There are two levels of treatment of the hands of medical personnel:

Hygienic processing of hands:

1. hygienic hand washing with soap,

   hygienic treatment of hands with a skin antiseptic (without pre-washing them).

Treatment of the hands of surgeons.

Hygienic processing of hands.

Target: removal of contaminants and reduction of the number of microorganisms to a safe level (prevention of HAIs).

Indications:

before direct contact with the patient;

after contact with the patient's intact skin;

before performing various manipulations to care for the patient;

after contact with the biological media of the body, mucous membranes, dressings;

after contact with medical equipment and other objects in the immediate vicinity of the patient;

after treatment of a patient with purulent inflammatory processes;

after each contact with contaminated surfaces and equipment.

Contraindications: individual intolerance to the soap or skin antiseptic used.

Efficiency conditions:

short cut nails;

lack of nail polish;

lack of artificial nails;

absence jewelry on hands (rings, rings, etc.);

providing in sufficient quantities effective means for washing and disinfecting hands, as well as means for caring for the skin of hands (creams, lotions, balms).

Hygienic hand washing with soap.

Equipment: a sink equipped with a faucet with an elbow (non-contact) valve; liquid soap; dispenser for liquid soap(elbow or other non-contact); paper towels (or individual cloth towel); paper towel holder; pedal bucket with class A waste bag.

Manipulation algorithm:

Rice. 2. Hygienic hand washing with soap.

Hygienic treatment of hands with skin antiseptic.

Equipment: skin antiseptic approved for use in an elbow dispenser (or other non-contact dispenser) or in an individual container.

Hand processing. The most important "tool" of the dentist are the hands. Proper and timely processing of hands is the key to the safety of medical personnel and patients. Therefore, great importance is attached to hand washing, systematic disinfection, hand care, as well as wearing gloves to protect and protect the skin from infections.

For the first time, hand treatment for the prevention of wound infection was used by the English surgeon J. Lister in 1867. Hand treatment was carried out with a solution of carbolic acid (phenol).

The microflora of the skin of the hands is represented by permanent and temporary (transient) microorganisms. Permanent microorganisms live and multiply on the skin (Staphylococcus epidermidis, etc.), while transient ones (Staphylococcus aureus, Escherichia coli) are the result of contact with the patient. Approximately 80-90% of permanent microorganisms are found in surface layers skin and 10-20% is in the deep layers of the skin (in the sebaceous and sweat glands and hair follicles). The use of soap during handwashing removes most transient flora. Permanent microorganisms cannot be removed from the deep layers of the skin with ordinary hand washing.

When developing an infection control program in health care facilities, clear indications and algorithms for treating the hands of medical staff should be developed, based on the characteristics of the diagnostic and treatment process in departments, the specifics of the patient population and the characteristic microbial spectrum of the department.

Types of contact in the hospital, ranked according to the risk of hand contamination, are as follows (in order of increasing risk):

1. Contact with clean, disinfected or sterilized objects.

2. Objects not in contact with patients (food, medicines, etc.).

3. Objects with which patients have minimal contact (furniture, etc.).

4. Objects that have been in close contact with non-infected patients (bedding, etc.).

5. Patients who are not the source of infection, during procedures characterized by minimal contact (measuring the pulse, blood pressure, etc.).

6. Objects that are likely to be contaminated, especially wet objects.

7. Objects that were in close contact with patients that are sources of infection (bed linen, etc.).

8. Any secrets, excretions or other body fluids of an uninfected patient.

9. Secrets, excretions, or other body fluids from known infected patients.

10. Foci of infection.

1. Regular hand washing

Washing moderately soiled hands with plain soap and water (antiseptics are not used). The purpose of regular hand washing is to remove dirt and reduce the amount of bacteria found on the skin of the hands. Routine hand washing is mandatory before preparing and distributing food, before eating, after going to the toilet, before and after patient care (washing, making bed, etc.), in all cases when the hands are visibly dirty.

Thorough hand washing with detergent removes up to 99% of transient microflora from the surface of the hands. At the same time, it is very important to observe a certain hand washing technique, since special studies have shown that during formal hand washing, fingertips and fingertips remain contaminated. internal surfaces. Hand treatment rules:

All jewelry, watches are removed from the hands, as they make it difficult to remove microorganisms. Hands are lathered, then rinsed with warm running water and everything is repeated anew. It is believed that during the first soaping and rinsing warm water microbes are washed off the skin of the hands. Under the influence of warm water and self-massage, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes from the opened pores are washed off.

Warm water makes the antiseptic 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.

The sequence of movements when processing hands must comply with the European standard EN-1500:

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. Cover the base of the thumb of the left hand between the thumb and index fingers 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.

7. Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute.

For washing hands, it is most preferable to use liquid soap in dispensers with single-use bottles liquid soap "Nonsid" (firm "Erisan", Finland), "Vase-soft" (firm "Lyzoform SPb"). Do not add soap to a partially empty dispenser bottle due to their possible contamination. Acceptable for health facilities can be considered, for example, Dispenso-pac dispensers from Erisan, with a sealed dosing pump device that prevents the possible ingress of microorganisms and substituting air into the package. The pumping device ensures complete emptying of the package.
If soap bars are used, small fragments of them should be used so that individual pieces do not remain. long time in a humid environment that supports the growth of microorganisms. It is recommended to use soap dishes that allow the soap to dry between separate handwashing episodes. Hands should be dried with a paper (ideally) towel, which then turn off the tap. In the absence of paper towels, pieces of clean cloth measuring approximately 30 x 30 cm can be used for individual use. After each use, these towels should be discarded in the containers specially designed for them and sent to the laundry. Electric dryers are not effective enough as they dry the skin too slowly.
Personnel should be cautioned against wearing rings and using nail polish, as rings and cracked polish make it difficult to remove microorganisms. Manicure (especially manipulations in the area of ​​the nail bed) can lead to microtraumas that are easily infected. Hand washing facilities should be conveniently located throughout the hospital. In particular, it should be installed directly in the room where diagnostic or penetrating procedures are performed, as well as in each ward or at the exit from it.

2. Hygienic disinfection (antiseptic) of hands

It is intended to interrupt the process of transmission of infection through the hands of the staff of institutions from patient to patient and from patients to staff and should be carried out in the following cases:

Before performing invasive procedures; before working with particularly susceptible patients; before and after manipulations with wounds and catheters; after contact with the secretions of the patient;

In all cases of probable microbial contamination from inanimate objects;

Before and after working with a patient. Hand treatment rules:

Hygienic processing of hands consists of two stages: mechanical cleaning hands (see above) and disinfection of hands with a skin antiseptic. After the end of the mechanical cleaning stage (double soaping and rinsing), the antiseptic is applied to the hands in an amount of at least 3 ml. In the case of hygienic disinfection, preparations containing antiseptic detergents are used for washing hands, and hands are also disinfected with alcohols. When using antiseptic soaps and detergents, the hands are moistened, after which 3 ml of an alcohol-containing preparation is applied to the skin (for example, Isosept, Spitaderm, AHD-2000 Special, Lizanin, Biotenzid, Manopronto) and carefully rubbed into the skin until completely dry (do not wipe your hands). If the hands were not contaminated (for example, there was no contact with the patient), then the first stage is skipped and an antiseptic can be applied immediately. Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute. Alcohol formulations are more effective than aqueous solutions of antiseptics, however, in cases of severe contamination of the hands, they should be thoroughly washed with water, liquid or antiseptic soap beforehand. Alcoholic compositions are particularly preferred also in the absence of adequate conditions for washing hands or in the absence of the necessary time for washing.

To prevent damage to the integrity and elasticity of the skin, skin softening additives (1% glycerin, lanolin) should be included in the antiseptic, if they are not already contained in commercial preparations.

3. Surgical hand disinfection

It is carried out during any surgical interventions, accompanied by a violation of the integrity of the patient's skin, to prevent the introduction of microorganisms into the surgical wound and the occurrence of infectious postoperative complications. Surgical treatment of hands consists of three stages: mechanical cleaning of hands, disinfection of hands with a skin antiseptic, closing hands with sterile disposable gloves.

Such hand treatment is carried out:

Before surgical interventions;

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

Hand treatment rules:

1. In contrast to the mechanical cleaning method described above, at the surgical level, the forearms are included in the treatment, sterile wipes are used for blotting, and the hand washing itself lasts at least 2 minutes. After
drying, the nail beds and periungual ridges are additionally treated 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.

2. After the end of the mechanical cleaning stage, an antiseptic (Allcept pro, Spitaderm, Sterillium, Octeniderm, etc.) is applied to the hands in 3 ml portions and, preventing drying, is rubbed into the skin, strictly following the sequence of movements of the EN-1500 scheme. 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.

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

4. 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 (table).

Table. Stages of surgical hand disinfection

Two types of antiseptics are used for hand treatment: water, with the addition of surface-active substances (surfactants) and alcohol (table).

Table. Antiseptics used for hygiene and surgical treatment hands

Alcohol products are more effective. They can be used for quick hand hygiene. The group of alcohol-containing skin antiseptics includes:

0.5% alcohol solution of chlorhexidine in 70% ethanol;

60% isopropanol solution or 70% ethanol solution with additives,

Softening the skin of the hands (for example, 0.5% glycerin);

Manopronto-extra - a complex of isopropyl alcohols (60%) with additives softening the skin of the hands and lemon fragrance;

Biotenzid - 0.5% solution of chlorhexidine in a complex of alcohols (ethyl and isopropyl, with additives softening the skin of the hands and lemon flavor.

Water-based antiseptics:

4% solution of chlorhexidine bigluconate;

Povidone-iodine (solution containing 0.75% iodine).

Microorganisms representing the resident flora live and multiply on the skin (10-20% of them can be found in the deep layers of the skin, including the sebaceous and sweat glands, hair follicles).

The resident flora is represented mainly by coagulase-negative cocci and diphtheroids. Gram-negative bacteria (not counting members of the genus Acte1; obacleg) are rarely resident. Resident microorganisms are difficult to remove or kill with normal handwashing or even disinfection procedures, although their numbers can be reduced.

Resident microorganisms generally do not cause nosocomial infections, except in connection with vascular catheterization. Moreover, the normal microflora prevents colonization of the skin by other microbes.

Conditions for achieving effective washing and disinfection of hands, their preparation(Fig. 22): short cut nails, no nail polish, no artificial nails, no hands of rings, rings and other jewelry. Before processing the hands of surgeons, it is also necessary to remove watches, bracelets, etc.

Rice. 22.

To dry hands, clean cloth towels or disposable paper towels are used; when treating the hands of surgeons, only sterile cloth ones are used.

Skin antiseptics for hand treatment - for example: lizhen, chlorhexidine bigluconate, isosept, allsept, etc., should be in dispensers in appropriate concentrations. In departments with a high intensity of patient care and with a high workload on staff, dispensers with skin antiseptics should be placed in places convenient for use by staff (at the entrance to the ward, at the patient's bedside, etc.). It should also be possible to provide medical workers with individual containers (bottles) with small volumes of skin antiseptic (100-200 ml).

Hand washing (Figure 23) is the most effective method prevention of nosocomial infections in healthcare facilities.

Rice. 23.

There are three levels of hand decontamination:

• 1) social (routine handwashing);
• 2) hygienic (disinfection of hands);
• 3) surgical (sterility of the hands of surgeons is achieved for a certain time).

The reasons for the insufficient level of processing of the hands of medical personnel, according to some sources, are forgetfulness, insufficient awareness of the problem, lack of knowledge, lack of time, skin problems - dryness, dermatitis, etc. All these reasons can lead to the occurrence of nosocomial infections. Junior medical staff treats hands on social and hygienic level within its competence.

Social level of hand treatment

Regular hand washing. It is carried out before the start of any work (Table 4).

Purpose: to remove dirt and temporary (transient) microflora from the skin of the hands by washing twice with water and soap.

Indications: when hands are contaminated, before and after the treatment procedure, with and without gloves, when caring for the patient (if the hands are not contaminated with the patient's biological fluids), before eating, feeding the patient, and after going to the toilet.

Equipment: liquid soap, neutral, odorless, soap dispenser (dispenser), watch with second hand, warm running water. To dry hands, use napkins 15x15 single use, a napkin for a tap.

It must be remembered that when using the dispenser, a new portion of soap (or antiseptic) is poured into the dispenser after it has been disinfected, rinsed with running water and dried. Preference should be given to elbow dispensers and dispensers on photocells.

Table 4

Hygienic level of hand treatment (Table 5)

There are two processing methods:

• 1) hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;
• 2) hygienic treatment of hands with a skin antiseptic to reduce the number of microorganisms to a safe level.

Hand hygiene should be carried out in the following cases:

• ? 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.

Purpose: to remove or completely destroy the transient microflora from the hands.

Equipment: liquid soap, soap and skin antiseptic dispensers, a watch with a second hand, warm running water (35-40 ° C), sterile tweezers, cotton balls, napkins; skin antiseptic. Container for waste disposal with disinfectant solution.

Fulfill the mandatory conditions - the same as for the social processing of hands. To dry hands, clean cloth towels or disposable paper towels are used; when treating the hands of surgeons, only sterile cloth ones are used.

It is important to observe the exposure time: hands must be wet from the use of an antiseptic for at least 15 s.

Table 5

Hand hygiene technique

Note. If necessary, if there was contact with the secretions or blood of the patient, hygienic treatment of hands is carried out after mechanical cleaning. Then the hands are treated with an alcohol-containing or other approved antiseptic from a dosing device in an amount of at least 3 ml, recommended by the instructions for use, by rubbing it into the skin of the hands. Special attention pay for the treatment of the fingertips, the skin around the nails, interdigital spaces. An indispensable condition for effective disinfection of hands is to keep them moist for the recommended processing time until completely dry.

Rice. 24.

If there was no contact with the secretions or blood of the patient, hygienic treatment is carried out with an alcohol-containing antiseptic without first washing the hands (Fig. 25).

Rice. 25.

Surgical level of hand treatment (Table 6)

Purpose: to achieve the sterility of the nurse's hands to reduce the risk of wound infection in case of accidental damage to sterile gloves during work.

Indications:

• ? the need to cover a sterile table;
• ? participation in the operation, puncture and other surgical intervention;
• ? participation in childbirth.

Contraindications:

• ? the presence of pustules on the hands and body;
• ? cracks and wounds of the skin;
• ? skin diseases.

Equipment:

• ? liquid soap in a dispenser;
• ? hourglass- 1 min, 3 min.
• ? 0-30 ml of skin alcohol antiseptic;
• ? sterile tray with forceps;
• ? sterile bix with targeted styling.

Mandatory condition: use only alcohol-containing skin antiseptics. The procedure is achieved with the help of an assistant supplying sterile material from sterilization boxes, dispensers with soap and an alcohol solution of an antiseptic.

Hand surgery technique

Table 6

There are two levels of treatment of the hands of medical personnel:

Hygienic processing of hands:

1. hygienic hand washing with soap,

   hygienic treatment of hands with a skin antiseptic (without pre-washing them).

Treatment of the hands of surgeons.

Hygienic processing of hands.

Target: removal of contaminants and reduction of the number of microorganisms to a safe level (prevention of HAIs).

Indications:

before direct contact with the patient;

after contact with the patient's intact skin;

before performing various manipulations to care for the patient;

after contact with the biological media of the body, mucous membranes, dressings;

after contact with medical equipment and other objects in the immediate vicinity of the patient;

after treatment of a patient with purulent inflammatory processes;

after each contact with contaminated surfaces and equipment.

Contraindications: individual intolerance to the soap or skin antiseptic used.

Efficiency conditions:

short cut nails;

lack of nail polish;

lack of artificial nails;

lack of jewelry on the hands (rings, rings, etc.);

providing in sufficient quantities effective means for washing and disinfecting hands, as well as means for caring for the skin of hands (creams, lotions, balms).

Hygienic hand washing with soap.

Equipment: a sink equipped with a faucet with an elbow (non-contact) valve; liquid soap; dispenser for liquid soap (elbow or other non-contact); paper towels (or individual cloth towel); paper towel holder; pedal bucket with class A waste bag.

Manipulation algorithm:

Rice. 2. Hygienic hand washing with soap.

Hygienic treatment of hands with skin antiseptic.

Equipment: skin antiseptic approved for use in an elbow dispenser (or other non-contact dispenser) or in an individual container.

Decree of the Chief State Sanitary Doctor of the Russian Federation of May 18, 2010 N 58 (as amended on June 10, 2016) "On approval of SanPiN 2.1.3.2630-10" Sanitary and epidemiological requirements for organizations engaged in medical activities "(together with ...

12. Rules for the processing of hands of medical personnel and skin

covers of patients

12.1. In order to prevent nosocomial infections, the hands of medical workers are subject to disinfection (hygienic treatment of hands, treatment of the hands of surgeons) and the skin of patients (treatment of the operating and injection fields, elbow folds of donors, sanitization skin covers).

Depending on the medical manipulation being performed 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 surgeons' hands. The administration organizes training and monitoring of compliance with hand hygiene requirements by medical personnel.

12.2. 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. Clean cloth towels or single-use paper towels are used to dry the hands, and only sterile cloth ones are used when treating the hands of surgeons.

12.3. medical staff must be provided in sufficient quantity effective means for washing and disinfecting hands, as well as hand skin care products (creams, lotions, balms, etc.) to reduce the risk of contact dermatitis. When choosing skin antiseptics, detergents and hand care products, individual tolerance should be taken into account.