Standard for equipping a vaccination room for licensing. Standard equipment for the vaccination room, requirements for the organization of work
1. Nurse's desk
2. Nurse chair
3. Helical chair
6. Nightstand
9. Medical couch
10.Treatment table
12.Sinks;
14. Cleaning equipment:
Bucket for cleaning floors
Bucket for washing walls
Window cleaning bucket
16. Disinfectants
17. Detergents
Documentation of the vaccination room
1. Notebook for cabinet quartzing.
2. General cleaning notebook
3. Vaccination room appointment log.
4. Daily cleaning notebook.
5. Notebook for temperature control in refrigerators.
6. Notebook for recording intravenous blood sampling for biochemical analysis.
7. Notebook for recording intravenous blood sampling for HbSAg.
8. Notebook for recording intravenous blood sampling for blood group and Rh factor.
9. Notebook for recording intravenous blood sampling at RW.
10. Notebook for recording intravenous blood sampling for HIV infection.
11. Assignment journal.
12. Log book prof. vaccinations: DTP, ADS, ADS-m,
13. Log book prof. vaccinations: measles, mumps, rubella.
14. Polio vaccination record book.
15. Hepatitis vaccination log.
16. Journal of Mantoux reactions.
BCG log book., BCG-m.
Chickenpox vaccination log.
Vaccination log against hemophilus influenzae.
Medicines (Medicines) in the vaccination room
In the clinic, work with medications, their accounting, storage and consumption occurs in accordance with the instructions and orders of the Ministry of Health of the RSFSR.
All medications are divided into three groups: “A”, “B” and “General List”. According to the method of administration, medications are divided into: parenteral, internal and external.
To group "A" include narcotic and poisonous funds that are stored at the main medical center. sisters in a metal safe under lock and key to the floor. On the inside wall of the safe door is a list of narcotic and poisonous drugs, their highest daily and single doses.
All potent funds include to group "B" , are stored in locked cabinets marked: on the back wall there is a red letter “B” on a white background. List “B” includes 14 groups of medications, determined by their mechanism of action:
1. Antibiotics
2. Sulfonamides
3. Some digitalis preparations
4. Analgesics
5. Antispasmodics
6. Hypotensive
7. Sedatives
8. Sleeping pills
9. Hormonal
10. Diuretics
11. Anticonvulsants
12. Antiarrhythmic
13. CNS stimulants
14. Stimulating the respiratory center.
The cabinets are arranged according to their mechanism of action and application. Internal agents are separate from parenteral ones.
Medicines "general list" stored in cabinets with the inscription inside: “general list” in black letters on a white background.
Parenteral drugs are stored separately from internal and external drugs, arranged according to their mechanism of action.
Based on Order No. 523, all medications must be in their original packaging, with a clear name, series and expiration date. It is prohibited to pour, pour, re-glue, or transfer from one package to another. Colorful, odorous and flammable medicines are stored separately from each other. Medicines that require protection from light are stored in dark glass containers. Medicines that require a certain temperature regime are stored in the refrigerator.
Disinfectants are stored separately from medications of all groups.
Dressings, rubber products, medical instruments are stored separately.
Biological products, serums, vaccines are stored in the refrigerator at a temperature of +2 to +8 degrees Celsius.
Alcohol is subject to quantitative accounting, which is taken into account by the main medical officer. sisters. Alcohol is provided to the office upon request by the vaccination clinic. sisters and writes out in a notebook to obtain alcohol.
2.4 To provide emergency care The office has special facilities for providing assistance in emergency situations:
1. Cardiovascular failure
3. Anaphylactic shock
4. Hyperthermic syndrome.
5. Bronchial asthma.
Scope of work performed in the vaccination room.
They do it in the vaccination room
▪ subcutaneous,
▪ intramuscular and
▪ intravenous
jet injections.
Procedures are prescribed either by local pediatricians or by specialists.
After the injection, a record of the procedure performed is made in the appointment sheet and vaccination log.
In the vaccination room, on specially designated days, intravenous blood is drawn for research: RW, HIV infection, HbSAg, and biochemical analysis.
2.6 The essence and goals of immunoprophylaxis.
Immunity - this is the immunological surveillance of the body, its way of protecting itself from various antigens that carry signs of genetically foreign information.
The penetration (or introduction during vaccination) of microbial or viral antigens causes immune response , which is a highly specific reaction of the body.
Main role in the development of acquired immunity belongs to the cells of the lymphoid system - T and B lymphocytes .
Other cell populations also take part in immune reactions, and nonspecific factors protection (lysozyme, complement, interferon, properdin, etc.)
Vaccination work
Vaccination work is carried out according to plan.
There are documents regulating vaccination:
1. Federal Law No. 157 of 1998 “On Immunoprophylaxis of Infectious Diseases”.
2. Order No. 9 of January 16. 2009.
All preventive vaccinations are planned strictly taking into account the national calendar of preventive vaccinations,
Monitoring of vaccinations and timely registration of medical exemptions is carried out.
2.7.1 Vaccination calendar:
Newborns (in the first 24 hours) - V1p.hepatitis B
4-7 days V BCG (M)
3 months V1 DTP + V1 poliomyelitis + V2 hepatitis B
4.5 months V2 DTP + V2 polio.
6 months V3 DTP + V3 poliomyelitis + V3 hepatitis + V1 p. hemophilic infection.
7 months V2p.hemophilic infection
12months.V measles, mumps, V rubella.
18 months R1 DTP+R1poliomyelitis.Rp.hemophilic infection
20 months R2 polio.
24 months. Vp. chickenpox + Vp. pneumococcal infection
6 years R measles, R mumps, R rubella
7 years R BCG (performed in children not infected with Mycobacterium tuberculosis, tuberculin - negative children) + R2 ADS-M
13 years old V rubella (for girls who have not previously been vaccinated or have received only one vaccination), V (girls) p. papilloma virus human, hepatitis V(not previously vaccinated)
14 years old R2 BCG (carried out to tuberculin-negative children not infected with Mycobacterium tuberculosis, who were not vaccinated at 7 years old)
R3 ADS-M, R3 poliomyelitis.
2.7.2 ADDITIONAL INFORMATION on Mantoux test and Viral hepatitis B.
1. Mantoux reaction every year.
2. Viral hepatitis B:
◦ 1 scheme – 0 -3 months. -6 months
Children born to mothers who are carriers of the hepatitis B virus or who are sick with viral hepatitis B in the third trimester of pregnancy are vaccinated against hepatitis B according to the schedule of 0-1-2-12 months.
Vaccination against geratitis B at 13 years of age and for children after 1 year of age is carried out to those who have not previously been vaccinated.
◦ according to scheme 2 0-1 month-6 months.
3. In the absence of BCG, Rmantu twice a year.
4. Up to 2 months BCG without Mantoux.
Those used within the framework of the national Calendar of preventive vaccinations (except BCG) can be administered simultaneously with different syringes in different areas body or at intervals of 1 month.
3. Infection control system, infectious safety of patients and medical personnel.
Each medical institution has an infection control system, which is regulated by orders.
The infection control system includes a set of sanitary and epidemiological measures that reliably prevent the occurrence and spread of nosocomial infections.
To prevent infection of patients and medical personnel, the sanitary anti-epidemic regime is strictly followed in the vaccination room, and the rules of both asepsis and antiseptics are strictly observed.
Asepsis - a set of measures aimed at preventing the entry of microorganisms into the wound during operations, diagnostic and therapeutic procedures.
Antiseptics - a set of measures aimed at limiting and eliminating infection that has entered the wound.
There are methods:
1. Mechanical method . This is the primary surgical treatment of the edges and bottom of the wound, washing.
2. Physical method - drainage of the wound.
3. Chemical method - use of hydrogen peroxide, bacteriostatic drugs.
4. Biological method - use of serums, vaccines, enzymes and antibiotics.
Hand treatment.
1. Hands are washed with soap twice, thoroughly rinsed with warm water and wiped dry with a clean towel or napkin.
2. Hands are disinfected with a 70% ethyl alcohol solution.
3. Hands are treated with skin antiseptics
Tool processing
After use, the tools pass three processing stages :
1. Disinfection
2. Pre-sterilization treatment
3. Sterilization
Disinfection is a set of measures aimed at destroying pathogenic and conditionally pathogenic pathogens.
Definition and etiology
Anaphylaxis is an acute, life-threatening hypersensitivity syndrome. Any drug can cause anaphylaxis.
The most common reasons:
Insect bites,
Medicinal substances(antibiotics, especially penicillins and anesthetics,
It should be noted that there is no dose dependence of anaphylactic shock. The method of administration plays a certain role (intravenous injections are the most dangerous).
Clinic and pathogenesis
The clinical picture of anaphylactic shock is varied, which is caused by damage to a number of organs and systems of the body. Symptoms usually develop within a few minutes from the onset of exposure to the causative factor and reach a peak within 1 hour.
The shorter the interval from the moment the allergen enters the body until the onset of anaphylaxis, the more severe it is. clinical picture. Highest percentage deaths Anaphylactic shock occurs when it develops 3-10 minutes after the allergen enters the body.
Symptoms include:
Skin and mucous membranes: urticaria, itching, angioedema.
Respiratory system: stridor, bronchospasm, asphyxia.
Cardiovascular system: acute decrease in blood pressure due to peripheral vasodilation and hypovolemia, tachycardia, myocardial ischemia.
Digestive system: abdominal pain, vomiting, diarrhea.
Convulsive syndrome during loss of consciousness.
It is necessary to differentiate anaphylactic shock from a heart attack (infarction, arrhythmias), ectopic pregnancy(in a collaptoid state in combination with sharp pain lower abdomen), heat stroke, etc.
Therapy
Treatment is divided according to urgency into primary and secondary measures.
Primary activities
Adrenaline 0.1% - 0.5 ml IM. Injections are best performed in top part body, for example into the deltoid muscle. If there is no reaction, the dose can be repeated after 5 minutes. Intramuscular injections, unlike intravenous ones, are safe. For intravenous administration, 1 ml of 0.1% adrenaline is diluted in 10 ml of saline and administered slowly over 5 minutes (risk of myocardial ischemia). In case of deep shock and clinical death, adrenaline is administered intravenously without dilution.
Airway patency: suction of secretions, if necessary, insert an air duct. Inhale 100% oxygen at a rate of 10-15 l/min.
Fluid infusion. First, it is administered as a stream (250-500 ml in 15-30 minutes), then as a drip. The first isotonic sodium chloride solution 1000 ml is used, then polyglucin 400 ml is added. Although colloidal solutions fill the vascular bed faster, it is safer to start with crystalloid solutions, because dextrans themselves can cause anaphylaxis.
Secondary events
Prednisolone IV 90-120 mg, repeat every 4 hours if necessary.
Diphenhydramine: IV slowly or IM 20-50 mg (2-5 ml of 1% solution). If necessary, repeat after 4-6 hours. Antihistamines It is better to prescribe after hemodynamic recovery, because they can lower blood pressure.
Bronchodilators. Inhaled beta 2-agonists by nebulizer (salbutamol 2.5-5.0 mg, repeat as needed), ipratropium (500 mcg, repeat as needed) may be useful in patients being treated with beta-blockers. Eufillin (initial dose: iv 6 mg/kg) is used as a reserve drug in patients with bronchospasm. Eufillin, especially in combination with adrenaline, can provoke arrhythmias, so it is prescribed only when necessary.
Additional events
Place the patient in a horizontal position with legs elevated (to increase venous return) and neck straightened (to restore airway patency).
Remove (if possible) the causative factor (insect sting) or slow down absorption ( venous tourniquet above the injection/bite site for 30 minutes, apply ice).
Forecast
About 10% of anaphylactic reactions result in death. Stopping an acute reaction does not mean a successful outcome. A second wave of blood pressure drop may develop after 4-8 hours (two-phase course). All patients, after relief of anaphylactic shock, should be hospitalized for at least 1 week for observation.
Prevention
Any allergic reaction, even limited urticaria, should be treated to prevent anaphylaxis. Among antihistamines of the latest generation, the most effective is claritin, which is used once a day. Of the complex antiallergic medications, the drugs of choice are fenistil and clarinase.
Do not get carried away with polypharmacy, observe patients after injections of the patient for 20-30 minutes. Always collect an allergic history.
Medical personnel must be specially trained to provide emergency care for anaphylactic shock and treat similar conditions.
All vaccination rooms must have a special layout to relieve anaphylaxis.
EMERGENCY MANAGEMENT FOR ANAPHYLACTIC SHOCK
(optional)
Adrenaline hydrochloride 0.1% – 1.0 (COLD) 10 ampoules
Atropine sulfate 0.1% - 1.0 (List A, SAFE) 10 ampoules
Glucose 40% - 10.0 10 ampoules
Digoxin 0.025% - 1.0 (List A, SAFE) 10 ampoules
Diphenhydramine 1% - 1.0 10 ampoules
Calcium chloride 10% - 10.0 10 ampoules
Cordiamin 2.0 10 ampoules
Lasix (furosemide) 20 mg – 2.0 10 ampoules
Mezaton 1% - 1.0 10 ampoules
Sodium chloride 0.9% - 10.0 10 ampoules
Sodium chloride 0.9% - 400.0 ml / or 250.0 ml 1 bottle / or 2 bottles
Poliglyukin 400.0 1 bottle
Prednisolone 25 or 30 mg - 1.0 10 ampoules
Tavegil 2.0 5 ampoules
Eufillin 2.4% - 10.0 10 ampoules
System for intravenous drip infusions 2 pcs.
Disposable syringes 5.0; 10.0; 20.0 5 pcs.
Disposable alcohol wipes 1 pack.
Rubber tourniquet 1 pc.
Rubber gloves 2 pairs
Ice pack (COLD) 1 pc.
ACTION ALGORITHM
1. Stop administering the drug that caused shock, if the needle is in the vein, do not remove it and carry out therapy through this needle; in case of a hymenoptera bite, remove the sting.
2.Note the time when the allergen entered the body, the appearance of complaints and the first clinical manifestations of an allergic reaction.
3. Lay the patient down with the lower limbs raised, turn the head to the side, push it forward lower jaw to prevent tongue retraction and aspiration of vomit. Remove existing dentures.
4.Assess the patient’s condition and complaints. Measure pulse, blood pressure (BP), temperature. Assess the nature of shortness of breath and the prevalence of cyanosis. Conduct an examination of the skin and mucous membranes. If blood pressure decreases by 20% of the age norm, suspect the development of anaphylactic reaction.
5.Provide access fresh air or give oxygen.
6. Apply a tourniquet above the drug injection, if possible (every 10 minutes, loosen the tourniquet for 1 minute, total time applying a tourniquet for no more than 25 minutes).
7. Place an ice pack on the injection site.
8. All injections must be made with syringes and systems that have not been used to administer other medications, in order to avoid recurrent anaphylactic shock.
9. When inserted allergic drug into the nose or eyes, rinse them with water and drop 1-2 drops of 0.1% adrenaline solution.
10. When administering a drug that caused shock subcutaneously, prick the injection site crosswise with 0.3 - 0.5 ml of a 0.1% solution of adrenaline (dilute 1 ml of a 0.1% solution of adrenaline in 3 - 5 ml of physiological solution).
11. Before the doctor arrives, prepare an intravenous infusion system with 400 ml of saline solution.
12. At the doctor’s command, slowly inject 1 ml of 0.1% adrenaline solution diluted in 10-20 ml of saline intravenously. If it is difficult to puncture a peripheral vein, it is permissible to administer adrenaline soft fabrics sublingual area.
13. Introduce glucocorticosteroids (90-120 mg prednisolone) intravenously in a stream and then drip.
14. Administer 1% diphenhydramine solution at a dose of 2.0 ml or 2.0 ml tavegil solution intramuscularly.
15. For bronchospasm, administer intravenous aminophylline 2.4% - 5-10 ml.
16. If breathing weakens, administer s.c. Cordiamine 25% - 2.0 ml.
17. For bradycardia, administer atropine sulfate 0.1% - 0.5 ml subcutaneously.
9. APPENDIX 2 Job Description vaccination room nurse:
9.1.1 I. General provisions
To professional activity as a medical professional. nurses in the vaccination room are allowed nurse with at least three years of experience in a hospital, having qualification category, certificate in Pediatric Nursing and trained at the workplace.
Appointment and dismissal of honey. the sister of the vaccination room is carried out by the chief physician on the recommendation of the head. department, senior medical sister of the department and in agreement with the chief medical officer. hospital nurse.
Honey. The treatment room nurse is directly subordinate to the head of the clinic and the chief medical officer. sisters.
9.1.2 II. Responsibilities
The nurse checks the number of vaccine vials for the work day, monitors the temperature in the refrigerator, and notes the readings in a log. The nurse conducts psychological preparation child for vaccination. In the history of development, it records the doctor’s admission to vaccination, the intervals between vaccinations and their compliance with the individual vaccination calendar. Registers the vaccination in the preventive vaccination card (form No. 063/u), the preventive vaccination logbook (form No. 064/u) and in the child’s development history (form No. 112/u) or in individual card child (form No. 026/u). Performs vaccinations and gives recommendations to parents on child care.
The nurse receives vaccinations and medications. Responsible for the use and rejection of bacterial preparations. Complies with the rules for storing vaccines during immunization and the rules for processing vaccination instruments. Responsible for the sanitary and hygienic regime of the vaccination room.
During the workday, the nurse destroys any remaining vaccine in open vials, records the amount of vaccine used and totals the number of doses remaining in a log book, and checks and records the temperature of refrigerators.
The nurse prepares a monthly report on vaccination work.
1. Organization of work in accordance with these instructions, hourly work schedule.
2. Organization of the vaccination room according to the standard.
3. Compliance with the requirements for labeling items medical purposes.
4. Accurate and timely maintenance of medical records. Timely submission of a report on the performed manipulations for a month, half a year, year.
5. Preparing the office for work.
6. Perfect knowledge of methods of carrying out preventive, therapeutic, diagnostic, sanitary and hygienic procedures, manipulations and their high-quality, modern implementation.
7. Strict adherence to blood collection technology for all types of laboratory tests.
8. Timely and correct transportation of the test material to laboratory departments.
9. Timely notification to the attending physician about complications from the manipulations, about the patient’s refusal to undergo the manipulation.
10. Ensuring the availability and completeness of a first aid kit for emergency care, provision of emergency first aid.
11. Carrying out control of the sterility of the received material and medical instruments, compliance with the shelf life of sterile products.
12. Regular and timely medical examinations. examination, examination for RW, HbSAg, HIV infection, carriage of pathogenic staphylococcus.
13. Ensuring proper order and sanitary condition of the vaccination room.
14. Timely discharge and receipt from the main medical center. nurses need the medications, tools, systems, alcohol, honey for work. instruments, medical items. appointments.
15. Ensuring proper accounting, storage and use of medicines, alcohol, honey. instruments, medical items. appointments.
16. Carrying out dignity. enlightenment of work on health promotion and disease prevention, promotion of a healthy lifestyle.
17. Constant increase professional level knowledge, skills and abilities. Timely completion of improvement.
9.1.3 III. Rights
1. Obtaining the necessary information for the accurate performance of professional duties.
2. Making proposals to management to improve the work of medical staff. nurses of the vaccination room and organization of nursing in the clinic.
3. Requirements from the main m/s for timely provision of medicines necessary for work, honey. tools, forms.
4. Requirement from the senior m/s to provide timely vaccines;
5. Requirement from the sister-housekeeper to timely provide the necessary soft and hard equipment, disinfectants, detergents and cleaning agents.
6. Improving your qualifications in in the prescribed manner, passing certification, recertification in order to assign a qualification category.
7. Participation in the public life of the clinic.
9.1.4 IV. Responsibility
The nurse in the vaccination room is liable for failure to fulfill her professional duties, accounting, storage and use of medicines, as provided for by current legislation.
Your gender
1. man
2. woman
1. 20 -30
2. 30-40
3. 40-55
Above 55
Education
1. secondary special
2. incomplete higher education
4. Please indicate how many years you have devoted to medicine (work experience)?
1.5 or less
2. there is the first one
3. there is a higher
What brought you to medicine?
2. desire to help patients
APPENDIX 4 Table of answers to the Questionnaire.
| Question number | Reply number | Answer number - 2 | Reply number | Reply number | Reply number |
| 1. | |||||
| 2. | |||||
| 3. | |||||
| 4. | |||||
| 5. | |||||
| 6. | |||||
| 7. | |||||
| 8. | |||||
| 9. | |||||
| 10. | |||||
| 11. | |||||
| 12. | |||||
| 13. | |||||
| 14. | |||||
| 15. | |||||
| 16. | |||||
| 17. | |||||
| 18. | |||||
| 19. | |||||
| 20. |
Your gender
1. man
2. woman
1. 20 -30
2. 30-40
3. 40-55
4. above 55
Education
1. secondary special
2. incomplete higher education
3. higher
What brought you to medicine?
2. desire to help patients
References - websites
1. https://ru.wikipedia.org/wiki/
2. http://www.homfo.ru/stat/neotlozhnaya_pomosch/
List of abbreviations
I. WHO
The World Health Organization dates back to April 7, 1948. WHO headquarters are in Geneva.
II. BCG
BCG (Bacillus Calmette-Guérin or Bacillus Calmette-Guérin, BCG) is a vaccine against tuberculosis prepared from a strain of weakened live bovine tuberculosis bacillus (lat. Mycobacterium bovis BCG), which has practically lost its virulence for humans, having been specially grown in an artificial environment.
III. DPT
DTP (international abbreviation DTP) is a combined vaccine against diphtheria, tetanus and whooping cough.
IV. HbSAg
Hepatitis B virus is a DNA virus from the hepadnavirus family, the causative agent viral hepatitis B. In the world, according to various estimates, from 3 to 6% of people are infected with the hepatitis B virus. Carriage of the virus is not necessarily accompanied by hepatitis
VII. HIV
Human immunodeficiency virus is a retrovirus from the genus of lentiviruses that causes a slowly progressive disease - HIV infection.
VIII. AIDS
Acquired immune deficiency syndrome (AIDS) is a condition that develops against the background of HIV infection and is characterized by a decrease in the number of CD4+ lymphocytes, multiple opportunistic infections, non-infectious and tumor diseases. AIDS is final stage HIV infections.
IX. Mantoux test
A research method that evaluates the body's response to the entry of the tuberculosis pathogen antigen into it. In addition, the Mantoux test is used to confirm the diagnosis of tuberculosis and as a control test in assessing the effectiveness of treatment.
X. Ministry of Health of the RSFSR.
MINISTRY OF HEALTH OF THE RSFSR
Glossary
II. Clinic
A highly developed specialized medical and preventive institution that provides mass types of medical care (for the prevention and treatment of diseases) to the population living in the territory of its operation.
Immunoprophylaxis
III. Disinfection
Disinfection is a set of measures aimed at destroying pathogens infectious diseases and destruction of toxins in environmental objects.
IV. Sterilization
Sterilization (microbiology) - complete liberation various substances, objects, food products from living microorganisms.
V. Immunity
Immunity (lat. immunitas - liberation, getting rid of something) is the ability immune system rid the body of genetically foreign objects.
VI. Immune response
The immune response is a complex, multicomponent, cooperative reaction of the body's immune system, induced by an antigen and aimed at its elimination. The phenomenon of immune response is the basis of immunity.
Equipping the vaccination room with solid equipment
1. Nurse's desk
2. Nurse chair
3. Helical chair
4. Medical cabinet for sterile solutions and medications
5. Instrument tables for preparing and conducting procedures;
6. Nightstand
7. 2 refrigerators for storing vaccines;
3. Refrigerator for storing medicines;
9. Medical couch
10.Treatment table
11. Cabinet for emergency and syndromic medicines
12.Sinks;
13. Garbage container (enamel bucket with lid)
14. Cleaning equipment:
Bucket for cleaning floors
Bucket for washing walls
Window cleaning bucket
Container for washing heating devices
15. Apparatus for irrigation of disinfectants. product (general cleaning)
16. Disinfectants
17. Detergents
Submitting your good work to the knowledge base is easy. Use the form below
Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.
Posted on http://www.allbest.ru/
Work report
Nursing
Completed
Muzafarova Natalya Mikhailovna
Toritsk 2011
1. Brief description Health care facilities
Municipal medical treatment and preventive institution "Central district hospital Troitsk and Troitsky district."
On April 24, 2008, by decision of the licensing and accreditation commission of the Ministry of Health of the Chelyabinsk region, license No. LO-74-01-000070 was issued to carry out medical activities, types of services performed as part of a licensed type of activity.
The structure of the bed capacity for 2011 is:
24-hour hospital, 453 beds in total;
Day hospital at the clinic 133 beds;
Dialysis department with 4 beds.
Central District Hospital is multidisciplinary hospital, which has 17 branches: emergency department No. 1, emergency department No. 2, department of anesthesiology-reanimation, gynecological, cardiological, department purulent surgery, neurological, pediatric, traumatological, therapeutic, maternity, surgical, department of newborns, infectious boxing of children, oncology department, emergency department, as well as a number of auxiliary departments that provide the diagnostic process.
Outpatient care.
The planned capacity of the clinic is 1,450 visits per shift.
Dental department - 300 visits.
Children's clinic - 300 visits.
Maternity consultation - 150 visits.
Preventive vaccinations are carried out in medical institutions by the state and municipal health care system (MM healthcare facility “CRH of Troitsk and Troitsky district”). Responsible for organizing and conducting preventive vaccinations is the head of the medical institution (Deputy head physician for polyclinic service Bobrysheva L.N., Head. Therapeutic department No. 3 Shchekotova L.A.), and persons conducting vaccinations (procedural nurse of vaccination room No. 2 of the polyclinic Muzafarova N.M.).
The clinic is located on the street. Krupskaya-3, built in 1972 and designed for 300 visits per shift, is part of the Municipal Medical Treatment and Prevention Institution “Central District Hospital of Troitsk and Troitsky District”.
To carry out preventive vaccinations on site Russian Federation vaccines are used that are registered in the Russian Federation and have a certificate from the National Authority for the Control of Medical Immunological Preparations.
Preventive vaccinations are carried out in vaccination room No. 2 of the clinic. The office is located on the second floor of the clinic building. The walls of the office are lined with glazed tiles to the height of the room, the floor is covered with linoleum. The office is natural and artificial lighting. In certain situations, vaccinations are carried out at home or at the place of work by mobile teams.
2. Basic documents defining vaccination work
Federal Law of March 30, 1999 No. 52-FZ “On the sanitary and epidemiological welfare of the population.”
SanPiN 2.6.1.2612-10 “Sanitary and epidemiological rules and standards.”
OST 42-21-2-85 “Sterilization and disinfection of medical supplies. Methods, means and modes."
SP 3.1.958-00 “Prevention of viral hepatitis. General requirements for epidemiological surveillance of viral hepatitis."
SP 3.3.2.2330-08 “Sanitary and epidemiological requirements for the conditions of transportation, storage and release to citizens of medical immunobiological preparations, used for immunoprophylaxis by pharmacies and healthcare institutions.”
SP 3.1.1.2341-08 “Prevention of viral hepatitis”.
SP 3.1.1.2137-06 “Prevention typhoid fever and paratyphoid."
Order of the USSR Ministry of Health dated July 12, 1989. No. 408 “On measures to reduce the incidence of viral hepatitis in the country.”
Order of the USSR Ministry of Health dated July 31, 1978. No. 720 “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections.”
Order of the Ministry of Health of the Russian Federation dated November 26, 1997. No. 345 “On improving measures to prevent nosocomial infections in obstetric hospitals».
Order of the Ministry of Health of the Russian Federation dated November 26, 1998. No. 342 “On strengthening measures to prevent epidemic typhus and combat pediculosis.”
Order of the Ministry of Health of the Russian Federation dated May 17, 1999. No. 174 “On measures to further improve the prevention of tetanus.”
Order of the Ministry of Health of the Russian Federation dated October 7, 1997. No. 297 “On improving measures to prevent people from getting rabies.”
3. Documents regulating infection safety
Federal Law dated September 17, 1998 No. 157 - Federal Law “On Immunoprophylaxis of Infectious Diseases”.
Order of the Ministry of Health. RF. No. 229 dated June 27, 2001 “On the national calendar of preventive vaccinations and the vaccination calendar for epidemiological indications.”
Order of the Ministry of Health and Social Development of the Russian Federation No. 673 of October 30, 2007. “On introducing amendments and additions to the Order of the Ministry of Health. RF. No. 229 dated June 27, 2001 “On the national calendar of preventive vaccinations and the vaccination calendar for epidemiological indications.”
Order No. 5/N dated January 31, 2011 “On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications.”
SP 3.1.1.2341-08 dated 02/28/2008 “Prevention of viral hepatitis B”.
SP 3.1.1.1118-02 “Prevention of polio.”
SP 3.1.1295-03 “Prevention of tuberculosis.”
SP 3.1.2.1176-02 “Prevention of measles, rubella, epidemiological mumps.”
SP 3.1.2.1320-03 “Prevention of pertussis infection.”
SP 3.1.2.2156-06 “Prevention of meningococcal infection.”
SP 3.1.2.1203-03 “Prevention of streptococcal (group A) infections.”
SP 3.3.2367-08 “Organization of immunoprophylaxis of infectious diseases.”
SP 3.3.2342-08 “Ensuring the safety of immunization.”
SP 3.1.2.1108-02 “Prevention of diphtheria.”
SP 3.1.2.1319-03 “Prevention of influenza.”
Order of the Ministry of Health of the Chelyabinsk region dated November 28, 2006. 3 450 “On approval of clinical and organizational guidelines for ensuring biological safety in health care facilities.”
SP 3.1.3.2352-08 “Prevention of tick-borne viral encephalitis.”
SP 3.1.1.2343-08 “Prevention of polio in the post-certification period.”
SP 3.1.1381-03 “Prevention of tetanus”.
MU 3.3.1252-03 “Tactics of immunization of the adult population against diphtheria.”
MU 3.3.1889-04 “Procedure for preventive vaccinations.”
MU 3.3.1891-04 “Organization of the work of the vaccination room, immunoprophylaxis room and vaccination teams.”
MU 3.3.1.1095-02 “Medical contraindications to preventive vaccinations with drugs from the national vaccination calendar.”
4. Documents on HIV prevention
Federal Law of March 30, 1995 No. 38-FZ “On preventing the spread of the disease caused by the human immunodeficiency virus (HIV infection) in the Russian Federation.”
Order of the Ministry of Health of the Russian Federation dated November 24, 1998 No. 338 “On introducing amendments and additions to the order of the Ministry of Health of Russia dated November 26, 1997 No. 345 “On improving measures for the prevention of nosocomial infections in obstetric hospitals.”
Paperwork documents - order of the USSR Ministry of Health dated October 4, 1980 No. 1030 “On approval of forms of primary medical documentation of healthcare institutions.”
5. Equipment for the vaccination room
Refrigerator with a supply of vaccine for 1 day, with labeled shelves. Installed at a distance of 10 cm from the wall, away from heat sources, on the refrigerator - a specialist’s opinion on the technical condition and the ability to maintain the temperature required for storing vaccines at 2-8 o C, the average percentage of wear, year of manufacture, date and nature of repair. Thermometers-2, placed on the upper and lower shelves, I record the temperature 2 times a day in a log. Cold elements, the number of cold elements corresponds to the standards specified in the instructions for use of the thermal container available. Cooling elements are located in the freezer compartment of the refrigerator, rubber warmers with ice.
Thermal containers - 4 pcs.
Medical couch - 1 pc.
Separate marked tables for types of vaccinations - 2 pcs.
Desk for nurses and document storage - 1 pc.
Chair - 1 pc.
Germicidal lamp - 1 pc.
Sink for washing hands.
Containers - puncture-proof containers with a lid and a “drowner” for disinfection of processed syringes, needles, cotton balls, vaccines.
Needle cutter - 1 piece.
Cabinet for storing medical devices and drugs in emergency conditions.
Class A waste container - 1 pc.
Cleaning equipment (labeled) should be kept in a specialized room.
6. Toolkit
Disposable syringes for vaccinations in sufficient quantity with an additional supply of needles.
Bixes with sterile material (cotton balls in packs of 25 pieces, bandages, napkins).
Tweezers - 5 pcs.
Scissors - 2 pcs.
Rubber band - 2 pcs.
Warmers - 2 pcs.
Kidney-shaped trays - 4 pcs.
Band-Aid.
Towels, diapers, sheets.
Disposable gloves.
Containers with disinfectant solution.
7. Storage and transportation of medical immunobiological preparations
Storage and transportation of medical immunobiological drugs is carried out at temperatures from +2 o C to +8 o C. Transportation and storage of each immunobiological drug is determined by the instructions for this drug.
Medical immunobiological preparations are placed in refrigerators in such a way that access to cooled air is provided to each package. Vaccines are stored on different labeled shelves, drugs of the same name are stored in batches, taking into account expiration date and receipt. The solvent for dry vaccines should be stored in the refrigerator along with the vaccine. There must be a sufficient supply of cold cells in the freezer compartment of the refrigerator.
Not allowed:
Storing other items, food or medicines in the refrigerator together with medical immunobiological preparations.
Storage of medical immunobiological preparations on the refrigerator door panel and tray boxes.
To record the temperature regime of the refrigerator, use mercury thermometers. The use of water or alcohol thermometers is not permissible, since they do not have a scale with negative values. Each unit of refrigeration equipment must be equipped with temperature measuring equipment. Facts of emergency or planned shutdown of the refrigerator are recorded in the temperature log of the refrigerator. The vaccination nurse is responsible for the accuracy of the records.
The duration of storage of medical immunobiological preparations at the 4th level of the “cold chain” should not exceed one month. All applicants to M.I.P. institutions The head nurse records in the journal the receipt and consumption of medical immunobiological drugs in the established form. Transportation of medical immunobiological preparations is carried out only in thermal containers that provide a temperature range from +2 o C to +8 o C. Medical thermal containers that have passed state registration. Thermal containers must be equipped with a passport, instructions for use and the required number of cold elements. Disinfection of thermal containers is carried out with a passport and instructions for use. The use of cold elements is possible only after they have been conditioned. During transportation, it is necessary to check the tightness of the container closure. Loading and unloading of the thermal container is carried out in the shortest possible time (5-10 minutes). In order to ensure uninterrupted operation of refrigeration equipment, an agreement was concluded for maintenance technology. A passport, instructions for use on the refrigerator and an emergency plan for the “cold chain” in case of a power outage in the clinic are kept at the workplace.
8. Organization of vaccination
To ensure timely implementation of preventive vaccinations, we invite persons subject to vaccination, verbally or in writing, on the day determined for vaccination. Before carrying out preventive vaccination, a medical examination is carried out, taking into account anamnestic data (previous diseases, tolerability of previous vaccinations, the presence of allergic reactions to medications, products, etc.) medical card An appropriate note from the doctor (paramedic) regarding the vaccination is made. If necessary, a medical examination is carried out before vaccination. Immediately before vaccination, thermometry is performed. I carry out all preventive vaccinations with disposable syringes and disposable needles.
I carry out preventive vaccinations in strict accordance with the indications and contraindications for their use according to the instructions included with the drug.
9. Methodology for carrying out preventive vaccinations
Procedure sequence:
Prepare sterile syringes and needles for subcutaneous injections, vaccine ampoules, sterile cotton balls, 70% ethyl alcohol solution, soap, towel, sterile gloves, glasses, mask, dishes with disinfectant solution, garbage tray, anti-shock agents;
Psychologically prepare the patient for manipulation;
Perform hand hygiene.
Hygienic treatment of hands consists of two stages: mechanical cleaning of hands and disinfection of hands with a skin antiseptic. After completing the mechanical cleaning stage (twice soaping and rinsing), the antiseptic is applied to the hands in an amount of at least 3 ml and thoroughly rubbed into the skin until completely dry (do not wipe your hands). If the hands were not contaminated (for example, there was no contact with the patient), then the first stage is skipped and the antiseptic can be immediately applied. The sequence of movements when processing hands is consistent. Each movement is repeated at least 5 times. Hand treatment is carried out for 30 seconds - 1 minute.
Wear a mask, goggles, sterile gloves;
Visually check the integrity of the ampoule or bottle, the quality of the administered drug and its labeling.
Opening of ampoules and dissolution of lyophilized vaccines should be carried out in accordance with the instructions, strictly observing the rules of asepsis and cold chain. Parenteral administration of immunobiological drugs should be carried out with a disposable syringe and a disposable needle, observing the rules of asepsis. In case of simultaneous administration of several vaccinations (except BCG), I administer each vaccine with a separate disposable syringe and disposable needle into different parts of the body.
Draw the vaccine into the syringe and remove air from it. The vaccine is administered in a dose that strictly corresponds to the instructions for use of the drug, with the patient lying or sitting in order to avoid falling in case of fainting.
Wipe gloves with alcohol;
Wipe the injection site twice with cotton balls soaked in alcohol;
The field treated with alcohol must dry;
Grasp with your index finger and thumb left hand skin with subcutaneous tissue at the injection site;
Insert a needle into the base of the formed fold (with a quick movement at an angle of 30-45°) two-thirds of its length;
Pull the piston towards you and make sure that the needle does not fall into the lumen of the vessel;
Slowly inject the vaccine by pressing the plunger with your left hand;
Apply a dry cotton ball to the injection site with your left hand;
Pull out the needle with a quick movement;
Disinfect used equipment;
Make a note of the completed manipulation.
A record of the vaccination is made:
In the work log of the vaccination room.
Card of preventive vaccinations (form. 063-u).
Medical record (form 025-u).
Certificate of preventive vaccinations (f. 156/u-93) The data entered in the certificate is certified by the signature of the doctor and the seal of the medical institution.
After preventive vaccination, observation is provided for the period specified in the instructions for use of the appropriate vaccine preparation(at least 30 min.). The medical record notes the nature and timing of general and local reactions, if they occur. Adverse reactions during routine vaccinations are currently quite rare.
There are general and local complications.
Local complications include reactions at the site of vaccine administration - redness, suppuration, lymphadenitis. General complications: allergic reactions, increased body temperature, the appearance of symptoms of an infectious disease. Complications associated with individual hypersensitivity to the vaccine. This group complications pose the greatest danger, since predicting them possible development in a particular patient, in most cases it is impossible. Most dangerous reaction considered anaphylactic shock. More often they manifest themselves in the form of allergic and neurological reactions. Depending on the type of vaccine, complications of this kind may be due to:
Toxic effect of the drug itself (inactivated vaccines);
An infectious process that occurs after the administration of a vaccine (live vaccines);
Development of perverse sensitivity to the drug (sensitization).
With the development of unusual, strong reaction or complications with the introduction of the vaccine, immediately notify the head of the clinic and send an emergency notification (f. 058/u) to the Federal State Institution "Center for Hygiene and Epidemiology" in the Chelyabinsk region. The fact of refusal of vaccination with a note that honey. the employee provided explanations about the consequences of such a refusal, it is documented in the outpatient card and signed by both the citizen and the medical professional. employee.
Immunization of citizens with a vaccine purchased at pharmacies. In pharmacies, medical immunobiological drugs must be dispensed with a doctor's prescription. Transportation of the vaccine to a medical institution is possible only in a thermal container or thermos. Immunization with the vaccine in the treatment room is carried out with a receipt for the vaccine, or a mark on the date and time of sale of the vaccine on the packaging, if no more than 48 hours have passed since the date of purchase.
Disposal of vaccine residues, used syringes and needles.
Remains of vaccines in ampoules or vials, used disposable needles, syringes, cotton swabs, napkins, gloves after injection are dumped into containers with a disinfectant solution prepared in accordance with the instructions for its use. The following medical immunobiological preparations are subject to destruction:
WITH expired suitability.
Stored in violation of the “cold chain”.
With changed external properties not indicated in the instructions.
After disinfection treatment, I dispose of medical waste in accordance with sanitary rules and SanPiN standards.
SanPiN 2.1.7.2790-10 “Sanitary and epidemiological requirements for the management of medical waste.”
SanPiN 2.1.7.728-99 "Rules for the collection, storage and disposal of waste from medical institutions."
10. Sanitary and epidemiological regime in the workplace
Disinfection of medical products.
Reusable ( glass jars, trays, tweezers).
Pre-sterilization cleaning involves the final removal of protein, fat, mechanical contaminants and residual quantities medicines. All products to be sterilized must undergo pre-sterilization cleaning.
Disassembled products are subjected to pre-sterilization cleaning in disassembled form with full immersion and filling the channels. Pre-sterilization cleaning is carried out manually in containers made of plastic, glass or enamel-coated (without damage). Currently, there are a number of means that allow you to combine disinfection and pre-sterilization cleaning into one processing stage.
Disinfection steps are the same as for disposable syringes
|
Disinfectant agent |
Concentration of the working solution according to the preparation) % |
Cooking method |
Disinfection time |
||
|
AHDEZ - 2000 express |
ready solution |
||||
|
Sonata-Sept |
ready solution |
5 ml (surgeon's hand) 3 ml (hand hygiene) |
|||
|
10ml + 990ml water |
|||||
|
10ml + 990 ml water |
|||||
|
Sonata - Dez |
10ml + 990ml water |
||||
|
Peroximed |
100ml per 1 liter of water |
||||
|
7 tablets per 10 liters of water |
|||||
|
Javel-Solid |
7 tablets per 10 liters of water 1 tablet per 10 liters of water |
||||
|
7 tablets per 10 liters of water |
|||||
|
Clorendez |
6 tablets per 11 liters of water |
Stages of pre-sterilization cleaning:
Stage 1: rinsing with running water after disinfection over the sink for 30 seconds until the smell of disinfectants is completely eliminated;
Stage 2: rinsing with distilled water for 30 seconds;
Stage 3: drying with hot air at a temperature of +75..+87 in drying cabinets.
To dispose of waste material and disposable medical devices, disinfectants containing chlorine are used - Clorendez, Javel - Sin, Deachlor, Javel - Solid, Javel, etc.
Control of the concentration of chlorine-containing solutions is determined by the express method, the indicator "Dezikont X-02" from the company "Vinar" with a mark in the logbook for monitoring the concentrations of working solutions of disinfectants and sterilants.
Every six months, disinfectants are changed according to the microflora.
Quality control of pre-sterilization cleaning
The results of pre-sterilization cleaning control are recorded in the Form -366/у journal. 1% of processed products of the same name, but not less than 3-5 units, are subject to control. The effectiveness of subsequent sterilization directly depends on the completeness and quality of pre-sterilization treatment; therefore, standards have introduced mandatory quality control of pre-sterilization cleaning carried out by the medical institution itself. Self-monitoring of the quality of PSO in departments of medical institutions is carried out daily. Organized and supervised by the head nurse at least once a week. When choosing disinfectants used in health care facilities, the effectiveness of disinfection and destruction of various types of microorganisms, including spore forms and viruses, is taken into account. Every six months, disinfectants are changed according to the microflora. At positive test for blood detergent the entire group of controlled products from which the control was taken is subjected to repeated processing until negative results are obtained.
Sterilization.
Sterilization is a method that ensures the death of vegetative and spore forms of pathogenic and non-pathogenic microorganisms in the sterilized material.
Sterilization methods:
Thermal (steam, air, glassperlene);
Chemical (gas, solutions of chemical compounds);
Radiation;
Plasma and ozone (group of chemical agents).
In a clinical setting, the most common methods for sterilizing instruments and medical devices are:
Steam (autoclaving),
Air (dry-heat oven),
Chemical (gas, solutions of chemical compounds).
Steam sterilization is carried out by supplying saturated water steam under pressure in steam sterilizers (autoclaves). Steam sterilization is considered the most effective method due to the fact that the bactericidal power of hot air increases as it is humidified, and the higher the pressure, the higher the temperature of the steam. Steam sterilization products made from textiles (linen, cotton wool, bandages, suture material), rubber, glass, some polymer materials, nutrient media, medications.
Steam sterilization modes.
132 °C -- 2 atmospheres (2 kgf/cm2) -- 20 minutes -- main mode. All products (glass, metal, textiles, except rubber) are sterilized.
120 °C -- 1.1 atmosphere (1.1 kgf/cm2) -- 45 minutes -- gentle mode (glass, metal, rubber products, polymer products - according to the passport, textiles).
110 °C -- 0.5 atmosphere (0.5 kgf/cm2) -- 180 min -- especially gentle regime (unstable drugs, nutritional media).
Packaging materials for steam sterilization:
The sterilization box (bix) is simple. Shelf life 3 days after sterilization.
Sterilization box (bix) with filter. Shelf life is 20 days after sterilization.
Infection safety in the workplace.
For medical personnel, every patient should be considered a possible carrier viral infection. The danger of infection exists if the generally accepted rules of asepsis and hygienic regime are violated during the execution. medical procedures. Regulatory document on infectious safety of medical personnel, order of the Ministry of Health of the Russian Federation No. 338 of November 24, 1998 “On introducing amendments and additions to the order of the Ministry of Health of Russia of November 26, 1997 No. 345 “On improving measures for the prevention of nosocomial infections in obstetric hospitals”, SaN PiN dated May 18, 2010 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities.”
11. Personal protective equipment
Disposable rubber gloves.
Safety glasses or shields.
Laminated robe, apron.
Shoes made of leather or leatherette.
The danger of contracting HIV infection can arise in emergency situations (cuts, injections with instruments contaminated with blood and other biological fluids or contact with the mucous membranes of the eyes, oropharynx and nose. An Anti-HIV first aid kit is available to provide assistance.
|
Purpose |
Name and quantity |
|
|
For treating wound surfaces |
5% alcohol solution iodine in a bottle - 1 pc. |
|
|
To disinfect material that comes into contact with the skin |
70% ethyl alcohol solution - 1 bottle 100 ml |
|
|
For disinfection of biological fluid that gets on mucous membranes |
Weighed in a dark container of dry potassium permanganate 0.05 g each - in an amount sufficient for double treatment of the skin and mucous membranes. Graduated container for 100 and 500 ml for preparing 0.01%, 0.05% potassium permanganate solution. |
|
|
For treating the nasal mucosa |
||
|
For washing eyes with 0.01% solution of potassium permanganate |
Glass pipettes |
|
|
To protect eyes, face and skin in the workplace there must be: |
Goggles, face shield, mask, gloves, finger pads. |
|
|
Dressing |
Sterile bandage or napkins, sterile cotton wool, bactericidal plaster |
First aid kit "Anti HIV" - available, stored in a container that is processed. Any emergency situation is recorded in the Journal of Medical Personnel Injuries and Post-Traumatic Prevention.
In the MM health care facility “CRH of Troitsk and the Troitsky district”, order No. 458 dated October 20, 2009 was issued “On ensuring the prevention of nosocomial HIV infection among medical workers of the Troitsk urban district”; it developed an algorithm for carrying out measures for post-exposure prevention of HIV infection medical workers. In case of contact with blood or other biological fluid of an HIV-infected person, you should: start taking specific antiretroviral drugs as soon as possible (preferably for the first 2 hours after the accident): azidothymidine (zidovudine) orally 0.2 g 3 times a day (the drug is stored in the emergency room Department No. 1, 2 - responsible senior nurse of the admission department).
Then: make an entry about what happened in the emergency log with a note about the date, time and place of the emergency, full name. and the position of the medical worker, full name, age and address of the patient, the circumstances of the emergency and the nature of the injury, the scope of first aid. Inform the head of the institution about it. Donate blood for the presence of antibodies to the HIV virus on the day of the accident to establish the fact of their absence or presence at the time of the emergency. If the patient's HIV status is unknown, carry out express diagnostics with registration of the results in the express testing journal (admission department No. 1, 2 - responsible senior nurse of the admission department). If the rapid diagnostic result is positive or questionable, or if the result is negative, but the patient has an unfavorable epidemiological history and alarming clinical data, the healthcare worker should continue taking antiretroviral drugs.
Regardless of the results of express diagnostics, blood is collected from the patient for testing for HIV infection using ELISA. Within 24-48 hours, the injured medical worker must contact the infectious diseases department and then be referred for a consultation to the AIDS Center at the Clinic of the State Educational Institution of Higher Professional Education "ChSMA" of the Russian Health Ministry (Chelyabinsk, Cherkasskaya str. 2, tel. 83517218282). Take medications received at the AIDS center for 30 days. Register with the infectious diseases department and donate blood for the presence of antibodies to the HIV virus at the AIDS laboratory 3, 6, 9, 12 months after the emergency. In the absence of antibodies to the HIV virus 12 months after the emergency dispensary observation stops. The Central District Hospital received "RETROCHEK HIV" rapid tests, which make it possible to determine within a few minutes whether a patient is infected. Health care facilities have a stock of drugs for chemoprophylaxis of HIV infection.
All clinic employees are vaccinated against:
Hepatitis B.
Diphtheria and tetanus.
Rubella (according to indications).
Corey (according to indications).
Swine flu H 1 N 1.
Seasonal flu.
12. Disinfection of premises and furnishings of the vaccination room
The vaccination room has a bactericidal lamp corresponding to the area of the room. Work tank. lamps are carried out according to schedule. Every day the bactericidal irradiator works for at least 2 hours a day, and on the day of general cleaning for one hour more. The operating time of the lamp is strictly recorded in the “Bactericidal lamp working time log”, because Having worked 1/3 of the set time, the quartzing time increases by 30 minutes. During general cleaning, the surface of the bacterial installation is treated with a sterile cloth moistened with 95° alcohol.
Routine and general cleaning.
During the working day and after finishing work, routine cleaning (disinfection) is carried out: with a rag moistened with disinfectant. with a solution, wipe the walls to the height of an outstretched arm, tables, a couch, all objects are moved away from the walls. Wet cleaning is carried out twice. After the current cleaning of the cabinet with quartz for 1 hour. Once a week is carried out general cleaning. A rag moistened with disinfectant. solution, I wipe the walls (to their entire height), ceiling, furniture, windows, objects, as well as the surface of the tank. lamps. IN given time There are disinfectants with a cleaning effect that allow you to combine the first two stages into one.
General cleaning is carried out in three stages:
Stage - irrigation disinfection. agent (Aminaz 1%) - 200 ml per 1 sq. meter.
Stage - Ventilate (prevent poisoning from chlorine vapors), rinse, wipe dry with a rag.
Stage - Turn on the bactericidal lamp for 2 hours.
The date of general cleaning and the name of the disinfectant used is indicated in the “Log of General Cleaning Conducted.” Routine and general cleaning in the vaccination room is carried out according to:
Order No. 720 of July 31, 1978 “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections.”
Order No. 338 of November 24, 1998 “On introducing amendments and additions to Order No. 345 of November 26, 1997 “On improving measures for the prevention of nosocomial infections in obstetric hospitals.”
13. Bacteriological control
The vaccination room is regularly monitored by the sanitary group. bacteriological laboratory, once every 6 months. The following are carried out: washings from the walls and furniture in the office, washings from the nurse’s gown and hands, air seeding (for the number of colonies and flora seedings), monitoring the operation of the tank. lamps, seeding of sterile material, as well as flushes after general cleaning (to control the quality of its implementation).
I carry out sanitary and preventive work on hygienic education of the population in the clinic in the form of conversations on various topics of interest.
Topics of sanitary and preventive work
In 2010, she prepared and held conferences for clinic staff on the topic: “Prevention tick-borne encephalitis»
14. Analysis of work for 2010 in comparison with 2009
In 2010, the immunization plan included the following types of vaccination:
Against influenza (education, medicine, people over 60 years old) - 2943 people.
Against hepatitis of citizens from 18 to 55 years old - 5 people and RV 30 people - health workers.
Against measles - 3 people.
Against diphtheria -1190 people.
20 people against rubella.
Against polio - 6 people.
Against tick-borne encephalitis - 96 people.
The plan was carried out 100%.
24% of the adult population has been vaccinated against influenza.
Since 2006, 7,930 people have been vaccinated against hepatitis.
The result of immunization over 3 years was:
Reducing the incidence of influenza,
Reduced incidence of hepatitis B,
Absence of diphtheria, tetanus, and measles for several years.
New ways of working in 2010. Developed and approved by the chief physician (order dated March 15, 2010 No. 91) “On approval of algorithms for providing emergency assistance"and put into operation:
Algorithm of measures for anaphylactic shock;
Algorithm of measures for fainting;
Algorithm of measures for insect bites;
Composition of the “First aid kit for assistance with anaphylactic shock.”
The “Vaccine Prevention” program was introduced - a computer version in the vaccination room. The vaccination room has a “DI-1M” Destructor for destroying needles.
vaccination room vaccine medical immunobiological
Posted on Allbest.ru
...Similar documents
General characteristics activities of the Yakut City Hospital No. 3. Number of flu vaccinations performed, implementation of the immunization plan. Equipment for vaccination room. Organization of work and infectious safety of a vaccination nurse.
practice report, added 11/12/2012
Transportation and storage of medical immunobiological preparations. The role of the State Sanitary and Epidemiological Supervision in the organization and conduct of preventive vaccinations. Methods for testing the immune layer of the population. Monitoring the level of population immunity and its assessment.
abstract, added 11/24/2012
Preparation of medical nursing documentation. Blood pressure measurement. Equipment for the vaccination room. Treatment of the umbilical wound. Bacteriological research feces Algorithm for setting mustard plasters. Performing intramuscular injections.
practice report, added 01/25/2016
Immunoprophylaxis - carrying out calendar preventive vaccinations and vaccinations for epidemic indications in accordance with federal legislation. Active and passive immunization of the population. Types of medical immunobiological preparations.
abstract, added 11/06/2012
Advantages of combination vaccines. Justification of the need to introduce new, modern vaccines against diphtheria, tetanus, whooping cough and polio in the Calendar of preventive vaccinations of the Republic of Kazakhstan. What's different about the new calendar? Doses of oral polio vaccine.
presentation, added 10/04/2015
Immunoprophylaxis of infectious diseases. Contraindications to vaccinations. Review of vaccine preparations. Composition of vaccines and control over their quality. Measures to prevent the spread of infection. National vaccination calendar.
course work, added 05/12/2016
The importance of immunoprophylaxis. Indications and contraindications for the prevention of weakened immunity. Tactics regarding unvaccinated children. Post-vaccination complications, management tactics for children. Features of organizing the work of the vaccination room.
presentation, added 09/21/2013
Design, equipment, equipment of a physiotherapy room. Types of procedures. Instructions for occupational safety and health, organization of work in a physiotherapy room. General rules carrying out physiotherapeutic procedures.
test, added 11/05/2009
Studying the work of a treatment room nurse inpatient department Republican Dermatovenerological Dispensary. Cabinet equipment, disinfection regimes and general cleaning procedures. Basic activities during injections.
practice report, added 07/01/2010
General documentation for the treatment room. Functions of a treatment room nurse. Regulatory documents regulating the accounting, storage and dispensing of medicines various groups. Sterilization and disinfection of medical products.
16.In the vaccination room, cleaning, ventilation, and disinfection with UV radiation are observed. Medical documents of the vaccination office and the immunization room: a log of examinations and vaccinations performed (f. 064/u); forms “Certificate of preventive vaccinations” (f. 156/u-93) or certificates of vaccinations performed; outpatient cards patients (f. 112/u, f. 025/u); emergency notification of side effects of vaccines (f. 058); instructions for use of all medical immunobiological drugs used in Russian (in separate folder); log of completed vaccinations (for each type of vaccine); journal of accounting and consumption of medical immunobiological preparations; refrigerator temperature log; log of the operation of the bactericidal lamp; general cleaning log; emergency plan to ensure the cold chain in emergency situations.
Equipment for the vaccination room.
Equipment: vaccine storage refrigerator with labeled shelves with two thermometers; cold elements (the number of cold elements must be no less than that specified in the instructions for use of the thermal container or cooler bag available in the vaccination room, which are constantly located in the freezer compartment of the refrigerator); medical cabinet for medicines and instruments - 1; medical couch - 1; changing table - 1; medical tables marked by types of vaccinations (at least three); nurse's desk and storage of documents, instructions for the use of all medical immunobiological drugs (MIBP) - 1; chair - 1; bactericidal lamp; hand washing sink; cleaning equipment; thermal container or cooler bag with a set of cold elements.
Capacity- puncture-proof container with a lid for disinfection of used syringes, tampons, used vaccines. Disposable syringes (based on the number of vaccinated people + 25%), with a capacity of 1, 2, 5, 10 ml with a set of needles. Bixes with sterile material (cotton wool - 1.0 g per injection, bandages, napkins). Tweezers - 5, scissors - 2, rubber band - 2, heating pads - 2, kidney-shaped trays - 4, adhesive plaster, towels, diapers, sheets, disposable gloves, container with disinfectant solution.
Medicines: anti-shock kit with instructions for use (0.1% solution of adrenaline, mezaton, norepinephrine, 5.0% solution of ephedrine, 1.0% tavegil, 2.5% suprastin, 2.4% aminophylline, 0.9% calcium chloride solution, glucocorticoid drugs - prednisolone, dexamethasone or hydrocortisone, cardiac glycosides - strophanthin, korglykon), ammonia, ethanol(at the rate of 0.5 ml per injection), a mixture of ether and alcohol, oxygen.
Vaccinations against tuberculosis and tuberculin diagnostics are carried out in separate rooms, and in their absence - on a specially designated table, with separate instruments that are used only for these purposes. A specific day is allocated for BCG vaccination and tuberculin tests.
When monitoring the equipment and equipment of the vaccination room, it is necessary to pay attention to the presence of:
An ultraviolet irradiator switched on outside the room (except for those that can operate in the presence of people) with a power corresponding to the volume of the room;
- medical furniture resistant to detergents, disinfectants and medications;
A refrigerator for storing MIBP with marked shelves and two thermometers, cold elements (the number of cold elements must be no less than that specified in the instructions for use of the thermal container or cooler bag available in the vaccination room);
- medical cabinet for medicines and instruments;
- medical couch;
- changing table;
- medical tables marked by types of vaccinations (at least 3);
- a desktop for storing documentation, instructions for using all MIBP, a chair;
- sinks for washing hands;
- a thermal container or cooler bag with a set of cold elements;
- container - a puncture-proof container with a lid for disinfection of used syringes and needles;
- a container with a lid for disinfection of used swabs and used vaccines;
- disposable syringes (based on the number of vaccinated + 25%), with a capacity of 1, 2, 5, 10 ml with a set of needles;
- needle removers (cutters), needle destructors;
- reversible bags with soft material;
Biks with sterile material (cotton wool - 1.0 g per injection, bandages, napkins), tweezers - 5, scissors - 2, rubber band - 2, heating pads - 2, kidney-shaped trays - 4, adhesive plaster, towels, diapers, sheets;
- a supply of disposable rubber medical gloves;
- containers for storing disinfectant solution;
A syndromic list of medications for antishock therapy approved by health authorities with instructions for use (indicating age dosages, methods of administration);
- medical documents of the vaccination room and immunization room:
- log of examinations and vaccinations performed according to f. 064/у;
- forms of a certificate of preventive vaccinations (form 156/u-93);
- outpatient cards of patients (f. 112/u, f. 025/u);
- f. 058 - emergency notification side effect vaccines;
- instructions for use of all used MIBP in Russian (in a separate folder);
- f. 63 - record card of preventive vaccinations;
- a log of vaccinations performed (for each type of vaccine);
- journal of accounting and consumption of medical immunobiological preparations;
- refrigerator temperature log;
- logbook for recording the operation of the bactericidal lamp;
- journal for registering general cleaning;
- emergency plan to ensure the cold chain in emergency situations;
Sets of removable clothing for medical personnel of the vaccination room of the hospital: gowns, caps, masks, removable shoes (slippers);
- individual lockers for storing a change of clothes;
- conditions for washing clothes;
- a schedule for changing clothes (should be carried out as they get dirty, but at least twice a week);
Conditions for washing and disinfecting the hands of doctors and nurses before examining each patient or performing vaccinations, as well as after performing “dirty procedures”
Question 4 Child development is normal
Ticket No. 13 (1)
Child mode at the age of 3 years. Preschool age 1-3 years
This is characterized by rapid maturation nervous system. Expansion of motor capabilities. Improving speech. Development of mental reactions adequate to the situation. Expanding contacts with other children and adults.
Children of this age are sociable, inquisitive, and emotional. By the age of 3, communication with peers is needed. Children develop fine coordinated movements, develop drawing and modeling skills, and develop fine motor skills.
AFO skin: Skin folds are smoothed out. Self-hygiene training is important.
AFO Musculoskeletal system: Bones contain a lot of cartilage tissue. Large muscles develop. The spine grows evenly up to 1.5 years, then the growth of the thoracic and cervical vertebrae slows down.
AFO SSS. Pulse 105 ular per minute, arrhythmic in 60 seconds, blood pressure 90+2p, where p is age.
AFO of the digestive system. The stomach capacity is 300 ml, and by 3 years 500 ml. Stool 1-2 times a day.
AFO of the Urinary system. Single volume of urine. Specific gravity 1010 mg/l. During this period, girls 1.5 - 2 years old, boys 3 years old, are potty trained.
Respiratory system. From 2 years to 3 years, frontal sinuses are formed. The respiratory tract is still narrow, the mucous membranes are loose, often acute viral diseases, the type of breathing is diaphragmatic-thoracic. RR 28 puerile breathing loud sonorous breathing.
Calculation of height and weight:
M = 10kg + 2p (±10%) e = 75 + 5p (±5%) - error
Night sleep 12 hours. Daytime 3 hours.
Meals 4 times a day, by the age of 3 3 meals a day. Daily volume 1l – 300, 1l – 400g.
Protein – 55g, fat – 55g, carbohydrates – 200g in the daily diet. Calorie content 1600 kilocalories. Distributed throughout the day: breakfast 25%, lunch - 40%, afternoon snack - 10%, dinner - 25%
Drink 600 ml milk daily.
Preparing for kindergarten.
1. The home schedule corresponds to the kindergarten.
2. Stop using pacifiers and bottle feedings.
3. Personal hygiene and neatness.
4. Vaccination.
- refrigerator with labeled shelves for storing vaccines;
- cabinet for instruments and anti-shock therapy (0.1% solutions of adrenaline, mezaton or norepinephrine), 5% solution of ephedrine; glucocorticosteroid drugs - prednisolone, dexamethasone or hydrocortisone, 1% tavegil solution, 2.5% suprastin solution, 2.4% euphyllin solution, cardiac glycosides (strophanthin, korglykon), 0.9% sodium chloride solution;
- ammonia, ethyl alcohol, a mixture of ether and alcohol;
- disposable syringes with an additional supply of needles, thermometers, tonometer, electric suction, sterile tweezers (forceps);
- containers for disinfectant solutions and resetting used tools;
- bins with sterile material;
- separate marked tables for types of vaccinations;
- changing table and (or) medical couch;
- table for storing documentation and records;
- hand washing sink;
- bactericidal lamp.
- instructions for the use of all drugs used for preventive vaccinations (in a separate folder);
- instructional and methodological documents on immunization;
- journal of accounting and consumption of vaccines and other drugs;
- a log of vaccinations performed (for each type of vaccine);
- refrigerator temperature log;
- log of the operation of the bactericidal lamp;
- general cleaning log.
- check the availability of a doctor’s (pediatrician, therapist) report on the health status of the person who came for vaccination; as well as the absence of contraindications to the administration of the vaccine;
- wash your hands;
- check the name of the drug on the ampoule (vial) with the doctor’s prescription;
- carry out the necessary procedures for preparing the drug (shaking the sorbed vaccine, processing and opening the ampoule in compliance with antiseptic rules, dissolving the lyophilized drug, etc.) according to the instructions for its use.
SANITARY AND EPIDEMIOLOGICAL REQUIREMENTS FOR THE ORGANIZATION OF THE WORK OF THE VACCINATION OFFICE
I.N. Lytkina
Center for State Sanitary and Epidemiological Supervision in Moscow
Vaccine prevention occupies a priority position among measures aimed at reducing morbidity and mortality from infectious diseases.
In accordance with the Law of the Russian Federation “On Immunoprophylaxis of Infectious Diseases” (Article 9), citizens of the Russian Federation are vaccinated against hepatitis B, diphtheria, whooping cough, measles, rubella, polio, tetanus, tuberculosis, mumps within the established time limits national calendar preventive vaccinations.
To organize and conduct vaccinations, a medical institution must have a license for the appropriate type of activity issued by the territorial (city, regional, regional) health authority and a premises (vaccination room) that meets the requirements of SPiN 2.08.02-89.
If it is impossible to allocate a separate room (for example, in a clinic serving adult population) for routine vaccinations, it is necessary to determine a strictly fixed time during which other medical procedures and manipulations should not be carried out in this room.
The equipment of the vaccination room should include:
In addition, the vaccination room should have:
In medical institutions serving the children's population, it is advisable to provide for the organization of two vaccination rooms: one for tuberculin tests and vaccinations against tuberculosis, the other for other vaccinations. If it is not possible to allocate a room for a second vaccination room, it is necessary to determine special days and hours for carrying out anti-tuberculosis vaccinations, allocating a separate table for vaccination material (BCG vaccine, tuberculin) with marked containers for disposing of used syringes and needles.
The work of the vaccination room is supervised by the deputy chief physician for medical work (in accordance with the order of the chief physician of the institution), in his absence - by the head of the department.
Vaccinations must be carried out by medical personnel trained in the field of vaccination. The training of nurses conducting immunization against tuberculosis is carried out annually by specialists from anti-tuberculosis dispensaries, in accordance with the order of the Ministry of Health of the Russian Federation dated November 22, 1995 No. 324 (Appendix 10), who have a permit to carry out these manipulations.
Vaccinations are only allowed for healthy people. medical personnel, vaccinated against diphtheria, tetanus and viral hepatitis B.
For preventive vaccinations, only domestic and foreign-made vaccines that are registered and approved for use on the territory of the Russian Federation in the prescribed manner should be used.
Storage of medical immunobiological preparations in the vaccination room must be carried out in compliance with sanitary rules"Conditions for transportation and storage of medical immunobiological preparations" (SP 3.3.2.029-95), namely in the refrigerator at a temperature of +2 to +8°C in strict accordance with the instructions for use of the preparations.
The vaccine diluent should also be stored in the refrigerator so that when preparing the vaccine for use it does not cause an increase in the temperature of the latter.
The duration of storage of the vaccine in the vaccination room should not exceed 1 month. Based on given period it is necessary to plan the number of incoming drugs taking into account the volume of vaccination work performed per month in a given medical institution.
Before administering the vaccination, the nurse must:
Vaccines cannot be used:
- with inappropriate physical properties;
- with violation of the integrity of the ampoules;
- with unclear or missing markings on the ampoule (bottle);
- expired;
- stored in violation of the temperature regime.
When carrying out immunization, it is necessary to ensure:
- correct treatment of the injection site (for example, with subcutaneous and intramuscular injections– 70% alcohol);
- using only disposable syringes and needles;
- dosage of the drug, method and place of its administration.
Tweezers for collecting sterile material are stored in a container with a 0.5% chloramine solution or 1% aqueous solution chlorhexidine bigluconate (solutions are changed daily, the container and tweezers are sterilized).
After vaccination you should:
- place the ampoule (bottle) in the refrigerator when the drug is repackaged in compliance with the conditions and terms of its storage;
- make a record of the vaccination in the medical documentation (f. 112/u, f. 026/u, f. 025-1/u, f. 025/u, as well as in the register of preventive vaccinations by type of vaccine) and the “Certificate of preventive vaccinations" (f. 156/u-93), which is in the hands of citizens, indicating the name of the drug administered, the date of its administration, dose and series;
- inform the vaccinated person (or his parents) about possible reactions for vaccinations and pre-medical care for them, the need to apply for medical care if you have a strong or unusual reaction;
- monitor vaccinated people immediately after administration of the drug for the period specified in the instructions for its use;
- The vaccination room must be wet cleaned 2 times a day using separately marked cleaning equipment (before starting work and after finishing it) using disinfectants (1% solutions of chloramine, performa, alaminol, etc.). The office is thoroughly cleaned once a week.
LITERATURE
- Tatochenko V.K., Ozeretskovsky N.A. Vaccine prevention. – Moscow, 1994. – P.30-34.
- Tatochenko V.K., Ozeretskovsky N.A. Immunoprophylaxis. – Moscow, 1998. – P.12-14.
- Ozeretskovsky N.A., Ostanin G.I. Bacterial, serum and viral therapeutic and prophylactic drugs. Allergens. Disinfection and sterilization regimes of clinics. – St. Petersburg, 1998. – P.40-43, 333, 370.
