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Šta treba dezinfikovati pri previjanju?

Pri previjanju rane ili centralnog venskog katetera, obavezno dezinfikujte ruke alkoholnim rastvorom pre i posle procedure, a kožu oko mesta ulaska katetera ili rane tretirajte 0,5-2% alkoholnim rastvorom hlorheksidina.

Algoritam dezinfekcije pri previjanju

1. Dezinfekcija ruku (PRIORITET #1)

Dezinfekcija ruku je najvažnija mera za sprečavanje kontaminacije 1. Postupak:

  • Pre početka procedure: Obavezno dezinfikujte ruke alkoholnim rastvorom (preferira se nad pranjem sapunom i vodom) 1
  • Posle završetka procedure: Ponovo dezinfikujte ruke alkoholnim rastvorom 1
  • Tehnika: Rastvor mora doći u kontakt sa svim površinama šake, posebno vrhovima prstiju, palčevima i prostorima između prstiju. Trljajte dok rastvor ne ispari i ruke ne budu suве 1

Važno: Nošenje rukavica NE eliminiše potrebu za dezinfekcijom ruku 1. Rukavice se koriste samo kada se očekuje kontakt sa krvlju ili telesnim tečnostima.

2. Dezinfekcija kože oko rane/katetera

Koristite 0,5-2% alkoholni rastvor hlorheksidina (Grade A preporuka) 1, 2:

  • Hlorheksidin značajno smanjuje infekcije u poređenju sa povidon-jodom 1
  • Alternativa (ako postoji kontraindikacija za hlorheksidin): tinktura joda, jodofor, ili 70% alkohol 1

3. Dezinfekcija konektora i portova (za centralne katetere)

Pre pristupa kateteru 3, 4:

  • "Scrub the hub": Očistite hub katetera hlorheksidinom 3
  • Koristite pasivnu dezinfekciju sa kapicama koje sadrže 70% izopropil alkohol 4
  • Ili primenite mehaničku dezinfekciju sa antiseptičkim padom 4

Ključne mere aseptične tehnike

  • Striktna aseptična tehnika mora se održavati tokom cele procedure (Grade A) 1
  • "No-touch" tehnika: Svi otvoreni portovi i krajevi katetera ne smeju se dodirivati rukama ili rukavicama 3
  • Pacijent treba da minimizuje razgovor i okrene glavu u suprotnom pravcu od katetera 3

Česte greške koje treba izbegavati

  1. Preskakanje dezinfekcije ruku između koraka procedure
  2. Nedovoljno vreme kontakta antiseptika sa kožom - dozvolite da se dezinficijens osuši pre nastavka 5
  3. Dodirivanje dezinfikovanih površina nakon što su očišćene
  4. Korišćenje rukavica kao zamene za dezinfekciju ruku 1

Dodatne mere

  • Zamena obloga: sterilna gaza svaka 2 dana, transparentne obloge svakih 7 dana 6
  • Obloge menjati odmah ako postanu vlažne, labave ili prljave 1, 6
  • Infuzioni setovi za parenteralnu ishranu: zamena svakih 24 sata 1

Ove preporuke su zasnovane na najnovijim ESPEN smernicama iz 2023. godine 1 i KDOQI smernicama iz 2020. 3, koje pokazuju da pravilna dezinfekcija značajno smanjuje rizik od infekcija povezanih sa kateterima (CRBSI) i poboljšava ishode pacijenata.

References

2
Guideline

espen guideline on home parenteral nutrition.

Clinical Nutrition, 2020

3
Guideline

kdoqi clinical practice guideline for vascular access: 2019 update.

American Journal of Kidney Diseases, 2020

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.