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Prophylactic (aseptic) measures during pregnancy
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Prophylactic (aseptic) measures during pregnancy
Prophylactic (aseptic) measures during pregnancyinclude the following:
• strict following the rules of personal hygiene during pregnancy;
• elimination of chronic foci of infection in a pregnant woman organism (oral cavity sanation, treatment of pustular diseases, chronic pyelonephritis, bronchitis, colitis, colpitis and other inflammatory process;
• limitation (and if possible absolute elimination) of pregnant woman contacts with infectious patients;
• sexual continence during last two months of pregnancy;
• vitamin therapy, dietary nutrition which increase organism resistance to infections.
Prophylactic (aseptic) measures during delivery
All puerperas are examined on admission to maternity home. Puerperas with signs of infection in the organism as well as with a high risk of infection development are isolated immediately in the second obstetric department (observation department).
Indications for hospitalization to observation obstetric department are:
• increase of body temperature over 37. 5º C;
• abscesses, pustules, vesicles on the skin;
• dead fetus of unknown etiology;
• a long waterless period;
• purulent discharge from vagina (III-IV degree of vagina discharge purity);
• exacerbation of chronic inflammatory diseases during pregnancy and in the moment of admission to the hospital (pyelonephritis, bronchitis); the women who delivered outside the obstetric in-patient department (at home, in ambulance, etc. ), and also pregnant women who were not examined (not cheched up in maternity welfare clinics) are also hospitalized here. Those ill with angina, influenza, gonorrhea and other diseases are isolated from healthy pregnant women and sent to the isolation ward of the second obstetric department.
On admission to maternity home a woman undergoes sanitization: pilar areas of the body are thoroughly examined, fingernails and toenails are cut, she is suggested to evacuate urinary bladder, have cleansing enema, shave hair from pilar areas of the body — external genital organs and underarms, wash and dry them. After that a woman in childbirth takes a shower, puts on clean underwear and goes to prenatal ward. Delivery is held in a special delivery room which is kept as clean as an operating room where operations are performed.
All things which get in touch with genitals of a woman in childbirth must be sterile. Rubber catheters, hand brushes are sterilized by boiling.
It is of utmost importance for doctors, obstetricians taking delivery to have disinfected hands. There are always a lot of different microbes including pathogenic on the skin of hands. Microbes are located in a fat layer covering hands, in excretory ducts of sweat and sebaceous glands.
It is possible to have practically sterile hands if to cleanse them correctly.
Before any disinfection nails are previously cut short and dirt under nails is removed. Disinfection of hands is performed before:
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• vaginal examination of women in childbirth;
• delivery;
• obstetric operations (manual removal of afterbirth, applying obstetric forceps, putting stitches on perineum ruptures, etc. );
• taking a newborn.
Doctors and obstetricians working in obstetric institutions must wash their hand with soap before work in delivery rooms, before inspection of women in childbirth and puerperas, examination and swaddling of newborn children. To prevent HIV-infection all above-mentioned examinations are made in single-use sterile gloves.
During delivery genitals are washed every 5-6 hours. Disinfected by boiling bedpan is put under sacrum and genitals are washed by slight disinfecting solution (Potassium permanganat solution 1: 5000 — 1: 8000) with the help of sterile cotton wool taken by dressing forceps.
First the area of pubis is washed, then the inner surface of hips, genitals, perineum and anus. In the same order the external genitals and adjoining areas are dried with sterile cotton wool taken by dressing forceps.
Before delivery the external genitals and adjoining areas are washed with warm water, dried with sterile cotton wool taken by dressing forceps, wiped with alcohol, painted with a 5% iodine tincture. A woman in childbirth is dressed in sterile underwear, shoe covers are put on legs, and a sterile sheet is placed under the woman. In modern clinics more often the single-use sets are used which include all the necessary things for woman and napkins for newborn.
Everything necessary for delivery or operation (linen, bandaging material, suture material, instruments, equipment) is sterilized for aseptic condition.
Personal Hygiene of Maternity Home Medical Staff
Doctors and obstetricians mustn’t be carriers of pathogenic microbes able to cause afterbirth diseases of mothers. Physicians and obstetricians ill with influenza, tonsillitis, pustular and other diseases are not allowed to contact mothers. Physicians and obstetricians working in observation maternity ward, isolation ward, doctors who contact infectious patients, pustular wounds and other sources of infection are not permitted to work in physiological maternity ward without sanation and dress change. Availability of abrasions and chaps, eczema, pustules and other diseases on hands does not permit to work in maternity home. Medical staff is systematically (every three months) examined for bacilli. Hand microflora is investigated, nasal and throat cavities are inspected, Wassermann and AIDS tests, bacteriologic examination of stool and vaginal discharge (for women) are made. Every 6 months fluorography of lungs is made. Examination of specialist in skin and venereal diseases is obligatory. The carriers of pathogenic microbes are admitted to work in maternity home only after sanation and proper treatment.
At the beginning of a working day in maternity home medical staff takes a shower, changes linen, puts on cotton clothing and then clean smocks. The smocks are boiled and then ironed before wearing. A smock should cover the whole dress. Before delivery an obstetrician puts on an apron and then a sterile smock.
A cap should completely cover hair. While working in the delivery room and newborn ward a mask covering nose and mouth must be worn. The mask prevents respiratory infection transmission. Microbes from nasal and oral cavities are stopped by mask. Masks are made of 3 or 4 layers of gauze. Dirty masks are put into special boilers, then washed and sterilized in autoclave.
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