The issue of the need for hand hygiene by medical personnel was first raised only in the middle of the 19th century. At that time, due to unsanitary conditions in Europe, almost 30% of women giving birth died in hospitals. The main cause of death was the so-called puerperal fever. It often happened that doctors went to women giving birth after dissecting corpses. At the same time, they did not treat their hands with anything, but simply wiped them with a handkerchief.

Types of processing

Keeping hands clean is a requirement for all healthcare personnel. Hygiene treatment of medical staff’s hands can be carried out in two ways:

• removing contaminants and reducing the number of microorganisms on the skin of the hands using soap and water;
• the use of special alcohol-containing skin antiseptics, which reduce the number of bacteria on the skin to a minimum level.

Only the second method can be called hand hygiene. The first is just hygienic washing. Hands should be washed with liquid soap with a dispenser and dried with an individual disposable towel. But disinfection is carried out using skin antiseptics.

According to the rules, medical personnel must always have hand sanitizer available. In addition, they must be provided with creams, balms, and lotions intended for skin care. Indeed, with constant hygienic treatment, the risk of developing contact dermatitis increases. Also selection detergents and antiseptics should be carried out taking into account individual intolerance.

Important Terms

Every hospital employee should know when the hands of medical staff should be sanitized. This is necessary in the following situations:

• before and after contact with each patient;
• before and after putting on gloves that are used during medical procedures, contact with excreta or body secretions, dressings, mucous surfaces;
• after contact with intact skin, for example, after measuring blood pressure, pulse, or shifting the patient;
• after working with equipment that is located in close proximity to the patient;
• after treating patients with various purulent-inflammatory processes.

If there is obvious contamination of the skin of the hand with the patient’s blood or secretions, they must first be thoroughly washed with soap and water and dried. After this, they must be treated twice with an antiseptic.

Hand washing technique

Do not forget about the importance of cleansing the skin not only in hospitals, but also in other places. The hand treatment technique remains the same everywhere. Before starting the procedure, you must remove all rings, watches and bracelets. Any foreign objects make it difficult to remove pathogenic microorganisms. It is advisable to wash your hands with moderately warm water.

To increase the effectiveness of the procedure, you must first wet your hands and squeeze them liquid soap. The hand processing algorithm looks like this:

1. Lather the soap by vigorously rubbing your palms together.
2. Rub one palm against the other in a back-and-forth motion.
3. Rub the back surface right hand left palm and vice versa.
4. Connect the fingers of the right hand and the interdigital spaces of the left, carefully process them.
5. It is also necessary to go through the inner surface of the fingers.
6. Cross your outstretched fingers and rub your palms together.
7. Clasp your hands and walk the backs of your fingers across your palm.
8. Thoroughly rub your thumb in a circular motion; to do this, its base must be covered with your thumb and index fingers other hand.
9. The wrist is treated in a similar way.
10. Rub your palm with your fingertips in a circular motion.

Each movement should be repeated at least 5 times, and the total duration of this wash should be about a minute.

Rules for medical personnel

Every hospital and clinic worker should know how to clean the hands of medical staff. SanPiN (the proper washing diagram is given above) establishes a procedure not only for cleaning skin, but also their disinfection. Healthcare workers should also remember the following requirements:

• short-cut nails without varnish;
• absence of rings, signet rings and other similar jewelry.

Nail polish can cause unwanted dermatological reactions that can lead to secondary infection. In addition, dark varnish does not allow assessing the degree of cleanliness of the subungual space. This may cause poor quality processing. Cracked varnish is considered the most dangerous. Indeed, in this case, it becomes more difficult to remove microorganisms from the surface of the hands.

Performing a manicure itself is associated with microtraumas that can easily become infected. This is one of the reasons why medical professionals are prohibited from wearing false nails.

Any jewelry or costume jewelry can cause the hand hygiene of medical staff to become less effective. In addition, they can damage gloves and make putting them on more difficult.

Nuances for surgeons

The treatment of the hands of people participating in surgical interventions is carried out according to a slightly modified scheme. For example, the washing time for them is extended and amounts to 2 minutes. The further algorithm for processing hands is as follows. After mechanical cleaning It is necessary to dry the skin using a sterile cloth or disposable paper towel.

In addition to washing, treatment with an antiseptic is also important. Attention must be paid not only to the hands, but also to the wrists and forearms. The skin should remain moist during the prescribed treatment time. You cannot wipe your hands; you must wait until the antiseptic has completely dried. Only after this can surgeons put on gloves.

Selection of hygiene products

Many people are now opting for antibacterial soap. But it is important to follow the skin cleansing technique. If done correctly, washing your hands with regular soap will be just as effective. In surgical practice they use special means For antiseptic treatment hands The soap contains chlorhexidine gluconate or povidone iodine. These substances can reduce the number of bacteria by 70-80% upon first use and by 99% upon repeated use. Moreover, when using povidone-iodine, the microflora grows faster than when in contact with chlorhexidine.

To be in full compliance regulatory requirements The hands of medical staff were sanitized; it is advisable to equip medical institutions with elbow dispensers. They are controlled without the use of hands.

Also in surgical practice, brushes can be used to clean hands, but this is not considered necessary. They must be either sterile for single use or capable of withstanding autoclaving.

Time periods

In surgical practice, special rules for cleaning the skin have been established. After the usual thorough washing according to the established protocol, they must be disinfected.

It is mandatory to sanitize the hands of medical staff. SanPin (the washing scheme remains the same) stipulates that skin cleansing before surgical procedures can be carried out using the same means as hygiene.

It is important to remember that throughout the entire period of hand disinfection, they must remain wet. To carry out the procedure, as a rule, it is necessary to use more than 6 ml of antiseptic. As a result of research, it was found that for high-quality destruction of bacteria, a five-minute treatment of the skin is sufficient. It has also been confirmed that performing this procedure for three minutes reduces the number of microorganisms to an acceptable level.

Rules for treating hands with antiseptic

After thoroughly washing the skin of your hands, wrists and forearms, you need to dry them. After this, the established standard for hand treatment for workers in operating rooms requires the use of special disinfectants.

Before this, if necessary, you need to treat the nail beds and periungual folds. For these purposes, use sterile disposable wooden sticks, which must be additionally moistened with an antiseptic.

The disinfectant is applied 2.5 ml to the hands and forearms. One treatment of two hands should require about 10 ml of disinfectant liquid. The antiseptic must be rubbed into the skin according to the same scheme as hand washing, observing correct sequence movements.

Only after complete absorption/evaporation of the product can you put on gloves. If the surgical operation lasts more than 3 hours, the treatment is repeated. After all, pathogenic microorganisms can begin to multiply again under gloves.

Final stage

But this is not all levels of hand treatment. It is important to remove gloves after working with gloves and wash your hands with soap. In this case, there is no longer any need to use a disinfectant solution. Washing with liquid soap is sufficient, preferably with a neutral pH.

After cleaning the skin, it is necessary to moisturize it. For these purposes they are used various creams, lotions. Their main purpose is to prevent the drying effect of alcohol-containing disinfectants.

It is also worth noting that hand hygiene in the absence of visible contamination can be performed without washing. In most cases, it is enough to use antiseptic solutions for 30-60 seconds.

Possible complications

It is worth noting that regular use of disinfectants does not have the best effect on the skin. medical workers. There are two main types of reactions that hospital employees encounter. Most often they complain of itching, dryness, irritation, cracks with bleeding. These symptoms can be either minor or significantly affect the general condition of workers.

There is also another type of complications - allergic dermatitis. They occur when there is intolerance to any components of products intended for hand disinfection. Allergic dermatitis can manifest itself in both mild localized and severe generalized forms. In the most advanced cases, they can be combined with respiratory distress syndrome or other manifestations of anaphylaxis.

Prevalence of complications and their prevention

The significance of the problem can be understood by knowing that such hand cleaning practices result in 25% of nurses presenting with signs of dermatitis, and 85% report a history of skin problems.

The irritating effect of antiseptics can be slightly reduced by adding emollients to them. This is one way to reduce the incidence of contact dermatitis. The risk of their occurrence can also be minimized if you use moisturizers that are designed to care for the skin of your hands after each wash.

To prevent the development of complications, do not wash your hands every time before treating them with an antiseptic. It is also important to ensure that gloves are only put on when the skin is completely dry.

Do not neglect the use of moisturizers. On the market you can find special protective creams designed to prevent the occurrence of contact dermatitis. However, research has failed to confirm their unambiguous effectiveness. Stops many high price for these creams.

Hygienic treatment of the hands of medical staff: methods, algorithm and preparations

Hand hygiene for medical staff is mandatory procedure before performing any action on the patient. Used for processing various means and drugs that do not require a long time and are approved by the Pharmacology Committee Russian Federation.

Why is disinfection needed?

Hand hygiene is a disinfecting procedure that prevents hospital-acquired infections, protecting not only the staff themselves, but also the patients. The purpose of the treatment is to neutralize microbes that are on human skin after contact with an infected object or are part of the natural flora of the skin.

There are two types of procedures: hygienic and surgical hand treatment. The first is mandatory before contacting the patient, especially if he must undergo surgery. Hygienic treatment of personnel's hands must be carried out after contact with saliva and blood. Disinfection must be carried out before sterile gloves are put on. You can wash your hands with a special soap that has an antiseptic effect or wipe your skin with a product containing alcohol.

When to carry out hygienic treatment

Hygienic treatment of the hands of medical staff is mandatory in the following situations:

1. After therapy for patients diagnosed with an inflammatory process with the release of pus.
2. After contact with devices and any other object located near the patient.
3. After each contact with contaminated surfaces.
4. After contact with human mucous membranes, human excreta and gauze dressings.
5. After contact with the patient's skin.
6. Before performing casualty care procedures.
7. Before each contact with the patient.

Correctly carried out hygienic treatment involves washing with soap and running water in order to get rid of contaminants and reduce the number of microorganisms. In addition, hand cleaning in a hygienic way also includes procedures for treating the skin with antiseptic agents, which help reduce the number of bacteria to a minimum safe level.

What is used for processing

Liquid soap, which is dispensed using a dispensary, is ideal for washing the hands of medical staff. Not recommended for use hot water due to an increased risk of dermatitis. Be sure to use a towel to close a faucet that is not equipped with an elbow drive. To dry clean hands, you should use disposable paper towels (or individual fabric towels).

Hygienic hand treatment, the algorithm of which includes several simple steps, can be carried out using a skin antiseptic. In this case, pre-washing with soap is not necessary. The product is rubbed into the skin of the hands in the amount indicated on the antiseptic packaging. Particular attention is paid to the fingers, the skin between them and the areas around the nails. A prerequisite for achieving the desired effect is keeping your hands wet for a certain time (usually indicated on the product). After hand hygiene has been carried out, there is no need to dry them with a towel.

Equipment for hygiene procedures

In order for the hygiene procedure to be carried out in accordance with all rules and requirements, the following is necessary:

• Running water.
• Liquid soap with a neutral pH level.
• Washbasin with mixer, operated without the touch of the palms (elbow method).
• Alcohol-based antiseptic.
• Disposable towels, both sterile and non-sterile.
• Detergent with antimicrobial action.
• Disposable rubber gloves (sterile or non-sterile).
• Hand skin care product.
• Household rubber gloves.
• Bin for used supplies.

Mandatory requirements

In the room where antimicrobial hand treatment is planned, the washbasin should be located in an accessible place. It is equipped with a tap through which hot and cold water, a special mixer. The faucet must be designed in such a way that splashing water is minimal. The hygienic level of hand treatment involves the maximum reduction in the number of microorganisms on the skin, so it is advisable to install several dispensers with products next to the washbasin. One contains liquid soap, the other contains an antimicrobial drug, and another should be filled with a product that cares for the skin of the hands.

It is not recommended to dry your hands using electric dryers, as they will still remain wet, and the device causes air turbulence, where contaminated particles may be located. All containers with products must be disposable. Hospitals should always have several hand antiseptics on hand, some of which are intended for workers with sensitive skin.

Algorithm

Hand hygiene is mandatory for all healthcare workers. The algorithm for cleansing with soap is as follows:

1. Squeezing out the required amount of liquid soap from the dispenser.
2. Rubbing in palm-to-palm mode.
3. Rubbing one palm of the hand on the back of the other.
4. Rubbing the inner surfaces of the fingers vertically.
5. Rubbing the back of the fingers of the hand folded into a fist onto the palm of the other (do the same with the other hand).
6. Rubbing all fingers in a circular motion.
7. Rubbing each palm with your fingertips.

Surgical disinfection

Surgical hand disinfection is required to completely remove flora from the hands: resistant, as well as transistor. This is done to prevent the infection from being transmitted through hands. Like hand hygiene, surgical disinfection is performed by washing and wiping. The use of alcohol solutions is widespread due to the rapid and targeted action, optimal skin perception of the product, long period of action, and the effect of complete removal of microorganisms.

The process of surgical disinfection includes almost the same steps that involve hand cleaning at a hygienic level. Algorithm for surgical antisepsis:

1. Wash your hands with water and soap for at least two minutes.
2. Dry your hands using a disposable napkin or towel.
3. Treat your hands, forearms, and wrists with an antiseptic, without wiping your hands afterward.
4. Wait for the product to dry completely and put on sterile gloves.

Time of exposure to a specific antiseptic drug, its dosage and others important parameters can be read on the product label or in its instructions. The first hand treatment of each work shift should include the stage of cleaning the areas around each nail using a special soft brush - sterile and disposable (or one that has been sterilized by autoclaving).

Antiseptic treatment

An antiseptic solution is one of the main means of combating microorganisms, which includes hand hygiene. The algorithm is as follows:

1. Wash your hands in water at room temperature with liquid soap, dry with a disposable towel.
2. Apply the disinfectant using rubbing movements, which disinfects the hands.
3. With interlaced fingers, massage the backs of your hands.
4. With crossed fingers, widely spaced, rub your palms.
5. Rub the product into your thumbs with clenched palms one at a time.
6. Rubbing the forearms for at least 2 minutes, maximum 3 minutes, treating the nails and subungual area.

Each stage must be repeated 4-5 times. Throughout the entire procedure, you must ensure that your hands do not dry out. If necessary, apply another portion of the disinfectant.

Hand hygiene is a mandatory disinfection process for all medical personnel who come into contact with patients or various contaminated hospital facilities. For processing, chlorhexidine bigluconate (alcohol solution) in ethyl alcohol (70%) is used. In addition, the following drugs are used:

• "Octenisept."
• Ethyl alcohol with additives that effectively soften the skin.
• "Octeniderm".
• "Chemisept."
• "Higenix."
• “Isopropanol” – 60%.
• "Octenman."
• "Dekosept+".
• "Veltosept."

Before carrying out hygienic treatment, be sure to remove all wrist accessories and jewelry. Don’t forget to clean your hands with a sterile brush, paying special attention Special attention nail area. The procedure is carried out once at the beginning of the working day.

Requirements for hygiene products

If antiseptic and soap containers are not disposable, then refilling should only be done after they have been thoroughly disinfected, rinsed under running water and completely dried. It is recommended to use dispensers that operate on photocells or those from which the product is squeezed out using the elbow.

All used antiseptics intended for skin treatment should be readily available at all stages of the treatment process. If the unit is aimed at intensive patient care, then containers with antiseptics should be placed in places that are most convenient for medical personnel, for example, at the patient’s bedside or near the entrance to the hospital ward. It is recommended to provide each employee with an individual small container of antiseptic.

Rules for antiseptic hand treatment drawing

2. HANDS TREATMENT OF MEDICAL STAFF

Hand sanitizing is a simple but very important method of preventing HAIs. P Correct and timely hand washing is the key to the safety of medical personnel and patients .

Rules for preparing for hand treatment:

1. Remove rings and watches.

2. Nails must be cut short; polish is not allowed.

3. Fold the long sleeves of the robe over 2/3 of your forearms.

All jewelry and watches are removed from hands, as they make it difficult to remove microorganisms. Hands are soaped and then rinsed warm running water and everything repeats itself from the beginning. It is believed that during the first soaping and rinsing warm water germs are washed off from the skin of the hands. Under the influence of warm water and self-massage during mechanical treatment, the pores of the skin open, so when repeated soaping and rinsing, germs are washed away from the opened pores. Warm water makes the antiseptic or soap work more effectively, while hot water removes the protective fat layer from the surface of the hands. In this regard, you should avoid consuming too much hot water for washing hands.

When entering and exiting the intensive care unit or intensive care unit, personnel must treat their hands with a skin antiseptic.

There are three levels of hand treatment:

1. Household level (mechanical hand treatment);

2. Hygienic level (hand treatment using skin antiseptics);

3. Surgical level (special sequence of actions when treating hands, increasing treatment time, treatment area, followed by putting on sterile gloves).

1. Mechanical treatment of hands

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

· after visiting the toilet;

· before eating or working with food;

· before and after physical contact with the patient;

· for any contamination of hands.

Required equipment:

1. Liquid dosed neutral soap. It is advisable that the soap does not have a strong odor. Open liquid soap quickly becomes infected with microbes, so you need to use closed dispensers, and after finishing the contents, process the dispenser, and only fill it with new contents after processing.

2. Disposable, clean, 15x15 cm napkins for drying hands. Using a towel (even an individual one) is not advisable, because it does not have time to dry and, moreover, is easily contaminated with germs.

Hand treatment - the necessary sequence of movements:

1. Rub one palm against the other palm in a back-and-forth motion.

2. Use your right palm to rub the back surface of your left hand, switch hands.

3. Connect the fingers of one hand in the interdigital spaces of the other, rub the inner surfaces of the fingers with up and down movements.

4. Connect your fingers into a “lock” and rub the palm of your other hand with the back of your bent fingers.

5. Cover the base thumb left hand between the thumb and index finger of the right hand, rotational friction. Repeat on the wrist. Change hands.

6. Rub the palm of your left hand in a circular motion with the fingertips of your right hand, switch hands.

HAND HYGIENIC RULES

European standard E N -1500

Palm to palm, including wrists

Right palm on the left back of the hand and left palm on the right back of the hand

Palm to palm of hands with fingers crossed

Outer side of fingers on opposite palm with fingers crossed

Circular rubbing of the left thumb in the closed palm of the right hand and vice versa

Circular rubbing of the closed fingertips of the right hand on the left palm and vice versa

2. Hand hygiene

The purpose of hygienic treatment is to destroy resident microflora from the surface of the skin of the hands using antiseptics.

A similar hand treatment is carried out:

· before putting on gloves and after taking them off;

· before caring for a patient with a weakened immune system or during ward rounds (when it is not possible to wash hands after examining each patient);

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

· after contact with biological fluids (for example, emergency situations with blood).

Required equipment:

2. Napkins measuring 15x15 cm, disposable, clean (paper or fabric).

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

Hand hygiene consists of two stages:

1 - mechanical cleaning of hands followed by drying with disposable napkins;

2 - disinfection of hands with a skin antiseptic.

3. Surgical treatment of hands

The purpose of the surgical level of hand cleaning is to minimize the risk of disruption of surgical sterility in the event of glove damage.

A similar hand treatment is carried out:

· before surgical interventions;

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

Required equipment:

1. Liquid dosed pH-neutral soap.

2. Wipes measuring 15x15 cm are disposable, sterile.

3. Skin antiseptic.

4. Disposable sterile surgical gloves.

Hand treatment rules:

Surgical treatment hands consists of three stages:

1 - mechanical cleaning of hands followed by drying,

2 - hand disinfection with skin antiseptic twice,

3 - covering hands with sterile disposable gloves.

In contrast to the above-described method of mechanical cleaning at the surgical level, the forearms are included in the treatment; sterile wipes, and itself hand washing lasts at least 2 minutes. After drying, the nail beds and periungual folds are additionally treated with disposable sterile wooden sticks soaked in an antiseptic solution.

It is not necessary to use brushes. If brushes are used, sterile, soft, single-use or autoclave-resistant brushes should be used only for periungual areas and only for the first brush of a work shift.

At the end of the mechanical cleaning stage, an antiseptic is applied to the hands in 3 ml portions and, without allowing drying, rubbed into the skin, strictly observing the sequence of movements. The procedure for applying skin antiseptic is repeated at least twice, the total consumption of antiseptic is 10 ml, the total procedure time is 5 minutes.

Sterile gloves are worn only on dry hands. If you work with gloves for more than 3 hours, hand treatment is repeated with a change of gloves.

After removing the gloves, hands are wiped again with a cloth moistened with a skin antiseptic, then washed with soap and moisturized with an emollient cream.

Bacteriological control of the effectiveness of personnel hand treatment.

Personnel's hands are washed with sterile gauze wipes measuring 5x5 cm, soaked in a neutralizer. Using a gauze napkin, thoroughly wipe the palms, periungual and interdigital spaces of both hands. After sampling, the gauze pad is placed in wide-neck test tubes or flasks with saline solution and glass beads and shaken for 10 minutes. The liquid is inoculated and incubated for 48 hours at a temperature of + 37 0 C. Recording of results: absence of pathogenic and opportunistic bacteria ( Guidelines 4.2.2942-11).

Dermatitis associated with frequent hand cleaning

Repeated hand cleaning may cause skin dryness, cracking and dermatitis in sensitive subjects. A healthcare worker suffering from dermatitis increases the risk of infection for patients due to:

· the possibility of colonization of damaged skin by pathogenic microorganisms;

Difficulties in adequately reducing the number of microorganisms when washing hands;

Tendency to avoid hand-handling.

Measures to reduce the likelihood of developing dermatitis:

Thorough rinsing and drying of hands;

· use an adequate amount of antiseptic (avoid excess);

· usage modern and various antiseptics;

· mandatory use of moisturizing and softening creams.

Skin microflora

The superficial layer of the epidermis (the top layer of skin) is completely replaced every 2 weeks. Daily from healthy skin Up to 100 million skin flakes are exfoliated, of which 10% contain viable bacteria. Skin microflora can be divided into two large groups:

1. Resident flora

2. Transitory flora

1. Resident microflora- these are those microorganisms that constantly live and multiply on the skin without causing any diseases. That is, this is normal flora. The number of resident flora is approximately 10 2 -10 3 per 1 cm 2. The resident flora is represented predominantly by coagulase-negative cocci (primarily Staphylococcus epidermidis) and diphtheroids (Corinebacterium spp.). Despite the fact that Staphylococcus aureus is found in the nose of approximately 20% of healthy people, it rarely colonizes the skin of the hands (if it is not damaged), however, in hospital conditions it can be found on the skin of the hands of medical personnel with no less frequency than in the nose.

Resident microflora cannot be destroyed by regular hand washing or even antiseptic procedures, although its numbers are significantly reduced. Sterilization of the skin of the hands is not only impossible, but also undesirable: because normal microflora prevents the colonization of the skin by others, much more dangerous microorganisms, primarily gram-negative bacteria.

2. Transient microflora- these are those microorganisms that are acquired by medical personnel as a result of contact with infected patients or contaminated objects environment. Transient flora can be represented by much more epidemiologically dangerous microorganisms (E.coli, Klebsiella spp., Pseudomonas spp., Salmonella spp. and other gram-negative bacteria, S.aureus, C. albicans, rotaviruses, etc.), including hospital strains of pathogens of nosocomial infections. Transient microorganisms persist on the skin of the hands a short time(rarely more than 24 hours). They can be easily removed by regular hand washing or destroyed by using antiseptics. While these microbes remain on the skin, they can be transmitted to patients through contact and contaminate various objects. This circumstance makes the hands of the staff the most important factor transmission of infection.

If the integrity of the skin is compromised, then transient microflora can cause an infectious disease (for example, whitlow or erysipelas). You should be aware that in this case, the use of antiseptics does not make your hands safe from the point of view of transmission of infection. Microorganisms (most often staphylococci and beta-hemolytic streptococci) remain on the skin during the disease until recovery occurs.

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The issue of the need for hand hygiene by medical personnel was first raised only in the middle of the 19th century. At that time, due to unsanitary conditions in Europe, almost 30% of women giving birth died in hospitals. The main cause of death was the so-called puerperal fever. It often happened that doctors went to women giving birth after dissecting corpses. At the same time, they did not treat their hands with anything, but simply wiped them with a handkerchief.

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Keeping hands clean is a requirement for all healthcare personnel. Hygiene treatment of medical staff’s hands can be carried out in two ways:

• removing contaminants and reducing the number of microorganisms on the skin of the hands using soap and water;
• the use of special alcohol-containing skin antiseptics, which reduce the number of bacteria on the skin to a minimum level.

Only the second method can be called hand hygiene. The first is just hygienic washing. Hands should be washed with liquid soap with a dispenser and dried with an individual disposable towel. But disinfection is carried out using skin antiseptics.

According to the rules, medical personnel must always have hand sanitizer available. In addition, they must be provided with creams, balms, and lotions intended for skin care. Indeed, with constant hygienic treatment, the risk of developing contact dermatitis increases. Also, the selection of detergents and antiseptics should be carried out taking into account individual intolerance.

Important Terms

Every hospital employee should know when the hands of medical staff should be sanitized. This is necessary in the following situations:

• before and after contact with each patient;
• before and after putting on gloves that are used during medical procedures, contact with excreta or body secretions, dressings, mucous surfaces;
• after contact with intact skin, for example, after measuring blood pressure, pulse, or shifting the patient;
• after working with equipment that is located in close proximity to the patient;
• after treating patients with various purulent-inflammatory processes.

If there is obvious contamination of the skin of the hand with the patient’s blood or secretions, they must first be thoroughly washed with soap and water and dried. After this, they must be treated twice with an antiseptic.

Hand washing technique

Do not forget about the importance of cleansing the skin not only in hospitals, but also in other places. The hand treatment technique remains the same everywhere. Before starting the procedure, you must remove all rings, watches and bracelets. Any foreign objects make it difficult to remove pathogenic microorganisms. It is advisable to wash your hands with moderately warm water.

To increase the effectiveness of the procedure, you must first wet your hands and squeeze them. The hand treatment algorithm looks like this:

1. Lather the soap by vigorously rubbing your palms together.
2. Rub one palm against the other in a back-and-forth motion.
3. Rub the back of your right hand with your left palm and vice versa.
4. Connect the fingers of the right hand and the interdigital spaces of the left, carefully process them.
5. It is also necessary to go through the inner surface of the fingers.
6. Cross your outstretched fingers and rub your palms together.
7. Press together and run the backs of your fingers across your palm.
8. Thoroughly rub your thumb in a circular motion; to do this, you need to cover its base with the thumb and forefinger of your other hand.
9. The wrist is treated in a similar way.
10. Rub your palm with your fingertips in a circular motion.

Each movement should be repeated at least 5 times, and the total duration of this wash should be about a minute.

Rules for medical personnel

Every hospital and clinic worker should know how to clean the hands of medical staff. SanPiN (the proper washing diagram is given above) establishes the procedure for not only cleaning the skin, but also disinfecting it. Healthcare workers should also remember the following requirements:

• short-cut nails without varnish;
• absence of rings, signet rings and other similar jewelry.

Nail polish can cause unwanted dermatological reactions that can lead to secondary infection. In addition, dark varnish does not allow assessing the degree of cleanliness of the subungual space. This may cause poor quality processing. Cracked varnish is considered the most dangerous. Indeed, in this case, it becomes more difficult to remove microorganisms from the surface of the hands.

Performing a manicure itself is associated with microtraumas that can easily become infected. This is one of the reasons why medical professionals are prohibited from wearing false nails.

Any jewelry or costume jewelry can cause the hand hygiene of medical staff to become less effective. In addition, they can damage gloves and make putting them on more difficult.

Nuances for surgeons

The treatment of the hands of people participating in surgical interventions is carried out according to a slightly modified scheme. For example, the washing time for them is extended and amounts to 2 minutes. The further algorithm for processing hands is as follows. After mechanical cleaning, it is necessary to dry the skin using a sterile fabric or disposable paper towel.

In addition to washing, treatment with an antiseptic is also important. Attention must be paid not only to the hands, but also to the wrists and forearms. The skin should remain moist during the prescribed treatment time. You cannot wipe your hands; you must wait until the antiseptic has completely dried. Only after this can surgeons put on gloves.

Selection of hygiene products

Many people are now opting for antibacterial soap. But it is important to follow the skin cleansing technique. If done correctly, washing your hands with regular soap will be just as effective. In surgical practice, special means are used for antiseptic hand treatment. The soap contains chlorhexidine gluconate or povidone iodine. These substances can reduce the number of bacteria by 70-80% upon first use and by 99% upon repeated use. Moreover, when using povidone-iodine, the microflora grows faster than when in contact with chlorhexidine.

In order to ensure that the hands of medical staff are treated hygienically in full compliance with regulatory requirements, it is advisable to equip medical institutions. They are controlled without the use of hands.

Also in surgical practice, brushes can be used to clean hands, but this is not considered necessary. They must be either sterile for single use or capable of withstanding autoclaving.

Time periods

In surgical practice, special rules for cleaning the skin have been established. After the usual thorough washing according to the established protocol, they must be disinfected.

It is mandatory to sanitize the hands of medical staff. SanPin (the washing scheme remains the same) stipulates that skin cleansing before surgical procedures can be carried out using the same means as hygiene.

It is important to remember that throughout the entire period of hand disinfection, they must remain wet. To carry out the procedure, as a rule, it is necessary to use more than 6 ml of antiseptic. As a result of research, it was found that for high-quality destruction of bacteria, a five-minute treatment of the skin is sufficient. It has also been confirmed that performing this procedure for three minutes reduces the number of microorganisms to an acceptable level.

Rules for treating hands with antiseptic

After thoroughly washing the skin of your hands, wrists and forearms, you need to dry them. After this, the established standard for hand treatment for workers in operating rooms requires the use of special disinfectants.

Before this, if necessary, you need to treat the nail beds and periungual folds. For these purposes, use sterile disposable wooden sticks, which must be additionally moistened with an antiseptic.

The disinfectant is applied 2.5 ml to the hands and forearms. One treatment of two hands should require about 10 ml of disinfectant liquid. The antiseptic must be rubbed into the skin according to the same pattern as hand washing, observing the correct sequence of movements.

Only after complete absorption/evaporation of the product can you put on gloves. If it lasts more than 3 hours, then the treatment is repeated. After all, pathogenic microorganisms can begin to multiply again under gloves.

Final stage

But this is not all levels of hand treatment. It is important to remove gloves after working with gloves and wash your hands with soap. In this case, there is no longer any need to use a disinfectant solution. Washing with liquid soap is sufficient, preferably with a neutral pH.

After cleaning the skin, it is necessary to moisturize it. Various creams and lotions are used for these purposes. Their main purpose is to prevent the drying effect of alcohol-containing disinfectants.

It is also worth noting that hand hygiene in the absence of visible contamination can be performed without washing. In most cases, it is enough to use antiseptic solutions for 30-60 seconds.

Possible complications

It is worth noting that regular use of disinfectants does not have the best effect on the skin of medical workers. There are two main types of reactions that hospital employees encounter. Most often they complain of itching, dryness, irritation, cracks with bleeding. These symptoms can be either minor or significantly affect the general condition of workers.

There is also another type of complications - allergic dermatitis. They occur when there is intolerance to any components of products intended for hand disinfection. Allergic dermatitis can manifest itself in both mild localized and severe generalized forms. In the most advanced cases, they can be combined with respiratory distress syndrome or other manifestations of anaphylaxis.

Prevalence of complications and their prevention

The significance of the problem can be understood by knowing that such hand cleaning practices result in 25% of nurses presenting with signs of dermatitis, and 85% report a history of skin problems.

The irritating effect of antiseptics can be slightly reduced by adding emollients to them. This is one way to reduce the incidence of contact dermatitis. The risk of their occurrence can also be minimized if you use moisturizers that are designed to care for the skin of your hands after each wash.

To prevent the development of complications, do not wash your hands every time before treating them with an antiseptic. It is also important to ensure that gloves are only put on when the skin is completely dry.

Do not neglect the use of moisturizers. On the market you can find special protective creams designed to prevent the occurrence of contact dermatitis. However, research has failed to confirm their unambiguous effectiveness. Many are stopped by the high price of these creams.

Hands play a significant role in the transmission of nosocomial pathogens in dentistry. Numerous studies have proven significant contamination of the hands of medical personnel with microorganisms. In this case, the species composition depends on the characteristics of the work performed.

There are three levels of hand treatment for medical personnel:

normal washing;

hand hygiene;

surgical treatment of hands.

Routine hand washing ensures the removal of dirt and transient microflora that gets on the doctor’s skin during contact with the patient or contaminated environmental objects. Carry out thorough hand washing:

before starting work;

before and after physical contact with the patient;

when changing clothes and place of work.

It is necessary to wash twice, because... in this case, the effectiveness will be 65 - 70% (with a single dose - 40%). It is better to use liquid soap in disposable dispensers.

When using bar soap, you must place small bars of soap in special racks that have drainage so that the soap dish allows the soap to dry before subsequent use.

Methodology:

Remove jewelry and watches (as quality decreases);

Use a dry hand to squeeze liquid soap out of the dispenser or take dry soap with a dry hand;

Rub the soap vigorously under running water for at least 30 seconds;

Rinse off any remaining soap under running water and repeat;

Dry with a disposable paper or personal towel. In medical institutions it is not recommended to use reusable fabric towels, as well as roll-type towels.

Hand hygiene ensures the removal or destruction of transient (superficial) pathogenic or conditionally pathogenic microflora in order to prevent its spread through the hands of personnel to surrounding objects and patients served, as well as after manipulations that may lead to contamination of the hands of personnel during examination and treatment of patients. All personnel are required to carry out hygienic hand disinfection regularly.

Treatment includes routine hand washing and use of disinfectants - skin antiseptics , which in accordance with the purpose are divided into groups :

For hygienic treatment of the hands of medical personnel (doctors, nurses, etc.);

For disinfection of the hands of surgeons, operating nurses and other participants in the operation;

For disinfection of the surgical field;

For disinfection of the injection field, etc. (carried out by wiping with a sterile swab moistened with an antiseptic)

To prevent damage to the integrity and elasticity of the skin, skin softening additives should be included in the antiseptic: 1% glycerin, lanolin. Personnel should be cautioned against wearing rings or wearing nail polish, as rings and cracked polish make it difficult to remove microorganisms. Manicure can lead to microtraumas that become easily infected.

Skin antiseptics:

Special liquid bactericidal soaps;

Alcohol solutions of skin antiseptics;

Bacterial agents in gel form.

Hygienic treatment of the dentist's hands is carried out before manipulations with gloves (BEFORE and AFTER), after contact with body fluids.

Method of using skin antiseptics: Apply 3 – 5 ml to moistened hands. products and rub until dry. If the product is alcohol-based, then apply the antiseptic to dry hands and rub in for at least 15 seconds.

Surgical treatment of hands (surgeon's hand sanitization) ensures the highest level of cleanliness. It is carried out only with alcohol-containing antiseptics. Processing time is at least 2-5 minutes.

Preparations: “AHD – 2000”, “AHD – 2000 special” (JSC Petrospirt, Russia), “Dekosept” (Bohrer Chemie GmbH, Germany), “Lizanin” (JSC Petrospirt, Russia), “Sterillium” (Bode Chemie GmbH and Co., Germany), etc.

Using ethyl alcohol to disinfect the dentist's hands is not advisable because... its frequent use leads to dry skin of the hands, and in cases of use for disinfection of gloves, it leads to the appearance of microcracks, reducing their barrier function.

Rules for working with gloves:

Gloves are changed to new ones after seeing each patient!

Gloves are worn on thoroughly washed hands!

Jewelry and watches must be removed from hands before putting on gloves!

If the doctor uses non-sterile gloves, then after putting them on, the gloved hands should be thoroughly washed with soap and treated with an antiseptic solution!

After the gloves are removed, hands must be washed thoroughly!

Do not touch the mucous membranes of your eyes, nose, oral cavity, as well as unprotected areas of the skin!

You cannot leave your workplace wearing gloves!

If a glove breaks, remove it immediately, wash your hands thoroughly and put on a new glove!

To maintain the normal condition of the skin of your hands during work, it is recommended:

Wash your hands with water at room temperature (about +20°C) before and after each patient;

After washing, thoroughly dry the skin of your hands with a dry individual towel (the use of paper towels is recommended);

Avoid exposure of exposed skin surfaces to medicinal allergens (antibiotics, novocaine, polymers, components of adhesive systems, etc.);

Use neutral types of soap, for example, “Silk”, “Silk with antiseptic”;

Treat the skin of your hands before starting work with protective creams, for example

Soften the skin of your hands with nourishing and moisturizing creams, for example

Read: A- Made of medical plaster with permanent stumps made of the same material Certificate of medical examination for the state of intoxication of a person driving a vehicle Algorithm of actions of a medical worker in case of cuts and injections Algorithm for protecting medical staff during invasive procedures. Algorithm “Action of a medical worker in the event of identifying a patient with a suspected intestinal infection (salmonellosis, dysentery, escherichiosis, staphylococcal infection, diarrhea)” Algorithm “Action of a medical worker in the event of identifying a patient with suspected norovirus infection and algorithm for collecting clinical material” Algorithm “Action of a medical worker in the event of identification of an infectious patient with suspected anaerobic infection” Algorithm “Action of a medical worker in the event of a puncture or cut of the skin (emergency).” Algorithm “Action of a medical worker when identifying a patient with malaria.”

There are 3 levels of hand decontamination (disinfection):

1. Social.

2. Hygienic (disinfection).

3. Surgical.

SOCIAL LEVEL OF PROCESSING

Wash lightly soiled hands twice with soap and water. Allows you to remove most transient microorganisms from the skin.

Social hand treatment is carried out:

Before meals

After visiting the toilet

Before and after patient care

When your hands are dirty

Before putting on gloves after taking off gloves

EQUIPMENT: soap, liquid soap, napkins, sterile towel.

When using soap, it must be kept dry (by hanging it or storing it in a special soap dish) to prevent contamination by certain microorganisms that grow in such an environment.

ALGORITHM

2. Lather your palms, wash your hands by vigorous mechanical rubbing of the soaped palms for 10 seconds, rinse the soap under running water, hold your hands so that your wrists and hands are above elbow level.

NOTE: In this position, water flows from the clean area to the dirty area.

ATTENTION: DO NOT USE A WET TOWEL!!!

Considering the number of microorganisms transmitted through hands, it is important to understand that hand washing is a serious prevention of nosocomial infections and viral hepatitis.

HYGIENIC LEVEL OF HAND TREATMENT

A certain washing technique, including the use of antiseptics. It's more effective method removal and destruction of microorganisms.

Hand hygiene is carried out:

Before performing invasive procedures

Before caring for an immunocompromised patient

Before and after wound care, urinary catheter

Before putting on and after taking off gloves

After contact with body fluids

Before working with a sterile table

EQUIPMENT: soap, liquid soap, skin antiseptic, sterile wipes or disposable towels.

ALGORITHM

1. Remove all rings from your hands, take off your watch, open water tap, using a disposable napkin, adjust the water temperature.

2. Lather your palms, wash your hands by vigorous mechanical friction of soaped palms for 10 seconds:

1) palm friction

2) palm to palm: friction between fingers

3) washing the back of the fingers with the opposite palm

4) alternate friction thumbs palms

5) alternately rub the palms with the fingers of the other hand. Rinse off the soap under running water.

3. Close the water tap using a paper napkin and dry your hands with a disposable towel.

4. Apply 3-5 ml of antiseptic.

TREATMENT OF HANDS AND MUCOS IN CONTACT WITH BIOLOGICAL FLUIDS.

1. When the skin of your hands is contaminated with secretions, blood, etc. You must wash your hands with soap and water; Dry your hands thoroughly with a disposable towel; treat twice with an antiseptic.

2. Treat gloved hands with a napkin moistened with a disinfectant, then wash with running water, remove the gloves, wash your hands and treat with a skin antiseptic.

3. If biological fluid gets on the mucous membranes of the oropharynx, immediately rinse your mouth and throat with 70% alcohol or 0.05% potassium permanganate solution.

4. If biological fluids get into your eyes, rinse them with a solution of potassium permanganate in water in a ratio of 1:10000.

5. For injections and cuts, wash your hands without taking off your gloves with running water and soap, remove the gloves, squeeze out the blood from the wound, wash your hands with soap and treat the wound with 5% alcohol tincture Yoda. If there are microtraumas, scratches, or abrasions on your hands, cover the damaged areas with adhesive tape.

6. According to indications, emergency prevention of hepatitis and HIV infection is carried out.

7. If you receive injuries, including microtraumas (injections, cuts), dangerous in terms of infection, the person responsible for the prevention of parenteral infections in the healthcare facility organizes registration in the injury log and draws up a report in accordance with the legislation of the Russian Federation.

8. To care for the skin of the hands, softening and protective creams are used to ensure the elasticity and strength of the skin.

Disinfection

Disinfection is a system of measures aimed at the complete destruction of pathogenic microorganisms and the destruction of opportunistic pathogens to a safe level in environmental objects.

When disinfecting high level(TLD) only some types of microbial spores remain viable (used for final processing of flexible endoscopes).

Types of disinfection

1. Preventive - before the appearance of cases of infectious diseases (chlorination tap water, cleaning premises with disinfectant solutions).

2. Focal - when a focus of the disease appears (in an apartment, hospital, etc.) It is divided into:

1) current - from the moment the infectious disease is detected until the patient is removed from the outbreak;

2) final - after removing the patient from the epidemic. hearth.

Disinfection methods

1. Mechanical methods:

Wet cleaning of premises and furnishings;

Freeing the premises from dust using a vacuum cleaner, whitewashing, painting the premises;

Hand washing.

2. Physical means and methods (thermal):

Sun rays;

Exposure to ultraviolet radiation;

Ironing with a hot iron;

Burning waste and items of no value;

Processing with boiling water or heating to a boil;

Pasteurization;

Boiling.

3. Chemical methods (Chemical substance, destroying microorganisms):

Irrigation;

Rubbing;

Full immersion;

Spraying (aqueous solutions, emulsions, powders are used).

Disinfection control methods:

1. Visual (art. m/s, gl. m/s, epidemiologist);

2. Chemical (indicator strips - determine the percentage concentration of the active substance in the working solution).

3. Bacteriological (washes).

Documentation for working with disinfectants:

1. “Logbook for recording the receipt and consumption of disinfectants”;

2. “Working instructions for preparing a disinfectant solution”;

3. “Folder with the results of chemical control of the percentage concentration of the active substance in the working solution.”

PRECAUTIONS WHEN WORKING WITH DISINFECTANTS

1. Used for disinfection, pre-sterilization treatment, sterilization, disinfection chemicals have local and general toxic effects to varying degrees.

2. Persons at least 18 years of age who have undergone appropriate instruction in the duties, safety precautions, precautions and prevention of accidental poisoning set out in the “Rules for labor protection of workers of disinfection departments, preventive disinfection departments of sanitary-epidemiological stations, individual disinfection installations” approved by the USSR Ministry of Health on 02/09/1979 No. 1963-79. The head physician of the institution or a specially appointed person is responsible for the instruction.

3. Persons with hypersensitivity to the chemicals used and allergic diseases are excluded from working with them.

4. When carrying out work, it is necessary to observe the rules of personal hygiene. Smoking, drinking, and eating are prohibited. After work open areas Wash your body (face, hands) with soap and water.

5. Soaking linen, dishes and other items in disinfectant solutions, pre-sterilization treatment and sterilization of medical products with chemicals are carried out in special rooms equipped with supply and exhaust ventilation.

6. Preparation of working solutions of disinfectants is carried out in well-ventilated areas. Store the solutions and keep the objects being treated in them in tightly closed containers. Stocks of drugs are stored in places inaccessible to common use, in a dark container, in a dry, dark and cool room. All disinfectants and solutions must be labeled with name, concentration, date of manufacture and expiration date. In departments, disinfectants and their solutions are stored under lock and key in places inaccessible to children and persons not involved in disinfection, separately from medicinal preparations.

7. The sequence is strictly observed, and the stages of washing and disinfection are carried out precisely, ensuring maximum removal of residual detergents and disinfectants from the objects being processed.

8. All work with disinfectants and chemicals is carried out in accordance with the instructions.

9. When cleaning up spilled product concentrate, you must use protective clothing, boots and personal protection: respiratory organs with universal respirators of the RPG-67 or RU-60M type with a cartridge of grade B; eyes - sealed glasses; hand skin - rubber gloves. Spilled concentrated product should be adsorbed with a moisture-retaining substance (sand, sawdust) or rags and sent for disposal. Do not pour the concentrated product into the sewer.

First aid for accidental poisoning with disinfectants.

1. If the operating regime is violated, safety precautions are not observed, and in emergency situations, personnel may experience symptoms of general poisoning or local irritation from disinfectants. Typical for most applications chemicals disinfection and sterilization is irritating to the skin, mucous membranes of the eyes, and respiratory tract.

2. If the drug gets on your skin, wash off the area immediately clean water. Lubricate the skin with emollient cream.

3. If signs of irritation of the respiratory system appear, you should stop working with the product. Immediately remove the victim from the premises for Fresh air or in a well-ventilated area, rinse your mouth and nasopharynx with water, and consult a doctor if necessary.

4. If the drug gets into your eyes, immediately rinse them under running water for 10-15 minutes and drop in a 30% solution of sodium sulfacyl. See a doctor immediately.

5. If the product gets into the stomach, give the victim several glasses of water with 10-20 crushed tablets of activated carbon. Do not rinse the stomach. If necessary, consult a doctor.

Before using any new disinfectant, carefully study the instructions and precautions.

TECHNIQUES FOR PREPARING DISINFECTANTS PURPOSE: use for disinfection, in accordance with the order for compliance with sanitary and epidemiological regulations.

EQUIPMENT:

Workwear:

Long robe

cap

Oilcloth apron

Medical gloves

Respirator (4-ply gauze mask)

Protective glasses

Indoor shoes

Dez. means

- containers:

For water marked with caps

For disinfectant solution labeled with caps

For detergents marked with lids.

ATTENTION: See instructions for preparation and use

STEPS	JUSTIFICATION
PREPARATION FOR THE PROCEDURE
1. Put on overalls.	Ensuring the safety of m/s in the workplace
2. Prepare equipment	Maintaining clarity in work
3.check the labeling (name of disinfectant, concentration, purpose, date of preparation)	Ensuring personal responsibility
PERFORMANCE OF THE PROCEDURE
1.Pour water into the container up to the mark
2. Place disinfectant in a container with water	Compliance with the procedure for preparing a solution of percentage concentration
3.Stir the solution with a wooden spatula
4.Close with lid
5. Put the date of preparation of the solution and the signature of the m/s on the tag.	Ensuring continuity in work with disinformation. solutions, personal responsibility.

Rules for treating the hands of medical personnel and the skin of patients.

1. 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 of the skin).

Depending on the medical procedure being performed and the required level of reducing microbial contamination of the skin of the hands, medical personnel perform hand hygiene or surgical hand treatment. The administration organizes training and monitoring of compliance with hand hygiene requirements by medical personnel.

2. To achieve effective hand washing and disinfection, it is necessary to observe following conditions: short-cut nails, no nail polish, no artificial nails, no rings, signet rings, etc. 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.

3. Medical personnel must be provided in sufficient numbers effective means for washing and disinfecting hands, as well as hand skin care products (creams, lotions, balms, etc.) to reduce the risk of contact dermatitis. 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 intact skin of the patient (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.

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

2. 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.

3. 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.

4. 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.

1. Remove rings, rings and other jewelry, because they make it difficult effective removal microorganisms.

2. Under a moderate, comfortable stream warm water Hands should be vigorously soaped and rubbed together for at least 10 seconds using the following method:

Rub your hands palm to palm;

Right palm over the back of the left palm and vice versa;

Palm to palm, fingers crossed;

Place your fingers in a lock and rub your fingers together;

Friction with rotational movements of the thumb of the right hand held in the left palm and vice versa;

Friction with rotational movements back and forth with the fingers of the right hand clenched into a pinch on the left palm and vice versa.

3. Rinse your hands under running water.

4. Dry your hands paper towel, which then closes the tap.

Use of gloves.

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

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

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

In order to prevent blood-contact infections, gloves must be worn before any parenteral manipulation of the patient. After removing gloves, perform hand hygiene.

Changing work clothes in the hospital.

4. Personnel are provided with personal protective equipment in required quantity and appropriate sizes (gloves, masks, shields, respirators, aprons, etc.) depending on the profile of the department and the nature of the work performed.

5. Medical personnel must be provided with sets of replacement clothing: gowns, caps, replacement shoes in accordance with the equipment sheet, but not less than 3 sets of special clothing per worker.

In the operating room, doctors and other persons involved in the operation must work in sterile gowns, gloves and masks. Replaceable shoes should be made of non-woven material.

6. Washing of staff clothes should be carried out centrally and separately from the laundry of patients.

7. Change of clothing in surgical and obstetric departments is carried out daily and when soiled. In therapeutic institutions - 2 times a week and when soiled. Replaceable footwear for personnel working in rooms with aseptic conditions must be made of non-woven material that can be disinfected. Changeable clothing and footwear should also be provided for medical personnel of other departments providing advisory and other assistance, as well as for engineering and technical workers.

8. During manipulations on the patient, staff should not take notes or touch handset etc.

Eating is prohibited in the workplace.

It is not allowed to wear medical clothing and shoes outside the medical facility.

Surgical treatment of hands.

Surgeons' hands are treated by everyone involved in surgical interventions, childbirth, and catheterization of great vessels. Processing is carried out in two stages:

Stage I - washing hands with soap and water for two minutes, and then drying with a sterile towel (napkin);

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

The amount of antiseptic required for treatment, the frequency of treatment and its duration are determined by the recommendations set out in the guidelines/instructions for use specific means. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

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

Classic methods treatment of the surgeon's hands:

The following antiseptic solutions are used to treat hands:

a) Pervomur S-4 (2.4% or 4.8%)

Pervomur is used throughout the day. Before use, mix 17.1 ml of 33% hydrogen peroxide and 6.9 ml of 100% formic acid. Place the reagent in the refrigerator for 1 hour, shaking alternately. Before use, the mixture is poured into a basin of water up to 10 liters. Wash your hands in a basin with the prepared solution for 1 minute. Dry your hands and put on gloves.

b) cerigel

Apply 4 ml of cerigel to your hands. Rubs for 10-15 seconds. A film forms on your hands.

c) chlorhexidine bigluconate (hibitan) – 0.5% alcohol solution.

Hands are treated with two wipes generously soaked in cerigel for 2 minutes each.

Disinfection of patients' skin (injection and surgical field)

Treatment of the patient's surgical field Before surgery and other manipulations associated with violation of the integrity of the skin (puncture, biopsy), it is preferable to use an antiseptic containing a dye.

Treatment of the injection field involves skin disinfection using an alcohol-containing antiseptic at the injection site (subcutaneous, intramuscular, intravenous) and blood collection.

To treat the elbow bends of donors, the same antiseptics are used as for treating the surgical field.

For sanitizing the skin patients (general or partial) use antiseptics that do not contain alcohol and have disinfectant and detergent properties. Sanitation is carried out on the eve of surgery or when caring for the patient.