Руководство к практическим занятиям по общему уходу за хирургическими больными (стр. 8 )

As footwear it should used slippers from a waterproof, easily washed and disinfectant material. Carrying in surgical department of street footwear and slippers from fluffy synthetics or fur is absolutely inadmissible. In order to prevent excessive noise at walking it is more preferable to use footwear with a soft sole.

When coming in hospital patient changes his clothes in hospital reception where is the special room for this purpose. Changing clothes in surgical department is not supposed.

If relatives will not prefer to take away the patient clothes, it locate to special room for storage of clothes. It is not allowed to hold superfluous clothes and footwear in wards of surgical department.

In wards hangers or cases should be for hospital clothes. It is impossible to keep clothes on stools, chairs, bedside-tables.

Hygiene of underwear

At surgical patients it is expedient to be limited to a minimum of underwear (except for patients with the general regimen), as the last:

- always becomes soiled and is a potential source of infectious danger;

- demands often replacement enough, that can give trouble to patient with procedure of changing clothes;

- frequently it purse up folders and can the reason of decubitas ulcers (bedsores);

- to a greater or lesser extent complicates carrying out of hygienic actions and also medical and diagnostic manipulations.

In particular it concerns grave condition patients with limited activity. The slightest folders on linen cause them additional sufferings. Except for that action on hygiene of a body at these patients are carried out enough frequently, and even minimal additional disturbance (connected to replacement of linen) it is not desirable. Therefore the heaviest surgical patients (for example, in ICU) frequently are without underwear. Less grave surgical patients from underwear have enough one shirt (or night-dress). It should be convenient, easily ch shirt should be:

- from cotton of light colours;

- the simple style (baggy) which is not limiting respiratory movements;

- with big wholes for a head and hands;

- with a minimum quantity of seams;

- without fasteners, buttons;

- on length up to the top or average third of hips.

Change of underwear is carried out individually as required (at pollution), but in any case not less often than 1 time a week.

Patients with a bed care are changed clothes with help of medical staff. To replace at such patient a shirt, it is necessary to bring hands under him sacrum, to grasp edges of a shirt and, cautiously raising a breast, to roll up a shirt from a back to a neck and to shift it to a nape. Then, slightly having raised a head and hands of the patient, it is necessary to take off the rolled shirt all over again from a head, then - from hands. If one hand at the patient is damaged, a shirt remove all over again with healthy, and then from a sick hand. Putting on the patient in a clean shirt make in the reverse sequence: in the beginning pass in sleeves of a hand of the patient, then having collected a shirt in folds, carry out it through a head and straighten along a back under the patient.

In surgical department there should be a stock clean bed-clothes and underwear for day.

Gathering, sorting and transportation of dirty linen carry out junior medical staff. The medical sisters participating in various medical manipulations and researches, to this are not supposed. Their duties are limited only to the actions directly connected to care by patients (change bed-clothes and underwear). At gathering and sorting of dirty linen the personnel should use separate overalls, a mask, rubber gloves, plastic apron which after each gathering wipe the rags with a disinfectant. At change clothes it accurately collect in bags (from a dense cotton or plastic). It is strictly forbidden to fling second-hand linen on a floor or in open receivers. It results in bacterial contamination of environment. For strongly polluted (pus, excrements) linen it is expedient to use separate capacity (bucket). The collected dirty linen should be taken out from department at once. Delivery clean and sending of dirty linen should be carried out separately, on different carriages. Carriages after each transportation are necessary for disinfecting.

Change of underwear at patients should be carried out in process of pollution, but not less often than one time in 7 days. The stock of linen should be at the sister - mistress of department who is responsible for its storage and delivery. If the patient uses the him linen to change it should in due time. The control over change of linen is carried out by the attending physician and the nurse..

Hygiene of bed-clothes

The important element of the general care to surgical patients is maintenance for him convenient and clean bed. Creation to the patient of comfortable conditions in bed - the factor rendering serious influence on an outcome of all treatment as a whole. The great value thus has observance of rules of hygiene of bedding and bed-clothes.

To bedding concern:

- mattresses

- pillows

- blankets.

Pillows should be the sufficient sizes (on width of shoulders of the patient). Two pillows are usually used: bottom and top. The top pillow rests in beds back.

The sizes of a blanket should be such that it was possible to cover with it bed completely. It is better to use woolen or flannelette blankets (it is especial flannelette as they are well aired and disinfected).

Mattresses in the sizes should correspond to bed. It is important, that the surface of a mattress was absolutely equal.

It is desirable for grave patients to use special antidecubital mattresses, which elastic surface precisely models a surface of a patient body. Due to increase in a surface of contact and uniform distribution of loading of all body to the big area specific pressure decreases, that considerably reduces probability of bedsores, promotes a relaxation of all muscles groups. With this purpose mattresses from thick foam rubber, hydromattresses, inflatable multisection pneumomattresses are used. The last, with alternating pressure, can be used for carrying out of easy massage (due to increase and pressure decline in various sections).

Disinfection of bedding is carried out in vapor formalin boxes (75 ml of formalin on 30 kg; temperature 57-59 °, an exposition of 45 minutes) and a steam-air method (60 kg on 1м2 the box area, temperature 80-90 °, an exposition of 20 minutes).

To bed-clothes concern:

- pillowcases

- bedsheets

- blanket covers

- napkins

- towels.

The bed-clothes is produced from not rough, hygienic fabrics (cotton, linen), white color. Seams, patchs and folds on the surfaces are not supposed on pillowcases and bedsheets. The bedsheet should be sufficient size that the mattress was closed by it from all sides. Edges of a bedsheet should be turned up under a mattress from different directions that the bedsheet was not forced down and were not formed folds.

Blanket cover and pillowcases should correspond strictly to the sizes of a blanket and pillows and to not have fasteners, buttons.

On a regular basis, not less often 3 times day (in the morning, before day time rest and for the night), it is necessary to re-make bed of the patient, straightening folds, shaking off grits.

Change of bed-clothes at surgical patients is carried out individually, as required, but, in any case, not less often than 1 time a week. At grave patients constantly taking place in bed the bed-clothes varies daily, and if necessary - some times in day. Usually change of bed-clothes combine with the next sanitary processing the patient.

It is more difficult to change bed-clothes at grave patients. Change of a bedsheet here is carried out by two medical workers and demands the certain skills. There are various ways of change of bed-clothes at such patients. If to the patient is allowed to move in bed, medical personal help him to turn sideways. On a released half of bed it is rolled to patients back a dirty bedsheet and on its place (up to half of bed) straighten a clean bedsheet. On one is shifted the patient, helping him to turn all over again on a back, and then on other side therefore the patient appears laying on a clean bedsheet. After that it is removed a dirty bedsheet and straighten clean on other part of a bed.

At patients with a strict bed care a bed re-makes as follows. Since the foot end of a bed, it is rolld a dirty bedsheet under the patient, consistently raising shins, hips, buttocks; simultaneously straighten from below the clean rolled bedsheet. Then one of re-making raises a breast and a head of the patient, and another removes a dirty bedsheet and straightens clean under a back and a head of the patient. Sometimes it more expediently to move the patient on a wheelchair (near a bed) and to re-make bed. In any situation change of bed-clothes by the seriously ill patient should be made with the big care and art.

For protection of bed-clothes at patients with wound discharge over of bandages are imposed napkins. At patients with involuntary urination and defecation are used plastic napkins on sheet. Above plastic napkin it must be cotton napkin. For these patients are used rubber bedpans or the special mattresses consisting of three fragments, one of which (average) can be removed for statement on its place of a bedpan.

Bed-clothes is disinfected by washing in a laundry by boiling during 30 minutes with detergents. Dirty linen of patients with anaerobic infection and strongly polluted linen must be destroyed with help special muffle furnaces.

Hygiene of patients personal things

The quantity of personal things at patients in a surgical hospital should be minimum. Private patients things frequently are contaminated by microbs and can be source of infection. It is certainly allowed to have toilet and shaving accessories, towels, underwear, the literature in personal using patients. All things should be kept in bedside-tables or the cases allocated for it, but not on tables, window sills. Storage of things in the bags under a bed is absolutely inadmissible. The patient should not block up ward with a plenty of things, it is necessary to hand over all superfluous things on a hospital starage or to transfer home. It is necessary to disinfect subjects of personal hygiene daily. For this purpose 0,5 % spirit solution chlorhexidine is used. Is inadmissible to keep toilet accessories in plastic packages as in the last the damp environment favorable for microorganisms is quickly created. Women for the period of a presence in a hospital are recommended to limit sharply or absolutely to stop the use of the cosmetics, especially strongly smelling and irritating means.