What can be cooked from squid: quick and tasty

Resolution of the Chief State Sanitary Doctor of the Russian Federation of 05/18/2010 N 58 (as amended on 06/10/2016) "On the approval of SanPiN 2.1.3.2630-10" Sanitary and epidemiological requirements for organizations carrying out medical activities "(together with ...

12. Rules for the treatment of hands of medical personnel and skin

covers of patients

12.1. In order to prevent nosocomial infections, the hands of medical workers (hygienic treatment of hands, treatment of the hands of surgeons) and the skin of patients (treatment of the operating and injection fields, elbow bends of donors, sanitization skin).

Depending on the performed medical manipulation and the required level of reduction of microbial contamination of the skin of the hands, medical personnel carry out hygienic treatment of hands or treatment of the hands of surgeons. The administration organizes training and monitoring of the implementation of hand hygiene requirements by medical personnel.

12.2. To achieve effective washing and disinfection of hands, the following conditions must be observed: short-cut nails, no nail polish, no artificial nails, no rings, rings and other jewelry on the hands. Before treating the hands of surgeons, it is also necessary to remove watches, bracelets, etc. For drying hands, use clean cloth towels or disposable paper napkins, when treating the hands of surgeons - only sterile tissue.

12.3. Medical personnel must be provided in sufficient numbers effective means for washing and disinfecting hands, as well as hand care products (creams, lotions, balms, etc.) to reduce the risk of contact dermatitis. When choosing skin antiseptics, detergents and hand care products, individual tolerance should be taken into account.

The purpose of the household level of hand treatment is the mechanical removal of most of the transient microflora from the skin (antiseptics are not used).

A similar hand treatment is carried out:

after using the toilet;
before eating or before handling food;
before and after physical contact with the patient;
with any contamination of hands.

Necessary equipment:

Liquid dosed neutral soap or individual disposable soap in bars. It is desirable that the soap does not have a pungent odor. Opened liquid or bar soap, reusable non-individual soap quickly becomes infected with microbes.
Disposable wipes 15x15 cm in size, clean for getting hands wet. The use of a towel (even an individual one) is not advisable, since it does not have time to dry out and, moreover, is easily contaminated with microbes.

Hand processing rules:

All jewelry and watches are removed from the hands, since they make it difficult to remove microorganisms. Hands are soaped, then rinsed with warm running water and everything is repeated from the beginning. It is believed that the first time you soap and rinse with warm water, germs are washed off the skin of your hands. Under the influence of warm water and self-massage, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes are washed away from the opened pores.

Warm water makes the antiseptic or soap more effective, while hot water removes the protective grease layer from the surface of your hands. In this regard, you should avoid using too much hot water for hand washing.

Hand treatment - the necessary sequence of movements

1. Rub one palm on the other palm in a reciprocating motion.

Rub the back of the left hand with the right palm, change hands.
Connect the fingers of one hand in the interdigital spaces of the other, rub the inner surfaces of the fingers with up and down movements.
Connect the fingers in a "lock", rub the palm of the other hand with the back of the bent fingers.
Grasp the base of the left thumb between the thumb and forefinger of the right hand, rotational friction. Repeat on wrist. Change hands.
Rub the palm of the left hand with the fingertips of the right hand in a circular motion, change hands.

Each movement is repeated at least 5 times. Hand processing is carried out within 30 seconds - 1 minute.

It is very important to follow the described hand washing technique, as special studies have shown that during routine hand washing, certain areas of the skin (fingertips and their inner surfaces) remain contaminated.

After the last rinse, hands are wiped dry with a napkin (15x15 cm). The water taps are closed with the same napkin. The napkin is dropped into a container with a disinfectant solution for disposal.

In the absence of disposable wipes, it is possible to use pieces of clean cloth, which after each use are thrown into special containers and, after disinfection, are sent to the laundry. Replacing disposable wipes with electric dryers is impractical because they do not rub the skin, which means that there is no removal of the residues of the detergent and desquamation of the epithelium.

Unfortunately, adults quite often neglect hand washing, guided by various considerations: fear of accelerated aging of the skin from constant contact with water and degreasing agents (mainly women), lack of comfortable conditions for carrying out such a procedure under certain working conditions, or simply - without giving of great importance this procedure. Compliance with only one rule - "wash your hands before eating and after using the toilet" is not enough and it is recommended to wash your hands much more often.

This issue is especially acute at catering establishments, trade and childcare facilities. To employees of similar institutions especially stringent requirements are imposed, since The health of hundreds of people depends on how scrupulously they observe the rules of hand hygiene, but even those who cannot be accused of not observing these rules do not always do it right.

We remind you of the main points that are recommended to be adhered to when carrying out the hand washing procedure.

Food production personnel are required to wash and, if necessary, disinfect their hands: before starting any food processing, immediately after using the toilet or blowing their nose, and after handling potentially contaminated material.
Keep your fingernails clean and trimmed.
The hygiene of food production personnel also includes the organization of a sanitary lock - a system consisting of blocks for cleaning shoes, washing and disinfecting hands.
Washstands should be equipped with liquid soap, skin antiseptic, disposable paper towels, a foot pedal bin, and instructions for hand washing.
Dermal hand sanitizers should be readily available at all stages of the work process.

Algorithm for hygienic hand treatment:

Point one. Remove jewelry (rings, bracelets that fall below the wrist, etc.) from your hands.
Second point. Turn on the tap, wash your hands with soap and water.
Third point . Lather your hands again (both on the inside and on the outside, between your fingers), rinse the soap off your hands.
Point four. Dry with an electric towel or dry your hands, preferably with a disposable towel.
If necessary, apply a skin antiseptic to dried hands in accordance with the instructions for use.

It's important to know:

- just wet and not thoroughly washed hands are a wonderful breeding ground for microbes, so - do not save soap and do not be lazy to foam it well on the skin of your hands;
- the towel or hand napkins must be clean and dry. They should be changed as often as possible.

The rules are simple, but, for some reason, few people strive to observe them with particular care, and after all, its effectiveness directly depends on how well the hands were soaped or how carefully they were wiped at the end of the procedure.

In washrooms, bactericidal liquid soap is poured into dispensers.

This increases protective measures, destroys pathogenic microorganisms, fungi, and prevents the emergence of epidemics. Sprays with disinfectants are effectively used to treat the hands of workers standing at the food service or waiters working in conditions of lack of free time.

The memo was prepared by LS Goncharova, an employee of the Department of Civil Defense and V of the FBUZ "Center for Hygiene and Epidemiology in the Kaliningrad Region"

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GOU SPO "TULA REGIONAL MEDICAL COLLEGE"

DEPARTMENT OF POSTGRADUATE EDUCATION

TEST

Rules for the treatment of hands of medical personnel, hygienic treatment of hands

CYCLE OF PROFESSIONAL RETRAINING FOR THE SPECIALTY "NURSING"

Completed by: Pluzhnikov Sergey Vladimirovich

Introduction

1. Historical information

2. Microflora of the skin of the hands

3. Resident microflora

4. Transient microflora

Bibliography

Introduction

Hands are one of the main factors in the transmission of nosocomial pathogens. Transient pathogenic or opportunistic microflora, opportunistic microbes are transmitted through the hands of personnel. Possible contamination of the surgical wound and representatives of the resident microflora of the skin

1. Historical information

For the first time, the treatment of hands with a solution of carbolic acid (phenol) for the prevention of wound infection was used by the English surgeon Joseph Lister in 1867. D. Lister's method (1827 - 1912) became a triumph of medicine in the 19th century.

Robert Koch (1843 - 1910) - German microbiologist, one of the founders of modern bacteriology and epidemiology

In his publications, Koch developed the principles of "obtaining evidence that a particular microorganism causes certain diseases." These principles still underlie medical microbiology.

Hand hygiene is a priority measure that has proven to be highly effective in preventing nosocomial infections and the spread of antimicrobial resistance of pathogenic microorganisms. However, even today, the problem of handling the hands of medical personnel cannot be considered fully resolved. Research conducted by WHO has shown that poor hand hygiene compliance among health-care workers is observed in both developed and developing countries.

According to modern concepts, the transmission of nosocomial infections occurs in various ways, but the most common transmission factor is the contaminated hands of medical workers. In this case, infection through the hands of personnel occurs in the presence of a number of the following conditions:

1) the presence of microorganisms on the patient's skin or objects in his immediate environment;

2) contamination of the hands of medical workers with pathogens through direct contact with the patient's skin or surrounding objects;

3) the ability of microorganisms to survive in the hands of medical personnel for at least a few minutes;

4) incorrect performance of the hand treatment procedure or ignoring this procedure after contact with the patient or objects of his immediate environment;

5) direct contact of the contaminated hands of a medical worker with another patient or an object that will come into direct contact with this patient.

2. Microflora of the skin of the hands

I. Resident (normal) microflora are microorganisms that constantly live and multiply on the skin.

II. Transient microflora is a non-colonizing microflora acquired by medical personnel in the process of work as a result of contact with infected environmental objects.

1. Pathogenic microflora is a microflora that causes a clinically expressed disease in healthy people.

2. Conditionally pathogenic microflora is a microflora that causes disease only in the presence of a specific predisposing factor.

3. Microbes - opportunists - a microflora that causes generalized disease only in patients with a pronounced decrease in immunity.

3. Resident microflora

Resident microflorastimulates the formation of antibodies and prevents the colonization of the skin with gram-negative microorganisms. It lives in the stratum corneum, is located in hair follicles, sebaceous, sweat glands, in the area of nail ridges, under nails, between fingers.

It is mainly represented by cocci: epidermal and other types of staphylococci, diphtheroids, propionibacteria.

It cannot be completely removed by conventional hand washing and antiseptic treatment.

4. Transient microflora

It is represented mainly by microorganisms located in the external environment of the institution, which are epidemiologically dangerous:

pathogenic microorganisms (salmonella, shigella, rotaviruses, hepatitis A viruses, etc.);

opportunistic microorganisms:

Gram-positive (staphylococcus aureus and epidermal);

Gram-negative (Escherichia coli, Klebsiella, Pseudomonas);

Mushrooms (candida, aspirgillus).

It remains on the hands for no more than 24 hours and can be removed by routine hand washing and antiseptic treatment.

The most contaminated areas of the skin of the hands are:

Subungual space;

Periungual rollers;

Finger pads.

The most difficult areas to be washed are:

Subungual space;

Interdigital spaces;

Thumb notch.

Hand disinfection is one of the most effective measures to prevent nosocomial infections and to protect patients and medical personnel from infection. The basis for the prevention of nosocomial infections is hygienic culture and preparedness in the epidemiological plan at all stages of work.

5. Rules for handling the hands of medical personnel

To achieve effective hand washing and disinfection, the following conditions must be observed:

1.Clean, short-cut nails, no nail polish, no artificial nails; well-groomed (no cracks or burrs) hands, trimless (European) manicure;

2. the absence of rings, rings and other jewelry on the hands; before handling the hands of surgeons, it is also necessary to remove watches, bracelets, etc.;

3. application of liquid soap using a dispenser;

4. use for drying hands of clean cloth individual towels or single-use paper napkins, when treating the hands of surgeons - only sterile cloth.

6. Hygienic treatment of hands

Hygienic treatment of hands with a skin antiseptic should be carried out in the following cases:

Before direct contact with the patient;

Before putting on sterile gloves and after removing gloves when placing a central intravascular catheter;

Before and after placement of central intravascular, peripheral vascular and urinary catheters or other invasive devices, if these manipulations do not require surgical intervention;

After contact with the intact skin of the patient (for example, when measuring the pulse or blood pressure, shifting the patient, etc.);

After contact with secretions or excretions of the body, mucous membranes, dressings;

When performing various manipulations for patient care after contact with areas of the body contaminated with microorganisms;

After contact with medical equipment and other objects in the immediate vicinity of the patient.

Hand hygiene treatment is carried out in two ways:

Hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;

Treating hands with a skin antiseptic to reduce microbial counts to a safe level.

For washing hands, use liquid soap using a dispenser (dispenser). Wipe your hands with an individual towel (napkin), preferably disposable.

Hygienic treatment of hands with alcohol-containing or other approved antiseptic (without their preliminary washing) is carried out by rubbing it into the skin of the hands in the amount recommended by the instructions for use, paying special attention to the treatment of fingertips, the skin around the nails, between the fingers. A prerequisite for effective hand disinfection is keeping them moist for the recommended processing time.

When using the dispenser, a new portion of the antiseptic (or soap) is poured into the dispenser after it has been disinfected, rinsed with water and dried. Preference should be given to elbow dispensers and photocell dispensers.

Skin antiseptics for treating hands should be readily available at all stages of the diagnostic and treatment process. In units with a high intensity of patient care and with a high workload on staff (resuscitation and intensive care units, etc.), dispensers with skin antiseptics for treating hands should be placed in places convenient for staff use (at the entrance to the ward, at the patient's bedside) and etc.). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (up to 200 ml) with a skin antiseptic.

7. Technique for treating hands with an alcohol-based skin antiseptic

Rub in hand sanitizer! Wash your hands only if visible contamination is present!

8. Technique of washing hands with soap and water

The processing time is 2-3 minutes, special attention is paid to the nails and subungual areas.

The movements of each stage are repeated five times, constantly making sure that the hands remain moist throughout the treatment. If necessary, use a new portion of the disinfectant solution. Currently, an alcohol solution of 0.5% chlorhexidine bigluconate in 70% ethyl alcohol, Okteniderm, Octeniman, Octenisept, Veltosept, AHD 2000 special, Decosept plus, 60% isopropanol, 70% ethyl alcohol with skin softening additives, etc. ...

Recently, studies have emerged that prove that wristwatches, fountain pens and mobile phones of healthcare workers are also breeding grounds for germs.

Thus, hand hygiene is an integral part of the system of measures for the prevention of nosocomial infection in a medical organization.

hand infection antiseptic

Bibliography

Afinogenov G.E., Afinogenova A.G. Modern approaches to hand hygiene of medical personnel // Clinical microbiology and antimicrobial chemotherapy. 2004. T. 6.No. 1.

Opimakh I.V. The history of antiseptics is a struggle of ideas, ambition, ambitions ... // Medical technologies. Evaluation and selection.

WHO Guidelines for Hand Hygiene in Health Care: Executive Summary, 2013.

SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations carrying out medical activities."

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Social Hand Treatment Standard

Target: removal of dirt and transient flora from the contaminated skin of the hands of medical personnel as a result of contact with patients or environmental objects; ensuring the infectious safety of the patient and staff.

Indications: before serving food, feeding the patient; after using the toilet; before and after caring for the patient, if the hands are not contaminated with the patient's body fluids.
Prepare: liquid soap in single-use dispensers; watch with a second hand, paper towels.

Algorithm of action:
1. Remove rings, signet rings, watches and other jewelry from your fingers, check the integrity of your hands.
2. Fold the sleeves of the robe over 2/3 of the forearm.
3. Open the water tap with a paper towel and adjust the water temperature (35 ° -40 ° C), thereby preventing hand contact with microorganisms located on the tap.
4. Wash your hands with soap under running water up to 2/3 of the forearm for 30 seconds, paying attention to the phalanges, interdigital spaces of the hands, then wash the back and palm of each hand and rotate the base of the thumbs (this time is enough for decontamination of hands on a social level if the surface of the skin of the hands is thoroughly lather and does not leave dirty areas of the skin of the hands).
5. Rinse your hands under running water to remove soap suds (keep your hands up with your fingers so that the water flows into the sink from the elbows, without touching the sink. The phalanges of the fingers should remain the cleanest).
6. Close the elbow valve with a movement of the elbow.
7. Dry your hands with a paper towel, if there is no elbow tap, cover the edges with a paper towel.

Standard "Hand processing on hygienic level»

Target:
Indications: before and after performing invasive procedures; before putting on and after removing gloves, after contact with body fluids and after possible microbial contamination; before caring for an immunocompromised patient.
Prepare: liquid soap in dispensers; 70% ethyl alcohol, watch with seconds, warm water, paper towel, safe disposal container (CBU).

Algorithm of action:
1. Remove rings, signet rings, watches and other jewelry from your fingers.
2. Check the integrity of the skin of the hands.
3. Fold the sleeves of the robe over 2/3 of the forearm.
4. Open the water tap with a paper towel and adjust the water temperature (35 ° -40 ° C), thereby preventing hand contact with microorganisms. located on the crane.
5. Use a moderate stream of warm water to vigorously lather your hands until
2/3 forearms and wash your hands in the following sequence:
- palm on palm;

Each movement is repeated at least 5 times within 10 seconds.
6. Rinse your hands under running warm water until all soap is removed, holding your hands so that the wrists and hands are above the level of the elbows (in this position, water flows from a clean area to a dirty area).
7. Close the tap with your right or left elbow.
8. Dry your hands with a paper towel.
If there is no elbow tap, close the tap with a paper towel.
Note:
- with absence necessary conditions for hygienic hand washing, you can treat them with an antiseptic;
- apply to dry hands 3-5 ml of antiseptic and rub it on your hands until dry. Do not wipe your hands after processing! It is also important to observe the exposure time - hands must be moist from an antiseptic for at least 15 seconds;
- the principle of surface treatment "from clean to dirty" is observed. Do not touch foreign objects with washed hands.

1.3. Standard "Hygienic treatment of hands with an antiseptic"

Target: removal or destruction of transient microflora, ensuring the infectious safety of the patient and staff.

Indications: before injection, catheterization. operation

Contraindications: the presence of pustules on the hands and body, cracks and wounds of the skin, skin diseases.

Prepare; skin antiseptic for treating the hands of medical personnel

Algorithm of action:
1. Decontaminate hands at a hygienic level (see standard).
2. Dry your hands with a paper towel.
3. Apply 3-5 ml of antiseptic on the palms of your hands and rub it into the skin for 30 seconds in the following sequence:
- palm on palm
- right palm on the back of the left hand and vice versa;
- palm to palm, fingers of one hand in the interdigital spaces of the other;
- the backs of the fingers of the right hand on the palm of the left hand and vice versa;
- rotational friction of the thumbs;
- with the fingertips of the left hand gathered together on the right palm in a circular motion and vice versa.
4. Ensure that the hand sanitizer is completely dry.

Note: before starting to use a new antiseptic, it is necessary to study the guidelines for it.

1.4. Standard "Putting on sterile gloves"
Target: ensuring the infectious safety of the patient and staff.
- gloves reduce the risk of occupational infection through contact with patients or their secretions;
- gloves reduce the risk of contamination of the hands of personnel with transient pathogens and their subsequent transmission to patients,
- gloves reduce the risk of contamination of patients with microbes that are part of the resident flora of the hands of medical workers.
Indications: when performing invasive procedures, in contact with any biological fluid, in violation of the integrity of the skin, both the patient and the medical worker, during endoscopic examinations and manipulations; in clinical diagnostic, bacteriological laboratories when working with material from patients, during injections, when caring for a patient.
Prepare: gloves in sterile packaging, container for safe disposal (CBU).

Algorithm of action:
1. Decontaminate your hands at a hygienic level, treat your hands with an antiseptic.
2. Take gloves in sterile packaging, unfold.
3. Grasp the right-hand glove by the cuff with your left hand so that your fingers do not touch the inside of the cuff.
4. Close the fingers of your right hand and insert them into the glove.

5. Open the fingers of your right hand and pull the glove over them, without breaking its lapel.
6. Place under the cuff of the left glove the 2nd, 3rd and 4th fingers of the right hand, already wearing the glove, so that the 1st finger of the right hand is directed towards the 1st finger on the left glove.
7. Keep left glove 2nd, 3rd and 4th fingers of the right hand vertically.
8. Close the fingers of your left hand and insert them into the glove.
9. Open the fingers of your left hand and pull the glove over them, without breaking its lapel.
10. Spread the cuff of the left glove by pulling it on the sleeve, then on the right with the help of the 2nd and 3rd fingers, bringing them under the rolled edge of the glove.

Note: If one glove is damaged, both must be changed immediately, because you cannot remove one glove without contaminating the other.

1.5. Glove Removal Standard

Algorithm of action:
1. Using the gloved fingers of your right hand, make a fold on the left glove, touching only the outside of the glove.
2. Using the gloved fingers of your left hand, make a fold on the right glove, touching it only from the outside.
3. Remove the glove from the left hand by turning it inside out.
4. Hold the glove removed from your left hand by the cuff in your right hand.
5. With your left hand, grasp the glove on your right hand by the lapel on the inside.
6. Remove the glove from the right hand by turning it inside out.
7. Place both gloves (left inside right) into the KBU.

The composition of the cleaning solution

3. Immerse completely disassembled medical devices in the washing solution for 15 minutes, after filling the cavities and channels with the solution, close the lid.
4. Brush each item with a brush (gauze swab) in the detergent solution for 0.5 minutes (pass the detergent solution through the channels).
5. Place medical supplies in the tray.
6. Rinse each item under running water for 10 minutes, passing water through the channels and cavities of the items.
7. Carry out quality control of pre-sterilization cleaning with an azopyram sample. Control is subjected to 1% of simultaneously processed products of the same name per day, but not less than 3-5 units.

8. Prepare a working solution of the azopyram reagent (the working reagent is used for 2 hours after preparation).
9. Apply the working reagent with a reagent pipette on medical devices (on the body, channels and cavities, places of contact with biological fluids).
10. Hold medical devices over cotton or tissue, observing the color of the flowing reagent.
11. Evaluate the result of the azopyram test.

Ear Care Standard

Target: observance of personal hygiene of the patient, prevention of diseases, prevention of hearing loss due to the accumulation of sulfur, instillation of a medicinal substance.

Indications: serious condition of the patient, the presence of sulfur in the ear canal.
Contraindications: inflammatory processes in the auricle, external auditory canal.

Prepare: sterile: tray, pipette, tweezers, beaker, cotton balls, napkins, gloves, 3% hydrogen peroxide solution, soap solution, containers with disinfectant solutions, KBU.

Algorithm of action:

1. Explain to the patient the course of the procedure, get his consent.

3. Prepare a container of soapy water.

4. Tilt the patient's head to the side opposite the ear to be treated, place the tray.

5. Moisten the cloth in warm soapy water and wipe the auricle, dry it with a dry cloth (to remove dirt).

6. Pour into a sterile beaker, preheated in a water bath (T 0 - 36 0 - 37 0 C) 3% hydrogen peroxide solution.

7. Take a cotton swab in your right hand with tweezers and moisten it with a 3% solution of hydrogen peroxide, and with your left hand pull the auricle back and top to align the ear canal and insert the turunda with rotational movements into the external auditory canal to a depth of no more than 1 cm by 2 - 3 minutes.

8. Insert dry turunda with light rotational movements into the external auditory canal to a depth of no more than 1 cm and leave for 2 - 3 minutes.

9. Remove the turunda with rotational movements from the external auditory canal - the removal of secretions and wax from the ear canal is ensured.

10. Treat the other ear canal in the same sequence.

11. Take off your gloves.

12. Place used gloves, turundas, napkins in the KBU, tweezers, and a beaker in a container with disinfectant solutions.

13. Wash and dry your hands.

Note: when processing ears, cotton wool should not be wrapped on solid objects, possibly trauma to the ear canal.

Algorithm of action:

1. Explain to the patient the purpose of the procedure, get his consent.

2. Decontaminate hands at a hygienic level, wear gloves.

3. Place an oilcloth under the patient.

4. Pour warm water into the basin.

5. Expose the patient's upper body.

6. Dampen a napkin, a piece of a towel or a cloth mitten in warm water, lightly squeeze out excess water.

7. Wipe the patient's skin in the following sequence: face, chin, behind the ears, neck, arms, chest, creases under the mammary glands, armpits.

8. Wipe the patient's body dry with the dry end of the towel in the same sequence and cover with a sheet.

9. Treat the back, live, hips, legs in the same way.

10. Trim your fingernails.

11. Change underwear and bedding (if necessary).

12. Take off your gloves.

13. Wash and dry your hands.

Algorithm of action:

1. Wash the head of a seriously ill person in bed.
2. Give your head an elevated position, i.e. put a special headrest or roll up the mattress with a roller and tuck it under the patient's head, lay an oilcloth on it.
3. Tilt the patient's head back at neck level.
4. Place a bowl of warm water on a stool at the head end of the bed, at the level of the patient's neck.
5. Moisten the patient's head with a stream of water, lather the hair, massage the scalp thoroughly.
6. Wash your hair from the front of your head back with soap or shampoo.
7. Rinse your hair and wring it dry with a towel.
8. Comb your hair with a fine comb daily, short hair should be combed from roots to ends, and long ones are divided into strands and slowly combed from ends to roots, trying not to pull them out.
9. Place a clean cotton kerchief over your head.
10.Lower the headrest, remove all care items, straighten the mattress.
11. Place used care items in disinfectant solution.
Note:
- the head of a seriously ill patient (in the absence of contraindications) should be washed once a week. The optimal device for this procedure is a special headrest, but the bed should also have a removable back, which greatly facilitates this laborious procedure;
- women comb their hair daily with a fine comb;
- men have their hair cut short;
- a fine comb dipped in a 6% vinegar solution is good at combing out dandruff and dust.

Ship Delivery Standard

Target: providing physiological procedures for the patient.
Indication: used in patients who are on strict bed and bed rest during bowel emptying and Bladder. Prepare: disinfected vessel, oilcloth, diaper, gloves, diaper, water, toilet paper, container with disinfectant, KBU.
Algorithm of action:
1. Explain to the patient the purpose and course of the procedure, get his consent,
2. Rinse the boat with warm water, leaving some water in it.
3. Separate the patient with a screen from others, remove or fold the blanket to the waist, put an oilcloth under the patient's pelvis, and a diaper on top.
4. Decontaminate hands at a hygienic level, wear gloves.
5. Help the patient to turn on the side, bend the legs slightly at the knees and spread them at the hips.
6. Move your left hand to the side under the sacrum, helping the patient to raise the pelvis.

7. With your right hand, move the boat under the patient's buttocks so that his crotch is over the opening of the boat, while moving the diaper to the lower back.
8. Cover the patient with a blanket or sheets and leave him alone.

9. At the end of the act of defecation, slightly turn the patient to one side, holding the vessel with your right hand, remove it from under the patient.
10. Wipe the anal area toilet paper... Place the paper on the ship. If necessary, wash the patient, dry the perineum.
11. Remove the boat, oilcloth, diaper and screen. Replace the sheet if necessary.
12. Help the patient to lie down comfortably, cover with a blanket .
13. Cover the boat with a diaper and linen and carry it to the washroom.
14. Empty the contents of the boat into the toilet, rinse it with hot water .
15. Immerse the boat in a container with disinfectant solution, discard gloves in
KBU.
16. Wash and dry your hands.

Discharged liquid

9. Record the amount of fluid drunk and injected into the body on the record sheet.

Injected fluid

10. At 6:00 am the next day, the patient hands over the registration sheet to the nurse.

The difference between the amount of fluid you drink and the daily amount of the night is the amount of the body's water balance.
The nurse should:
- Ensure that the patient can measure fluid.
- Ensure that the patient has not taken diuretics within 3 days prior to the study.
- Tell the patient how much fluid should normally be excreted in the urine.
- Explain to the patient the approximate percentage of water in food to facilitate the recording of the introduced fluid (not only the water content in food is taken into account, but also the introduced parenteral solutions).
- Solid foods can contain 60 to 80% water.
- Not only urine, but also vomit, feces of the patient are monitored for the amount of fluid released.
- The nurse calculates the number of entered and removed nights per day.
The percentage of fluid excretion is determined (80% of the normal amount of fluid excreted).
the amount of urine excreted x 100

Removal percentage =
amount of fluid injected

Calculate the water balance according to the following formula:
the total amount of urine excreted per day multiplied by 0.8 (80%) = the amount of night that should be excreted normally.

Compare the amount of fluid released with the amount of calculated fluid in the norm.
- The water balance is considered negative if less liquid is released than calculated.
- The water balance is considered positive if more fluid is released than calculated.
- Make entries in the water balance sheet and evaluate it.

Result evaluation:

80% - 5-10% - the rate of excretion (-10-15% - in the hot season; + 10-15%
- in cold weather;
- positive water balance(> 90%) indicates the effectiveness of treatment and the convergence of edema (reaction to diuretics or fasting diets);
- negative water balance (10%) indicates an increase in edema or ineffectiveness of the dose of diuretics.

I.IX. Punctures.

1.84. Standard "Preparation of a patient and medical instruments for pleural puncture (pleurocentesis, thoraccentesis)".

Target: diagnostic: a study of the nature of the pleural cavity; therapeutic: the introduction of drugs into the cavity.

Indications: traumatic hemothorax, pneumothorax, spontaneous valvular pneumothorax, respiratory diseases (croupous pneumonia, pleurisy, pulmonary empyema, tuberculosis, lung cancer, etc.).

Contraindications: increased bleeding, skin diseases (pyoderma, shingles, chest burns, acute heart failure.

Prepare: sterile: cotton balls, gauze wipes, diapers, needles for intravenous and subcutaneous injections, needles for puncture 10 cm long and 1 - 1.5 mm in diameter, syringes 5, 10, 20, 50 ml, tweezers, 0, 5% novocaine solution, 5% iodine alcohol solution, 70% alcohol, clamp; cleol, adhesive plaster, 2 chest X-rays, sterile container for pleural fluid, container with disinfectant, referral to the laboratory, kit for assisting with anaphylactic shock, gloves, CBU.

Algorithm of action:

2. Sit the patient, stripped to the waist, on a chair facing his back, ask him to rest on the back of the chair with one hand, and bring the other (from the side of the pathological process localization) behind his head.

3. Ask the patient to slightly tilt the torso to the side opposite to the one where the doctor will perform the puncture.

4. Pleural puncture is performed only by a doctor, a nurse will assist him.

5. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, wear gloves.

6. Treat the proposed puncture site with 5% alcohol solution iodine, then 70% alcohol solution and iodine again.

7. Give the doctor a syringe with a 0.5% solution of novocaine for infiltration anesthesia of the intercostal muscles and pleura.

8. The puncture is made in the VII - VII intercostal spaces along the upper edge of the underlying rib, since the neurovascular bundle passes along the lower edge of the rib and intercostal vessels can be damaged.

9. The doctor inserts a puncture needle into the pleural cavity and pumps the contents into the syringe.

10. Place a container for the fluid to be removed.

11. Empty the contents of the syringe into a sterile jar (tube) for laboratory testing.

12. Give the doctor a syringe with the collected antibiotic to be injected into the pleural cavity.

13. After removing the needle, treat the puncture site with 5% alcohol solution of iodine.

14. Apply a sterile napkin to the puncture site, fix with adhesive tape or glue.

15. Carry out tight bandaging of the chest with sheets to slow down the exudation of fluid into the pleural cavity and prevent the development of collapse.

16. Remove gloves, wash hands and dry.

17. Used disposable syringes, gloves, cotton balls, napkins put in the KBU, a puncture needle in a container with a disinfectant solution.

18. Monitor the patient's well-being, the condition of the dressing, count his pulse, measure blood pressure.

19. Escort the patient to the ward on a gurney, lying on his stomach.

20. Warn the patient about the need to stay in bed for 2 hours after the manipulation.

21. Send the received biological material for research to the laboratory with a referral.

Note:

When removing more than 1 liter of fluid from the pleural cavity at once, there is a great risk of collapse;

Delivery of pleural fluid to the laboratory should be carried out urgently in order to avoid the destruction of enzymes and cellular elements;

When the needle enters the pleural cavity, there is a feeling of "failure" into the free space.

1.85. Standard "Preparation of the patient and medical instruments for abdominal puncture (laparocentesis)".

Target: diagnostic: laboratory examination of ascitic fluid.

Therapeutic: removal of accumulated fluid from the abdominal cavity with ascites.

Indications: ascites, with malignant neoplasms of the abdominal cavity, chronic hepatitis and cirrhosis of the liver, chronic cardiovascular insufficiency.

Contraindications: severe hypotension, adhesions in the abdominal cavity, severe flatulence.

Prepare: sterile: cotton balls, gloves, trocar, scalpel, syringes 5, 10, 20 ml, napkins, jar with a lid; 0.5% novocaine solution, 5% iodine solution, 70% alcohol, container for extracted liquid, basin, test tubes; a wide towel or sheet, an adhesive plaster, a set to help with anaphylactic shock, a container with a disinfectant solution, a referral for examination, dressings, tweezers, KBU.

Algorithm of action:

1. Inform the patient about the upcoming study and obtain his consent.

2. On the morning of the study day, give the patient a cleansing enema until the effect of "pure water".

3. Immediately before performing the manipulation, invite the patient to empty the bladder.

4. Ask the patient to sit in a chair, leaning on its back. Cover the patient's legs with oilcloth.

5. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.

6. Give the doctor a 5% alcohol solution of iodine, then a 70% alcohol solution to treat the skin between the navel and the pubis.

7. Give the doctor a syringe with 0.5% novocaine solution for layer-by-layer infiltration anesthesia of soft tissues. A puncture during laparocentesis is performed along the midline of the anterior abdominal wall at an equal distance between the navel and the pubis, retreating 2-3 cm to the side.

8. The doctor cuts the skin with a scalpel, with his right hand pushes the trocar through the thickness of the abdominal wall with his right hand, then removes the stylet and ascitic fluid begins to flow through the cannula under pressure.

9. Place a container (basin or bucket) in front of the patient for fluid flowing out of the abdominal cavity.

10. Put 20 - 50 ml of liquid for laboratory research (bacteriological and cytological) into a sterile jar.

11. Place a sterile sheet or wide towel under the patient's lower abdomen, the ends of which should be held by the nurse. Tighten the abdomen with a sheet or towel covering it above or below the puncture site.

12. Use a wide towel or sheet to periodically tighten the patient's anterior abdominal wall as fluid is removed.

13. After the end of the procedure, you need to remove the cannula, suture the wound with a skin suture and treat with 5% iodine solution, apply an aseptic bandage.

14. Remove gloves, wash hands and dry.

15. Place the used tools in disinfectant solution, gloves, cotton balls, place syringes in the KBU.

16. Determine the patient's pulse, measure blood pressure.

17. Transport the patient to the ward on a gurney.

18. Warn the patient to stay in bed for 2 hours after the procedure (to avoid hemodynamic disturbances).

19. Send the received biological material to the laboratory for research.

Note:

When carrying out the manipulation, strictly follow the rules of asepsis;

With a rapid withdrawal of fluid, collapse and fainting may develop, due to a drop in intra-abdominal and intrathoracic pressure and redistribution of circulating blood.

1.86. Standard "Preparation of the patient and medical instruments for the lumbar puncture".

Target: diagnostic (for the study of cerebrospinal fluid) and therapeutic (for the introduction of antibiotics, etc.).

Indications: meningitis.

Prepare: sterile: syringes with needles (5 ml, 10 ml, 20 ml), a puncture needle with a mandrel, tweezers, napkins and cotton balls, tray, culture medium, test tubes, gloves; manometric tube, 70% alcohol, 5% alcohol solution of iodine, 0.5% novocaine solution, adhesive plaster, KBU.

Algorithm of action:

1. Inform the patient about the upcoming procedure and obtain consent.

2. The puncture is carried out by a doctor in strict adherence to the rules of asepsis.

3. Take the patient to the treatment room.

4. Place the patient on the right side closer to the edge of the couch without a pillow, tilt the head forward towards the chest, bend the knees as much as possible and pull up to the abdomen (the back should be arched).

5. Place your left hand under the patient's side, hold the patient's legs with your right hand to fix the back position. During the puncture, another assistant fixes the patient's head.

6. The puncture is made between the III and IV lumbar vertebrae.

8. Treat the skin at the puncture site with 5% iodine solution, then 70% alcohol solution.

9. Fill a syringe with a 0.5% solution of novocaine and give it to the doctor for infiltration anesthesia of soft tissues, and then a puncture needle with a mandrel on the tray.

10. Collect 10 ml of CSF in a test tube, write a referral and send to the clinical laboratory.

11. Collect 2-5 ml of cerebrospinal fluid in a test tube with culture medium for bacteriological examination. Write a referral and send the biological material to the bacteriological laboratory.

12. Give the doctor a CSF pressure gauge tube.

13. After removing the puncture needle, treat the puncture site with 5% alcohol solution of iodine.

14. Apply a sterile napkin to the puncture site, cover with adhesive tape.

15. Place the patient on his stomach and take him to the ward on a gurney.

16. Place the patient on the bed without a pillow in the prone position for 2 hours.

17. Observe the patient's condition throughout the day.

18. Take off your gloves.

19. Place the syringes, cotton balls, gloves in the KBU, place the used instruments in the disinfectant solution.

20. Wash and dry.

1.87. Standard "Preparation of the patient and medical instruments for sterile puncture".

Target: diagnostic: examination of the bone marrow to establish or confirm the diagnosis of blood diseases.

Indications: diseases of the hematopoietic system.

Contraindications: myocardial infarction, attacks of bronchial asthma, extensive burns, skin diseases, thrombocytopenia.

Prepare: sterile: tray, syringes 10 - 20 ml, Kassirsky's puncture needle, 8 - 10 slides, cotton and gauze balls, forceps, tweezers, gloves, 70% alcohol, 5% alcohol solution of iodine; adhesive plaster, sterile dressing material, KBU.

Algorithm of action:

1. Inform the patient about the upcoming study and obtain his consent.

2. Sternal puncture is performed by a doctor in a procedure room.

3. The sternum is punctured at the level of the III - IV intercostal space.

4. The nurse assists the doctor during the manipulation.

5. Invite the patient to the treatment room.

6. Offer the patient to undress to the waist. Help him lie on the couch, on his back without a pillow.

7. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.

8. Treat the front surface of the patient's chest, from the collarbone to the gastric region with a sterile cotton ball moistened with 5% iodine solution, and then 2 times 70% alcohol.

9. Perform layer-by-layer infiltration anesthesia of soft tissues with 2% novocaine solution up to 2 ml in the center of the sternum at the level of III - IV intercostal space.

10. Give the doctor the Kassirsky's puncture needle, setting the guard-limiter to 13-15 mm of the needle tip, then a sterile syringe.

11. The doctor pierces the outer plate of the sternum. The hand feels the failure of the needle, removing the mandrel, a 20.0 ml syringe is attached to the needle and 0.5-1 ml of bone marrow is sucked into it, which is poured onto a glass slide.

12. Dry the slides.

13. After removing the needle, treat the puncture site with 5% alcohol solution of iodine or 70% alcohol solution and apply a sterile bandage, fix with adhesive plaster.

14. Take off your gloves.

15. Dispose of used gloves, syringes and cotton balls into the CBU.

16. Wash your hands with soap and dry.

17. Escort the patient to the ward.

18. Send the slides to the laboratory after the material has dried.

Note: Kassirsky's needle is a short thick-walled needle with a mandrel and a shield that prevents the needle from penetrating too deeply.

1.88. Standard "Preparation of the patient and medical instruments for the puncture of the joints."

Target: diagnostic: determination of the nature of the contents of the joint; therapeutic: removal of effusion, rinsing of the joint cavity, introduction of medicinal substances into the joint.

Indications: joint diseases, intra-articular fractures, hemoarthrosis.

Contraindications: purulent inflammation of the skin at the puncture site.

Prepare: sterile: a puncture needle 7-10 cm long, syringes 10, 20 ml, tweezers, gauze swabs; aseptic dressing, napkins, gloves, tray, 5% alcohol solution of iodine, 70% alcohol solution, 0.5% novocaine solution, test tubes, KBU.

Algorithm of action:

1. The puncture is carried out by the doctor in the treatment room in strict observance of the rules of asepsis.

2. Inform the patient about the upcoming study and obtain his consent.

3. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.

4. Ask the patient to sit comfortably or in a comfortable position.

5. Give the doctor a 5% alcohol solution of iodine, then a 70% alcohol solution to treat the intended puncture site, a syringe with a 0.5% novocaine solution for infiltration anesthesia.

6. The doctor with his left hand covers the joint at the puncture site and squeezes the effusion to the puncture site.

7. The needle is inserted into the joint and the effusion is collected with a syringe.

8. Pour the first portion of the contents from the syringe into the test tube without touching the walls of the laboratory test tube.

9. After the puncture, antibiotics and steroid hormones are injected into the joint cavity.

10. After removing the needle, lubricate the puncture site with 5% alcohol solution of iodine and apply an aseptic dressing.

11. Place used syringes, napkins, gloves, gauze swabs in the KBU, a puncture needle in a disinfectant solution.

12. Remove gloves, wash and dry your hands.

I.XII. "Preparing a patient for laboratory and instrumental research methods."

Standard "Preparing a patient for fibrogastroduodenoscopy"

Target: provide high-quality preparation for the study; visual examination of the mucous membrane of the esophagus, stomach and duodenum
Prepare: sterile gastroscope, towel; direction for research.
FGDS is carried out by a doctor, a nurse is assisting.
Algorithm of action:
1. Explain to the patient the purpose and course of the upcoming study and obtain his consent.
2. Conduct psychological preparation of the patient.
3. Inform the patient that the test is done in the morning on an empty stomach. Exclude food, water, medications; do not smoke, do not brush your teeth.
4. Provide the patient with a light supper the night before, no later than 6 pm; after supper, the patient should not eat or drink.
5. Make sure that the patient removes any removable dentures before the examination.
6. Warn the patient not to speak or swallow saliva during the endoscopy (the patient spits saliva into a towel or napkin).
7. Take the patient to the endoscopy room with a towel, medical history, referral to the appointed hour.
8. Accompany the patient to the ward after the examination and ask him not to eat food for 1-1.5 hours until the swallowing is fully restored; no smoking.
Note:
- remedication n / a is not carried out, because changes the state of the examined organ;
- when taking material for biopsy - food is served to the patient only cold.

Standard "Preparing a patient for colonoscopy"

Colonoscopy - This is an instrumental method for examining high-lying parts of the colon using a flexible endoscope probe.
Diagnostic value of the method: Colonoscopy allows direct