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Hygienic hand washing of medical staff. Treatment of surgeons' hands. Hand hygiene. Reasons why staff don't wash their hands

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

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

3. Clean the areas under the nails with a nail cleaner. 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 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 necessary 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 when personnel are working directly on large wound surfaces, such as open surgical wounds or burns, or when performing procedures on infectious patients from whom infection can be easily transmitted through airborne transmission.

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.

There are two levels of hand treatment for medical personnel:

Hand hygiene:

1. hygienic hand washing with soap,

   hygienic treatment of hands with a 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;

lack of jewelry on 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:

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. General Provisions

1.2. Definition of terms

- Antimicrobial agent- a product that suppresses the vital activity of microorganisms (disinfectants, antiseptics, sterilants, chemotherapeutic agents, including antibiotics, cleansers, preservatives).

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

- Hand sanitizer- an alcohol-based product with or without the addition of other compounds, intended for decontamination of the skin of the hands in order to interrupt the chain of transmission of infection.

- Nosocomial infection (HAI)- any clinically significant 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 among personnel of a healthcare institution as a result of their professional activities.

- Hygienic hand antisepsis- This is hand treatment 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.

- Routine hand washing- washing procedure with water and regular (non-antimicrobial) soap.

- Irritant contact dermatitis (IC)- unpleasant sensations and changes in the condition of the skin, which can manifest themselves in dry skin, itching or burning, redness, peeling of the epidermis and the formation of cracks.

- Resident microorganisms- microorganisms that constantly live and reproduce on the skin.

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

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

- Surgical hand antisepsis- this is a procedure for 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 hand washing is a hand washing procedure using a special antimicrobial agent to eliminate transient microorganisms and reduce the number of resident microorganisms as much as possible.

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

1.4. For hand hygiene, medical personnel use antiseptic agents registered in Ukraine in accordance with the established procedure.

2. General requirements

2.1. Healthcare facility staff keep their hands clean. It is recommended that nails be cut short and level with the tips of the fingers, without varnish or cracks on the surface of the nails, and without false nails.

2.2. Before hand treatment, bracelets, watches, and rings are removed.

2.3. Hand hygiene equipment

Tap water.
- Washbasin with cold and hot water and a mixer, which should preferably be operated without touching hands.
- Closed containers with water taps if there are problems with water supply.
- Liquid soap with neutral pH.
- Alcohol antiseptic.
- Antimicrobial detergent.
- Skin care product.
- Non-sterile and sterile disposable towels or napkins.
- 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.
- Household rubber gloves.

2.4. In the room where hand washing 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 should preferably be operated without touching hands, and the water stream should be directed directly into the drain siphon to prevent splashing of water.

2.5. It is advisable to install three dispensers near the washbasin:
- with antimicrobial hand treatment;
- with liquid soap;
- with skin care product.

2.7. Each hand washing station, if possible, is equipped with dispensers for disposable towels, napkins and a container for used products.

2.9. Do not add product to antiseptic dispensers that are not completely emptied. All emptied containers must be filled aseptically to prevent contamination. It is recommended to use disposable containers.

2.10. Dispensers detergents and skin care products, it is recommended to thoroughly wash and disinfect before each new filling.

2.12. In the absence of a centralized water supply or in the presence of another problem with water, departments are provided with closed water containers with taps. Boiled water is poured into the container and changed at least once a day. Before further filling, the containers are thoroughly washed (disinfected if necessary), rinsed and dried.

3. Surgical treatment of hands

Surgical hand cleaning is an important and responsible procedure that is carried out before any surgical intervention in order to prevent infection. surgical wound the patient and at the same time protecting personnel from infections transmitted through the blood or other secretions of the patient’s body. It consists of several stages:
- regular hand washing;
- surgical hand antisepsis, or washing them using a special antimicrobial agent;
- putting on surgical gloves;
- hand treatment after surgery;
- hand skin care.

3.1. Routine hand washing before surgical hand preparation

3.1.1. Routine washing before surgical hand treatment is carried out in advance in the department or airlock room of the operating unit, alternatively - in the room for antiseptic hand treatment, in the preoperative room before the first operation, and subsequently - as necessary.
Regular washing is intended exclusively for mechanical cleaning hands, while dirt and sweat are removed from the hands, spore-forming bacteria are partially washed away, as well as partially transient microorganisms.

3.1.2. To wash your hands, use regular liquid or powder soap or washing lotion with a neutral pH. Preference should be given to liquid soap or washing lotion. The use of soap in bars is unacceptable.

3.1.4. Given the large number of microorganisms under the nails, mandatory treatment of the subungual areas is recommended. To do this, use special sticks or soft disinfected brushes, preferably disposable ones.

3.1.5. Hands are washed with warm water. Hot water leads to degreasing and irritation of the skin, as it enhances the penetration of detergents into the epidermis of the skin.

3.1.6. The usual washing technique is as follows:
- the hands and forearms are moistened with water, then the detergent is applied so that it covers the entire surface of the hands and forearms. Hands with fingertips raised up and forearms, with elbows low, should be washed for about one minute. Particular attention should be paid to the treatment of subungual areas, nails, periungual ridges and interdigital areas;

3.2. Surgical hand antisepsis

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

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

If necessary, wash your hands with detergent and rinse thoroughly;
- dry your hands thoroughly with a disposable towel;
- using a dispenser (press the lever with your elbow), pour the antiseptic into the recess of your dry palm;
- first moisten your hands with an antiseptic, then your forearms and elbows;
- rub the antiseptic in separate portions for the time specified by the developer, while keeping the hands above the elbows;
- after antiseptic treatment, do not use a towel, wait until your hands are completely dry, put gloves only on dry hands.

3.2.3. 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 antiseptic is applied only to dry hands.

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

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

Each stage of processing is repeated at least 5 times. When performing hand treatment techniques, the presence of so-called “critical” areas of the hands that are not sufficiently wetted with the product is taken into account: thumbs, fingertips, interdigital areas, nails, periungual ridges and subungual areas. Surfaces are treated most thoroughly thumb and fingertips, since they contain the largest number of bacteria.

3.2.6. The last portion of the antiseptic is rubbed in until it dries completely.

3.2.7. Sterile gloves are worn only on dry hands.

3.2.8. After the operation/procedure is completed, the gloves are removed, hands are treated with an antiseptic for 2 x 30 s, and then with a hand skin care product. If blood or other secretions get on your hands under gloves, these contaminants are first removed with a swab or napkin moistened with an antiseptic, and washed with detergent. Then thoroughly wash with soap and water and dry with a disposable towel or napkins. After this, the hands are treated with an antiseptic 2 x 30 s.

3.3. Surgical hand washing

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

3.3.1. Phase 1 - normal hand washing - is carried out in accordance with clause 3.1.

3.3.2. Before starting phase 2 of surgical washing, hands, forearms and elbows are moistened with water, with the exception of those products that, as directed by the developer, are applied to dry hands and then water is added.

3.3.3. An antimicrobial detergent in quantities prescribed by the developer is applied to the palms and distributed over the surface of the arms, including the elbows.

3.3.4. Hands with fingertips pointing upward and forearms with low elbows are treated with the product for the time specified by the developer of this product.

3.3.5. Throughout the washing process, the hands and forearms are moistened with an antimicrobial detergent, so the amount of the product is not strictly regulated. Keep your hands up all the time.

3.3.6. When washing, adhere to the sequence of actions in accordance with that specified in paragraphs. 3.2.2 and 3.2.5.

3.3.7. Hands are dried with a sterile towel or sterile wipes using aseptic technique, starting with the fingertips.

3.3.8. Surgical sterile gloves are worn only on dry hands.

3.3.9. After the operation/procedure, gloves are removed and hands are treated with an antiseptic according to clause 3.2.8.

3.4. If no more than 60 minutes pass between operations, only antiseptic surgical treatment of the hands is performed.

4. Hygienic treatment hands

Hand hygiene includes normal hand washing water and regular (non-antimicrobial) soap and hygienic hand antiseptics, i.e. rubbing an alcohol antiseptic, without using water, into the skin of the hands in order to reduce the number of microorganisms on them.

Requirements for antimicrobial agents and alcohol antiseptics

1. Antimicrobial and antiseptic alcohol-containing rubbing products must meet the following requirements:
- a wide spectrum of antimicrobial action in relation to transient (hygienic hand treatment) and transient and resident microflora ( debridement hands);
- quick action, that is, the duration of the hand treatment procedure should be as short as possible;
- prolonged action (after treating the skin of the hands, the antiseptic must delay the reproduction and reactivation of resident microorganisms for a certain time (3 hours) under medical gloves);
- activity in the presence of organic substrates;
- absence negative impact on the skin;
- the lowest possible dermal resorption;
- absence of toxic, allergenic side effects;
- absence of systemic mutagenic, carcinogenic and teratogenic effects;
- low probability of developing resistance of microorganisms;
- readiness for direct use(do not require advance preparation);
- acceptable consistency and smell;
- easy rinsing from the skin of the hands (for detergent compositions);
- long term suitability.

2. All antimicrobial agents, regardless of the method of their use, must be active against transient bacteria (with the exception of mycobacteria), fungi of the genus Candida, as well as enveloped viruses.

3. Products used in phthisiatric, dermatological, and infectious diseases departments must be additionally tested in tests for Mycobacterium terrae (tuberculecidal activity) for use in phthisiological departments, for Aspergillus niger ( fungicidal activity) for use in dermatological departments, on Poliovirus, Adenovirus (virucidal activity) for use in infectious diseases departments if necessary.

The standard procedure during the working day is hand antiseptic treatment without the use of water, i.e. rubbing alcohol antiseptic into the skin of the hands.

4.1. Indications

4.1.1. Routine hand washing using a non-antimicrobial detergent is recommended:
- at the beginning and end of the working day;
- before preparing and serving food;
- in all cases, before treatment with an antiseptic, when hands are clearly dirty;
- in case of contact with pathogens of enteroviral infections in the absence of appropriate antiviral agents, it is recommended to mechanically eliminate viruses with prolonged hand washing (up to 5 minutes);
- in case of contact with spore microorganisms - prolonged hand washing (minimum 2 minutes) for mechanical elimination dispute;
- after using the toilet;
- in all other cases, in the absence of a risk of infection or special instructions.

4.1.2. Hand hygiene using alcohol antiseptics is recommended before:
. entrance to aseptic rooms (preoperative, sterilization departments, intensive care units, hemodialysis, etc.);
. performing invasive interventions (installation of catheters, injections, bronchoscopy, endoscopy, etc.);
. activities in which infection of the object is possible (for example, preparing infusions, filling containers with solutions, etc.);
. every direct contact with patients;
. transition from an infected to an uninfected area of ​​the patient’s body;
. contact with sterile material and instruments;
. using gloves.
After:
. contact with contaminated objects, liquids or surfaces (for example, with a urine collection system, contaminated linen, biological substrates, patient secretions, etc.);
. contact with already inserted drainages, catheters or their insertion site;
. every contact with wounds;
. every contact with patients;
. removing gloves;
. using the toilet;
. after cleaning the nose (with rhinitis there is a high probability of having viral infection followed by isolation of S. aureus).

4.1.3. The given indications are not final. In a number of specific situations, staff takes independent decision. In addition, each healthcare institution can develop its own list of indications, which are included in the plan for the prevention of nosocomial infections, taking into account the specifics of a particular department.

4.2. Regular washing

4.2.1. Regular washing is intended exclusively for mechanical cleaning of hands, while dirt and sweat are removed from the hands, spore-forming bacteria are partially washed off, as well as other transient microorganisms are partially washed away. The procedure is carried out according to paragraphs. 3.1.2.-3.1.5.

4.2.2. The usual washing technique is as follows:
- the hands are moistened with water, then the detergent is applied so that it covers the entire surface of the hands and wrists. Hands are washed for about 30 seconds. Particular attention is paid to the treatment of subungual zones, nails, periungual ridges and interdigital zones;
- after treatment with detergent, hands are thoroughly washed with soap and water and dried with disposable towels or napkins. The last napkin is to close the water tap.

4.3. Hygienic antiseptics

4.3.1. The standard method of rubbing in an antiseptic includes 6 stages and is presented in paragraph 3.2.5. Each stage is repeated at least 5 times.

4.3.2. 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 wrists for 30 seconds.

4.3.3. 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 in until it dries completely. Wiping hands is not allowed.

4.3.4. When performing hand treatment, take into account the presence of so-called “critical” areas of the hands that are not sufficiently moistened with an antiseptic: thumbs, fingertips, interdigital areas, nails, periungual ridges and subungual areas. The surfaces of the thumb and fingertips are treated most thoroughly, since the largest number of bacteria are concentrated on them.

4.3.5. If there is visible contamination of your hands, remove it with a napkin moistened with an antiseptic and wash your hands with detergent. Then thoroughly wash with soap and water and dry with a disposable towel or napkins. Close the tap with the last napkin. After this, the hands are treated with an antiseptic twice for 30 seconds.

5.Usage medical gloves

5.1. The use of gloves does not provide an absolute guarantee of protection of patients and staff from infectious agents.

5.2. The use of medical gloves protects patients and medical personnel from the spread of transient and resident microflora directly through the hands and indirectly through contact with contaminated environmental objects.

5.3. Three types of gloves are recommended for use in medical practice:
- surgical- used for invasive interventions;
- examination rooms- provide protection for medical staff when performing many medical procedures;
- household- provide protection for medical personnel when processing equipment, contaminated surfaces, instruments, when working with waste from medical institutions, etc.

5.4. Sterile gloves are recommended for use when:
- in all surgical interventions, to reduce the frequency of punctures, it is recommended to use two gloves put on each other, replacing the outer glove every 30 minutes. during the operation; It is also recommended to use gloves with a perforation indicator, in which damage to the glove quickly leads to a visible change in color at the puncture site;
- invasive manipulations (intravenous infusions, collection of biosamples for research, etc.);
- installation of a catheter or guidewire through the skin;
- manipulations associated with contact of sterile instruments with intact mucous membranes (cystoscopy, bladder catheterization);
- vaginal examination;
- bronchoscopy, endoscopy gastrointestinal tract, sanitation of the trachea;
- contact with endotracheal suctions and tracheostomies.

5.5. Non-sterile gloves are recommended for use when:
- contact with hoses of artificial respiration devices;
- working with biological material from patients;
- blood sampling;
- carrying out intramuscular and intravenous injections;
- cleaning of equipment and disinfection;
- removal of secretions and vomit.

5.6. Requirements for medical gloves:
- for operations: latex, neoprene;
- for inspections: latex, tactilon;
- when caring for the patient: latex, polyethylene, polyvinyl chloride;
- it is allowed to use fabric gloves under rubber ones;
- gloves must be of the appropriate size;
- gloves must provide high tactile sensitivity;
- contain a minimum amount of antigens (latex, latex proteins);
- when choosing medical gloves, it is recommended to take into account possible allergic reactions patient history on the material from which the gloves are made;
- for pre-sterilization cleaning of acute medical instruments Gloves with a textured outer surface must be used.

5.7. Immediately after use, medical gloves are removed and immersed in a disinfectant solution directly at the place where the gloves are used.

5.8. After disinfection, disposable gloves must be disposed of.

5.9. Rules for using medical gloves:
- the use of medical gloves does not create absolute protection and does not exclude compliance with the hand treatment technique that is used in every special case immediately after removing gloves if there is a threat of infection;
- disposable gloves cannot be reused; non-sterile gloves cannot be sterilized;
- gloves must be changed immediately if they are damaged;
- it is not allowed to wash or treat hands with gloves between “clean” and “dirty” manipulations, even in the same patient;
- moving with gloves in the hospital department(s) is not allowed;
- before putting on gloves, do not use products containing mineral oils, petroleum jelly, lanolin, etc., as they may damage the strength of the gloves.

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

5.11. Errors 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 (household) gloves;
- improper storage gloves (in the sun, when low temperatures, contact with gloves chemical substances and so on.);
- putting gloves on hands moistened with antiseptic residues (additional stress on the skin;
- ignoring the need for antiseptic hand treatment after removing gloves in contact with potentially infected material;
- the use of surgical gloves for aseptic work, while the use of sterile examination gloves is sufficient for this;
- use of ordinary medical gloves when working with cytostatics (insufficient protection of medical staff;
- insufficient care of the skin of the hands after using gloves;
- refusal to wear gloves in situations that at first glance seem safe.

5.12. Reuse of disposable gloves or their disinfection is prohibited. Carrying out hygienic hand antisepsis in disposable gloves is allowed only in situations that require frequent replacement of gloves, for example, when drawing blood. In these cases, the gloves should not be punctured or contaminated with blood or other secretions.

5.13. Disinfection of gloves is carried out according to the manufacturer’s instructions.

6. Advantages and disadvantages of hand treatment methods

6.1. Efficiency, practical use and the acceptability of hand sanitization depend on the method and accompanying conditions of hand sanitization that are available in the health care facility.

6.2. Conventional washing is ineffective in eliminating both transient and resident microorganisms. In this case, microorganisms do not die, but with splashes of water fall on the surface of sinks, staff clothing, and surrounding surfaces.

6.3. During the washing process, secondary contamination of hands with microorganisms from tap water is possible.

6.4. Regular washing has a negative effect on the skin of the hands, since water, especially hot water, and detergent lead to disruption of the surface water-fat layer of the skin, which increases the penetration of the detergent into the epidermis. Frequent washing with detergent leads to swelling of the skin, damage to the epithelium of the stratum corneum, leaching of fats and natural moisture-containing factors, which can lead to skin irritation and cause CD.

6.5. Hygienic hand antisepsis has several practical advantages over hand washing, which allows us to recommend it for wide practical use.

Advantages of hygienic hand antisepsis with alcohol antiseptics compared to conventional hand washing

6.6. Errors in hygienic antiseptics include the possible rubbing of alcohol antiseptic into hands that are damp from the antiseptic, which reduces its effectiveness and skin tolerance.

6.7. Saving antimicrobial agents and reducing exposure time makes any method of hand treatment ineffective.

7. Possible negative consequences of hand treatment and their prevention

7.1. If the requirements of the instructions/guidelines for the use of hand treatment products are violated and if there is a careless attitude towards preventive skin care, CD may occur.

7.2. KD can also be caused by:
- frequent use of antimicrobial detergent;
- long-term use of the same antimicrobial detergent;
- increased skin sensitivity to chemical composition funds;
- presence of skin irritation;
- excessively frequent routine hand washing, especially with hot water and alkaline detergents or detergents without emollients;
- long-term work with gloves;
- putting on gloves on wet hands;
- absence in medical institution sound skin care system;

7.3. For the prevention of CD, in addition to avoiding the causes of CD according to paragraphs. 7.1-7.2, it is recommended to fulfill the following basic requirements:
- provide staff with hand sanitizers that are potentially mild irritants to the skin of the hands and at the same time effective;
- when selecting an antimicrobial agent, take into account its individual suitability for the skin, smell, consistency, color, ease of use;
- V medical institution It is recommended to have several products so that employees with hypersensitive skin have the opportunity to choose a product that is acceptable to them;
- introduce into practice antiseptics made on the basis of alcohol with various softening additives, since pure alcohols dry out the skin of the hands with frequent use;

Properties of alcohol-based antiseptics

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

8. Hand skin care

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

8.2. KD can only be avoided if a skin care system is implemented in a healthcare facility, since when using any antimicrobial agents there is a potential risk of skin irritation.

8.3. When choosing a skin care product, take into account the type of skin on your hands and the following properties of the product: holding power normal condition fat lubrication of the skin, moisture, pH level of 5.5, ensuring skin regeneration, good absorption, the ability of the product to give elasticity to the skin.

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

Choosing a skin care product depending on its type

8.5. When selecting skin care products, it is important to consider their compatibility with antimicrobial hand sanitizers to prevent creams or lotions from negatively affecting the antimicrobial effect of the product.

8.6. It is advisable to apply cream or other product to your hands several times during the working day, thoroughly rub into the skin of dry and clean hands, paying special attention to the treatment of skin areas between the fingers and periungual ridges.

Maintaining hygiene and cleanliness is the key to health in all areas of life. If we are talking about medicine, then cleanliness of hands should be an integral rule, because the life of both the entire medical staff and the patient depends on such a seemingly trifle. The nurse is responsible for ensuring that the condition of her hands is satisfactory and meets medical health standards. It is important to get rid of micro cracks, hangnails, clean your nails and remove any nails, if any. Why is this so important and what are the requirements?

In order for all staff to comply with the European medical standard, it is important to tell each employee about existing requirements disinfection of hands, instruments and other medical supplies. There are separate rules for hand care for nurses, these include the following requirements:

• you cannot paint your nails or glue artificial ones
• nails should be neatly trimmed and clean
• It is not recommended to wear bracelets, watches, rings or any other jewelry on your hands, as they are sources of bacteria and germs

It was found that it is the lack of respect for hands among doctors and nurses that contributes to the development and rapid spread throughout the clinic of hospital-acquired infectious agents. Touching manipulation devices, devices, patient care items, test equipment with unclean hands, technical equipment, clothing and even medical waste can negatively affect the health of the patient and everyone in the hospital for a long period of time.

To prevent the spread of microorganisms and reduce the risk of infection through hands, there are rules and means of disinfection. Any hospital employee must follow these recommendations, especially those who work closely with sources of infection and infected patients.

In medicine, several methods have been developed for disinfecting the hands of all medical staff:

• Hand washing with soapy water and plain water, without the use of additional products
• washing hands with antiseptic hygiene products
• surgical disinfection standards

Cosmetological and folk remedies for hair care

However, there are rules for washing hands this way. It was noticed that in frequent cases, after treating the skin of the hands on inner surface and there are a lot of bacteria left on your fingertips. To avoid this, you must follow the following recommendations:

1. First, you need to remove all unnecessary items: watches, jewelry, and other small items that contribute to the proliferation of microorganisms.
2. The next step is soaping your hands; you need the soap to penetrate all areas.
3. Rinse off the foam under running warm water.
4. Repeat the procedure several times.

When the washing procedure is performed for the first time, dirt and bacteria located on the surface of the skin are removed from the hands. When repeated treatment with warm water, the skin pores open and the cleaning goes deeper. It is useful to do light self-massage when soaping.

Cold water is less useful in this case, because it elevated temperature allows soap or other hygiene products to penetrate deeply into the skin and remove thick fatty layers from both hands. Hot water is also not suitable; it can only lead to negative results.

Surgical rules for disinfection

Surgery is an area where neglect of hand hygiene rules can cost the patient’s life. Hand treatment is carried out in the following situations:

• Before any type of surgery
• During invasive procedures such as vascular puncture

Of course, the doctor and everyone assisting during the operation put on disposable sterile gloves on their hands, but this does not give the right to forget about hygienic means of protection and hand treatment.

Next, the usual hand cleaning is carried out again and three milligrams of an antiseptic are applied, and it is rubbed into the fabric and skin in a circular motion. It is advisable to carry out this entire process several times. A maximum of ten milligrams of antiseptic is used. The processing time takes no more than five minutes.

After the procedure or operation has been completed, the sterile gloves are thrown away, and the skin of the hands is washed with soap and treated with lotion or cream, preferably made from natural substances.

Modern methods of disinfection

Medicine is moving forward and disinfection techniques are improving every day. At the moment, a mixture is widely used, which includes the following components: distilled water and formic acid. The solution is prepared daily and stored in enamel dishes. Immediately wash your hands with ordinary soap, and then rinse with this solution for a couple of minutes (the part from the hand to the elbow is treated for 30 seconds, the rest of the time the hand itself is washed). Hands are wiped with a napkin and dried.

Another method is disinfection with chlorhexidine, which is initially diluted 70% medical alcohol(dosage one to forty). The processing procedure lasts about three minutes.

Iodopirone is also used for hygienic treatment of the hands of medical staff. The whole process follows a similar pattern: hands are washed with soapy water, then nails, fingers and other areas are disinfected with cotton swabs.

Ultrasound treatment. The hands are lowered into a special one through which ultrasonic waves pass. Processing lasts no more than a minute.

All methods are good, it’s just important not to neglect the general recommendations.

So, hand disinfection plays a role in medicine important role. It is not enough to simply wash your hands with water. Hand treatment is carried out in different ways, various hygiene products are used, depending on the situation. Neglecting basic rules can lead to negative consequences, from which not only patients, but also medical personnel will suffer.

Jun 22, 2017 Violetta Doctor

In order to prevent nosocomial infections, the hands of medical workers (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 of the skin) are subject to disinfection. 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.

To achieve effective hand washing and disinfection, the following conditions must be observed: short-cut nails, no nail polish, no artificial nails, no hands of rings, rings and other jewelry. Before treating surgeons' hands, it is also necessary to remove watches, bracelets, etc. To dry hands, use clean cloth towels or disposable paper napkins; when treating surgeons' hands, use only sterile cloth ones.

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

Hand hygiene.

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.

Hand hygiene is carried out in two ways:

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

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

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

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

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

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 (up to 200 ml) with skin antiseptic.