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Introduction

FamousPolishdoctorwrote:"Whomnottoucheshumanneed,whonotpossessesgentlenessvhandling,atwhomnot enoughstrengthwill,toeverywhereandsunewheredominateaboveby yourself,thatletit is betterelectsanotherprofession,forhenevernotbatchildrengoodmedicalan employee ".

SAKHALIN REGIONAL ONCOLOGICAL DISPENSER, is a medical and medical institution that unites a 302-bed hospital and a polyclinic.

The head of the medical institution is OVSYANNIKOV. V.G

Chief Nurse - N.A. ZHAROVTSEVA

The medical base of the Oblonkodispensary includes

1-oncology-department of abdominal surgery-40 beds

2-oncology department of head and neck tumors - 40 beds

3-oncology department of gynecological oncology -40 beds

4-oncology-department of thoracic surgery-30 beds

5-Oncology Department of Mammology-40 beds

6-chemotherapy department - 30 beds

7- urology department - 30 beds

8-radiological department

It should be noted that the ONCOLOGICAL DISPENSER is the only one in the entire Sakhalin region and accepts patients from all regions. Oncology is a special "branch" of medicine and requires more ethics in working with patients.

Today, the institution is a close-knit, qualified team capable of using the most high-tech medical equipment in treatment.

Medical professionals are able to provide medical care in many areas, not only within the walls of the hospital, but also in extreme conditions, during emergencies, during the period of sports competitions at the federal level.

Surgicalbranchhospital deployed for 40 beds.

In the department, patients receive treatment with pathology from the gastrointestinal tract, trauma with damage to internal organs abdominal cavity and patients with purulent-septic diseases.

Currently, the department is located on the 2nd floor of a 3-storey building. The department includes: 14 rooms, of which 5 have 2 beds, the rest have 4, each is equipped with a shower and toilet, treatment room, a dressing room, 2-manipulation rooms, a sanitary room, a nurse's post, a senior nurse's office, and at the other end of the corridor, there is an office and a buffet.

Branchcarries outthe followingfunctions:

Provision of diagnostic, therapeutic and prophylactic assistance to patients with oncological diseases;

Provision of advisory assistance to doctors of other departments of a medical organization in solving issues of diagnostics and rendering medical care to patients with oncological diseases;

Development and implementation of measures to improve the quality of medical and preventive work of the department;

Participation in the promotion process professional qualifications staff on diagnostics and medical care for cancer patients;

Implementation in clinical practice modern methods of diagnostics, treatment and rehabilitation of patients with oncological diseases;

Examination of temporary disability;

Conducting conferences on the analysis of the causes of death in the treatment of patients with oncological diseases in conjunction with the pathological department;

Implementation of sanitary and hygienic and anti-epidemic measures to ensure the safety of patients and staff, to prevent the spread of nosocomial infection;

Maintaining accounting and reporting documentation, submitting reports on its activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by law.

DressingToabinetsurgicalbranches- this is my workplace. For the convenience of cleaning, the floor is covered with ceramic-granite tiles, the walls are tiled, the ceiling and doors are painted with light-colored oil paint. There is a centralized supply of cold and hot water, heating, power supply and ventilation. Artificial lighting is provided by a lamp daylight located above the dressing table, and lighting fixtures. The electrical wiring is hidden and there is a ground loop. There are two sinks for washing hands and washing tools. The doors of cabinets and doors are covered with plastic.

Equipmentdressingcabinet: table for instruments and dressings - 1 pc. Ultralight - for storing sterile instruments 1 piece, Drying cabinet for sterilizing instruments 1 piece, Bactericidal lamp - 1 piece; tripod; Hemostatic tourniquets - 2 pcs.; Chairs and stools - 3 pcs.; Bench stands - 2 pcs.; operating table / gynecological chair - 1 pc .; tool cabinet - 1 pc .; medicine storage cabinet - 1 pc .; work table - 1 pc .; table for medical records- 1 PC.; forceps for collecting contaminated dressings - 2 pcs .; containers for disinfection solutions - 8 pcs.; buckets for class A and B waste: dry white bag; medical yellow bag - 2 pcs .; movable reflector lamp - 1 pc .; aprons made of oilcloth and plastic - 4 pcs.; glasses - as a means of eye protection - 4 pcs .; disposable sterile gowns, gloves, hats, masks, shoe covers - in abundance; disposable sterile linen - in abundance; ready-made sterile material - in abundance; containers for the preparation of working solutions of disinfectants, measuring containers for diluting disinfectants, brushes, brushes - for processing instruments, a bedside table for storing detergents and disinfectants detergents... Anti-shock and anti-AIDS first-aid kits with instructions for their use, also next to the office there is a sanitary room for the dressing room, where there is cleaning equipment for routine and general cleaning - 2 buckets for washing floors and walls, containers for processing furnishings, surfaces -2 pcs, mops for cleaning floors and walls-2 pcs and containers for diluting disinfectants.

Toolsdressingcabinet: maskites; Volkmann spoons; disposable sets for pleural puncture; suture material, anatomical, surgical and claw tweezers - 8 pcs.; hemostatic clamps - 8 pcs .; abdominal scalpels -3 pcs.; pointed scalpels - 2 pcs.; pointed scissors -2 pcs .; sharp-pointed eye scissors - 1 pc .; blunt scissors, curved along the plane, - 2 pcs.; lamellar hooks - 1 pair; general surgical needle holders - 2 pcs .; different surgical needles - 10 pcs .; forceps - 2 pcs.; long tweezers - 2 pcs.; bulbous and grooved probe - 1 pc .; kidney-shaped trays; different cuvettes - 5 pcs. Sterile disposable dressing trays are also available with ready-to-use dressing material.

REQUIREMENTS FOR THE POSITIONING OF THE EQUIPMENT OF THE SIDING ROOM.

The dressing room is conventionally divided into two zones: clean and conventionally clean.

In the clean area: place a table with sterile instruments, a dry heat cabinet, a cabinet for medicines and instruments.

In a conditionally clean area: place the rest of the equipment, a nurse's desk, an operating and dressing table, a table with disinfectants, a sink, etc.

A RESPONSIBILITY.

The dressing nurse is responsible for:

1.Lack of sanitary and hygienic regime in the dressing room.

2. safety of instrumentation, suture material, equipment.

3. violation of the rules of asepsis.

4. failure and delay of dressings through their own fault.

5. lack of knowledge about the course of dressings.

Mydofficialduties:

In the dressing room, dressing is carried out and monitoring postoperative wounds, small operations and punctures are performed. As well as:

1. The manipulations prescribed by the attending physician are performed, which are allowed to be performed by the nursing staff.

2. Seriously ill patients are accompanied to the ward after the performed manipulations.

3. Instruments and dressings are being prepared for sterilization.

4. Systematic sanitary and hygienic control over the dressing room is carried out.

5. Systematic replenishment, accounting, storage and consumption of medicines, dressings, instruments and linen is provided.

6. The junior medical personnel of the dressing room are instructed and their work is supervised.

7. Regulatory medical documentation is kept in accordance with the nomenclature of cases.

8. Collection, disinfection and disposal of medical waste is carried out.

9. Measures are being taken to comply with the sanitary and hygienic regime in the room, the rules of asepsis and antiseptics, the conditions for sterilizing instruments, to prevent post-infectious complications, hepatitis, HIV infection. 10. Immediately inform your immediate supervisor about any industrial accident, signs of an occupational disease, as well as a situation that poses a threat to the life and health of people. If necessary, perform the functions of an operating nurse when performing simple surgical interventions carried out in a dressing room.

Volumecarried outwork.

My working day begins with an inspection of the dressing room. As a nurse in the dressing room, I check whether the staff on duty used the dressing room at night. In case of emergency intervention or unscheduled dressing, the used and contaminated dressing material is removed into buckets with lids (yellow bag - waste of class "B"), used instruments are soaked in a disinfectant solution.

I check whether wet cleaning has been carried out with the use of disinfectants, I take sterile instruments from the CSO, arrange the beads with the material, install the medicines received from the pharmacy the day before.

I get a list of all dressings for the day, set their order. First of all, I bandage patients with a smooth postoperative course (removal of stitches), then with granulating wounds. After making sure that the dressing room is ready, I start processing my hands.

After processing my hands, I start putting on a sterile gown. Opening the bix lid, I check the indicator. Taking the robe, I gently unfold it, holding the edges of the collar with my left brush on an outstretched hand so that it does not touch the surrounding objects and clothes, put on the robe on the outstretched right hand... With this hand I take the left edge of the collar and put it on left hand pulling them forward and up. The assistant ties the ribbons on the back of the robe. Next, I tie the ribbons on the sleeves, as well as the belt, taking it by the free ends, without touching the robe and hands. After that I put on sterile gloves.

When I put on a sterile gown and gloves, I start preparing a sterile table. A sterile table is being prepared, which is covered with a sterile sheet in one layer, so that it hangs 15-20 cm below the table surface. The second sheet is folded in half and placed on top of the first. After laying out the tools (material), the table is covered with a sheet (folded in 2 layers), which should completely cover all objects on the table, and is tightly fastened with clamps to the bottom sheet. The sterile table is set for 6 hours. In cases where instruments are sterilized in individual packaging, there is no need for a sterile table or it is covered immediately before manipulation.

Dressings are carried out in a mask, cap and sterile gloves, which are changed for each patient. All items from the sterile table are taken with forceps or long tweezers, which are also subject to disinfection and sterilization.

Analysis of work for the reporting period:

№ p.p	Name:	Quantity:
	Pleural puncture
	Bandaging postoperative patients
	Laparocentesis
	Lancing of purulent parapractitis
	Opening of panaritiums and phlegmon
	Lancing of abscesses
	Applying compresses


	Cholecystoma
	CYSTOMES

2. Knowledge and skills of the certified specialty

During her work, she perfectly mastered the following manipulations:

ь Maintaining medical records.

b Control of compliance with the rules of asepsis and antiseptics in the dressing room.

ь Carrying out cleaning in the dressing room.

b Preparation of linen, dressings, masks for sterilization.

b Preparation of surgical styling.

b Preparation of instruments and equipment for sterilization.

ь Ensuring the patient's infectious safety.

ь Carrying out disinfection in the dressing room.

ь Participation in all types of punctures.

b Acquisition of sets of surgical instruments.

b Preparation of suture material.

b Imposition of all types of bandages.

ь Providing various methods of hemostasis.

ь Assisting with terminal conditions.

b Modern techniques processing of the operating field.

l Performing various types of patient placement on the operating table.

b Use individual funds protection.

b Preparation of disinfectants.

ь Submission of instruments during the operation and dressing.

b Collection and disposal. used materials and tools.

Manipulations are performed in a certain sequence: removal of the bandage applied earlier; primary toilet of the skin around the wound; initial examination and toilet of the wound; re-examination of the wound; performing diagnostic or treatment procedures; repeated skin toilet, bandaging.

The primary toilet of the skin is made in order to remove blood, pus, etc. from the areas of the skin surrounding the wound (hair is shaved off for wounds of the hairy areas of the body). The toilet is performed with gauze (or cotton) balls dipped in ethyl alcohol, etc.; the skin is treated in the direction from the edges of the wound to the periphery in order to protect it from contamination and infection.

When examining aseptic wounds with sutures, attention is paid to the appearance of local signs of inflammation (hyperemia, edema, eruption of sutures, necrosis). In the absence of inflammation and necrosis, the wound along the suture line is lubricated with 5% alcohol solution of iodine or 1% alcohol solution of brilliant green, 3-5% solution of potassium permanganate, solution of chlorhexidine bigluconate and apply a dry aseptic bandage from gauze wipes, which are fixed with an aseptic sticker, tubular or regular bandage.

In case of wound suppuration, the sutures are removed in whole or in part, while paying attention to the nature of the discharge. When assessing the wound process, the condition of the wound is of great importance. With the development of a putrefactive infection, the surface of the wound is distinguished by dryness, the absence of granulations, the presence of necrotic tissues, in gray muscles; crepitus of tissues, indicating the presence of gas in them, is rare. With anaerobic infection, the edges of the wound are edematous, and finger pressure does not leave a mark in the edematous tissues, muscle swelling, traces of the dressing being pressed, eruption of sutures, crepitus are noted. The slightest suspicion of the presence of an anaerobic infection is an alarming signal and requires the adoption of the necessary urgent measures.

Pleuralpuncture: My responsibilities include helping a doctor with a pleurocentesis. Puncture pleural cavity carried out with a diagnostic therapeutic purpose... The patient is placed in a comfortable sitting position, with the shoulder girdle resting on the back of the chair or lying on his side. We treat our hands with 70% alcohol or the CHISTEA skin antiseptic, put on sterile gloves. We treat the puncture site with iodine, alcohol using cotton balls. The doctor conducts local anesthesia with 0.5% novocaine solution. The fluid is aspirated using a disposable pleural puncture kit. After the procedure, we process the puncture site and apply a sterile bandage. We immediately send the pleural contents to the laboratory in a special labeled jar.

Vdressingcabinetby meis underwaynextdocumentation:

* Journal of registration and control of the bactericidal installation;

* Log book for general cleaning;

* Sterilization log;

* Journal of quality control of pre-sterilization cleaning (azopyram and phenolphthalein samples);

* Register of dressings;

* Small register surgical operations;

* Biopsy log;

* Log book for dressing and consumables;

* Journal of receiving medicines from the head nurse;

* Log of emergency situations.

Carrying outanti-epidemicactivities.

The department has a dressing room for dressing clean and purulent wounds. To do this, it was necessary to isolate the so-called clean and purulent dressings, first of all, clean dressings are carried out. After each dressing of patients with signs of suppuration or with purulent wounds, the sheet on the dressing table is replaced, so we use disposable linen as soon as possible. Bandaging is carried out according to the schedule, which is approved by the head of the department. The schedule is posted in a conspicuous place - on the door of the office.

Prevention of the development of postoperative purulent-septic infections consists of a set of measures aimed at breaking the chain of occurrence of the epidemiological process. One of the important sections of this complex is the observance of the sanitary-hygienic and anti-epidemiological regime in the dressing room.

WorkvdressingcabinetwhichI amdoingdaily:

1. I process my hands, process them at a hygienic level, put on sterile clothes and open the bix.

2. Using sterile forceps (forceps), gently unfold the lining diaper so that its ends remain inside the bix. The tweezers are stored in a sterile bag, in a sterile bix; tweezers are changed after 1 hour.

3. The sterile table is set for 6 hours of work.

4. An individual dressing kit is covered for each patient. The complete set of laying depends on the dressing profile or minor surgery.

5. After the dressing, all used instruments are placed in a container with a disinfectant for 30 minutes and closed with a lid.

6. After bandaging each patient, the oilcloth of the dressing table is wiped with a rag moistened with a disinfectant solution.

7. Used balls, tampons are disinfected, and then collected in disposable plastic bags yellow color, which, after filling, are sealed and removed from the compartment for disposal.

8. Every 2 hours intensive work dressing room to be closed for 30 minutes for current cleaning, airing and quartzing. In this case, the sheet on the dressing table is replaced.

9. The work of the dressing room is carried out in accordance with the schedule approved by the head of the department, the schedule is posted on the door of the office.

10. When treating surgical patients with drains: every day, all connecting tubes and jars for the discharge are changed to sterile, the used ones are disinfected; jars for the drainage system are not placed on the floor, they are tied to the patient's bed or placed next to them on a stand.

11. Sterile gloves are changed:

In case of contamination with blood or other discharge from the wound and during instrumental dressing - after each patient! Hygienic hand antiseptics is preliminarily carried out.

The sterile dressing tray in the ward can only be covered for one patient!

Asepsis is violated if, during dressing, a sterile napkin is moistened by pressing it against the neck of the bottle or pouring it from the bottle. Pour sterile solution into a glass or tray and immerse the tissue there. If the dressing is ointment, then put the napkin in a sterile tray and apply the ointment with a sterile spatula, then give it to the doctor.

PREPARATION OF KITS FOR STERILIZATION IN A DRY CABINET.

The cabinet, before placing items in it, is wiped with a solution of a disinfectant twice, with an interval of 15 minutes.

Tools on the grates are placed in one row, with no more than 10 locks open.

180-degree stericons are placed in each laying, 5 pieces for each grate in the middle and on the sides of the grate.

The sterilization time is 60 minutes, after which the instruments are placed in the ULTRALITE STERILE TABLE, which is also treated once a week with a disinfectant, distilled water and 6% hydrogen peroxide.

ALGORITHM OF PREPARATION OF BIX FOR STERILIZATION AND TRANSPORTATION IN CSO.

Bix is wiped with a disinfectant solution twice with an interval of 15 minutes.

The bix is lined with a large napkin, which should hang from the outside by 2/3 of the bix height; we put an indicator on the bottom. Products packed in coarse calico or kraft paper are laid vertically or on the edge, the distance between the packages is equal to the thickness of the palm, so that steam can evenly penetrate between the products. We put an indicator at 132 degrees in the middle of the bix, cover the product with a large napkin and put another indicator on top, close the bix and attach a tag to the handle on which the material laid in the bix is indicated. The bix windows are open, the bix is delivered to the central office in two bags. When opening the bag, pay attention to the date of sterilization, the color of the indicator should be brown. The products in the mix must be dry. WET PRODUCTS - NOT STERILE.

GENERAL REQUIREMENTS FOR THE ORGANIZATION OF STORAGE OF MEDICINAL PRODUCTS IN THE DRESSING ROOM ORDER-523 dated 03 07 1968. hospital dressing room organization

Storage of medicines for external and internal use should be carried out on separate shelves, about which the appropriate labeling should be made from the pharmacy, medicines come in finished form with an accurate and clear designation on the label (internal, external).

PACKAGING, DISTRIBUTING, TRANSFERRING, AND ALSO REPLACING LABELS IS PROHIBITED.

SHELF LIFE OF MEDICINAL PRODUCTS MANUFACTURED IN A PHARMACY:

Order of the Ministry of Health of the Russian Federation - 214 of 07.16 1997.

Injection solutions in vials, hermetically rolled up for 30-90 days.

Opened vials 6 hours.

Ointment for 10 days.

Hydrogen peroxide 10 days.

Potassium permanganate 10 days.

ALGORITHM OF ACTIONS FOR ANAPHYLACTIC SHOCK.

Anaphylactic shock is a consequence of allergic reaction immediate type, accompanied by a life-threatening violation of all body systems (respiratory, cardiovascular, nervous, endocrine, etc.). The development of shock is provoked by any drugs (antibiotics, sulfonamides, vitamins, etc.).

CLINICAL SIGNS:

Against the background or immediately after the administration of the drug (serum), etc.

Weakness, dizziness appeared.

Difficulty breathing, feeling short of breath.

· Anxiety, a feeling of heat throughout the body.

Dry mouth, difficulty swallowing (sometimes vomiting)

· The skin is pale, cold, moist.

· Frequent, shallow breathing.

· Systological pressure 90 mm Hg. and below.

· V severe cases depression of consciousness and breathing.

· Later, convulsions appear, consciousness dims.

· The skin is covered with itchy patches (hives).

NURSE TACTICS:

· Call a doctor immediately.

· Give the patient a stable lateral position, raise the leg end.

· Give humidified oxygen.

Measure arterial pressure, heart rate.

Prepare medications from an anti-shock first aid kit.

FIRST AID KIT (ANTI-SHOCK KIT):

1 Adrenaline 0.1% -1.0

3 Isotonic solution of 0.9% sodium chloride

4 Dropper

5 Syringes 5.0 10.0 20.0

6 Rubber tourniquet

PROTECTION OF MEDICAL PERSONNEL FROM INFECTION.

COMPOSITION OF THE FIRST AID KIT IN EMERGENCIES WITH BLOOD.

1 Alcohol 70% -200 ml

2 Alcohol solution of iodine 5% 15 ml

3 bandage sterile 2 pcs

4 Sterile wipes 10 pcs

5 Bactericidal adhesive plaster 5 pcs

A first aid kit for HIV prevention should be kept in a separate, labeled container.

INSTRUCTIONS ON ACTION BY A MEDICAL WORKER IN AN EMERGENCY SITUATION.

To avoid contamination with parenteral viral hepatitis, HIV infection, you should follow the rules for working with stabbing and cutting objects.

1. In case of cuts and injections, immediately remove gloves, wash hands with soap under running water, treat hands with 70% alcohol, lubricate the wound with 5% iodine solution.

2. In case of contact with blood or other biological fluids on the skin, this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol.

3. If the patient's blood and other biological fluids get into the mucous membranes of the eyes, nose and mouth, oral cavity rinse with plenty of water and rinse with 70% alcohol, rinse the mucous membrane of the eyes and nose with plenty of water, do not rub !!!

4. If blood and other biological fluids of the patient get on the gown, clothes: take off work clothes and immerse them in a disinfectant solution and in a bucket for autoclaving.

5. Start taking antiretroviral drugs as soon as possible for post-exposure prophylaxis of HIV infection.

With the aim of emergency prevention For HIV infections, azidomycin is prescribed for one month. The combination of azidomycin and lamivudine enhances antiviral activity and overcomes the formation of resistant clamps. At high risk HIV infection (deep cut, hit visible blood on damaged skin and mucous membranes from patients infected with HIV) to prescribe chemoprophylaxis, you should contact the territorial centers for the control and prevention of AIDS.

Persons exposed to the threat of HIV infection are under the supervision of an infectious disease doctor for 1 year from compulsory examination for the presence of a marker of HIV infection.

Personnel who had contact with material infected with the hepatitis B virus in different parts of the body according to the scheme 0-1-2-6 months, followed by monitoring of the hepatitis marker (at least 3-4 months, after the administration of immunoglobulin). If contact has occurred in a previously vaccinated health worker, it is advisable to determine anti-HBs in the blood serum. If there is a concentration of antibodies in a titer of 10 IU / L and higher, vaccine prophylaxis is not carried out; in the absence of antibodies, it is advisable to simultaneously administer 1 dose of immunoglobulin and a booster dose of the vaccine.

Qualitativecontrolpercarrying outmanipulations

Qualitative indicators include the results of washings from objects external environment conducted in the surgical department regularly throughout the year. The washings determined the presence of conditionally pathogenic and pathogenic forms, Table No. 1, as well as the sterility of medical instruments and dressings, Table No. 2.

Table No. 1

Conclusion: during the year there was not a single positive result. The department carries out high-quality disinfection in accordance with SanPiN 3.1.5.2826-10, Industry standard 42-21-2-85 and orders No. 288, No. 254.

Table No. 2

Conclusion: During the year there was not a single positive washout for sterility, which indicates high-quality processing and sterilization of medical instruments and dressings.

Table No. 3

Conclusion: during the year there was not a single positive result.

Vthe presenttimeforfulfillmentsanitary and anti-epidemiologicalregime,Sothe sameforstreamliningworkvtreatment-and-prophylacticinstitutionsactsleblowingdocumentationandorders:

Sh Industrystandard42-21-2 - 85 defining methods, means and mode of disinfection and sterilization of products medical purpose.

Sh Order№1204 from 16.11.87, "On the medical and protective regime in medical institutions."

Sh AtkazMHthe USSRfrom12.07.89 № 408 "On measures to reduce the incidence of hepatitis viruses in the country."

Sh Order№ 288 “On the Sanitary and Epidemiological Regime of a Medical Preventive Institution.

Sh Federallaw“On the prevention of the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV) from 24.02.95.

Sh OrderMHRFfrom26.11.98 G№ 342 "On strengthening measures to prevent epidemic typhus and the fight against head lice. "

Sh OrderMHthe USSR№ 254 from 03.09.1991 "On the development of disinfection business in the country."

Sh OrderMHRF№ 109 from 21.03.2003 "On the improvement of anti-tuberculosis measures in the Russian Federation."

Sh OrderMHRF№ 229 from 27.06.2001 "About national calendar preventive vaccinations and the calendar of vaccinations for epidemic indications ”.

Sh SanPiN2.1.3.2630-10 "Sanitary and Epidemiological Requirements for Organizations Performing Medical Activities."

Sh SanPiN2.1.7.2730-10 from09.12.10 of the year- "Sanitary and Epidemiological Requirements for Medical Waste Management".

Sh SanPiN3.1.5.2826-10 from11.01.11 of the year- "Prevention of HIV infection".

3. Sanitary and educational activities

The work on medical prevention and promotion of a healthy lifestyle for the population is carried out on the basis of the order of the Russian Federation No. 455 of September 29, 2003. 4 hours of budget time are worked out for medical prevention of the population.

Various forms of work are used: conversations, decoration of health corners, health bulletins, lectures.

I am supposed to work 44 hours a year in sanitary and educational work. Most comfortable shape work is a conversation. After each conversation I have, I make a note in the logbook for conducting sanitary and educational work. I constantly conduct conversations not only with the patient, and their relatives to promote a healthy lifestyle.

One of the main goals of a nurse's work is continuous improvement, adherence to ethics and deontology in relation to patients and colleagues. A nurse must promote the preservation and strengthening of health, and encourage a healthy lifestyle. By virtue of my profession, instill in patients the rules of self-care and hygiene. The significance of these measures prevents chronic diseases and their complications. Study of the activities of the secondary medical staff showed that this category of workers has sufficient work experience, high qualifications, great responsibility and independence.

I carry out sanitary and educational work in the department all the time. I form the need for patients to refuse bad habits, motivation for recovery, the ability and skills for self-control of the state of health, for providing first aid in case of an exacerbation. Main topics of conversation:

v Varicose veins veins of the lower extremities.

v About the dangers of smoking.

v Correct administration of tablet medicines.

v Patient education on how to take care of the calostomy and change the bag.

v Diet in case of diabetes mellitus.

Health bulletins were issued in 2014 on the topics: "Prevention of hemorrhoids", "Phlegmon" and others.

Conclusion

The hospital is constantly working to improve the qualifications of nursing staff. Every year, advanced training courses for nurses are held on the basis of the SBMK of the SAKHALIN BASIC MEDICAL COLLEGE. The main nursing staff has qualification categories and work experience of over twenty years.

Once a month, conferences are held on compliance with the sanitary and epidemiological regime in the department, processing equipment and instruments, problems of first aid, etc.

Kindsenhancementsprofessionalqualifications

I improve my professional level by attending nursing conferences, learning new technologies. The department holds monthly thematic conferences, where we are introduced to new means of protection, innovations in dressings or equipment, etc. The department is constantly studying new orders and instructions, as well as classes on topics. For instance:

§ Organization of the dressing room. Bix packing, sterile table setting. Tool processing.

§ Types of desmurgy.

§ Technique for dressing postoperative wounds.

§ Care of stomas (intestinal). Features depending on the place of imposition. Means for leather processing.

§ Care of drainage tubes. Types of drainages. The need to flush the drainage tubes.

§ Care for wounds: purulent and clean. Types of dressings.

The nurses of the department are fluent in the technique of central venous catheterization, all types of dressings, medical records, etc. All personnel are instructed every six months with passing sanitary and epidemiological examinations. Instructions are constantly conducted to familiarize themselves with the functional responsibilities of the department employees.

Self-education

In the modern world there is enough professional literature, which contains all the material that you need to know medical professional... Thanks to this, self-education becomes available to a wide range of people. The development of communications, the media, the Internet, television allows us to perceive new information and use it professional activity... A large selection of medical journals for nursing staff: "nursing", "medical bulletin", " nurse" etc. provides the necessary information from which to learn from other regions of Russia. Attending nursing conferences, seminars, talks, is also an integral part of my self-education.

Planningwork

Every day in the department, the head of the department and the head nurse before the start of the working day hold planning meetings, at which the dressing plan for the day is clarified, all current affairs are discussed, problems are identified and decisions are made to eliminate them.

Mentoring

I conduct training for junior medical personnel on compliance with the rules of the sanitary and epidemiological regime, work with disinfectants, and labor protection rules.

On the basis of the department, students of a medical school undergo practical training. I teach them dressings. I try to ensure that during the practice, future nurses receive the basic knowledge and skills of nursing.

Privateprofessionalplan

ь Confirm the qualification category in the specialty "Nursing".

ь Constantly improve their professional level of knowledge, skills and abilities through self-education, participation in general hospital, intradepartmental conferences, technical training, seminars.

ь Actively participate in the life of the department and the hospital.

ь Constantly use the library with medical literature on the specifics of the department, as well as read the magazines "Nursing", "Nurse".

ь Take an active part in training young professionals

Offers

According to the specifics of the department's work, patients are admitted both as planned and urgently. For postoperative patients and patients with amputation of limbs, functional beds, reusable and disposable linens are required.

For patients who have temporarily lost their motor function, individual wheelchairs and crutches are needed.

An important role is played by the employee's appearance; it is necessary to highlight medical gowns and suits.

1. Provide disposable medical products, consumables in full.

2. Computerization of medical records.

3. Continue the planned work on the passage of studies, advanced training of the medical staff of the department.

4. Invert Special attention: to improve working and rest conditions, moral and material encouragement of the department employees.

5. Introduce an experience exchange program nurses from other areas of the Sakhalin region.

Nurse of the dressing room FISCHUK E. B

Senior Nurse IVANOVA S.N.

Chief Nurse ZHAROVTSEVA N.A.

Bibliography

1. The official website of the National Library of the Federal State Budgetary Institution "UOMC FMBA of Russia".

2. Petrovskaya S.A. Handbook of the head (senior) nurse. M .: Dashkov and K, 2007.

3. Yu.P. Lisitsyn "Guide to Social Hygiene and Health Organization". 1987.

4. Directory "Prevention of nosocomial infections in the work of nursing staff." 2010 year.

5. Methodical letters and orders of the Ministry of Health of the USSR and the RSFSR, job description.

6. Barykina N.V., Chernova O.V. Nursing in surgery: workshop. Rostov n / a: Phoenix, 2007.

7. S.I. twins Fundamentals of Nursing. Moscow: Academy, 2007.

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Participation in the work of the surgical (dressing) room of the surgical department

Much surgical work is carried out in the surgery rooms of polyclinics, outpatient clinics and dispensaries. It consists mainly of dressings and partially in small operations performed on the go (minor surgery). It is desirable that the outpatient reception room be isolated from the surgical department and maintained by special, at least nonoperative, personnel, since most of the work in the surgical room is purulent.

Three rooms are needed for a surgical room. In the first room, patients are examined without damage to the integument and, if necessary, the patient undresses; the second room is the dressing room, where the patient with open injuries is bandaged and examined, and the third is the operating room.

The operating room and dressing room arrangement is simpler than in the corresponding rooms of the surgical department. In the dressing room and operating room, sinks are arranged for washing hands; boilers for instruments are placed in the dressing room; it is desirable to sterilize the material in a special, fourth room (sterilization room, it is also material) or outside the surgery room of the outpatient clinic.

In well-organized polyclinics, as well as in the polyclinics of the medical and sanitary units of enterprises, a trauma center or an office is allocated in which emergency care for injuries is provided. Its device and equipment provide for the possibility of dressing, performing primary surgical treatment of a wound with minor injuries and applying a splint or plaster cast.

In a small outpatient clinic, often all work has to be done in one room. At the same time, in one part of the room, a table is placed for the person conducting the reception, for the necessary entries in outpatient cards and prescriptions, a table with dressings, instruments and medicines. In another part of the room, a table for examining patients and stools for sedentary patients are placed. Buckets and basins for dirty dressings are placed near them.

In a rural setting, at district medical centers, it is often outpatient appointment, including surgical patients, is led by a paramedic, and therefore he must know well the structure of the surgical office of the outpatient clinic. The closer the outpatient surgery room gets to the dressing room, the better. The paramedic should not only know the device of the dressing room, but also be able to properly organize it, having provided all the necessary equipment.

We indicate necessary equipment: a table for dressing patients, a table for instruments and dressing material, 2-3 stools for sedentary patients, a stool for the receptionist, a washbasin with hot water, a bucket or basin for removed dressings, a vessel with boiled brushes for washing hands, a plate for soap. In addition, you need: a bottle with a disinfectant solution (for example, a solution of 1: 1000 mercuric chloride), a box with sterile material, a tray with clean instruments, trays for dirty instruments, jars and bottles with ointments and disinfecting liquids. Necessary medicines: iodine tincture, hydrogen peroxide, 2% soda solution, rivanol, sterile petroleum jelly, ointments (zinc, bismuth). Sterilize instruments in the surgery room of the outpatient clinic or in the next room. All items of equipment must be easy to clean.

The organization and distribution of work depends on how many people are involved in the work. If a nurse helps a paramedic, he examines the sick and gives appointments; the nurse bandages and bandages the sick, and the nanny monitors the cleanliness and order and unbands the sick. If a paramedic is receiving only with a nanny, then the latter must be taught not only to unbind, but also to apply the simplest bandages.

For fast and good work, it is necessary to establish the correct sequence of patients' arrival and fight against the formation of queues. This works best if a certain number of patients are assigned for each hour, especially those who are for re-dressings. Outpatient cards should be kept in order so that they are not lost or searched for. Good reception of patients and order in the cards greatly facilitate the work.

After getting acquainted with the outpatient card, the paramedic examines the patient. To put the patient to bed, the nanny should help him to undress. After interviewing and examining the patient, he is prescribed treatment and a paramedic or nurse makes a dressing.

Dressings should be organized according to the type of instrumental, and the necessary tools (10-15 tweezers, 3-4 scissors, 1-2 probes, 1 scalpel, 1-2 hemostatic clamps, 2-3 spatulas) should be boiled in advance and lie in a tray. As they become dirty, the nanny should wash them over the sink and put them back in the boiler. With such an organization of work, many dressings can be made quickly and correctly during the appointment.

The paramedic should give advice to the patient how he should behave, make marks in outpatient card(diagnosis, course of the disease, treatment) and sick leave if the patient is insured, and give the necessary certificates.

Dressing room equipment:

1) Table for instruments and dressings - 1 pc .;
2) Distiller - 1 pc .;
3) Bactericidal lamp - 1 pc .;
4) Stands for long-term infusion - 2 pcs .;
5) Refrigerator for storing medicines, etc. - 1 pc .;
6) Hemostatic tourniquets - 2 pcs.;
7) Chairs or stools - 3 pcs.;
8) Stand-benches - 2 pcs.;
9) Operating table / gynecological chair - 1 pc .;
10) Tool cabinet - 1 pc .;
11) Cabinet for storing medicines - 1 pc .;
12) Work table - 1 pc .;
13) Table for medical records - 1 pc .;
14) Forceps for collecting contaminated dressings - 2 pcs .;
15) Containers for disinfection solutions - at least 4 pcs .;
16) Waste bins: dry white bag; medical yellow bag - 2 pcs. ;
17) Movable reflector lamp - 1 pc .;
18) Aprons made of oilcloth or plastic - 4 pcs .;
19) Glasses - as a means of eye protection - 4 pcs .;
20) Disposable sterile gowns, gloves, hats, masks, shoe covers - in abundance;
21) Disposable sterile linen - in abundance;
22) Ready sterile material - in abundance;
23) Containers for the preparation of working solutions of disinfectants, measuring containers for diluting disinfectants, a water thermometer, antiallergenic disinfectants - alaminol, brushes, brushes - for processing instruments.

Dressing room instrumentation:

- Trays;
- Tweezers;
- Clamps;
- Maskits;
- Needle holders;
- Volkman spoons;
- Probes;
- Scissors for removing seams;
- Scalpels;
- Fenestrated tweezers;
- Regular scissors;
- Disposable sets for pleural puncture;
- Suture material.

The structure and staffing of surgical rooms and departments depend on the structure of the polyclinic, the number of visits per shift (depending on this, there are 5 categories of polyclinics - from 400 to 1200 visits or more), its functions and tasks, in particular, on the patient population. According to the norm, the population's need for polyclinic services is 12.9 visits per year per one city resident and 8, 2 - per one villager, including 1, 4 visits to surgical rooms (departments).

The surgical room of the district polyclinic consists of two, less often one or three rooms. In one room, the doctor surgeon performs reception, registration and examination of patients, the second, connected to the first, is used as a dressing room. If the office is one-room, the doctor's table and the couch for examining the patient are in one half of the room, and the dressing table is in the second, and they are separated by a screen.

If the office or department consists of three rooms, the middle one is equipped like a doctor's office where he receives patients, the other two, located on both sides, are equipped with a dressing room and an operating room or (less often) two dressing rooms - clean and purulent.

In large polyclinics (city, regional, etc.), the surgical department has four or more rooms: a doctor's office, two dressing rooms (clean and purulent), an operating room, a preoperative room, and sometimes also a sterilization room. This is already an operating dressing unit.

In the surgical room, which is combined with the dressing room, the distribution of patients with clean and purulent wounds and processes is achieved by setting priorities in work: first of all, patients with clean wounds are bandaged and operated on, and secondly - with purulent processes. In the presence of two dressings (without an operating room) in a clean room, surgical treatment of fresh wounds, dressing of clean wounds, as well as operations for planned patients are performed.

In those surgical departments, which also have an operating room, planned operations, surgical treatment of fresh wounds is carried out in the operating room. The premises of the surgical room and department, in particular, their dressing and operating rooms, according to their design features and interiors must comply with all those sanitary and hygienic requirements for similar premises in a surgical hospital.

Report matrix for assigning a qualification category.

The text of the report should be typed in font 14, “Times New Roman”, bold, line spacing 1.5, the pages of the report should be numbered.

Diagrams and graphs can be in color or black and white.

Page numbers should correspond to the table of contents of the text.

I approve:

Chief Physician of the State Healthcare Institution ________

Full name chap. doctor completely

about work for 20 years

Full name of the specialist

dressing (procedural, ward) nurse

List of used literature …………… p. nineteen

Summary

I, full name _____ in ______, graduated from the Chita Medical School (GOU SPO Chita Medical College) with a degree in ____________________________________.

Started her labor activity in the GUZ ( title medical institution) as a ward (dressing, procedural) nurse.

Brief information on the transfer to other health care facilities, to other positions.

In ______, she completed an advanced training course in the cycle "Nursing in surgery", received a specialist certificate.

In _____, she was certified for the (second, first, highest) qualification category.

Work experience in the specialty ______ years.

Since ________, I have been a member of the Trans-Baikal Regional public organization « Professional Association medical specialists ".

Introduction

ORGANIZATION AND STRUCTURE

SURGICAL DEPARTMENT.

The surgical department is located in a typical building on the ______ floor. Designed for ___ 24-hour hospital beds and ___ beds day hospital... In the department of ___ wards, ___ of them are paid, 1 box with 2 beds.

The premises of the surgical department include: list the premises _________________________________________________.

To characterize the profile of the surgical department, the specifics of surgical care.

The surgical department is staffed only by certified and certified medical personnel: doctors and nurses.

I carry out my work in the department under the guidance of the head of the department, a senior nurse.

STAFF POTENTIAL

surgical department

for ____ year.

Position	Number of rates employed by individuals	Individuals	Staffing
Head branches
Surgeon
Senior m / s
Dressing nurse
Procedural nurse
Charge nurse
Sister hostess
Ward nurse
Dressing room nurse
Nurse procedural

Cleaner nurse

STAFF SCHEDULE

SURGICAL DEPARTMENT

Head of the department, surgeon
Surgeon
Head nurse
Nurse procedural
Dressing room nurse
Nurse ward
Sister - mistress
Ward nurse
Dressing room nurse
Barmaid nurse
Nurse procedural
Cleaner nurse
Total for the surgical department
Including doctors
Nursing staff
Junior nursing staff

The indicator of the ratio of doctor: nursing staff as of 01.01.2012

EQUIPMENT, MEDICAL EQUIPMENT

surgical department.

MATERIAL EQUIPMENT OF THE SURGICAL DEPARTMENT

The department is sufficiently equipped with the necessary instrumentation and the latest equipment to carry out high-quality therapeutic and prophylactic treatment.

Workplace equipment and documentation of the dressing (procedural, ward) nurse.

For instance:

Dressing room equipment:

Dressing table -1 pc.

Step - 1 pc.

· Air sterilizer GP - pcs.

· UV chamber - bactericidal, for storage of sterile instruments - 1 pc.

· Manipulation table - 3 pcs.

· Stand for sterile bix - 1 pc.

· Sterilization boxes - 4 pcs.

· UZO - "Medel" -1 pc.

· Recirculator UV - bactericidal two-lamp with forced circulation of air flow for disinfection of indoor air in the presence of people, wall-mounted - 1 pc.

· Container for class "A" and class "B" waste.

· Sink for washing tools - 1 pc.

· Hygrometer 1 pc.

· Container.

Dressing room documentation:

· Journal - a map of active monitoring of the outcomes of surgical operations.

· Log book of ethyl alcohol 95%.

· Register of alcohol-containing antiseptic solutions.

· Journal of the dressing material.

· Journal of medical supplies (gloves, syringes, suture material, adhesive plaster).

· Journal of registration of medicines.

· Journal of registration of disinfectants.

· Log of the control of the air sterilizer.

· A logbook of air temperature and humidity.

General cleaning schedule approved by the epidemiologist

· Log of the recirculator operating hours.

Chapter 1

In my work, I am guided by regulatory documents

Ministry of Health and Socialist Republic of the Russian Federation, by orders of the Ministry of Health Trans-Baikal Territory, internal orders of the State Healthcare Institution _______, job descriptions of a dressing nurse, standards of professional activity, protocols for performing a simple medical services observing the hourly work schedule of the day and night shift, safety and fire safety regulations according to the instructions.

(Using the example of a dressing nurse)

I, the dressing nurse of the surgical department, organize my work for the dressing room:

I am preparing dry heat, ultralight, UZO for work.

I fill out and maintain the documentation of the office for general cleaning and sterilization of instruments, dressings, bacteriological control.

I organize the observance of infectious safety in the dressing room:

Complies with asepsis and antiseptics during work;

Conducts preventive actions on the prevention and development of nosocomial infection;

Observes safety precautions when working with blood, pus, wounds.

I organize the dressing according to the list of medical prescriptions:

I follow the algorithm of action when dressing "clean", "purulent" in the dressing room in accordance with this instruction, the hourly work schedule and the standard of practice of the dressing room nurse;

I accept and hand over the dressing room to the ward nurse on duty;

I observe a restricted movement area in the dressing room (red line);

I fill out the documentation for the dressing room;

Distributes drugs by pharmaceutical group, storage location and temperature;

I supervise the work of the nurse in the dressing room;

I am preparing a dressing room for work;

I control the general cleaning according to the schedule;

I follow the instructions for processing surgical instruments, dressings, etc .;

I prepare the necessary disinfectant solutions according to the instructions;

I cover the sterile dressing table, according to the instructions;

I put the bixes for the dressing material;

I prepare and pack dressings, drains;

I prepare working solutions for disinfection of instruments and class B waste;

I use medications, ointments as prescribed by a doctor in accordance with the phase of the wound process;

I collect sets of tools for diagnostic manipulations, small operations;

Complete dressing material in bags for various types of dressings individually for each patient;

I remove the seams;

I take care of various drains;

I prepare a set of surgical instruments and assist the doctor in minor operations: diagnostic curettage, examination of the cervix in the mirrors;

I take part in endoscopic manipulations (cystoscope, hysteroscope);

I am preparing the EHVC apparatus for the DEK;

I carry out disinfection of instruments in an RCD;

I carry out sterilization by air method in a dry heat cabinet;

I store sterile instruments in an ultra-lye;

I keep a journal of dynamic observation of postoperative wounds;

I am engaged in the prevention of postoperative complications;

I provide first aid in case of complications;

I carry out all kinds of cleaning of the dressing room.

Observing and caring for the patient:

I transport patients from the ward to the dressing room;

I perform physical preparation of the patient during dressings (position on the table, get up correctly from the bed, table, etc.);

Solving patient problems caused by dressings, drains.

Render emergency care patient with urgent complications.

I conduct talks on the hygienic education of the population.

Regulations for the dressing (ward, procedural) nurse.

Hospital performance indicators for ------ years

(Select the most significant indicators for your department)

Indicator
Patients treated
Bed days spent
Implementation of the bed-day plan
Bunk work
Bed turnover
Average bed stay
Surgical activity
Died patients, including operated
General lethality
Postoperative mortality
Average pre-operative k / day
Average postoperative k / day

Graphs (revealing the essence of the dynamics of numbers)

Diagrams

with comments, conclusions

Performance indicators of the dressing (ward, procedural) nurse for the reporting period:

1. According to job description carry out medical appointments, various manipulations corresponding to the professional level

The number of manipulations performed during the reporting period

For instance:

List the MUs used in the surgical department for the reporting period.

The diagram shows an increase in surgical activity, an increase in the intensity of the dressing nurse's work.

Production control of hand processing.

I control the cleaning in the dressing room.

Dressing (treatment) room cleaning

1. Preliminary.

2. Current

3. Final.

4. General.

Production quality control of cleaning:

Chapter 2

In the conditions of the surgical department, the dressing (ward, procedural) nurse performs the following MU:

(list all MU, care methods carried out in the department by a specialist)

Methods of preparation for diagnostic examinations of the patient.

(transfer)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Analysis of the quality of a specialist's work

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Chapter 3

Mentoring

Hygienic education of the population.

Methodical activity

ü spoke at the Regional Conference ___________________________

ü organized a master class on training young specialists in innovative technologies in the field of nursing ______________

ü attended monthly departmental, general hospital, regional seminars and practical classes, conferences _____________________

ü self-training for periodicals: "Nurse", "Sister", the magazine "Nursing", brochures: "To help a practicing nurse", "Bulletin", etc.

ü constantly studies methodological and educational literature on the introduction of new technologies, which is issued by the ZRO.

During the reporting period, the following was completed:

Based on Order No. 000 of the Ministry of Health of the Trans-Baikal Territory dated 0.04.2009

"On improving the expertise of activities and quality nursing care in the Trans-Baikal Territory ", the ranking is carried out on a quarterly basis according to the criteria for assessing the quality of work.

Surgical department according to the ranking structural units in _____ year took ____ place.

in the I quarter ____ place

_____ place in the II quarter

______ place in the III quarter

in the IV quarter _______ place

For the reporting period, individually ranked:

1st quarter ____ place

2nd quarter _____ place

3rd quarter _____ place

4th quarter ____ place

Passed the exam for professional competence with the following results:

2) Pharmacology

3) Provision of emergency medical care

5) Preparing patients for diagnostic methods research

6) Medical ethics

On the cumulative system of postgraduate education I have __ certificates, _______ hours.

Based on test results: answered _____ tests, scored __%.

Conclusion

List of normative and legal acts:

List of used literature:

1. Scientific and practical medical journal "Health"

2. Annual report 2009 - 2011. Head. branch

3. Scientific and practical journal "Nursing" 2009 - 2011

4. Collection of normative legal documents "Chief Physician".

5. Journal to help the nurse practitioner

"Head nurse"

The report was (a):

Dressing (ward, procedural) nurse

surgical department ________________ / _________________ /

The report was checked by:

Head surgical department _______________________ / ______________ /

Chief Nurse of the State Healthcare Institution ____________________ / _________________ /

A dressing room is a room designed for the production of dressings, injections, transfusions, small operations, and removal of stitches. In the surgical department, a clean and purulent dressing is usually deployed.

The dressing nurse checks the quality of cleaning the dressing room (cleanliness of windows, walls, floors, furniture, etc.), boils tools, syringes, rubber products (drains), optical instruments(rectoscope, cystoscope), arranges bixes with dressing material, rubber sterile gloves, sterile systems for transfusion of blood-substituting solutions, arranges medicines in the cabinet, receives a list of patients who need dressings from the head of the department (resident), and sets the order of dressings. First of all, clean dressings are prescribed for patients with a smooth postoperative course - removal of sutures, examination of postoperative uncomplicated wounds, transfusion of blood-substituting solutions, etc. Secondly, dressings are prescribed for patients with granulating wounds, as well as for patients who need cystoscopy Bladder, sigmoidoscopy and other studies. In the last place, dressings are prescribed to patients with purulent wounds. Such dressings are usually carried out in a purulent dressing room. After preparing the dressing, the nurse ties the hair with a kerchief and prepares the hands. She cuts short nails, washes her hands under running warm water and soap, then processes them. Arrangement of tools and material on the dressing table using one of the accepted methods (formic acid, diocide, etc.). Then he puts on a sterile gown and mask. To do this, he takes a sterile gown from the bix, unfolds it on outstretched arms and puts it on his hands. The nurse from behind her sister grabs the upper straps of the robe, pulls it over her arms, torso and ties the straps from the back. On the sleeves (in the area of the wrist joints) the straps of the robe are tied by the sister herself and after that she puts on sterile rubber gloves so that the tied straps are covered by them. The nurse then sets up the sterile instrument table in the same way as in the operating room. She puts the tools on the table in a convenient order (fig. 7).

After such preparation, the dressing nurse and the nurse begin dressing. Responsible dressings are performed by a doctor.

After the patient is delivered to the dressing room on a gurney, he is transferred to the dressing table and placed so that there is access to the wound to be bandaged in a comfortable position for the patient and the bandaging rules can be followed.

Any dressing consists of several stages:

1. Removing the old dressing, followed by its disinfection or burning and carrying out a toilet of the skin around the wound (wiping it with ether, then 96% ethyl alcohol and lubricating with 5-10% alcohol solution of iodine).

2. Protection of the skin around the wound with sterile gauze napkins from discharge from it.

3. Performing manipulations in the wound (treatment of the scar with 5-10% alcohol solution of iodine, removing sutures or probing in the area of the scar, with purulent wounds - removing pus from the wound with sterile napkins, washing the wound with antiseptics, etc.).

4. Applying a new aseptic dressing. After removing the stitches, the scar is lubricated with a 5-10% alcohol solution of iodine and most often a dry aseptic bandage is applied. After processing a granulation or purulent wound, the skin around it is lubricated zinc paste(to prevent skin maceration) and apply a bandage with antiseptics.

After each dressing or manipulation, the medical staff must wash their hands with soap, wipe them dry with a sterile towel (napkin), and then with a gauze napkin or a ball, abundantly moistened with 96% ethyl alcohol and served by the dressing nurse. At the end of the dressings, the nurse collects the instruments and other items that were used in the dressings. Contaminated instruments, rubber and glass objects are disinfected in a 3% lysol solution for 30 minutes or in a 0.5% ammonia solution for 3 hours. After disinfection, they are washed with soap in running water, then boiled in a 2% sodium bicarbonate solution 20 min. It is better to autoclave them. The nurse washes and dries systems for transfusion of blood substitute solutions, syringes, needles, rubber gloves, which, after drying, are poured with talcum powder. All this, as well as dressing material and surgical linen, she puts in bixes, which the nurse takes to the autoclave for sterilization. Each bix has its own address.

A dressing room is a specially equipped room for the production of dressings, examination of wounds and a number of procedures performed during the course of treatment. Small operations, more often with purulent diseases (carbuncle,), intravenous fluids, punctures, blockades, taking blood from a vein, etc., are also performed in the dressing room, if there is no special procedural room.

In large surgical departments there are two dressings: "clean" and "purulent". If there is only one, then both aseptic and infected wounds are bandaged in it. With good organization of work and strict adherence to asepsis, this does not pose a danger.

A spacious, light room is allocated for the dressing room, the floor, ceiling and walls of which are covered with oil paint or tiles so that they can be easily washed. The dressing room is well ventilated, the temperature is maintained at least 18 °, and impeccable cleanliness is maintained.

In the outpatient clinic of the rural medical district, at the feldsher-obstetric station, there is a doctor's office (paramedic) and a dressing room. In the dressing room of the feldsher-obstetric station (see), small ones are also produced (bandaging and sutures when injured, stopping bleeding, repositioning of simple dislocations, splinting for bone fractures, opening superficial abscesses, etc.); provide gynecological care to the extent permitted by midwives. To perform these manipulations, the necessary set of instruments, splints for immobilizing fractures (dislocations) and medications must be in the dressing room.

In hospitals, dressing rooms are usually located in isolated from other rooms (wards, operating unit) rooms. If there is one operating room in the surgical department for aseptic (clean) operations, surgical treatment of wounds, removal of atheromas, foreign bodies, as well as purulent operations (opening of a panaritium, carbuncle) are performed in the dressing room. After dressings, the dressing room can be used to examine patients, prepare them for surgery, etc.

The dressing room equipment consists of one or two tables (wooden or metal) for patients, several stools for seated patients, tables for sterile instruments and sterile dressings, glazed cabinets for storing instruments, medicines and bandages, a washbasin with hot and cold water, stands for sterilizers, heat source (electric stove), basins for removed dressings, bottles with disinfectant solutions, trays for dirty tools. Sets for anesthesia, a basin with a solution of diocide for treating hands, bixes with sterile dressings and trays for syringes, boiled brushes are also placed; install lighting devices, bactericidal lamps. In the dressing room, you must have: with a capacity of 20, 10 and 5 ml, anatomical and surgical tweezers, straight and curved scissors, blunt and sharp hooks for spreading the edges of the wound, hemostatic clamps, scissors for removing bandages, both soft and hard (plaster), bulbous and grooved probes, tourniquets, forceps, scalpels, needle holders, spatulas, catheters,.

Before starting work in the dressing room, the dressing nurse treats her hands in the same way as before the operation, covers the table with a sterile sheet, lays on it the necessary sterile material, instruments, which are covered with a second sterile sheet. The doctor (paramedic) working in the dressing room receives everything he needs from the sterile table through the dressing nurse, who uses a sterile forceps.

Instruments are sterilized in the dressing room itself or in a separate room associated with the dressing room - in the pre-dressing room.

What the dressing room consists of. The work of the dressing room of the surgical department. Arrangement of instruments and material on the dressing table

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