Dressing material is a medical category that surgeons, nurses, emergency doctors, motorists and pedestrians face, ordinary people in the street, in short, all people who have anything to do with medical care for injuries or injuries.
The use of various types of dressing materials is due to the need to protect wounds from infection, immobilize the damaged area, drainage of cavities and wounds, tamponade wounds to stop bleeding. They are used during and after surgery, during first aid, for the implementation of dressings of any type.
The concept of “dressing means”, referring to the medical science categories of desmurgy, is related. Medical scientists note that dressings are devices for bandaging patients.
General classification, purpose, requirements for dressings
Dressings are multifunctional products, which are threads, fabrics, films, various non-woven materials. They can be used by industrial enterprises for the manufacture of dressings, or used by doctors and end-users. According to their structure, materials can be natural, synthetic or mixed. The most popular dressings are cotton wool and gauze.
The main classification of medical wool implies its division into hygroscopic and compressive. The first one has a high absorption capacity, it is successfully used to stop bleeding, to apply medical dressings with drugs. Compressed wool is used in laying tires and warming compresses.
Cotton wool is a natural material, it is produced from natural cotton fibers, and it can be dressing-compressible, unbleached, or cleaned dressing. The first is not intended for direct contact with the wound surface, it is made from cotton fiber, and does not undergo degreasing. The second type of cotton wool is sterile or non-sterile, medical and hygienic tampons are made from it.
Viscose wool is made from specially processed cellulose.
If we consider the material on the application, we can distinguish:
- cotton hygroscopic eye wadding;
The first two species may be sterile or non-sterile. Surgical cotton is only sterile.
Gauze is a special medical fabric, but with a more rare arrangement of longitudinal and transverse threads, which makes it look like a net. Manufacturers offer different types of gauze:
- bleached gyroscopic;
- cotton net;
- cotton mixed with viscose.
What can a dressing be used for? Usually the patient is bandaged for:
- protection of the place of injury from heat, cold, dust, dirt, its disinfection;
- prevent pathogens from entering the wound;
- fixing dressing medications at the site of injury;
- providing therapeutic effects on the wound process;
- removal of tissue pieces, decomposition products of toxins, allergens, enzymes from the lesion area.
The main properties of any dressing means - atraumatic and durability, if necessary - sterility. Materials for dressing must be flexible, air permeable and impermeable to microorganisms.
Dressings of various forms used for medical procedures:
- wound coverings;
- medical sponges.
Bandages are products that are made from various types of fabrics, have a certain elasticity, density, strength, and are a cloth with absorbency and ventilation.
There are these types of bandages:
- bandage bandage;
The application of medical bandages can be first aid or qualified medical care, traumatology, sports.
Means, representing a ready-made dressing for imposing on the wound, to prevent the loss and contamination of the blood, ingress of pollution and infection. The kit includes a sterile hydrophilic bandage and cotton pad, which is sewn to one of the ends of the bandage, or is positioned freely. There can be one or two pillows. Both products are wrapped in parchment paper, and are in a rubberized sterile bag.
Such a device for dressing is often used for first aid in case of burns, gunshot and knife wounds, in addition, each soldier must have an individual dressing bag while in the war zone.
These medicines can be gauze dressings, as well as medical ones. They are made of high density fabric, in strict accordance with the requirements of GOST. Napkins for dressing have high hygroscopicity, and the seam must have a high tightness.
Gauze napkins are two-layer cuts of gauze, which are available in packs of 5, 10, 20, 40 pieces.
Medicinal napkins - a fabric cloth, treated with therapeutic agents - healing or antiseptic.
What are medical wipes used for? They are used for:
- draining wounds;
- disinfecting the wound surface or cavity;
- bandage substrates to prevent direct contact damage and bandages;
- prevention of wound contamination.
Strips of gauze up to 50 centimeters long, up to 10 centimeters wide, can be folded in 3-4 layers, with the edges wrapped inside. They are used for tamponade wounds, limiting the area of operation, sometimes for drainage. Turundas call narrow strips of gauze material up to 2 centimeters wide, less than 10-15 centimeters in length. They are prepared in the same way as tampons, used to drain and prepare drainage of narrow wounds and fistulas. Gauze balls - another type of tampons, which is a small pieces of gauze, folded in several layers, and having the form of a triangle or quadrangle. These materials are necessary for draining wounds, abdominal injuries, for treating the surgeon's hands and the skin operated in the operating area. Cotton-gauze balls have a similar appearance and scope of application, but are prepared from cotton wool wrapped in gauze.
Used as dressing agents, can be a covering or fixing: the first contain medicinal substances, the second - no.
Fixing patches are relevant for use in surgery or traumatology, they fix bandages. Cover plasters are necessary for the treatment of certain diseases and mechanical damage, they are used in dermatology.
Another name for these products is adhesive plasters. The shape of the adhesive plaster can be:
On the one hand, the patch has a sticky surface. For cover patches, a gauze pad is provided on the sticky side to prevent injury to the wound due to adhesion of the patch.
Dressings plasters can be designed in the form of coils, or individually wrapped individually.
Wound coverings for dressing
Relatively new, modern invention in the dressing market. They are used, most often, for the treatment of chronic wounds. Depending on the type of wound, the coatings can have a different shape and composition, for example, intended for cleaning, removal of organic fragments, granulation or epithelialization of injuries.
Wound coverings are issued in the form:
- hydrocolloid coatings.
Of these funds, special dressings are made to absorb wound exudate, to control the processes of wound hydration. Another type of coating is membranes and vapor-permeable films.
Why are wound dressings more versatile and better wound care? The use of films, membranes and spongy coatings solves the problem of drying the dressing material, can have a gluing effect on the tissues, some types of agents do not require further removal from the wound, as they dissolve themselves with time.
Films for closing the wound surface usually contain antiseptics or healing agents. Such films are “Aseplen-D”, “Aseplen-K”, “Viniplen”.
Biological wound coverings, for example, “Biokol-1”, has the form of a transparent, porous and elastic film. After application, it is self-fixed on the wound, stimulates cell regeneration, thereby accelerating the healing process. This tool is completely atraumatic, has a slight anesthetic effect. It is used to treat trophic ulcers, burn lesions, donor wounds.
This tool is a dosage form of dosage or non-dose nature, with a porous structure, of various shapes and weights. The material contains medicinal, antiseptic and auxiliary substances.
In appearance, such a sponge looks like a dry, porous plate of white color, with a yellowish tint, which can have various sizes. Means are made from biological materials, for example, algae, skins or bovine tendons, and produced individually in sterile packaging.
Hemostatic sponges are prepared on the basis of human blood plasma, calcium chloride and aminocaproic acid are added to it. In the process of local application, the applied sponge gradually dissolves. May contain collagen, thrombin, fibrin, is available in vials.
Gelatin absorbable sponge is a sterile, frozen foam that dissolves well in water. In the tissues of the human body, it undergoes a process of resorption. The tool is used to stop bleeding during surgery.
Collagen sponges are made in the form of porous sterile plates containing collagen fibers. These medical products have adhesive, hemostatic, absorbing properties, so they are often used for laying on the wound surfaces, and also combined with natural polymers and medicines (pectin, antibiotics, chitosan).
Requirements for the use of dressings: preparation, sterilization
Gauze for surgery and dressing procedures is prepared in the form of napkins of several sizes - 8x8 centimeters, 50x10 centimeters, 50x30 centimeters.
Separate the napkin from the piece of cloth with the appropriate size, after which the edges are folded inwards along the cut, the napkin is folded into 4 layers. The finished wipes can be used in a dry state, or soaked in warm sterile sodium chloride solution, for example, if you need to protect the intestinal loops and the peritoneum from abdominal surgery during drying.
Tampons in the form of long strips of gauze are prepared in the amount of 5-10 centimeters in width, 20-30 centimeters in length. The edges of the edge are folded inward, the prepared tampons are folded along the length, and then into 4 layers.
Tampons according to the method of Mikulich, as well as small tampons in sizes of 10x10 centimeters are used by surgeons during operations. They must be folded in such a way that the crumbling edges of the canvas do not crumble into the wound.
Clean wounds overlap with stripes or stickers of cotton wool wrapped in gauze. Ways of fixation - collodion or cleol bandage overlaid.
The main method of sterilizing dressings during their preparation is autoclaving, that is, sterilization in an autoclave. What is an autoclave? This sterilization apparatus is used to disinfect instruments, materials, medical supplies. Sterility is achieved by treating objects with hot water under pressure above normal atmospheric pressure. The temperature in the autoclave reaches 125-135 degrees Celsius, while in a dry-heat cabinet the processing of materials and objects occurs at temperatures up to 180-190 degrees, which significantly increases their wear. Autoclaving is also one of the methods of sterilization of surgical clothes, as well as surgical dressings.
The duration of the disinfection procedure at 0.5 atmosphere is usually about an hour - this time is enough to destroy most of the known pathogenic microorganisms. If the pressure reaches 1 atmosphere, the process is reduced to 45 minutes, at 1.5 atmospheres sterilization lasts 30 minutes. At 2 atmospheres, the steam temperature reaches 134 degrees Celsius, and the processing time takes 15-20 minutes.
If the device is working properly, the personnel need only monitor the sterilization regime, the readings of the pressure gauge and timer. For faulty devices, additional tests and sterility indicators are provided, for example, Mikulich test. Its essence lies in the fact that the word “sterilized” is written on a strip of paper, after which the paper is treated with starch paste. After drying, a piece of paper is covered with Lugol's solution, which is why it acquires a blue color. The word written on paper becomes invisible. After drying the paper, it is laid in the material, which is further sterilized. Due to the effects of temperatures above 100 degrees, the word written on paper appears again. The control can also be carried out using benzoic acid, sulfur, Aspirin, resorcinol, urea. Substances in powder or solid state are placed in test tubes, sealed with a lid, and under the influence of temperature in the autoclave, the substance melts, forming a compact mass after cooling.
How does the device work? The autoclave has double metal walls, between which there is water, the lid closes, the water from the bottom heats up to boiling. When boiling water vapor fills the inner cavity of the autoclave. Before this, the sterilized material is placed in the bix or bag, and is sent to the autoclave. Bix has a lid, on the side surfaces there are holes for the passage of steam. After completion of the autoclaving process, the holes are closed with a special metal rim to achieve tightness. Outside the autoclave, these fixes can be stored for up to 2 days. Inside the fixes are lined with a napkin or cloth.
Mandatory requirement for sterility dressings - their dryness. Wet or wet materials cannot be considered sterile.
In case of emergency, if it is not about the surgical preparation of dressings, but, for example, about providing first aid at home, any clean material that was previously ironed with a hot iron on both sides can be used for dressing. If there is no iron on hand, the canvas is treated with a solution of boric acid, potassium permanganate, rivanol, or other sterilizers.
In addition to the aseptic dressing in medicine, they use antiseptic - gauze and cotton soaked in antiseptic or antibiotic solutions to preserve the sterility of the material. It should be noted that antiseptic materials are used quite rarely, as they can have a significant impact on the affected tissues, destroy them, or cause irritation.
Ligation of superficial abrasions and wounds can be done with a plaster or bactericidal paper impregnated with silver salts. The paper is moistened with sterile water, and then applied to the wound.
To stop bleeding using materials impregnated with appropriate means, as well as wound coverings.
It is convenient to use individual dressing bags for first aid; they are ready for use, materials do not need to be further sterilized. Usually they are present in the first-aid kits of vehicles, in the syndromic stacking, as well as in individual military first-aid kits.
On the package must indicate the method of opening the package, suitable in order not to violate its sterility. Before using an individual package made at the factory, it is necessary to check the integrity of the package shells.
Accounting, storage and laying of dressing materials in medical institutions
The need to account for medical devices - medicines, materials, devices - due to the fact that public institutions receive them under a strict report, and all of these categories are acquired for budgetary funds.
Dressings for accounting purposes include dressings, films, bandages, patches, sanitary napkins, cotton wool of any type, burns, dressings, bandages, adhesive plasters, and other devices for direct contact with the wound surfaces.
If there is a pharmacy in a medical institution, materials are recorded at retail prices for the total amount of cost, but subject-quantitative accounting is not carried out. Receipt of materials in the pharmacy is made with checking the invoice from the manufacturer or seller. After verification, accounts are recorded in a special registration book.
The release of dressings to medical personnel occurs only to the responsible persons of the offices or departments on invoices. At the same time, the recipient signs in receipt of the material in a special journal. Invoices are issued in two copies - one remains in the pharmacy, the other - from the materially responsible person in the office or department.
Records of dressings lost due to damage are also kept. They draw up an act on the write-off of material values that have become unusable. The act in duplicate shall be drawn up by a commission with the participation of the chief accountant of a medical institution. Funds that have become unsuitable for use and use shall be destroyed in the presence of a commission.
If there is no pharmacy in the medical institution, accounting takes place in a slightly different way, namely, individually. The release of medical dressings is made in the amount of a ten-day need. There is a joint delivery schedule. The funds received are stored in offices for offices.
In addition to the general audit and accounting, dressing means, received for use in a hospital, clinic or specialized medical center, are subject to accounting.
The receipt and internal movements of medical devices are made on the basis of:
- invoices from the supplier;
- the act of acceptance;
- statements on the issuance of material values for the needs of the department (office);
The marking of the packaging of any item or device should contain the name and address of the manufacturer, the mass or size of the product, the date of manufacture or expiration date, a sterile or non-sterile product, a valid method of opening, the designation of technical conditions, GOST.
How is the dressing material stored? This requires special furniture - cabinets, drawers, racks, covered with light oil paint from the inside, with pallets, which should be always clean. They must be placed in dry and well ventilated areas. Cabinets, shelves, racks periodically need to be treated with a 0.2% bleach solution or bleach solution for disinfection. According to the storage conditions, sterile devices are stored in their original packaging; such material cannot be stored in the primary opened packaging. The rooms in which the material is located must have a stable temperature so that the package does not collect condensate when it drops. Shelf life - no more than 5 years.
As for non-sterile products, they can be kept wrapped in thick paper, or in tissue bags on pallets and racks. According to the rules of storage should not be allowed to sudden changes in temperature, the formation of mold and mildew, as well as the appearance of dampness in the room. Violation of the integrity of the package or its wetting means that a particular object can no longer be considered sterile.
Gypsum bandages are stored in dry rooms, preventing them from mechanical damage. On average, the shelf life is 5 years.
For all medical supplies and drugs, including for dressings, certain expenditure rates are provided based on bed or separation. The calculation of the norm should occur on the basis of real costs for different types of patients. It is established by orders, decrees and other by-laws of the authorized body on health issues.
Re-use of dressings and their disposal
Can a consumable such as a dressing agent be reused? Sterile bandages, individual dressing bags, patches, wound dressings are disposable means and cannot be sterilized after being applied to patients.
Re-disinfection of used bandages, tampons, napkins in order to save may be appropriate - they can be washed and sterilized in autoclaves, for example, after operations, but only if they have not been smeared with pus.
Gauze, which is used again, after washing has a pronounced lower suction ability. The materials used are soaked in cold water or in a solution of ammonia in a concentration of 0.5%, and this must be done before the blood has dried. Then they are washed, boiled, rinsed, dried, sterilized in autoclaves. The purpose of these materials at the end of all procedures - only the implementation of dressings.
The characteristic of the potential hazard of the used dressing materials makes it possible to classify them as a group B of medical waste - potentially hazardous and infected waste to be disposed of.
The algorithm for utilization of such materials includes several stages. Initially, they are collected throughout the medical facility, then moved to temporary storage in the organization. The next step is the disinfection of waste, after which they are transported from the premises, burned, buried or destroyed in any other way.
Materials for medical dressing can be tissue or cotton, natural and synthetic. Some of them undergo periodic sterilization and reuse, others are recyclable and cannot be reused.