ProCure Disposable Nitrile Gloves – Powder Free, Rubber Latex Free, Medical Exam Grade, Non Sterile, Ambidextrous - Soft with Textured Tips – Cool Blue (Large, 1 Pack, 200 Count)

HOW TO MAKE A PATIENT BED

Generally, patients spend most of the day in bed. Therefore, the clean and comfortable bed of the patient will affect the patient physically and psychologically. Patient bed should be tidy and clean. The following describes in detail how a patient bed should be made.

Making the bed: The bed can be made by one person or with the help of two people. Care should be taken to observe the body mechanics while making the patient bed. When making the patient bed, care should be taken to use easy-to-clean and durable materials.

Important Note: During the construction of the Patient Bed, platinum recommends opening the windows to ventilate the bedroom. When the room is ventilated, the patient bed is ventilated.

Materials to be used in Patient Bed Construction;
- Gloves
- Patient bed protective cover (Alez)
- Bed linen
- Linoleum
- Intermediate sheets
- Linens
- Blanket
- Pillow
- Pillowcase
- Pike

How to make an empty hospital bed?
- Hands are washed, dried, gloves are worn. This prevents contamination.
- The window of the room is opened and the room is ventilated. At the same time, the patient bed is ventilated during the construction of the bed.
- Clean bedding sets (bed top, bottom cover), bed sheet, linen sheet, intermediate sheet, blanket, bed linen, pillowcases and pique folded are kept next to the patient bed. The purpose of this is to provide convenience in bed construction and to prevent waste of time
- Borders of the patient bed are lowered for ease of application.
- To prevent contamination of the bed, the bed protector is laid on the mattress (mattress) by passing to the close side of the bed.
- For ease of application, Bed linen is taken, folded in quadruple width, folded on the bedside. The first floor is spread out on the opposite side of the bed, and the other floor is spreading towards the foot of the bed.
- In order to prevent the formation of bed sores and to ensure that the bed is tidy, the platinum bed is recommended to be tightened under the bed by making triangular corners.
- If necessary, the linoleum is placed in the middle of the bed (ready-made diapers can also be used).
- Intermediate sheets are laid on the intermediate linoleum (instead of the intermediate sheets, the bed linen can be doubled.) The linoleum and the linen on both sides of the bed are placed together under the tension. Objectives; To prevent contamination of beds and sets and prevent the formation of bed sores (decubitus)
- Blanket is put on the bed linen and laid on the sheets. The parts of the bed hanging from the sides are folded inward. Purpose of construction Prevent contamination of the blanket.
- Pike is placed on the bed linen, the edges are corrected curled under the bed with the foot bed linen. Objectives; To ensure regular beds
- Pillow cover is put on the pillow and placed on the bedside. It is made to create the bed arrangement and ensure the use of the pillow of the patient.
- Remove gloves, wash hands and dry. The purpose is to prevent contamination.

ATTENTION: When collecting dirty patient bed sets, tossing them and collecting them nicely, the microorganisms in the teams, skin rashes and the air into the environment. Therefore; while collecting bedding sets should be collected without hurling and their volumes should be reduced and thrown into the dirty cart.

Making the patient bed with the patient:
It is a system applied to change bed sets without removing bed dependent patients from patient bed. Apart from the materials used in the construction of an empty patient bed, it will help in making the patient bed; If necessary, the bolt or duck should be kept with you. Cleaning cloths also need to be kept in accordance with the need.
- The procedure for informing the patient is explained and permission is requested.
- During the construction of the patient bed, the patient's participation is ensured and communication is supported.
- Wash hands, dry and wear gloves to prevent contamination.
- To facilitate the application, bed linen is brought to the patient bed with a trolley or basket. Patient bed sets are taken according to the order of use.
- The window of the room is opened to allow ventilation of the room. Note that the room's door must be closed when the room window is opened.
- In order to facilitate the application again, tools such as whatnot, chairs and calling etc. are removed from the patient beds.
- To ensure the privacy of the patient, external images are prevented.
- The patient is asked if there is a need for discharge, if any, it is removed and cleaned first.
- If the patient needs to evacuate, the healthiest method is to clothe the patient. Sliders etc. inventory increases the risk of infection.
- After cleaning the patient's bottom is removed with gloves.
- The first thing to do to protect the privacy of the patient and prevent it from chilling is to cover the patient with diving.
- The collection of dirty bedding starts by pulling the blanket with bed linen under the pike to the foot of the patient.
- Blanket is removed from the bed linen and then put on the chair. To reduce the risk of infection in the linen, the dirty side is folded in and placed in the dirty bag.
- Starting from the remote area, the lower patient bed sets are loosened.
- The patient's pillow is removed and the sheath is removed and flipped again and thrown into the dirty bag. Pillows are put on the chair.
- The bearing border on the far side is removed. The patient is placed on the bed in the lateral position with the patient's back facing the nurse.
- Dirty bed linen is rolled or rolled up and pressed under the patient without disturbing the patient.
- Half of the clean bed linen is rolled or crimped and pressed against the patient.
- Linoleum and linen sheets are placed in the same way.
- Lift the bearing edge on the working side and move to the remote side. The bearing edge on the far side is lowered. The patient is turned laterally to the side where the clean bedding is placed.
- Dirty bed sets that we roll from under the patient are pulled and thrown into the dirty bag. Clean bed linen is pulled from the bottom of the patient towards the edge of the bed.
- The patient is placed in the supine position.
- All sides of the clean bedding are tightened and the corners are made triangular and compressed under the mattress.
- The corrected undercarriage must be taut and free of wrinkles. Relieve the patient. Prevent bed sores
- The blanket is laid over the patient with the head open.
- The blanket is placed inside the duvet with the corners of the blanket facing the corners of the duvet.
- Pike is covered on the bed linen with the patient's head open.
- Foot side is placed under the bed.
- Put a clean cover on the pillow.
- Etajer and calling bell are placed within the reach of the patient.
- Remove gloves, wash hands.
- Points to consider;
- Care is taken not to open the top while protecting the privacy of the patient.
- Screen or curtain is drawn around the patient bed.
- Room temperature is taken care of to prevent the patient from getting cold.
- The application is made by contacting the patient.

CHARACTERISTICS AND ARRANGEMENT OF THE PATIENT BEDROOM
In order to make patients feel comfortable and safe during the treatment process, patient beds should meet the requirements under appropriate conditions. In order for the patient to undergo a more efficient care process, it is important to arrange the bed in conditions that will increase the treatment efficiency. Patient bed models produced for patients may vary depending on the patient. Patient beds should be organized and organized. The patient must be electric and motorized to use the patient bed if necessary. Thus, the patient bed should be able to use the bed itself. While choosing from patient bed models, it is useful to choose an electric patient bed model.
There may be a single patient bed (single bed) or companion bed in the patient room.

How should the patient bed room be?
The Patient Bed should be designed to meet the physical and psychological needs of the patient and to allow the caregiver to perform the care of the patient comfortably.
The room where the patient bed will be placed should be at least nine square meters. Assuming that the companion sleeps in the same room, it should be at least fourteen square meters.
There should be a space-saving built-in cupboard in the patient room where the patient can put his / her special belongings.
The room should be designed so that the patient can be intervened at any time.
There should be at least one meter intervention area on the right, left and bedside of the patient bed. There should be at least thirty cm air passage at the head.
Ventilation and lighting of the room where the patient bed will be placed should be sufficient.
The wall color of the room where the patient bed will be placed should be selected from natural, soft and pastel colors in a way that will comfort the patient.
Patient bed rooms should be able to receive direct and sufficient amount of daylight, smooth and easy to clean walls and floors and be suitable for disinfection.
The patient bed wheels are rubber and the platinum bed recommends that all four have brakes. It is difficult to keep patient beds with four wheels without brakes, if there is play on the floor. In order to secure the patient bed without any problems, floor coverings should be preferred from durable, non-slippery and noise-preventing materials.
The patient bed should be easy to clean, durable and easy to move when necessary.
When arranging patient beds and room;
Regulation of physical environment
Ventilation of the room and patient bed
elucidation
good regulation of temperature and humidity should be considered.
1-) Regulation of Physical Environment
It is effective on the physical environment, human health and behavior. The regulation of the physical environment makes the patient feel safe, protected from accidents and infections, and the treatment process is comfortable.
The order of the physical environment should be soothing to the individual. The regularity of the physical environment also relieves the patient psychologically.

In the Patient Room;
There should be patient beds that are useful for the patient and can meet the physical needs of the patient.
Patient beds should be placed near the window according to the characteristics of the room.
The bedside table must have a drawer inventory or a patient dining table.
There should be a chair next to the patient bed so that the patient can sit as needed.
There may be a telephone and television in the patient's room for a better time. The platinum bed recommends that the patient bed be positioned so as not to interfere with watching television.

2-) Ventilation of Patient Bed Room:
The air of the closed room where the patient bed is located; It is polluted by the microorganisms that are scattered to the environment by the breath, sweat, smell, heat, humidity of the room. The oxygen of the air decreases and the carbon dioxide increases. In this case, the room should be ventilated.
In the environment of the patient bed; clean air, humidity and heat should be sufficient. The replacement of the ambient air with dirt and bacteria-free air is called ventilation. Ventilation is done in two ways. These; natural ventilation and artificial ventilation.

Natural ventilation of the Patient Bed Room: Before the ventilation process is performed, the procedure and its cause are explained to the patient. The patient should be protected from airflow and dressed according to room temperature. Doors and windows are ventilation by opening each other.

Artificial ventilation of the Patient Bed Room: It is provided by the use of ventilation systems. Special means are used in this type of ventilation. For example; air conditioners and ventilators can be used for this purpose. The patient is covered over the air conditioner or ventilator to protect it from the air flow while it is operating.
Ventilation also recommends that the platinum mattress be at least twice a day without crashing in the morning and evening.
The short stay in patient visits is an element preventing the room from being airless. The platinum bed recommends that the patient visit one at a time if possible and do not stay inside for long.

Patient Bed Room Things to consider for the prevention of bad odors:
Frequent replacement and keeping of patient bed sets is recommended, and platinum bed sets are recommended to be cleaned in a dry cleaner.
Keeping the materials used by the patient such as cups, spoons and forks in a clean and closed place
Giving importance to patient and patient bed hygiene
Cleaning the patient rooms with suitable materials
No smelling food (eg pickles, etc.) being introduced into patient rooms
Removal of residual nutrients from the room after meals
If the patient has changed dressing wastes should not be left in the room
If there is a flower vase in the room, its water should be changed every day.
There are ducks, sliders and so on. the bucket in the room is closed and the garbage bag is changed every day

3-) Illumination of Patient Bed Room: The desired level of illumination of patient bed rooms ensures that the patient is in a comfortable environment and that the procedures to be carried out are easy to carry out. Lighting is divided into natural and artificial lighting.

Patient Bed Room Natural lighting: The lighting obtained by using the sun. The sun plays an important role in health. The sun gives people joy, plays a role in the development of children; Gives natural heat and illuminates indoor areas and relaxes the person. The patient recommends the use of platinum bed windows and curtains to make the most of the sun in bed rooms.

Patient Bed Room Artificial lighting: Artificial lighting is the electricity provided by the lighting. In electrical lighting, it should be ensured that the light is not very bright and does not come directly into the eye. The general illumination of the environment should be sufficient. Adequate light in artificial lighting is important in creating a suitable environment for nursing care and treatment and ensuring safety. At night, the platinum bed recommends using light-emitting lamps that distribute light to the wall or ceiling so that patients are not disturbed by excessive light and are safe.

4-) Heat and Humidity in Patient Bed Room: Platinum bed is recommended to be 18-22 0C in patient bed rooms. This heat should be maintained in summer and winter. In summer, this heat is provided by opening the room door, window or by using cooling devices (air conditioning, ventilator, etc.). In winter it is maintained with central heating and air conditioning. In some applications, room temperature may need to be increased (such as a bed bath) .The cilia in the respiratory tract mucosa must be moistened with mucus to function. Drying in the mucosa increases susceptibility to infections. It is therefore important to moisten the inhaled environment. The humidity of the patient room air should be between 30-60%. If necessary, the humidity of the air breathing can be increased by special devices.

5-) Noise in Patient Bed Room: Noise is an important source of stress. Patients need a quiet environment in the hospital. Stimuli that may cause noise should be minimized in order not to disturb patients. 9 In the researches, it was found that the types of noise that disturbed the patients were the voice of personnel speeches, footsteps, patient shouts, telephone bell, food, dressing carts and elevator doors.

Some of the measures to be taken to prevent noise;
Making warnings that should not be spoken loudly,
Ensuring that the sound of the call systems is reduced in a way that does not interfere with communication,
To ensure that the wheels of moving vehicles are covered with rubber,
Choosing materials that do not transmit noise in material selection,
Appropriate warnings when there is noise,
Wearing silent shoes or slippers,
MATERIALS NEEDED IN THE PATIENT BEDROOM
The patient bed room should be designed and arranged to meet the needs of the patient. In the patient's room, patient bed, patient bed (mattress) patient bed sets (blankets, linens, pillows, etc.) chairs, oxygen system, if necessary, patient dining table is useful.

1- Patient Bed: According to the needs of patients, at least the head and foot tip should be raised and lowered. Controlled patient cots should be preferred and the control should allow both the patient's use and the caregiver's use. The feet are wheeled and should be able to move to the bedstead and when it is desired to be fixed, platinum bed recommends that all wheels should be braked as opposed to normal bedsteads. The patient bed should have a guardrail. Patient bed; at least the head and foot part of the shield, wheel, designed for patients with side railings are called beds.

2- Patient Bed (mattress): Patient bed to be used in the patient bed must be suitable for long-term bed. Bed models that minimize the formation of pressure sores should be preferred. For long-term use, the platinum bed 23 recommends the use of a mattress with a dance hardness, and an air bed to prevent wound formation in patients hospitalized for more than 10 hours per day.

3- Pillow: The pillow can be of various size and thickness. It is made of cotton, feather, fiber, sponge pieces and wool. Although useful and comfortable, wool pillow is not preferred because it is difficult to clean in hospital 10 conditions. The purposes of the pillow are; placing them under the head to sleep, positioning or supporting the patient, relieving the breathing of asthmatic patients and raising the extremities high. Viscoelastic pillows can be preferred for ease and comfort.


4- Pillow cases: The pillow case is used to prevent the pillow from getting dirty. It is made of cotton fabric or calico. The sheath must be slightly larger than the pillow to fit it comfortably.


5- Intermediate tarp: Intermediate tarp is used to prevent contamination of the patient bed. An average length of 70-80 cm and 60-70 cm width of linoleum, 40-50 cm wide fabric is added to the bottom of the mattress to compress. Disposable spacers are preferred. Linen sheets that cover the bed completely can be used in units where patient beds are frequently contaminated, such as emergency services, children's services and intensive care. Bed linen in contact with the bed and mattress protectors made of cotton material in contact with the patient are used.


6- Intermediate sheet: Intermediate sheet is used to cover the intermediate sheet. It is usually made two meters wide and one meter tall. If there is no intermediate sheet, the bottom sheet can be folded and used for the same purpose. Today, ready-made diapers are also used instead of intermediate tarp and intermediate sheet.

7- Bed linen: Bed linen is made of linen, cotton fabric or calico. The width and length of the bed sheet (mattress) can enter under the size. Today, sheets and corners with rubber edges are also used.

8- Duvet Cover: Duvet cover is made of cotton or calico fabric. It is used by passing a blanket. It should be large enough to accommodate blankets.

9- Pique: Pique is made of light, washable and cotton fabric. It is used with or as a single bed linen.

10- Blanket: Blanket is made of synthetic and wool blend. It is preferably used by passing through the linen. Can be used as a single. The light weight is preferred.

11- Dining table: Dining table, height adjustable, wheeled, easy movement of the bed on the table makes it easy to eat.

12- Chair: Chairs that the patient or companion can sit should be durable and comfortable. Seats should be preferred if possible. It should be preferred that it is easily cleaned and covered with microorganism free material.


13- Etajer: Etajer is a small cupboard with drawers where the patient can put his / her daily use goods such as glasses, water and napkins. patient bed


14AXX
ProCure Disposable Nitrile Gloves – Powder Free, Rubber Latex Free, Medical Exam Grade, Non Sterile, Ambidextrous - Soft with Textured Tips – Cool Blue (Large, 1 Pack, 200 Count)

AMMEX Medical Blue Nitrile Gloves - 4 mil, Latex Free, Powder Free, Textured, Disposable, Non-Sterile, Small, APFN42100-BX, Box of 100

Importance of Patient Accompanying Training

The Ministry of Health has taken steps in the field of patient companion, which has become a major problem in the country for many years and is needed in hospitals. The Ministry has initiated a trained, controlled and accompanied patient training program under the Ministry of Health. Those who completed the training of the patient companion received their certificates at a ceremony.

Specialist Nurse Mine Bahçeci, who gave the Patient Companion Training, explained the definition of the duty of the Patient Companion, the differences with the patient carer, how they went through a training process, and the criteria that those who want to start the profession by taking the patient companion training after that.

Differences between Caregiver and Patient Attendant

Specialist Nurse Mine Bahçeci, who made explanations about the difference of companions from the patient carer, said;

“Accompanying persons do not support the patient and the disabled in medical terms. Exactly the word equivalent of the companion is 'Patient Relative'. Accompanying person is the person who protects and supports the person in need in hospitals, home environment or when needed when he / she is with the patient and helps him / her in daily routine activities such as nutrition, cleaning, dressing and toilet. For example; like when one of our relatives gets old, is not self-sufficient and has difficulty in keeping up with his individual works, his sons alternately stand by and support the old person.

The caregiver serves the general public within the clinic, just like nurses or other health group workers. They do not serve as relatives of patients. They don't always look after a single patient. They give alternate institutional care to multiple patients in one cycle. They participate in all medical tasks together with the nurse.

Nowadays, there is a real need for people who can stand as relatives of the family and the disabled, and these companions are trained.

These are the reasons for a long time in our hospitals, uneducated people, mostly people who do not speak our language, citizens who can disrupt the order of the hospital to provide financial support for high amounts of companion service.

TC Accompanying Training Program ”was initiated as a result of the consultations of TRNC Ministry of Health with the Ministry of Health.

As a result of the TRNC Ministry of Health's consultations with the Turkish Ministry of Health, the Companion Training Program implemented by the Turkish Ministry of Health was reorganized by TRNC Ministry of Health educators' nurses. Within the scope of a project established by TRNC Ministry of Health, Ministry of Labor and Social Security and Orthopedic Disability Association, Patient Accompanying Program was established. Within the scope of this project, the Ministry of Labor contributed financially to the training fields and provided training materials to the project. The Ministry of Health team conducted the training program and the Orthopedic Disability Association provided coordination support to the project. Our companions are internship for one month. However, even during the internship period, we found that our hospitals and patients had a very shortcoming.

Even if there is a companion in health, the trainings do not end. As with all other health care workers, the training of both our attendants and caregivers will continue by the Ministry of Health.

The fact that ongoing public support trainings are brought under a project and extended to hospitalized patients shows that all these efforts are not wasted and that it is a necessary initiative that can really meet the need.

The first group training was completed on 25 January. The second group trainings were held on 25 February 2019 in Nicosia. Burhan Nalbantoglu State Hospital will start at Thalassamia Conference Hall and at Famagusta State Hospital Conference Hall starting from 4 March 2019 at 9.00. The trainings will last for 3 weeks as in the first group program.

2. TITLES OF THE TRAINING RECEIVED BY COMPETITORS

(You can find in the images)

3. DUTIES, AUTHORITIES AND RESPONSIBILITIES OF PATIENTS AND INDIVIDUALS WITH DISABILITIES

Position in terms of operation : Determined Responsible Nurse

Power of attorney and administrative commitment : Hospital Administration

Duties, Authorities and Responsibilities:

It is decided upon the request of the physician and the approval of the nurse, provided that it is a medical obligation to remain with the patient
Each companion works with the jerseys given to him. He does his job with his hair gathered, shaved for male companions and his fingernails cut to the edge of his fingertip.
Throughout his / her companion duty, he works in a patient-oriented manner without prioritizing his personal needs.
He does not leave his patient, and if he has to leave, he should get permission from his nurse. Working hours will be 08: 00-20: 00, 20: 00-08: 00. It takes 15 minutes to eat and 10-15 minutes for 2 times a day.
Accompanying persons cannot use tobacco or alcoholic substances within the hospital. Patient next to food is invincible. Also, the core does not chew gum.
He cannot take patients anywhere without the permission of the nurses.
Changes the bed linen that the patient is in under the supervision and supervision of the nurse.
Complies with infection control rules. The patient's companion must keep the hospital belongings clean and tidy, and the companion who is damaging the hospital's property must cover the damage.
The patient companion cannot use the empty beds in the ward. The patient companion does not speak loudly in the patient rooms and corridors and does not disturb the employees and other patients. He doesn't make a phone call neglecting his patient. Does not listen to music loud or uncomfortable. It does not take any action and behavior that will disrupt the service order.
It does not interfere with the treatment of the patient in any way (such as inserting, removing, adjusting the serum). The patient does not touch the monitor.
He doesn't sleep during his seizure.
Corrects if there is a situation in the patient's living area that may impair safety or create an accident risk. Keeps the bed guards closed.
The patient cannot benefit from personal interests.
The patient companion does not bring food or drink to the patient and does not give any food or drink to the patient without consulting the physician or nurse.
If the patient does not have the permission of the nurse does not give drugs next.
The patient companion (other than the physician and nurse directives) does not make any application for the patient.
With the knowledge and permission of the nurse, he gives duck and sliders to his patient. Urine and stool are either poured according to the nurse's directive or stored or stored for the nurse to see.
Performs perineal care in accordance with the training given. Helps mobilize patients with mobility under the supervision of a nurse.
Assists the nurse in preparing for the morgue if her patient is ex.
In case of a change in the patient's general condition (if he is not himself, his breathing is impaired, insomnia, dull look, awakening for a long time, excessive sweating, tremor, if he does not respond despite the call) immediately informs his nurse. Accompanying person can not take measures in his own way, can not practice.
If the patient has a catheter, if there is a change in urine color, if there is a leak, the patient will inform the nurse if the bed is getting wet.
The patient escort informs the nurse in case of any problems with the patient.
The companion helps the patient to the extent allowed. Apart from the treatment practices of the physician and nurse, the companion cannot make any application to the patient.
It is obliged to perform the duties given in line with the training.
The companion must follow hospital rules. In case of violation, the patient escort status of the person concerned is not accepted and / or legal action is initiated. The certificate is revoked.

4. QUALIFICATIONS REQUIRED FOR APPLICANTS;

- Being a TRNC citizen (TRNC ID card photocopy)

- To be at least a primary school graduate (Approved diploma sample is the original)

- Not having any physical, physical or mental disability that prevents him / her from doing this job (Current Health Report required)

- No offense to blame (character certificate from new police)

- Being in the 20-55 age range

- Petition (a petition stating that you want to be a companion and sign it)

5. WHERE TO APPLY WHERE TO APPLY

- The documents specified in Article 4 should be submitted to the Archive of the Department of Inpatient Treatment Institutions of the Ministry.


13AXX
AMMEX Medical Blue Nitrile Gloves - 4 mil, Latex Free, Powder Free, Textured, Disposable, Non-Sterile, Small, APFN42100-BX, Box of 100

Adenna Night Angel 4 mil Nitrile Powder Free Exam Gloves (Black, Medium) Box of 100

NURSE

You can entrust your relatives who are in need of care to a trusted, experienced doctor, nurse or caregiver who provides experienced elderly and patient carer services. If you say how to find a reliable and professional patient caregiver for your inpatient caregiver, day caregiver, patient or bedridden family member, your mother or father, as Quality Human Resources, we will find the most suitable personnel in a short time!

WHERE DO WE SERVE?
In the European and Asian sides of Istanbul, Turkey's 81 provinces, the US, Germany, we have been serving a lot of countries, including the UK and Dubai.

WHY US?
The caregiver you are looking for is available to you within 1 day.
You can change caregivers 2 times in 6 months.
Of the 10,000 registered CVs, the most suitable candidate is selected carefully.
All foreign nationals are on residence permit.
We have full references by private and legal persons we serve.

HOW DO WE FIND THE MOST SUITABLE PATIENT CARE FOR YOU?
You can send us your contact information in the form below. Our customer representative will call you to determine the service you want and the characteristics of the reliable specialist caregiver you are looking for and provide you with at least 4 caregiver profiles in 1 day with their pictures and references.

What if I don't stay satisfied with the caregiver?
After choosing the most suitable element from the options offered to you, our contract process starts. If you are not satisfied with the caregiver within 6 months, this 3-sided contract with you and our company is committed to provide you with 2 new employees with the same criteria.


12AXX
Adenna Night Angel 4 mil Nitrile Powder Free Exam Gloves (Black, Medium) Box of 100

ProCure Disposable Nitrile Gloves – Powder Free, Rubber Latex Free, Medical Exam Grade, Non Sterile, Ambidextrous - Soft with Textured Tips – Cool Blue (Medium, 1 Pack, 200 Count)

In-Hospital and Inter-Hospital Patient Referral and Infection Control

The personnel involved in patient referral within and between hospitals should first be made aware of and trained by hospital infection control committee members on hospital isolation measures. Standard precautions apply to blood, whole body secretions, excretions, skin and mucous membranes. These measures include all patients admitted to the hospital. Today it is called universal measures. Prevention measures include patients with proven or suspected infections or colonization with certain microorganisms.

These measures have been prepared for the care of all patients, regardless of the diagnosis or the estimated condition of the infection. Fulfilling standard measures is the primary strategy of success in hospital infection control. These measures are useful in reducing the risk of transmission of microorganisms that are the source of identified or unspecified nosocomial infections. Of these, washing hands or decontamination with hand disinfectants is generally indicated as the single most important measure to prevent the passage of microorganisms and reduce the risk of passage from one person to another or from one person to another. Although wearing gloves is important in hospitals, it is necessary to exchange gloves between patient contacts and wash hands after gloves are removed and decontaminate. Wearing gloves does not eliminate the need to wash hands. From hospital isolation measures, patient placement is also important in preventing direct and indirect transmission (a special room, etc.) for patients who cannot help maintain the infection control measures taken to limit the passage of microorganisms with environmental contamination.

In addition, face masks (respiratory protection, eye protection), goggles should be used to prevent contact of the mucous membranes of the eye, the mouth and nose with pathogenic microorganisms, while applying procedures that may sputter blood, body fluids, secretions and excretions. Protective clothing should be worn to provide a protective barrier and reduce the likelihood of microorganisms passing through the hospital. It is also worn when interfering or transporting to a patient infected with epidemiologically important microorganisms to reduce the risk of transmission to other patients or staff. If worn during the procedure, removed without leaving the room, contaminated with blood and body fluids should be disposed of in a medical waste bag and hands washed before leaving the room. Again, the tools and equipment used when dealing with patients require special attention and regulation. It requires special attention both during disinfection and placement. For those infected with an epidemiologically important pathogen in inpatients, additional measures as well as standard measures are required. There are three types of transitional measures. Airway precautions, droplet precautions and contact precautions.

Airway precautions: Monitored, negative pressure, specially ventilated rooms should be used. If the patient is going to be transferred from one room to another, an isolation mask must be worn. The room should usually be kept closed, and everyone who comes in should wear a respirator. Tuberculosis, rubeola varicella and so on. airway infections.

Droplet precautions: Droplet passage should not be confused with airway passage. A surgical isolation center should be used by persons who are within 3 m of the patient within the scope of droplet precautions, or by those who care directly with the patient. Patients should be allowed to leave the room only for the most necessary cases, and if the transplant is absolutely necessary, a surgical mask should be worn.

Infections requiring droplet prevention; mumps, whooping cough, meningococcal meningitis, Haemophilus influenzae infection (neonatal and pediatric pneumonia), influenza virus infection.

Importance of contact : Transition by direct contact is a very important and common form of transition, including indirect contact. Again, contact measures should be applied in addition to standard measures. In particular, these types of patients should be treated by wearing gloves and non-sterile gowns properly, hands should be washed without leaving the room and without contact with clothing. If it does not come into contact with blood and body fluids, it should be disposed of in different, if so, medical waste bags. Patient transport should be restricted to allow exit from the room only when necessary. If the patient is to be transported, precautions should be taken to minimize the risk of microorganism penetration to other patients, environmental surfaces and equipment. The equipment used in dealing with the patient should be dedicated to the use of a single patient as much as possible within the framework of contact precautions. Contact precautions should be applied to patients known or suspected to be ill in the following cases. Patients infected or colonized with multi-drug resistant microorganisms with Clostridium difficile enterocolitis, major infected wounds and pressure ulcers, respiratory syncytial virus (RSV), ebola virus infections.

Procedures to be applied in in-hospital and inter-clinic patient transport

1. Personnel to transport the patient should use the necessary equipment and clothing to prevent contamination of skin and clothing without placing the patient in a stretcher or wheelchair.

2. A clean sheet should be covered over the transport vehicle. If the vehicle can be contaminated with blood or body fluids, a disposable disposable pad should be laid on it.

3. After placing the patient on a stretcher or wheelchair, a clean sheet should be covered.

4. Personnel should remove the protective clothing, including gloves, used by them during transport on their way out of the room and wash their hands.

5. In particular, gloves that contact the patient should not be used during transport.

6. If the patient has persistent cough and sneezing, the patient should be provided with a clean box of tissue paper and a plastic bag to dispose of

7. An extra apron, a clean bed sheet, a waterproof disposbl pet should be carried in tow to be used to the patient when required.

8. If the patient is not capable of contaminating the vehicle with blood or body fluids, no action other than hand washing is necessary.

9. When the patient arrives at the other care unit, the carrier should check that the transport vehicle is contaminated with blood or body fluids. If contaminated, clean the vehicle with disinfectant.

10. Infected patients should not be referred to another service unless it is very necessary.

Patients should also be prevented from moving between services. For example; transport and isolation of critically ill patients to single rooms carries various risks. The available data show that isolation rules need to be reviewed in intensive care units where methicillin-resistant Staphylococcus aureus (MRSA ) carriers are endemic. Cross-infection cannot be reduced by taking MRSA-positive patients into single rooms, and more effective ways to reduce the spread of MRSA should be tried. Patients infected with vancomycin-resistant enterococci (VRE) should not leave their chambers as much as possible. Before leaving the room, the patient should wear a clean apron and wash his hands with an antimicrobial soap (chlorhexidine, etc.). The team carrying the patient must be informed about the patient's condition. Any equipment or articles touched by the patient should then be cleaned with disinfectant. The patient should avoid touching the general surfaces (oven, television, etc.), using the public places (kitchen) and being in places such as cafeteria and living room. After the patient is taken to a stretcher or wheelchair, the carrier personnel should leave their aprons and gloves in the patient's room and wash their hands before starting to move. Contacted gowns and gloves should not be used outside the room during routine VRE patient transport.

In addition to standard precautions, respiratory (airway) and droplet precautions should be taken in all patients with symptoms of respiratory infections in inter-hospital patient transfers . For example; Transplant personnel who are thought to be infected with SARS (severe acute respiratory syndrome) should be informed and experienced in the prevention. Such patients can be transported safely in any emergency vehicle (ambulance) if certain appropriate measures are taken. These;

1. During transport, patient and carrier personnel should wear surgical (high-protective) masks.

If it is not possible for the patient to wear a surgical mask, if the respiratory condition does not allow, the patient should cover his mouth / nose with a tissue when coughing.

2. Where possible, the driver and patient compartments must be separated from the vehicles and have different (separate) ventilation systems. The window or door between these compartments should be closed after the patient has entered the vehicle.

3. Ventilation of the vehicle should be such that it cannot recirculate repeatedly, so that the maximum volume of air entering the vehicle from outside. If there is a fan, the fan must be set up so that the air flows from the drive part to the patient part and then the air comes out. Some vehicles have circulation ventilators that pass air through HEPA filters without returning the vehicle to the vehicle. If there are no separate compartments in the vehicle and ventilation has to be used, open air vents are opened in the driver's area and the fans for air outlet are set to the highest setting. This creates a negative pressure gradient in the patient area.

4. Pre-hospital interventions should be avoided from procedures that cause coughing (mechanical ventilator, nebulizer).

5. Disposable aprons, gloves, eye protection and high efficiency respirator (high efficiency respirator) are provided for the safety of transport personnel. After the transport is completed, all such material should be treated as medical waste. Reusable patient intervention devices should be cleaned and disinfected according to the manufacturer's instructions. Every patient contact (inside the ambulance) must be thoroughly cleaned and disinfected. As a result, in inter-clinic and inter-hospital patient transfers, first of all the personnel in charge (physician, nurse, caregiver, etc.) should be educated and disciplined in order to apply the universal precautions and / or transmission route related to patient information.



11AXX
ProCure Disposable Nitrile Gloves – Powder Free, Rubber Latex Free, Medical Exam Grade, Non Sterile, Ambidextrous - Soft with Textured Tips – Cool Blue (Medium, 1 Pack, 200 Count)

SAS Safety 66518 Raven Powder-Free Disposable Black Nitrile 6 Mil Gloves, Large, 100 Gloves by Weight

External Contamination and Decontamination Techniques

Login

Contamination; the transmission of dangerous substances (chemical, biological, radiological and nuclear agents) to the human body, objects and the environment. The subject of this paper is contamination with radioactive materials. Contaminating radioactive substances may be in solid, liquid, gas and aerosol form and may enter the human body in different ways (skin, eyes, lungs, digestive tract, injection route). The most common form of external contamination in the human body is through the percutaneous (skin).

External External Dose Exposure ”means the person's external irradiation without being contaminated with radiation sources. The difference in contamination of a patient exposed to radioactive irradiation is that there is no physical contact or contamination with any radioactive material and that it has no harmful effects on the environment. External contamination is mentioned in the presence of physical contact with radioactive material in the human body, articles or environment.

Sources of radioactive external contamination can be summarized as follows (1):

- Accidents in medical treatment units (radiotherapy, nuclear medicine),

- Nuclear reactors,

- Industrial radiation,

- Lost / stolen medical / industrial radioactive sources,

- Accidents during storage, transportation,

- Terrorism,

- Dirty bomb,

- Attack on nuclear facilities, sabotage,

- Nuclear weapons.

The most common radioactive contaminants are alpha and beta emitters. Gamma-ray emitters cause the whole body irradiation. Beta emitters can cause skin burns and scars. Alpha emitters cannot penetrate the epithelium.

The devices used for detecting and measuring radiation to determine contamination and the amount of exposure are:

- Geiger Mller (GM) meter: Surface contamination meter. It provides a radiation measurement of radioactive material on a surface, a device suitable for measuring open radioactive material. It is used for soil contamination measurement, body contamination screening and routine workplace screening. Different probes are used to measure different types of radiation.

- Ion chamber.

- Personal dosimeters.

- Film dosimeter.

- Pen dosimeter (analog & digital).

Decontamination; to ensure the safety of people, goods and the environment by removing or inactivating chemical, biological, radiological and nuclear agents from the human body, objects and environment.

Decontamination has two main purposes:

1. To reduce the dose to which the patient will be exposed by removing harmful substances from the skin and thus the severity of the effects of the radioactive agent,

2. Protecting healthy people (emergency response teams, health teams, etc.) by preventing secondary exposure.

Decontamination in the first few minutes after exposure is the most effective way of protecting the patient, and it should not be ignored that the later decontamination process may benefit the patient by reducing the dose the patient is exposed to and protect healthy people from secondary exposure.

The first rule of controlling radioactive contamination is to limit the spread of the material. This is usually achieved by controlling the entrances and exits to the contaminated area, the use of appropriate protective clothing, minimization of the amount of radioactive material emitted in the air, and personnel monitoring (2).

Patients contaminated with radiological material are generally considered not to pose a potential risk to health personnel. Therefore, medical or surgical treatment should never be postponed. The first thing to do is to take life-saving measures independent of contamination.

As a result of nuclear terrorist attacks, many contaminated patients are encountered. Most of them are contaminated, not injured. Decontamination is the medical management of the panic and informing the public. These people should not be allowed to apply to hospital emergency services at the same time and lock the system. A triage area should be established outside the emergency room.

Radiation Measurement in Workplace Control

After the completion of the daily work in the radiopharmacy laboratory are:

- Materials such as injector casing, lead bottle protector, forceps are measured with GM counter for contamination. No contamination; these materials are removed from the closet for reuse. If contamination occurs; the lead is left behind for half-life or cleaning and measuring is done until the end of contamination.

- Tc-99m milking bottle is taken from working area like laminar flow / fume hood and left behind lead.

- Using GM, laminar flow / fume cupboard walls and the entire area are measured.

Decontamination Steps (2,3)

The first step of decontamination; decontamination. Everyone should be decontaminated, whether injured or not, if exposure is suspected.

The first principle for effective decontamination is to perform decontamination as soon as possible. Early decontamination is very important for chemical agents, especially those in liquid form. Since the absorption amount of liquid agents changes in direct proportion with the contact time, the removal of the agent in a short time decreases the penetration and absorption and minimizes the effects.

- Firstly, after taking life-saving measures and stabilizing the patient clinically, the first thing to do is to remove the people from the contaminated area. Contamination control should be performed by radiation measurement. Special transport measures should be taken for contaminated patients and a “decontamination area” should be established. In general, outdoors, the opposite direction of the direction of the wind blow is preferred, but in cases where the amount of agent in the air increases (continuation of the attack, etc.), closed areas may also be preferred. Radiation detection (in and out) should be performed in this area.

- Once the person has been taken to a safe place, clothing and accessories (jewelry, watch, clasp, etc.) are completely removed (cut if possible) and hair and skin decontamination is performed. Multiple shower systems can be installed for the injured. The removed clothing and accessories are placed in a medical waste bag, labeled and stored.

- Even simply removing clothes or combing the hair usually reduces the amount of agent carried by the patient to a large extent, and in some cases even provides the necessary decontamination.

- Secondary exposure to the liquid or gaseous agent in the patient's clothing and hair may cause contamination of the surrounding healthy individuals. It is therefore important that persons and health personnel in close contact with the contaminated person wear protective equipment (masks, clothing, pair of gloves, etc.).

- A decontamination area should also be established for health personnel.

- A place where people can rest after decontamination should be provided.

Decontamination Methods

1. Physical removal.

2. Detoxification.

The first and most effective decontamination is the physical removal of the chemical agent. Detoxification is the second target, but not always possible.

Decontamination Materials

- Gloves,

- Bag,

- Decontamination drugs,

- Absorbent paper, paper towel,

- Shoe covers.

Radioactive Area Decontamination

- The radiation protection officer shall be informed and supervised,

- Radioactive area is determined by measuring with radiation monitor,

- Immediately absorbing paper is placed on the contamination area to prevent its spreading, its surroundings are determined and passages are prevented,

- Absorbing paper is removed, paper towel is wiped from outside to inside and re-measured,

- Dry area is wiped and dried from outside to inside with towel moistened with decontamination drugs,

- Cleaning is continued until the radioactivity of the area is less than 2-3 times the background count.

Wound Decontamination

In the event of exposure to most radioactive agents, removal of clothing from the wound provides a substantial decontamination, no other method is necessary. However, additional measures may be required. During decontamination, all bandages that are suspected of contamination are removed and the wounds are washed with isotonic solution or water. If there is bleeding after decontamination, the wound is bandaged again. During decontamination, the skin should not be rubbed; rubbing of the skin accelerates the penetration of the agent to the skin (2,3).

Personnel Decontamination

- The bottle of radioactive material breaks, spills and so on. In this case, everyone in the room proceeds to the door and calls for help,

- The radiation protection officer is informed and decontamination is carried out under his supervision,

- Everybody in the room is measured by using radiation monitor.

- Contaminated clothes are placed in plastic bags and waste is applied,

- Radiation measurement is done again, if contamination continues, showering is provided,

- Skin; Wash with mild soap and plenty of water, no hard brush or irritant soap,

- Body; areas are marked and quickly entered into the shower,

- Eye; rinse with plenty of water and saline, take precautions for irritation,

- Hair; It is cleaned with a mild detergent and care is taken to the eyes, ears and mouth area when washing.

Patient Management and Decontamination (2,3)

- Carefully take off the clothes and personal belongings of the injured, bag them, store them safely (contamination is reduced by 95%).

- Take biological samples from the injured (nasal smear) if possible.

- Treat foreign objects as if they were radioactive material until otherwise instructed.

- Decontamination priority:

a. First wounds, then solid skin.

b. Start at the most contaminated area.

- Replace the outer gloves after each injury.

- To minimize contamination, shave mustaches and beards with the aid of an electric machine.

- Cover non-contaminated wounds with waterproof material.

- Contaminated wounds:

a. Irrigate with sterile material.

b. After consultation with a specialist, remove contaminated debridements and store in a safe place.

- Avoid aggressive intervention.

- Change the cleaning agent frequently.

- Decontaminate scalp and intact skin with soap and water.

- Cover cleaned and dressed wounds with waterproof material.

- Additional measures may be taken for sweating the injured hands and feet (surgical gloves).

- Detect and measure after decontamination.

- Accumulate the medical devices used in sealed bags and special containers.

- Always use stretchers in the dirty area.

decontaminant for

An ideal decontaminant should be capable of removing or neutralizing or detoxifying all known agents from the human body, articles and environment. During decontamination, responsible personnel should wear protective clothing.

Properties of Ideal Decontaminant (4,5,6)

- Effective against chemical, biological, radiological and nuclear agents, toxic industrial substances, toxic industrial chemicals and new threats,

- Neutralizing all chemical and biological agents,

- Safe to use on skin, eyes and wounds,

- Able to clean the agent under the skin,

- Easy to apply,

- Ready to use,

- Fast action over a wide temperature range,

- No toxic product,

- Can be stored for a long time,

- Accessibility,

- Not to increase percutaneous absorption of the agent,

- No irritant,

- Hypoallergenic,

- It must be easily destroyed.

Substances recommended for skin decontamination:

- Water and soap,

- Dry decontaminants,

- Liquid decontaminants,

- Chemical decontaminants.

Water and soap: Liquid decontaminants are best suited for decontamination of large or uneven surfaces. The most suitable decontaminant for decontamination of health centers and equipment is soapy water. Washing using high amounts of soapy water removes the agent by hydrolysis and is also an extremely inexpensive method. It is also a convenient and practical method for emergency decontamination.

One liter of water, five milliliters of soap by putting; For decontamination suitable liquid is prepared (Approximately 1 bucket of water 3 spray). Depending on the amount of water used for decontamination, it is collected in tanks, neutralized or directly supplied to the sewer.

Dry decontaminants: All substances capable of absorbing and drying liquid agents and then removing them by means of wiping or brushing without damaging the skin can be used for decontamination of liquid agents. Clean sand, clay, baking soda, Fuller soil, dry or wet wipes are applied to the liquid agent, after absorbing the agent, it is removed from the skin. Maximum effectiveness is achieved if the absorbent is applied within the first 4 minutes after exposure. However, dry decontaminants are not suitable for wound decontamination.

Liquid decontaminants: Liquid decontaminants are available to rapidly decontaminate radioactive contamination. It can be applied directly to leather, clothing, all surfaces, plastic and glass materials, laboratory equipment. It removes radioactive particles, the resulting composition is non-toxic and is removed from the contaminated area by washing with water. It is not used for wound and eye decontamination. After application to the contaminated area, it is dried with dry and clean paper towels.

Chemical decontaminants: 0.5% sodium or calcium hypochlorite solution is used for skin decontamination and 5% for equipment decontamination. The solution should be prepared before use, should not be prepared and kept in advance. The pH of the solution should be at alkaline pH (pH 10-11). Hypochlorite solutions (bleach) are not suitable for eye and wound decontamination and may cause corneal damage and adhesions.

Post-decontamination procedures

- Record in record format,

- Investigation of the causes of contamination,

- Take necessary measures to prevent it from recurring.

Result

It is essential that health personnel first protect themselves. Protective clothing is a must. Decontamination is not a simple process. It requires a high number of staff, materials and effort. Effective decontamination has two basic principles: the shortest time and the most appropriate method. If an attack is suspected, everyone is considered contaminated and decontaminated, whether injured or not, until proven otherwise. During skin decontamination, the skin should not be rubbed, it accelerates the penetration of the rubbing agent into the skin.


10AXX
SAS Safety 66518 Raven Powder-Free Disposable Black Nitrile 6 Mil Gloves, Large, 100 Gloves by Weight

BeeSure BE1116 Nitrile Powder Free Exam Gloves, Small (Pack of 100)

Endotracheal Aspirate Culture Used to Diagnose Ventilator-Related Pneumonia Comparison of Mini-BAL Culture

SUMMARY

The aim of this study was to compare the culture results of endotracheal aspirate (ETA) and mini-bronchoalveolar lavage (BAL) methods, which are used to quickly and accurately identify the possible cause of ventilator-associated pneumonia (VAP), especially in intensive care units. Thirty (32.2%) patients who developed VAP from 92 patients who were followed up on mechanical ventilator between June 2010 and June 2011 in our intensive care unit were included in the study. The diagnosis of VAP was made clinically and radiologically; The patients were evaluated with clinical pulmonary infection score (CPIS) scoring system and CPIS value> 6 was considered in the diagnosis. ETA and mini-BAL samples were collected before VAP patients; In addition, two blood cultures and urine cultures were obtained from the patients. Microbiological evaluation and identification were performed using conventional methods and the Phoenix 100 automated system (BD Diagnostic Systems, USA). Bacterial growth of> 10,000 cfu / ml for BAL and> 100,000 cfu / ml for ETA was considered significant in the evaluation of quantitative cultures. The mean age of patients who developed VAP (n = 30; 18 males) and non-developed (n = 62; 39 males) during mechanical ventilation; 68.23 ± 16.19 and 52.16 ± 10.41 years; the duration of mechanical ventilation was as follows; 29.57 ± 15.78 and 12.11 ± 6.01 days. When examined by multivariate logistic regression analysis; advanced age (p <0.001) and duration of mechanical ventilation (p <0.001) were independent risk factors for VAP development. There was a statistically significant difference between CPIS values ​​of patients with and without VAP (6.8 ± 1.15 and 2.71 ± 1.06 points, respectively; p <0.001). Accordingly, the use of a CPIS score was considered useful in the diagnosis of VAP in patients with mechanical ventilators. In our study, 16 strains (six Acinetobacter baumannii , three Pseudomonas aeruginosa , one Klebsiella pneumoniae , six Staphylococcus aureus ) and 30 strains (16 A.baumannii , six P.aeruginosa , four Klebsiella ) from ETA cultures of 30 patients with VAP pneumoniae , two, Escherichia coli , six S.aureus ). Contamination rate was 27% (8/30) in ETA cultures, while no contamination was observed in mini-BAL cultures. There was no growth in 20% (6/30) of ETA cultures and 7% (2/30) of mini-BAL cultures. Pathogenic bacterial growth (six A.baumannii , one K.pneumoniae ) was detected in 7 (87.5%) of the mini-BAL cultures from eight patients with ETA contamination. Similarly, pathogenic bacteria (two E.coli , two K.pneumoniae , one P.aeruginosa ) were isolated from mini-BAL cultures of 5 (83%) of six patients who had no growth in ETA culture. No statistical correlation was found between the culture results of the samples taken by ETA and mini-BAL methods (p = 0.464). The agreement between the culture results of the samples taken by ETA and mini-BAL methods was found to be 50%. In conclusion, due to the increased risk of contamination in ETA culture methods and higher isolation rate from mini-BAL samples, it was concluded that mini-BAL sampling would be more suitable for EAP instead of ETA microorganisms.

Key words: Ventilator-associated pneumonia; bronchoalveolar lavage; mini-BAL, endotracheal aspirate; culture.

ABSTRACT

The objective of this study was to compare the results of cultures obtained by mini-bronchoalveolar lavage (BAL) and endotracheal aspiration (ETA) techniques, used for rapid and accurate determination of pathogens causing ventilator-associated pneumonia (VAP) in intensive care units. Of the 92 patients on mechanical ventilation followed by the emergency care unit of our hospital between June 2010 and June 2011, 30 (32.2%) patients were diagnosed as VAP and they were included in this study. VAP diagnosis was based on clinical and radiological findings. Clinical pulmonary infection score (CPIS) of> 6 was accepted as the clinical criteria of VAP. Initially ETA samples were collected from the patients followed by mini-BAL sampling 15 minutes later, together with urine and two blood cultures. Microbiological evaluation and identification were performed by conventional methods and Phoenix 100 (BD Diagnostic Systems, USA) automated system. In quantitative culture analysis,> 10,000 cfu / ml for BAL and> 100,000 cfu / ml for ETA were accepted as positive results. The mean ages of VAP-developed (n = 30; 18 were male) and nondeveloped (n = 62; 39 were male) patients were 68.23 ± 16.19 and 52.16 ± 10.41 years, respectively, and the mean durations of mechanical ventilation were 29.57 ± 15.78 and 12.11 ± 6.01 days, respectively. Multivariate logistic regression analysis showed that older age (p <0.001) and duration of mechanical ventilation (p <0.001) were independent risk factors for VAP development. VAP and not (6.8 ± 1.15 and 2.71 ± 1.06, respectively; p <0.001). The use of CPIS for VAP diagnosis has been found to be useful in patients on mechanical ventilation. In our study, a total of 16 strains (six A.baumannii , three P.aeruginosa , one K. pneumoniae , six S.aureus ) were isolated from ETA cultures, while 34 strains (16 A.baumannii , six P.aeruginosa , four K. pneumoniae , two E. coli , six S. aureus ) were isolated from mini-BAL cultures of 30 VAP patients. The contamination rate for ETA cultures was found as 27% (8/30), however there was no contamination in mini-BAL samples. The rates of negative cultures for ETA and mini-BAL were 20% (6/30) and 7% (2/30), respectively. Seven (87.5%) of the eight contaminated ETA samples, yielded pathogenic bacterial growth (six A.baumannii , one K. pneumoniae ) in mini-BAL samples. Similarly, of the six negative ETA samples, 5 (83%) yielded bacterial growth (two E. coli , two K. pneumoniae , one P. aeruginosa ) in mini-BAL samples. Statistical analysis with Spearman test indicated no positive correlation between the results of mini-BAL and ETA (p = 0.464), and the concordance between the results of these methods was found as 50%. It was used in the study of mini-BAL instead of ETA samples for the isolation of causative microorganisms of VAP.

Key words: Ventilator-associated pneumonia; bronchoalveolar lavage; mini-BAL; endotracheal aspirate; cultura.

Received Date: 14.11.2011 • Accepted Date: 13.03.2012

LOGIN

Ventilator-associated pneumonia (VAP) is pneumonia that develops 48 hours after intubation in a patient without invasive mechanical ventilation and without pneumonia during intubation 1 , 2 . Tracheal intubation and mechanical ventilation increase the incidence of pneumonia 7 to 21 times 3 .

The diagnosis of VAP is very difficult. Studies have shown that 50% of patients diagnosed with VAP clinically do not have VAP, whereas approximately 1/3 of patients with VAP cannot be diagnosed 4 . Diagnosis alone is not sufficient clinical evaluation, radiological methods, microscopic and microbiological examination of respiratory secretions are needed. The clinical pulmonary infection score (CPIS) may also contribute to the diagnosis of patients with VAP. In this scoring, the presence of CPIS> 6 increases the probability of pneumonia. One of the important criteria for the diagnosis of VAP is the diagnostic criteria of "Centers for Disease Control and Prevention (CDC)". In addition to all these diagnostic criteria, the diagnosis of patients with clinical suspicion of VAP should be supported by microbiological cultures. Respiratory tract samples are obtained by bronchoscopic and nonbronchoscopic methods. Today, nonbronchoscopic methods are preferred more because of its ease of use and less cost.

Microbiological examination of endotracheal aspirate (ETA) sample is the most commonly used method in the diagnosis 1 . Another method used for diagnosis is the examination of mini-bronchoalveolar lavage (BAL) sample. The most important advantage of this method is to minimize contamination with possible upper respiratory tract flora. The aim of this study was to compare the results of ETA and mini-BAL culture used to quickly and accurately identify the possible cause of VAP, especially in intensive care units.

Materials and Methods

Selection of Cases and Data Collection

Thirty patients (32.6%) diagnosed as VAP were included in this study from 92 patients who were followed up in mechanical ventilator between June 2010 and June 2011 in the internal medicine intensive care unit of our hospital. All patients who were seropositive to human immunodeficiency virus (HIV), who received immunosuppressive therapy, and who had radiotherapy and / or chemotherapy oncology, and who had mechanical ventilation for more than 48 hours were included in the study. The patients underwent a physical examination every day; Daily fever follow-up, daily leukocyte count and chest x-ray every three days. The amount and character of tracheobronchial secretion were also noted at the same time; mechanical ventilation times were recorded. Clinically diagnosed patients with VAP were evaluated with CPIS scoring system and CPIS was considered to be over 6. Antibiotic use of the patients was monitored before culture. ETA, mini-BAL, two blood cultures and urine cultures were obtained.

Clinically, VAP was defined by adding at least two of the following criteria to the newly detected infiltration or increase in existing infiltrative involvement on chest X-ray: (1) Fever (> 38.5 ° C) or hypothermia (<36 ° C), (2) Purulent tracheobronchial (3) leukocytosis (12,000 / µL) or leukopenia (4000 / µL). Pneumonia developed in the first four days in patients who underwent mechanical ventilation was defined as early-onset VAP and pneumonia developed in the fifth and subsequent days were defined as late-onset VAP.

Taking Samples

Collection of the ETA sample: Fourteen F sterile aspiration catheters ( Figure 1A ) were advanced through the endotracheal tube and further distal 2 cm. The tip of the aspiration probe was connected to the aspiration device. 5-10 ml of ETA was obtained in the aspirate tube 6 .

Picture 1

Mini-BAL removal: 10-15 minutes after ETA removal , a mini-BAL catheter (Combicath ® ) ( Figure 1B ) was advanced blindly through the endotracheal tube. When catheter progression stopped, the outer catheter was withdrawn and the inner catheter was advanced 2-3 cm further. 20 ml of saline was administered through the internal catheter. A sterile syringe was aspirated to obtain 1-3 ml of bronchoalveolar fluid.

Microbiological Methods

After the sample was vortexed for 1 minute, sheep blood agar (CCA), chocolate agar and EMB agar were added with 0.001 loop. CCA and chocolate agar were incubated for 48 hours in a CO 2 oven and EMB in an aerobic environment for 48 hours. Plates were checked after 24 hours and no growth was expected at the end of 48 hours. Gram staining was performed from the colonies. Bacteria were identified as gram-negative or gram-positive as a result of gram staining and evaluation of growth in culture plates. Species identification and antibiogram tests of the bacteria were performed using the Phoenix 100 automated system (BD Diagnostic Systems, USA). The colonies of single fallen bacteria on the blood agar were removed with sterile swabs and the McFarland was adjusted to turbidity of 0.5-0.6. Bacterial suspension prepared from gram-negative bacteria was placed into the device via the Phoenix NMIC / ID panel and gram-positive bacteria were placed into the device via the Phoenix PMIC / ID panel. Reading and evaluation procedures were performed automatically by the device.

The quantitative evaluation was performed as follows: The total number of colonies was multiplied by 1000 and the result was the number of bacteria per ml. If this number was over 10,000 for BAL and over 100,000 for ETA, the result was considered positive. The values ​​below were evaluated as oropharyngeal contamination. In addition, Corynebacterium spp., Group A beta-hemolytic streptococcus and Neisseriae spp. As it was found in normal throat flora, it was not defined as VAP agent and was considered as contamination.

Statistical Evaluation

After the data were transferred to the computer, SPSS 15.0 package program was analyzed. Frequency, percentage, mean, standard deviation, minimum and maximum values ​​were used as descriptive statistics. The difference between the groups with and without VIP in terms of age and duration of mechanical ventilation was compared with Student-t test and CPIS with Mann-Whitney U test. The chi-square test was used to compare the two groups in terms of gender. The effect of gender, age and duration of mechanical ventilation for VAP development was examined by multivariate logistic regression analysis. Spearman correlation was used to determine whether there was a correlation between ETA and mini-BAL in the VAP group. A p value of <0.05 was accepted for statistical significance.

RESULTS

In the intensive care unit (ICU), between June 2010 and June 2011 due to mechanical ventilation, 18 (60%) of the 30 patients who developed VAP were male and 12 (40%) were female; Of 62 patients who did not develop VAP, 39 (63%) were male and 23 (37%) were female. Table I presents the age, follow-up time and CPIS score characteristics of patients with and without VAP during mechanical ventilation.

Table I

Of the 30 patients diagnosed as VAP, 24 (80%) were mortal during the follow-up and treatment period; Six patients (20%) were discharged from the ICU after completion of their treatment. The rate of VAP development in internal ICU was 18.3 per 1000 ventilator days.

ETA and mini-BAL samples were taken in all 30 patients who developed VAP during mechanical ventilation. The reproduction results of these samples were shown in Table II . Mini-BAL cultures showed higher bacterial growth than ETA cultures; It was determined that contamination which was 27% in ETA cultures was not seen in mini-BAL cultures and Escherichia coli and more than one microorganism growth could not be detected in ETA culture in mini-BAL cultures.

Table II

Acinetobacter baumannii , Klebsiella pneumoniae growth was observed in 6 (75%), 1 (12.5%) of the mini-BAL cultures taken from eight patients whose endotracheal aspirate sample cultures were evaluated as contamination. In the ETA sample, E.coli was isolated in 2 (33%), K.pneumoniae in 2 (33%) and P. aeruginosa in 1 (17%) of six mini-BAL specimens without reproduction. In 1 (17%) sample, mini-BAL culture also showed no growth ( Table III ).

Table III

In the statistical analysis, the mean age (68.23 ± 16.19 years and 52.16 ± 10.41 years; p <0.001) and the duration of mechanical ventilation (29.57 ± 15.78 days and 12.11 ± 6.01 days, respectively; <0.001). When the effect of gender, age and mechanical ventilation duration for VAP development was examined by multivariate logistic regression analysis; It was found that gender was not a risk factor in the development of VAP, whereas mechanical ventilation time and patient age significantly increased the risk of developing VAP independently of each other and gender. OR = 1.205, 95% CI = 1.104-1.316 and p <0.001 for mechanical ventilation time, OR = 1.162, 95% CI = 1.074-1.258 and p <0.001 for age.

The results of Mann-Whitney U test revealed significant differences in CPIS scores (6.8 ± 1.15 and 2.71 ± 1.06, respectively) between the patients with and without VAP (p <0.01).

As a result of statistical evaluation with Spearman test, no significant correlation was found between the culture results of the samples taken by ETA and mini-BAL methods (p = 0.464); The agreement between the culture results of the samples taken by ETA and mini-BAL methods was found to be 50%.

DISCUSSION

VAP is the most important infection seen in patients undergoing mechanical ventilation in ICUs. According to the results of various studies, 28-85% of patients who underwent mechanical ventilation may develop VAP 2 , 7 , 8 , 9 , 10 , 11 , 12 . In our study, 30 (32.6%) of 92 patients who underwent mechanical ventilation developed VAP. This ratio was found to be compatible with other studies conducted in our country and in the world. In studies performed, 2.5-39 VAP development rate was found in 1000 ventilator days in patients who were connected to ventilator 2 , 3 , 8 , 13 , 14 . In our study, the rate of VAP development was found to be 18.3 per 1000 ventilator days, which was consistent with previous studies.

Advanced age is one of the important risk factors that increases the risk of nosocomial pneumonia 2-3 times 2 . Besides, it carries 1-3% risk increase for VAP development every day due to mechanical ventilator 15 . In the 16 studies of Gedik et al., The mean age of the patients who developed VAP was 56 years and the mean duration of mechanical ventilation was 20 days. In the study performed by Khilnani et al. 17 , mean age was 55.6 ± 16.17 years, mean mechanical ventilation time was 34.88 ± 32 days; In another study by Bacakoglu et al. 18 , the mean age was 63.9 ± 19 years and the mean duration of mechanical ventilation was 7.4 ± 6.3 days. In our study, the mean age of patients who developed VAP was 68.23 ± 16.19 years and the mean duration of mechanical ventilation was 29.57 ± 15.78 days. As a result of the multivariate logistic regression analysis of the data obtained in our study, patient age (p <0.001) and duration of mechanical ventilation (p <0.001) were determined as a risk factor for the development of VAP. a correlation was shown.

The most common cause of mortality among hospital-acquired infections is pneumonia. The rate of mortality in VAP cases varies between 24-76% 16 , 17 , 18 , 19 , 20 , 21 , 22 . In our study, the mortality rate was found to be 80% and this rate was higher than the other studies. This was thought to be due to the long mechanical ventilation periods and the advanced age of the patients. In addition, other underlying conditions, ICU stay and increased frequency of A.baumannii infection in ICU during this period may be other causes of mortality.

The major disadvantages of CPIS calculation used in the diagnosis of VAP are the differing interpretation of variables by clinicians and incorrect calculation of scoring 23 . The presence of CPIS above 6 increases the likelihood of pneumonia. In a study, the diagnosis of VAP; The sensitivity of CPIS ≥ 6 was 93% and the specificity was 100% 23 . However, some researchers have indicated that CPIS should be used in the evaluation and management of treatment 24 . Khilnani et al. 17 , mean CPIS score of patients diagnosed with VAP was 6.76 ± 1.67; Bacakoglu et al. 18 reported 7.2 ± 2.1 points. In our study, the mean CPIS score was 6.8 ± 1.15 points in patients with VAP and 2.71 ± 1.06 points in those who did not, and the difference between the two groups was significant (p <0.001). Based on these results, the use of CPIS score may be useful in the diagnosis of VAP in patients with mechanical ventilators. In a study, mini-BAL, bronchoscopic BAL, bronchoscopic brush culture results and CPIS values ​​of CPIS ≥ 6 patients were compared; The correlation between CPIS and mini-BAL was 80%, the correlation with bronchoscopic brush was 86%, and the correlation with bronchoscopic BAL was 76% 17 . In our study, the agreement between CPIS and ETA was 60% and the agreement between mini-BAL was 80%. However, in addition to all these diagnostic criteria, the diagnosis of patients with clinically suspected VAP should be supported by microbiological cultures.

Gram-negative bacteria are most frequently isolated as VAP agents in the studies 16 , 17 , 18 , 22 , 25 , 26 , 27 . In our study, it was observed that the most frequently isolated microorganisms were gram-negative bacteria. Khilnani et al. 17 reported that 88% of pathogenic microorganisms causing VAP were grown in mini-BAL culture and 68% in ETA culture. In our study, A.baumannii , P.aeruginosa and S.aureus (methicillin resistant or susceptible) isolation rates in mini-BAL and ETA cultures were as follows; 53% and 20%, 20% and 10%, 20% and 20% respectively ( Table II ). It was thought that the high A.baumannii ratio in our study may be due to ICU flora. Therefore, it is important to carry out surveillance studies in each hospital and in each ICU in the same hospital, to detect environmental contamination in these units and to determine their resistance profiles. Thus, effective empirical antibiotic therapy for an infection with high mortality can be determined.

Quantitative culture of mini-BAL ( protected telescoping catheter (PTC)) is used instead of bronchoscopic methods for the diagnosis of VAP especially in some centers because of the low level of contamination due to upper respiratory tract flora, not an invasive method and high specificity 26 , 28 . However, the most common method used for the diagnosis of VAP in centers without bronchoscopy is the quantitative culture of ETA. The most important disadvantage of this method is the high level of contamination due to upper respiratory tract flora 29 . In our study, oropharyngeal contamination was detected in 27% of ETA samples, while no contamination was observed in mini-BAL samples. Seven out of eight patients with contamination in the ETA specimen were found to have pathogen bacterial growth in the mini-BAL specimen culture ( Table III ). In the study of Fangio et al. 30 , the sensitivity and specificity of ETA quantitative cultures were reported as 89.5% and 66.7%, respectively. In contrast, Elatrous et al. 26 , when the cut-off value was 10 4 cfu / ml, the sensitivity and specificity of ETA quantitative culture were 92% and 85%, respectively; reported that when the evaluation threshold was taken as 10 5 cfu / ml, these rates were determined as 84% ​​and 90%, respectively. In our study, sensitivity and specificity values ​​of ETA and mini-BAL quantitative culture methods could not be determined due to lack of control group. The clinical and radiological diagnosis of VAP in this patient group led to this limitation.

In the studies, a strong agreement (77-88%) was observed between the results obtained with mini-BAL and bronchoscopic brush methods. 17 , 31 , 32 , 33 . In contrast, Khilnani et al. 17 reported that among the methods used to obtain distal airway specimens, ETA was the most unsuccessful in obtaining the correct specimen; Bacakoglu et al. 18 reported 67% agreement between ETA and mini-BAL. In our study, the agreement between ETA and mini-BAL was found as low as 50%.

Advantages of nonbronchoscopic methods include; less invasive, requiring less experienced personnel, affecting less oxygenation, continued ventilation and respiration during the procedure, less intracranial pressure increase and arrhythmia, less risk of contamination and less expensive 17 , 23 26 , 30 . Although Mini-BAL is a blinding method, it is quite compatible with the results obtained with bronchoscopic brush. Routine application of bronchoscopic methods in ICU patients is not possible in our country and other developing countries. Therefore, evaluation of nonbronchoscopic techniques is important. As a result, in our study, there was no significant correlation between ETA and mini-BAL culture methods, increased risk of contamination in ETA culture method and higher isolation rate from mini-BAL samples. It has been considered.


9AXX
BeeSure BE1116 Nitrile Powder Free Exam Gloves, Small (Pack of 100)

AMMEX Medical Clear Vinyl Gloves - 4 mil, Latex Free, Powder Free, Disposable, Non-Sterile, Large, VPF66100-BX, Box of 100

URINARY TRACT INFECTIONS IN CHILDREN

Urinary tract infection (UTI) is one of the most common infections in childhood. It is the second most common cause of upper respiratory tract infections. It is the infection of any part of the urinary system (kidneys, ureters and bladder) with germs, especially bacteria.

The infection is called “cystitis se only if it is located in the bladder and iyel pyelonephritis sa if it reaches the kidney. In the first year of life, it is more common in boys, especially in uncircumcised babies, while the frequency increases in later years. It is generally seen in 3-7% of girls under 5 years of age and 1-2% in boys.

WHY IS URINARY TRACT INFECTION IMPORTANT IN CHILDREN?

Urinary tract infection is usually recurrent in childhood and often has an underlying urinary tract anomaly that facilitates the development of UTI. In addition, it may cause kidney damage and cause serious problems such as high blood pressure, pregnancy problems and chronic renal failure in long-term follow-up. The risk of developing kidney damage is higher in patients who develop at an early age (especially in infancy), who are treated late and have recurrent UTIs. For all these reasons, it is very important to define the first UTI, to treat it adequately and timely and to follow it up appropriately.

HOW DOES URINARY TRACT INFECTION IN CHILDREN?

Under normal conditions, urine is sterile and contains no microorganisms. The most common agent of UTI in children is intestinal bacteria and 80-90% is caused by bacteria called Escherichia Coli (E. coli). Less frequently, other bacteria and rarely viruses and fungi also cause UTI. Bacteria that settle and proliferate around the anal and genital area enter the urinary canal, called the urethra, first reach the bladder and then the kidney, and multiply there, causing infection. Less frequently, bacteria can come directly into the urinary tract through blood or infection of neighboring organs.

INCREASING THE RISK OF URINARY TRACT INFECTION IN CHILDREN

1-Newborns and babies are prone to UTI because their immune systems are not fully developed, especially in the first months of life.

2-Because the urethra is shorter in girls, germs reach the urinary tract more easily and UTI develops more easily.

3-In uncircumcised boys, especially in the first year of life, bacteria grow more easily under the foreskin and may pass to the urinary tract and cause infection.

4-Structural disorders of the urinary system disrupt the flow of urine to facilitate the development of UTI. The most common disorder is vesicoureteral reflux (VUR), which is called urinary escape from the bladder to the kidneys. In addition, urinary stenosis and many rare renal anomalies lead to the development of UTI. For this reason, renal disorders detected by ultrasonography performed in the womb should be followed up after birth.

5-Bladder emptying of the urinary disorders or urinary problems in children who hold the urine flow slows down the bacteria can not be sufficiently cleaned and UTI can develop easily. Constipation, which disrupts the emptying of the bladder due to the pressure of the intestines, is one of the reasons facilitating the development of UTI.

WHAT ARE THE SYMPTOMS OF URINARY TRACT INFECTION?

In infants under two years of age, the findings are not specific to the disease. UTI should be investigated in every baby with high fever. The baby's intermittent urination, crying while urinating, male baby's urine can not gush, the smell of urine to be warned families are signs. However, in addition to these, prolonged jaundice, tendency to sleep, decrease in movements, crying, moodiness, restlessness, loss of appetite, malnutrition, diarrhea, vomiting, and inability to gain weight constitute the UTI symptoms.

Older children may express their complaints. In urinary tract infection, ie cystitis, symptoms such as burning while urinating, frequent urination, urgent urination, bad smelling urine, incontinence, and bloody urination are observed. Infections involving the kidney are accompanied by symptoms such as fever, vomiting, side pain, and abdominal pain. These patients may also have complaints such as growth retardation and inability to gain weight.

HOW IS THE DIAGNOSIS OF URINARY TRACT INFECTION?

The presence of white cells and bacteria in the urine test may suggest UTI. The definitive diagnosis is made by the growth of bacteria in urine culture. For the urine culture, the beginning and end of the urine is thrown out and the mid-stream urine sample is taken in older children. In children and infants who have not yet been able to tell the urine, the most commonly used method is to connect the bladder after the necessary cleaning. As this method is highly likely to contaminate, the bag should be replaced frequently. In some cases, urine can be taken from the urethra with a urinary catheter or a needle under the umbilicus to enter the bladder. Urine specimens reach the laboratory immediately, preventing the possibility of contamination and providing a more reliable result.

HOW TO TREAT AND TREAT URINARY TRACT INFECTION?

Urinary tract infection is treated with appropriate antibiotics for 7-14 days. In addition to UTI treatment in children, it is very important to examine risky patients with various imaging methods and to apply preventive treatment in order to prevent the development of new infections. Renal ultrasonography is the most commonly used method for research purposes. If necessary, urinary cystography can be performed by attaching a catheter to the bladder for VUR detection. The scintigraphic examinations performed in the departments of Nuclear Medicine can be used to investigate the damage and functions of the kidney. Adequate fluid intake and hygiene as a preventive treatment, frequent emptying of the bladder, prevention of constipation, correction of voiding disorder, if any, and circumcision of boys are recommended. Apart from these precautions, some selected patients should be put on continuous preventive antibiotic treatment.

As a result, it can be ensured that the risk of kidney damage can be minimized by the good cooperation of the family and physician, the initiation of appropriate and timely treatment, and the necessary preventive measures by taking adequate precautions in the necessary patients.


8AXX
AMMEX Medical Clear Vinyl Gloves - 4 mil, Latex Free, Powder Free, Disposable, Non-Sterile, Large, VPF66100-BX, Box of 100

MedPride Powder-Free Nitrile Exam Gloves, X-Large, Box/100

What is dysentery disease? What is bacillary dysentery?

Dysentery is an infectious and epidemic large bowel disease associated with diarrhea. Bacilli dysentery is spread as a result of human faecal contamination of water sources and foods. People suffering from bacillary dysentery should receive appropriate antibiotics and fluid-electrolyte supplements as well as easy-to-digest foods and plenty of water. So, what is Basilli dysentery?

Bacilli Dysentery; It is an acute gastrointestinal infection caused by Shigella species. Because human is the only source of active bacteria in nature, the disease is spread by human faecal contamination of fecal sources of water and food in society.

How is it transmitted?

Even a small number of Shigella group bacteria (only 10 bacteria) can cause the disease to occur. The disease is transmitted through contaminated water and nutrients. Fecal-oral spreading occurs rapidly in environments where cleaning conditions are inadequate, inadequate and safe domestic water is not available and hands are not washed. Waterborne outbreaks occur, especially when sewage is mixed with water. Transmission can also be person to person. It passes directly or indirectly from the patient or carrier by fecal-oral route.

What are the symptoms?

The onset of symptoms usually begins 2-4 days after oral ingestion of the microorganism, but may also extend up to a week. The disease usually lasts for a few days, but sometimes it can last for weeks. Shigella; It causes diarrhea by irritating the intestinal mucosa. Headache, nausea and vomiting, fever rapidly rising to 38 ° C, cramp-like abdominal pain, tenesmus (painful defecation) with bloody diarrhea begins. The stool may contain blood, mucus or pus. However, in one-third of cases, only watery stools may occur. In rare cases (young children), referral may occur. The healing process of the disease lasts 4-7 days.

How is it diagnosed?

Since the clinical picture caused by shigellas cannot be distinguished from other dysentery-like conditions, especially amoebic dysentery, the diagnosis is based on laboratory examination. Laboratory outcome is critical, especially in the direction of treatment (for the differentiation of antibiotic or antiparasitic drug administration). In addition to clinical findings, the diagnosis is made by the production of agents in culture made from stool samples taken from the patient. Antibiotic resistance should also be investigated.

The disease is spread by human faecal contamination of water resources and food in the community, and people living in these areas are most affected.

What is the treatment?

Appropriate antibiotic and liquid-electrolyte support, as well as easy to digest foods and plenty of water should be given. Sick persons should consult their physician as soon as possible.

What are the ways of protection?

There is no vaccine for the disease. Control of drinking and potable water, adapting living conditions to hygiene conditions and paying attention to hygiene rules are the basic protection measures. It is practically impossible to prevent the spread of the disease in the community, in the absence of an improved sewage system and safe drinking water. Therefore, national public health strategies should include improvement of sewerage systems, water and food hygiene, public education and the use of antibiotics.


7AXX
MedPride Powder-Free Nitrile Exam Gloves, X-Large, Box/100