Руководство к практическим занятиям по общему уходу за хирургическими больными (стр. 5 )

The equipment of the dressing room are:

operational universal table

common sterilized table (table for sterile instruments and dressings)

small tool and dressing table for direct dressing job

supports for drum sterilized boxes

glass cases for drugs

overhead light

tanks (vessels, plastic cases) for chemical disinfection of instruments, gloves, cottons and so on.

certain sets for wound treatment (for example lasers)

In each dressings one special dressing sister works. She prepares a patient for dressing, sterile table, helps to the doctor (gives tools, applies bandages and so on), keeps up the order in dressing, carries out its cleaning. The cleaning is carried out by the same rules, as in operational theatre (see below).

Type of work in "clean" dressing:

dressing of patient with clean wounds

punctures and drainages of pleural cavity

novocain blockades

puncture biopsy

primary treatment of wounds

Type of work in "purulent" dressing:

dressing of patient with purulent wounds

opening of suppurative processes (abscesses, phlegmons)

drainages of purulent cavities

small amputations (for example fingers)

necrectomies

In small departments sometimes there is only one dressing. In this case patients after operations with clean wounds are dressed in the first turn and only then - the patients with purulent processes and postoperative purulent complications.

The operational block is placed separately from wards. The best conditions may be created in the separate premise connected with the basic bulk by a transition or the lift and connected to resuscitation unit. The modern operational block should include operational theatres, preoperative, sterilizing, material, an equipment room, rooms for medical staff. Every operational theatre should have one operational table. Its area should make up 36-48 m2 at the height of room not less than 3,5 m. It’s expediently even in the rather small departments to have separate operational for emergency and for purulent operations. The operational block is among the premises with the limited access. For maintenance of sterility in the operational block 4 zones are allocated:

- zone of a sterile mode (operational, preoperative, sterilizing)

- zone of a strict mode (rooms for storage of tools and devices, rooms for the personnel)

- zone of the limited mode (technical zone for technical equipment)

- zone of the common mode (cabinets of the head, the senior sister, a room for dirty operational cloth, etc.).

The ceiling, floor and walls of an operational theatre should rounded to pass each other, to avoid congestions of a dust in the corners and to facilitate cleaning. A ceiling must be painted with white oil-colour, walls and floor are covered with tile. In operational it is necessary to have big light windows focused on the north.

The capital equipment operational are:

an operational table

overhead lamp

mobile lamp

big sterilized table

mobile sterilized table for particular operation

special tables (glass or stainless steel) for drugs, antiseptics, suture materials

suction apparatus

apparatus for artificial ventilation of the lung

anesthetic apparatus

anesthetic table

supports for infusion sets

other equipment (diathermy apparatus, lasers, laparoscopic sets, etc.)

Preoperative room is destined for preparation of the personnel before an operation. It must be in an adjacent room with an operational theatre. A ceiling, walls and a floor are done the same as in operational theatre. In preoperative place 2-3 washstands with cranes which may be opened with an elbow. On a table drum boxes with sterile brushes, napkins, masks are placed. In this room surgeons and sisters wash hands and take in plastic aprons, masks, caps. The operational brigade uses sterile masks and sterile dressing gowns.

In material room spirit, gloves, surgical tools and products of medical assignment are kept.

Sterilizing it is intended for disinfection, presterilizing clearing and sterilization of products of medical assignment. In the majority of modern hospitals there are available centralized sterilizing, therefore in the operational block only metal tools with the help of dry heat sterilizers are treated.

For diminishing the risk of pollution of operational block the persons from outside must not be allowed. There are some simple rules of students behavior in operational theatre. Students must put on medical masks in a corridor and the bootee they have to put on at a preoperative room. Students must not have wool cloth under apron. Long hair must be hidden under cap. In the operational theatre there must not be any divagation, talks and noise. It is not allowed to come in and out very often. Students must take allocation in a specified place. They do not allow to touche operational sheets, doctors gowns and especial operational table. It is disallow to pick up instruments or cotton fallen down on the floor. Students must get off bootee before to come out thw operational block.

Cleaning of operational block. is made by damp way (1 % Chloramin, 3 % peroxide of hydrogen from 0,5 % of washing-up liquids, 0,2 % dezoxon-1 and dezoxon -4, 2 % dichloramine-1, alaminol, vapusan, lysaphin etc.:

There are following kinds of operational block cleaning:

- the current cleaning during operation (nurse select napkins fallen on the floor, tools and wipe the soiled floor);

- cleaning after operation; it provides cleanliness of an operational hall before the following patient;

- daily cleaning at the end of operational day (wash a floor and walls on height of human growth);

- the general cleaning is made under the plan weekly (wash all operational theatre including the ceiling, walls, floor, furniture, etc.);

- preliminary cleaning (before to start the work, the horizontal surfaces are wiped).

For disinfection of air bactericidal ultra-violet lamps are used. They are placed along walls at height not less than 2 m from a floor or hung to a ceiling. Each lamp makes around a sterile zone in diameter about 2-3 m. After 2-3 hours of work the bactericidal lamps work the contamination of decrease microbes in air on 50-80 %.

Ventilation operational is carried out by installations of air conditioning with antimicrobic filters. Cleared air moves in operational under small pressure (air affluent) that is why the air from the nearest rooms does not come.

The temperature in operational should not be higher than24°C, optimum humidity of air of 50-65 %.

There are so called especially clean operations (transplantation of organs, implantation of valves of heart). For this operations operational theatre with laminar (vertical or horizontal) a stream of sterile air are used. Thus it is required to provide a laminar stream with an exchange of air up to 500 times at one time. Number of microorganisms in such operational is reduced in ten times in comparison with those in standard operational, supplied with conditioners. The vertical stream of air is the best. Also there are special equipment for operational brigade. It is so called body exhaust systems. This set include special isolating suit with helmet under which the fresh air is moved.

For especially difficult operations on organs of blood circulation special hyperbaric oxygenation operational theatres are created.

Chapter 5

SAFETY ENGINEERING OF CARE IN SURGICAL DEPARTMENT AND THE ROLE OF THE AVERAGE AND PREVENTIVE OF IATROGENIC DESEASES

Safety engineering at work with the medical facilities

Safety engineering – is a complex of actions and means providing healthy and safe working conditions.

In medical practice only the standard technical equipment should be applied. To operate with the medical techniques the specially trained and certificated personnel which state of health supposes performance of the specified works are permitted. Before starting work the personnel has a briefing that is registered in a log-book. In a room where the medical techniques is used, there must be papers with service regulations. The personnel should be provided with protective facilities.

More often the incorrect manipulations with devices results in defeat by an electric current. It is necessary to watch correctness of electrical apparatus constantly. Connection and shutdown of equipment has to be fulfilled according to instructions. It is forbidden to demount apparatus or to remove the protective details. Maintenance of devices should be provided by special technical personnel.

There are medical apparatus with high voltage: surgical diathermic coagulation devices, defibrillators. These tools must be apply only by specially trained staff.

We ought to be cautious when applying the laser technique also. Laser shaft is dangerous for eyes, therefore it is necessary to have protective eye-glass. The contact with light of surgical laser (destruction of tissue) is not allowed. It is necessary to remember that the light of some laser types can be invisible (for example at CO2-laser).

The prevention of fires and explosions

In medical establishments there is always danger of fire accidents. There is a great number of flammable substances, a plenty of electrical equipment which increases this danger.

The principal causes of fires are:

- infringements of standing order,

- incorrect service of electric devices.

To prevent fires it is necessary to follow the rules.

All hospital rooms should be equipped with automatic alarm system. Alarm console should be in the reception.

The cause of fires may be smoking. Smoking in wards must be strictly prohibited. For smoking it is necessary to allocate a special place (it is a toilet more often), equipped with ash-bin and fire extinguishers.

In department it is forbidden to use heaters (for example, boil devices). Patients must not use home-made heaters. For needs of patients the hospital administration should provide special stationary equipment for quick boiling of water.

The fire in ward can arise at misuse wall and table lamps. It is unallowable to cover those lamps with inflammable material (a newspaper, a napkin, etc.) sometimes it is used to decrease light the intensity of light.