Where the handling instructions should be. Processing of surgeons. Hygienic handling. Hand treatment is a simple, but very important method of prevention of an ansis. P ravil and timely handling of hands is the security deposit of the medical

Standard "Hand processing at the social level"

purpose: removal of dirt and transient flora with contaminating skin of the hands of medical personnel as a result of contact with patients or environmental objects; Ensuring infectious safety patient and personnel.

Indications: Before distributing food, feeding the patient; After visiting the toilet; Before and after care for the patient, if the hands are not contaminated with the patient's biological fluids.
Prepare: Liquid soap in one-time dispensers; Clock with a second arrow, paper towels.

Algorithm Actions:
1. Remove the rings, rings, hours and other decorations with fingers, check the integrity of the skin of the hands.
2. Wrap the robe sleeves on 2/3 of the forearm.
3. Open the water tap with a paper napkin and adjust the water temperature (35 ° -40 ° C), thereby preventing the hand contact with microorganisms located on the tap.
4. Wash your hands with soap under running water up to 2/3 of the forearm for 30 seconds, paying attention to the phalanges, interfallated spaces of hands, then wash the rear and palm of each brush and rotational movements of the base of large fingers of the hands (this time is enough to decontaminate hands at the social level If the surface of the skin of the hands is embedded carefully and dirty areas of the skin of the hands are left).
5. Rinse your hands under running water to remove soap foam (keep your hands with your fingers up so that the water glass into the sink from the elbows, without touching the sink. The phalanges of the fingers should remain the cleanest).
6. Close the elbow cock with the elbow movement.
7. Dry the hands with a paper towel, in the absence of an elbow crane, close the edges with a paper towel.

Standard "Hand processing in the hygienic level"

Purpose:
Indications: before and after the implementation of invasive procedures; before putting on and after removing gloves, after contact with biological fluids of the body and after possible microbial contamination; Before leaving a patient with a weakened immunity.
Prepare: Liquid soap in dispensers; 70% ethyl alcohol, watches with a second arrow, warm water, paper towel, safe recycling container (CBU).

Algorithm Actions:
1. Remove the rings, rings, clocks and other decorations from your fingers.
2. Check the integrity of the skin's skin.
3. Wrap the robe sleeves on 2/3 of the forearm.
4. Open the water tap with a paper napkin and adjust the water temperature (35 ° -40 ° C), thereby preventing the contact of the hands with microorganisms. Located on the crane.
5. Under a moderate jet of warm water vigorously handhed hands
2 / 3Replace and wash your hands in the following sequence:
- palm about palm;

Each movement is repeated at least 5 times for 10 seconds.
6. Rinse your hands under running warm water until the soap is completely removed, keeping hands so that the wrists and brushes are above the level of the elbows (in this position water flows from a clean zone to the dirty).
7. Close the crane right or left elbow hand.
8. Dry the hands with a paper towel.
In the absence of an elbow crane, close the crane with a paper towel.
Note:
- in the absence of the necessary conditions for hygienic handwash, you can handle them using an antiseptic;
- Apply on dry hands 3-5 ml of antiseptic agent and rub it on the skin of the hands before drying. Wipe your hands after processing! It is also important to observe the exposure time - the hands must be wet from the antiseptic of at least 15 seconds;
- The principle of processing surfaces "from pure to dirty" is observed. Washing hands can not be touched before foreign objects.

1.3. Standard "Hygienic Handling Antiseptic"

Purpose: Removal or destruction of transient microflora, ensuring patient and personnel infectious safety.

Indications: Before injection, catheterization. Operation

Contraindications: Presence on hand and body of guns, cracks and injuries of skin, skin diseases.

Prepare; Skin antiseptic for hand treatment of medical personnel

Algorithm Actions:
1. Spend decontamination of hands on the hygienic level (see Standard).
2. Dry the hands with a paper towel.
3. Apply 3-5 ml of the antiseptic to the palm and rub it into the skin for 30 seconds in the following sequence:
- Palm about palm
- right palm on the back of the left hand and vice versa;
- palm to the palm, fingers of one hand in the interfallated intervals of the other;
- the rear side of the fingertips of the right hand on the palm of the left hand and vice versa;
- rotational friction of large fingers;
- collected together with the tips of the left hand about the right palm with circular movements and vice versa.
4. Ensure complete drying of the antiseptics on the skin of the hands.

Note: Before using the new antiseptic, it is necessary to study the methodical instructions for it.

1.4. Standard "Wearing sterile gloves"
Purpose:ensuring infectious safety patient and personnel.
- gloves reduce the risk of professional infection when contacting patients or their secretions;
- gloves reduce the risk of contamination of the hands of personnel with transient pathogens and subsequent patients,
- Gloves reduce the risk of infection of patients with microbes, which are part of the residential flora of medical workers.
Indications: When carrying out invasive procedures, with contact with any biological fluid, with impaired integrity of the skin, both a patient and a medical worker, with endoscopic studies and manipulations; In clinical and diagnostic, bacteriological laboratories when working with material from patients, when conducting injections, when caring for the patient.
Prepare: Sterile Packaging Gloves, Safe Recycling Container (CBU).

Algorithm Actions:
1. Spend decontamination of hands on the hygienic level, handle your hands with an antiseptic.
2. Take gloves in sterile packaging, expand.
3. Take the glove for the right hand for the lapse with your left hand so that the fingers do not touch the inner surface of the glove challenge.
4. Commmise the fingers of the right hand and enter them into the glove.

5. Front the fingers of the right hand and pull the glove on them without disturbing its challenge.
6. Start the left glove on the last glove, the 3rd and 4th fingers of the right hand, already dressed in the glove so that the 1st finger of the right hand was directed toward the 1st finger on the left glove.
7. Keep the left glove 2nd, 3rd and 4th fingers of the right hand vertically.
8. Compact the fingers of the left hand and enter them into the glove.
9. Open your fingers and pull the glove on them without disturbing its challenge.
10. Pour the lapse of the left glove by pulling it on the sleeve, then on the right with the help of the 2nd and 3rd fingers, taking the fluid turned on the edge.

Note: If one glove was damaged, it is necessary to change both immediately, because it is impossible to remove one glove, without polluting the other.

1.5. Standard "Removing gloves"

Algorithm Actions:
1. To the fingers of the right hand in the glove, make a lapse on the left glove, touching it only outdoor.
2. To the fingers of the left hand in the glove make a lapse on the right glove, touching it only from the outside.
3. Remove the glove with the left hand, turning it inside out.
4. Keep removed from the left hand the glove for the outstand in the right hand.
5. Left hand Take the glove on the right hand for the lapse from the inside.
6. Remove the glove with the right hand, turning it inside out.
7. Both gloves (left in the right) Place in the CBU.

Composition of detergent solution

3. Immerse all the medical products in a disassembled form in the detergent solution for 15 minutes, after completing the cavity solution, the channels, close the lid.
4. Proceed by the ears (gauze tampon) in the detergent solution every item for 0.5 minutes (pass the detergent solution through the channels).
5. Place medical products in the tray.
6. Rinse under running water for 10 minutes each product, passing water through the channels, cavities of products.
7. Perform quality control of preservation with azopyram. The control is subjected to 1% of the simultaneously processed products of one name per day, but not less than 3-5 units.

8. Prepare a working solution of azopyram reagent (the use of the working reagent -2 hour after cooking).
9. Apply a worker reagent with a pipette "for reagent" to medical products (on the body, channels and cavities, places of contact with biological fluids).
10. Keep medical products over cotton or napkin, watching the color of the flowing reagent.
11. Rate the result of azopiram sample.

Standard "Care for ears"

purpose: Compliance with personal hygiene patient, prevention of diseases, preventing hearing reduction due to sulfur accumulation, injection of medicinal substance.

Indications: Heavy condition of the patient, the presence of sulfur in the auditory passage.
Contraindications:inflammatory processes in the ear shell, external auditory passage.

Prepare:sterile: tray, pipette, tweezers, minzur, cotton turtle, napkins, gloves, 3% hydrogen peroxide solution, soap solution, disinfecting solutions, CBU.

Algorithm Actions:

1. Explain to the patient the course of the procedure, get it consent.

3. Prepare a container with soap solutions.

4. Tilt the patient's head to the side opposite to the ear ones, substitute the tray.

5. Moisten the napkin in the warm soap solution and wipe the ears, dry the dry cloth (to remove dirt).

6. Pour into a sterile menu, pre-heated in a water bath (T 0 - 36 0 - 37 0 C) 3% solution of hydrogen peroxide.

7. Take a cottling tapurund in the right hand and moisten a 3% solution of hydrogen peroxide, and delay the ear shell back and top to align the auditory passage and enter the turtle movements to the outer hearing passage to the depth of no more than 1 cm for 2 - 3 Minutes.

8. Enter dry Turundum with light rotational movements into the outer hearing passage to a depth of no more than 1 cm and leave for 2 to 3 minutes.

9. Remove Turundum by rotational movements from the outer auditory passage - it is possible to remove the discharge and sulfur from the auditory pass.

10. Process another hearing pass in the same sequence.

11. Remove the gloves.

12. Place the used gloves, tours, napkins in the CBU, tweezers, a menzurka in a container with disinfecting solutions.

13. Wash and drain your hands.

Note: When processing the ears, the wool can not be coated on solid items, perhaps a hearing aid injury.

Algorithm Actions:

1. Explain to the patient the purpose of the procedure, get its consent.

2. Spend decontamination of hands on the hygienic level, put on gloves.

3. Sharpen under the patient the oilbox.

4. Pour warm water in the pelvis.

5. Adjust the top of the patient's body.

6. Moisten the napkin, part of a towel or a moster in warm water, slightly peel out the excess water.

7. Wipe the patient's skin in the following sequence: face, chin, ears, neck, hands, chest, folds under the lactic glands, armpit depressions.

8. Wipe the patient's body in the same sequence with a dry end of the towel and cover the sheet.

9. Treat the back, alive, thigh, legs in the same way.

10. Put the nails on your hands.

11. Change and bed linen (if necessary).

12. Remove the gloves.

13. Wash and drain your hands.

Algorithm Actions:

1. Wash your head seriously ill in bed.
2. Remove the head exalted position, i.e. Put a special headrest or roll the mattress with a roller and turn it under the patient's head, beds on it glued.
3. Throw the patient's head at the neck level back.
4. Put a basin with warm water into a stool at the head end of the bed at the patient's neck level.
5. Moisten the jet of the patient's head, wash the hair, carefully massage the scalp.
6. Wash your hair towards the head of the head back with soap or shampoo.
7. Rinse your hair and squeeze them with a towel dry.
8. Combing hair with a frequent comb daily, short hair should be combed from the roots to the ends, and the longs are divided into strands and slowly combed from ends to the roots, trying not to pull them out.
9. Purpose Clean Cotton Sloves on the head.
10. The headrest, remove all objects of care, straighten the mattress.
11. Place the used lesor care objects.
Note:
- Wash your head as seriously ill (in the absence of contraindications) follows 1 time per week. The optimal, device for this procedure is a special headrest, but the bed at the same time should be with a removable back, which greatly facilitates this time-consuming procedure;
- women every day combing hair with frequent ridge;
- Male briefly cut hair;
- a frequent comb, moistened in a 6% vinegar solution, is well combed to dandruff and dust.

Standard "Summary"

Purpose:ensuring physiological shipments in a patient.
Indication: Apply patients in strict bed and bedding during the empty of the intestines and the bladder. Prepare: Disinfected vessel, oilcloth, diaper, gloves, diaper, water, toilet paper, Capacity with deshercy, CBU.
Algorithm of action:
1. Explain to the patient the purpose and course of the procedure, get its consent,
2. Rinse the vessel with warm water, leaving in it some water.
3. Extinguish the patient with a screen from others, remove or lean the blanket to the wax, to put the patient under the pellet, the diaper from above.
4. Spend the decontamination of hands on the hygienic level, put on gloves.
5. Help the patient turn on the side, legs slightly bend in the knees and spread in the hips.
6. Left-handed the side under the crushes, helping the patient raise the pelvis.

7. The right hand is moving the vessel under the patient's buttocks so that his crotch is above the vessel opening, while the shower is rapidly.
8. Strong the patient of the assaulomygostnyy, leave it one.

9. At the end of the act of defecation, slightly turn the patient to the next hand, holding the ship with the right hand, remove it from under the patient.
10. Wipe the area of \u200b\u200bthe anal opening toilet paper. Place the paper into the ship. If necessary, fit the patient, drain the crotch.
11. The ship, the oilbox, diaper and shirma. Forwards replace the sheet.
12. Help the patient make it convenient, cover the blanket .
13. Cover vertexailoilenenco-toilet room.
14. Pour the contents of the vessel in the toilet, rinse with rye .
15. Immerse the vessel in the container with deeschor, lose gloves in
CBU.
16. Wash and drain your hands.

Dedicated liquid

9. Secure the amount of drunk and injected fluid into the body in the accounting sheet.

Insertion

10. At 6 00 o'clock in the morning the next day, the patient gives a nurse accounting list.

The difference between the amount of drilled liquid and the daily amount of the night is the magnitude of the water balance of the body.
Nurse must:
- Make sure the patient will be able to record fluid.
- Make sure the patient did not take diuretics within 3 days before the study.
- Tell a patient as the amount of fluid should stand out with urine normally.
- Explain the patient an approximate percentage of water in food products to facilitate the accounting of the injected fluid (not only the polls of water in food, but also introduced parenteral solutions).
- Solid food can contain from 60 to 80% water.
- Accounting for the amount of dedicated fluid is not only urine, but also vomit masses, patient feces.
- The nurse calculates the number of insertion and bred night per day.
Determined by the percentage of fluid removal (80% normal amount of liquid removal).
Number of urine derived x 100

The percentage of removal \u003d
The number of injected fluid

Calculate the accounting of water balance according to the following formula:
The total number of selected urine per day is multiplied by 0.8 (80%) \u003d the amount of night, which should be highlighted normally.

Compare the amount of dedicated fluid with the amount of calculated liquid is normal.
- The water balance is considered negative if less fluid is released than calculated.
- The water balance is considered positive if more fluid is isolated than calculated.
- Make records on a sheet of water balance account and evaluate it.

Result rating:

80% - 5-10% - the expenditure rate (-10-15% - in the hot season; + 10-15%
- in the cold time;
- positive water balance (\u003e 90%) indicates the effectiveness of the treatment and convergence of edema (reaction to diuretics or unloading diets);
- Negative water balance (10%) indicates the increase in edema or the inefficiency of dosuretic dose.

I.IX. Puncture.

1.84. Standard "Preparation of a patient and medical instruments for pleural puncture (picking, thrauccenis)".

Purpose: Diagnostic: study of the nature of the pleural cavity; Medical: Introduction to the cavity of medicines.

Indications: Traumatic hemotorax, pneumothorax spontaneous valve pneumothorax, respiratory organs (brute pneumonia, pleurisy, pulmonary emphasis, tuberculosis, lung cancer, etc.).

Contraindications: Increased bleeding, skin disease (pyodermia, slimming, chest burns, acute heart failure.

Prepare: Sterile: cotton balls, gauze napkins, diapers, needles for in / to and p / k injections, needles for puncture 10 cm long and diameter 1 - 1.5 mm, syringes 5, 10, 20, 50 ml, tweezers, 0, 5% novocaine solution, 5% iodine alcohol solution, 70% alcohol, clamp; Cleol, adhesive plaster, 2 radiographs of the chest, sterile tank for pleural fluid, a container with a derazor, direction to the laboratory, a set to assist in anaphylactic shock, gloves, CBU.

Algorithm Actions:

2. Let's put the patient, put on the belt, on the chair face to his back, ask him to rely on the back of the chair, and another (on the side of the localization of the pathological process) begged.

3. Ask the patient slightly tilt the torso to the side opposite to the one where the doctor will conduct puncture.

4. The pleural puncture is performed only by the doctor, the nurse assisters him.

5. Conduct the decontamination of hands on the hygienic level, treat them with a skin antiseptic, put on gloves.

6. Process the estimated place of the puncture of 5% alcohol solution of iodine, then 70% solution of alcohol and again with iodine.

7. Apply a syringe doctor with a 0.5% novocain solution for the infiltration anesthesia of intercostal muscles, pleura.

8. The puncture is made in VII - VII intercostal on the upper edge of the underlying edge, since a vascular-nerving beam passes along the bottom edge of the rib and the intercostal vessels can be damaged.

9. The doctor introduces the puncture needle into a pleural cavity and pumps the contents into the syringe.

10. Substitute the container for the extracted fluid.

11. Release the contents of the syringe into a sterile bank (tube) for a laboratory study.

12. Apply a syringe doctor with an antibiotic to introduce into the pleural cavity.

13. After removing the needle, the prolque place is treated with 5% iodine alcohol solution.

14. In place of the puncture, impose a sterile napkin, fix the leukoplasty or rolling.

15. Spend a tight binting of the chest sheet for slowing the exudation of the liquid into the pleural cavity and prevention of the collapse development.

16. Remove the gloves, wash your hands and drain.

17. Used disposable syringes, gloves, cotton balls, napkins Put in the CBU, a puncture needle into a container with a deeschor.

18. Watch out for the patient's well-being, the state of the bandage, calculate the pulse, measure the hell.

19. Scroll into the patient to the Chamber on the catal, lying on the stomach.

20. Warning the patient about the need to comply with bed regime for 2 hours after the manipulation.

21. Send the resulting biological material to study in the laboratory with a direction.

Note:

When extracting from the pleural cavity, more and more than 1 liter of liquid is large, the risk of the occurrence of the collapse;

Delivery of pleural fluid to the laboratory must be carried out without delay in the essence of the destruction of enzymes and cell elements;

If the needle gets into the pleural cavity, the feeling of "failure" appears in the free space.

1.85. Standard "Preparation of a patient and medical instruments to carry out abdominal puncture (laparocenesis)."

Purpose: Diagnostic: laboratory study of ascitic fluid.

Medical: Removing the accumulated liquid from the abdominal cavity during ascite.

Indications: Ascites, with malignant neoplasms of the abdominal cavity, chronic hepatitis and liver cirrhosis, chronic cardiovascular failure.

Contraindications: pronounced hypotension, adhesion process in the abdominal cavity, a pronounced meteorism.

Prepare: Sterile: cotton balls, gloves, trocar, scalpel, syringes 5, 10, 20 ml, napkins, bank with lid; 0.5% novocaine solution, 5% iodine solution, alcohol 70%, tank for extracted liquid, pelvis, tubes; Wide towel or sheet, leucoplasty, a set for an anaphylactic shock, a container with a deceor, direction to the study, dressing material, tweezers, CBU.

Algorithm Actions:

1. Inform the patient about the upcoming study and get its consent.

2. In the morning on the day of research, make a patient a cleaning enema to the effect of "clean water".

3. Immediately before carrying out the manipulation, offer the patient to empty the bladder.

4. Ask the patient to sit on the chair, leaning on his back. Patient legs cover with loaf.

5. Extend the decontamination of hands on the hygienic level, process them with the skin antiseptic, put on the gloves.

6. Feed a 5% alcoholic iodine alcohol solution, then a 70% alcohol solution for skin treatment between navel and pubic.

7. Apply a syringe doctor with a 0.5% novocain solution for layer-by-layer infiltration anesthesia of soft tissues. The puncture with laparocentsis is made along the middle line of the front abdominal wall at an equal distance between the navel and the pubic, retreating 2-3 cm to the side.

8. The doctor with a scalpel opens the skin, the right hand with ruling movements push the trocar through the thickness of the abdominal wall, then removes the stiletto and the ascitic fluid begins under pressure on the water cannula.

9. Substitute the capacitance (pelvis or bucket) in front of the patient for fluid flowing from the abdominal cavity.

10. Type 20 - 50 ml of liquid for laboratory research (bacteriological and cytological) in a sterile jar.

11. Put under the bottom of the patient's abdominal sterile sheet or a wide towel, the ends of which should keep a nurse. Tighten the stomach with a sheet or a towel covering it above or below the point of puncture.

12. A wide towel or sheets periodically tighten the front abdominal wall of the patient as fluid removes.

13. After the procedure is completed, it is necessary to remove the cannula, the wound to take the skin seam and process with 5% iodine solution, impose a aseptic bandage.

14. Remove the gloves, wash your hands and drain.

15. Used tools. Put in deeschor, gloves, cotton balls, syringes. Put in the CBU.

16. Determine the patient the pulse, measure the hell.

17. Transport the patient to the Chamber on the catal.

18. Warning the patient to observe the bed regime within 2 hours after the manipulation (in order to avoid hemodynamic disorders).

19. Send the resulting biological material to study in the laboratory.

Note:

When conducting manipulation, strictly follow the Asepta rules;

With the rapid seizure of the liquid, a collapse and a fainting condition may develop, due to the fall in intra-abdominal and intrabrudal pressure and the redistribution of circulating blood.

1.86. Standard "Preparation of a patient and medical instrument for the conduct of spinal puncture (lumban)".

purpose: Diagnostic (for the study of the cerebrospinal fluid) and therapeutic (for the introduction of antibiotics, etc.).

Indications: meningitis.

Prepare: Sterile: syringes with needles (5 ml, 10 ml, 20 ml), puncture needle with mandzers, tweezers, napkins and cotton balls, tray, nutrient medium, test tubes, gloves; pressure gauge tube, 70% alcohol, 5% alcohol solution of iodine, 0.5% novocaine solution, leucoplasty, CBU.

Algorithm Actions:

1. Inform the patient about the upcoming procedure and agree.

2. The puncture is carried out in conditions of strict compliance with Asepta rules.

3. Spend patient to the procedural office.

4. Squeeze the patient on the right side closer to the edge of the couch without a pillow, tilt your head forward to the chest, bend your legs as much as possible and tighten to the stomach (the back should be flexing with arc).

5. Slide the left hand under the side of the patient, holding the patient's legs with his right hand to fix the position piled back. During the puncture, another assistant fixes the patient's head.

6. The puncture is made between III and IV lumbar vertebrae.

8. Treat the skin on the site of the puncture of 5% iodine solution, then 70% solution of alcohol.

9. Type a solution of a 0.5% solution of novocaine in a syringe and submit a doctor to carry out infiltration anesthesia of soft tissues, and then a puncture needle with mandren on the tray.

10. Collect the spinal fluid in the amount of 10 ml into the test tube, write the direction and send to the clinical laboratory.

11. Collect 2-5 ml of spinal fluid into a tube with a nutrient medium for bacteriological research. Write the direction and send biological material to the bacteriological laboratory.

12. Apply the doctor a pressure gauge to determine the likvorn pressure.

13. After removing the puncture needle, processes the prolque position of 5% iodine alcohol solution.

14. Take a sterile napkin to the place of puncture, glue the leukoplasty.

15. Place the patient on the stomach and take on the boarding school.

16. Squeeze the patient on the bed without a pillow in the stomach position for 2 hours.

17. Observe the patient's condition during the day.

18. Remove the gloves.

19. Place the syringes, cotton balls, gloves in the CBU, used toolkit in the deeschor.

20. Wash and dry.

1.87. Standard "Preparation of a patient and medical instrument for sterile puncture."

purpose: Diagnostic: Bone marrow research to establish or confirm the diagnosis of blood diseases.

Indications: Diseases of the hematopoietic system.

Contraindications: Myocardial infarction, bouts of bronchial asthma, extensive burns, skin diseases, thrombocytopenia.

Prepare: Sterile: Tray, syringes 10 - 20 ml, puncture needle of cashier, slide glass 8 - 10 pieces, cotton and gauze balls, Corncang, tweezers, gloves, 70% alcohol, 5% alcohol iodine solution; Adamoplasty, sterile dressing material, CBU.

Algorithm Actions:

1. Inform the patient about the upcoming study and get its consent.

2. Sternal puncture is carried out by a doctor in the procedural office.

3. Punctured yard at level III - IV intercostal.

4. The nurse assists a doctor when conducting manipulation.

5. Invite the patient to the procedural office.

6. Offer the patient to undress to the belt. Help him lie on the couch, on the back without a pillow.

7. Spend the decontamination of hands on the hygienic level, treat them with skin antiseptic, put on gloves.

8. Treat the front surface of the patient's chest, from the clavicle to the Zpigastric region with a sterile cotton ball, moistened with 5% iodine solution, and then 2 times 70% alcohol.

9. Spend a layered infiltration anesthesia of soft tissues with 2% novocaine solution up to 2 ml in the center of the sternum at the level III - IV interchange.

10. Apply to the Cassirsky punctural needle, setting the limiter shield to 13-15 mm tip of the needle, then sterile syringe.

11. The doctor pierces the outer plate of the sternum. The hand feels the failure of the needle, having reached Mandren, 20.0 ml of syringe join the needle and the 0.5 ml of bone marrow, which poule onto the slide glass to the needle.

12. Dry slide glass.

13. After removing the needle, the prolque place is treated with 5% iodine alcohol solution or 70% alcohol solution and impose a sterile bandage, fix the leukoplasty.

14. Remove the gloves.

15. Reset the spent gloves, syringes and cotton balls in the CBU.

16. Wash your hands with soap and dry.

17. Conduct the patient to the ward.

18. Send glass slots to the laboratory direction after the material drying.

Note: Cashier's needle is a short fat-walled needle with Mandren and a shield that protects against too deep penetration of the needle.

1.88. Standard "Preparation of a patient and medical instrument for conducting puncture of the joints."

purpose: diagnostic: determination of the character of the contents of the joint; Therapeutic: removal of reach, washing the body of the joints, the introduction into the joint of medicinal substances.

Indications: Diseases of the joints, intra-articular fractures, hemoarthrosis.

Contraindications: Purulent inflammation of the skin at the point of puncture.

Prepare: sterile: puncture needle 7 - 10 cm long, syringes 10, 20 ml, tweezers, gauze tampons; Aseptic dressing, napkins, gloves, tray, 5% iodine alcohol solution, 70% alcohol solution, 0.5% novocaine solution, test tubes, CBU.

Algorithm Actions:

1. The puncture is carried out by a doctor in a procedural office in conditions of strict compliance with the Asepta rules.

2. Inform the patient about the upcoming study and receive its consent.

3. Spend decontamination of hands on the hygienic level, treat them with a skin antiseptic, put on the gloves.

4. Ask the patient to sit on the chair conveniently or take a convenient position.

5. Feed a 5% alcoholic iodine alcohol solution, then a solution of 70% alcohol for processing the intended place of puncture, a syringe with a 0.5% solution of novocaine for infiltration anesthesia.

6. The doctor with the left hand covers the joint at the point of puncture and presses the effusion to the place of puncture.

7. The needle is introduced into the joint and the syringe is gaining effusion.

8. Pour the first portion of the contents from the syringe into the test tube without touching the walls of the test tube for a laboratory study.

9. After puncture in the body cavity, antibiotics, steroid hormones are introduced.

10. After removing the needle, the prolque place is greased by a 5% iodine alcohol solution and impose a aseptic bandage.

11. Place the used syringes, napkins, gloves, gauze tampons in the CBU, puncture needle to destery.

12. Remove the gloves, wash and drain your hands.

I.XII. "Preparation of a patient to laboratory and instrumental research methods."

Standard "Preparing a patient for fibrogastroduodenoscopy"

Purpose:provide high-quality preparation for research; Visual inspection of the mucous membrane of the esophagus, stomach and duodenal
Prepare:sterile gastroscope, towel; Direction for research.
FGDS holds a doctor, a nurse assistive.
Algorithm Actions:
1. Explain to the patient the purpose and course of the upcoming study and get its consent.
2. Spend psychological training of the patient.
3. Inform the patient that the study is conducted in the morning on an empty stomach. Exclude meals, water, drugs; Do not smoke, not brush your teeth.
4. Ensure the patient in the evening with a light dinner no later than 18 hours, after dinner, the patient should not eat and drink.
5. Make sure the patient before the study removed removable dentures.
6. Warning the patient that during endoscopy he should not speak and swallow saliva (saliva the patient spits in a towel or into a napkin).
7. Conduct the patient into an endoscopic office with a towel, the history of the disease, the direction to the appointed hour.
8. Scroll into the patient to the ward after the study and ask him for 1-1.5 hours not to eat until a complete recovery of the act of swallowing; Do not smoke.
Note:
- Moving P / K is not carried out, because Changes the state of the under study;
- When taking material on a biopsy - food is fed to the patient only in a cold form.

Standard "Preparation of a patient for colonoscopy"

Colonoscopy -this is the instrumental method of studying highly located colon departments with a flexible endoscope probe.
Diagnostic value of the method:Colonoscopy allows you to justice

Infections related to the provision of medical care (ISMP) are the main problem in ensuring patient safety, which is why the prevention of their occurrence should be a priority for medical organizations of any profile. According to the World Health Organization, out of 100 hospitalized patients at least 7 are infected with IPSM. Among the seriously ill, the treatment of which is carried out in the departments of intensive therapy, this indicator increases approximately 30 cases of IPMP per 100 people.

The Ismp often arise in situations when the source of pathogenic microorganisms for the patient are the hands of medical workers. To date, washing hands with medical personnel or their treatment with skin antiseptics are the most important measures of infectious control, which make it possible to significantly reduce the dissemination of infections arising during the medical and diagnostic process in organizations exercising medical activities.

History of the question

History of the hands of medical personnel is rooted in the middle of the XIX century, when the highest mortality of European countries was observed in the obstetric clinics of European countries due to the "postpartum ferment". Septic complications carried about 30% of the birthdayrs.
In the medical practice of that time, the passion for doctors by the preparation of corpses was widespread. At the same time, after visiting the anatomical theater, the doctors walked to patients, without treating their hands, and simply rub their nasal scarf.
There were many different theories of the origin of the maternity fever, but to open the true reasons for its distribution was only a Viennese doctor Ignats Filippe Ambolweissi. The 29-year-old doctor suggested that the main cause of postpartum complications is the contamination of the hands of medical personnel by the corpse material. The farmelweiss drew attention that the chlorine solution eliminates the smell of rotting, and therefore can destroy the infectious beginning present in the corpses. The observational doctor suggested processing the hands of obsteckers with a chlorine solution, which led to a decrease in mortality in the clinic 10 times. Despite this, the opening of Ignatz Ambreams was rejected by contemporaries and received recognition only after his death.

Hand hygiene is a priority measure that has proved high efficiency in preventing ISMP and the spread of antimicrobial resistance of pathogenic microorganisms. However, even today, the problem of treating the hands of medical personnel cannot be considered solved to the end. WHO studies have shown that insufficient compliance with hand hygiene rules with medical workers is observed both in developed and developing countries.

According to modern ideas, the transfer of pathogens of the ECMP is occurring in various ways, but the most common factor in the transfer is the contaminated hands of medical workers. Wherein infection through the hands of personnel occurs in the presence of a number of the following conditions :

1) the presence of microorganisms on the peat cover of the patient or the subjects of its closest environment;

2) contamination of the hands of medical workers by pathogens with direct contact with the patient's skin or its surrounding items;

3) the ability of microorganisms to survive on the hands of medical personnel at least a few minutes;

4) incorrect implementation of the procedure for processing hands or ignore this procedure after contact with the patient or items of its nearest environment;

5) direct contact of the contaminated hands of a medical worker with another patient or subject, which will come into direct contact with this patient.

Microorganisms associated with the provision of medical care are quite often detected not only on the surface of infected wounds, but also in areas of absolutely healthy skin. Daily about 10 6 skin scales with viable microbes are exfoliated, contaminating and bedding of patients, bedside furniture and other objects. After direct contact with the patient or the objects of the surroundings of microorganisms can survive on the hands of medical workers for quite a long time, most often from 2 to 60 minutes.

The hands of medical personnel can be populated by representatives of their own, resident, microflora, as well as contaminated by potential pathogens (transient microflora) during the execution of various manipulations, which has a large epidemiological value. In many cases, the pathogens of purulent-septic infections that are distinguished from patients are not detected by anywhere, except for the hands of medical workers.

Medical staff handling rules

In the Russian Federation, the rules for processing the hands of medical personnel are regulated by SanPine 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations carrying out medical activities." Depending on the nature of the medical manipulation performed and the required level of reduction in microbial skin contamination, medical personnel should carry out hygienic handling of hands or the so-called treatment of surgeons.

To achieve an effective level of eye disinfection medical workers must comply with the following requirements. :

1. Have a short trimmed natural nails without a varnish coating.

It should be understood that in itself the use of nail polish does not lead to elevated contamination of the hands, but the cracked lacquer makes it difficult to remove microorganisms. Dark color varnish can hide the state of the subnight space, which leads to insufficiently high-quality processing. In addition, the use of nail polish can cause unwanted dermatological reactions, the consequence of which is often secondary infection. The procedure for performing a manicure is quite often accompanied by the emergence of microtrams that can be easily infected. For the same reasons, medical workers are unacceptable to wear artificial nails.

2. Do not wear on your arms while working rings, rings and other decorations. Before conducting surgical handling, it is also necessary to remove wrist watches, bracelets and other accessories.

Hand decorations can lead to elevated contamination of the skin and the difficulty of removing microorganisms, jewelry and jewelry complicate the process of worn gloves, and also increase the likelihood of their damage.

According to Sanpin 2.1.3.2630-10 there are two types of disinfecting of the hands of medical workers - hygienic treatment of hands and treatment of surgeons.

Hygienic handling It must be carried out in the following cases:

Before direct contact with the patient;

After contact with the intact patient's skin (for example, when measuring the pulse or blood pressure);

After contact with secrets or excretions of the body, mucous membranes, bandages;

Before performing various patient care manipulations;

After contact with medical equipment and other objects in close proximity to the patient;

After the treatment of patients with purulent inflammatory processes, as well as after each contact with contaminated surfaces and equipment.

Exist two ways Hygienic handling: washing soap and water to remove contaminants and reduce the number of microorganisms, as well as skin antiseptic treatment to reduce the number of microorganisms to a safe level.

A liquid soap doses using a dispenser is used for hand washing. The use of hot water should be avoided, since this may increase the risk of dermatitis. If the valve is not equipped with an elbow drive, you must use a towel to close it. For drying hands, individual clean fabric or paper towels are used preferably a single use.

Hygienic treatment of hands (without their pre-washed) The skin antiseptic is carried out by rubbing it into the skin of hands in the amount of hand, recommended by the instructions for use, paying particular attention to the tips of the fingers, the skin around the nails and between the fingers. Important condition for effective hygienic hand treatment It is maintaining them in a wet state during the recommended exposure time. Wipe hands after processing should not.

For your information

Skin antiseptics based on alcohol show b about effectiveness compared to water-based antiseptics, and therefore their use is preferable in the absence of conditions necessary for washing hands, or in the shortage of working time.

Handling surgeons It is made by all medical workers involved in the conduct of operational interventions, childbirth and catheterization of the main vessels. Surgical antiseptics of hands includes two mandatory stages:

1. Washing hands with soap and water for 2 minutes, followed by drying with a sterile tissue towel or a napkin.

At this stage, it is recommended to use sanitary and technical devices and elbow dispensers, which are carried out without the help of hand brushes. In the case of the use of brushes, which is not a prerequisite, it is necessary to choose in favor of either sterile soft disposable brushes, or brushes that can withstand sterilization by the method of autoclaving. Using brushes should only be used for the processing of near-gas areas at the first disinfection of hands during the work shift.

2. Treatment of the skin antiseptic of hands, wrists and forearms.

It is necessary to maintain hands in a wet state throughout the recommended processing time. After holding the exposure of the skin antiseptics, it is forbidden to wipe hands. The amount of specific means necessary for processing, the time of its impact and the multiplicity of application is determined by the recommendations set out in the instructions attached to it. Sterile gloves are put on immediately after complete drying antiseptics on the skin of the hands.

For surgical handling, the same drugs can be used as for hygienic. However, it is very important to use skin antiseptics that have a pronounced residual action.

Filling dispensers for soap or skin antiseptics is produced only after their disinfection, washing with water and drying. Preferences should be given to elbow dispensers and dispensers working on photocells.

Skin antiseptics for hand processing should be easily accessible at all stages of the medical diagnostic process. In units with high intensity of patients and high load on personnel, skin antiseptic dispensers should be placed in a place convenient for use (at the entrance to the ward, in the sick bed, etc.). It should also provide for the possibility of providing medical workers with individual leather antiseptics of small volumes (up to 200 ml).

Prevention of professional dermatitis

Multiple treatment of hands during the work of labor duties with medical personnel can lead to irritation of skin cover, as well as the emergence of dermatitis - one of the most widespread professional diseases of medical workers. The most common skin reaction is irritative contact dermatitiswhich manifests itself with such symptoms as dryness, irritation, itching, and in some cases skin cracking. The second type of skin reaction - allergic contact dermatitis, occurring much less often and is allergic to certain ingredients in the medium used for antisetics of hands. Manifestations and symptoms of allergic contact dermatitis can be diverse and varied from light and localized to heavy and generalized. In the most difficult cases, allergic contact dermatitis may be accompanied by difficulty breathing and some other symptoms of anaphylaxis.

Irritative contact dermatitis is usually associated with the use of iodophores as skin antiseptics. To other antiseptic components that can cause contact dermatitis, as the incidence of cases is designed, chlorhexidine, chlorquileneol, triclozan and alcohols are attributed.

Allergic contact dermatitis occurs when used to handle the means containing quaternary compounds of ammonium, iodine or iodophore, chlorhexidine, triclosan, chlorocyleneol and alcohols.

There is a large amount of data obtained in various studies, the best tolerability of the skin of the hands of alcohol-containing antiseptics.

Allergic reactions and irritation of the skin of medical personnel cause a sense of discomfort, thereby worsening the quality of medical care, and also increase the risk of transmission of patients with ESMP causative agents due to the following reasons:

Due to skin damage, it is possible to change its resident microflora, colonization of staphylococcal or gram-negative microorganisms;

During the procedure of hygienic or surgical treatment of hands, the required level of reduction in the number of microorganisms is not achieved;

As a result of discomfort and other unpleasant subjective sensations from a medical worker who has skin reactions, a tendency arises to avoid hand treatment.

Advice

In order to prevent the development of dermatitis, medical personnel need to be followed by a number of the following additional recommendations:
1) Do not resort to the frequent wash of hands with soap immediately before or after using the alcohol-containing agent. Hand washing before processing an antiseptic is necessary only if there are visible contaminants on the skin;
2) when washing hands, it is worth avoiding the use of very hot water, since this may lead to trauma of the skin;
3) when using disposable towels, it is very important to get skin to get skin, and not rub it to avoid the formation of cracks;
4) Do not wear gloves after hand processing to complete drying in order to reduce the risk of skin irritation;
5) It is necessary to regularly use creams, lotions, balsams and other skin care products.

One of major prevention measures The development of professional dermatitis in medical professionals is to reduce the impact of the impact of the hand of soap and other annoying detergents by widely implementing aliceptic based on alcohol containing various softening additives. According to WHO recommendations, use in the medical organization of alcohol-containing products for hand hygiene preferably subject to their presence, since this type of antiseptics has a number of advantages, such as a wide range of antimicrobial activity, including viruses, a short exposure time, good skin tolerance .

Problem Compliance with Human Human Resources Hands Rules

Numerous epidemiological studies of commitment (compliance) of medical personnel to the recommended hand hygiene rules show unsatisfactory results. On average, the frequency of compliance with medical staff requirements for handling of hands is only 40%, and in some cases are much lower. An interesting fact is that doctors and junior medical staff are much more common than nurses do not comply with the recommendations on the antiseptic skin of the hands. The highest level of compliance is observed on weekends, which, apparently, is associated with a significant decrease in the workload. The lower level of hand hygiene is registered in the departments of intensive therapy, as well as during periods of intense patients, while the highest level is observed in children's offices.

Obvious barriers to properly implementing recommendations For handling medical staff are skin allergic reactions, low availability of means for antiseptics of hands and conditions for its implementation, prioritization of patient care measures and providing medical care, the use of gloves, working time deficit and high professional load, forgetfulness of medical workers, lack Elementary knowledge of existing requirements, misunderstanding the role of hand processing in the prevention of the IPMP.

Activities aimed at improving hand hygiene practice In a medical organization, there must be wide educational programs among staff treatment personnel, control over the use of knowledge gained in professional activities, the development of written recommendations on antiseptic processing issues when performing various manipulations, reduced workload on medical professionals, creating proper hand hygiene conditions , providing personnel not only by antiseptics, but also by the means of skin care, various administrative measures, sanctions, support and encourage employees, quality handling.

The introduction in organizations exercising medical activities, modern antiseptics, skin care and equipment for hand hygiene, as well as wide educational programs for medical personnel is absolutely justified. These numerous studies show that the economic costs associated with the treatment of 4-5 cases of an ancient severity exceed the annual budget necessary for the acquisition of hand hygiene for the entire medical and preventive organization (LGO).

Medical gloves

Another aspect associated with the hygiene of the medical staff is use of medical gloves. Gloves significantly reduce the likelihood of professional infection in contact with patients or their secretions, reduce the risk of contamination of the hands of medical personnel with transient microflora and subsequent transmission to patients, impede the infection of patients with microorganisms, which are part of the residence of the hands of medical workers. Creating an additional barrier for potentially pathogenic agents, gloves are simultaneously a means of protecting both a health worker and a patient.

The use of gloves is an important component of the system of universal precautions and infectious control in LGOs. However, medical staff often neglects the use or shift of gloves, even in cases where there are clear indications, which significantly increases the risk of transmission of infection both the health worker, and from one patient to another through the hands of personnel.

According to the existing requirements of sanitary legislation gloves need to wear in all the following cases :

There is a possibility of contact with blood or other biological substrates, potentially or obviously contaminated microorganisms;

There is a possibility of contact with mucous membranes or damaged skin patient.

In the case of pollution of gloves with blood or other biological fluids in order to avoid contamination of hands in the process of removing gloves, you should remove visible contaminants with a tampon or a napkin, moistened with a solution of a disinfectant or skin antiseptic. Used gloves are disinfected and disposed together with other medical waste of the corresponding class.

Significant effectiveness of gloves in preventing pollution of the hands of medical personnel and reducing the risk of microorganisms when providing medical care was confirmed in clinical studies. However, medical professionals must be aware that gloves cannot provide full protection against microbial contamination of hands. Microorganisms are capable of penetrating through the smallest defects, pores and holes in the material, as well as to enter the hands of staff during the removal of gloves. Penetration of liquids inside gloves is most often observed in the field of fingertips, especially large. At the same time, only 30% of medical personnel notice such situations. Due to these circumstances before putting on gloves and immediately after their removal, it is necessary to carry out antiseptic handling of hands.

Gloves are products for medical purposes of one-time application, so their decontamination and re-processing are not recommended. This practice should be avoided in all. In organizations carrying out medical activities, where the level of material resources is low, and the stock of gloves is limited.

Allocate the following main types of medical gloves:

Viewing (diagnostic) gloves;

Surgical gloves having an anatomical shape providing high-quality wrist girth;

Special purpose (for use in various sectors of medicine): orthopedic, ophthalmologic, etc.

In order to facilitate the process of managing gloves, manufacturers use various substances. Most often used talc containing starch powder, magnesium oxide, etc. We should not forget that the use of fried gloves can lead to a decrease in tactile sensitivity. It is undesirable to enter the glovenant powder into the wound area, since cases of postoperative complications are described due to hypersensitivity reactions in patients. The use of discouraged gloves and in dental practice is not recommended, since this may cause unpleasant sensations in the patient's mouth.

The following requirements are presented to medical gloves :

Should fit tightly to hand throughout the time of their use;

Should not cause hand fattens and correspond to the size of a medical worker's brush;

Must maintain good tactile sensitivity;

The material from which gloves are made, as well as substances used for their diversion, should be hypoallergenic.

Compliance with modern requirements for the hygiene of the hands of medical personnel is able to significantly improve the quality of medical care in the LGO due to a significant reduction in the risk of infection of the Patients of the ISMP.

Literature

1. Athenogenov G. E., Athenogenova A. G.Modern approaches to medical personnel hygiene // Clinical microbiology and antimicrobial chemotherapy. 2004. T. 6. No. 1. P. 65-91.
2. Hygiene of the hands and use of gloves in LPU / Ed. Academician of Raen.L. P. Zueva. St. Petersburg., 2006. 33 s.
2. Oops I.V. The history of antiseptics is the struggle of ideas, ambition, ambitions ... // Medical technologies. Evaluation and selection. 2010. No. 2. P. 74-80.
3. WHO Hand hygiene guide in Health: Summary, 2013. Access mode:http.:// www. who. int./ gPSC./5 may./ tools./9789241597906/ ru/ . Date of handling: 01.11.2014.
4. SanPine 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations carrying out medical activities."

Dubel E. V., Head. Epidemiological Department, Epidemiologist BUZ in the Vologda City Hospital No. 1; Gulakova L. Yu., Home Medical sister Buz in the "Vologda City Hospital No. 1"

Any implies preparation and directly decontamination (removal of contaminants). Hands of a medical sister should be well-groomed, without inflammatory phenomena, burr and microcracks.

Nails must be neatly trimmed and not covered with varnish. The skin edge of the nail bed does not cut off due to the risk of microtrase and inflammation. Artificial nails on the hands of nurses are unacceptable. Before starting For manipulations, wrist watches and decorations must be removed.

Preparing the hands of nurse for processing

• Remove the clock and decorations.
• We inspect your hands on the subject of inflammatory phenomena and skin damage.
• If there are wounds, the phenomena of skin inflammation is informed by the eldest medical sister.
• If there are minor damage and local inflammatory phenomena, we put the problem areas of the leafoplasty and put on the attack.

Mechanical treatment of nurse hands

Normal hand washing is carried out with liquid soap from the dispenser, and in the case of its absence, simple pieces. Manipulation offices must be equipped with elbow control faucets.

After preparing the hands, we make them warm water, launder the palms, the rear sides of the brushes, interfallated gaps and nail beds.

Energetically three hands for each other:

1. palm about palm;
2. right palm about the rear of the left brush and vice versa;
3. clutch hands with shutders and three inner surfaces of the fingers up-down movements;
4. we fold the hand in the fist and the back side of the fingers of one hand three palm of another hand (repeat for each hand);
5. squeeze your hand in the fist and cover your finger of another hand, three finger with circular movements - repeat with each finger on both hands;
6. three palm of one hand with finger tips, then change your hands.

Each action should last at least 30 seconds. After washing, we wipe your hands with a one-time towel, or fabric, which is immediately removed from the appeal.

When clicking on a picture, it opens in a new window, where it increases in the amount of another click.

Hygienic antiseptic handling of nurse hands

1. Preparation of hands to processing.
2. Washing hands using antiseptic soap.
3. Hand machining with a water or alcohol antiseptic in accordance with the instructions for use. Drying with a towel after treatment with an antiseptic is not allowed.

Surgical Hand Processing Nurse

1. Preparation of hands.
2. Wash with an ordinary or antiseptic soap - brush, wrist, forearm. Nails are processed by brushes.
3. Drying hands with a sterile napkin.
4. Application of alcohol solution of the skin antiseptic, rubbing it into the skin to complete drying (the aqueous solutions of antiseptics do not apply).
5. Re-applying and rubbing the alcohol antiseptic followed by drying without drying with a towel.
6. Wearing sterile gloves on dry hands.

1. Remove all rings with hands (deepening on the surface of jewelry are the reproduction of microorganisms).

2. Shift the clock above the wrist or remove them.

3. Areas under the nails cleaned the nail cleaning device under running water.

4. Apply 3-5 ml of liquid soaps or thoroughly straighten your hands with bars soap.

5. Wash hands using the following technique:

Energetic mechanical friction of palms (repeat 5 times);

Right palm with rubric movements washes the back side of the left brush, then the left palm washes the rear of the right brush (repeated 5 times);

Palm to the palm, fingers of one hand in the interfallated intervals of the other (repeat 5 times);

The rear side of the fingers to the palm of the other hand (the fingers are intertwined - repeat 5 times);

Alternating rotational friction of large fingers of one hand with palms of another, palms are compressed (repeated 5 times);

A variable friction of the palm of one hand closed with the fingers of another hand (repeat)

fig.6. Washing hands.

6. Rinse your hands under running water, keep them so that the wrists and brushes are below the level of elbows and to avoid contamination from touching with sink, bathrobe and other objects.

7. Close the crane, take care of it only through a paper towel, as it can be a source of pollution.

8. Seeing the hands with a sterile marlevary cloth.

8. Carefully treat the skin of the hands for 2-3 minutes with 2 tampons, moistened with 70% alcohol or alcohol-containing skin antiseptic, having a virularidal effect (at least one minute per hand) or apply 5-8 ml of 70% ethyl surface Alcohol or alcohol-containing skin antiseptic, having a virulicidal effect and rub into the skin for 2 minutes.

9. Used balls to throw into a disinfection container.

10. Put the gloves according to the action algorithm.

The use of protective specials.

Bathrobes.

With the exception of operating or dressing, where sterile bathrobes are worn to protect the patient, the main goal of the coats to exclude causative agents of infection on clothing and the skin of personnel.

Hatts.

Medical hats securely cover hair, not allowing them to act as a source of pollution.

Aprons.

Rubber and polyethylene aprons are necessary to protect specials. Logging and skin of personnel in the threat of splashing of blood and other and other biological fluids and secretions.

Masks.

The masks are necessary to avoid air-drip transfer of microorganisms, as well as in cases where there is a possibility of entering liquid substances of the human body into the nose or mouth. They are especially important if the personnel is working directly over a large wound surface, such as open surgical wounds or burns, or in procedures with infectious patients, from which the infection can easily pass by air-droplet.

The masks should be replaced every 3-4 h (depends on the profile of the work performed) or when they are moistened during operation. It is impossible to lower the mask on the neck, use again. All masks must fully close the nose and mouth.

It is known that human skin performs a number of essential functions, one of which is protection against the impact of harmful environmental factors. The skin, especially the skin of the hands, is constantly populated by microorganisms. Intact (unharmed) human skin, even thoroughly washed, colonized by microorganisms, which can be different for individual areas of the skin and relatively constant for each person.

Man's skin microflora is divided into resident and transient.

Resident (constant)microflora is represented by bacteria that constantly live and multiply in the skin. These microorganisms colonize deeper layers of skin, including rigorous, sweat glands and hair follicles, and are mainly represented by staphylococci coagulates (more often than staphylococcus epidermidis) and dipteroids (CoryntBacterium SPP.) Basically the resident microflora does not cause pathological processes in patients with intact skin, However, it may cause the infectious process when entering sterile cavities of the human body. Resident microorganisms are almost impossible to remove, but their number can be significantly reduced. In the same time sterilization of hand It is not easy impossible, but also undesirable, because the resident microflora warns the skin settling with more dangerous microorganisms, and also synthesizes fatty acids that have an antimicrobial effect.

Transient (temporary) The microflora is represented by microorganisms, temporarily settled on the skin of the hands, they colonize surface layers of the skin and have the greatest epidemiological value. The transient microflora may consist of any microorganisms, including pathogenic, including causative agents of nosocomial (nosocomial) infections, such as Escherihia Coli, Klebsiella SPP, Pseudomonas SPP, Salmonella SPP., St. Aureus (including MRSA), Candidae albicans, rotaviruses, etc. When damaged skin cover, including during the use of inadequate methods of washing and disinfection of hands, the transient microflora penetrates deeper into the skin, displacing the resident flor from there.

The transfer of microorganisms through the hands depends on the various conditions, including from the type of microorganisms, the possibility of their survival in the hands, the degrees of seeding of the skin with microorganisms etc. In this case, the species composition of microflora of the skin of the medical staff depends on the profile of the institution or department and the nature of professional work. According to the Central Research Institute of Epidemiology (Moscow, Corresponding Member. Ramna, Professor N. A. Semin, Professor A. P. Kovaleva), the number of nosocomial infections in Russia is 52-60 thousand annually. It has been proven that the cause of infections in hospitals in 50-80% of cases has hands of medical personnel, that is, hands are one of the key factors in the transfer of pathogenic microorganisms, both from medical personnel to patients and vice versa. According to the results of the analysis of the statistical indicators of the American Society for Control and Prevent Diseases (CDC), about 2 million patients annually receive nosocomial infections during treatment. The so-called nosocomial or hospital, hospital infections are the cause of not only the suffering and death of patients. They also cause significant economic damage and pay $ 5 billion annually for expenses for additional hospitalization and expensive antibiotic treatment. All outlined once again underlines the extreme importance of strict compliance with the principles of hand hygiene.

Medical staff hand processing methods

Hygiene hand - A common term used to identify procedures such as usual hand washing, hygienic disinfection of hands and surgical disinfection of hands.

Normal hand washing - It is washing hands with water and usual (non-antiseptic) soap.

Hygienic disinfection of hands It is carried out in order to reduce the number of pathogenic microorganisms on the skin of the hands, is applied in the following cases:

• before direct contact with the patient;
• before performing invasive procedures;
• before and after manipulation with wounds and catheters.
• before and after dressing gloves;
• after contact with the biological fluids of the body or after possible microbial insemination;
• before treatments to patients with weakened immunity;
• before the examination of the pure section after contact with the contaminated part of the body, etc.

It has been proven that the cause of infections in hospitals in 50-80% of cases has hands of medical personnel, that is, hands are one of the key factors in the transfer of pathogenic "microorganisms both from medical personnel to patients and vice versa.

It can be performed using special antiseptic recipes during surgical washing. There are two ways of hygienic disinfection of hands: hygienic washing of hands and processing (wiping) with antiseptic hands.

Hygienic hand washing - It is washing hands with water and soap or other detergent containing an antiseptic drug. As a result of hygienic washing, most of the transient microflora is removed, but even with routine washing, some skin sections (internal surfaces, fingertips) remain contaminated.

Treatment of hands antiseptic It is more often applied in practice and according to the results of laboratory research is more efficient. Hands are wiping with enough antiseptic agent without adding water to it before starting and during the procedure (most often it is a drug based on a combination of alcohols with a variety of antiseptic additives) so that the skin remains humid for the necessary exposure time from 30 to 60, depending on the manufacturer's recommendations. . The most carefully you need to handle your nails and fingertips.

Hygienic processing of hands (Using the antiseptics) after the implementation of medical manipulations should be carried out before washing, and not vice versa to avoid contamination of the surrounding surfaces by pouring polluted water. When care for patients with infections caused by sporing-forming bacteria (for example, Clostridium difficile), the use of only antiseptic agents without pre-hand washing will not provide reliable decontamination due to the fact that they do not have a sporocidal. activity. In such cases, as well as if the skin must be cleaned of visible contaminants (including organic origin), the previous hygienic hand washing is mandatory before treating the hands of the antiseptic.

An important condition for the effectiveness of hygienic hand treatment is observing the following rules:

• when carrying out hygienic disinfection of the hands by wiping the alcohol antiseptic, it is necessary to apply to the palm of one hand and rub over the entire surface of the brushes and fingers of both hands to their complete drying.
• when washing hands, you must first moisten with water, then apply the required amount of money and thoroughly wipe your hands for at least 15 s to process the entire surface of the brushes and fingers, then wash your hands with water and thoroughly dry them with a disposable towel that is used to close the crane ;
• it is advisable to use small slices of soap and apply supports in the form of grids for its rapid drying.
• it is not recommended to use reusable tissue towels.

Surgical disinfection of hands - It is handling hands before surgery, providing removal of transient and reduce the amount of residency microflora.

Surgical disinfection of hands It can be performed using special antiseptic recipes during surgical washing. This method has been applied for a long time, and the recipes used have long been known. These are such as treatment with chlorhexidine Bigluconate (hybitan), C-4 recipe (exception), etc. Specified antiseptic formulations are quite aggressive for the skin, especially considering the frequency of application by their medical personnel, which takes part in operational interventions. In addition, to mechanical damage to the skin, the appearance of microtrase leads and use during surgical washing of special brushes using the aforementioned antiseptic recipes.

Promising for today is to use for surgical disinfection of the hands of antiseptic agents made on the basis of a combination of alcohols with other antimicrobial additives. Such drugs are characterized by a rapid destructive effect on the microflora, high antimicrobial properties. For surgical disinfection of hands, the same drugs can be used as for hygienic disinfection, while the difference is to increase the amount of antiseptic for one processing (from 6 to 10 ml - the wrist and forearms are needed in additional processing) and the extension of time and exposure up to five minutes , depending on the manufacturer's recommendations. It is not necessary to use brushes during processing.

In order to reduce the number of microorganisms that breed on the skin under gloves, it is quite effective to use antiseptics with constituents that provide time prolonged antimicrobial effects. Reducing the number of residual skin bacteria in the members of the surgical brigade during the operation reduces the risk of bacteria to enter the site of the operating field in cases of punishing or breaking gloves during operational interventions.

To effectively carry out surgical disinfection of hands, it is necessary to strictly follow the following rules:

• before surgical disinfection, you need to remove rings, rings, clocks and bracelets;
• hands washing with water with soap, preferably liquid (the use of antiseptic soap is not necessary);
• thoroughly dry with sterile napkins (before starting treatment with an antiseptic, the skin must be absolutely dry, because the antiseptic rubbing into the moistened skin leads to its dilution, a decrease in efficient concentration and, as a result, to the impossibility of achieving the desired result.
• during treatment, the skin sections should remain a moistened antiseptic, while the drug is applied to the hands of 3-5 ml portions;
• fully dry the skin before dressing sterile gloves in order to prevent intense reproduction of microorganisms, which can occur in a wet layer.

With affordable antiseptics, alcohols are most safe, while ethyl alcohol is characterized by a less irritant action than propyl or isopropyl alcohol.

Side effect of antiseptics on the skin of the staff.

According to various studies, approximately 25% of the nursing staff feel the symptoms and signs of dermatitis with localization on the skin of the hands. Skin irritation associated with the use of antiseptic soap can be due to both the antimicrobial substance that is included in its composition and other components. Leather damage also leads to a change in the composition of its microflora, increasing the frequency of colonization of staphylococci and gram-negative microorganisms.

With affordable antiseptics, alcohols are most safe, with ethyl alcohol characteristic less irritating effect than N-propyl or isopropyl alcohol. Most often, contact dermatitis is observed when using iodoform. Other antiseptics that can cause contact dermatitis: chlorhexidine, chlorxylene, triclozane and alcohol-containing means. However, the factors causing the occurrence of contact dermatitis associated with frequent hand wash can be the following: use for washing very hot water, low relative humidity (especially in winter), insufficient use of protective creams, low quality paper towels and allergies to Latex.

It is worth noting that most often the cause of contact allergies when using hand hygiene tools is flavors and preservatives, and less frequently - emulsifiers. Liquid soap, lotions and creams may contain ingredients that can cause contact allergic reactions in health workers. Alcohi-containing means for hygienic disinfection rarely become the cause of allergic dermatitis, but it is necessary to take into account that, to enhance the antimicrobial properties, alcohol-containing drugs are combined with different substances, for example, with quaternary ammonium compounds (hour), lactic acid, chlorhexidine Bigluconatte, octalidine hydrochloride.

Recently, new antiseptics in the form of gels have been offered in the market of antiseptic tools.

Due to their recipe, such drugs are suitable for antiseptic processing particularly sensitive to skin irritation.

To prevent the occurrence of contact dermatitis, it is advisable to consider the possibility of reducing the risk of their occurrence, which may include:

• reduction of the frequency of application of irritants (especially anionic detergents);
• replacement of funds having a strong irritating effect on those that are less irritated to the skin;
• training of health workers to the right use of antiseptics;
• ensuring health workers with skin care and protective creams.

Reducing the frequency of use of antiseptic treatments for hand hygiene is an unwanted strategy, given the low level of observance of the hygiene of the hands of health workers. The introduction into the practice of alcohol-containing antiseptics with softening additives allows to reduce the frequency of influence on the personnel of irritating substances (soap and detergents).

General approaches to the choice of antiseptic

The administration of the medical and prophylactic institution should take into account that, thanks to the acquisition of more efficient antiseptics, the practice of hand hygiene is improved, and therefore it is possible to prevent the emergence of nosocomial infections. The attention of all of several cases of nosocomial infections compensates for the additional expenses of the LPZ associated with the acquisition of more effective hand hygiene.

When choosing an antiseptic agent for hand hygiene, it is necessary to take into account the opinion of the staff of the compatibility of antiseptics with the skin, the frequency of irritation due to their use.

The cost of hand hygiene should not be the main factor in their choice, because low-cost disinfectants may not contain highly efficient skin care additives, warning the occurrence of allergies, irritations of skin cover.