How to wash your hands with a hygienic way. The rules for processing the hands of medical staff is the most important component of the security of medical care. Sanitary rules

All its basic actions dentist handle hands. For this reason, the purity of the dentist's hands is essential. After all, numerous microbes that stay on the skin of unwashed hands, in case of entering open wounds, can cause infection with the subsequent development of pathological processes. Therefore, the necessary procedure in the preparation of a doctor to work is sanitary handling of hands in order to ensure the lack of microorganisms that are capable of causeing a disease.

The microflora of the skin includes both microorganisms that are constantly living on the skin and bacteria, viruses, rubber and mushrooms entering the skin surface when contacting the external environment. It is to the temporary inhabitants of the skin of the hands include golden staphylococcus and other dangerous bacteria. The bulk of microorganisms that are permanent on the skin is in its surface layer. A small part of them (about ten-twenty percent), penetrates deep skin layers, swing glands and hair bulbs.

Staphylococci are gram-positive
sharovid bacteria, which, with microscopic studies resemble the bunches of grapes.

Before carrying out surgical procedures, it is necessary to eliminate the arms of the hands of both constant and temporal microflora. The usual hand washing with soap makes it possible to clean your hands from the bulk of temporary microorganisms. However, this method of sanitary processing is not enough to remove permanent inhabitants of deep layers of skin.

In view of the presence of the risk of infection during various medical procedures, the hygiene of the hands of doctors and other medical workers is strictly regulated. There are rules for processing the hands of medical personnel, determined by the specific working conditions and the level of existing risks. So, what are the ways to ensure the required cleanliness of the skin?

Types of hygienic procedures in the preparation of a doctor for work

In accordance with the requirements for cleaning the skin, when preparing medical staff, the following hygienic procedures apply to work:

• Normal hand washing.
• Hygienic disinfection of skin cover.
• Surgical disinfection of hands.

Each subsequent methods provide a higher level of skin cleaning from microbiological pollution.

Easy washing hands

In the case of a moderate degree of contamination of the skin surface of hands to remove pollutants, an ordinary soap and water are applied. Disinfectants are not used. This hygiene method ensures the elimination of dirt and reduce the number of microbes on the skin surface.

Normal hand washing is a mandatory procedure in the following situations:

• before the preparation of food and their issuance;
• immediately before meals;
• after sending natural needs;
• before contact with the patient and at its end;
• before and after the care of patient care;
• with any apparent contamination of the skin surface.

With careful cleaning of hands using detergents from the skin, the order of ninety-nine percent of temporary microorganisms is eliminated. As studies have shown, the formal carrying out of this hygienic procedure does not eliminate pollution from fingertips, as well as their internal surfaces. Therefore, hand processing rules require the use of a certain method of washing, including the following actions:

• removal from the hands of the clocks and various accessories that interfere with the cleaning of the skin from microflora;
• applying a layer of soap to the skin surface;
• rinsing hands with flowing warm water;
• repeat procedure.

Under the first execution of the procedure, microorganisms are removed from the skin surface. Its repetition ensures the elimination of bacteria from the pores, opened under the action of water with a temperature above room and from the massaging of the skin surface.

It is desirable that during the cleaning of the hands the water was warm, but not hot. Overweight water temperature leads to washing the fat layer, protecting the skin surface.

Currently, the rules for processing the hands of medical personnel require your hands to wash not an arbitrary way, but by performing a certain sequence of movements that meets the adopted European standard.

What actions need to perform during hand washing

When washing up pollution from skin cover, a medical worker must perform the following sequence of movements:

1. Fringe of palms for each other.
2. Alternately rubbing the back side of the brush of one hand with palm of another hand.
3. Alternately rubbing the inner surface of the interfallated gaps of one hand with the fingers of the other.
4. Grinding with palms with the tile sides of the bent fingers connected in the castle.
5. Alternate friction of the base of the thumb of one hand by rotational movements when covered by the index and thumbs of another hand.
6. Rotationally rubbing the wrist of one hand when covered by its index and thumbs of another hand.
7. Rubbing the palm of one hand by rotational movements of the fingertips of the other hand.

Hand processing rules in pictures

Each movement when washing hands should be repeated at least five times. The duration of the entire procedure should be at least half a minute.

What is used for washing hands in clinics

When processing hands in medical institutions, it is recommended to use liquid soap filled into disposable bottles. At the same time, it is undesirable to fill the bottle of the bottle, which already has soap, as it can be contaminated. It is best if the liquid soap dispenser is equipped with a hermetic pump that excludes entering the vessel with soap microbes and air from the external environment, and providing full pumping of soap from the bottle.

When used in the medical institutions of lump soap, the latter must be divided into small portions. Large pieces will be too long in a wet environment, with the result that intensive reproduction of microorganisms can begin in soap. It is desirable that the design of the soap box ensure the drying of the sideline of the soap in the intervals between hygienic procedures.

The better use to dry the hands after washing

The best option for drying the skin after hygienic processing is disposable paper towels, which, after washing and wiping hands, are used to close the cranes and are emitted. Clean fabric can also be used, which is washed after one-time application.
After sanitary treatment of hands in medical institutions, electrical dryers are undesirable due to the too low speed of the drying process.

Doctors, nurses and other medical institutions are undesirable to wear rings on the hands of the rings, as such decorations interfere with the elimination of microbes. For the same reason, you should not cover nails with varnish. Also undesirable are manicure procedures that can lead to the emergence of microscopic wounds, easily infected during operation.

Hygienic handling points should have a convenient location throughout the healing institution. In the wards, as well as in those cabinets where diagnostics and procedures associated with penetration into the body should be installed their own services.

What is hygienic disinfection

The appointment of this type of sanitary treatment is to prevent the spread of pathogenic microorganism along the clinic through the hands of medical workers. It is used hygienic disinfection of the skin in the following situations:

Before carrying out manipulations related to the penetration into the body, as well as before the start of therapeutic measures with patients having increased susceptibility to infections.

1. Before starting work with wounds and at their end.
2. In case of contact with blood, saliva, mucus, urine or feces of the patient.
3. With the possibility of contamination of the hands of pathogenic microorganisms through various items.
4. Before working with infectious patients and upon completion.

The hygienic disinfection procedure includes two stages:

1. Actually hygienic disinfection.

Under mechanical processing, the usual two-hand washing of hand is meant. Actually, hygienic disinfection is to apply at least three milliliters of the antiseptic agent to the skin. For disinfection of the skin surface, both ethanol-based disinfectants can be used and the aqueous solutions of antiseptics, and the first act more efficiently.

Hand processing sterillium

During the first stage of the procedure, you can use both ordinary soaps and soaps with an additive antiseptic. After washing the hand, the disinfection solution is applied to the skin and rubs the movements, each of which is repeated, at least five times - until the skin becomes dry. After skin treatment with a disinfecting drug, you do not need to wipe hands. The duration of antiseptic processing should be at least half a minute.

If the skin leather procedure was not exposed to contamination - for example, the doctor has not yet contacted the patient - then the pre-hand washing can not be performed, and immediately apply an antiseptic to the skin.

Antiseptic agents can adversely affect the skin, causing, for example, its dryness and cracking. Therefore, the solution used for disinfection should contain glycerin or lanolin.

What is the surgical disinfection of hands

This type of sanitary handling of hands is intended to prevent the infection of surgical wounds and, accordingly, preventing the occurrence of postoperative complications caused by microbes in the tissue. Procedure for surgical disinfection of the skin of the hands includes the following three stages:

1. Mechanical treatment of skin cover.
2. Skin treatment with antiseptic means.
3. Skin insulation from the external environment with sterile gloves of one-time use.

The surgical level of hand disinfection is used in the following situations:

• before carrying out surgical operations;
• before complex penetrating manipulations.

Hand processing rules when conducting surgical disinfection

A feature of the mechanical cleaning of the skin surface during surgical disinfection is that the cleaning is cleaned by the skin of not only the hands of the doctor's hands, but also his forearm. Skin drying is carried out using sterile napkins. The minimum duration of this stage of the procedure is two minutes. After removal of moisture from the skin, an additional processing of nail lies and otolo-tailed rollers with special chopsticks of wood, antiseptic means is carried out. Also for this purpose can be used sterile brushes.

After the first stage of surgical disinfection on the skin of the hands, ten milliliters of the antiseptic preparation by portions of three milliliters are applied. The applied tool must be launched into the skin before it dries, while the same sequence of movements are used as when washing hands. The duration of this phase of the procedure should be five minutes.

Before putting on sterile gloves, the skin must necessarily be dry. If the doctor works in some gloves for more than three hours, he must re-conduct surgical disinfection of hands and put on a new pair of gloves.

After work, it is necessary to wipe the skin of the hand with a disinfixed napkin, wash your hands with soap, and then apply a cream-softening and moisturizing effect on the skin.

For disinfection of the surface of the skin, disinfectants can be used, both on the water and alcohol basis. The second are more preferred. The most common antiseptic compositions are:

1. General Provisions

1.2. Definition of terms

- Antimicrobial - remedy for the vital activity of microorganisms (disinfectants, antiseptics, sterilians, chemotherapeutic agents, including antibiotics, cleansing agents, preservatives).

- Antiseptics - chemicals of microbostatic and microbocidal action used for preventive and therapeutic antiseptics of intact and damaged skin and mucous covers, cavities, wounds.

- Antiseptic for hand - A well-based means with adding or without adding other compounds designed to decontaminate the skin of the hands in order to interrupt the infection transmission chain.

- National accident infection (VBI) - Any clinically pronounced disease of infectious nature, striking the patient due to hospital stay or visiting a medical institution, as well as infections arising from health care institutions as a result of their professional activities.

- Hygienic antiseptics hands - It is handling hands by rubbing the antiseptic into the skin of the hands to eliminate transient microorganisms.

- Invasive interventions - The use of devices and devices overcoming the natural barriers of the body with which the causative agent can penetrate directly into the bloodstream, organs and systems of the patient's body.

- Normal hand washing - The procedure for washing with the usual (without antimicrobial action) soap.

- Irritating contact dermatitis (CD) - the unpleasant sensations and changes in the condition of the skin, which can manifest itself in dry skin, the appearance of itching or burning, redness, peeling of the epidermis and the formation of cracks.

- Resident microorganisms - Microorganisms that constantly live and breed on the skin.

- Spore-forming bacteria - These are bacteria with the ability to form special structures covered with a dense shell, they are conventionally called disputes, they are highly resistant to the action of many physicochemical factors.

- Transient microorganisms - Microorganisms that temporarily fall on the surface of the human skin when contact with various alive and non-residential objects.

- Surgical antiseptics of the hands - This is the procedure for rubbing the antimicrobial agent (antiseptic) into the skin of the hands (without water use) to eliminate transient microorganisms and the maximum possible reduction in the number of resident microorganisms.

- Surgical washing hands - This is a procedure for washing up hands using a special antimicrobial agent to eliminate transient microorganisms and the maximum possible decrease in the number of resident microorganisms.

1.3. Hand hygiene involves surgical and hygienic handling, simple washing and protection of the skin of the hands.

1.4. For hygiene of the hands of medical personnel, antiseptic drugs registered in Ukraine are used in the prescribed manner.

2. General requirements

2.1. Personnel of health care facilities watches the purity of their hands. It is recommended that the nails are briefly cut into the level with the tips of the fingers, without the coating of varnish and cracks on the surface of the nails, without false nails.

2.2. Before treating hands, bracelets, clocks, rings are removed.

2.3. Hand hygiene equipment

Tap water.
- Washbasin with cold and hot water and a mixer, which is desirable to act without touching the hands.
- Closed containers with water cranes in the presence of problems with water supply.
- Liquid soap with neutral pH.
- Alcohol antiseptic.
- antimicrobial detergent.
- Skin care agent.
- non-sterile and sterile disposable towels or napkins.
- Dosing devices for detergents and disinfectants, leather care products, towels or napkins.
- Capacities for used towels and napkins.
- Rubber disposable non-sterile and sterile gloves.
- Rubber household gloves.

2.4. In the room where the hand treatment is carried out, the washbasin is in an easily accessible place, equip the crane with cold and hot water and the mixer, which is desirable to act without touching the hands, and the water jet should be directed directly to the plum siphon to prevent splashing water.

2.5. Near the washbasin, it is advisable to install three dispensers:
- with a means for antimicrobial handling of hands;
- with liquid soap;
- with a skin care tool.

2.7. Each place for washing hands, if possible, is equipped with disposable towels, napkins and a capacity for used tools.

2.9. It should not be addressed to the dispensers of antiseptics that are not completely emptied. All empty tanks must be filling in aseptic conditions to prevent infection. It is recommended to use disposable containers.

2.10. Dispensers of detergents and leather care products Before each new filling, it is recommended to carefully flush and disinfect.

2.12. In the absence of centralized water supply or in the presence of another problem with water, the separation is provided by closed water tanks with cranes. In the container poured boiled water and change it at least once a day. Before the subsequent filling of the tank is thoroughly clean (if necessary, disinfected), rinsed and dried.

3. Surgical Hand Treatment

Surgical handling of hands is an important and responsible procedure, which is carried out before any surgical intervention in order to prevent the patient's surgical wound infection and simultaneously protecting personnel from infections transmitted through blood or other discharge of the patient's body. It consists of several stages:
- ordinary hand washing;
- surgical antiseptics of hands, or their washing using a special antimicrobial agent;
- putting on surgical gloves;
- Hand processing after surgery;
- Caring for the skin of the hands.

3.1. Normal hand washing in front of surgical handling

3.1.1. Normal washing before surgical treatment of hands is carried out in advance in the separation or gateway room of the operating unit, alternatively, in the room for antiseptic handling of hands, in a preoperative before the first operation, in the future, if necessary.
Conventional washing is intended exclusively for mechanical cleaning of hands, while contamination is eliminated, sweat, the spore-forming bacteria is partially washed away, and partially transit microorganisms are partially washed.

3.1.2. An ordinary liquid, powder soap or washing lotion with neutral pH is used for washing hands. You should give preference to liquid soap or cleaning lotion. The use of soap in the brooms is unacceptable.

3.1.4. Given the large number of microorganisms under the nails, the mandatory treatment of sub-zones is recommended. For this use special sticks or soft disinfected brushes, better - disposable.

3.1.5. Hands wash warm water. Hot water leads to degreasing and skin irritation, because it enhances the penetration of detergents in the epidermis of the skin.

3.1.6. The technique of conventional washing is carried out as follows:
- hand and forearm brushes are wetted with water, then a detergent is applied so that it covers the entire surface of the hands and forearms. Hand brushes with raised up the tips of the fingers and forearm, with low-lowered elbows, you need to wash around one minute. Special attention should be paid to the processing of subnogric zones, nails, near-gas rollers and interpal zones;

3.2. Surgical antiseptics of the hands

3.2.1. Surgical antiseptics of hands is carried out using various alcohol antiseptics by using them to rub in hand and forearm, including elbow bends.

3.2.2. Rubbing funds are carried out in accordance with the standard procedure developed:

If necessary, wash your hands with a detergent, thoroughly rinse;
- thoroughly dry hands with a one-time towel;
- with the help of a dispenser (press the elbow on the lever) to pour the antiseptic agent into the deepening of the dry palm;
- first of all, moisten the antiseptic agent of hand brushes, then forearm and elbow bends;
- an antiseptic agent to individual portions to rub over the time specified by the developer, while the brush hands must be kept above the elbow folds;
- After antiseptic processing, do not use a towel, wait for a complete drying of the hands, dress gloves only on dry hands.

3.2.3. The antiseptic is applied by portions (1.5 - 3.0 ml), including the elbow bends and rub into the skin during the time specified by the developer. The first portion of the antiseptic is applied only on dry hands.

3.2.4. Throughout the time of rubbing the antiseptics, the skin is maintained wet from the antiseptic, so the number of portions of a rubbed means, and its volume is strictly not regulated.

3.2.5. During the procedure, special attention is paid to the standard technique for processing the hands of the hands by the antiseptic according to EN 1500.

Each processing stage is repeated at least 5 times. When performing hand treatment techniques, the presence of so-called "critical" sections of the hands is taken into account, which are not wetted enough: thumbs up, fingertips, interfallated zones, nails, octal rollers and subnogric zones. The most carefully process the surfaces of the thumb and fingertips, since they are focused on them the greatest number of bacteria.

3.2.6. The last portion of the antiseptics is rubbed to its complete drying.

3.2.7. Sterile gloves wear only on dry hands.

3.2.8. After the completion of the operation / procedure, the gloves are removed, the hands are processed by an antiseptic for 2 x z0 s, and then the hand leather care agent. If blood or other allocations hit the hands under gloves, these contaminants are pre-removed by a tampon or a napkin, moistened with an antiseptic, washed with detergent. Then they are carefully laundered with water from soap and dried with a disposable towel or napkins. After that, the hands are treated with an antiseptic 2 x z0 s.

3.3. Surgical washing hands

Surgical washing of hands consists of two phases: 1 phase - usual washing and 2 phase - washing using a special antimicrobial agent.

3.3.1. 1 Phase - the usual hand washing - is carried out in accordance with clause 3.1.

3.3.2. Before you begin 2 phases of surgical washing of handbrushes, the forearm and the elbow bends are wetted with water, except for the means that in the direction of the developer are applied on dry hands, and then water is added.

3.3.3. The antimicrobial detergent in the quantities stipulated by the developer is applied to the palms and distributed over the surface of the hands, including the elbow bends.

3.3.4. Hand brushes with finger tips directed upwards and forearm, with low elbows, processed by means of the time specified by the developer of this product.

3.3.5. Throughout the entire time, the washing of handbrushes and forearm is wetted by antimicrobial detergent, so the amount of means is strictly not regulated. Hand brushes hold up all the time.

3.3.6. During washing, the sequences of actions are followed in accordance with the specified in P.P. 3.2.2 and 3.2.5.

3.3.7. Hands dried with a sterile towel or sterile napkins with compliance with the rules of aseptic, starting with the tips of the fingers.

3.3.8. Surgical sterile gloves are worn only on dry hands.

3.3.9. After the operation / procedure, the gloves are removed and processed with the hands of the antiseptic in accordance with clause 3.2.8.

3.4. If there are no more than 60 minutes between operations, only antiseptic surgical handling of hands is carried out.

4. Hygienic hand treatment

Hygienic handling Includes normal hand washing water with ordinary (nonantimicrobial) soap and hygienic antiseptica hands. Running the alcohol antiseptic, without the use of water, in the skin of the hands in order to reduce the number of microorganisms located on them.

Requirements for antimicrobial means and alcohol antiseptics

1. Antimicrobial and antiseptic alcohol-containing means for rubbing must meet the following requirements:
- a wide range of antimicrobial effects with respect to transient (hygienic treatment) and transient and resident microflora (surgical treatment of hands);
- rapid effect, that is, the duration of hand processing procedure should be as short as possible;
- prolonged action (after processing the skin of the hands, the antiseptic must delay the reproduction and reactivation of resident microorganisms (3 hours) under medical gloves);
- activity in the presence of organic substrates;
- lack of negative impact on the skin;
- the lowest possible dermal resorption;
- lack of toxic, allergenic side effect;
- lack of systemic mutagenic, carcinogenic and teratogenic action;
- the low probability of the development of microorganisms resistance;
- willingness to direct use (do not require advanced training);
- acceptable consistency and smell;
- Easy wash with the skin of the hands (for detergent);
- long shelf life.

2. All antimicrobial means, regardless of the method of their application, should be active with respect to transient bacteria (with the exception of mycobacteria), mushrooms of the genus Candida, as well as viruses having a shell.

3. The means used in phthisiatric, dermatological, infectious offices must be further investigated in tests on Mycobacterium terrae (tuberculosis activity) for use in phthisiatric departments, on Aspergillus Niger (fungicidal activity) for use in dermatological departments, on poliovirus, adenovirus (Viruticide Activity) for use in infectious compartments if necessary.

The standard procedure during the working day is antiseptic treatment of hands without water use, i.e. rubbing alcohol antiseptics in the skin of the hands.

4.1. Indications

4.1.1. The usual washing of hands with the use of nonantimical detergent is recommended to be carried out:
- at the beginning and at the end of the working day;
- Before cooking and distribution of food;
- in all cases before processing the antiseptic, when the hands are clearly contaminated;
- in contact with the pathogens of enteroviral infections in the absence of appropriate antivirus funds, the mechanical elimination of viruses with prolonged in time is recommended (up to 5 min.) Hand washing;
- when contacting spore microorganisms - crawled hand washing time (at least 2 minutes) for mechanical correction dispute;
- after using the toilet;
- In all other cases, in the absence of risk of infection or special instructions.

4.1.2. Hygienic handling of hands with the use of alcohol antiseptics is recommended before:
. entrance to aseptic premises (preoperative, sterilization departments, resuscitation, hemodialysis, etc.);
. carrying out invasive interventions (installation of catheters, injection, bronchoscopy, endoscopy, etc.);
. activities at which it is possible to infect an object (for example, the preparation of infusions, filling the containers with solutions, etc.);
. every direct contact with patients;
. the transition from the patient's infected to the uninfected portion;
. contact with sterile material and tools;
. Apply gloves.
After:
. contact with contaminated objects, liquids or surfaces (for example, with urine collection system, contaminated underwear, biosubstrats, patient secretions, etc.);
. contact with the already introduced drainage, catheters or with the place of administration;
. each contact with wounds;
. each contact with patients;
. removal of gloves;
. use of the toilet;
. After cleaning the nose (with ritin, there is a high probability of presence of a viral infection with the subsequent release of S.Aureus).

4.1.3. The following testimony is not final. In a number of specific situations, personnel accept an independent decision. In addition, each health facility can develop its own list of indications, which includes a WBI prevention plan, taking into account the specifics of one or another branch.

4.2. Normal wash

4.2.1. Conventional washing is intended exclusively for mechanical cleaning of hands, with hands eliminate contamination, sweat, partially washed off sporing bacteria, as well as partially other transient microorganisms. The procedure is carried out according to P.P. 3.1.2.-3.1.5.

4.2.2. The technique of conventional washing is carried out as follows:
- Hand brushes are wetted with water, then determine the detergent so that it covers the entire surface of the hands and wrist brushes. Hands wash about 30 s. Special attention is paid to the processing of subnogric zones, nails, near-gas rollers and interpal zones;
- After treatment with the cleanser, the hand is thoroughly washed with water from soap and dried with disposable towels or napkins. The last napkin closes the crane with water.

4.3. Hygienic antiseptic

4.3.1. The standard method of rubbing the antiseptic includes 6 stages and is presented in clause 3.2.5. Each stage is repeated at least 5 times.

4.3.2. An antiseptic in an amount of at least 3 ml is poured into the deepening of the dry palm and is vigorously rubbed into the skin of the hands and wrist for 30 s.

4.3.3. During the entire time of rubbing the means, the skin is maintained wet from the antiseptic, so the number of portions of the facility is strictly regulated. The last portion of the antiseptics is rubbed to its complete drying. Hand wiping is not allowed.

4.3.4. When machining hands, the presence of so-called "critical" sections of the hands are taken into account, which are not wetted enough with an antiseptic: thumbs, fingertips, interfallated zones, nails, octal rollers and subnog zones. The most carefully process the surfaces of the thumb and fingertips, since they are focused on them the greatest number of bacteria.

4.3.5. If there are visible contamination of hands, remove it with a napkin, moistened with an antiseptic, and wash your hands with a detergent. Then they are carefully laundered with water from soap and dried with a disposable towel or napkins. The last napkin closes the crane. After that, the hands are treated with an antiseptic twice to 30 s.

5. Use of medical gloves

5.1. The use of gloves does not give an absolute guarantee protection of patients and personnel from infection pathogens.

5.2. The use of medical gloves protects patients and medical personnel from the propagation of transient and resident microflora directly through hands and indirectly through contact with contaminated environment objects.

5.3. For use in medical practice, three types of gloves are recommended:
- surgical - Used when conducting invasive interventions;
- watching - provide protection of medical staff when performing many medical manipulations;
- household - ensure the protection of medical staff in the processing of equipment, contaminated surfaces, tools, when working with the waste of medical institutions, etc.

5.4. Sterile gloves are recommended for:
- All surgical surgical interventions, to reduce the frequency of punctures, it is recommended to use two gloves attached to each other, replacing the upper glove every 30 minutes. During the operation; It is also recommended to use gloves with a perforation indicator in which damage to the glove quickly leads to a visible change in the color in the punctureflide;
- invasive manipulations (intravenous infusions, the selection of a biocrobal for research, etc.);
- installation of the catheter or conductor through the skin;
- manipulations associated with the contact of sterile tools with intact mucous membranes (cystoscopy, urinary bubble catheterization);
- vaginal examination;
- bronchoscopy, endoscopy of the gastrointestinal tract, trachea reservations;
- Contact with endotracheal suction and tracheostoms.

5.5. Non-sterile gloves are recommended to use when:
- contact with hoses of artificial respiratory devices;
- working with biological material from patients;
- blood fence;
- conducting intramuscular, intravenous injections;
- carrying out cleaning equipment and disinfection;
- Delete secrets and vomiting.

5.6. Requirements for medical gloves:
- for operations: latex, neoprene;
- For inspections: latex, tactylonial;
- when careing for the patient: latex, polyethylene, polyvinyl chloride;
- It is allowed to use gloves from tissue under rubber;
- gloves must be the corresponding size;
- gloves should provide high tactile sensitivity;
- contain a minimum number of antigens (latex, latex proteins);
- when choosing medical gloves, it is recommended to take into account possible allergic reactions in the history of patients on the material from which gloves are made;
- To carry out a preservation of acute medical tools, it is necessary to use gloves with a textured outer surface.

5.7. Immediately after use, medical gloves are removed and plunged into a disinfectant solution directly at the place of use of gloves.

5.8. After disinfecting a disposable gloves, disposal is recycled.

5.9. Terms of Use of Medical Gloves:
- the use of medical gloves does not create absolute protection and does not exclude compliance with hand processing techniques, which is used in each case immediately after removing gloves in the threat of infection;
- Disposable gloves are not allowed to use again, non-sterile sterilization gloves are not subject to;
- gloves need to be changed immediately if they are damaged;
- Is not allowed or handling of hands in gloves between the holding of "clean" and "dirty" manipulations, even in one patient;
- It is not allowed to move in gloves in the department (s) of the hospital;
- Before putting on gloves, it is impossible to use products containing mineral oils, vaseline, lanolin, etc., as they can lead to a violation of glove strength.

5.10. The chemical composition of the material of the gloves can cause instant and slow-type allergies or contact dermatitis (CD). CD may appear when using gloves from any material. This contributes: a long continuous stay in gloves (more than 2 hours), use of powdered from the inside gloves, the use of gloves when skin irritation, putting on the gloves to wet hands, too frequent use of gloves during the working day.

5.11. Errors that often occur when using gloves:
- The use of medical disposable gloves when working in a sophistication. In these cases, preferred reusable gloves (domestic) should be given;
- improper storage of gloves (in the sun, at low temperatures, entering the gloves of chemicals, etc.);
- putting on the gloves on the hands moistened by the remnants of the antiseptic (additional load on the skin;
- ignoring the need for antiseptic handling of hands after removing gloves when contacting a potentially infected material;
- Applications of surgical gloves for aseptic work while this is enough to use viewing sterile gloves;
- the use of ordinary medical gloves when working with cytostatics (insufficient medical protection;
- insufficient care of the skin of the hands after applying gloves;
- Refusal of gloves in situations that at first glance seem safe.

5.12. The secondary use of disposable gloves or their disinfection is prohibited. Conducting hygienic antiseptics of hands in disposable gloves is allowed exclusively in situations requiring frequent replacement of gloves, for example, when blood fence. In these cases, gloves should not have punctures or be contaminated with blood or other discharge.

5.13. Proprietary gloves are carried out according to the manufacturer's instructions.

6. Advantages and disadvantages of hand processing methods

6.1. Effective, practical application and acceptability of hand treatment depends on the method and related processing conditions that are in health care facilities.

6.2. Conventional washing is ineffective to eliminate both transit and resident microorganisms. At the same time, microorganisms do not die, and with splashes of water fall on the surface of shells, clothes of personnel surrounding surfaces.

6.3. In the process of washing, it is possible to secondary pollution of the hands of microorganisms from tap water.

6.4. The usual wash negatively acts on the skin of the hands, since water, especially hot, and the detergent leads to a violation of the surface water-fat layer of the skin, which increases the penetration of detergent in the epidermis. Frequent washing with detergent leads to a skin edema, damage to the epithelium of the horn layer, washing out fats and natural humid-containing factors, which can cause skin irritation and call CD.

6.5. Hygienic antiseptics of hands has several practical advantages compared to washing, which makes it possible to recommend it to a wide practical application.

Advantages of hygienic antiseptics of hands with alcohol antiseptics compared to conventional washing

6.6. It includes the possible rubbing of the alcohol antiseptic to wet from the antiseptics of the hand, which reduces its efficiency and skin portability.

6.7. Saving antimicrobial agents and reducing exposure time makes any method of hand processing ineffective.

7. Possible negative effects of hand processing and their prevention

7.1. If you violate the requirements of the instructions / methodological instructions on the use of handling tools and with a negligence attitude to prophylactic skin care, kD may occur.

7.2. The cause of the CD may also be:
- frequent use of antimicrobial detergent;
- long-term use of the same antimicrobial detergent;
- increased skin sensitivity to the chemical composition of funds;
- the presence of skin irritation;
- too frequently washing hands, especially with the use of hot water and alkaline detergents or means without softening additives;
- long work in gloves;
- putting on gloves on wet hands;
- the absence of an informed skin care system in a medical institution;

7.3. For the prevention of the CD, in addition to avoiding the causes of the CD according to P.P. 7.1-7.2, it is recommended to perform the following basic requirements:
- provide personnel with means for hand processing, which are potentially weak irritants of the skin of the hands and at the same time effective;
- when selecting an antimicrobial agent, take into account its individual acceptability for skin, smell, consistency, color, ease of use;
- In a medical institution, it is recommended to have several funds so that employees having increased skin sensitivity have the ability to choose a means acceptable for themselves;
- to introduce antiseptics into the practice, made on the basis of alcohol with various softening additives, since clean alcohols with frequent use dried the skin of the hands;

Alcohol-based antiseptic properties

Indicators	Result of action
Antimicrobial spectrum	Bactericidal (including antibiotic resistant strains), fungicidal and virulicidal
Creation of resistant strains	absent
Antimicrobial Detection rate	30 C - 1.5 min - 3 min
Skin irritation	With prolonged violation of the rules of application may occur dry skin
Holding leather lipids	Practically does not change
Transdermal water loss	Practically absent
Humidity and pH leather	Practically do not change
Protective effect on the skin	The presence of special moisturizing and fatting additives
Allergenic and sensitizing action	Not visible
Resorption	Absent
Remote side effects (mutagenicity, carcinogenicity, teratogenicity, ecotoxicity)	Absent
Economic expediency	High

Conduct a mandatory periodic briefing on the use of antimicrobial agent (dose, exposure, processing technique, sequence of actions) and skin care.

8. Hand care

8.1. Hand skin care is an important condition for the prevention of the transfer of pathogens of the WBI, because only intact skin can be effectively treated with an antimicrobial agent.

8.2. CD can be avoided only if the skin care system has been deployed in the health care facility, since when using any antimicrobial means there is a potential risk of skin irritation.

8.3. When choosing a skin care medium, the skin type and the following properties of the means are taken into account: the ability to hold the normal body grease, moisture, pH at the level of 5.5, ensuring skin regeneration, good absorption, the ability tools to attach skin elasticity.

8.4. It is recommended to use the type of emulsion opposite to the emulsion sheath of the skin: M / B emulsion (oil / water) should be used for oily skin, as well as at elevated temperature and humidity; For dry skin, it is recommended to use emulsions in / m (water / oil), especially at low temperature and humidity.

Choosing skin care products depending on its type

8.5. When selecting skin care products, it is important to take into account their compatibility with antimicrobial means for hand processing to prevent the negative effects of creams or lotions on the antimicrobial effect of the means.

8.6. It is advisable to apply a cream or other agent several times during the working day, thoroughly rub dry and clean hands into the skin, pay special attention to the processing of skin sections between the fingers and the separation rollers.

World practice shows that high-quality hand hygiene is carried out only in 40.0%, i.e. Of the 10 cases under which it is necessary, only four. This is due, first of all, with the lack of sufficient knowledge and skills on the technique of hand processing and due to motivation in personnel. Of other reasons, this is a lack of time, the absence of the necessary conditions, the presence of problems with the skin of the hands and professional dermatitis, as well as the lack of financing this area and as a result, the acquisition of poor-quality antiseptics or in smaller quantity than the need for them.

1. Antiseptic hand washing is:

1) washing hands with soap and water or with other means containing and antiseptic substances, and surfactant substances;
2) performing hand hygiene for the purpose of physical or mechanical removal of dirt;
3) applying an antiseptic drug or skin antiseptic, or a disinfectant for hands to reduce or prevent growth of microorganisms;
4) Washing hands with simple or antimicrobial soap and water.

2. Hygienic antiseptics of hands - this is:

2) processing of hands using an antiseptic drug or skin antiseptic, or disinfectant to reduce the transient bacterial flora without affecting the residual skin fluor;
3) performing hand hygiene for the purpose of physical or mechanical removal of dirt, organic material and / or microorganisms;
4) Antiseptic washing or antiseptic processing performed before surgical brigade to destroy the transient flora and reduce the residency skin.

3. High levels of hand hygiene rules

1) reciphence of hospitals;
2) a sufficient amount of time for hand hygiene at nursing staff;
3) the lack of knowledge of existing recommendations and regulatory documents on this issue.

4. Specify the right positions on the use of medical gloves.

1) Medical personnel should learn how to plan and implement procedures in accordance with the rational technique of their implementation;
2) if the integrity of the glove is broken, then there is no need to replace it with another glove;
3) gloves are not an effective means to prevent contamination of the hands of medical personnel and reduce the scale of transmission of potentially dangerous microorganisms;
4) It is necessary to use gloves when necessary and in cases when there is no need.

5. Washing hands - this is:

1) washing hands with soap and water or with other means containing and antiseptic substances;
2) applying an antiseptic drug or skin antiseptic, or disinfectant for hands to reduce or prevent growth of microorganisms;
3) washing hands with simple or antimicrobial soap and water;

6. For medical gloves include:

1) workers;
2) surgical;
3) viewing;
4) Casual.

7. Indications for the use of gloves

1) no contact with damaged skin;
2) before aseptic procedure that requires the conditions of sterility;
3) if contact with blood or other biological fluids;
4) When contacting the patient.

8. Indications for removing gloves

1) after the contact with one patient is completed;
2) immediately after the gloves are damaged;
3) if there are testimony for hand hygiene;
4) before aseptic procedure.

9. Cleansing hands is

1) applying an antiseptic drug or skin antiseptic, or disinfectant for hands to reduce or prevent growth of microorganisms;
2) antiseptic washing or antiseptic processing performed before surgical crew operation to destroy the transient flora and reduce the residual skin fluor;
3) performing hand hygiene for the purpose of physical or mechanical removal of dirt, organic material and / or microorganisms;
4) Hand processing to reduce the transient flora without affecting the resident skin fluor.

10. Increasing hand hygiene leads to

1) an increase in the financial costs of therapeutic institutions;
2) a decrease in the frequency of colonization / infection caused by antibiotic-resistant strains of microorganisms;
3) a decrease in the development of infections related to the provision of medical care.

11. For the formulation of non-invasive ventilation equipment and oxygen cannula needs.

2) use sterile gloves;
3) to carry out only hand hygiene;
4) No hygiene measures are required.

12. For the preparation of the preparation for parenteral nutrition, it is required:

1) use non-sterile gloves;
2) use sterile gloves;
3) no hygiene measures are required;
4) Implement only hand hygiene.

13. Medical gloves are:

1) Gloves of Reusable Application for Medical Procedures;
2) view of clothes for hand brushes, with compartments for each finger;
3) disposable gloves used during medical procedures;
4) Fabric products with separation for each finger, worn on hand brushes.

14. Non-sterile gloves must be used in cases

1) with direct (straight) contact with the patient;
2) access to vessels and manipulation with it (central line);
3) preparation of preparations for parenteral nutrition and chemotherapeutic agents;
4) with invasive radiological procedures.

15. Hygienic hand washing is:

1) antiseptic washing or antiseptic processing performed before surgical brigade to destroy the transient flora and reduce the residual skin fluor;
2) processing of hands using an antiseptic drug or skin antiseptic, or disinfectant to reduce the transient bacterial flora without affecting the residual skin fluor;
3) Hand processing to reduce transient flora without affecting the resident skin fluor;

16. Antiseptic handling of hands is:

1) reduction or prevention of growth in microorganisms by applying an antiseptic drug or skin antiseptic;
2) washing hands with soap and water or with other means containing and antiseptic substances, and surfactant substances;
3) applying an antiseptic drug or skin antiseptic, or a disinfectant for hands to reduce or prevent growth of microorganisms;
4) Performing Hand hygiene for the purpose of physical or mechanical removal of dirt.

17. Preoperative antiseptics of hands - this is:

1) washing hands with soap and water or with other means containing and antiseptic substances;
2) antiseptic washing or antiseptic processing performed before surgical crew operation to destroy the transient flora and reduce the residual skin fluor;
3) handling of hands using an antiseptic drug or skin antiseptic, or disinfectant to reduce the transient bacterial flora without affecting the resident skin fluor;
4) Performing Hand hygiene for the purpose of physical or mechanical removal of dirt, organic material and / or microorganisms.

18. Sterile gloves must be used when

1) the catheterization of the bladder;
2) surgical procedures;
3) handshake;
4) invasive radiological procedures.

19. Gloves should not be used in situations

1) administration of subcutaneous and intramuscular injections;
2) measuring blood pressure, temperature and pulse;
3) bladder catheterization;
4) eye care and ears (in the absence of discharge).

1) Use gloves while complying with the precautions;
2) the use of gloves cancels the need for hand hygiene;
3) remove the gloves after contact with the patient;
4) Use gloves at the slightest possibility of contact with blood.

21. Examples for performing hygiene to contact with the patient, the following situations may be:

1) before helping the patient to carry out personal hygiene;
2) before assisting and non-invasive types of treatment;
3) after carrying out non-invasive physical examination;
4) After a handshake, after touching the child.

22. Hand processing with antiseptic enough to perform

1) within 1-2 minutes;
2) for 2-3 minutes;
3) for 3-5 minutes;
4) for 30 seconds.

23. Examples to perform hand hygiene after a relationship associated with the risk of contact / contact with biological fluids may be the following situations:

1) before removing the invasive medical device;
2) before the introduction of an invasive medical device (vascular access, catheter, tube, drainage, etc.);
3) after contact with mucous membranes and with damaged skin;
4) Before working with a sample containing an organic matter.

24. The purpose of performing hygiene to contact with the patient is:

1) Protection of personnel;
2) patient protection;
3) protection of the external environment.

25. The purpose of performing hand hygiene to pure / aseptic procedures is: a) patient protection; b) staff protection; c) protection of the external environment. Select the correct response combination

1) Protection of personnel;
2) protection of the external environment;
3) patient protection.

26. Indicate the right statement:

1) Your nails must be such a length so that the tip is not more than 1.0 cm;
2) Before working with medications or cooking, perform hand hygiene using an alcohol antiseptic for hands, or wash your hands with conventional or antimicrobial soap and water;
3) Wearing artificial or extensive nails with direct contact with patients;
4) Soap and alcohol antiseptic for hand hygiene should be used simultaneously.

27. Benefits of using anhydrous antiseptic for hand hygiene:

1) reduces the number of microorganisms 104 times;
2) the application does not lead to microbial pollution of medical workers;
3) requires less time;
4) requires additional washing of hands that do not have visible contaminants.

28. The main purpose of the hygiene of the hands "After contact with the" one "/ means of individual protection":

1) protection (preventing infection / colonization) of the patient from potentially dangerous microorganisms located on the hands of medical personnel;

3) protection of medical personnel from colonization or infection and preventing the contamination of the external environment of therapeutic institution potentially dangerous microorganisms that may be present on the means of individual personnel protection.

29. Indicate the right statement:

1) If the alcohol antiseptic for hand hygiene is unavailable, rinse your hands under running water;
2) if the exposure to potential spore-forming pathogens is not large (it is assumed or proven), washing with soap and water is the preferred measure;
3) Use an alcohol antiseptic for hand hygiene as a preferred measure in all clinical cases, if you do not doubt your hand clean;
4) Wash your hands with soap and water when they are not contaminated, not blurred with blood or other biological fluids.

30. Antiseptic handling of hands is:

1) performing hand hygiene for the purpose of physical or mechanical removal of dirt;
2) washing hands with soap and water or with other means containing and antiseptic substances, and superficially active substances;
3) reduce or preventing the growth of microorganisms by applying an antiseptic drug or skin antiseptic;
4) applying an antiseptic drug or skin antiseptic, or disinfectant for hands to reduce or prevent growth of microorganisms.

31. Antiseptic substances (antiseptics) are used for: a) reduction in the number of resident microflora; b) removal of dirt; c) the destruction of the pathogenic microflora; d) the destruction of transient microflora. Select the correct response combination

1) the destruction of the pathogenic microflora;
2) the destruction of transient microflora;
3) removal of dirt;
4) Reducing the number of resident microflora.

32. Effective methods of improving hygiene of the hands of medical personnel are:

1) support administration;
2) use of old hand hygiene programs;
3) posters (visual materials) in the workplace;
4) observation of hand hygiene.

33. The purpose of performing hand hygiene after contact with the patient is:

1) the protection of the external environment;
2) patient protection;
3) Protection of personnel.

34. Examples for performing hand hygiene after contact with the patient, the following situations may be:

1) before the non-invasive physical examination: measurement of the pulse, blood pressure measurement, thoracic auscultation, ECG record;
2) before providing assistance and other non-invasive types of treatment;
3) after you helped the patient in conducting personal hygiene: in movement, 3) bathing, making food, dressing, etc.;
4) before the handshake.

35. The main purpose of hand hygiene "to contact with the patient"

1) protection of medical personnel from colonization or infection with potentially dangerous patient microorganisms and preventing the contamination of the external environment of therapeutic institution;
2) protection against penetration into the patient's body of potentially dangerous microorganisms, including through mediated contact in contamination of sterile objects of the external environment (equipment, tools, materials);

36. Examples to perform hand hygiene after contact with the subjects from the patient's environment, the following situations may be:

1) after other contacts with surfaces or inanimate objects;
2) in front of the activities, including physical contact with objects surrounded by the patient: replacement of bed linen in the absence of a patient, movement of the bank;
3) before you helped the patient in conducting personal hygiene;
4) Before therapeutic procedures: Adjusting the speed of perfusion, checking the signaling devices.

37. The main purpose of the hygiene of the hands "After the situation associated with the risk of contact / contact with biological fluids"

3) Protection (preventing infection / colonization) of the patient from potentially dangerous microorganisms located on the hands of medical personnel.

38. The duration of hygienic antiseptic hands is:

1) about 1-2 minutes;
2) about 20-30 seconds;
3) about 10-15 seconds;
4) about 2-3 minutes.

39. The drug selection for the routine handling of the hands of medical personnel is:

1) the use of water-based antiseptics;
2) washing hands with soap;
3) washing hands under running water;
4) Using anhydrous antiseptic.

40. Hands become factors of transmission of infection in the following circumstances:

1) when contacting contaminated hands with medical equipment;
2) upon contact with the objects of the external environment, non-targeted other medical personnel;
3) when leaving one patient from one body locus to another;
4) upon contact with "name" / means of individual protection.

41. Hand hygiene "to pure / aseptic procedures" is carried out:

1) if the contact was in gloves, then the hygiene must be carried out after removing the gloves;
2) for any actions requiring compliance with asepsis;
3) In all cases, when a medical worker adopted to the objects of the external environment surrounded by a patient, even if there was no contact with the patient;
4) In all cases, when the staff touched to the means of individual protection with their hands without gloves.

42. Hygiene of the hands of medical personnel is carried out:

1) to contact with objects from the patient's environment;
2) to contact "with me" / means of individual protection;
3) after the situation associated with the risk of contact / contact with biological fluids;
4) to contact with the patient.

43. The main purpose of hand hygiene "to pure / aseptic procedures"

1) protection against penetration into the patient's body potentially dangerous microorganisms, including through mediated contact in contamination of sterile objects of the external environment (equipment, tools, materials);
2) protection of medical personnel from colonization or infection with potentially dangerous patient microorganisms and preventing the contamination of the external environment of therapeutic institution;
3) Protection (preventing infection / colonization) of the patient from potentially dangerous microorganisms located on the hands of medical personnel.

44. Duration of hand washing with soap and water is:

1) about 20-30 seconds;
2) about 1-2 minutes;
3) about 2-3 minutes;
4) about 40-60 seconds.

45. Washing hands with soap must be carried out:

1) for 30 seconds, 1 min;
2) within 1-2 minutes;
3) for 2-3 minutes;
4) for 3-5 minutes.

46. \u200b\u200bExamples to perform hand hygiene to pure / aseptic procedures, the following situations may be:

1) after lining the wound using or without the use of tools;
2) after cooking, preparation of drugs, pharmaceutical products, sterile materials;
3) after applying ointment;
4) before cleaning the patient's teeth, instilcing eye drops before carrying out a finger vaginal or rectal survey.

47. Hand hygiene should be performed:

1) before and after contact with the patient;
2) before the entrance and before leaving the chamber;
3) after they touched the invasive patient care device, regardless of whether you use gloves or not;
4) After removing sterile or non-sterile gloves.

1) nails can be arbitrary length;
2) Your nails must be short (tip less than 0.5 cm);
3) soap and alcohol antiseptic for hand hygiene should not be used at the same time;
4) Do not wear artificial or extensive nails with direct contact with patients;
5) Soap and alcohol antiseptic are used simultaneously to enhance the effect.

49. The main purpose of hand hygiene "after contact with the patient"

1) protection against penetration into the patient's body potentially dangerous microorganisms, including through mediated contact in contamination of sterile objects of the external environment (equipment, tools, materials);
2) protection of medical personnel from colonization or infection with potentially dangerous patient microorganisms and preventing the contamination of the external environment of therapeutic institution;
3) Protection (preventing infection / colonization) of the patient from potentially dangerous microorganisms located on the hands of medical personnel.

Select a few correct answers.
1) Hand hygiene measures should be an integral part of the program of infectious control in a medical and prophylactic institution;
2) Hand hygiene measures must have priority financing;
3) Hand hygiene measures should not include personnel training to all sections of hand hygiene.

1) Follow the instructions of the manufacturer in the duration of use when using hand hygiene;
2) apply a means exclusively to wet hands;
3) Use successively surgical scrub for hands and alcohol antiseptic for hands;
4) After putting on sterile gloves, it is necessary to perform a preoperative antiseptic of hands using an alcohol antiseptic for hands.

52. Washing hands with soap and water applied to:

1) reduce the number of resident microflora;
2) the destruction of the pathogenic microflora;
3) removal of dirt;
4) Removal of transient microflora.

1) Thoroughly dry hands in a way that allows not to contaminate hands;
2) pour 1/4 palm of the alcohol antiseptics for hands and cover all surfaces of the hand;
3) Rinse your hands with water and partially wipe the reusable towel;
4) Use mainly hot water.

1) Get information from manufacturers about the risk of product contamination;
2) Ensure medical personnel with effective means for hand hygiene, with an average content of potentially irritating skin components;
3) Make sure the dispensers are available in medical care places.

55. Preoperative (surgical handling of hands) implies:

1) the destruction of normal microflora;
2) reduction of the number of resident microflora;
3) Destruction of transient flora.

1) the sinks must be designed in such a way as to reduce the amount of splashes;
2) Remove the dirt from under the nails using the nail stitch, preferably under running water;
3) Recommended brushes for hand washing before surgery;
4) Remove the rings, wrist watches and bracelets before proceeding to hand hygiene in front of surgical intervention.

57. The criteria for selecting an antiseptic means for treating the hands of medical personnel are:

1) safety, non-toxicity;
2) moderate value;
3) availability;
4) the optimal composition of ethyl and / or isopropyl alcohols with a total concentration of at least 40%;
5) high level of antimicrobial activity.

58. When hand hygiene, the following areas of skin are most often skipped:

1) thumb;
2) interfallated intervals;
3) Mysiline;
4) fingertips.

1) Soap and alcohol antiseptic for hands should be used at the same time;
2) in special educational programs inform medical personnel on hand care;
3) Provide medical staff with lotions or creams to reduce cases of irritative contact dermatitis;
4) Use alternative Hand hygiene for persons with confirmed allergies.

60. Basic requirements for dosing devices:

1) applying dosage devices of domestic purposes;
2) the most accurate dosing of detergents;
3) the possibility of using means "to the last drop";
4) The exclusion of splashing of the means and blockade of the outlet.

61. Criteria for the choice of liquid soap:

1) the presence of prevention and moisturizing components;
2) the absence of dyes, flavors, preservatives;
3) pH of soap 3,5-5.0;
4) Good foaming and lightweight water temperature.

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.

Hygiene of the hands of medical workers - doctors, nurses and the rest of the hospital personnel refers to a mandatory procedure.

During it, special funds approved by the Russian pharmacology committee are used.

Hands are always treated in front of physical contact with the patient and after it.

Cleansing the skin is aimed at preventing in-hospital infections, eliminating microbes and other decay products. It ensures the protection of the patient and the physicians themselves from infections.

Note!
Hygiene of the hands of Medpersonal It was introduced in the 19th century by Dr. Lister Joseph.
It was a breakthrough in medicine and the prevention of infectious diseases. Since then, the widespread disinfection of the hands of medical personnel has been gradually introduced.

Hygiene of the hands of medical personnel aims to ensure patient safetyAfter all, during the examination of the patient or with a different physical contact, the microbes can get on the patient.

His immunity has already been weakened by the disease, infection with another disease is extremely negatively affecting well-being, delayed recovery.

Regular disinfection and compliance with medical personnel hygiene requirements Protects doctors themselves and nurses from infectious diseases.

Hygiene of the hands of ordinary people involves washing under running water with liquid or lump soap. Then the hands wipe the tissue towel, in rare cases by disposable paper napkins. In domestic conditions, such events will protect against infections.

Doctors and medical workers regularly work with dozens of patients. They are carried out not only inspections, but also in contact with open wounds, carry out operations, take birth.

It is necessary to exclude any possibility of infection to the skin of the patient (especially in blood). Therefore, physician hygiene includes not only mechanical cleansing, but also antiseptic processing even when working in sterile gloves.

It is worth noting!Many people neglect the hygiene hands in everyday life. In medical practice, such violations are fraught with serious consequences.

Requirements for the purity of the hands of doctors

Any medical worker is familiar with hygiene algorithm and situations when processing is needed. Requirements installed SanPin. They are specified how to wash your hands in medicine, cleaning and disinfection of brushes, fingers and forearms.

To get acquainted with the document "WHO Hand Hand Guide for Medical Workers" you can.

In addition to observing the purity of the hands of doctors and the rest of the medical staff should not paint the nails with varnish. When contacting it can cause dermatitis in the patient. Dark and cracked lacquer is most dangerous, it does not allow to assess the degree of purity of nails.

During the manicure procedure, you can easily get cuts and microtraums, which is associated with the possibility of infection. Also, doctors can not wear decorations.

What are hand hygiene levels

Hygiene and antiseptics of medical staff It is divided into three main types:

1. Mechanical or household - It implies the cleansing of the hands, eliminating transient microflora. This is an elemental method of purification at which the antiseptic means are not used.
2. Hygienic - Disinfection of hands with special preparations (antiseptics). It is applied after mechanical cleansing. If there is no contact with the patient, and the hands are not contaminated, then you can skip household handling and immediately apply a disinfectant to the skin.
3. Surgical - Complete removal of any microflora from the hands of medical staff. The method allows you to save sterility in the operating room. Surgical disinfection will ensure patient safety, if a doctor or nurses suddenly break the gloves.

Mechanical washing hands

This processing is considered the main necessary to cleanse the hands of medical personnel. Its applied in the following situations:

• before the physical contact of the doctor and the patient and immediately after it;
• medic must wash his hands after visited the toilet;
• hands are thoroughly clean before meals;
• with different contaminants.

As cleansing neutral soap should be used, without a pronounced smell. The tube must be constantly closed.

Open liquid soap and non-indisimed slicing cannot be used, as it is infected with microbes and bacteria.

Cleaning rules

1. Remove all decorations with brushes and fingers, wet your hands under warm running water and wash them, guided by a special algorithm.
2. Wash the soap, wash your hands again and repeat the necessary movements. Repeated cleansing is necessary because initially the microbes are washed off from the skin and open the pores. During the next wash, bacteria are removed from them.
3. Rinse your hands, wipe them dry with a one-time towel. Usually used classic paper towels, size 15 to 15. It is allowed to use pieces of tissue, but after one-time use, they should be sent to the laundry for disinfection. Use tissue towels, even individual use is prohibited. They may not dry until the next time. A wet surface is beneficial for breeding bacteria and microbes.

After washing the tap should be closed with a towel or a paper napkin, without touching it with clean hands.

The used napkin should be thrown into a special bucket for waste.

It is better to stop on the liquid dosage tool as soap. You can also apply lump if it is individual use. How to wash the hands of the nurse read below.

Attention!When washing use only warm flow water. Hot water is washing off with covering protective layer of fat.

Algorithm for cleansing hands

When washing it is necessary follow the instructions that are approved by Sanpin. All movements perform at least five times. Usually, mechanical processing takes 30 - 60 seconds.

1. Distribute one palm about another, it is carried out by the movements of a progressive nature.
2. Right hand scatter the left brush (back side). Then, on the contrary.
3. Divide your fingers of one hand, connect them with the interfallated intervals of the other. Then move your fingers up - down.
4. "Close" both brushes (connect out of the castle), bent my fingers wash the skin of each hand.
5. Rotational circular motions Wash the base of thumb and brushes. To do this, grab big and index fingers right hand left brush and thumb. Similarly, do with the other hand.
6. The fingertips of the left hand wash the palm right, making circular movements.

Note!
The most contaminated areas of the skin of the hand:

• subnotal space
• occondugery rollers
• pads finger

The most difficult rinsed areas of the skin:

• interfallated intervals
• large thumb

Hercustle's hand wash frequencydepends on the separation - hand hygiene is carried out by necessity before and after contact with the patient. In the children's office, it can be 8 times an hour, in resuscitation - 20 times per hour. On average, the nurse should wash their hands 5 - 30 times.

Hygienic treatment

This procedure is designed to remove any microflora from the skin. With such a cleaning antiseptics are necessarily used.

Hygienic processing includes mechanical cleansing, the antiseptic is applied to the skin.

After its final drying (only naturally), you can proceed to work.

Antiseptic should be applied on clean and dry brushes. The minimum number is 3 milliliters. It is rubbing until complete drying. Movements according to which the antiseptic is applied to the skin are similar to the handwash algorithm and described above.

In the WHO guide on hand hygiene 5 most important pointsWhen hygiene handling of hands is required:

1. Before contact with the patient;
2. Before aseptic procedure;
3. After contact with biological fluids;
4. After contact with the patient;
5. After contact with the surrounding items.

Surgical hygiene

Disinfection implies under him full removal of any flora with the hands of doctors and other medical personnel. It is carried out before childbirth, operations or punctures. The procedure is required in the case of the preparation of the operating table.

The algorithm includes the following steps:

1. It is necessary to prepare hands, remove rings, bracelets and other decorations, roll the sleeves of the robe on the elbow;
2. You need to wash your hands (brushes, palm and forearm) with antiseptic soap. Nails are processed by a special brush;
3. Dry dry hands with a disposable towel;
4. An antiseptic alcohol solution should be applied to the skin, wait for complete drying;
5. Re-launched a alcohol antiseptic into the skin, wait until it dry;
6. At the final stage, sterile gloves are put on dry hands.

Dosage of antiseptic means, features of use, time during which it works, depend on the specific drug And listed in the instructions.

Surgical hand cleansing is different from hygienic in that mechanical washing continues at least two minutes. Doctors necessarily process forearms.

After washing the hands, only one-time towels are wedged.

Be sure to handle nails with sterile chopsticks, which are moistened in the antiseptics. The antiseptic means is applied twice, total consumption - at least 10 milliliters. Application procedure should be strictly observed.

Attention! After applying the antiseptic, you can not use a towel. Hands should dry naturally.

Surgical hand hygiene has its own contraindications. It can not be used if there are wounds, injuries, cracks, jet. It is prohibited if there are any skin diseases.

Useful video

How to wash your hands in medicine. See this small, but very profitable vide:

Disinfection means

As antiseptics, use means that recommended by the Ministry of Health. Alcohol-containing drugs should be applied. Typically, doctors use seventy percentage solution of ethyl alcohol or 0.5% solution of bigluconata chlorhexidine (it is divorced in ethyl alcohol 70%). It is possible to disinfect the hands of Hemiseceptom, "Octanecept", "Hichenix", "Wellosept", "Okinhederm" and others.

Reservoirs with antiseptic and soap must be disposable. This is spoken by federal clinical recommendations of hygiene of the hands of medical personnel.

If reusable containers are used, then before new filling, they must be disinfected.

Important! All tanks must have dispensers that are extruded with a liquid with an elbow way.

Hygiene Hands of Medical Personnel - Presentation:

Problems

Doctor - Allergologist Alexey Semenovich Dolgin believes that many problems can be avoided. Almost half of the cases, the medical staff does not comply with all the recommendations of the war.

- "The main mistake is that doctors do not wait until the hands are completely dry after washing. The antiseptic rubs into wet skin. And this will definitely be irritated. "

Permanent disinfection of hands inevitably leads to rashes, dermatitis and skin irritation. Most often, allergies are caused by means of added to ethyl alcohol: iodine, triclosis, some ammonium compounds. Surgeons with experience argue that when purified by pure ethyl allergic reactions was many times less, and the disinfection effect remained high.

Medical personnel are not recommended to wash your hands very hot water, use alkaline soap and hard brushes for washing nails. With excessive dryness, it is necessary to moisten the skin with protective means (usually before bedtime), avoid aggressive substances. This will help minimize allergic skin reactions.