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Occupational safety instructions for procedural nurses. Full document

Occupational Safety and Health / Standard instructions for labor protection

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Safe Operation

General safety requirements

Nursing staff at least 18 years of age who have undergone special training, including electrical safety group I, and who have no contraindications due to health conditions, are allowed to work independently as procedural nurses.

Procedural nurses must undergo a mandatory medical examination upon entry to work. Procedural nurses who, by the nature of their work, have contact with blood and its components are subject to examination for the presence of HBsAg upon entry to work, and then at least once a year.

When HbsAg is detected, an in-depth clinical and laboratory examination is carried out by an infectious disease specialist. Nurses with identified Hbs antigenemia who belong to risk groups are required to observe personal hygiene rules aimed at preventing patients from becoming infected with hepatitis B. All parenteral manipulations must be carried out with rubber gloves.

Procedural nurses who have violations of the integrity of the skin are temporarily suspended from work.

These restrictions are lifted with repeated negative blood tests for the presence of HbsAg using highly sensitive methods.

All newly hired employees must undergo an introductory briefing by an occupational safety engineer. The results are recorded in the registration log of the introductory briefing on labor protection. After that, the personnel department makes the final registration of the newly arriving employee and sends him to the place of work.

All newly hired must undergo an internship of 14 shifts.

Each newly hired person must undergo initial training at the workplace and be recorded in the training log.

Procedural nurses undergo refresher training at least once every 6 months. The briefing is carried out by the head of the unit and is recorded in the briefing log.

Upon entry to work and periodically at least once every 12 months, they must undergo a knowledge test on occupational safety issues according to a program approved by the chief physician.

When performing occasional work not related to their direct duties, procedural nurses must undergo targeted training.

Procedural nurses are required to comply with internal labor regulations, work and rest schedules.

When carrying out work, procedural nurses may be exposed to the following dangerous and harmful production factors:

• the risk of infection with pathogens of various infectious diseases (hepatitis, HIV, etc.) and their transmission to other persons when working with blood;
• the danger of allergic reactions to the content of aerosols of antibiotics, vitamins and disinfectants in the air of the working area;
• mechanical injury from fragments of laboratory glassware, glass syringes, needles;
• the possibility of acute and chronic poisoning as a result of the toxic effects of disinfectants when toxic substances are absorbed through mucous membranes and skin and enter the gastrointestinal tract: increased voltage in the electrical circuit, the closure of which can pass through the human body.

Procedural nurses should be provided with free sanitary and hygienic and special clothing, special shoes and other personal protective equipment:

• bathrobe (dress) or cotton suit;
• cotton cap or scarf;
• additionally when working with blood:
• mask;
• protective glasses;
• rubber gloves.

The administration is obliged to ensure regular disinfection, washing and repair of work clothing. Washing workwear at home and in work premises outside a specialized laundry is prohibited.

Procedural nurses are required to be guided in their work by their job descriptions, comply with the requirements of this labor protection instruction, as well as the requirements of manufacturers for the operation of equipment and tools used or in the process of work.

Procedural nurses must be proficient in the techniques of providing first aid for injuries, burns, poisoning, know the location and contents of the pharmacy, and be able to use the funds in it.

Procedural nurses must know and observe personal hygiene requirements. All personnel performing disinfection work must be provided with soap, towels and skin softeners. Smoking and eating are allowed only in a special place.

Treatment nurses must know and follow fire safety rules, know the location of fire extinguishing equipment, and be able to use them.

The victim or eyewitness to the accident must immediately notify the manager about every accident related to production. The manager organizes the provision of first aid and transportation of the victim to a medical facility. To investigate the causes of the accident before the arrival of the commission, it is necessary to maintain the situation at the scene of the incident as it was at the time of the incident, if this does not threaten the lives of other workers or aggravate the emergency situation.

Procedural nurses who fail to comply or violate labor safety instructions are subject to disciplinary action in accordance with internal labor regulations and, if necessary, an extraordinary knowledge test.

Safety requirements before starting work

Turn off germicidal lamps in the treatment room.

Check the serviceability of sanitary clothing, the integrity of gloves, masks. Wear sanitary clothing.

All manipulations in which contamination of hands and mucous membranes with blood or serum is possible should be done with rubber gloves. If there is a risk of splashing blood or serum, you should work in masks and goggles.

There should be no jewelry (rings, bracelets) on the hands of treatment nurses. Nails should be cut short. All damaged areas of the hands should be covered with a plaster or finger pads.

Prepare the workplace, check the availability of detergents, disinfectants, sterile instruments, specifying the period of their sterilization, the availability of trays for sterile materials, dishes with disinfectant for used instruments and materials.

Before performing injections, you must:

• clarify entries in the appointment log;
• wash your hands thoroughly;
• carefully read the inscription on the bottle, ampoule;
• check the expiration date of medicines.

When preparing materials for washing, disinfection and sterilization, one should be guided by the requirements of the sanitary regime.

Safety requirements during work

Medicines for parenteral use, internal use and external use are stored separately on separate shelves. Medicines must be delivered to the treatment room in finished form with the signature or label saying “Internal” and “External”.

In the absence of the listed designations on the packages of medicines, storage and use of medicines is not allowed.

Packaging, scattering, hanging, transferring and pouring medications into containers in the treatment room, as well as replacing labels is prohibited.

The stock of medicines should not exceed 10-day requirement.

Poisonous and narcotic medicines are stored in safes (metal steel cabinets), on the inside of which the inscription “Group A” is written and a list of poisonous and narcotic medicines is placed. Stocks of poisonous drugs should not exceed 5 days, and narcotic drugs - 3 days.

Disassembling, washing and rinsing medical instruments. contact with blood or serum of people must be carried out after preliminary disinfection. Work is carried out wearing rubber gloves.

Disinfection (disinfection) of needles and syringes is carried out to destroy pathological microorganisms. When disinfecting products with internal channels, a disinfectant solution in a volume of 5-10 ml is passed through the channel to remove blood residue immediately after use, after which they are completely immersed in a disinfectant solution.

Disposable items: syringes, dressings, gloves, masks must be subjected to pre-sterilization treatment, followed by sterilization and disposal.

After any procedure, including parenteral intervention (injections, blood sampling, etc.), wash your hands twice in warm running water and soap.

When treating hands, you should avoid frequent use of disinfectants, which can cause skin irritation and dermatitis, which facilitates the penetration of the pathogen, as well as contact with medications (antibiotics, novocaine, vitamins) on your hands.

When working in the treatment room, it is prohibited:

• work with a faulty tool, use faulty equipment;
• stay indoors with unshielded bactericidal lamps on;
• store and use drugs in damaged containers, without labels, expired drugs;
• leave unattended electrical equipment;
• work without established sanitary and hygienic clothing and other personal protective equipment;
• store food in the refrigerator for medicines;
• store personal items, clothing in the workplace;
• use cosmetics, smoke, eat at the workplace.

Safety requirements in emergency situations

If your hands are contaminated with blood, you should immediately treat them with a swab moistened with a disinfectant solution (1% chloramine solution) and wash them twice with warm running water and soap, wipe dry with an individual towel or disposable napkin.

If blood gets on the mucous membranes of the eyes, they should be washed with a 1-2% solution of boric acid; on the oral mucosa - rinse with 70-degree alcohol, on the nasal mucosa - treat it with a 1-2% protargol solution.

If work surfaces are contaminated with blood (tables, manipulation tables, instrument tables), they must be immediately treated with a 3% chloramine solution.

If malfunctions of the equipment or instruments used are detected during work, in which, according to the requirements of the manufacturers' instructions, their operation is prohibited, the procedural nurses are obliged to stop work, turn off the equipment and report this to the senior nurse of the department (head of the department).

In the event of a fire, it is necessary to call the fire brigade, organize a meeting, report the fire to the head of the department, and begin evacuating people. Before the fire brigade arrives, take measures to extinguish the fire using available fire extinguishing equipment.

All cases of accidents, microtraumas and injuries, as well as measures taken in connection with this, are subject to registration in a special free-form journal.

Safety requirements at the end of work

At the end of each shift, the surfaces of work tables, manipulation tables, and instrument tables must be treated with a 3% chloramine solution.

The premises are cleaned at least twice a day (shift) with the mandatory use of disinfectants. Garbage is removed as it accumulates. The cleaning equipment of the treatment room must be labeled and stored in a specially designated place separately from the cleaning equipment of other rooms.

At the end of work, treatment nurses must put away sanitary and hygienic clothing and spare shoes in individual closets. Take a shower if necessary. After finishing work and washing hands, the skin is lubricated with a softening cream.

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