INDEX

1. Introduction
2. District Hospital
3. Training under Surgeon
4. Conclusion

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 Introduction
The public healthcare system in India evolved due to a number of influences from the past 70
years, including British influence from the colonial period. The need for an efficient and effective
public health system in India is large. Public health system across nations is a conglomeration of
all organized activities that prevent disease, prolong life and promote health and efficiency of its
people. Indian healthcare system has been historically dominated by provisioning of medical care
and neglected public health. 20% of all maternal deaths and 25% of all child deaths in the world
occur in India. 34 out of 1000 children are dead by the time they reach the age of 5. 58% of
Indians are immunized in urban areas compared to only 39% in rural areas. Communicable disease
is the cause of death for 53% of all deaths in India.
Public health initiatives that affect people in all states, such as the National Health Mission,
Ayushman Bharat, National Mental Health Program, are instilled by the Union Ministry of Health
and Family Welfare. There are multiple systems set up in rural and urban areas of India including
Primary Health Centres, Community Health Centres, Sub Centres, and Government Hospitals.
These programmes must follow the standards set by Indian Public Health Standards documents
that are revised when needed.

District Hospitals
District Hospitals are the final referral centres for the primary and secondary levels of the public
health system. It is expected that at least one hospital is in each district of India, although in 2010

it was recorded that only 605 hospitals exist when there are 640 districts. Civil surgeon
A civil surgeon is a senior designated post in the govt medical and health service. This post
signifies certain status, power and rank to the holder. A civil surgeon is merely a designation and
the incumbent need not be a surgeon A civil surgeon is a senior doctor in any of the medical
branches. Most commonly, all the professors in the teaching hospitals and the senior posts in the
district hospitals are civil surgeons. Civil surgeon is a rank in India. First a government doctor has
a rank of medical officer (M.O),then after more than 15 years of service he has chance of
promotion to senoir medical officer (SMO) of a block I.e of small part of district . After that he got
chance to serve as CIVIL SURGEON or CHIEF MEDICAL OFFICER of a district.

DISTRICT HOSPITAL
District Hospital

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 Access to services:
This is a general hospital. It provides medical care to all patients who come to hospital. Emergency
services are available 24 x 7 without any discrimination. The management of this hospital is
responsible for ensuring the delivery of services.

Services available:
Multi Specialist OPD Indoor Treatment / 24 hours Emergency Maternity Services
Wards (including High Risk
Pregnancy)
Radiology Laboratory Pharmacy ICU
(X-Ray, Ultrasound (with Semi Automatic
and CT Scan) Analyzer and Blood
Counter)
Family Planning ICU Physiotherapy Operation Theatre
Services (Intensive Care Unit)
Ayurvedic & Medico legal and 24 hours Ambulance Immunisation
Homeopathy OPD Post-mortem services for referral
(AYUSH) (Mortuary Services
available)
Dentistry Accident & Trauma Blood Bank ICTC (Integrated
Unit Counseling and
Testing Center)
At present, all the above services are provided to people free of cost.

Casualty & Emergency Services:

 All Emergency Service available round the clock

 Specialist doctors are available on call from resident doctors.

 Emergency services are available for all specialties as listed in the OPD Services.
 Medico legal services are available.
 Referral Services to higher center in case facilities for treatment are not available in the hospital.
 Round the clock ambulance services with basic life support.
 In serious cases, treatment/management gets priority over paper work like registration and medico-
legal requirements. The decision rests with the treating doctor.

OPD Services:
OPD services are available on all working days excluding Sundays and Gazetted Holidays.
Timings -
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Monday to Friday : 9.00 am to 1.00 pm and 2.30 pm to 5.00 pm
Saturday : 9.00 am to 1.00 pm

Services / Schemes are implemented in this District Hospital for the benefits of the people:
Name of the Broad objective Eligibility Amount of No. of days
Scheme / Service of scheme Criteria Financial required to
assistance deliver service
(if any)
Compensation To promote Family Planning Cash assistance Cash assistance
for Family Family Planning Operation of ` 600/- to SC/ will be disbursed
Planning (Tubectomy) at ST /BPL through
(Female) Govt. Hospital / and for other respective ANM
CHC/PHC of category ` 250/- of Sub-center
UT of District to the acceptor where
hospital beneficiary
Compensation Family Planning Cash assistance reside.
for Family Operation of ` 1100/- to the
Planning (Male) (Vasectomy) at acceptor
Govt. Hospital /
CHC/PHC of
UT
Matru Samrudhhi To promote Either parent Cash assistance 5 working days
Yojana institutional should be of ` 5,000/- to after submission
delivery and residence of UT delivered mother of form along
reduction of of District with requisite
MMR and IMR hospital document
Delivery taken
place at Govt.
Health Institution
of UT of District
hospital
Only up to first
two live birth.
Marriage after 18

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 years of age (for
female)
Dikari To save girl child Either parent ` 40,234/- will be 2 months after
Development and increase sex should be deposited under submission of
Scheme ratio domicile of UT Profit Plus form along with
of District Scheme / Term requisite
hospital and Deposit Scheme document
mother must be in LIC /Bank for
of above 18 years 18 years in the
old. name of girl child
Delivery taken
place at Govt.
Health facilities
of UT of District
hospital
The first two girl
in a family of two
children will only
be considered.
Issue of Fitness -- Taking treatment -- One working day
Certificate / from this health after medical
Medical institution. examination
Certificate
Issue of Handicap
Certificate

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 TRAINING UNDER SURGEON
DRESSING
A dressing is an adjunct used by a person for application to a wound to promote healing and/or
prevent further harm. A dressing is designed to be in direct contact with the wound, which makes it
different from a bandage, which is primarily used to hold a dressing in place. Some organisations
classify them as the same thing (for example, the British Pharmacopoeia) and the terms are used
interchangeably by some people. Dressings are frequently used in first aid and nursing.
CORE PURPOSES OF A DRESSING
A dressing can have a number of purposes, depending on the type, severity and position of the
wound, although all purposes are focused towards promoting recovery and preventing further
harm from the wound. Key purposes of are dressing are:
 Stem bleeding - Helps to seal the wound to expedite the clotting process
 Absorb exudate - Soak up blood, plasma and other fluids exuded from the wound, containing it in
one place
 Ease pain - Some dressings may have a pain relieving effect, and others may have a placebo effect
 Debride the wound - The removal of slough and foreign objects from the wound
 Protection from infection and mechanical damage, and
 Promote healing - through granulation and epithelialisation

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 TYPES OF DRESSING
Historically, a dressing was usually a piece of material, sometimes cloth, but the use of cobwebs,
[1]
dung, leaves and honey have also been described. However, modern dressings include gauzes
(which may be impregnated with an agent designed to help sterility or to speed healing), films,
gels, foams, hydrocolloids, alginates, hydrogels and polysaccharide pastes, granules and beads.
Many gauze dressings have a layer of nonstick film over the absorbent gauze to prevent the wound
from adhering to the dressing. Dressings can be impregnated with antiseptic chemicals, as in
boracic lint or where medicinal Castor oil was used in the first surgical dressings [2]
In the 1960s, George Winter published his controversial research on moist healing. Previously, the
accepted wisdom was that to prevent infection of a wound, the wound should be kept as dry as
possible. Winter demonstrated that wounds which were kept moist healed faster than those which
were left exposed to the air or covered with traditional dressings.
Various types of dressings can be used to accomplish different objectives including:
 Controlling the moisture content, so that the wound stays moist or dry,
 Protecting the wound from infection,
 Removing slough, and
 Maintaining the optimum pH and temperature to encourage healing.
Occlusive dressings, made from substances impervious to moisture such as plastic or latex, can be
used to increase the rate of absorption of certain topical medications into the skin.

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USAGE OF DRESSINGS
Applying a dressing is a first aid skill, although many people undertake the practice with no
training - especially on minor wounds. Modern dressings will almost all come in a prepackaged
sterile wrapping, date coded to ensure sterility. This is because it will come in to direct contact
with the wound, and sterility is required to fulfil the 'protection from infection' aim of a dressing.
Historically, and still the case in many less developed areas and in an emergency, dressings are
often improvised as needed. This can consist of anything, including clothing or spare material,
which will fulfil some of the basic tenets of a dressing - usually stemming bleeding and absorbing
exudate.
Applying and changing dressings is one common task in nursing.
An "ideal" wound dressing is one that is sterile, breathable, and conducive for a moist healing
environment. This will then reduce the risk of infection, help the wound heal more quickly, and
reduce scarring.

SURGICAL DRESSING

Rapid covering and healing of both acute skin defects and chronic skin defects are
important objectives for wound healing. The best way to heal a wound is to close it according
to surgical standards as quickly as possible after injury. However, this procedure is limited to
those wounds and those anatomical regions that allow both excision and adaptation of wound
borders to close the wound by primary intention orperprimam (Latin term meaning to close the
wound by suturing [or equivalent method] and restructuring of the skin continuity).
In large-surface and deep wounds in which the primary wound closure is not
possible or not practicable, the most important issue is to dress the wound
with appropriate materials to allow the following:

(1) to keep the wound free of infection,

(2) to reduce or eliminate pain,
(3) to reduce or eliminate all potential factors inhibiting natural healing (eg,
dead tissue in burns, superficial fibrosis, necrotic tissue), and (4) to replace or
substitute the missing tissue as much as possible. Wound repair
Wound repair involves the timed and balanced activity of inflammatory, vascular,
connective tissue, and epithelial cells. All of these components need an extracellular
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matrix to balance the healing process. Skin wounds heal by the formation of epithelialized scars
of different contraction ability rather than by the regeneration of a true full-thickness tissue. To
minimize scar formation and to accelerate healing time, different wound dressings and different
techniques of skin substitution have been introduced in the last decades.
Autologous skin grafting in the form of split- or full-thickness skin is still a criterion standard.
However, in many patients, this technique may not be practicable for a variety of reasons, and the
wound must be allowed to heal by second intention. Moreover, in cases in which skin grafts are
used, a new wound is created on the donor side. Thus, eliminating a new wound to close
the old one and to close as many tissue defects as possible without the risk of large area
infection, necrosis, tissue hypertrophy, and contraction, as well as deformation of wound borders, is a
necessity.
The next important problem is to reduce or eliminate scar formation, particularly in the field
of large-surface wounds.
Traditional management of large-surface or deep wounds involves open and closed methods.
In the open method, the wounds are left in a warm, dry environment to crust over,
whereas, in the closed method, wounds are covered with different kinds of temporary
dressings and topical treatment, including antibiotics, until healing by secondary intention. The
early removal of the dead tissue (eg, in burns) reduced pain, the number of n surgical
procedures, and the length of the hospital stay.
The surgical intervention (ie, tangential excision of partial- or full-thickness wound) followed
by wound closure with autografts or temporary dressings is one of the currently used methods. In
large-surface, full-thickness wounds, the wound can be excised down to the fat or the fascia,
particularly if infection is present. Excision to the fat induces the removal of the subdermal
plexus of blood vessels and decreases the take of autografts because this tissue is less
vascularized. Excision down to the fascia induces better take of the autografts but has
aesthetic disadvantages.
Wound debridement can also be achieved by enzyme digestion of the dead tissues.
Proteolytic enzymes (eg, collagenases used topically) allow a more specific destruction of
necrotic tissues, while preserving viable dermis and avoiding blood loss, but the treatment
can be painful and can increase the risk of local infection. In addition, it takes a long time to
achieve a clean wound bed.
•
Wound coverings

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 Currently available wound coverings can be divided into 2 categories: (1) permanent
coverings, such as autografts, and (2) temporary coverings, such as allografts (including de-
epidermized cadaver skin and in vitro reconstructed epidermal sheets), xenografts (ie,
conserved pig skin), and synthetic dressings.
Conventional autograft (epidermis and a significant amount of dermis) obtained from
healthy skin areas is considered the optimum wound cover in that its viability yields immediate
take (incorporation into the wound bed) and resistance to wound infection. However, harvesting of
autograft creates a second wound in the healthy tissue, a donor wound.
This open wound increases the risk of infection and fluid/electrolyte imbalance. Repeated
conventional harvests of autograft from a donor wound site can result in contour defects or scarring.
Optimizing the healing of both main wounds and donor wounds becomes a later goal of patient
management and the development of different surgical dressings, which can be used based on
the principle of phase-adapted wound healing. Most recently, developed wound dressings are
in use only as temporary dressings because of their synthetic or chemical components, limited
persistence on the wound surface, and foreign body character.
Some of the currently available surgical dressings used in dermatologic and
dermatosurgical practice are discussed.
Wounds encountered in surgical and dermatosurgical practice can be classified according
to their thickness, the involvement of skin or other structures, the time elapsing from the trauma
(breaking of skin continuity), and their morphology. Additional classifications include factors
that determine how to close the wound, classification of how the wound heals, and classification
of the wound by bacterial contamination.
THICKNESS OF THE WOUND

• Superficial wounds, involving only the epidermis and the dermis up to the dermal papillae
• Partial-thickness wounds, involving skin loss up to the lower dermis (Part of the skin remains, and
shafts of hair follicles and sweat glands are leftover.)
• Full-thickness wounds, involving the skin and the subcutaneous tissue (Tissue loss occurs, and the
skin edges are spaced out.)
• Deep wounds, including complicated wounds (eg, with laceration of blood vessels and nerves),
wounds penetrating into natural cavities, and wounds penetrating into an organ or tissue

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