In order to prevent nosocomial infections, the hands of medical workers are subject to disinfection (hygienic treatment of hands, disinfection of surgeons’ hands) and the skin of patients (treatment of surgical and injection fields, elbow bends of donors, sanitary treatment skin).
Hand hygiene should be an integral part of the system of measures to combat and prevent nosocomial infections in a medical organization.
Algorithms/standards for all epidemiologically significant therapeutic and diagnostic procedures must include recommended means and methods of hand treatment when performing the relevant manipulations.
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 with a high workload on staff (resuscitation and intensive care units, etc.), dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by staff (at the entrance to the ward, at the patient’s bedside and etc.). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (100-200 ml) with skin antiseptic
Depending on the medical procedure being performed and the required level of reduction in microbial contamination of the skin of the hands, medical personnel perform hygienic treatment of hands or treatment of the hands of surgeons. The administration organizes training and monitoring of compliance with hand hygiene requirements by medical personnel.
Hand hygiene includes two methods:
Hygienic hand washing - washing hands with soap and water to remove contaminants and reduce the number of microorganisms;
Hand hygiene is the treatment of hands with an alcohol-based skin antiseptic to reduce the number of microorganisms to a safe level.
Treatment of surgeons' hands
1. Hygienic hand washing
Indications for hygienic hand washing
For all types of normal hand contamination;
Before and after any physical contact with the patient;
Before preparing and serving food, before eating;
After performing certain natural functions of your own body (sneezing, blowing your nose, coughing, going to the toilet, etc.).
Soap requirements:
Soap can be used in any standard form (liquid, solid, granular, powder, etc.);
Bar soap should be stored in magnetic soap dishes that have good stock for water, which ensures the soap dries;
Preference is given to liquid soap in standard dispensers, because... in this case, contact of the personnel’s skin with soap is excluded, which prevents infection;
When using reusable dispensers: Do not add soap to a partially emptied dispenser. After the dispenser is completely emptied of soap, it is thoroughly washed, disinfected, dried and only then refilled with soap.
Hand washing technique.
Hand washing with soap is carried out under a moderate stream comfortably warm water within 10-20 seconds.
Hands are generously lathered with soap and then 6 standard stages (There are no requirements for a strict sequence of stages):
rub palm against palm, “lock” movement - washing
nail phalanges
rub the back and sides in a circular motion
surface of fingers thumbs (alternately)
each hand (alternately)
Hand washing at social, hygienic, surgical level
Hand washing is the most effective method warnings of nosocomial infections in health care facilities.
1) social (regular hand washing);
2) hygienic (disinfection of hands);
3) surgical (sterility of surgeons’ hands is achieved for a certain time).
Conditions for achieving effective hand washing and disinfection, their preparation: short-cut nails, no nail polish, no artificial nails, no rings, rings or other rings on the hands jewelry. Before treating surgeons' hands, it is also necessary to remove watches, bracelets, etc.
Routine hand washing. It is carried out before starting any work.
Target: remove dirt and temporary (transient) microflora from the skin of your hands by washing twice with soap and water.
Indications: when hands are contaminated, before and after a medical procedure, with and without gloves, when caring for a patient (if the hands are not contaminated with the patient’s biological fluids), before eating, feeding the patient, and also after visiting the toilet.
Equipment: liquid soap, neutral, odorless, soap dispenser (dispenser), clock with second hand, warm running water. To dry your hands, use 15x15 disposable napkins and a faucet napkin.
| Stage | Rationale |
| Preparation for the procedure | |
| 1. Fulfill the mandatory conditions for achieving effective hand washing and disinfection, check the integrity of the skin of the fingers | There may be skin maceration (damage to the epidermis), which prevents hand decontamination |
| 2. Roll up the sleeves of the robe | Dripping water should not get on the sleeves of the robe. |
| 3. Open the tap, adjust the water temperature (35-40 0 C) | Optimal water temperature for hand decontamination |
| Executing the procedure | |
| 1. Lather your hands and wash the water tap with soap (the elbow tap is not washed) | The water tap is being decontaminated |
| 2. Lather your hands for 30 s, rinsing the soap with water and paying attention to the phalanges and interdigital spaces of the hands, then wash the back and palm of each hand and rotational movements wash the bases of your thumbs | Uniform decontamination of the hands is ensured if the surface is soaped thoroughly and evenly. During the first soaping, the bulk of the microflora is washed off, then after exposure to warm water and self-massage, the pores open and are washed away. It must be remembered that hot water removes the protective fat layer of the skin. |
| 3. Rinse your hands under running water To remove soap scum, hold your hands so that the water flows into the sink from your forearms or elbows (do not touch the sink). Repeat steps 2 and 3 of the procedure | The phalanges of the fingers should remain the cleanest |
| Completing the procedure | |
| 1. Close the tap using a napkin (close the elbow tap with your elbow) | |
| 2. Dry your hands with a dry, clean personal towel or using a dryer | According to the principle “from clean to dirty”, i.e. from the fingertips (they should be the cleanest) to the elbow |
Hygienic level of hand washing
There are two processing methods:
1) Hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;
2) Hygienic treatment of hands with a skin antiseptic to reduce the number of microorganisms to a safe level.
Hand hygiene should be carried out in the following cases:
- before direct contact with the patient;
- after contact with the patient’s intact skin (for example, when measuring 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.
Target: remove or completely destroy transient microflora from hands.
Equipment: liquid soap, soap and skin antiseptic dispensers, a clock with a second hand, warm running water (30-40 0 C), sterile tweezers, cotton balls, napkins, skin antiseptic, waste disposal container with a disinfectant solution.
Execute prerequisites - the same as for social hand processing. To dry hands, use clean cloth towels or disposable paper napkins; when treating surgeons' hands, use only sterile cloth ones.
It is important to observe the exposure time: hands must be wet from applying the antiseptic for at least 15 s.
The dentist performs all his main actions with his hands. For this reason, the cleanliness of the dentist's hands has vital importance. After all, numerous microbes that reside on the skin of unwashed hands, if they get into open wounds, can cause infection with the subsequent development of pathological processes. Because necessary procedure When preparing a doctor for work, he sanitizes his hands to ensure that they are free of microorganisms that can cause disease.
The microflora of the skin includes both microorganisms that constantly live on the skin and bacteria, viruses, protists and fungi that enter the skin surface upon contact with the external environment. It is the temporary inhabitants of the skin of the hands that include Staphylococcus aureus and other dangerous bacteria. The bulk of microorganisms that constantly live on the skin are located in its surface layer. A small part of them (about ten to twenty percent) penetrates into the deep layers of the skin, the ducts of the sebaceous glands and hair follicles.
Staphylococci are gram-positive
spherical bacteria that, when examined microscopically, resemble bunches of grapes.
Before performing surgical procedures, it is necessary to remove both permanent and temporary microflora from the skin of the hands. Regular hand washing with soap makes it possible to clean your hands of the bulk of temporary microorganisms. However, this method of sanitization is not enough to remove the permanent inhabitants of the deep layers of the skin.
Due to the risk of infection during various medical procedures, hand hygiene of doctors and other medical workers is strictly regulated. There are rules for treating the hands of medical personnel, determined by the specific working conditions and the level of existing risks. So, what are the ways to ensure the required cleanliness of the skin?
Types of hygiene procedures when preparing a doctor for work
In accordance with the requirements for cleanliness of the skin, the following hygiene procedures are applied when preparing medical staff for work:
- Routine hand washing.
- Hygienic disinfection of the skin.
- Surgical hand disinfection.
Each subsequent method provides more high level cleansing the skin of microbiological contaminants.
Simple hand washing
In case of moderate contamination of the skin surface of the hands, ordinary soap and water are used to remove contaminants. Disinfectants are not used. This method hygiene ensures the elimination of dirt and a reduction in the number of microbes on the skin surface.
Routine hand washing is mandatory in the following situations:
- before starting food preparation and dispensing;
- immediately before meals;
- after bowel movements;
- before and after contact with the patient;
- before and after patient care activities;
- for any obvious contamination of the skin surface.
When thoroughly cleaning your hands using detergents, about ninety-nine percent of temporary microorganisms are eliminated from the skin. As studies have shown, the formal implementation of this hygienic procedure does not ensure the removal of contamination from the fingertips, as well as their internal surfaces. Therefore, the rules for hand treatment require the use of a certain washing method, which includes the following actions:
- removing watches and various accessories from hands that interfere with the cleansing of microflora from the skin;
- applying a layer of soap to the skin surface;
- rinsing hands with running warm water;
- repeating the procedure.
When the procedure is performed for the first time, microorganisms are removed from the surface of the skin. Its repetition ensures the elimination of bacteria from pores that have opened under the influence of water at a temperature above room temperature and from massaging the skin surface.
It is advisable that the water be warm, but not hot, when cleaning your hands. Too heat water leads to washing away the layer of fat that protects the skin surface.
Currently, the rules for hand washing of medical personnel require washing hands not randomly, but by performing a certain sequence of movements that corresponds to the accepted European standard.
What actions should you take while washing your hands?
When washing off contaminants from the skin of the hands, a medical worker must perform the following sequence of movements:
- Rubbing palms against each other.
- Alternately rubbing the back of one hand with the palm of the other hand.
- Alternately rubbing the inner surface of the interdigital spaces of one hand with the fingers of the other.
- Friction of the palms with the backs of bent fingers connected into a lock.
- Alternately rubbing the base of the thumb of one hand with rotational movements while covering it with the index and thumb of the other hand.
- Rotational rubbing of the wrist of one hand while grasping it with the index and thumb of the other hand.
- Rubbing the palm of one hand with rotational movements of the fingertips of the other hand.
Hand treatment rules in pictures
Each movement when washing hands should be repeated at least five times. The duration of the entire procedure should be at least half a minute.
What is used for hand washing in clinics
When cleaning hands in medical institutions, it is recommended to use liquid soap poured into disposable bottles. However, it is not advisable to fill a bottle with detergent that already contains soap, as it may become contaminated. It is best if the liquid soap dispenser is equipped with a hermetic pump, which prevents microbes and air from the external environment from entering the container with soap, and ensures complete pumping of soap from the bottle.
When using bar soap in medical institutions, the latter should be divided into small portions. Large pieces will remain in a humid environment for too long, as a result of which intensive proliferation of microorganisms may begin in the soap. It is desirable that the design of the soap dish ensures that the bar of soap dries in between hygiene procedures.
What is the best way to dry your hands after washing?
The best option for drying the skin after hygienic treatment is disposable paper towels, which, after washing and drying hands, are used to close the taps and thrown away. You can also use a clean cloth that can be washed after one use.
After sanitizing hands in medical institutions, it is undesirable to use electric dryers due to the too low speed of the drying process.
It is not advisable for doctors, nurses and other healthcare workers to wear rings on their hands at work, as such jewelry interferes with the elimination of germs. For the same reason, you should not cover your nails with varnish. Also undesirable are manicure procedures that can lead to the appearance of microscopic wounds that are easily infected during work.
Hand hygiene stations must have convenient location throughout medical institution. In the wards, as well as in those rooms where diagnostics and procedures involving penetration into the body are carried out, their own washstands must be installed.
What is hygienic disinfection?
The purpose of this type of sanitization is to prevent the spread of pathogenic microorganisms throughout the clinic through the hands of medical workers. Hygienic skin disinfection is used in the following situations:
Before carrying out manipulations associated with penetration into the body, as well as before starting therapeutic measures with patients who have an increased susceptibility to infections.
- Before starting work on wounds and upon completion.
- In case of contact with blood, saliva, mucus, urine or feces of the patient.
- If there is a possibility of contamination of hands with pathogenic microorganisms through various objects.
- Before working with infectious patients and after its completion.
The procedure for hygienic hand disinfection includes two stages:
- Actually hygienic disinfection.
Under machining This means routine hand washing twice. Actually, hygienic disinfection consists of applying at least three milliliters of an antiseptic to the skin. To disinfect the skin surface, both ethanol-based disinfectants and aqueous solutions of antiseptics can be used, and the former are more effective.
Hand treatment with Sterillium
During the first stage of the procedure, you can use both regular soaps and soaps with an antiseptic additive. After washing your hands, the disinfectant solution is applied to the skin and rubbed in with movements, each of which is repeated at least five times until the skin becomes dry. There is no need to wipe your hands after treating your skin with a disinfectant. The duration of antiseptic treatment should be at least half a minute.
If the skin of your hands was not contaminated before the procedure - for example, the doctor has not yet had contact with the patient - then you can skip pre-washing your hands and immediately apply an antiseptic to the skin.
Antiseptics can have a negative effect on the skin, causing, for example, dryness and cracking. Therefore, the solution used for disinfection must contain glycerin or lanolin.
What is surgical hand disinfection?
This type of hand sanitization is intended to prevent infection of surgical wounds and, accordingly, to prevent the occurrence of postoperative complications caused by microbes entering the tissue. The procedure for surgical disinfection of hand skin includes the following three stages:
- Mechanical treatment of the skin.
- Treating the skin with antiseptic agents.
- Isolate the skin from the external environment with sterile disposable gloves.
The surgical level of hand disinfection is used in the following situations:
- before performing surgical operations;
- before complex penetrating manipulations.
Rules for hand treatment during surgical disinfection
A feature of mechanical cleaning of the skin surface during surgical disinfection is that the skin of not only the doctor’s hands, but also his forearms is subject to cleaning. Drying the skin is done using sterile wipes. The minimum duration of this stage of the procedure is two minutes. After removing moisture from the skin, additional treatment of the nail beds and periungual folds is carried out with special wood sticks and antiseptic agents. Sterile brushes can also be used for this purpose.
After the first stage of surgical disinfection, ten milliliters of an antiseptic drug is applied to the skin of the hands in portions of three milliliters. The applied product must be rubbed into the skin before it dries, using the same sequence of movements as when washing your hands. The duration of this stage of the procedure should be five minutes.
Before putting on sterile gloves, the skin must be dry. If a doctor works with gloves on for more than three hours, he should surgically disinfect his hands again and put on a new pair of gloves.
After work, you need to wipe the skin of your hands with a disinfected napkin, wash your hands with soap, and then apply a cream to the skin that has a softening and moisturizing effect.
To disinfect the surface of the skin, disinfectants can be used, both water-based and alcohol based. The latter are more preferable. The most common antiseptic formulations are:
It is known that human skin performs a number of essential functions, one of which is protection from harmful factors environment. The skin, especially the skin of the hands, is constantly populated by microorganisms. Intact (unharmed) human skin, even thoroughly washed, is colonized by microorganisms that can be different for individual areas of the skin 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 sebaceous, sweat glands and hair follicles, and are mainly represented by coagulase-negative staphylococci (usually Staphylococcus epidermidis) and diphtheroids (Coryntbacterium spp.). Basically, 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 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 temporarily settle on the skin of the hands; they colonize the surface layers of the skin and are of greatest epidemiological significance. Transient microflora can consist of any microorganisms, including pathogenic ones, 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 methods of washing and disinfecting hands, the transient microflora penetrates deeper into the skin, displacing the resident flora.
The transmission of microorganisms through 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 acquire hospital-acquired infections during treatment. The so-called nosocomial or hospital-acquired infections cause not only the suffering and death of patients. They also cause significant economic damage, costing the United States $5 billion annually in additional hospitalizations and expensive antibiotic treatments. All of the above once again emphasizes the extreme importance of strict adherence to hand hygiene principles.
Hand treatment methods for medical personnel
Hand hygiene - general term, used to define procedures such as routine hand washing, hygienic hand disinfection, and surgical hand disinfection.
Routine hand washing- This is washing your hands with water and regular (not antiseptic) soap.
Hygienic hand disinfection carried out to reduce the number of pathogenic microorganisms on the skin of the hands, used in the following cases:
- before direct contact with the patient;
- before performing invasive procedures;
- before and after manipulation of wounds and catheters.
- before and after putting on gloves;
- after contact with body fluids or after possible microbial insemination;
- before procedures for patients with weakened immune systems;
- before examining 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 cleansing. There are two ways to hygienically disinfect hands: hygienic hand washing and treating (wiping) hands with an antiseptic.
Hygienic hand washing - This is hand washing with water and soap or other detergent containing an antiseptic drug. 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.
Treating hands 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 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 for the required exposure time from 30 to 60, depending on the manufacturer’s recommendations . In this case, you need to treat your nails and fingertips most carefully.
Hygienic hand treatment(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 out contaminated water. When caring for patients with infections caused by spore-forming bacteria (eg, Clostridium difficile), using antiseptics alone without first washing hands will not provide reliable decontamination due to the fact that they are not sporicidal. activity. In such cases, as well as if the skin needs to be cleaned of visible contaminants (including organic origin), previous hygienic hand washing is mandatory before treating hands with an antiseptic.
An important condition for the effectiveness of hand hygiene is compliance with the following rules:
- When carrying out hygienic disinfection of hands by rubbing with an alcohol antiseptic, it is necessary to apply the product to 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 your hands, you must first moisten them with water, then apply required amount products and thoroughly wipe your hands for at least 15 seconds to treat the entire surface of your hands and fingers, then wash your hands with water and dry them thoroughly using a disposable towel, which you use to turn off the tap;
- It is advisable to use small pieces of soap and use stands in the form of grids for quick drying.
- It is not recommended to use reusable fabric towels.
Surgical hand disinfection- this is a treatment of hands before surgery, ensuring the removal of transient and reducing the amount of resident microflora of the hands.
Surgical hand disinfection can be performed using special antiseptic formulations during surgical cleansing. This method is already used for a long time, and the recipes used have long been known. These are such as treatment with chlorhexidine digluconate (Gibitan), formulation C-4 (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 using the above-mentioned antiseptic formulations during surgical washing also leads to mechanical damage to the skin and the appearance of microtraumas.
Promising today is the use of antiseptics made on the basis of a combination of alcohols with other antimicrobial additives for surgical disinfection of hands. Such drugs are characterized by a rapid detrimental effect on microflora and high antimicrobial properties. For surgical disinfection of hands, the same preparations can be used as for hygienic disinfection, the difference being an increase in the amount of antiseptic per treatment (from 6 - 10 ml - in additional processing wrists and forearms are needed) and extending the times and exposure to up 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 on the skin of the hands of members of the surgical team during surgery reduces the risk of bacteria entering the surgical field in cases of puncture or tearing of gloves during surgical interventions.
For effective implementation surgical hand disinfection must strictly adhere to the following rules:
- before surgical disinfection, rings, rings, watches and bracelets must be removed;
- Wash your hands with water and soap, preferably liquid (the use of antiseptic soap is not necessary);
- dry thoroughly using 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 the effective concentration and, as a result, to the impossibility of achieving the desired result.
- During treatment, the skin areas should remain moisturized 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 intensive proliferation of microorganisms, which can occur in the wet layer.
Among the available antiseptics, alcohols are the safest, while ethyl alcohol has a less irritating effect than propyl or isopropyl alcohol.
Side effects of antiseptics on the skin of personnel’s hands.
According to various studies, approximately 25% of nursing staff experience symptoms and signs of dermatitis localized to the skin of the hands. Skin irritation associated with the use of antiseptic soap may be due to both the antimicrobial substance included in its composition and other components. Damage to the skin also leads to changes in the composition of its microflora, increasing the frequency of colonization by staphylococci and gram-negative microorganisms.
Among 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 causing the occurrence of contact dermatitis associated with frequent hand washing may include the following: use for washing is very hot water, low relative humidity (especially in winter period), insufficient use of barrier creams, poor quality paper towels and latex allergies.
It is worth noting that most often the cause of contact allergies when using hand hygiene products is fragrances and preservatives, and less often - emulsifiers. Liquid soap, lotions and creams may contain ingredients that can cause contact allergic reactions in healthcare workers. Alcohol-containing products for hygienic disinfection rarely cause allergic dermatitis, but it must be borne in mind that to enhance the antimicrobial properties, alcohol-containing preparations are combined with various substances, for example, quaternary ammonium compounds (QAC), lactic acid, chlorhexidine digluconate, octenidine hydrochloride, etc.
Recently, new antiseptics in the form of gels have been offered on the antiseptic market.
Thanks to their formulation, such preparations are suitable for antiseptic treatment particularly sensitive to skin irritations.
To prevent the occurrence of contact dermatitis, it is advisable to consider options for reducing the risk of their occurrence, which may include:
- reducing the frequency of use of irritating agents (especially anionic detergents);
- replacing products that have a strong irritant effect with those that irritate the skin less;
- training of health workers correct use antiseptics;
- providing health workers with skin care products and protective creams.
Reducing the frequency of hand antiseptic use is not a desirable strategy given the low level of hand hygiene compliance among HCWs. The introduction into practice of alcohol-containing antiseptics with softening additives can reduce the frequency of exposure of personnel to irritating substances (soaps and detergents).
General approaches to the selection of antiseptics
The administration of a health care facility should take into account that the acquisition of more effective antiseptics improves hand hygiene practices, which means it is possible to prevent the occurrence of hospital-acquired infections. The attention of just a few cases of hospital-acquired infections compensates additional expenses LPZ associated with the acquisition of more than effective means for hand hygiene.
When choosing an antiseptic for hand hygiene, it is necessary to take into account the opinion of the personnel of the compatibility of antiseptics with the skin and the frequency of irritation due to their use.
The cost of hand hygiene products should not be the main factor when choosing them, because low-priced disinfectants may not contain highly effective skin care additives that prevent allergies and skin irritations.
- Remove decay products and microorganisms.
- Ensure patient infection safety.
- Ensure a high level of cleanliness and personal hygiene.
- 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:
- Before eating. 2. Feeding the patient. 3. Working with food products. 4. After visiting the toilet. 5. Before and after patient care.
- When your hands are dirty.
Equipment:
- Soap (liquid with dispenser).
- Paper napkins.
- Paper towel or clean, dry cotton towel.
Hand washing techniques should be strictly followed. The duration of the procedure is 40-60 seconds.
- Remove all jewelry.
- Release your forearms from the sleeves of your robe.
- Open the water tap using a paper towel to avoid contact with microorganisms present on the tap. Adjust the water temperature.
- Wet your hands with water.
- Apply a sufficient amount of soap to the entire surface of your hands.
- Each movement is repeated 5 times:
- Rub palm against palm.
- Run your right hand along the back of your left, intertwining your fingers, and vice versa.
- Rub palm against palm, interlacing fingers, treating the spaces between the fingers.
- Clasp your fingers and intertwine them.
- Rub with rotational movements thumb left hand to the right and vice versa.
- Rub with rotating movements of clenched fingers right hand left forward and backward and vice versa.
- Rubbing your wrists in a circular motion.
- Rinse your hands with water.
- Dry thoroughly with a disposable towel.
- Close the tap using a towel (napkin).
2.Hygienic level.
Indications:
- Before and after invasive procedures.
- Before caring for an immunocompromised patient.
- Before and after wound care and urinary catheter use.
- Before putting on and after removing sterile gloves.
- After contact with body fluids or after possible microbial contamination.
Equipment:
- Liquid soap.
- Clock with second hand.
- Skin antiseptic: 70 o ethyl alcohol (0.5% alcohol solution of chlorhexidine bigluconate, or other modern skin antiseptic).
- Sterile: tweezers, cotton balls, napkins.
- Paper napkins.
- A paper towel or a clean, dry cotton towel.
- Container for disinfection.
Required condition: no injuries on hands.
When washing your hands you should:
- Remove finger rings, watches, and bracelets.
- Fold the sleeves of the robe over 2/3 of your forearms.
- Open the water tap using a paper towel to avoid contact with microorganisms present on the tap.
- Wash your hands with soap and running water up to 2/3 of your forearm, strictly following the hand washing technique (see social level).
- Rinse your hands under running water to remove soap suds.
- Repeat washing each hand.
- Rinse your hands under running water, holding them so that your wrists and hands are above elbow level.
- Dry your hands with a personal towel (napkin).
- Using a napkin, close the water tap.
- Dispose of the napkin into a container for disinfection.
- Apply 3-5 ml of antiseptic to the palms, treating all surfaces of the hand, following the technique of treating hands with an antiseptic.
- Exposure when using an alcohol-containing antiseptic is usually 20-30 seconds, but more accurate information should be obtained from methodological instructions on the use of antiseptics.
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, 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.
3. Surgical level.
Indications:
- The need to cover a sterile table.
- Participation in surgery, puncture, childbirth.
Contraindications:
- Presence of pustules on the hands and body.
- Cracks and wounds of the skin.
- Skin diseases.
Mandatory condition: processing is carried out in areas of strict or special sterility.
Performing the procedure:
- Hand treatment is carried out according to individual instructions for each method.
- 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.
