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How to Prevent Infections in Intensive Care ?

Intravascular catheters are widely used especially in intensive care units for fluid replacement, parenteral nutrition, blood and blood product transfusion, drug applications and hemodynamic monitoring. However, catheter use causes infectious and noninfectious complications. The risk of catheter infection is 1-2 / 1,000 catheter days. Intravascular catheter infections are important causes of morbidity and mortality. Coagulase-negative staphylococci, Staphylococcus aureus, enterococci, aerobic gram-negative bacilli and Candida albicans are the most common microorganisms that cause catheter infection [1] . The treatment of catheter infection varies according to the catheter used, the type of infection developed and the causative microorganism [2] . Therefore, the definition should be made well ( Table 1 ) [1-4] .

DIAGNOSIS

Clinical Diagnosis

The sensitivity and specificity of the clinical findings are low in catheter infection. Catheter infections are clinically seen as skin infection, subcutaneous tunnel infection, thrombophlebitis, bacteremia, sepsis, infective endocarditis, metastatic infections (diffuse abscesses, osteomyelitis, septic arthritis) [3,5,6] . Catheter infection may present with local and / or systemic symptoms.

Local infection findings: Inflammation at the site of catheter entry is one of the most common signs of infection. Redness, heat increase, pain, and exudate are encountered around the catheter exit site. Phlebitis develops in up to 30% of patients with a peripheral venous catheter, but catheter-related infection occurs in up to 10% of cases [3,6] . In tunneled, long-term catheters, such as Hickman-Broviac catheters, exit site infection can spread through the catheter (over an area greater than 2 cm), causing cellulite [3,4] . Inflammation, fluctuation and cellulitis around the implanted port, and sometimes necrosis in the skin covering the port [1,3-5] .

Systemic findings: Fever, chills, tremor and bacteremia may lead to septic shock. Hypotension, hyperventilation, respiratory failure, abdominal pain, vomiting, diarrhea, confusion, convulsions may occur in patients going into shock [3,5-7] .

Peripheral or central septic thrombophlebitis may be accompanied by chills, chills, fever and shock; this is especially the case in gram-negative bacilli infections [3,5,6] . Conditions suggesting catheter-related sepsis are summarized in Table 2 [1-6,8] .

Shock occurs more frequently when the infusate is contaminated and has a fulminant course; however, these findings are not common in catheter-related infections [3,5,6] .

Embolic events or other signs of metastatic infection may occur (such as Candida endophthalmitis) [5,6,9] .

Laboratory Diagnosis

Clinical findings (evaluation of local and systemic findings in patients with catheters) and microbiological studies are two important aspects of the definition.

In some cases, radiological investigations are also applied (investigating thrombotic / embolic events: radiographs, ultrasonography (USG), computed tomography (CT), radiological evaluation after venous catheter administration or venous Doppler USG study showing fibrin formation or intra-lumen narrowing. may contribute to the diagnosis of catheter infection [9-11] .

Gram Staining

Gram and acridine staining from catheter discharge is helpful in rapid diagnosis, but its sensitivity is low compared to quantitative methods [12,13] .

Catheter Outlet Culture

Swab culture from the catheter outlet site predicts catheter-related infection by 66%; the absence of reproduction in the culture indicates that the catheter culture would be 97% negative [6,11,14] .

Catheter Culture

The catheter can be semi-quantitative (Maki method) or quantitative (sonication method) culture; they are more specific than qualitative cultures. The predictive value of quantitative and semi-quantitative cultures varies according to the type, localization, type of culture and source of colonization. In the semi-quantitative culture, the tip of the catheter is rolled onto the media surface and ≥15 colony bacteria growth is significant in the culture after a 24-48 hour incubation period [1,4,6,11,15,16] . To assess the bacteria in the catheter lumen, 1 mL of tryptic line broth is sonicated in the catheter or sonicated in the broth, followed by seeding after 100 consecutive dilutions. At the end of 48-72 hours of incubation at 35 ° C, 10 2 or more colonies are indicative of catheter infection. With this method, it is possible to reach not only microorganisms that are on the outer surface of the catheter, but also lumens and biofilm adherent microorganisms, and sensitivity and specificity have been found to be generally 80-90% in the studies and it is a sensitive method especially for catheters that remain in place for more than 1 week. 20% more sensitive than the method [1,5,7,14,17] . Bacterial growth 18-24 hours after the catheter tip is simply thrown into a liquid medium does not give specific results due to the possibility of contamination during removal and this seeding method is not preferred [1,14,15] .

If the catheter is not removed, Gram staining or quantitative culture of the catheter outlet smear together with catheter hub cultures may help to diagnose.

Another method that does not require catheter removal is to take the sample through the kat brushing içinden technique, allowing the biofilm in the catheter lumen and the microorganisms attached to the thrombus to the end to be grown and cultured in culture; however, this method has a 6% risk of transient bacteremia [5,18] .

Blood Cultures

At least two sets of blood cultures should be taken from patients with suspected catheter-related infections. In case of suspected catheter infection, quantitative culture is performed from the blood taken from a peripheral vein with the relevant catheter lumen or the reproduction time of blood cultures taken from automated systems is monitored. Skin antisepsis should be considered when taking blood culture, contamination can lead to misleading results. The positive predictive value of catheter and peripheral venous blood culture for catheter infection was 63% and 73%, respectively; negative predictive value is 99% and 98%, respectively [19] .

If the number of colonies detected in the culture of catheter blood is 5-10 times higher than the culture of peripheral venous blood, the diagnosis of catheter infection is made. In automated systems that detect reproduction by signal, catheter blood reproduction is 2 hours before the peripheral vein blood sample, indicating catheter infection; sensitivity and specificity of this method have been reported as 91% and 94%, [1,4,7,8,11,14,20] . Simultaneous blood culture from catheter and peripheral blood allows diagnosis and selection of appropriate treatment in Hickman Broviac or subcutaneous central venous catheters without catheter removal. A single positive blood culture is important for the diagnosis of candidemia [2] .

Bacteremia due to infusion fluid is rare. The growth of the same microorganism in infusion fluid and blood culture is diagnostic. Clinical manifestations immediately after infusion suggest bacteremia due to infusion fluid.

PROTECTION

Catheter-related precautions and catheter-related infections can significantly reduce catheter-related infections and bacteremia. Risk factors associated with catheter infections should be considered at the point of prevention ( Table 3 ) [4,6,21] .

Catheter Indication

For catheter insertion, it should be indicated first.

1. Inadequate venous access,

2. Requires long-term total parenteral nutrition (TPB) or chemotherapy,

3. Venous sclerosing agent application,

4. Indication of catheter insertion in emergency situations.

Unnecessary catheter application should be avoided and the catheter removed when the indication ends [4] .

Infusion Treatment Team

Written rules on infusion therapy and catheter use should be established and updated regularly. A team of pharmacologists, infectious diseases and clinical microbiologists, nurses and physicians performing intravenous (IV) interventions may be involved in the preparation of guidelines and guidelines. Special IV treatment teams can be established for IV interventions. The formation of experienced infusion treatment teams can reduce the catheter-related infection rate by 8-10 times. Especially in centers with a high incidence of catheter infections, it is more economical to appoint an infusion treatment team. In the absence of a team to monitor the event at all levels, relevant health personnel should be trained at regular intervals [4,22,23] .

Selection of Catheter Type and Place of Application

Catheter type and site are effective on the risk of infection development ( Table 3 ). For example, the rate of infection in central venous catheters is higher than in peripheral venous catheters; in adults, the venous catheter to the lower extremity (femoral) is more risky than the upper extremity (subclavian <jugular) [21] . In the upper extremity, the risk of infection in the upper hand veins is lower than in the upper arm and elbow. On children's hands and feet or scalp may be preferred. Infection in peripheral venous catheters is lower than central venous catheters. For central venous catheter insertion, the risk of infection in the subclavian vein is lower than in the jugular and femoral vein. If there is no contraindication, the subclavian vein should be used instead of the jugular and femoral vein [24] . It should be noted that down cut-down dı increases the risk of infection. Multi-lumen catheters should not be used unless specific indications, as they are more infected. Multi-lumen catheters are useful when different fluids such as long-term high-dose chemotherapy, blood products, total parenteral nutrition (TPB) are required. If a multi-lumen catheter is used, a lumen should be reserved for hyperalimentation [24] . Multi-lumen and multi-purpose catheters have a high risk of developing infections, so these types should be avoided as much as possible [4,22,23] .

The catheter should be chosen with the lowest and most economical risk of infection according to the treatment considered, and the catheter should be removed immediately after the indication is eliminated. The construction material is also important in the selection of the catheter. Polyvinyl chloride and polyethylene catheters have a higher risk of thrombosis and infection than teflon, silicone and steel titanium catheters [4,23] .

Many microorganisms (staphylococci, candida) show more adhesion than polyvinyl chloride catheters, polyurethane and teflon catheters. There is a greater risk of mechanical complications (obstruction, thrombosis, leakage, displacement) with polyvinyl chloride catheters. The risk of infection in steel needle use is similar to that of Teflon catheters. However, irritant IV fluids used from steel needles can escape into subcutaneous tissues and cause complications. Steel needles should not be used in cases where such fluids should be given [4] .

Dacron cuff in non-implanted catheters causes inflammatory reaction and fibrosis. Dacron cuff does not prevent the development of infection [22] .

Central venous catheter (SVC) or peripherally inserted SVC (PSVC) should be used if treatment longer than 30 days is required in patients older than 4 years. Tunneled or implanted catheters should be used when longer treatment is required [24] .

Catheter Installation

Maximum barrier and asepsis precautions should be taken during catheter insertion. Particular attention should be paid to the rules of asepsis (hand washing, long-sleeved sterile shirt, mask, cap, large sterile drape, sterile gloves ...), especially when inserting a central venous catheter [6,23,25,26] . Using local antimicrobials (mupirocin, chlorhexidine), washing the catheter lumen with antibiotics, using catheters with antiseptics or antibiotics, and tunneling are among these measures [2,4-6,22,23,27-29] .

In case of insertion or removal of catheter, daily examination of catheter insertion area, before and after dressing, hands should be washed. Water, soap, antiseptic soaps or alcohol-based gels can be used in hand washing [30,31] . Sterile gloves should be worn after handwashing during catheter insertion / removal [4,22] .

The most important point during catheter insertion is skin cleaning; 2% chlorhexidine, 10% povidone iodine and 70% alcohol are more effective for this purpose [25] . Povidone iodine may be used in patients with chlorhexidine allergy. If povidone iodine is used, it should be applied for 3 minutes and iodine should be allowed to dry. The use of post-iodine alcohol in povidone prevents irritation. Organic solvents such as acetone should not be applied to the skin before catheter insertion. In addition, routine administration of antibiotic pomades instead of catheter access is not recommended [24] .

The bristles at the catheter inlet can be cleaned, but should not be shaved. It is useful for patients to bathe with disinfectant before catheter insertion. After skin cleansing, the entry site should not be palpated (palpable if working in a sterile area).

Catheter Care

Catheter infection rates (infection per 1,000 catheter days) are monitored by regular surveillance. In this context, variables such as catheter wearer (s), catheter insertion time, catheter insertion site, catheter type, treatment administered, and catheter removal time should be processed and evaluated on surveillance forms. Complaints and symptoms related to catheter infections should be evaluated daily and necessary diagnosis and treatment procedures should be performed in case of suspected catheter infection [4,6,22,23,29] . An intravenous catheter should be applied and the patient should be examined daily. Wound dressing should be performed after catheter insertion. Porous adhesive dressings should be used instead of occlusive dressings. Good quality sterile gauze is used for dressing; In recent years, transparent, semi-permeable and polyurethane dressing has been increasing in practice [4,22] . The dressing of the peripheral catheters can be changed every 72 hours. It is reported that this period can be extended up to 7 days [31] . The dressing should be changed when the catheter is altered, removed, or when the dressing is contaminated, wetted, loses its sealing ability, and bleeding occurs [22,24,31] . Wash hands before and after dressing change. Sterile or clean gloves should be used when changing dressings [30].

Catheter Insertion Time and Replacement

Peripheral venous catheters should be replaced after 72-96 hours, and if the catheter is inserted in an emergency, it should be replaced within 48 hours [30] . The catheter can be left in place as long as there is no sign of inflammation in children and the catheter works. Artery catheters can be left in place for 6 days and pulmonary artery catheter for 5 days; suitable for longer periods in children. Leaving catheters in place longer than the specified periods increases the risk of infection. The total parenteral feeding catheter may remain in place for up to 30 days [4,22] . Routine replacement of central venous catheters has no role in preventing catheter infection.

The IV administration sets do not need to be replaced before 72 hours unless otherwise indicated. There was no difference in the risk of infection between the replacement of peripheral catheters at 72 hours and at 96 hours [30] . If blood, blood products, lipid solutions have been administered, IV administration sets should be changed at the end of the infusion or within 24 hours.

Catheter hubs and ports should be cleaned with alcohol, chlorhexidine or povidone iodine prior to drug administration [21] . Sterile syringes should be used in every attempt.

Washing Solutions and Anticoagulant Usage

In long-term catheters, there are various recommendations for washing the lumen with washing solutions and anticoagulants. The use of heparin for this purpose prevents the development of thrombophlebitis, but facilitates coagulase-negative staphylococcal growth in catheters. The use of EDTA reduces the risk of infection due to coagulase-negative staphylococci. In high-risk patients, washing with EDTA and minocycline may prevent recurrent catheter infection [4,22] . Low-dose warfarin prophylaxis is useful in preventing thrombosis in patients on long-term intravascular catheters [21] . Patients should be educated verbally and in writing about catheter care and hand washing.

Filters

Filters prevent the passage of contaminated liquids. It reduces the risk of phlebitis due to infusion. It prevents the passage of gram-negative microorganism endotoxins. However, fluids such as dextran, lipid, and mannitol can lead to clogging of the filters and reduce the efficacy of drugs, so the use of filters for infection control is not recommended routinely [30] .

Antibiotic Prophylaxis and Antibiotic Catheters

Although antibiotic pomades administered during and after catheter insertion may prevent the development of infection, they increase the risk of Candida colonization; mupirocin administration, for example, reduced internal jugular catheter colonization by 5-fold; but the same effect was not observed in peripheral vein and artery catheters; and the use of prophylactic mupirocin has led to selection of resistant strains. Antibiotic pomades are not recommended for catheter dressing applications at additional costs [6,22,23,27,29] . Systemic antibiotic prophylaxis is also not required. The use of prophylactic glycopeptides may cause selection of resistant microorganisms [21] .

Antibiotic (vancomycin / teicoplanin, minocycline + rifampin), antiseptic (chlorhexidine, chlorhexidine + silver sulfadiazine) coated catheters have been shown to reduce the risk of infection with antiseptic hub administration [23,28,29] .

The use of antimicrobial-containing catheters may lead to the development of resistance to the antibiotics used [32] . The duration of protection in antimicrobial catheters was reported to be 14 days. In this context, it is recommended to limit the use of such catheters in cases where infection rates and risk of sepsis are high. Antibiotic catheters should be used when short-term (<10 days) catheter insertion and at risk of catheter-associated bacteremia (total parenteral nutrition, immunodeficiency, intensive care stay) and if the catheter will remain for more than 4 days [24,30,31] .

Antibiotic lock prophylaxis is to wash the catheter lumen with antibiotic solutions and then release the antibiotic into the catheter lumen. Vancomycin and ciprofloxacin were used for this purpose. Routine use of vancomycin cannot be recommended since vancomycin may cause a risk of enterococcal resistant infections [30] .

Indications for Catheter Removal

In cases where catheter-related infection is considered but there is no redness, tenderness, purulent discharge at the catheter insertion site, the catheter should be removed and cultured from the tip. A new catheter is inserted from the same place via the guide wire. If culture is negative, the catheter is left in place, if culture positivity is present, the catheter should be removed and a new catheter inserted from a different area. Indications for catheter removal as a result of catheter infection are given in Table 4 and cases where they can be left in place are given in Table 5 [1,3-6,8-11] .

As a result; appropriate catheter and catheter placement, aseptic catheter placement, proper catheter care, replacement of the catheter if necessary, avoidance of antibiotic prophylaxis are the basic rules that must be followed in preventing catheter infections.

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Radiation and radioactive materials have become an indispensable part of today's modern society and industry. With its unique properties, radiation provides benefits in many areas, particularly in energy, industry and health. Some of these uses are: precision clock production, sterilization, DNA sequencing, determination of metal fatigue in aircraft and generation of large amounts of electrical energy. The range of application of radioactive materials is so extensive that modern life is unthinkable without these materials. We benefit from the benefits of this technology as well as the necessary safety during the production, use and storage of these materials. If safety precautions are not taken properly, radiation accidents will be inevitable.

General Preparation in Hospitals to Intervene in Radiation Accidents

Hospitals should regularly assess the risks in the environment they serve and have the necessary personnel and equipment available in accordance with the risk they determine. However, a minimum level of preparation is required in all hospitals. Since hospitals will need to cooperate with the fire brigade, the security forces and the relevant government agencies, it is beneficial to establish a certain level of relationship with these units. It should be kept in mind that decontamination can be completed at the scene to a great extent if the teams performing the first response to the accidents intervene as necessary (1,2).

A planned activity should be initiated when there is a notice that a radiation casualty will be brought to the hospital. The person answering the phone should try to get as much information as possible about:

- Number of wounded,

- The medical condition and the type of injury of each injured,

- whether the survivors were screened for radiation,

- Radiological status of survivor (irradiated?, Contaminated?),

- Material causing contamination,

- Estimated time of arrival.

If there is doubt about contamination, the victim should be considered contaminated until proven otherwise. If the hospital has a special entrance for this type of incident, the ambulance personnel will be warned. If the notification comes from someone other than the emergency response teams, the telephone number to be requested is called back to verify the event before alarming the radiation responding team and starting preparations.

If a hospital is to respond to persons exposed to irradiation or contamination, provision should be made for such a situation. First, a treatment area should be identified. This area should be known by everyone and all the services of the hospital should be easily accessible. The treatment unit should be equipped with facilities to treat life-threatening wounded. Generally, a part of the emergency department will be allocated as “radiation emergency area” (RAA). Some centers have separated the morgue section for this purpose. However, the environment is not suitable for patients and relatives, and the necessary equipment for intervention may not be available in this section. In addition, the media may make inaccurate inferences due to the location of the patients (1).

Ideally, the RAA should have a separate entrance from the emergency room. This prevents entry-exit of other patients. However, this is not an absolute requirement. Access to RAA should be limited to personnel who will intervene in patients. RAA should be considered as a contaminated area. Everyone entering this area should wear protective clothing as if intervening in a septic phenomenon. No one should leave the RAA without a full-body contamination scan. Since the whole body scan will take 10-15 minutes at a time, unnecessary entries and exits to this area should be prevented. Personnel should remain in this area until the intervention is completed (1,3,4).

A region other than RAA is designated as the buffer region. In this zone, there should be a cabinet with all kinds of special equipment that may be needed to intervene in the radiation accident. Entry and exit to this buffer zone is limited to a nurse or staff assigned to this area. This area is considered a potentially contaminated area. The nurse in the buffer zone communicates with other emergency services and transmits any other material that may be needed, such as mobile x-ray, fluid, device or medication, to the RAA. This nurse can also record patient procedures, contamination levels and decontamination procedures, if any. To prevent unnecessary contamination, this area should be closed to personnel and other human traffic (3,4).

If time remains, the RAA and buffer should be covered with floor protection material. For this purpose, waterproof thick plastic material or thick paper can be used. The material should be taped to the floor (Figure 1). Covering the floor is not mandatory, but makes it easier to clean later. Traditionally, RAA is coated with “yellow” and the buffer zone is “green”. Plastic garbage bags should not be used to cover the floor. They are slippery and can cause accidents. Similarly, sheets or other fabric materials are easily folded, making movement difficult. In addition, fabric material is a material that makes it difficult to decontamination and can lead to the transport of radioactive material to shoes in other areas (3,4).

Personnel who will intervene in the patient should be protected from the possibility of contamination. For this purpose, it is enough to wear a double surgical gown and gloves. The double coat is intended to be easily removed when the outer coat is contaminated. Over-dressing can make work difficult if ventilation is not sufficient. To protect the shoes from contamination, plastic shoe covers should be worn on the feet and taped on both the wrist and the middle section (Figures 2, 3).

Dosimeters should be given to each personnel entering RAA. This rule normally includes personnel such as nuclear medicine-radiology technicians and nuclear medicine-radiology physicians who wear dosimeters. The aim of the dosimeter is to measure the radiation dose to which personnel is exposed during the patient intervention. A thermoluminescent (TLD) dosimeter should be fitted to the innermost body. If desired, a ring TLD dosimeter is attached under the gloves. TLD serves to determine the official radiation dose received. A pen dosimeter to be attached to the outermost can read the dose the staff is exposed to at any time. However, pen dosimeters are sensitive to vibrations and impacts may not provide accurate information in determining the exact irradiation dose (1,4).

Personnel Required for First Response

In any case, appropriate and trained personnel are required for on-site intervention. Anyone in this team, which can be defined as a radiation emergency response team, should be familiar with the radiation emergency plans of the hospital and participate in the exercises. For some subgroups in this group (such as decontamination, triage and radiological monitoring teams), the frequency of administration may be increased. Changing personnel are also subjected to the same training to ensure compliance with the team. These trainings should include emergency medical technicians and personnel carrying the wounded from the scene to the hospital. This is because these personnel play important roles in the pre-warning of the hospital and the proper transport of radiation injured (2). The tasks and functions of the radiation emergency response team are presented in a table below (Table 1).

Let us examine in detail the functions of some of the personnel to be employed in the team.

Emergency nurses: Nurses play the most important role in the intervention of many emergency patients. They clean the wounds and make them ready for the intervention of the physician. Emergency nurses are responsible for taking samples from suspected contaminated areas and performing final decontamination. Depending on the size of the accident, 1 or 2 nurses should always be present in the RAA.

Emergency Medical Specialist: Emergency medical doctors are used to respond to casualties. The task of the emergency physician is to stabilize the patient medically. Decontamination is performed after the patient has stabilized. Emergency medical attention always has priority over radiation decontamination. The emergency physician will remain in the RAA until the patient has stabilized and the life-threatening has been eliminated.

Trauma surgeon: Surgery is sometimes necessary to stabilize the victim. This intervention is performed by the surgeon or trauma surgeon. Again, these surgical interventions are performed before decontamination. The trauma surgeon stays in RAA until he no longer needs it. If the trauma surgeon undertakes treatment, the emergency medical practitioner may leave this area.

Nuclear medicine technician or radiation technician: If the patient survives and stabilizes, the areas of contamination should be identified, if any. This is done by a nuclear medical technician or radiation technician (radiation safety officer). These personnel should wait in this area during the patient intervention. If contaminated areas are known when the patient arrives, the technician reminds the patient to intervene to change contaminated gloves and gowns after the intervention. In no event shall this technician prevent or delay the initial medical intervention of the patient.

Security personnel: The presence of security personnel is important for two reasons. The first is the patient's privacy. Only the name of the patient, the time of admission to the emergency department and the general condition can be explained. Any other information to be disclosed is a violation of patient rights. Second, if people potentially enter this area continuously, contamination will be very likely to spread. Security personnel control the entry and exit of this area to prevent the spread of contamination and leakage of unauthorized information.

Public relations: Most of the time, radioactive accidents do not attract much attention and media coverage, but sometimes it can happen in front of everyone. In this case, the hospital should appoint someone experienced in this area to contact the press.

Necessary Staff for Advanced Care and Treatment

Surgeon: A trauma surgeon is often needed as most trauma is accompanied by a certain degree of trauma. This staff member could be called early or later. Surgeons should be aware of contamination control as these personnel intervene in other complications of wounds, burns and trauma, and may be needed at any time during the intervention.

Radiation technician: If there is contamination, the duration of irradiation, the distance to the source, and the amount of shielding and activity, if any, should be known to determine the irradiation that will occur. Dosimeters are read and prepared for complications of radiation. If contamination is present, necessary analyzes should be performed to determine the isotope. If an isotope is identified, appropriate decontamination therapy may also be initiated.

Nuclear medicine and / or radiotherapy specialist: Both of these experts will benefit from the management of radiation accidents. Nuclear medicine specialists are experienced in dealing with internally administered radionuclides. They can apply treatment for internal contamination of different isotopes. Radiotherapy specialists are also experienced in patients exposed to high doses of external irradiation. Their knowledge and experience will be helpful in identifying early and late effects in patients exposed to high dose irradiation.

Oncology / hematology specialist: Radiation casualties are in the high risk group for cancer in the long term, but the oncology / hematology specialist will be useful for other reasons in the early period. The oncology / hematology specialist is experienced in the treatment of immunosuppressed patients. If leukopenia is evident, protective isolation may be required. Bone marrow transplantation may also be a treatment alternative in patients exposed to a dose close to the lethal dose.

Internal medicine specialist: Patients with serious injuries may need to be hospitalized for long periods of time. If surgery is not required, an internal specialist may be required to coordinate the overall treatment of the patient. Liquid electrolyte balance may be impaired in patients exposed to high doses of radiation. The patient may be lost if not treated properly. Infection and other complications due to long-term hospitalization may also require treatment.

Legal adviser: Radiation accidents can also have legal consequences. The hospital and personnel being prepared for this situation will undoubtedly allow for the proper preparation of the necessary materials and documentation.

Emergency Response Team (ADME) Preparation

Protective clothing: Protective clothing is intended to protect bare skin and personnel clothing from contamination. Team members should wear surgical clothing (gowns, masks, caps, eye protection and gloves). Waterproof shoe covers or shoe covers are used. All open areas and floor sections are taped. The end of the tapes is folded for easy removal when necessary. Gloves should be worn in double coats. The first layer of gloves is taped under the surgical gown arm. The second coat must be easily removed and replaced if necessary. The dosimeter to be distributed to each team member is attached around the neck area outside the surgical gown. If available, another type of dosimeter is worn under a surgical gown. Each team member who uses fluids for decontamination should also use a waterproof outer apron.

These protective suits effectively inhibit alpha and some beta particles, but are not useful for gamma rays. Bulletproof aprons that cannot stop most gamma rays are not recommended, as they create a false sense of security.

Preparing the treatment area for contamination control: The treatment room should be prepared , if possible, near the external entrance. Visitors and patients are removed from this area. Equipment that will not be used in emergency response to the victim is either removed from this area or covered. Several large plastic trash cans will be needed.

The treatment table is covered with several layers of waterproof disposable drapes. Plastic waste bags should be available in all sizes.

The devices used in radiation monitoring are checked for batteries and operation. Again, background activity is determined and recorded before patients arrive. The team is prepared to receive the patient by the ambulance.

Covering the floor: Brown wrapping paper is laid out from the ambulance area to the treatment room. Regardless of the material used to cover the floor, it should be fixed with tape on the ground. This path is then separated by safety ropes to prevent unauthorized access. The decontamination chamber and treatment area are also covered with the same material if time is left. This will facilitate subsequent cleaning. The threshold of the decontamination chamber is clearly marked with a thick band to define the boundary of the contaminated and clean zone.

Control of ventilation: It is preferred that the ventilation of the separated section is a separate ventilation from other areas. Or the passage of air in this area to other sections without filtering should be prevented. Contamination is very unlikely to be suspended in the air and into the ventilation system.

Patient Admission

Pre-admission: The most often overlooked issue in hospital preparation is pre-admission to the hospital with the first intervention team. The emergency department team is contacted about patient and injury patterns. The emergency personnel are familiar with respiration, pulse, blood pressure, skin color, pupillary reflex, and other signs and symptoms. However, the average staff does not know enough about the evaluation of radiation data. A description by the on-site radiation technician of 10,000 10,000 hands and 2,000 DPM contamination of the scalp abilir can create hesitation and fear for staff interfering with the patient. If the hospital is close to the facility that uses radioactive material, it is imperative that both the emergency responders and hospital staff understand the radiation language. Drills are an important part of the preparation and should be carried out at least once a year with the participation of the facility using the radiation, the emergency response team and the emergency service team.

As in any accident involving dangerous substances, it would be very useful to know the material causing contamination, the amount of irradiation and the affected body areas. If the accident occurred during the transport of radioactive material, the contents and the amount of activity shall be clearly written on the package.

A common pre-agreed language should be used in pre-acceptance communication. It is not easy to determine the radiation in rad or gray at the scene. Instead, it is easier to express contamination in terms of DPM (counting per minute) or CPM (counts per minute). This data should be provided by persons who are knowledgeable. Information should be provided not only on contamination, but also on the type of the boiler, the material involved and the affected areas, if known.

Clean transfer between teams: When the patient arrives at the hospital, the ambulance / helicopter and personnel should be considered as contaminated. The patient should not be directly admitted to the hospital by a potentially contaminated ambulance gurney or staff. In this case, contamination can spread rapidly throughout the hospital by other unaware staff.

The easiest way to overcome this problem is to perform clean transfers between teams. To perform such a transfer, a potentially contaminated area around the incoming vehicle is determined. The ambulance will approach this area. Ambulance personnel should not leave this area. Ambulance personnel are met by hospital personnel at the border of this region. The ambulance and hospital gurney are brought side by side to this border and the patient is taken to a clean stretcher and transports to the hospital. A similar procedure can be applied for helicopters. The inside of the helicopter runway ring is designated as a contaminated area and transfer is made in this line.

Thanks to the clean transfer, the patient can be taken to the emergency room or the operating room without suspicion of contamination.

Releasing the emergency response team: The team members bringing the patient are checked for contamination by an experienced technician. Until this process occurs, team members are not allowed to eat, smoke or drink liquids. If there is contamination, it will be inevitable that external contamination, which can be treated more easily in this way, will turn into internal contamination, which is more difficult to control.

The whole body scan of the team and the control of the vehicle interior are performed according to the routine procedure. If no contamination is detected or contamination is removed, the team is allowed to leave.

Result

Radiation and radioactive materials have become an indispensable part of today's modern society and industry. So we have to learn to live with them. Increasing use of radiation and radioactive materials increases the risk of accidents with them.

Intervention to radiation accidents should be a multidisciplinary approach. It is of utmost importance to bring the survivor from the place where the incident took place to the health institution, and to train personnel who are conscious about radiation and radioactivity in all the processes up to the discharge of all kinds of interventions there. In addition, health institutions where the first interventions of such victims should be prepared should be made ready for radiation accidents. Consequently, the establishment of a team (ADME) to intervene in possible radiation accidents in each health facility and providing continuous in-service training to this team will also minimize the risk of injury to an accident victim and other personnel in charge.

16AXX
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TRAVEL VACCINES

Passengers traveling abroad face many risks of infectious diseases that are not seen in their home countries. Passengers should be informed about the risks of diseases and preventive measures in the countries to be visited and necessary vaccinations should be given.

It is decided by the evaluation of the characteristics of the person and the journey which vaccines should be given before the trip. In other words, the vaccination schedule required before the trip is individual. The characteristics considered in this risk assessment are:
Personal features:

Age (some vaccines may not be available in children and the elderly or their efficacy and side effects may be different)
Health status (Some chronic diseases, such as diabetes, may cause more susceptibility to certain diseases, some vaccines may not be available in some diseases)
Pregnancy and lactation (Some vaccines may not be available)
Immune system failure (Some vaccines should not be given)
Allergy history
Vaccination history

Features:

Country of destination (Some diseases may be more frequent in some countries)
Time of journey (Some diseases may occur at certain times of the year. For example, during the rainy period)
Duration (Increased duration increases risk)
Accommodation (Rural disease risks may be higher, camping site risk is higher than hotel)
Travel activities (activities such as working in rural areas, hiking can increase the risk)

Following vaccination, a period of time must elapse for the protection to begin. This time varies depending on the type of vaccine, the number of vaccination doses required, the vaccination history. Passengers should contact Travel Health Centers at least 4-6 weeks before travel to ensure adequate immune response and to complete the necessary vaccination schedule. Ministry of Health, Turkey General Directorate of Border and Coastal Health Travel Health depends on a free vaccines made in Central and preventive medications. Travel Health Centers can be applied by making an appointment at the addresses of our centers.

It should be borne in mind that no vaccine can provide 100% protection and that general infection prevention measures should be followed, even if the vaccine is administered.
Routine Vaccines

In some countries of the world, diseases such as tetanus, diphtheria and measles are endemic. For this reason, it is very important that the passengers receive their vaccinations in accordance with the national calendar. Many childhood vaccines require additional doses of vaccine throughout life to maintain effective protection. If there are any missing vaccines according to the routine vaccination schedule in the pre-voyage assessment, people who have never been vaccinated should complete the first vaccination series. Some of the vaccines included in the routine vaccination program include:

Tetanus-Diphtheria (Td)
Measles-Rubella-Mumps (NCC)
Polio

Travel Vaccines

Recommended for each passenger based on journey risk assessment.

Yellow Fever (mandatory)
Meningococcus (mandatory)
Typhoid

Cholera
Hepatitis A
Rabies

Japanese Encephalitis
Tick-borne encephalitis




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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


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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.


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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.


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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.



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External Contamination and Decontamination Techniques

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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.


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