Means for washing and disinfecting the hands of staff. Instructions for sanitizing the hands of personnel. Hand treatment is a simple but very important method of preventing stroke. Proper and timely hand treatment is the key to medical safety.

Sanitary maintenance of premises, inventory equipment

Lecture #8

Topic 2.4. Sanitary regime in pharmacy organizations.

3. Sanitary maintenance of premises, equipment, inventory.

4. Sanitary and hygienic requirements for pharmacy staff.

5.1. Before starting work, it is necessary to carry out a wet cleaning of the premises (floors and equipment) using disinfectants. Dry cleaning is prohibited.

5.2. General cleaning of production premises should be carried out at least once a week. Wash walls, doors, equipment, floors. Ceilings are cleaned of dust with damp cloths once a month. Window panes, frames and spaces between them are washed hot water with soap or other detergents at least once a month.

5.3. The equipment of industrial premises and trading floors is subjected to daily cleaning, cabinets for storing medicines in storage rooms ( material rooms) are cleaned as needed, but at least once a week.

5.4. Cleaning equipment must be labeled and used strictly for its intended purpose. It is stored separately in a specially designated place (room, cabinets). Rags intended for cleaning production equipment, after disinfection and drying, are stored in a clean, labeled, tightly closed container (jar, saucepan, etc.). Cleaning equipment for the aseptic unit is stored separately.

5.5. Cleaning of the premises of the aseptic unit (floors and equipment) is carried out at least once a shift at the end of work using disinfectants (Appendix 8). Once a week, a general cleaning is carried out, if possible with the release of equipment. It is necessary to strictly follow the sequence of stages when cleaning the aseptic block. You should start with aseptic. First, wash the walls and doors from the ceiling to the floor. Movements should be smooth, always from top to bottom. Then they wash and disinfect stationary equipment and, last but not least, floors. All equipment and furniture brought into the aseptic unit is pre-treated with a disinfectant solution. For cleaning and disinfecting surfaces, foam rubber sponges, napkins with closed edges made of non-fibrous materials are recommended. To wipe the floors, you can use rags with closed edges made of harsh fabrics.

5.6. The preparation of disinfectants should be carried out by specially trained personnel in accordance with current instructions. For disinfection of surfaces, it is allowed to use disinfectants from among those permitted by the Ministry of Health of Russia

5.7. Production waste and garbage must be collected in special containers with a drive cover and removed from the premises at least once per shift. Hand wash basins, sanitary facilities and waste containers are washed, cleaned and disinfected daily.

5.8. A sanitary day in pharmacies is carried out once a month (at the same time, in addition to thorough cleaning, minor repairs can be carried out).

6.1. Heads of pharmacies at all levels need to take care of the correct placement of specialists and auxiliary personnel, ensuring their training and retraining according to the rules of personal hygiene and safety, as well as regular medical examinations (preliminary and periodic examinations) by the staff.

6.2. Pharmacy workers involved in the manufacture, control, packaging of medicines and the processing of pharmacy utensils, as well as those in contact with finished products, undergo a medical examination upon admission to work, and later on, a preventive examination in accordance with the current orders of the Ministry of Health of the Russian Federation. The results of the examinations are recorded in the sanitary book.

6.3. Each employee must notify the management staff of any deviations in the state of health. Employees with infectious diseases, damage to the skin are not allowed to work. Identified patients are sent for treatment and sanitation. Admission to work is carried out only if there is a certificate from the medical professional institution on recovery.

6.4. Personnel must follow the rules of personal hygiene and industrial sanitation, wear technological clothing appropriate for the operations performed.

6.4.1. At the entrance to the pharmacy, the staff must take off their outerwear and shoes in the dressing room, wash and disinfect their hands, put on sanitary clothes and sanitary shoes. Be sure to take off your bathrobe before going to the toilet.

6.4.2. It is forbidden to leave the pharmacy in sanitary clothes and shoes. During periods of the spread of acute respiratory diseases, pharmacy staff should wear gauze bandages on their faces.

6.4.3. Sanitary clothes and sanitary shoes are issued to pharmacy employees in accordance with applicable standards, taking into account the production operations performed. Sanitary clothing should be changed at least 2 times a week, towels for personal use - daily. A set of special clothing for personnel working in aseptic conditions must be sterile before starting work. It is advisable to provide distinctive signs in the sanitary clothing of personnel, for example, overalls or its parts of a different color than white, in order to more easily recognize violations of the order of movement of personnel in the aseptic area, between rooms or outside the aseptic unit, in other production areas.

6.4.4. Production personnel should take a shower regularly, carefully monitor the cleanliness of their hands, cut their nails short, and do not cover them with varnish.

6.4.5. Production personnel are prohibited from eating, smoking, and storing food, smoking materials and personal medicines in the production areas of pharmacies and in storage areas. finished products. Gown pockets should not contain personal items, except for a handkerchief.

6.5. Particular attention should be paid to the selection and training of production personnel for work in aseptic conditions. The staff of the aseptic unit must have, in addition to special knowledge and practical experience, knowledge of the basics of hygiene and microbiology, in order to consciously comply with sanitary requirements and rules, must be prepared for possible inconveniences in work associated with the systematic processing of hands and a strictly defined sequence of changing clothes, using breathable bandage on the face, rubber gloves on the hands, etc. (Appendices 5, 6).

6.6. For production personnel, on the basis of existing documents, personal hygiene rules, entry and exit rules, cleaning procedures, rules for transporting products and materials in accordance with the course technological process and others, taking into account the peculiarities of this pharmacy enterprise. The rules and measures of personal hygiene, including the requirements for the use of sanitary clothing, should be applied to everyone entering the production premises - temporarily and permanently working, not working (guests, inspection, top management, etc.).

6.7. Pharmacy workers need to systematically take part in classes on topics related to personal hygiene, industrial sanitation, safety, organized by the administration in a time frame that ensures staff awareness of modern requirements. Invited consultants must have the appropriate qualifications (education and experience), about which the necessary records are made.

6.8. Pharmacy staff must follow current rules safety precautions and industrial sanitation when working in pharmacies.

6.9. In pharmacies, the necessary composition of sanitary facilities for staff should be provided:

Dressing rooms with 100% individual wardrobes for separate storage of outer, home and sanitary clothing. The area of dressing rooms for home and sanitary clothing should be taken at the rate of 0.55 sq. m for a double wardrobe and the addition of aisle area;

Wardrobe outerwear and shoes 0.08 sq. m per hook in the dressing room (for 60% of workers in 2-shift work and 100% in single-shift work);

Showers - one shower per pharmacy;

Bathrooms (number of sanitary appliances, based on the number of employees);

Rooms for eating and resting (should be isolated from other rooms).

Annex 5

Training of personnel for work in the aseptic unit

1. Trained personnel of the aseptic unit should have a special set of sanitary technological clothing: a dressing gown, or a trouser suit, or overalls (optimally: a stand-up collar, tied at the waist, tight-fitting cuffs); safety shoes and shoe covers; hat or helmet with a mask covering the mouth and nose or a hood, if necessary - rubber gloves without talc. The set must be made of materials or mixed fabrics that meet hygiene requirements with minimal linting.

2. A set of clothes is sterilized in biks in steam sterilizers at 120 -C for 45 minutes or at 132 -C for 20 minutes and stored in closed biks for no more than 3 days. If possible, use a set of disposable sterile clothing.

3. Staff shoes are disinfected before and after work and stored in closed cabinets or in boxes in the gateway. Disinfection is carried out by 2-fold wiping the outside with a solution

chloramine 1% or 0.75% with the addition of 0.5% detergent. Except

In addition, disinfection of shoes is carried out in a bag with cotton wool moistened with a 40% formaldehyde solution or acetic acid 40%, neutralized with ammonia or alkali.

4. Entry and exit in aseptic rooms, the transfer of necessary items and materials should be carried out only through the air lock. At each entrance to the aseptic room, a set of sterile clothing should be changed.

5. When entering the lock put on shoes. It is advisable to provide a two-sided bench with cells for shoes in the lower part. Sitting on a bench, the worker takes off his slippers and places them in an individual cell. Then, throwing his legs over the bench, he turns 180 and takes a bag or bix with sterile technological clothes from an individual shelf or rack. The bench is designed to conditionally separate the stages of preparation. After washing and drying the hands, put on a set of sterile clothing, except for gloves, then treat the hands and, if necessary, put on sterile gloves.

6. During operation, the minimum required number of workers should be in the aseptic unit. Personnel movements should be slow, smooth, rational. Avoid sudden movements, limit conversations and movements. If it is necessary to communicate verbally with an employee outside the aseptic unit, a telephone or other intercom should be used.

7. For notes, pre-cut parchment sheets should be used and ballpoint pens or felt-tip pens, which should be wiped with a lint-free cloth moistened with ethyl alcohol.

8. When working in aseptic conditions, it is prohibited:

Enter the aseptic room in non-sterile clothing and exit the aseptic unit in sterile clothing;

Have voluminous fleecy clothing under sterile sanitary clothing or in which the employee is on the street;

Use cosmetics and aerosol deodorants;

Wear watches and jewelry;

Bring in personal items (keys, combs, handkerchiefs, etc.);

Clear your nose. To do this, go to the gateway, use a sterile handkerchief or napkin; then wash and disinfect hands;

Pick up and reuse items dropped on the floor during work;

Rubbing your hands or face, scratching your head, bending over bottles or other containers with medicines;

Use pencils, erasers, fountain pens.

Appendix 6 to the Instructions on the sanitary regime of pharmacy organizations

Processing of staff hands

1. Processing of hands is carried out in specially designed places. It is forbidden to wash your hands over the sink for washing pharmacy dishes.

2. For mechanical removal of contaminants and microflora, hands are washed with warm running water and soap for 1-2 minutes, paying attention to the periungual spaces. It is optimal to use soaps with high foaming ability (bath, children's, laundry). Then the hands are rinsed with water to remove soap and treated with disinfectants.

3. In the aseptic block (in the airlock), the hands are wiped dry after rinsing, put on sterile clothes, then the hands are washed off with water and treated with disinfectants. Processing is repeated if the work lasts more than 4 hours.

4. To disinfect the skin of the hands, 70% ethyl alcohol or other alcohol-containing preparations (AKhD-2000, octoniderm, octonisept), a solution of chlorhexidine bigluconate 0.5% (in 70% ethyl alcohol), a solution of iodopyrone and other iodophors (iodonate, iodvidone) are used 1% solution of chloramine B 0.5% (in the absence of other drugs) or other means permitted by the Ministry of Health of the Russian Federation for these purposes.

5. When disinfecting hands with alcohol-containing preparations, they are wiped with a gauze cloth moistened with a solution. At the same time, tanning of the skin is achieved; when using solutions of chlorhexidine or iodophors, the drug is applied to the palms in an amount of 5-8 ml and rubbed into the skin of the hands; when treating hands with a solution of chloramine, they are immersed in the solution and washed for 2 minutes, then the hands are allowed to dry.

6. At the end of the work, the hands are washed with warm water and treated with emollients, for example, a mixture of equal parts of glycerin, alcohol, 10% ammonia solution and water, which is thoroughly shaken before use. It is possible to use other emollients, ready-made creams that provide elasticity and strength to the skin of the hands.

Annex 7 to the Instructions on the sanitary regime of pharmacy organizations

Rules for the operation of germicidal lamps

Premises where bactericidal lamps are installed: distillation, washing-sterilization, assistant, aseptic, sterilization dosage forms.

Bactericidal irradiators are discharge lamps low pressure, emitting ultraviolet rays with a wavelength of 254 nm, corresponding to the area of \u200b\u200bthe greatest bactericidal action of radiant energy. The irradiators have open lamps for quick disinfection of air and surfaces in the absence of people and shielded lamps for irradiation upper layers air in the presence of people (in this case, the lower layers of air are disinfected due to convection).

1. The use of open lamps.

1.1. Open bactericidal lamps are used in the absence of people in the breaks between work, at night or at a specially allotted time - before starting work for 1 - 2 hours.

1.2. Switches for open lamps should be placed in front of the entrance to the production room and equipped with a signal inscription "Bactericidal lamps are on" or "Do not enter, the bactericidal irradiator is on." The presence of people in rooms in which unshielded lamps are used is prohibited.

1.3. Entry into the room is allowed only after the unshielded bactericidal lamp is turned off, and a long stay in the specified room is allowed only 15 minutes after the turn off.

1.4. The installed power of open lamps should not exceed (2 - 2.5) W of power consumed from the network per 1 cubic meter. m of premises.

2. Use of shielded lamps.

2.1. Air disinfection in the presence of people can be carried out by placing screened bactericidal lamps in special fittings at a height of at least 2 m from the floor. The armature should direct the beams of the lamp upwards at an angle ranging from 5 to 80 above the horizontal surface.

2.2. Screened germicidal lamps can work up to 8 hours a day. If, after 1.5 - 2 hours of continuous operation of the lamps, in the absence of sufficient ventilation, a characteristic smell of ozone is felt in the air, it is recommended to turn off the lamps for 30 - 60 minutes.

2.3. When using a tripod irradiation installation for special irradiation of any surfaces, it must be as close as possible to carry out irradiation for at least 15 minutes.

2.4. The installed power of shielded lamps should not exceed 1 W of power consumed from the network per 1 cubic meter. m of premises.

3. The optimal climatic parameters for the operation of bactericidal irradiators are - ambient temperature 18 - 25 -C and relative humidity not more than 65%.

4. The average life of a germicidal lamp is 1500 hours. It is necessary to take into account the duration of the operation of each irradiator in a special log, fixing the time the lamp is turned on and off. Do not use expired germicidal lamps.

5. Exterior finish bactericidal irradiators allows wet sanitization of external surfaces.

Appendix 8 to the Instructions on the sanitary regime of pharmacy organizations (pharmacies) Table 1 Means and modes of disinfection of various objects (thermal)

Object name	disinfectant agent	Thermal disinfection mode	Conditions for disinfection
temperature, -C	holding time
nominal value	limit deviation	nominal value	limit deviation
Glass, metal, heat-resistant polymer materials, rubber (spatulas, scissors, tweezers, tubes, brushes for washing hands, brushes)	Purified water or purified water with 2% sodium bicarbonate	98	+-1	30	+5	Boiling when products are completely immersed in water
		15		disinfection boiler
Products made of glass, metal, rubber, latex and heat-resistant polymers	Saturated water steam under pressure P=0.05 MPa (0.5 kgf/sq. cm)	110	+-2	20	+5	In a steam sterilizer, packed in sterilization boxes
Hand washing brushes		120		20
Products from glass, metal	dry hot air	120	+-4	45	+5	In an air sterilizer without packaging (in trays)
Rags, rags for cleaning	Water	98	+-1	30	+5	After washing, boil when fully immersed in water

Table 2 Means and modes of disinfection of various objects (chemical)

Object name	disinfectant agent	Disinfection mode	Processing method	Guidelines
concentration in %	Exposure in minutes
Rooms, furnishings, equipment (walls, doors, floor, hard furniture)	1) chloramine B	1	30-60	2-fold wiping or irrigation of the surface at the rate of 300 ml/sq.m.	№1359-75
2) chloramine B with 0.5% detergent	0,75
3) sodium hypochlorite	1	60	irrigation	№ 9429-71
4) sodium hypochlorite obtained in the electrochemical installation ELMA - 1	0,5		Wiping twice with an interval of 15 minutes 200 ml / sq.m.	No. 15-b/15 02/15/1989
5) hydrogen peroxide with 0.5% detergent	3	60	Orsheniya at the rate of 300 ml per sq.m. for furniture, followed by wiping with a dry, clean cloth	№858-70 29.08.1970
Foam rubber mats	1) chloramine B with 0.5% detergent	0,75	30	Immersion in solution
2) hydrogen peroxide with 0.5% detergent	3	30	Immersion in solution
Foam Rugs	hydrogen peroxide with 0.5% detergent	3	30	Immersion in solution
Cleaning equipment, rags	1) chloramine B	1	60	Immerse in solution, rinse and dry
2) dichlor -1	2	60
3) chlordesine	1	60
4) sodium hypochlorite	1	60	Immerse at the rate of 4-5 liters per 1 kg of dry weight of things	№942а-71
	0,25	60	Soaking, rinsing, followed by washing and drying	No. 15-b/15 15.02.89
	1	120	Soak
Staff hands	1) ethyl alcohol	70		After washing with soap, wipe with a gauze cloth moistened with a solution
2) solution of chlorhexidine bigluconate in 70% alcohol	0,5		The drug is applied to the palms in an amount of 5-8 ml and rubbed into the skin of the hands.
3) iodopyrone solution (iodonate, iodvidone)	1
4) chloramine B	0,5		Hands are immersed in the solution and washed for 2 minutes, then allowed to dry.
Shoes	1) chloramine B	1		2 times wipe
2) chloramine B with 0.5% detergent	0,75
3) hydrogen peroxide with 0.5% detergent	3
4) formaldehyde solution	40		In a bag with a cotton swab moistened with a solution of neutralized ammonia or alkali
5) acetic acid solution	40
Sanitary equipment (sinks, toilets)	1) detergent-disinfectants "Dichlor-1", cleaner-disinfectants: Dezus, Sanita, Shine-2	0.5 g per 100 sq. cm	5	Wipe with damp cloth
2) chloramine B	1		2 times wipe
3) chloramine B with 0.5% detergent	0,75		2 times wipe
4) sodium hypochlorite	1		2 times wipe
5) sodium hypochlorite obtained in the electrochemical installation ELMA - 1	0,25		2x wiping followed by exposure
6) hydrogen peroxide with 0.5% detergent	3,0	60	Irrigation followed by wiping with a rag soaked in a disinfectant solution

After disinfection by immersion, the products must be washed in running water until the smell of the disinfectant is completely removed. Disinfectant solution should be used once

Workshops- not provided

Independent work students: work with the order of the Ministry of Health of the Russian Federation of 21. 10.97 No. 309

“On approval of instructions on the sanitary regime of pharmacy organizations”, preparation of the workplace of a pharmacist; carrying out wet cleaning of industrial premises of the pharmacy; preparing a pharmacist for work

It is a mandatory procedure before performing any action with the patient. Used for processing various means and drugs that do not require a long investment of time and are approved by the Committee of Pharmacology of the Russian Federation.

What is disinfection for?

Hand hygiene is a disinfecting procedure that prevents, protecting not only the staff, but also the patients. The purpose of the treatment is to neutralize microbes that are on human skin after contact with an infected object or are part of the natural flora of the skin.

There are two types of procedures: hygienic and surgical hand treatment. The first is mandatory before contacting the patient, especially if he is to undergo surgery. Hygienic treatment of the hands of personnel must be carried out after contact with saliva, as well as blood. Disinfection must be carried out before sterile gloves are put on. You can wash your hands with special soap with an antiseptic effect or wipe the skin with an alcohol-based product.

When to Hygiene

Hygiene treatment of the hands of medical staff is mandatory in the following situations:

After the therapy of patients diagnosed with an inflammatory process with the release of pus.
After contact with devices and any other object located near the patient.
After each contact with contaminated surfaces.
After contact with the mucous membranes of a person, his excretions and
After contact with the skin of the patient.
Before performing patient care procedures.
Before each contact with the patient.

Proper hygiene treatment involves washing with soap and running water in order to get rid of dirt and reduce the number of microorganisms. In addition, hand treatment in a hygienic way- these are procedures for treating the skin with antiseptic agents that help reduce the number of bacteria to a minimum safe level.

What is used for processing

Soap in liquid form, which is dispensed using a dispensary, is ideal for washing the hands of medical staff. It is not recommended to use hot water due to an increased risk of dermatitis. Be sure to use a towel to turn off a faucet that is not equipped with an elbow drive. In order to dry clean hands, single-use paper towels (or individual fabric ones) should be used.

Hygienic treatment of hands, the algorithm of which includes several simple steps, can be carried out using a skin antiseptic. In this case, pre-washing with soap is not necessary. The product is rubbed into the skin of the hands in the amount indicated on the packaging of the antiseptic. Particular attention is paid to the fingers, the skin between them and the areas around the nails. A prerequisite for achieving the desired effect is keeping the hands moist for a certain time (usually it is indicated on the product). After hygienic processing of hands is carried out, it is not required to wipe them with a towel.

Equipment for hygiene procedures

In order for the hygiene procedure to be carried out in accordance with all the rules and requirements, the following is necessary:

Running water.
which has a neutral pH.
Washbasin with faucet operated without the touch of the palms (elbow method).
Alcohol-based antiseptic.
Disposable towels, both sterile and non-sterile.
Detergent with antimicrobial action.
Disposable rubber gloves (sterile or non-sterile).
Hand care product.
Household rubber gloves.
Urn for used accessories.

Mandatory requirements

In the room where antimicrobial hand treatment is planned, the washbasin should be located in an accessible place. It is equipped with a tap through which hot and cold water flows, a special mixer. The design of the faucet should be made in such a way that splashing of water is minimal. The hygienic level of hand treatment provides for the maximum reduction in the number of microorganisms on the skin, so it is advisable to install several dispensers with products next to the washbasin. In one - liquid soap, in the other - an antimicrobial drug, another must be filled with a hand care product.

It is not recommended to dry hands with electric type dryers, as they will still remain damp, and the device causes air turbulence, where contaminated particles may be. All containers with funds must be disposable. Hospitals should always have several hand sanitizers on hand, some of which are intended for workers with hypersensitivity skin.

Carrying out algorithm

Hand hygiene is mandatory for all healthcare workers. The algorithm for cleaning with soap is as follows:

Squeezing out the required amount of liquid soap from the dispenser.
Rubbing in palm-to-palm mode.
Rubbing one palm of the hand against the back of the other.
Wiping the inner surfaces of the fingers vertically.
Rubbing the back of the fingers of the hand folded into a fist, the palm of the second (do the same with the other hand).
Rubbing all fingers in circles.
Rubbing each palm with fingertips.

Surgical disinfection

Surgical hand disinfection is required to completely remove the flora from the hands: resistant, as well as transistorized. This is done so that the infection cannot be transmitted through the hands. Like hand hygiene, surgical disinfection is performed by washing and wiping. The use of solutions on alcohol is widespread due to the fast and directional action, optimal perception of the product by the skin, long period action, the effect of complete removal of microorganisms.

The process of surgical disinfection includes almost the same steps that involve the processing of hands at a hygienic level. Algorithm of surgical antisepsis:

Wash hands with soap and water for at least two minutes.
Dry your hands using a disposable tissue or towel.
Treat the hands, forearms, and wrists without wiping the hands afterwards.
Wait for the product to dry completely, put on sterile gloves.

The time of exposure to a particular antiseptic drug, its dosing and others important parameters can be read on the label of the product or in its instructions. The first hand treatment of each work shift should include the stage of cleaning the areas near each nail with a special soft brush - sterile and disposable (or one that has been sterilized by autoclaving).

Antiseptic treatment

Antiseptic solution is one of the main means of combating microorganisms, which includes hygienic treatment of hands. The algorithm is the following:

Washing hands in room temperature water with liquid soap, drying with a disposable towel.
Applying a disinfectant with rubbing movements, which disinfects the hands.
With interlaced fingers massage back sides hands.
With widely spaced, rub your palms.
Rub the product into the thumbs with clenched palms alternately.
Rubbing the forearms for a minimum of 2 minutes, a maximum of 3 minutes, processing nails and subungual area.

Each step needs to be repeated 4-5 times. Throughout the procedure, you need to ensure that your hands do not dry out. If necessary, apply another portion of the disinfectant.

Hand hygiene is a mandatory disinfection process for all medical personnel in contact with patients or various contaminated hospital facilities. For processing is used (alcohol solution) in ethyl alcohol (70%). In addition, the following drugs are used:

"Octenisept".
Ethyl alcohol with additives that effectively soften the skin.
"Octeniderm".
"Hemisept".
"Higenix".
"Isopropanol" - 60%.
"Octeniman".
"Decosept+".
"Veltocept".

Before hygienic treatment Be sure to remove all wrist accessories and jewelry. We must not forget about cleaning the hands with a sterile brush, paying special attention to the nail area. The procedure is carried out once at the beginning of the working day.

Requirements for hygiene products

If the containers for antiseptics and soaps are not disposable, then refilling should be done only after they have been thoroughly disinfected, rinsed with running water and completely dried. It is recommended to use dispensers that work on photocells or those from which the product is squeezed out in an elbow way.

All antiseptics used for skin treatment should be readily available at all stages of the treatment process. If the unit is focused on intensive patient care, then containers with antiseptics should be placed in places most convenient for medical personnel, for example, at the patient's bedside or near the entrance to the hospital ward. It is recommended to provide each worker with an individual container of a small volume with an antiseptic preparation.

Distinguish between hygienic and surgical disinfection. Hygienic hand disinfection aims to neutralize microbes that are on the skin after contact with an infected object or are part of the skin's natural flora.

Hygienic hand disinfection necessary in the following cases: before and after contact with a patient who is to undergo surgery, after contact with blood, saliva. Such disinfection is carried out before putting on sterile gloves. For this purpose, rubbing the skin with an alcohol-containing antiseptic or washing with antiseptic soap is used.

aim surgical hand disinfection is the removal of transient flora and resistant flora from the hands to prevent transmission of infection through the hands. Surgical disinfection is also carried out in two ways: wiping and washing. Alcohol solutions are the most convenient and effective, as they have a fast action, a wide range of effects on microorganisms, are well perceived by the skin, and have a duration of action.

Hand treatment with alcohol-based skin antiseptic
Rub the antiseptic for hygienic processing of hands! Wash your hands only if visible contamination is present! The movements of each stage are repeated five times, constantly making sure that the hands remain wet during the entire treatment. If necessary, use a new portion of the disinfectant solution. Currently, an alcohol solution of 0.5% chlorhexidine bigluconate in 70% ethanol is used for hand treatment.

Hand washing technique with soap and water
Wash your hands only if visible contamination is present! In all other cases, rub the antiseptic! Hands are washed in warm running water (hands and forearms) with soap for 2 minutes, then wiped with a sterile gauze or towel.

The presence of rings and watches is unacceptable, sterile brushes are used only for nails and are used only once at the beginning of the working day.

Putting on and removing sterile gloves is also carried out in a certain sequence:

Treatment operating field or injection site. To treat the skin or mucous membrane of the surgical field, iodonate, iodopyrone, chlorhexidine bigluconate are used. It is forbidden to use tincture of iodine, as it causes a burn.

Mask use

Wash hands before and after putting on and taking off the mask

When putting on the mask, avoid touching the front of the mask.

Change every 2 hours and when dirty or wet

A new mask is used for each invasive procedure

It is forbidden to reuse the mask after removal

After removal, the mask should not remain hanging around the neck.

Goggles and face shield, apron, gown

The robe and cap must be clean and ironed.

Collection of class A and B waste

Class A - non-hazardous waste of healthcare facilities (not having contact with the biological fluids of patients, infectious patients, non-toxic waste - food waste from all departments, except for infectious ones, non-infected paper, construction waste). Places of education: chambers of departments of health care facilities; administrative and utility rooms of health care facilities; central catering units, canteens of departments; out-of-building territory of medical facility

Collection class A waste carried out in reusable containers or disposable bags. The color of the packages can be any, except for yellow and red. Disposable bags are placed on special trolleys or inside reusable containers. Waste collection containers and trolleys must be marked "Waste. Class A". Filled reusable containers or disposable bags are delivered using small-scale mechanization and reloaded into labeled containers designed to collect waste of this class, installed on a special site (room). The reusable container after emptying is subject to washing and disinfection.

For organizations that have the issue of household Wastewater into the city sewerage system, the preferred system for the disposal of food raw materials and prepared food waste from catering units and canteens is the discharge of food waste into the city sewerage system by equipping internal sewerage food waste grinders (disposers).

Temporary storage of food waste in the absence of a specially allocated refrigeration equipment allowed no more than 24 hours.

Class A bulky waste is collected in special bulky waste bins. Surfaces and aggregates of bulky waste that have had contact with infected material or patients are subject to mandatory disinfection before they are placed in a storage bin.

Class B - hazardous waste (risk) (potentially infected waste materials and tools contaminated with biological fluids, patient excretions, pathological waste, organic operational waste, waste from infectious diseases departments, microbiological laboratories working with pathogenicity classes 3-4, vivarium biological waste) . Places of education: operating rooms; resuscitation; procedural; dressings; infectious; dermatovenerological departments of medical and prophylactic institutions; honey. and pathological laboratories.

Class B waste are collected in disposable soft (bags) or hard (non-puncture) packaging (containers) of yellow color or with yellow marking.

Soft packaging (single-use bags) must be fixed on special carts or containers.

After filling the bag no more than 3/4, the employee responsible for the collection of waste in this medical unit ties the bag or closes it using tie tags or other devices that prevent Class B waste from spilling out. Solid (non-piercing) containers are closed with lids. Displacement of class B waste outside the unit in open containers is not allowed.

During the final packaging of class B waste to remove it from the subdivision (organization), disposable containers (bags, tanks) with class B waste are marked with the inscription "Waste. Class B" with the name of the organization, subdivision, date and surname of the person responsible for waste collection.

Class B medical waste from departments in closed disposable containers (bags) is placed in containers and then transferred to a waste management site or a temporary storage room for medical waste until it is transported by specialized organizations to the place of decontamination / neutralization. Access of unauthorized persons to the temporary storage of medical waste is prohibited.

Class B pathological and organic operational waste (organs, tissues) are subject to cremation (burning) or burial in cemeteries in special graves in a specially designated area of cemeteries. Disinfection of such waste is not required.

Similar information.

Hand processing. Processing of hands is carried out in specially designated places. It is forbidden to wash your hands over a sink designed for washing pharmacy dishes.

First, for mechanical removal of contaminants and microflora, hands are washed in warm running water with soap for 1-2 minutes. Then the hands are rinsed with water to remove soap, after which they are treated with disinfectants.

In the gateway of the aseptic block, the hands are wiped dry after rinsing, put on sterile clothes, then the hands are washed with water and treated with disinfectants. The treatment is repeated if the work lasts more than 4 hours.

To disinfect the skin of the hands, gauze wipes soaked in 70% ethyl alcohol or another alcohol-containing preparation (AKhD-2000, octoniderm, octonisept), iodopyrone solution and other means permitted by the Ministry of Health of the Russian Federation for these purposes are used.

After finishing work, the hands are washed with warm water and treated with emollients, for example, a mixture of equal parts of glycerin, alcohol, 10% ammonia solution and water, which is thoroughly shaken before use.

The trained personnel of the aseptic unit should have a special set of sanitary clothing: a dressing gown or trouser suit or overalls, safety shoes and shoe covers, a hat or a helmet with a mask, rubber gloves. This set of clothes is sterilized in biks in steam sterilizers at 120 0 C for 45 minutes and stored in closed biks for no more than 3 days.

Staff shoes are disinfected before and after work and stored in closed cabinets or in boxes in the airlock. Disinfection is carried out by 2-fold wiping the outside with a 1% solution of chloramine or 0.75% with the addition of 0.5% detergent or 3% with 0.5% detergent. In addition, disinfection of shoes can be carried out in a bag of cotton wool moistened with a 40% formaldehyde solution.

The work of personnel in the aseptic unit takes place in a certain algorithm, set out in the Instructions for the Sanitary Regime of Pharmacy Organizations (No. 309 of 10/21/97).

For production personnel, in accordance with the specified instructions, personal hygiene rules, entry and exit rules, cleaning regulations, rules for transporting products and materials in accordance with the course of the technological process, etc., should be developed and strengthened in the right places, taking into account the characteristics of this pharmacy enterprise. The rules and measures of personal hygiene, including the requirements for the use of sanitary clothing, should be applied to everyone entering the production premises - temporarily and permanently working, not working. >

For staff in pharmacies, the following composition of sanitary facilities should be provided:

Dressing rooms with individual wardrobes for separate storage of outer, home and sanitary clothing for the entire payroll of employees. The area of cloakrooms for home and sanitary clothes should be taken at the rate of 0.55 m 2 per double wardrobe and the addition of the required area for passages;

Wardrobe of outerwear and shoes, 0.08 m 2 per hook in the dressing room (60% of workers in two-shift work and 100% in single-shift work);

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1. Pharmacy department or type of work activity

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The first day of my training practice, I got acquainted with the organization of the work of pharmacies for drug services to the population and health care facilities. Pharmacy organizations include pharmacies, drugstores, pharmacy stores, pharmacy kiosks.

Pharmacies are classified:

Pharmacies serving the population; they may specialize in the sale of drugs of a certain range (children's pharmacies, homeopathic pharmacies, green pharmacies) or have a profile of activity (gynecology, oncology, endocrinology, psychiatry, etc.)

Pharmacies of medical institutions (hospital pharmacies); interhospital pharmacies - supply several health facilities and other organizations.

The nature production activities pharmacies are divided into:

For production, manufacturing drugs according to the prescriptions of doctors and the requirements of health facilities and selling finished drugs;

Ready-made forms that sell ready-made drugs to the population and healthcare facilities.

Industrial pharmacy at the railway hospital. Serves:

Hospital for 180 beds

Polyclinic for 300 visitors per day

Honey. points (railway stations "B", "R", "G")

Type of pharmaceutical activity:

Sale of medicines and medical products;

Production of dosage forms according to prescriptions;

Quality control of dosage forms;

Obtaining distilled water;

Unpacking the goods.

1.Administrative and managerial personnel:

Head

2.Pharmaceutical staff:

2 pharmacists - technologists

1 pharmacist - analyst

2.5 pharmacists

1.5 packers

3. Support staff:

2 nurses - washers

Pharmacy staff can be divided into 3 groups:

management employees,

specialists,

Production staff (pharmaceutical and support)

The management personnel include: director of the pharmacy (pharmacist), deputy director (pharmacist);

For specialists - chief accountant, accountant, accountant, economist, senior cashier, cashier.

A pharmacy should be headed by a specialist with a higher pharmaceutical education who has a specialist certificate and work experience of at least 3 years.

The pharmaceutical staff is divided into pharmacists and pharmacists. Persons with higher and secondary pharmaceutical education can carry out pharmaceutical activities in pharmacy organizations if they have a specialist certificate. Pharmacist staff: pharmacist-technologist, pharmacist-analyst, senior pharmacist, pharmacist-intern, pharmacist-trainee. Middle pharmaceutical staff: senior pharmacist, junior pharmacist, pharmacist, kiosk salesman, optics salesman, packer.

Auxiliary personnel include nurses, drivers, workers, etc.

Arrangement and equipment of working and auxiliary premises, their purpose.

The composition of the premises includes: the manager's office, a locker room, a bathroom, a washing room, an assistant's, an aseptic assistant's, a cubicle, an autoclave, a pharmacist-analyst's office, an expedition room, and a stock department (unpacking and storerooms).

Room for the preparation of medicines

The assistant's room is the main production area of the pharmacy. It must be equipped with:

Special pharmacy furniture;

appliances;

equipment for the preparation, mixing, filtering, packaging, labeling, packaging and capping of medicines;

safes (special cabinets) for storing poisonous, potent, narcotic drugs and ethyl alcohol;

barbells;

means of measuring weight, volume and specific gravity;

* reagents for chemical control of drugs. In the premises for the preparation of medicines, workplaces for the preparation and quality control of medicines should be organized. A production pharmacy to perform its main task may have additional premises:

aseptic block for the preparation of aseptic and sterile dosage forms;

autoclave;

office of a pharmacist-analyst;

room for obtaining pyrogen-free water.

Assistant:

Production of dosage forms for internal

use;

Production of dosage forms for external use;

Packing of medicines for internal use;

Packing of medicines for external use;

Pharmacist-technologist;

Enlarged production of dosage forms for healthcare facilities;

Packaging of medicines for healthcare facilities.

Analytical:

Quality control of manufactured medicines.

Harvesting concentrates and semi-finished products:

Production of concentrates and semi-finished products.

Washing-sterilizing:

Prescription tableware processing;

Processing of glassware for sterile dosage forms;

Sterilization of dishes;

Preparation of closures and auxiliary material

Distillation:

Obtaining distilled water (purified).

Disinfection:

Processing of returnable tableware from hospitals.

Unpacking:

Unpacking the goods.

Prescription forwarding:

Acceptance of requirements (prescriptions) from health facilities;

Completing and issuing orders to hospitals.

Assistant-aseptic:

Manufacture of sterile medicines;

Packaging of manufactured medicines.

Sterilization:

Sterilization of dosage forms;

Sterilization of dosage forms for healthcare facilities.

Control and marking:

Registration of manufactured dosage forms for healthcare facilities.

Requirements for premises and equipment. The premises of pharmacy organizations should be used strictly for their intended purpose. As finishing materials for walls and ceilings of premises of pharmacy organizations, waterproof paints, enamels or smooth glazed tiles of light colors are used, approved by the authorities and institutions of the State Sanitary and Epidemiological Supervision for use in medical organizations, resistant to disinfectants, ultraviolet radiation. In industrial premises (assistant, washing, sterilization, distillation, packaging) - smooth glazed tiles of light colors are used for walls, laid out to the height and width of the entire wall, waterproof paints are used for ceilings.

* The floors are covered with ceramic unglazed (terracotta) tiles, linoleum or release with mandatory welding of seams. Floors in pantries of flammable explosive, combustible, volatile liquids must be made of a material with antistatic properties. The arrangement of equipment and pharmacy furniture should be convenient for cleaning the premises and not block the light source. The surface of pharmacy equipment, both outside and inside, must be smooth, made of materials that are resistant to drugs and chemicals. It is forbidden to place in the production premises equipment that is not related to the work performed.

*Windows located on sunny side, must be provided with sun protection devices (blinds, awnings), which are located on the outside of the windows or between the frames.

* Window transoms or vents used for ventilation of rooms are protected from flying insects in the warm season by removable metal or plastic meshes with mesh sizes not exceeding 2x2 millimeters.

* It is not allowed to hang curtains, spread carpets, plant flowers,

Post posters, with the exception of corridors, rest rooms for personnel of pharmacy organizations and offices.

*Decorative design of non-industrial premises, including landscaping, is allowed provided that they are provided with necessary care(dust cleaning, washing) as needed, but at least once a week.

* Workplaces of personnel in the visitor service hall must be equipped with devices that protect workers from airborne infection.

* For washing the hands of personnel in the locks of the aseptic unit, assistant, washing, toilet, sinks should be installed, which should be equipped with pedal taps with elbow or foot drives. Tanks with a disinfectant solution and electric air dryers are installed next to the washbasin. It is prohibited to use sinks in industrial premises for persons who are not engaged in the manufacture and packaging of medicines.

In the washing room, washing bathtubs or sinks for washing pharmacy utensils intended for the manufacture of: injection solutions and eye drops, internal dosage forms, external dosage forms should be allocated and marked. Dishes (cylinders, measuring cylinders, funnels, mortars and other pharmaceutical utensils) used in the manufacture of these dosage forms are washed in the same baths or sinks. Separate sinks should be equipped for washing hands.

* Before entering the aseptic unit and assistant rooms, as well as in the toilet vestibule, there must be foam rubber mats moistened with a disinfectant solution on the floor.

* Before entering the pharmacy organization, devices for cleaning shoes from dirt must be equipped. Cleaning of the fixtures themselves should be carried out as needed, but at least once a day.

* Production waste and garbage must be placed in special containers with the appropriate marking. Containers must be taken out to specially designated places in non-buildings and their contents regularly removed.

I got acquainted with the requirements for personal and professional hygiene of pharmacy employees.

Pharmacy workers involved in the manufacture, control, packaging of medicines and the processing of pharmacy utensils, as well as those in contact with finished products, undergo a medical examination upon admission to work, and in the future - a preventive examination in accordance with the current orders of the Ministry of Health

RF. The results of the examinations are recorded in the sanitary book.

Each employee must notify the management staff of any deviations in the state of health. Employees with infectious diseases, damage to the skin are not allowed to work. Identified patients are sent for treatment and sanitation.

Admission to work is carried out only if there is a certificate from the medical professional institution on recovery.

At the entrance to the pharmacy, the staff must take off their outerwear and shoes in the dressing room, wash and disinfect their hands, put on sanitary clothes and sanitary shoes. Be sure to take off your bathrobe before going to the toilet.

It is FORBIDDEN to go outside the pharmacy in sanitary clothes and shoes. During periods of the spread of acute respiratory diseases, pharmacy staff should wear gauze bandages on their faces.

Sanitary clothes and sanitary shoes are issued to pharmacy employees in accordance with applicable standards, taking into account the production operations performed. Sanitary clothing should be changed at least 2 times a week, towels for personal use - daily. A set of special clothing for personnel working in aseptic conditions must be sterile before starting work. It is advisable to provide distinctive signs in the sanitary clothing of personnel, for example, overalls or its parts of a different color than white, in order to more easily recognize violations of the order of movement of personnel in the aseptic area, between rooms or outside the aseptic unit, in other production areas. Production personnel are prohibited from eating, smoking, and storing food, smoking materials and personal medicines in the production areas of pharmacies and in the storage areas for finished products. Gown pockets should not contain personal items, except for a handkerchief.

For production personnel, on the basis of existing documents, personal hygiene rules, entry and exit rules, cleaning regulations, rules for transporting products and materials in accordance with the course of the technological process, etc., should be developed and strengthened in the right places, taking into account the characteristics of this pharmacy enterprise. The rules and measures of personal hygiene, including the requirements for the use of sanitary clothing, should be applied to everyone entering the production premises - temporarily and permanently working, not working (guests, inspection, top management, etc.).

In pharmacies, the necessary composition of sanitary facilities for staff should be provided:

Wardrobe outerwear and shoes 0.08 sq. m per hook in the dressing room (for 60% of workers in 2-shift work and 100% in single-shift work);

Showers - one shower per pharmacy;

Bathrooms (number of sanitary appliances, based on the number of employees);

Rooms for eating and resting (should be isolated from other rooms).

Personal hygiene of pharmacy workers. Compliance with the rules of personal hygiene is mandatory and should be the norm of behavior for every person. The personal hygiene of pharmacy workers is especially important, since if the sanitary rules of behavior are violated, the transmission of an intra-pharmacy infection and the contamination of drugs are possible. In addition, the appearance of pharmacy workers, their neatness, cleanliness of clothes, hands, hairstyle, hygiene skills play an important sanitary and educational role. A pharmacy worker is a personal example of a culture of behavior for visitors with whom he constantly communicates. Each pharmacy worker at work must constantly wear a dressing gown and a hat (hat). To do this, he has at his disposal three dressing gowns and three hats, which he must change at least 2 times a week. Arriving at work, you should put on a bathrobe, wash your hands thoroughly with soap and treat with a disinfectant solution, and completely remove your hair under a headdress.

Store personal and work clothing separately. Pharmacy workers must have a change of shoes. During the working day, you need to monitor the cleanliness of hands, overalls, your workplace, change your hand towel daily. Before visiting the toilet, the pharmacy worker must remove the gown, and after the visit, thoroughly wash their hands with soap and treat them with a disinfectant solution. All this is done in front of the lavatory, where there should be a sink with cold and hot water, a container with a disinfectant solution, an electric air dryer, hangers for towels and for a bathrobe. It is forbidden to go outside the production premises in dressing gowns, and even more so outside the pharmacy, enter the production premises without a bathrobe, carry personal items in its rooms, with the exception of a clean handkerchief, store personal and industrial clothes in the same closet.

Skin care and keeping it clean is one of the basic requirements of personal hygiene. Particular attention should be paid to the condition "under the nail spaces. Workers who manufacture medicines under aseptic conditions must especially strictly observe the rules of personal hygiene. The manufacture of sterile medicines must be carried out under conditions of careful observance of personal hygiene rules.

2. Ptraining of personnel for work in the aseptic unit. Behavior rules

The kit must be made from hygienic materials or blended fabrics with minimal lint.

3. Staff shoes are disinfected before and after work and stored in closed cabinets or in boxes in the airlock.

Disinfection is carried out by 2-fold wiping the outside with a solution of chloramine 1% or 0.75% with the addition of 0.5% detergent. In addition, shoes are disinfected in a bag of cotton wool moistened with a solution of 40% formaldehyde or 40% acetic acid, neutralized with ammonia or alkali.

7. For notes, use pre-cut sheets of parchment and ballpoint pens or felt-tip pens, which should be wiped with a lint-free cloth moistened with ethyl alcohol.

8. When working under aseptic conditions, IT IS FORBIDDEN:

Enter the aseptic room in non-sterile clothing and exit the aseptic unit in sterile clothing;

Have voluminous fleecy clothing under sterile sanitary clothing or in which the employee is on the street;

Use cosmetics and aerosol deodorants;

Wear watches and jewelry;

Bring in personal items (keys, combs, handkerchiefs, etc.);

Clear your nose. To do this, go to the gateway, use a sterile handkerchief or napkin; then wash and disinfect hands;

Pick up and reuse items dropped on the floor during work;

Rubbing your hands or face, scratching your head, bending over bottles or other containers with medicines;

Use pencils, erasers, fountain pens.

3. Ostaff handwork

1. Processing of hands is carried out in specially designed places. It is forbidden to wash your hands over the sink for washing pharmacy dishes.

Helped specialists and junior pharmaceutical workers to carry out general cleaning in the pharmacy. General cleaning of production premises should be carried out at least once a week. Wash walls, doors, equipment, floors.

Industrial premises of pharmacies, production equipment and industrial furniture should be subjected to wet cleaning using detergents and disinfectants. Dry cleaning is strictly prohibited.

Floors are washed at least once per shift, and walls and doors are washed at least once a week using disinfectants: 2% anolyte neutral (with active chlorine concentration) with an exposure of 60 minutes. Ceilings are cleaned once a month with a damp cloth.

Window panes, frames and spaces between them are washed with hot water and soap or detergents at least once a month. At the same time, outside windows are washed only in the warm season.

The equipment of production premises and trading floors is subject to daily cleaning, cabinets for storing medicines (material rooms) are cleaned as needed, but at least once a week.

* Handwashing sinks and sanitary facilities are cleaned and disinfected daily.

If necessary, cleaning of premises and equipment is carried out more often.

For cleaning various premises(premises for the manufacture of dosage forms in aseptic conditions; other production facilities; shopping room; sanitary units) cleaning material (foam rubber sponges, napkins, rags) and cleaning equipment (buckets, basins, brushes, mops) are allocated, which must be marked, used strictly for their intended purpose and stored separately, in a specially designated place (room, closet).

*Cleaning material intended for cleaning production equipment, after disinfection and drying, is stored in a clean, labeled, tightly closed container (jar, saucepan).

*Cleaning and disinfection of industrial premises should be carried out in clothes specially designed for this purpose, and if necessary, in a respirator.

* It is necessary to rotate disinfectants every five to six days to prevent the emergence of resistant forms of microorganisms. To prevent the growth of microorganisms, working disinfectant solutions should be stored for a limited time in clean, tightly closed containers. Partially empty storage containers for these solutions must not be refilled with freshly prepared solutions.

Sanitary day in pharmacy organizations is held once a month. On sanitary days, in addition to cleaning, minor repairs can be carried out.

For air disinfection in the aseptic unit, assistant for intra-pharmaceutical preparation, distillation, sterilization, unshielded bactericidal lamps are installed at the rate of 2-2.5 W per 1 m 3 of room volume, which are turned on in the absence of people in between work breaks, at night or at specially allotted time - before the start of work for one - two hours. The switch for open lamps must be located in front of the entrance to the room and interlocked with the light board "Do not enter, the bactericidal irradiator is on" or "Do not enter, the bactericidal lamps are on."

Do not work indoors with an unshielded bactericidal lamp on.

Before entering the room, you must first turn off the unshielded germicidal lamp and ventilate for fifteen minutes.

I studied the device, the principle of operation of the distiller.

Receipt and storage of purified water.

It is a colorless, transparent, odorless and tasteless liquid with a pH of 5.0-7.0.

Purified water should be provided to all premises for the manufacture of dosage forms and washing. The distillation room should be directly adjacent to the assistant-aseptic room or close to them.

Purified water and water for injection should be obtained under aseptic conditions.

The management of the pharmacy appoints a person responsible for obtaining purified water and water for injection.

Water purified according to physical and chemical parameters must meet the requirements state standards that regulate the quality of medicines. Particular attention in the manufacture of dosage forms requiring aseptic conditions is paid to the microbial purity of purified water, which must comply with the requirements of the current regulatory documentation.

For the manufacture of solutions for injections and infusions, water for injections is used that meets the requirements of state standards, which must withstand tests for purified water and must be pyrogen-free. The receipt and storage of purified water and water for injection is carried out in a room specially equipped for these purposes. It is forbidden to perform work in this room that is not related to the distillation of water.

Obtaining purified water and water for injection is carried out using water distillers, according to the instructions attached to them. Before using a new device, if the design allows, its inner surface is wiped with cotton wool moistened with a mixture of ethyl alcohol and ether (1: 1), and then with a 6% hydrogen peroxide solution. After that, steam is passed through the apparatus for 20-30 minutes without cooling it, the first portions of distilled purified water (40-60 liters) are not used, they are drained.

Every day, before starting the distillation, it is necessary to pass steam through the water distiller for 10-15 minutes, not including the refrigerator. The first portions of water, obtained within 15-20 minutes, are drained and only after that the collection of water begins.

The resulting purified water and water for injection are collected in clean, sterilized or steamed collections. industrial production or, as an exception, in glass cylinders.

Collections should have a clear inscription: “Purified water”, “Water for injection”. If several collections are used at the same time, they are numbered. Glass collections should be tightly closed with stoppers (lids) with two holes: one for the tube through which water enters, the other for the glass tube into which a sterile cotton swab is inserted (changed daily).

Collectors are installed on pallets or in balloon dumpers. The collectors are connected to the water distiller using glass tubes, silicone rubber hoses or other water-indifferent material approved for use in medicine and withstanding steam treatment, which must be in close contact with the cooler tube.

Water is supplied to workplaces through pipelines or in cylinders. Pipelines for supplying purified water and water for injection to workplaces are made of materials approved by the authorities and institutions of the State Sanitary and Epidemiological Supervision.

For ease of operation and disinfection of glass and steel pipelines, it is advisable to use tubes with an inner diameter of at least 16-20 millimeters. With a significant length of the pipeline for the convenience of washing, sterilizing and sampling the distillate for microbiological analysis, tees with an external outlet and a tap should be provided every 5-7 meters. Washing and disinfection of the pipeline is carried out before assembly, during operation at least once every 14 days, as well as in case of unsatisfactory results of laboratory bacteriological tests. To disinfect glass and metal pipelines, live steam from the autoclave is passed through them, the sterilization time is counted from the moment the steam exits at the end of the pipeline. Steam treatment is carried out for 30 minutes.

Pipelines made of polymeric materials and glass are disinfected with a 6% hydrogen peroxide solution for 6 hours, followed by rinsing with purified water. Then they check for the absence of reducing substances. The processing of the pipeline is recorded in a special journal. To clean it from pyrogenic substances, glass tubes and vessels are treated with a hot acidified 1% solution of potassium permanganate for 25-30 minutes

To prepare a solution, six parts of a 1.5% solution of sulfuric acid are added to ten parts of a 1% solution of potassium permanganate. After this treatment, the vessels and tubes are thoroughly washed with freshly distilled water for injection until a negative reaction to the sulfate ion.

The distillate supply is regulated in such a way that air does not enter the pipeline and air locks do not form. After completion of work, the water from the pipeline is drained. Purified water is used freshly prepared or stored in closed containers made of materials that do not change the properties of water and protect it from mechanical impurities and microbiological contamination, but not more than three days.

Assisted in the preparation of pharmacy utensils for work in the sterile unit, assistants for the manufacture of external and internal dosage forms.

Cleaning of the aseptic unit using disinfectants is carried out at least 1 time per shift.

The aseptic block is separated from the rest of the pharmacy by gateways.

Medicinal products must be stored in sterile bixes and stem-glasses in conditions that exclude their contamination. Shank glasses are washed and sterilized before each filling.

4 . Treatmentpharmacycrockery

Glassware processing includes the following technological operations:

disinfection;

soaking and washing (or washing-disinfecting treatment);

rinsing;

drying (or sterilization);

processing quality control.

1. Disinfection of used dishes. Used pharmacy utensils

received from the departments must be subjected to disinfection. For disinfection, use a 1% solution of activated chloramine with immersion of dishes for 30 minutes or a 3% solution of hydrogen peroxide with immersion for 80 minutes.

Disinfectant solutions are prepared in containers (tanks) made of glass, plastic or enameled (enamel without damage) in the quantities necessary for complete immersion of the processed dishes. Solutions of activated chloramine are prepared by dissolving chloramine in tap water(100 g per 10 l of working solution) followed by the addition of an equal amount of activator (ammonium chloride or sulphate or nitric acid). To prepare 10 liters of a 3% hydrogen peroxide solution, take 1200 ml of perhydrol, adding it to the appropriate amount of water.

Storage of prepared disinfectant solutions should not exceed 24 hours. Reuse of the same solution is not allowed.

Dishes in a perforated container are lowered into a tank with a disinfectant solution and left for a certain time (30 or 80 minutes).

After disinfection, the dishes are washed with running tap water until the smell of disinfectants disappears. means and subjected to washing with solutions of detergents.

2. Washing pharmacy dishes

Pharmaceutical utensils (new and used after disinfection) are soaked in a solution of the available detergent of the appropriate concentration:

The detergent is dissolved in water heated to 50-60 s. The dishes are soaked in the solution for 25-30 minutes when fully immersed. Heavily soiled dishes are soaked for a longer time. In the same solution, the dishes are washed with a ruff. When washing dishes with mustard, roughening is done with hot water. When using synthetic detergents, washing and rinsing with a washing machine is possible

3. Washing and disinfecting treatment of dishes It is most rational to treat returnable dishes with solutions of detergents and disinfectants. For this purpose, for heavily soiled dishes, it is advisable to use a 1% solution of cyanogen chloride or 0.2% DP-2 with immersion for 120 minutes. For the rest of the dishes, a 0.5% solution of cyanogen chloride, a 0.1% solution of DP-2 or a 3% solution of hydrogen peroxide with the addition of 0.5% detergent is used.

For the preparation of working solutions, closed containers made of glass, plastic or enameled (enamel without damage) are used. For 10 liters of working solution, you need 50.0 cyanogen chloride or 10.0 DP-2 or 1.2 liters of perhydrol with the addition of 50.0 detergent. The dishes are completely immersed in warm solution(40-50 C), kept in it for 15 minutes, then washed in the same solution with a brush. Then rinse with running tap water (hot) until complete disappearance odor des. means, but not less than 5-7 times. The final washing of dishes is carried out with purified water.

4. Rinsing pharmacy dishes

Glassware is rinsed with tap and purified (distilled) water. Pharmaceutical dishes are rinsed with tap water 7 times, then purified - 1 time. When treating dishes with mustard with tap water, it is enough to rinse 5 times.

Glassware intended for the manufacture of sterile solutions is rinsed with tap water 5 times, purified - 3 times.

Optimally, the last rinse is carried out with water for injection filtered through a 5 µm filter.

5. Drying and sterilization of dishes

Clean dishes are dried and stored in closed cabinets. Vials intended for injection solutions and eye drops are sterilized.

Sterilization mode: hot air - at 180 C - 60 minutes or saturated steam under pressure at 120 C - 45 minutes. After lowering the temperature in the sterilizer to 60-70 C, the dishes are removed, closed with sterile stoppers and used to pour solutions.

5 . Oprocessing of rubber stoppers

1. New rubber stoppers are washed by hand or in a washing machine in a hot (50-60 degrees C) 0.5% detergent solution for 3 minutes (weight ratio of stoppers and detergent solution is 1:5); washed 5 times with hot tap water, each time replacing it with fresh, and 1 time with purified water; boiled in 1% sodium bicarbonate solution for 30 minutes, washed 1 time with tap water and 2 times with purified water. Then they are placed in glass or enamel containers, filled with purified water, closed and kept in a steam sterilizer at 120 ° C for 60 minutes. After that, the water is drained and the plugs are washed again with purified water.

2. After processing, the corks are sterilized in bixes in the right sterilizer at 120°C for 45 minutes. Sterile stoppers, without being subjected to sterilization, are dried in an air sterilizer at a temperature not exceeding 50 ° C for 2 hours and stored for no more than 1 year in closed bottles or jars in a cool place. Before use, rubber stoppers are sterilized in a steam sterilizer at 120°C for 45 minutes.

3. Used rubber stoppers are washed with purified water, boiled in purified water 2 times for 20 minutes, each time replacing the water with fresh water, and sterilized.

4. Rubber stoppers that were in use in the infectious disease department are not disinfected and are not reused.

6 . Oprocessing of aluminum caps

Aluminum caps intended for capping injection solutions and eye drops are kept for 15 minutes in a 1-2% solution of detergents, heated to 70-80 degrees. C, then the solution is drained, and the caps are washed with running tap water. Clean caps are dried in air sterilizers (in biks) at a temperature of 50-60 ° C and stored in closed containers (biks, jars, boxes) under conditions that exclude their contamination.

7 . Pprocessing of polyethylene caps

New polyethylene plugs are washed several times with hot (50-60 degrees C) tap water, rinsed with purified water and sterilized by immersion in a fresh 6% hydrogen peroxide solution for 6 hours, after which they are washed with purified water and dried in drying cabinet at 50-60 degrees. C. Dried corks are stored in sterile jars with ground corks, bixes for 3 days under conditions that exclude their contamination. In case of contamination of the corks during storage, they are pre-washed using detergents.

8 . PProcedure for processing plastic screw caps

New plastic plugs are washed several times with hot (50-60 degrees C) purified water and dried in an oven at a temperature of 50-60 degrees. WITH.

Dried corks are stored in closed boxes, boxes in conditions that exclude their contamination.

I got acquainted with the organization of the work of the stock department: the principles of storage of medicines, taking into account toxicological and pharmacological groups, depending on the physical - chemical properties, method of application, nature of various dosage forms. Participated in the receipt of goods, laid them out in storage places.

The stock department determines the current need of the pharmacy for the necessary medicines and medical products. Timely submission of orders-requirements to pharmacy warehouses and other supply bases, acceptance of incoming medicines in terms of quantity and quality, ensuring them proper storage depending on toxicity, physico- chemical properties and other features, as well as the distribution of medicines and medical products to other departments of the pharmacy. An important part of the work of the stock department is the correct determination of the need for medicines and medical products, the preparation and timely submission of orders to the pharmacy warehouse. To do this, pre-printed standard orders-requirements for each department of the warehouse are used, which contain the entire nomenclature of medicines, units of measure, item number and the corresponding wholesale and retail prices. Orders for poisonous, narcotic drugs and ethyl alcohol are issued on separate forms in Latin.

The stock department includes the following premises: unpacking, material, pantries (for storing alcohol, dressings, finished medicines, auxiliary materials), a room for storing narcotic and potent drugs.

The room for storing narcotic and potent drugs is equipped with: a metal door that has 2 mortise locks and 1 padlock, 3-way alarm, a grill with a padlock, 3 safes (attached to the wall), a refrigerator. Alarm button.

Poisonous medicinal products belonging to list A, regardless of the dosage form (with the exception of especially toxic ones), are stored in isolation, in specially allocated for this purpose. metal cabinets under lock and key. Narcotic medicines are stored only in safes. On the inside the doors of the safe and the cabinet in which medicines of list A are stored, the inscription “Venena” is made, and on the inside of the doors of the cabinet in which medicines of list B are stored, the inscription “Heroica” and the list of poisonous, potent medicines indicating the highest single and daily doses. The inscriptions on the stem-glasses in which poisonous drugs are stored are written in Latin in white letters on a black background, and on the stem-glasses containing potent drugs, in red letters on a white background; in both cases, the highest single and daily doses are indicated on the barbells.

The main principle of storing medicines is to place them in strict accordance with toxicological groups: list A (poisonous and narcotic substances), list B (strong substances) and the general list.

Depending on the method of application (internal, external); medicinal substances in accordance with the state of aggregation (liquid separately from loose, powdered); in accordance with physical and chemical properties and the influence of various environmental factors; taking into account the nature of the various dosage forms.

It is not recommended to have nearby medicines that are consonant with the intended purpose, HP. for internal use list B, with very different higher doses, and also arrange them in alphabetical order. Particular attention should be paid to the storage of HP, requiring protection from exposure to elevated temperatures. Narcotic drugs must be kept in safes. It is allowed to store poisonous medicines in a separate metal or wooden cabinet under lock and key. On the inside of the doors of the safe where narcotic substances are stored, there must be an inscription "A" and a list of narcotic substances indicating the highest single and daily doses.

Dosage forms for parenteral use, internal use and for external use should be stored in separate cabinets or on separate shelves.

Depending on the physical and chemical properties of drugs, the impact of factors on them external environment they are divided into drugs that require protection from moisture, drying light, high and low temperatures, coloring and odorous, disinfectants.

Preparations such as burnt gypsum and mustard powder require special storage, since at high humidity they lose their properties and may be unsuitable for use. Burnt gypsum is stored in a tightly closed container.

Immunobiological preparations are stored separately by name, series, and expiration date.

The storage of antibiotics is usually carried out at room temperature in industrial packaging, unless otherwise indicated in the instructions.

Coloring and odorous drugs and parapharmaceutical products (such as brilliant green, indigo carmine, methylene blue) are stored in special cabinet in tightly packed containers separately by name. To work with substances of each name, they allocate separate scales, spatula, mortar and other inventory.

*Ready-to-use products are packaged with the label facing out.

A rack card is attached to cabinets and shelves, which reflects the names of the medicine, series and expiration date. Such a card is entered for each newly received series, which allows you to control its timely implementation.

* Tablets and dragees must be stored separately from other products in their original packaging in a dry and, if necessary, protected from light place.

*Liquid dosage forms are stored in a sealed container filled to the top, in a dark and cool place.

* Disinfectants are stored in a cool, dark place, in a hermetically sealed container, away from the storage of plastic, metal and rubber products, from premises for obtaining distilled water.

* Rubber products must be stored in a dark place, protected from mechanical damage, aggressive substances (formalin, lysol.) Ammonium carbonate contributes to the preservation of rubber elasticity, it is recommended to place vessels with which in cabinets and storage rooms for rubber products. To prevent products from being squeezed, they cannot be stacked in cabinets in several layers. Cabinets for rubber products and parapharmaceutical products should have tight-closing doors and a smooth inner surface. Harnesses, probes are stored in a suspended state on removable hangers, under the cabinet lid. Rubber heating pads, overhead circles, ice packs are stored slightly inflated. Removable parts are stored separately. Elastic catheters, gloves, bougie, rubber bandages, fingertips are stored in tightly closed boxes, sprinkled with talc.

*Metal medical products, including surgical instruments, are stored in dry rooms at room temperature. Sharp fluctuations in temperature and humidity in the storage room are unacceptable. Relative humidity should not exceed 60% (rarely 70%). Metal products that do not have anti-corrosion grease must be treated with a thin layer of petroleum jelly. Such instruments should be stored wrapped in paraffin paper. Take tools with a gauze cloth or tweezers. Scalpels and knives are stored in special cases of boxes to avoid blunting. Store surgical instruments by name. This is convenient for their vacation and control. Copper (brass), tin products do not require lubrication.

Proper storage of medicines is based on the correct and rational organization of storage, strict accounting of its movement, regular monitoring of the expiration dates of medicines.

It is also very important to maintain the optimum temperature and humidity of the air, to observe the protection of certain preparations from light.

Violation of the rules for storing medicines can lead not only to a decrease in the effectiveness of their action, but also to harm health. excessive long-term storage drugs (even if the rules are observed) is unacceptable, since the pharmacological activity of drugs changes. An important condition storage is the systematization of drugs by groups, types and dosage forms. This allows you to avoid possible errors due to the similarity of drug names, simplify the search for drugs and control their expiration date. Narcotic drugs (List A) should be stored in safes or iron cabinets with secure locks. A printed list of poisonous drugs is kept in a cabinet with the indication of the highest single daily doses. It is recommended to record the taking of drugs and their balance. Rooms and safes with narcotic and especially poisonous drugs must have an alarm system, there must be metal bars on the windows.

The stock of poisonous and narcotic medicines should not exceed the general standard of commodity stocks established for this pharmacy.

Drugs from list B are stored in lockers with a list of drugs and higher single and daily doses. Instructions for organizing the storage of medicines and medical products apply to all pharmacies and pharmacy warehouses.

The equipment of storage rooms should ensure the safety of medicines. These rooms are provided with fire-fighting equipment, they maintain the necessary temperature and humidity. Checking the parameters of humidity and temperature is carried out 1 time per day. Thermometers and hygrometers are fixed on internal walls far away from heating appliances at a distance of 3 m from the door and 1.5 m from the floor. To register the parameters of temperature and relative humidity, an accounting card is created in each department. Big role the air purity of the medicine storage rooms plays a role, for this they must be equipped supply and exhaust ventilation or in extreme cases, vents, transoms, lattice doors.

Heating of the room should be carried out by devices central heating, the use of gas appliances open flame or electrical appliances with an open helix.

There should be a sufficient number of cabinets, racks, pallets in the storage rooms for medicines. Racks should be at a distance of 0.5-0.7 m from the outer walls, at least 0.25 m from the floor and 0.5 m from the ceiling. The distance between the racks should be at least 0.75 m, the aisles should be well lit. The cleanliness of the premises of pharmacies and warehouses is ensured by wet cleaning at least once a day using approved detergents. Medicines are placed according to toxicological groups.

Poisonous, narcotic drugs - list A. This is a group of highly toxic drugs.

Their storage and use require special care. Poisonous and addictive drugs are kept in a safe. Particularly toxic agents are stored in the inner compartment of the safe, which is locked with a lock. List B - potent drugs. Medicines of list B and ready-made products containing them are stored in separate lockers with the inscription "B". Storage of drugs depends on the method of their use (internal, external), these funds are stored separately.

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