Sanitization is necessary, first of all, to prevent nosocomial infection.
A nurse supervises the sanitary and hygienic treatment of the patient.
In the examination room, the patient is undressed, examined for pediculosis and prepared for sanitary and hygienic treatment. There is a couch, a table, chairs, a thermometer on the wall (the air temperature in the examination room must be at least 25 ° C).
Stages of sanitary and hygienic treatment of patients.
- * Examination of the patient's skin and hair.
- * Cutting hair, nails, shaving (if necessary).
- * Washing under the shower or hygienic bath.
Examination of the patient's skin and hair
Examination of the skin and hair of the patient is carried out in order to identify lice (lice). Various types of lice can be found (head lice - affects the scalp; clothing - affects the skin of the body; pubic - affects the hairy surface of the pubic region, hairy armpits and face - mustache, beard, eyebrows, eyelashes. The presence of nits (lice eggs, which are glued by the female to the hair or fibers of the tissue) and the insects themselves; itching of the skin; traces of scratching and impetiginous (pustular) crusts on the skin.
In case of detection of pediculosis, a special sanitary and hygienic treatment of the patient is carried out; the nurse makes an entry in the "Pediculosis examination log" and puts a special mark ("P") on the title page of the medical history, and also reports the detected pediculosis to the sanitary-epidemiological station.
If head lice is not detected, the nurse helps the patient to undress, then fills in two copies of the "Admission receipt" (form No. 1-73), which indicates a list of things, their brief description. One copy of the receipt is put into the "Medical card of an inpatient", the second is attached to things sent to the storage room.
Then the patient, accompanied by his sister, goes to the bathroom. The washing of the patient can be done by a nurse or a nurse under the supervision of a nurse. Depending on the patient's condition, sanitization can be complete (bath, shower) or partial (wiping, washing). The patient is washed with a washcloth and soap: first the head, then the body, upper and lower extremities, groin, perineum.
The duration of the procedure is no more than 20 minutes. The presence of a nurse is mandatory, she is always ready to provide first aid in case of a possible deterioration of the patient's condition.
To perform rubdown, the patient is placed on a couch covered with oilcloth. Sponge moistened with warm water, wipe the neck, chest, hands. Dry these parts of the body with a towel and cover them with a blanket. In the same way, they wipe the stomach, then the back and lower limbs.
After sanitization, the patient is put on clean hospital underwear, a dressing gown (pajamas), and slippers. Sometimes you are allowed to use your own linen, which must be changed according to the hospital's schedule.
All data on the treatment of an admitted patient must be recorded in the medical history so that the ward nurse can re-process it in 5-7 days.
If the patient is in serious condition, he is taken to the intensive care unit or the intensive care unit without sanitary and hygienic treatment.
2. If it is necessary to carry out anti-lice and anti-scabios treatment.
3. Hygienic water procedures (rubdown, shower or bath).
4. Shaving, cutting hair and nails.
5. Dressing in hospital gowns.
There are the following types of sanitization of patients: full (includes all activities) and partial; general hygiene procedures and special measures (anti-lice and anti-scabia). The doctor decides on the scope of the patient's sanitization. admission department after examining the patient, establishing a diagnosis and assessing his general condition. The patient is sanitized directly by the nurse with the help of a nurse.
General sanitization is carried out in full for patients who have a satisfactory general condition, as well as those who do not have serious diseases or damage to the skin. Severely ill patients (myocardial infarction, stroke), patients with high fever, fainting, severe skin lesions undergo partial treatment, and in cases of a severe condition of the patient who need urgent resuscitation measures, sanitization is not carried out.
Sanitary inspection inventory for carrying out sanitary and hygienic treatment of the patient: couches, cabinets for clean linen and containers for dirty linen, washcloths for washing patients, soap, hair clippers, shaving razors, scissors, air and water thermometers, washcloths and brushes for bath treatment, marked inventory (buckets, mops), disinfectant solutions.
The procedure for sanitizing the patient:
1. Examine the patient's body for the detection of infectious diseases, scabies, head lice and make an appropriate entry on the title page of the medical record.
2. Decide with your doctor about the need and type of sanitization and its extent.
3. If necessary, cut the patient's nails: cutting, shaving hair
4. Help the patient to undress. Put your clothes in a specially designated clean bag, while filling out a receipt in duplicate with an exact description of the name and quantity of things. Attach one copy to the bag with things, the second - paste it into the medical record.
5. Carry out hygienic water procedures (rubdown, shower or bath)
If possible, it is better to wash patients under the shower, which is easier for them to tolerate.
Remember! If the patient's well-being worsens (dizziness, palpitations, pain in the heart area, pallor), stop washing, help the patient get out of the bath, put on a couch with a raised foot end, cover with a sheet, bring a tampon soaked in ammonia to your nose, rub the temples on put a towel soaked in cold water on your forehead and call a doctor.
If head lice is not detected, the nurse helps the patient to undress, then fills in two copies of the “Admission Receipt” (form No. 1-73), which indicates a list of things, their brief description.
One copy of the receipt is put into the "Medical card of an inpatient", the second one is attached to the things sent to the storage room.
In many health centers, the patient is allowed to stay in the department in his own clothes.
Sanitization can be:
1. Complete - disinsection, disinfection, hygienic bath or shower.
2. Partial - only one of the components of complete sanitization, depending on the severity of the patient's condition and the contamination of the skin - either washing or rubbing off individual parts of the body.
Sanitization is necessary to prevent nosocomial infection. A nurse supervises the sanitary and hygienic treatment of the patient. In the sanitary inspection room of the admission department, disinfestation is carried out - the destruction of harmful insects (lice), if they are found during examination of the patient; hygienic bath (shower or wiping off the patient); dressing (if necessary) in clean hospital linen. The sanitary checkpoint of the admission department usually consists of an examination room, a dressing room, a bathroom-shower room and a room where patients dress. Some rooms can be combined, for example an observation room and a dressing room.
The sanitary inspection room is equipped with everything necessary for treating a patient. There should be couches, cabinets for clean and containers for dirty linen, a wardrobe and a table with items for sanitizing - oilcloth, bath soap, washcloths for individual use, hair clippers, razors (single use), scissors, and thermometers for air and water temperature measurements, special washcloths and brushes for bath disinfection, marked buckets and mops for cleaning and disinfection of the sanitary inspection room, etc. Disinfectants and pediculicides should be in sufficient quantities, as well as a hydraulic control unit for manual spraying of solutions of these substances.
After undressing, the patient, accompanied by his sister, goes to the bathroom, where there should be forced ventilation and a constant temperature (about 25 ° C), on the floor there are wooden bars. Do not open doors, windows and vents in the bathroom in order to avoid drafts and not to chill the patient.
A junior nurse or a nurse can wash the patient under the supervision of a nurse. Depending on its condition, washing can be complete (bath, shower) or partial (wiping, washing).
The method of washing is determined by the doctor. The presence of a nurse during patient sanitization is mandatory. If his condition worsens (the appearance of pain in the heart, palpitations, dizziness, pallor of the skin and other signs), you should stop hygiene procedures, immediately inform the doctor on duty about the deterioration of the patient's condition, provide first aid.
Treatment of the bath after washing is carried out in accordance with the current instructions.
Complete patient wash
Material resources: waterproof apron, terry mitten, ladle, soap, shampoo, towel, diaper, hairbrush.
Algorithm of execution.
Preparing for the procedure
1. Explain to the patient the course of washing and obtain his consent.
2. Fill the bath, measure the water temperature (35-37 ° C).
3. Warn the patient about possible discomfort (palpitations, shortness of breath, etc.) and the need to inform the nurse about it.
4. Help the person get into the bath by supporting him under the elbows.
5. Help him to sit comfortably in the bath: water is filled to the level of the xiphoid process; put a footrest in the bathtub.
6. Assist in cleaning only if necessary.
Procedure execution
7. Put on an apron. Wash the patient's head:
8. To help the patient, if necessary, wash the torso, upper and lower limbs, groin and perineum, using a terry mitten and a shower.
9. Help the patient to stand up in the bath (if necessary, provide assistance together).
Completion of the procedure
10. Cover the shoulders of the person with a towel and help him get out of the bath (if necessary, provide assistance together).
11. Help the patient wipe the body dry. Make sure the skin between your toes is dry.
12. Help him comb his hair, put on clothes and shoes.
13. Remove the apron, throw it into a waterproof bag, wash and dry your hands.
14. Make a record of the procedure performed and the patient's response.
Partial wash
In this way, you can wash the patient, both on the gurney and in bed.
Due to the absence of mechanical means of movement (lifts) that allow washing patients who have lost the ability to move in the bathroom, this method allows you to wash the patient without much physical effort.
Material resources: a container with warm water, a jug for rinsing hair, a towel - 3 pcs., a washcloth - 2 pcs., a sheet, gloves, soap, a bedpan, oilcloth, clean linen, shampoo, comb, garbage bag, bag for dirty linen ...
Algorithm of execution.
Preparing for the procedure
1. Explain the course of the upcoming procedure and obtain consent (if possible).
2. Lower the head of the bed to a horizontal level (or to the lowest possible level if the patient cannot lie horizontally). Lower the side rail.
3. Move it to the edge of the bed where you are standing.
4. Remove the blanket, roll it up and place it on the headboard, cover the patient with a sheet.
5. Take off his underwear under the sheet.
6. Unfold the towel and place it across the patient's chest.
7. Raise the side rail. Prepare a container with warm water. Make sure the water is at a comfortable temperature by testing it with your wrist.
8. Moisten a terry cloth and prepare a washing mitten from it:
Procedure execution
9. Rinse the eyelids of one eye of the patient with a terry mitten (without soap!) (From the inner corner to the outer corner). Wipe your eyelids dry.
10. Wash the eyelids of the other eye with the other side of the mitt. Wipe them dry.
11. Wash with soap, rinse and dry the neck and ears. Make sure the skin behind the ears is dry.
12. Fold back the sheet covering the patient. Place a towel under one hand, wash, rinse and dry the forearm, shoulder and armpit. Use a towel on hand to dry. Support your hand in the joint area as you wash and dry.
13. Wash, rinse and dry the patient's brush, if possible, lower it into a container with water: put an oilcloth (absorbent diaper) on the bed, place a container with water and lower the brush. Remove the towel from under the patient's arm. Cover your hand with a sheet.
14. Fold back the sheet on the patient's other hand. Put a towel under it.
15. Wash, rinse and dry forearm, shoulder and armpit and hand. Remove the towel from under the patient's arm and cover it with a sheet. Place a towel over the patient's chest and abdomen over the sheet.
16. Remove the sheet from under the towel, rolling it towards your feet.
17. Cover the washed leg with a sheet, remove the towel. Fold the sheet over the patient's leg, which is on your side. Put a towel under it. Wash, rinse and dry your leg and foot. Cover the leg with a sheet, remove the towel.
18. Help the patient to turn on their side with their back to you.
19.Place a towel (over the sheet) along the patient's back and buttocks.
20. Cover (chest, arms, legs) with a sheet.
21. Wash, rinse and dry the patient's neck, back and buttocks. Examine the skin.
Completion of the procedure
22. wash and dry your hands.
23. Make a record of the procedure performed and the patient's response.
The described method of partial processing is used not only in ultrasound, but also at home when washing seriously ill patients.
Patient transportation.
The method of delivering a patient from the reception to a specialized department is determined by the doctor depending on the severity of the patient's condition: on a stretcher or on a gurney, on a wheelchair, on his hands, on foot.
The most convenient, reliable and gentle way of transporting seriously ill patients is on a gurney. The patient should be in a comfortable position on the gurney. A seriously ill or unconscious person is securely fixed with the help of special belts or handrails. If they are absent, the patient is restrained while moving by someone from the staff.
If there is no stretcher, then 2-4 people carry the stretcher manually. The patient should be carried without haste and shaking. Down the stairs he is carried with his feet forward, the front end of the stretcher is slightly raised, the rear end is lowered. Thus, a horizontal position is achieved. Up the stairs, the patient is carried head first, also in a horizontal position.
Attention! When transporting a patient on a stretcher, it is necessary to walk not in the leg, but in short steps, slightly bending the knees, keeping the stretcher at the same level.
If someone becomes tired while carrying, report them immediately, as tired fingers may involuntarily relax. During transport, ask the patient about their well-being.
For any method of transportation, the accompanying person is obliged to hand the patient and his "Medical card" to the ward nurse.
Do not let the patient's arms hang over the armrests of the wheelchair when transporting.
When transporting the patient by hand, use the correct holding technique and body biomechanics.
Control questions.
1. Disinfection measures for pediculosis.
2. Pediculicidal preparations.
3. Complete sanitization of patients.
4. Partial sanitization of patients.
5. Types of patient transportation.
Junior nurses take part in the sanitization of patients. Sanitary and hygienic processing is carried out in the sanitary inspection room of the reception department.
The sanitary checkpoint of the admission department usually consists of an examination room, a dressing room, a bathroom-shower room and a room where patients dress.
In the examination room, the patient is undressed, examined for head lice and prepared for sanitary and hygienic treatment.
If the linen is clean, it is put in a bag, and the outerwear is hung on a hanger and handed over to the storage room. The list of things (admission receipt) is made up in two copies: one is handed over in things to the storage room, the other is glued to the history of the disease and, upon discharge, they receive things for the patient. The existing valuables and money, against receipt, are handed over to the senior nurse for storage in a safe.
If the patient has an infectious disease, the linen is placed in a tank with bleach or chloramine B for 2 hours and sent to a special laundry. When the linen is lined, it is pre-treated with a disinfectant solution and sent to a disinfection chamber for special treatment. On the bags with such clothes there should be a corresponding inscription - "Pediculosis".
Stages of sanitary and hygienic treatment of patients:
Examination of the patient's skin and hair.
Hair cutting, nails, shaving (if necessary).
Shower or hygienic bath.
Examination of the patient's skin and hair
The presence of nits (lice eggs, which are glued by the female to the hair or fibers of the tissue; Fig. 2-2) and the insects themselves;
Itching of the skin;
Scratches and impetiginous (pustular) crusts on the skin.
In case of detection of pediculosis, a special sanitary and hygienic treatment of the patient is carried out; the nurse makes an entry in the "Pediculosis examination log" and puts a special mark ("P") on the title page of the medical history, and also reports the detected pediculosis to the sanitary-epidemiological service. Partial or complete sanitation can be carried out.
Partial sanitary and hygienic treatment consists in washing the patient with soap and a washcloth in a bath or shower, disinfection and disinsection of his clothes and shoes. Full sanitation refers to the treatment of bedding and living quarters.
All data on the treatment of an admitted patient must be recorded in the medical history so that the ward nurse can re-process it in 5-7 days.
Stages of sanitary and hygienic processing:
1) pest control (lat. des- prefix denoting destruction, insectum- insect; the destruction of arthropods, which are carriers of infectious diseases);
2) hygienic bath (shower, wiping);
3) cutting hair and nails;
4) dressing the patient in clean linen.
There are several types of pest control solutions. 20% solution of benzyl benzoate emulsion. Special shampoos (for example, "Elko-Insect"). Special lotions (for example, "Nittifor").
3. If necessary, trim the hair over the prepared pelvis.
4. Treat the hair with a pest control solution, tie the head with a plastic kerchief and a towel on top, leaving for a certain time specified in the instructions.
5. Untie the head and rinse with warm running water, then shampoo.
6. Dry hair with a towel and treat hair with heated 6% acetic acid solution.
7. Re-tie the head with a plastic kerchief and a towel on top, leaving for 20 minutes.
8. Untie the head and rinse with warm running water, dry with a towel.
9. Tilt the patient's head over the white paper and carefully comb through the strands of hair with a fine comb, then re-examine the patient's hair.
10. Burn cut hair and paper in a basin.
11. Fold the patient's clothes and the protective clothing of the nurse in an oilcloth bag and send to the disinfection chamber. Treat the comb and scissors with 70% alcohol, the room - with a pest control solution.
The use of disinsecticidal solutions is contraindicated in pregnancy, in women in labor and breastfeeding, in children under 5 years of age, as well as in diseases of the scalp.
The procedure for performing pest control in the presence of contraindications to the use of pest control solutions:
1. Prepare for sanitation: lay out the necessary equipment and put on protective clothing.
2. Lay an oilcloth on a stool (couch), sit the patient on it and cover his shoulders with a plastic wrap, if necessary, cut the hair over the prepared basin
3. Treat hair (not scalp) with a heated 6% vinegar solution, mechanically picking out and destroying lice.
4. Tie the head with a plastic kerchief and a towel on top, leaving for 20 minutes.
5. Untie the head and rinse with warm running water, then shampoo, dry with a towel.
6. Tilt the patient's head over the white paper and carefully comb through the strands of hair with a fine comb, then re-examine the patient's hair.
7. Burn cut hair and paper in a basin.
8. Fold the patient's clothes and the protective clothing of the nurse in an oilcloth bag and send to the disinfection chamber. Treat the comb and scissors with alcohol (70%), the room - with a pest control solution.
Hair cutting, nails, shaving.Haircut.
Necessary equipment:
Scissors, hair clipper.
Hair burning basin, matches.
Alcohol (70%).
The order of the procedure:
1. Prepare for the sanitary-and-hygienic processing: unfold the necessary equipment.
2. Lay an oilcloth on a stool (couch), sit the patient on it and cover his shoulders with a plastic diaper.
To remove hair with a hair clipper, in case of a skin disease of the scalp - cut the hair over the prepared pelvis
4. Burn your hair.
5. Treat scissors, razor with alcohol.
Shaving
Necessary equipment:
Rubber gloves.
Razor, brush and shaving cream.
Napkin, towel, water container.
The order of the procedure:
1 . Prepare for sanitary and hygienic processing: lay out the necessary equipment, put on gloves.
2. Heat water (up to 40-45 ° С), soak a napkin in it, wring out and cover the patient's face.
3. Remove the napkin, apply shaving cream with a brush.
4. Shave the patient, pulling the skin with the other hand in the opposite direction in relation to the movement of the razor.
5. Blot your face with a damp, then dry cloth.
6. Treat the razor with rubbing alcohol.
7. Take off gloves, wash your hands.
Nail clipping
Necessary equipment:
Rubber gloves.
Scissors and nail clippers.
Warm water, liquid soap, hand and foot cream, alcohol (70%).
Basin and water tray, towels.
1. Prepare for the sanitary and hygienic processing: lay out the necessary equipment, heat the water, put on gloves.
2. Add liquid soap to the tray with warm water and dip the patient's brushes into it for 2-3 minutes (alternately as the nails are trimmed).
3. Taking the patient's fingers out of the water one by one, wipe them and carefully trim the nails.
4. Treat the patient's hands with cream.
5. Add liquid soap to a basin with warm water and lower the patient's feet into it for 2-3 minutes (alternately as the nails are trimmed).
6. Put the foot on a towel (alternately as the nails are trimmed), wipe it off and cut the nails with special tweezers.
7. Treat feet with cream.
8. Disinfect scissors and tweezers with alcohol.
9. Take off gloves, wash your hands.
When a patient is admitted to the emergency department, it is carried out thorough examination for the purpose of detecting head lice. In such cases, head lice, body lice and pubic lice can be found.
Sanitary treatment of the patient is reduced to cutting hair (for medical reasons), followed by burning it or disinfecting it in steam sterilizers, cutting nails (on hands and feet), washing in the bathroom or in the shower, collecting things (clothes, linen, shoes of the patient) subject to disinfection, in individual bags for their subsequent sending for disinfection in a disinfection chamber. Before the chamber disinfection, belongings of infectious patients are not given out to relatives. At the same time, it is not necessary to disinfect the personal belongings of patients with influenza and other acute respiratory diseases, paratitis, chickenpox and whooping cough. These things are allowed to be taken home by relatives. After undergoing sanitization, the patient receives clean hospital linen, a dressing gown (pajamas), and slippers.
Lice (body lice) are carriers of typhus and lice relapsing fever, the pathogens of which penetrate the damaged skin when the lice are crushed and subsequently scratched. The spread of head lice is observed under unfavorable sanitary and hygienic conditions and indicates, first of all, a poor setting of the bath and laundry business.
If lice is found, sanitization is carried out, which can be complete (washing the patient with soap and a washcloth in a bath or shower, destroying microorganisms and insects in linen, clothes, shoes, bedding and living quarters, i.e. disinfection and pest control) or partial, implying only washing people and disinfection (disinsection) of linen, clothes and shoes.
To combat PEDICULOSIS AT THE PRESENT TIME, THERE ARE MANY SPECIAL PRODUCTS THAT ARE NON-TOXIC AND DO NOT REQUIRE A STYLISH AND HAIR. The product is applied to the scalp and covered with waxed paper, a kerchief is tied on top of the head or a hat is put on, or they are simply washed with a special shampoo. To remove nits for several days, comb the hair again with a fine comb with cotton wool soaked in a hot 10% solution of table vinegar.
To kill pubic lice, the affected hair is shaved off, after which it is usually sufficient to wash the body again with hot water and soap.
The linen and clothes of patients are disinfected in disinsection chambers (steam-air, hot-air, etc.). Medical personnel treating patients with head lice should use special long clothing made of rubberized fabric or thick canvas.
Lice prevention consists in regular washing of the body, timely change of underwear and bed linen.
Upon admission to the hospital, if necessary, patients accept a hygienic bath or shower, and patients in need of outside help are lowered into the bath on a sheet or placed on a stool placed in the bath and poured over with the help of a shower.
All patients must take a hygienic bath or shower in the emergency room (sometimes this is not quite correctly called sanitization), then they change into hospital clothes. On practice this rule is not always observed due to several reasons. On the one hand, patients admitted to hospital on a planned basis, as a rule, take a shower or a bath at home. On the other hand, the admission department of a hospital often lacks space and medical staff to organize a bath or shower for all incoming patients.
As for hospital linen (pajamas and dressing gowns), they are often of poor quality, and patients change into clothes taken with them from home. Therefore, patients take a bath in the emergency department and change into hospital clothes, usually only for certain indications (in infectious hospitals, with severe contamination of the skin, etc.).
Not allowed accept hygienic bath for patients with severe diseases (with hypertensive crisis, acute myocardial infarction, acute cerebrovascular accident, with severe insufficiency circulation, tuberculosis in the active phase, etc.), some skin diseases, diseases requiring emergency surgery, as well as women in labor. Usually, in such cases, the patient's skin is wiped with a swab moistened with warm water and soap, then clean water and wiped dry.
You can also use warm water with added cologne or rubbing alcohol for wiping down. Patients' nails are cut short.
If the patient is prescribed bed rest or independent movement is contraindicated, then his transportation to auxiliary diagnostic and treatment rooms, as well as to the dressing room or operating room, is carried out on a special gurney.
A nurse must be able to correctly transfer a seriously ill patient from bed to gurney and back.
For ease of portability, the stretcher can be placed at right angles to the bed, parallel or in series. The patient should be transported on a gurney carefully, the head end should be in the direction of travel.
The trolley for transporting patients with TBP-2 is intended for transporting patients to operating rooms, X-ray, procedural and other rooms within the hospital building. The trolley panel is hydraulically operated with a foot pedal to the desired height, making it easy to transfer patients. The trolley has side folding guards. The panel is lifted and lowered by a hydraulic actuator driven by a foot pedal.
The cart is designed taking into account the requirements of modern medicine, it is safe, has a solid frame structure, which is convenient and reliable in operation. The cart is mounted on wheels, two of which have brakes.
