Under the hygienic regime is understood a scientifically based system of rules governing proper communal conditions in hospital premises. The hygienic regime is ensured by the sanitary improvement of hospitals.
The hospital is a school of personal hygiene for the patient, and the education of patients in hygiene skills helps to consolidate the results of treatment after discharge from the hospital.
The hygienic regime in the hospital is ensured by the creation of an optimal microclimate, light comfort, sufficient insolation regime, clean air, sanitary maintenance of the premises.
Favorable conditions should be created for patients and medical personnel in hospitals to comply with the rules of personal hygiene.
These issues will be the subject of separate topics of practical exercises.
Sanitary regime and sanitary maintenance. Cleanliness is an essential element of good hygienic regime medical institution.
An environment of absolute cleanliness, together with other aspects of the hospital regime, creates the best conditions for the implementation of the treatment process. It inspires the patient's confidence in the hospital staff, creates a favorable impression of the hospital, and contributes to the patient's well-being.
The importance of hospital frequency in the implementation of the treatment process and the prevention of nosocomial infection can be illustrated by the following examples.
Insufficiently clean maintenance of the surgical department and the operating unit, increasing the dust content and contamination of the air, adversely affects the creation of sterile conditions necessary for the production of operations and the storage of sterile material and instruments.
Poor cleaning of floors, furniture in wards and other places where patients stay, dust accumulation behind cabinets and heating radiators leads to air pollution and creates a direct threat of infections, in the transmission of which dust plays an important role.
Among the most important elements of the sanitary regime of medical institutions are those that are aimed at maintaining the purity of the air in hospital premises. Among them, indoor air exchange and dust control play a leading role.
Dust control in hospital premises is carried out by:
a) systematic cleaning of the premises, combined with their ventilation;
b) systematic cleaning of soft equipment in the open air:
c) fixing dust by covering floors and impregnating bathrobes.
Cleaning of all premises of the hospital department is carried out daily.
In the wards, corridors and offices, cleaning is done in the morning after the patients wake up.
After the morning toilet of the sick, making the beds and putting the bedside tables in order, wet sweeping of the floors, sweeping dust from the furniture with a damp cloth and wiping doors, panels, window sills, surfaces of heating appliances, etc. is carried out. Cleaning is completed by mopping the floors.
To reduce dust, odorless dust-binding agents can also be used to cover the floor. To do this, use special formulations containing oils that hold the dust settling on the floor.
A study of bacterial contamination of the air showed that it is minimal before the patients get up.
The number of microorganisms in the air increases 2-4 times when patients and staff move in the ward, 2-5 times when beds are made, and 2-10 times when floors are dry-sweeped. With well-conducted wet cleaning of the wards, the number of microorganisms in the air does not increase. This is facilitated by the ventilation of the wards after cleaning. In the warm season, windows and transoms in the wards should be open as long as possible.
In severe frosts, the corridors are ventilated with the doors of the wards closed.
Cleaning should be repeated throughout the day as needed to ensure that the premises are kept clean at all times. Canteens and buffets are cleaned after each meal. Before the patients go to bed, the beds are made, the floor is swept, and the room is ventilated. In winter, the corridors are ventilated several times at night. Bed linen must be changed once every 7-10 days, and also as it becomes dirty for individual patients.
The most complete removal of dust in the hospital is achieved with vacuum cleaners. Vacuum cleaners can be portable and stationary. The disadvantage of portable vacuum cleaners is the noise they create with a volume of 70-80 dB. This drawback is not the central vacuum station, which equip the hospital during construction.
An important source of ward air pollution with dust, volatile odorous substances and microorganisms are mattresses, bedding, runners and other soft materials. Cleaning and knocking out of the listed items is carried out periodically in the open air (verandas are used). The number of microorganisms after cleaning and knocking out decreases by 10-15 times, and the number of dust particles - by 2-3 times.
In order to prevent air pollution, in a number of foreign countries, in hospitals, mattresses and bedding in the wards are not changed, but the beds are completely replaced. Change of mattresses, bedding and, if necessary, disinfection of beds are carried out in a special room.
Some researchers recommend impregnating bedding and linen with dust-binding compounds. The most accessible remedy is a 3-5% aqueous solution of emulsol, which includes spindle oil (72.5%), asidol (18%), ethylene glycol (20%), caustic soda (1%), water (6.5% ). Linen is immersed in the emulsol solution for 2-3 minutes, then squeezed and dried.
Hygienic properties of impregnated linen (including smell and color) do not change. To cover the floors, a 30% aqueous solution of emulsol is used (30 ml per 1 m3).
Using rational cleaning methods and systematic aeration, it is possible to significantly reduce the microbial contamination and dust content of the air in hospital rooms. However, the growing proportion of droplet infections and ever-increasing requirements for asepsis dictate taking measures to further reduce the microbial contamination of the air in the wards of children's infectious diseases departments, in operating rooms, dressing rooms, maternity, etc. To this end, various methods of indoor air disinfection have been studied in recent years.
Irradiation with ultraviolet rays has received the greatest practical application. Ultraviolet radiation is a powerful and fast bactericidal agent when irradiating the air or the surface of various objects. The bactericidal effect of ultraviolet rays decreases with increasing dust and humidity.
There are two sources of artificial ultraviolet radiation: high-pressure mercury-quartz lamps (PRK type) and low-pressure bactericidal ultraviolet lamps (BUV type). Mercury-quartz lamps can be of high power (up to 1000 watts), but they have less bactericidal rays output per unit of power.
Therefore, lamps of the PRK type are currently recommended for use in hospitals for irradiating various objects and indoor air in the absence of patients.
Lamps of the BUV type are of lower power than the PRK (15 and 30 watts), but they have a much greater output of bactericidal rays per unit of power.
The emission spectrum of these lamps consists of 80% of the most germicidal rays, so their side effect(ozone formation) is much less.
There are three methods of using ultraviolet radiation:
1) direct irradiation,
2) indirect irradiation - by reflected beams,
3) irradiation of supply air in ventilation or circulation devices.
Direct irradiation is carried out with the help of lamps suspended from the ceiling and directing a direct stream of rays downwards. It can also be carried out with lamps mounted on walls or special tripods standing on the floor. Requires a power of 1.5-2 W per 1 m 3 of the room. In this way, a high degree of disinfection of furnishings and air can be achieved.
So, after 1-2 hours of irradiation of the dressing room during operation, the total number of bacteria in the air decreased by 60-70%, while without irradiation, the contamination of the air continuously increased.
However, a direct stream of ultraviolet rays from lamps of the PRK type and even the BUV type has an unfavorable side effect and therefore direct irradiation can be carried out only in the absence of people (during breaks, before starting work) or when they are provided with special eye protection goggles.
The most widely used indirect ultraviolet irradiation of premises. To do this, a source of ultraviolet radiation is suspended at a height of 1.8-2 m from the floor with a reflector facing upwards so that the direct radiation flux enters the upper zone of the room; the lower area of the room is protected from direct rays by a lamp reflector.
The air passing through the upper zone of the room is actually exposed to direct radiation. In addition, reflected from the ceiling and the top of the walls (for better reflection, the walls should be painted in White color) ultra-violet rays irradiate the lower area of the room in which people can be.
The ultraviolet radiation reflected from the ceiling and walls, with the right dosage, has not only a bactericidal, but also a beneficial biological effect (formation of vitamin D, improvement of the body's immunological reactivity, stimulation of hematopoiesis), since the intensity of the reflected radiation is 20-30 times less than the direct one.
There are observations about the positive effect of indirect irradiation in the wards for newborns and premature babies (better weight dynamics, less airborne diseases, easier course of the disease).
Ultraviolet irradiation in wards with children with scarlet fever reduced the frequency of complications by 3 times. In the irradiated wards of the children's infectious diseases department, several times less diphtheria bacillus, hemolytic streptococcus and pyogenic staphylococcus were sown from the air.
It is advisable to irradiate the chambers in autumn-winter and early spring 3-4 times a day for 1 hour.
Artificial ultraviolet irradiation, even indirect, is contraindicated in children with active tuberculosis, nephrosonephritis, fever and severe exhaustion.
Disinfection of premises and care items is carried out as follows.
In the infectious wards, during daily cleaning, the surfaces are wiped with a rag. Wiping with one rag increases its contamination and is ineffective in disinfecting wiped surfaces. Therefore, it is recommended to use three rags in a solution of chloramine and periodically change them when wiping surfaces.
Tableware after washing is disinfected by boiling or washing in a 0.2% clarified solution of bleach, followed by rinsing.
In the infectious disease department, the duration of disinfection of dishes with bleach should be at least 1 hour. Toilets, urinals, bathrooms, washbasins are thoroughly cleaned of dirt (with kerosene, acids or detergent composition), and then washed with hot water and soap. Bathrooms after each patient are washed with warm water.
The wooden parts of the toilet bowls are washed with a 5% bleach solution. Bedpans are washed and disinfected after each use. Disinfection is carried out with steam or in a 0.2% bleach solution for an hour.
It is necessary to introduce everywhere devices for washing and thermal sterilization of bedpans and urinals, operating on electricity or on water from a connected hot water supply system. This refers to such devices as "Purifeks", the Czech device of the company "Hirana", etc.
The procedure for the neutralization of items for the care of seriously ill patients in these preparations takes 7-8 minutes.
Toys are neutralized by washing in a 3% solution of chloramine or with a brush dipped in it, as well as ultraviolet irradiation (15 minutes at a distance of 30 cm from the lamp to the surface of the toy).
It is desirable to carry out whitewashing of premises in hospitals at least once a year. After whitewashing, which is combined with a thorough cleaning of hospital premises, the content of microorganisms in the air of the wards for a long time remains within the lower limits, and after a few months, even with an unchanged sanitary regime, it begins to rise.
Another important condition for ensuring a hygienic regime is the organization of the timely collection, disinfection and disposal of waste generated during the operation of hospitals.
Personal hygiene of medical personnel. Neat, collected and cultured appearance, pedantic observance of the rules of personal hygiene by medical personnel are necessary conditions patient care.
Medical personnel should serve as a model for patients in observing the rules of personal hygiene.
In addition, the implementation of personal hygiene rules by staff is of great importance for the prevention of nosocomial infections among both medical workers and patients.
All employees entering the hospital are subject to a mandatory medical examination. In the future, employees of the food unit and junior staff directly serving patients are subjected to a medical examination every month, and once every six months to a study on bacillus carriers. Employees who become ill with diseases that are dangerous in terms of the possibility of transmitting them to patients are not allowed to work.
Arriving at work, a medical worker must take off his outer clothing in the wardrobe, wash his hands thoroughly with soap and water, and then put on the established overalls (gown, scarf, gauze bandage on his mouth and nose, etc.). Overalls must be immaculately clean, ironed, of the appropriate size.
Each time after dirty work, personnel should thoroughly wash their hands with hot water with a brush and soap, and if necessary, treat them with a disinfectant solution, such as a 0.2% clarified bleach solution or a 1% chloramine solution. This must be done after servicing infectious patients, as well as before and after various manipulations. Hand washing brushes should be kept in a disinfectant solution.
Employees' nails are required to be cut short. Technical staff involved in cleaning the premises are not allowed to distribute food.
Every hospital should provide for staff to shower after work. Pass-type showers are arranged for the personnel of the infectious and disinfection departments.
Objective monitoring of the sanitary condition of the hospital. An objective and reliable assessment of the sanitary condition of the hospital is impossible without systematic hygienic studies of the external environment.
The most important of them include: instrumental studies of microclimatic factors (temperature, humidity and air velocity, temperature of external walls), examination of air for bacterial contamination, oxidizability and carbon dioxide content, examination of noise intensity, examination of the sterility of surgical instruments and dressing material, study of swabs from the hands of staff and patients, from clothing, furniture, household items and the degree of contamination with Escherichia coli; the study of food for caloric content and nutrient content, including vitamins; study drinking water etc.
All data characterizing the sanitary state of the external environment in the hospital are recommended to be recorded in a special sanitary journal.
Analysis of the results of these studies helps to uncover the causes of shortcomings and find effective measures to eliminate them.
Hygienic conditions are an important prerequisite for the prevention of nosocomial (nosocomial) infection. The fight against hospital infection is relevant not only for infectious, pediatric, surgical, maternity, but also for all other departments. In recent years, there has been an increase in hospital diseases in hospitals, especially due to staph infection, which has even been called the "hospital plague of the 20th century." Thus, in the United States, up to 6.3% of all those treated in hospitals suffer from a hospital infection. In England, during the year, about 1 million additional bed-days account for postoperative purulent-septic and other complications. At the same time, all researchers invariably emphasize that the basis for the prevention of nosocomial infection is a hygienically rational device, equipment and maintenance of hospitals.
Hospital hygiene must ensure healthy working conditions for all staff. Medical personnel may be exposed to a number of occupational hazards. These include: neuropsychic stress (surgeons, resuscitators-anesthesiologists, obstetricians-gynecologists, staff of psychiatric hospitals, etc.), skeletal muscle tension (surgeons, dentists, etc.), night work (duty staff), chemical (anesthesiologists and etc.) and physical agents (personnel of X-ray, physiotherapy, barooperative and other departments), nosocomial infection (influenza and other droplet infections), etc.
A particularly high level of hygienic provision is necessary when introducing the latest scientific achievements into medicine. So, for example, without the development and implementation of appropriate hygienic measures, it is impossible to use radioisotopes and other sources of ionizing radiation, electron microscopes, lasers, barooperative, and the latest physiotherapeutic installations. Carrying out a complex system of hygienic measures is necessary for organ transplantation operations. The use of various polymeric materials, germicidal paints, disinfectants, detergents and cleaners in a hospital also requires hygienic competence. Exemplary compliance with hygiene requirements in the hospital helps it to become a school of hygiene skills for patients. Given the increased importance of hospital hygiene, a new position of "hospital hygienist" is being introduced to hospital staff in several countries. In Russia - "hospital epidemiologist".
The main tasks of its activity:
1) Improving hygiene conditions in the hospital;
2) Systematic monitoring of the sanitary condition of the hospital;
3) Minimizing the risk of nosocomial infection.
The creation of hygienic conditions depends on the system of hospital construction, properties land plot and the location of the hospital in the settlement, the arrangement and internal layout of hospital buildings, sanitary and technical improvement, equipment and sanitary maintenance.
LOGICAL STRUCTURE OF THE SECTION« HYGIENE OF MEDICAL AND PREVENTIVE INSTITUTIONS» (in the aspect of the work of a medical profile doctor)
1. Assessment of the location of healthcare facilities in settlements, land plot planning, taking into account the creation of a medical and protective regime, protection of hospital premises from noise, pollution, creation of a favorable insolation regime, the possibility of using the site for patients to stay in the fresh air. 2. Assessment of compliance with hygienic requirements for the layout of departments for the reception and discharge of patients, taking into account the possibility of providing a medical and protective regimen and preventing nosocomial infections. 3. Evaluation of the features of the layout of various departments of the hospital (children's, surgical, obstetric-gynecological, infectious diseases, etc.). 4. Evaluation of the sanitary and hygienic regime in the department.Topic 1. HYGIENIC REQUIREMENTS FOR LOCATION, LAYOUT AND EQUIPMENT OF MEDICAL INSTITUTIONS (sanitary examination of the hospital project)
PRACTICAL SIGNIFICANCE OF THE TOPIC:
The creation of optimal hygienic conditions in medical institutions is determined by the features of the layout and development of the hospital site, the arrangement and internal layout of buildings, their sanitary and technical improvement, as well as the sanitary condition during operation.
PURPOSE OF THE LESSON:
Learn the basic hygiene requirements for accommodation and interior layout medical institutions on the example of analysis of a typical hospital project.
THEORY QUESTIONS:
1. Modern hygienic problems of hospital construction.
2. Hygienic requirements for the location of hospitals and the layout of the land.
3. Hospital building systems, land zoning.
4. Hygienic requirements for the admission department, for the ward section and other structural units of hospitals.
5. Planning and mode of operation in the therapeutic, surgical, children's, obstetric and infectious diseases departments of hospitals.
PRACTICAL SKILLS:
To master the methodology of hygienic examination of projects of medical institutions.
LITERATURE:
Main: 1. Rumyantsev G.I. et al. General hygiene.-M.,-1986.-S.230-253, 289-300. 2. Gabovich R.D., Poznansky S.S., Shakhbazyan, G.Kh. Hygiene. Kiev.- 1984.-p.277-304. 3. Pivovarov Yu.P. Goeva O.E. Velichko A.A. Guide to laboratory studies in hygiene. M. Medicine.-1983.-S.59-92.
Additional: 1. Bystrova T.A. Hygiene of medical institutions. -M.-1971. 2. Sakhnovskaya N.N., Manenko A.K. Hygiene of medical institutions. - Kyiv. -1982. 3. Hospital hygiene. Translation from German. -Minsk. -1984.
ASSIGNMENT FOR INDEPENDENT WORK OF STUDENTS:
Based on the literature and the given educational material
I. To study the sanitary and hygienic principles of the planning of medical institutions.
II. To study the hygiene requirements for the location of medical institutions in settlements and the layout of the hospital site, taking into account the creation of a favorable medical-protective and anti-epidemic regime.
III. To study the hygienic requirements for the layout of the department of admission and discharge of patients and the features of admission and discharge in various departments of hospitals.
IV. Learn the hygiene requirements for the ward section (for example, the layout of the therapeutic department). Features of the layout of the children's, obstetric-gynecological, surgical and infectious diseases departments of hospitals.
V. Learn the hygiene requirements for the layout of the outpatient department.
VI. Master the program of sanitary examination of the hospital project.
TRAINING MATERIAL FOR INDEPENDENT TRAINING
1.1. Hygienic principles of placement of medical institutions and planning of land plots.
A modern hospital is a medical center designed for medical and preventive care of the population. Given the fact that most hospitals provide services not only to hospitalized patients, but also to the population of the location area, it is necessary to provide for the location of the hospital directly in the residential (residential) zone or in the center of the serviced area (somatic profile). Specialized departments or complexes with a capacity of more than 1000 beds, for the stay of patients for a long time (psychiatric, tuberculosis, rehabilitation treatment, etc.) must be located in a suburban area or outlying areas, if possible in green areas or in close proximity, observing gaps in 1000 m from the residential area, for the use of natural conditions as an additional healing factor. Women's clinics, dental clinics and other outpatient facilities can be located in residential and public buildings within walking distance (1.5-2 km), near streets and roads with public transport. Medical institutions, according to SNiPP-69-78 "Treatment and preventive institutions" should be located in accordance with the general plan and detailed planning projects of the settlement, taking into account its functional zoning.
The territory of the hospital should be removed from sources of noise (airfields, railways, main city highways) and pollution of air, soil and water (municipal dumps, sewage fields, animal burial grounds and industrial enterprises) with a sanitary protection zone from 50 to 1000 m, depending on the degree of harmfulness of the object, on the windward side - from sources of air pollution. The site is placed on well-insolated, ventilated and rich in vegetation soil, with a natural or organized slope (0.5-10 0) to ensure insolation and atmospheric water runoff. Soils should allow the use of natural bases without additional measures, have uncontaminated, filtering soil. low standing ground water(no closer than 1.5 m from the ground surface and 1 m from the base of the foundation) should allow construction without artificial lowering of the level and complex waterproofing. The site should not be flooded, swamped, it should not have karst and landslide phenomena.
The calculation of the needs of the population in healthcare facilities and the size of land plots is carried out in accordance with the SNiP "Planning and development of cities, towns and rural settlements". For a medical institution, green areas are allocated, the most favorable in terms of their natural conditions, located on an elevated, dry area, well ventilated. When choosing a site, one should take into account the possibility of connecting the hospital building to the existing water supply, sewerage, electrification, heating and gasification networks.
To prevent nosocomial infections, compliance with the hygienic rules for maintaining hospital premises and personal hygiene by staff is of great importance. Consider the basic rules for maintaining the sanitary and hygienic regime in health facilities.
1. Upon admission to the hospital, patients, depending on their condition, undergo sanitization in the emergency department: shower / bath / wet wiping, cutting nails, examination for pediculosis and, if detected, appropriate hair treatment. After sanitation, patients are given a set of clean underwear and slippers, and bed linen in the ward. When patients are discharged, underwear and bed linen are washed.
2. In the ward, the patient must have individual glass, spoon, Toothbrush, towel, soap and can be - toothpaste and a razor.
3. Hygienic washing- Once a week with a note in the medical history.
4. hygiene care for seriously ill patients - washing, wiping the skin of the face and parts of the body, rinsing the mouth - are carried out after eating and when the body is contaminated.
5. Nursing staff must have a kit interchangeable work clothes - dressing gown, hat and shoes.
6. Before examining each patient and after "dirty procedures" - medical staff should wash their hands by 2 times soaping.
7. To maintain cleanliness and prevent infections, a wet cleaning- at least 2 times a day with the use of detergents (soap-soda solutions) and disinfectants and the use of marked equipment: mopping, wiping furniture, equipment, doors;
8. Once every 10 days, a general cleaning of the premises is carried out - sweeping ceilings, walls, washing panels and floors, changing bed linen, cleaning blankets with a vacuum cleaner
9. Complied sanitary and anti-epidemic regime in healthcare facilities: a) toilet bowls and urinals are treated daily with a 0.5% solution of bleach; bedpans after each use are disinfected with a 0.2% bleach solution; b) to reduce microbial contamination, bactericidal lamps with indirect irradiation are periodically turned on.
10. From staying in the hospital, patients experience anxiety and dissatisfaction with the hospital environment, which causes a deterioration in their condition. Therefore, hospitals must comply medical and protective regime , which consists in the elimination of adverse stimuli and the inclusion of measures that have a beneficial effect on the patient's body. Particular attention is paid to measures sparing the patient's psyche: a) it must be remembered that a carelessly spoken word can cause excitement and deterioration of the patient's condition; b) patients tend to read the medical history and this can get upset - therefore, it is necessary to streamline the storage of medical histories; c) the lengthening of physiological sleep is of great importance for rest - daytime sleep is observed, at this time there should be silence in the department, talking quietly; use light signaling; d) personnel must wear soft shoes; e) cleaning in the wards to do after the rise of patients; f) elimination of unpleasant “hospital” odors, tidy maintenance of the premises, cozy atmosphere in the wards and department are of no small importance; g) this also includes dietary nutrition, taking into account the pathology of the patient and h) strict observance of the daily routine by patients and staff.
The layout of the wards and boxes is designed to prevent nosocomial infections, which infect up to 10% of hospitalized patients, and 2% of them die. Nosocomial infections are abscesses after injections, cystitis and urethritis after catheterization, infectious hepatitis, pustular and fungal diseases. According to the WHO definition, “nosocomial infection is this is any clinically pronounced disease of microbial origin that affects the patient as a result of hospitalization or visits to a health facility for the purpose of treatment, as well as hospital personnel in the course of their activities ... ". In fact, a hospital infection is an infectious disease that occurs during or after inpatient treatment (in parturient women - mastitis, in newborns - sepsis; a patient was admitted with pneumonia - fell ill with dysentery, hepatitis). The infection can be introduced by both patients and staff, as well as carried by staff from the hospital to their families. The longer a child is treated in a hospital, the more viruses enter his body, which is determined by antibodies in the blood, and this increases the child's stay in the hospital by an average of 14 days.
Where do pathogenic staphylococci come from in the department? When examining service personnel, carriers are detected - 54% (including nurses - 54%, nurses - 70%, doctors - 42%), among children - 60%, in swabs from objects of the hospital environment in the wards for newborns - 8% , in the children's department - 12% and surgical - 14%.
The main causes of nosocomial infections:
A) Intrahospital causes:
1. Incomplete diagnosis: admission of a patient with one diagnosis, despite the fact that he is already sick with another infectious disease (influenza, acute respiratory infections).
2. Unsatisfactory medical examination of patients upon admission (staphylococcal diseases in the maternity hospital with missed pustules).
3. Insufficient isolation of patients, especially weakened ones - contacts in common wards, corridors, toilets.
4. Insufficient control of medical staff over patients: a child with acute respiratory infections has undiagnosed diarrhea and it infects others.
5. Unsatisfactory intra-hospital sanitary and anti-epidemic regime: in general places, poor disinfection, linen is not boiled, wards are unsatisfactorily disinfected after the discharge of women in labor; additional beds are deployed in corridors and non-ward rooms (which is prohibited).
6. Poor sterilization of syringes and instruments (positive benzidine test for occult blood).
B) Social reasons:
1. Introduction of a range of new diagnostic and therapeutic manipulations that increase the number of interventions of medical equipment and drugs inside the body.
2. Extension of application medicines that suppress the immune system (immunosuppressants).
3. Habituation of microorganisms to typical antibiotics, which determines the evolution of microbes.
4. Insufficient socio-economic security of hospitals: accumulation in one department with incurable diseases of elderly or debilitated patients who require not so much treatment as care in a social institution.
The problem of reducing nosocomial infections is a matter not only of junior and middle medical staff, but also of the attending physician and workers of the sanitary and epidemiological service, as well as heads of healthcare and government agencies.
Organization of sanitary-hygienic and anti-epidemic regime. Personal hygiene of medical staff. Disinfection and sterilization of baby care items
MINISTRY OF HEALTH OF UKRAINE
NATIONAL MEDICAL UNIVERSITY
named after O.O. BOGOMOLETS
"Approved"
at a methodological meeting
Department of Pediatrics No. 2 and Medical Genetics
Head of Department
Professor A.P. Volosovets ____________
"____" ___________________ in 200
METHODOLOGICAL INSTRUCTIONS
FOR INDEPENDENT WORK OF STUDENTS
IN PREPARATION FOR A PRACTICAL (SEMINAR) LESSON
1. Relevance of the topic:
In the system of children's medical institutions, the children's hospital plays a special role. It is here that seriously ill patients are hospitalized, modern diagnostic equipment is concentrated here, highly qualified doctors and nurses work here. Knowledge of the specifics of the work, structure, functions of the main subsections of the pediatric hospital is necessary for the future doctor. Violation of the sanitary-hygienic and anti-epidemic regimes of medical institutions, unsatisfactory preventive work of medical personnel are the causes of the spread of infections within hospitals, in particular the emergence of nosocomial foci, which significantly complicate the course of the underlying disease, cause fair complaints from parents, reduce the authority of the hospital among the population. Carrying out a complex set of numerous and versatile measures to prevent infectious outbreaks, coordinating and monitoring their implementation is the responsibility of medical personnel, primarily doctors.
2. Specific goals:
- Interpret the concept of medical-protective and sanitary-hygienic regimes in a children's hospital;
- Classify the main types of disinfection;
- To carry out the processing of child care items after their use with the use of modern disinfectants;
- Explain the features of personal hygiene of medical personnel;
- Demonstrate personal hygiene skills of medical staff
- Distinguish the main types of sterilization of child care items
3. Basic knowledge, abilities, skills necessary to study the topic (interdisciplinary integration)
4. Task for independent work while preparing for the lesson.
4.1. The list of basic terms, parameters, characteristics that a student must learn in preparation for the lesson:
Definition |
|
| 1. Sanitary-hygienic and anti-epidemic regime | A set of organizational, sanitary preventive and anti-epidemic measures that prevent the occurrence and spread of nosocomial infection |
| 2. Therapeutic and protective regime | Organization of complex drug treatment of the underlying disease, as well as the organization of the optimal regime, that is, mental rest for the resumption of the physiological functions of the central nervous system and its vegetative department |
| 3. Disinfection | This is a system of measures that are aimed at the destruction of pathogens and the creation of conditions that prevent their spread in the environment. |
| 4. Disinsection | A method that ensures the destruction of insects that are carriers of infectious diseases. |
| 5. Sterilization | A method that ensures the death of vegetative and spore pathogenic and non-pathogenic microorganisms in the sterilizing material |
4.2. Theoretical questions for the lesson:
1. The concept of medical-protective and sanitary-hygienic regimes, the features of their application in a children's hospital.
2. The concept of personal hygiene of medical staff.
3. The concept of disinfection and sterilization. Types of disinfection.
4. Methods of sterilization, their advantages and disadvantages.
3. Disinfection and sterilization of child care items (treatment of beakers, pots, toys, bottles, nipples, thermometers, changing tables after using them).
4.3. Practical tasks that are performed in the classroom
1. Carrying out the processing of child care items after use.
THE CONCEPT OF THE FEATURES OF MEDICAL-PROTECTIVE, SANITARY-HYGIENIC AND ANTI-EPIDEMIC REGIME.
FEATURES OF THEIR APPLICATION IN CHILDREN'S HOSPITAL
In the activities of the children's hospital, particular importance is given to maintaining order, cleanliness, as well as continuity in the work of medical personnel. Junior nursing, nursing and medical personnel must comply with the rules of the sanitary and anti-epidemic regime, which provides for the organization and implementation of the necessary sanitary and preventive and anti-epidemic measures. Sick and weakened children are concentrated in the hospital, therefore the most serious attention should be directed to the prevention of nosocomial (nosocomial) infections. To ensure sanitary and anti-epidemic well-being in a children's hospital, it is necessary to adhere to existing sanitary rules: adherence to the principle of isolating certain groups of children when filling departments (wards, boxes, etc.), use the available premises for their intended purpose, create an optimal air-heat flow in the premises, strictly adhere to the rules of the catering department; comply with the rules for hiring personnel and ensure timely completion of mandatory preventive medical examinations; children and staff to observe the rules of personal hygiene, to have means for carrying out disinfecting measures ( enough overalls, cleaning equipment, detergents and disinfectants); carry out engineering, technical and sanitary improvement of the institution and plots of land that belong to him.
Sanitary and hygienic standards provide for the allocation of each child a bed made with clean linen, a bedside table for storing personal belongings. If necessary, the child is given a pot, bedpan, personal care items (drinker, mug), clothes. The patient takes personal hygiene items with him to the department.
On individual tables or bedside tables, which are located next to the beds, put a glass; they store toilet items (toothbrush, paste, soap, comb) and some personal items (paper, pencils, pens, books, toys). It is strictly forbidden to store food in the cabinets. To store food in the pantry or dining room should be a refrigerator.
Each patient at least once every 7-10 days (if necessary) is given a hygienic bath with a complete change of underwear and bed linen. The child's toilet is carried out daily. Before each meal, patients must wash their hands. For severe and lying patients, washing is carried out in bed.
In the department, it is necessary to strictly observe the sanitary regime. Ventilate the wards at least 4 times a day, preferably during the period when the children are in the dining room. When airing the room at other times and when quartzing the chambers, children are taken out into the corridor or the playroom. For early detection of infectious diseases, children are examined daily. Carefully examine the skin and visible mucous membranes, keep a careful record of all children with fever; if necessary, carry out bacteriological and bacterioscopic examination of blood, feces.
The proper organization of children's nutrition, food preparation, its transportation and distribution are of great importance in observing the anti-epidemic regime in the hospital.
One of the essential factors in compliance with the anti-epidemic regime in a children's hospital is personal hygienemedical staff. Only healthy persons who have undergone a medical examination are allowed to work in a children's medical institution.
The health worker must have a neat and tidy appearance. The nurse before duty takes a shower, puts on clean underwear. Hands should be washed with soap and nails cut short. Clothing must be of the prescribed form; a white robe worn over a dress with short sleeves and a cap (kerchief) that covers the hair must be clean and ironed. For the duration of the duty, the sister puts on special shoes, which allows you to move silently. Slippers should be easy to disinfect. At the end of the duty (shift), the dressing gown, headgear and slippers are left in a closet specially designated for the medical worker.
In some cases, it is mandatory for medical workers to wear a mask that should cover the mouth and nose. It is obligatory to wear a mask for the staff of the department of newborns, infants, infectious wards and boxes, treatment rooms, as well as during epidemics. Masks are usually made of gauze folded in 4 layers, since thinner ones allow microorganisms to pass through. Prolonged use of the mask reduces the effectiveness of its action as a filter for microorganisms. Therefore, every 4 hours the mask must be changed. Used masks are placed in a separate bowl, boiled and ironed with a hot iron. In recent years, disposable sterile non-woven textile masks have been used.
For most childhood infections, fever and a rash are characteristic. If a diagnosis of an infectious disease is made or there is a suspicion of an infectious disease, then the patient is immediately isolated in a box or sent to an infectious diseases hospital.
The main sanitary and epidemiological orders that regulate the work of medical institutions:
- OST 4221-285 "Sterilization and disinfection of products medical purpose. Methods, means and modes of disinfection, pre-sterilization treatment (stages), sterilization (methods, modes, means).
- Order No. 288 "On the sanitary and epidemiological regime of a medical institution."
- Order No. 408 "On measures to reduce the incidence of viral hepatitis and prevent AIDS."
- Order No. 450 "On measures to prevent the incidence of diphtheria, its prevention"
- Order No. 720 "On strengthening medical care for patients with purulent-septic diseases and strengthening the fight against nosocomial infection"
DISINFECTION AND STERILIZATION OF CHILD CARE ITEMS (PROCESSING OF BEAKERS, POTS, TOYS, BOTTLES, NIPPLES, THERMOMETERS, CHILD TABLES AFTER THEIR USE).
Disinfection. This is a system of measures that are aimed at the destruction of pathogens and the creation of conditions that prevent their spread in the environment.
There are two types of disinfection: prophylactic and disinfection in an epidemic focus, which in turn is divided into current and final.
Preventive and current disinfection in the epidemic focus is carried out by junior nurses and nurses. Employees of the Center for Sanitary and Epidemiological Surveillance and disinfection stations may be invited to carry out the final disinfection in the epidemic focus.
Equipment for carrying out disinfection measures (buckets, mops, rags, etc.) is marked and used only in those premises for which it is intended.
Preventive disinfection is carried out in the premises, regardless of the presence of infectious diseases in order to prevent the accumulation and spread of pathogens. For air disinfection, ultraviolet radiation and ventilation are used. Furnishings, toys, floors, etc. wipe (at least 2 times a day) with a cloth moistened with disinfectant solutions.
Wet wiping of furniture is carried out daily. The panels are washed or wiped with a damp cloth once every 3 days. The upper parts of the walls, ceiling, ceilings are cleaned of dust once a week, window frames and doors are wiped with the same frequency. Daily damp wiping of radiators and central heating pipes is very important, as existing dust can burn through, creating carbon monoxide, which is unacceptable. Soft things (carpets, curtains, bedspreads, blankets) are knocked out and shaken out in the open air or vacuumed. General cleaning is carried out once a week.
Sterilization rules for teats and bottles. Dirty nipples are thoroughly washed first in running water, and then with warm water and soda (0.5 teaspoon of baking soda per glass of water), while they are turned inside out. Then the nipples are boiled for 10-15 minutes. Teats are sterilized once a day, usually at night. Conducted by her ward nurse. Clean rubber nipples are stored dry in a closed (glass or enamel) container labeled "Clean nipples". Clean nipples are removed with sterile tweezers, and then put on the bottle with cleanly washed hands. Used nipples are collected in dishes labeled "Dirty nipples".
Bottles are sterilized in the pantry. First, the bottles are degreased in hot water with mustard (50 grams of dry mustard per 10 liters of water), then washed with a ruff, washed with running water externally and internally (using a device in the form of bottle rinsing fountains) and rinsed. Clean bottles are placed upside down in metal nets, and when the remaining water drains, the bottles in the nets are placed in a dry heat cabinet for 50-60 minutes (temperature in the cabinet is 120-150 ° C).
Bottles can be sterilized by boiling. To do this, they are placed in a special dish (tank, pan), poured with warm water and boiled for 10 minutes. Store sterile bottles with a neck closed with sterile cotton-gauze swabs in separate cabinets.
Characteristics of some effective moderndisinfectants:
"Sterilium", "Octeniamin", "Bactolin basic" is used for surgical and hygienic antisepsis of the hands of medical personnel in order to prevent hepatitis B, AIDS.
"Yodobak", "Kutasept-g" - antiseptic preparations for the skin, mucous membranes, wounds, burns before and after the surgical treatment of the surgical field and other cases.
Teralin (TRN-5225) is a concentrate for wet cleaning.
"Perform" is used to treat the surfaces of objects, especially in rooms where there are immunocompromised patients and newborns.
"Gigasept FF" is used for disinfection and chemical sterilization of endoscopic and resuscitation anesthetic equipment.
"Lisetol AF" is used for processing medical instruments. Due to the high cleaning properties of the drug, it is used for simultaneous disinfection of products and pre-sterilization cleaning. Lysetol is the only agent that can dilute the remains of dried blood, mucus and other human biological fluids in finely capillary medical devices.
"Bodefen" is used for disinfection and pre-sterilization cleaning of thermolabile and thermostable medical instruments, including flexible endoscopes.
"Mikrobak forte" is used for disinfection and cleaning of surfaces of rooms (walls, floors), medical equipment.
"Sanifect - 128" is used for disinfection and pre-sterilization cleaning of medical devices, preventive, current and final disinfection, general cleaning, disinfection of indoor surfaces, hard furniture, medical devices and equipment, linen, dishes, patient care items.
The listed disinfectants do not fully exhaust the list of effective drugs.
Preventive disinfection measures also include washing hands with soap (it is necessary to carry out systematically for both staff and sick children), boiling water, and observing sanitary rules when distributing food.
Current disinfection is carried out to reduce the infection of furnishings, premises that are located near the source of infection. Disinfect all the secretions of the patient and objects that the patient has touched, current disinfection is especially important for intestinal infectious diseases.
There are mechanical, physical and chemical methods of disinfection. With a mechanical method, they wash clothes, wash their hands, remove dust and dirt with a damp cloth. Physical methods include boiling, the effectiveness of which increases when sodium bicarbonate (20 grams per 1 liter of water) and laundry soap (10-20 grams per 1 liter of water) are added to the water. Water vapor is also used, which destroys not only microorganisms, but also spores. Chemical methods of disinfection are the most common and consist in the use of different disinfectant solutions.
The final disinfection is carried out for the complete elimination of pathogens in the box, ward, department. Rooms, household items, clothing are disinfected. The most important method of final disinfection of premises is their treatment from a hydraulic console with a mixture of different disinfectant solutions. The final disinfection of the surfaces of objects by wiping or washing them can also be. Some items (for example, upholstered furniture, books, shoes, etc.) should be disinfected in disinfection chambers.
To facilitate quality control of cleaning, disinfection and sterilization of medical supplies should be carried out in the central sterilization departments (CSOs). In the CSO, a room is allocated for washing, disinfection, packaging and subsections for sterilization and separate storage of sterile items. Air temperature in all subdivisions should be between 18°C and 22°C, relative humidity 35-70%, air flow direction should be from clean to relatively polluted areas. Prior to sterilization, all items undergo pre-sterilization treatment. For packaging material, muslin, kraft paper, paper/plastic bags are used.
In hospitals, different methods of sterilization are used:
– steam
- air (dry hot air)
- gas (ethylene oxide, vapors of formaldehyde solution, vapors of hydrogen peroxide)
In industrial conditions, the radiation method is used to sterilize disposable products.
Advantages and disadvantages of different sterilization methods
| Method | Advantages | disadvantages |
| Steam |
|
|
| Air |
|
|
| Sterilization |
100% ethylene oxide
- Easy to use and control
- Requires time to aerate
- Ethylene oxide is toxic, is a reliable carcinogen, flammable, requires storage in fireproof rooms
Sterilization
hydrogen peroxide vapor
- Low temperature mode
- Does not need aeration
- Safe for the environment and medical personnel
- End products are non-toxic
- Easy to use and control
- Unable to sterilize paper products, laundry and solutions
- Small sterilization chamber
Sterilization
vapor of formaldehyde solution
- Can be used to sterilize most medical devices
- The need to wash the surface from formaldehyde residues
- toxic, allergenic
- long exposure
Sterilization quality control is one of the most important infection control measures:
The physical method of controlling the operation of sterilizers is to measure such parameters as temperature, pressure and duration of sterilization.
The chemical method of control consists in registering a change in color or physical properties of indicators
The most important quality control method for sterilization is the biological method. The Centers for Disease Control and Prevention (CDC) recommends testing steam sterilizers once a week. Bacillus stearothermophilus spores are used as biological indicators in air sterilizers, and Bacillus subtilus spores in gas sterilizers.
Liquid chemicals or wet pasteurization can be used for disinfection.
All medical instruments and patient care items, depending on the degree of risk of infection of the patient, can be divided into three categories:
1) "critical" tools and care items;
2) "semi-critical" tools and care items;
3) "non-critical" tools and care items;
« Critical" Items are instruments that enter the bloodstream and are normally sterile body tissues. These include, for example, surgical instruments, cardiac catheters, and implants. In case of contamination with microorganisms, there is a significant risk of infection of patients. Therefore, instruments and objects that fall into this category must be sterile.
« Semi-critical" these are objects that come into contact with mucous membranes or damaged skin (inhalers, bronchoscopes, endoscopes). Semi-critical instruments must be thoroughly cleaned and disinfected to kill all micro-organisms and most bacterial spores.
« Non-critical" items contact only with intact skin (for example, blood pressure cuffs, stethoscopes, bedpans). These items do not need to be sterile and may contain bacterial spores on their surface.
Depending on the type of medical device and the purpose of its use, disinfection is carried out high level (TLD), intermediate level (LLT) and low level (LLT)
During HLD, all microorganisms die, except for bacterial spores.
This disinfection method should be used for all "semi-critical" items. For HLD, glutaraldehyde, chlorine dioxide, 6% hydrogen peroxide, and peracetic acid products are used. These chemicals can also be used for sterilization, but the exposure time is greatly increased.
During DPU, vegetative forms of bacteria, including mycobacteria, most viruses and fungi (except bacterial spores) die. Small non-lipid viruses (eg enteroviruses, rhinoviruses) are more resistant to the action of bactericidal agents, while large lipid viruses (adenoviruses, hepatitis B virus and HIV) die during APD. DPU should be used for "non-critical" items. This method can also be used to disinfect some "semi-critical" items such as hydrotherapy baths for patients with damaged skin. DPU products include compounds based on 70% and 90% ethyl or isopropylene alcohol, chlorine-containing drugs, some phenol-containing products and iodophors.
Vegetative forms of most types of bacteria and fungi are killed during DND. Spores of bacteria, mycobacteria and small non-lipid viruses do not die. DND can only be used for "non-critical" tools. To disinfectants of low
levels include preparations based on quaternary ammonium compounds, some iodophors and phenol-containing agents.
For qualitydisinfection is influenced by the following factors:
- The material from which the items to be sterilized are made. It is difficult to clean equipment that has gaps. Germicidal agents may not reach all parts of the equipment completely, which reduces the effectiveness of sterilization.
Level and type of microbial contamination. Equipment with high level contamination requires a longer treatment with bactericidal agents than equipment with a low level of contamination.
— Presence of organic contaminants. Germicidal agents may come into contact with blood, plasma, pus or other organic matter on the surface of the equipment being disinfected and lose their potency as a result.
- Concentration of bactericidal agents and exposure time. As a rule, the higher the concentration of the bactericidal agent, the less time is needed for adequate disinfection. The exceptions are iodophors, alcohols and alcohol-containing products, which lose their activity when used in concentrations greater than those recommended by the manufacturer.
— Other physical and chemical factors. Temperature, pH, water hardness and the presence of other chemicals (soap) can affect the effectiveness of disinfectants.
In some cases, in a hospital, it may be necessary to reuse disposable medical supplies. These situations include problems with provision of a hospital, the use of "non-critical" items instead of "critical", or if there is a need to save money. But with the reuse of single-use equipment, unresolved issues arise that relate to the toxicity of the resulting waste, the formation of pyrogens, the functional reliability of the equipment and its structural integrity, legal and ethical issues, and the degree of risk of patient infection. Multiple use of the equipment should be avoided and limited only to cases provided by the manufacturer, while adhering to special instructions for reuse.
Materials for self-control:
1. Fill in the table
- Current
- Final
2. Questions for self-control:
1) Name the main elements of the anti-epidemic regime.
2) What is the personal hygiene of the staff of the children's institution?
3) What equipment do you need to have for wet cleaning of the premises?
4) What are the main sanitary and epidemiological orders that regulate the work of medical institutions.
5) What disinfectant solutions are most often used in children's institutions?
6) How is the current and final disinfection carried out?
7) What are the main means of disinfection?
8) Name the main methods of sterilization, describe their advantages and disadvantages.
9) What are the main methods of quality control of sterilization.
10) Give a classification of medical instruments and patient care items depending on the degree of risk of patient infection
11) Give a classification of disinfection depending on the type of medical device and the purpose of its use.
12) Name the factors that affect the quality of disinfection.
13) List the basic rules for sterilizing child care items.
3. Tests for self-control
- Sanitary and hygienic requirements for the medical staff of the hospital:
A. Must be neat and tidy, be sure to wash your hands by 2 times
soaping before examining each patient or performing procedures and after that.
C. Have a changeable set of work clothes (robe, cap or scarf, change of shoes)
what is stored in individual lockers.
C. The edges of work clothing should completely cover personal (home) clothing.
D. It is forbidden to be in a work gown and shoes outside the medical institution.
E. All of the above.
- What is the frequency of general cleaning?
A. Once a week.
B. 2 times a week.
C. 3 times a week.
D. Daily.
E. 1 time in 2 weeks.
- Masks are changed every:
A. 2 hours. At 4 o'clock. C. 6 o'clock. D. 8 hours. E. 12 hours.
- In bedside cabinets not allowed to store:
A. Dishes. B. Personal hygiene products. C. Stationery.
D. Food. E. Toys.
- Sterilization methods:
A. Steam. B. Air C. Gas.
D. Radiation E. All of the above.
- The main disadvantage of the steam method of sterilization of medical supplies is:
A. Long exposure
B. Toxic
C. Unable to sterilize paper products, laundry and solutions
D. Allergenic
E. Products that are sensitive to high temperature and humidity may be damaged
7. What is the frequency of cleaning rooms in the hospital:
A. 1 time per day. B. At least 2 times a day. C. In a day. D. 1 time in 3 days.
8. What are the types of sterilization quality control:
A. Steam, chemical, physical.
B. Physical, chemical, biological.
C. Chemical, air, radiation
D. Air, Gas, Steam
9. Frequency of ventilation of wards in the hospital in winter:
A. 1 time per day. B. 2-3 times a day. C. 4 times a day.
D. 1 time in 2 days. E. 1 time in 3 days
10. The procedure for sterilizing bottles for milk and milk formulas is as follows:
A. Washing in hot water, drying, boiling.
C. Cleaning with a brush from food debris, washing in hot water, drying.
C. Degreasing, cleaning with a brush, rinsing with running water, rinsing, drying. boiling.
D. Cleaning with a brush from food residues, washing in hot water, boiling for 20 minutes,
drying.
E. Cleaning with a brush from food debris, washing in hot water, boiling for 5 minutes,
drying.
11. Preventive deinfection includes:
A. Wet wiping of toys, objects with which the patient comes into contact; window frames, doors, walls, ceiling lamps, furniture, radiators, heating pipes.
B. Airing the premises, wet cleaning.
C. Planned disinsection (destruction of flies, mosquitoes, lice).
D. Proper food storage.
E. All of the above.
12. Inhalers, bronchoscopes, endoscopes, depending on the degree of risk of infection of the patient, are categorized as:
A. "Critical" Items
B. "Semi-critical" subjects
C. "Non-Critical" Items
Answers to tests:
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 |
| E | IN | IN | D | E | E | B | B | C | C | E | B |
4.Tasks forself-control:
- In the somatic department, a 5-year-old child who was admitted for treatment with a diagnosis of bilateral pneumonia was diagnosed with an acute intestinal infection. The child was transferred for further treatment to the infectious department. What type of disinfection should be carried out in the department. List all necessary funds.
- After graduating from a medical college, the nurse was enrolled in the neonatal pathology department and is on duty for the first time. What hygienic measures should she take before this and what features of her appearance.
- A sick child aged 5 months, who is deprived of parental care, is being treated in a children's hospital with a diagnosis of ARVI. The nurse needs to feed the baby with formula milk. What steps need to be taken to prepare the bottle and nipple for feeding the baby.
Answers to situational tasks:
1. It is necessary to carry out final disinfection in order to completely eliminate pathogens in the ward and department. Disinfection must be carried out in the ward and toilet, pantry room. The patient's household items and clothes are also disinfected. The most important method of final disinfection of premises is their treatment from a hydraulic console with a mixture of different disinfectant solutions. The final disinfection of the surfaces of objects by wiping or washing them can also be. Some items (e.g. upholstered furniture, books, shoes, mattress) should be disinfected in the disinfection chamber.
2. The medical worker must have a neat and tidy appearance. The nurse before duty takes a shower, puts on clean underwear. Hands should be washed with soap and nails cut short. Clothing must be of the prescribed form; a white robe worn over a dress with short sleeves and a cap (kerchief) that covers the hair must be clean and ironed. For the duration of the duty, the sister puts on special shoes, which allows you to move silently. Slippers should be easy to disinfect. The dressing gown, headdress and slippers after the end of the duty (shift) are left in a closet specially designated for the medical worker. Wearing a mask is mandatory for neonatal staff. The mask must be changed every 4 hours.
3. The nurse takes out a clean nipple with sterile tweezers, and then puts it on the bottle with cleanly washed hands. Clean rubber nipples are stored dry in a closed (glass or enamel) container labeled "Clean nipples". Sterile bottles with a neck closed with sterile cotton-gauze swabs are stored in separate cabinets.
Used nipples are collected in dishes labeled "Dirty nipples". Used nipples are thoroughly washed first in running water, and then with warm water and soda (0.5 teaspoon of baking soda per glass of water), while they are turned inside out. Then the nipples are boiled for 10-15 minutes. Teats are sterilized once a day, usually at night. Conducted by her ward nurse.
Bottles are sterilized in the pantry. First, the bottles are degreased in hot water with mustard (50 grams of dry mustard per 10 liters of water), then they are washed with a ruff, washed with running water from the outside and inside (using a device in the form of bottle rinsing fountains) and rinsed. Clean bottles are placed upside down in metal nets, and when the remaining water drains, the bottles in the nets are placed in a dry heat cabinet for 50-60 minutes (temperature in the cabinet is 120-150 ° C).
Main literature:
- V.G. Maydannik, V.G. Burlay. Your child (Care and upbringing). - Kyiv 2004.-298 p.
- Workshop on pediatrics propaedeutics with childcare. - Kyiv 2002. Knowledge of Ukraine. Maydannik V.G., Duka K.D., Burlai V.G.
3. T.V. Captain Propaedeutics of childhood diseases with child care. - Vinnitsa. – 2006.
4A.N. Buraya, I.A. Golovko, V.S. Tikhomirova / Guide to practical exercises in caring for a healthy and sick child. - Moscow. - 1982.
5. Mazurin A.V., Zaprudnov A.M., Grigoriev K.I. / General childcare. - "Medicine" Moscow - 1998
6.A.V. Tokar, V.I. Dzhemaylo but others / Handbook for nurses - Kyiv 2002
7.S.P. Vinnikova, I.N. Dygalo and others / Practical skills and abilities of a pediatric nurse - Rostov-on-Don "Phoenix" 2002.
Additional literature:
- R.V. Tonkova-Yampolskaya. T.Ya.Chertok, I.N.Alferova / Fundamentals of medical knowledge.- Moscow.- 1981
- Grebenev A.L., Sheptulin A.A., Khokhlov A.M. Fundamentals of General Nursing. - M: Medicine, 1999.
- P.G. Zhuchenko, N.S. Pushkar, I.A. Sytnik / Antenatal protection of the fetus and care of the newborn. - Kyiv. 1983
- Fundamentals of medical knowledge and methods of treatment according to Davidson / transl. from English. In 2 T. - Kiev: "Kobza",
Sanitary and hygienic conditions in the hospital largely depend on the sanitary maintenance of the premises and the patient's compliance with the rules of personal hygiene. With a long stay in the premises of people, a gradual change in the microclimate of the air environment occurs.
The content of water vapor, dust increases in the air, its temperature rises, unpleasant odors appear due to the release and decomposition of sweat and organic substances on the skin. All these changes adversely affect the well-being of patients. In addition, humans are a source of bacterial air pollution.
When talking, sneezing and coughing, a huge amount of droplets of saliva enters the air, which may contain pathogens of infectious diseases. Therefore, such diseases as influenza, seasonal catarrh of the upper respiratory tract, scarlet fever, measles, whooping cough, chicken pox, epidemic cerebrospinal meningitis, etc. can be transmitted through the air.
Large droplets of saliva quickly settle on various surfaces, small ones hover in the air for a long time. Drops of saliva with microorganisms that have settled on the floor, bed and other furnishings of a medical institution dry up, and if the premises are not properly cleaned, microorganisms can become viruses together with dust again in the air.
It should be remembered that microorganisms such as streptococci, diphtheria bacillus, tuberculosis mycobacteria remain viable, being in the dust for tens of days. Therefore, the prevention of air pollution in the premises of medical institutions is of great hygienic importance.
Cleaning of all hospital premises should be carried out daily at certain hours. In wards and corridors, cleaning is done after lifting the patients: they sweep the floor in a wet way, wipe furniture, doors, handles, panels, etc. with a damp clean cloth. Cleaning is completed by washing the floor or rubbing it, for example, with some dust-binding solution.
After the final cleaning, the wards must be ventilated by opening windows (in the warm season) or vents (in winter). Before going to bed, patients wet cleaning and ventilation of the wards are required. In winter, at night, it is necessary to ventilate the corridors several times. Toilets, urinals, washbasins are washed daily with hot water, soap and a disinfectant solution (chloramine solution). Baths after each patient are thoroughly washed with warm water and soap, followed by rinsing with a disinfectant solution.
The junior nurse should immediately take out the vessels, urinals and other utensils with discharges of patients from the ward. Bedpans are washed and disinfected after each use. Disinfection is carried out using a 0.2% bleach solution.
Do you know that: + + + + +
TRAUMATOLOGY (from trauma and ...ology), a section of clinical medicine that studies injuries: their causes, types, course, methods of prevention and treatment. Together with orthopedics of traumatology in Russian Federation constitutes a single medical specialty.
TOILET SPONGES, large (usually up to 20-50 cm) sponges from the silicon-horn order. The skeleton consists of a dense porous network of elastic fibers. Object of fishing in the Mediterranean, Red, Caribbean and other seas. Used for hygienic, medical and technical purposes.
THIAZOL, colorless liquid, bp 116.8 °C. Structural fragment of the coenzyme thiamine (vitamin B..1) and many drugs. The hydrogenated core of thiazole is included in the structure of penicillins.
TAMPONADA (from the French tampon - plug, plug), filling wounds and body cavities, for example, with gauze strips (tampons), to stop bleeding, delimit the infected area of the wound during surgery, and remove purulent effusion.
TECHNOLOGICAL EQUIPMENT, a set of devices for installing and fixing workpieces and tools, performing assembly operations, transporting workpieces, parts or products.
TREPANATION (from the French trepan - drill), the operation of opening any bone cavity (eg, skull).
Treatment-and-prophylactic institutions (HCIs) - hospitals, maternity hospitals, treatment and diagnostic hospitals and centers - due to their characteristics, pose a threat of the emergence and spread of hospital-acquired infections (HAIs). Factors contributing to the spread of nosocomial infections include: a large concentration of persons susceptible to infection during their round-the-clock stay in a hospital, many specific ways of moving microorganisms during medical diagnostic procedures and patient care (personnel hands, instruments, tools, etc. .), the use of agents and influences that weaken the anti-infective protection of patients, the irrational use of antimicrobial agents. The greatest risk arises from blood transfusion and so-called invasive manipulations (surgeries, injections, catheterizations, etc.) associated with damage to the natural barriers of the skin and mucous membranes. With the spread of nosocomial infections, both patients and staff members can be included in the epidemic process. To minimize the possibility of occurrence and spread of nosocomial infections in institutions, it is necessary to maintain a sanitary regime.
Security measures in health care facilities
The sanitary regime of health facilities includes:
organizational measures (control over the mode of admission, stay and discharge of patients, over the service of blood and its products, over the appointment of invasive manipulations and antimicrobial agents, over the regime of sterilization and disinfection in health facilities);
medical examinations and examination of personnel (upon admission to work and periodic preventive): for causative agents of venereal infections, Staphylococcus aureus, pathogenic enterobacteria (the results of examinations are entered in an individual sanitary book);
work only in overalls corresponding to the operations performed (for work in aseptic conditions, a set of sterile clothing is required);
observance of the terms of storage of sterile material (see subsection 12.1.4);
compliance with the rules of personal hygiene;
wet cleaning of premises (equipment, walls, floors) using disinfectants;
ultraviolet disinfection of the air in the operating unit, dressing rooms, etc.;
compliance with the rules for the use of disinfectants and antiseptics (including shelf life);
disinfection of used materials (see subsection 12.1.3); conducting sanitary and microbiological research.
To prevent nosocomial infections in terms of current supervision, sanitary and microbiological studies are carried out: the hands of surgeons, the skin of the surgical field, dressings and sutures, instruments, air, and equipment surfaces. Specific devices located in the operating room, anesthesia, pre- and postoperative wards, dressing rooms, as well as in intensive care and resuscitation wards, physiotherapy and exercise therapy rooms are subject to mandatory research. In obstetric hospitals, it is obligatory to examine maternity wards, an operating unit, postpartum and children's wards, pasteurization and breast milk storage rooms. Important areas are the control of the sterility of medical devices and the examination of personnel for microbial carriage. Specific objects of control, for example, are: basins and brushes for washing the hands of surgeons, gloves, probes, catheters, a bed prepared for an operated patient, a laryngoscope, a breathing bag, a couch for dressings, a dressing gown and a nurse's work table, thermometers, dosage forms for injections , for skin care of newborns, the inner surface of the refrigerator for storing medicines, etc. They also control the quality of cleaning and disinfection of the premises.
In terms of self-control, laboratories of healthcare facilities conduct sanitary and microbiological studies 1-4 times a month, laboratories of state sanitary and epidemiological supervision centers - 2-4 times a year and unscheduled (according to epidemiological indications, in case of sanitary problems).
The control of sterility of medical devices is described in subsection. 12.1.4. Hand washings are taken from all those involved in the operation; the study is carried out as described above. To identify carriers of Staphylococcus aureus, the personnel of surgical and obstetric departments, as well as intensive care units and intensive care units, are examined once a quarter. The material from the anterior sections of both halves of the nose is taken with a sterile dry or moistened swab and directly inoculated with strokes on the surface of the yolk-salt agar in a Petri dish (rotating the swab). In another variant, 0.1 ml of 5 ml of ICN is inoculated on the same medium, rubbing with a spatula, in which the swab was washed for 10 minutes. After incubation of the medium, the number of colonies formed by Staphylococcus aureus is counted (according to cultural and morphological and physiological characteristics). Repeated isolation of these microorganisms in high concentration (103 CFU in 1 ml or more) indicates microcarriage. For rehabilitation, microcarriers undergo special procedures using antimicrobial effects.
Sanitary and microbiological examination of equipment, hands and overalls of personnel
Sample selection. From working tables, scales, utensils, containers for storing material, equipment, hands and overalls of personnel, samples are taken by flushing with a sterile cotton swab placed in test tubes with sterile CNI or peptone water. When sampling from large flat surfaces (tables, dressing gowns, etc.), a 100 cm2 wire template frame is used. Before sampling, the template is flambéed and the swabs are moistened. To carry out washings from the hands with a moistened cotton swab (or gauze, 5x5 cm), the hands of the subject are wiped, starting from the less contaminated areas of the skin: the back of the hand, palm, interdigital surfaces, nail beds and subungual surfaces. Before the study, the washing liquid with a swab or napkin is shaken for 10 minutes to desorb microorganisms, and then the washing liquid is used for crops.
Research methodology. Definition of BGKP (see above).
Determination of Staphylococcus aureus. 1 ml of the washing liquid is inoculated into a test tube with 5 ml of saline broth, incubated in a thermostat at 37 ° C for 24 hours (hereinafter, as in the section on the study of food products).
Requirements for microbiological purity: the presence of BGKP, Pseudomonas aeruginosa, Proteus, Staphylococcus aureus in swabs is not allowed.
