Clpitolul1 CONTROLUL lNI'EC l llLOR l.l Defini!ie. tnclofi si strr.. d. conrdnin!re, cri dc rdnsnit rc Inrecti0nosocomialr (lN) ene infcclia mnhchla in 0nil.lis&irarc cL panrri (d. et !iprivatc)j carc sc ftferi h oricc boali lnftciioast cc podrc U ftcuosturd ctric .\iriJu microbjotoeic si pentru c!rc *nlndolad. cp cnjoldgic, a conticririlin iDpul snildliziriiracNlui ncdi.d sal oatrcvrc or mcdicdlc, crrc rttcrca2t lic bolnlvul d oriti in-qrijnilor mcdicrtc prinirc, fie Nrsonrlul Mnna. dar'.iri scririrSlii lalc ti csc legdli Drir jncubrhc dc ltrio a asknrli modicdlc in uniraiea respectiri, indifcrcr da.i slmproDrle bolii apdr srl nu 4d pc pcrio . Factori $ su rsc dc mntrm i n,rc i ntrr ep itlli ccrti gc ii resDonsabili dc co aminrrc sunt tbalc nuncbsi Eidetemini intectii urjmutl etr mrr p tir eE!c. Adc$i dcvin rcziionh latrildncnc. Ascriiillarogcnisntr rlcr.bn (nunc !.ncric dar dc Prncur .rganisoclor uniccluta invtTibjte ' hr rer l. r.rob. r x rcn -J'n g, nrl ot l,r{.4. |J' ciupcrcisan Levui carc dcrclnind ni.ozci - pamz ili i rcsnor e bil i dc p.riztozc: vm$n Ld (heFiortupej ncurooopcj clc )i Slrsele dc conr.ninarejn spiral sunt rcprczcrlalc dc pcnonxl d. ingrijncl cch ipdme nic si surniclc conraminarc,.x.lojeriedep.t. srLrelc. ioatorc comune, erc i - scclcii i, c xcr.tii prdbc dc lib.rardr, rintpligil mxrcrialc utlli/are c.nbriixic: l,rcienliisnirrleLorsuot m!isuscctlibiti la intccrii ddiorir! rezisrcnleiratumtc ditrinuare dc bo.li s,ude nclc nrcdicamcnro(inmodcptosoare, ohnniotcmpi.e) Toalctclc comunc sau pro\nnnaM xh.r pacic{iniftsc riscul irltqiilorincrucis.tc. Pnndpalelccii dc r.nsmirerea infcciiilor sunr: ' hnsmitcrca irrcrunrM.ccxraiiic.vcniiesreprininrcmedjut mainilor: calcd $irni. tnn iu!e. rrrinui, expccronlie (picituitc FlLrggc), e$c rcspdnsabiti dc apanria unul pm. r dc l0% di.trc infectjilc nosocomirtc Aerosoln djn dispozjrivc c dc cur4arc san din scnigi pdt tnnsport! porlictrl. nidoscopise.lc drganismcor gd $ 6i! i' .L f n F 1,. .'.acrorl'.9.d tu !r r'i - irocul.rc cu acc sau soluii conraninare: . pcncrarea organGmutLi cu oc.zia $ndajcior urirarc, inubariet oror,heate. imjziitor dLPOViNF o!a l.: lrnirLl i nruL'r'n. dr \upr.'tcch r\i,uq'roldinr'i'iilor lcnm r nrdntrr. in{turiiLc lnmizoacd.nrlri;i irrlccr i. if rtrnl L9r0 ccn.rh ltfku c.ntroLr'l .ri.So i d.0ro..dtr'L d.lTolrr R...rnxMiriLc i1.di.rc ii.nntL i. .rd.x rtr,c subcotr[o h.lilo.ltr p,hlLr trtr ltrtril.rc Jcr]Lir I rdu!e'.a prlccduilor i,,utiler uhLi/rrcr p!,r.dtrr LnDrx/tretu unrrirledeingi ne ftirni: !r'dr.xrro ,iirDitrLi' ii!r'rLlo' ]rrblctri 'c/islcrri x ixlinLrl i,r xntrl l9st.cnrc. lr.ntL onb.hrl boliLl)r \i pR!enlic rL lntrodus prc.rtrftrfile rfireAx. fri', caE sc rc!oD.odi pc$onalului nedical si loinc cchipdcnfuld. rnncctic fonflL. .r1tr.. posihllir.r...oDr.cn'lu, (ncd cn sitrlclc:i rlrc tlLrid. nro\cdn. d. ll 0]ri.rii in r9t6 c.rrcL. pcrru.oDf.h'llxrLiLr ' |rr.ric xu itutud's f.cnuL Lril. {rnda'd.x hx/i x ]\r lnn rdatrlar prf/ari f, vi'(la r.I cili dc conLrnrlnxr si f'orocorL.tc {xiddrl. ( s(oprl p(\cni'Litr,tr L.'iih.li"Jtrl pxcicllilor. $rirrr trlui sj \izrdrrLltr ir prczcnr in r[rc lpnrleLe r\nLr Dqid]rnenrul dc Supnr.ghnc \i (ort.l I hrlacf to brtuJr [lccsr ca$ colcd.aza d.r. p1n iM cthadcL. rnh.foa\e $ safiNr.n r.'lonxlL'lur rn r'u rizciza rlonn.tii /niid rn.unlc por. rirlc l-unrr sxr r trrsrrxL rt.c r 5.rn. Lnon.x/r l l : |.1 iplr trLL'i\.rh nr Drisr idc rklir \idccoDrrftr.i i.!{.ri'r1cftr PoirLr. \ prlccrlLilr dc corrol tt l.diiLr trcbule \, tie clxr. ri crr.s. r tc id'.-!ul Nr{irl tr'cdirxl P.nLn r rn,! {'b coDfll iDtcciiilc shr dlootribt! N[r Nnrcc !ccontuninxr.x. rufuenir. de/ ilcc! I !lanrisepsi.. Drr0nt,mirarca. ii tm.hcr nrldicrLi. \e rdrr.r7. !rrl'sn nr{cmLulu n d.r !j se rDLici nar.n.lcLttr ert (supDrni.. Nn,.Nlc) ^rc cx sdor dilnilNrrm ru inrt r d. nrinoor-lxnnnre ir utc d. crrih.c. t,'orcj.,{ pcAoftlulLi d. o c.ntaDifuto iin{xDcd. d. t. irlx dc F'srnctrl! itr' lLli dc op.rxhi) \i ri[rca niJcmi'iri micrtffsri nn!]or h ncdn,t (1'riitenia.s. r.riuer !a'e !0,,$a in ind.Fnrtor nrurdiirici ls|iL ca podclcli'. $LDrltirclor '-l ' itr'. 1.,i,pi'r r ..1r, r ' \' 'L' ,ct.,,t., rc rtrn in sotutic dcziitaclmri iiarnr. dr r n rpihr.,dr;ihr.drsiingc \ccr!lii. d. ) l)ezinfccti..k rpeatir *'r \c r|Li.i nr nr ir nrnr. D./ff..!ia cnc hrprr srtcf..,ti I dcconh.rfirir \i sc .0lici fuiui pc nd.rialc sn sunnlir. curore Nu \s n!7i icrli/i dcctr I LtrrL.ril \i J.rii,li.li) rul ti rer i/rle itr a.c..tr on.nlic p. . np.1lra. Jrbnd uttizitLii p,od \rlorJNludleni!/dczinlcclic Curo c...r. drdi tle/i'ni.ri. ifto ii{. nerilizxn Mri obled. .r rcbri.. in n$d mp..arn :li se il.i i'i r li'nf $pa tr (cuirtrc rpor dc/inridic) anris{ri, cnr. ficlLnlii dc Ninx[c,. i n icLici.aft se xplica l. nivenL r urior vLi. . i'n lr]k sxL dNn.rinJ m,cnrlnnnnrclc pre/eirc nr Nom.rtulde.u]ilil|i.ccdtr.ir. MONTORULOFICIALALROMAN E Decontaminarca, .u cnia. dczintulia concuri aseDsia ca.c rcprczin{i un a.sanbtu dc misui trc.i rn n-Fli.".nroou.oercn.n'o t ngf trJ'5r'i.r lgicna .sc un msamblu dc pnncipii !t praclici carc vizcazi xhd|orarca s:lnftilij si pru$phc: . lu!rca La co.osinrt (infomir.a); - m cohpo a'nenthdividu.l Jicolecri!: o lilo/ofie sio momla: . un ansrnrblu dorcguli dc munci 1,3 Chiddc pr.rulii univ.rsalc Ordinul Di.isrului siniriiii Dr 916/2006 p vind aprohrea Nofreto! dc suptuv.gh.r. pEvcnirc ,si contnl al inlicliilor nosoconialc in uniriilc santurc (Anck nr.J) denD.n. con..nruldc..prccluriluiivcrelcisiyabil.+cmodatirarcadcapLi.!rcaaccjon Scopol4li.nrii precauiiitor univds r (pU) Scopul aplicirli precaulilor uilveEale csic trcvciina ldcul dc 'nunca .l p.*onalului. Corccp(ul dc prdatrrii universale se rclera lai - ma$dlc carc se aplioi nr vcdcrcr flevennii hnsnritcii HIV. ViIB. vH(.n al| tr!.mi .r'. 1o(' i ., 'e Llc ri| n. .tr1h-' r'd rdt !inge, altc iudc bnt.gice i lcsubrilc tuluror prci.n!ilor se consideri a li por$rirl inridrr cu Hlv,vIIB.VHCl !i Jlfi 4cnii inicmbicni c! calc deransnitcrcDrrcrtcmti Ganquini): to! pacienliisc considcrr porcntial intcchri cu HlV, \rIlB. VHC sau ctr ahi rsen! mi.obre,i .rc,I Jc LI -N.b sd : dco.a.. rci . quh'J' -._1r,.,,1elr\'rlB\Ij.. .'1" p nr i.c-ootra' dnr$'ntr,', i. .i 'r. r'1u..To|x.r..o..to rmnsm rcr ' 'nr<hilff p! !J. ;ne ni h Regull dc brzi in rplicrrdN prrcruliitor unircbrlo I C .ns ideri toii pa cicnl n pdrcnri al in lccrari: 2. (lonsidqa ca singcl.. alre flui{Gbioloei.e.\i!csuturitc sunr.onramiDrc cu HtV.HC\'. HC\ l l. Clonsidcta cr acclc si dlrc oblectefolosirc in p.acric. N.dicdli suDr conraminatc dtrpr uriti/are: Conlaclul rcgunenrelorqi rucoasetorcu unnarorrulc prodlsc rrcburc considcftro h nscl ' ichid amnioli0. lichid pcricardic, lichid pernorc0t. tichjJ plcuEl lichid sirovtxt. lichid spcnnd j secEtii vasinalel oiicc rlre fluidco icc vizibil conrami'rotc cu sdnge. I mpl.n.rtlrc! Dre., uliild r un ivcrsr re L Uritiarcdechipomenlului dc pr.recfic!d.cvdl, cdbpldr, corccri 2 Spehrc.niinllor!l arLtorpi4i olcrcsmc clorl 3. Prclcnndi accidenlclo!sia alior lipui dc expunere piofesion ii 4. Penomlintict .uHrV: 5 FraluaNr risculri pc caregorli dc locui de Dunca si .clivirad pEsare & I.mon.tul ncdi.o sanibrn, fuDclie dc conta.rulcu sangc iirlto lichidc biologi.e. MON TORULOF C ALAL ROMAN E Rr$msndiii nrivind uliliare{ echin!meDtelor dc Droicctic - ii (intul rutrcr rdivn ilor d tr onililo mcdicrLe fortrri, bluc nnpcnncabi lc. oc hclar d c sc.vi. i dc tr'8ci1r. l$ontr rre comnlctrli Don0l lal.rclf.runci cdnd sc ,nticjpc!za produ.o.a de *ropi. liiciluri. jcturi cu pr.dFc hnnogicc Dorcnti.l contrnrnlte. ir scctli c! ptulil clirursicrl. i'nervcnrii carc nnpli.i cdnrrtol cu r.EnDi ale lorpului in tu)d n.rnral sic'ilc .b.rd \2{u rr p.i,r Dun.lic contr.rul cu rcsnNcitr'l pacr$rulLi dre r.zi i soll(ii d. oonrintrilde (nlis0 - Mnipulxrcr m.r D reLialc porcnrirl conrrnimn ne{eilc.nrrr. ,lez!hnr!;fl dr n11!nr nc.i ro' r, mrnipularcr d. Dnnrnal. coDrxrnimrc - ctrriitcf ic. ndcpinrrca de produse bxnoqi.c - colcdxrc mate.irh.oikmrnrd. cu.ili.clidcco nrcirrnun.nrft. Miru\ilc fu sunr nn strb$itu ncnrtr diin,lor. prin Lm,oLc niiille rchuic dlpa ir depanmc. xce$m rcrlvitili .rrc ni!n'pm conruimrc sau nmDir! cu dilc c nuideorlaii.e silr dc op.riric. in rlnrpul tuxilruli ii r nJ'.nr ui lc\rlnlrl cortrclul cu Dlc ctr! cr mcni'isira vimli \au bad.rixra. or TBC ptrhnonara cxre sunr BK conhcfu I cu |Ecicnli cxre tuscsc aspnarca secrqnlor rn hco hrcniccpc - ingrilnca pligiloi suptrrdrc prcgiiiEaNrli'ziitorcLchn odanrcc Drclalircx lrccinuriLor pcnh rdnri'risnalc di2oL\'rcr Dulberilor h.n izarc Miri c tcbuic sa iic de rit ulrru si si lic binc vo\rTocur orr rA' Ar RovAlE Spil0rca h6injlor dsigrd igidr, prdiccrir $i sccurir.ica pcrsornci ti . modillli siu, prcvcnind ltutrrnircrca gcnnenil purtai pc nl1ni, resDonsabili dc o mdc pane dinrc intecriite nosocdniale. E$c o sarcini anr.nonr. asnrcntul mcdic0l cac rsponsabit ditoct peniru -tipuri dc sDilare, neinilor Lrlajul rinplu clinin Uord tmnzitoic lomuri din orcrobacdii. lirusuri, lcyui. ciqrcrct Dul nnr sdr nni purin FrogeDe ti care nu se nultitli.i. l. se .Limirt h roulna[ dupa o spil.rc mcliduloasi$ coDtactul cu m a$iscpric Lrvrjul igie c sau .miscpri. elimini in totoliralc fioh rdibie si difrinudr/i flom roncn .L, sau ETidenii. adici gcnncnii opontrdii .m sd gisesc i. nod natlral nc pictc Ghnbc.culaudu dc cxqnplu) corc sc mutripli*i anonnat in rbseni. nr$LnLordc jgictri !idrc ln scidcu rczistcnlci organismtrlui. Frictiunea igidnici cu un Fddtri hidm,lcoolic clinina fl.rr haDzi!.ric si dhinu.azi flora Lnvnjul rhi rgicrl se pnoticd in sililc dc operalii, siliLc dc ndsorc sittte dc pxisxrnente lDdicaliilc spnlirii niinilor - hi rarcdsila lcsim din scRiciu: i.dimc sidupituhtunrc. manuiilorsau a oricnrultip dc cchiphrentdc prorecric: dupa oricc gest contrnrinantj - duDi a.or!arca nrgrijirildr 1!i0ni.c dc conlon san hotclie' s. cu oorzid insijinbr nei'rv!,ive (injcctii. recottarc ljc sansc. pu.re! uno so e sasticc. ulpao En.lnreDrului sondaiului linar. etc.): - imi c dcnrcnrmrea !idistribuirca 0timcnrctor si a ncdicamcmctortcr osi - duDi lolosirca loalclci. dtrp, ingnj;M Lnul paoie imunodcpresivsru punator al mciinfeodii - cuocazi.mLizirii unei proccduri iNrzivcl - uu.Jzi snrJrrr..""1"' r' -ora'. .rpr.!J. , d.-n" '. dupi dolt sccvcnle de jngrijnc cu nsc de conrairiraN ta acctari pacihr sau n rc doi SoLuia hldturlclolici- sa! eclul. Int ulilizdc pdnrru a subshui Laujul andscpric i,r oaat oiinilorcurrtc dir Nnc. dc vcdcrc nrros.opic ficliurca cu $l!ti0 hldr.alcoolici sau ctr eet sc aptic, pc hiinilc !arc nu prcr'ne umc virhitc 'lc murdiiric sa!pulben. in cuoontuarsc rccurge h spaLorc!ctr ap, si srpun. cu o.arr unor prcccduri cu rhc inoLr dc inltcrii (caiereiynut cennat, Nnorix loibari. &enajul plcuml. clc )l MONIIORUL OFICIAL AL ROMANIE ' ncntu inrercntiilc .hirueicalc la blocul opcr.lor sau in seflicnrt de adiotosic - in alrc scnloii de lnve$igaEr pcntfl anearcx nNbnlf. - slipnn lichidcu dhnibuitor: Drcsoapc ic unjcil lolorinli indisdbdori sanun lichid rtrriscpric sdu soh4ic spudorst .nriscntici du disrributrorl - pbs.dpc Jc unici folosi|li in disiribuilol solulic sau g.l nr dislribdorsd r_n anbalajul dc ptozdni!rc - dhiuveri cL n,hi'ric cr sci7.n: api conhtd ri brc(erio log ic: . solulic spumarli.ntiscprici cLr spcch larg (clorlExidind dc cxcnrplul: polnLr:i s(nli dc uici loloin!i lmprcgndi cu solulicnniiscttica sprtranri: - nnliie sau Ccl hjdroalcoolic in disdbuito.l p0bclc cu scnrri (neartionatcmnual) R.Nlizarer proccdurii Lrvajul sinplu ' sedescopcEmdinilcsis cb lclcl "-dip.n.,7;brr ' i" ' i ", sc .. c - r" .' /h l. - rc udimAinilc$.niculxliilemiinilorl sc arlici o lioza dc sipun: - sc snoli fi.cam ftint pnn ffcri.narer .$inrisl5inspatiilcinrcrdigihte,injurulunghiitor,hcrtumnatcadceeretor.Lapoticcril, n$iietclc Dain ilori penh n ecare dir lccslc ngiuni sc cxecuta ciro J nriscirti sD sprLi din abundcnli rir. si hsrm si clryi srpun pe o zoni deja chrnr: sc r$rci prin ramponare cu $eNelclc dc liici folorjlF hr. { rcvhi $npn trnei zorc dcja selnchide robinetul (daci nu csic !ulondic).u ulrinu leNclcl de mijni0!itizdri . r' tr r.. si(.J., Lptrbrli l; i rr ."e ur'Dcl.,. r n in" Ntr sc acrgc chiuvera dupA spalarc. m,rilor! manev.a va murd*i din nou niitut.. sc spalimainilc inainrc dc a inbricr n1lnusilc dcunic. tuLosinlr. MONIORUL OFICIAL AL ROMAN E Rexl iz*or proced u.ii Lav.j u I igi enic sau $opric sculi bine rdinilc ii tialatiilc: - slplici o dozi d. sipun antjscpti.l ' $ sprlt ficcaE mdni nDsand: s insnti in snatiiLe inrerdi-sihle. jnjurul unghiilor, l. cxtdhihrea dcgdckr de ta licc!rc nini carc sc ficlcd. Dc raDd in po'lu p{lmci oprs. cxccurtrd 5 Di$crril sc spali pc rinJ, rsp..rtnd ..ftgula 5-(cinci D(.fui cicularcl pdli.cl. si rpoi ,niculaliile nlinilori se slatDic din ahmdsnlidinspft virtuI d*crclorsprc rrlicutnriilc'nri'riloli su dcnridpalmclc dncnhrc in ruslenr'! a clna oncc.onhmirarci !e uluci or snjt. pnn hnpon.rc o 5crvelele dcurici fnlosifli] . sejnchidcFbinctul(docinucNrom.LiclctrulrimulscncreLdemiiniurlliTat: sc.runcli $dvcrclclc in pubch cu pcddr Eri se adreeD tuboLi cu Drana TinpulJc spilrre: 2,1 'ninute,lir; pcrierc Lavriul anliscptic rrcbuic cfcctuat .orcd iminte dc rcolizarco inrrililii, uritiTtnd rrsx d. aDi c.a rr cprop..' ru.eh' l! r r. J ,i' i tcocgca.Jn'(!..c'r'e) Se cxcor:l snJlrfta $risepricia nrainilo'in!intc dc { inbric. ninqiledcnnicti fotosinri llediarq proc.durii Spnlrq igienicn r nAinilor priD lric{iunc sc pun rphinaiiv 2 'n de solulie in scobirura miinii uscarc si $ cteci@aza iii.trmea rinl de 30 secuDdc licciind p.lnclc lini la dcgclc !!oi insisdnd in spatiil. jnre.djeitatc ' sc lreri nccarc policcin irlcriorul mtinn inchtse, inoi cxftm irfti tc dcsclclor itoprc unde de h licc c mara in nod(l pdlm.i dpusc. Rcalnjren procodurii Ldv,jul chirurgical Nuccsn, punarcr uneinretd.calotc tiutilizaredde 5crcfclc slcdlc pcnrru uscarc, nainilor Sc ph inp allhil na$a ti caloi.. Sd pEparn/prcgatcJrc nond impregnali cu solufn sptrma.fi h&epti.a. sc ud:r minlilc, inicu aliile. stebFlclc nlini h coatci ' sc rplici o dozl dc sapun anriscntic tisc irc spuma di. abundenF nnn ,nasaiut cicctrrr J"ld.\rttr'J. lgaeu p, ,l,.ao.r.'hp k I n' L'i . se mcriir nrtinilc doa$rpra.oarclorin rimpul acc*ci oneritii; sc clircsc din dhunder!i manib, antcul4iile. antcblatclci sc psic unghiile tiide scun cu Dcria sldili inprcgnatn cu soturie sDumanli amis+rici ."rl:'c..dinJL',Je J naioile. r.hc'ctu ' r J eo' dcl ' sc ia inci odozi dc sapun ontiscptic tlsc tuscrzi dnp & I ninur mainjLc, inchcictunh. antcbr4cLc, anoi sc cliilcscr se u$Ei. prir r.mpon.rc scrlclclc s.nlc ficcxr. rnenrbnL- irccpind dc r dcsclc spru ..ate s menrnind mtinilcr icate l)"l)ii ? orc cIc ncccsur r.litcc(r isictrci rii'nlor. L:rajLLl chinryical poalc fi conulchr ctr lrlcrilri chnuBiclle cu soh'hi hidoalcoolicc sru Dcnndnc dcrcnrnkrc dc trrlLi^rcd pLodusclor riscprrc sipun liohid bhnd (doux). saipld liclid anhi$hc, soluric rpunrrli anriscprici: in r.$ 0rz. cstc rccohxtuLnl si 1. rcduci sru si se interuDr udli/Nr podusului rcspcdiv si si, \e r|rlicc..rcnri hidrd.nra dupa liccarc spiloLc a rniinilor. lonnr.cr uDci pcliculc ulennse, Liticiorsc priri utilizdco 'cpclrri a soturiilitrr.scluilor hid..rlcooLi..: sc rcconrndi spiLa.cr ru rpi di| .hul.ila a iiinilor Usratoxri n aicrpirliip nicpinrc, grisi'minrml. r reguncntuhir sc r.c.mrnlti clirn ctr rpi din rhmdcnlll \irpLicarer, dupi u\cxE. a uncicrcnre em.lictricd. triiirri cxrt si nudete'ioE/c D,inu!ile de cauciuc nrc.dl in crr. ac.nea khui. Du'1 c l.: Pt.crurn dr p'!r,n"r r inlrrn'l ' r'rn\mi\cpi !slcacrirnd Aii.tiuric crr! ilccsilr n!lcl dc oruer1n s11: zona zoo$$dN.minxl: - /otu 7.o{c' Locrlizit lx F. cnr i irnuodcprllivr: plcicrti hhco$onrl/nti lcc*c f'c.au1i . ilitrr dc prccrtrriilc mnJrrd. prcrnr risn ndir.r agcriior palog$i cc sc trnnnir D. cdlcd &nrlul pin iinul. rusc v.rbn. respmlic. A.cic pnrurii ncceriri. efecN. o camcri.u trdsnnc ncgrtiv,,. cu Lsi inctiisi_ pcnhr. n ntinc o t,rsiurc adc$"n . .lJulLi intc.an.ra dc iz.lrr \ihol P(\iLrerrcg jvi.rdultriJircxrnende Tolarc. trla'ic 'noriroriari ixr aerutrrcbrie d;ijri i'l ertcriofl I cLidini sru tihot imintc dc rcciclarc trotccrir respnaro c irchuic uriliz r dc ci[! roarc pdAo]ncle carc nrr in raDrch GuDr idcdc \r|]aratcl.c c tuLo$sc l,lrn dcacr). P&icrlll va prnr in alara cameRi (riuncicirt r. rtobur s. ti.iscarcii pcnrn cfccuarea uDor pro.rdd.i) mr\ca chiruryicala a$zara pc$c glri s n s. u t.c! i to c mdd rl.lc fc.csrtu rcspccriii prccruliilor dc [ey.Di.c I irl.clijLor tan nlsc pccrlc n ipcunciruc,or. in anric$reF. cancli ncntu usrcrnrercide irc rt: hr la tc, nr 6nuti dc unici lolosin ril naleriale Dc ru isicna melnilor. - sc nlasev-n pacicrtoup.cidtii (n.xlm 2 pa.icnri) inlr-o csncri cu prcstunc negativi. cu llta inchisiljrevizuri cu anticlnrcri sau hol: - 5e vorcxplica prccaulillcdo izolfo pdcidrLluit a familici a.enuia: sc vdr nc.tinc inchirc ror timDul atal nt. canereicir tiut!lrlccdmc iFnruancilinc prcsiuns negltivd a acnlniii pcnrru rnurispardi alcniip.ldgcni di'r aer sc vor afi$i pe nla camcrci prccauliilc spccifi.c provcnini iEnsnircrti infecliitor lc .atc reriani pcnrru a fi cnitc dc oricD pcNodni cxrt inrri in comcra dc izoLarc: sc insrui$lc pacicntulsi si acop.ft nasul ti gun cu $rveletdc hdnicdruncicind rulesrc - \e plascaza uniccipimr Gac) pe unadin lotcmlclc polrl pcmru capacjcmutsi coL.ctcz. matcrialclc rolosire (lerelele. coDprcsc): - 5e thilcazd mobilizarca pdcicntul0iin afara ra'neEi: d.g, tcbuic rt ptriscrsci cameB pcntfl divene pruccduli, pdcicnrlt v0 pun. o n.s.i lhiru rgica li iar $efrlo iul de iNsrigatii/rrahme nl va fi anun td I d.sprc nrcaulii lc de i70 Larc nabilire pentn cr rcnca s:l fic nentnrutc ri ncoto St pcntu cr pacicntut si tic adus nr c nera dc izolxrc cir mi repede posibil. 1.6 Prcc tii dcpr.venire a nfstiilor Irrnsnise prin picnorilc Flugge llolilu !a6 ncccsni a{lel de precaulii su : - fncunionia hcmothiLusinflenTrdctiDb: - Falif gila slrupto.o.ici; Pncononiilc hrcrerienci - Scarlatinalacopiiifrici: Paroridi ri ep idem ici: - lnlcclia N adchovitusun bcopii. prcc.miile. in accslc cauri, ru nacsirt in 'nod obligarriu clDrcrc dc izotre cu prcsjund nesativi !i cu sislcm d. inchiddc auro'nati anjiii rcspocrma acc{or p'eoautii prcvirc rispindnco ilicc(i]lorcc sc ransnn pri,r picntuiitc hi Pulgge (slopi dc salivr rhptndiii in acr prjn tLNc. srinut. rorbit): accn pic un, inoircaic cn gcfteni patogeli. cad !c podca si sc 6ucn, rftnsformind0-s. in Draful bactcnrn crre cstc lDoi irlDiatl - ratcriolclc ncocsdm aplicini accsior prccautii vdr fi pestmlc pc un cincjor in llaE - prciclrtul\o fi p asar ifu-ocdmcd pmvrzuri ou toale.i completutila!.i vo\ oP rorrr{ a FoviNr - prcicoillDoatc i'npi4icanrcm cn Ln all bolna\.clrc arc acccasi.iccrnbci sc lor crpll.a pa.icntuhn$diliciptuccduril. dc izoldsi sc lor ati$ prcoutiilc dc izolar pe usa ca.sci pcotfl a intumra, in prcalaul, Dc orici[c sc vor sD6b Nairih nroirtc ri dupa icsnca dif caNn dc izoldrc.ir si lrc prrcu$u inr$vontilor d$prx pacicnl0luii se ra ixa nasca pe fa!d. Drin/ind o ntrmride irefun in dnpul maninulrni: . se ftsiaicfc lacieDtulsi utlll/e/. s.rvelele dehinie.comprcsc Dcnr .{iacopfi gun i Msul atunci ciird tuicstc, srrinuii ;i si lc colcclczc in rccificrtul dc ld pdri . riznaMii lor li inntoirisi podnc brlar. si diej p. cdr lc ror nrocum din auron.tutcu cchiDarnenb de proretric $ sa pistczc disranrd dc ccllUrln un melru liti dc prcienr: . dri ldcientul rRb ie si prrisc.sca cnm.ra ncnro invcnigrlii. va puna o msci ficiali bire firari pe guri )i nrs irr scrvrciul respectiv lr fi inlrii'rlrt dcsprc procauliunilc d. 1,? lr.cnuiii de prlrdire n infediilor trrnsnile prin coni|rt direct cu sc$chilc siu Sc \or tftgili mrlerlalele necesxre rplicirii [ecrnliikn de.orhd p. n cin'cnn if llin hrldrc. ni$ chidrsi.rl.i n,inu$l de unici lilosinF: ars.j pontucamera de i,llxEi ec1 rru pungi dc plaiic sc vor explicr pacicnt'lui/liDrillciFo.cduil.dc i,o atu: sc vordfie pc trs, aucvc pto.adiiponhr inlbnrardi sc vor spila mii'rilcinrinre i dlpi ie!re! dh c.mDia. si duni nrdcpdnarca nfmsitr: probclc biologicc iccokatc lor li pl.rde in curii iDpcrnclbic. cri.hcrare oorer sj s. v.r tinile lmedirt la hborito. sc vo' ak\r pc pdn* cxrcrn, a.rniilorin(n'ctilnide mancu.rc prudcntdl - vzna(orii vor n ln$ruirl si poarre Darusi i1 hntdc nc rot tlrarsrt vizrci !i ri ti spclc mainilc drpa indcFtrarc. cchip.ncn tr' lui de Folcclic: - l.r1e obiccrclc carc au rcnn ir .otrrad cu picicntul \or fi tlasatc inr. sinSud purga iotcmcabild ri sc vor m nlirdlc trc.csdc pcnr indLTinaEa sau penru dczinlickrcd - sr vor uriliza matciale scparilc pedn tlc.arc Fcicnr in panc (lcnnon.rcj rensiomctuc. s.'. c..i,cr 'c 'u ".J1 . ' i 'l"n.r ' i h,. r n.'_r'.dc - $ limirca?'i mobili^r.api!icnulul hrfa.rcxncrci: . in cazul dcplasirii pacieniului la diL re seFic n dc invc$igrlii i i toranc n!. sc vdr dcopcri lreil dnile dacb cxisa. iar scriciilc rcsncdive r.r fi informalc dcsp ptucaulitle de MoNToRULoFrc]ALALRoMANIE - !c lor schinba ninnsilc dupi lic.rE prcccduri cticruar; prcienrnluj g se vor spito n$i.ilc dupi indepi rrea fic.irui dnd dc mintrsi. l.S lrrautii dopreveniru, infecliilor Ir p&inti cu trutroponic Acc{c preclulii suntindi. c pmrtu prorectirpacicntilorcu: . SindtunrullrunodcficicrbiDohindilci boll inLcriorse cu eDplie ycziculrlil - rni!'nentcimunosuprcso.rc. Anlicrrer accslor Drccaulii variaza dc td m spirdt ta atruL, tiind influeniat ri dc lradtrl dc ETisicnr6 a olgani$nuluj pacicnrulli; Accstc prcc.trlii paniculaizarc in lundiic de paroloei. pacidtrLLuisunt: . rlz ed p(rc'tu|,n ..ng inh- r, ne' d. r/. d! (. pcrLF.pJ rq\J Il.nr i tnr na iculcbana[ii suspensie s, se dcpure sau si liD sodds. afira din cancr.ij ' limitEailaicului ircnnrmdcizolfci - tunotur haldrclor dcpmlccric. ntririlorsi rninutitor de citrc ticadnalltde hArijnc si de . urili/G! dc lcilcnc iriti ii de cchip0mcnr .omplcr de pmtc.rie in clat ingrijnii pxcieDtnhi cato. n'leriiun trnslla dcoltmi . \$larcr nriinilor in mrimtrhc ctdpcpdrn decodani.aRi triarcd lpidctuiologici prin coDroatc rigurorse {cxudar nno&ringir., examcn coprupardznologic. ridiogr"ii. pulfomri) a pcsoanclorcarc ingrrjesc tactentut, pcfrru a li idcn ri fi crli punatorii sinftoiii - elirara pio.cdurile inuziac la plcicntii cu nculbpcDic ntrtucir accsrco prczimi un i$ crcscur p.ntupacicnlll { imunilalc sot^tri; - peBonllul dc cur:ircnic va fi in(ruirsn,t puni hrLare. misri Sinrnusinraific si innc ir Mlrerialclc necesarc vor li DislmtD r_n .nticdncri lre un cSrucior specilt. - ntnltide unica tblosimii acopunorj pcntu incil!!mi'nei - se Dlascun nacicnlulsinxurint-o crh.di MONITORLLOF CALAL ROUAN]E . s. r\rlici nrrl.nruhLirfxmiLi.i prccruliunlLe de izorre pcnrto x i drnnnfa afxLcucn si f-i $iDnla cootcnr.i cu.clita dc iilriir: r \o. rfin Nnn.tnD lc0c u\rcrnrc.c: sr\o'spaLirilhilcctrtrtrxlcrdfriscp(irn(i'ncsidtr0,ir.|turaLcrlninonlfnrecr si rr rrcu'nLl rudtu il inqritinlor s.vorpun.h.lxrclcdcprorc!licsirl.nr\iL...nfti.nnrtcxuriL'ni.r{r dxnli v.rtiirtcrzis.!i7rlc1r. \orrcl{r curorc i..xllii,dbon\csrtrnrticIrc: ' drortc rrci.ntr'i m r. o bot'Li conhun*i nur.rirleLe sau obi.d.le crre Fisr\! unda dc to re Du nrr!\iLll FccxuliunlspeciaLe ni rlaftr.l.riiidNnr l-9 ltilizrrcx.chipimtntului dc iTolarc - prcrcnncr rnniniLrrii inl..rnlor dc h p.Aornx ira..L!i hr(ip.ciunri sxrdc Lr n.nh N{,nrlu uine irg,irire lr Drcirnri: rcdNdcarn.uhLiiifc.rinini.crlilttr.tri rfrtrre\.i7uri { | lclc cch ipalrntrLl izohror n, lnNr. dc \!,r: rorte coNpo0cDr.lc..hlp.lncnn,lui Llc nrorc.i.lhrxl rf-! cn Dti!f kn'!i $ \n.rl\rtr tcuorr.nirnn.Drini.ochcl.ridc|li(t.roc.hond.)srs.r.i/rid.D.lirtrrorlt ni DdcrixLr irr tufcLie de rr)cedun cxre unn.xTii \ctrgt.n.^m(.1!.r' ! cf.r,cLr. bctrziizolxlorr \r.in. tLL.n' rNrir rnrn..tr. d. nixni. Nfl ! cN/irxu Dncrnrlclor tblosirc r:lerlunru pmc.durii dr inb$$& \e +,ila Niinilc.u m rgrnr de ctr.itrrc rrF.fri( pcdn I prc\cni d.^okrrer mLcroorg.rlmc or i'r e.tunLL inu\i1.. sc inihm.. h. rtul iri sr irjliisoxn dcrtrtrl imllreiutrlclrprlrr pere uojtamr !bijrurii,. .ai.rcbr c rn o N!P.r. .onlplrl: - sc lcrui bi'r ) rcntrilc rtr sc r.!c htuorru s rp.i s. tcxll b.idcL! halrtutur irr jLn se .r.azri mr\cr conn)nlbil l]cft nrs si !u.i ri rc l.xg:i )lrentritc nrini ir r.! trica or.ifnrLi. {ir.i!dr dcsrs( sa I ilLftc.: (lr(ll snr rc$srri ocl,.lxri d! tror.cric. $'b n]rrgifex dc los a inantr!ilc se x,r nurc r{tiLi'rit si r.oNrc nrrsnrilc rnindcilorhrtatLt idc|nrcclrc indrpirh(i.chipinre tuluideprolerrir schrc$rmrJcIintLLd:iFrrllee\rem..lcrdripafl.nr'lu dc ]rt{..!! \unr rotrkrjimr.i cuniinr donrn.nLi inrninuvrii \eind.F rxTa nriid0si dc pc mria n.dornrnlnti mti' irl sc iftlcprncui sj miitrtr\r d. p. matir ioniin. a inroducird nnt.r' dou, JNgtre prr i 1 ,, i i I ' J 'p. i . ni !m lindqrinirii iifusilr nu \c \i ir! nicr.. o prn.r c\reM a x.ci..a: \crntr'c.ut nLrn,v.rl\NcirlNr[ cchirrn]cDro.ofilDn.arc. MONITORLJL OF C AL AL ROMANIE . se dczlcaen masca lnand-o numi dc lireruri i sc dqjorteudj de $cn6e4 h sa l pcnlru cchipanmrc conhmin el - daca pacientul arc o bo.h.c sc rispind.itc tc crlca.cnLlui. $a$ scv. indepinalhimr: sc dczlede'i hahtul din j!ru| situluii - sc prindc halalul do pancd cxrcdi dinre une Si sc tr.g. de pe mdncc i idorendu- t pe dos pc nrsura cc csc scos de pe coaj perm a cvirdconraminorcal se jnrc h.latul nrorccror ci1 n.i deplrtc dc utritormr. sc impiturcilc pe dos ri rc dcno/nerl.iin recipicntuL pcniru ccbitamcnlc conrhninatcj - 5c stala mliinilc si .mcbratclc cu sipun $i agenl lnliscl)lic inainrc dc a icsi din camera (da.5 chnNcb sc alliin.mcD pacienrului)i - !c inchide rcbinctul (dac. nu c$c aubmrtic) inlosind un pro$p de irAric cc sc rtunci in - se acfioncazi clonF '\sii, pcnlru a o dcschld.. rol$ind un alr pr.sop dc hdnic djnr: sc va jnohjdc lsa c.ncd, pc dimfari. cu ne.a ncprotcjdtl - daci dhiuvera esic in anccarn$a. sc vor srita miinitc St dnrcbialete cu satnn \i rgenl mliscpric d.p:l pirisned camerei de izolorci . dupi ficcorc trocc'l(i. cinrcioruld.luctu vr fi oldrar. dczintecrat :i dokr .0 oacnrtcte ncccsorc unci {lrc procoduri: .dmcn dc izolatu M fi complet curitaia si dcTinfedrlt ljupi c\rcmdrca p,cientuhi