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NABH guidelines - Dr Chintan N Patel
The document discusses the National Accreditation Board for Hospitals & Healthcare Providers in India, focusing on its mission to establish a healthcare accreditation and quality improvement program. It outlines procedures for managing surgical wounds, including classifications of wounds and appropriate cleaning and treatment methods. Additionally, it includes guidelines for wound care in poly-trauma cases and suction protocols to maintain patient airways and improve oxygenation.
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NABH guidelines - Dr Chintan N Patel
- 1. NABH : NATIONALNABH: NATIONAL ACCREDITATION BOARD FORACCREDITATION BOARD FOR HOSPITALS & HEALTHCAREHOSPITALS & HEALTHCARE PROVIDERSPROVIDERS Dept of Orthopaedics , J.N. Medical College and Dr. Prabhakar Kore Hospital and PRESENTER : Dr CHINTAN N PATEL
- 2. INTRODUCTIONINTRODUCTION • Is aconstituent board of Quality Council of India.Is a constituent board of Quality Council of India. • Set up to establish and operate accreditation programme for healthcare organisations.Set up to establish and operate accreditation programme for healthcare organisations. • MISSION :MISSION : To be apex national healthcare accreditation and quality improvement body,To be apex national healthcare accreditation and quality improvement body, functioning at par with global benchmarks.functioning at par with global benchmarks.
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- 6. 7 STEPS OFHAND WASHING7 STEPS OF HAND WASHING
- 12. Blood and Body FluidSpill
- 18. • How youwill prepare the site – before giving injection/inserting iv line Use 70 % alcohol (sprit) for cleaning the site from centre to periphery and wait for 30 second
- 19. CLASSIFICATION OF SURGICALWOUNDS (NATIONAL RESEARCH COUNCIL)CLASSIFICATION OF SURGICAL WOUNDS (NATIONAL RESEARCH COUNCIL) SURGICAL WOUND TYPES:SURGICAL WOUND TYPES: • Clean wound – no signs of infection / inflammation e.g.; skin, eye,Clean wound – no signs of infection / inflammation e.g.; skin, eye, vascular system.vascular system. •Clean contaminated wound: e.g. post – op infected cases, abscess.Clean contaminated wound: e.g. post – op infected cases, abscess. •Contaminated wound : e.g. gunshot injury.Contaminated wound : e.g. gunshot injury. •Dirty contaminated: where there is exposure to fecal mass, openDirty contaminated: where there is exposure to fecal mass, open fistulas.fistulas.
- 20. MANAGEMENT:MANAGEMENT: •Clean wound: cleanwith Betadine 10%.Clean wound: clean with Betadine 10%. •Wound surroundings to be cleaned and keep dry.Wound surroundings to be cleaned and keep dry.
- 21. CONTAMINATED WOUND:CONTAMINATED WOUND: •Woundsurface 1Wound surface 1stst to be cleaned with Betadine 10%.to be cleaned with Betadine 10%. •Internal wound cleaned by H O / Saline.₂ ₂Internal wound cleaned by H O / Saline.₂ ₂ •Removal of slough, (Debridement, +dressing vac +Hydrogen).Removal of slough, (Debridement, +dressing vac +Hydrogen). •Send pus for culture sensitivity reporting.Send pus for culture sensitivity reporting. •Antibiotics according to culture sensitivity report.Antibiotics according to culture sensitivity report.
- 22. DIRTY CONTAMINATED WOUND:DIRTYCONTAMINATED WOUND: •Proper irrigation with saline.Proper irrigation with saline. •Betadine 10% H 0 / saline cleaning.₂ ₂Betadine 10% H 0 / saline cleaning.₂ ₂ •Inj TT/TT Immunoglobulin.Inj TT/TT Immunoglobulin. •Adequate Hydration –I.V. fluids/ pcv transfusion.Adequate Hydration –I.V. fluids/ pcv transfusion. •Antibiotics.Antibiotics. •Prepare pt for wound debridement ± # Stabilization, ± Dressing.Prepare pt for wound debridement ± # Stabilization, ± Dressing.
- 23. WOUND CARE GUIDELINESWOUNDCARE GUIDELINES • In poly-trauma cases Provide AirwayIn poly-trauma cases Provide Airway and Urgent resuscitationand Urgent resuscitation • Treat open fractures as emergenciesTreat open fractures as emergencies • Immobilise injured extremity and cover wound with sterile dressing -Immobilise injured extremity and cover wound with sterile dressing - cover with saline soaked gauzecover with saline soaked gauze • IV Antibiotics within 3 hours of injury and continue for 72 hoursIV Antibiotics within 3 hours of injury and continue for 72 hours • Serial neurovascular examinationsSerial neurovascular examinations • Vascular repair ≤6 hoursVascular repair ≤6 hours • Urgent optimum wound debridementUrgent optimum wound debridement • External fixation for damage control, definitive internal fixation at theExternal fixation for damage control, definitive internal fixation at the earliest (within 72 hours and not exceed 7 days)earliest (within 72 hours and not exceed 7 days) • Early bone graftingEarly bone grafting • Delayed wound closure with SSG/FlapDelayed wound closure with SSG/Flap
- 26. SUCTION PROTOCOLSUCTION PROTOCOL •The purpose of suctioning is to maintain a patent airway and improveThe purpose of suctioning is to maintain a patent airway and improve oxygenation by removing mucous secretions and foreign material (vomitoxygenation by removing mucous secretions and foreign material (vomit or gastric secretions) from the mouth and throat (oropharynx).or gastric secretions) from the mouth and throat (oropharynx). • PROCEDURE:PROCEDURE: • Wash hands and wear personal protective equipment as indicated.Wash hands and wear personal protective equipment as indicated. • Adjust vacuum between-80 to -120 mmHg for adults or -60 to-80 mmHgAdjust vacuum between-80 to -120 mmHg for adults or -60 to-80 mmHg for pediatrics.for pediatrics. • Provide semi-fowler’s position (30 to 40 degree elevation).Provide semi-fowler’s position (30 to 40 degree elevation).
- 27. • Check heartrate before, during and after procedure .(If tachycardia orCheck heart rate before, during and after procedure .(If tachycardia or bradycardia occurs discontinue the procedure until it resolves).bradycardia occurs discontinue the procedure until it resolves). • Put clean gloves on both hands.Put clean gloves on both hands. • Open suction catheter exposing only the connector, attach to connective tubingOpen suction catheter exposing only the connector, attach to connective tubing and maintain sterility of catheter.and maintain sterility of catheter. • If patient has an artificial airway in place, hyper oxygenate with a resuscitationsIf patient has an artificial airway in place, hyper oxygenate with a resuscitations bag or mechanical ventilator.bag or mechanical ventilator.
- 28. • Insert thecatheter through the nose or endotracheal tube to the pointInsert the catheter through the nose or endotracheal tube to the point of restriction without applying suction (do not aggressively force theof restriction without applying suction (do not aggressively force the tip of the catheter )tip of the catheter ) • Slowly insert catheter & ask patient to take deep breaths or watch forSlowly insert catheter & ask patient to take deep breaths or watch for inspiration.inspiration. • Pinch and Pass catheter into trachea, and slowly withdraw whilePinch and Pass catheter into trachea, and slowly withdraw while applying intermittent suction and rotating.applying intermittent suction and rotating. • Hyper oxygenate the intubated patient or request the non-intubatedHyper oxygenate the intubated patient or request the non-intubated patient to take several deep breaths.patient to take several deep breaths. • Auscultate the patient’s chest if secretions can still be heard repeat theAuscultate the patient’s chest if secretions can still be heard repeat the suctioning proceduresuctioning procedure
- 29. • Before re-suctioning,clear catheter with normal salineBefore re-suctioning, clear catheter with normal saline • Discard gloves and catheters in an aseptic manner, clear connectiveDiscard gloves and catheters in an aseptic manner, clear connective tubing with remaining NS and turn off suction.tubing with remaining NS and turn off suction. • Note: -Note: - Coat tip of catheter with lubricant only if nasotrachealCoat tip of catheter with lubricant only if nasotracheal suctioning is to be performed.suctioning is to be performed. • Remember:Remember: - Suction should not be applied for more than 10 sec.- Suction should not be applied for more than 10 sec. - First oral suction to be done and followed by ET suctioning.- First oral suction to be done and followed by ET suctioning. - ET tube pressure - 25-30 mmHg.- ET tube pressure - 25-30 mmHg.
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