Methods of application of sterilium
Hygienically disinfection hands: 3 to rub ml 30 seconds in a dry skin. For the prophylaxis of tuberculosis treatment is executed twice.
Surgical disinfection hands: a minimum 10 to ml solution to rub by portions during 3 minutes in the skin of brushes and forearms.
Cutasept G i Cutasept F are used for before- after operation treatment of skin and wounds.
Preparation by a tampon to inflict on a skin, well to moisten her, to survive 5 minutes. For a disinfection skin before the injections, catheterization, punction, taking of blood, shallow medical operations, at the damages as a result of unhappy case and shallow traumas, at the eczematous infections of bacterial or fungus origin. Areas of skin, that is subject to disinfection to moisten to the complete impregnation and survive during 30 seconds.
Before operation treatment of skin of the operating field: The tampon moistened by preparation to apply for 2th or 3th multiple wiping out, then to replace. At first disinfection the place of the supposed cut of skin, after adjoining natural habitat of skin. The disinfection operating field to do twice. Time of influencing – 5 minutes.
Hygienical disinfection hands: 3ml - 30 seconds Surgical disinfection hands: 2х5 ml – 5 minutes
V. Reference basis of action
Order of conducting of the general cleaning up in an operating-room.
The general cleaning up is conducted a 1 time per a week, and also not provided for by the plan after operative interferences, during which contamination of operating-room happened by intestinal maintenance, pus, after operative interference at a patient with the necrotic process caused by an anaerobic clostridia infection). The general cleaning up is conducted on principle of final disinfection.
At the beginning of cleaning up it is needed to calculate the quantity of disinfection solution, which is to be used. Room measure of operating-room usually known and is indicated in “Magazine of consideration of conducting of the general cleaning” up on a title page. The norm of charges on 1 m2 relies on the variety of disinfection, that will be applied. It is the most widespread norm 150-200 ml on 1 m2 depending on a surface, that is processed (it is covered by a tile, the quality of coverage, covered by a paint and others like that). It is needed to take into account chemical properties of disinfection, to cause his power the corrosion of metals, to damage a paint, fabric and others like that. During cleaning up to use the rules of safety for work with given disinfection, to use facilities of defence.
For conducting of the general cleaning up apply most often:
Solution of hydrogen peroxide 3% from a 0,5% cleanser.
Solution of hydrogen peroxide 4% from a 0,5% cleanser.
Solution of hydrogen peroxide 6% from a 0,5% cleanser.
Solution of chloramini 1%.
From imported disinfection means, that can be used in Ukraine, preparations are applied on the basis of aldehyde (aerodezin, basilol plus, deconecs 50 AF), sodium salt of dichlorizianurow acid (chlorsept), izopropenal (deconecs, solarsept) and other facilities.
The sequence of cleaning up consists in the following:
To free a surface, that is processed, from objects which are found on them (except for a bactericidal lamp), to draw aside from the walls of closet, apparatus and other.
Irrigate walls, doors of window of disinfection solution, beginning from above, on a height there are not less 2th meters.
To wipe by a rag, moistened disinfection solution,, equipments, during ovens, apparatus and other.
Irrigate disinfection floor, here the charges of disinfection solution must be from computation 200-250 ml on 1 m2.
In the case of conducting by the disinfection method of wiping out, surfaces twice wipe 15 minutes with an interval.
Plug in bactericidal lamps on 60 minutes.
To wipe the all treated surfaces by a rag, moistened plumbing water.
Plug in bactericidal lamps on 30 minutes.
To ventilate the apartment.
During conducting of the general cleaning up also disinfetion, there are worn through bactericidal lamps. Glass of bactericidal lamp is worn through a 70% ethyl alcohol, screen of apparatus – by a dry rag, the corps of armature is worn through the rag moistened in a 3-6% solution of hydrogen peroxide.
Solution of a 6% of hydrogen peroxide with a 0,5% cleanser is used in the case of presence (suspicions) of microbnih cages, that form spores, in that number anaerobic infections. At presence of in mid air apartment, on the articles of fungi a 4% solution of hydrogen peroxide is used for cleaning up. In other case – a 3% solution.
In the magazine of consideration of the general cleaning up are written down to give conducting of the general cleaning up, which disinfection conducted disinfection, their concentration, how many solution is used, signature of person which conducted cleaning up.
Dressing of operating linen.
After treatment of hands an operating sister first passes to the operating-room, where by means junior nurse or other medical sister proceeds to dressing of sterile to the dressing-gown. Still in before operating a junior nurse wipes to the operating sister oil cloth apron which hands are usually washed in, and carefully, that not to soil the treated hands, takes off him. A medical sister opens bikes with sterile dressing-gowns and, checking up the fitness of dressing-gowns after the reaction of indicator of sterility, takes out dressing-gown which is built as a roll, opens out him and puts on. A junior nurse or other medical sister strings behind a plot and belt. Watch thus, that the edges of sterile to the dressing-gown fully closed unsterile linen. Then from the second to bicsou or from the non-permanent packing reaches sterile rubber gloves and dress them.
Surgeons also get dressed independently, but a dressing-gown gives them operating sister, and sometimes and helps, supporting him at a sleeve. Plots on sleeves surgeons string, but, if it is needed hurry, an operating sister helps them herein. Plots behind and a belt strings junior nurse or other trained nurse. Gloves to the surgeon an operating sister gives thus, that last by rapid motion brought a hand into a glove how possible is deep. The put on gloves are usually processed by a 96% ethyl alcohol, that to delete tailings of powder.
Methods of before operation preparation of hands.
Method Spasococotsci-Cochergin.
At the beginning of hand wash by soap under a faucet by hot water. Then during 6 minutes (2 times on 3 minutes) wash hands in two pelves in a 0,5% solution of ammonia by means the serviette. Pelves before pouring of solution of ammonia are baked by an alcohol. After washing of hands in solution of ammonia of them wipe by a sterile towel and wipe by the serviette moistened in a 96% solution of ethyl alcohol. Then oil nail beds by a 5% alcoholic solution of iodine and dress gloves.
Treatment of chlorgecsedinbiglyoconat (gibitan).
A 20% solution of chlorgecsidinbiglyoconat is let out in glass bottles on 500 ml. Hands are processed by a 0,5% alcoholic solution of gibitan, for what conduct a 20% solution of chlorgecsidinbiglyoconat in a 70% ethyl alcohol in correlation 1:40, that is on 500 to the ml 70% ethanol add a 12,5 ml 20% solution of chlorgecsidinbiglyoconat.
Hands at the beginning are washed by warm water with soap, then wipe them by a sterile towel, whereupon during 2-3 minutes wipe by a 0,5% alcoholic solution of chlorgecsidinbiglyoconat by means the serviette. Wiping out needs to be conducted systematic, finger after a finger, watching, that to skip none area of skin of fingers, brush and lower part of forearm. After wiping of hand out dry out.
Before operationtreatment of hands of pervomur.
Pervomour is a mixture the of hydrogen peroxides, ant and nadmuravin acids, here the last appears in the process of reaction between two first ingredients. Solution of pervomur, initial and works (2,4% and 4,8% on nadmuravin acid), is prepared, coming from the computation presented in table.
Computation of component parts for making of solutions of pervomur
|
Initial solution |
Working solution | |||
|
Pergidrol, ml |
Ant acid, ml |
H2O, | ||
|
100% |
85% |
2,4% |
4,8% | |
|
17,1 34,2 85,5 171,0 |
6,9 13,8 34,5 69,0 |
8,1 16,2 40,5 81,0 |
To 1 To 2 To 5 To 10 |
0,5 1 2,5 5 |
* Water can be distilled, plumbing, artesian and marine outboard, taken at a sea or in an ocean. Concentration is given in the percents of nadmuravin acid.
For preparation of initial solution in a glass retort the proper quantity of hydrogen peroxide of is poured, and then add ant acid. Shake a retort off and will prevent in a pan with cold water, or in a refrigerator, on 1-1,5 hours, shaking off a retort every 20-30 minutes. For this term ant acid appears in solution. Initial solution can be saved at a room temperature a 1 day. Working solution suitable to the use during a 1 day. Consequently, pervomur it is possible to prepare every 2 days.
For treatment of hands solution of pervomur 2,4% is applied on nadmuravin acid. For this purpose a 120 ml fresh initial solution add a to 4,880 ml water. Initial solution of pervomur, getting on a skin and mucus, can cause a burn, therefore during work with the concentrated solution of this preparation it is necessary to be careful. Drops of solution, that got on a skin, it is needed immediately to wash off by a plenty of plumbing water. If the drop of solution got in an eye, immediately it is needed to wash an eye by water, repeating this procedure repeatedly, whereupon it is necessary to appeal for the help to the oculist.
Treatment of hands of pervomur consists in the following: at the beginning of hand wash with soap under running water during a 1 minute without a brush; hands are wiped dryly by a sterile towel; dip hands in solution of pervomur to the elbow bends on a term a 1 minute; hands are wiped by a sterile serviette or towel; sterile gloves are dressed. In one to the pelvis can process hands to 10 persons.
Transporting of patients in an operating-room and in a chamber from an operating-room.
Transporting of patients in an operating-room and in a chamber is executed with the use of wheel stretcher which is covered by polyethylene tape or oilcloth. Tape or oilcloth are processed by the rag moistened by a 3% solution of hydrogen peroxide with a 0,5% washing solution. After it cover them by a clean sheet and blanket. Transporting must be sparing and with the exception of shoves.
To carry and translate a patient 2 or 3 men can on hands.
From the chamber of surgical separation in an operating-room a patient is transported on wheel stretcher only. In before operation room a patient translate into wheel stretcher of operating block and deliver to operating table, looking after after his state. After the operation of patient a doctor-anaesthetist is transported in the separation of intensive therapy at obligatory participation. A patient is inlaid on a functional bed. Especially carefully it is needed to translate a patient with external drainages. It is needed to use an elevator. At his absence of patient 2 or 4 men carry on loads by a head ahead at getting up on shoots or feet ahead – at lowering.
VІ. System of teaching tasks for verification of eventual level of knowledge’s:
Situation tasks
During transporting of patient contamination of sheet and oilcloth happened from an operating-room, that wheel stretcher was covered, by excretions from drainage and operating wound. What appearance it is necessary to prepare wheel stretcher by for transporting of other patient to the operating-room?
Answer: oilcloth, that covers wheel stretcher it is necessary to process by a 3% solution of hydrogen peroxide with a 0,5% cleanser, to substitute a sheet by clean.
Sick D., under local anesthesia by a 0,5% solution of novocaine in an operating-room lipoma is remote in the area of corner of right shoulder-blade. The state of patient during the operation and after her is stable, satisfactory. By What appearance delivery a patient to the chamber from an operating block?
Answer: to transport the given patient in a chamber it is necessary in recumbency on wheel stretcher.
During an operating day at a pelvis with pervomur it is executed treatment of hands a 10 time by surgeons, that took part in the operations. Another operative interference in which three surgeons will take part is to happen. Where must they process hands by solution of disinfection?
Answer: after 10 treatments of hands in solution of pervomur the last is to be transferable on fresh solution, after it the surgeons will process in it the hands before the operation.
During preparation of working solution of pervomur for surgical treatment of hands a medical sister by a chance poured out itself on the left brush the two-bit of initial of solution of this preparation. In an area, where the contact with solution happened, appeared burning character the pain, hyperemia of skin. What must be done in such case?
Answer: the concentrated initial solution of pervomur caused a burn on a cyst at an operating medical sister; it is necessary protractedly to wash the staggered brush by plumbing water, then to impose an aseptic bandage.
For preparation of solution of pervomur for surgical treatment of hands an operating sister in a glass retort mixed up to 85,5 ml pergidrol from a 34,5 ml 100% ant acid. Well-educated mixture she led to to 5 l by plumbing water at a pelvis for treatment of hands before the operation. What error was assumed by a medical sister?
Answer: mixture to pergidrol and ant acid is to be self-possessed during 1-1,5 hours in a refrigerator, periodically during this display she must be shaken off; only after it she is conducted in the proper quantity of water at a pelvis.
During preparation to urgent interference in to the operating-room the distilled water turned out absent. By What appearance to divorce the initial concentrate of pervomur, that to do working solution for surgical treatment of hands?
Answer: for preparation of working solution of pervomur it is possible to apply plumbing water.
It is necessary to prepare pervomur for surgical treatment of hands in a quantity 10 to l. What ingredients and in what quantity it is necessary to apply for this purpose?
Answer: it is necessary to take a 240 ml initial concentrated solution of pervomur and divorce them at a 9760 ml plumbing or distilled water.
In an urgently surgical clinic urgent operative interference concerning sharp appendicitis is to happen in the evening. The operating trained nurse for surgical treatment of hands took solution of pervomur 2,4%, that was prepared still in a wound before the beginning of operating day and in which the executed treatment of hands was a 9 time. How did an operating sister act right?
Answer: a medical sister acted right, the given solution suitable to the use during a 1 day.
During implementation of operative interference to sick S. concerning sharp intestinal impassability the contamination of operating-room happened by maintenance to the intestine. What is to be executed in an operating-room after the given operation before a next operative interference to other patient?
Answer: in an operating-room it is necessary to execute the general cleaning up not provided for by the plan.
The general cleaning up is to happen in an operating-room. General area, that is to be subject to treatment is evened 150 m2. What quantity of solution for cleaning up needs to be prepared?
Answer: it is necessary to prepare solution from computation 150-200 ml on 1 m2, consequently it is necessary to prepare 30 l of solution for cleaning up of the given operating-room.
Sick D., 65 years, prepared to the planned operative interference concerning left-side inguinal hernia. A medical sister with the purpose of preparation of the operating field to the operation executed shaving of area of last on eve day of operation in the evening. At the review of patient in the day of operation exposure of area of hyperemia and also infection scratches in the town of the future operating field. Operative interference by a surgeon was abolished. What happened? What error was assumed by a medical sister at preparation of the given patient to operative interference.
Answer: shaving of area of the operating field is to take place in a wound in the day of operation; to the given patient the interference was abolished from development at him of festering defeats of skin after shaving.
Operative interferences is to happen in an operating block. That it is necessary to do in an operating-room at the beginning of operating day with the purpose of preparation of her to work.
Answer: in an operating-room before the beginning of operating day the previous cleaning up is to be executed.
During implementation of operative interference muddy blood serviettes and marbles fell down on the floor of operating-room, were outpoured washing water after sanatio of abdominal region. What actions are to be executed by the personnel of operating-room in such case?
Answer: the junior nurse of operating block in such case must execute the current cleaning up.
An operating medical sister opened bics with operating linen, that to cover table before the operation. Linen is moist, an urea was not melted. It is possible to apply such linen during the operation, why?
Answer: no, applying such linen not impossible.
During put of stitches on wound a student by a hand in a glove remedied a mask on the face and continued farther to assist. Nobody noticed it. Could student continue to assist? What complications can development at a patient and what type of infection she belongs to.
Answer: no, he could not continue to assist, he was to repeat treatment of hands and replace gloves. Violation of rules of asepsis can result in development of festering-septic complications.
VII. The method of conducting of employment is that organizational structure of employment
Distributing of marks, that are appropriated to the students:
At mastering of theme №5 from rich in content to the module №1 for educational activity to the student the estimation for 4th is proposed by a mark (traditional) scale which are after converted in marks as follows:
-
Estimation
Marks
“5”(fine)
6
“4” (well)
4
“3”(satisfactorily)
2
“2” (unsatisfactorily)
0 marks
Technological card of employment
|
№ p/p |
Basic stages of employment, their functions and maintenance |
Level of zasvo- ennya |
Methods of control and teaching |
Materials of the methodical providing |
Distributing of time (hv.) |
|
1. 2.
3.
|
Preparatory stage Organizational measures Raising of educational purposes is that motivation
Control of initial level of knowledges, skills, abilities
|
AND ІІ
ІІ
ІІ
ІІ
ІІ
ІІ
|
Individual questioning
Tests ІІ of
|
П.1 "Actuality of theme" П.2 "Educational purposes"
Table: ways of distribution of infection
Table: principle of structure and work to the autoclave.
Table: structure of operating block
Table: preparation and sterilization of bandaging material, methods of control after sterility
Table: preparation of hands and operating field to operative interference
|
1-3 5
20
|
|
4.
|
Basic stage
|
ІІІ
ІІІ
ІІІ ІІІ
ІІІ
|
Professional training in the decision of untypical clinical tasks Practical training
|
Loads, wheel stretchee. Operating block, facilities of cleaning up. Operating linen, bics Shimelbush. Facilities for treatment of hands before the operation. Facilities for treatment of the operating field. Tasks ІІІ of
|
5
10
10 15
10
|
|
5. 6.
7. |
Final stage Control and correction of level of professional abilities and skills Work out the totals of employment Domestic task (basic and additional literature after a theme) |
ІІІ
|
Individual control of skills Tests ІІІ of
|
Tests ІІІ of Tasks ІІІ of
“Short methodical pointing” to work on practical employment. |
12
|
Methodical pointing for work of students on practical employment
Module 1
Semantic module 1.
Practical employment №5
Theme: Sterilization of bandaging material and operating linen. Organization of work in an operating-room. Surgical treatment of hands of surgeon and operating field.
Theoretical questions for the extra auditory independent study and discussion to practical employment №5:
History of development of asepsis.
Determination of asepsis, ways of transmission of exogenous infection.
Structure of operating block, methods of providing of the sanitation-hygienic mode in an operating block.
Structure and principle of work to the autoclave, accident prevention during work in an autoclave to hit.
Preparation to sterilization, methods of sterilization of bandaging material and operating linen, tests on quality of sterilization.
Methods of preparation of hands of surgeon to the operation, elements of care of hands of surgeon.
Methods of treatment of the before operation field.
Transporting of patients in an operating-room and from an operating-room.
Conducting of cleaning up in an operating-room.
Dressing of operating linen.
Literature:
The basic literature:
Butyrsky A. General surgery. – Simferopol. 2004.
Schevchenko S.I. and others. Surgery. – Kharcov. 2004
The additional literature:
Kushnir R. Lectures of General surgery. – 2005.
Lyapis M.A. Methods of examination of a surgical patients. – 2004.
Methodological recommendations on surgical patients care. – Vinnitsa medical national university. 2006.
Distributing of the marks appropriated to the students:
At mastering of theme №5 with to the module №1 for educational activity to the student the estimation for 4th is proposed by a mark (traditional) scale which are after converted in marks as follows:
-
Estimation
Marks
“5”(fine)
6
“4” (well)
4
“3”(satisfactorily)
2
“2” (unsatisfactorily)
0