Surgical dressing unit

Surgical dressing unit is a complex of rooms of medical institutions, intended to prepare patients for the operation of its production, breeding operated because of her condition, bandaging wounds, imposing fixed plaster bandages. In the surgical dressing unit (Fig. 1) includes: material (linen, tool); sterilization; rooms for staff (including medical, nursing, Protocol, bathroom); anesthetic; operating with preoperative; hardware; intensive care; recovery room; dressing (gypsum). Depending on the number of serviced surgical beds specification premises O.-p. B. and the area occupied by them, vary dramatically (see table).
Approximate composition and area of operations of the dressing unit depending on the hospital bed capacity of medical institutions
* The operating area of 40 m2.
** Number of rooms depending on the host operating.
*** In parentheses indicate the number of tables.

Fig. 1. Scheme of premises surgical dressing unit: 1 - operating; g - sterilization; 3 - the equipment; 4 - anesthetic; 5 - preoperative; 6 - hardware; 7 - gateway-preparatory; 8 - the material; 9 - room surgeon; 10 - room nurses; 11 of the Protocol; 12 - room anesthesiologist; 13 - room personnel; 14 - recovery room; 15 - ski storage dirty Laundry.

One operating table (ACC. one operating) is calculated for 30 - 40 surgical beds. Avoid entering from outside infections O.-p. B. in General should be isolated from other departments of the medical institution, but at the same time be located not far from the Commerce Department. In old buildings hospitals and clinics surgical dressings blocks placed in a variety of ways. Modern construction typical of the hospital's buildings in the USSR gives an opportunity to plan their scientifically based standards (see the Hospital). The practice of building large hospitals provides two systems planning O.-p. b.- decentralized and centralized. Last more rational subject of concentration in one unit not more than 6 operational. The most advantageous economically and technologically complex is with two operating; other rooms O.-p. B. are related on both sides of each of them (Fig. 2). Doors between rooms O.-p. B. should open automatically for easy transportation of patients and the staff in the sterile clothes.

Fig. 2. The scheme of the operational unit of the 2 operating:
1 - operating; 2) preoperative; 3 - sterilization; 4 - anesthetic.

In order to achieve the most acepting working conditions surgical dressing block produce "clean" and "clean". In the "sterile" area permitted to enter, only dressed shoes or putting on his shoes cloth stockings (covers), coat, cap and mask covering his mouth and nose. Some operating intended for aseptic operations, others for purulent.
Material - instrumental and the Laundry room - serves for cabinets with the Toolkit, dressing and suture materials, with operating linen and bathrobes for staff. The room is harvested from a gauze napkins, balls, tampons. In the sterilization are autoclaves and sterilizers. The most economical and reasonable to set in large hospitals Central sterilization, serving all of the surgical dressings blocks, ward offices and clinics. It produces cleaning, laundering, cleaning and sterilization of surgical linen, bathrobes, syringes with needles, catheters, drainage tubes, of rubber gloves, and part or all of surgical instruments. Preferably sterilization to put out other premises O.-p. b., on another floor, and materials to deliver on the elevators. The premise for the staff consists of a changing-room staff, to record transactions in the transaction log for older sister, shower and bathroom. Anaesthetic room in a small surgical dressing blocks can be combined with intensive care.

Fig. 3. The scheme operating for surgical operations of medium complexity: 1 - the operating table; 2 - lamp ceiling; 3 - lamp mobile; 4 - electrocautery; 5 - odesilatel-tank; 6 - portable defibrillator universal; 7 - anesthesia apparatus; 8 - a ventilator; 9 - anesthetic table; 10 - gas controller (outdoor); 11 - table of the operating sisters; 12 - table for sterile materials; 13 - table instrumental; 14 - stand for sterilization boxes; 15 - stand for cans; 16 - stand for hand washing; 17 - the footrest; 18 - bactericidal irradiator; 19 - gear box of sterilization.

The main premise of the surgical dressing unit is operating (Fig. 3) with preoperative. In recent personnel wearing aprons, processes hands (see hands Processing), using a wash basin or basins. Usually the area of General surgical operating on 1 table equal to 35 m2; such transaction must be square-shaped on the plan). If under operating divert a large area (46 m2)it do rectangular with a ratio of 4:3. Altitude operating 4-5 m In the last time, operating sometimes build without natural light, but it complicates compliance with sanitary and hygienic requirements, so often prefer to do open. Windows pay to the North-West or North. Now adopted bright green-blue room painting operating, which does not tire the eyes of the personnel; instead of white surgical linen and clothing of personnel is implemented linen light blue or green. In hospitals and clinics that serve as the base for teaching students, nurses or doctors-specialists, ceiling arrange in the form glazed dome, through which students outside the operating room, watching the progress of the operation. In addition, operating are television devices for transmission of image and explanations operations on TVs in classrooms.
Equipment operating consists of the operating table (see Operating tables, tables for placement of instruments, lighting, clinical diagnostic and therapeutic and surgical instruments, among which belong to the anesthesia machine, electrocautery, diathermocoagulator, electric pumps, equipment for blood transfusion, ECG, EEG, and so on, the Number of devices can be so large that they have to allocate special bathroom - hardware - next door to the operating room.
Centralized eyeliner in operating four channels: three gases are fed (O2, CO2, N2O), on the fourth creates a vacuum. Due to the use of operating flammable ether, cyclopropane, and other gases and their mixtures with air and oxygen in contact with nachalnymi subjects (electrocautery) and an open flame (flame alcohol burner), sparks, arising when operating the devices, and, finally, from static electricity in operating occasionally may occur explosions. Therefore personnel will be permitted to wear out. woolen, silk and synthetic fabrics; requires ground all devices, maintaining C. operating relative humidity of 60 - 65%. The optimum temperature operating in 22 degrees. The necessary supply and exhaust ventilation with currency 3-4 of air volume in 1 hour, but it is better to equip operating units conditioned air, which provides not only optimum temperature and humidity at any time of the year, but also the exchange of air.
Resuscitation rooms are equipped with functional beds, equipment for blood transfusion, artificial respiration, pacing and defibrillation. Patients transferred from the intensive care in a recovery room for intensive care. Dressings can be located in the ward office away from the rest of the surgical dressing unit. The equipment consists of simple tables, tables for instrumentation, medical supplies and bandaging materials and equipment for the treatment. The purpose of dressing depends on the type of the Department: in the trauma institutions it is usually room for applying plaster bandages, urologic uses for various procedures, etc.

Fig. 4. The scheme beoperational: 1 - compartment lock; 2 - operating compartment; 3 - experimental operating.

A special type of operating rooms are beoperational camera is a separate building consisting of actually operating, locks chambers in which interventions are made under the pressure of 2.5-3 ATM. (absolute). Beoperational is a steel cylindrical room area from 10 to 24 m2, which comes compressed Vozduh and oxygen (Fig. 4). This increases physical dissolution O2 in the tissues of the body. Application beoperational shown if necessary saturation of tissues O2, such as heart operations, in anaerobic infections, poisoning and other poisons.
Weekly do the General cleaning of the surgical dressing unit hot water with soap and disinfectants (formalin, Lysol). Every day after the end of the operational day produce regular cleaning and washing the floor. After each operation damp cleaning operating. During operation clean in cans or bags contaminated linen and bandages and wipe the floor, before the end of the work the blood, until it seemed to be stuck to the floor. The necessary control of the ventilation installation or air conditioning. Before the operation, the air is disinfected with bactericidal ultraviolet lamps that consume at least 2.0-2.5 watts. on 1 m3 volume operating. When switching on the lights for 2-3 hours microbial contamination of air, as compared with the initial reduced by 50 - 80%. Exposure to air operating bactericidal lamps reduces the number of suppuration after acepting operations of 3-star,5 times (C. I. Pods, 1962).
Mechanization of the work of the surgical dressing unit is critical. Can be mechanised cleaning of the premises; the transportation of patients, tools, clothes; to establish a telephone or radio communications; apply tape or other mechanical write to conduct proper medical documentation.
Direct management of the work of O.-p. B. carries out the older operating sister, and in large institutions with a large number of operating tables - doctor, head of operational body. It establishes the procedure of operations every day, specialization operating tables, distributes staff, carries out the control over observance of rules of aseptics, the operational log, statement of medicines and other
The operational log is the only legal document in which a surgeon for a specific form briefly describes each transaction immediately after its completion. In addition to the description of the operation, shall specify the sequence number, the date of receipt of the patient, surname, name, patronymic name, age, diagnosis, date of operation, title, date of issue and the outcome. The operational log is a source for a report on the work of the surgical dressing unit.