14第3章无菌与隔离技术
第1节无 菌 技 术
一、目的
（1）保持无菌物品及无菌区域不被污染。
（2）防止病原微生物侵入或传播给他人。
二、操作流程


三、准备
1护士准备护士着装整洁，修剪指甲，洗手，戴口罩。
2用物准备治疗车上层置无菌容器及持物钳、敷料缸、棉签、消毒剂、无菌溶液、无菌巾包、无菌碗、有盖方盘或储槽内盛无菌物品、无菌手套、弯盘、开瓶器、笔和纸 、抹布，另备清洁治疗盘2个。物品应放置有序，便于操作。
3环境准备环境应清洁、干燥和宽敞，操作前半小时停止清扫地面，并用蘸有消毒液的抹布擦净治疗盘和治疗台，避免不必要的人群流动，降低室内空气中的尘埃。
四、操作标准
实施（1）查看无菌物品的灭菌日期和手套号码，包布有无破损、潮湿。查看指示胶带是否变色以及无菌溶液的质量，并将物品有序摆放，符合无菌操作原则。
（2）拿起无菌巾包，解开系带，绕好并置于包下；先打开无菌巾包的远侧，再打开无菌巾包的两侧，最后打开无菌巾包的近侧；查对消毒指示卡；用无菌持物钳夹取一块无菌巾放在手上，放回持物钳；捏无菌巾包外面将余物按原样折好。
（3）单巾铺盘法
1）手拿无菌巾，短边朝上，用一只手在靠近散边边缘2cm处抓住无菌巾一侧，用另一只手在对侧相同处抓住无菌巾另一侧，将其轻轻抖开，双折平铺于盘上；双手捏住无菌巾上层的两角，呈扇形折叠，开口边缘向外。2）打开无菌容器，取无菌持物钳，用无菌持物钳夹取无菌物品，将无菌物品放入无菌盘的无菌区内，将无菌持物钳放回无菌容器内并松开钳轴节，盖严无菌容器（取放无菌持物钳时，钳端应闭合，垂直取放，不碰及瓶口，并始终保持钳端向下）。双手捏住无菌巾上层两角的外面，使上层与下层的边缘对齐，盖住无菌物品。将无菌巾开口处向上折两次，无菌巾两边各向下折一次，记录铺盘时间，有效期为4h。
3）当打开的无菌包仍有未用完的无菌物品时必须系“一”字形带，并注明开包日期和时间，有效期为24h。
（4）双巾铺盘法
1）查对无菌巾包，并按单巾铺盘法打开无菌巾包。用无菌持物钳夹取一块无菌巾放在空手上，放回持物钳，然后将无菌巾包按原样折叠好。无菌巾长边朝上，双手在两角靠近散边边缘2cm处抓住无菌巾两侧，轻轻打开，将无菌巾由对侧向近侧平铺于盘上，无菌面朝上。
2）左手拿起无菌碗包，用右手依次打开包布的三个角并抓在左手上，再将包的第四个角一起抓住，露出无菌碗，并稳妥地将它放入无菌盘内。
3）仔细核对无菌溶液的名称、浓度、质量和有效期。用开瓶器打开瓶盖，用双手大拇指将瓶塞边缘上推，用右手大拇指和示指将瓶塞拔出。左手拿无菌溶液瓶，手掌紧贴瓶签，先倒少许溶液冲洗瓶口，再由原处倒出适量溶液于容器内，套上瓶塞。
4）用左手抓住无菌容器盖的外面将其打开，右手持无菌持物钳夹取无菌纱布，盖好无菌容器，将无菌纱布放在无菌区内，放回持物钳。
5）用无菌持物钳夹取另一块无菌巾放在空手上，放回持物钳，双手抓住无菌巾外面两角，轻轻打开，边缘对齐，由近侧向对侧覆盖于无菌盘上，边缘剩余部分向上反折。
6）消毒无菌溶液瓶盖和瓶口后盖严，注明开瓶时间后放回原处，把准备好的无菌手套放在无菌盘内。已开瓶的溶液有效期为24h。
7）拿开无菌手套，打开治疗盘上层无菌巾的小部分，露出无菌纱布。再次核对无菌手套号码，灭菌效果和日期，解开手套袋的系带，绕好置于一侧，取出滑石粉扑在手上。持手套翻折部分，同时取出两只手套。一手伸入手套内戴好，再以戴好手套的手伸入另一手套反折部分依法戴好，将手套反折部分拉平，调节手指。从无菌盘内取纱布擦净手套上的滑石粉并双手抓碗。
8）操作完毕，用戴好手套的手抓住另一只手套的上端外面脱下手套，使其反面朝外；用脱掉手套的手指伸入另一只手套内面脱下手套，使其反面朝外。
（5）整理用物，将用物放回原处。
第1篇·第3章无菌与隔离技术基础护理学实践教程五、要求
（1）在规定时间内熟练完成操作。
（2）有较强的无菌观念。
（3）操作中始终坚持无菌原则。
六、无菌技术的操作原则
（1）无菌技术操作场所应清洁、宽敞；在进行无菌操作30min前，应停止清扫工作并减少人员走动，避免尘埃飞扬导致污染；每天用紫外线消毒。
（2）工作人员无菌操作前应着装整齐、戴好帽子、口罩，修剪指甲并洗手。必要时穿无菌衣，戴无菌手套。
（3）进行无菌操作时，应首先明确无菌区、非无菌区和无菌物品的概念。无菌物品必须与非无菌物品分开放置，并且有明显标志；无菌物品应存放于无菌包或无菌容器内，不可暴露于空气中。
（4）无菌包外应标明包内无菌物品的名称及灭菌日期，并按有效期先后顺序摆放；无菌包的有效期一般为7～14天，过期或受潮应重新灭菌。
（5）进行无菌操作时操作者身体应与无菌区保持一定距离；取用无菌物品时应使用无菌持物钳；手臂应保持在腰部或治疗台面以上，不可跨越无菌区，手不可接触无菌物品；无菌物品一经取出，即使未用，也不可放回无菌容器内；避免面对无菌区谈笑、咳嗽、打喷嚏；如用物疑有污染或已被污染，应予更换并重新灭菌。
（6）一切无菌操作均应使用无菌物品。
（7）一套无菌物品只供一位患者使用一次。

Techniques of Asepsis and Isolation
Chapter3


Section 1Performing Common Practices of Asepsis
Purpose
（1）To maintain sterile articles and sterile area sterile
（2）To halt the spread of microorganisms and minimize the threat of infection and disease
Preparing
1 NurseWear the uniform，round cap，shoes and maskFail nails short and wash your hands
2 EquipmentSterile container and sterile forceps，dressing jar，swabs，disinfectant，sterile solution，sterile package，a sterile bowl，square plate containing sterile articles，sterile gloves，emesis basin，bottle opener，pen and paper，cleaning cloth，two clean traysAssemble equipment and arrange on a nursing cart in the order of their use
3 EnvironmentThe environment should be clean，dry and brightStop sweeping to keep indoor air freshAvoid raising dust，which may carry organisms
Standards and Procedure
Action(1)Gather equipmentCheck that sterile wrapped drape or package is dry and unopenedAlso note expiration date
(2)Select a work area that is waist level or higherOpen sterile wrapped drape by folding the topmost part of the covering wrapper away from youNext，open the sides of the setRemove forceps from the container，keep the prongs together and lift the forceps without touching any part of the containerThe forceps tips need to be held down，particularly if they become wet，so that fluid will not flow from a contaminated area to a sterile oneAs with other sterile objects，forceps should be kept above waist levelRemove a sterile drape from the sterile packageGently tap the prongs together directly over the container to remove excess solutionFold the sterile package as it is
(3)Apply the sterile treatment tray with one drape
1）Hold the outer surface of the one side of the drape at about 2 cm from the edge of unilateral drape with one hand，hold the other side of the drape at the same area with the other hand，gently open and place the drape with double folds in the tray;hold the outer surface of the upper layer of the drape at two corners with both hands and fanfold it with its edge toward outside
2）Place additional sterile items on field as neededFold the opening end of drape twice upward，tuck the sides of the drape in and record the date and time of applying the trayThe aseptic tray is considered as sterile for 4 hours
3）Wrap the sterile package with one tape and write the opening date and time in the label or paper of the package when the sterile items are still leftThe sterile package opened and uncontaminated is considered as sterile for 24 hours
(4)Apply the sterile treatment tray with two drapes
1）Read the label on the sterile package and open the sterile package as the same way as applying the sterile treatment tray with one drapeHold the outside of the drape at two corners with both hands，gently open and place it in the tray evenly from opposite side of the tray to near side and make the sterile side upward
2）Pick up the sterile bowl package with the left hand，open the sterile bowel and drop it onto the sterile field from a safe distance，being careful that the outside wrapper does not touch the sterile fieldThe nondominant hand should be used to secure the loose ends away from the item and protect them from contaminating the sterile field3）Check the sterile solution carefullyRemove the cap carefullyPour a small amount of the solution into waste container to clean the lip of the bottleBe sure the label side of the container is uppermost when pouring so that the label does not become wet and soiledPour carefully so as not to splash the solutionTouch only the outside of the cap when recapping
4）Place additional sterile items on field as needed
5）Remove a sterile drape with a sterile forcepsHold the outside of the drape at two corners with both hands，gently open and place it in the tray evenly from near to off side and fold them upward
6）Once a solution has been opened，the outer bottle should be labeled and dated if it is to be reusedMost solutions are considered sterile for 24 hours after they are opened
7）Place sterile glove package on clean，dry surface above your waistExpose the sterile gauze by open a part of the drapeCarefully open the inner package and expose the sterile gloves with the cuff closed to youGrasp edge of folded cuffLift and hold gloves with fingers downPull first glove on with cuff foldedSlide fingers of gloved hand under cuff of second gloveInsert hand with cuff foldedAdjust gloves on both handsLift up the gauze from the tray，wipe the talcum powder on the gloves and then hold the sterile bowl with both hands
8）Invert glove as it is removedSlide ungloved fingers inside second gloveRemove second glove inside outDiscard gloves in appropriate container and wash hands
(5)Dispose of the equipment used
Requirement
（1）Have finished the procedure in the given time correctly and skillfully
（2）Perform the aseptic idea during the procedure
（3）Insist on the aseptic principles all the time during the procedure
Principia of Aseptic Technique
（1）The environment of aseptic technique should be clean，spacious and disinfected at regular intervalsSterile articles should be properly placedCleaning should have been completed at 30 minutes before the commencement of any sterile procedure and other health personnel are limited to go about so as to prevent the dust from floating
（2）The health personnel should wear round cap and mask;file nails short and wash handsIf necessary，wear gowns and sterile gloves before performing the sterile procedure
（3）Persons who are sterile touch only sterile articles;persons who are not sterile touch only unsterile articlesSterile articles must be separated from unsterile articles，and have an obvious labelSterile articles should not be exposed to the air and stored in the sterile containersSterile package should have a label with its name and the sterile date
（4）Arrange sterile articles in order according to the expirations of the articlesThe wrapped sterile packages are usually kept 7 to 14 daysThe sterile article should be sterilized again when it has been damp or beyond the expiration
（5）Stand back at a safe distance from the operating table when performing the sterile procedureHold sterile articles with sterile forcepsGowns are considered sterile only from the waist to shoulder level in front and above the elbowsKeep hands in sight or above waist level away from the faceArms should never be foldedArticles dropped below waist level are discardedStep back away from the sterile field to sneeze or coughSterile persons keep contact with sterile areas to a minimumIf in doubt about the sterility of anything consider it not sterileUnsterile articles should be put far from the sterile fieldThe sterile article taken from the sterile container should be considered as unsterile and not be replaced in the container
（6）All articles used in an operation have been sterilized previously
（7）Assemble sterile equipment only supplies one patient each time
第2节穿、脱隔离衣及手的消毒
一、目的
（1）保护患者不受混合感染，工作人员不被感染。
（2）防止院内感染。
二、操作流程


三、准备
1护士准备着装整洁，修剪指甲，取下手表，并卷袖过肘（冬季卷至前臂中部即可），洗手，戴口罩。
2用物准备隔离衣、一个面盆内盛05%～1%巴氏消毒液（浓度1∶100～1∶200）、一个面盆内盛清水（也可用流动水洗手）、肥皂、毛巾和闹钟。按方便的原则放好所需用物。
3环境准备保持室内清洁、干净。
四、操作标准
实施（1）手持衣领取下隔离衣，清洁面朝向自己，将衣领的两端对折，对齐肩缝，露出袖笼。右手持衣领，左手伸入袖内并向上抖，依法穿好另一只衣袖，两手上举，将衣袖尽量上抖。两手由衣领中央顺边缘向后，扣好领扣，系好袖口。
（2）双手在腰带下约5cm处，向后分别捏住两侧衣边的正面，两侧衣边对齐，向一侧折叠，不暴露清洁面。
（3）一手按住衣边，另一手持侧腰带绕至前面系好，进入病房进行操作，操作完毕，处理用物后脱隔离衣。
（4）先解开腰带的活结，再解开袖口，将部分衣袖塞入工作服下，暴露出双手前臂。
（5）双手浸泡于消毒液中，从腕上10cm至指尖清洗两手（每只手各1min），搓手的顺序依次为手腕→手掌→手背→指缝→指关节→大拇指→指尖，注意清洗指甲及指缝、腕纹。用清水洗净，毛巾擦干。
（6）解开衣领，一手伸入另一手袖口内，拉下一侧衣袖。用衣袖遮盖住的手捏住另一手隔离衣袖的外面，将衣袖拉下。
（7）两手在衣袖内解开腰带，尽量后甩。对齐肩缝，把一侧的隔离衣翻转盖在另一侧上。双手退出，整好衣领，按规定挂好隔离衣。
（8）隔离衣使用后应每天更换，将隔离衣卷好（清洁面在外），投入污衣袋内。五、要求
(1)隔离衣长短适合，能遮盖工作服。
(2)穿、脱隔离衣时，未污染脸、颈、口罩和帽子。
(3)洗手时，隔离衣未被溅湿，也未污染水池。
(4)隔离衣每天更换，当隔离衣污染或潮湿时，立即更换。
(5)操作熟练，敏捷，在规定时间内完成。
(6)隔离观念强。
Section 2Putting on and Removing the Isolation Gown
Purpose
(1)To protect medical workers and patients
(2)To prevent nosocomial infections
Preparing
1 NurseWear the uniform，nurses cap，shoes and maskTake off watch，file nails short and wash your handsIf you have a longsleeved uniform，roll the sleeves up above your elbows before you put the gown on
2 EquipmentGown，stand，a face basin with 05% to 1% “84” disinfectants，a face basin with water (running water)，soap，towel，alarm clockAssemble equipment in the order of their use
3 EnvironmentKeep the environment clean
Standards and Procedure
Action（1）Pick the gown up，have the clean side of the gown toward operatorPut on one sleeve，then the other sleeveButton the gown at the neckButton the cuffs of the sleeves
（2）Pull the one side of the gown，then the other side of the gownAlign two band edges of the gown at the backFold two band side edges of the gown up
（3）Tie the strings at the waistlineMove to the ward and care of patient
（4）Untie the strings at the waistlineUnfasten the waistTuck the part of the sleeves of the gown above elbows Expose the forearms
（5）Do not allow your uniform to touch the sink during the washing procedureWet the hands and wrist areaWith firm rubbing and circular motions，wash forearms，wrists，the palms and backs of the hands，each finger，the areas between the fingers，the knuckles and nail bedContinue this friction motion for 2 minRinse thoroughlyDry hands and wrists with a towel
（6）With clean hands，unfasten the clean neck stringsWriggle your arm and shoulders out of the gown，drawing your clean hands up through the clean sleeves
（7）With hands inside the shoulders of the gown，bring the shoulder seams togetherGrasp the gown and hang it on the hookIf placing it in the clean area with the clean side outIf placing it in the contaminated area with the contaminated side out
（8）The isolation gown should be changed every day after their useRoll it with the clean side out and place it in a laundry bagRequirement
(1)The size and length of the isolation gown is appropriate and it covers the uniform
(2)During donning and removing an isolation gown，the face，neck，mask and cap are not contaminated
(3)The isolation gown is not moist and，during disinfecting the hands
(4)The isolation gown should be changed every dayIt should be changed at once when it is contaminated or moistened
(5)The nurse has carried out the procedure expertly and rightly，finished the procedure in the given time correctly
(6)The nurse has insisted on the principles of isolation during the procedure
21第4章清洁与卫生
第1节口 腔 护 理
一、目的
(1)保持口腔清洁、湿润，使患者舒适，预防口腔感染、中耳炎等并发症。
(2)防止口臭和牙垢，增进食欲，保持口腔正常功能。
(3)观察口腔黏膜及舌苔的变化，特殊的口腔气味，提供病情的动态信息。
二、操作流程


三、准备
1护士准备着装整洁，修剪指甲，洗手，戴口罩。
2患者准备向患者解释，让其了解口腔护理的目的及注意事项，有活动性假牙者应取下假牙并用冷开水冲刷干净后浸泡于清水中。
3用物准备治疗盘内放治疗碗（内盛棉球、根据患者情况和医嘱选用的漱口溶液、血管钳、用无菌纱布遮盖）、压舌板、纱布、弯盘、吸水管及盛水口杯、棉签、石蜡油或唇膏等润滑剂、治疗巾、手电筒、口腔用药、必要时备开口器。按方便操作的原则放好所需用物。
4环境准备保持室内安静，环境清洁、干净，床旁桌上无多余用物。
四、操作标准
实施人文护理用语（1）携用物至患者床旁，再次核对床号、姓名。3床，孙叔叔，您好，现在我要为您做口腔护理了，您准备好了吗？（2）协助患者右侧卧位(或头偏向右侧)，面向护士；颌下围治疗巾，弯盘置于口角旁。请您面向我。（3）用棉球湿润和清洁口唇，饮水管饮水湿润口腔后吐入弯盘。请您用饮水管吸水漱口。（4）护士一手用压舌板协助清醒患者张口或用开口器协助昏迷患者张口，另一手拿手电筒检查患者口腔黏膜。让我检查下您的口腔。（5）嘱患者咬合上下齿，用压舌板轻轻撑开左侧颊部，用血管钳夹取棉球并拧干至不滴水后由内向外纵向擦洗左外侧上下牙齿；用压舌板从右侧轻轻撑开患者下颌（昏迷患者将开口器从臼齿处放入），夹取棉球依次擦洗左上内侧面，左上咬合面，左下内侧面，左下牙咬合面；用压舌板轻轻撑开患者左侧颊部，夹棉球弧形擦洗左侧颊部。同法擦洗右侧。擦洗舌背、舌下和硬腭部。一个棉球只用一次，不可遗漏在口腔中。请您张开嘴巴，并咬合上下牙齿。（6）擦洗完毕，协助患者用吸水管吸漱口液漱口，然后吐入弯盘内。请您再漱下口。（7）移开弯盘，取下治疗巾并擦干面部。为昏迷患者做口腔护理时棉球不可过湿，禁忌漱口。我要给您上点药，可能有点痛，请忍耐下。我帮您润滑一下嘴唇。（8）再次检查口腔黏膜，并根据患者口腔情况涂药，必要时涂润滑剂。（9）整理床单位，清点棉球数量，清洁、消毒灭菌用物，并记录口腔护理情况。协助患者取舒适体位。这个体位舒服吗？（10）向患者解释口腔护理的重要性，介绍口腔护理的相关知识，使患者能够做到有效地清洁口腔。
五、要求
第1篇·第4章清洁与卫生（1）与患者有效沟通，使患者能够明白口腔护理的目的和注意事项，并积极配合。
（2）护士操作方法正确、动作轻巧、细致，口腔卫生得到改善，无并发症发生。
（3）患者感觉舒适，衣被未湿。
（4）患者健康知识增加，对护士操作满意。
（5）在规定的时间内准确地完成了操作。
六、漱口液的选择
（1）清洁口腔，预防感染：等渗盐水或2％～3％硼酸液或002％呋喃西林液。
（2）轻度口腔感染：朵贝溶液。
（3）口腔感染、口臭：1％～3％过氧化氢溶液或甲硝唑。
（4）霉菌感染：1％～4％碳酸氢钠溶液。
（5）铜绿假单胞菌感染：01％醋酸溶液。
（6）其他：根据病情和医嘱选择特殊漱口液，如复合酶漱口水、芦荟漱口水和除菌漱口水等。


Hygiene
Chapter4


Section 1Providing Oral Care for the Dependent Patient
Purpose
（1）To keep the patients mouth and teeth clean and moist
（2）To prevent a foul breath and tartar and increase of appetite
（3）To observe the changes in the patients condition
Preparing
1 NurseWear the uniform，nurses cap，shoes and maskFile nails short and wash your hands
2 PatientExplain the aims to the patientRemove dentures if present
3 EquipmentTwo bowls covered by sterile gauze (one containing mouthwash and suction catheters，another containing some cotton balls，vascular forceps)，tongue blades，gauzes，emesis basin，straw and a cup of water，swabs，petroleum jelly or lip cream，towel，flashlight，medicine for dental ulcer，mouth gag if needed
4 EnvironmentA neat and quiet ward
Standards and Procedure
ActionNursing Expression（1）Carry the nursing cart to the bedsideIdentify patient—Hello，MrSunIm going to help you clean your moth nowAre you ready for it（2）Position the patient on the side with head turned toward you and tilted toward the mattressPlace the towel across the patients chest and emesis basin in position under the chin—Face me please（3）Moisten patients lips with wet cotton ballsAssist a conscious patient to rinse the mouthIt is contraindicated for an unconscious patient.—Now，rinse your mouth，please You can use a straw to drink water（4）Open the patients mouth and gently insert a padded tongue blade between the back molars if he is unconscious or too ill to open his mouthExamine the patients mouth with a flashlight—Let me check your mouth（5）If teeth are present，brush carefully with cotton balls moistened with mouthwashThen cleanse gums，mucous membranes，hard plate，and tongue—Open your mouth please and close your teeth（6）Position the patients head to allow for return of water or use suction apparatus to remove the water from oral cavity—Now，please rinse your mouth again（7）Remove the emesis basin;take away the towel and dry patients face with it—Now，Im going to apply some medicine to treat your ulcersIt may cause a little painPlease be patientIll use some petroleum jelly to lubricate your lips（8）Check the mouth again with a flashlight，apply medicine if neededApply petroleum jelly or lip cream to the patients lips（9）Dispose of equipment used and return the patient to a position of comfortRecord any unusual bleeding or inflammation—How about this position（10）Carry out health education
Requirement
（1）The nurse can communicate with the patients effectively to make them understand the aims and precautions of providing oral care patients cooperate with the nurse actively
（2）The way of the mouth care is correct，gentle and skillfulThe patients mouth hygiene has been improved and no complications happen
（3）The patient feels comfortable and his clothes and linens have not been wet
（4）The patient has increased health knowledge about mouth care and is satisfied with the procedure
（5）Have finished the procedure in the given time correctly