Staff hand washing or decontamination.

Decontamination is the process of removing or destroying microorganisms for the purpose of neutralization and protection - cleaning, disinfection, sterilization.

Hand washing– the most important procedure to prevent nosocomial infections. There are 3 levels of hand decontamination: social level, hygienic (disinfection), surgical level.

Social level – washing lightly soiled hands with soap and water, which allows you to remove most transient microorganisms from the skin.

Social hand treatment is carried out:

1. Before eating

2. After going to the toilet

3. Before and after patient care

4. When your hands are dirty.

Equipment: liquid soap(soap dish with wire rack and a bar of soap), napkins, paper towel.

Preparation for the procedure:

Performing the procedure:

4. Lather your palms (if using bar soap, rinse and place in a soap dish with a wire rack).

5. Wash your hands by vigorously and mechanically rubbing your soaped palms together for 10 seconds.

6. Rinse off the soap under running water: Hold your arms so that your wrists and hands are below the level of your elbows (in this position, water flows from the clean area to the dirty area).

Completing the procedure:

7. Close water tap using a paper napkin.

8. Dry your hands with a paper towel (a cloth towel quickly becomes damp and is an ingenious breeding ground for organisms).

Note: Without running water a bowl of clean water can be used.

Hygienic level hand washing.

Equipment: liquid soap (soap dish with wire rack and a bar of soap), skin antiseptic, napkins, paper towel.

Hygienic level of hand treatment– This is washing using antiseptic agents. It's more effective method removal and destruction of microorganisms.

Hand hygiene is carried out:

1. Before performing invasive procedures

2. Before caring for an immunocompromised patient.

3. Before and after care of the wound and urinary catheter.

4. Before putting on and after taking off gloves.

5. After contact with body fluids or after possible microbial contamination.

Preparation for the procedure:

1. Remove all rings from your hands, with the exception of the wedding ring (the depressions on the surface of jewelry are breeding grounds for microorganisms).

2. Move the watch above your wrist or remove it. Place in your pocket or pin to your robe.

3. Open the water tap, using a paper napkin to avoid contact with microorganisms present on the tap, adjust the water temperature.

Performing the procedure:

4. Wet your hands under running water or in a bowl of water.

5. Apply 4-5 ml of antiseptic to your hands or thoroughly wash your hands with soap.

6. Wash your hands using the following technique:

a) Vigorous mechanical friction of the palms - 10 seconds (repeat 5 times).

b) The right palm washes (disinfects) the back of the left hand with rubbing movements, then the left palm also washes the right one, repeat 5 times.

c) The left palm is on the right hand, fingers intertwined, repeat 5 times.

d) The fingers of one hand are bent and are on the other palm (fingers intertwined) - repeat 5 times.

e) Alternately rubbing the thumbs of one hand with the palms of the other, palms clenched, repeat 5 times.

f) Alternating friction of the palm of one hand with the closed fingers of the other hand, repeat 5 times.

7. Rinse your hands under running water, holding them so that your wrist and hands are below the level.

Completion of the procedure.

8. Close the tap with a paper towel.

9. Dry your hands with a paper towel.

Note: if hygienic hand washing with water is not possible, you can treat them with 3-5 ml of antiseptic (based on 70% alcohol for 2 minutes).

Gloves.

Clean or sterile, also part of protective clothing. They are worn when:

1. Contact with blood

2. In contact with seminal fluid or vaginal secretions

Indications for hand hygiene:

Before direct contact with the patient

Before putting on sterile gloves and after removing gloves when placing a central intravascular catheter;

Before and after placement of central intravascular, peripheral vascular and urinary catheters or other invasive devices, if these manipulations do not require surgical intervention;

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

After contact with body secretions or excreta, mucous membranes, dressings;

When performing various manipulations to care for a patient after contact with areas of the body contaminated with microorganisms;

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

Technique hygienic treatment hands:

With this type of treatment, the use of a skin antiseptic is mandatory. To disinfect hands, use alcohol-containing and other approved skin antiseptics. Antiseptics are used, including gels in individual packaging (small-volume bottles), which are disposed of after use.

When choosing skin antiseptics, detergents and hand skin care products, one should take into account their skin tolerance, the intensity of skin coloring, the presence of fragrance, etc.

Hygienic treatment of hands with skin is carried out by rubbing it into the skin of the hands in the amount recommended in the instructions for use, turning Special attention for treating fingertips, skin around nails, between fingers. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time. When using most alcohol-containing skin antiseptics, pour 2.5 - 5 ml of the drug onto the palms and rub it into the skin of the hands for 2.5 - 3 minutes, repeating the hand washing technique until they are completely dry.

Medical personnel must be provided in sufficient numbers 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 associated with washing and disinfecting them.

Surgical treatment of hands.

Indications for surgical treatment of hands:

Before any surgical or equivalent interventions;

Before the delivery.

Technique for surgical hand antisepsis:

Before treating surgeons' hands, remove watches, bracelets, rings, and signet rings.

Processing is carried out in two stages:

Stage I - washing hands with soap and water for two minutes, and then drying with a sterile towel (napkin), hands are washed with soap in accordance with the hand washing technique, grabbing the skin of the forearms (to the elbow) and observing the direction of washing - from fingers to elbow;

Stage II - treatment of hands, wrists and forearms with a skin antiseptic.

The amount of skin antiseptic required for treatment, the frequency of treatment and its duration are determined in the guidelines/instructions for use of a particular product. An indispensable condition for effective disinfection of hands is keeping them moist for the recommended treatment time, then not wiping the hands until they are completely dry.

Sterile gloves are put on immediately after the skin antiseptic has completely dried.

The use of gloves in health care facilities serves 3 purposes:

Gloves reduce the risk of occupational infection of personnel when in contact with patients and their biological material;

Gloves reduce the risk of contamination of personnel’s hands with transient microbes and transmission to patients;

Gloves reduce the risk of infection of patients with microbes from resident hand microflora medical personnel.

Gloves must be worn in all cases where contact with blood or other biological substrates, potentially or obviously contaminated with microorganisms, mucous membranes, or damaged skin is possible.

It is not allowed to use the same pair of gloves when in contact (for care) with two or more patients, when moving from one patient to another, or from a body area contaminated with microorganisms to a clean one. After removing gloves, perform hand hygiene.

When gloves become contaminated with secretions, blood, etc. To avoid contamination of hands during the process of removing them, use a swab (napkin) moistened with a solution disinfectant(or antiseptic), remove visible dirt. Remove gloves, immerse them in the product solution, then discard. Treat your hands with an antiseptic.

Use of sterile gloves:

To perform any surgical interventions and similar manipulations;

When carrying out dressings;

When working with intravenous catheters;

When performing lumbar punctures;

When placing a urinary catheter;

During intubation;

When working with any wound surfaces;

During vaginal examination;

When carrying out any endoscopic examinations and treatment procedures;

When working with sterile material and drugs;

When working with immunocompromised patients.

Use of disinfected gloves (or clean gloves if the gloves are disposable):

In clinical diagnostic laboratories, bacteriological laboratories, when working with any biological material (blood, urine, cerebrospinal fluid, etc.);

When performing intramuscular, subcutaneous, intradermal, intravenous and cutaneous injections;

When performing any disinfection work;

When working with cytostatics and other chemicals;

In prosthesis when working with any material.

Treatment of reusable gloves after use is carried out according to the same scheme as reusable instruments: disinfection - pre-sterilization cleaning - sterilization. To sterilize gloves, it is advisable to use soft packages in small packages (no more than 10 pairs). With this packaging, sterilization of gloves is easier than in bags. Before sterilization, gloves are soaped, lined with gauze or paper on the inside, then unfolded and folded in pairs, placing a layer of gauze between the gloves. Each pair is wrapped in gauze or a napkin. The gloves come unfolded in the package. Sterilization is carried out in an autoclave at 120C – 1.1 atm – 45 minutes.

Resolution of the Chief State Sanitary Doctor of the Russian Federation dated 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...

12.4. Hand hygiene

12.4. Hand hygiene.

12.4.1. 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 pulse or blood pressure);

After contact with body secretions or excreta, mucous membranes, dressings;

Before performing various patient care procedures;

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

After treating patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment.

12.4.2. Hand hygiene is carried out in two ways:

Hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;

Treating hands with a skin antiseptic to reduce the number of microorganisms to a safe level.

12.4.3. To wash your hands, use liquid soap using a dispenser. Dry your hands with an individual towel (napkin), preferably disposable.

12.4.4. Hygienic treatment of hands with alcohol-containing or other approved antiseptic (without prior washing) is carried out by rubbing it into the skin of the hands in the amount recommended in the instructions for use, paying special attention to the treatment of the fingertips, the skin around the nails, between the fingers. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

12.4.5. When using a dispenser, a new portion of antiseptic (or soap) is poured into the dispenser after it has been disinfected, washed with water and dried. Preference should be given to elbow dispensers and photocell dispensers.

12.4.6. Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In departments with high intensity of patient care and high workload on staff (intensive care units and intensive care etc.) dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by staff (at the entrance to the ward, at the patient’s bedside, etc.). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (up to 200 ml) with skin antiseptic.

12.4.7. Use of gloves.

12.4.7.1. Gloves must be worn in all cases where contact with blood or other biological substrates, potentially or obviously contaminated with microorganisms, mucous membranes, or damaged skin is possible.

1. Remove decay products and microorganisms.
2. Ensure patient infection safety.
3. Provide high level cleanliness and personal hygiene.
4. Retard the development of microorganisms.

Highlight three levels of hand treatment: social, hygienic (disinfection of hands), surgical (sterility of hands is achieved for a certain time).

1. Social level.

Indications:

1. Before eating. 2. Feeding the patient. 3. Working with food products. 4. After visiting the toilet. 5. Before and after patient care.
2. When your hands are dirty.

Equipment:

1. Soap (liquid with dispenser).
2. Paper napkins.
3. Paper towel or clean, dry cotton towel.

Hand washing techniques should be strictly followed. The duration of the procedure is 40-60 seconds.

1. Remove all jewelry.
2. Release your forearms from the sleeves of your robe.
3. Open the water tap using a paper towel to avoid contact with microorganisms present on the tap. Adjust the water temperature.
4. Wet your hands with water.
5. Apply a sufficient amount of soap to the entire surface of your hands.
6. Each movement is repeated 5 times:
7. Rub palm against palm.
8. Run your right hand along the back of your left, intertwining your fingers, and vice versa.
9. Rub palm against palm, interlacing fingers, treating the spaces between the fingers.
10. Clasp your fingers and intertwine them.
11. Rub with rotational movements thumb left hand to the right and vice versa.
12. Rub with rotating movements of clenched fingers right hand left forward and backward and vice versa.
13. Rubbing your wrists in a circular motion.
14. Rinse your hands with water.
15. Dry thoroughly with a disposable towel.
16. Close the tap using a towel (napkin).

2.Hygienic level.

Indications:

1. Before and after invasive procedures.
2. Before caring for an immunocompromised patient.
3. Before and after wound care and urinary catheter use.
4. Before putting on and after removing sterile gloves.
5. After contact with body fluids or after possible microbial contamination.

Equipment:

1. Liquid soap.
2. Clock with second hand.
3. Skin antiseptic: 70 o ethyl alcohol (0.5% alcohol solution of chlorhexidine bigluconate, or other modern skin antiseptic).
4. Sterile: tweezers, cotton balls, napkins.
5. Paper napkins.
6. A paper towel or a clean, dry cotton towel.
7. Container for disinfection.

Required condition: no injuries on hands.

When washing your hands you should:

1. Remove finger rings, watches, and bracelets.
2. Fold the sleeves of the robe over 2/3 of your forearms.
3. Open the water tap using a paper towel to avoid contact with microorganisms present on the tap.
4. Wash your hands with soap and running water up to 2/3 of your forearm, strictly following the hand washing technique (see social level).
5. Rinse your hands under running water to remove soap suds.
6. Repeat washing each hand.
7. Rinse your hands under running water, holding them so that your wrists and hands are above elbow level.
8. Dry your hands with a personal towel (napkin).
9. Using a napkin, close the water tap.
10. Dispose of the napkin into a container for disinfection.
11. Apply 3-5 ml of antiseptic to the palms, treating all surfaces of the hand, following the technique of treating hands with an antiseptic.
12. Exposure when using an alcohol-containing antiseptic is usually 20-30 seconds, but more accurate information should be obtained from the guidelines for using an antiseptic.

Hygienic treatment of hands with a skin antiseptic (without prior washing) is carried out by rubbing it into the skin of the hands in the amount recommended in the instructions for use, paying special attention to the treatment of the fingertips, the skin around the nails, between the fingers. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

3. Surgical level.

Indications:

1. The need to cover a sterile table.
2. Participation in surgery, puncture, childbirth.

Contraindications:

1. Presence of pustules on the hands and body.
2. Cracks and wounds of the skin.
3. Skin diseases.

Mandatory condition: processing is carried out in areas of strict or special sterility.

Performing the procedure:

1. Hand treatment is carried out according to individual instructions for each method.
2. Hand sanitization of personnel involved in the operation is mandatory.

Various preparations are used for hand treatment, approved by the pharmacological committee of the Ministry of Health and social development RF.

Infections associated with the provision of medical care(HAIs) are the main problem in ensuring patient safety, which is why preventing their occurrence should be a priority for medical organizations of any profile. According to the World Health Organization, out of 100 hospitalized patients, at least 7 become infected with HAIs. Among seriously ill patients treated in intensive care units, this rate increases to approximately 30 HAIs per 100 people.

HAIs often occur in situations where the source of pathogenic microorganisms for the patient is the hands of healthcare workers. Today, hand washing by medical personnel or treating them with skin antiseptics are the most important infection control measures that can significantly reduce the spread of infections that arise during the diagnostic and treatment process in organizations engaged in medical activities.

Background

The history of hand hygiene for medical personnel dates back to the mid-19th century, when the highest mortality rate due to “puerperal fever” was observed in obstetric clinics in European countries. Septic complications claimed the lives of about 30% of women in labor.
In the medical practice of that time, doctors' passion for dissecting corpses was widespread. Moreover, after visiting the anatomical theater, the doctors went to the patients without treating their hands, but simply wiping them with a handkerchief.
There were many different theories about the origin of puerperal fever, but only the Viennese doctor Ignaz Philipp Semmelweis was able to discover the true reasons for its spread. The 29-year-old doctor suggested that the main cause of postpartum complications is contamination of the hands of medical personnel with cadaveric material. Semmelweis noticed that a solution of bleach eliminates the smell of rotting, which means it can also destroy the infectious principle present in corpses. An observant doctor suggested treating obstetricians' hands with a chlorine solution, which led to a 10-fold reduction in mortality in the clinic. Despite this, Ignaz Semmelweis's discovery was rejected by his contemporaries and received recognition only after his death.

Hand hygiene is a first-line intervention that has proven highly effective in preventing HAIs and the spread of antimicrobial resistance in pathogens. However, even today the problem of cleaning the hands of medical personnel cannot be considered completely resolved. Research conducted by WHO has shown that poor hand hygiene compliance among health care workers occurs in both developed and developing countries.

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

1) the presence of microorganisms on the patient’s skin or objects in his immediate environment;

2) contamination of the hands of medical workers with pathogens through direct contact with the patient’s skin or surrounding objects;

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

4) incorrect implementation of the hand disinfection procedure or ignoring this procedure after contact with the patient or objects in his immediate environment;

5) direct contact of the contaminated hands of a medical worker with another patient or an object that will come into direct contact with this patient.

Microorganisms associated with the provision of medical care can often be found not only on the surface of infected wounds, but also on areas of completely healthy skin. Every day, about 10 6 skin flakes with viable microbes peel off, contaminating patients' underwear and bed linen, bedside furniture and other objects. After direct contact with a patient or environmental objects, microorganisms can survive on the hands of healthcare workers for quite a long time, most often from 2 to 60 minutes.

The hands of medical personnel can be colonized by representatives of their own, resident microflora, and can also be contaminated with potential pathogens (transient microflora) during various manipulations, which is of great epidemiological significance. In many cases, pathogens of purulent-septic infections released from patients are not found anywhere except on the hands of medical workers.

Rules for hand treatment of medical personnel

IN Russian Federation the rules for treating the hands of medical personnel are regulated by SanPiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities.” Depending on the nature of the medical procedure being performed and the required level of reduction in microbial contamination of the skin, medical personnel must perform hand hygiene or the so-called surgical hand treatment.

To achieve an effective level of hand skin disinfection healthcare workers must comply with the following requirements :

1. Have short-cut natural nails without varnish.

It should be understood that the use of nail polish itself does not lead to increased contamination of the hands, but cracked polish makes it difficult to remove microorganisms. Varnish dark colors may hide the condition of the subungual space, which leads to insufficient treatment. In addition, the use of nail polish can cause unwanted dermatological reactions, which often result in secondary infection. The procedure for performing a manicure is quite often accompanied by the appearance of microtraumas, which can easily become infected. For the same reasons, medical workers should not wear artificial nails.

2. Do not wear rings, rings or other jewelry on your hands while working. Before surgical treatment of the hands, it is also necessary to remove wrist watch, bracelets and other accessories.

Jewelry on the hands can lead to increased contamination of the skin and difficulty in removing microorganisms, jewelry and Jewelry complicate the process of putting on gloves and also increase the likelihood of damage.

According to SanPiN 2.1.3.2630-10, there are two types of disinfection of the hands of medical workers - hygienic hand treatment and disinfection of the hands of surgeons.

Hand hygiene must 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 pulse or blood pressure);

After contact with body secretions or excreta, mucous membranes, dressings;

Before performing various patient care procedures;

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

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

Exist two ways hand hygiene: washing with soap and water to remove contaminants and reduce the number of microorganisms, and using a skin antiseptic to reduce the number of microorganisms to a safe level.

For hand washing, liquid soap is used, dispensed using a dispenser. Use should be avoided hot water, as this may increase the risk of dermatitis. If the faucet is not equipped with an elbow drive, you must use a towel to close it. To dry your hands, use individual clean cloths or paper towels preferably single use.

Hygienic treatment of hands (without prior washing) with a skin antiseptic is carried out by rubbing it into the skin of the hands in the amount recommended in the instructions for use, paying special attention to the fingertips, the skin around the nails and between the fingers. An important condition effective hand hygiene is to keep them moist for the recommended exposure time. You should not wipe your hands after handling.

For your information

Alcohol-based skin antiseptics show b O greater effectiveness compared to antiseptics on water based, and therefore their use is preferable in the absence of conditions necessary for hand washing, or in conditions of shortage of working time.

Treatment of surgeons' hands performed by all medical workers involved in surgical interventions, childbirth and catheterization of great vessels. Surgical antisepsis hands includes two mandatory stages:

1. Wash hands with soap and water for 2 minutes, then dry with a sterile cloth towel or napkin.

On at this stage It is recommended to use sanitary devices and elbow dispensers, which can be operated without the use of hands. If brushes are used, which is not a requirement, the choice should be either sterile, soft, disposable brushes or brushes that can withstand autoclaving. Brushes should only be used to treat periungual areas when disinfecting hands for the first time during a work shift.

2. Treatment of hands, wrists and forearms with a skin antiseptic.

Hands must be kept moist throughout the recommended treatment time. After exposure to a skin antiseptic, it is prohibited to wipe your hands. The amount of a particular product required for treatment, the time of its exposure and the frequency of application are determined by the recommendations set out in the instructions attached to it. Sterile gloves are put on immediately after the antiseptic has completely dried on the skin of the hands.

For surgical hand treatment, the same preparations can be used as for hygienic treatment. However, it is very important to use skin antiseptics that have a pronounced residual effect.

Fill dispensers for soap or skin antiseptic only after they have been disinfected, washed with water and dried. Preference should be given to elbow dispensers and dispensers powered by photocells.

Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In departments with a high intensity of patient care and a high workload for staff, dispensers with skin antiseptics should be placed in places convenient for use by medical workers (at the entrance to the ward, at the patient’s bedside, etc.). It should also be possible to provide medical workers with small-volume individual bottles of skin antiseptic (up to 200 ml).

Prevention of occupational dermatitis

Repeated hand cleaning by medical personnel during the performance of work duties can lead to skin irritation, as well as the occurrence of dermatitis - one of the most common occupational diseases of medical workers. The most common skin reaction is irritative contact dermatitis, which is manifested by symptoms such as dryness, irritation, itching, and in some cases, cracking of the skin. The second type of skin reaction is allergic contact dermatitis, which is much less common and is an allergy to certain ingredients in a hand sanitizer. The manifestations and symptoms of allergic contact dermatitis can be varied and range from mild and localized to severe and generalized. In the most severe cases, allergic contact dermatitis may be accompanied by difficulty breathing and some other symptoms of anaphylaxis.

Irritative contact dermatitis is usually associated with the use of iodophors as skin antiseptics. Other antiseptic components that can cause contact dermatitis, with decreasing incidence, include chlorhexidine, chloroxylenol, triclosan and alcohols.

Allergic contact dermatitis occurs when hand products containing quaternary ammonium compounds, iodine or iodophors, chlorhexidine, triclosan, chloroxylenol and alcohols are used.

Available a large number of data obtained in various studies on the best skin tolerance of alcohol-containing antiseptics.

Allergic reactions and irritation of the skin of the hands of medical personnel cause a feeling of discomfort, thereby worsening the quality of medical care, and also increase the risk of transmitting HAI pathogens to patients due to the following: reasons:

Due to skin damage, a change in its resident microflora, colonization with staphylococci or gram-negative microorganisms is possible;

When carrying out the procedure for hygienic or surgical treatment of hands, the required level of reduction in the number of microorganisms is not achieved;

As a result of discomfort and other unpleasant subjective feelings There is a tendency for a health care worker who experiences skin reactions to avoid hand sanitizing.

Adviсe

In order to prevent the development of dermatitis, medical personnel must observe a number of the following additional recommendations:
1) do not resort to frequent washing wash your hands with soap immediately before or after using an alcohol-based product. Washing your hands before using an antiseptic is only necessary if there is visible contamination on the skin;
2) when washing your hands, you should avoid using very hot water, as this can lead to skin injury;
3) when using disposable towels, it is very important to blot the skin rather than rub it to avoid the formation of cracks;
4) you should not wear gloves after treating your hands until they are completely dry in order to reduce the risk of developing skin irritation;
5) it is necessary to regularly use creams, lotions, balms and other hand skin care products.

One of basic preventive measures The development of occupational dermatitis in medical workers is to reduce the frequency of exposure of the skin to soap and other irritating detergents through the widespread introduction into practice of alcohol-based antiseptics containing various emollient additives. According to WHO recommendations, the use of alcohol-containing hand hygiene products in a medical organization is preferable, provided they are available, since this type of antiseptics has a number of advantages, such as a wide range of antimicrobial activity, including against viruses, short exposure time, good skin tolerance .

The problem of medical personnel compliance with hand hygiene rules

Numerous epidemiological studies of the adherence (compliance) of medical personnel to the recommended rules of hand hygiene show unsatisfactory results. On average, medical staff compliance with hand sanitizing requirements is only 40%, and in some cases much lower. Interesting fact is that doctors and junior medical staff are much more likely than nurses to not follow recommendations for hand antiseptics. The highest level of compliance is observed on weekends, which is apparently associated with a significant reduction in workload. More low level hand hygiene is recorded in intensive care units and during busy periods of patient care, while the highest levels are observed in children's wards.

Obvious barriers to proper implementation of recommendations hand treatment by medical personnel are skin allergic reactions, low availability of means for hand antisepsis and conditions for its implementation, priority of measures to care for the patient and provide medical assistance to him, the use of gloves, lack of working time and high professional load, forgetfulness of medical workers, lack of basic knowledge of existing requirements, misunderstanding of the role of hand cleaning in the prevention of HCAI.

Activities to improve hand hygiene practices in a medical organization, there should be extensive educational programs among personnel on the issues of hand treatment, monitoring the application of acquired knowledge in professional activities, development of written recommendations on the issues of antiseptic treatment when performing various manipulations, reducing the workload on medical workers, creating appropriate conditions for hand hygiene , providing staff not only with antiseptics, but also with skin care products, various administrative measures, sanctions, support and encouragement for employees who perform quality hand cleaning.

The introduction of modern antiseptics, skin care products and hand hygiene equipment, as well as extensive educational programs for medical personnel, in organizations engaged in medical activities is absolutely justified. Data from numerous studies show that the economic costs associated with treating 4-5 cases of moderate HAI exceed the annual budget required to purchase hand hygiene products for the entire health care organization (HPO).

Medical gloves

Another aspect related to hand hygiene for medical personnel is use of medical gloves. Gloves significantly reduce the likelihood of occupational infection when in contact with patients or their secretions, reduce the risk of contamination of the hands of medical personnel with transient microflora and its subsequent transmission to patients, and prevent infection of patients with microorganisms that are part of the resident flora of the hands of medical workers. By creating an additional barrier to potentially pathogenic agents, gloves simultaneously protect both the healthcare worker and the patient.

The use of gloves is an important component of universal precautions and infection control in healthcare facilities. However, medical personnel often neglect to use or change gloves even in cases where there are clear indications for this, which significantly increases the risk of transmission of infection both to the medical worker himself and from one patient to another through the hands of staff.

According to existing requirements of sanitary legislation gloves must be worn in all of the following situations :

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

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

If gloves are contaminated with blood or other biological fluids, in order to avoid contamination of hands during the process of removing gloves, remove visible contamination with a swab or napkin moistened with a solution of a disinfectant or skin antiseptic. Used gloves are disinfected and disposed of along with other medical waste of the appropriate class.

The significant effectiveness of gloves in preventing contamination of the hands of medical personnel and reducing the risk of transmission of microorganisms during the provision of medical care has been confirmed in clinical studies. However, healthcare workers must be aware that gloves cannot provide complete protection against microbial contamination of the hands. Microorganisms are able to penetrate through the smallest defects, pores and holes in the material, and also get onto the hands of personnel during the procedure for removing gloves. Penetration of liquids into gloves is most often observed in the area of ​​the fingertips, especially the thumb. However, only 30% of medical personnel notice such situations. In connection with these circumstances, before putting on gloves and immediately after removing them, it is necessary to carry out antiseptic treatment of hands.

Gloves are single-use medical devices and therefore decontamination and reprocessing are not recommended. This practice should be avoided, including in organizations engaged in medical activities, where the level of material resources is low and the supply of gloves is limited.

The following main ones are distinguished types of medical gloves:

Examination (diagnostic) gloves;

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

Special purpose (for use in various branches of medicine): orthopedic, ophthalmological, etc.

To make putting on gloves easier, manufacturers use various substances. Most often, talc, starch-containing powder, magnesium oxide, etc. are used. It should not be forgotten that the use of powdered gloves can lead to a decrease in tactile sensitivity. It is undesirable for glove powder to get into the wound area, since cases of postoperative complications due to hypersensitivity reactions in patients have been described. The use of powdered gloves in dental practice is not recommended, as this can cause discomfort in the patient’s oral cavity.

The following requirements apply to medical gloves: :

Should fit snugly to the hand throughout the entire time of use;

Should not cause hand fatigue and correspond to the size of the healthcare worker’s hand;

Must maintain good tactile sensitivity;

The material from which the gloves are made, as well as the substances used to powder them, must be hypoallergenic.

Compliance with modern requirements for hand hygiene of medical personnel can significantly improve the quality of medical care in healthcare facilities by significantly reducing the risk of patients becoming infected with HAIs.

Literature

1. Afinogenov G. E., Afinogenova A. G. Modern approaches to hand hygiene of medical personnel // Clinical microbiology and antimicrobial chemotherapy. 2004. T. 6. No. 1. P. 65−91.
2. Hand hygiene and the use of gloves in health care facilities / Ed. Academician of the Russian Academy of Natural SciencesL. P. Zuevoy. St. Petersburg, 2006. 33 p.
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