovich - Professor, Head of the Department of Traumatology and Orthopedics, Rostov State Medical University. Doctor medical sciences, Professor. Member of SICOT from Russia. Vice President of the All-Russian Association of Traumatologists and Orthopedists. Traumatologist-orthopedist the highest category. Chairman of the Society of Orthopedic Traumatologists of the Rostov Region.

Golubev Georgy Shotovich - Professor, Doctor of Medical Sciences, Chief Traumatologist-Orthopedist of the Southern Federal District, Head of the Department of Traumatology and Orthopedics, Exercise and Sports Medicine of the FPC and PPS of Rostov State Medical University, Head of the Orthopedic Department of the ML PHI "GB No. 1 named after. N. A. Semashko”, Member of the International Association for the Study and Implementation of the Ilizarov Method (ASAMI), Member of the American Association of Orthopedic Surgeons (AAOS), Member of the Russian Arthroscopic Association.

Krolevets Igor Vladimirovich - Doctor of Medical Sciences, Traumatologist-orthopedist of the highest category, Assistant of the Department of Traumatology and Orthopedics, physiotherapy exercises and sports medicine FPC and teaching staff, Full member of the Russian Arthroscopic Society, Chairman of the Rostov-on-Don branch.

Alabut Anna Vladimirovna, Associate Professor of the Department of Traumatology and Orthopedics, Head of the Department of Traumatology and Orthopedics of the Clinic of Rostov State Medical University, Doctor of Medical Sciences

Aschev Alexander Viktorovich - Assistant of the Department of Traumatology and Orthopedics, Physical Therapy and Sports Medicine of the Faculty of Physical Education and Training of the Rostov State Medical University, Candidate of Medical Sciences, Traumatologist-orthopedist of the highest category.

Zabrodin Mikhail Alekseevich - Head of the trauma center, MBUZ "City Hospital No. ON THE. Semashko" of the city of Rostov-on-Don, Traumatologist-orthopedist of the first qualification category, Chief freelance rabiologist of the Ministry of Health of the Rostov region, Medical lawyer

Page editor: Oksana Kryuchkova

In the work of the surgical department, dressing rooms play no less a role than operating rooms. The scope of work in the dressing room is vast and varied. In addition to dressings, small clean operations can be performed in them (primary surgical treatment of wounds, removal of atheromas, etc.), and in purulent dressing rooms, panaritium and other abscesses can be opened. A nurse in a dressing room should provide such manipulations: diagnostic and therapeutic punctures, blood infusions and transfusions, endoscopy, reduction of dislocations and fractures, and the application of plaster bandages.

Bandaging of postoperative wounds is performed, as a rule, if the bandage is wet or there is pain. If a bandage has been applied, the soaked bandages are cut with scissors, if a sticker, it is removed with alcohol or ether. With tweezers, take the edge of the bottom napkin (lying directly on the wound) and remove it along the wound. The skin is held with a special napkin and slightly pulled, then the bandage from the postoperative wound is easily removed. The skin around the wound is lubricated with alcohol, completely removing the cleol, then the skin is dried with a dry sterile swab. The line of sutures and the skin around the wound are lubricated with iodonate, the wound is covered with a sterile napkin, a bandage, glue or adhesive bandage is applied. Cut off excess gauze. Cleol lubricates only the skin, but not the gauze, otherwise it will not hold. If the edges of the wound or the skin around it are pink and tense, then the doctor removes 1-2 stitches, the wound is dried and the manipulations described above are performed. Sometimes it is necessary to introduce drainage or turunda into the wound, which, as a rule, are removed the next day or replaced with new ones. If the dressing has dried to the wound, then before removing it, moisten it with a 3% solution of hydrogen peroxide and remove it.

When the wound suppurates before dressing, the sister puts an oilcloth under the patient and substitutes a kidney-shaped tray so that the purulent discharge does not fall on the table. The bandage is removed and thrown into a bucket with a closed lid. The surgeon removes all sutures, examines the wound, sometimes widening its edges, and proceeds to treat it. A napkin or tampons moistened with antiseptic solutions, drain (if necessary), cover with sterile cotton and apply bandage. All these manipulations are carried out in the dressing room for purulent dressings.

To combat nosocomial infection (this also applies to dressing rooms), the dressing room is cleaned 2 times a day in a wet way using disinfectant solutions. General cleaning should be done once a week. For this purpose, the dressing room is freed from equipment, inventory, apparatus, tools, medicines, etc. A detergent with the addition of 6% hydrogen peroxide solution is used as a disinfectant solution. After cleaning, the dressing room is irradiated with ultraviolet light or a bactericidal irradiator (one irradiator per 30 m3 for two hours).

There must be a muffle furnace for the disposal of dressings. After bandaging, the instrument must be washed under running water for 1 minute, immersed for 15 minutes in a washing solution (at a temperature of 50 ° C), rinsed with running water, dried in a dry-air sterilizer at a temperature of 80-85 ° C and handed over for sterilization (steam, dry air or chemical). The quality of washing tools, syringes, needles is determined mainly by the benzidine test.

To conduct a benzidine test, mix a 0.5-1% solution of benzidine chloride prepared in distilled water with an equal amount of a 3% hydrogen peroxide solution or in a solution consisting of 5 ml of 50% acetic acid and 0.025 g of benzidine sulfate dissolved in it, add 5 ml of a 3% hydrogen peroxide solution.

Then, 2-3 drops of the reagent are applied to the controlled product. In the presence of blood contamination, a blue-green color appears.

A phenolphthalein test can also be used. 1-2 drops of 1% phenolphthalein solution are applied to the washed product. In the presence of residual quantities detergent a pink color appears.

Products that test positive for blood are reprocessed and retested.

After washing, tools, oilcloths, gloves are sterilized. Before sterilization, rubber gloves are washed, dried, then poured outside and inside with talc to prevent sticking. Gauze is laid between the gloves. Each pair of gloves is wrapped separately and placed in a sterilization box (bix). The dressing material is placed in another sterilization box, but not tightly, but loosely - for the free flow of steam. For packaging, you can use a double layer of calico fabric. Cutting instruments are sterilized in air sterilizers. Examination instruments are disinfected by boiling or immersion in disinfectant solutions, after which they are rinsed under running water.

Steam sterilization of dressings, instruments, syringes, glassware at a temperature of 132 ° C lasts 20 minutes, at a temperature of 120 ° C - 45 minutes. With the air method of sterilization, the temperature should be 180 ° C for 1 hour; at chemical - 50 °C for 3 hours.

The nurse in the dressing room checks the instruments and other materials for sterility. To do this, one instrument or part of the dressing material is taken out of the sterilization box with sterile tweezers, completely immersed in a nutrient medium and handed over to the bacteriological laboratory.

The equipment in the dressing room is sanitized after use: wiped with a clean rag, abundantly moistened with a detergent complex to remove blood, mucus, wound contents, etc., then with a 1% solution of chloramine.

ORGANIZATION OF THE WORK OF DRESSING ROOMS

Parameter name	Meaning
Article subject:	ORGANIZATION OF THE WORK OF DRESSING ROOMS
Rubric (thematic category)	Sport

erythromelalgia

The disease was first described by Mitchell in 1878 ᴦ. The name comes from the Greek words erythros - red, melos - part of the body, algos - pain. It is believed that the development of the disease is due to a violation of the innervation of blood vessels lower extremities. In patients, acute expansion of capillaries, arterioles, and veins occurs. Clinically, this is manifested by bouts of burning, throbbing pain in the feet, much less often in the legs and thighs. There is hyperemia of the skin, a sharp local increase in temperature, edema, hyperhidrosis. These symptoms usually occur in the evening or at night and are aggravated by heating the legs, walking, standing, mechanical irritation. Seizures can last up to several hours. The intensity of pain decreases with cooling (under the influence of cold water). With the progression of the disease, permanent trophic changes in the limbs appear (edema, dryness and peeling of the skin, brittle nails and changes in the bones). However, patients never experience trophic ulcers. The cause of erythromelalgia are injuries, thermal effects (overheating or frostbite), diseases internal organs. Quite often, such disorders occur in patients with syringomyelia, myelitis, multiple sclerosis, polycythemia, sometimes as an independent disease.

Dressing room - a specially equipped room for the production of dressings, examination of wounds and a number of procedures performed in the process of treating a wound. Minor operations, more often with purulent diseases(carbuncle, panaritium), intravenous infusions, punctures, blockades, taking blood from a vein, etc.
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also produced in the dressing room, if there is no special treatment room.

In large surgical departments there are two dressing rooms: ʼʼcleanʼʼ and ʼʼpurulentʼʼ. If there is only one dressing room, then both aseptic and infected wounds are bandaged in it. With good organization of work and strict observance of asepsis, this does not pose a danger.

Under the dressing room, a spacious, bright room is assigned, the floor, ceiling and walls of which are covered with oil paint or tiles so that they can be easily washed. The dressing room is well ventilated, the temperature is maintained at no lower than 18°C, and impeccable cleanliness is maintained.

In the outpatient clinic of the rural medical district, at the feldsher-obstetric station, there is a doctor's office (paramedic) and a dressing room. In the dressing room of the feldsher-obstetric station (see), dressings and small surgical operations(applying a bandage and sutures for wounds, stopping bleeding, reducing simple dislocations, splinting for bone fractures, opening superficial abscesses, etc.); provide gynecological care to the extent permitted by midwives. To perform these manipulations, the dressing room should contain the necessary set of tools, dressing material, splints for immobilizing fractures (dislocations) and medicines.

In hospitals, dressing rooms are usually located in rooms isolated from other rooms (wards, operating rooms). If there is one operating room in the surgical department for aseptic (clean) operations debridement wounds, removal of atheromas, foreign bodies, as well as purulent operations (opening panaritium, carbuncle) are performed in the dressing room. After dressings, the dressing room should be used to examine patients, prepare them for surgery, etc.

The equipment of the dressing room consists of one or two tables (wooden or metal) for patients, several stools for sedentary patients, tables for sterile instruments and sterile dressings, glass cabinets for storing instruments, medicines and bandages, a washbasin with hot and cold water, stands for sterilizers, a heat source (electric stove), basins for removed dressings, bottles with disinfectant solutions, trays for dirty instruments. They also place sets for anesthesia, tracheotomy, a basin with a diocide solution for treating hands, bixes with sterile dressings and gloves, trays for syringes, boiled brushes; install lighting fixtures, bactericidal lamps. It is extremely important to have in the dressing room: syringes with a capacity of 20, 10 and 5 ml, anatomical and surgical tweezers, straight and curved scissors, blunt and sharp hooks for diluting the edges of the wound, hemostatic clamps, scissors for removing bandages, both soft and hard (gypsum ), bellied and grooved probes, tourniquets, forceps, scalpels, needle holders, spatulas, catheters, suture material.

Before starting work in the dressing room, the dressing nurse treats her hands in the same way as before the operation, covers the table with a sterile sheet, lays out the necessary sterile material and tools on it, which she covers with a second sterile sheet. The doctor (paramedic) working in the dressing room receives everything extremely important from the sterile table through the dressing nurse, who uses a sterile forceps.

Instruments are sterilized in the dressing room itself or in a separate room associated with the dressing room - in the pre-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 the observance of the sanitary-hygienic and anti-epidemic regime during various surgical procedures.

Organization of the work of dressing rooms. In accordance with the requirements of the current regulatory documents (SNiP 2.08.02-89), the department should have two dressing rooms (for clean and purulent dressings). At the same time, in many medical institutions, one dressing room has been allocated. For this reason, 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.

In the presence of one dressing dressing for patients with purulent wounds, it is extremely important to prescribe procedures at the end work shift. Here are the main requirements that are extremely important to strictly observe when performing dressings in the department:

All dressings and instruments should be stored in boxes for no more than 3 days or in wrapping 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. The bix should have a mark about the time of opening;

For dressings, a sterile table is prepared, which is covered with a sterile sheet in one layer, so that it hangs 15-20 cm below the table surface. The second sheet is folded in half and placed on top of the first. After laying out the tools (material), the table is covered with a sheet (folded in 2 layers), which should completely cover all objects on the table, and is tightly fastened with clips to the bottom sheet. The sterile table is covered for 6 hours. In cases where the instruments are sterilized in individual packaging, the sterile table is of no importance or it is covered immediately before manipulations. Dressings are carried out in 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. Chloramine solution is changed once a day. 6% hydrogen peroxide is changed after three days. Containers for storing forceps (tweezers) are subject to sterilization in a dry-heat cabinet every 6 hours;

Unused sterile material is set aside for re-sterilization;

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

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

The used dressing material is collected in plastic bags or in special marked buckets and, before disposal, is subjected to preliminary disinfection 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 oven is controlled by chemical tests: hydroquinone or tesourea at 180°. The drying oven works twice a day, and the operating mode is noted in the journal "Accounting for the operation of the dry-heating oven". Dressings and rubber products in biks are sterilized in the central autoclave and delivered to all departments by specially designated vehicles.

Twice a day - in the morning before starting work and in the oven after finishing work - they carry out routine cleaning, combined with disinfection. For disinfection, a 1% solution of chloramine is used. Once a week, a mandatory general cleaning is carried out: the premises are freed from equipment, inventory, tools, medicines, etc. A combination of disinfectant and detergent is used as a disinfectant. Disinfectant solution by irrigation or wiping, apply to walls, windows, window sills, doors, tables and turn on a bactericidal lamp for 60 minutes. Then all surfaces are washed with clean rags 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 allocated for work in the dressing room (buckets, rags, etc.) is marked and, after cleaning, disinfected in a disinfectant solution for an hour.

Each office keeps a journal "Accounting for General Cleaning".

Intrahospital laboratory quality control of cleaning, incl. in the dressing rooms is conducted by an assistant epidemiologist according to a special schedule. At the same time, bakanalyzes for sterility and crops for air sterility are taken.

The results of the control are heard at the council of the elder sisters.

Control over the sanitary and epidemiological regime in the dressing room, as well as work on the training of nurses, is carried out by the chief nurses of the hospital and specialists from the epidemiological department of the hospital.

ORGANIZATION OF THE WORK OF DRESSING ROOM - concept and types. Classification and features of the category "ORGANIZATION OF THE WORK OF dressing rooms" 2017, 2018.

A dressing room is a room intended for the production of dressings, injections, transfusions, minor operations, and removal of sutures. In the surgical department, clean and purulent dressings are usually deployed.

The dressing nurse checks the quality of dressing room cleaning (cleanliness of windows, walls, floors, furniture, etc.), boils instruments, syringes, rubber products (drainages), optical devices (rectoscope, cystoscope), arranges bixes with dressing material, rubber sterile gloves , sterile systems for transfusion of blood-substituting solutions, arranges medicines in the closet, receives from the head of the department (resident) a list of patients who need dressings, and sets the order of dressings. First of all, clean dressings are prescribed for patients with a smooth postoperative course - removal of sutures, examination of postoperative uncomplicated wounds, transfusion of blood-substituting solutions, etc. Secondly, dressings are prescribed for patients with granulating wounds, as well as for patients who need cystoscopy of the bladder, sigmoidoscopy and other studies. Last of all, dressings are prescribed for patients with purulent wounds. Such dressings are usually carried out in a purulent dressing room. After preparing the dressing, the nurse ties her hair with a scarf and proceeds to prepare her hands. She cuts her nails short, washes her hands under running water. warm water with soap, then treats them. Arrangement of instruments and material on the dressing table using one of the accepted methods (performic acid, diocide, etc.). Then he puts on a sterile gown and mask. To do this, he takes a sterile bix gown, unfolds it on outstretched arms and puts it on his hands. The nurse behind the sister grabs the upper straps of the dressing gown, pulls it over her arms and torso, and ties the straps from the back. On the sleeves (in the area of the wrist joints) the ribbons of the dressing gown are tied by the sister herself and after that she puts on sterile rubber gloves so that the tied ribbons are closed by them. The nurse then covers the sterile instrument table in the same way as in the operating room. She lays out the tools on the table in a convenient order for herself (Fig. 7).

After such preparation, the dressing nurse and the nurse begin dressings. Responsible dressings are performed by a doctor.

After the patient is delivered to the dressing room on a gurney, he is transferred to the dressing table and laid so that there is access to the wound being dressed in a comfortable position for the patient and the bandaging rules can be observed.

Any dressing consists of several stages:

1. Removal of the old dressing followed by its disinfection or burning and toileting the skin around the wound (wiping it with ether, then 96% ethyl alcohol and lubricating with 5-10% alcohol solution of iodine).

2. Protection of the skin around the wound with sterile gauze from discharge from it.

3. Performing manipulations in the wound (treatment of the scar with 5-10% alcohol solution of iodine, removal of sutures or probing in the area of the scar, with purulent wounds - removal of pus from the wound with sterile wipes, washing the wound with antiseptics, etc.).

4. Applying a new aseptic dressing. After removing the sutures, the scar is smeared with a 5-10% alcohol solution of iodine and most often a dry aseptic bandage is applied. After treatment of a granulation or purulent wound, the skin around it is smeared with zinc paste (to prevent skin maceration) and a bandage with antiseptics is applied.

After each dressing or manipulation, the medical staff must wash their hands with soap and water, wipe them dry with a sterile towel (napkin), and then with a gauze pad or ball, abundantly moistened with 96% ethyl alcohol and served by the dressing nurse. At the end of the dressings, the nurse collects the instruments and other items that were used in the dressings. Contaminated tools, rubber and glass objects are disinfected in a 3% Lysol solution for 30 minutes or in a 0.5% ammonia solution for 3 hours. After disinfection, they are washed with soap and running water, then boiled in a 2% sodium bicarbonate solution 20 min. Better to autoclave them. The nurse washes and dries the systems for transfusion of blood-substituting solutions, syringes, needles, rubber gloves, which, after drying, are sprinkled with talc. She puts all this, as well as dressings and surgical linen, into bixes, which the nurse takes to the autoclave for sterilization. Each bix has its own address.