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Nurse's hand washing techniques. Hand hygiene. What is used for hand washing in clinics

Hand treatment methods

It would seem, what difficulties can arise when performing such a simple manipulation? In fact, everything is not so simple; in certain situations, hands should be treated strict rules using disinfectants for hands. In general, there are several levels of hand treatment, which have their own characteristics:

• Hygienic;
• Surgical.

Preference is given to one method or another depending on the task at hand.

Routine hand washing

The household level of treatment involves mechanical cleansing of hands with water and soap, which allows you to remove dirt, sweat and partially microflora from the skin. In this case, it is preferable to use soap with a dispenser, for example, “Amber” liquid soap or “Septolite” antibacterial soap. In medical practice, it is worth using an elbow dispenser for soap and antiseptics, which prevents re-contamination of hands.

Routine hand washing is carried out in the following situations:

1. After visiting the toilet;
2. Before eating;
3. Before working with food products;
4. When contacting a patient (client);
5. At various contaminants hands

Regular hand washing is an absolutely simple procedure. First of all, you need to remove jewelry from your hands. Next, wet your hands with water and apply soap liberally. Rub your soapy hands vigorously for thirty seconds. Then hands are washed with water and dried with a towel.

Hand hygiene

This type of hand treatment involves better cleansing of the skin using soap and antiseptics. This method is used during medical procedures, after contact with biological fluids, etc.

Hygienic treatment is carried out in two successive stages. The first stage is washing your hands with soap, and they do it according to the following scheme:

1. Rub your soapy palms together.
2. Use your palm to rub the back of the other hand, then change hands.
3. Interlace your fingers and rub the skin between the fingers.
4. Place your fingers together and rub the palm of your other hand with bent fingers.
5. Grab the first finger of the hand with the other hand and rub it around, repeat the manipulation on the wrist. Change hands.
6. Rub your fingers in a circle on the palm of your other hand. Change hands.

Each of these movements is performed five times. The entire procedure should take one minute. Upon completion, hands are washed with water and blotted with a disposable towel.

The second stage is the disinfection of the skin with antiseptic agents, for example, skin antiseptics and Septolite antiseptic gel. So, squeeze out a portion of the antiseptic onto the palm of your hand and thoroughly rub it into the skin. In this case, special attention should be paid to the treatment of nails, subungual space and interdigital spaces.

Surgical treatment of hands

Purpose surgical treatment hands is reduced to the maximum reduction of microbial contamination of the skin of the hands, which will prevent infection of patients (clients). Medical staff resort to this method of hand treatment before performing surgical interventions.

The first stage of treatment consists of washing hands and forearms with soap according to the scheme described above for two minutes, followed by blotting with sterile napkins.
The second stage is a thorough treatment of the hands and forearms with antiseptics. To do this, squeeze a portion of antiseptic onto the palm of your hand and rub it into the skin for five minutes. In this case, it is necessary to squeeze out new portions of the antiseptic so that your hands are constantly wet. Upon completion of hand treatment, put on sterile gloves and begin the operation.

Staff hand washing or decontamination.

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

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

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

Social hand treatment is carried out:

1. Before eating

2. After going to the toilet

3. Before and after patient care

4. When your hands are dirty.

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

Preparation for the procedure:

Performing the procedure:

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

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

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

Completing the procedure:

7. Close the water tap using a paper napkin.

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

Note: If running water is not available, a basin of clean water can be used.

Hygienic level of hand washing.

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

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

Hygienic treatment hands is carried out:

1. Before performing invasive procedures

2. Before caring for an immunocompromised patient.

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

4. Before putting on and after taking off gloves.

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

Preparation for the procedure:

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

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

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

Performing the procedure:

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

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

6. Wash your hands using the following technique:

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

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

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

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

d) Alternating friction thumbs one hand with the palms of the other, palms clenched, repeat 5 times.

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

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

Completion of the procedure.

8. Close the tap with a paper towel.

9. Dry your hands with a paper towel.

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

Gloves.

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

1. Contact with blood

2. In contact with seminal fluid or vaginal secretions

End of the procedure.

Execution of the procedure.

Social level of hand handling

Hand treatment levels for healthcare workers

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

Target: remove microflora from the surface of the hands using a mechanical method. Ensure infection safety of patients and staff.

Indications:

Before and after performing treatment procedures with and without gloves;

Before and after eating, feeding the patient;

After visiting the toilet;

Before and after caring for the patient, as long as the hands are not contaminated with the patient's body fluids.

Equipment: laundry soap (liquid) for one-time use, watch with second hand, warm running water, sterile wipes on a tray, individual towel (electric dryer).

Required condition: healthy hand skin, nails no more than 1 mm, without varnish. Before the procedure, clean under the nails and wash under running water.

Preparing for the procedure.

1. Remove the rings from your fingers, check the integrity of the skin of your HANDS .
2. Roll up the sleeves of the robe to the elbows, take off your watch.
3. Open the tap, adjust the water temperature (35-40°).

1. Lather your hands and wash the water tap with soap (the elbow tap is not washed, if you use a bar of soap, wash it, put it on a clean napkin or in a lattice soap dish).

2. Wash your hands with soap and running water up to 2/3 of the forearm for 30 seconds, paying attention to the phalanges and interdigital spaces of the hands, then wash the back and palm of each hand and rotate the base of the thumbs.

Note: this time is enough to decontaminate hands social level, if the surface of the skin of the hands is washed thoroughly and dirty areas of the skin of the hands are not left.

3. Rinse your hands under running water to remove soap suds.

Note: Hold your hands with your fingers up so that the water flows into the sink from your elbows (do not touch the sink). The phalanges of the fingers should remain the cleanest.

4. Repeat hand washing in the same sequence.

1. Close the tap using a napkin (close the elbow tap with your elbow).

2. Dry your hands with a dry, clean individual towel or dryer.

Target: ensuring hand decontamination at a hygienic level.

Indications:

Ø before putting on and after taking off gloves;

Ø after contact with biological fluids of the body and after possible microbial contamination;

Ø before caring for an immunocompromised patient.

Ø before and after contact with infectious patients of known or suspected etiology;

Ø after contact with patient secretions (pus, blood, sputum, feces, urine, etc.);

Ø before and after manual, instrumental examinations and interventions not related to penetration into sterile cavities;

Ø after visiting the box in infectious diseases hospitals and departments;

Ø after visiting the toilet;

Ø before leaving home.

Equipment: bactericidal soap, watch with a second hand, warm running water, sterile: tweezers, cotton balls, napkins, disposal container with disinfectant solution.

Required condition: no skin damage on hands.

Stages	Notes
Preparation for the procedure
1 . Remove the rings from your fingers.	Preparation for processing the required surface of the hand.
2. Fold the sleeves of the robe 2/3 of the way up your forearms and take off your watch.	Ensuring infection safety for nurses.
3. Open the tap.	Running water is used.
Executing the procedure
1 . Wash your hands with soap and running water up to 2/3 of the forearm, paying attention to the phalanges and interdigital spaces of the hands for 10 seconds.	Ensuring the greatest degree of decontamination of fingers, adhering to the principle of surface treatment “from clean to dirty.”
2. Rinse your hands under running water to remove soap suds.
3. Repeat washing each hand up to 5-6 times.
Completing the procedure
1 . Dry your hands with a napkin.	Ensuring infection safety.
2. Throw the napkin into a container with disinfectant solution.
3. Close the tap using a sterile cloth, or ask an assistant to do this.

Note: Without necessary conditions for hygienic hand washing, you can treat them with 3-5 ml of antiseptic for 2 minutes.

Nails should be cut short and not painted. It is also necessary to take care of your hair, which should be neatly combed and tucked under a medical cap. It is important to keep not only your hands and entire body clean, but also your mouth and nasopharynx. You should brush your teeth 2 times a day (at night and in the morning after meals) and rinse your mouth after eating.

Compliance with the rules of personal hygiene of medical personnel and hand disinfection is regulated by Resolution No. 71 of the Chief State Sanitary Doctor of the Ministry of Health of the Republic of Belarus dated July 11, 2003. “On the approval and implementation of sanitary rules.”

Hygienic hand skin antiseptics are carried out with the aim of removing and destroying the transient population of microorganisms.

Indications for hygienic hand antisepsis:

Before and after contact with infectious patients (AIDS patients, viral hepatitis, dysentery, staphylococcal infection, etc.);

After contact with patient secretions (pus, blood, sputum, feces, urine, etc.);

Before and after manual and instrumental examinations and interventions not related to penetration into sterile cavities;

After visiting the box in infectious diseases hospitals and departments;

After visiting the toilet;

Before leaving home.

Stages of hygienic hand skin antiseptics:

1. Apply 3 ml of antiseptic to your hands and thoroughly rub into the palmar, back and interdigital surfaces of the skin of your hands for 1 minute until the antiseptic is completely dry.

2. In case of heavy contamination with biomaterials (blood, mucus, pus, etc.), first remove the contamination with a sterile cotton-gauze swab or gauze pad moistened with a skin antiseptic. Then apply 3 ml of antiseptic to your hands and rub until completely dry (at least 30 s), then wash your hands with soap and running water.

Scheme for hand treatment of medical personnel

According to the European standard EN1500, the treatment of the skin of the hands of medical personnel should be carried out according to the following scheme:

Rub your palm against your palm (Fig. 1, a);

Rub your left palm along the back of your right hand, and vice versa (Fig. 1, b);

Rub your palms with crossed fingers spread out (Fig. 2);

Rub the back of your bent fingers over the palm of your other hand (Fig. 3);

Alternately rub your thumbs in a circular motion (Fig. 4);

Alternately rub your palms with the fingertips of the other hand in multidirectional circular movements.

Every day, nurses deal with a huge amount of chemicals, which can cause general and local changes in the body. Chemicals can enter the body through the respiratory tract in the form of dust or vapor, or be absorbed through the skin and mucous membranes. Their effects can manifest themselves in the form of skin reactions, dizziness, headaches, etc. Individual results of exposure may include miscarriages, infertility, and diseases of various organs. The most common manifestation of exposure to chemicals in nurses is irritation and inflammation of the skin and mucous membranes - occupational dermatitis. Nurses are exposed to this risk because of the need frequent washing hands and influence pharmacological drugs, disinfectants and even rubber gloves.

Dermatitis can cause:

Ø primary irritants (chlorine- and phenol-containing disinfectants) cause inflammation of the skin only in the area of ​​direct contact with the substance;

Ø sensitizers (antibiotics, antibacterial soap, etc.) cause allergic reaction in the form of dermatitis or is even more severe (swelling of the lips, eyelids, face, nausea, vomiting).

There are two levels of hand treatment for medical personnel:

Hand hygiene:

1. hygienic hand washing with soap,

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

Treatment of surgeons' hands.

Hand hygiene.

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

Indications:

before direct contact with the patient;

after contact with the patient's intact skin;

before execution various manipulations patient care;

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

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

after treating a patient with purulent inflammatory processes;

after each contact with contaminated surfaces and equipment.

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

Effectiveness conditions:

short-cut nails;

lack of nail polish;

no artificial nails;

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

provision of sufficient quantities of effective means for washing and disinfecting hands, as well as products for hand skin care (creams, lotions, balms).

Hygienic hand washing with soap.

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

Manipulation algorithm:

Stages	Rationale
1. Preparation for the procedure
1.1. Check the conditions necessary for effective hand washing.
1.2. Prepare everything you need.
1.3. Stand in front of the sink, trying not to touch its surface with your hands and clothes.	Prevention of contamination of hands and clothing.
1.4. Turn on the water and adjust the water temperature to a comfortable value (35-40 o C).	Optimal temperature for hand decontamination and prevention of dermatitis.
2. Performing the procedure (Fig. 2)
2.1. Wet your hands with water.	Efficiency of manipulation.
2.2. Apply soap to your palm using an elbow dispenser (or any other).	Prevention of hand contamination.
2.3. Rub palm against palm.	Ensuring uniform decontamination of hands.
2.4. Rub your right palm over the back of your left hand and vice versa.
2.5. Treat the spaces between the fingers: rub your palms with your fingers crossed and spread out.
2.6. Interlock your fingers and rub the back of your bent fingers across the palm of your other hand.
2.7. Rub your thumbs alternately in a circular motion.
2.8. Rub your palm alternately with the fingertips of the opposite hand in multidirectional circular movements.
2.9. Rinse off the soap with running water. Note: dose of liquid soap and treatment time according to instructions for use.	Efficiency of manipulation.
3. End of the procedure
3.1. Turn off the water using the elbow tap.
3.2. Dry your hands with a paper towel (individual cloth).	Efficiency of manipulation, prevention of contact dermatitis.
3.3. Dispose of the paper towel in the pedal bin with a Class A waste bag without touching it.	Proper handling of Class A medical waste. Prevention of hand recontamination.
Note: If the sink does not have a touchless faucet, first wipe your hands, then close the valve, using the paper towel used to dry the nurse's hands.

Rice. 2. Hygienic hand washing with soap.

Hygienic treatment of hands with skin antiseptic.

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

1. Remove all rings from your hands (the indentations on the surface of jewelry are breeding grounds for microorganisms).

2. Move the watch above your wrist or remove it.

3. Clean the areas under the nails with a nail cleaner under running water.

4. Apply 3-5 ml of liquid soap to your hands or thoroughly lather your hands with bar soap.

5. Wash your hands using the following technique:

Vigorous mechanical friction of the palms (repeat 5 times);

The right palm washes the back of the left hand with rubbing movements, then the left palm washes the back of the right hand (repeat 5 times);

Palm to palm, fingers of one hand in the interdigital spaces of the other (repeat 5 times);

The back of the fingers to the palm of the other hand (fingers intertwined - repeat 5 times);

Alternating rotational friction of the thumbs of one hand with the palms of the other, palms clenched (repeat 5 times);

Alternating friction of the palm of one hand with the closed fingers of the other hand (repeat)

Fig.6. Hand washing.

6. Rinse your hands under running water, holding them so that your wrists and hands are below elbow level and to avoid contamination from touching the sink, robe and other objects.

7. Close the tap, handling it only with a paper towel, as it can be a source of contamination.

8. Dry your hands with a sterile gauze pad.

8. Thoroughly treat the skin of your hands for 2-3 minutes with 2 swabs moistened with 70% alcohol or an alcohol-containing skin antiseptic with a virucidal effect (at least one minute on each hand) or apply 5-8 ml of 70% to the palm surfaces. ethyl alcohol or an alcohol-containing skin antiseptic with a virucidal effect and rub into the skin for 2 minutes.

9. Throw the used balls into a container for disinfection.

10. Put on gloves according to the action algorithm.

Use of protective clothing.

Robes.

With the exception of operating rooms or dressing rooms, where sterile gowns are worn to protect the patient, the main purpose of the gowns is to prevent the contact of infectious agents with the clothing and skin of personnel.

Hats.

Medical caps reliably cover the hair, preventing it from acting as a source of contamination.

Aprons.

Rubber and polyethylene aprons are necessary to protect the protective clothing and skin of personnel in the event of the threat of splashing blood and other biological fluids and secretions.

Masks.

Masks are required to avoid airborne transmission of microorganisms, as well as in cases where there is a possibility of liquid substances from the human body entering the nose or mouth. They are especially important if personnel are working directly over a large wound surface, such as an open surgical wounds or burns, or during procedures with infectious patients, from whom the infection can be easily transmitted by airborne droplets.

Masks should be replaced every 3-4 hours (depending on the type of work being performed) or when they become wet during work. Masks should not be lowered onto the neck or reused. All masks must completely cover the nose and mouth.