Руководство к практическим занятиям по общему уходу за хирургическими больными (стр. 6 )

Dirty bed-cloth, mattresses, pillows, etc. must be kept in the places not accessible to patients and visitors.

In the department all used electric equipment: sockets, switchboards, refrigerators, TVs, etc should always be ready to expluatation.

If you apply narcosis with ether it is necessary to remember about the possibility of explosions in operation theatre. At the presence of open fire (sparks of static electricity or electrical tools) ether and oxygen compositions can detonate. However suchlike accident can occur only if this composition is accrued in closed space (for example because of ether blowing). Modern construction of anesthetic apparatus practically excludes such accidents.

For prevention of the grave consequences of fires in medical establishments there are certain rules:

- keys from all closed rooms and exits from department should be kept in certain places known to the personnel on duty;

- exits should not be blocked by any furniture or other objects;

- in department it is necessary to have emergency sources of illumination;

- fire extinguishers and fireplugs must be in accessible places;

- in department should hung out (in corridors) schemes of the patients’ evacuation;

At occurrence of a fire the junior medical personnel inform the duty doctor and call up the fire brigade. Further the doctor makes a decision either to evacuate patients from department, or to try to liquidate the fire focus with the help of staff. If there is necessity of evacuation all exits of the department are opened. Patients who can walk should specify the way of evacuation. Bed patients are evacuated on stretchers. It is necessary to know that using lifts at fires is impossible.

Prevention of the medical personnel from microbic contamination, allergic diseases and chemical damages

On the workplace the medical staff can be exposed to influence of various adverse factors of the environment.

In surgical department these factors are: patients with contagious forms of infection (purulent, anaerobic); pathogenic microorganisms pollution of rooms and equipment; contact to different drugs and other chemical substances (agents for cleaning of rooms, processing of tools and other products of medical purpose).

The medical worker should remember rules of his personal hygiene, cloth hygiene.

High air bacterial contamination of surgical department may be the cause of microbic damages. Hygienic rates of microbic contents in the air are (in brackets for winter):

microorganisms in 1m3 – 1500 (4500);

hemolytic staphylococcus in 1m3 – 24 (52);

hemolytic streptococcus in 1m3 – 16 (36).

Content of bacterial air may be reduced with the help of a regular wet cleaning and other measures (see chapter 3).

All medical actions must be performed in rubber gloves. This concerns to dressings, injections, infusions, transfusions, blood taking for analyses, etc. Aprons (surgical coat, whites) and mask are also preventing cloth. In dressings, before to start the work the doctor should change his surgical coat on another designed for dressings. Sometimes it is necessary to put on plastic apron preservative from pus and blood pollution. During operations it is expedient to apply special tools for face protection. It can be plastic shields, spectacles.

It is well-known that the most dangerous is the blood transmitting infections: hepatitis B, C; HIV; syphilis. Skin injuries during operations or care can be the cause of severe diseases. HIV and hepatitis prophylaxis rules are:

in skin injuries it is necessary to get off the gloves immediately and try to squeeze out the blood under the flowing water;

to wash skin with the soap and process by spirit;

to paint wound with iodine;

when the blood gets on the eye mucosa it must be washed immediately with water and then with solution of boric acid (1%);

when blood gets on in hit of blood (and other infectious material) on skin it is necessary to remove one by a cotton with 70% spirit or 5% iodine and then to wash skin with flowing waters.

If there is an injury by HIV-infected tool it must be made emergency (in the same day, during the first hours) chemoprophylaxis with special antivirus drugs. After 72 hours chemoprophylaxis is useless.

Except gloves safety measures are the common medical cloth: changeable dress, cotton aprons, caps, masks. It is necessary to keep all this cloth separately in special box.

Tools and other products of medical assignment after using are necessarily disinfected. Right after using the tools are immersed into disinfectant solutions (chloramine, hydrogen peroxide, desoxone, “Alaminol”, “Vapusan”, etc.). Disposable tools are removed after disinfection. Other tools are washed and then presterilisation preparation are carried out. This preparation includes:

- soaking in a washing solution;

- washing in a washing solution with brush;

- washing in water;

- washing in distilled water;

- drying by hot air at temperature 85 ° before full disappearance of a moisture.

Premises for steep of operation sheets and napkins, for presterilization cleaning of tools have to be equipped with combined extract and input ventilation. Prepackaging and preparation of disinfectants it carried out in the exhaust hoods or, at least, in well ventilated rooms. All job with disinfectants is done with rubber gloves and, perhaps, in protective spectacles, masks, respirators. Sequence of washing and disinfection must be kept strictly. It is necessary to keep all solutions in a tight closed vessels.

At infringement of an operating mode with disinfectants, non-observance of safety measures and in emergencies the personnel may get general and local poisoning. Chemical solutions can get to skin, eyes, respiratory ways and to stomach. First aid at hit of a disinfectant on a skin is lavish washing the skin with pure water. At defeat by formaldehyde it is better to wash the skin with 5 % solution of liquid ammonia. First aid at a poisoning through respiratory ways consists in immediate removal of the victim from the room into the fresh air or into a well aired room. It is necessary to rinse a mouth and a nasopharynx with water. In case of poisoning with formaldehyde vapors inhalation of water vapors with several drops of liquid ammonia is applied. At hit of a disinfectant or other substance in eyes, 2% solution of soda is necessary to wash out the eyes immediately.

First aid at hit of a disinfectant into stomach is washing one with pure water with the use of gastric tube (probe) and Jane's syringe. If chlorine disinfectants get into the stomach it is washed out with 2% hyposulphite and 5-15 drops of liquid ammonia with water, milk, soda inside. At the casual intake of formaldehyde washing of stomach with water and liquid ammonia is usually helpful.

Allergic aspects. Various medical drugs and disinfectants can be the cause of allergic reactions and diseases. An allergy - is a condition of the changed immunologic activity of an organism due to increase of his sensitivity repeated influences on any agents. The substance causing an allergy, refers to an allergen. Allergic diseases are the pathological processes when the basis of development is the damage of tissues caused by immune reactions. Allergens may be in air, on medical tools.

The iatrogenic pathology

Iatrogenic diseases are the diseases which arise at patients as consequence of the preventive, diagnostic and medical actions which are carried out by doctors and other medical workers. In other words, Iatrogenic diseases present any harm or the damage done by medical workers without malicious intention to the patient.

Cases of iatrogenic diseases happen due to the actions and behaviour of the average and junior medical personnel not so rare (including during care of patients).

To the number of iatrogenic diseases which occur due to the activity of the junior medical personnel, postinjection abscesses belong. Abscess - is the limited suppurative inflammation in tissues. As well as the other purulent processes, abscess is caused by pyogenic bacteria (staphylococcuses, streptococci, etc.). This agent gets into the tissues during the performance of intramuscular or hypodermic injections. It may happen, if the personal uses bad sterilized tools (syringes and needles), injection place is badly prepare and breaks the rules of injections. The cause of postinjection abscess occurrence can be incorrect skin care of the surgical patient.

Defects in heavy patients care who are taking place on a confinement to bed, may be the cause of decubital ulcers (bedsores). Decubital ulcer (bedsore) is necrosis of skin and deeper soft tissues, arising at the lying weakened patients on the places, exposed to constant pressure. More often decubital ulcers are formed on sites of a body where the skin adjoins to bone prominences. At the position on a back decubital ulcers usually arise in the fields of the sacrum, spinous process of vertebras, scapulas, heels, elbows and back of the head. To formation of decubital ulcers the dirty wet skin and bed-cloth promote. At first there is redness (hyperemia) of skin, then on this site there are purulent bubbles. Bubbles burst, therefore papillary layer of the skin is exposed. Then mortification all skin thickness and underlying tissues occurs. The purulent infection always joins. Prevention of decubital ulcers is:

- the main action is regularly (each 1-2 hours) to change position of the patient;

- patient's skin must be clean and dry;

- tidy bed (absence of folds, dry and clean sheets, absence of garbage on sheet);

- it is obligatory to wipe the skin with solutions of camphoric spirits (1%), salicylic acid (1-2%) or special ointments;

- body massage;

- immediate washing of body after defecation or urination;

- using rubber pneumatic rings and antidecubital mattresses.

Iatrogenic damages are possible at a catheterization of a bladder, gastric intubation and enema. In such cases injures of urethra, gullet or rectum correspondingly by catheters and rigid tubes may appear. To avoid such complications, it is necessary to possess good techniques to these manipulations and to adhere the rules and sequence of performance of corresponding techniques strictly.