The final disinfection is carried out in the hearth. How is the current and final disinfection carried out
Disinfection itself is a complex of techniques and methods aimed at killing or removing pathogens of infectious diseases in a vegetative form from various objects and in various substrates of the external environment.
Disinfection is based not only on knowledge of epidemiology, biology, microbiology, but also on knowledge of physics, chemistry and the mechanism of action of disinfectants.
Disinfection pursues the goal of destroying not all microorganisms in general, but only pathogenic ones. And therefore, objects that have undergone disinfection are not always completely disinfected. In this, disinfection differs from sterilization, in which all types of microorganisms are destroyed, not only in a vegetative form, but also their spores.
Therefore, disinfection does not mean sterilization, although some disinfection processes lead to sterilization.
Disinfection, taking into account the sanitary and anti-epidemic significance, is divided into prophylactic and focal, and focal disinfection is divided into current and final disinfection.
Indications for the use of focal or prophylactic disinfection differ. However, the only thing is that all disinfection measures must be carried out in accordance with the regulations prescribed during preventive, current and final disinfection.
Preventive disinfectionPreventive disinfection is carried out constantly, regardless of the presence of infectious diseases, in order to prevent the accumulation and spread of infectious agents, as well as to prevent the occurrence of infection.
Preventive disinfection includes disinfection of drinking water, waste water, pasteurization of milk and dairy products, washing fruits, processing raw materials of animal origin, etc.
Preventive disinfection is widely used in veterinary medicine, agriculture, agronomic practice, Food Industry, in the production of various biological preparations (vaccines, serums, medicines), in the dairy industry and in other areas of the national economy.
Prophylactic disinfection refers to the sanitization of the population, persons in contact with patients.
Prophylactic disinfection is widely used in sanitary and epidemiological practice. It constitutes a very important part in the general system for preventing the introduction of infection.
It is carried out at individual facilities, limited areas, over large areas, throughout the entire settlement.
With the help of preventive disinfection, the spread of infection in the external environment is prevented, the rupture of the transmission routes of infection, as well as the timely and reliable destruction of the cause of the infectious disease is ensured.
Preventive disinfection must be constantly carried out in polyclinics, dispensaries, children's clinics and other children's institutions, in public places and in crowded places, in industrial enterprises, in public institutions, in railway station buildings, hostels, canteens, baths, schools, in swimming pools, in saunas, etc.
Regularly carried out preventive disinfection prevents the accumulation and spread of an infectious principle in the external environment of a person, into which it can get from unexplained infectious patients or carriers.
Preventive disinfection is carried out in the absence of an identified source of infection - and this is its main difference from focal. Its great epidemiological significance is determined by the fact that the sources of infection (patients or carriers) are not always detected in a timely manner and, remaining undetected, release an infectious principle into the external environment. So dysentery, diphtheria and a number of other infectious diseases can spread, especially if they proceed in a mild or worn out form.
Carrying out preventive disinfection allows you to prevent the possible dispersion of the infectious principle and ensure its timely destruction in the external environment.
Prophylactic disinfection in some cases is carried out as a one-time event, in other cases - as an event that does not allow interruptions, or vice versa, requiring certain intervals.
Prophylactic disinfection can be carried out to prevent both diseases caused specifically by one pathogen, or several. So, in order to combat anthrax, wool is disinfected, skins removed from animals, in pools and showers, preventive treatment is carried out to prevent fungal diseases and pyoderma. Waste materials are subject to prophylactic treatment.
Current disinfectionFocal disinfection is disinfection carried out in the foci of an infectious disease. This is the destruction of the causative agent of a particular disease.
Focal disinfection is carried out with the aim of eliminating the focus of infection in a family, a hostel, a child care institution, on a railway, water or air transport, in a medical institution, etc. in the event that a case of an infectious disease is registered, suspicion of it or a case of carriage of an infectious agent.
There are two forms of focal infection - current and final. This division is somewhat arbitrary, because the processes of disinfection work for the current and final treatment are very closely related to each other. Although the tasks and scope of each of these two processes are slightly different, in fact they form a single whole.
Disinfection in the focus, which is carried out repeatedly during the entire time the source of infection is in it, is called current. Routine disinfection is a disinfection in the immediate environment of a patient or a microbial discharger, carried out in order to prevent the dispersion of infectious agents into the environment.
Current disinfection is carried out in existing foci in order to reduce the massiveness of microbial contamination, as well as the number of contaminated objects, and thus interrupt or slow down the transmission of the pathogen. Routine disinfection should include various measures to prevent the spread of the pathogen in the outbreak and beyond, both by the patient or the carrier, and by those caring for the patient. In a number of infections, measures are required to prevent the spread of the pathogen by vectors - insects and arthropods. It is of great epidemiological importance in hospitals, especially in infectious diseases. In this case, the current disinfection is mandatory as a measure to prevent the danger of nosocomial infections.
The current disinfection carried out in infectious diseases hospitals, infectious wards of hospitals, in tuberculosis hospitals ensures not only the prevention of the occurrence of nosocomial infections, but also excludes the spread of infection outside hospitals, by staff, visitors, through flies and other insects or arthropods, through wastewater, dirty laundry, etc.
The lack of proper observance of the sanitary regime, constant cleaning and correctly carried out preventive and ongoing disinfection in obstetric institutions leads to the occurrence of colienteritis, adenovirus, staphylococcal and other diseases among newborns. Particular attention should be paid to careful handling of the hands of medical staff and mothers, since microorganisms from contaminated hands get onto clean nipples, baby clothes, and a table with instruments.
After hospitalization, leaving for a sanatorium, moving to a new home, as well as after the recovery or death of an infectious patient, there are infected things around him (furnishings, care items, dishes, bed and underwear, toys, furniture, carpets, tools, appliances, air premises, sewage and other objects), which can serve as a factor in the transmission of the pathogen.
In order to prevent further spread of the infection, it is necessary to decontaminate all objects in the patient's environment. Such disinfection is called final and, unlike the current one, is carried out after the patient has left.
With no identified or difficult to detect sources of infection, current disinfection is of great importance among the methods of combating alimentary infections in their modern clinical, etiological and epidemiological forms.
Current disinfection is carried out in apartments in cases of late hospitalization or when the patient is left at home, as well as in medical institutions where infectious patients are or may be located, in infectious diseases hospitals, in tuberculosis dispensaries, in the offices of intestinal infections of polyclinics, in maternity hospitals and in children's institutions ...
Current disinfection at home, where the patient is left, is carried out by persons caring for the patient with home remedies (hot water, soap, soda, clean rags), well-instructed by health workers (doctor, nurse)
In hospitals, the current disinfection is provided by nurses and nurses, and the disinfection of linen is provided by disinfectants.
Current disinfection for a number of infections (scarlet fever, tuberculosis, chronic dysentery, etc.), when the patient is kept at home for one reason or another, is mandatory.
In addition, for some infections, the current disinfection should be carried out in the environment of a convalescent discharged from the hospital, as well as in the environment of healthy carriers of infectious agents registered in medical institutions.
Disinfectants dispensed for ongoing disinfection should be labeled with their concentration and method of use.
Final disinfectionThe final disinfection is carried out after isolation (hospitalization), the patient's recovery, and also in case of his death.
It must be carried out as soon as possible - in the first six hours after, but no later than 12 hours after the isolation of the patient or after the removal of infectious materials from the focus - corpses, animal products, contaminated clothing, various items, dead rodents.
Final disinfection, as a rule, is carried out by employees of disinfection facilities (disinfectants).
The purpose of the final disinfection is the complete destruction of pathogens in the room in which the infectious patient was located, as well as on all objects in this room.
In the hospital room, the final disinfection is carried out after the patient is discharged from the infectious diseases department. In the somatic department, the final disinfection is carried out after identifying an infectious patient and transferring him to the infectious diseases department. In addition, the final disinfection is carried out after the closure of the hospital or department for epidemiological reasons.
The final disinfection is carried out in polyclinic institutions, dispensaries after being sent to an isolation ward or hospital for an infectious patient or a patient with suspected infectious disease. In addition, the final disinfection is carried out after the detection of a nosocomial infection or in case of a change in the diagnosis, as well as before the repair of premises (wards, departments) in which infectious patients were located.
It must be remembered that under no circumstances can the final disinfection replace the current one.
The final disinfection in the outbreak is performed by an on-site team of the disinfection station, consisting of at least two people (disinfector and instructor). To carry out the final disinfection, the disinfection team must be equipped with a hydraulic control panel, a bucket, brushes for cleaning clothes and soft things, sprayers for powders and liquids, bags for transporting things to the disinfection chamber. The team must have a container for disinfectants, clean disinfected rags, oilcloth bags for used overalls, prepackaged disinfectants, gowns, caps or scarves, respirators, goggles, rubber gloves, soap.
The use of a particular method of final disinfection in infectious foci depends on the etiology of infectious diseases.
Upon arrival at the hearth for final disinfection, the team brings disinfectants, bags for packing things to be disinfected in the chamber, and the necessary equipment.
Persons involved in disinfection must wear protective clothing.
The team leader determines the amount of disinfection work and outlines a method that ensures a break in the transmission of infection and guarantees complete disinfection of all things in the patient's room and persons in contact with him.
Then, in accordance with the instructions, disinfectant solutions of the required concentration and required volume are prepared for disinfecting the premises and objects with this infection.
It is strictly forbidden to leave disinfectants unattended.
Before starting work, the personnel of the mobile team is obliged to check the serviceability of equipment, overalls, respirators or gauze bandages, check the presence and serviceability of safety glasses and rubber gloves.
If flies are found in the room where the patient was, they must be destroyed for any infection. The destruction of flies with the use of special preparations is carried out before the start of the final disinfection, having previously closed the eyes and doors.
If lice are found, disinfestation is required, both in relation to the lice of the patient and in relation to the insects of those around him.
The final disinfection is carried out in a certain order: first, the cleaning equipment (broom, brushes, rags for cleaning floors, buckets, basins) are disinfected with a disinfectant solution. After that, the doors to the room where the patient was located are irrigated, then the floor in the room and in the nearest rooms.
In the presence of conditions, linen, dishes and food debris are recommended to be disinfected by boiling. If this is not possible, disinfection of linen, dishes and food debris is carried out with disinfecting liquids.
Disinfection of premises begins from the most remote places, gradually approaching the exit. The laundry is soaked in disinfectant solution, the collected garbage and low-value items are burned.
Irrigation of premises is carried out with the help of a hydraulic control unit. The walls are irrigated evenly from top to bottom, right to left. The floor is treated after irrigation of the walls.
At the end of the disinfection, the room is cleaned no earlier than 60 - 90 minutes. All liquid accumulated on the floor should be wiped off, moistened hard and painted objects should be wiped off, the room should be ventilated.
In addition to the behavior of wet disinfection in the hearth, the team picks up and sends things for chamber processing. All things sent to the disinfection room are registered and handed over to the disinfection department. When taking things in bags out of the room into a car, the outer surfaces of the bags are pre-irrigated with a disinfectant solution.
Chamber disinfection should be subject to things not only of the patient, but also of those who were in contact with him. Items subject to chamber disinfection are sorted and placed in bags separately for steam-air, steam or steam-formalin disinfection.
When disinfecting for cholera, smallpox, plague, anthrax and other dangerous infections, the disinfection team should consist of four people. The team should be headed by a doctor.
When you receive a message about the presence of a patient or a corpse suspected of plague, you must urgently go to the place of call, having anti-plague overalls with you. All persons in contact with the patient must be isolated for nine days.
In case of a plague disease in the outbreak, disinfection, disinsection and deratization treatments are carried out.
Before carrying out these treatments, it is prohibited to enter the room where the patient was and to take things out of this room.
APPROVED
deputy. Chief of the Chief
epidemiological management
Ministry of Health of the USSR
G.G. Onischenko
dated 18.04.89 N 15-6 / 12
1. General Provisions
1.1. These Guidelines regulate the organization and conduct of disinfection measures in acute intestinal infections(OCI) of bacterial etiology: salmonellosis, shigellosis, yersiniosis (pseudotuberculosis and intestinal yersiniosis), escherichiosis and other intestinal infections, except typhoid fever and paratyphoid fever, disinfection measures for which are regulated by order of the USSR Ministry of Health of 03/02/89 N 139 "On measures to reduce the incidence of morbidity the population of the country with typhoid fever and paratyphoid fever ".
1.2. These Guidelines have been developed taking into account the following epidemiological features of the above infections: pathogens are isolated in environment with human excreta; the duration of their survival on objects of the external environment is significant and it depends on temperature, humidity, massiveness of infection, the presence of biological pollution, their resistance to the effects of physical and chemical agents; the importance of the contact-household route of transmission of infection in the leading main routes (food and water) remains.
1.3. Taking into account the resistance of pathogens to the effects of environmental factors and disinfectants, the recommended disinfection measures are unified for two groups of infections: 1) salmonellosis and intestinal yersiniosis; 2) shigellosis, escherichiosis and pseudotuberculosis.
1.4. In case of acute intestinal infections, the current final and preventive disinfection is carried out.
2. Current disinfection
2.1. The current disinfection is carried out in the surroundings of the patient in the outbreak and in medical institutions.
2.2. The current disinfection in the outbreak of a patient with AEI is organized by a medical institution from the moment an infectious patient is identified until his hospitalization or recovery and is carried out by the patient's relatives, or the patient himself, selectively controlled by employees of sanitary-epidemiological stations (SES) or disinfection stations (DS).
2.3. A doctor (paramedic), who has identified a patient with intestinal diseases, decides on his hospitalization in a hospital. Before hospitalization of the patient or in the case of treatment of the patient at home, he prescribes treatment and organizes the current disinfection, instructing one of the family members about the rules for observing personal hygiene for patients and measures to prevent infection of others, which is noted in the outpatient card.
2.4. When organizing the current disinfection, attention is paid to:
- isolation of the patient, if possible, with the maximum limitation of contact with other family members;
- providing him with individual bed linen, a towel, dishes, a receiver for secretions and care items;
- provision of separate collection and storage of dirty linen before washing;
- the use of easily handled items by patients for their daily needs;
- maintaining cleanliness in the premises, especially in places common use;
- the presence of flies for the subsequent conduct of pest control measures;
- systematic disinfection of the patient's secretions and food debris;
- maintenance of outbuildings and cesspools.
2.5. When carrying out the current disinfection, the population uses the most simple methods disinfection (boiling, wet cleaning, etc.).
2.6. If a patient or suspect for acute intestinal diseases is identified in somatic hospitals, departments for young children and newborns, immediately before transfer to an infectious diseases hospital, he should be isolated in a separate ward or isolation ward, where current disinfection is carried out.
2.7. In infectious diseases wards of hospitals, personnel carry out routine disinfection in accordance with the recommendations of the order of the Ministry of Health of the USSR dated 04.08.83 N 916.
3. Final disinfection
3.1. The final disinfection is carried out by the forces of disinfection stations, disinfection departments of the SES, as well as by the population at home.
3.2. Final disinfection is not carried out after the recovery of the patient with AEI, treated at home, as well as after the expiration of the incubation period from the moment of identification and isolation of the patient.
3.3. Final disinfection performed by the forces of disinfection stations, disinfection departments of the SES.
3.3.1. Final disinfection is carried out at:
- hearths, sanitary and uncomfortable, populous communal apartments, in the presence of a family outbreak, with dysentery and other AEI;
- home foci, where there are young children (up to two years old), with salmonellosis and intestinal yersiniosis at the conclusion of a doctor, medical assistant or an epidemiologist's request;
- hostels and hotels;
- comfortable preschool children, incl. specialized institutions, boarding schools in the event of group diseases (two or more cases);
- uncomfortable childcare facilities for each case;
- schools in the event of group diseases (5 or more cases);
- Medical facilities, only by the conclusion of a doctor-epidemiologist;
- at the catering units of organized collectives, public catering enterprises, the products of which caused the emergence of group morbidity (5 or more cases) of salmonellosis, intestinal yersiniosis and pseudotuberculosis.
3.3.2. The disinfection team performs the final disinfection of the outbreaks in the following order:
- before entering the hearth, they are irrigated from a hydraulic control unit front door on both sides, then disinfect the "path" passage to the room where the patient was (the carrier of bacteria), after that the team leader determines the amount of work to be done, prepare a disinfectant solution of the required concentration for disinfecting the premises and individual objects;
- in the presence of flies in the outbreaks, first with closed windows and doors, they are destroyed using insecticides (Table 2);
- after the disinfestation, open the window (window), begin to disinfect, first of all, the most epidemiologically dangerous objects (patient discharge, pots, underwear and bed linen, tea and dining utensils, food leftovers, door handles, toys, cleaning material , patient care items (Table 1).
3.3.3. Chamber disinfection of things is carried out according to epidemiological indications. To do this, they draw up documentation for things, put them in a bag and take them out of the hearth, having previously irrigated the bag with a disinfectant solution. After that, they begin to disinfect all rooms and furniture; process common areas: bathroom, corridor, toilet. In the presence of yard sanitary installations, they are disinfected and disinsected, after which garbage bins and the territory of the yard (in places of fecal contamination of the soil) are disinfected, etc.
In the outbreaks of salmonellosis and yersiniosis, special attention should be paid to the disinfection of places where food is stored, processed and distributed. In the foci of intestinal yersiniosis and pseudotuberculosis, according to epidemiological indications and the conclusion of a disinfection doctor, it is necessary to provide for deratization measures, mainly in places where food is stored and processed.
3.3.4. At the end of the work in the hearth, the team members change their robes, pack them for subsequent chamber disinfection, wash their hands with soap and water.
3.4. Final disinfection carried out by community forces.
3.4.1. The final disinfection is carried out after the isolation of the patient with acute intestinal infections or if they are suspected in home foci: sanitary-comfortable, sparsely populated apartments, in the absence of family foci, as well as young children.
3.4.2. The final disinfection by the population is organized by the personnel of the medical institution who identified the patient.
The doctor (paramedic), who has identified the patient with AEI, instructs him or his family members about the rules and measures to prevent others; leaves a memo, developed taking into account the peculiarities of local conditions, gives instructions to the nurse on the timing of the final disinfection by the forces of the population and recommends disinfection regimes for individual objects.
In the patient's outpatient card, the district doctor marks the date, the hours of the diagnosis and the organization of disinfection by the forces of the population and its implementation. In the emergency notification (form 58), he makes a note about the sanitary condition and maintenance of the hearth.
If necessary, a nurse goes to the hearth to organize the final disinfection at the direction of the attending physician.
3.4.3. For institutions working on the principle of simultaneous hospitalization and disinfection with a significant workload of district nurses during the seasonal rise in the incidence of intestinal infections, the organization of the final disinfection by the population is carried out by the nurse for the evacuation of infectious patients from sanitary and epidemiological stations (dezstations).
The evacuator instructs a family member of the patient about disinfection and leaves a memo.
3.4.4. The family member conducting the disinfection puts on easily washable clothes, a kerchief, preferably rubber gloves and proceeds to disinfect the patient's room, then processes common areas. The person conducting the treatment, after completing it, thoroughly washes the gloves, takes off the work dress, kerchief, places them in the boiling tank (basin), then washes his hands, takes a shower.
3.4.5. When performing the final disinfection by the population, the most simple ways disinfection:
- boiling of linen, dishes, toys (within 15 minutes from the moment of boiling);
- wet cleaning of premises (floor, window sills, doors, etc.), furniture, kitchen, toilet using detergents and disinfectants household use or 2% soap and soda or other detergent solution.
3.4.6. When performing the final disinfection in the centers of the OKI by the forces of the population, chamber disinfection is not carried out.
3.4.7. The disinfection department (department) of the sanitary-epidemiological station or the disinfection station annually instructs the personnel of medical and prophylactic institutions on the rules for conducting final disinfection by the population in the foci of infectious diseases.
3.5. Final disinfection in health care facilities.
3.5.1. In infectious diseases hospitals, final disinfection is regulated by order of the USSR Ministry of Health dated 04.08.83 N 916 *.
________________
* On approval of the Instruction on the sanitary and anti-epidemic regime and labor protection of the personnel of infectious diseases hospitals (departments).
3.5.2. In somatic hospitals, after isolation of patients with acute intestinal infections, the final disinfection is carried out by the hospital staff according to the modes indicated in table. 1.
3.5.3. If a patient with acute intestinal infection is identified at an outpatient clinic, after isolation of the patient, in the office (box), as well as in the rooms where the patient was, final disinfection is carried out by the personnel of this institution according to the modes indicated in table. 1. If an infectious patient is identified at the reception, the staff must change their dressing gowns and wash their hands twice with warm running water and toilet soap.
4. Prophylactic disinfection
4.1. Preventive disinfection is carried out in order to prevent the accumulation of pathogenic and opportunistic microorganisms on objects of the external environment, as well as their carriers (insects, rodents, etc.), the occurrence of acute intestinal infections and their spread.
4.2. Preventive disinfection is carried out in:
- medical and preventive institutions, preschool institutions, schools, boarding schools by personnel;
- at public catering establishments, as well as for the production, processing of food products and raw materials of animal origin, by the workers and forces of disinfection stations or disinfectants of the SES.
4.3. In medical and prophylactic institutions, the implementation of preventive measures is regulated by order of the USSR Ministry of Health dated 03.23.76 N 288 "On approval of the Instruction on the sanitary and anti-epidemic regime of hospitals and on the procedure for the implementation of state sanitary supervision over the sanitary state of medical and preventive institutions by bodies and institutions of the sanitary and epidemiological service" ...
5. Disinfection measures in preschool institutions
5.1. After isolation of the patient in the group he attended, final disinfection is carried out, see paragraph 3.3.1.
After the final disinfection in the group for the quarantine period, disinfection measures are carried out according to the modes indicated in table. 3.
5.2. During the period of being in the isolation ward of a patient or suspected of having an OCI, current disinfection is carried out, and after the patient is removed from it, final disinfection is organized there.
5.3. In the absence of isolation between groups, the volume of disinfection measures is determined by the degree of contact of children attending these groups.
5.4. Disinfection is carried out in the absence of children at the end of the change of work of the childcare institution or during the walk of children by agreement with the staff of the childcare institution.
5.5. When disinfection is carried out, bed linen is removed from all beds of the patient's group and disinfected by boiling with detergents in a specially allocated room (if possible) or soaked in disinfectant solutions. The patient's linen is disinfected in a separate container.
Bedding from the patient's bed and adjacent beds is disinfected in a disinfection chamber. When bedding is stored together, the latter are sent for chamber processing. If there are mattress cases, they are disinfected. In this case, mattresses are not sent for chamber processing, but mechanical cleaning is carried out with a brush or a vacuum cleaner, as well as by shaking out, etc.
When disinfecting objects, use disinfectants and methods indicated in table. 1 and 3.
In case of presence of flies in children's institutions, disinsection is carried out before disinfection (Table 2).
5.6. Final disinfection in suburban children's institutions (children's institutions that go out of town for the summer, pioneer camps, etc.) are carried out by disinfection of local sanitary and epidemiological stations.
5.7. The administration and medical staff of the institution are responsible for the organization and implementation of the current, final disinfection in preschool institutions.
6. Disinfection measures in schools
6.1. In isolated cases of acute intestinal infections, the final disinfection is performed by school personnel.
In the event of group diseases (5 or more cases), the final disinfection is performed by the forces of the disinfection teams.
6.2. Compulsory disinfection are subject to: buffet, dining room and sanitary facilities. At the direction of the epidemiologist, the list of objects can be expanded.
6.3. Responsibility for organizing and implementing routine, final and preventive disinfection in schools lies with the school administration and medical staff.
7. Control over the quality of disinfection measures
7.1. The quality control of disinfection is carried out: by visual and laboratory (bacteriological and chemical) methods in accordance with the order of the Ministry of Health of the USSR dated 01.17.79 N 60 "On measures to further strengthen and develop disinfection business."
7.2. The foci of intestinal infections located in sanitary uncomfortable, populous communal apartments, hostels, foci where children under two years of age live, as well as foci as directed by the epidemiologist, are subject to mandatory control by the medical staff. When visiting the outbreak, the nurse monitors the correctness of the current disinfection carried out by the population.
7.3. Bacteriological quality control of the final disinfection performed by the population is not carried out.
7.4. With bacteriological control, flushing is performed from an area of at least 200-300 sq. Cm in 2-3 adjacent areas of the inspected object. When taking samples from toys, dishes, etc. swab washes are made from the surface of the entire object.
7.5. Accelerated method (one-stage) of bacteriological quality control of disinfection.
This express method using Heifetz's medium is based on the possibility of counting E. coli in crops only by changing the color of the medium without isolating a pure culture and identifying it. Heifetz's medium makes it possible to obtain the final result 18-24 hours after seeding the washes. In doubtful cases, they use a three-stage method for examining flushes.
The composition of the Heifetz medium: 10 g of peptone, 5 g of mannitol, 5 g of sodium chloride, 1 liter of tap water; after boiling, the pH of the solution is set in the range of 7.4-7.6, and then the indicators are added: 1 ml of a 5% alcoholic solution of rosolic acid and 2.5 ml of a 0.1% aqueous solution of methylene blue. At the specified pH, the color of the medium is red-violet. A red color without a purple tint indicates that the medium is highly alkaline and should be discarded.
In the production of washes after disinfection with chlorine-containing preparations, 10 g of hyposulfite is added to the proposed recipe. Preparation of indicators:
a) 0.5 g of rosolic acid powder is placed in a small bottle with a ground-in lid and filled with 10 ml of alcohol;
the indicator is ready after 24 hours. The solution is valid for 1 month;
b) 0.1 g of methylene blue is poured into 100 ml of distilled water, heated to boiling; the solution has no expiration date.
The prepared medium is sterilized by boiling or heating in a boiling water bath for 5 minutes.
The medium is poured into test tubes (8-10 ml), subjected to a single heating with current steam for 20-30 minutes.
Inoculated tubes are placed in a thermostat at 37 ° C for 18 hours. After the specified time has elapsed, the results are taken into account on the basis of a change in the color of the medium. In the presence of a green color of the medium and abundant characteristic turbidity, the growth of E. coli is recorded.
7.6. Standard (three-stage) method for the study of flushes. For bacterial control of the effectiveness of disinfection in the foci of infections of the intestinal group, nutrient media of Eikman or Heifetz are used. The latter medium provides a higher seeding rate of E. coli in washes than Eikman's medium.
Crops in Eikman's medium are kept in a thermostat at a temperature of 43 ° C, on Heifetz's medium - at 37 ° C for 18 hours. The next day, from test tubes in which there is turbidity, a platinum loop is applied to Endo medium in Petri dishes. To obtain isolated colonies, the loop with the collected material is immersed at the edge of the Petri dish into the agar, and then the loop is removed and a series of strokes are made in the same place. After that, strokes are applied to the rest of the Endo medium.
The seeded Petri dishes are placed in a thermostat at 37 ° C for a day. If there is no growth of colonies on Endo's medium, the study ends there. If there is a colony, a smear is made from one half of the colony and stained according to Gram. The other half of the colony is inoculated with an injection in a semi-liquid column with glucose. Since the usual criterion - a metallic sheen on Endo's medium - is not sufficient for recognizing E. coli, a smear and inoculation in a semi-liquid Giss medium with glucose are made not only from a colony with a characteristic metallic sheen, but also from colonies of red and colorless.
Inoculated test tubes with glucose are placed in a thermostat at 43 ° C for 2-3 hours. The final result is given in the presence of acid and gas formation in a semi-liquid column with glucose and typical gram-negative rods during microscopic examination of smears.
7.7. Evaluation of the results of studies of samples from the surface of disinfected objects and from linen.
A satisfactory assessment of disinfection - in the absence of Escherichia coli growth in all studied samples.
Unsatisfactory assessment - when Escherichia coli is found in at least one of them.
Table 1. Methods and means of disinfection of objects during the current and final disinfection
Table 1
An object | Way | Funds | Infection name |
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salmonellosis, | dysentery, |
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Time | Norm | Time | Norm |
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Allocation | Falling asleep | Bleaching powder, | 150 g / kg | 150 g / kg |
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Urine, oo- | Falling asleep | Bleaching powder | 5 g / l | 5 g / l |
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Crockery from- | Immersed | 1% solution | ||||||||||||
Patient's dishes (tea, | Boiling Immersion in disinfectant solution | 2% baking soda solution 0.5% chloramine solution | 30 | 2 l per room 2 l on a com -"- 2 l on a com | 30 | 2 l for a set of dishes -"- |
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________________ * From the moment of boiling. |
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Patient's dishes (tea, | Boiling Immersed | 2% baking soda solution | 15* | 2 l for a set of dishes -"- | 15* | -"- 2 l for a set of dishes |
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________________ * From the moment of boiling. |
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Leftovers | Boiling Falling asleep | Bleaching powder | 200 g / kg | 200 g / kg |
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________________ * From the moment of boiling. |
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The room, | With the current When con- | 0.5% solution 1% solution 0.5% clarified 0.1% sulfochlorantin solution 3% hydrogen peroxide solution with 0.5% | 60 | -"- -"- 300 ml / sq.m 200 ml / sq.m | 60 | 200 ml / sq. m 300 ml / sq. m |
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________________ * From the moment of boiling. |
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Linen without visible marks | Boiling Soaking- | 2% soda solution or any detergent solution | - | -"- 4 l / kg | 30 | 4 l / kg -"- |
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________________ * From the moment of boiling. |
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Laundry that is soiled with | Boiling Soaking- | 2% soda solution | 90 | 4 l / kg -"- | 60 | 4 l / kg -"- |
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________________ ** Products of electrolysis of sodium chloride solution (used during the current disinfection in a healthcare facility). |
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Boiling | 2% soda solution 0.25% clarified 0.5% chlorocine solution | 60 | Full immersion Full immersion | 30 | Full immersion or |
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________________ ** Products of electrolysis of sodium chloride solution (used during the current disinfection in a healthcare facility). |
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Bedding | Disinfection- | Steam-air at a temperature of 80- | 60 kg / sq.m | 60 kg / sq.m. floor area of the chamber |
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Clothing, | Disinfection- | Paroformalino- | 30 kg / sq.m. floor area of the chamber |
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Flushing water after washing the patient, after washing dishes | Falling asleep after- | Bleach or heat-resistant bleaching lime, | ||||||||||||
Orderly | Two-fold against Rubbing with a cloth to which the detergent is applied | Disinfectants used for disinfection of premises Dichlor-1, "Belka", Blesk-2, "Sanita", PSHD "Dezus" and others | 60 | 500 ml / sq.m | 60 | 500 ml / sq.m |
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________________ **** During the final disinfection, irrigate twice or wipe with a rag with a disinfectant solution with an interval of 15 minutes. |
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Burning Pour in one of the disinfectants | 10% clarified solution of bleach or heat-resistant bleach lime 5% NGK solution 20% chlorine-lime milk | 120 | In relation to | 120 | In relation to |
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Out-door toilets, cesspools and waste bins | Irrigate with one of the disinfectants | 10% solution of bleach or bleach | 500 ml / sq.m | 500 ml / sq.m |
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Table 2. Fly control measures
table 2
Name | Means and methods of dealing with flies |
Fighter: a) destruction b) destruction c) destruction | The use of aqueous emulsions of larvicides: 0.2% trolene; 1% karbofos, 0.5% DDVF, diaphos, dikresil; 1% Dust Difocarb. The waste surface is evenly poured (filled in) at the rate of 2-5 liters per 1 sq. M with a waste layer thickness of up to 0.5 m. The dust consumption rate is 300 g / sq. M. Frequency rate of treatments once every 5-10 days. The use of chemicals: 2-3% aqueous solutions of chlorophos, insecticidal paper, baits from 1% chlorophos or from a mixture of 0.5% aqueous solution with 0.5% dry ammonium carbonate with fly-attracting substances (sugar waste); bait Riapan-M and Alfatsid, aerosol cans designed to kill flying insects. Use of mechanical means: sticky tapes, flycatchers. Using a mixture of 2% aqueous chlorophos with 0.2% aqueous emulsion DDVF (10: 1); 0.5% water emulsion DDVF; baits from a 1% aqueous solution of chlorophos with 0.5% dry ammonium carbonate with the addition of substances attracting flies ( fish or meat waste). |
Table 3. Sanitary and disinfection regime in children's institutions during quarantine
Table 3
Object name | Method and time of disinfection |
Spatulas (metal) Thermometers (maximum) Dishes freed from food debris Leftover food Rags for washing dishes and tables Dining tables Toys Bedding Cleaning of premises Cleaning equipment: Allocations Outbuildings | After a single use, boil for 15 minutes from the moment of boiling. Store clean and used spatulas in separate, labeled containers. Disinfect by full immersion in 2% solution of chloramine or another solution specified in Table 1 for disinfecting toys with an exposure of 5 minutes. See table 1. Do not wipe the washed dishes, but dry them on the rack shelves. See table 1. After each disposal of food waste, the container is washed (at least three times a day) with water and detergents. After washing the dishes, wash, then boil for 15 minutes from the moment of boiling, dry and store dry in a closed labeled container or after washing contain in a 1% solution of chloramine, a clarified solution of bleach or calcium hypochlorite - 60 minutes. Change the solution after each use of the rags. After disinfection, rinse with running water, dry, store in a closed labeled container. See table 1. After disinfection, rinse the disinfectant hot water and wipe the surface dry. See table 1. Brush twice with a brush moistened with 1% chloramine solution, ventilate after one hour. See table 1. In case of complication of the epidemiological situation, carry out wet cleaning using one of the solutions indicated in Table 1. In case of complication of the epidemiological situation, disinfect according to the modes indicated in Table 1. See table 1. See table 1. Discharge utensils. Wash the toilet seats with warm soapy water. We wash the toilet bowls. Treat the surfaces with a 10% solution of bleach and once a week cover the discharge with dry bleach (at the rate of 1 kg per 1 sq. M). Wash the inner surfaces of the courtyard toilet and door handles daily using 1% chloramine or 1% solutions of clarified bleach. Used kwachs are immersed in a 0.5% solution of clarified bleach or calcium hypochlorite for 30 minutes. Store clean and used kwach in separate labeled containers. Have at least 6 kwachas per group. Change the disinfectant after the organized planting of children. |
Note.
prohibited:
- carry out the treatment of pots with disinfectant solution in the presence of children;
- store kwach for washing pots and toilet bowl outside the cabinet;
- disinfect linen in group rooms;
- put the tank for disinfection of dishes on the table, stool, children's chair;
- store cans with disinfectants for rags in places accessible to children.
Methodical instructions are intended for medical personnel of sanitary-epidemiological and disinfection stations, treatment-and-prophylactic and children's preschool institutions, organized groups (school, etc.).
Consider invalid the Instruction on the organization and conduct of disinfection in dysentery, approved. Ministry of Health of the USSR 09.09.71 N 934-71.
The text of the document is verified by:
"Chief Nurse",
No. 6, 2001
Current
Current disinfection - This is disinfection, which is carried out in the outbreak in the presence of a source.
The current disinfection is carried out during the entire period while the patient or the carrier is a source of infection. It is aimed at the constant disinfection of excrement, vomit, sputum, etc. Disinfection is considered timely if it begins to be performed no later than 3 hours after the patient is identified. They also disinfect the patient's items of use, tableware, sanitary equipment, utensils from the discharge, bedding and underwear. Disinfecting objects that were in the use of the patient. ... The purpose of ongoing disinfection is to prevent the spread of infection.
They systematically carry out wet cleaning of the premises with the help of disinfectant solutions, soap, treat toys, dishes.
The final
Final disinfection - This is disinfection, which is carried out after hospitalization, recovery or death of the patient, that is, after removing the source of infection in order to completely free the focus from pathogens scattered by the patient.
Subsequence:
1) pre-irrigate the floor with a disinfectant solution, then conduct an examination of the focus of intestinal infection in order to determine the volume and sequence of disinfection measures;
2) in the summer, in the presence of flies, they are destroyed with closed windows and vents; dead flies are swept away and sent down the drain;
3) the most significant factors of transmission of pathogens of intestinal infections are primarily disinfected:
o discharge of the patient: covered with dry bleach or two-tertiary salt of calcium hypochlorite in a ratio of 1: 5, exposure - 1 hour;
o utensils for secretions are immersed in a disinfectant solution;
o underwear and bed linen: immersed in a disinfectant solution;
o utensils for food and drink: boil for 15 minutes in a 2% sodium bicarbonate solution or detergent solution or immerse in a disinfectant solution; after disinfection, the dishes are washed with hot water;
o toys: treated in the same way as eating and drinking utensils; soft toys should be treated in disinfection chambers;
o food leftovers: boil for 15 minutes; liquid food residues can be covered with dry bleach (1: 5, exposure - 1 hour);
o surfaces of the floor, walls and others: treated by irrigation from a hydraulic control unit or wiping with a rag soaked in a disinfectant solution;
o cleaning material: immersed in disinfectant solution
5) disinfection of all rooms in the hearth (floor, furniture, window sills, doors, door handles) is carried out sequentially, moving from more distant rooms (or parts of a room) to those closer to the exit;
6) quartzing is carried out
Ticket 9
1.Inform the patient about diathermoexcision surgery
Diathermoexcision of the cervix both treatment and biopsy of the cervix are used, produced by the method of diathermocoagulation using a loop-shaped electrode. This method removes the affected tissue in many diseases of the cervix. As a rule, diathermoexcision is performed in the first half of the menstrual cycle.
Diathermoexcision should be used to treat erosion only in patients of the older age group, since after it very rough scars remain and during childbirth difficulties with opening the cervix and extensive ruptures may occur. Also, due to the excision of the cervical tissue during pregnancy, difficulties with gestation may arise, when, due to cicatricial deformity and a decrease in size, the cervix may open ahead of schedule and a miscarriage may occur. Diathermoexcision can be considered in nulliparous women only as a method of treating precancerous diseases of the cervix or early forms of cervical cancer, as well as cicatricial deformity after a previous birth. Therefore, in young women, it is impossible to cauterize erosion by the method of diathermoexcision.
Indications for diathermoexcision of the cervix: erosion, severe dysplasia, chronic endocervicitis with recurrent cervical polyps, suspected cervical cancer
The operation is performed under local anesthesia. The affected area of the cervix is removed with a loop heated by an electric current. In this case, the loop acts as a scalpel.
The advantage of this method over simple surgical removal of tissue is better visualization of the affected area and less blood loss.
2. Rules for the preparation of the drug "thick drop" and "thin smear", scope, technique
Preparation of a thin smear and thick drop for the diagnosis of malaria. Blood is usually taken from 4 fingers of the left hand, as it is the least susceptible to contamination.
- Wear gloves before handling.
- Prepare the necessary equipment and tools:
- Disposable scarifier.
- 70% ethyl alcohol solution.
- Cotton balls.
- Slide.
- Microscope slide with a polished edge.
- Petri dish.
- Sterile tray.
- Waste material tray.
- Dry soap.
- A gauze napkin.
3. Preparing the patient.
- Invite the patient to sit comfortably in the chair.
- Explain to him the essence of the manipulation.
- Find out which hand the patient has not working.
- Massage your ring finger.
- Treat the skin of the nail phalanx with a cotton ball moistened with 70% ethyl alcohol according to all the rules and dry with a second (dry) cotton ball.
- Follow the rules of ethics and deontology when dealing with a patient.
4. Preparation of a blood smear.
- Make a puncture of the skin with a scarifier.
- Remove the first drop with a dry cotton ball.
- Touch the bottom surface of the slide to the second drop on your finger at a distance of 1-1.5 cm from the edge of the slide.
- Turn the glass over with a drop upward and take the side edges of the glass in your left hand. The drop is located at the top and right. The diameter of the drop on the glass should be 2-3 mm.
- Place the glass with a polished edge to the left of the drop at an angle of 45 0 with an inclination towards the drop with your right hand. The glass with a polished edge should be slightly narrower than the glass slide with a drop of blood. Move the sanded edge to the right until it touches the drop and wait for the blood to flow over the edge of the sanded glass.
- Without pressing, in a quick, even motion, slide the glass with a ground edge over the slide until the drop is exhausted. The smear should be thin and uniform, have a light pink color, shine through, end with a brush
- If not enough blood is released, invite the patient to lower his hand down - it is impossible to squeeze out a drop of blood
- Do not touch the glass slide to the skin
5. Cooking "thick drop".
- Apply 2-3 drops of blood on a glass slide at a short distance from each other.
- Mix them with a glass rod or the corner of another microscope slide. Mix lightly to form a spot with a diameter of 1.5 cm. The layer of blood should not be too thick, otherwise, when it dries, it will simply form a crust that will fall off.
Air dry, write a number on the glass that matches the number in the direction, put the preparations in a Petri dish and deliver to the laboratory
Ticket 10
1.Inform the patient about the alimentary method of provocation, the goal
Provocation of gonorrhea - special measures during which the body tissues are irritated or methods are used that lead to a change in the general condition of the patient (in fact, weakening of the immune system). This is how they achieve the release of the gonococcus to the mucous membrane of the genitourinary system for its further bacterioscopic examination (under a microscope) or bacterial inoculation.
The purpose of the provocation is the diagnosis of chronic gonorrhea or the establishment of the fact of recovery from the disease. In the latter case, the provocation is carried out a week after the completion of the course of treatment.
Alimentary - a provocation, during which the patient is required to consume alcohol, spicy and salty foods, the intake of completely incompatible foods (for example, milk and pickled cucumbers) is encouraged. Scrapings are taken with the same frequency as after chemical provocation - after 24, 48 and 72 hours, bacteriological inoculation is carried out on the third day after the provocation;
2.The rules for taking a swab from the nasopharynx. Application, pick-up conditions, transportation rules.
Target: identify the causative agent of the disease.
Equipment: a rack with a sterile test tube, tightly closed with a cotton-gauze swab, into which a rod with a wound dry cotton swab is mounted for taking material; sterile spatula in a craft bag; a vial or test tube with a nutrient medium obtained in a bacteriological laboratory; bix with foam rubber, heating pad, thermometer for placing the sample and maintaining the temperature within 38 ° С at the time of transportation; referral form (accounting form No. 204 / U); rack for test tubes with samples; glass recorder for labeling test tubes.
| STEPS | NOTE |
| PREPARATION FOR THE PROCEDURE | |
| 1. Explain to the patient the meaning and necessity of the forthcoming study and obtain consent. | The material is taken in the morning, on an empty stomach, before treatment. |
| 2. Wash your hands with soap, put on a gown, mask and gloves. | |
| 3. Put the number on the tube corresponding to the direction number with the glass-recorder. | |
| 4. Place the test tube in the rack. | |
| PERFORMANCE OF THE PROCEDURE | |
| 1. Pour 3-5 ml of culture medium into a test tube. | Observe sterility |
| 2. Bend a sterile cotton swab over the edge of the tube at an angle of 135 ° at a distance of 3-4 cm from the end. | You can take a ready-made curved rod with a swab. |
| 3. Offer the patient to open his mouth wide. | |
| 4. Press with a spatula, which is in the left hand, on the root of the tongue. | |
| 5. Insert the tampon, end up, under the soft palate into the nasopharynx and carefully collect the mucus. | It is necessary to hold the tampon under the soft palate 2-3 times. |
| 6. Remove the tampon without touching the mucous membrane of the mouth and teeth. | |
| 7. Place in a test tube with a culture medium without touching its walls. | |
| 8. Place the test tube in the test tube rack, then the rack in the bix. | Check the correspondence of the tube number with the direction number and full name. the patient. |
| 9. Put the heating pad in the bix, sealing with foam rubber, the thermometer to maintain the temperature within 38 ° С during transportation. Close the bix on the "lock". | Meningococcus dies at temperatures below 37 ° C. On the bix there are special devices for the case of fastening the bix cover. |
| END OF PROCEDURE | |
| 1. Remove gloves, mask and immerse them in a disinfectant solution. | |
| 2. Deliver the taken material in a bix with direction to the bacteriological laboratory. | Biological material is delivered as quickly as possible, within 1 hour. |
8 Ticket. 1 question"Inform the patient with NMC about the method of measuring basal temperature - purpose, indications, contraindications"
- You need to measure basal temperature every day. (Within six months)
- Measured in the rectum (can be in the mouth, vagina)
The narrow part of the thermometer is inserted for 3 minutes. - Take measurements in the morning without getting out of bed.
- It is necessary to measure basal temperature at the same time.
- Basal temperature is measured while lying motionless. Do not make unnecessary movements, activity should be minimal.
- Basal temperature after measurement is best recorded immediately. If the thermometer reading is between two digits, record the lower reading.
- The schedule must indicate the reasons that could lead to an increase in basal temperature (acute respiratory infections, inflammatory diseases, etc.).
- Business trips, travel and flights, intercourse the night before or in the morning can significantly affect the basal temperature.
- Basal temperature can be affected by various medications, such as sleeping pills, sedatives and hormonal.
Measurement of basal temperature and the simultaneous use of oral contraceptives does not make any sense. Basal temperature depends on the concentration of hormones in the tablets.
Indications: 1) When planning pregnancy . 2) As a complex method of contraception. (Not effective) 3) When diagnosing pathologies of the menstrual cycle (anovulatory mestral cycle)
Contraindications: fever, diarrhea, rectal diseases
Ticket 8. 2 Question“Technique for taking blood for serological research. Serological reactions "
It is used to detect specific antibodies in the blood serum that are produced in the human body in response to the introduction of pathogens of this infectious disease. It is taken in the morning on an empty stomach. Use a needle with a wider lumen so that the red blood cells are not damaged. The blood from the cubital vein is collected in a test tube. It is placed in a thermostat for 30 min at t37 C, then transferred to a refrigerator for 30-60 min at t 4C. After the test tube is centrifuged, the blood serum is transferred into another dry test tube (using a pipette) and stored in a refrigerator at 4C until the reaction.
Serological reactions: RA - agglutination reaction. RNGA-reaction of indirect hemagglutination. CSC reaction of complement binding. RIF-reaction of immunofluorescence. ELISA-enzyme-linked immunosorbent assay.
7 Ticket. 1 question"Draw a graph of the basal temperature of the anovulatory menstrual cycle."
Anovulatory mestral cycle is a disorder characterized by the absence of ovulation, the corpus luteum is not formed, therefore progesterone is not produced (there is little of it). Therefore, the temperature will not change, because this is due to a sufficient amount of progesterone. (Normally, it slightly exceeds 37 degrees)
Ticket 8.2 Question"Actions of a nurse in case of skin injury with a tool that came into contact with the biological fluids of an HIV-infected patient"
1. Remove gloves. 2. wash your hands with soap and running water. 2. to treat hands with 70% alcohol. 4. lubricate the wound with a 5% alcohol solution of iodine;
1.Take off gloves and put them in disinfection. means, squeeze blood out of the wound, wash the injury site with soap and water, without stopping the bleeding. Treat the injury site twice with 5% iodine solution, cover with adhesive plaster or apply a bandage.
2. Inform the administration about the incident. 3. Consult an infectious disease specialist. 4. Undergo a medical examination for the presence of markers of viral hepatitis B, C and HIV infection. 5. In order to prevent HIV infection, conduct PTP (post-traumatic prophylaxis) with antiretroviral drugs (azidothymidine).
1.Excision of the walls of the uterine cavity - instrumental removal of the functional layer of the uterine mucosa along with possible pathological formations.
Indications: uterine bleeding, dysfunctional uterine bleeding, suspected hyperplastic process or malignant tumor of the endometrium, incomplete abortion, placental polyp after abortion or childbirth.
Contraindications: acute inflammatory processes of the genital organs
Treatment of the external genitalia and vagina;
Exposure of the cervix using mirrors and fixation of the cervix with bullet forceps;
Expansion of the cervical canal;
Curettage of the mucous membrane of the uterus with a curette;
Treatment of the cervix with iodine tincture and removal of instruments
The patient should refrain from sexual activity for 1 month after the operation.
2. First way:
Equipment: sterile 200 ml jar, warm boiled water, soap, sterile saline solution, sanitary napkin, referral forms, pen, pencil on glass, reset tray, sterile tweezers, tray, cotton balls, napkins, vessel, oilcloth, diaper.
Performance:
Explain the purpose and course of the procedure
Shield the patient with a screen
Wash your hands, put on gloves
Put an oilcloth, a diaper on the bed
Substitute the ship
Wash the external genitals, pubis, anus with tweezers, tampons, pouring water
Discard swabs in tray
Wash the external opening of the urethra with sterile saline solution using tweezers and cotton balls
Dry the skin with a napkin, shed it
Invite the patient to release the first stream of urine into the vessel
Suggest the patient to delay urination
Substitute a sterile jar, collect the middle portion of urine
Prompt the patient to complete urination
Close the jar with a lid, remove the vessel
Number the bank, issue a direction
Send material to baklaboratory
Wash, dry your hands
The second method (taking urine with a catheter):
Equipment: sterile: tray, catheter, tweezers, cotton balls, napkins, liquid paraffin, furacilin solution or physical solution, solution container, forceps, urine container; oilcloth, diaper, vessel, warm water, tray for dump, forms of directions, pen, steklograph, container with disinfectant r-rum.
Performance:
Explain the purpose and course of the procedure, shield the patient with a screen
Wash your hands, put on gloves
Place under the patient's pelvis: oilcloth, diaper, vessel
Wash the patient with warm water and soap using forceps and cotton swabs, discard the swabs
Dry the skin with a napkin, throw them off, take tweezers
Wash the external opening of the urethra with furacillin solution
Change the tampon, attach the tampon to the opening of the urethra for 1 min
Discard the tampon, take the catheter's beak with sterile tweezers at a distance of 4-6 cm from its end, clamp the outer end of the catheter between the 4th and 5th fingers of the right hand, pour sterile vaseline oil on the catheter's beak
Spread the labia with your left hand, insert the catheter into the urethra with your right hand by 5-6 cm
Release the first portion of urine into the vessel, release the free end of the catheter into a sterile container
Drop the forceps, push with the left hand over the pubis while removing the catheter, place the catheter in the discharge tray
Suggest the patient to release the last portion of urine in a natural way, number the container with urine, close the stopper, issue a referral, send to the bacteriological laboratory
Remove gloves, wash and dry hands
1.Ectopic pregnancy is a complication of pregnancy in which the attachment of a fertilized egg occurs outside the uterine cavity. ectopic pregnancy distinguish: tubal, ovarian, abdominal pregnancy and pregnancy in the rudimentary horn of the uterus. Treatment of tubal pregnancy is surgical.
In case of progressive ectopic pregnancy, endoscopic surgery can be performed; in other cases, the volume depends on the degree of change in the fallopian tube. oviduct Plastic surgeries are performed in nulliparous women or when the ovum is located in the ampullary section of the fallopian tube, adequate replacement of blood loss is necessary. Patients who have undergone surgery need to undergo rehabilitation therapy aimed at preventing the development of adhesions, repeated adhesion of the fallopian tube, and restoring its functional activity. It is recommended to prevent pregnancy for one year.
2.When high temperature it is permissible for 1-2 days only to drink drinks that quench thirst well. Patients should be given food in small portions 5-6 times a day with more abundant nutrition during the hours when the temperature drops. Cakes, pastries, shortcrust pastry products are not shown. All types of culinary processing are allowed: boiling, stewing, baking and frying without breading. Diet 3-4 times a day. In case of complications and dyspeptic symptoms (upset stools, bloating and other symptoms), it is necessary to appoint a fasting day (boiled vegetables without salt and oil, baked apples).
If the diarrhea is not pronounced, the condition of the patient is of moderate severity, then it is useful to spend a tea fasting day.
In the first 3 to 5 days of illness, dairy products are excluded from the diet, vegetable oil, vegetables and fruits. These foods strengthen and stimulate the stomach and intestines. At this time, a sparing diet of 4a or 4b is usually prescribed.
After 3 - 5 days, with the improvement of the patient's condition, a full diet 4 or 4c is prescribed. This diet is prescribed for a fairly long period. With colitis - for 6 weeks, with enteritis - up to 10 weeks.
After 2-2.5 months from the onset of the disease, it is recommended to adhere to diet number 15.
1) Colposcopy is an examination of the vaginal part of the cervix, its detailed examination using a binocular microscope - a colposcope with an increase of 30 times.
Indications for colposcopy of the uterus:
genital warts;
precancerous changes in the tissue of the vulva, vagina, cervix;
cancer of the vulva, vagina, cervix.
- Contraindications
the first 8 weeks after childbirth, - 3-4 weeks after the abortion,
- recent treatment of the cervix with cryodestruction or surgery.
When carrying out a special, extended colposcopy, a contraindication is an allergy to iodine or acetic acid.
Temporary contraindications for colposcopy can be:
- bleeding from the uterus or cervix, including menstruation,
- pronounced inflammatory process,
- a pronounced state of atrophy of the ectocervix.
2) Infectious - toxic shock - an emergency condition caused by the action of bacteria and their toxins, which is manifested by a violation of the activity of all systems (blood circulation, respiration, the activity of the central nervous system (CNS), blood coagulation, endocrine regulation)
Algorithm for providing emergency care.
1) In case of an infectious-toxic complication, before providing assistance, lay the patient on a flat surface and slightly raise his legs.
2) Create peace and quiet, the sick person should not get up.
3) Provide the flow fresh air(open the window), free from embarrassing clothing (unfasten the top buttons, belt, tie).
3) Warm the person (warm clothes, blanket), put a heating pad at his feet.
4) In case of infectious toxic shock, be sure to monitor the indicators of pulse, respiration and blood pressure.
5) If vomiting is present, help with cleansing is needed oral cavity from vomit, turn the patient's head to one side. These steps will help prevent tongue retraction and vomiting particles aspirated in the event of loss of consciousness.
6) Respiratory or circulatory arrest is possible, start CPR immediately.
Infectious-toxic shock develops in bacterial (meningococcal infection, typhoid fever, plague, dysentery, anthrax), viral (influenza, hemorrhagic fever), rickettsial and fungal diseases.
Shock degrees
1 with compensated shock
(clear consciousness, motor restlessness, anxiety, breathing becomes more frequent., tachycardia up to 110-120 beats per minute. satisfactory filling, a slight decrease in blood pressure, oligoanuria).
2. With subcompensated shock
(apathy, the skin is pale, cold, moist, there is acrocyanosis. Constant shortness of breath. Pulse reaches 160 beats per minute, weak filling, arrhythmic. Heart sounds are deaf. Blood pressure is significantly reduced (85 / 60-60 / 20 mm Hg) . Oliguria or anuria is noted).
3. With decompensated shock (convulsions, loss of consciousness before coma, hypothermia, cyanosis, threadlike pulse, blood pressure may not be detected, shortness of breath, anuria increases).
Treatment
The main principle is detoxification!
1. Detoxification therapy: hemodesis, plasmapheresis, hemosorption….
2.In order to normalize hemodynamics, crystalloid and colloidal solutions of albumin, rheopolyglucin are injected.
3. Corticosteroids have a therapeutic effect ...
4. Mechanical ventilation. Anticoagulants: heparin. Etiotropic therapy. Diuretics and sorbents….
· Routine disinfection is aimed at preventing the spread of pathogenic microbes outside the isolation ward of a medical center or an infectious disease department of a hospital where patients with infectious diseases are located. It is carried out from the moment of isolation or hospitalization of the patient until his complete recovery.
Disinfection exposes the patient's discharge (sputum, vomit, urine, feces) and food residues, patient care items, dishes, underwear and bed linen and other items that the patient comes into contact with, as well as the rooms where he is (ward, dining room, washbasin, toilet, shower, etc.).
Disinfection is carried out daily, and objects with which the patient comes into contact, such as dishes, are disinfected after each use.
Features of disinfection
in the focus of airborne infections
Infection with these infections occurs mainly through the air, which is infected by patients and carriers that release an infectious principle (bacteria, viruses, and others) into the external environment along with droplets of mucus (when sneezing, coughing, loud talking). Large droplets of secretions settle on surrounding objects and infect them.
In case of airborne infections, measures such as ventilation, aeration of premises, their wet cleaning and washing floors with the use of disinfectants in order to reduce air pollution with dust particles and microbes enclosed in them are of great importance for airborne infections. Other disinfection measures are mainly aimed at disinfecting the patient's secretions, things contaminated with them (linen, clothes, dishes, furniture and others) and the premises (barracks, tents, isolation ward, etc.) where the patient was or is, see (Table 4 Appendix No. 4).
In the focus of tuberculosis, the following are subject to disinfection: the patient's discharge (sputum, feces, urine), underwear and bedding, uniforms, bedding, dishes, premises, furniture, household items, etc. methods and means specified in (Table 4 Appendix No. 4).
In the room where the patient was located, the floor, walls, doors, furniture are abundantly and thoroughly irrigated from a hydropower or automax with 5% chloramine solution, 3% HC DCC (or D "GS HK) solution, 6% hydrogen peroxide solution at the rate of 500 ml per 1 m. Cleaning equipment must be soaked in a disinfectant solution.
Transmission mechanism Is an evolutionary process of movement of the pathogen within one population from the organism of one host to the susceptible organism of another host, which ensures the preservation of the pathogen as biological species in nature.
An infected human or animal organism, in which pathogenic pathogens can live, multiply, accumulate and be released into the external environment, is called source of infection.
Epidemic focus- this is the place of residence of the source of infection with the people around it and in the territory within which the transmission of the causative agent of an infectious disease is possible. From the standpoint of the population approach, the epidemic focus is the population of the pathogen with people supporting it.
Anti-epidemic measures and means
Before proceeding to the consideration of individual measures in the prevention of infectious diseases, it is necessary to understand what is meant by the terms that are widely found in the literature on epidemiology, and what is the theoretical basis for organizing and conducting certain measures.
Each section of medicine has a specific system of measures. An important section of clinical medicine is the system of therapeutic measures. In preventive medicine, we can talk about a section that systematizes knowledge about preventive measures. In hygiene, the concepts of primary and secondary prevention are formulated. Measures aimed at preventing infectious diseases are called anti-epidemic measures.
Anti-epidemic measures Is a set of actions justified at this stage of the development of science, ensuring the prevention of the occurrence of infectious diseases among certain groups of the population, reducing the incidence of the total population and eliminating individual infections.
The above definition of the concept of "anti-epidemic measures" fits all actions, in one way or another associated with the prevention of infectious diseases. This does not take into account the time of the events in relation to the time of the onset of infectious diseases (before the onset, during the spread, after the spread). It is customary to differentiate anti-epidemic measures by the time they are carried out into two groups: 1) preventive actions- carried out before the incidence of infectious diseases and are aimed at preventing the occurrence of these diseases; 2) activities carried out in the epidemic focus(actually anti-epidemic) - are carried out in connection with the emergence of an epidemic focus in order to prevent the spread of infection in this focus and beyond.
Development of the theory of self-regulation of the epidemic process V.D. Belyakov made it possible to explain the internal content of the two groups of events identified. Those measures are of a preventive nature, the implementation of which prevents the formation of epidemic variants of the pathogen. The measures carried out in the epidemic focus (anti-epidemic) include measures that prevent the spread of epidemic variants of the pathogen.
There are many activities that can be attributed to preventive or measures carried out in the epidemic focus. From a practical standpoint, the most rational is the grouping of each of the named groups according to the direction of their action. There are activities aimed at: 1) the source of infection; 2) transmission mechanism; 3) the susceptibility of the organism. In addition, a group of general events is distinguished in this grouping.
Additional approaches to grouping involve the allocation of the following groups of anti-epidemic measures:
dispositional measures - prevent disease in case of infection (immunocorrection, immunoprophylaxis, emergency prevention);
exposition measures - prevent infection (isolation, treatment, restrictive, sanitary and veterinary, sanitary and hygienic measures, deratization, disinfection, disinsection);
measures requiring anti-epidemic agents or drugs (treatment, deratization, disinfection, disinsection, immunocorrection, immunoprophylaxis, emergency prevention);
measures that do not require anti-epidemic agents or drugs (isolation, restrictive, sanitary and veterinary, sanitary and hygienic measures).
Criteria for the selection of anti-epidemic measures.
The first criterion is the peculiarities of the epidemiology of individual groups and nosological forms of infectious diseases, which predetermine the possible causes and conditions for the development of the epidemic process.
The second criterion for choosing the main measures is the specific causes and conditions for the development of the epidemic process.
The third criterion that is used when choosing the main directions of activities is the degree of their effectiveness and availability for practical application.
Disinfection Is a set of measures aimed at destroying or reducing the population of vegetative or dormant forms of pathogenic and opportunistic pathogens on abiotic objects of the external environment in order to prevent the spread of infectious diseases.
Distinguish between prophylactic and focal types of disinfection.
Preventive disinfection is carried out in places of probable accumulation of pathogens of infectious diseases out of connection with the epidemic focus.
Focal disinfection is carried out in an epidemic focus in connection with an emerging case of an infectious disease or bacterial carriage. Focal disinfection can be the current and the final.
Current disinfection is carried out in the outbreak in the presence of a source of infection and is aimed at destroying pathogens as they are excreted by a patient or carrier.
Final disinfection carried out after hospitalization, recovery or death of the patient, i.e. after removing the source of infection in order to completely free the focus from pathogens.
Mechanical disinfection method- This is a decrease in the population of pathogens under the influence of mechanical factors (washing, cleaning, filtration, ventilation, etc.).
Physical method of disinfection- This is the destruction or decrease in the population of pathogens under the influence of physical factors (high temperature, ultraviolet radiation, ultrasound, etc.).
Chemical disinfection method- This is the destruction or decrease in the population of pathogens under the influence of chemicals.
Biological disinfection method- this is the destruction of pathogens of infectious diseases in the external environment by means of a biological nature (with the help of antagonist microbes); has a strictly specific purpose.
Disinfection quality is the degree to which disinfection complies with a standard or regulatory requirement.
Disinfection efficiency is the degree to which the end result is achieved due to disinfection.
Preventive disinfection.
The indications for conducting are a high probability of the accumulation of microorganisms and the threat of the spread of infection. It is carried out without regard to the onset of the disease and the formation of an epidemic focus. The main objects of preventive disinfection are:
Treatment-and-prophylactic organizations, children's consultations and other similar institutions (disinfection is carried out during breaks or after the end of receptions);
Preschool and school organizations;
Common areas or crowded places (train stations, steamers, carriages, cinemas, hostels, etc.);
Food industry, trade and public catering organizations, markets;
Enterprises for the processing and storage of raw materials of animal origin;
Intake and water supply facilities;
Hairdressers, saunas, swimming pools and other sports and fitness organizations.
Depending on the nature of the object, prophylactic disinfection is carried out by the economic organizations themselves, if it requires constant and continuous implementation. For example, the milk needs to be pasteurized constantly in dairies; continuous and continuous disinfection of water in waterworks, especially from open water intakes, as well as in swimming pools. Prophylactic disinfection in the listed cases is carried out by the personnel of these organizations. Disinfection departments of territorial CGEiOZ perform methodological and control functions. When preventive disinfection is of a one-time or periodic nature, then it is carried out on a contractual basis by the forces and means of the Centers for Preventive Disinfection or disinfection departments of the CGEiOZ. This, for example, periodic disinfection of markets, premises and equipment of public catering establishments after major repairs or re-profiling, etc.
Current disinfection.
The most common indications for its implementation are:
Stay of the patient in the outbreak before hospitalization;
Treatment of an infectious patient at home until recovery;
The presence of a bacterial carrier in the outbreak until its complete reorganization and removal from dispensary registration;
The presence of a convalescent in the outbreak before being removed from the dispensary register.
Current disinfection in residential hearths infectious diseases are organized by a medical worker who has identified an infectious patient, more often by a district doctor - he explains and trains the patient or persons caring for the patient on the method of conducting the current disinfection. It is carried out in apartment centers by the patients themselves, by bacteria carriers or by persons caring for the sick.
Current disinfection in residential centers includes two groups of measures: sanitary and hygienic and disinfection of objects of the external environment, as well as the patient's secretions. Sanitary and hygienic measures include:
isolation of the patient in a separate room or a fenced off part of it; exclusion of contact with children; limiting the number of objects with which the patient can come in contact;
the allocation of a separate bed, care items, dishes for food and drink - they are stored and washed separately from the belongings of other family members;
compliance with the rules of personal hygiene;
maintaining cleanliness in rooms and common areas (airing and wet cleaning 2-3 times a day using cleaning equipment separately for the patient's room and other rooms); in foci of aerosol infections - wearing cotton-gauze bandages; in the summer, systematic control of flies.
For disinfection of objects of the external environment in apartment centers, physical and mechanical methods of disinfection are usually used using detergents and disinfectants of household chemicals (soda, soap, boiling and hot water, as well as washing, ironing). Chemical disinfectants are used only to decontaminate secretions.
Routine disinfection in infectious diseases and somatic hospitals is carried out in order to prevent nosocomial infections and prevent the spread of infection outside the hospital. Management and control over the current disinfection in health care facilities is entrusted to one of the doctors by order of the chief physician of the organization. The immediate implementation of measures for the current disinfection in hospitals is carried out by junior medical personnel. Current disinfection is carried out during the entire period of patients' stay in a medical institution, from their admission to discharge. An important role in the prevention of nosocomial infections is played by measures aimed at reducing the level of microbial contamination of surfaces and air in the premises of health care facilities. These include cleaning and using ultraviolet rays to reduce microbial contamination and improve hygiene.
Depending on the functional purpose of the premises, they are cleaned in different ways. Distinguish between current and general cleaning in LPO. Routine cleaning is carried out daily, general cleaning (in treatment rooms, dressing rooms, operating rooms, distribution rooms) - weekly.
The current cleaning is carried out with a wet method using detergents and disinfectants. At the same time, they wipe floors, walls, doors and door handles, windows, window sills, radiators, sinks for washing hands and toilets. Cleaning equipment and rags should be clean and stored in a separate cabinet or room. For each functional room, its own marked inventory must be allocated, which is prohibited to use for other rooms. After cleaning, inventory and rags should be disinfected in a disinfectant solution. When carrying out the current disinfection in a medical facility in the presence of patients, it is prohibited to irrigate surfaces with disinfectant solutions, and when wiping, it is prohibited to use drugs that have an irritating effect or cause allergies.
General cleaning is carried out once a week according to the schedule approved by the head of the department. If unsatisfactory results are obtained, the assessment of the degree of microbial contamination of the external environment of the functional premises of the health care facility is carried out outside the schedule. For general cleaning, medical personnel must have special clothing, rubber gloves, goggles (if necessary), sterile rags. Disinfection is carried out by sprinkling or wiping the ceiling, walls, windows, furniture, doors, floor. At the end of the cleaning, bactericidal irradiation is carried out, after which the premises are additionally ventilated for 30 minutes.
Particular attention should be paid to the decontamination of patient care items. For this purpose, they are washed with hot water, soaked in water with the addition of disinfectants, or wiped with a cloth soaked in the same water. Bedding, underwear, dressing gowns after discharge of patients must be disinfected in a chamber method.
In the prevention of nosocomial infections, disinfection of the hands of medical personnel is of great importance. There are three levels of hand decontamination: routine washing, hygienic disinfection, and debridement. Regular wash hands are carried out to remove obvious dirt and bacteria on the skin. Thorough washing of hands with detergents can remove up to 99% of the microflora from the skin surface. Hands must be washed before eating, preparing and serving food, before and after examining patients, visiting the toilet. It is believed that liquid soap is preferable for routine hand washing; hands should be dried with disposable paper towels or personal towels. Before performing invasive procedures, before and after manipulating wounds, after contact with the patient's secretions, hands should be hygienically disinfected using antiseptic soap or wiped with tampons moistened with skin antiseptics, followed by two washing with toilet soap. Surgical hand disinfection is performed by surgeons and nurses before the operation in order to destroy all microorganisms.
Routine disinfection in quarantine groups and classes preschool and school organizations, in closed children's and adolescent organizations, it is carried out in the same way as in LPO, by its own medical and technical personnel.
The general management of the current disinfection, quality control of its implementation is carried out by the Disinfection and Sterilization Centers and the disinfection departments of the CGE.
Final disinfection is carried out after hospitalization of an infectious patient or a carrier of bacteria, recovery or death, i.e. after removing the source of infection. Its goal is to completely free the focus from pathogens. It is necessarily carried out in the foci of infectious diseases indicated in table. 1.
Table 1
List of infectious diseases,
at which the final disinfection is carried out
|
Name diseases |
Indications for final disinfection |
Who is applying |
Terms of execution from the moment of receipt of the application |
Carrying out chamber disinfection of things |
|
Typhus (abdominal, typhus, recurrent, Brill's disease), paratyphoid fever, anthrax, quarantine diseases (plague, cholera, yellow fever), contagious VHF, fever NS(pulmonary form), psittacosis, leprosy. |
Registration of each case |
Directly for hospitalization of the patient |
Necessarily |
|
|
Fungal diseases (microsporia, trichophytosis, favus) |
Registration of each case |
Medical worker of the Skin and Venereal Dispensary |
Within 24 hours from the date specified in the application |
Necessarily |
|
Polio |
Registration of each case |
Epidemiologist or Physician Assistant Epidemiologist |
Necessarily |
|
|
Tuberculosis |
Registration of each newly identified case of an active process, regardless of localization at the place (change) of residence or death |
Dispensary medical worker |
Within 24 hours from the moment you receive the 058 / y form |
Mandatory for bedding, personal items, stuffed animals |
|
Registration of each case in hostels, hotels, hospitals, preschool and adolescent institutions; in health-improving organizations and homes of the elderly, as well as in places of residence of many children. and socially disadvantaged families |
Medical professional who made the diagnosis |
During the day |
Optional, at the request of an epidemiologist |
|
|
Diphtheria |
Registration of each case in educational organizations and apartment |
Medical professional who made the diagnosis |
Within a day from the date of receipt of f.058u |
Not carried out |
|
Viral hepatitis A and E, dysentery, rotavirus infection, salmonellosis, Escherichiosis |
Registration of each case in preschool institutions, boarding schools, orphanages, orphanages, hostels, hotels, health institutions for children and adults, homes for the elderly, in apartment centers of large and socially disadvantaged families |
Doctor-epidemiologist, in his absence - assistant doctor-epidemiologist |
Within a day from the date of receipt of f.058u |
Not carried out. With hepatitis A, E it can be carried out at the request of an epidemiologist |
The final disinfection is carried out by the Disinfection and Sterilization Centers or the disinfection departments of the territorial CGE. When making an application for final disinfection in the foci of tuberculosis and fungal diseases, indicate the date and time of its implementation. In organized teams, the time of the final disinfection is coordinated with the administration of these institutions. The question of the need for final disinfection at the place of work of the sick person or his study or stay in a preschool institution, as well as its scope, is decided by the epidemiologist. It is carried out by the medical and technical staff of the institutions under the guidance of the CGE workers. In case of other infectious diseases, the final disinfection is carried out depending on the epidemic situation by the decision of the chief state doctor of the administrative territory.
In apartment foci of scabies, diphtheria, viral hepatitis A and E, dysentery, salmonellosis, rotavirus infection, the final disinfection can be carried out by family members of the patient after instructions given by a medical worker of the health care facility or an epidemiologist.
In organized collectives, the final disinfection is carried out using chemical disinfectants in the absence of people (patients) who are not related to the treatment. The personnel involved in the final disinfection must use personal protective equipment (respirator, gloves, apron).
Final disinfection is carried out in stages:
Preparation of the required concentrations of disinfectant solutions;
Extermination of flies in the summer;
Treatment of the front door and floor of the patient's room;
Disinfection of the patient's underwear and bed linen by boiling or (according to indications - see Table 1) collecting them in bags for subsequent chamber disinfection, which are treated outside with a disinfectant solution before being removed from the outbreak;
Disinfection of the patient's secretions and containers for them;
- disinfection of sanitary equipment;
Disinfection of the patient's dishes intended for food and food debris;
Disinfection of toys used by the patient;
Processing of paintings, figurines, polished things in the patient's room with which he could contact;
Disinfection of walls, windows, floor in the patient's room; in this case, processing should begin from the distant corners of the room towards the exit;
Disinfection of cleaning equipment, rags;
Stacking disinfectants' overalls in bags intended for chamber treatment;
Hand washing of personnel involved in processing.
During the final disinfection, mainly physical (boiling, burning of low-value items) and chemical (solutions of disinfectants - irrigation, wiping, soaking, immersion) methods of disinfection are used. Moreover, the choice of disinfectants used is strictly selective, taking into account their advantages and disadvantages, focusing on the properties of pathogens of infectious diseases.
Objects are disinfected in the following ways:
Irrigation with disinfectant solutions of surfaces of premises, equipment, furniture, transport;
By wiping with a rag moistened with disinfectant solutions, furniture, equipment, toys, patient care items, medical products;
Immersion in a disinfectant solution of dishes, linen, toys, patient care items, medical products;
Treatment with disinfectants (in the form of powders, granules or concentrated solutions) of food residues, patient's secretions, corpses, waste bins, soil, water, etc.;
Processing in chambers (steam, steam-air or steam-formalin mixture, hot air) of clothes, shoes, bedding, linen, soft toys and other objects with which the patient came into contact;
Irradiation with ultraviolet rays of air, surfaces of various objects.
The choice of the disinfection method depends on the characteristics of the object to be disinfected.
Preventive disinfection- this is a set of measures aimed at destroying or reducing the population of vegetative and dormant forms of pathogenic and opportunistic pathogens on abiotic objects of the external environment in order to prevent the spread of infectious diseases and is carried out without connection with epidemic foci in places of probable accumulation of pathogens of infectious diseases.
The main objects of preventive disinfection are: polyclinics, children's consultations and other similar institutions (disinfection is carried out after the end of receptions or in between them); preschool institutions; common areas, crowded places (train stations, steamships, carriages, cinemas, hostels, markets, etc.); food industry enterprises, food trade and public catering establishments; waterworks; hairdressers, saunas, showers, swimming pools, etc .; enterprises where raw materials of animal origin are stored and processed.
Prophylactic disinfection, depending on the nature of the object, is carried out either by economic organizations themselves or by preventive disinfection centers (disinfection departments of territorial CGE). Business organizations carry out preventive disinfection measures when they need to be carried out continuously and continuously (disinfection of drinking water, pasteurization of milk and dairy products, water treatment in swimming pools, ventilation in cinemas, gyms, etc.). At the same time, disinfection institutions of the sanitary-epidemiological service carry out methodological and control functions.
In some situations, when preventive disinfection is of a one-time or periodic nature, it is carried out under contracts by the forces and means of preventive disinfection centers or disinfection departments of territorial CGE (disinfection of industrial premises after major repairs, periodic disinfection in markets, etc.).
Disinsection- is a set of measures aimed at the destruction and protection of humans from attacks by arthropods of epidemic and sanitary-hygienic importance. Extermination measures and protection from attacks by arthropods are carried out on the territory of settlements, indoors and in the environment. Disinsection measures are subdivided into preventive and destructive.
Target preventive measures- creation of conditions unfavorable for the reproduction and existence of insects. In this case, the main are sanitary and hygienic preventive measures (for example, cleaning the area from substrates favorable for breeding flies). If the development cycle of insects is associated with the aquatic environment, then irrigation and drainage activities play a preventive role.
Extermination activities carried out using mechanical, physical, chemical and biological methods.
Mechanical extermination of insects (the use of traps, paper glue surfaces, a vacuum cleaner, etc.) is advisable to practice in small rooms.
As physical factors that have a detrimental effect on insects, it is most advisable to use various types of exposure to high temperatures (burning, boiling, dry or humid hot air, water vapor, low temperatures, etc.), as well as generators of sound vibrations.
The chemical method is based on the use of chemical compounds - insecticides, biological agents (synthetic regulators of development, pathogens of arthropod diseases, predators-entomophages), repellents and attractants (repelling and attracting substances).
The biological method of insect control is the use of natural enemies of insects and microorganisms that are pathogenic for arthropods.
Depending on the ways of penetration of insecticides into the body of arthropods, they are divided into contact (penetrating through the integument of the body), intestinal (penetrating through the digestive system) and fumigants (penetrating through the respiratory tract).
Currently, preparations of the following groups of chemical compounds are used as the most common insecticides: pyrethrins and synthetic pyrethroids, organophosphorus compounds (karbofos, methyacetophos, etc.), carbamates; insecticides of other chemical groups: imidocloprid, lithium salts, borax, boric acid, benzyl benzoate, butadione, ethylene oxide and methyl bromide. Insecticides are used in the form of powders, dusts, aerosols, pastes, solutions, emulsions, smoke bombs.
When choosing insecticides, they are guided by the biological characteristics of arthropods (their type, stage of development, insecticide resistance). In addition, it is necessary to take into account the properties of the applied insecticides (spectrum of action, concentration of an active substance, form and method of application, toxicity to humans and animals). The choice of insecticide also depends on the type and sanitary condition of the treated object. Possible damage to surfaces by the drugs used, their impact on the environment. Disinsection can be carried out by: irrigation with insecticide solutions of equipment, furniture, surfaces in rooms, vehicles, etc.; - smoking with fumes or mists of insecticides in sealed premises; applying insecticides in the form of varnishes, dusts, gels on the surface; -Application of insecticidal baits locally in places of accumulation, shelter or movement of insects; impregnation with solutions, dusts of insecticides or repellents of clothing, tents, curtains, curtains, bedding, etc.; applying insecticides in the form of shampoos, lotions, ointments to various parts of the human body; treatment of vegetation, water surfaces, buildings, natural foci of infection for epidemic indications using aqueous solutions, suspensions, aerosols. When carrying out disinsection measures in health care facilities, it is prohibited to use drugs that cause an allergic reaction in people. For the treatment of premises, preparations should be used in the form of insecticidal gels, adhesive surfaces, microencapsulated agents, traps. Irrigation and pollination methods in LPO are not applicable.
In an epidemic focus, in connection with the occurrence of a case of an infectious disease or the detection of a bacterial carrier, it is important to carry out focal disinfection to rupture all transmission mechanisms. Focal disinfection is current and final.
Current disinfection is carried out in the outbreak in the presence of a source of infection and is aimed at destroying pathogens as they are excreted by a patient or carrier. The most frequent indications for the current disinfection are: the patient's stay in the outbreak before hospitalization; treatment of an infectious patient at home until recovery; the presence of a bacterial carrier in the outbreak until its complete reorganization; the presence of convalescents in the outbreak before being removed from the dispensary register.
The current disinfection in the apartment foci of infectious diseases is organized by a medical worker who has identified an infectious patient. At the same time, a medical worker (most often a district doctor) explains and trains the patient (or persons caring for the patient) on the method of conducting the current disinfection. It should be emphasized that the current disinfection includes two groups of measures: 1) sanitary and hygienic measures; 2) disinfection of objects of the external environment, discharge of the patient.
The current disinfection in the apartment epidemic foci is carried out by the sick themselves (bacteria carriers) or by persons caring for the sick.
Final disinfection is carried out after hospitalization, recovery or death of the patient, that is, after removing the source of infection in order to completely free the focus from pathogens scattered by the patient.
The final disinfection is carried out by disinfection and sterilization centers or disinfection departments of territorial CGE in epidemic foci with the following infectious diseases (or if this infectious disease is suspected): cholera, relapsing fever, epidemic typhus, Brill's disease, Q fever (pulmonary form), plague, anthrax, viral hemorrhagic fevers, typhoid fever, paratyphoid fever, salmonellosis, tuberculosis, leprosy, ornithosis (psittacosis), diphtheria, fungal diseases of hair, skin and nails (microsporia, trichophytosis, rubrophytosis, favus).
Final disinfection in foci of infectious diseases or with suspected viral hepatitis A and E, poliomyelitis and other enterovirus infections, dysentery, rotavirus infections, intestinal yersiniosis, acute intestinal infections caused by unidentified pathogens, scabies, can be carried out not only by disinfection and sterilization centers, disinfection departments of the CGE, disinfectants of medical institutions, but also (under the direction of the disinfection center sterilization, an employee of the CGE or a disinfectant of a medical institution): a) by medical personnel of medical and preventive institutions; b) medical personnel of children's and adolescent institutions; c) by the population in sparsely populated comfortable apartments or their own houses.
In case of other infectious diseases, the final disinfection is carried out depending on the epidemic situation by the decision of the epidemiologist of the territorial CGE.
The application for final disinfection is submitted to the disinfection and sterilization center or to the disinfection department of the territorial CGE by a medical worker who identified an infectious patient, or an epidemiologist.
It is one of the essential links in the complex of anti-epidemic measures in general. Given the great sanitary and epidemiological significance of disinfection measures, they distinguish between preventive, current and final disinfection. Prophylactic disinfection is carried out without connection with the infectious focus. Current and final disinfection is carried out in the event of infectious diseases, and therefore, these two types of disinfection are called focal disinfection.
Preventive disinfection is carried out to prevent the occurrence of infectious diseases or to prevent their spread to groups of people, among whom there are no specified diseases.
Preventive disinfection is carried out mainly in public places and crowds of people (clubs, theaters, train stations), in child care facilities and schools, in places where food is prepared, stored and distributed, as well as in markets, catering facilities, in medical institutions, in hotels, hostels, public restrooms. Preventive disinfection is carried out systematically, repeating it after a certain period of time.
The most common methods of preventive disinfection are boiling, chlorination, pasteurization, and treatment of crowded places.
Current disinfection is the main method of destroying the mechanism of transmission of infection from a sick person to a healthy person.
The current disinfection is organized in the foci of droplet infections and if they are suspected, with tuberculosis, acute intestinal infections, and skin diseases. When carrying out preventive disinfection, all methods of disinfection are used: mechanical, chemical and physical. The current disinfection is stopped after the patient is hospitalized or after his recovery as directed by the attending physician.
Final disinfection - carried out immediately after isolation, hospitalization, recovery or death of the patient.
It is carried out in order to completely free the infectious focus from pathogens. Final disinfection is especially important because many infectious microorganisms can remain viable in the external environment for several months after the patient or host is free of them or removed from the focus.
The quality of the final disinfection performed, as well as the current one,
controlled using bacteriological research.
Methods for conducting ongoing disinfection
Mechanical method- implies the disinfection of the infectious focus by removing the infectious principle by mechanical cleaning (rinsing with clean water, to which substances have been added that help wash off the dirt). Keeping the home clean is of great preventive importance (wet cleaning with a rag moistened with water or disinfectant liquid). Mechanical treatment of premises does not provide complete disinfection, but thorough and regularly performed wet cleaning of premises can significantly reduce the number of microorganisms in the indoor air.
Mechanical cleaning methods also include laundry. Boiling laundry, washing in hot water, drying and ironing not only the removal of dirt and microbes is achieved, but also the destruction of the latter. Disinfection of premises is also carried out by airing them daily several times a day.
Physical method- includes the use of steam, boiling, dry hot air, sunlight drying. Boiling is widely used in disinfection practice to disinfect items that do not deteriorate from such processing. Infected linen, dishes, some food products, surgical instruments, rubber products, and glassware are boiled. Steam treatment is an effective, manageable, germicidal agent. Usually, flowing steam (with a temperature of 100 ° C) and steam under pressure are used. Steam is also used for sterilization. This achieves the complete destruction of all microbes and their spores, without exception, regardless of whether they are pathogenic or harmless to the human body. Incineration is an effective measure to destroy contaminated low-value materials and objects - paper, rags, food debris, animal carcasses. Incineration is carried out only in case of epidemiological or economic feasibility.
Chemical method- chemical preparations with bactericidal properties are widely used in disinfection. Chemical disinfectants are used in various states: in gaseous, liquid (solutions, emulsions) and solid. In the practice of disinfection, the wet method is used most of all, i.e. treat objects and surfaces with disinfectant solutions. Disinfectants are divided into the following groups: halides, chlorine-containing agents, phenols and their derivatives, heavy metal salts, acids, alkalis, alcohols, quaternary ammonium bases, deodorant agents.
Prices for disinfection of apartments
|
Hotel type room |
|
|
1 bedroom apartment |
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2 room apartment |
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3 room apartment |
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4 room apartment |
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5 room apartment |