Hygienic level of hand washing. Hygienic and surgical antisepsis of the skin of the hands of medical personnel. Hand cleansing algorithm

Why is it necessary to sanitize the hands of medical personnel? Numerous studies have established that the hands of medical personnel are the main factor in the transmission of nosocomial infections.

High-quality processing of the hands of medical personnel helps to reduce the incidence of infections associated with the provision of medical care, reduce the length of stay of patients in the hospital, reduce the cost of using antibiotics, etc.

Therefore, the main goal of treating the hands of medical personnel is to reduce the number of microorganisms present on the surface of the skin of the hands to a safe level.

As early as 1843, Oliver Wendell Holmes concluded that doctors and nursing staff infect their patients with "puerperal fever" through unwashed hands. In the future, his assumption was repeatedly confirmed by researchers in the field of epidemiology and microbiology. However, the problem of processing the hands of medical personnel is still relevant. This is evidenced by the registration data of nosocomial infections compared with the monitoring of hand washing.

Practice shows that high-quality hand hygiene is carried out only in 4 out of 10 cases. The reasons for this are:

• lack of sufficient knowledge and skills in the technique of processing hands among medical personnel;
• Lack of time;
• lack of necessary conditions for the treatment of hands, including those associated with a lack of financial resources for the purchase of liquid soap, antiseptics, protective creams;
• the presence of skin diseases among staff (dermatitis, eczema, etc.).

In accordance with the requirements of clause 12, section 1 of SanPiN 2.1.3.2630 - 10 "Sanitary and epidemiological requirements for organizations engaged in medical activities", the administration of a medical organization organizes training and monitoring of compliance with hand hygiene requirements by medical personnel. These activities are carried out by the responsible person as part of the production control program. The person responsible for carrying out these activities is appointed by order of the head of the institution.

Depending on the performed medical manipulation and the required level of reduction of microbial contamination of the skin of the hands, medical personnel perform hygienic treatment of hands or treatment of the hands of surgeons.

Hygienic processing of hands, in contrast to the processing of the hands of surgeons, is carried out in one stage. In this case, any of the methods proposed in paragraph 12.4 of section 1 of SanPiN 2.1.3.2630 - 10 methods can be chosen: washing hands with soap and water or treating hands with a skin antiseptic.

Hand treatment of surgeons is always carried out in two stages: Stage I - washing hands with soap and water for two minutes, and then drying with a sterile towel (napkin); Stage II - antiseptic treatment of the hands, wrists and forearms (clause 12.5 of section 1 of SanPiN 2.1.3.2630 - 10).

To dry hands during hygienic processing, clean cloth towels or disposable paper napkins are used, and when treating the hands of surgeons, only sterile cloth towels are used.

Another difference is the use of gloves after the treatment: after the hygienic treatment of the hands, disposable clean gloves are used, and after the treatment of the hands of surgeons, they are exclusively sterile.

In what cases is the hygienic treatment of hands carried out, and in which cases - the treatment of the hands of surgeons?

In accordance with the requirements of clause 12.4 of section 1 of SanPiN 2.1.3.2630 - 10, hand hygiene is carried out:

• before direct contact with the patient;
• after contact with the patient's intact skin (for example, when measuring the pulse or blood pressure);
• after contact with secrets or excretions of the body, mucous membranes, dressings;
• before performing various manipulations to care for the patient;
• after contact with medical equipment and other objects in the immediate vicinity of the patient;
• after treatment of patients with purulent inflammatory processes;
• after each contact with contaminated surfaces and equipment;
• after removing gloves.

Treatment of the hands of surgeons (clause 12.5 of section 1 of SanPiN 2.1.3.2630 - 10) is carried out before the following manipulations:

• surgical interventions;
• childbirth;
• catheterization of the main vessels.

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In each room where it may be necessary to carry out hygienic treatment of hands, as well as the treatment of hands of surgeons, the following should be installed:

• sinks equipped with elbow mixers;
• dispensers (elbow or on photocells) with liquid soap;
• dispensers (elbow or on photocells) with skin antiseptic;
• towel holders for cloth towels or disposable wipes for drying hands.

The medical organization must determine the real need and maintain a minimum stock of the following tools and consumables (clause 12.4.6 of section 1 of SanPiN 2.1.3.2630 - 10):

• liquid handwash;
• skin antiseptics for use with wall dispensers;
• individual containers (bottles) of small volumes (up to 200 ml) with a skin antiseptic;
• hand skin care products (creams, lotions, balms, etc.) to reduce the risk of contact dermatitis;
• cloth towels and/or paper towels for drying hands;
• clean and sterile disposable gloves.

Particular attention should be paid to the following points:

• a new portion of antiseptic (or soap) is poured into the dispenser after it has been disinfected, rinsed with water and dried (clause 12.4.5 of section 1 of SanPiN 2.1.3.2630 - 10);
• skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process; in units with a high intensity of patient care and with a high workload on staff (intensive care units, etc.), dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by staff (at the entrance to the ward, at the bedside of the patient etc.) (clause 12.4.6. section 1 SanPiN 2.1.3.2630 - 10).

To achieve effective washing and disinfection of hands, the following conditions must be observed: short-cut nails, no nail polish, no artificial nails, no rings, rings and other jewelry on the hands. Before processing the hands of surgeons, it is also necessary to remove watches, bracelets, etc. (clause 12.2 of section 1 of SanPiN 2.1.3.2630 - 10).

In addition, it is necessary to constantly monitor compliance with hand hygiene requirements by medical workers and bring this information to the attention of personnel in order to improve the quality of medical care (clause 12.7 of section 1 of SanPiN 2.1.3.2630 - 10).

Hygienic treatment of the surgeon's hands before the operation is a necessary and mandatory procedure in the operating unit of a medical institution. According to the "Sanitary and epidemiological requirements for organizations engaged in medical activities", in the premises of the operating unit, there must be a dispenser with an antiseptic solution, with the help of which surgeons and other medical personnel perform hand hygiene.

Algorithm for processing the hands of surgeons

1. Wash your hands for one minute using liquid detergent.
2. Dry your hands thoroughly with a disposable paper towel.
3. Using an elbow dispenser, apply skin antiseptic to your hands.
4. Within 3-5 minutes, rub the skin antiseptic in small portions, treating first the hands, then the forearms and elbows.
5. Continue working on the forearms and hands, then just the hands. Hands must remain moist throughout the treatment. Rub the second portion of the antiseptic until completely dry.
6. After treatment, dry your hands naturally, do not use towels or electric dryers. Put on medical gloves on completely dry hands.

Hand hygiene instructions

1. Rub your palm with the fingertips of the opposite hand in a circular motion.
2. Rub your palm against your palm.
3. Rub your left hand on the back of your right hand and vice versa.
4. Carefully treat the spaces between the fingers.
5. Take your hands in the lock and rub the back of your bent fingers on the palm of your other hand and vice versa.
6. Rub your thumbs alternately in a circular motion.

Most often, healthcare-associated infections (HAIs) occur in situations where the source of pathogenic microbes for the patient is the hands of medical personnel. Therefore, hand washing and hand hygiene with skin antiseptics are essential infection control measures that reduce the risk of spreading infections during the treatment process.

Our trading company offers hospitals, polyclinics, dispensaries, outpatient clinics, first-aid posts and other medical institutions of various types, antiseptics and dispensers for them; disinfectants for the treatment of hands, surfaces and tools; medical gloves, including for surgical operations; disposable paper towels; wipes and other hospital hygiene products from the world's leading manufacturer - Ecolab.

Any involves preparation and direct decontamination (removal of contaminants). The hands of a nurse must be well-groomed, without inflammation, burrs and microcracks.

Nails should be neatly trimmed and unvarnished. The skin edge of the nail bed should not be cut due to the risk of microtrauma and inflammation. Artificial nails on the hands of a nurse are unacceptable. Before it startsfor manipulations, wristwatches and jewelry must be removed.

Preparing the nurse's hands for processing

• We remove watches and jewelry.
• We examine the hands for inflammation and skin damage.
• In the presence of wounds, inflammation of the skin, we inform the senior nurse.
• In the presence of small injuries and local inflammation, we seal the problem areas of the skin with adhesive tape and put on a fingertip.

Machining the hands of a nurse

Normal hand washing is carried out with liquid soap from the dispenser, and in case of its absence, with simple lumps. Manipulation rooms should be equipped with elbow-operated mixers.

After preparing the hands, we moisten them with warm water, lather the palms, the backs of the hands, the interdigital spaces and the nail beds.

Vigorously three hands together:

1. palm on palm;
2. right palm on the back of the left hand and vice versa;
3. we interlock our hands with spread fingers and three inner surfaces of the fingers with up and down movements;
4. we fold our hand into a fist and with the back of the fingers of one hand we three palm of the other hand (repeat for each hand);
5. we clench our hand into a fist and embrace the finger of the other hand, three fingers in a circular motion - repeat with each finger on both hands;
6. three palm of one hand with the fingertips of the other, then change hands.

Each action must last at least 30 seconds. After washing, we dry our hands with a disposable towel or cloth, which is immediately removed from circulation.

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Hygienic antiseptic treatment of the hands of a nurse

1. Preparing hands for processing.
2. Washing hands with antiseptic soap.
3. Treatment of hands with water or alcohol antiseptic in accordance with the instructions for use. Drying with a towel after treatment with an antiseptic is NOT ALLOWED.

Surgical treatment of the hands of a nurse

1. Hand preparation.
2. Washing with ordinary or antiseptic soap - hands, wrists, forearms. Nails are treated with brushes.
3. Drying hands with a sterile cloth.
4. Application of an alcohol solution of a skin antiseptic, rubbing it into the skin until completely dry (water solutions of antiseptics are NOT APPLIED).
5. Repeated application and rubbing of an alcohol antiseptic, followed by drying WITHOUT DRYING WITH A TOWEL.
6. Putting on sterile gloves on dry hands.

The question of the need for hand hygiene by medical personnel was first raised only in the middle of the 19th century. At that time, due to unsanitary conditions in Europe, almost 30% of women in childbirth died in hospitals. The main cause of death was the so-called puerperal fever. It often happened that doctors went to women in labor after dissecting corpses. At the same time, they did not treat their hands with anything, but simply wiped them with a handkerchief.

Types of processing

Keeping hands clean is a must for all medical staff. Hygiene treatment of the hands of medical staff can be carried out in two ways:

• removing impurities and reducing the number of microorganisms on the skin of the hands with soap and water;
• the use of special alcohol-containing skin antiseptics, which can reduce the number of bacteria on the skin to a minimum level.

Only the second method can be called hygienic processing of hands. The first is just hygienic washing. Hands should be washed with liquid soap with a dispenser and dried with an individual disposable towel. But disinfection is carried out using skin antiseptics.

According to the rules, medical personnel must always have hand sanitizers available. In addition, they must be provided with creams, balms, and lotions intended for skin care. After all, with constant hygienic treatment, the risk of developing contact dermatitis increases. Also, the selection of detergents and antiseptics should be carried out taking into account individual intolerance.

Important conditions

Each hospital employee should know when hygienic treatment of the hands of medical staff should be carried out. This is required in the following situations:

• before and after contact with each patient;
• before and after putting on gloves that are used during medical procedures, contact with excreta or body secrets, dressings, mucous surfaces;
• after contact with intact skin, for example, after measuring blood pressure, pulse, shifting the patient;
• after working with equipment that is located in the immediate vicinity of the patient;
• after treatment of patients with various pyoinflammatory processes.

If there is a clear contamination of the skin of the hand with blood or secretions of the patient, then first they must be thoroughly washed with soap and water and dried. After that, they must be treated twice with an antiseptic.

Hand washing technique

Do not forget the importance of cleansing the skin, not only in hospitals, but also in other places. Hand processing technique remains the same everywhere. Before proceeding with the procedure, it is necessary to remove all rings, watches and bracelets. Any foreign objects make it difficult to remove pathogens. It is advisable to wash your hands with moderately warm water.

To increase the effectiveness of the procedure, you must first moisten your hands and squeeze liquid soap onto them. The hand processing algorithm looks like this:

1. Lather the soap by intensively rubbing the palms together.
2. Rub one palm against the other in a reciprocating motion.
3. Rub the back surface of the right hand with the left palm and vice versa.
4. Connect the fingers of the right hand and the interdigital spaces of the left, carefully process them.
5. It is necessary to go through the inner surface of the fingers.
6. Cross your outstretched fingers and rub your palms together.
7. Lock your hands together and run the back of your fingers across your palm.
8. Thoroughly rub the thumb in a circular motion, for this its base must be covered with the thumb and forefinger of the other hand.
9. The wrist is processed in a similar way.
10. Rub your palms with your fingertips in a circular motion.

Each movement should be repeated at least 5 times, and the total duration of such a wash should be about a minute.

Rules for medical personnel

Every employee of hospitals and clinics should know how the hands of medical staff should be treated. SanPiN (the correct washing scheme is given above) establishes the procedure for not only cleaning the skin, but also disinfecting it. Health care providers should also be aware of the following:

• short cut nails without varnish;
• the absence of rings, rings and other similar jewelry.

Nail polish can cause unwanted dermatological reactions that can lead to secondary infection. In addition, dark varnish does not allow assessing the degree of cleanliness of the subungual space. This may result in poor processing. Cracked varnish is considered the most dangerous. Indeed, in this case, it becomes more difficult to remove microorganisms from the surface of the hands.

The very performance of a manicure is associated with microtraumas that are easy to infect. This is one of the reasons why medical professionals are not allowed to wear false nails.

Any jewelry or bijouterie can cause the hygienic treatment of the hands of the medical staff to become less effective. In addition, because of them, gloves can be damaged, and the process of donning them is complicated.

Nuances for surgeons

The processing of the hands of people involved in surgical interventions is carried out according to a slightly modified scheme. So, for example, the washing time for them is extended and is 2 minutes. The further hand processing algorithm is as follows. After mechanical cleaning, it is necessary to dry the skin with a sterile tissue or disposable paper towel.

In addition to washing, antiseptic treatment is also important. Attention must be paid not only to the hands, but also to the wrists and forearms. During the prescribed treatment time, the skin should remain moist. You can not wipe your hands, you must wait until the antiseptic is completely dry. Only then can surgeons put on gloves.

Selection of hygiene products

Many now opt for antibacterial soap. But it is important to follow the technique of cleaning the skin. If done right, washing your hands with regular soap will be just as effective. In surgical practice, special means for antiseptic treatment of hands are used. The soap contains chlorhexidine gluconate or povidone-iodine. These substances are able to reduce the number of bacteria by 70-80% at the first application and by 99% at the second application. At the same time, when using povidone-iodine, the microflora grows faster than when in contact with chlorhexidine.

In order for the hygienic treatment of the hands of medical staff to be in full compliance with regulatory requirements, it is desirable to equip medical facilities with elbow dispensers. They are controlled without the participation of the hands.

Also in surgical practice, brushes can be used to clean hands, but this is not considered mandatory. They must be either sterile, disposable, or capable of withstanding autoclaving.

Time periods

In surgical practice, special rules for cleaning the skin are established. After the usual thorough washing according to the established protocol, they should be disinfected.

It is imperative that the hands of the medical staff be processed. SanPin (the washing scheme remains the same) provides that skin cleaning before surgical procedures can be carried out using the same means as hygienic.

It is important to remember that throughout the entire period of disinfection of hands, they must remain moist. For the procedure, as a rule, it is necessary to use more than 6 ml of antiseptic. As a result of research, it was found that for the qualitative destruction of bacteria, a five-minute treatment of the skin is sufficient. It has also been confirmed that performing this procedure for three minutes reduces the number of microorganisms to an acceptable level.

Hand sanitizer rules

After thoroughly washing the skin of the hands, wrists and forearms, it is necessary to dry them. After that, the established standard for the processing of hands for workers in operating units provides for the need to use special disinfectants.

Before this, if necessary, it is necessary to process the nail beds and periungual ridges. For these purposes, sterile disposable wooden sticks are used, which must be additionally moistened with an antiseptic.

The disinfectant is applied in 2.5 ml to the hands and forearms. About 10 ml of disinfectant liquid should be spent on one treatment of two hands. The antiseptic must be rubbed into the skin in the same way that hand washing is carried out, observing the correct sequence of movements.

Only after complete absorption / evaporation of the product, you can wear gloves. If the surgical operation lasts more than 3 hours, then the treatment is repeated. After all, pathogens can begin to multiply under gloves again.

Final stage

But this is not all levels of hand processing. It is important to remove gloves after working and wash your hands with soap and water. In this case, it is no longer necessary to use a disinfectant solution. Washing with liquid soap is sufficient, it is desirable that its pH is neutral.

After cleaning the skin, they must be moisturized. For these purposes, various creams and lotions are used. Their main purpose is to prevent the drying effect of alcohol-containing disinfectants.

Separately, it should be noted that the hygienic treatment of hands in the absence of visible contamination can be performed without washing. In most cases, it is enough to use antiseptic solutions for 30-60 seconds.

Possible Complications

It is worth noting that the regular use of disinfectants does not have the best effect on the skin of medical workers. There are two main types of reactions experienced by hospital staff. Most often they complain of itching, dryness, irritation, the appearance of cracks with bleeding. These symptoms can be both minor and significantly affect the general condition of workers.

There is also another type of complications - allergic dermatitis. They occur with intolerance to any components of products intended for hand disinfection. Allergic dermatitis can manifest itself both in mild localized and in severe generalized form. In the most advanced cases, they can be combined with respiratory distress syndrome or other manifestations of anaphylaxis.

The prevalence of complications and their prevention

You can understand the significance of the problem if you know that such methods of hand washing lead to the fact that 25% of nurses present with signs of dermatitis, and 85% reported that they had a history of skin problems.

You can slightly reduce the irritating effect of antiseptics if you add emollients to them. This is one way to reduce the prevalence of contact dermatitis. Also, the risk of their occurrence can be minimized by using moisturizers that are designed for hand skin care after each wash.

To prevent the development of complications, do not wash your hands every time before treating them with an antiseptic. In addition, it is important to ensure that gloves are put on only when the skin is completely dry.

Do not neglect the use of moisturizers. On the market you can find special protective creams designed to prevent the onset of contact dermatitis. However, as a result of studies, it was not possible to confirm their unambiguous effectiveness. Many are stopped by the high price of these creams.

Hygienic treatment of the hands of medical staff: methods, algorithm and preparations

Hygiene treatment of the hands of medical staff is a mandatory procedure before performing any action with the patient. For processing, various means and preparations are used that do not require long time-consuming and are approved by the Committee of Pharmacology of the Russian Federation.

What is disinfection for?

Hand hygiene is a disinfecting procedure that prevents nosocomial infection, protecting not only the staff, but also the patients. The purpose of the treatment is to neutralize microbes that are on human skin after contact with an infected object or are part of the natural flora of the skin.

There are two types of procedures: hygienic and surgical hand treatment. The first is mandatory before contacting the patient, especially if he is to undergo surgery. Hygienic treatment of the hands of personnel must be carried out after contact with saliva, as well as blood. Disinfection must be carried out before sterile gloves are put on. You can wash your hands with special soap with an antiseptic effect or wipe the skin with an alcohol-based product.

When to Hygiene

Hygiene treatment of the hands of medical staff is mandatory in the following situations:

1. After the therapy of patients diagnosed with an inflammatory process with the release of pus.
2. After contact with devices and any other object located near the patient.
3. After each contact with contaminated surfaces.
4. After contact with mucous membranes of a person, his excretions and gauze bandages.
5. After contact with the skin of the patient.
6. Before performing patient care procedures.
7. Before each contact with the patient.

Proper hygiene treatment involves washing with soap and running water in order to get rid of dirt and reduce the number of microorganisms. In addition, hand hygiene includes antiseptic skin treatment procedures that help reduce the number of bacteria to a minimum safe level.

What is used for processing

Soap in liquid form, which is dispensed using a dispensary, is ideal for washing the hands of medical staff. It is not recommended to use hot water due to an increased risk of dermatitis. Be sure to use a towel to turn off a faucet that is not equipped with an elbow drive. In order to dry clean hands, single-use paper towels (or individual fabric ones) should be used.

Hygienic treatment of hands, the algorithm of which includes several simple steps, can be carried out using a skin antiseptic. In this case, pre-washing with soap is not necessary. The product is rubbed into the skin of the hands in the amount indicated on the packaging of the antiseptic. Particular attention is paid to the fingers, the skin between them and the areas around the nails. A prerequisite for achieving the desired effect is keeping the hands moist for a certain time (usually it is indicated on the product). After hygienic processing of hands is carried out, it is not required to wipe them with a towel.

Equipment for hygiene procedures

In order for the hygiene procedure to be carried out in accordance with all the rules and requirements, the following is necessary:

• Running water.
• Liquid soap with a neutral pH.
• Washbasin with faucet operated without the touch of the palms (elbow method).
• Alcohol-based antiseptic.
• Disposable towels, both sterile and non-sterile.
• Detergent with antimicrobial action.
• Disposable rubber gloves (sterile or non-sterile).
• Hand care product.
• Household rubber gloves.
• Urn for used accessories.

Mandatory requirements

In the room where antimicrobial hand treatment is planned, the washbasin should be located in an accessible place. It is equipped with a tap through which hot and cold water flows, a special mixer. The design of the faucet should be made in such a way that splashing of water is minimal. The hygienic level of hand treatment provides for the maximum reduction in the number of microorganisms on the skin, so it is advisable to install several dispensers with products next to the washbasin. In one - liquid soap, in the other - an antimicrobial drug, another should be filled with a hand care product.

It is not recommended to dry hands with electric type dryers, as they will still remain damp, and the device causes air turbulence, where contaminated particles may be. All containers with funds must be disposable. Hospitals should always have several hand sanitizers on hand, some of which are for workers with sensitive skin.

Carrying out algorithm

Hand hygiene is mandatory for all healthcare workers. The algorithm for cleaning with soap is as follows:

1. Squeezing out the required amount of liquid soap from the dispenser.
2. Rubbing in palm-to-palm mode.
3. Rubbing one palm of the hand against the back of the other.
4. Wiping the inner surfaces of the fingers vertically.
5. Rubbing the back of the fingers of the hand folded into a fist, the palm of the second (do the same with the other hand).
6. Rubbing all fingers in circles.
7. Rubbing each palm with fingertips.

Surgical disinfection

Surgical hand disinfection is required to completely remove the flora from the hands: resistant, as well as transistorized. This is done so that the infection cannot be transmitted through the hands. Like hand hygiene, surgical disinfection is performed by washing and wiping. The use of alcohol-based solutions is widespread due to the fast and directional action, optimal skin acceptance of the product, long duration of action, and the effect of complete removal of microorganisms.

The process of surgical disinfection includes almost the same steps that involve the processing of hands at a hygienic level. Algorithm of surgical antisepsis:

1. Wash hands with soap and water for at least two minutes.
2. Dry your hands using a disposable tissue or towel.
3. Treat hands, forearms, and wrists with an antiseptic agent, without wiping your hands afterwards.
4. Wait for the product to dry completely, put on sterile gloves.

The exposure time of a particular antiseptic drug, its dosage and other important parameters can be read on the product label or in its instructions. The first hand treatment of each work shift should include the stage of cleaning the areas near each nail with a special soft brush - sterile and disposable (or one that has been sterilized by autoclaving).

Antiseptic treatment

An antiseptic solution is one of the main means of combating microorganisms, which includes hygienic treatment of hands. The algorithm is the following:

1. Washing hands in room temperature water with liquid soap, drying with a disposable towel.
2. Applying a disinfectant with rubbing movements, which disinfects the hands.
3. With interlaced fingers, massage the backs of the hands.
4. With crossed fingers, widely spaced, rub your palms.
5. Rub the product into the thumbs with clenched palms alternately.
6. Rubbing the forearms for a minimum of 2 minutes, a maximum of 3 minutes, processing nails and subungual area.

Each step needs to be repeated 4-5 times. Throughout the procedure, you need to ensure that your hands do not dry out. If necessary, apply another portion of the disinfectant.

Hand hygiene is a mandatory disinfection process for all medical personnel in contact with patients or various contaminated hospital facilities. For processing, chlorhexidine bigluconate (alcohol solution) in ethyl alcohol (70%) is used. In addition, the following drugs are used:

• "Octenisept".
• Ethyl alcohol with additives that effectively soften the skin.
• "Octeniderm".
• "Hemisept".
• "Higenix".
• "Isopropanol" - 60%.
• "Octeniman".
• "Decosept+".
• "Veltocept".

Before carrying out hygienic treatment, it is imperative to remove all wrist accessories and jewelry. We must not forget about cleaning the hands with a sterile brush, paying special attention to the nail area. The procedure is carried out once at the beginning of the working day.

Requirements for hygiene products

If the containers for antiseptics and soaps are not disposable, then refilling should be done only after they have been thoroughly disinfected, rinsed with running water and completely dried. It is recommended to use dispensers that work on photocells or those from which the product is squeezed out in an elbow way.

All antiseptics used for skin treatment should be readily available at all stages of the treatment process. If the unit is focused on intensive patient care, then containers with antiseptics should be placed in places most convenient for medical personnel, for example, at the patient's bedside or near the entrance to the hospital ward. It is recommended to provide each worker with an individual container of a small volume with an antiseptic preparation.

Rules for antiseptic treatment of hands drawing

2. PROCESSING OF HANDS OF MEDICAL PERSONNEL

Hand washing is a simple but very important method of preventing HCAI. P Correct and timely processing of hands is the key to the safety of medical personnel and patients .

Hand preparation rules:

1. Remove rings, watches.

2. Nails must be cut short, the presence of varnish is not allowed.

3. Wrap the long sleeves of the robe on 2/3 of the forearm.

All jewelry, watches are removed from the hands, as they make it difficult to remove microorganisms. Hands are soaped, then rinsed warm running water and everything repeats from the beginning. It is believed that during the first soaping and rinsing with warm water, microbes are washed off the skin of the hands. Under the influence of warm water and self-massage during mechanical treatment, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes from the opened pores are washed off. Warm water makes the hand sanitizer or soap work more effectively, while hot water removes the protective fatty layer from the surface of the hands. In this regard, you should avoid using too hot water for washing your hands.

When entering and leaving the intensive care unit or ICU, the staff should clean their hands with a skin antiseptic.

There are three levels of hand treatment:

1. Household level (machining of hands);

2. Hygienic level (treatment of hands using skin antiseptics);

3. Surgical level (a special sequence of actions when processing hands, increasing the processing time, processing area, followed by putting on sterile gloves).

1. Machining of hands

The purpose of the household level of hand treatment is the mechanical removal of most of the transient microflora from the skin (antiseptics are not used).

After visiting the toilet

before eating or before working with food;

before and after physical contact with the patient;

any contamination of the hands.

Required equipment:

1. Liquid dosed neutral soap. It is desirable that the soap does not have a strong odor. Open liquid soap is quickly infected with microbes, so closed dispensers should be used, and at the end of the contents, process the dispenser, only after processing, fill it with new contents.

2. Napkins measuring 15x15 cm are disposable, clean for drying hands. The use of a towel (even an individual one) is not desirable, because it does not have time to dry out and, moreover, is easily seeded with microbes.

Hand treatment - the necessary sequence of movements:

1. Rub one palm against the other palm in a reciprocating motion.

2. With the right palm, rub the back surface of the left hand, change hands.

3. Connect the fingers of one hand in the interdigital spaces of the other, rub the inner surfaces of the fingers with up and down movements.

4. Connect the fingers into a “lock”, rub the palm of the other hand with the back of the bent fingers.

5. Grasp the base of the thumb of the left hand between the thumb and forefinger of the right hand, rotational friction. Repeat on the wrist. Change hands.

6. In a circular motion, rub the palm of the left hand with the fingertips of the right hand, change hands.

HAND HYGIENE REGULATIONS

European standard E N -1500

Palm to palm including wrists

Right palm on the left back of the hand and left palm on the right back of the hand

Palm to palm of hand with fingers crossed

The outer side of the fingers on the opposite palm with crossed fingers

Circular rubbing of the left thumb in the closed palm of the right hand and vice versa

Circular rubbing of the closed fingertips of the right hand on the left palm and vice versa

2. Hand hygiene

The purpose of hygienic treatment is the destruction of resident microflora from the surface of the skin of the hands with the help of antiseptics.

Such hand treatment is carried out:

before putting on gloves and after taking them off;

before caring for a patient with a weakened immune system or when making rounds in the wards (when it is not possible to wash hands after examining each patient);

before and after performing invasive procedures, minor surgical procedures, wound care or catheter care;

after contact with body fluids (eg blood emergencies).

Required equipment:

2. Napkins measuring 15x15 cm are disposable, clean (paper or fabric).

3. Skin antiseptic. It is advisable to use alcohol-containing skin antiseptics (70% ethyl alcohol solution; 0.5% solution of chlorhexidine bigluconate in 70% ethyl alcohol, AHD-2000 special, Sterillium, Sterimax, etc.).

Hygienic processing of hands consists of two stages:

1 - mechanical cleaning of hands, followed by drying with disposable wipes;

2 - disinfection of hands with a skin antiseptic.

3 . Surgical treatment of hands

The goal of the surgical level of hand decontamination is to minimize the risk of violating operational sterility in the event of damage to gloves.

Such hand treatment is carried out:

before surgical interventions;

before serious invasive procedures (for example, puncture of large vessels).

Required equipment:

1. Liquid dosed pH-neutral soap.

2. Napkins measuring 15x15 cm are disposable, sterile.

3. Skin antiseptic.

4. Disposable sterile surgical gloves.

Hand treatment rules:

Surgical treatment of the hands consists of three stages:

1 - mechanical cleaning of hands followed by drying,

2 - disinfection of hands with a skin antiseptic twice,

3 - closing hands with sterile disposable gloves.

In contrast to the above-described method of mechanical cleaning at the surgical level, the forearms are included in the treatment; sterile wipes, but hand washing lasts at least 2 minutes. After drying, the nail beds and periungual ridges are additionally processed with disposable sterile wooden sticks soaked in an antiseptic solution.

Brushes are not required. If brushes are still used, sterile, soft, disposable or autoclavable brushes should be used, and brushes should only be used on the periungual area and only for the first brushing of a work shift.

At the end of the mechanical cleaning stage, an antiseptic is applied to the hands in portions of 3 ml and, preventing drying, is rubbed into the skin, strictly following the sequence of movements. The procedure for applying a skin antiseptic is repeated at least two times, the total consumption of the antiseptic is 10 ml, the total procedure time is 5 minutes.

Sterile gloves are put on dry hands only. If the duration of work with gloves is more than 3 hours, the treatment of hands is repeated with a change of gloves.

After removing the gloves, the hands are again wiped with a napkin moistened with a skin antiseptic, then washed with soap and moistened with an emollient cream.

Bacteriological control of the effectiveness of processing the hands of personnel.

The washings from the hands of the personnel are made with sterile gauze wipes 5 × 5 cm in size, moistened with a neutralizer. Thoroughly wipe the palms, periungual and interdigital spaces of both hands with a gauze cloth. After sampling, the gauze pad is placed in wide-mouth tubes or flasks with saline and glass beads and shaken for 10 minutes. The liquid is inoculated, incubated for 48 hours at a temperature of + 37 0 C. Accounting for the results: the absence of pathogenic and opportunistic bacteria (Guidelines 4.2.2942-11).

Dermatitis associated with frequent hand washing

Repeated hand washing may cause skin dryness, cracking and dermatitis in sensitive subjects. A healthcare worker suffering from dermatitis contributes to an increased risk of infection for patients due to:

the possibility of colonization of damaged skin by pathogenic microorganisms;

Difficulties in adequately reducing the number of microorganisms in handwashing;

Tendencies to avoid handling hands.

Measures that reduce the likelihood of developing dermatitis:

thorough rinsing and drying of hands;

use an adequate amount of antiseptic (avoid excess);

· usage contemporary and various antiseptics;

Mandatory use of moisturizing and emollient creams.

Skin microflora

The surface layer of the epidermis (top layer of the skin) is completely replaced every 2 weeks. Every day, up to 100 million skin scales are peeled from healthy skin, of which 10% contain viable bacteria. The microflora of the skin can be divided into two large groups:

1. Resident flora

2. Transient flora

1. Resident microflora are those microorganisms that constantly live and multiply on the skin without causing any diseases. That is, it is a normal flora. The number of resident flora is approximately 10 2 -10 3 per 1 cm 2. The resident flora is represented mainly by coagulase-negative cocci (primarily Staphylococcus epidermidis) and diphtheroids (Corinebacterium spp.). Despite the fact that Staphylococcus aureus is found in the nose of approximately 20% of healthy people, it rarely colonizes the skin of the hands (if it is not damaged), but in hospital conditions it can be found on the skin of the hands of medical personnel with no less frequency than in the nose.

The resident microflora cannot be destroyed by ordinary hand washing or even antiseptic procedures, although its numbers are significantly reduced. Sterilization of the skin of the hands is not only impossible, but also undesirable: because the normal microflora prevents the colonization of the skin by other, much more dangerous microorganisms, primarily gram-negative bacteria.

2. Transient microflora- These are those microorganisms that are acquired by medical personnel as a result of contact with infected patients or contaminated environmental objects. Transient flora can be represented by much more epidemiologically dangerous microorganisms (E.coli, Klebsiella spp., Pseudomonas spp., Salmonella spp. and other gram-negative bacteria, S.aureus, C. albicans, rotaviruses, etc.), including hospital strains of pathogens of nosocomial infections. Transient microorganisms remain on the skin of the hands for a short time (rarely more than 24 hours). They can easily be removed with normal hand washing or destroyed with antiseptics. As long as these microbes remain on the skin, they can be transmitted to patients through contact and contaminate various objects. This circumstance makes the hands of personnel the most important factor in the transmission of infection.

If the integrity of the skin is broken, then the transient microflora can cause an infectious disease (for example, panaritium or erysipelas). You should be aware that in this case, the use of antiseptics does not make hands safe in terms of infection transmission. Microorganisms (most often staphylococci and beta-hemolytic streptococci) remain with the disease on the skin until a cure occurs.

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1. Remove all rings from your hands (depressions on the surface of jewelry are a breeding ground for microorganisms).

2. Move the watch above the wrist or take it off.

3. Clean the areas under the nails with a nail cleaner under running water.

4. Apply 3-5 ml of liquid soap to your hands or lather your hands thoroughly with bar soap.

5. Wash your hands using the following technique:

Vigorous mechanical friction of the palms (repeat 5 times);

The right palm washes the back of the left hand with rubbing movements, then the left palm washes the back of the right hand (repeat 5 times);

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

The back of the fingers to the palm of the other hand (fingers interlaced - repeat 5 times);

Alternating rotational friction of the thumbs of one hand with the palms of the other, palms clenched (repeat 5 times);

Variable friction of the palm of one hand with the closed fingers of the other hand (repeat)

fig.6. Hand washing.

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

7. Turn off the faucet, holding it only with a paper towel, as it can be a source of contamination.

8. Dry hands with sterile gauze.

8. Thoroughly treat the skin of the hands for 2-3 minutes with 2 swabs moistened with 70% alcohol or an alcohol-containing skin antiseptic with a virucidal effect (at least one minute for each hand) or apply 5-8 ml of 70% ethyl alcohol to the palmar surfaces alcohol or an alcohol-containing skin antiseptic with a virucidal effect and rub into the skin for 2 minutes.

9. Throw away the used balls into a container for disinfection.

10. Put on gloves according to the algorithm of actions.

Use of protective clothing.

Bathrobes.

With the exception of operating rooms or dressing rooms, where sterile gowns are worn to protect the patient, the main purpose of the gowns is to prevent the entry of infectious agents on the clothing and skin of personnel.

Beanies.

Medical caps securely cover the hair, preventing it from acting as a source of pollution.

Aprons.

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

Masks.

Masks are necessary to avoid airborne transmission of microorganisms, as well as in cases where there is a possibility of liquid substances of the human body entering the nose or mouth. They are especially important when personnel work directly on a large wound surface, such as open surgical wounds or burns, or in procedures with infectious patients from whom the infection can be easily transmitted by airborne droplets.

Masks should be replaced every 3-4 hours (depending on the type of work performed) or when they are moistened during work. Masks must not be lowered around the neck, reused. All masks must completely cover the nose and mouth.

Eye protection (glasses, screens).

Eye and face barriers are required to protect the eyes from splashes of blood or other liquid secretions. The shape of the goggles provides complete protection against accidental droplets without restricting the specialist's field of vision. The transparency and smoothness of the lenses ensures that there is no refractive effect, which allows you to work for a long time without overwork. Can be worn with regular glasses.

Gloves.

Gloves should be worn at the slightest possibility of contact with the patient's blood, body fluids, mucous membranes, or broken skin. The use of gloves is also necessary in cases where there are cuts, skin lesions or any open wounds on the hands of a healthcare worker.

Gloves should be changed between patient contacts. In addition, gloves are changed if, during patient care, contact with the patient's biological secretions has occurred.

Sterile gloves are used for surgical interventions, dressings, any invasive procedures and medical manipulations.

Disinfected gloves are used in laboratories when working with any patient's biological material, with disinfectants, cytostatics and other chemicals.

Airing

Target: Improvement, disinfection of air mechanically. Providing a barrier for the reproduction of pathogenic flora and the spread of nosocomial infections by airborne droplets. Enrichment of air with oxygen Indications: All premises of medical institutions. The necessary conditions:

regularity of airing (at least 4-5 times a day);

the presence of vents, opening sashes

P/No.	PREPARATION PROCESS FOR PROCEDURES	RATIONALE
1.	Warn patients in the ward about the upcoming manipulation and obtain consent to it.	Motivating the patient to cooperate. Respect for the rights of the patient.
2.	Determine the most appropriate method of ventilation (it depends on the season, the presence of vents, the patient's condition).	Ensuring the technicality and correctness of the manipulation.
3.	Ask patients who can walk to leave the room	Ensuring the effectiveness of manipulation
4.	For seriously ill patients, provide reliable protection against hypothermia: - cover with a blanket - cover your head	Maintain the body's defenses of weakened patients
5.	Open windows, sashes (depending on the season) for 20 minutes. During the summer, they can be kept open around the clock.	Provision of ventilation, air disinfection.
6.	Close windows, shutters.	end of manipulation.
7.	Invite patients to the room.	Ensuring the comfort of patients.

QUARTZING

Target: Destruction of pathogenic flora as a result of exposure to the rays of a bactericidal lamp Indications: All regime rooms of health care facilities. The frequency and duration of quartzing depends on the area of ​​​​the room (1 watt per 1 cubic meter), as well as on the functional load of the room (in treatment rooms, dressing rooms every 4-6 hours).

The necessary conditions:

regularity of quartzing,

the presence of a stationary or mobile ultraviolet irradiator,

the absence of patients and medical pereonal in the room during quartzization.

P/No.	PREPARATION PROCESS FOR THE PROCEDURE	RATIONALE
1.	Warn patients and medical staff about the upcoming manipulation and ask them to leave the room.	Avoidance of possible complications. Respect for the rights of the patient.
2.	For patients who are forced to be indoors during quartzization, provide eye protection.	Avoid damage to eyes sensitive to UV exposure
3.	Turn on the bactericidal lamp (time is regulated)	Air disinfection
4.	Turn off the lamp when finished.	completion of the manipulation.
5.	Invite patients to the ward, medical staff to their workplaces.	Ensuring the comfortable condition of patients. Continued work of the medical staff.

The date and time of quartzization is recorded in special documentation.

Independent work.

Complete the task: Carry out the final disinfection of the treatment room

Final disinfection.

An important link in disinfection measures in health facilities is the final disinfection. In health care facilities, general cleaning is used as the final disinfection. When organizing general cleaning, it is necessary to divide all the functional premises of the health facility into categories - regime, non-regime and auxiliary.

The category of regime cabinet includes all rooms in which any invasive manipulations are carried out, processing of instruments, preparation for sterilization, work is carried out with sterile instruments and material (procedure room, dressing room, operating unit, delivery room, intensive care wards), work with patients' biomaterial.

The outliers include rooms intended for the stay of patients, without performing invasive manipulations, as well as for feeding patients and organizing recreation (wards, buffet, halls, etc.)

Ancillary facilities include where patients stay for a short time and rooms for medical staff (registration, cloakroom, staff room, etc.).

On the day of general cleaning in sensitive subdivisions, it is recommended to choose a disinfection regime that is maximally aimed at preventing viral hepatitis and fungal infections (in accordance with OST 42-21-2-85). The frequency of general cleaning depends on the profile of the unit:

In the delivery room every other day or 1 time per day;

Dressing rooms, treatment rooms, operating room - 1 time in 7 days;
Carrying out general cleaning in sensitive rooms requires careful selection

working disinfectant, taking into account the most epidemiologically significant group of microorganisms for a given profile of the HCI unit. So, operative blocks, dressing rooms require measures aimed at the destruction of anaerobic flora, i.e. it is advisable to use 6% hydrogen peroxide as a disinfectant.

For general and current disinfection, it is necessary to have a specially allocated cleaning equipment in sufficient quantities. All cleaning equipment is separated and labeled according to the type of cleaning and premises. For security offices, individual inventory is allocated, with the appropriate marking, which is stored on site. It is not allowed to replace inventory and use it for other purposes. For off-duty offices, cleaning equipment should be stored in a separate room. This room provides a place for processing inventory, drying and storage. For storage of buckets, basins, racks with a hygienic coating and appropriate markings are equipped. For mops and brushes, special racks are equipped that allow separate storage. For rags and gloves, it is advisable to have racks that allow you to dry soft inventory.

For general and current disinfection, it is necessary to have separate rags. Rags for general cleaning are not subject to separation by objects of use and are marked only with the icon: for general cleaning (the icon is chosen arbitrarily). After use, the rags must be disinfected, washed, dried and sterilized. Rags for general cleaning are stored in the same packing in which they were sterilized until use, regardless of the shelf life. The styling includes rags and special clothing.

Rags used for current disinfection must be processed according to two schemes.

Scheme for processing rags for current disinfection:

Rags after processing the object (use)

Disinfection after use

Ready rags for use Sterilization

Ready-made rags for work (the period of preservation of sterility is not taken into account)

When using scheme A- rags are divided according to the objects of disinfection:

Equipment.

1. Sanitary equipment.

2. Surfaces.

3. Work surfaces.

Labeled and used strictly for its intended purpose.

When choosing scheme B- rags are stored in a common package, without marking and are used

for disinfection of any objects.