Руководство к практическим занятиям по общему уходу за хирургическими больными (стр. 4 )

Movement of air. Except the temperature and humidity the movement of air also influences on heat exchange. Speed of air movement less than 1 m/s is not appreciated by a person.

Organism of the patients and furthermore postoperative patients, reacts sensitively on changes of temperature, humidity, movement of air. It is especially sensitive to sudden cooling, draughts. The optimum combination of temperature, humidity and speed of air movement is named a zone of comfort. This optimum combination of parameters cause the best state of health (a condition of thermal balance): air temperature in wards about 20 ° (optimum for patients), speed of air movement about 0,5 m/s and humidity should be 55-65 %.

Dust. In atmospheric air of the closed premises there is always a dust. Concentration of a dust in the bottom layers of atmosphere changes in very wide limits: from 0,01 mg/m3 up to tens milligrams on 1m3. During breathing the parts of dust remain in respiratory ways. Some of them settle on the mucous membranes of trachea and bronchial tubes and are released from an organism by action of vibrating epithelium and cough. The parts of dust (finest particles) penetrate into alveoli. In alveoli the parts of motes are exposed to phagocytosis by leukocytes and epithelium cells (epithelium of respiratory bubbles, another - is enveloped by lung phlegm and then released from an organism. Not all kinds of dust particles are equally exposed to phagocytosis by phagocytes. Some part of dust remain in lungs forever.

High dust concentration in medical premises isn't allow. Dust can irritate mucosal membranes (of eyes, nose), can cause acute conditions of chronic respiratory diseases. But this is not the main point. Air dust contains a lot of microorganisms (bacteria, viruses, spores, fungi). This dust with microorganisms settles down on a surface and is transferred with air steam. A source of pathogenic microorganisms in air of the closed rooms are the saliva exuded at conversation and cough and bacilli carriers. It is known, that at sneezing about 40 000 drops are formed and an absolutely healthy person exuded in air about 10 000 - 20 000 microbes. Splashes of a liquid at cough, sneezing, conversation can scatter on distance in some meters (so, drops in diameter of 1 mm are scattered in air to distance up to 11 m). Drops of saliva stay in air for a long time period (some hours). Drops of saliva with microorganisms on the floor and other surfaces dry up and can rise up with dust on air. It is necessary to remember, that such microorganisms as staphylococcus, diphtheritic bacillus, tubercular mycobacterium keep viability, being in a dust for tens years.

Smells. Smells can influence on the state of health and mood of patients. The person is capable to distinguish up to 10 000 various smells. The source of unpleasant smells in wards may be patients with intestinal and urinal fistulas, with purulent processes, gangrenes and other.

Especially it is necessary to tell about harmful influence of tobacco smoking on an organism. On a tobacco smoking there are many strong cancerogenic substances (3,4-benzpyren). The harmful influence of smoking on state of lungs, hearts, stomach, vessels is proved.

Optimum conditions in surgical department

For the prevention of environmental contamination in wards, halls, corridors of surgical department there is a number of rules, which must be kept by medical staff, patients and their visitors.

There is a specific system of cleaning premises of surgical department. Only wet cleaning must be done. Kinds of cleaning of surgical wards are a planned, general and current cleaning.

Planned cleaning is carried out two times a day. It is recommended to wash the floor with water with detergents and sodium carbonate and after washing to wipe it twice with a damp cloth. Walls up to height of extended hand, windows, window-sills, heating radiators, doors are wiped with wet cloth (water with detergents, hydrate of sodium, liquid ammonia 0,5%) and then with dry cloth. The process of bed cleaning, bedside-tables, tables, chairs, cases is the same. In wards for patients with purulent-septic diseases and postoperative purulent complications a daily cleaning is carried out with obligatory using of disinfectants.

General cleaning of wards is performed once a week. A floor, windows, ceiling, walls, beds, furniture and all equipment is washed by disinfectants (3% chloramine solution, 0,5% bleach solution, 0,2% desoxone solution, the mix of 3% hydrogen peroxide and 0,5% a solution of detergent powder). The last mixture does not damage wooden and metal things which are necessary to wipe up to dryness after processing. Now there are many modern disinfectants for surfaces (for example "Septopole", "Javelion", "Presept", "Perform" and so on, see appendix). The furniture with a covering from fabrics is processed with 3% solution of formaldehyde.

A current cleaning of floor is performed after bandaging of patients during working day, change of drainages and bed-clothes is necessary, at pollution of floor during those or other ch cleaning is especially important in wards for purulent patients. The current cleaning is usually carried out only within the limits of the area which was polluted.

After discharging the patients a proper cleaning with the disinfectants of their beds and bedside-table must take place.

For a period of cleaning the patients, as a rule, leave the ward. If there are bed case patients, it is necessary to take certain measures: to cover with a towel, sheet or to move a bed from that place to wipe a ceiling, floor or walls. To begin cleaning it is necessary with bedside-tables. It is necessary to dust them. Then it is necessary to dust window-sills, plafonds, beds and other furniture. It is necessary to keep quiet, actions of junior medical staff should not disturb patients. During cleaning it is necessary to open ventilation panes and to air ward but so that there were no drafts.

The special attention is given to cleaning the sanitary-engineering equipment. Cleaning of bathrooms should be carried out daily with using disinfectants. Baths, washstands, urinals, bidet, lavatory pan can be processed with the help available modern detergents and disinfectants. It is possible to apply also 1% chloramines, 0,75% chloramines plus 0,5% detergents, 3% hydrogen peroxide plus 0,5% detergents and others (sulfochlorantines, dichlor-1, "Alaminol", "Vapusan"). A toilet should be aired carefully.

Brushes and other implements are disinfected by 2% bleach, 1% chloramines, 0,2% sulfochlorantines, 2% dichlor before cleaning the other disinfectants also can be used (see appendix).

The cleaning inventory is marked strictly according to the assignment (they are marked: "for cleaning corridors", "for processing toilets" etc.). The marked cleaning inventory is kept in established places and used only according direction. Its usage for the other purposes or cleaning other premises is forbidden.

To prevent penetration of infection in wards, especially at purulent department, bactericidal ultra-violet lamps (portable or stationary) are applied. Lamps have to be switched on for 30-40 minutes with breaks not less than 2-3 hours. Inclusion of one lamp during 10-15 minutes reduces number of bacteria in air on 70-80 %. Action radius of ultra-violet lamps is 2-3 m on the average.

Ultra-violet irradiation exert bad influence on people’s eyes. During this procedure patients and personal must leave the ward.

About ventilation. Two basic systems of air ventilation are applied: natural and artificial. The natural ventilation which is carried out through window, ventilation panes, transoms is more distributed nowdays. The full exchange of air should takes place 4-6 times in an hour. For this purpose the most acceptable is often through airing of chambers (for 10-15 minutes).

Artificial ventilation (with different blowers and air-conditioners) is the most effective. Air-conditioner not only provides an exchange of air, but also keeps the temperature and humidity. Artificial ventilation allows to create optimum air exchange in wards, i. e. an exchange of air in volume of 40 m3 in hour on one ch ventilation is especially necessary in postoperative wards (in ward of intensive therapy), and also in burn departments.

It is preferable that visitors visit only bed case patients in wards. The bulk of visitors should communicate with patients in halls, in special rooms (see chapter 8).

In surgical department it is forbidden to smoke.

It was spoken above about the influence of smells. Main sources of unpleasant smells are patients with intestinal fistulas, the purulent and putrid infection. For prevention of unpleasant smells it is necessary to care about this patients carefully (washing, change bandages, change bed-cloth, airing and deodorization).

Protection of patients against excessive noise has important value. The degree of intensity noise in hospital depends directly on work and behavior of the personnel. Medical workers should talk in a low voice. It is not necessary to clap the doors, to rattle utensils and cleaning tools.

It is necessary to eliminate possible negative emotions in patients which can be caused by sight of medical care subjects (blood pieces of a gauze, syringes and scalpels with traces of blood, basins with dirty bandage and cotton etc.).

Chapter 4

SANITARY-AND-HYGIENIC MODE IN DRESSING AND THE OPERATIONAL BLOCK.

Dressing in surgical department are intended to perform the bandaging and some other manipulations to the patents. It is a measure of prevention of purulent infection distribution in the surgical department there are two dressings: "clean" and "purulent".

For dressing with one table the area of 20-22 m2 is provided. The dressing floor and walls should be cover with a tile. The ceiling must be painted with an oil-colour. This measure is done to diminish the dirt and be easily washed with disinfecting substances. Colour of floor, walls and ceiling should be tender, it may be white or with green, blue tinctures. Usually in dressing the bactericidal ultra-violet lamp is present. This lamp is switched on after bandagings to kill microbes in the air.