Руководство к практическим занятиям по общему уходу за хирургическими больными (стр. 3 )

For the personnel of surgical department the six-hour working day is established. The staff of radiological departments have the five-hour working day, the four-hour working day is established to medical staff in radiation-activity zones. In such way it is possible to achieve increase in labour productivity and at the same time preservation of health of employees.

Hygiene of work of the medical personnel depends and on conditions of water supply, the water drain, illumination, heating, etc.

Water has important hygienic role but can be source of infectious diseases. The waterway of distribution is most typical for cholera, typhoid, dysentery, hepatitis A. The state of health is influenced by mineral structure of water. For example, lack of iodine causes development of goitre, lack of fluorine promotes development of caries, etc.

Personal hygiene

Personal hygiene is the branch of common hygiene studying questions of preservation of human health by observance of a hygienic mode of life and activity. To personal hygiene carry the hygienic conditions of a body, linen, clothes, footwear, bed-clothes, kitchen utensils.

Rules of personal hygiene of the medical personnel have the specific character connected to character of theirs activity.

Special importance for the medical worker has the clean integuments. A minimum the washing of a body once a week is necessary to carry out. Especially careful care should be carried out hands. It is necessary to wash hands before and after manipulations, before and after contact with patient, before reception of food. The medical staff should preserve hands against pollution during all time of day. Nails should be shortly cut. For preventive of hands skin dryness it is necessary to grease it with creams. All dangerous manipulation must be performed with rubber gloves (injections, infusions, bandagings). After contact with infected patients (or suspicious) it should wash hands with antiseptic (for ex. alcohol).

It is necessary to watch carefully hygienic condition of hair. Hair accumulate a dust and together with it a plenty of microflora. In surgical department there is a danger of wound contamination by this microflora. Therefore hair should pure, brushed.

Care of an oral cavity is carried out with usual way.

The medical staff should be undergone the dispensary supervision providing carrying out of routine inspections once in half-year.

Hygiene of clothes

Clothes and footwear of medical personnel have great important for normal work. In hospital departments it must not be in usual footwear you walk along the street. Hygienic regimen of medical departments demand of this fact.

Therefore in medical establishments there is a necessity of carrying of replaceable footwear. These are usual shoes or slippers which the medical personnel of surgical department puts on only in work time. It is the best way to have leather (plastic) replaceable footwear. It must not wear in department felt or woolen slippers as these materials usually strongly become soiled microbes. In the operation theatre visitors must put on cover on slippers (cotton or plastic).

In an operating time in operation block and dressing medical personnel must use masks. Improvising masks are made of 4-6 layers of a gauze is more often. Masks of disposable using are issued by the medical industry. Mask should close mouth and nose completely. In such a way the personnel protects wounds of patients from hit of microbes during cough and conversation. Protection appears insufficient at presence at the worker of a respiratory infection, therefore the personnel with acute respiratory diseases is not supposed to work in operational.

The basic kind of working clothes of the personnel of surgical department is the medical dressing gown. It is intended for protection of personal clothes against pollution. Dressing gownes are made cotton. There are two types dressing gownes: surgical which are fastened behind, and therapeutic, fastened in front. Sleeves should be short or rolling up. Any decorations on dressing gownes it is not supposed. The dressing gown should be fastened well (not wide open). Instead of a dressing gown it is possible to use a working medical suit from a cotton fabric. Medical workers in surgical department must has also caps covering hair on a head. All medical cloth are stored separately from personal clothes.

In surgical department it is not necessary to carry woolen things are capable to accumulate infection and are the source of dust.

In dressings and operation theatres with a view of the prevention of infectious pollution of special and personal clothes the personnel use plastic aprons, rubber gloves which after work are disinfected.

Carriage of bacilli

Carriage of bacilli is a preservation in an organism of the person and allocation in an environment of infecting agents without seen clinical display of disease. In surgical department bacilli carriers purulent microorganisms (staphylococcus, streptococcus, E. coli, etc.) there can be doctors, medical sisters, nurses. At carriers infecting agents are allocated through the same organs and systems, as at obviously expressed clinical forms of disease, for example, at intestinal infections infecting agents are allocated with excrements, at air drop infections - through respiratory ways. Distinguish three categories of bacilli carriers: 1) not was ill in the past; 2) had been ill and becoming after that carriers; 3) got immunity after the transferred illness in the past and becoming carriers as a result of new infection. Bacilli carriers are a potential source of infection. Bacilli carriers among hospital personnel can become the causal factor of mass infections of patients. For preventive transmission of infection medical personnel must undergo periodically examinations.

Deontology

Medical deontology is a set of ethical standards and behaviour principles of the medical staff at performance of the professional duties. Medical deontology defines rules and forms of mutual relations of the doctor with patients, their relatives, with colleagues.

The main point of medical personnel have to care of sick person, attentiveness, readiness to help. The sensitive, attentive and accurate person can carry out these duties only. Personnel relations with the patient are based on mutual respect. The great value has skill to have a conversation with the patient. Tone of conversation should be quiet, convincing. Patients should be named only by name or to use the impersonal polite address. At questions on the diagnosis and the mechanism of action of medical drugs it is necessary to send patients to the attending physician to exclude possible contradictions which can undermine trust of the patient to medical staff. At realization of actions on care to demonstrate squeamishness and neglect to the patient are not allowable.

Relations of medical personnel among themselves also have important value. Precise observance of a subordination here is necessary. So duty sister should submit directly to the senior sister and the intern or the doctor on duty. All workers of department should concern to each other benevolently. It is impossible to do sharp remarks on work at the presence of patients. All professional conversations must be in doctors room only. Patient listen doctor and sister talking aiways and can do mistaken interpretation their words.

Rather important also the correct contact of the medical personnel with relatives of the patient. Dialogue with them should be under construction on the basis of mutual interest.

Chapter 3

CLINICAL HYGIENE OF THE ENVIRONMENT AT SURGICAL DEPARTMENT

Environment is the physical, chemical, biological and psychological factors having influence on patients at surgical department during fulfillment of medical actions. These factors are: air volume, air temperature, humidity, air moving, dust, smells, air bacterial contamination, noise and other.

About surgical wards

It is not recommended to create ward more than on 5 - 6 person. The optimum number of beds in many-placed wards is 4. According to hygienic rules 25 m3 of air should be provided to each adult patient. It is achieved by the area of 7 m2 on one bed at height of a room of 3,5 m. Now many hygienists consider, that the air volume in wards should be within the limits of 40-50 m3 for one ch air volume allows supporting cleanliness and optimum qualitative structure of air. Small chambers are most convenient. In a department it is necessarily to have some wards for one place.

The basic parameters of air condition of surgical department

Carbonic gas. In premises the contents of carbonic gas is regulated and should not exceed 0,1 %. Falling of its concentration in air is not dangerous, increasing – exerts influence on a person. A plenty of carbonic gas in air of rooms is the proove of their high pollution.

Temperature. The important value has maintenance of optimal temperature at surgical department. Heat exchange is one of the basic functions of the human organism. As it is well known the temperature of human body is constant and organism is very sensitive to change of air temperature. Optimal temperature in rooms has to be 18 – 20ºC. Very high air temperature is supplementary load for cardiovascular and respiratory system and may cause the worse feeling of a patient after operations. On the contrary low air temperature may cause a common cold and epidemic situation. And surely common cold burden condition of patients especially after operations. High body temperature can dissemble postoperative complications.

Humidity. In atmospheric air there is always some water vapours. Humidity of air influences an organism of the person as:

- high humidity of low temperature air raises thermal output;

- high humidity of high temperature air complicates thermal output;

- low humidity of air having rather low temperature, does not render appreciable influence on health state of a person;

- low humidity of high temperature air has an adverse effect on health state of a person, raises loss of moisture by an organism, causes dryness of mucous membranes of the top respiratory ways, dry cough, woolly voice.