Methodical pointing for work of students on practical employment

Module 1
Semantic module 1.
Practical employment №4
Theme: Asepsis. The main pathways of infection. Airborne droplets, contact,
implantation, endogenous, nosocomial and HIV-infection.
Theoretical questions for the extra auditory independent study and discussion to
practical employment №4:
1. History of development of asepsis.
2. Determination of asepsis, ways of transmission of exogenous infection.
3. Structure of operating block, methods of providing of the sanitation-hygienic
mode in an operating block.
4. Structure and principle of work to the autoclave, accident prevention during
work in an autoclave to hit.
5. Preparation to sterilization, methods of sterilization of bandaging material and
operating linen, tests on quality of sterilization.
6. Methods of preparation of hands of surgeon to the operation, elements of care of
hands of surgeon.
7. Methods of treatment of the before operation field.
8. Transporting of patients in an operating-room and from an operating-room.
9. Conducting of cleaning up in an operating-room.
10. Dressing of operating linen.
Literature:
The basic literature:
1. Butyrsky A. General surgery. – Simferopol. 2004.
2. Schevchenko S.I. and others. Surgery. – Kharcov. 2004
The additional literature:
1. Kushnir R. Lectures of General surgery. – 2005.
2. Lyapis M.A. Methods of examination of a surgical patients. – 2004.
3. Methodological recommendations on surgical patients care. – Vinnitsa medical
national university. 2006.

Distributing of the marks appropriated to the students:

At mastering of theme №4 with to the module №1 for educational activity to the
student the estimation for 4th is proposed by a mark (traditional) scale which are after
converted in marks as follows:

Estimation Marks
“5”(fine) 6
“4” (well) 4
“3”(satisfactorily) 2
“2” (unsatisfactorily) 0
 Methodical development for practical employment №4
Module 1
Semantic module 1.
Theme: Asepsis. The main pathways of infection. Airborne droplets, contact,
implantation, endogenous, nosocomial and HIV-infection
I. Actuality of theme
The prophylaxis of hit of infection in a wound matters very much at the grant to the patients of
surgical help. Attaining it is possible thanks to adherence of rules of asepsis, basic position of which
the following is: all, that runs into a wound. it is to be from microorganisms at leisure, that is sterile.
During the given employment the students are to capture the rules of asepsis during organization of
work in an operating block, at preparation to the use of operating linen and bandaging material, to
master the rules of dressing of operating linen, methods of before sterilization treatment of hands and
operating field. Those knowledge’s are important as for the subsequent teaching on the departments of
surgical type so for work already as future specialists.

II. Whole teaching

1. To have imagination about history of development of asepsis (α =І).
2. To know determination of asepsis, ways of transmission of exogenous
infection (α =ІІ).
3. To know the structure of operating block, methods of providing of the
sanitation-hygiene mode in an operating block (α =ІІ).
4. To know the structure and principle of work to the autoclave, accident
prevention during work in an autoclave to her (α =ІІ).
5. To master preparation to sterilization and methods of sterilization of
bandaging material and operating linen, tests on quality of sterilization (α
=ІІ).
6. To know the methods of preparation of hands of surgeon to the operation,
elements of care of hands of surgeon (α =ІІ).
7. To know the methods of treatment of the before sterilization field (α =ІІ).
8. To be able to transport patients in an operating-room and from an operating-
room (α =ІІІ).
9. To be able to conduct cleaning up in an operating-room (α =ІІІ).
10. To be able to dress operating linen (α =ІІІ).
11. To be able prepare solutions and process hands before operative interference
(α =ІІІ).
12. To be able to conduct preparation of the operating field (α =ІІІ).
ІII. Providing of initial level of knowledge’s - abilities
Literature:
The basic literature:
3. Butyrsky A. General surgery. – Simferopol. 2004.
4. Schevchenko S.I. and others. Surgery. – Kharcov. 2004
The additional literature:
4. Kushnir R. Lectures of General surgery. – 2005.
5. Lyapis M.A. Methods of examination of a surgical patients. – 2004.
6. Methodological recommendations on surgical patients care. – Vinnitsa medical
national university. 2006.
ІІІ курс, тема 5 2
 Tests for verification of initial level of knowledges

The founders of aseptic method in surgery are:

A. Pirogov
B. Bergman (+)
V. Paster
G. Shimelbush (+)
D. Lister

Methods of control after sterility of bandaging material and operating linen:

A. Fuse rezortsin
B. Bacteriologichniy method (+)
V. Fuse urea (+)
G. Fuse sulphurs
D. Metod Miculicha

Choose the modes which sterilization in an autoclave is at:

And. 2,5 atm, 145оC, 10 hv.
2,0 Atm, 132 оC, 20 hv. (+)
In. 1,5 atm, 125 оC, 30 hv.
G. 1,1 atm, 120 оC, 45 hv. (+)
D. 0,5 atm, 110 оC, 35 hv.

Which from the transferred methods are the methods of conclusion in bics?
A. Universal (+)
B. Layer (+)
V. Materialniy
G. many purpose
D. Aseptic

An exogenous surgical infection is passed by next ways

A. mechanical
B. rotary
V. hospital
ІІІ курс, тема 5 3
 G. implantation (+)
D. contact (+)

In an operating block the following areas are distinguished:

A. aseptic mode
B. general mode (+)
V. mode antiseptic
G. implantation (+)
D. unsterile mode

In an operating-room the following types of cleaning up are executed:

A. repeated
B. current (+)
V. mechanical
G. previous (+)
D. evening

The conclusion in drum Shimelbush can be:

A. universal(+)
B. sector (+)
V. base
G. sectional
D. air-tight

In work to the autoclave the following phases are distinguished:

A. slow elimination
B. balancing (+)
V. rise of pressure in chambers
G. pressurization
D. elimination (+)

For the control in quality of sterilization it is possible to apply in an autoclave:

A. bacteriological method (+)
B. termoindicatori (+)
V. indexes to the barometer to the autoclave
G. study of color of the sterilization of linen
ІІІ курс, тема 5 4
 D. chemical microbes method

Treatment of hands to the operation can be executed after the following methods:
A. with the use of solution “Pervomour” (+)
B. after a method Kocher
V. after a method Bilrota-Micoulicha
G. after a method Spasocoucotscogo-Cochergina (+)
D. with the use of a 40% solution of ethyl alcohol

For treatment of the operating field use:

A. solution “Dezactin”
B. solution “Yodobac” (+)
V. solution “Yodonat” (+)
G. solution “Yodopiridol”
D. a 100% solution of ethyl alcohol

During the general cleaning up of operating-room it is possible to apply the following

solutions:
A. solution of chloramin 10%
B. solution of hydrogen peroxide 10% from a 0,5% cleanser
V. solution of hydrogen peroxide 6% from a 0,5% cleanser (+)
G. solution of chloramin 1% (+)
D. solution of chloric lime 5%

The general cleaning up is conducted:

A. at the end of working day
B. in the planned order a 1 time per a week (+)
V. in the planned order 2 times per a week
G. not provided for by the plan after the operations, during which contamination of
operating-room happened by intestinal maintenance (+)
D. every time before the beginning of operating day

It is necessary to use for preparation of solution of pervom:

A. a 6% solution of hydrogen peroxide
B. pergidrol (+)
V. a 96% solution of ethyl alcohol
ІІІ курс, тема 5 5
 G. a 100% vinegar acid
D. a 100% ant acid (+)

IV. Table of contents of teaching

History of development of asepsis and antiseptic.
The weakness of surgeons before infectious complications in IX age was simply scare.
Very exactly the large Russian surgeon N.A.Velyaminov after the visit of one of large
Moscow clinics described the state of surgery in those times: “Saw the brilliant operations
and... tsarstvo of death”. So proceeded until at the end of XIX age in surgery did not get
distribution of teaching about an asepsis and antiseptic in the origin of which it is possible to
select the five perietapiv:
 Empiric period
 Before Lister antiseptic of XIX age
 Antiseptic Listera
 Origin of asepsis
 Modern asepsis and antiseptic

Empiric period. First, as we name now, “methods antiseptic”, it is possible to find in

works of doctors of still ancient times. Some of them: they were considered obligatory by
deleting of strange body from rani, in the laws of moses was banned to touch a wound by
hands, Gippocrat preached principle of cleanness of hands of doctor, applied for treatment of
wounds a rain-water, wine; shaved off a hair cover from the operating field; spoke about the
necessity of cleanness of bandage material. However purposeful, intelligent actions of
surgeons in relation to warning of festering complications began considerably later – only in
the middle of XIX age.
Before Lister antiseptic ХA Х age. A Hungarian accoucheur Ignats Zemmelveys in
1847 assumed that at women the post-natal fever develops as a result of skidding of ptomaine
in privy parts by students and doctors during implementation of vaginal research (students
and doctors got busy also in an anatomic theater). Zemmelveys offered before internal
research to process hands by a chloric lime and obtained phenomenal results: post-natal
lethality as a result of development of sepsis went down from 18,3% to 1,3%. However, did
not support Zemmelveys, and persencution and humiliation, that he tested, was led to that he
was hospitalized in a funny house, and later died from a sepsis as a result of to the whitlow.
M.I.Pirogov did not create whole works on the fight against an infection. But he was
in a half-pace from creation of teaching about antiseptic. Still in 1844 he wrote: “From us

ІІІ курс, тема 5 6

there is near that time, when the careful study of traumatic and hospital will give miazm to
surgery other direction”. M.I.Pirogov respectfully behaved to labours I.Zemmelveys and, still
to Listera, applied on occasion for medical treatment the row of matters antiseptichnih (nitric
acid silver, chloric lime, winy and camforniy alcohol).
Works Zemmelveys, M.I.Pirogov could not do revolution in science. In appearance of
“lister antiseptic” the robots of Lewie Pastera about the role of microorganisms in the
processes of fermentation and decay (1863г).
Origin of antiseptici. Successes of microbiology, labours L.Pastera and R.Coha pulled
out the row of new principles in the basis of prophylaxis of surgical infection. They became in
a basis for creation of study Listera about a method antiseptic. Main from them was out
contamination by the bacteria of hands of surgeon and objects, that run into wound. Thus, in
surgery entered treatment of hands of surgeon, sterilization of instruments, bandage material
and linen. Development of aseptic method is related to the names E.Bergman and his student
C. Shimelbush.
On Х International congress of surgeons in Berlin in 1890 principles of asepsis at
medical treatment of wounds got common confession. E.Bergman showed the patients
operated in aseptic terms without application of “lister antiseptic”. The basic postulate of
asepsis was here accepted: “All, that runs into wound, there must be the sterile”.
For sterilization of bandage material a high temperature was used above all things. R.
Cochom (in 1881) and E. Esmarch were offered method of sterilization by fluid steam. In the
same time in Russia Heydenreych first in a world led to, that sterilization of steam under the
promoted pressure is most accomplished, and in 1884 suggested to use an autoclave for
sterilization.
A large merit belongs to the Russian surgeons M.S. Subotin and L.L.Levshin, which
created, strictly speaking, the about type of modern operating-rooms. N.V. Sclifosovskiy
suggested distinguishing operating-rooms for the different on infectious contamination
operations.
Modern asepsis and antiseptic. A high temperature, that is the basic method of asepsis,
could not be used for treatment of living fabrics. Thanks to successes of chemistry for
medical treatment of festering wounds and infectious processes the row of new facilities
antiseptic was offered. Similar matters began to be used for treatment of surgical instruments
and articles of care of patients. Thus, gradually asepsis very tightly interlace with antiseptic,
and now without unity of these two disciplines surgery it is simple unthinkable.
Theodore Bilrot, which still recently make fun of antiseptic Listera, in 1891 said:
“Now by clean hands and clean conscience an inexperienced surgeon can attain the best
results, than earlier the most famous professor of surgery”.
ІІІ курс, тема 5 7
 The model following numbers: before introduction of asepsis and antiseptic after
operation lethality in Russia in 1857 made 25%, and in 1895 – only 2,1%.

Asepsis – complex of the cure - prophylaxis measures directed on warning of hit of

microorganisms in a wound or in the organism of man in whole one.

Ways of distribution of infection in an organism:

An infection is considered exogenous, that inculcate in a wound from an external
environment: and) from air – air infection; ) with the breezes of saliva or other liquids –
drops infection (sometimes unite in one kind – air-drops infection); in) from objects, that run
into wound – contact infection; g) from objects, that remain in a wound (stitches, drainages,
metallic or plates the bars, artificial valves of heart and etc) – implantation infection.
The transfer of pathogenic microorganisms from a patient to the patient is reflected as
a cross infection.
Endogenous an infection is considered, that is found in an organism or on his
scinofbody. An endogenous infection gets in a wound either directly (contact), or on vascular
ways (limfogenic or gematogenic). Inflammatory processes on a skin (furuncles, carbuncles,
piodermii, eczema and in.) are the basic hearths of endogenous infection, hearth infection
GCT (tooth decay, gingivitis’s, holetsistitis, holangitis, pancreatitis and in.), infection of
respiratory tracts (sinusitis, traheitis, bronchitis, bronhoectaticha illness), infection of
urogenitalis ways (pielitis, cystitis’s, prostatitis, ouretritis, salpingoooforitis), hearths of
criptogenus infection.

Operating block – it is the set of the special apartments for implementation of

operative interferences and conducting of measures, that they are provided. An operating
block must be disposed in the separate apartment either wing of building and be the united
corridor with the surgical separation, or on the separate floor of multistory surgical corps.
More frequent are present division between itself operating-rooms for implementation of
interferences at “clean and “festering” patients”, although more expedient is to foresee
separate, the isolated operating block at the festering surgical separations.
An operating block is separated from the surgical separations by the special platform –
more frequent it is part of corridor, in which the apartments of operating block of the general
mode go out. For providing of the mode of sterility in an operating block the special
functional areas are selected.

ІІІ курс, тема 5 8

 1. The area of the sterile mode unites an operating-room before operation and
sterilization room. In the apartments of this area execute: in an operating-room –
directly operations; in before sterilization – preparation of hands of surgeon to the
operation; in sterilization room – sterilization of instruments.
2. Such apartments enter in the area of the strict mode, how sanitation room is that
consists of rooms for undressing of personnel, shower-bath options, booths for
dressing of sterile clothes. These apartments are disposed consistently, and a
personnel goes out from a booth for dressing straight or through a corridor in
before sterilization. The apartments for saving of surgical instruments and
vehicles, anesthesia apparatus and medicines enter in this area, cabinet of blood
transfusion, apartment for a duty brigade, senior operating sister, and sanitary knot
for the personnel of operating block.
3. The area of the limited mode, or technical area, unites the production apartments
for providing of work of operating block: an apparatus for disinfection of air is
here found, vacuum options, options for providing of operating-room by oxygen
and narcotic gases, accumulator substation for the emergency enlightening,
photographic laboratory for the display of x-ray photography tapes.
4. In the area of the general mode the cabinets of manager, senior medical sister,
apartment for sorting of muddy linen and others like that are found.

The mode of operations of operating block foresees the limited his visit; in the area of
the sterile mode a personnel must be found only, that takes part in the operation (surgeons and
their assistants, operating sisters, anaesthetists and anestezist, junior nurses). In the area of the
sterile mode students and doctors, that pass internship are assumed. A man is the main source
of infection in an operating-room, therefore working of operating block wear special clothes:
dressing-gowns or jackets and pantaloons, that differ in color from the clothes of employees
of other separations. In this clothes to them it is banned to go out from an operating block.
The hygiene of employees of operating block must be ever-higher. They must regularly pass
the bacteriological control, sanouvati the chronic hearths of infection.
The apartment of operating block must be built so that maximally lighten support of
surgical cleanness. The walls of apartment dye to ceiling by an oil paint or cover by a tile,
corners round off. On windows there must be large glass with transoms that are opened
inward. A floor is covered by a tile. The area of operating hall on a 1 operating table must
make not less than 40 m2.
The equipment of operating-room consists of operating table, special lamp, special
movable lamp, anesthesia apparatus, anesthesia dinner-wagon, large instrumental table,
ІІІ курс, тема 5 9
movable dinner-wagon for instruments, dress box on supports with a pedal occasion, wall or
ceiling bactericidal lamps, surgical tool, vehicles for electro-coagulation and other.
Furnitures in an operating-room is to be light, easy (from a metal, glass, plastic),
comfortable, simple after construction, it is easily to wash.
For the rise of sterility of air facilities are used for cleaning of air. For this purpose use
to the wave drawing ventilation and transoms which open during cleaning up. In an operating-
room the humidity must be not less than 60%, temperature 22-23 oC. The promoted pressure in
an operating-room is instrumental in the current of air from an operating-room in other
apartments – it allows in a few one time to decrease the number of before operating
complications.
Disinfection of air is executed by local or centralized methods. Deleting of air takes
place through the drawing opening, that are disposed on an opposite wall. Efficiency of
measures on cleaning of air in an operating-room is controlled by sowing of air to, under time
and after the operation, from the hands of operating brigade.
Transporting of patients in an operating-room and in a chamber is executed on heel -
stretcher, which are covered by polyethylene tape or oilcloth which process properly
disinfectant.
It is necessary for warning of contact infection, that all, that is to run into a wound,
was sterile. It is achieved by sterilization of operating linen, bandaging and stitch material,
instruments, by treatment of hands of surgeon and operating field. Sterilization of stitch
material is directed on warning both contact, and implantation infection of wound.
Sterilization of instruments, bandaging material and linen includes the following basic
stages:

1. before sterilization preparation of material.

2. Conclusion and preparation to sterilization.
3. Sterilization.
4. Saving of sterile material.

Gauze marbles, serviettes, tampons, belong to bandaging material, bandages. Apply

them during the operation and bandaging with the purpose of drainage of wound, stops of
bleeding, for dreinage or tamponadi wound. Bandaging material is prepared from a gauze and
cotton wool, rarer from a viscose and lignin.
All wares which are used during the operation enter in notion of operating linen, and
also in work of bandaging, manipulation and specialized cabinets. Dressing-gowns surgical,
sheets, towels, masks, little caps, bahili, belong to operating linen. Cotton fabric serves by
ІІІ курс, тема 5 10
material for their making. Operating linen of reusing must have the special mark and seem for
elimination separately from other linen in the special waterproof sacks. At dressing-gowns
must not be pockets, belts.
Usually bandaging material that operating linen is sterilized in an autoclave. The for
this purpose provided and prepared to sterilization material is inlaid in drum. In default of
bicsiv sterilization in linen sacks is assumed. There are next methods and types of conclusions
of material in bicsi Shimelbush.
Universal conclusion – in drum place the material intended for one small typical
operation (apendectomi, flebectomi and others like that).
Conclusion having a special purpose – in drum inlay the necessary set of bandaging
material and operating linen, intended for implementation of concrete operation
(pnevmonectomi, resection of stomach and others like that).
Specific conclusion – in drum inlay the definite type of bandaging material or linen
(drum with dressing-gowns, drum with serviettes and others like that).
Basic rules of technician of safety during work with an autoclave:
 Exploitation to the autoclave is possible at presence of permission of Inspection
from the care of caldrons.
 Before work with an autoclave the persons, that handed over a technical minimum
from exploitation to the autoclave and that a proper license is had, are assumed.
 Necessarily it is needed to earth a steam sterilizer with the electric warming up.
 Not to proceed to work on a defective vehicle.
 During work not to abandon a vehicle without examination.
 Not to refill water in a watering-can during work of sterilizer.
 After sterilization to disconnect heater from the network of feed and cover the
valve of admittance steam in sterilization camera from steam for make camera.
 To open the lid of sterilization chamber only since the pointer of manometer will
go down to the zero.

Dressing material Operation linen

gauze swabs overalls

napkins sheets
tampons towels
turundas Stages of preparation to apply pilovs
bandages mask
cap
clots

ІІІ курс, тема 5 11

 Before sterilization Packing and Sterilization Preserve sterilization of
preparation praparation to material
sterelization

universal steam under the In drum of

purpose pressure Shimelbush
view rays-sterilization In sack
lager
sector

Methods of control for sterilization

Direct Undirect

Bacteriological

Apply of substance Apply of Apply of

with definite mark thermoindication thermometers
of fuse

Autoclave

Works fases Heating Balance Destruction Cold

Regime of Base Add

work

Pressure – 2 at. Pressure – 1,1 at.

Temperature – 132o Temperature – 120o
Exposition – 20 min Exposition – 45 min

Preparation of hands to the operation. Treatment of hands — important mean of

prophylaxis of contact infection. Doctors-surgeons, operating and dressing nurse must
constantly care of cleanness of hands, to look after after a skin nails. Most of microorganisms
are saved under nails, in the region of nail valiciv, in the cracks of skin. Departure after hands
ІІІ курс, тема 5 12
foresees warning of cracks and defeats of skin, cutting of nails (they must be short), deleting
of scratch’s. The work related to contamination and infection skins of hands, it is needed to
execute in gloves. Correct departure after hands needs to be considered as a stage in
preparation of them to the operation. Treatment of hands by any method is begun with the
mechanical cleaning.
Methods Furbringer belong to the classic methods of treatment of hands, Alfeld,
Spasocucotsciy-Cochergin, which now, however, are not practically used. Methods
Furbringer, Alfeld and others foresee the previous washing of hands by a sterile brush and
soap. Brush, that hold in a right hand, soap by soap, then nicely conclude on the back surface
of brush and retain by a palm which a brush is found in. Whether brush the serviette must
move in direction from fingers to the forearm, brushes — to be found higher than forearms
and stream of warm running water — to be sent from fingers to the elbow. In such the
position begin and conclude washing by a brush, out edema of water from an elbow to the
brush. Palm's surface of every finger is washed at first, then back surface and nail beds,
interfinger intervals of the left brush, then right, then palm and rear of the left and right
brushes and, finally, forearm to granitsi of the their overhead and middle third. Soap-suds are
constantly washed off by running water, a brush is soaped as far as a necessity. For all time of
washing of hands do not touch to the faucets, the stream of water and its temperature is
regulated before washing. On ending of washing brush and nicely conclude on a dinner-
wagon, hands rinse by water and, still holding the brushes of hands at the level of breasts, dry
out a skin by sterile gauzes or serviettes by a towel, not touch to the unwashed-up areas of
skin. Farther (in dependence on the method of treatment) fingers, brushes, the lower third of
forearms is wiped by serviettes, abundantly moistened by an alcohol, solution of cerigel or
other antiseptic. On the method of the Alfeld hand wipe by a 96% alcohol during 5 hv. For
Furbringer after the mechanical cleaning of hand wipe hv during 1. by solution of soulemi by
a 1:1000 and then 96% alcohol during 3 hv.; in conclusion nail beds grease by a 5% brandy of
iodine.
A method Spasocucotsci-Cochergin and treatment of hands of pervomour (preparation
C-4), gibitan is presently more widespread methods of washing of hands
(hlorgecsidinabigluconat).
A method Spasocucotsci-Cochergin foresees the mechanical cleaning of hands by a 0,5%
solution of liquid ammonia. Hands wash in two pelves on 3 hv. by a napkin, execute to
motion consistently, as at washing by a brush, beginning with the fingers of the left hand. In
the first pelvis the hands are washed to the elbows, in the second – to granitsi of overhead and
middle third of forearm. On ending of washing of hand rinse by solution of liquid ammonia
and brush lift up so that drops of water flowed down to the elbows. From this time of brush of
ІІІ курс, тема 5 13
hands are constantly found higher than forearms. The skin of hands is drained by sterile
napkin: at first both brushes (this napkin is given up), then consistently lower and middle third
of forearms. Disinfect a skin by the serviettes moistened by a 96% alcohol, processing twice
on 2,5 hv. brushes to lower third of forearms, then tags of fingers, nail valici; nail beds and
folds of skin of fingers to oil by a 5% alcoholic solution of iodine.
Treatment of hands of pervomur (preparation C-4). Pervomur – mixture which appears
at the reaction of ant acid and of hydrogen peroxide. At first basic solution is prepared in
correlation of a 81 ml 85% ant acid and 171 ml 33% solution of hydrogen peroxide, that mix
up in a glass crockery with a cork grinding in and place in a refrigerator on 2 hours,
periodically shaking off a mixture. Nadmouravin acid will appear at co-operation of ant acid
and of hydrogen peroxide, that owns strong bactericidal action. From the noted quantity of
basic solution it is possible to prepare 10 l of working solution of pervomur, mixing up him
with the distilled water. Working solution suitable to application for a day. At preparation of
solution it is necessary to work as in rubber gloves for warning of burns the concentrated
solutions of ant or acids of hydrogen peroxide. Treatment of hands foresees the previous
washing of them during 1 by hv running water with soap. Then brushes and forearms to the
level of the middle third wash by napkin in a pelvis with solution of pervomur during 1 hv.
And drain by sterile serviettes; in one pelvis the treatment of hands can be done by 10
persons.
Treatment of hands of chlorgecsidinbiglyoconat. He as a 20% water solution is let out.
For treatment of hands a 0,5% alcoholic solution is prepared: a to 500 ml 70% alcohol is
added to a 12,5 ml 20% solution of chlorgecsidinbiglyoconat. Preliminary wash hands by
running water with soap, drain by sterile napkin or towel, and then wipe by the gauze
serviette moistened by the prepared solution, during 2-3 hv.
The speed-up methods of treatment of hands are applied in ambulatory practice or in
extreme situations. For speed-up disinfection of hands preparation of cerigel is used, that
differs by strong bactericidal action. In his composition enter from make fiem and a 96%
ethyl alcohol. Hands are washed by water with soap, drain carefully. On a palm pour 3-4 ml
cerigel and carefully during 10 seconds moisten them the fingers, nail beds and nail fold,
brushes and lower part of forearm. Half-bent fingers hold in the divorced position during 2-3
hv., while tape of cerigel will not appear on a skin. Tape, that appeared, is protective and
bactericidal characteristics, on ending of operation she is easily taken off by the gauze
marbles moistened by an alcohol.
Preparation of the operating field. Previous preparation of place of the supposed
operating cut (operating field) begins in eve the operation and includes general hygienical

ІІІ курс, тема 5 14

bath, change of linen, shaving of hair by a dry method directly in the place of operating
access. After shaving of hair a skin is wiped by an alcohol.
At treatment of operating field i directly in an operating-room it is needed to observe
the following principles:
- treatment must be considerably wider, than area of operative access
- sequence the treatment – «from centra to periphery»
- recurrence of treatment during the operation (to beginning and before imposition of
stitches)
- most muddy areas are processed in the last turn
Before surgical operation on operating table the field of operation widely lubricate by
a 5% alcoholic solution of iodine. Insulate the direct place of operation by sterile linen and
again lubricate by a 5% alcoholic solution of iodine. Before imposition and after put of
stitches on the skin of her process by the same alcoholic solution. This method is known as a
method Grossicha-Filonchicova.
At intolerable of iodine by a skin at adult patients and at children conduct treatment of
operating field by a 1% alcoholic solution of brilliant green (method Baccala).
For treatment of the operating field use 0,5% alcoholic solution of gibitan
(chlorgecsidinbiglyoconat), as well as for treatment of hands of surgeon before the operation.
Treatment of the operating field of pervomur can be applied (3-multiple, during 1,5
minutes).
During the urgent operation the preparation of the operating field consists in shaving
of hair, to treatment of skin by a 0,5% solution of liquid ammonia, and then apply one of
methods for treatment of the operating field.
Sterilium is used for hygienical and surgical disinfection hands. Instantaneous action
of alcoholic constituent against microorganisms is complemented by antimicrobial additions
which simultaneously guarantee optimum of long duration action. Additions for the care of
skin protect hands even at frequent application of preparation.
Numerous researches led to the wide spectrum of action, instantaneous of action (at
the hygienical use – 30 s) and remaining action (over 3 hours under a glove) Sterilium in the
relation of microorganisms.
Sterilium is preparation for frequent application.
Sterilium is a universal and everywhere applicable mean. The systems of dosage allow
to take away him uncontact. Metering devices can be placed wherein necessary hygienical
disinfection hands.
Methods of application of sterilium
Hygienically disinfection hands: 3 to rub ml 30 seconds in a dry skin. For the
ІІІ курс, тема 5 15
prophylaxis of tuberculosis treatment is executed twice.
Surgical disinfection hands: a minimum 10 to ml solution to rub by portions during 3
minutes in the skin of brushes and forearms.

Cutasept G i Cutasept F are used for before- after operation treatment of skin and
wounds.
Preparation by a tampon to inflict on a skin, well to moisten her, to survive 5 minutes.
For a disinfection skin before the injections, catheterization, punction, taking of blood,
shallow medical operations, at the damages as a result of unhappy case and shallow traumas,
at the eczematous infections of bacterial or fungus origin. Areas of skin, that is subject to
disinfection to moisten to the complete impregnation and survive during 30 seconds.
Before operation treatment of skin of the operating field: The tampon moistened by
preparation to apply for 2th or 3th multiple wiping out, then to replace. At first disinfection
the place of the supposed cut of skin, after adjoining natural habitat of skin. The disinfection
operating field to do twice. Time of influencing – 5 minutes.
Hygienical disinfection hands: 3ml - 30 seconds
Surgical disinfection hands: 2х5 ml – 5 minutes

V. Reference basis of action

Order of conducting of the general cleaning up in an operating-room.
The general cleaning up is conducted a 1 time per a week, and also not provided for by
the plan after operative interferences, during which contamination of operating-room
happened by intestinal maintenance, pus, after operative interference at a patient with the
necrotic process caused by an anaerobic clostridia infection). The general cleaning up is
conducted on principle of final disinfection.
At the beginning of cleaning up it is needed to calculate the quantity of disinfection
solution, which is to be used. Room measure of operating-room usually known and is
indicated in “Magazine of consideration of conducting of the general cleaning” up on a title
page. The norm of charges on 1 m2 relies on the variety of disinfection, that will be applied. It
is the most widespread norm 150-200 ml on 1 m2 depending on a surface, that is processed (it
is covered by a tile, the quality of coverage, covered by a paint and others like that). It is
needed to take into account chemical properties of disinfection, to cause his power the
corrosion of metals, to damage a paint, fabric and others like that. During cleaning up to use
the rules of safety for work with given disinfection, to use facilities of defence.
For conducting of the general cleaning up apply most often:
 Solution of hydrogen peroxide 3% from a 0,5% cleanser.
ІІІ курс, тема 5 16
  Solution of hydrogen peroxide 4% from a 0,5% cleanser.
 Solution of hydrogen peroxide 6% from a 0,5% cleanser.
 Solution of chloramini 1%.
From imported disinfection means, that can be used in Ukraine, preparations are
applied on the basis of aldehyde (aerodezin, basilol plus, deconecs 50 AF), sodium salt
of dichlorizianurow acid (chlorsept), izopropenal (deconecs, solarsept) and other
facilities.

The sequence of cleaning up consists in the following:

 To free a surface, that is processed, from objects which are found on them (except
for a bactericidal lamp), to draw aside from the walls of closet, apparatus and
other.
 Irrigate walls, doors of window of disinfection solution, beginning from above, on
a height there are not less 2th meters.
 To wipe by a rag, moistened disinfection solution,, equipments, during ovens,
apparatus and other.
 Irrigate disinfection floor, here the charges of disinfection solution must be from
computation 200-250 ml on 1 m2.
 In the case of conducting by the disinfection method of wiping out, surfaces twice
wipe 15 minutes with an interval.
 Plug in bactericidal lamps on 60 minutes.
 To wipe the all treated surfaces by a rag, moistened plumbing water.
 Plug in bactericidal lamps on 30 minutes.
 To ventilate the apartment.
During conducting of the general cleaning up also disinfetion, there are worn through
bactericidal lamps. Glass of bactericidal lamp is worn through a 70% ethyl alcohol, screen of
apparatus – by a dry rag, the corps of armature is worn through the rag moistened in a 3-6%
solution of hydrogen peroxide.
Solution of a 6% of hydrogen peroxide with a 0,5% cleanser is used in the case of
presence (suspicions) of microbnih cages, that form spores, in that number anaerobic
infections. At presence of in mid air apartment, on the articles of fungi a 4% solution of
hydrogen peroxide is used for cleaning up. In other case – a 3% solution.
In the magazine of consideration of the general cleaning up are written down to give
conducting of the general cleaning up, which disinfection conducted disinfection, their
concentration, how many solution is used, signature of person which conducted cleaning up.
ІІІ курс, тема 5 17
 Dressing of operating linen.
After treatment of hands an operating sister first passes to the operating-room, where
by means junior nurse or other medical sister proceeds to dressing of sterile to the dressing-
gown. Still in before operating a junior nurse wipes to the operating sister oil cloth apron
which hands are usually washed in, and carefully, that not to soil the treated hands, takes off
him. A medical sister opens bikes with sterile dressing-gowns and, checking up the fitness of
dressing-gowns after the reaction of indicator of sterility, takes out dressing-gown which is
built as a roll, opens out him and puts on. A junior nurse or other medical sister strings behind
a plot and belt. Watch thus, that the edges of sterile to the dressing-gown fully closed unsterile
linen. Then from the second to bicsou or from the non-permanent packing reaches sterile
rubber gloves and dress them.
Surgeons also get dressed independently, but a dressing-gown gives them operating
sister, and sometimes and helps, supporting him at a sleeve. Plots on sleeves surgeons string,
but, if it is needed hurry, an operating sister helps them herein. Plots behind and a belt strings
junior nurse or other trained nurse. Gloves to the surgeon an operating sister gives thus, that
last by rapid motion brought a hand into a glove how possible is deep. The put on gloves are
usually processed by a 96% ethyl alcohol, that to delete tailings of powder.

Methods of before operation preparation of hands.

Method Spasococotsci-Cochergin.
At the beginning of hand wash by soap under a faucet by hot water. Then during 6
minutes (2 times on 3 minutes) wash hands in two pelves in a 0,5% solution of ammonia by
means the serviette. Pelves before pouring of solution of ammonia are baked by an alcohol.
After washing of hands in solution of ammonia of them wipe by a sterile towel and wipe by
the serviette moistened in a 96% solution of ethyl alcohol. Then oil nail beds by a 5%
alcoholic solution of iodine and dress gloves.

Treatment of chlorgecsedinbiglyoconat (gibitan).

A 20% solution of chlorgecsidinbiglyoconat is let out in glass bottles on 500 ml.
Hands are processed by a 0,5% alcoholic solution of gibitan, for what conduct a 20% solution
of chlorgecsidinbiglyoconat in a 70% ethyl alcohol in correlation 1:40, that is on 500 to the ml
70% ethanol add a 12,5 ml 20% solution of chlorgecsidinbiglyoconat.
Hands at the beginning are washed by warm water with soap, then wipe them by a
sterile towel, whereupon during 2-3 minutes wipe by a 0,5% alcoholic solution of
chlorgecsidinbiglyoconat by means the serviette. Wiping out needs to be conducted
ІІІ курс, тема 5 18
systematic, finger after a finger, watching, that to skip none area of skin of fingers, brush and
lower part of forearm. After wiping of hand out dry out.

Before operation treatment of hands of pervomur.

Pervomour is a mixture the of hydrogen peroxides, ant and nadmuravin acids, here the
last appears in the process of reaction between two first ingredients. Solution of pervomur,
initial and works (2,4% and 4,8% on nadmuravin acid), is prepared, coming from the
computation presented in table.

Computation of component parts for making of solutions of pervomur

Initial solution Working solution

Ant acid, ml H2O,
Pergidrol, ml
100% 85% 2,4% 4,8%
17,1 6,9 8,1 To 1 0,5
34,2 13,8 16,2 To 2 1
85,5 34,5 40,5 To 5 2,5
171,0 69,0 81,0 To 10 5
* Water can be distilled, plumbing, artesian and marine outboard, taken at a sea or in an
ocean. Concentration is given in the percents of nadmuravin acid.

For preparation of initial solution in a glass retort the proper quantity of hydrogen
peroxide of is poured, and then add ant acid. Shake a retort off and will prevent in a pan with
cold water, or in a refrigerator, on 1-1,5 hours, shaking off a retort every 20-30 minutes. For
this term ant acid appears in solution. Initial solution can be saved at a room temperature a 1
day. Working solution suitable to the use during a 1 day. Consequently, pervomur it is
possible to prepare every 2 days.
For treatment of hands solution of pervomur 2,4% is applied on nadmuravin acid. For
this purpose a 120 ml fresh initial solution add a to 4,880 ml water. Initial solution of
pervomur, getting on a skin and mucus, can cause a burn, therefore during work with the
concentrated solution of this preparation it is necessary to be careful. Drops of solution, that
got on a skin, it is needed immediately to wash off by a plenty of plumbing water. If the drop
of solution got in an eye, immediately it is needed to wash an eye by water, repeating this
procedure repeatedly, whereupon it is necessary to appeal for the help to the oculist.
Treatment of hands of pervomur consists in the following: at the beginning of hand wash with
soap under running water during a 1 minute without a brush; hands are wiped dryly by a
sterile towel; dip hands in solution of pervomur to the elbow bends on a term a 1 minute;

ІІІ курс, тема 5 19

hands are wiped by a sterile serviette or towel; sterile gloves are dressed. In one to the pelvis
can process hands to 10 persons.

Transporting of patients in an operating-room and in a chamber from an operating-

room.
Transporting of patients in an operating-room and in a chamber is executed with the
use of wheel stretcher which is covered by polyethylene tape or oilcloth. Tape or oilcloth are
processed by the rag moistened by a 3% solution of hydrogen peroxide with a 0,5% washing
solution. After it cover them by a clean sheet and blanket. Transporting must be sparing and
with the exception of shoves.
To carry and translate a patient 2 or 3 men can on hands.
From the chamber of surgical separation in an operating-room a patient is transported
on wheel stretcher only. In before operation room a patient translate into wheel stretcher of
operating block and deliver to operating table, looking after after his state. After the operation
of patient a doctor-anaesthetist is transported in the separation of intensive therapy at
obligatory participation. A patient is inlaid on a functional bed. Especially carefully it is
needed to translate a patient with external drainages. It is needed to use an elevator. At his
absence of patient 2 or 4 men carry on loads by a head ahead at getting up on shoots or feet
ahead – at lowering.

VІ. System of teaching tasks for verification of eventual level of knowledge’s:

Situation tasks

During transporting of patient contamination of sheet and oilcloth happened from an

operating-room, that wheel stretcher was covered, by excretions from drainage and
operating wound. What appearance it is necessary to prepare wheel stretcher by for
transporting of other patient to the operating-room?
Answer: oilcloth, that covers wheel stretcher it is necessary to process by a 3%
solution of hydrogen peroxide with a 0,5% cleanser, to substitute a sheet by clean.

Sick D., under local anesthesia by a 0,5% solution of novocaine in an operating-

room lipoma is remote in the area of corner of right shoulder-blade. The state of patient
during the operation and after her is stable, satisfactory. By What appearance delivery a
patient to the chamber from an operating block?

ІІІ курс, тема 5 20

 Answer: to transport the given patient in a chamber it is necessary in recumbency
on wheel stretcher.

During an operating day at a pelvis with pervomur it is executed treatment of hands

a 10 time by surgeons, that took part in the operations. Another operative interference in
which three surgeons will take part is to happen. Where must they process hands by
solution of disinfection?
Answer: after 10 treatments of hands in solution of pervomur the last is to be
transferable on fresh solution, after it the surgeons will process in it the hands before the
operation.

During preparation of working solution of pervomur for surgical treatment of hands

a medical sister by a chance poured out itself on the left brush the two-bit of initial of
solution of this preparation. In an area, where the contact with solution happened, appeared
burning character the pain, hyperemia of skin. What must be done in such case?
Answer: the concentrated initial solution of pervomur caused a burn on a cyst at an
operating medical sister; it is necessary protractedly to wash the staggered brush by
plumbing water, then to impose an aseptic bandage.

For preparation of solution of pervomur for surgical treatment of hands an operating

sister in a glass retort mixed up to 85,5 ml pergidrol from a 34,5 ml 100% ant acid. Well-
educated mixture she led to to 5 l by plumbing water at a pelvis for treatment of hands
before the operation. What error was assumed by a medical sister?
Answer: mixture to pergidrol and ant acid is to be self-possessed during 1-1,5 hours
in a refrigerator, periodically during this display she must be shaken off; only after it she is
conducted in the proper quantity of water at a pelvis.

During preparation to urgent interference in to the operating-room the distilled water

turned out absent. By What appearance to divorce the initial concentrate of pervomur, that
to do working solution for surgical treatment of hands?
Answer: for preparation of working solution of pervomur it is possible to apply
plumbing water.

It is necessary to prepare pervomur for surgical treatment of hands in a quantity 10

to l. What ingredients and in what quantity it is necessary to apply for this purpose?

ІІІ курс, тема 5 21

 Answer: it is necessary to take a 240 ml initial concentrated solution of pervomur
and divorce them at a 9760 ml plumbing or distilled water.

In an urgently surgical clinic urgent operative interference concerning sharp

appendicitis is to happen in the evening. The operating trained nurse for surgical treatment
of hands took solution of pervomur 2,4%, that was prepared still in a wound before the
beginning of operating day and in which the executed treatment of hands was a 9 time. How
did an operating sister act right?
Answer: a medical sister acted right, the given solution suitable to the use during a
1 day.

During implementation of operative interference to sick S. concerning sharp

intestinal impassability the contamination of operating-room happened by maintenance to
the intestine. What is to be executed in an operating-room after the given operation before a
next operative interference to other patient?
Answer: in an operating-room it is necessary to execute the general cleaning up not
provided for by the plan.

The general cleaning up is to happen in an operating-room. General area, that is to

be subject to treatment is evened 150 m2. What quantity of solution for cleaning up needs to
be prepared?
Answer: it is necessary to prepare solution from computation 150-200 ml on 1 m2,
consequently it is necessary to prepare 30 l of solution for cleaning up of the given
operating-room.

Sick D., 65 years, prepared to the planned operative interference concerning left-side
inguinal hernia. A medical sister with the purpose of preparation of the operating field to
the operation executed shaving of area of last on eve day of operation in the evening. At the
review of patient in the day of operation exposure of area of hyperemia and also infection
scratches in the town of the future operating field. Operative interference by a surgeon was
abolished. What happened? What error was assumed by a medical sister at preparation of
the given patient to operative interference.
Answer: shaving of area of the operating field is to take place in a wound in the day
of operation; to the given patient the interference was abolished from development at him
of festering defeats of skin after shaving.

ІІІ курс, тема 5 22

 Operative interferences is to happen in an operating block. That it is necessary to do
in an operating-room at the beginning of operating day with the purpose of preparation of
her to work.
Answer: in an operating-room before the beginning of operating day the previous
cleaning up is to be executed.

During implementation of operative interference muddy blood serviettes and

marbles fell down on the floor of operating-room, were outpoured washing water after
sanatio of abdominal region. What actions are to be executed by the personnel of operating-
room in such case?
Answer: the junior nurse of operating block in such case must execute the current
cleaning up.

An operating medical sister opened bics with operating linen, that to cover table before
the operation. Linen is moist, an urea was not melted. It is possible to apply such linen during
the operation, why?
Answer: no, applying such linen not impossible.

During put of stitches on wound a student by a hand in a glove remedied a mask on the
face and continued farther to assist. Nobody noticed it. Could student continue to assist?
What complications can development at a patient and what type of infection she belongs to.
Answer: no, he could not continue to assist, he was to repeat treatment of hands and
replace gloves. Violation of rules of asepsis can result in development of festering-septic
complications.
VII. The method of conducting of employment is that organizational structure of
employment
Distributing of marks, that are appropriated to the students:

At mastering of theme №4 from rich in content to the module №1 for educational

activity to the student the estimation for 4th is proposed by a mark (traditional) scale which
are after converted in marks as follows:

Estimation Marks
“5”(fine) 6
“4” (well) 4

ІІІ курс, тема 5 23

 “3”(satisfactorily) 2
“2” (unsatisfactorily) 0 marks

Technological card of employment

№ Basic stages of employment, their Level of Methods of control Materials of the methodical Distributin
p/p functions and maintenance zasvo- and teaching providing g of time
ennya (hv.)
Preparatory stage
1. Organizational measures 1-3
2. Raising of educational purposes П.1 "Actuality of theme" 5
is that motivation П.2 "Educational
purposes"

3. Control of initial level of Table: ways of 20

knowledges, skills, abilities Individual distribution of infection
1. History of development of AND questioning
asepsis. ІІ Table: principle of
2. Determination of asepsis, structure and work to the
ways of transmission of Tests ІІ of autoclave.
exogenous infection. ІІ
3. Structure of operating block, Table: structure of
methods of providing of the operating block
sanitation-hygienic mode in an
operating block. ІІ Table: preparation and
4. Structure and principle of sterilization of bandaging
work to the autoclave, accident material, methods of
prevention during work in an ІІ control after sterility
autoclave to her.
5. Preparation to sterilization, Table: preparation of
methods of sterilization of hands and operating field
bandaging material and operating to operative interference
linen, tests on quality of ІІ
sterilization.
6. Methods of preparation of
hands of surgeon to the operation, ІІ
elements of care of hands of
surgeon.
7. Methods of treatment of the
before operation field.

ІІІ курс, тема 5 24

 Basic stage
4. 1. To transport patients in an ІІІ Professional Loads, wheel stretchee. 5
operating-room and from an training in the Operating block,
operating-room ІІІ decision of facilities of cleaning up. 10
2. To conduct cleaning up in an untypical clinical Operating linen, bics
operating-room ІІІ tasks Shimelbush. 10
3. To dress operating linen ІІІ Practical training Facilities for treatment of 15
4. Prepare solutions and to hands before the
process hands before operative operation.
interference ІІІ Facilities for treatment of 10
5. To conduct preparation of the the operating field.
operating field Tasks ІІІ of

5. Final stage ІІІ Individual control Tests ІІІ of 12

6. Control and correction of level of skills Tasks ІІІ of
of professional abilities and Tests ІІІ of
skills
7. Work out the totals of
employment “Short methodical
Domestic task (basic and pointing” to work on
additional literature after a practical employment.
theme)

Tests for verification of initial level of knowledge’s theme №4

ІІІ курс, тема 5 25

 Sterilization of bandaging material and operating linen. Organization of work in an
operating-room. Surgical treatment of hands of surgeon and operating field.

The founders of aseptic method in surgery are:

A. Pirogov
B. Bergman
V. Paster
G. Shimelbush
D. Lister

Methods of control after sterility of bandaging material and operating linen:

A. Fuse rezortsin
B. Bacteriologichniy method
V. Fuse urea
G. Fuse sulphurs
D. Metod Miculicha

Choose the modes which sterilization in an autoclave is at:

And. 2,5 atm, 145оC, 10 hv.
2,0 Atm, 132 оC, 20 hv.
In. 1,5 atm, 125 оC, 30 hv.
G. 1,1 atm, 120 оC, 45 hv.
D. 0,5 atm, 110 оC, 35 hv.

Which from the transferred methods are the methods of conclusion in bics?
A. Universal
B. Layer
V. Materialniy
G. many purpose
D. Aseptic

An exogenous surgical infection is passed by next ways

A. mechanical
ІІІ курс, тема 5 26
 B. rotary
V. hospital
G. implantation
D. contact

In an operating block the following areas are distinguished:

A. aseptic mode
B. general mode
V. mode antiseptic
G. implantation
D. unsterile mode

In an operating-room the following types of cleaning up are executed:

A. repeated
B. current
V. mechanical
G. previous
D. evening

The conclusion in drum Shimelbush can be:

A. universal
B. sector
V. base
G. sectional
D. air-tight

In work to the autoclave the following phases are distinguished:

A. slow elimination
B. balancing
V. rise of pressure in chambers
G. pressurization
D. elimination

For the control in quality of sterilization it is possible to apply in an autoclave:

A. bacteriological method
B. termoindicatori (
ІІІ курс, тема 5 27
 V. indexes to the barometer to the autoclave
G. study of color of the sterilization of linen
D. chemical microbes method

Treatment of hands to the operation can be executed after the following methods:
A. with the use of solution “Pervomour”
B. after a method Kocher
V. after a method Bilrota-Micoulicha
G. after a method Spasocoucotscogo-Cochergina
D. with the use of a 40% solution of ethyl alcohol

For treatment of the operating field use:

A. solution “Dezactin”
B. solution “Yodobac”
V. solution “Yodonat”
G. solution “Yodopiridol”
D. a 100% solution of ethyl alcohol

During the general cleaning up of operating-room it is possible to apply the following

solutions:
A. solution of chloramin 10%
B. solution of hydrogen peroxide 10% from a 0,5% cleanser
V. solution of hydrogen peroxide 6% from a 0,5% cleanser
G. solution of chloramin 1%
D. solution of chloric lime 5%

The general cleaning up is conducted:

A. at the end of working day
B. in the planned order a 1 time per a week
V. in the planned order 2 times per a week
ІІІ курс, тема 5 28
 G. not provided for by the plan after the operations, during which contamination of
operating-room happened by intestinal maintenance
D. every time before the beginning of operating day

It is necessary to use for preparation of solution of pervomur:

A. a 6% solution of hydrogen peroxide
B. pergidrol
V. a 96% solution of ethyl alcohol
G. a 100% vinegar acid
D. a 100% ant acid

During transporting of patient contamination of sheet and oilcloth happened from an

operating-room, that wheel stretcher was covered, by excretions from drainage and
operating wound. What appearance it is necessary to prepare wheel stretcher by for
transporting of other patient to the operating-room?

Sick D., under local anesthesia by a 0,5% solution of novocaine in an operating-

room lipoma is remote in the area of corner of right shoulder-blade. The state of patient
during the operation and after her is stable, satisfactory. By What appearance delivery a
patient to the chamber from an operating block?

During an operating day at a pelvis with pervomur it is executed treatment of hands

a 10 time by surgeons, that took part in the operations. Another operative interference in
which three surgeons will take part is to happen. Where must they process hands by
solution of disinfection?

ІІІ курс, тема 5 29

 During preparation of working solution of pervomur for surgical treatment of hands
a medical sister by a chance poured out itself on the left brush the two-bit of initial of
solution of this preparation. In an area, where the contact with solution happened, appeared
burning character the pain, hyperemia of skin. What must be done in such case?

For preparation of solution of pervomur for surgical treatment of hands an operating

sister in a glass retort mixed up to 85,5 ml pergidrol from a 34,5 ml 100% ant acid. Well-
educated mixture she led to to 5 l by plumbing water at a pelvis for treatment of hands
before the operation. What error was assumed by a medical sister?

During preparation to urgent interference in to the operating-room the distilled water

turned out absent. By What appearance to divorce the initial concentrate of pervomur, that
to do working solution for surgical treatment of hands?

It is necessary to prepare pervomur for surgical treatment of hands in a quantity 10

to l. What ingredients and in what quantity it is necessary to apply for this purpose?

In an urgently surgical clinic urgent operative interference concerning sharp

appendicitis is to happen in the evening. The operating trained nurse for surgical treatment
of hands took solution of pervomur 2,4%, that was prepared still in a wound before the
beginning of operating day and in which the executed treatment of hands was a 9 time. How
did an operating sister act right?

ІІІ курс, тема 5 30

 During implementation of operative interference to sick S. concerning sharp
intestinal impassability the contamination of operating-room happened by maintenance to
the intestine. What is to be executed in an operating-room after the given operation before a
next operative interference to other patient?

The general cleaning up is to happen in an operating-room. General area, that is to

be subject to treatment is evened 150 m2. What quantity of solution for cleaning up needs to
be prepared?

Sick D., 65 years, prepared to the planned operative interference concerning left-side
inguinal hernia. A medical sister with the purpose of preparation of the operating field to
the operation executed shaving of area of last on eve day of operation in the evening. At the
review of patient in the day of operation exposure of area of hyperemia and also infection
scratches in the town of the future operating field. Operative interference by a surgeon was
abolished. What happened? What error was assumed by a medical sister at preparation of
the given patient to operative interference.

Operative interferences is to happen in an operating block. That it is necessary to do

in an operating-room at the beginning of operating day with the purpose of preparation of
her to work.

During implementation of operative interference muddy blood serviettes and

marbles fell down on the floor of operating-room, were outpoured washing water after

ІІІ курс, тема 5 31

sanatio of abdominal region. What actions are to be executed by the personnel of operating-
room in such case?

An operating medical sister opened bics with operating linen, that to cover table before
the operation. Linen is moist, an urea was not melted. It is possible to apply such linen during
the operation, why?

During put of stitches on wound a student by a hand in a glove remedied a mask on the
face and continued farther to assist. Nobody noticed it. Could student continue to assist?
What complications can development at a patient and what type of infection she belongs to.

ІІІ курс, тема 5 32