Hygienic hand washing of medical staff stages. Rules for the processing of the hands of medical personnel and the skin of patients

MINISTRY OF HEALTH OF THE REPUBLIC OF BURYATIA STATE AUTONOMOUS EDUCATIONAL INSTITUTION

SECONDARY VOCATIONAL EDUCATION

BAIKAL BASIC MEDICAL COLLEGE OF THE MINISTRY

HEALTH CARE OF THE REPUBLIC OF BURYATIA

KYAKHTINSKY BRANCH

Topic: Hand washing technique for medical personnel

Checked:

Completed by: Grigoryan A.A.

1. General Provisions

Definition of terms.

An antimicrobial agent is an agent that suppresses the vital activity of microorganisms (disinfectants, antiseptics, sterilants, chemotherapeutic agents, including antibiotics, cleansers, preservatives).

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

Hand antiseptic is an alcohol-based product, with or without the addition of other compounds, designed to decontaminate the skin of the hands in order to interrupt the chain of transmission of infection.

Nosocomial infection (HAI) is any clinically pronounced disease of an infectious nature that affects a patient as a result of a stay in a hospital or a visit to a medical institution, as well as infections that occur in healthcare facility personnel as a result of their professional activities.

Hygienic hand antisepsis is the treatment of hands by rubbing an antiseptic into the skin of the hands to eliminate transient microorganisms.

Invasive interventions - the use of devices and devices that overcome the natural barriers of the body, with which the pathogen can penetrate directly into the bloodstream, organs and systems of the patient's body.

Conventional handwashing is the procedure for washing with water and regular (non-antimicrobial) soap.

Irritant contact dermatitis (CD) is an unpleasant sensation and changes in the condition of the skin, which can manifest itself in dry skin, itching or burning, redness, peeling of the epidermis and the formation of cracks.

Resident microorganisms are microorganisms that constantly live and multiply on the skin.

Spore-forming bacteria are bacteria that have the ability to form special structures covered with a dense shell, they are conditionally called spores, they are highly resistant to the action of many physicochemical factors.

Transient microorganisms are microorganisms that temporarily enter the surface of human skin upon contact with various living and inanimate objects.

Surgical hand antisepsis is the procedure of rubbing an antimicrobial agent (antiseptic) into the skin of the hands (without the use of water) to eliminate transient microorganisms and reduce the number of resident microorganisms as much as possible.

Surgical handwashing is a handwashing procedure using a special antimicrobial agent to eliminate transient microorganisms and reduce the number of resident microorganisms as much as possible.

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

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

2. Proper hand washing

Proper hand washing includes the following steps.

Moisten your hands with warm running water and apply liquid soap or use bar soap.

· Rub hands vigorously for at least 15-20 seconds.

· Scrub all surfaces, including the back of the hands, wrists, between the fingers and under the nails, if necessary - use a special brush.

Rinse your hands well with running water.

· Dry your hands with a clean or disposable towel.

· Use a napkin to turn off the faucet.

Proper use of an alcohol-based disinfectant.

An alcohol-based sanitizer that does not require water is an excellent alternative to handwashing, especially when soap and water are not available. In fact, it is more effective at killing bacteria and viruses than soap and water. Commercial disinfectants contain ingredients that help prevent dry skin. The use of such products is more effective in reducing dry skin and soothing irritations than washing hands in the usual way.

However, not all disinfectants are the same. Some waterless disinfectants do not contain alcohol, which reduces their disinfectant qualities. Therefore, use only alcohol-based products. The Centers for Disease Control and Prevention recommends choosing foods that contain at least 60% alcohol.

To use an alcohol-based disinfectant:

Dispense approximately ½ teaspoon of product into the palm of your hand.

· Rub your hands, covering all surfaces until dry.

· However, if your hands are extremely dirty, wash them with soap and water, if available.

You should wash your hands in such cases:

Unfortunately, it is impossible to save open hands from getting bacteria on them, at the same time, each of us can limit the spread of bacteria, viruses and other microorganisms through the hands.

Always wash your hands:

· After going to the toilet.

After changing diapers. Also wash your hands and the person you changed diapers.

After contact with animals and animal waste.

· Before and after food preparation - especially before and immediately after contact with raw meat, poultry or fish.

· Before eating.

After clearing the nose.

· After you sneezed or coughed into your hands.

Before and after treatment of wounds or cuts.

Before and after contact with a sick or injured person.

· After contact with debris.

· Before inserting or removing contact lenses.

· After visiting public toilets, such as at airports, railway stations, bus stations and restaurants.

3. Dangers of dirty hands

Despite the proven benefits of handwashing, many people don't practice it as often as they should - even after going to the toilet. Meanwhile, during the day, we accumulate bacteria on our hands from various sources - direct contact with people, contaminated surfaces, food, animals and their waste products. If you don't wash your hands often enough, you can infect yourself with bacteria when you touch your eyes, nose, or mouth. You can also spread these bacteria to other people by touching them or surfaces they also touch, such as doorknobs.

Infectious diseases that are commonly spread through hand contact include the common cold, flu, and a number of gastrointestinal disorders such as infectious diarrhoea. While most people get over a cold well, the flu can be a much more serious illness. Some people with the flu, especially older people and people with chronic illnesses, can develop pneumonia. The combination of influenza with pneumonia is the eighth leading cause of death among Americans. Inadequate hand hygiene also contributes to the development of diseases associated with poor quality food, such as salmonellosis and dysentery.

4. Hand washing technique

Hand washing technique includes hand washing warm water soap or using an alcohol-based disinfectant. Antimicrobial wipes are as effective as soap and water but are inferior in their cleaning power to alcohol-based disinfectants.

IN last years Antibacterial soaps are becoming more and more popular. However, this soap is no more effective at killing germs than regular soap.

Purpose: decontamination of hands (kill all microorganisms)

Indications:

Before eating, feeding the patient, working with food

After going to the toilet

Before and after patient care

Any soiled hands

Necessary equipment: sink, paper napkins, liquid soap with dispenser, paper towel.

Execution features

Theoretical justification

I. Preparation for the procedure 1. Remove rings, bracelets, watches

make it difficult effective removal microorganisms

2. Open the faucet, adjust the water temperature

Water should be moderately warm

Hot water opens the pores and promotes the release of microorganisms to the surface of the skin

II. Carrying out procedure 3. Moisten hands under running water

To improve the cleaning properties of soap

4. Apply liquid soap to the palm

Most preferably liquid soap in single use dispensers. Reusable dispensers become contaminated over time: do not add liquid soap to a partially filled dispenser. It should be emptied, washed, dried and only then filled with a fresh portion of soap.

To improve the quality of hand washing

5. Lather liquid soap

Soap is foamed by intense rubbing of the palms against each other

Foam has detergent properties

6. Rubbing the wrists in circular motions

Removing dirt from hands

7. Palm friction: palm to palm

8. Friction of the back of the hand

Right palm over the back of the left hand. Left hand over the back right hand.

9. Palm to palm, fingers of one hand in the interdigital spaces of the other hand

10. Washing your fingertips

The fingers are bent and are on the other palm (in the "lock")

11. Rotational thumb friction

12. Rotational friction of the palms

III. End of procedure 13. Wash off soap from hands

Soap is washed off the hands in the same order as when washing hands.

Removing soap from hands along with dirt and microorganisms

5. Hand treatment is divided into three levels

Household level (machining of hands).

· Hygienic level(treatment of hands with the use of skin antiseptics).

· Surgical level (a special sequence of manipulations in the treatment of hands, followed by putting on sterile gloves).

6. Mechanical processing of hands

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

After visiting the toilet;

Before eating or before working with food;

Before and after physical contact with the patient;

Required equipment:

Liquid dosed neutral soap or individual disposable soap in pieces. It is desirable that the soap does not have a strong odor. Open liquid or bar reusable non-personal soap quickly becomes infected with germs.

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

Hand treatment 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 all over again. It is believed that during the first soaping and rinsing with warm water, microbes are washed off the skin of the hands. Under the influence of warm water and self-massage, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes are washed away from the opened pores.

Warm water makes the hand sanitizer or soap work more effectively, while hot water removes the protective fatty layer from the surface of the hands. In this regard, you should avoid using too hot water for washing your hands.

Hand treatment - the necessary sequence of movements

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

Rub the back surface of the left hand with the right palm, change hands.

Connect the fingers of one hand in the interdigital spaces of the other, rub internal surfaces fingers up and down.

Connect the fingers in a "lock", rub the palm of the other hand with the back of the bent fingers.

Grasp 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.

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

The above manipulations are illustrated on the next page - see EN-1500 diagram. Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute.

It is very important to follow the described handwashing technique, since special studies have shown that during routine handwashing, certain areas of the skin (fingertips and their inner surfaces) remain contaminated.

After the last rinse, the hands are wiped dry with a napkin (15x15 cm). The faucets are closed with the same napkin. The tissue is discarded into a container with a disinfectant solution for disposal.

In the absence of disposable wipes, it is possible to use pieces of clean cloth, which, after each use, are discarded into special containers and, after disinfection, sent to the laundry. Replacing disposable wipes with electric dryers is impractical, because. with them, there is no rubbing of the skin, which means that there is no removal of detergent residues and desquamation of the epithelium.

7. Hand hygiene

The purpose of hygienic treatment is the destruction of the microflora of the skin with the help of antiseptics (disinfection).

Such hand treatment is carried out:

before putting on gloves and after removing them;

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

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

after contact with body fluids (e.g. blood emergencies).

Napkins size 15x15 cm disposable, clean.

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

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 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. The sequence of movements during the processing of hands corresponds to the EN-1500 scheme. Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute.

Hygienic antiseptic

The standard method of rubbing an antiseptic includes 6 stages. Each step is repeated at least 5 times.

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

During the entire time of rubbing the product, the skin is kept moist from the antiseptic, so the number of servings of the rubbed product is not strictly regulated. The last portion of the antiseptic is rubbed until it is completely dry. Hand wiping is not allowed.

When performing hand treatment, the presence of so-called "critical" areas of the hands that are not sufficiently wetted with an antiseptic are taken into account: thumbs, fingertips, interdigital zones, nails, periungual ridges and subungual zones. The surfaces of the thumb and fingertips are treated most carefully, since they contain the largest number of bacteria.

In the presence of visible contamination of the hands, remove it with a napkin moistened with an antiseptic, and wash hands with detergent. Then they are thoroughly washed with soap and water and dried with a disposable towel or napkins. Close the faucet with the last napkin. After that, the hands are treated with an antiseptic twice for 30 seconds.

Advantages of hygienic handrub with alcohol-based hand rubs compared to conventional handwashing

The errors of hygienic antiseptics include the possible rubbing of an alcohol antiseptic into hands that are wet from the antiseptic, which reduces its effectiveness and skin tolerance.

Saving antimicrobial agent and reducing exposure time makes any hand sanitizing method ineffective.

Surgical treatment of hands

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

Such hand treatment is carried out:

before surgical interventions;

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

Required equipment:

Liquid dosed pH-neutral soap or individual disposable soap bars.

Napkins size 15x15 cm disposable, sterile.

Skin antiseptic.

Disposable sterile surgical gloves.

Hand treatment rules:

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. In contrast to the above-described method of mechanical cleaning at the surgical level, the forearms are included in the treatment, sterile wipes are used to get wet, 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.

Routine hand washing before hand debridement

Routine washing prior to debridement is performed in advance in the ward or lock room of the operating unit, alternatively in the antiseptic hand treatment room, in the preoperative room before the first operation, and then as needed.

Normal washing is intended exclusively for mechanical cleaning of the hands, while dirt, sweat are removed from the hands, spore-forming bacteria are partially washed off, as well as transient microorganisms are partially washed off.

Surgical hand sanitizer

Surgical hand antisepsis is carried out using various alcohol antiseptics by rubbing them into the hands and forearms, including the elbows.

Rubbing the product is carried out in accordance with the developed standard procedure:

if necessary, wash hands with detergent, rinse thoroughly;

dry hands thoroughly with a disposable towel;

using a dispenser (press the lever with your elbow), pour the antiseptic into the deepening of a dry palm;

first of all, moisten the hands with an antiseptic, then the forearms and elbows;

rub the antiseptic in separate portions for the time specified by the developer, while holding the hands above the elbows;

after antiseptic treatment, do not use a towel, wait until the hands are completely dry, put on gloves only on dry hands.

The antiseptic is applied to the hands in portions (1.5 - 3.0 ml), including the elbows and rubbed into the skin for the time specified by the developer. The first portion of the antiseptic is applied only to dry hands.

Throughout the entire time of rubbing the antiseptic, the skin is kept moist from the antiseptic, so the number of servings of the rubbed product and its volume are not strictly regulated.

During the procedure, special attention is paid to the standard method of treating hands with an antiseptic according to EN 1500.

Each processing step is repeated at least 5 times. When performing the hand treatment technique, the presence of the so-called "critical" areas of the hands that are not sufficiently wetted by the agent is taken into account: thumbs, fingertips, interdigital zones, nails, periungual ridges and subungual zones. The surfaces of the thumb and fingertips are treated most carefully, since they contain the largest number of bacteria.

Surgical hand washing

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

phase - normal hand washing.

Before the beginning of the 2nd phase of surgical washing, the hands, forearms and elbows are moistened with water, except for those products that, according to the developer's instructions, are applied to dry hands, and then water is added.

The antimicrobial detergent in the amounts provided by the developer is applied to the palms and distributed over the surface of the hands, including the elbows.

Throughout the entire time of washing, the hands and forearms are moistened with an antimicrobial detergent, so the amount of the product is not strictly regulated. The hands are kept up all the time.

Hands are dried with a sterile towel or sterile wipes in compliance with the rules of asepsis, starting from the fingertips.

Surgical sterile gloves are worn only on dry hands.

General requirements

Healthcare staff keep their hands clean. It is recommended that the nails be cut short to fingertip level, without polishing and cracking on the surface of the nails, and without false nails.

Before processing hands, bracelets, watches, rings are removed.

Equipment for hand hygiene.

Tap water.

Washbasin with cold and hot water and a mixer, which is preferably operated without the touch of hands.

Closed containers with taps for water in case of problems with the supply of water.

Liquid soap with neutral pH.

Alcoholic antiseptic.

Antimicrobial detergent.

Skin care product.

Non-sterile and sterile disposable towels or wipes.

Dosing devices for detergents and disinfectants, skin care products, towels or wipes.

Containers for used towels and napkins.

Disposable rubber gloves, non-sterile and sterile.

Domestic rubber gloves.

In the room where hand treatment is carried out, the washbasin is located in an easily accessible place, equipped with a tap with cold and hot water and a mixer, which is desirable to be activated without touching the hands, and the water jet should be directed directly into the drain siphon to prevent water splashing.

It is advisable to install three dispensers near the washbasin:

with antimicrobial hand sanitizer;

with liquid soap;

Each handwashing place is equipped, if possible, with dispensers for disposable towels, napkins and a container for used products.

Do not add the agent to antiseptic dispensers that are not completely empty. All empty containers must be filled aseptically to prevent contamination. It is recommended to use disposable containers.

Detergent and skin care dispensers are recommended to be thoroughly washed and disinfected before each new filling.

In the absence of a centralized water supply or in the presence of another problem with water, the departments are provided with closed water tanks with taps. Boiled water is poured into the container and it is changed at least once a day. Before the next filling, the containers are thoroughly washed (if necessary, disinfected), rinsed and dried. Non-sterile gloves are recommended for:

contact with the hoses of artificial respiration apparatuses;

work with biological material from patients;

blood sampling;

carrying out intramuscular, intravenous injections;

equipment cleaning and disinfection;

removal of secretions and vomiting.

Requirements for medical gloves:

for operations: latex, neoprene;

for examinations: latex, tactylone;

when caring for a patient: latex, polyethylene, polyvinyl chloride;

it is allowed to use gloves made of fabric under rubber ones;

gloves must be of the appropriate size;

gloves should provide high tactile sensitivity;

for pre-sterilization cleaning of sharp medical instruments, it is necessary to use gloves with a textured outer surface.

Immediately after use, medical gloves are removed and immersed in a disinfectant solution, directly at the point of use of the gloves.

After disinfection, disposable gloves must be disposed of.

Rules for the use of medical gloves:

the use of medical gloves does not create absolute protection and does not exclude the observance of the hand treatment technique, which is used in each individual case immediately after removing the gloves in case of a threat of infection;

disposable gloves cannot be reused; non-sterile gloves cannot be sterilized;

gloves should be changed immediately if they are damaged;

it is not allowed to wash or treat hands with gloves between "clean" and "dirty" manipulations, even for one patient;

it is not allowed to move with gloves in the department (s) of the hospital;

Do not use products containing mineral oils, petroleum jelly, lanolin, etc. before putting on gloves, as they may damage the strength of the gloves.

The chemical composition of the glove material can cause immediate and delayed type allergies or contact dermatitis (CD). CD can appear when using gloves made of any material. This is facilitated by: prolonged continuous use of gloves (more than 2 hours), use of gloves powdered inside, use of gloves with existing skin irritation, putting gloves on wet hands, using gloves too often during the working day.

Mistakes that often occur when using gloves:

use of medical disposable gloves when working in the catering department. In these cases, preference should be given to reusable gloves (household);

improper storage of gloves (in the sun, at low temperatures, contact with gloves chemical substances and so on.);

putting on gloves on hands moistened with the remnants of an antiseptic.

hand hygiene medical antiseptic

10. Possible negative consequences of hand treatment and their prevention

In case of violation of the requirements of the instructions / guidelines for the use of hand sanitizers and with a careless attitude to preventive skin care, KD may occur.

The cause of CD can also be:

frequent use of antimicrobial detergent;

prolonged use of the same antimicrobial detergent;

increased sensitivity of the skin to the chemical composition of the funds;

the presence of skin irritation;

Washing your hands too often, especially with hot water and alkaline or non-softening detergents

putting on gloves on wet hands;

lack of a reasonable skin care system in a medical institution;

For the prevention of KD, in addition to avoiding the causes of KD, it is recommended to fulfill the following basic requirements:

provide staff with hand sanitizers that are potentially mild hand irritants and yet effective;

when selecting an antimicrobial agent, take into account its individual acceptability for the skin, smell, consistency, color, ease of use;

introduce into practice antiseptics made on the basis of alcohol with frequent use dry the skin of the hands.

11. Properties of an alcohol-based antiseptic

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

12. Hand care

Hand skin care is an important condition for preventing the transmission of HAI pathogens, because only intact skin can be effectively treated with an antimicrobial agent.

KD can only be avoided if a skin care system is implemented in the healthcare facility, as there is a potential risk of skin irritation with the use of any antimicrobial agent.

When choosing a skin care product, the type of skin of the hands and the following properties of the product are taken into account: the ability to maintain the normal state of skin grease, moisture, pH at 5.5, ensuring skin regeneration, good absorption, the ability of the product to give skin elasticity.

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

The choice of skin care products depending on its type

Bibliography

1. Anichkov S.V., Belenky M.L. Textbook of pharmacology. - MEDGIZ Leningrad Association, 1955.

Krylov Yu.F., Bobyrev V.M. Hand washing technique. - M.: VKhNMTs MZ RF, 1999. - 352 p.

Kudrin A.N., Skakun N.P. Washing technique and medicines: "Medicine" series. - M.: Knowledge, 1975

Prozorovsky V.B. Medical stories. - M.: Medicine, 1986. - 144 p. - (Scientific-popular medical literature).

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. About 80-90% of permanent microorganisms are in the superficial layers of the skin and 10-20% are in the deep layers of the skin (in the sebaceous and sweat glands and hair follicles). The use of soap in the process of washing hands allows you to remove most of the 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 their inner surfaces remain contaminated. 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 lathering and rinsing with warm water, germs 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. Grasp the base of the thumb of the left hand between the thumb and forefinger of the right hand, rotational friction. Repeat on the wrist. Change hands.

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

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 of 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 processed with disposable sterile wooden sticks soaked in an antiseptic solution. Brushes are not required. If brushes are still used, sterile, soft, disposable or autoclavable brushes should be used, and brushes should only be used on the periungual area and only for the first brushing of a work shift.

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).

It is known that human skin performs a number of important functions, one of which is protection from harmful factors. environment. The skin, especially the skin of the hands, is constantly colonized by microorganisms. Intact (intact) human skin, even if thoroughly washed, is colonized by microorganisms that may be different for individual skin areas and relatively constant for each person.

The microflora of human skin is divided into resident and transient.

Resident (permanent) microflora is represented by bacteria that constantly live and multiply in the skin. These microorganisms colonize the deeper layers of the skin, including the sebaceous, sweat glands and hair follicles, and are mainly represented by coagulase-negative staphylococci (usually Staphylococcus epidermidis) and diphtheroids (Coryntbacterium spp.) Basically, the resident microflora does not cause pathological processes in patients with intact skin, however, it can cause an infectious process if it enters the sterile cavities of the human body. Resident microorganisms are almost impossible to remove, but their numbers can be significantly reduced. In the same time hand sterilization is not only impossible, but also undesirable, because the resident microflora prevents the colonization of the skin by more dangerous microorganisms, and also synthesizes fatty acids that have an antimicrobial effect.

Transient (temporary) microflora is represented by microorganisms that have temporarily settled on the skin of the hands, they colonize the surface layers of the skin and are of the greatest epidemiological significance. The transient microflora can consist of any microorganisms, including pathogens, including pathogens of nosocomial (nosocomial) infections, such as Escherihia coli, Klebsiella spp, Pseudomonas spp, Salmonella spp., St. Aureus (including MRSA), Candidae albicans, rotaviruses, etc. When the skin is damaged, including during the use of inadequate hand washing and disinfection methods, the transient microflora penetrates deeper into the skin, displacing the resident flora from there.

The transmission of microorganisms through the hands depends on various conditions, including the type of microorganisms, the possibility of their survival on the hands, the degree of insemination of the skin by microorganisms, etc. At the same time, the species composition of the microflora of the skin of the hands of medical personnel depends on the profile of the institution or department and the nature professional work. According to the Central Research Institute of Epidemiology (Moscow, Corresponding Member of the Russian Academy of Medical Sciences, Professor N. A. Semina, Professor A. P. Kovaleva), the number of nosocomial infections in Russia is 52-60 thousand annually. It has been proven that the cause of infections in hospitals in 50-80% of cases is the hands of medical personnel, that is, hands are one of the key factors in the transmission of pathogenic microorganisms both from medical personnel to patients and vice versa. According to an analysis of statistics from the American Society for Disease Control and Prevention (CDC), about 2 million patients annually receive nosocomial infections during treatment. The so-called nosocomial or hospital-acquired infections cause not only suffering and death of patients. They also cause significant economic damage and cost the US $5 billion annually in additional hospitalizations and expensive antibiotic treatment. All of the above emphasizes once again the extreme importance of strict adherence to the principles of hand hygiene.

Methods for processing the hands of medical personnel

Hand hygiene is a general term used to define procedures such as routine hand washing, hygienic hand disinfection, and surgical hand disinfection.

Routine hand washing- this is hand washing with water and ordinary (not antiseptic) soap.

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

• before direct contact with the patient;
• before performing invasive procedures;
• before and after manipulations with wounds and catheters.
• before and after putting on gloves;
• after contact with body fluids or after possible microbial insemination;
• before procedures in immunocompromised patients;
• before examination of a clean area after contact with a contaminated area of ​​the body, etc.

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

Can be performed using special antiseptic formulations during surgical washing. There are two ways of hygienic hand disinfection: hygienic hand washing and hand sanitizing (rubbing) with an antiseptic.

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

Hand treatment with antiseptic is more often used in practice and, according to the results of laboratory studies, is more effective. Hands are wiped with a sufficient amount of an antiseptic without adding water to it before and during the procedure (most often this is a preparation based on a combination of alcohols with various antiseptic additives) so that the skin remains moist during the required exposure time from 30 to 60, depending on the manufacturer's recommendations . In this case, the nails and fingertips should be treated most carefully.

Hygienic processing of hands(using an antiseptic) after performing medical procedures should be carried out before washing, and not vice versa, in order to avoid contamination of surrounding surfaces by pouring contaminated water. When caring for patients with infections caused by spore-forming bacteria (eg, Clostridium difficile), using antiseptics alone without first washing the hands will not provide reliable decontamination due to the fact that they do not have sporicidal properties. activity. In such cases, and also if the skin needs to be cleaned of visible contaminants (including those of organic origin), the previous hygienic handwashing is mandatory before treating the hands with an antiseptic.

An important condition for the effectiveness of hand hygiene is the observance of the following rules:

• when carrying out hygienic disinfection of hands by wiping with an alcohol antiseptic, it is necessary to apply the product on the palm of one hand and rub over the entire surface of the hands and fingers of both hands until they are completely dry.
• when washing hands, they must first be moistened with water, then applied required amount means and thoroughly rub hands for at least 15 seconds to treat the entire surface of the hands and fingers, then wash hands with water and dry them thoroughly with a disposable towel, which is used to turn off the tap;
• it is advisable to use small bars of soap and use racks in the form of lattices for its quick drying.
• It is not recommended to use reusable fabric towels.

Surgical hand disinfection- this is the treatment of hands before surgery, which ensures the removal of transient and a decrease in the amount of resident microflora of the hands.

Surgical hand disinfection can be performed using special antiseptic formulations during surgical washing. This method has been used for a long time, and the recipes used have long been known. These are such as treatment with chlorhexidine bigluconate (Gibitan), C-4 formulation (Pervomur), etc. These antiseptic formulations are quite aggressive for the skin, especially considering the frequency of their use by medical personnel who take part in surgical interventions. In addition, the use of special brushes during surgical washing with the use of the aforementioned antiseptic formulations also leads to mechanical damage to the skin, the appearance of microtraumas.

Promising today is the use of antiseptics for surgical hand disinfection, made on the basis of a combination of alcohols with other antimicrobial additives. Such drugs are characterized by a rapid detrimental effect on the microflora, high antimicrobial properties. For surgical hand disinfection, the same preparations can be used as for hygienic disinfection, with the difference being an increase in the amount of antiseptic per treatment (from 6 - 10 ml - wrists and forearms need additional treatment) and an extension of time and exposure to five minutes depending on the manufacturer's recommendations. It is not necessary to use brushes during processing.

In order to reduce the number of microorganisms that multiply on the skin of the hands under gloves, the use of antiseptics with components that provide a prolonged antimicrobial effect is quite effective. Reducing the number of resident bacteria in the skin of the hands of members of the surgical team during the operation reduces the risk of bacteria entering the area of ​​the surgical field in cases of piercing or tearing gloves during surgical interventions.

For effective surgical hand disinfection, the following rules must be strictly adhered to:

• before surgical disinfection, remove rings, rings, watches and bracelets;
• wash hands with soap and water, preferably liquid (the use of antiseptic soap is not necessary);
• dry thoroughly with sterile wipes (before starting treatment with an antiseptic, the skin must be completely dry, because rubbing the antiseptic into moistened skin leads to its dilution, a decrease in effective concentration and, as a result, to the impossibility of achieving the desired result.
• during treatment, skin areas should remain moistened with an antiseptic, while the drug is applied to the hands in portions of 3-5 ml;
• completely dry the skin before putting on sterile gloves in order to prevent the intensive growth of microorganisms, which can occur in the wet layer.

Of the available antiseptics, alcohols are the safest, while ethyl alcohol is less irritating than propyl or isopropyl alcohol.

Side effects of antiseptics on the skin of the hands of staff.

According to various studies, approximately 25% of nursing staff experience symptoms and signs of dermatitis localized on the skin of the hands. Skin irritation associated with the use of antiseptic soap can be due to both the antimicrobial agent in its composition and other components. Damage to the skin also leads to a change in the composition of its microflora, increasing the frequency of colonization by staphylococci and gram-negative microorganisms.

Of the available antiseptics, alcohols are the safest, while ethyl alcohol is less irritating than n-propyl or isopropyl alcohol. Most often, contact dermatitis is observed when using iodoform. Other antiseptics that can cause contact dermatitis include chlorhexidine, chloroxylene, triclosan, and alcohol-based products. However, factors that cause contact dermatitis associated with frequent handwashing may include the following: use of very hot water for washing, low relative humidity air (especially in winter), insufficient use of protective creams, poor quality paper towels and allergies to latex.

It is worth noting that most often the cause of contact allergies when using hand hygiene products is flavors and preservatives, and less often emulsifiers. Liquid soaps, lotions, and creams may contain ingredients that can cause allergic contact reactions in healthcare workers. Alcohol-containing products for hygienic disinfection rarely cause allergic dermatitis, but it must be borne in mind that in order to enhance antimicrobial properties, alcohol-containing preparations are combined with various substances, for example, quaternary ammonium compounds (QAC), lactic acid, chlorhexidine bigluconate, octenidine hydrochloride, etc.

IN Lately new antiseptics in the form of gels are offered on the antiseptic market.

Due to their formulation, such preparations are suitable for antiseptic treatment of skin that is especially sensitive to irritations.

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

• reducing the frequency of use of irritants (especially anionic detergents);
• replacement of products that have a strong irritant effect with those that irritate the skin less;
• health workers training correct use antiseptics;
• providing healthcare workers with skin care products and protective creams.

Reducing the frequency of hand hygiene use of antiseptics is an undesirable strategy given the low level of adherence to hand hygiene among health workers. The introduction of alcohol-containing antiseptics with emollient additives into practice makes it possible to reduce the frequency of exposure of personnel to irritating substances (soaps and detergents).

General approaches to the choice of antiseptics

The administration of the health care facility should take into account that the acquisition of more effective antiseptics improves the practice of hand hygiene, which means that it is possible to prevent the occurrence of nosocomial infections. Attention to just a few cases of nosocomial infections compensates for the additional costs of the PHC associated with the purchase of more effective means for hand hygiene.

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

The cost of hand hygiene products should not be a major factor in their selection, as low-priced hand sanitizers may not contain highly effective skin care additives that prevent allergies and skin irritations.

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 nails, no nail polish, no artificial nails, the absence 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 subdivisions 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 bedside of the patient, etc.). It should also provide for the possibility of providing 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 processes hands at a social and hygienic level within their 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), clock with a 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 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

The hygiene of the hands of medical workers - doctors, nurses and other hospital staff is a mandatory procedure.

During it use special means approved by the Committee of Pharmacology of Russia.

Hands are always treated before and after physical contact with the patient.

Cleansing the skin is aimed at preventing nosocomial infections, removing microbes and other decay products from the hands. It provides protection to the patient and the physicians themselves from infections.