The question 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 in labor died in hospitals. The main cause of death was the so-called postpartum fever. It often happened that doctors went to women in labor after dissecting corpses. At the same time, they did not process their hands with anything, but simply wiped them with a handkerchief.
Types of processing
Keeping your hands clean is a must for everything medical staff... Hygienic treatment of medical staff's hands can be carried out in two ways:
- removing impurities and reducing the number of microorganisms on the skin of the hands with soap and water;
- the use of special alcohol-containing skin antiseptics, which can 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 wiped off with an individual disposable towel. But disinfection is carried out using skin antiseptics.
According to the rules, medical personnel should always have hand care products available. In addition, they must be provided with creams, balms, 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 conditions
Every hospital employee should know when to perform hand hygiene treatment for nursing staff. 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, transferring the patient;
- after working with equipment that is located in the immediate vicinity of the patient;
- after treatment of patients with various purulent-inflammatory processes.
If there is a clear contamination of the skin of the hand with blood or secretions from the patient, then first they must be thoroughly washed with soap and water and dried. After that, they must be treated twice with an antiseptic.
Hand washing technique
Don't forget the importance of cleansing your skin not only in hospitals, but elsewhere as well. The technique of processing hands remains the same everywhere. Before proceeding with the procedure, it is necessary to remove all rings, watches and bracelets. Any foreign objects make it difficult to remove pathogenic microorganisms. It is advisable to wash your hands with lukewarm water.
To increase the effectiveness of the procedure, you must first moisten your hands and squeeze them out.The algorithm for processing hands looks like this:
- Foam the soap by rubbing the palms together intensively.
- Rub one palm against the other in a reciprocating motion.
- Rub the back of the right hand with the left palm and set.
- Connect the fingers of the right hand and the interdigital spaces of the left, carefully process them.
- It is necessary to go through the inner surface of the fingers.
- Cross your spread fingers and rub your palms together.
- Fasten and walk with the back of your fingers on the palm of your hand.
- Thoroughly rub the thumb in a circular motion; for this, it is necessary to cover its base with the thumb and forefinger of the other hand.
- The wrist is processed in a similar way.
- Wipe your palm with your fingertips in a circular motion.
Each movement should be repeated at least 5 times, and the total duration of such a wash should be about a minute.
Rules for medical personnel
Every worker in hospitals and clinics should know how to handle the hands of medical staff. SanPiN (the correct washing scheme is given above) establishes the procedure for not only cleaning the skin, but also disinfecting it. Also, healthcare providers should remember the following requirements:
- short cut nails without varnish;
- lack of rings, signet rings and other similar ornaments.
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 can 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.
The very execution of a manicure is associated with the receipt of microtraumas that are easy to infect. This is one of the reasons why medical professionals are prohibited from wearing false nails.
Any jewelry or bijouterie can make the hygienic treatment of medical staff's hands less effective. They can also damage the gloves and make donning difficult.
Nuances for surgeons
The processing of the hands of people involved in surgical interventions is carried out according to a slightly modified scheme. So, for example, the washing time for them is lengthened and is 2 minutes. The further algorithm for hand processing is as follows. After mechanical cleaning it is necessary to dry the skin with a sterile tissue or disposable paper towel.
In addition to washing, antiseptic treatment is also important. Attention must be paid not only to the hands, but also to the wrists and forearms. During the specified processing time, the skin must remain moist. You cannot wipe your hands, you must wait until the antiseptic is completely dry. Only then can surgeons put on gloves.
Selection of hygiene products
Many now opt for antibacterial soaps. But it is important to follow the technique of cleaning the skin. If done correctly, hand washing 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 are able to reduce the number of bacteria by 70-80% on the first use and by 99% on repeated use. At the same time, when using povidone-iodine, the microflora grows faster than when in contact with chlorhexidine.
So that in full compliance regulatory requirements the hands of the medical staff were handled hygienically, it is desirable to equip the medical facilities. They are controlled without the participation of the hands.
Also in surgical practice, brushes can be used to clean the hands, but this is not considered mandatory. They must be either sterile, disposable, or autoclavable.
Time intervals
In surgical practice, special rules have been established for cleaning the skin. After the usual thorough washing according to the established protocol, they should be decontaminated.
The processing of the hands of the medical staff must be carried out without fail. SanPin (washing scheme remains the same) provides that cleaning the skin before surgical procedures can be carried out using the same means as hygienic.
It is important to remember that during the entire period of hand disinfection, they must remain moist. For the procedure, as a rule, it is necessary to use more than 6 ml of antiseptic. As a result of the research, it was found that for the qualitative destruction of bacteria, a five-minute treatment of the skin is sufficient. It was also confirmed that performing this procedure for three minutes reduces the number of microorganisms to an acceptable level.
Hand antiseptic rules
After thoroughly washing the skin of the hands, wrists and forearms, dry them. After that, the established standard for hand treatment for workers in operating units requires the use of special disinfectants.
Before this, if necessary, it is necessary to process the nail beds and periungual ridges. For these purposes, sterile disposable wooden sticks are used, which must be additionally moistened with an antiseptic.
Disinfectant is applied at 2.5 ml to the hands and forearms. One treatment of two hands should consume about 10 ml of disinfectant liquid. The antiseptic must be rubbed into the skin according to the same scheme according to which hand washing is carried out, observing correct sequence movements.
Gloves can be worn only after complete absorption / evaporation of the agent. If it lasts more than 3 hours, then the treatment is repeated. Indeed, under gloves, pathogens can begin to multiply again.
The final stage
But these are not all the levels of hand processing. It is important to remove gloves after work and wash your hands with soap and water. In this case, it is no longer necessary to use a disinfectant solution. Washing with liquid soap is sufficient, preferably a neutral pH.
After cleaning the skin, they must be moistened. For these purposes are used various creams, lotions. Their main purpose is to prevent the drying effect of alcohol-containing disinfectants.
Separately, it should be noted that the hygienic treatment of hands in the absence of visible contamination can be performed without washing. In most cases, it is sufficient to use antiseptic solutions for 30-60 seconds.
Possible complications
It should be noted that the regular use of disinfectants does not have the best effect on the skin of healthcare workers. There are two main types of reactions experienced by hospital staff. Most often, they complain of itching, dryness, irritation, cracks with bleeding. These symptoms can be both minor and significantly affect the general condition of workers.
There is also another type of complication - allergic dermatitis. They are found in cases of intolerance to any components of hand sanitizers. Allergic dermatitis can manifest itself in both a mild localized and severe generalized form. In the most advanced cases, they can be combined with respiratory distress syndrome or other manifestations of anaphylaxis.
The prevalence of complications and their prevention
You can understand the significance of the problem if you know that such hand treatment methods lead to the fact that 25% of nurses are treated with signs of dermatitis, and 85% reported that they had a history of skin problems.
You can slightly reduce the irritating effect of antiseptics by adding emollients. This is one way to reduce the prevalence of contact dermatitis. Also, the risk of their occurrence can be minimized by using moisturizers that are designed to care for the skin of the hands after each wash.
To prevent the development of complications, you should not wash your hands every time before treating them with an antiseptic. In addition, it is important to ensure that gloves are only worn 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 appearance of contact dermatitis. However, as a result of studies, it was not possible to confirm their unequivocal effectiveness. Many are stopped by the high price of these creams.
1. Remove all rings from your hands (grooves on the surface of 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 under running water.
4. Apply 3-5 ml of liquid soap to your hands or thoroughly lather your hands with bar soap.
5. Wash your hands using the following technique:
Vigorous mechanical friction of the palms (repeat 5 times);
The right palm washes the back of the left hand with rubbing movements, then left palm washes the rear of the right hand (repeat 5 times);
Palm to palm, fingers of one hand in the interdigital spaces of the other (repeat 5 times);
The back of the fingers to the palm of the other hand (fingers are intertwined - repeat 5 times);
Alternating rotational friction thumbs one hand with the palms of the other, palms clenched (repeat 5 times);
Alternating rubbing of the palm of one hand with closed fingers of the other hand (review)
fig. 6. Hand washing.
6. Rinse your hands under running water, keep them so that the wrists and hands are below the level of the elbows and to avoid contamination from touching the sink, dressing gown and other objects.
7. Close the tap by only grasping it with a paper towel, as it may be a source of contamination.
8. Dry your hands with a sterile gauze pad.
8. Thoroughly treat the skin of the hands for 2-3 minutes with 2 tampons 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% ethyl alcohol or an alcohol-containing skin antiseptic with a virucidal effect and rub into the skin for 2 minutes.
9. Dispose of the used balls into a container for disinfection.
10. Put on gloves according to the algorithm of actions.
Use of protective clothing.
Bathrobes.
With the exception of operating theaters or dressing rooms, where sterile gowns are worn to protect the patient, the main purpose of the gowns is to keep infectious agents out of staff's clothing and skin.
Hats.
Medical caps securely cover the hair, preventing it from acting as a source of pollution.
Aprons.
Rubber and polyethylene aprons are necessary to protect the overalls and skin of personnel in case of the threat of splashing blood and other 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 ingress of liquid substances human body in 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 dealing with infectious patients from whom the infection can be easily transmitted by airborne droplets.
Masks should be replaced every 3-4 hours (depending on the profile of the work being performed) or when they are moistened during work. You can not lower the masks around the neck, reuse. All masks must completely cover the nose and mouth.
Social Hand Treatment Standard
Target: removal of dirt and transient flora from the contaminated skin of the hands of medical personnel as a result of contact with patients or environmental objects; ensuring the infectious safety of the patient and staff.
Indications: before serving food, feeding the patient; after using the toilet; before and after caring for the patient, if the hands are not contaminated with the patient's body fluids.
Prepare: liquid soap in single-use dispensers; watch with a second hand, paper towels.
Algorithm of action:
1. Remove rings, signet rings, watches and other jewelry from your fingers, check the integrity of your hands.
2. Fold the sleeves of the robe over 2/3 of the forearm.
3. Open water tap using a paper napkin and adjust the water temperature (35 ° -40 ° C), thereby preventing hand contact with microorganisms located on the tap.
4.
Wash your hands with soap under running water up to 2/3 of the forearm for 30 seconds, paying attention to the phalanges, interdigital spaces of the hands, then wash the back and palm of each hand and rotate the base of the thumbs (this time is enough for decontamination of hands on a social level if the surface of the skin of the hands is thoroughly lather and does not leave dirty areas of the skin of the hands).
5. Rinse your hands under running water to remove soap suds (keep your hands up with your fingers so that the water flows into the sink from your elbows, without touching the sink. The phalanges of the fingers should remain the cleanest).
6. Close the elbow valve with a movement of the elbow.
7. Dry your hands with a paper towel, if there is no elbow tap, cover the edges with a paper towel.
Hygienic Hand Treatment Standard
Target:
Indications: before and after performing invasive procedures; before putting on and after removing gloves, after contact with body fluids and after possible microbial contamination; before caring for an immunocompromised patient.
Prepare: liquid soap in dispensers; 70% ethyl alcohol, watch with a second hand, warm water, paper towel, safe disposal container (CBU).
Algorithm of action:
1. Remove rings, signet rings, watches and other jewelry from your fingers.
2. Check the integrity of the skin of the hands.
3. Fold the sleeves of the robe over 2/3 of the forearm.
4. Open the water tap with a paper towel and adjust the water temperature (35 ° -40 ° C), thereby preventing hand contact with microorganisms. located on the crane.
5. Under a moderate stream warm water lather your hands vigorously before
2/3 forearms and wash your hands in the following sequence:
- palm on palm;
Each movement is repeated at least 5 times within 10 seconds.
6. Rinse your hands under running warm water until the soap is completely removed, holding your hands so that the wrists and hands are above the level of the elbows (in this position, water flows from a clean area to a dirty area).
7. Close the tap with your right or left elbow.
8. Dry your hands with a paper towel.
If there is no elbow tap, close the tap with a paper towel.
Note:
- Without necessary conditions for hygienic hand washing, you can treat them with an antiseptic;
- apply to dry hands 3-5
ml of antiseptic and rub it on your hands until dry. Do not wipe your hands after processing! It is also important to observe the exposure time - hands must be moist from an antiseptic for at least 15 seconds;
- the principle of surface treatment "from clean to dirty" is observed. Do not touch foreign objects with washed hands.
1.3. Standard "Hygienic treatment of hands with an antiseptic"
Target: removal or destruction of transient microflora, ensuring the infectious safety of the patient and staff.
Indications: before injection, catheterization. operation
Contraindications: the presence of pustules on the hands and body, cracks and wounds of the skin, skin diseases.
Prepare; skin antiseptic for treating the hands of medical personnel
Algorithm of action:
1. Decontaminate hands at a hygienic level (see standard).
2. Dry your hands with a paper towel.
3. Apply 3-5 ml of antiseptic on the palms and rub into the skin for 30 seconds in the following sequence:
- palm on palm
- right palm on the back of the left hand and vice versa;
- palm to palm, fingers of one hand in the interdigital spaces of the other;
- the backs of the fingers of the right hand on the palm of the left hand and vice versa;
- rotational friction of the thumbs;
- with the fingertips of the left hand gathered together on the right palm in a circular motion and vice versa.
4. Ensure that the hand sanitizer is completely dry.
Note: before using a new antiseptic, it is necessary to study guidelines to him.
1.4. Standard "Putting on sterile gloves"
Target: ensuring the infectious safety of the patient and staff.
- gloves reduce the risk of occupational infection through contact with patients or their secretions;
- gloves reduce the risk of contamination of the hands of personnel with transient pathogens and their subsequent transmission to patients,
- gloves reduce the risk of contamination of patients with microbes that are part of the resident flora of the hands of medical workers.
Indications: when performing invasive procedures, in contact with any biological fluid, in violation of the integrity of the skin, both the patient and medical worker, during endoscopic examinations and manipulations; in clinical diagnostic, bacteriological laboratories when working with material from patients, during injections, when caring for a patient.
Prepare: gloves in sterile packaging, container for safe disposal (CBU).
Algorithm of action:
1. Decontaminate your hands at a hygienic level, treat your hands with an antiseptic.
2. Take gloves in sterile packaging, unfold.
3. Grasp the right-hand glove by the cuff with your left hand so that your fingers do not touch the inside of the cuff.
4. Close the fingers of your right hand and insert them into the glove.
5. Open the fingers of your right hand and pull the glove over them, without breaking its lapel.
6. Place under the cuff of the left glove the 2nd, 3rd and 4th fingers of the right hand, already wearing the glove, so that the 1st finger of the right hand is directed towards the 1st finger on the left glove.
7. Hold your left glove vertically with the 2nd, 3rd and 4th fingers of your right hand.
8. Close the fingers of your left hand and insert them into the glove.
9. Open the fingers of your left hand and pull the glove over them, without breaking its lapel.
10. Spread the cuff of the left glove by pulling it on the sleeve, then on the right with the help of the 2nd and 3rd fingers, bringing them under the rolled edge of the glove.
Note: If one glove is damaged, both should be changed immediately, because you cannot remove one glove without contaminating the other.
1.5. Glove Removal Standard
Algorithm of action:
1. Using the gloved fingers of your right hand, make a fold on the left glove, touching only the outside of the glove.
2. Using the gloved fingers of your left hand, make a fold on the right glove, touching it only from the outside.
3. Remove the glove from the left hand by turning it inside out.
4. Hold the glove removed from your left hand by the cuff in your right hand.
5.
With your left hand, grasp the glove on your right hand by the lapel with inside.
6. Remove the glove from the right hand by turning it inside out.
7. Place both gloves (left inside right) into the KBU.
The composition of the cleaning solution
3. Immerse completely disassembled medical devices in the washing solution for 15 minutes, after filling the cavities and channels with the solution, close the lid.
4. Brush each item with a brush (gauze swab) in the detergent solution for 0.5 minutes (pass the detergent solution through the channels).
5.
Place medical supplies in the tray.
6. Rinse each item under running water for 10 minutes, passing water through the channels and cavities of the items.
7. Carry out quality control of pre-sterilization cleaning with an azopyram sample. Control is subjected to 1% of simultaneously processed products of the same name per day, but not less than 3-5 units.
8. Prepare a working solution of the azopyram reagent (the working reagent is used for 2 hours after preparation).
9. Apply the working reagent with a reagent pipette on medical devices (on the body, channels and cavities, places of contact with biological fluids).
10. Hold medical devices over cotton or tissue, observing the color of the flowing reagent.
11. Evaluate the result of the azopyram test.
Ear Care Standard
Target: observance of personal hygiene of the patient, prevention of diseases, prevention of hearing loss due to the accumulation of sulfur, instillation of a medicinal substance.
Indications: serious condition of the patient, the presence of sulfur in the ear canal.
Contraindications: inflammatory processes in the auricle, external auditory canal.
Prepare: sterile: tray, pipette, tweezers, beaker, cotton balls, napkins, gloves, 3% hydrogen peroxide solution, soap solution, containers with disinfectant solutions, KBU.
Algorithm of action:
1. Explain to the patient the course of the procedure, get his consent.
3. Prepare a container of soapy water.
4. Tilt the patient's head to the side opposite the ear to be treated, place the tray.
5. Dampen a tissue in warm soap solution and wipe the auricle, dry with a dry cloth (to remove dirt).
6. Pour into a sterile beaker, preheated in a water bath (T 0 - 36 0 - 37 0 C) 3% hydrogen peroxide solution.
7. Take a cotton swab in your right hand with tweezers and moisten it with a 3% solution of hydrogen peroxide, and with your left hand pull the auricle back and up to align the ear canal and insert the turunda with rotational movements into the external auditory canal to a depth of no more than 1 cm by 2 - 3 minutes.
8. Insert dry turunda with light rotational movements into the external auditory canal to a depth of not more than 1 cm and leave for 2 - 3 minutes.
9. Remove the turunda with rotational movements from the external auditory canal - the removal of secretions and wax from the ear canal is ensured.
10. Treat the other ear canal in the same sequence.
11. Take off your gloves.
12. Place used gloves, turundas, napkins in the KBU, tweezers, and a beaker in a container with disinfecting solutions.
13. Wash and dry your hands.
Note: When processing ears, cotton wool should not be wrapped on solid objects, possibly trauma to the ear canal.
Algorithm of action:
1. Explain to the patient the purpose of the procedure, get his consent.
2. Decontaminate hands at a hygienic level, wear gloves.
3. Place an oilcloth under the patient.
4. Pour warm water into the basin.
5. Expose upper part the patient's body.
6. Dampen a napkin, a piece of a towel or a cloth mitten in warm water, lightly squeeze out excess water.
7. Wipe the patient's skin in the following sequence: face, chin, behind the ears, neck, arms, chest, creases under the mammary glands, armpits.
8. Wipe the patient's body dry with the dry end of the towel in the same sequence and cover with a sheet.
9. Treat the back, live, hips, legs in the same way.
10. Trim your fingernails.
11. Change underwear and bedding (if necessary).
12. Take off your gloves.
13. Wash and dry your hands.
Algorithm of action:
1. Wash the head of a seriously ill patient in bed.
2. Give your head an elevated position, i.e. put a special headrest or roll up the mattress with a roller and tuck it under the patient's head, lay an oilcloth on it.
3. Tilt the patient's head back at neck level.
4. Place a bowl of warm water on a stool at the head end of the bed at the level of the patient's neck.
5.
Moisten the patient's head with a stream of water, lather the hair, massage the scalp thoroughly.
6. Wash your hair from the front of your head back with soap or shampoo.
7. Rinse your hair and wring it dry with a towel.
8. Comb your hair with a fine comb daily, short hair should be combed from roots to ends, and long hair should be divided into strands and combed slowly from ends to roots, being careful not to pull them out.
9. Place a clean cotton kerchief over your head.
10.Lower the headrest, remove all care items, straighten the mattress.
11. Place used care items in disinfectant solution.
Note:
- the head of a seriously ill patient (in the absence of contraindications) should be washed once a week. The optimal device for this procedure is a special headrest, but the bed should also have a removable back, which greatly facilitates this laborious procedure;
- women comb their hair daily with a fine comb;
- men have their hair cut short;
- a fine comb, dipped in a 6% vinegar solution, combes out dandruff and dust well.
Standard "Ship delivery"
Target: provision of physiological procedures for the patient.
Indication: used in patients who are on strict bed and bed rest during bowel and bladder emptying. Prepare: disinfected vessel, oilcloth, diaper, gloves, diaper, water, toilet paper, container with disinfectant solution, KBU.
Algorithm of action:
1. Explain to the patient the purpose and course of the procedure, get his consent,
2. Rinse the boat with warm water, leaving some water in it.
3. Separate the patient with a screen from others, remove or fold the blanket to the waist, put an oilcloth under the patient's pelvis, and a diaper on top.
4. Decontaminate hands at a hygienic level, wear gloves.
5. Help the patient to turn on the side, bend your legs slightly at the knees and spread them apart at the hips.
6. Move your left hand to the side under the sacrum, helping the patient to raise the pelvis.
7. With your right hand, move the boat under the patient's buttocks so that his crotch is over the opening of the boat, while pushing the diaper towards the lower back.
8. Cover the patient with a blanket or sheets and leave him alone.
9. At the end of the act of defecation, slightly turn the patient to one side, holding the vessel with your right hand, remove it from under the patient.
10. Wipe the anal area with toilet paper. Place the paper on the ship. If necessary, wash the patient, dry the perineum.
11. Remove the boat, oilcloth, diaper and screen. Replace the sheet if necessary.
12.
Help the patient to lie down comfortably, cover with a blanket .
13.
Cover the boat with a diaper and linen and carry it to the washroom.
14.
Empty the contents of the boat into the toilet, rinse it with hot water .
15.
Immerse the boat in a container with disinfectant solution, discard gloves in
KBU.
16.
Wash and dry your hands.
Discharged liquid
9. Record the amount of fluid drunk and injected into the body on the record sheet.
Injected fluid
10. At 6:00 am the next day, the patient hands over the registration sheet to the nurse.
The difference between the amount of fluid you drink and the daily amount of the night is the amount of the body's water balance.
The nurse should:
- Ensure that the patient can measure fluid.
- Ensure that the patient has not taken diuretics within 3 days prior to the study.
- Tell the patient how much fluid should normally be excreted in the urine.
- Explain to the patient the approximate percentage of water in food to facilitate the recording of the introduced fluid (not only the water content in food is taken into account, but also the introduced parenteral solutions).
- Solid foods can contain 60 to 80% water.
- Not only urine, but also vomit, feces of the patient are monitored for the amount of excreted fluid.
- The nurse calculates the number of entered and removed nights per day.
The percentage of fluid excretion is determined (80% of the normal amount of fluid excreted).
the amount of urine excreted x 100
Removal percentage =
amount of fluid injected
Calculate the water balance according to the following formula:
the total amount of urine excreted per day multiplied by 0.8 (80%) = the amount of night that should be excreted normally.
Compare the amount of excreted fluid with the amount of calculated fluid in the norm.
- The water balance is considered negative if less liquid is released than calculated.
- The water balance is considered positive if more fluid is released than calculated.
- Make entries in the water balance sheet and evaluate it.
Result evaluation:
80% - 5-10% - the rate of elimination (-10-15% - in the hot season; + 10-15%
- in cold weather;
- a positive water balance (> 90%) indicates the effectiveness of treatment and edema convergence (reaction to diuretics or fasting diets);
- negative water balance (10%) indicates an increase in edema or ineffectiveness of the dose of diuretics.
I.IX. Punctures.
1.84. Standard "Preparation of a patient and medical instruments for pleural puncture (pleurocentesis, thoraccentesis)".
Target: diagnostic: a study of the nature of the pleural cavity; therapeutic: the introduction of drugs into the cavity.
Indications: traumatic hemothorax, pneumothorax, spontaneous valvular pneumothorax, respiratory diseases (croupous pneumonia, pleurisy, pulmonary empyema, tuberculosis, lung cancer, etc.).
Contraindications: increased bleeding, skin diseases (pyoderma, shingles, chest burns, acute heart failure.
Prepare: sterile: cotton balls, gauze napkins, diapers, needles for intravenous and subcutaneous injections, needles for puncture 10 cm long and 1 - 1.5 mm in diameter, syringes 5, 10, 20, 50 ml, tweezers, 0, 5% novocaine solution, 5% iodine alcohol solution, 70% alcohol, clip; cleol, adhesive plaster, 2 chest X-rays, sterile container for pleural fluid, container with disinfectant, referral to the laboratory, kit for assisting with anaphylactic shock, gloves, CBU.
Algorithm of action:
2. Sit the patient, stripped to the waist, on a chair facing his back, ask him to rest on the back of the chair with one hand, and bring the other (from the side of the localization of the pathological process) behind his head.
3. Ask the patient to slightly tilt the torso to the side opposite to the one where the doctor will perform the puncture.
4. Pleural puncture is performed only by a doctor, a nurse will assist him.
5. Decontaminate hands at a hygienic level, treat them with a skin antiseptic, wear gloves.
6. Treat the intended puncture site with 5% alcohol solution of iodine, then 70% alcohol solution and again with iodine.
7. Give the doctor a syringe with a 0.5% solution of novocaine for infiltration anesthesia of the intercostal muscles and pleura.
8. The puncture is made in the VII - VII intercostal space along the upper edge of the underlying rib, since the neurovascular bundle passes along the lower edge of the rib and intercostal vessels can be damaged.
9. The doctor inserts a puncture needle into the pleural cavity and pumps the contents into the syringe.
10. Place a container for the fluid to be removed.
11. Empty the contents of the syringe into a sterile jar (tube) for laboratory testing.
12. Give the doctor a syringe with the collected antibiotic for injection into the pleural cavity.
13. After removing the needle, treat the puncture site with 5% alcohol solution of iodine.
14. Apply a sterile napkin to the puncture site, fix with adhesive tape or glue.
15. Carry out tight bandaging of the chest with sheets to slow down the exudation of fluid into the pleural cavity and prevent the development of collapse.
16. Remove gloves, wash hands and dry.
17. Used disposable syringes, gloves, cotton balls, napkins, put in the KBU, the puncture needle in a container with a disinfectant solution.
18. Monitor the patient's well-being, the condition of the dressing, count his pulse, measure blood pressure.
19. Escort the patient to the ward on a gurney, lying on his stomach.
20. Warn the patient about the need to stay in bed for 2 hours after the manipulation.
21. Send the received biological material for research to the laboratory with a referral.
Note:
When more than 1 liter of fluid is removed from the pleural cavity at once, there is a great risk of collapse;
Delivery of pleural fluid to the laboratory should be carried out urgently in order to avoid the destruction of enzymes and cellular elements;
When the needle enters the pleural cavity, there is a feeling of "failure" into the free space.
1.85. Standard "Preparation of a patient and medical instruments for an abdominal puncture (laparocentesis)".
Target: diagnostic: laboratory examination of ascitic fluid.
Therapeutic: removal of accumulated fluid from the abdominal cavity with ascites.
Indications: ascites, with malignant neoplasms of the abdominal cavity, chronic hepatitis and cirrhosis of the liver, chronic cardiovascular failure.
Contraindications: severe hypotension, adhesions in the abdominal cavity, severe flatulence.
Prepare: sterile: cotton balls, gloves, trocar, scalpel, syringes 5, 10, 20 ml, napkins, jar with a lid; 0.5% novocaine solution, 5% iodine solution, 70% alcohol, container for extracted liquid, basin, test tubes; a wide towel or sheet, an adhesive plaster, a set to help with anaphylactic shock, a container with a disinfectant solution, a referral for examination, dressings, tweezers, KBU.
Algorithm of action:
1. Inform the patient about the upcoming study and obtain his consent.
2. On the morning of the study day, give the patient a cleansing enema until the effect of "pure water".
3. Immediately before performing the manipulation, invite the patient to empty the bladder.
4. Ask the patient to sit in a chair with the back supported. Cover the patient's legs with oilcloth.
5. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.
6. Give the doctor a 5% alcohol solution of iodine, then 70% alcohol solution to treat the skin between the navel and the pubis.
7. Give the doctor a syringe with 0.5% novocaine solution for layer-by-layer infiltration anesthesia of soft tissues. A puncture during laparocentesis is performed along the midline of the anterior abdominal wall on equal distance between the navel and the pubis, stepping back 2-3 cm to the side.
8. The doctor cuts the skin with a scalpel, with his right hand pushes the trocar through the thickness of the abdominal wall with his right hand, then removes the stylet and ascitic fluid begins to flow through the cannula under pressure.
9. Place a container (basin or bucket) in front of the patient for fluid flowing out of the abdominal cavity.
10. Fill a sterile jar with 20-50 ml of liquid for laboratory research (bacteriological and cytological).
11. Place a sterile sheet or wide towel under the patient's lower abdomen, the ends of which should be held by the nurse. Tighten the abdomen with a sheet or towel covering it above or below the puncture site.
12. Use a wide towel or sheet to periodically tighten the patient's anterior abdominal wall as fluid is removed.
13. After the end of the procedure, you need to remove the cannula, suture the wound with a skin suture and treat with 5% iodine solution, apply an aseptic bandage.
14. Remove gloves, wash hands and dry.
15. Place the used tools in disinfectant solution, gloves, cotton balls, place syringes in the KBU.
16. Determine the patient's pulse, measure blood pressure.
17. Transport the patient to the ward on a gurney.
18. Warn the patient to stay in bed for 2 hours after the procedure (to avoid hemodynamic disturbances).
19. Send the obtained biological material to the laboratory for research.
Note:
When carrying out the manipulation, strictly follow the rules of asepsis;
With a rapid withdrawal of fluid, collapse and fainting may develop, due to a drop in intra-abdominal and intrathoracic pressure and redistribution of circulating blood.
1.86. Standard "Preparation of the patient and medical instruments for the lumbar puncture".
Target: diagnostic (for the study of cerebrospinal fluid) and therapeutic (for the introduction of antibiotics, etc.).
Indications: meningitis.
Prepare: sterile: syringes with needles (5 ml, 10 ml, 20 ml), a puncture needle with a mandrel, tweezers, napkins and cotton balls, tray, culture medium, test tubes, gloves; manometric tube, 70% alcohol, 5% alcohol solution of iodine, 0.5% novocaine solution, adhesive plaster, KBU.
Algorithm of action:
1. Inform the patient about the upcoming procedure and obtain consent.
2. The puncture is carried out by a doctor in strict adherence to the rules of asepsis.
3. Take the patient to the treatment room.
4. Lay the patient on the right side closer to the edge of the couch without a pillow, tilt the head forward towards the chest, bend the knees as much as possible and pull up to the abdomen (the back should be arched).
5. Push left hand under the patient's side, hold the patient's legs with your right hand to fix the position given to the back. During the puncture, another assistant fixes the patient's head.
6. The puncture is made between the III and IV lumbar vertebrae.
8. Treat the skin at the puncture site with 5% iodine solution, then 70% alcohol solution.
9. Fill a syringe with a 0.5% solution of novocaine and give it to the doctor for infiltration anesthesia of soft tissues, and then a puncture needle with a mandrel on a tray.
10. Collect 10 ml of CSF in a test tube, write a referral and send to the clinical laboratory.
11. Collect 2-5 ml of cerebrospinal fluid in a tube with culture medium for bacteriological examination. Write a referral and send the biological material to the bacteriological laboratory.
12. Give the doctor a CSF manometric tube.
13. After removing the puncture needle, treat the puncture site with 5% alcohol solution of iodine.
14. Apply a sterile napkin to the puncture site, cover with adhesive tape.
15. Place the patient on his stomach and take him to the ward on a gurney.
16. Place the patient on the bed without a pillow in the prone position for 2 hours.
17. Observe the patient's condition throughout the day.
18. Take off your gloves.
19. Place the syringes, cotton balls, gloves in the KBU, place the used instruments in the disinfectant solution.
20. Wash and dry.
1.87. Standard "Preparation of the patient and medical instruments for sterile puncture".
Target: diagnostic: examination of the bone marrow to establish or confirm the diagnosis of blood diseases.
Indications: diseases of the hematopoietic system.
Contraindications: myocardial infarction, attacks of bronchial asthma, extensive burns, skin diseases, thrombocytopenia.
Prepare: sterile: tray, syringes 10 - 20 ml, Kassirsky's puncture needle, 8 - 10 slides, cotton and gauze balls, forceps, tweezers, gloves, 70% alcohol, 5% alcohol solution of iodine; adhesive plaster, sterile dressing material, KBU.
Algorithm of action:
1. Inform the patient about the upcoming study and obtain his consent.
2. Sternal puncture is performed by a doctor in a procedure room.
3. The sternum is punctured on level III- IV intercostal space.
4. The nurse assists the doctor during the manipulation.
5. Invite the patient to the treatment room.
6. Offer the patient to undress to the waist. Help him lie on the couch, on his back without a pillow.
7. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.
8. Treat the front surface of the patient's chest, from the collarbone to the gastric region with a sterile cotton ball moistened with 5% iodine solution, and then 2 times 70% alcohol.
9. Perform layer-by-layer infiltration anesthesia of soft tissues with 2% novocaine solution up to 2 ml in the center of the sternum at the level III - IV intercostal space.
10. Give the doctor the Kassirsky's puncture needle, setting the guard-limiter at 13-15 mm of the needle tip, then a sterile syringe.
11. The doctor pierces the outer plate of the sternum. The hand feels the failure of the needle, removing the mandrel, a 20.0 ml syringe is attached to the needle and 0.5-1 ml of bone marrow is sucked into it, which is poured onto a glass slide.
12. Dry the slides.
13. After removing the needle, treat the puncture site with 5% alcohol solution of iodine or 70% alcohol solution and apply a sterile bandage, fix with adhesive plaster.
14. Take off your gloves.
15. Dispose of used gloves, syringes and cotton balls into the KBU.
16. Wash your hands with soap and dry.
17. Escort the patient to the ward.
18. Send the slides to the laboratory after the material has dried.
Note: Kassirsky's needle is a short thick-walled needle with a mandrel and a shield that prevents too much deep penetration needles.
1.88. Standard "Preparation of the patient and medical instruments for the puncture of the joints."
Target: diagnostic: determination of the nature of the contents of the joint; therapeutic: removal of effusion, rinsing of the joint cavity, introduction of medicinal substances into the joint.
Indications: joint diseases, intra-articular fractures, hemoarthrosis.
Contraindications: purulent inflammation of the skin at the puncture site.
Prepare: sterile: a puncture needle 7-10 cm long, syringes 10, 20 ml, tweezers, gauze swabs; aseptic dressing, napkins, gloves, tray, 5% alcohol solution of iodine, 70% alcohol solution, 0.5% novocaine solution, test tubes, KBU.
Algorithm of action:
1. The puncture is carried out by the doctor in the treatment room in strict observance of the rules of asepsis.
2. Inform the patient about the upcoming study and obtain his consent.
3. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, wear gloves.
4. Ask the patient to sit comfortably in a chair or in a comfortable position.
5. Give the doctor a 5% alcohol solution of iodine, then a 70% alcohol solution to treat the intended puncture site, a syringe with a 0.5% novocaine solution for infiltration anesthesia.
6. The doctor with his left hand covers the joint at the puncture site and squeezes the effusion to the puncture site.
7. The needle is inserted into the joint and the effusion is collected with a syringe.
8. Pour the first portion of the contents from the syringe into the test tube without touching the walls of the laboratory test tube.
9. After the puncture, antibiotics and steroid hormones are injected into the joint cavity.
10. After removing the needle, lubricate the puncture site with 5% alcohol solution of iodine and apply an aseptic dressing.
11. Place used syringes, napkins, gloves, gauze swabs in the KBU, a puncture needle in a disinfectant solution.
12. Remove gloves, wash and dry your hands.
I.XII. "Preparing a patient for laboratory and instrumental research methods."
Standard "Preparing a patient for fibrogastroduodenoscopy"
Target: to provide high-quality preparation for the study; visual examination of the mucous membrane of the esophagus, stomach and duodenum
Prepare: sterile gastroscope, towel; direction for research.
FGDS is carried out by a doctor, a nurse is assisting.
Algorithm of action:
1. Explain to the patient the purpose and course of the upcoming study and obtain his consent.
2. Conduct psychological preparation of the patient.
3. Inform the patient that the test is done in the morning on an empty stomach. Eliminate food intake, water, drugs; do not smoke, do not brush your teeth.
4. Provide the patient with a light supper the night before, no later than 6 pm; after supper, the patient should not eat or drink.
5.
Make sure that the patient removes any removable dentures before the examination.
6. Warn the patient not to speak or swallow saliva during the endoscopy (the patient spits saliva into a towel or napkin).
7. Take the patient to the endoscopy room with a towel, medical history, referral to the appointed hour.
8. Accompany the patient to the ward after the examination and ask him not to eat food for 1-1.5 hours until the swallowing is fully restored; no smoking.
Note:
-
remedication n / a is not carried out, because changes the state of the examined organ;
- when taking material for biopsy - food is served to the patient only cold.
Standard "Preparing a patient for colonoscopy"
Colonoscopy - This is an instrumental method for examining high-lying parts of the colon using a flexible endoscope probe.
Diagnostic value of the method: Colonoscopy allows direct
End of the procedure.
Performing the procedure.
Social level of hand processing
Levels of treatment for the hands of a healthcare professional
There are three levels of hand processing: social, hygienic (disinfection of the hands), surgical (sterility of the hands is achieved for a certain period of time).
Target: remove microflora from the surface of the hands by a mechanical method. Ensure the infectious safety of the patient and staff.
Indications:
Before and after execution treatment procedures with and without gloves;
Before and after eating, feeding the patient;
After using the toilet;
Before and after caring for the patient, as long as the hands are not contaminated with the patient's body fluids.
Equipment: household soap (liquid) for single use, a watch with a second hand, warm running water, sterile napkins on a tray, an individual towel (electric dryer).
Required condition: healthy skin of hands, nails no more than 1 mm, without varnish. Before the procedure, clean under the nails, wash under running water.
Preparation for the procedure.
- Remove rings from fingers, check the integrity of the skin of the HANDS .
- Wrap the sleeves of the robe up to the elbow, take off the watch.
- Open the tap, adjust the water temperature (35-40 °).
1. Lather your hands and wash the faucet with soap (the elbow faucet is not washed; if a bar of soap is used, wash it, put it on a clean napkin or in a bar soap dish).
2. Wash hands with soap in running water up to 2/3 of the forearm for 30 seconds, paying attention to the phalanges and interdigital spaces of the hands, then wash the back and palm of each hand and rotate the base of the thumbs.
Note: this time is sufficient for decontamination of hands on a social level, if the surface of the skin of the hands is thoroughly soaped and dirty areas of the skin of the hands are not left.
3. Rinse hands under running water to remove soap suds.
Note: hold your hands with your fingers upward so that the water drains into the sink from your elbows (do not touch the sink). The phalanges of the fingers should remain the cleanest.
4. Repeat hand washing in the same sequence.
1. Close the tap using a napkin (close the elbow tap by moving the elbow).
2. Dry your hands with a dry clean individual towel or dryer.
Target: ensuring hand decontamination at a hygienic level.
Indications:
Ø before putting on and after taking off gloves;
Ø after contact with body fluids and after possible microbial contamination;
Ø before caring for an immunocompromised patient.
Ø before and after contact with infectious patients of known or suspected etiology;
Ø after contact with the secretions of patients (pus, blood, sputum, stool, urine, etc.);
Ø before and after manual, instrumental examinations and interventions not related to penetration into sterile cavities;
Ø after visiting boxing in infectious diseases hospitals and departments;
Ø after using the toilet;
Ø before leaving home.
Equipment: bactericidal soap, a watch with a second hand, warm running water, sterile: tweezers, cotton balls, napkins, a container for dumping with disinfectant solution.
Required condition: no skin damage on the hands.
| Stages | Notes (edit) | ||
| Preparing for the procedure | |||
| one . Remove rings from fingers. | Preparation for processing the required surface of the hand. | ||
| 2. Wrap the sleeves of the robe on 2/3 of the forearm, remove the watch. | Ensuring the infectious safety of the nurse. | ||
| 3. Open the tap. | Running water is used. | ||
| Procedure execution | |||
| one . Wash hands with soap and running water up to 2/3 of the forearm, paying attention to the phalanges and interdigital spaces of the hands for 10 seconds. | Ensuring the highest degree of decontamination of fingers, adherence to the principle of surface treatment "from clean to dirty". | ||
| 2. Rinse hands under running water to remove soap suds. | |||
| 3. Repeat washing of each hand up to 5-6 times. | |||
| Completion of the procedure | |||
| one . Dry your hands with a napkin. | Ensuring infectious safety. | ||
| 2. Throw the napkin into a container with disinfectant solution. | |||
| 3. Turn off the tap using a sterile tissue or ask a helper to do so. | |||
Note: in the absence of the necessary conditions for hygienic hand washing, you can treat them with 3-5 ml of antiseptic for 2 minutes.
Nails should be cut short and unpainted. It is also necessary to take care of the hair, which must be neatly combed and tucked under a medical cap. It is important to keep clean not only the hands and the whole body, but also the oral cavity and nasopharynx. Brush your teeth 2 times a day (at night and in the morning after eating) and rinse your mouth after eating.
Compliance with the rules of personal hygiene of medical personnel, and the disinfection of hands are regulated by Resolution No. 71 of the Chief State Sanitary Doctor of the Ministry of Health of the Republic of Belarus dated July 11, 2003. "On the approval and implementation of sanitary rules."
Hygienic antiseptics of the skin of the hands is carried out in order to remove and destroy the transient population of microorganisms.
Indications for hygienic handrub:
Before and after contact with infectious patients (patients with AIDS, viral hepatitis, dysentery, staphylococcal infection, etc.);
After contact with the secretions of patients (pus, blood, sputum, stool, urine, etc.);
Before and after manual and instrumental examinations and interventions not related to penetration into sterile cavities;
After visiting boxing in infectious diseases hospitals and departments;
After using the toilet;
Before leaving home.
Stages of hygienic hand antiseptics:
1. Apply 3 ml of the antiseptic to your hands and rub thoroughly into the palmar, dorsal and interdigital surfaces of the skin of the hands for 1 min until the antiseptic is completely dry.
2. In case of severe contamination with biomaterials (blood, mucus, pus, etc.), first remove the contamination with a sterile cotton-gauze swab or gauze pad moistened with a skin antiseptic. Then apply 3 ml of antiseptic on the hands and rub until completely dry (at least 30 s), then wash your hands with soap and water under running water.
Treatment scheme for the hands of medical personnel
According to the European standard EN1500, the treatment of the skin of the hands of medical personnel should be carried out according to the following scheme:
Rub with palm on palm (Fig. 1, a);
Rub with the left palm on the back of the right hand, and vice versa (Fig. 1, b);
Rub palms with crossed fingers spread out (fig. 2);
Rub the back of the bent fingers on the palm of the other hand (Fig. 3);
Rub the thumbs alternately in circular motions (Fig. 4);
Rub the palms of the palms with the fingertips of the other hand alternately in multidirectional circular movements.
Every day, nurses deal with a huge number of chemicals that can cause general and local changes in the body. Chemicals can enter the body through the respiratory tract in the form of dust or vapors, be absorbed through the skin, mucous membranes. Their effect can manifest itself in the form of skin reactions, dizziness, headaches, etc. Miscarriages, infertility, diseases of various organs can be separate results of exposure. The most common manifestation of exposure to chemicals in a nurse is irritation and inflammation of the skin and mucous membranes - professional dermatitis. Nurses are at risk from frequent hand washing and exposure to pharmaceuticals, disinfectants and even rubber gloves.
Dermatitis can cause:
Ø primary irritants (chlorine and phenol-containing disinfectants) cause skin inflammation only in the area of direct contact with the substance;
Ø sensitizers (antibiotics, antibacterial soaps, etc.) cause an allergic reaction in the form of dermatitis or even more severe (swelling of the lips, eyelids, face, nausea, vomiting).
Hand processing. The most important "tool" of a dentist is his hands. Correct and timely hand treatment is the key to the safety of medical personnel and patients. So great importance given by hand washing, systematic disinfection, hand care, and wearing gloves to protect and protect the skin from infections.
For the first time, the treatment of hands for the prevention of infection of wounds was used by the English surgeon J. Lister in 1867. The treatment of hands was carried out with a solution of carbolic acid (phenol).
The microflora of the skin of the hands is represented by permanent and temporary (transient) microorganisms. Permanent microorganisms live and multiply on the skin (Staphylococcus epidermidis, etc.), and transient (Staphylococcus aureus, Escherichia coli) are the result of contact with the patient. About 80-90% of persistent microorganisms are found in the surface layers of the skin and 10-20% are in the deep layers of the skin (in the sebaceous and sweat glands and hair follicles). The use of soap during hand washing removes most of the transient flora. It is impossible to remove persistent microorganisms from the deep layers of the skin during routine hand washing.
When developing an infection control program in a healthcare facility, clear indications and algorithms for treating the hands of medical personnel should be developed, based on the characteristics of the treatment and diagnostic process in the units, the specifics of the patient population and the characteristic microbial spectrum of the unit.
The types of contacts in the hospital, ranked according to the risk of hand contamination, are as follows (as the risk increases):
1. Contact with clean, disinfected or sterilized objects.
2. Objects not in contact with patients (food, medicine, etc.).
3. Objects with which patients have minimal contact (furniture, etc.).
4. Objects that have been in close contact with uninfected patients (bed linen, etc.).
5. Patients who are not a source of infection during procedures characterized by minimal contact (measurement of pulse, blood pressure, etc.).
6. Items suspected of being contaminated, especially wet items.
7. Objects that have been in close contact with patients that are sources of infection (bed linen, etc.).
8. Any secretions, excretions or other biological fluids of the body of an uninfected patient.
9. Secrets, excretions or other body fluids from known infected patients.
10. Foci of infection.
1. Routine hand washing
Washing moderately contaminated hands with plain soap and water (antiseptics are not used). The purpose of routine hand washing is to remove dirt and bacteria on the skin of your hands. Routine hand washing is required before preparing and serving food, before eating, after using the toilet, before and after caring for the patient (washing, making the bed, etc.), in all cases where hands are visibly dirty.
Thorough hand washing with detergent removes up to 99% of transient microflora from the surface of the hands. At the same time, it is very important to observe a certain hand washing technique, since special studies have shown that formal hand washing leaves the fingertips and their inner surfaces contaminated. Hand processing rules:
All jewelry and watches are removed from the hands, since they make it difficult to remove microorganisms. Hands are soaped, then rinsed with warm running water and everything is repeated anew. It is believed that the first time you soap and rinse with warm water, germs are washed off your hands. Under the influence of warm water and self-massage, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes from the opened pores are washed away.
Warm water makes the antiseptic or soap more effective, while hot water removes the protective layer of grease from the surface of your hands. In this regard, you should avoid using too much hot water for hand washing.
The sequence of movements when processing hands must comply with the European standard EN-1500:
1. Rub one palm on the other palm in a reciprocating motion.
2. Right palm rub the back of the left hand, change hands.
3. Connect the fingers of one hand in the interdigital spaces of the other, rub the inner surfaces of the fingers with up and down movements.
4. Connect the fingers in a "lock", rub the palm of the other hand with the back of the bent fingers.
5. Cover the base thumb left hand between the thumb and forefinger of the right hand, rotational friction. Repeat on wrist. Change hands.
6. Rub the palm of the left hand with the fingertips of the right hand in a circular motion, change hands.
7. Each movement is repeated at least 5 times. Hand processing is carried out within 30 seconds - 1 minute.
For washing hands, it is most preferable to use liquid soap in dispensers with single-use bottles, liquid soap "Nonsid" (company "Erisan", Finland), "Vaza-soft" (company "Lizoform SPb"). Do not add soap to a partially emptied dispenser bottle due to possible contamination. For example, Dispenso-pac dispensers manufactured by Erisan, with a hermetically sealed dispensing pump, preventing the possible ingress of microorganisms and replacement air into the package, can be considered acceptable for healthcare facilities. Pumping device ensures complete emptying of the package.
If soap is used in lumps, small fragments should be used so that the lumps do not remain for long periods of time in a humid environment that supports the growth of microorganisms. It is recommended to use soap dishes that allow the soap to dry between hand washing. Hands should be dried with a paper (ideally) towel, which then turn off the tap. Without paper towels pieces of clean cloth approximately 30 x 30 cm can be used for personal use. After each use, these towels should be discarded in their designated containers for sending to the laundry. Electric dryers are not efficient enough as they dry out the skin too slowly.
Personnel should be advised against wearing rings and using nail polish as rings and cracked polish make it difficult to remove microorganisms. Manicure (especially manipulations in the area of the nail bed) can lead to microtraumas that are easily infected. Hand washing equipment should be conveniently located throughout the hospital. In particular, it should be installed directly in the room where diagnostic or penetrating procedures are performed, as well as in each ward or at the exit from it.
2. Hygienic disinfection (antiseptic) of hands
It is intended to interrupt the process of transmission of infection through the hands of staff of institutions from patient to patient and from patients to staff and should be carried out in the following cases:
Before performing invasive procedures; before working with particularly susceptible patients; before and after manipulating wounds and catheters; after contact with the patient's secretions;
In all cases of probable microbial contamination from inanimate objects;
Before and after working with the patient. Hand processing rules:
Hand hygiene treatment consists of two stages: mechanical hand cleaning (see above) and hand disinfection with a skin antiseptic. After the end of the mechanical cleaning stage (double soaping and rinsing), the antiseptic is applied to the hands in an amount of at least 3 ml. In the case of hygienic hand disinfection, preparations containing antiseptic detergents are used for washing hands, and hands are disinfected with alcohols. When using antiseptic soaps and detergents, hands are moistened, after which 3 ml of an alcohol-containing preparation is applied to the skin (for example, Isosept, Spitaderm, AHD-2000 special, Lisanin, Biotenzid, Manopronto) and carefully rubbed into the skin until completely dry (you should not wipe your hands). If the hands were not dirty (for example, there was no contact with the patient), then the first stage is skipped and an antiseptic can be applied immediately. Each movement is repeated at least 5 times. Hand processing is carried out within 30 seconds - 1 minute. Alcohol formulations are more effective than aqueous solutions of antiseptics, but in cases of severe hand contamination, they should be thoroughly washed with water, liquid or antiseptic soap. Alcohol compositions are particularly preferred in the absence of adequate conditions for hand washing or in the absence of the necessary time for washing.
To prevent a violation of the integrity and elasticity of the skin, skin softening additives (1% glycerin, lanolin) should be included in the antiseptic, if they are not already contained in commercial preparations.
3. Surgical hand disinfection
It is carried out for any surgical interventions accompanied by a violation of the integrity of the patient's skin, to prevent the introduction of microorganisms into the operating wound and the occurrence of infectious postoperative complications. Surgical hand treatment consists of three stages: mechanical hand cleaning, hand disinfection with a skin antiseptic, and hand covering with sterile disposable gloves.
A similar hand treatment is carried out:
Before surgery;
Before major invasive procedures (for example, puncture of large vessels).
Hand processing rules:
1. Unlike the above-described method of mechanical cleaning, at the surgical level, the forearms are included in the treatment, sterile wipes are used for blotting, and the hand washing itself lasts at least 2 minutes. After
drying, the nail beds and periungual rollers are additionally processed with disposable sterile wooden sticks dipped in an antiseptic solution. It is not necessary to use brushes. If brushes are still used, then sterile soft brushes of single use or those capable of withstanding autoclaving should be used, while brushes should be used only for treating the periungual areas and only for the first treatment during the work shift.
2. After the end of the mechanical cleaning stage, an antiseptic is applied to the hands (Allsept pro, Spitaderm, Sterillium, Okteniderm, etc.) in 3 ml portions and, without allowing drying, rubbed into the skin, strictly observing the sequence of movements of the EN-1500 diagram. The procedure for applying a skin antiseptic is repeated at least two times, the total consumption of the antiseptic is 10 ml, the total time of the procedure is 5 minutes.
3. Sterile gloves should only be worn on dry hands. If the duration of work with gloves is more than 3 hours, the treatment is repeated with a change of gloves.
4. After removing the gloves, the hands are again wiped with a napkin moistened with a skin antiseptic, then washed with soap and moistened with an emollient cream (table).
Table. Stages of surgical hand disinfection
To treat hands, antiseptics of two types are used: water, with the addition of surfactants (surfactants) and alcohol (table).
Table. Antiseptics used for hygienic and surgical treatment of hands
Alcohol products are more effective. They can be used for quick hand hygiene. The group of alcohol-containing skin antiseptics includes:
0.5% alcohol solution of chlorhexidine in 70% ethyl alcohol;
60% isopropanol solution or 70% ethyl alcohol solution with additives,
Softening the skin of the hands (for example, 0.5% glycerin);
Manopronto-extra - isopropyl alcohol complex (60%) with hand skin softening additives and lemon scent;
Biotenside is a 0.5% solution of chlorhexidine in a complex of alcohols (ethyl and isopropyl, with additives that soften the skin of the hands and lemon scent).
Water-based antiseptics:
4% solution of chlorhexidine bigluconate;
Povidone-iodine (solution containing 0.75% iodine).