13. Treatment of the surgeon's hands before the operation.

Equipment: containers with solutions of antiseptics (0.5% solution of chlorhexidine, cerigel, manopronto), a basin with a working solution of Pervomura, sterile wipes, gauze balls.

Execution technique. Before treatment with antiseptic solutions, the surgeon will wash his hands. Hands alternately lather with liquid soap up to the upper third of the forearms and then wash off the foam with warm running water, while the hands should be above the elbows so that dirty water flowed from the wrist to the elbows. Hand washing continues until the foam and washing water is completely clean. Then the surgeon dries his hands with a sterile towel or napkin and proceeds to the treatment with antiseptics.

When using a 0.5% solution of chlorhexidine, the surgeon with two gauze balls abundantly moistened with a solution of chlorhexidine for 3 minutes treats the hands to the upper half of the forearms, paying special attention to the treatment of the periungual spaces and interdigital spaces.

When using pervomur, after the hands are washed with running water and soap and dried with sterile wipes, the hands and forearms to the level of the middle third are washed with wipes in a basin with a working solution of pervomur for 1 minute and dried with sterile wipes.

Pervomur (preparation C-4) - a mixture consisting of formic acid and hydrogen peroxide. Pervomur stock solution is prepared from 81 ml of 85% formic acid and 171 ml of 33% hydrogen peroxide solution in a glass bottle with a ground stopper. The bottle with the resulting mixture is placed in the refrigerator for 2 hours and shaken periodically. The working solution is prepared by diluting the specified mixture with distilled water up to 10 liters. The solution is suitable for use during the day.

When using cerigel it is necessary:

Apply 3-4 g of cerigel to the skin of the palms.

Rub the solution for 8-10 seconds to the lower third of the forearm, distributing it thoroughly and evenly.

Dry your hands by slightly spreading your fingers.

Put on sterile gloves.

After the operation, the film is washed off the hands with alcohol.

When using a solution of manopronto, the agent is applied to the hands twice in 5 ml and rubbed into the skin of the hands and to the middle of the forearms until the agent evaporates. After treatment with the drug put on gloves.

14. Preparation of the surgical field.

Equipment: razor, antiseptic solution, sterile adhesive film, cotton wool, forceps, sterile gauze wipes.

Execution technique. On the eve of the operation, the skin in the area of ​​the proposed surgical intervention is thoroughly washed with soap and water, and during orthopedic operations and operations with large foreign bodies (pins, meshes, artificial joints and other structures) left in the wound, after mechanical cleaning of the skin, the surgical field is treated with an antiseptic and closed aseptic dressing.

On the morning of the operation, the hair in the area of ​​the surgical field is widely shaved dry and wiped with alcohol.

For the treatment of the skin of the surgical field are used:

1% iodonate solution,

0.1% iodopyrone solution,

0.5% solution of chlorhexidine bigluconate,

pervomur solution.

Skin treatment is performed by double lubrication with an antiseptic before applying sterile material, lubricating the skin before incision, lubricating the skin before suturing and lubricating the skin after suturing.

Currently, various schemes for processing the surgical field and covering materials are used in the world. The use of traditional cotton sheets does not completely isolate the patient's skin from contact with instruments, the surgeon's hands in gloves, etc. To create a truly sterile surface, it is recommended to cover the surgical field with a sterile plastic film through which the skin is incised.

Special sterile adhesive films are used, which are applied to the antiseptic-treated and dried skin in a taut state. The skin incision is made through the film. At the end of the operation, before suturing, the film is peeled off, and the skin is treated with an antiseptic.

Rice. 41. The operating field is covered with sterile

plastic film.

From traditional ways processing of the surgeon's hands is widely used simple and affordable Spasokukotsky-Kochergin method. First, wash your hands up to the elbow running water with a brush and soap, then with a napkin in a 05% solution ammonia up to the upper third of the forearm sequentially in two basins for 3 minutes. Dry hands with a towel or napkins (sterile); hands are treated with 96 ° ethyl alcohol for 2 minutes. To treat hands before surgery, you can also use a number of antiseptics - degmin, chlorhexidine (gibitan), pervomur, tserigel. Hand treatment with 1% degmin solution is convenient. Wash hands first warm water with soap, rinsed in running water, then treated twice with napkins (foam rubber sponges) moistened in a basin with 1% degmin solution for 3 minutes and wiped with a sterile towel. The pharmacy network produces a 30% solution of degmine (degmicide) in vials. Before use, degmicide should be diluted 30 times plain water. The bactericidal properties of the solution are preserved. Chlorhexidine (gibitan) is produced in vials of 500 ml of a 20% aqueous solution. On the day of hand treatment, it is diluted 40 times with 70 ethyl alcohol until a 0.5% solution is obtained. A 1% aqueous solution of chlorhexidine is also used, for which the initial solution is diluted 20 times with distilled or boiled water. First, hands are washed in running water with soap and then in a basin with 0.5% alcohol or 1% aqueous solution of chlorhexidine for 3 minutes and wiped with a sterile towel. The procedure for preparing the working solution of Pervomur is as follows - first mix 171 ml of a 33% hydrogen peroxide solution and 69 ml of a 100% formic acid solution with the addition of water to 1 liter. This mixture is placed in the refrigerator for one hour. Up to 5 liters of tap water are added to 120 ml of the initial solution and a working solution is obtained in which no more than 15 people can handle the hands. The solution is only suitable for 6-8 hours. First, hands are washed in running water, wiped with a clean towel and then immersed in Pervomura solution for 1 minute and wiped with a sterile towel. A very simple method of preparing the surgeon's hands with cerigel, a synthetic film-forming antiseptic liquid. In the amount of 3-4 ml, it is carefully rubbed on the skin of the hands and the lower third of the forearms. Then the hands are dried in the air; fingers spread apart so that when the antiseptic dries, they do not stick together. The resulting film is sterile and prevents direct contact between the skin of the hands and the wound. After processing the hands in any way, sterile rubber gloves should be worn to keep the skin aseptic. During the operation, gloves are periodically treated with antiseptics, especially after the "dirty" stages.

Treatment of the surgical field. On an outpatient basis, the processing of the surgical field can be associated with certain difficulties. interventions in emergency cases have to be performed on contaminated areas, especially on the hand and foot. The skin is first washed with napkins with soap, solution washing powder or ammonia (05% solution). Fuel oil, fatty contamination is removed with napkins moistened with gasoline. Then the skin is treated with 70% ethyl alcohol and twice with an iodine alcohol solution. However, in this solution, when stored for more than 3 months, hydroiodic acid is formed, which, together with iodine, has an irritating effect on the skin, causing dermatitis or burns. AT last years to treat the surgical field, other antiseptic preparations began to be used: 1% solution of degmin, with which tampons are abundantly moistened and the skin is treated twice; 05% solution of chlorhexidine (water-alcohol), which is used to treat the skin twice with an interval of 2 minutes. A rational substitute for an alcoholic solution of iodine is iodonate - an aqueous solution of a complex of a surfactant with iodine. The drug contains 45% iodine. To process the surgical field, a 1% solution is used, for which the initial iodonate is diluted 45 times with distilled water. The skin is smeared twice with this solution before the operation. Before suturing the skin, it is treated again. Control over the state of asepsis in dressing rooms, operating rooms is carried out by sanitary and epidemiological institutions that periodically perform bacteriological examinations of the treated hands of the surgeon, suture material, tools, dressing material from sterile biks. In dressing rooms, at least once a month, bacteriological air cultures are performed. The number of microorganisms in 1 m "of air in the room should not exceed 500-1000. The head of the medical center controls the results of bacteriological studies for the timely adoption of measures to eliminate deficiencies in sterilization and adherence to the work of dressing rooms.

Treatment of the surgical field- the general name of measures aimed at disinfecting the integument of the body in the area of ​​the surgical field.

Hand treatment

Hand treatment - I

disinfection of the skin of the hands of personnel involved in operations, dressings and other surgical procedures in order to prevent the entry of microorganisms into the wound and onto objects in contact with it. On the skin of the hands, both on its surface and in cracks, folds, sweat and sebaceous glands, hair follicles and especially under the nails, there are constantly many microorganisms. Therefore careful O. river. is a prerequisite for compliance with asepsis (Asepsis).

The basis various ways O. r. mechanical cleaning (washing with water with brushes), disinfection with antiseptic solutions, tanning of the skin. With the help of mechanical cleaning and antiseptic agents, it is possible to free only the surface of the skin from microorganisms, while the microbes that are in the ducts of the sweat and sebaceous glands, in the hair follicles, remain and can, in a short time after O. p. get on the surface of the skin and cause its infection. Therefore, with O. p. in order to compact the surface layers of the skin, tanning agents are used (ethyl alcohol, iodine alcohol solution, tannin solutions, etc.). The tanning effect of these remedies is more pronounced if they are applied to dry skin; the tanning effect persists for 20-30 minutes, but quickly disappears when the skin is moistened.

With all methods of O. p. first, they wash the palmar, then the back surface of each finger, the interdigital spaces and the nail beds of the left, then right hand, after which they wash the wrists, and only then the forearms. Particularly carefully treat the skin in the area of ​​the interphalangeal joints and the nail bed. Wipe hands with a sterile napkin and treat with antiseptics in the same sequence. The hands and forearms should be kept in a slightly elevated position so that the water from the forearms does not flow onto the hands. Applied to O. river. brushes, tools, wipes must be sterile. The brushes used for O. of river maintain in soapy water and then boil.

With insufficient care for the hands, the presence of cracks, abrasions and scratches on them, the infection of the skin increases. In these cases it is very difficult to achieve effective O. p. Therefore, doctors and nurses involved in the operation must carefully take care of their hands, keep them clean, cut their nails neatly and shortly, and protect the skin from scratches, burrs, and abrasions. A good effect is provided by the use of hot baths and lubrication of hands at night with petroleum jelly with lanolin, a mixture of ammonia, glycerin and ethyl alcohol in equal amounts or special hand creams. When working in the kitchen, in the garden, etc. the surgeon and operating nurse are advised to use rubber gloves. Periodically, at least once a month, bacteriological control of the sterility of the hands of participants in operations should be carried out (see Sterilization).

All existing O. methods of river. do not provide absolute sterility. In addition, during the operation, the hands become contaminated with microorganisms that enter the surface of the skin from its pores. Therefore, operations and surgical procedures should be carried out with rubber gloves (see. Medical gloves), which, during long-term operations, are treated with antiseptic solutions every hour, replace them if integrity is broken or after the completion of the stage of operations associated with possible infection (for example, suturing an intestinal defect) .

classic ways. To classical ways O. r. include the methods of Spasokukotsky - Kochergin, Furbringer and Alfeld.

Method of Spasokukotsky - Kochergin. With this method, O. p. use a 0.5% solution of ammonia, which has a good degreasing effect. After washing hands under running water, they are washed in a 0.5% solution of ammonia (for every 100 ml hot water- 0.5 ml of ammonia) with gauze napkins sequentially in two basins for 3 minutes each. After a single use, the solution in the basin is changed. Then the hands are wiped dry with a sterile towel and, for the purpose of tanning, are treated for 5 minutes with a gauze ball soaked in 96% ethyl alcohol.

Furbringer's method(modified). Hands are washed with a sterile brush with soap under running water warm water within 10 min. At the same time, the brush is changed after 5 minutes, after which the hands are wiped with a sterile towel and treated with a 1:1000 sublimate solution for 1-2 minutes and 96% ethyl alcohol for 3 minutes. The nail beds are lubricated with a 5% alcohol solution of iodine.

Alfeld method. Hands are washed in the same way as in the Furbringer method, but they are treated for 5 minutes with 96% ethyl alcohol.

Currently, these methods are rarely used, because. they take a lot of time and are not always effective enough.

Modern methods. In connection with the emergence of new antiseptic agents with good disinfecting, wetting, washing properties, providing deep penetration them into the skin, use O.'s methods of river. without the use of brushes and tanning agents.

Hand treatment with novosept, degmicide. Hands are washed with warm water and soap for 2-3 minutes, rinsed thoroughly and wiped with two cotton swabs or foam rubber sponges (3 minutes each). A solution of novosept (3%) or degmicide (1%) is poured into the pelvis and they rub their hands first with one and then with another foam rubber sponge (3 minutes each). Thanks to good penetration preparations in the skin tanning with alcohol is not required. This consumes about 50 ml of solution.

Hand treatment with a mixture of hydrogen peroxide and formic acid solutions (Pervomur, C-4). AT glass vessel pour 170 ml of 30-33% hydrogen peroxide and 69 ml of 100% (or 81 ml of 85%) formic acid, after which the vessel is placed in cold water for 1-1.5 hours and shake occasionally. For O. river. use a 2.4% solution of this mixture, which is obtained by adding up to 10 l tap or distilled water. Hands are washed with soap for 1 minute, wiped dry with a sterile cloth and then treated with Pervomur solution in an enamel basin for 1 minute and wiped again. The solution retains its bactericidal properties for 6-8 hours.

Hand treatment with chlorhexidine bigluconate (gibitan). Gibitan is produced as a 20% aqueous solution in glass containers up to 500 ml. For O. river. this solution is diluted in 70% ethanol in a ratio of 1:40, i.e. 12.5 ml of 20% chlorhexidine solution is added to 500 ml of 70% alcohol (0.5% water-alcohol solution is obtained). After preliminary washing of hands with soap and water and subsequent drying with a sterile napkin, O. p is produced. with a cotton swab moistened with a solution of gibitan for 2-3 minutes.

Treatment of hands with cetylperidine chloride in a film-forming composition (tserigel). After pre-washing hands with soap and water, 2-3 ml of liquid cerigel is applied to dry skin and thoroughly rubbed for 8-10 seconds so that the preparation evenly covers the entire surface of the hands up to the middle third of the forearms. Hands are dried in air for 2-3 minutes, after which they are covered with a thin and durable film.

Hand treatment with brandosept. After pre-washing the hands in running water with soap, without drying them, pour 5 ml of brandosept into the palm, which is rubbed on the hands and forearms for 1 minute. Such rubbing is carried out five times, then the hands are dried, preferably with a sterile towel.

Other Methods. In the absence of the above antiseptics, you can use the Brun method, which consists in rubbing your hands with 96% ethyl alcohol for 10 minutes, or treating your hands with 2% iodine alcohol solution for 3 minutes.

In case of emergency, quick disinfection of hands is carried out with 70% alcohol (ethyl, isopropyl) within 1 minute after preliminary washing of hands with soap (96% alcohol has a predominantly tanning effect, 70% alcohol is bactericidal). Iodophors (iodopyron, iodonate), deoxon-1 are quite suitable for hand treatment.

Bibliography: General Surgery, ed. V. Schmitt and others, trans. from English, vol. 1, M., 1985; Struchkov V.I. and Struchkov Yu.V. General surgery, p. 64, M., 1988.

the general name of measures aimed at disinfecting the hands of personnel involved in a surgical operation.

encyclopedic Dictionary medical terms M. SE-1982-84, PMP: BRE-94, MME: ME.91-96

The surgeon and his assistant must carefully prepare their hands for the operation. Hand disinfection is very difficult due to the inability to use for this purpose high temperature and concentrated solutions of antiseptics. The greatest number of microorganisms accumulates under the nails, in the area of ​​the nail folds, in skin cracks. Their care includes the prevention of cracks and calluses of the skin, trimming nails (they should be short), removing burrs. Of particular difficulty is the disinfection of hands from microbes that accumulate in the excretory ducts of the sebaceous and sweat glands, in hair follicles. Work associated with contamination and infection of the skin of the hands should be done with gloves. Proper Care behind the hands should be considered as a stage in preparing them for surgery. Hand washing method should be skin friendly. The surgeon's skin cannot be disinfected in 100% of cases, so the main task of preparing hands for surgery is to minimize the number of microorganisms on the skin and prevent the release of new bacteria from its depth.

Great importance it also has the preparation of the surgical field (zone of the proposed incision) before surgery in order to prevent possible postoperative complications.

Existing methods processing of the surgeon's hands before the operation can be divided into two groups - classical, currently having more historical meaning(Alfeld, Furbringer, Brun, Spasokukotsky-Kochergin,) and modern, based on the use of effective antiseptics of the latest generation.

Classical methods of processing hands have lost their importance due to a number of circumstances. Their technique is described in detail in the relevant textbooks and manuals on general surgery and dwell on them. detailed description not necessary.

It is necessary to remember the fact that in order to reduce the bacterial contamination of the surgical field, the Russian surgeon Zege-von-Manteuffel for the first time in the world proposed the use of rubber gloves.

Some details should be emphasized, for example, that the Furbringer method is harmful to the body, since one of the stages of hand treatment uses a solution of sublimate (mercury dichloride), which is a heavy metal salt with a pronounced hepato- and nephrotoxic effect.

The purpose of using alcohol for leather tanning in a number of other classical methods (for example, according to the Brun method) is to reduce the pores of the skin and, as it were, “immure” bacteria in them for the duration of the operation.

The method of hand treatment according to Spasokukotsky-Kochergin is based on the dissolution of alkaline ammonia solution (0.5% ammonia solution is used) of fats on the surface and in the pores of the skin and washing out with a solution of bacteria.

Iodine tincture in the form of a 5% solution for hand treatment is not currently used, since iodine has a pronounced allergenic effect, and, according to a number of authors, a carcinogenic effect.

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Preparing the surgeon's hands for surgery pursues not sterilization of the skin of the hands, but:

Minimize the number of germs on the hands;

Prevent the entry of microbes from the depths of the hands during the operation.

The main stages of all methods:

1. mechanical cleaning;

2. degreasing;

3. disinfection or disinfection;

4. tanning.

Hand washings for sowing should be carried out every 15 days.

Classical methods of processing the surgeon's hands:

a) Furbringer method:

1) wash your hands in warm water with a brush and soap for 10 minutes

2) rinse with 80% alcohol for 1 min

3) immerse hands in a 1:1000 sublimate solution for 1-2 minutes

b) Alfeld method:

1) wash hands with soap and water with two sterile brushes under running warm water (1 brush for 5 minutes)

2) wipe your hands with a sterile cloth

3) treat with a gauze ball with 96% alcohol for 5 minutes

4) lubricate the fingertips with weak alcohol iodine tincture

in) Spasokukotsky-Kochergin method:

1) wash hands in two enameled basins with 0.5% warm solution NH 4 OH 3 min each

2) dry hands with a sterile cloth

3) treat hands with a gauze swab with 96% alcohol for 5 minutes

Modern Method processing of the surgeon's hands (EN-1500):

1) wash your hands with warm water and soap for 2 minutes, then dry your hands with a sterile cloth

2) treat the nail beds and periungual areas with disposable sterile wooden sticks moistened with an antiseptic

3) apply an antiseptic on the skin of the hands and forearms in portions, rubbing thoroughly:

a) rub palm on palm

b) rub the left hand on the back of the right and vice versa

c) rub palms with fingers crossed and spread apart for at least one minute

d) rub the back of the bent fingers on the palm of the other hand

e) alternately rub the thumbs in a circular motion

f) alternately rub the palms with the fingertips of the opposite hand in multidirectional circular motions

For one treatment 10 ml of antiseptic.

After the antiseptic has completely evaporated, we put on sterile gloves.

For the treatment of hands, the following solutions of antiseptics are used:

a) Pervomur C-4 (2.4% or 4.8%)

b) cerigel

c) chlorhexidine bigluconate (gibitan)

d) septocide.

Operating field preparation(5% iodine solution is prohibited):

1% solution of iodonate;

1% iodine pyrone;

0.5% alcohol solution of chlorhexidine

Rokkal 2 minutes;

Pervomur 1 minute.

Grossich-F method:

The operating field is widely processed three times;

Covered with operating linen;

We process immediately before the cut;

During the operation when changing clothes;

Before suturing the skin;

After suturing.

When disinfecting the air in the operating room, ventilation, air conditioning, UV irradiation, spraying of antiseptics (hydrogen peroxide), and filtration are used.

500 microbial bodies in one cubic meter allowed at the time of the operation, by the end should not exceed 3000 per cubic meter.

General processing of the operating room - 6% hydrogen peroxide solution preliminary and 3% current.

Sterilization of surgical instruments carried out in several stages - first, pre-sterilization preparation is carried out: mechanical cleaning, immersion for 1 hour in 3% chloramine, rinsing with water, drying. The sterilization method depends on the type of instrument. in:

· Non-cutting instruments (tweezers, clamps) are sterilized in an autoclave or dry oven. Disposable instruments are sterilized by radiation. In extreme cases, boiling in a 2% soda solution for 30 minutes is possible. Tools contaminated with pus are boiled for 45 minutes.

Cutting and stabbing instruments (needles, scalpels) are sterilized by soaking in an antiseptic solution. best methods in this case are gas and radiation sterilization. Thermal methods (boiling, dry heat sterilization) lead to blunting of instruments and can be used only in extreme cases when other methods cannot be used.

· Rubber and plastic instruments (catheters, probes) are sterilized by autoclaving or (in extreme cases) boiled for 15 minutes. Disposable products are subjected to radiation sterilization plants.

· Sterilization of gloves is carried out in an autoclave at a temperature of 130 ° C and a pressure of 1 atmosphere for 30 minutes. Before sterilization, each glove is sprinkled with talc and wrapped in a separate gauze napkin. AT recent times Increasingly, disposable gloves are used, sterilized beam method in factory conditions.

Optical equipment is sterilized in formalin vapor for 48 hours. Endoscopes can also be sterilized by immersion in alcohol, chlorhexidine or sideks.

Operating linen (gowns, sheets) and dressings (gauze balls, swabs, napkins, turundas) are sterilized in an autoclave at a temperature of 130 ° C and a pressure of 1 atmosphere for 1 hour (or at a pressure of 2 atmospheres for 30 minutes) . After washing, the linen is sterilized, having previously laid it in Schimmelbush biks. Bix is ​​considered sterile within 3 days after sterilization.

Types of bix styling:

one). Bix universal laying is divided into sectors, each of which is filled with a certain type of material.

2). Targeted placement All instruments, dressings and underwear necessary for the implementation of a particular operation are placed in the bix.

3). Species styling is used when in large numbers operations: a certain type of material is placed in each bix.

Recently, dressings and disposable surgical underwear have appeared, sterilized by the radiation method in the factory.