无菌技术是指在医疗

无菌技术是指在医疗 一、概念 无菌技术是指在医疗～护理操作中～防止一切微生物侵入人体和防止无菌区域和无菌物品被污染的操作技术。 二、无菌技术操作原则 1、环境要清洁。进行无菌技术操作前半小时～须停止清扫地面等工作～避免不必要的人群流动～防止尘埃飞扬。治疗室每日用紫外线照射消毒一次。 2、进行无菌操作时～衣帽穿戴要整洁。帽子要把全部头发遮盖～口罩须遮住口鼻～并修剪指甲～洗手。 3、无菌物品与非无菌物品应分别放置～无菌物品不可暴露在空气中～必须存放于无菌包或无菌容器内～无菌物品一经使用后～必须再经无菌处理后方可使用～从无菌容器中取出的物品～虽未使用～也不可放回无菌容器内。 4、无菌包应注明无菌名称～消毒灭菌日期～并按日期先后顺序排放～以便取用～放在固定的地方。无菌包在未被污染的情况下～可保存7-14天～过期应重新灭菌。 5、取无菌物品时～必须用无菌钳,镊,。未经消毒的物品不可触及无菌物或跨越无菌区。 6、进行无菌操作时如器械、用物疑有污染或已被污染～即不可使用～应更换或重新灭菌。 7、一套无菌物品～只能供一个病员使用～以免发生交叉感染。 the needs of future rehabilitation centre. facilitates future expansion of the hospital-wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a security point of view, the internal network of centres for the rehabilitation of the project system and Internet construction independently. to protect data within medical rehabilitation center from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and not the hospital external link external network and an external network and data Association, two independent sets of network equipment. Medical network to four-room for 2 large Gigabit switches at the core, double-machine 三、手术室人员配备和职能 手术是集体智慧和劳动的集中体现～手术人员必须有明确的分工和职责～但又需互相协同和配合才能安全顺利完成手术。 1、手术医师 ?手术者 ?第一助手 ?第二助手 2、麻醉师 3、器械护士 4、巡回护士 四、术前准备 ?手术人员术前准备 1、一般准备:进手术室要换穿手术室准备的清洁鞋和衣裤～戴好口罩及帽子。口罩要盖住鼻孔～帽子要盖住全部头发。剪短指甲～并除去甲缘下积垢。手臂皮肤破损有化脓感染时～不能参加手术。 2、手臂消毒法:在皮肤皱纹内和皮肤深层如毛囊、皮指腺等都藏有细菌。手臂消毒法仅能清除皮肤表面的细菌～并不能完全消灭藏在皮肤深处的细菌。在手术过程中～这些细菌会逐渐移到皮肤表面～故在手臂消毒后～还要戴上消毒橡胶手套和穿手术衣～以防止这些细菌污染手术伤口。沿用多年的肥皂刷手法已逐渐被应用新型灭菌剂的刷手法所代替。后者刷洗手时间短～灭菌the needs of future rehabilitation centre. facilitates future expansion of the hospital-wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a security point of view, the internal network of centres for the rehabilitation of the project system and Internet construction independently. to protect data within medical rehabilitation center from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and not the hospital external link external network and an external network and data Association, two independent sets of network equipment. Medical network to four-room for 2 large Gigabit switches at the core, double-machine 效果好～能保持较长时间的灭菌作用。洗手用的灭菌剂有含碘与不含碘两大类。 ?肥皂刷手法 1,参加手术者先用肥皂作一般的洗手后～再用无菌毛刷蘸煮过的肥皂水刷洗手和臂～从手指尖到肘上10cm处～两臂交替刷洗～特别注意甲缘、甲沟、指蹼等处的刷洗。一次刷完后～手指朝上肘朝下～用清水冲洗手臂上的肥皂水。反复刷洗三遍～共约10分钟。用无菌毛巾从手到肘部擦干手臂～擦过肘部的毛巾不可再擦手部。 2,将手和前臂浸泡在70,酒精内5分钟。浸泡范围到肘上6cm处。 3,如用新洁尔灭代替酒精～则刷手时间可减为5分钟。手臂在彻底冲净肥皂和擦干后～浸入1:1000新洁尔灭溶液中～用桶内的小毛巾轻轻擦洗5分钟后取出～待其自干。手臂上的肥皂必须冲净～因新洁尔灭是一种阳离子除污剂～肥皂是阴离子除污剂～带入肥皂将明显影响新洁尔灭的杀菌效力。配制的1:1000新洁尔溶液一般在使用40次后～不再继续使用。 4,洗手消毒完毕～保持拱手姿势～手臂不应下垂～也不可再接触未经消毒的物品。否则～即应重新洗手。 ?碘而康刷手法:肥皂水擦洗双手、前臂至肘上10cm 3分钟～清水冲净～用无菌纱布擦干。用浸透0(5,碘而康的纱布球涂擦手和前臂1 遍～稍干后穿手术衣和戴手套。 the needs of future rehabilitation centre. facilitates future expansion of the hospital-wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a security point of view, the internal network of centres for the rehabilitation of the project system and Internet construction independently. to protect data within medical rehabilitation center from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and not the hospital external link external network and an external network and data Association, two independent sets of network equipment. Medical network to four-room for 2 large Gigabit switches at the core, double-machine ?灭菌王刷手法:灭菌王是不含碘的高效复合型消毒液。清水洗双手、前臂至肘上10cm后～用无菌刷蘸灭菌王3，5ml刷手和前臂3分钟。流水冲净～用无菌纱布擦干～再取吸足灭菌王的纱布球涂擦手和前臂。 皮肤干后穿手术衣和戴手套～如果手术完毕～手套未破～连续施行另一手术时～可不用重新刷手～仅需浸泡酒精或新洁尔灭溶液5分钟～也可用碘而康或灭菌王涂擦手和前臂～再穿无菌手术衣和戴手套。但应采用下列更衣方法:先将手术衣自背部向前反折脱去～使手套的腕部随之翻转于手上～然后用右手扯下左手手套至手掌部～再以左手指脱去右手手套～最后用右手指在左手掌部推下左手手套。脱手套时～手套的外面不能接触皮肤。若前一次手术为污染手术～则连接施行手术前应重新洗手。 3、穿无菌手术衣和戴手套的方法:目前多数医院都采用经高压蒸气灭菌的干手套～仅少数使用消毒液浸泡的湿手套。如用干手套～应先穿手术衣～后戴手套,如用湿手套～则应先戴手套～后穿手术衣。 ?穿无菌手术衣,将手术衣轻轻抖开～提起衣领两角～注意勿将衣服外面对向自己或触碰到其他物品或地面。将两手插入衣袖内～两臂前伸～让别人协肋穿上。最后双臂交叉提起腰带向后递～仍由别人在身后将带系紧。 ?戴无菌手套:没有戴无菌手套的手～只允许接触手套套口的向外翻折部分～不应碰到手套外面。 the needs of future rehabilitation centre. facilitates future expansion of the hospital-wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a security point of view, the internal network of centres for the rehabilitation of the project system and Internet construction independently. to protect data within medical rehabilitation center from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and not the hospital external link external network and an external network and data Association, two independent sets of network equipment. Medical network to four-room for 2 large Gigabit switches at the core, double-machine 1,戴干手套法:取出手套夹内无菌滑石粉包～轻轻地敷擦双手～使之干燥光滑。用左手自手套夹内捏住手套套口翻折部～将手套取出。先用右手插入右手手套内～注意勿触及手套外面,再用已戴好手套的右手指插入左手手套的翻折部～帮助左手插入手套内。 已戴手套的右手不可触碰左手皮肤。将手套翻折部翻回盖住手术衣袖口。用无菌盐水冲净手套外面的滑石粉。 2,戴湿手套法:手套内要先盛放适量的无菌水～使手套撑开～便于戴上。戴好手套后～将手腕部向上举起～使水顺前臂沿肘流下～再穿手术衣。 ?病人的准备 1、一般准备 2、手术体位 其要求是:?最大限度的保证病人的安全与舒适, ?充分暴露手术区域～同时减少不必要的裸露, ?肢体及关节托垫须稳妥～不能悬空, ?保证呼吸和血液循环通畅～不影响麻醉医师的观察和检测, ?妥善固定～避免血管、神经受压、肌肉扭伤及压疮等并发症的发生。 常用的手术体位有: ?仰卧位: the needs of future rehabilitation centre. facilitates future expansion of the hospital-wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a security point of view, the internal network of centres for the rehabilitation of the project system and Internet construction independently. to protect data within medical rehabilitation center from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and not the hospital external link external network and an external network and data Association, two independent sets of network equipment. Medical network to four-room for 2 large Gigabit switches at the core, double-machine ?侧卧位: ?俯卧位: ?膀胱截石位: ?半坐卧位: 3、手术区皮肤消毒: 目的是消灭拟作切口处及其周围皮肤上的细菌。如皮肤上有较多油脂或胶布粘贴的残迹～可先用汽油或乙醚拭去～然后用2.5,，3,碘酊涂擦皮肤～待碘酊干后～以,,,酒精将碘酊擦净两次。另一消毒方法是用,:1000新洁尔灭酊涂擦两遍。对婴儿、面部皮肤～口腔、肛门、外生殖器～一般用1:1000新洁尔酊或1:1000洗必泰酊涂擦两次消毒。 注意事项:?涂擦上述药物时～应由手术区中心部向四周涂擦。如为感染伤口或肛门等处手术～则应自手术区外周涂向感染伤口或会阴肛门处。已经接触污染部位的药液纱布～不应再返擦清洁处,?手术区皮肤消毒范围要包括手术切口周围15cm的区域。如手术时有延长切口的可能～则应适当扩大消毒范围。 4、手术区铺单法: 手术区消毒后～铺无菌布单。铺盖无菌布单的目的是除显露手术切口所必需的皮肤区以外～遮盖住其他部位～以避免和尽量减少手术中的污染。也可在手术区的皮肤上粘贴无菌塑料薄膜～切开后薄膜仍粘附在伤口边缘～可防止皮肤常存细菌在术中进入伤口。小手术仅盖一块孔巾即可～对较大手术～须铺盖无菌巾和the needs of future rehabilitation centre. facilitates future expansion of the hospital-wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a security point of view, the internal network of centres for the rehabilitation of the project system and Internet construction independently. to protect data within medical rehabilitation center from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and not the hospital external link external network and an external network and data Association, two independent sets of network equipment. Medical network to four-room for 2 large Gigabit switches at the core, double-machine 其他必要的布单等。原则是除手术野外～至少要有两层无菌布单遮盖。一般的铺巾方法如下:用四块无菌巾～每块的一边双折少许,掩盖手术切口周围～每侧铺盖一块无菌巾。通常先铺操作者的对面～或铺相对不洁区,如会阴部、下腹部,～最后铺靠近操作者的一侧～并用布巾钳夹住交角处～以防止移动。无菌巾铺下后～不可随便移动～如位置不准确～只能由手术区向外移～而不应向内移动。然后～根据情况～再铺中单、大单。大单的头端应盖过麻醉架～两侧和足端部应垂下超过手术台边30cm.。 五、手术进行中的无菌原则 在手术过程中～虽然器械和物品都已灭菌、消毒～手术人员也已洗手、消毒、穿戴无菌手术衣和手套～手术区又已消毒和铺覆无菌布单～为手术提供了一个无菌操作环境。但是～在手术进行中～如果没有一定的规章来保持这种无菌环境～则已经灭菌和消毒的物品或手术区域仍有受到污染～引起伤口感染的可能～有时可能使手术失败～甚至影响病人的生命。这个所有参加手术的人员必须认真执行的规章～即称无菌操作规则～如发现有人违反时～必须立刻纠正。无菌操作规则包括: 1、手术人员一经"洗手"～手臂即不准再接触未经消毒的物品。穿无菌手术衣和戴无菌手套后～背部、腰部以下和肩部以上都应认为是有菌地带～不能接触,同样～手术台边缘以下的布单～也不要接触。 2、不可在手术人员的背后传递器械及手术用品。坠落到无the needs of future rehabilitation centre. facilitates future expansion of the hospital-wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a security point of view, the internal network of centres for the rehabilitation of the project system and Internet construction independently. to protect data within medical rehabilitation center from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and not the hospital external link external network and an external network and data Association, two independent sets of network equipment. Medical network to four-room for 2 large Gigabit switches at the core, double-machine 菌巾或手术台边以外的器械物品～不准拾回再用。 3、手术中如手套破损或接触到有菌地方～应另换无菌手套。前臂或肘部碰触有菌地方～应更换无菌手术衣或加套无菌袖套。无菌巾、布单等物～如已被湿透～其无菌隔离作用不再完整～应加盖干的无菌单。 4、在手术过程中～同侧手术人员如需调换位置时～应先退后一步～转过身～背对背地转到另一位置～以防止污染。 5、手术开始前要清点器械、敷料～手术结束时～检查胸、腹等体腔～核对器械、敷料数无误后～才能关闭切口～以免异物遗留腔内～产和严重后果。 6、切口边缘应以大纱布垫或手术巾遮盖～并用巾钳或缝线固定～仅显露手术切口。 7、作皮肤切口以及缝合皮肤之前～需用70,酒精或0.1,新洁尔灭溶液～再涂擦消毒皮肤一次。 8、切开空腔脏器前～要先用纱布垫保护周围组织～以防止或减少污染。 9、参观手术人员不可太靠近手术人员或站得太高～也不可经常在室内走动～以减少污染的机会 the needs of future rehabilitation centre. facilitates future expansion of the hospital-wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a security point of view, the internal network of centres for the rehabilitation of the project system and Internet construction independently. to protect data within medical rehabilitation center from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and not the hospital external link external network and an external network and data Association, two independent sets of network equipment. Medical network to four-room for 2 large Gigabit switches at the core, double-machine