Руководство к практическим занятиям по общему уходу за хирургическими больными (стр. 2 )

The patient accepted for treatment into the hospital, passes through a sanitary inspection room. The sanitary inspection room is intended for carrying out of sanitary processing patients. The question of necessity of sanitary processing is solved by the doctor on prehensive sanitary processing consists of a hair-cut, cut of the nails, shaving, taking a shower or a hygienic bath. At first patient should be carefully examined on pediculosis (parasitic disease, infestation of lice). At the present time it is not necessary to carry out the comprehensive sanitary manipulations of all patients because the overwhelming majority of admitting patients keeps hygiene. The sanitary manipulation with the patients who are in a severe state and need the emergency surgical help is not carried out. The technique of sanitary manipulations, and also features of the work with severe state patients in a reception are described more detailed in the chapter 11.

After sanitary processing the patient change his cloth. The outer clothes of each patient are placed in a separate plastic bag in storage. Bags are marked and placed on special hangers in the certain order. The list of the things is checked and pasted in the history case.

Intrahospital infections

Intrahospital infections - are infectious diseases and the wound infections acquired by a patient at a hospital in addition to the basic disease, and also diseases of medical personnel appeared because of the treatment and care of infectious patients.

The source of intrahospital infection can be the patient carrying pathogenic microorganisms among patients, the personnel, and also visitors of patients.

Occurrence of an intrahospital infection is connected with late revealing and isolation of infectious patients in the hospital, underestimation epidemiological anamnesis concerning infectious diseases transferred before at coming patients, wrong placing of patients in wards, non-keeping measures of detection activators of infectious illnesses among patients and the personnel, default of rules of the current and final disinfection, unsatisfactory sanitary processing of patients. To development of an intrahospital infection decrease in resistance of an organism of patients under influence of basic disease, operative intervention, a blood loss, treatment by immunodepressive drugs promote.

On taking the patient to a hospital it is necessary to collect exhaustive data about infectious diseases suffered from before (Botkin's illness, etc.) and about contacts with infectious patients. For this purpose can be made laboratory research of excrements, urine, lung phlegm, blood, a smear from a pharunx, etc. to reveal infectious illness and bacterium carriers. Reception to hospital patients with suspicion on infectious illness or being in contact to infectious patients is performed at isolating wards of admission department.

Epidemic trouble is especially concerning air - i. e. drop infections (flu), visiting patients is forbidden.

The particular place among intrahospital infections belongs to virus hepatitis B, C, D and HIV In prophylaxis of this disease the extremely careful processing of reusable syringes and needles has great value.

In a surgical departments there are specific conditions for occurrence of intrahospital infections, having a strong character. Wounds of surgical patients are an open gate for infections. Modern intrahospital infections in surgical clinics are shown basically by a syndrome of suppurations and septic defeats. There are various agents of purulent infection: staphylococci, streptococci, Proteus, E. coli, bacteria of blue-green pus, etc. Infection agents of gas gangrene are especially dangerous. Sources of pathogenic microorganisms in surgical hospitals are the patients with chronic infection, trophic ulcers, purulent wounds, tracheostomy, colon fistulas, etc. The certain value in occurrence of intrahospital infections is given to the medical and paramedical personnel who can carry pathogenic microorganisms.

There are some ways of distribution of intrahospital infections inside the surgical departments: air - drop, contact and implantational ways. Infection is especially dangerous for patients with major defects of integument (burns, scalped wounds, frostbites). The complex of measures to prevent microbes invasion in an operational wound is called an aseptic. Prophilaxis of an intrahospital infection in surgical department base on rules of aseptic. For reduction of air pollution in operational and dressing the medical staff should have special surgical masks, aprons and bootee. There are ultra-violet lamps for disinfection air. For prophilaxis of a contact infection it is necessary to apply special methods of washing hands before operation and an operational field of patient. At operations and bandagings it is necessary to exclude completely an opportunity of microbes’ contamination of wounds from tools, cotton and bandaging. So before to use this things are exposed to sterilization, i. e. full clearing of microbes and their spores. Sterilization in medical establishment is carried out with the help of steam sterilizers, dry heat sterilizers and other methods. With the purpose of prophilaxis of implantational infection all suture materials and endoprosthesises are subjected to sterilization by hard radiation or gas at the factories. An effective measure of prevention of hospital infection is application medical products of disposable using (syringes, needles, infusions sets, intubation tubes, etc.). The correct organization of carrying out the operations and bandagings has great value. Expansion of isolated purulent departments or, at least, presence of separate dressing, "clean" and "purulent", and also discharges of special sisters and doctors for work only with infected patients is the most expedient.

Chapter 2.

CLINICAL HYGIENE AND RULES OF BEHAVIOUR OF THE MEDICAL PERSONNEL IN SURGICAL DEPARTMENT

Hygiene is a part of a medical science which studies influence of life conditions on health of the person. Hygiene solves the following problems:

- sanitation of the environment (protection of ground, water and air);

- prevention of infectious illnesses;

- Creation of the sanitary legislation.

The part of hygiene developing specifications and the requirements, directed on maintenance of optimum conditions for treatment of patients and work of medical workers in hospitals refers to as clinical hygiene.

Care of patients is based on positions of clinical hygiene. An integral part of the last is the clinical hygiene of the medical personnel. One developing from set of factors among which the most value have hygiene of a nutrition, hygiene of work, personal hygiene, hygiene of clothes.

Hygiene of a feed

Hygiene of a feed as a part of the common hygiene studies all aspects directly connected to a feed. The primary problem of nutrition hygiene is the scientific basis of the optimum feed.

All physical actions and biological processes of the organism use his power resources. Power inputs of people of different trades vary in limits from 3000 up to 5000 kcal/day. Medical workers power inputs on the average are about 3000 kcal/day. For reception of such quantity of power resources it is necessary, that a diet includes: proteins - 118 g, fats - 56 g, carbohydrates – 500 g. Rational and balanced nutrition is determined not only structure of food, but also distribution of daily diet and intervals between meals.

Power inputs are high in an operating time. Therefore dinner should take 45-50 % of daily caloric content. For a breakfast should have about 30-35 %, for a supper - 15-20 %. For the personnel working during night and evening time, the breakfast in volume of 25-30 % of daily caloric content, a dinner (2-2,5 hours prior to work) - 40-45 %, a supper - 20 % is recommended.

Intervals between breakfast, dinner and supper should not be more than 6-7 hours. The "hungry" secretion stimulates intestine peristalsis with unpleasant sensations otherwise begins. At a four-times meal intervals between receptions should be 4 - 4,5 hours.

Changes of a diet result in infringement of the established rhythm of work of a digestive tract.

The set of necessary products is developed on the basis of human physiological requirements for various food substances, in view of nutritional value of foodstuff and influence on their structure of culinary processing.

It is necessary to take into account also, that food rate value of vegetable products is lower, than products of animal origin. Mixed food is better than separate foodstuff is assimilated. Vitaminization of a feed has great value. The better way is use vitamin-rich foodstuff then artificial vitaminization. Natural vitamins are in a complex with other nutrients that provides their good assimilation.

The food factor has important role in development of diseases. Especially frequently it appear on the background of alimentary insufficiency. The person in this case becomes easily susceptible to infectious diseases and unstable to influence of adverse factors of an environment. Alimentary insufficiency (malnutrition) can be caused:

- The use of low-calorie, defective food;

- Insufficient quantity of food;

- Bad assimilation of food substances in a gastroenteric tract;

- Infringement of metabolic processes;

- Increase in allocation of food substances;

- Blocking food substances by antimetabolic substances.

For normal physiological processes the water and salt metabolism is very important. Its infringement is result of some pathological syndromes. As an example can be potassium deficiency калия shown as a nausea, muscular weakness, depression, hart problems.

In medical establishment normal conditions for nutrition of medical personnel should be created.

Hygiene of work

Hygiene of work, or professional hygiene studies labour activity of the person and surrounding industrial environment from the point of view of their possible influence on an organism, develops hygienic specifications and actions which purpose of favorable working conditions. Hygiene of work of medical workers investigates influence on an organism of physical, chemical and mental factors of the environment, develops hygienic specifications of the environment (bacterial contamination of operation block, dressings, wards, etc.), studies labour processes and generate physiological, physiological and pathological alterations in an organism, develops a rational mode of work and rest.