To prevent infection from entering the wound , first of all, you need to know its sources and ways of spreading.
An infection that enters a wound from the external environment is called exogenous . Its main sources are: air with dust particles on which microorganisms settle; discharge from the nasopharynx and upper respiratory tract of patients, visitors and medical staff ; wound discharge from purulent wounds, various household pollution. An exogenous infection can enter the patient’s wound in three main ways: airborne, contact and implantation. An infection that enters the wound from the patient’s body is called endogenous . Its main sources: the patient’s skin, internal organs, pathological foci.
Airborne infection control techniques .
Masks are used by medical staff to reduce the release of secretions from the nasopharynx and oral cavity during breathing into the external environment. There are two types of masks: filtering and reflective. First of all, gauze masks are filtering masks. Three-layer gauze masks that cover the mouth and nose trap 70% of exhaled microorganisms, four-layer – 88%, six-layer – 96%. However, the more layers, the more difficult it is for the surgeon to breathe. When the gauze is moistened, the filtering capacity decreases. After 3 hours, 100% of three-layer gauze masks are abundantly seeded with microflora. To give masks a greater effect, they are impregnated with an antiseptic, dried and autoclaved.
The properties of such masks are retained for 5-6 hours. Modern disposable cellulose masks are usually effective within 1 hour. In reflective masks, condensation from exhaled air flows down the walls of the mask in a special container. It is difficult to operate in such masks; now they are practically not used. Wearing masks is mandatory in the operating room (and a new one every time) and dressing rooms, in case of a flu epidemic – in the wards, in some cases – in the recovery ward. Masks must be used when performing any manipulations.
There are special lamps that emit ultraviolet rays with a certain wavelength, which have the maximum bactericidal effect. Such rays are harmful to humans. Therefore, the lamps have some protection. In addition, there is a mode of their operation – a mode of quartzization, in which the lamps work at a time when both personnel and patients are absent in the room. One germicidal lamp sterilizes up to 30 cubic meters of air for 2 hours and destroys germs on open surfaces. Bactericidal lamps must be in operating rooms, dressing rooms, treatment rooms, recovery wards and wards for purulent patients.
Ventilation and ventilation of premises reduces air pollution by microbes by 30%. If at the same time air conditioners with bacterial filters are additionally used, the effectiveness of these measures increases to 80%. In particularly clean places , for example, in operating rooms, ventilation should be supply and exhaust, with the required frequency in accordance with GOST. In some cases, the development of infection after surgery is especially dangerous. First of all, this applies to patients after organ transplantation, receiving immunosuppressive drugs, as well as burn patients who have a huge area of the entrance gate for infection. For such cases, there are ultra-clean operating rooms with laminar air flow , pressure operating rooms and wards with an abacterial environment.
Personal hygiene of patients and medical staff.
Upon admission, patients pass through a sanitary inspection room in the admission department (sanitation, changing clothes, control for head lice). Then, patients must follow the rules of personal hygiene. Serious patients are assisted in this by nurses (washing, cleaning the mouth, shaving, changing the bed). Bed linen and underwear should be changed every 7 days. In the surgical department, there are certain rules regarding the nursing staff. First of all, this is the control of compliance with the rules of personal hygiene, the absence of colds and pustular diseases.
In addition, once every 3 months, the staff undergoes an examination for the carriage of staphylococcus in the nasopharynx. If the test is positive, the employee is removed from work, within 3 to 4 days he instills an antiseptic (chlorhexidine) into his nose, regularly rinses the throat.
Prevention of contact infection
Prevention of contact infection, in essence, comes down to the implementation of one of the main principles of asepsis: “Everything that comes into contact with the wound must be sterile.”