MINISTRY OF PUBLIC HEALTH OF UKRAINE

O.O.BOGOMOLETS NATIONAL MEDICAL UNIVERSITY

“Approved”
on the methodical meeting of the
Department of General Surgery №2
Head of Department
Professor Ioffe O.Y.

_____________________________

25 August 2021

Academic Guides
for individual work of students to prepare for practical lesson

Academic discipline General Surgery

Module № 1 Introduction to surgery. Desmurgy. Bases of sanitary and
epidemic regimes in surgical clinic. Urgent surgical conditions.
Basical principles of transfuziology, anesthesiology and
reanimatology.
Content module № 1 Desmurgy. Antisepsis. Asepsis. Bleeding. Haemotransfusion.
Traumatic injuries.
Subject of lesson № 2 Antisepsis. Types of antiseptics. Characteristics of the main
groups of antiseptic agents and the main methods of their
application. Intrahospital infection. Sanitary-epidemiological
regime. Asepsis.
Course 3
Faculty Medical

Kyiv-2021
 1. RELEVANCE OF THE TOPIC

By the middle of the 19th century more than 80% of operated patients died
from purulent complications of surgical wounds, the causes of which at that time
were unknown. The work of the French military doctor, Jean-Charles Chenu
(Jean-Charles Chenu) shows loss of 309,000th of the French army in the Crimea
(1854-1856), namely, killed 10,000 soldiers (3.3% of total forces) and died from
the consequences of injury 85000 (27.6%) postoperative lethality was 92%.
Hungarian Application obstetrician Semmelweis in 1847, in an antiseptic
bleach during vaginal studies in patients, allowed to reduce the postnatal
mortality associated with the development of sepsis, from 18.3% to 1.3%.
Thanks to the discovery of L. Pasteur (1863), it was found that the cause
of purulent diseases and wound complications are microorganisms. The latter
became the basis for the creation in the future of scientifically based measures to
combat infection (antiseptics) and its prevention (aseptic).
The facts cited above clearly outline the relevance and importance of aseptic
and antiseptic issues in the work of medical and preventive institutions. That is
why, the study and knowledge of the bases of aseptic and antiseptic is necessary
for medical workers of all specialties. The urgency class is dictated by the fact
that issues relating to this topic. They will be reviewed and senior years at training in
the departments of surgery, therapeutic and preventive profile.

2. SPECIFIC OBJECTIVES:

Identify basic functions and structure of a surgical hospital.

Demonstrate possession of skills of compliance with the sanitary-hygienic regime
of the surgical hospital and its structural units.
Learn basics of care for surgical patients with infectious pathology.
Learn basic principles of observing aseptic and antiseptic in a surgical hospital.
Demonstrate methods of care for patients in the postoperative period and
methods of preventing possible complications.

3. BASIC KNOWLEDGE, SKILLS, NECESSARY FOR THE

STUDY OF THE LESSON:
Names of previous Obtained skills
disciplines
Normal Describe the features of the structure of human
anatomy and histology surfaces.

Chemistry Determine the chemical structure of substances with

antiseptic properties. Know about the consequences of
their interaction with other organic and inorganic
compounds and environmental factors.
Physics Identify the parameters of the physical impact
factors used to control the infection. To know the
rules for using devices that affect biological tissues
with the help of ultraviolet irradiation, high
temperatures, ultrasound, and demonstrate on the
dressing the hygroscopic properties of gauze,
bandages.
Microbiology Describe the main groups and properties of bacterial
flora, its sensitivity to antiseptics, ultraviolet radiation
and high temperatures, to determine the presence of
microflora by inoculation, to master the technique of
growing colonies of microorganisms with the definition
of sensitivity to antibiotics, to identify these colonies
and compare with standard schemes.

4. REQUIREMENTS FOR SELF-WORKING AT THE

PREPARATION FOR THE LESSON.

4.1 A list of the main terms, parameters, characteristics that the student
must learn in preparation for the lesson:
Term Definition
Asepsis A complex of therapeutic and preventive measures
and methods aimed at preventing hit potential
causative agents of the disease in the wound, on the
surface of the skin, in the organs and cavities of the
patient's body.
Antiseptic A set of measures aimed at the destruction or
suppression of the growth of potentially dangerous
microorganisms in the wound, pathological focus, in
the body of the patient as a whole and the environment.
Virulence The degree of pathogenicity (the level of the potential
capacity of a given microorganism to cause disease in
the respective host). The concept includes the degree
of invasiveness and toxicity.
Surgical infection The process of interaction of a microorganism with a
macroorganism, at which the microorganism penetrates
into the host's organs, the multiplication of the
microorganism and possibly tissue damage (invasion)
as a result of direct action, which includes the release
of toxins by the microorganism or by immune
reactions.
Incubation The time interval between contact with the
period pathological agent and the manifestation of the first
clinical symptoms of the disease.
A source of The natural habitats of microorganisms, where their
infection growth and reproduction are ensured, from where they
 are released into the external environment.
Mechanism of Evolutionary ability of the pathogen to move from
transfer one person to another. In hospital conditions it is
realized, as a rule, only in cases of drift of pathogens of
traditional infections.
Carrier of The presence in the body of an individual (host) of a
infection pathogenic microorganism without clinical
manifestations of infection or sometimes without signs
of any immune response.
Pathogenicity The ability of the microorganism to cause disease.
Way of A set of transmission factors that act under specific
transfer conditions for that infection.
Factors of Elements of the environment that participate in the
transfer transmission of the causative agent of infection.
Exogenous Infection that develops as a result of infection with
infection microorganisms from outside.
Endogenous An infection that is caused by activation of its own
infection (endogenous) cutaneous flora's and mucous
membranes, or by micro-organisms, which were
previously colonized patient's organs.
Decontamination The general term, which refers to the processing
process, which removes the causative agents of
infectious diseases, as a result of which the use of the
processed object becomes safe.
Cleaning The process of removing visible dust, dirt, organic
and other foreign materials. It is usually carried out
with water with soap, detergents or enzyme products.
Cleaning must always be carried out before disinfection
or sterilization begins.
Disinfection The process of destruction of most microorganisms
except bacterial spores. The term "disinfection"
applies to inanimate objects.
Sterilization The process of destroying all forms of microbial life,
including bacteria, viruses, spores and fungi.

4.2 Theoretical questions for the lesson:

1. Surgical infection: definition of the concept, species, sources, ways and

factors of transmission, ways of infection of the operating wound;
2. History of the origin and development of antiseptics;
3. Contribution of ukrainian scientists in improving the antiseptic method of
surgery;
4. Define antiseptics.
5. Types of antiseptics.
6. Basic methods of mechanical antiseptics.
7. Basic methods of physical antiseptics.
 8. Chemical group of antiseptics and their clinical characteristics.
9. Methods of biological antiseptics.
10. The main groups of antibiotics.
11. Principles of antibacterial therapy in surgery.
12. The main complications of antibiotic therapy in the treatment of surgical
diseases.
13. Features of care of patients with purulent pathology.
14. Sources and ways of spreading the infection.
15. Measures to prevent infection of the surrounding environment.
16. Identify the ways of infection of the wound in the operating room.
17. Describe each group from chemical antiseptics.
18. What is the role of biological antiseptics among antiseptic agents?
19. What is included in the concept of mixed antiseptics?
20. Clean and purulent dressings.
21. The organization of the purulent dressing and the special care for patients
with purulent pathology.
22. Disposal of dressings contaminated with purulent compartments.
23. Organization of care for patients with anaerobic infection.
24.Methods of processing the hands of the surgeon, the means for their
implementation, the advantages and disadvantages of individual methods,
processing the operating field.
25.Structural and organizational features of the structure of the operating unit.
26.Features of the sanitary and hygienic mode of the operating room.
27.Types of cleaning of the operating room, facilities and equipment for their
conduct.
28.Pre-sterilization cleaning of surgical instruments.
29.Methods of sterilization of medical supplies, indications for use, their
advantages and disadvantages.
30.General principles of the structure and work of the autoclave, modes of steam
sterilization, types of stacking materials in the box.
31.Safety rules for working with autoclave.
32.Features of sterilization of optical instruments, cutting tools and rubber
products.
33.Methods of sterilization of suture material.
34.Quality control of sterilization.
35.Storage of sterile materials for medical purposes.
36.What types of cleaning are used in the operating room?
37.The method used for air disinfection in the operating room.
38.Why do I need to do presterilization processing of tools, and what does it
include?
39.Where the sterilization of instruments, surgical linen, gloves is done?
40.How to carry out sterilization of instruments with optics?
41.Can I use material from the boxes if it is stored for more than 48 hours with
the windows closed in bixies?
42.Control of the sterility of the material in autoclaves.
43.Historical and modern ways of processing the hands of the surgeon.
 44.Provide justification for the most reliable method of sterilization and storage
of suture material.
45.Features of work in clean and purulent dressing.
46.Disposal of dressings contaminated with purulent compartments.
47.Organization of care for patients with anaerobic infection.
48.The structure of the operating unit and maintenance of the sanitary and
hygienic regime in the operating room.
49.Organization of various types of cleaning in the operating room.
50.Means and methods of processing the hands of the surgeon and the operating
field.
51.Definition and classification of sterilization methods for cutting, optical and
general surgical instruments.
52.The main methods of sterilization of suture material.
53.The structure, principle and mode of the autoclave, safety rules for working
with an autoclave.

4.3 Practical work (tasks) that are performed during the lesson:

1. To carry out hygienic disinfection of hands.

2. Perform surgical treatment of hands with an alcohol-containing antiseptic.
3. To make test for sensitivity to antibiotics.
4. Perform the treatment of the operating field with a clean wound.
5. Perform the treatment of the operating field with a purulent wound.
6. To know the first aid of allergic reaction on an antibiotic.
7. Organize the work and care for patients in purulent dressing room;
8. Prepare antiseptic agents for dressing patients with purulent pathology.
9. To make wound dressings of inflammatory processes;
10. To make allergy test for antibiotic susceptibility;
11. Perform utilization of the dressing materials;
12. Organize measures to prevent spreading of anaerobic infection;
13. Prepare and stack boxes with dressing, linen and gloves for various types of
operations.
14. Prepare disinfecting solutions and sanitary treatment of premises of stationary
branches of various profiles;
15. Prepare disinfecting solutions and prepare disposal of used disposable
instruments;
16. Prepare instruments for sterilization and pre-sterilization cleaning of surgical
instruments;
17. Conduct samples for the quality of pre-sterilization cleaning;
18. Sterilization of surgical instruments in a dry-hit cabinet;
19. Implementation of the installation of medical supplies in the box;
20. Ensuring aseptic hands of the surgeon and the operating field
21. Conduct quality control of sterilization;
22. Prepare and clean hands with a solution of c-4, demonstrate the rules for
dressing operating underwear;
 23. Carrying out the processing of the operating field;
24. Covering the sterile dressing table;
25. Manufacturing of napkins, tampons, balls for care of surgical patients;
26. Demonstration of sterilization of suture material;
27. Organization of transportation of the patient to the operating room.

5. CONTENT OF THE TOPIC

Sources and ways of spreading surgical infection.

Exogenous infection is an infection that enters the wound from the external
environment:
a). from air - air infection;
b). with splashes of saliva or other liquids - drip infection (sometimes
combined in one form - airborne infection);
c). from objects that come into contact with the wound - contact infection;
d). from items that remain in the wound (seams, drains, metal rods, artificial
heart valves, etc.) - implantation infection.
Hiting pathogenic microorganisms from the patient to the patient is
called - cross-infection .
Endogenous infection considered an infection that is contained inside the
body or on its cover. Endogenous infection gets into the wound directly (contact) or
in vascular pathways (lymphogenous or hematogenous). The major endogenous
infection foci are: inflammatory processes of the skin (furuncles, carbuncles,
pyoderma, eczema, etc.); gastrointestinal infection (dental caries, gingivitis,
cholecystitis, cholangitis, pancreatitis, etc.); respiratory tract infection (sinusitis,
tracheitis, bronchitis, bronchiectasis); urogenital infection (pyelitis, CYSTITIS,
prostatitis, urethritis, salpingoophoritis); cryptogenic infections.
Fighting with the microflora in the way of air infection. When no centralized
air treatment system from dust and microbes is present, the special mobile air
purifier is used. During 15 minutes the apparat can reduce the number of microbes
in the operating room in 7-10 times. The multiplicity of exchange of air in the
operating room should at least 6-8 times when using active-passive ventilation,
and 10 times – using air conditioning.
Fighting with the microflora in the stages of the contact wound infection. To
prevent contact infection it is necessary to achieve sterility of all, that will be in
contact with the wound. This is achieved by sterilizing surgical linen, dressings
and sutures, gloves, tools, treatment of hand surgery and the surgical field.
Sterilization of suture is directed to prophylaxis of contact and implant wound
infection.
Prevention of implant wound infection. The suture has the highest value in the
occurrence of implant infection. Wound suppuration occurs much less frequently in
case of using sutures which have antimicrobial activity due to the introduction into
it antimicrobial drugs (synthetic surgical threads VICRYL processed by antiseptic
(triclosan); letilan-polyester, ftorlon and other processed by nitrofurans, antibiotics,
etc.).
 Antiseptic - a set of tools and activities aimed at the destruction of potential
pathogens in the wound (or in the tissue / cavity, surrounding it), or in the
pathological focus in the body as a whole.
Disinfection (disinfection) - destruction pathogenic and conditionally
pathogenic microorganisms in environmental objects.
In a more narrow sense, in the context of surgery, the term "disinfection"
means the use of chemical methods (means) and the destruction of microorganisms
on inanimate objects, and for people - use the term "antiseptic".
Microorganisms, survivors of the action of antiseptics, do not cause disease
due to lack of infective dose and reduced virulence and subsequently neutralized by
the immune system factors.
The disinfecting agent - active substance which ensures the destruction of
pathogenic and conditionally pathogenic microorganisms, environmental objects.
Decontamination - reducing the number of microorganisms on
environmental objects.
Sterilization - a process, which provides destruction of vegetative and spore
forms of pathogenic and non-pathogenic microorganisms.
Underlying mixed antiseptics lies combined use of various antiseptic
techniques, which today is widely used in practice.

Preparation of disinfectant solutions and preparation for disposal of the used

material. Disinfectant solutions are prepared just before use. Disinfectant solutions
are carried out with water in a suitable percentage, which corresponds by instruction
and orders .
Disinfection of the used material takes place by soaking it in 0.2% solution of
Chlorantoin for 1 hour, and subsequently with folding by prying into a plastic bag.
Records about procedure are made in a notebook of recycling material in a muffle
oven. The used material is disinfected by dissolving 2g Chlorantoin in 1 liter of liquid
during 1 hr. The container is rendered harmless by a 0.2% solution of chloroantoin
for 1.5 hours.
Production of napkins, tampons, and balls for care of surgical patients. For
the dressing we use gauze balls, napkins, tampons, bandages. They can be applied
at the wound in order to dewater the wound, stop bleeding, drain or plug it.
Dressings are made from gauze and wool, viscose and less lignin. Cotton is
previously cut into pieces. Material is harvested for future use, for replenishing least
expenditure.
The beads are made from pieces of gauze by dimensions of 10x10 m. They are
collected and carefully wrapping around the finger in a ball form, which is charged
into the free ends of the gauze. Balls stored in a gauze bag by 50 pcs. Napkins are
made in three sizes: large (60x40 cm), medium (40x30 cm) and small (20x15 cm).
The edges of cut gauze wrapped inwardly, folded in half along the length and width
and knotted to 10 pcs. ribbon of gauze. Tampons are made of gauze 20,30,50 cm
long pieces of material to the middle bending edge. Turunds are manufactured from
gauze pieces 40-50 cm long and 5 cm wide. The ends of the bandage wrapped inside,
pulled through the edge of the table and is rolled into a roll.
 Stacking of medical materials in a box. Harvested material is folded into a
metal box to further sterilization. In the absence of box, sterilization in linen bags is
allowed.
In the case of universal packing, a material intended for one small typical
operation (appendectomy, herniotomy, phlebectomy, etc.) is placed in the box. In
the case of targeted packing, a necessary set of dressings and surgical materials
intended for a specific operation (pneumonectomy, gastrectomy, etc.) is placed in
the box. In the case of specific packing, a certain kind of dressing material and linen
is put in the box (box with gowns, box with napkins, box with balls, etc.).
Before packing, it is nessesary to check the serviceability of the box, then
from the middle it is wiped with a napkin, moistened with alcohol, the bottom is
placed on the unfolded sheet, the ends of which are from the outside. Dressing
material is inserted vertically by sectors or packs. Dressing gowns, towels, sheets are
put into the box vertically, so that when removing the sterile material, one object
does not interfere with taking out the other. The material is laid loose, to provide
access to the steam, sterilization indicators are placed inside, the edges of the sheet
are wrapped, the bix is closed with a lid and the lock is locked. On the cover of the
bix, attach a tag from the oilcloth on which the name of the material is indicated, and
after sterilization the date of its carrying out and the name of the person who carried
out the sterilization.
Storage time of material, sterilized in box with filter - 20 days, without a filter
and other containers - to 3 days.
Presterilizing processing of reusable equipment.
1.All medical instruments are disinfected after use in disinfectant solution
(3% chloramine solution, 0.2% Chlorantoin solution, 6% hydrogen peroxide
solution and others) for one hour. Disinfection is carried out in closed vessels
under full immersion of the tool into the solution.
2. After exposure, the instruments are rinsed under running water.
3. The next step - presterilizing purification to remove protein, fat and
mechanical impurities as well as pharmaceuticals. Presterilizing purification is
carried out by manual or mechanical manner using a washing solution (17 ml of
27.5% solution, 5 g of detergent hydrogen peroxide "Lotus", 1.4 g ingibit of
corrosion sodium oleate, potable water to 1 liter at a temperature of 50-55 0 C ).
The first stage - soaking in the wash liquid during full immersion products for
15 min. Subsequently washing is performed for each product in the detergent
races creates via ruff or gauze swab.
4. The next step - rinsing instruments under running water for 10
minutes, followed by the quality control before the sterilization treatment.
5. Next, desalting of tools is carried by washing during 1 min in distilled
water.
6.Drying instruments in a hot air oven at a temperature of 85 0 C.
Conducting tests on the quality of presterilizing processing.
Verification tools of presterilizing purification is carried out by placing the
samples for the presence of residual blood and completeness of laundering product
from the alkaline components of detergents. Control subject is 1% of each product
names treated per day, but not less than 3-5 units. Products that monitor, wipe with
gauze, moistened with a reagent or 2-3 drops of reagent with a pipette is applied to
the product.
Quality of tools laundering from residual blood is evaluated using
- Azopiram sample (100 g amidopirina, 1-1.5 g of aniline hydrochloride, 95%
ethyl alcohol to 1l). In the presence of blood the azopiram sample appears initially
from violet coloration to pink-lilac or brown.
- Amidopirin sample (equal amounts of 5% alcoholic solution of amidopirin,
30% acetic acid solution and a 3% solution of peroxide of hydrogen). In the presence
of blood the amidopirin sample change color to blue-violet.
- Samples reagent "Torch-2" (0.2% aqueous solution of the drug "Torch-2", 1 ml
of 3% hydrogen peroxide), the positive sample with a reagent "Torch-2" change
color to cherry red.
The sample of complete laundering of alkaline components of detergents is
carried out with fenolftalein reagent (1% solution in alcohol). The presence of
detergent on the products change color of reagent to pink.
Sterilization of medical devices. Sterilization is required for all products that
touch the wound surfaces or come into contact with blood or injectable preparations
and the individual devices of medical instruments, which relate to the operation of
the mucous membranes and may cause damage. Use following sterilization methods.

1. Steam sterilization method (in autoclave). When the steam pressure

in the sterilization chamber is 2 atm and the temperature is 132 0 C, during time
20 minutes, the instruments become sterilize. It is recommended for
sterilization of products of corrosion resistant metal, glass, manufacturing of
textiles. For articles made of rubber, latex and selected polymeric materials
(high density polyethylene, PVC plastic) used sterilization mode with the
following parameters: pressure 1.1 atm, the temperature - 120 0 C, exposure 45
min or pressure 0.5 atm, the temperature – 110C, 180 min exposure.
Sterilization is carried out in bix, double soft packing with calico, parchment
paper.
2. Air sterilization method (in a hot air oven). This method is
recommended for sterilization of products made by metal and glass in the mode of
180 0 C with a holding time of 60 minutes and the product made of silicone
rubber in the mode of 160 0 C with an exposure of 150 min. Sterilization
products are be dried in open tanks or in parchment paper.
3. Chemical sterilization method suitable for thermolabile surgical
instruments made from metal, glass, plastics and rubber. It carried out in two
ways: by the use of chemicals in a gaseous state (ethylene oxide), and by
immersing the instruments in a chemical solution (6% hydrogen peroxide,
CIDEX, Korzoleks, Korzolin, Odokson et al.). Exposure time is indicated in the
operating instructions of the sterilization agent. After sterilization the product is
washed from residues, and then placed into the sterilization box, contained
sheets.
4. Radiation sterilization method. Using gamma - or X – ray radiation.
According to the report of the International Agency for Atomic Energy (IAEA) in
2015 in developed countries by 50% to 60% of disposable medical products are
sterilized by radiation method.
 In our country, the suture material is sterilized by gamma radiation in the
factory. In ampoules or packets, the skeins of silk, lavsan, capron are stored at room
temperature and used as needed in terms corresponding to the shelf life. Metal suture
material (wire, braces) can be sterilized in an autoclave.
Control of sterilization quality. Control of sterility of the material and the
autoclave sterilization mode is carried out by direct and indirect methods.
Direct way - bacteriological, namely sowing with dressing material and linen
or bacteriological tests. Crop research from dressing material and linen is carried
out once every 10 days.
Indirect method of sterility test is applied continuously during each
sterilization. For this purpose, a substance with a specific melting point (benzoic
acid, whose melting point - 120 ° C), resorcinol (119 ° C), antipyrine (110 ° C)) are
used. These substances are available in ampoules. They are also used in test tubes
(0.5 grams), covered with a gauze plug. The ampoules are putting between the
layers of material each 1-2 lay. Melting a powder and convert it into a solid mass
indicates that the temperature is inought for sterilization. To monitor sterilization
in a heat mode sterilizers used powdered substance with a higher point of melting:
ascorbic acid (187-192 ° C), succinic acid (180-184 ° C), pilocarpine hydrohlorid
(200 ° C), urea (180 ° C ) .
Sanitary cleaning of the dressing room .
The main route of infection in the wound dressing room - a pin (about 90% of
cases), only 10% of cases of infection occurs by air.
Presents of microorganisms in the air are very rare things in isolation, mostly
they are fixed on a microscopic fraction of dust. Therefore, careful removal of dust,
as well as preventing its penetration into the dressing room, reduces the degree
of microbial contamination.
In the dressing room the following types of cleaning provided:
• pre-cleaning,
• actual cleaning - during dressing,
• after each ligation,
• final cleaning at the end of the working day,
• general cleaning .
Before the start of dressings, with a damp cloth wipe all items, window sills,
remove the precipitated dust per night (pre- cleaning). During the dressings remove
permanently fallen to the floor cloths, beads, tools and other (current cleaning ). In
the interval between dressings, when the patient is taken out, clean linen, towels,
tools, damp cloth with a pickled solution disinfecting their tools, wipe the table for
dressings patients and covere by sheets, wipe the floor with a damp cloth (cleaning
after each ligation). Upon completion of working day complete a final cleaning ,
including wet cleaning by wiping with a ceiling, walls, window sills, and all items of
equipment, floors, using disinfectants 1-3% hydrogen peroxide solution with a
synthetic detergent, dezokson solution and other. Turn on UV lamps. The time of
sterilization is 1 hour. Bactericidal lamps, equipped with special screens protect
from direct exposure to UV rays, and can operate in the presence of people in the
room. At the end of week carry out general cleaning of dressing room with 6%
solution of hydrogen peroxide or a 1% chloramine solution B.
 Methods of modern antiseptics, their characteristics.
There are the following methods of modern antisepsis:
• mechanical methods ,
• physical methods ,
• chemical and
• biological.
At the heart of the mechanical antiseptics is debridement. The operating carve
out edge walls and bottom of the wound to remove dead and nonviable tissue
together with the microflora.
Methods of physical antiseptics based on the use of the laws of capillarity,
hygroscopicity, diffusion, osmosis, and others. By drainage of purulent wounds and
lesions, conditions are created for the outflow of the contents out. As drainage for
treating wounds using gauze pads, which, due to their hygroscopicity, absorb blood,
pus, ecsudate. To improve draining properties of a bandage we use moistened
tampons with hypertonic solution (10% sodium chloride). Drainage can also be
performed using rubber and PVC tubes.
Low frequency ultrasound shows both physical and chemical properties.
The laser radiation of low power has a bactericidal effect but causes no damaging
effect on the fabric.
Chemical method - is the use of the chemical substance in to fight infection
in the wound or inflammation.
There are many chemical antiseptics; they are sectioned into the following groups:
1.Nitrofuran derivative. Furatsilin Solution 1: 5000, 0.1% Furamagum district.
1. Furacillin - for processing wounds, instruments.
2. Furadonin, Furazolidonum - uroantiseptics.
3. Furagin - for intravenous introduction.
2. Group acids. Boric acid 2-3% solution salicylic acid 1-2% alcohol solution.
1. Acidum boricum - in the form of a powder, in the form of 4 % sol. for a
lavage of the wounds. It is especially effective at a pyocyanic infection.
2. The Formic acid - is applied to preparation pervomur
(For processing the hands of the surgeon).
3. The hydrochloric acid – sol/ a hydrochloric acid is a part of 0,1 %
Davlatov’s solution.
3. Oxidants. A solution of hydrogen peroxide 3%, potassium permanganate 0.1 - 5%.
1. Hydrogen dioxid, in contact to a wound Н2О2 decays with remission О2,
plentiful foam is formed. Antiseptic action Н2О2 speaks as strong oxidizing
action, and mechanical clearing of a wound of pus and alien bodies;
2. Perhydrolum, contains about 30 % of peroxide of Hydrogenous, is used for
preparation of a solution pervomur;
3. Permanganate of a potassium (potassium permanganate) - apply to a lavage
of the wounds - 0,1 % sol., for a lavage of an oral cavity and a stomach - 0,01
sol.;
Oxidizers are especially effective at anaerobic and putrefactive diseases.
4. Dyes. 1. Metilene blue 1-3 % alcohol solution.
2. Diamond green 1-2% sol.
3. Rivanolum
5. Detergents. These are strong surface-active compound.
1. Chlorhexidine begluconate.
Apply to processing hands of the surgeon - 0,5 % alcohol solution, for
processing of an abdominal cavity at a peritonitis - 5 % an water solution.
2. Cerygel - apply to processing hands of the surgeon.
3. Roccalum - 10 % and 1 % an water solution.
6. Group of haloids:
1. Chloramines: apply to a lavage of the purulent wounds with 1-2 % sol., for
disinfection of hands - 0,5 % sol., for current disinfection of the rooms - 2 %
sol.;
2. Preparations of an iodine: Вetadine, Iodonatum of 1 % sol., Iodinolum of 1
% sol., 1 % iodopironi sol, alcohol tincture of iodine1-5% .
7. Alcohols. Ethyl alcohol - 70 % and 96 % sol., for processing edges wounds,
processing hands of the surgeon and a surgery field.
8. Salts of heavy metals(Al, Pb, Ag.). 0,2-1% solution of kolarhol, 1-5% solution of
silver nitrate -caustic chemical reagent and compound, important as an antiseptic, in
the industrial preparation of other silver salts, and as a reagent in analytical
chemistry. Its chemical formula is AgNO3
1. Sodium nitritum of silver of 0,1-0,03 % an water solution for a lavage
purulent wounds and bladder; 1-2 % and ointments use solutions for
cauterization Granulations, at treatment of fistulas.
2. Corrosive sublimate (dichloride Hydrargyriasis) - a strong poison. A
solution 1:1000 or 1:2000 Apply to processing instruments, gloves.
3. Salts of silver: a colloid silver is Protargol. 1 - 3% solution of
Protargol (SILVER PROTEIN)
9. Aldehydes:
1. A formic aldehyde
2. Lysoformium
3. Formalinum
10. Phenolums:
1. Acidum carbolicum
2. Ichthyolum applied in the form of ointment

4. Biological antiseptic – is the utilization of different groups of biological

substance like:
a.) Antibiotics.
b.) Bacteriophages.
 c.) Immune agents – Plasma, Antitoxins, Vaccines, anatoxins,
immunoglobulin, induced in the organism body to improve the immune system.
d.) Proteolitic ferments that lyse / distroys the nectotic tissues. Enzyme
preparations protease - terylityn, sterptokinaza, trypsin, chymotrypsin.
We use mixed methods of antiseptic, for example chemical and physical methods.
The biological antiseptic provides using the agents of a biological parentage,
and also influence on the immune system of a microorganism. The largest group of
agents of a biological parentage - antibiotics, as a rule, is products of vital activity of
the funguses of various kinds. Some of them are applied without changing, some are
exposed to an additional chemical treatments (semisentetic’s preparations), exist also
synthetic antibiotics. Antibiotics are sectioned into the various groups, especially
widely is applied the penicillin groups, offered in 30th years by Fleming. The
introduction of Penicillin in a medical practice has caused a revolution in medicine.
However misuse of Penicillin within 20 years has led to that already in 50th years
physicians have completely compromised it. It has occurred because strict indications
to application of Penicillin were not considered; appointed Penicillin at flu, in order
to prevent the complications - a pneumonia caused by staphilococcus or
pneumococcus. Or surgeons, doing operation in occasion of an inguinal hernia
appointed antibiotics in order to prevent purulent complications. Now with the
preventive purpose to apply antibiotics it is impossible, except for cases of
emergency prophylaxis - that it appointed the second circumstance in low doses. As a
result not all microbes influencing Penicillin, and survived after application of
Penicillin microbes, started to produce protective mechanisms. The most known
protective mechanism is a development of penicillin’s - enzymes which blasts
Penicillin. This property is characteristic for staphylococci. Microbes began to
include tetracycline antibiotics of some in the metabolic cycle. Strains, which are
capable of living only at presence of these antibiotics, were produced. Some microbes
have reconstructed receptors of the cellular membranes so that to not perceive a
molecule of antibiotics.
In 60s, a new group of antibiotics opened up - antimicotic antibiotics. The
matter is that as a result of scale application of antibiotics for people began to be
observed suppression of own micro flora of a colon, it suppresses E. coli, and vital to
the person, for example, for mastering vitamins. Recently one more mechanism of
interaction of an organism of the person with an intestinal rod has been found out: it
is E. coli soaked up in vessels intestinal villi and on intestinal of veins gets in a portal
vein, and further in a liver and there are killed by Kupfers cells. Such bacteriemia in
structure of a blood of a portal vein matters for maintenance of a constant tonus of
immune system. And so at suppression of an intestinal rod these mechanisms are
broken. Thus, antibiotics reduce activity of immune system.
There are three ways of influence on immunity:
1 Active immunization when antigens are entered, in surgery is vaccines, anatoxins.
2 Passive immunization by Serums, scale a globulin. In surgeons it is widely applied
antitetanic, antistaphylococcal gamma-globulins.
3 Immune response modifier. Application of various stimulators of immunity: an
extract of an aloe, an autohemotherapy, etc. methods, but a disadvantage of
stimulating action that we operate blindfold, not on what that the certain immune
mechanism. Alongside with normal pathological immune reactions - autoimmune
aggression take place also. Therefore, not immunostimulation, and
immunomodulation, that is action only on a defective part of immunity now takes
place. Now as immune response modifier use various lymphokines, interleukins,
interferon’s, preparations received of a thymus influencing on the F-population of
lymphocytes. It is possible to apply also various extracorporal techniques of the
Immune response modifier : ultra-violet shine through of bloods, a hemosorption, a
hyperbaric oxygenation, etc.

The main groups of antibiotics currently divided into three groups:

• Antibacterial;
• antifungal;
• anticancer.
In addition, the orientation of this kind of medicines are divided into:
• active against gram-positive bacteria;
• TB;
• active against gram-positive and and gram-negative bacteria;
• antifungal;
• destroy the helminths;
The nature of influence on cell bacteria.
-Baktericid Drugs - kill pathogens.
- Bakteriostatyk - stop the growth and proliferation of cells

Antibiotics:
1. Groups of Penicillin: Benzillpenicillin, Bicillin 1,3,5. Semisentetic’s Penicillin’s:
Methicillin, Oxacillin, Ampioks, Carbenicillin.
2. Group of Tetracycline’s: Tetracycline, Oxytetracycline, Morphocycline,
Biomycine.
3. Group of Levomycetine: Levomycetin, synthomycin.
4. Macrolides: erythromycin, Oleandomycin, Oletetrin, Tetraolen, Sigmamycin.
5. Aminoglycosides: Kanamycin, gentamycin, Amikacin, Brulamycin, Geramicin,
Sizomicin.
6. Group of cephalosporin’s: Ceporin, Kefzol, Clophoran, Cetaceph.
7. Rifamycin’s: Rifamycin, Rifampicin, Rifadin.
8. Antimicotic antibiotics: Nistatin, Levorin.
9. Fluoroquinolones. Low toxicity drugs bactericidal action. Drugs, levofloxacin,
gatifloxacin,, Ofloxacin.
10. Glycopeptides. In respect of most species has a bactericidal effect, in relation to
streptococci, staphylococci and enterococci - bacteriostatic effect. Preparations
glycopeptides, teicoplanin (Tarhotsyd), Vancomycin.
11. Carbapenems - broad-spectrum antibiotics. Carbapenems structure makes them
highly resistant to beta-lactamases. By carbapenems include: Meropenem and
Imipinem.
12. Other antibiotics: Lincomicin, polymyxin, Ristomycin, etc.
Enzymes: Render necrolysis, bactericidal, antiinflammator action.
1. Himotrypsin; 2. Trypsin; 3. Himopsin; 4. Terrilytin;
5. Enzymes in ointments: Iruxol
6. Immobilization enzymes - are entered into structure of a dressing material,
operate during 24 - 48 hours.
Bacteriophags: Staphylococcal, streptococcal, pyocyanic, proteus, combined, etc.
Serums:
1. Antistaphylococcal
2. Antitetanic
3. Antigangrenous, etc.
Immunoglobulins:
1. Gamma – globulin
2. Influenza
3. Staphylococcal
Preparations of a natural parentage
1. Chlorophylipt - an admixture of chlorophylls;
2. Ectericid - receive from cod-liver oil;
3. Baliz;
Sulfanilamide:
1. Streptocid;
2. Sulfadimezin;
3. Sulfalen;
4. Urosulfan;
5. Sulfadimethoxin;
6. Biseptol.
ointment antiseptics:
In surgery is using 2 kinds of ointments:
1. on fatty and vaseline-lanoline basis (sintomicin, Vishnevskiy ointment,
furacillin);
2-water-soluble ointments (levocin, levomicol, betadine,). The best at purulent
processes are water-soluble ointments. They, first, contain Antibiotic
(Levomycetin and betadine), secondly, possess high osmotic activity,
exceeding activity of a hypertonic salt solution at 10-15 time, thus activity is
kept during 20-24-hours.
Ways of introduction of antiseptics:
1. Enteral introduction - through a gastrointestinal tract.
This by enter antibiotics and Sulfanilamide.
 2. External application - for treatment of wounds: in the form of a powder,
ointment, solution.
3. Cavities introduction - in a cavity of joints, in abdominal, pleural cavities.
4. Intravenous introduction (intra-arterial).
5. Endoscope introduction.
6. Endolimphatic introduction - in lymphatic vessels and units.
So, the antibiotic therapy is widely applied in surgery.
Sanitary and hygienic treatment of patients with anaerobic infection.
For the treatment of patients with anaerobic infections allocated a separate
chamber, possibly with a special entrance. At hospitalization and after discharge, all
facilities should be wiped 6%, Sol. hydrogen peroxide with 0.5% detergent solution.
Bed linen in that chamber is disinfected by a mode for spore forms of bacteria. Dirty
linen is disinfected by soaking and boiling it in 2% of sodium carbonate for 2 hours.
The Chamber accepts at least 2 times a day, a wet cleaning with 6%, Sol. hydrogen
peroxide and 0.5% detergent. Staff changes clothes before performing dressing, with
a dress robe, mask, apron. Used dressing material is collected in a special dressing
box, autoclaving during 20 minutes and destroyed. After an operation or dressing all
tools immerse in a 6% solution of hydrogen peroxide with 0.5% detergent solution
for 1 hour. Next before sterilization processing tools and the sterilization is similar
to the normal microbial contamination

Features of purulent dressing - treatment of purulent wounds.

Layout on the operating table napkins, tampons, strips. Before the dressings,
10% sodium chloride solution is prepared, drainage tubes, bandages, tweezers,
scissors, rubber gloves, 1% iodine solution, 96% ethanol solution, sticky plaster and
the like. In the correct sequence, put on a sterile gown, and gloves. At a distance
from the wound, a purulent dirty bandage is cut. After soaking with physiological
solution or a solution of potassium permanganate of the lower layers of the dressing,
the latter is removed with the help of tweezers. Napkins from the edges of the
wound purulent contents are removed. The skin of the edges of the wound is treated
with alcohol solutions of antiseptics (1% iodonate solution, 96% ethanol solution,
etc.).

Sources and ways of spreading a surgical infection. Exogenous infection is

considered to be infection that has gotten into the wound from the external
environment: a) from the air - airborne infections; b) with a spray of saliva or
other fluids - droplet infection (sometimes combined into one type - airborne
infection) at) of subjects colliding with the wound - contact infection, z) in
subjects who remain in the wound (sutures, drains, metal rods, artificial heart
valves, etc.) - implant infection.
Contact with pathogens from the patient to the patient is referred to as
cross-infection.
Endogenous considered an infection that is contained inside the body or on
its cover. Endogenous infection gets into the wound directly (contact) or vascular
pathways (lymphogenous or hematogenous). The major endogenous infection foci
are: inflammatory processes of the skin (furuncles, carbuncles, pyoderma, eczema,
etc.); alopecia gastrointestinal infection (dental caries, gingivitis, cholecystitis,
cholangitis, pancreatitis, etc .); respiratory infection tract infections (sinusitis,
tracheitis, bronchitis, bronchiectasis) infections of the urogenital tract
(pyelitis, CYSTITIS, prostatitis, urethritis, salpingoophoritis) hearth cryptogenic
infection.
Fight with the microflora in the air paths of infection. When no centralized
air treatment system from dust and microbes are special mobile air purifier used. 15
minutes of the apparatus number of microbes in the operating room is reduced by 7-
10 times. The multiplicity of ventilation in the operating room when using the
active-passive ventilation should be at least 6-8, and when conditioning air - 10.
Fight with the microflora in the stages of the contact wound infection. To
prevent infection of the contact is necessary to achieve sterility of all that will be
faced with a wound This is achieved by sterilization surgical linen, dressings
and sutures, gloves, tools, treatment of hand surgery and the surgical field.
Sterilization suture is directed to prophylaxis as a contact implantation and wound
infection.
Prevention implant wound infection. The highest value in the occurrence of
implant infection has a suture. Suppuration of wounds occurs significantly less
when using sutures having antimicrobial activity due to the introduction into their
structure of antimicrobial drugs (letilan-Mylar, acetate, and other yarns comprising
nitrofuranovye drugs, antibiotics, etc.).
Production napkins, tampons and balls care surgical patients. For the
dressing include gauze balls, napkins, tampons, turundy bandages. Applied at their
operations and the dressing in order to dewater the wound stops bleeding, drainage
or plugging the wound . Dressings made from gauze and wool, viscose and less
lignin. Vi rlyu previously cut into pieces. Fold it so that the edges are tucked
inside, and there was no free edge from which can "sleep" fiber cloth to the wound.
Material harvested for future use, adding at least costs.
The beads are made from pieces of gauze dimensions 10x10 cm. They were
collected and carefully wrapping around the index finger form a ball, which is
charged into the free ends of the gauze. Balls stored in a gauze bag of 50 pcs.
Napkins are made in three sizes: large (60x40 cm), medium (40x30 cm) and
small (20x15 cm). The edges of cut gauze wrapped inwardly folded in half along the
length and width and knotted to 10 pcs. ribbon of gauze.
Tampons made of gauze 20,30,50 cm long pieces of material to the middle
bending edge. Turundy pieces of gauze made from a length 40 of 50 cm and a
width of 5 cm. The ends of the bandage wrapped inside, pulled through the edge of
the table and is rolled into a roll.
 Dressings, bandages besides not contaminated with blood after application
combusted.
Laying of medical supplies in the box. Harvested material constitute a Bix to
further sterilization. In the absence of the latter may be sterilized in linen bags.
When universal stowage box is placed in a material intended for a small
model operation (Apen-dektomiya, herniotomy, phlebectomy, etc.). When n
elenapravlennoy laying - in laying box required set dressings and surgical linen,
intended for a specific operation (pneumonectomy, resection of the stomach ,
etc.). When laying species - a box put a certain kind of dressing and linen (bathrobes
boxing boxing with napkins, box with the balls, etc.).
Before laying serviceability check box, then it is wiped from the middle cloth
dampened with alcohol, is placed on the bottom unfolded sheet whose ends are
located outside. Dressings put vertically sectors or in batches. Bathrobes, towels,
bed sheets put in the box vertically, so that the extraction of one object does not
interfere with other sterile material to remove. The material is laid loosely, to
provide access pair placed inside the sterilization indicators, the edges wrap sheets,
boxing for Krivan lid and close the lock. On the cover of box attached tag with
oilcloth, on which point the name of the material, and after sterilization, - the
date thereof and the name of person performing the sterilization.
storage time of sterilized material Bix filter - 20 days, without a filter, and
other containers - to 3 days.
Presterilizing treatment of multiple tools. All medical instruments
disinfected after use in disinfectant solution (3% chloramine solution, 0.2%
Chlorantoin solution of 6% hydrogen peroxide solution, etc.). Within an hour.
Disinfection is performed in closed containers when full immersion tool into
solution. After exposure, the instruments are rinsed under running water. The
next step - presterilizing purification to remove protein, fat and mechanical
impurities as well as pharmaceuticals. Presterilizing purification is
carried out manually or mechanically using a washing solution (17 ml of 27.5%
hydrogen peroxide solution, 5 g of detergent "Lotus", 1.4 g of the corrosion
inhibitor, sodium oleate, potable water to 1 liter at a temperature of 50-55 °

FROM ). The first stage - soaking in the wash liquor during full immersion
products for 15 min. Subsequently washing is performed each product in the
wash liquor via a ruff or cotton-gauze tampon. The next step - rinsing
instruments under running water for 10 minutes followed by presterilization
quality control processing. Further obezsolennya tools carried by washing
for 1 min with distilled water and drying disassembled in a heat cabinet at 85 about

FROM.
Conducting tests on the quality of presterilizing processing. Verification tools
presterilizing purification is carried out by placing the samples for the presence of
residual blood and completeness of laundering product from the alkaline components
of detergents. Control subject 1% of each product names treated per day, but not less
than 3-5 units. Products that monitor, wipe with gauze moistened with a reagent or
2-3 drops of reagent with a pipette is applied to the product.
Quality laundering tools from residual blood was evaluated by azopiramovoy
(100 g amidopirina, 1 1.5 g of aniline hydrochloride, 95% ethyl alcohol to 1 l)
amidopirinovoy (equal amounts of 5% alcoholic solution amidopirina, 30% acetic
acid solution and 3% hydrogen peroxide solution) samples, samples with a reagent
"Fakel- 2" (0.2% aqueous solution of the drug "Fakel- 2", 1 ml of 3% hydrogen
peroxide). When setting azopiramovoy sample in the presence of traces of blood
appears initially violet coloration, which quickly turns into a pink-lilac or buroyu.
When setting amidopirinovoy sample in the presence of residual blood appears blue-
violet color reagent with the sample with a reagent "Fakel- 2" last becomes cherry
red.
The sample to be complete laundering of alkaline components of detergents is
carried out with Phenolphthalein reagent (1% solution in alcohol). The presence on
the products detergent residues evidenced by the appearance of pink color reagent.
Laparoscopic equipment are sterilized by immersion in a solution, for
example, korzoleks. Korzoleks used to disinfect the combined disinfection
processes and pre-cleaning and sterilization of instruments. Korzoleks Working
solutions are prepared by dissolution in cold water with occasional agitation,
and stored in a labeled container of any material with a sealed lid.
Exposure time indicated in the operating instructions of the sterilization
agent. After sterilization the product is washed closure means from residues,
and then placed in a sterile diaper is removed from water channels and
converted into the sterilization box, contained sheets.
Sterilization paraformalinovy chamber carried instruments (e.g. metallic
swirl drill synthetic PVC equipment) that can not be sterilized in a hot air oven,
or in a disinfectant solution. Paraformalinovaya chamber is a sealed container
with shelves that are stacked tools. On the bottom shelf tray mounted with 40%
solution of paraformaldehyde, which is a result of evaporation through the
upper grille of the tray is supplied to the entire cell. Sterilization chamber must
be administered within 6 hours paraformaldehyde solution replacement is
performed after 10 days, repeatedly if necessary.
Radiation sterilization.
This method is suitable for the treatment of drugs to a limited extent, but it
can be attributed to the most studied of all aspects of methods of sterilization,
not excluding heat. The reason for this somewhat paradoxical phenomenon is
that the radiation sterilization is widely used worldwide in the manufacture of
plastic medical products and is one of the main ways to ensure the sterility of
these systems.
The advantages of radiation following method:
 -tehnologichnost (including the possibility of organizing a continuous
automated process);
-universality (ability to provide high sterilization efficiency almost any
kind of object at the optimum irradiation conditions)
- The possibility of achieving any given reliability of sterilization; ease
of monitoring the effectiveness of the process through simple methods of
dosimetry absorbed energy.
There are two kinds of irradiation:
- Systems with cobalt-60 ;
- electron accelerators.
When sterilizing with ionizing radiation using radioactive sources based
Co60 or Cs132.
The disadvantages of radiation sterilization method may include:
- Radiation danger;
- The emergence of the reduced radiation;
- The destruction of the molecular structure of sterilized plastic items;
- the high cost and high power consumption equipment (e.g., particle
accelerators).
Sterilization of the suture. For compounds of tissue during surgery using yarns
of different origin, metal clips, staples, wire. There are more than 40 types of
suture. More common are silk, polyester, nylon, fiber, metal braces.
Apply thread absorbable schiesya , and non-absorbable schiesya . Natural
threads, which are absorbed are yarns with fibers. Prolongation resorption catgut
reached its impregnation metals (chromium-plated, silver fiber). The synthetic yarn,
which dissolve - with thread Dexon, spawned, oktsilona, the like. By natural yarns,
which are not absorbed are yarns with natural silk, cotton, horsehair, synthetic -
yarn of nylon, Dacron, Dacron, nylon, ftorlon, etc. .
Suture material should meet the following basic requirements: should have a
smooth, flat surface and does not cause additional tissue damage, have good
manipulation properties, good slip in the tissues to be elastic (sufficient
stretchability prevents compression and necrosis of tissue at their rising edema), be
robust in node do not have hygroscopic properties and do not swell, to be
biologically compatible with living tissues and do not leak allergic organism.
Destruction filaments should coincide with the timing of wound healing.
Suture material may be prosterilizovany g radiation in the factory
conditions. The vials or bags skeins silk fiber, nylon stored at room temperature and
are used as necessary in the periods corresponding to the expiry date. The metal
suture (wire, brackets) sterilized in an autoclave or by refluxing .
Control of sterilization quality. Control over sterile material and mode of
sterilization in an autoclave is performed by direct and indirect methods for the
direct method - bacteriological, namely sowing with dressing material and linen or
bacteriological tests. Seeding produced as follows: in operating open box, small
pieces of gauze moistened with a physiological solution of sodium chloride, is
carried out on the laundry several times, after which pieces of cheesecloth dipped
into the test tube, guided in the bacteriological laboratory. For bacteriological
test tubes using a known non-pathogenic spore-bearing culture of microorganisms,
which are killed at a given temperature. The tubes are put in the box. By the end of
sterilization is recovered and sent to the bacteriological laboratory. No growth of
bacteria indicates the sterility of the material. Crop research with dressing
material and linen is carried out once every 10 days.
Indirect methods sterility test material is applied continuously during each
sterilization. For this purpose, a substance with a specific melting point ( benzoic
acid (120 ° C), resorcinol (119 ° C), antipyrine (110 ° C)). These substances are
available in ampoules. They are also used in test tubes (0.5 grams), covered with a
gauze plug. In box between the material layers 1-2 lay ampoules. Melting a powder
and convert it into a solid mass indicates that the temperature is the melting point
Bikse control substance or exceeded it. To monitor sterilization in a heat mode
sterilizers used powdered substance with a higher point of melting: ascorbic acid
(187-192 ° C), succinic acid (180-184 ° C), pilocarpine hydrochloride (200 ° C),
urea (180 ° C) .
The daily work is widely used indirect methods of control of sterility -
physical and chemical, that allow you to quickly get the result and is used for
sterilization.
The physical method is based on a crystalline melting at a certain temperature.
Modern sterility indicators sealed in ampoules, each substance has its melting point.
As used indicators benzoic acid (120 ° C), which changes color from blue to gray-
ripe plum, and urea (132 ° C) - from pink to ripe plum. Thiourea, succinic acid and
tartaric acid at 180 ° C changed color from white to green-yellow. A disadvantage
of this control method is that one can not be sure that the desired temperature has
been the same throughout the sterilization time.
The chemical method is currently used most frequently. Are used IP-
temperature-sensitive tape 120 (if the required sterilization temperature 120 ° C).
Tape under the influence of the respective temperature changes its color from white
to brown. After the end of the sterilization indicator color ribbon necessarily
compared with the standard. The method has the same disadvantage as the physical.

Features of the structure of the operation unit. The operating unit - a set of
special premises for operations and events. The operating unit must be located in a
separate room or a wing of the house, connected by a corridor to the surgical
departments, or located on a separate floor (not the ground), a multi-storey surgical
case. It distinguishes between a comma operating to perform clean and purulent
operations. More suitably have purulent surgical wards separate insulated
operating unit.
The operating unit is isolated from the surgical departments special vestibule,
most often it is part of the corridor in which the premises are located in common
mode operation unit. To ensure sterility mode in the operation unit is isolated special
functional-hygienic area, separated by a "red line"
1. Zone sterile mode (absolute sterility) combines the operating and
sterilization. In areas of the zone and perform operations sterilized instruments.
The area of the operating room on a surgical table should not be less than 36 m
2
, 2 operating tables - not less than 56 m. It should be remembered that even in the
presence of two operating tables in the same operating room, the simultaneous
execution of two operations is strictly prohibited! Operating height should not be
less than 3.5 m. Walls and ceilings must be smooth, covered with tiles or oil
paint to facilitate cleaning. The color of the walls should be soothing (cold), not
to cause irritation. All kinds of heaters must be mounted on the wall (a kind of heat
- convection).
Optimum light ratio -2: 3, but is allowed to decrease to 1: 4. The general
illumination of the operating - 300-500 lux. (not less than 200 lux) wound
illumination due shadowless lamps must be at least 3,000-10,000 lux. Microclimatic
conditions in the operating room: temperature - 20-20 ° C (summer 19-20 ° C),
humidity - 50-55%, the rate of air flow of not more than 0.1 m / s.
2. The area of strict (relative sterility) mode includes such facilities as a
preoperative and sanitary inspection, consisting of rooms for undressing
personnel, shower units, cabins for donning sterile clothing. These premises are
located in series and the staff goes out of the cab for dressing straight through the
corridor in the preoperative. In the same area includes the premises for the storage
of surgical instruments and devices, medical supplies, facilities for rescue teams, the
senior operating sisters, WC for staff operating unit.
3. Restricted Zone mode, or the technical zone, combines production
facilities for the operation of the operating unit: here are the instruments for
air conditioning, vacuum systems, systems for delivery of operating with oxygen
and narcotic gases, here arranged substation battery for emergency lighting, photo
lab for developing X-ray films.
4. In the common mode area are offices manager, senior medical sister's room
for analysis of dirty linen etc.
Operating unit operating mode allows the restriction of visits it, and in the
sterile zone regime should only be participating in the operation: Surgeons and their
assistants, surgical nurses, anesthesiologists and anesthetist, a nurse for the
current harvest operating. The sterile zone regime are not permitted, students,
doctors, probation. Workers operating unit wear special clothes: gowns or jackets
and trousers, differ in color from the clothes of employees from other departments.
 Control mode sterility of the operation unit is performed periodically
bacteriological examination of the operating air washes the walls, ceiling,
apparatus and appliances. Fence materials for sowing doing twice a month.
Sterile operating mode is achieved by preventing the entry of microorganisms
into the operating room with the other rooms and the spread of microorganisms in
the operating room.
Special operation unit device, the use of sterile gateway before entering the
operating room, preparation of the patient for surgery (cleaning, linen, shave the hair
in the area of the surgical field), preparation for operations personnel (required
changing, the use of sterile clothes, putting on shoe covers, caps, masks, hand
treatment) significantly restrict the penetration of microorganisms in the operating
room. Masks made from gauze, have to be 4-6 layers, in which case they retain 88-
96% of the microorganisms. Sterility masks and gowns is maintained for 5-6 hours.
Modern mask cellulose are effective only within 1:00.
Sanitizing operating rooms. The main route of infection of the wound in the
operating room - pin (about 90% of cases), only 10% of cases of infection occurs by
air.
Micro-organisms in the air and are very rare things in isolation, mostly they
are fixed on a microscopic fraction of dust. Therefore, careful removal of dust, as
well as preventing its penetration into the operating room, reduces the degree of
microbial contamination.
The following types of operating cleaning provided: preliminary, current,
postoperative, and final general. Before starting the operation with a damp cloth
wipe all items, appliances, window sills, remove the settled dust per night (pre-
cleaning). During the operation, constantly clean fallen to the floor cloths, beads,
tools (current cleaning). Between operations, when the patient is taken out of the
operating room, clean linen, towels, tools, damp cloth moistened with a solution of
antiseptic, wipe the operating table and covered his sheets, the floor wiped with a
damp cloth (postoperative cleaning). At the end of the working day do final
cleaning, including wet cleaning by wiping with a ceiling, walls, window sills, and
all items of equipment, floors, using disinfectants 1-3% hydrogen peroxide solution
with a synthetic detergent, dezokson solution and followed by incorporation of
other bactericides lamps. At the end of week general cleaning is carried out
operating with 3-6% solutions of hydrogen peroxide or a 1% chloramine solution
B.
Begin cleaning disinfection the operating room: the ceiling, the walls, all the
items, the floor is sprayed with disinfectant solution, which is then removed by
wiping. After this wet cleaning is carried out general and include bactericidal
ultraviolet lamp. Final cleaning can be extraordinary if contaminated operating
manure, intestinal contents, after surgery in patients with anaerobic infection.
 For irradiating the air and objects in the operating room, using mobile, wall,
ceiling germicidal ultraviolet (UV) of different power lamps. Bactericidal lamps,
equipped with special screens protect from direct exposure to UV rays, and can
operate in the presence of people in the operating room. It should be remembered
that the wall germicidal lamps are hung at a height of not less than 2 m from the
floor. A sterilizing lamp for sterilizing 2:00 LP m of air. Each lamp generates
3

around itself zone sterility diameter of 2 - 3 meters. 3:00 UV lamp operation

amount of microbes in the air is reduced by 50-80%, the amount of infection is
reduced by 3-3.5 times.
Prevention of air pollution in the operating system is achieved mechanical
ventilation, carried by the air supply from outside or by recycling it. Ventilation
creates air through filters located under the ceiling in the operating room. With the
dust deposited on the filters are removed fixed her germs. The air comes out of
operating through natural cracks and through the holes located at the floor. Such
direction of air flow prevents the penetration of polluted air from adjacent
operating rooms, including the surgical departments.
Processing of the surgeon's hands. Hand Treatment - an important means of
contact to prevent infection. Doctors, surgeons, operating and dressing sisters must
constantly take care of the cleanliness of hands to care for skin and nails. The
greatest number of microorganisms accumulates under the nails in nail ridges,
cracks in the skin. Hand care includes prevention of cracking of the skin, nails,
hair cut (they have to be short), deburring. Work related to pollution and infection
of the skin of hands, should be done with gloves. Proper care of your hands
should be seen as a step in the preparation for their operation. Processing hands any
method starts with the mechanical purification.
Applicable sequence of processing actions of hands:
§ wash your left hand palm side, back side and each finger separately;
§ They should be treated with the fingers of his right hand;
§ to clean the top of the palm is treated with the brush left and right hands,
wrists and forearms
§ then wash each nail bed and wash under fingernails of both hands;
§ wipe your hands with a towel or napkins, following the same sequence;
§ while wiping hands should contain so that the water from the arm, missed the
brush;
§ antiseptic treatment that involves the use of antiseptics, double-dealing on the
skin.
The classic methods of treatment are methods for hand Fyurbringera,
Alfeld, Spasokukotsky-Kochergina, which are now practically used because of
its bulkiness and duration.

Orders MOZ of Ukraine allowed the use of such anti-septic and

disinfectant:
 • korzoleks plus extra korzoleks, dismozon Pur (for disinfection
and cleaning of medical devices);
• batsillotsid rasant (a special preparation for the rapid
disinfection in areas of extreme infectiousness)
• Kutasept F (for pre- and postoperative treatment of the skin and
joints, skin antiseptic disinfection before injections, hygienic and surgical
hand skin treatment)
• Sterillium, Baktolin windbags (for hygienic and surgical hand
antiseptic treatment of the skin).
Processing surgeon's hands pervomura solution (preparation C-4) retains the
leading place in the last decades.
A solution of S-4 (pervomur) - mixture of formic acid and hydrogen
peroxide. First, a basic solution at a ratio of 81 ml of 85% formic acid and 171 ml
of 33% hydrogen peroxide solution are mixed in a glass stoppered and placed in
a refrigerator for 1-1.5 hours. In the reaction of formic acid and hydrogen peroxide
is formed nadmurashina acid having a strong bactericidal effect. Of this amount the
base solution may be prepared 10 liter working pervomurom solution (2.4%
solution), mixing it with distilled water. The working solution is suitable for use
throughout the day. In preparing the solution it is necessary to work with rubber
gloves to prevent burns concentrated solutions of formic acid or hydrogen
peroxide. Hand Treatment involves their preliminary washing for 1 minute with
running water and soap. Then the hand and forearm to the level of the middle third
of wash cloths in a basin with pervomurom solution for 1 minute and dried with
sterile towels. In one treatment basin hands can perform 5 people. As antiseptics
used in the processing of hands also NovoSept, degmitsid, ayatin etc. All existing
hand processing methods do not provide absolute sterility, so most operations and
surgical procedures performed in rubber gloves.
Widely used disinfectants Ahd 2000 - antiseptic preparation for external use.
Ahd 2000 provides bactericidal, fungicidal, antiviral and tuberculocidal activity. The
drug is intended for surgical skin antiseptsii, to reduce the amount of skin microflora
100,000 times within 30 seconds. Ahd 2000 solution is effective against gram-
positive and gram-negative aerobic and anaerobic bacteria, various species of fungi
and viruses, including the human immunodeficiency virus and hepatitis B virus When
applied topically, the components of the drug do not penetrate into the bloodstream.
The drug Ahd 2000 is intended for topical application. The solution was used
undiluted. Before using the drug should wash your hands and dry them with a
disposable towel. For surgical antiseptic solution should be rubbed into the skin in
small portions over 4 min. Typically, one for the skin treatment, a minimum of 10 ml
Ahd 2000. For hygienic antiseptic solution should be rubbed in small portions over
30 seconds. After hygienic hand rub solution Ahd 2000 hands should be washed with
soap or detergent.
 Sterilium gel - it's ready to use antiseptic. For household use enough 3ml
Sterilium rub in dry hands for 30 seconds. and do not rinse. Surgical treatment of
hand held rubbing 6ml antiseptic Sterilium into clean and dry hands for 90 seconds.
maintaining the hydration of the skin throughout the treatment time.
Hand processing in extreme conditions can be done by wiping the skin with
96% ethanol for 10 min (method Bruna) and / or within 3 minutes of 2% ethanolic
solution of iodine.
Treatment of the surgical field. Preparing the site where the incision will be
performed (surgical field) begins before the operation and includes the general
sanitary bath, change of clothes, hair shaving a dry method in the place of the surgical
approach. After shaving the hair skin rubbed with alcohol. When processing the
surgical field directly in the operating room should adhere to the following
principles:
- Processing must be considerably wider than the area of random access ;
- processing sequence - "from the center to the periphery";
- repeatedly during processing operations (before and before suturing )
- The most contaminated sites are processed last.
Before surgery on the operating table, the field is wide lubricate 5% alcoholic
solution of iodine three times. Direct surgical site is isolated again and the sterile
sheets smeared 5% alcoholic solution of iodine. Before applying and after suturing
the skin it is treated with the same solution.
When hypersensitivity to iodine skin treated with 1% alcohol solution of
brilliant green (Method Bakkan). For the treatment of the surgical field is also used
0.5% alcoholic solution gibitan (chlorhexidine digluconate) pervomur.
When emergency surgery the surgical field is the preparation of a hair shaving,
the skin treated with 0.5% solution of ammonia and applying one of the solutions
mentioned above.

6. MATERIALS FOR SELF-CONTROL

6.1 Tests

1. Antiseptic is a set of tools and measures aimed at:

A. destroy germs in the wound tissues and body cavities
B. combination of macro- and microorganisms interactions
C. prevent ingress of potential pathogens into the patient
D. diagnose spread of infectious diseases in hospitals
E. contamination of medical instruments and equipment
2. Depending on the principle of action there is no antiseptic:
A. radiation;
B. physical;
 C. biological;
D. mechanical;
E. mixed.
3. Mechanical antiseptic:
A. removal from the wound non-viable tissues by means of surgical treatment
with a scalpel;
B. use of ointments, powders, aerosol for irrigation wounds;
C. the use of agents that provide drainage and the outflow from the wounds;
D. use of chemical substances that possess bactericidal action;
E. use of drugs of biological origin.
4. Method of physical antiseptics is based on:
A. use the laws of osmosis and absorbability.
B. timely surgical wound treatment;
C. immunological incompatibility between macro and micro-organism;
D. mutual action of biological substances viable tissues
E. chemicals possessing osmotic effect
5. Chemical antiseptic agents are:
A. substances to decontaminate the surface of the body cavities of the body;
B. chemical compounds, which are in contact with the blood give foam
formation;
C. Tools to create a protective film on the surface of the body;
D. inorganic substances, which are on the surface of objects
bactericidal action ;
E. Organic compounds that have a pronounced bacteriostatic effect.
6. Biological antiseptic tools are:
A. antibiotics;
B. Oxidizers;
C. organic compounds;
D. hygroscopic tampons;
E. alcohols.
7. Purulent wound drained pad with hypertonic salt solution. What kind of
antiseptic was used?
A. the physical;
B. biological;
C. mechanical;
D. the chemical;
E. mixed.
8. Which of the above methods applies to physical antiseptics?
A. drainage of the wound swab;
B. the removal of necrotic tissue from the wound;
C. primary surgical wounds;
D. washing the wound with an antiseptic;
E. the bandage on the wound with ointment that contains enzymes.
9. What is the action of hydrogen peroxide is the most weakly ?
A. antifungal;
B. foam formation;
C. detergent;
 D. oxidative action;
E. antimicrobial;
10 .Who is the founder of the introduction of antiseptics?
A. Lіster;
B. Pirogov;
S. Pasteur;
D. Bergman;
E. Semmelweis..
11. What are the tasks of antiseptics?
A. the destruction of the infection in the wound and in the tissues;
B. creating conditions unsuitable for the development of microorganisms;
C. the destruction of the infection in the materials that face with wound;
D. removal of foreign bodies from the wound;
E. quality control of sterilization of surgical instruments.
12. To halides not include:
A. Dioksydyn;
B. Water solution of iodine;
C. Chloramine;
D. Alcohol solutions of iodine;
E. Chlorhexidine.
13. Antiseptic effect of alcohol is:
A. dehydration microbial cells;
B. the mechanical treatment of pollution;
C. bacteriostatic chemical action;
D. litical effect purulent substrate;
E. change the acidity of microbial foci
14. Nitrofuran derivative is:
A. Furacilin.;
B. Hydrogen peroxide;
C. Dìoksidìn;
D. The Reduction of potassium;
E. Methylene blue
15 .What drugs are not biological antiseptic?
A. detergents;
B. bacteriophages;
C. Hama-globulin serum;
D. antibiotics;
E. proteolithic enzymes;
16. Which antibiotics are most pronounced bactericidal effects on polimorbid flora?
A. carbapenems;
B. cephalosporins;
C. penicillins;
D. fluorohuinolones;
E. aminoglycosides.
17. Immune toxoids and serum basically are:
A. purified immunoglobulins
B. highly chemical compounds;
 S. easing strains of microorganisms;
D. bacterial polysaccharides;
E. specific antibodies.
18. What concentration of hydrogen peroxide is not recommended to process the
wound surface?
A. 6%
B. 2%;
C. 3%;
D. 0, 5%;
E. 1%.
19. What antiseptic Lister discovered antiseptic era?
A. Carbolic acid
B. Aminocapron acid
C. Alcohol;
D. Lysol
E. Mercuric chloride solutions.
20. What is the main function of drainage :
A. Acceleration of outflow from the cavities of purulent wounds.
B. for an introduction to oral antiseptic agents;
C. prevent closing edges of purulent wounds;
D. bactericidal action of drainages;
E. for the control of haemostasis;
21. Open Method treatment of wound refers to:
A. physical antiseptics;
B. chemical antiseptics;
C. biological antiseptics;
D. mechanical antiseptics;
E. mixed antiseptics.
22. Who considered the founder of aseptic?
A. Bergman, Shymmelbush.;
B. Zemmelweis I;
C. Lister D;
D. Koch P .;
E. Mechnikov I.I ..
23. Which concentration used alcohol solution of iodine for the treatment of
the edges of the wound?
A. 3%;
B. 5%;
C. 10%;
D. 15%;
E. 20%.
24. What is the negative effect on tissues halides:
A. allergic effect .;
B. bacteriostatic effect;
C. tanning effect;
D. caustic effect;
E. bactericidal action
25. What is the advantage of iodofor for alcohol solutions of iodine:
A. minor irritant effect.
B. prolonged bacteriostatic effect;
C. relative cheapness of the drug;
D. long term storage;
E. pronounced bactericidal effect;
26. For the treatment of anaerobic infections using drugs that produce atomic
oxygen?
A. 3% hydrogen peroxide solution;;
B. 96% solution of ethanol
C. 33% solution perhidrol;
D. 5% solution of iodine;
E. 3% boric acid.
27. By nitrofuran drugs include?
A. furagin solution ;
B. 1% solution Collargolum;
C. 1% solution of hydrogen peroxide-urea;
D. 1% solution of mercury dichloride;
E. 3% solution of methylene blue
28. What is antiseptic?
A. a set of methods aimed to destroying or suppressing the growth of
potentially harmful microorganisms on the skin or in the body;
B. methods prevents ingress of potential disease pathogens on the surface, the
organs and cavities of the patient;
C. infection which is a patient at the time of admission to hospital and that was
acquired for hospitalization;
D. the ability of a microorganism to cause disease;
E. aggregate factors of transmission of infection.
29. The ability of a microorganism to cause disease are:
A. pathogenicity;
B. contamination;
C. transmission;
D. incubation period;
E. virulence.
30. What an antiseptic chemical oxidants belong to?
A. hydrogen peroxide;
B. salicylic acid;
C. chlorhexidine;
D. Furacilin.;
E. brilliant green.
31. What term defines the microbial contamination of the wound?
A. contamination;
B. colonization;
C. virulence;
D. pathogenicity;
E. wound infection.
32. Give a correct definition of the term "disinfection"?
 A. The process of destroying most pathogens on inanimate objects;
B. the process of removing the visible dust, dirt and other organic materials;
C. general term by which is meant the processing at which the removal of
infectious diseases;
D. process of destroying all forms of microbial life;
E. None of the above.
33. What is the biggest drawback of salts of heavy metals?
A. toxic effects for the patient and stuff
B. dear price when buying;
C. weakly expressed bactericidal effect;
D. the absence of bacteriostatic action;
E. difficulties in storage;
34. Which antibiotics are ototoxic effects are:
A. aminoglycosides;
B. penicillin’s;
C. the tetracycline;
D. cephalosporin;
E. macrolides.
35. Detergents agents are:
A. types of chemical antiseptic agents;
B. derivative of iodine;
C. salts of heavy metals;
D. sulphonamides derivatives;
E. antibiotics broad spectrum of action.
36. What chemical antiseptics refer to organic compounds?
A. alcohols;
B. Oxidizers;
C. heavy metals;
D. haloids;
E. alkalis.
37. What chemical antiseptics not related to organic compounds:
A. Oxidizes.
B. aldehydes;
C. phenols;
D. dyes;
E. alcohols.
38. What is the optimal treatment with antibiotics?
A. 7 days;
C. 3 days;
C. for 10 days;
D. 15 days;
E. 1 month.
39. During treatment of 2-3 antibiotics should be considered:
A. synergies;
B. means available;
C. the total cost;
D. general condition of the patient;
 E. antagonism.
40. With long-term antibiotics to prevent mycosis, at the same time appoint
A. fluconazole.;
B. mercury dichloride;
C. antibiotics synergists
D. enzyme preparations;
E. calcium chloride .
41. Proteolysis enzymes have the property:
A. lysis necrotic tissue;
B. bacteriostatic effect;
C. expressed against oedematous action;
D. lysis collagen tissue;
E. persistent bactericidal effect.
42. The methods of physical antisepsis include:
A. Ultrasonic cavitation wound;
B. washing wounds solution of chlorhexidine;
C. initial debridement;
D. drainage of the wound;
E. use of antibiotics
43. How Proteolytic enzymes are used to treat wounds:
A. locally, directly on the wound;
B. just inside the arterial;
C. by intra venous infusion;
D. using physical therapy devices;
E. all the above listed ways.
44. The main source of pathogens Staphylococcus aureus internal hospital
infection are:
A. hospital patients;
B. medical staff;
P. visitors;
D. technicians;
E. food
45. What properties have Bacteriophages?
A. reproduction in bacterial cell and her lysis;
B. stop the growth of microbial cells;
C. genotype change, stopping reproduction;
D. kill microorganisms;
E. All of the above.
46. Bacteriophages can be input, except:
A. endolymphatic introduction
B. endotracheal administration;
C. enter in cavity through drainage;
D. I / v input;
E. infiltration by irrigation and septic wounds;
47. Timalin, this drug is:
A. thymus;
B. thyroid gland;
 C. blood;
D. Genetic Engineering;
E. synthetic polysaccharide.
48. T-activin:
A. restores the activity of T- killer;
B. accelerates phagocytosis;
C. regulates the amount of B-lymphocytes;
D. activates proliferation;
E. restores regeneration.
49. Solution of boric acid 3% is used most often when:
A. wound complications Pseudomonas;
B. the appearance of pus in the domestic wounds;
C. for processing operational field;
D. to fight anaerobic microorganisms;
E. all of the above conditions.
50. Ciprofloxacin, it is:
A. The first generation fluoroquinolone;
B. antibiotic cephalosporin group;
C. Highly sulfanilamide;
D. broad-spectrum antibiotic;
E. glycoproteins.
51 The group of sulphonamides include all except:
A. etakrydin;
B. etazol;
C. sulfatsil sodium;
D. sulfapirydazyn;
E. streptocide.
52. . The most effective sulphonamides considered?
A. sulfamilon;
B. Biseptol;
C. streptocide;
D. sulfodymetoksyn;
E. etazol.
53. All of these drugs are enzymes except one
A. dermazyn.
B. imanin;
C. trypsin;
D. chymotrypsin;
E. lysozyme;
54. Solution ammonia 0,5% most widely used for:
A. treatment of hand surgery;
B. washing purulent wounds;
C. Irrigation deep cavities;
D. processing the edges of the wound;
E. against anaerobic infection.
55. Means preferred in modern antiseptic:
A. mixed,
 B. chemical;
C. biological;
D. radiation;
E . mechanical;
56. Solution sodium chloride 10% is used for:
A. drainage of purulent wounds and cavities;
B. imposing a compress;
C. disinfection of cutting instruments;
D. primary surgical treatment of the wound;
E. as a chemical antiseptic.
57. Carbolic acid is not used today because:
A. creates toxicity in the patient and staff;
B. causes necrosis of living tissues;
C. detrimental effect on flora;
D. No positive result for gram negative microorganisms;
E. combined.
58. Lugol solution must contain:
A. iodine
B. hydrogen peroxide
C. potassium permanganate
D. chloramine
E. Furatsilin.
59. What kind of cleaning is not there in the dressing room
A. Occasional cleaning.
B. Current cleaning ,
C. After each dressing,
D. Final cleaning
E. Prior cleaning,
60. As drainage for the treatment of wounds can be used, except:
A. Glass graduates;
B. rubber gloves;
C. vinyl chloride tube;
D. gauze swabs;
E. drainage special purpose.
61. In the method of continuous dialysis optimally use the combination:
A. the method of physical and chemical antiseptics;
B. the method of physical and biological antiseptics;
C. method of mechanical and physical interaction;
D. method of mechanical and chemical antiseptics;
E. all methods of antiseptics.
62. The methods of physical antiseptics include:
A. ultrasonic cavitation wounds;
B. flushing wounds solution chlorhexidine;
C. primary surgical treatment of the wound;
D. drainage of the wound;
E. use of antibiotics;
 PART 2
1. The following types of operating cleaning except:
A. preventive
B. final
C. current
D. preliminary
E. General
2. The territory of the operating unit has the following areas, except:
A. zone of special regime
B. controlled area
C. hospital-wide regime zone.
D. sterile zone
E. the restrictive zone
3. The composition of the cleaning solution is not included during the
purification presterilizing:
A. detergent
B. formic acid
C. drinking water
D. hydrogen peroxide
E. corrosion inhibitor
4. For the purpose of quality control are not used following purification
presterilizing sample:
A. reagent "Torch-2"
B. thymol
C. benzidine
D. amidopirinovoy
E. azopiramovaya
5. Some of the drugs should be used with candidiasis?
A. penicillin
B. streptomycin
C. nystatin
D. monostatin
E. sulfadimezin
6. When autoclaving counted time after heating to the working temperature
sterilizer. During what minimum time instruments are sterilized in an autoclave
at a pressure of 2 atm and a temperature of 132 ° C?
A. 1chas.30min.
B. 20 minutes.
C. 45 min.
D. 35 min.
E. 1:00
7. The action of hydrogen peroxide is markedly more poorly?
A. antifungal
B. cleanser
C. antimicrobial
D. blowing
E. oxidizing
8. Who is the founder of aseptic technique in surgery?
A. Pasteur
B. Pirogov
C. Lister
D. Semmelweis
E. Bergman
9. What tasks aseptic?
A. Infection destruction of the patient's body
B. destruction of infection in the materials that come in contact with the wound
C. destruction of infection in the wound
D. removal of foreign bodies from the wound
E. quality control of sterilization of surgical instruments
10. A method of sterilizing the suture filament of synthetic?
A. in formaldehyde vapors
B. by Claudius method
C. boiling in water for 20 minutes
D. mercury dichloride in solution
E. method of Kocher
11. The most reliable method for monitoring the sterilization of laundry?
A. sulfur melting
B. physical
C. melting resorcinol
D. melting of antipyrine
E. bacteriological
12. The frequency of change of ethyl alcohol while maintaining a sterile silk?
A. every 5 days
B. every 3 days
C. 1 time in 15 days
D. every 10 days
E. 1 time per month
13. As can be sterilized suture material made of synthetics?
A. like silk on the method of Kocher
B. air sterilization method
C. lowered to 2:00 mercuric chloride solution in 1: 1000
D. boil for 20 minutes
E. in formalin vapors
14. The method for controlling the laundry sterilization most reliable way?
A. melting of antipyrine
B. melting urea
C. sulfur melting
D. aspirin melting
E. melting amidopirina
15. What is the anti-contact infection?
A. irradiating UV lamp
B. in the wet cleaning of the operating
C. in antibiotic
D. sterilization of tools
E. sterilization of catgut
16. What is the anti-implant infection?
A. in hand washing
B. sterilization material for joints
C. to reduce the period of operation
D. irradiating UV lamp
E. in applying iodine and alcohol
17. What you need to be sterilized in an autoclave under pressure?
A. optical instruments
B. catgut
C. nylon thread
D. cutting tools
E. dressing
18. How is the sterilization of optical devices?
A. in a hot air oven
B. boiling
C. pressurized steam
D. sodium-4
E. in formaldehyde vapors
19. Hand processing means for Spasokukotsky - Kocherginima?
A. ammonia solution
B. A solution of hydrogen peroxide
C. mercury dichloride solution
D. C-4 solution
E. sterile brush
20. Treatment of the surgical field for Grossiha-Filonchikova is:
A. washing the skin with 0.5% solution of ammonia
B. Multiple skin lubrication 96 ° alcohol
C. skin lubricated with a solution of alcohol and tannin
D. multiple skin treatment solution C-4
E. multiple skin treatment with 5% iodine
21. At what treatment method surgeon's hands can not be used tincture of iodine
to lubricate your fingers?
A. diotsid processing
B. method Fyurbringera
C. way to Alfeld
D. way to Bruna
E. processing solution P-4
22. The method of the above does not provide for treatment of hands with soap
and running water?
A. of the Great Plain
B. for Brun
C. for Fyurbringera
D. for Spasokukotsky-Kochergina
E. processing solution pervomurom
23. What are the most reliable method of sterilization control?
A. instrumental
B. bacteriological
C. microscopic
D. melting crystalline substances
E. Mikulic method
 24. Sterilization with optics in formalin vapors continues:
A. 2 hours
B. 24 hours
C. 48 hours
D. 48 hours
E. ½ hours
25. To prevent contamination of the surgical department of the operating air in
the operating room must be provided for ventilation?
A. air handling units, equal in terms of supply and exhaust
B. only plenum
C. only exhaust
D. air handling units with a predominance of the influx
E. in this case the ventilation principle not critical.
26. What is the second name of the transit of the skin microflora?
A. autochthonous
B. none of the above.
C. constant
D. resident
E. normal
27. What is aseptic?
A. prevent potential pathogens on the surface, into the patient's organs and
cavities
B. plurality of transfer factors in the specific conditions in the infection.
C. the ability to cause disease microorganisms
D. destroying or suppressing the growth of potentially harmful micro-organisms
on the skin or in the body as a whole
E. an infectious disease that the patient at the time of admission, or he was in the
hospital, but that was acquired in the hospital
28. What is an autoclave?
A. drying cabinet Sterilizer
B. Schimmelbusch boxing
C. steam sterilizer
D. germicidal UV lamp
E. chamber for gas sterilization
29. Which group of substances include peracetic acid?
A. quaternary ammonium compounds
B. substances containing phenol
C. aldehydes
D. compounds containing oxygen
E. compounds containing halogen
30. sterilization method is the most common in the industrial manufacture of
single materials?
A. steam sterilization
B. sterilization of the solution
C. gas sterilization
D. air sterilization
E. radiation sterilization
31. Which of these belongs to the plasma sterilization methods?
A. gas
B. radiation
C. radiofrequency
D. chemical
E. air
32. Which of the methods of sterilization include the statement: sterilizing agent
is saturated with water vapor under high pressure?
A. air sterilization
B. sterilization of the solution
C. steam sterilization
D. gas sterilization
E. The "cold" sterilization
33. Which of these drugs can be used to improve the surgical field?
A. chloramine B
B. formalin
C. ternary solution
D. mercury dichloride
E. degmitsid
34. Use cold sterilization method?
A. ethylene oxide
B. steam
C. glyuteraldelgid
D. radio frequency
E. air
35. The following sterilization methods, except:
A. radiation
B. chemical
C. air
D. steam
E. biological
36. air method of sterilization mode assumes that the following parameters:
A. t -120 ° C, exposure - 150 minutes
B. t -160 ° C, exposure - 120 min
C. t -180 ° C, exposure - 45 min
D. t -180 ° C, exposure - 60 minutes
E. t -160 ° C, exposure - 60 minutes
37. steam sterilization treatment method assumes that the following parameters:
A. F - 1.1 atm, t -120 ° C, exposure - 60 minutes
B. P - 2 atm, t -132 ° C, exposure - 20 minutes
C. F - 1.1 atm, t -160 ° C, exposure - 30 minutes
D. P - 2 atm, t -160 ° C, exposure - 30 minutes
E. P - 2 atm, t -132 ° C, exposure - 60 min.
38. Means for chemical sterilization method the following except:
A. CIDEX
B. 6% hydrogen peroxide solution
C. korzoleks
D. 4.8% solution pervomurom
E. 0.2% solution Chlorantoin
39. General cleaning of operating is carried out:
A. after each operation
B. 2 times a day (morning and evening)
C. 1 time per month
D. everyday
E. 1 time per week
40. General cleaning chamber general surgical department performed:
A. 1 time per month
B. 1 time per day
C. 1 time per week
D. 2 times a day (morning and evening)
E. if necessary
41. Purposeful way of stacking the material in the box is:
A. laying in a box just need to work within one working day
B. laying in a box of only one type of material
C. laying in boxing material as directed by the physician.
D. in separate stacking Bix materials requiring different modes of sterilization
E. laying in a box all you need for a single operation
42. The maximum shelf life of sterilized material in the pits without a filter and
other packages are as follows:
A. 1 day
B. 10 days
C. 21 days
D. 7 days
E. 3 days
43. Specify which microorganisms do not cause the occurrence of nosocomial
infections?
A. salmonella
B. streptococci
C. colon bacillus
D. leptospira
E. staphylococci
44. Microbiological monitoring of health facilities conducted:
A. 1 time per month
B. 2 times per week
C. 1 time per week
D. 1 time in 2 weeks
E. daily
45. Microbiological monitoring of sanitary-epidemic stations performed:
A. 1 time per week
B. daily
C. spontaneously
D. 1 time per month
E. 1 time per quarter
46. The number of containers and rags needed for cleaning the operating unit?
A. 2 and 5 buckets rags
B. 1 bucket of a separate cloth for each room
C. 1 bucket and rag 1
D. 3 bucket and 3 rags
E. single bucket and a separate cloth for each room
47. What tool is strictly prohibited to use in the course of operating the cleaning?
A. a broom and a vacuum cleaner
B. mop and brush
C. a vacuum cleaner and a rag
D. cloth and brush
E. broom and mop
48. For general cleaning use solution:
A. 3% hydrogen peroxide, 0.5% detergent solution
B. pervomurom 4.8%
C. 3% chloramine
D. Hydrogen peroxide 6%
E. 6% hydrogen peroxide with 0.5% detergent solution
49. After-cleaning is carried germicidal lamp exposure for:
A. 30 min
B. 45 min
C. 120 min
D. 60 min
E. 20 minutes
50. In the area of high security operation unit include:
A. room surgeons and nurses
B. operating room
C. preoperative and anesthetic
D. head office
E. a room for the storage of blood
51. With a positive benzidine test on residual blood stain appears:
A. purple
B. pink
C. black
D. blue-green
E. yellow
52. With a positive Phenolphthalein test on the remains of detergent appears
coloring:
A. blue
B. green
C. blue-green
D. purple
E. pink
53. The composition of the cleaning solution includes:
A. 5 g of detergent ( "Lotus"), 17 ml of 27.5% hydrogen peroxide, 978 ml of
water
B. 15 g of detergent ( "Lotus"), 15 ml of 3% hydrogen peroxide, 970 ml of water
C. 10 g of detergent ( "Lotus"), 17 ml of hydrogen peroxide, 6%, 978 ml of
water
D. 20 g of detergent ( "Lotus"), 50 ml of 3% hydrogen peroxide, 970 ml of water
E. 5 g of detergent ( "Lotus"), 17 ml of hydrogen peroxide, 6%, 978 ml of water
54. One method for the sterile suture is microbiological control (growth of
microorganisms in a material taken). Crops are to monitor sterilization efficacy
of the suture should be carried out at one time:
A. 10 days
B. 20 days
C. 5 days
D. 15 days
E. 3 days
55. Of the following surgical instruments sterilization methods most reliable and
fast in a hospital?
A. in an autoclave with flowing steam
B. in an autoclave under pressure
C. bactericidal lamps
D. in a hot air oven
E. radiation sterilization
56. Number of 33% hydrogen peroxide solution should be taken for the
preparation of C-4 solution with respect to 1 liter of water?
A. 8.2 ml
B. 69 ml
C. 17.1 ml
D. 6.9 ml
E. 171 ml
57. Quantity 100% murashinnoi acid solution should be taken for the
preparation of C-4 solution with respect to 1 liter of water?
A. 171 ml
B. 6.9 ml
C. 17.1 ml
D. 8.2 ml
E. 69 ml
58. Decontamination of waste material occurs by:
A. burning
B. pouring in distilled water
C. Immersion in 0.2% hlorantainu solution at 1 hour
D. timely disposal into landfill
E. packaging in a sealed bag and immersing in a 0.2% solution hlorantainu for 1
hour
59. What is the sequence of dressing sterile gown, gloves, masks, caps and shoe
covers?
A. mask, cap, shoe covers, gloves, gown
B. mask, cap, shoe covers, gown, gloves
C. coat, gloves, hat, mask
D. gown, mask, cap, shoe covers, gloves
E. shoe covers, gown, gloves, cap, mask
60. What is included in presterilizing processing tools:
A. Wash tools as pollution control presterilizing cleaning
B. boiling tools to control presterilizing cleaning
C. rinsing, immersion in a cleaning solution, washing each mechanical tool
D. -
E. Rinsing with running water and drying with hot air

6.2. Case Studies

1. V. victim, 28 years brought in trauma center after the home injury. Diagnosis:
incised wound of the forearm. Injury occurred one hour ago. What method of
antiseptics should be apply to fight infection that gets into the wound?
A. The appropriate use of all antiseptic methods
B. mechanical and chemical;
C. physical and biological;
D. mechanical and biological;
E. mechanical and physical;
2. Patient S., 50 years old was taken to hospital surgical induction center. in the
emergency department diagnosed - anaerobic infection in the wound of the
middle third of the thigh. His status is deteriorating rapidly. What types of
antiseptics should be used to treat this patient?
 A. perform cutting and radical excision wound edges, wash the wound 3%
hydrogen peroxide solution, do not sew, apply a loose sterile bandage with
antiseptic, to adequate oxygen, assign antibiotic therapy;
B. crop the edges of the wound, wash the wound 3% hydrogen peroxide
solution, leave the wound drainage liquid sew seams, assign antibiotic therapy;
C. carve the edges of the wound, wash the wound with 5% solution of iodine
swab put Carpentry, assign antibiotic therapy;
D. crop the edges of the wound, wash the wound 3% hydrogen peroxide
solution, sew up the wound sutures separately, assign antibiotic therapy;
E. wash the wound 3% hydrogen peroxide solution, leaving a wound drainage
not sew up the wound, prescribe antibiotic therapy.

3. The surgeon examined the patient. The surgeon found that the bandage on
the wounds soaked pus blue-green color with an unpleasant odor. What
antiseptics should be used to control this infection?
A. 2% boric acid;
B. 70oethanol;
C. 0.2% water solution chlorhexidine;
D. 5% solution of iodine;
E. Furacilin.
4. Patient P., 45 years taken to hospital. Diagnosis - bruise right hand, which got
to work 3 days ago. What type of antiseptics should be applied?
A. Wash the wound with antiseptic solution, drain the wound, impose a
single stitches, administer antibiotic therapy;
B. Wash the wound with antiseptic solution, sew seams, assign antibiotic
therapy;
C. to surgical treatment, draining wound, to sew up the wound, prescribe
antibiotic therapy;
D. to surgical treatment, draining the wound, the wound did not stitch, to
appoint antibiotic therapy;
E. widely cut and carve the edges of the wound, wash the wound with
antiseptic solution, leave not sewn for adequate air access, administer antibiotic
therapy.
5. Patient Y., 17 years old appendectomy was done 4 days ago.
Severe pain in the wound appeared after 4 days. Clinically defined skin
redness and swelling around the wound, increased body temperature to 38,5 °
C. The doctor took off 3 stitches, threw the wound edges, 10 ml yellow-green
pus out of the wound
The doctor urgently summoned from the dressing room. A student who helped
doctor washed the wound with isotonic sodium chloride solution, installed
rubber drain, put a bandage with sterile distilled water. Is it right to do student
in the treatment of complications after appendectomy?
A. incorrectly chosen means of chemical antiseptics;
B. incorrectly chosen tool for physical antiseptics;
S. incorrectly selected tools for mechanical and physical antiseptics;
D. chosen not right tool for mechanical antiseptics;
E. done right.
6. Patient A., 28 years old is hospitalized in the surgical department. The patient
has a wound on the leg lateral size of 2 to 6 cm with jagged edges and signs of
local inflammation. In outpatient department doctor performed the surgical
treatment and wound care antiseptic, bandages soon after injury. Indicate which
types of antiseptics were applied to the local outpatient wound care?
A. mechanical, physical and chemical;
B. mechanical and chemical;
C. physical and chemical;
D. mechanical and physical;
E. reliably measured cannot.
7. In practical training 3 rd year student needle prick finger accidentally
in the course of blood taking from a vein in the patient for biochemical research.
What should be a further sequence of actions to prevent an infection transmitted
by parenteral route?
A. damaged place to process with antiseptic - 70o alcohol, active prevention of
possible infection carry antibacterial and antiviral drugs.
B. squeeze blood from a wound, damaged place to process 70o alcohol, wash
your hands thoroughly with soap and water, apply plaster on the wound, if necessary,
continue;
C. necessary to take blood of patients for virological investigation, pending the
outcome of action not to do;
D. give their own blood for virological investigation, the results of action not to
do;
E. immediately stop work, venous tourniquet put on the limb and seek help
from a specialized treatment facility;
8. Patient X., 47 years old, was hospitalized in the surgical department.
The patient was diagnosed anaerobic infection of the wound left thigh.
What is a feature of local antiseptics use during his treatment?

A. open wound should be treated periodic washing by 3% hydrogen peroxide

solution and gradually nekrektomy;
B. wound should be treated under the bandage, conduct passive wound
drainage tube drainage, and irrigation with antiseptic solutions;
C. the wound should be treated with hydrogen peroxide 3%, and loosely wound
tampon;
D. wound should be treated with antiseptic solution, tamponing napkin with
hypertonic solution;
E. wound should be treated under the bandage, wash the wound with a solution
of hydrogen peroxide 3%, active wound draining tube drainage.

9. The patient suffers from an existing long purulent wounds. Deep pocket
located on the bottom of the wound, the edges of it is covered with pus and
necrotic tissue. Using local antiseptics did not give a positive result. What
additional means necessary to add to local treatment of purulent wound and
it pocket?
A. surgery with wide access and adequate drainage;
B. Local irrigation with antibiotics;
C. using proteolytic enzymes;
D. additional drainage deep pockets;
E. using ultraviolet light and ultrasound low frequency.

10. Patient P., 45 years was taken in the surgical clinic with bruise wound right
wrist. The patient received a wound at work 2 hours later. What type of
antiseptics should be applied?
A. Chemistry;
B. Biology;
C. Mechanical;
D. physical;
E. mixed.
11. Drainage purulent wound was made. But drainage adjacent to the soft
tissues very tight. Pus flowing through drainage is not enough.
What mistake? What are your next steps?
A. widely re-disclosure of wound pockets;
B. re-introducing them into the deep pockets;
C. tight stitching wounds;
D. antiseptic wash drainage;
E. draining pockets through additional cuts.

12. The patient admitted to hospital the with a diagnosis of soft tissue abscess
buttocks. Surgery was performed disclosure of purulent cavity. What is further
tactics?
A. washing of the wound with antiseptics and loosely wound drainage;
B. abscess excision within healthy tissue;
C. washing of the wound with antiseptics
D. ultraviolet radiation after clearing from pus;
E. tight imposition of aseptic dressings.

13. The patient was taken to hospital with a diagnosis of erysipelas of the lower
extremity disease recurrence. Which antibiotics are most appropriate to use and in
what way it is advisable to introduce them to create a maximum concentration in
the affected area
A. The use of antibiotics in view of sensitivity to the microflora by the course
for 7 days inter muscular or in / vene.
B. Broad-spectrum antibiotic use through irrigation and the application of
napkins in inflamed soft tissue.
C. Antibiotics of penicillin group Long-term use by mouth, in / m, in/vena
D. Give any group of antibiotics directly into a vessel supplying blood to the
affected area
E. Injections single dose of antibiotics cephalosporin group in soft tissue limb -
 the edge of the inflammatory process

14. The young woman began to complain of fatigue, feeling of fear and dizziness,
tinnitus, itching of the skin 10 minutes after the inter muscular injection of
1million units of penicillin. The doctor found during the investigation flushing
skin fase and body, blood pressure decreased to 70/40 mm Hg, thready pulse,
shortness of breath. What is the diagnosis of complications:
A. anaphylactic shock.
B. allergic reaction
C. syncope
D. cardiogenic shock
E. collapse

15. The symptoms of candidiasis were patient with prolonged use of antibiotics.
What are the Symptoms of fungal process appeared in the body, as the fight of the
drugs should be assigned to the patient?

A. Scurf, expressed hyperemia appeared on the mucous membranes of the skin

and mucous membranes, wound healing process has slowed down. the drug
should immediately cancel the antibiotics, the patient appoint fluconazole.
B. Scurf, expressed hyperemia appeared on the mucous membranes of the
skin and mucous membranes, wound healing process has slowed down.
Another antibiotic from the same group must be assigned, and further treatment
is carried out under the guise of anti-fungal agents.
C. All antibacterial agents need to cancel before the full recovery. When the
general symptoms such as fatigue, malaise.
D. Scurf, expressed hyperemia appeared on the mucous membranes of the
skin and mucous membranes, wound healing process has slowed down. It is
necessary to reduce the dose of antibiotics, and to carry out the further
treatment under the guise of desensitizing agents.
E. Manifestations of candidiasis in the surface of the body to treat hormonal
ointments.

16. Purulent wound hip was washed pulsating jet antiseptic solution and drained
rubber graduate with a cotton swab moistened with a hypertonic solution of sodium
chloride. What kind of antiseptic was used in this case? What can serve as a modern
alternative to hypertonic sodium chloride solution
A mixed form of antiseptics was used instead of sodium chloride is used more
effective means:. Sorbents ointment composition on the basis of a water-
soluble, have a hypertensive effect.
B. physical antiseptic used was possible to apply antibacterial ointment on the
basis of fats
C. Mixed antiseptic was used. Antibiotics are used for the topical treatment of
wounds;
D. Mechanical antiseptic was used Perhaps the use of traditional medicine
products;
E. g mixed antiseptics was spolzovat When treating wounds Perhaps the use of
 physiotherapy (UHF, Darsonval, ultrasounds low frequency).
17. "Iruksol" ointment which contains enzymes used for the treatment of
purulent wounds of necrotic tissue. What Kind of antiseptics used in this
situation? You can supplement this method other manipulations?
A Biological antiseptic was used, can be supplemented by topical
treatment with other methods.
B. chemical antiseptic was used, it can be supplemented by topical
treatment with other methods.
C. Mixed antiseptic was used to complement other methods can not be
considered expedient.
D. Biological antiseptic was used to prevent the state of sensitization and
this ointment is used only by yourself.
E. Biological antiseptic was used for the topical treatment of wounds. Only
Means of biological antiseptics can be used.

18.The patient has a purulent wound on his shoulder. Biologicall antiseptic

need to add an treatment. Which medicines may be included in the
treatment?

A. After washing the wounds with a solution of hydrogen peroxide, purulent

necrotic areas sprinkle enzyme preparations.
В. Before performing primary surgical treatment of wounds certainl made
injection with antibiotics inside edge of wound.
C. After washing the wound with a solution of hydrogen peroxide, the wound
surface treat with alcoholic solution of iodine.
D. Irrigate the wound through the drainage system solutions of antibiotics.
E. Perform daily dressing purulent wound with ointments based on fat-soluble,
which contain the biological antiseptic.

19. What method to use hypertonic sodium chloride solution (or do not use
it) for dressing the patient with purulent inflammation of the
subcutaneous adipose tissue of the abdominal wall?

A. hypertonic solution for the treatment of purulent inflammation is not

appropriate to use, it must be replaced by more modern Osmotic agents.
Change bandage patients with purulent inflammation of the subcutaneous
tissue of the abdominal wall cavity advisable to complete drainage channel and
a gauze pad with hyperosmolar drugs dioksyzol.
B. After you dressing as a lotion.
C. hypertonic solution of sodium chloride to patients with purulent
inflammation of the subcutaneous tissue of the abdominal wall is applied
as a compress.
D. After changing the bandage dressing hypertonic solution used locally
by electrophoresis.
E. Change bandage patients with purulent inflammation of the
subcutaneous tissue of the abdominal wall cavity advisable to complete
 drainage channel and a gauze pad soaked hypertonic solution

20. The patient has large sores in the lower third of the tibia. You must
remove the old bandage that held firmly to the ulcer and not withdrawn
without pain. Which means (antiseptics) can be used to facilitate the
removal of bandages?

A. soak dressing solution of hydrogen peroxide

V. soak dressing in a basin of warm water.
C. Process dressing 96% ethanol ..
D. Process dressing tincture of iodine.
E. any antiseptics that has enzymatic properties – solve necrotic tissue
and pus changed.
PART 2
1. The sterilization was carried out sterilization of the laundry. Steam-sterilized
in an autoclave at a pressure of 152.5 kPa / 1.5 MPa / 45 minutes. At the end of
sterilization and disconnected operation time machine, the working of the
autoclave sterilization let the steam open the lid unit, window boxes nurse was
sealed and brought to the operating room. Properly executed sequence? What a
mistake the medical staff at the stage of delivery boxes in the operating room.
A. all done right
B. standards are not met transport boxes
C. not sustained sterilization mode
D. not done the laundry drying in the autoclave after sterilization
E. not executed sterilization quality control
2. After surgery for purulent process surgical instrument thoroughly washed
under running water "ruff" and soap, rinsed and placed in a boiler for
sterilization. Sterilization lasted for 15 minutes, then was taken to the operating
instruments. Specify any mistakes?
A. not made mechanical cleaning tools in the wash liquor
B. not made drying the sterilized instruments
C. violated all norms of presterilizing processing and sterilization
D. disinfection of surgical instruments is not made
E. failed to carry out desalination surgical instruments
3. Operating nurse opened the box with the laundry after sterilization, to set the
table before the operation. Underwear wet, sulfur melted. You can use this
linen?
A. impossible because the broken steam sterilization mode
B. is possible, but after a bacteriological control
C. is possible, but after drying laundry
D. possible, but only to carry out operations on the purulent processes
E. It can not be because the application of wet laundry is prohibited
4. When suturing the wound student gloved hand adjusted the mask on your
face and went on to assist. No one noticed. Or the student may continue to
assist?
A. can, but after re-treatment of hands and dressing surgical linen
B. can, but in conditions not to touch the edges of the wound
C. can, but after changing gloves
D. can, but after replacing the mask
E. can not, because a student there was a danger of infection by bacteria of the
patient
5. With the passage of an industrial practice students 3rd year as a nurse
dressing the surgical department, before the last it has been tasked to implement
presterilizing processing of used surgical instruments. What is the sequence of
its actions?
A. mechanical cleaning in detergent solution, rinsing under running water and
desalting, disinfectants disinfection of instruments in the solution, washing with
running water
B. disinfectants disinfection of instruments in the solution, washing with running
water, a mechanical cleaning in the wash liquor, rinse under running water and
desalting
C. mechanical cleaning in the washing solution, washing with running water,
disinfection of instruments in disinfectant solution, rinsing under running water,
desalination
D. disinfection of instruments in disinfectant solution, mechanical cleaning in the
cleaning solution, rinse under running water and desalination.
E. washing under running water, disinfectants disinfection of instruments in
solution, mechanical cleaning in detergent solution, rinsing in running water,
desalination
6. With the passage of an industrial practice 3rd year student as a nurse
dressing the surgical department, before the latter was tasked to carry out the
sterilization of surgical instruments. Where and how should it pursue?
A. in an autoclave at P - 1.1 atm, t -160 ° C and 30 minutes exposure
B. in a hot air oven at t -180 ° C and 60 minutes exposure
C. all options are suitable
D. in an autoclave at P - 2 atm, t -132 ° C and 45 minutes exposure
E. in a hot air oven at t -160 ° C and 120 minutes of exposure
7. With the passage of an industrial practice 3rd year student as a nurse
operational branch was asked to help the latter to conduct general cleaning of
the operating room. What is the sequence of its actions?
A. holding a total wet cleaning disinfectant, a germicidal lamp switch
B. conducting twice the total wet cleaning disinfectant, a germicidal lamp switch
C. holding 1 per week total wet cleaning with the inclusion of the germicidal
lamp
D. spraying the ceiling, walls and floors with a disinfectant solution, removing
the last by rubbing, holding general damp cleaning, the inclusion of the germicidal
lamp
E. All options are possible, depending on the species held within a week of
operations
8. At the lab, while visiting the operating room, the student was asked to
become an assistant at the surgical intervention. What is the sequence of its
actions in the treatment pervomurom hands before surgery?
A. treatment for 5 minutes 70 ° alcohol, dipping for 1 minute in a solution
pervomurom draining sterile wipes
B. prewash for 1 minute under running water with soap and water, dipping for 1
minute in a solution with pervomurom draining sterile napkins, processing
fingertips 5% alcoholic solution of iodine
C. prewash for 1 minute under running water with soap two brushes, dipping for
1 minute in a solution pervomurom draining sterile wipes
D. immersion for 1 min in a solution with pervomurom draining sterile napkins
treatment for 5 minutes 70 ° alcohol
E. prewash for 1 minute under running water with soap and water, dipping for 1
minute in a solution pervomurom draining sterile wipes
9. At the lab, while visiting the operating room, the student must assist the
surgeon in the surgery for acute appendicitis. The doctor suggested a colleague
to handle and form the operative field and an autopsy soft tissue. What is the
sequence of its actions?
A. processing thrice anterior abdominal wall 5% alcohol solution of iodine,
random access zone lining sheets, the processing zone lined with a 5% alcohol
solution of iodine, soft tissue dissection
B. processing the anterior abdominal wall 5% alcohol solution of iodine, random
access zone lining wash, twice processing zone lined with a 5% alcohol solution of
iodine, soft tissue dissection
C. processing the anterior abdominal wall 5% alcoholic solution of iodine zone
lining random access linen, lined with three treatment zones 5% alcohol solution of
iodine, soft tissue dissection
D. processing thrice anterior abdominal wall 5% alcohol solution of iodine,
random access zone lining sheets, opening the soft tissue
E. processing twice anterior abdominal wall 5% alcohol solution of iodine,
random access zone lining sheets, the processing zone lined with a 5% alcohol
solution of iodine, soft tissue dissection
 10. When practical training the student as a nurse operational branch General
Hospital were asked to carry out packing material, which is necessary for
separating the next day, in a box for further sterilization. How he should carry
out the above?
A. spend species laying the bookmark in the box material and operating linen,
designed for scheduled operations
B. hold universal packing with a bookmark in a certain type of box dressing
material or surgical linen
C. hold universal packing with a bookmark in the box material and operating
linen, designed for typical operation
D. spend species styling with a bookmark in a certain type of box dressing
material or surgical linen
E. spend purposeful styling with a bookmark in the box material and operating
linen, calculated on the planned operation .

7. RECOMMENDED LITERATURE
1. M. Townsend. Sabiston textbook of surgery.-16th ed
2. S.I. Shevchenko. Surgery: text-book for English medical students/S.I.Shevchenko /
-Kharkov: KSMU, 2000.-344 p.
3. A. Butyrsky. Общая хирургия (с алгоритмами ухода за хирургическими
больными ): для студентов, обучающихся на английском языке.-Симферополь:
КГМУ, 2004.-478 с.
4. O. Dronov. Lecture Course of General Surgery/ O. Dronov -K/: Medinform, 2011/-
343 p.
5. R.Kushnir. General surgery/ Lectures.-Ternopil: Ukrmedknyha, 2005.-308 p.