Pre-operative Preparation
(I) Pre-operative Visits
One day before the operation, the visiting nurse utilizes both written and verbal forms to provide psychological care for the patients, and explains the relevant precautions, such as the environment of the operating room, the coordinated position, the time of fasting and water fasting, the removal of body ornaments, watches, dentures, female patients do not wear make-up, do not wear nail polish, etc., so that patients can be relieved of their worries and better cooperate with anesthesia and surgery. This will relieve the patient's worries and help her to better cooperate with anesthesia and surgery. At the same time, through the visit to understand the patient's general condition, allergy history and special requirements, in order to better cooperate with the doctor to complete the operation.
(2) Preparation of articles
1. Preparation of instruments Choose the appropriate instruments according to the type of surgery, and make them into basic instrument packs and special instrument packs, and prepare them for use after autoclaving.
2. Dressing preparation Fold all kinds of dressings according to the requirements, wrapped into abdominal bag, chest bag, thyroid bag, limb surgical bag, single bag, treatment towel bag, etc., after autoclaving ready for use.
3. Drainage items, it is best to use disposable sterilized drainage tubes such as "T" tube, thoracic drainage tubes, urinary catheters, hollow drainage tubes, etc.
(C) Instrumentation Preparation
1. Central suction device consists of a motor, a vacuum pump, a pneumatic bottle, etc., and the value of the negative pressure is more than 650mmHg.
Use: the motor, vacuum pump, pneumatic bottle, etc., and the value of the negative pressure is more than 650mmHg. p>
How to use: insert the negative pressure connecting pipe socket into the wall or tower center suction socket, the other end connects the negative pressure suction cover extraction outlet, suction port connects the suction tube on the operating table, and check the size of the negative pressure.
2. High-frequency electric knife
(1) principle
1) the use of high-frequency electric current to make tissue coagulation to achieve hemostasis.
2) The use of high-frequency voltage to cut tissue to achieve hemostasis.
(2)Usage
1) Firstly, check whether the current switch of "Output Adjustment" is placed in "0" or "Off" position.
2) Turn on the power, open the main switch, adjust the output size (generally about 50).
3) Connect the ground wire.
4) Paste the negative plate in the muscle-rich parts, such as thighs, buttocks.
5) After use, adjust the output to "0", then cut off the power.
(3) Precautions
1) It is best to use high-frequency electrocautery with a safety device, once the negative electrode plate contact surface is not enough or fall off, the instrument automatically alarms and cuts off the current output, to ensure the safety of the patient.
2) Disposable negative plate to avoid repeated use.
3) It is prohibited for patients with pacemaker.
3. Ultrasonic knife
(1) Principle: Mechanical oscillation with ultrasonic frequency of 55.5 Hz, so that the water in the tissues is vaporized, the protein hydrogen bond is broken, and the cells are disintegrated, so that the tissues are cut or coagulated.
(2) multi-purpose scissors assembly steps: 1) tighten the conversion cap; 2) tighten the core of the knife; 3) with the pressure plate hand clockwise twisted twice, hear "click" sound can be; 4) on the jacket, pay attention to the tip of the jacket and the back handle are facing up.
(3) test: the host is connected to the power supply, the end of the handle connecting line into the host, the assembled multi-purpose scissors apart, the foot pedal, when the test passes before use.
4. air tourniquet is mainly used for limb surgery. Air tourniquet has two kinds of electric and manual.
(1) according to the patient's age, limb parts and surgical sites to choose the appropriate width of the air tourniquet.
(2) It must be used under anesthesia to prevent limb pain caused by tourniquet compression.
(3) If the site of use is close to the incision, the tourniquet must be sterilized before use.
(4) Check whether the pressure gauge and air tourniquet are intact and have no air leakage.
(5) Pressure: chengren upper limb 40kPa (300mmHg) lower limb 66.7kPa (500-600mmHg)
Children upper limb 27kPa (200mmHg) lower limb 54kPa (400mmHg)
(6) Time is 1-1.5 hours.
Intraoperative cooperation
(I) Roving nurse workflow
1. Preoperative visit to the patient, to understand the patient's general condition, preoperative preparations, and to do a good job of psychological care.
2. Check the patient's name, name of surgery, site of surgery, and check whether the materials needed for surgery are complete and applicable.
3. Assist in anesthesia, establish intravenous access, and set up the body position. Prepare all the surgical materials such as electric knife, suction device, etc., adjust the surgical lighting. Adjusts surgical lighting.
4. Assist the surgical personnel to dress, and the instrument nurse to carefully count the instruments, dressings, and make a good registration.
5. Observe the patient's condition at any time during the operation, the progress of the operation, and cooperate with the rescue and supply of goods, do not go AWOL for no reason.
6. Supervise the aseptic operation of all kinds of personnel in the operating room, and keep the operating room quiet and clean.
7. Strict checking system, before and after the closure of the body cavity and hand-washing nurses again check the number of instruments, dressings.
8. Assist in covering the wound, fill in the specimen delivery form, and urge the doctor to do a good job of specimen retention.
9. Fill out the billing form carefully and check the diagnosis, operation mode and operation personnel on the operation notice to make it consistent with the actual situation.
10. Clean up and replenish the items in the operating room after the operation, and locate and return them to the original.
(B) Hand-washing nurse workflow
1. Pre-operative review of the local anatomy of the operation and surgical steps, in order to better cooperate with the operation.
2. Check the patient's name, the name of the operation, the site of the operation, and check whether the supplies needed for the operation are complete and suitable.
3. Prepare the sterile instrument table, wash hands 15-20 minutes earlier than the operator, and organize the instrument table.
4. Carefully count the instruments and dressings, and check whether all kinds of instruments and dressings are perfect, and whether knives and scissors are sharp and suitable.
5. Prepare the instruments and accessories to be used, such as electric knife and suction tube.
6. Pay close attention to the progress of the operation, take the initiative to cooperate, and keep the sterile articles and instrument table dry and clean.
7. Carefully count the instruments and dressings before and after the closure of the cavity to prevent foreign bodies from being stored in the wound.
8. Assist in dressing wounds and handling specimens.
9. Clean instruments after operation, and bake dry, oil, packing. Special instruments are handed over to the instrument team and instrument carts are wiped clean and restored.
(C) surgical position
1. supine position is suitable for neck, maxillofacial, abdominal, hand surgery. The patient lies on his back, with his head on a soft pillow; both arms are fixed to the side of the body with a padded sheet; a soft pillow is placed under the knee, and the knee is fixed with a lower limb fixation belt.
(1) Breast surgery patient supine position, the operation side near the edge of the table, scapula under the pad with a folded sheet, the upper arm abduction, placed on the arm rest; the rest of the same as described above.
(2) Neck surgery, such as thyroid, tracheotomy, in the shoulder pad a soft pillow, with the shoulders, head under the head of a head circle, so that the head tilted back. The rest is the same as above.
(3) Hepatobiliary surgery pay attention to the patient's rib margins under the alignment of the lumbar bridge. Pelvic surgery requires a soft pillow in the sacrococcygeal region to facilitate exposure of the surgical field.
(4) Head surgery is immobilized with a head frame.
2. Lateral position For thoracic, renal and low back surgery.
(1) Thoracic surgery The patient lies on the side at 90 degrees, with a soft pillow under the armpit, which is pressed and tucked under the mattress with a padded sheet. The upper leg was flexed, the lower leg was straightened, a soft pillow was placed between the two legs, and the hip and knee were fixed with a pelvic tray and fixation belt. Both upper limbs were straightened and fixed on the brace.
(2) Renal surgery The patient lies on the side at 90 degrees, the renal area is aligned with the waist bridge of the operating table, the upper leg is straight, and the lower leg is flexed. The rest is the same as above.
3. Prone position For spine and back surgery. According to the length of the patient to adjust the prone position cushion, so that the patient lying on its head, the head placed on the head frame or fixed with head nails. The head is placed on the headrest or fixed with headpins. The arms are half-flexed and placed on the pallet. A head ring was placed under the knee and a soft pillow was placed on the calf. The pelvis and popliteal fossa were immobilized with fixation straps.
4. Lithotomy position is suitable for perineum, urethra and anus surgery. The patient lies on his back, the buttocks are moved to the end of the surgical bed, the leggings are put on, the legs are placed on the legrest, the popliteal fossa is padded with a cotton cushion, and the patient is fixed with a fixed band
5. Semi-sitting position is suitable for nasal and tonsil surgery. The head end of the surgical bed is swung up to 75 degrees, the tail end of the bed is swung down to 45 degrees, the legs are half-flexed, the head and trunk are close to the swung up surgical bed, the whole surgical bed is tilted back to 15 degrees, and the hands are fixed on both sides with the fixation straps.
6. Folding knife position For anal surgery. The buttocks are moved to the end of the surgical bed, put on the leggings, adjust the prone position cushion according to the length of the patient, so that the patient lies down on it, and the two legs are placed on the leg boards, which are separated from each other and fixed with the fixation straps.
7. Precautions
(1) Maximize the patient's comfort and safety with good exposure.
(2) Minimize the effect on respiration and circulation .
(3) There should be no compression or excessive stretching of any nerves to prevent paralysis.
(4) No excessive pulling on muscles to prevent injury or post-surgical pain.
(5) Extremities should not be excessively retracted to prevent dislocation of the joints.
(6) The limbs should not be suspended in the air, and must be stabilized with pads.
(7) Sponge pads should be used to protect the parts that are susceptible to pressure.
(D) the preparation of sterile table
1. hand-washing nurse in the hand-washing before the preparation of clean, dry, appropriate specifications of the instrument table and instrument package.
2. The instrument bag is placed on the instrument table, and after passing the inspection, the outer wrapping is opened by hand.
3. Take the sterile forceps and open the inner wrap and sterile sheet.
4. Place the items needed for the procedure on the sterile table and cover them with a sterile sheet after they are ready for use.
5. After the hand-washing nurse puts on the surgical gown and gloves, the nurse organizes the instrument table and arranges them according to the order and type of use.
6. Preparation of the sterile table should pay attention to
(1) The sterile table cushion sheet should be spread 4-6 layers, and the edge should be down 30cm.
(2) The prepared sterile table should not be more than 4-6 hours.
(3) After the sheet is wet with water or blood, it should be covered with a sterile sheet.
(E) the principle of asepsis in surgery
1. surgical operations must first establish a sterile area, only sterilized items can be used in the sterile area.
2. After the surgical personnel put on the surgical gown, the forearms should not droop and should be kept above the waist level. Hands should not be placed close to the face or crossed under the armpits; they should be elbowed in and close to the body.
3. When exchanging positions with another surgical staff member, they should be back to back.
4. It is forbidden to put back the item removed from the sterile container or sterile area even though it has not been used.
5. Items that fall below the edge of the operating table or the edge of the sterile table should be considered sterile, and any skin tubes, wires, sutures, etc. that fall down should not be lifted upward or reused.
6. Gloves should be replaced if they are torn.
7. Before cutting the skin, sterile gauze should be used to cover both sides of the incision or surgical film should be pasted on the skin, and the skin should be cut through the film to protect the incision from contamination. Before extending the incision or sewing the skin should be wiped again with antiseptic solution.
8. Gauze pads should be used to protect the surrounding tissues before handling cavity organs, and outflow of secretions should be aspirated at all times. Contaminated instruments and other items should be placed in a curved tray and isolation practiced.
Postoperative treatment
(A) Routine surgical treatment
1. Instruments Brush the instruments with running water on all surfaces, the axial joints should be opened, and the lumens should be brushed with a pass-through strip or a special brush. Ultrasonic cleaning machine or automatic cleaning and sterilizing machine can also be used. Then, the instruments will be baked dry, oiled, packed and restored.
2. Dirty dressings are placed in a designated place, and are handled by the laundry.
3. The floor and table of the operating room are wiped with disinfectant, and then the air is sterilized.
4. Organize the operating room, restore and replenish the supplies.
5. Medical waste is bagged and incinerated.
(2) infected surgical treatment
1. Should be arranged in the contaminated operating room or outdoor hanging isolation sign, the required items are passed by the outdoor traveling nurse.
2. Indoor nurses and anesthesiologists should wear isolation gowns, gloves and shoe covers. The surgeon should put on shoe covers and then wash his/her hands, and he/she should not leave the operating room during the operation.
3. After surgery, the cloths and attendants to remove the contaminated surgical gowns and pants, shoes and flat carts, air disinfection and then disposed of.
4. Use of disposable dressings, postoperative incineration.
5. All indoor objects and floors are scrubbed with disinfectant.
6. Instruments should be sterilized before cleaning.
7. Indoor air according to the air disinfection method.
8. Special infections such as tetanus, gas gangrene treatment should pay attention to:
(1) air according to a high concentration of disinfectant disinfection of airtight 24h, air and surface cultures negative, and then routine treatment.
(2) Use disposable quilts and burn them after surgery.
(3) Instruments are soaked in double disinfectant solution for 60min and then cleaned, then autoclaved and routinely processed.
II. Minimally invasive surgery with
Preoperative preparation
(1) Preoperative visit: same as before.
(II) Equipment and instruments preparation
1. TV camera system: consists of surgical lumens, micro-camera, monitor, video converter
2. cold light source.
3. Carbon dioxide pneumoperitoneum system: it consists of CO2 cylinder, high-pressure catheter, pneumoperitoneum machine and pneumoperitoneum catheter.
4. Bruising and cutting system: composed of high-frequency electric knife and ultrasonic knife.
5. Flushing and suction device.
6. Lumpectomy instruments.
Laparoscopic instruments: pneumoperitoneum needle, 5mm and 10mm perforator, 0 ° and 30 ° laparoscope, grasping forceps, separating forceps, tissue forceps, separating hooks, separating spoons, scissors, titanium clamps, puncture needles, irrigation and suction tubes, lithotripsy forceps, needle holders, push the knot, loopers core and a variety of connecting wires such as cameras, optical fibers, CO2 tubes, electrocautery connecting wires, multi-ultrasound scissors and handles, etc.. In particular, the insulation of the instruments should be checked for breaks and perforations to avoid electrical damage. (For thyroid surgery, prepare 0° and 30° 5mm endoscopes, sets of 3mm or 5mm plastic cannulas, 2mm surgical scissors, separation forceps, 5mm titanium clips, etc.) Separation forceps, 5mm titanium clamps.)
Thoracoscopic instruments: trocars (5.5mm,10.5mm,11.5mm three kinds) thoracic lens, lung grasping forceps, separation forceps, biopsy forceps, scissors, claw-type hooks, titanium clamping forceps, titanium clips, direct cutting sutures, stump closure, rinsing suction tubes, specimen bags, small retractors.
Spinal endoscopic instruments: guide pins and dilatation tubes, nerve strippers, spatulas, gun-type bone biting forceps, nerve hooks, micro-knife and scissors, fiber ring saws, channels, free arms, nucleus pulposus forceps, bipolar electrocoagulation, lenses and their optical fibers, and so on.
Knee arthroscopic instruments: knee arthroscope, foreign body pliers, blue pliers (scissors), puncture needles, hawksbill pincers, hook knife, fork knife, flat beak thwart, curved thwart, probe, planing cutter head, lens and its optical fiber.
Cystotomy instruments: 100 ° electro-knife mirror, 300 ° observation mirror, electro-knife mirror sheath, occluder, plasma electrosurgical ring, electrosurgical column, operating handle, Ellik rinser.
Lower extremity varicose vein laser treatment surgical instruments: optical fiber, indwelling needle (18, 20, 22,) each, vasodilator, angiographic tube core and cannula.
7. Routine surgical instruments.
(C) Sterilization of instruments
1. Instruments that are resistant to high temperatures are sterilized by autoclave.
2. The instruments that are not resistant to high temperature are sterilized by ethylene oxide or soaked in 2% alkaline garrison aldehyde for 10 hours.
Intraoperative care
(I) Minimally invasive surgical position
Abdominal surgery is usually performed in the supine position and thoracic surgery in the lateral position. For some procedures, the surgeon prefers to stand between the patient's outstretched legs. Tilting the operating table is a very effective method that facilitates exposure of the surgical field. For example, in upper abdominal surgery, the head is in a high and low position, the greater omentum, and the small bowel is moved downward. For pelvic surgery, the head is positioned low and the small bowel and sigmoid colon move toward the abdomen. Tilt to the left or right. Favorably separates the two sides of the colon.
(ii) Physiologic monitoring Closely observe blood pressure, pulse, oxygen saturation and body temperature to prevent hypothermia and surgical emphysema. To maintain the patient's body temperature, the room temperature should be controlled at 22-25°C, and the flushing fluid should be kept at 38°C.
(3) Keep the surgical area sterile Since the luminal scopes are relatively long, care should be taken to avoid contamination.
(IV) Technical supervision
1. Should be skilled in the performance of each instrument and operating procedures, the instrument cart placed opposite the operator, turn on the power supply, warm-up 15min, careful inspection and timely elimination of obstacles, the operation is strictly in accordance with the operating procedures.
2. Adjust the surgical position according to the surgical needs, connect the wires, and adjust the white balance and contrast.
3. When operating the pneumoperitoneum machine, adjust and strictly control the gas flow rate at any time, the flow rate is easy to be slow at the beginning of the inflation, in order to prevent gas embolism caused by the improper position of the needle tip, or because of the inflation speed is too fast, the flow rate is too large for the intra-abdominal pressure to rise suddenly. On the one hand, the diaphragm rises significantly, which can cause ventilation to decrease, prevent CO2 discharge, produce CO2 accumulation, and complicate hypercapnia. On the other hand, it stimulates the peritoneal tension receptors, excites the vagus nerve, and reflexively causes cardiac arrest.
4. Ensure that the manufacture of pneumoperitoneum must be CO2, the pressure is maintained at 12-14mmHg, when the inflatable flow rate reaches 15mmHg when the closure of the inflatable guardianship, intra-abdominal pressure will cause surgical emphysema.
5. Intravenous fluids should be selected from the upper extremities, because the pneumoperitoneum or head-high-feet-low position will affect the venous blood flow in the lower extremities, and with the prolongation of stasis, the incidence of thrombosis gradually increases.
6. Correct use of electrosurgical knife and ultrasonic knife, constantly checking the insulation and connection of instruments to prevent electrosurgical knife injury.
7. Monitor the working condition of the equipment to prevent the failure of the movie and television system and the interruption of the operation.
8. Carefully hold the lumens and instruments, always remove tissue debris in the tubes, the front of the instruments and the movable parts, and don't disconnect the fiber-optic guide from the endoscope unless the light source is turned off first, in order to prevent accidental burns.
(v) Maintain the correct number of items and instruments.
(vi) At the end of the procedure, remind the surgeon to release any residual CO2 in the abdomen when removing the last puncture device to minimize postoperative discomfort due to excessive intra-abdominal pressure.
(vii) Record the patient's condition correctly, and maintain effective communication between the nurse and the doctor during the operation to ensure the patient's safety.
Maintenance of minimally invasive surgical instruments and apparatus
(1) Instrument maintenance
1. Instrument cleaning: Disassemble each accessory first to wash out the blood, and then immerse it in the appropriate enzyme solution for 5 minutes, and then wash it under running water, paying attention to each small accessory to avoid loss. Can also use ultrasonic cleaning machine or automatic cleaning and sterilization machine cleaning.
2. Instrument inspection According to the use of the inspection function, there are joints of the instrument should check the joints; mobility, occlusion function and bite, sharp instruments and scissors should be tested for sharpness, insulated packaging or metal-plated instruments should be inspected for cracks or defects, there are screws of the instrument should be checked for completeness and loosening phenomenon.
3. The protection of the instruments should avoid falling, dropping or pressing under the heavy objects, should be gently put, can not be thrown, sharp or tip to protect the protection of the sleeve, avoid immersed in salt water, such as must be immersed, it is best to use the distilled water, to keep the instruments clean, there are joints in the instrument, the available water-soluble lubricants to deal with.
(B) the maintenance of the instrument
Strict implementation of the operating procedures, boot, first open the main power supply, and then open the instrument switch. Shutdown, the first off the instrument switch, and then off the main power supply, pull out the wires, conduits, clean spiral disk, do not discount, so as not to break the optical fiber. Do a good job of registration, keep clean, covered with a cloth cover, placed in a fixed position.
Third, the use and management of clean operating room
(a) the principle of purification of the operating room
Clean air through the high-efficiency filters and static pressure box (purification of the ceiling) after the equalization of pressure and flow, vertical delivery into the operating room. From the air supply to the two sides of the wall of the return air outlet, the air flow through the section on the way to a uniform flow rate, especially in the work area of the flow line unidirectional parallel, there is no overhang. Clean air like an air piston will be indoor polluted air from the return air outlet, so that the operating room always maintain a clean state.
(B) the purpose of the clean operating room environment
Surgical environment control is not the same as the beginning of the surgical incision, the final incision suture, it is a whole process control. Air purification measures are to eliminate hidden dangers, an important means of establishing a good environmental control, it is with the previous reliance on sterilization of aseptic control are two completely different concepts.
Item
Modern concept of control
Previous concept of control
Concept of control
Concept of whole-process control, not only the result of the "patient does not get infected"
Reliance on drug control to achieve "patient The result of no infection
Control requirements
Control of the entire surgical process, cut off all pathways of contamination (including the air), to prevent bacteria from contacting the wound
Dependent on the drug to disinfect the environment, the patient takes a large number of antibiotics
Control ideas
"Prevention" measures
"Remedial" measures
Effects
"Control of the whole process", preventing bacteria from entering the body, the drug is only a variety of safety measures to protect the patient to minimize the damage of the " Results"
Bacteria have already entered and damaged the human body, and then rely on a large number of drugs to control the infection, only reflects a "result", and the control process has failed
(3) classification
Clean operating room clean room level standards
Equivalent Class
Maximum average concentration of settled (planktonic) bacteria
Air cleanliness level
Ⅰ
Operating room
Operating area 0.2/30min-Φ90 dish (5/m3)
Peripheral area 0.4/30min-Φdish 90 (10/m3)
Operating area Class 100,
Peripheral area class 1000.
Clean auxiliary
Auxiliary rooms
Localized class 100 area 0.2/30min-Φ90 dishes (5/ m3)
Peripheral area 0.4/30min-Φdishes 90 (10/ m3)
Class 1000
(Localized class 1000)
II
Operating room
Operating area 1/30min-Φ90 dish(25pcs/m3)
Peripheral area 2/30min-Φ90 dish(50pcs/m3)
Operating area class 1000
Peripheral area class 10000.
Clean auxiliary
Auxiliary room
2/30min-Φ90 dishes (50/ m3)
10000 class
Ⅲ
Operating room
Surgical area 2/30min-Φ90 dishes (75/ m3)
Peripheral area 4/30min-Φ90 dishes (150/ m3)
Peripheral area 4/30min-Φ90 dishes (50/ m3). 90 dishes (150 dishes/m3)
Surgical area class 10000
Peripheral area class 100000.
Clean auxiliary
Auxiliary rooms
4/30min-Φ90 dishes (150/m3)
Class 100000
Class IV
Operating rooms
5/30min-Φ90 dishes (175/m3)
Class 300000
Clean auxiliary
Auxiliary rooms
Surgical scope of clean operating rooms
Clean operating rooms
Scope of application
Class Ⅰ special clean operating rooms
Joint replacement, organ transplantation, brain surgery, cardiac surgery, ophthalmology
Class Ⅱ standard clean operating rooms
Thoracic surgery, Plastic Surgery, Urology, Hepatobiliary and Pancreatic Surgery, Orthopedic Surgery and Ovulation and General Surgery of a class of aseptic surgery;
Ⅲ general clean operating room
General Surgery (excluding a class of surgery), Gynecological and Obstetric Surgery.
Class IV quasi-clean operating room
Anal surgery, contaminated type of surgery.
(D) clean operating room management
1. Strict partition management
Clean operating room is the application of clean air technology, through the establishment of a scientific character process and strict partition management, and ultimately achieve the control of particulate contamination, to ensure the safety of surgical patients. Therefore, in addition to air clean technology, staff, patients, sterile goods, dirt should be strictly separated, can not *** use a channel.
2. Control the source of pollution, reduce the occurrence of pollution
1) personnel entering the operating room need to change shoes and change clothes according to regulations. Promote the wearing of full-body suction suits, which can stop the dissemination of bacteria.
2) Strictly control the number of visitors to reduce the flow of people. It is best to utilize a television teaching system to watch surgical operations.
3)The items in the operating room should be simple and suitable. Strictly prevent the return air outlet from being blocked by items so as not to affect air circulation, and clean the filter every 1-2 weeks.
4)Transportation of patients should be exchanged when the car and marking, so that the inside and outside of the separation, in order to reduce the sick zone contamination sources brought into the clean operating room. Patients wear a good hat to enter.
5) equipment, instruments and items into the clean operating room, should be removed before the outer packaging, wipe clean before moving in.
3. Maintain positive pressure distribution in the operating room to maintain air flow must flow from the higher cleanliness area to the lower area. Should always close the operating room door to maintain positive pressure in the operating room.
4. Set up a full-time regular maintenance of the purification system, determination of the main technical indicators, according to the monitoring results of the replacement of filters.