IV. Table of contents of teaching Structural-logical chart of theme

Антисептика

Механічна

Фізична

Хімічна

Біологічна

1. Видалення згустків крові

2. Видалення сторонніхтіл

3. Видалення змертвілихтканин

1. Гіпертонічні розчини

2. Гідрофільні основи

3. Дренування

4. Гіпертермія

5. Гіпотермія

6. УВЧ, СВЧ

7. Ультрафіолетовеопромінення

8. Лазернеопромінення

9. Ультразвук

1. Антибіотики

2. Протеолітичні ферменти

3. Бактеріофаг

4. Імунні засоби (анатоксини, гіперімунна плаз­ма,сироватки, гама-глобуліни)

5. Неспецифічні стимуляториімунногозахисту

Комбінована

1. Неорганічні речовини

2. Біоорганічні речовини і їх синтетичніаналоги

3. Органічні сполученнясинтетичної природи.

Класифікація антисептиків за А.П.Красильниковим (1995)

За походженням

Неорганічні речовини

Біоорганічні речовини і їх синтетичні аналоги

Органічні сполучення синтетичної природи

За направ­лленістю дії

За механізмом дії

Деструктивні

Антиметаболічні

Окислювальні

Мембраноатакуючі

Антиферментні

За спектром про­тимікробної дії

Універсальні

Широкого спектру

Помірного спектру

Вузького спектру

За кінцевим ефектом

Мікробоцидні

Мікробостатичні

Мікробоста­тичні-цидні

Знижуючі численнічть мікробної популяції

За складом

Монопрепарати

Комплексні

Багатокомпонетні

За метою

Профілактичні

Бінарні – антисептичного і хіміотерапевтичного призначення

Терапевтичні

Бінарні – антисептичного і дезінфекційного призначення

Профілактично-терапевтичні

Багатоцільові

Протипаразитарні

Противірусні

Протигрибкові

Протибактеріальні

За місцем аплікації

Ранові

Шкірні

Пероральні

Офтальмологічні

Урологічні

Генітальні

Стоматологічні

ЛОР

Ті, що доносяться до місця дії кровоносною або лімфатичною системами

Інгаляційні

За хімічною будовою

Галогени і їх органічні та неорганічні похідні

Неорганічні і органічні кислоти і їх похідні

Альдегіди

Перекис водню і калію перманганат

Важкі метали і їх органіч­ні і неорганічні солі

Альдегіди

Спирти

8-оксихіноліни

Фенол та його похідні

Нітрофуранові антисептики

Сульфаніламідні антисептики

4-хінолони, хінок, саліни, нафтиридини

Імідазольні антисептики

Вищі жирні кислоти

Четвертично-амонієві сполучення і їх аналоги

Похідні арил- алкилсуль­фонів і їх аналоги

Іммобілізовані антисептики

Антисептики рослинного і тваринного походження

Антисептики синтетичного походження

Classification of antibiotix after the mechanism of action and chemical nature

• Ingibitori of synthesis of bacterial wall: betalactamni antibiotix – penicillin (benzilpenicillin sodium, potassium and novocaine salts, bicillin-1-1, -3, -5, fenoximetilpenicillin, ampicillin, cabenicillin, cabecillin) and cephalosporin (cephalosporin, cephazolin cephalexin); vancomicin.

• Inhibitors of synthesis of albumen at the level of ribosome: aminoglycozids (streptomicin, neomitsin, monomicin, canamicin, pentamicin, sizomicin, amicacin); tetraciclini (tetraciclin, oxitetraciclin, hlortetraciclin, morfociclin, metaciclin, doxiciclin); nitrobenzoli (levomicetin); steroidi (фузидин-sodium); macrolidi (eritromicin, oleandomicin); piranozidi (lincomicin).

• Inhibitors of synthesis of nucleic acids: rifamicini (rifamicin SV, rifampicin).

• Antibiotix which violate molecular organization and functions of cellular membranes: Polienovi (nistatin, levorin), cyclic decapeptid (gramicidin, polimixin M sulfate).

Principles of antibiotic therapy:

• Considerations of shows and chimiotherapeutic actions of preparation

• Consideration of possible contra-indications

• Early setting

• Creation of permanent bacteriostatic or bactericidal concentration

• Principle of shleyfou

Organization of work in the fastening bandaging one.

Bandaging, as a rule, takes place in one room, relatively small sizes. The area of bandaging on a 1 table must make 22 m2. Between that, in one room, except for bandaging, are executed before sterilization cleaning and disinfection instruments, here wash hands before and after bandaging doctors, trained nurses and students. In the same apartment immersion heaters are set for disinfection of instruments, closets for saving of different materials, instrumental closets, different necessary for work furnitures and equipments.

Usually bandaging are disposed on one corridor with chambers, but more comfortable to equip them in the eventual compartment of corridor, shut off by glass partition. A platform in which it is possible to put wheel-stretcher is thus created, closets for some articles of equipment, in a wall niche or in a separate closet to save facilities for cleaning up of bandaging.

Ceiling and walls of bandaging dye by an oily paint, but it is better, if walls face by a ceramic tile. A floor is to be covered by a ceramic tile. Ventilation must be wave-drawing with a double exchange for a 1 hour. All light must be subject to the moist cleaning up. In bandaging there must be two shells which place from sterile table a little rather and mark by inscriptions on a wall – “For washing of hands” , “For instruments” .

Fastening bandaging are used for bandaging running sore, and also puncture of abscesses and cavities, that contain a pus. Most fastening operative interferences, such how opening of abscess is, introduction of drainage to the pleura cavity at empiemi and others like that, are here executed. In the fastening bandaging patients are bandaged with intestinal and excrement noritsyami.

Support of cleanness and order in bandaging – it is an obligatory condition for implementation of rules of asepsis during bandaging. Work in bandaging, as well as in an operating block, is begun with the previous cleaning up. This measure sometimes takes quite a bit time, because bandaging is used by a duty personnel for the grant of urgent help to the patients, that are found in the separation. In evening and nightly time there can be a necessity in the change of the bandage wet through, introduction of tube, that fell out with wound and others like that. In bandaging for this purpose a “duty sterilization box” with bandaging material must be selected. After bandaging a duty personnel must do cleaning up, laying down the used instruments in a tank with solution of disinfection, and the bandages and bandage taken off, to collect muddy marbles and others like that in the special bucket with a lid, which is adjusted for collection of muddy material.

The current cleaning up is executed during bandaging. Near every bandaging table a pelvis or bucket for collection of the bandages and used in the process of bandaging material taken off stands necessarily. In intervals between bandaging a junior nurse translates maintenance of pelves in the special bucket with a lid, that after to take away him for incineration of muddy material. In bandaging are to be large to the pinch, which muddy bandages collect by.

After ending of bandaging the large cleaning up, similar to such cleaning up in an operating-room, is executed, and at the end of day the personnel of bandaging conducts the final cleaning up.

One time for a week in bandaging the general cleaning up similar to that is executed, that is executed in an operating block.

The important value in providing of cleanness and order in bandaging is had by clothes and conduct of people, healthy and patients, that` enter and work in bandaging. In bandaging enter in ordinary to the hospital clothes, that is in a dressing-gown and little cap, in which walk and work employees of surgical separation. Dressing-gowns and little caps are to be clean, on button up, sleeve are downed to the brushes or begun to swing, but so that with under them did not “look” the sleeve of lower shirt or blouse. To the personnel of bandaging it is better to use dressing-gowns, that are strung behind. Little caps must fully close a hair. All, who is included in bandaging, must put on sterile mask.

The trained nurses and junior nurses, that work in bandaging, change dressing-gowns every day, and floor to the dressing-gown dress aprons. Aprons daily disinfection, and at contamination during work are worn through a clean rag, moistened disinfection solution. Aprons must be dressed by doctors and students, that execute the fastening bandaging.

Like to the operating sisters of sister and junior nurse, that work in bandaging, must carefully toe the lines of the personal hygiene. Apodactilna work, that is not touching by fingers, is obligatory. All dirty jobs are needed to execute in working gloves or long tongs (for example, cleaning up from the floor of muddy serviette), to watch after the skin of hands, worry that there were no cracks, scratches.

For disinfection of air in bandaging ultraviolet lamps are applied. The ultraviolet irradiation of bandaging takes place according to the graph.

In the modern bandaging must be a place is selected for the before sterilisation cleaning of instruments, and in the festering bandaging – for previous disinfection. Usually near a shell with inscription “For instruments” a tank is disposed with a disinfection liquid, which all instruments, that was applied during fastening bandaging, are dipped in disinfection instruments, that were the use at bandaging of wounds, that granulate, are subject, and wounds with serous excretions, because there is no confidence in that these excretions are not contained by pathogenic microorganisms. As disinfection can be applied solution of pervomur, that stopped behind after treatment of hands, or a 6% solution of hydrogen peroxide from a 0,5% cleanser or 2,5% solution of chlorgexedin bigluconat, 0,2% solution of dezactin and others like that. These solutions have not a smell, and the stay in them of instruments during 30-60 does not lead minutes to corrosion of metal. For the before sterilisation cleaning it is necessary to have other tank which as well as a tank for disinfection is to be marked. Before sterilisation treatment of tool in bandaging is executed like to treatment of tool at a sterilization operating block.

The order of implementation of bandaging after the degree of aseptic consists in the following. Puncture of joints, soft fabrics and cistoc must be executed the first, then pleura puncture, as not always it is possible to foresee the character of maintenance which is found in a pleura cavity. Bandaging of fresh after operative wounds go farther; then removal of stitches and, on an end, bandaging of clean wounds, that granulate, gastrostom and others like that.

All bandaging of fastening wounds, exactly as well as puncture of abscess, washing of cavity of empiemi and others like that, and also bandaging of patients with fistula to the intestine are executed in the fastening bandaging In the fastening bandaging it is important out distribution of microorganisms outside the wound of patient. In communication with that above all things patients are bandaged with running sore, that heal over, then with considerable fastening excretions, and in the last turn – septic patients with intestinal fistula and others like that. Patients with an anaerobic infection need in the special measures.