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There are 3 levels of decontamination (disinfection) of hands:
1. Social.
2. Hygienic (disinfection).
3. Surgical.
SOCIAL PROCESSING LEVEL
Washing lightly soiled hands twice with soap and water. Allows you to remove most transient microorganisms from the skin.
Social processing of hands is carried out:
Before eating
After going to the toilet
Before and after patient care
When hands are dirty
Before putting on gloves After taking off gloves
EQUIPMENT: soap, liquid soap, wipes, sterile towel.
When using soap, it must be kept dry (by hanging or stored in a special soap dish) to prevent contamination by some microorganisms that grow in such an environment.
ALGORITHM
2. Lather your palms, wash your hands by vigorously rubbing the soapy palms for 10 seconds, rinse off 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!!!
Given the number of microorganisms transmitted through the hands, it is important to understand that hand washing is a serious prevention of nosocomial infections and viral hepatitis.
HYGIENIC LEVEL OF HAND PROCESSING
A certain washing technique, including the use of antiseptics. This is a more efficient method of removing and killing microorganisms.
Hygienic treatment of hands is carried out:
Before performing invasive procedures
Before caring for an immunosuppressed patient
Before and after wound care, urinary catheter
Before putting on and after removing 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, remove your watch, turn on the faucet using a disposable cloth, adjust the water temperature.
2. Soap your palms, wash your hands by vigorous mechanical friction of soapy palms for 10 seconds:
1) rubbing the palms
2) palm to palm: friction between the interdigital spaces
3) washing the back of the fingers with the opposite palm
4) alternate friction thumbs palms
5) carry out alternating friction of the palms with the fingers of the other hand. Wash off the soap under running water.
3. Turn off the tap using a paper towel and dry your hands with a disposable towel.
4. Apply 3-5 ml of antiseptic.
PROCESSING OF HANDS AND MUCOUS IN CONTACT WITH BIOLOGICAL FLUIDS.
1. When the skin of the hands is contaminated with secretions, blood, etc. wash hands with soap and water; dry 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 gloves, wash hands and treat with a skin antiseptic.
3. If the biological fluid gets on the mucous membranes of the oropharynx, immediately rinse the mouth and throat with 70% alcohol or 0.05% potassium permanganate solution.
4. If biological fluids get into the eyes, rinse them with a solution of potassium permanganate in water at a ratio of 1:10000.
5. In case of injections and cuts, wash hands without removing gloves with running water and soap, remove gloves, squeeze blood out of the wound, wash hands with soap and treat the wound 5% alcohol tincture iodine. If there are microtraumas, scratches, abrasions on the hands, seal the damaged areas with adhesive tape.
6. According to indications, emergency prevention of hepatitis and HIV infection is carried out.
7. In case of injuries, including microtraumas (shots, cuts), dangerous in terms of infection, the person responsible for the prevention of parenteral infections in the health facility organizes registration in the injury register and draws up an act in accordance with the legislation of the Russian Federation.
8. For hand skin care, softening and protective creams are used to ensure skin elasticity and strength.
Disinfection
Disinfection is a system of measures aimed at the complete destruction of pathogenic microorganisms and the destruction of opportunistic organisms to a safe level in environmental objects.
When disinfecting high level(TLD) only some types of spores of microorganisms remain viable (used for final processing flexible endoscopes).
Types of disinfection
1. Preventive - before the appearance of cases of infectious diseases (chlorination tap water cleaning of 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 an infectious disease is detected until the patient is removed from the outbreak;
2) final - after removal of the patient from epid. hearth.
Disinfection 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;
Irradiation ultraviolet radiation;
Ironing with a hot iron;
Burning garbage and items of no value;
Treatment with boiling water or heating to a boil;
Pasteurization;
Boiling.
3. Chemical Methods (Chemical substance that destroys microorganisms):
Irrigation;
Rubbing;
Full immersion;
Spraying (use aqueous solutions, emulsions, powders).
Disinfection control methods:
1. Visual (st. m/s, ch. m/s, epidemiologist);
2. Chemical (indicator strips - determine the percentage concentration of the active substance in the working solution).
3. Bacteriological (washouts).
Documentation for working with disinfectants:
1. "Journal of receipt and expenditure of disinfectants";
2. "Working instructions for the preparation of a disinfectant solution";
3. "Folder with the results of chemical control of the percentage concentration of the active substance in the working solution."
PRECAUTIONS FOR HANDLING DISINFECTANTS
1. Used for disinfection, pre-sterilization treatment, sterilization, disinfection chemicals have varying degrees of local and general toxic effects.
2. Persons under 18 years of age who have undergone appropriate instruction on duties, safety precautions, precautions and prevention of accidental poisoning, as set out in the “Rules for labor protection of employees of disinfection departments, preventive disinfection departments of sanitary and epidemic stations, individual disinfection units”, approved by the Ministry of Health of the USSR on February 9, 1979 No. 1963-79. Responsible for the briefing is the head physician of the institution or a specially designated person.
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. It is forbidden to smoke, drink, eat food. After work open areas body (face, hands) wash with soap and water.
5. Soaking linen, dishes and other items in solutions of disinfectants, pre-sterilization treatment and sterilization of medical devices with chemicals is 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 solutions and keep processed objects in them in tightly closed containers. Stocks of drugs are stored in places inaccessible to common use, in a dark dish, in a dry, dark and cool room. All disinfectants and solutions must be labeled with the 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 precisely carried out, ensuring the maximum removal of residues of detergents and disinfectants from the processed objects.
8. All work with disinfectants, chemicals is carried out in accordance with the instructions.
9. When cleaning up the spilled concentrate of the product, it is necessary to use protective clothing, boots and means personal protection: respiratory organs with universal respirators of the type RPG-67 or RU-60M with a cartridge of brand B; eye - sealed glasses; skin of hands - rubber gloves. Spilled concentrated agent should be adsorbed with a moisture-retaining substance (sand, sawdust) or rags and sent for disposal. It is forbidden to drain the concentrated agent into the sewer.
First aid for accidental poisoning with disinfectants.
1. In case of violation of the operating mode, non-observance of precautionary measures and in emergency situations, the personnel may experience general poisoning or local irritation with disinfectants. characteristic of most used chemicals disinfection and sterilization is an irritating effect on skin, mucous membranes of the eyes, respiratory tract.
2. If the drug gets on the skin, immediately wash off this area clean water. Lubricate the skin with a softening cream.
3. If signs of irritation of the respiratory system appear, stop working with the product. Immediately remove the victim from the room to fresh air or to a well-ventilated area, rinse the mouth and nasopharynx with water, if necessary, consult a doctor.
4. If the drug gets into the eyes, immediately rinse them under running water for 10-15 minutes, drip with a 30% solution of sodium sulfacyl. Urgently consult a doctor.
5. If the product enters the stomach, give the victim several glasses of water with 10-20 crushed activated charcoal tablets. Do not wash the stomach. Seek medical attention if necessary.
Read the instructions and precautions carefully before using any new disinfectant.
TECHNIQUE FOR PREPARING DISINFECTANTS PURPOSE: use for disinfection, according to the order for compliance with the sanitary and epidemiological regime.
EQUIPMENT:
Overalls:
Long robe
Beanie
Oilcloth apron
Medical gloves
Respirator (4 ply gauze mask)
Protective glasses
Indoor shoes
Des. means
- containers:
For labeled water with caps
For disinfectant solution labeled with lids
For detergents labeled with lids.
ATTENTION: See instructions for preparation and use
| STAGES | RATIONALE |
| PREPARATION FOR THE PROCEDURE | |
| 1. Put on overalls. | Ensuring the safety of m / s in the workplace |
| 2. Prepare equipment | Clarity in work |
| 3. check the labeling (name of disinfectant, concentration, purpose, date of preparation) | Ensuring Personal Responsibility |
| PERFORMING THE PROCEDURE | |
| 1.Pour water into the container up to the mark | |
| 2,Put the disinfectant into the water container | Compliance with the methodology for preparing a solution of percentage concentration |
| 3. Stir the solution with a wooden spatula | |
| 4. Close the lid | |
| 5. On the tag, put the date of preparation of the solution and the signature of the m / s. | Ensuring continuity in work with des. solutions, personal responsibility. |
The goal is to destroy transient flora to prevent the risk of contamination of the surgical wound when gloves are damaged.
Surgical treatment of hands is carried out:
Before surgical interventions;
When puncturing large vessels;
before intubating the patient.
Equipment:
Liquid dispensed soap.
Napkins (15x15) disposable for getting your hands wet.
Napkins (7x7) disposable for the treatment of hands with a skin antiseptic.
Skin antiseptic.
Disposable sterile rubber gloves.
Surgical treatment of the hands consists of two stages:
Stage 1– mechanical cleaning of hands.
Hands are washed with soap for one minute.
Hand washing routine.
Palm to palm;
Right palm over the back of the left;
Left palm over the back of the right;
nail beds;
Palm to palm, pollen from one hand between the fingers of the other;
Rotational friction of the thumbs;
Rotational friction of the palms.
Each movement is repeated 5 times.
Then the hands are thoroughly rinsed with warm water and blotted dry with a sterile napkin.
Stage 2- disinfection of hands with a skin antiseptic.
80% ethanol solution as a skin antiseptic in surgical hand treatmentnot used.
Technique for treating hands with a skin antiseptic.
Hands are wiped with a napkin (7x7) moistened with a skin antiseptic from the fingertips to the elbow. The nail beds are wiped especially carefully, between the fingers and the base thumb. Hands are wiped twice, with different sterile wipes for 1.5 minutes, and in total - 3 minutes.
Gloves are worn only on sterile and dry hands. Gloves are disposable.
After removing gloves, hands are wiped with a napkin (7x7) moistened with a skin antiseptic, then washed with soap, rinsed thoroughly and softened with cream.
When using alcohol-containing skin antiseptics, they can be rubbed 2.5 - 3.0 ml into the skin of the hands and forearms for 5 minutes. until completely dry, then sterile gloves are put on dry hands.
Spring-cleaning.
General cleaning is carried out Once a week or after removing the patient from the ward.
Preparing for a general cleaning.
On the eve of the cleaning, the rags are given for sterilization (8 pcs. - for walls, furniture, refrigerator, floor, 2 pcs each). The marking must be clear.
On the day of cleaning, the furniture is moved away from the walls, medications and food products are taken out of the room.
Sinks and skirting boards are cleaned with a cleaning agent with a brush.
The employee puts on a special clothes marked "for cleaning" - 2 sets.
Rules for putting on clothes:
A) cotton pajamas with fasteners on the back, elastic bands on the sleeves and legs, the blouse is tucked into trousers;
B) cotton-gauze mask or respirator;
B) goggles
D) a large cotton scarf;
D) rubber technical gloves;
E) rubber boots;
G) rubber or oilcloth apron.
At the end of wiping, ultraviolet irradiation (UVR) is carried out. The exposure time depends on the power of the lamp according to the passport and the area of the room. The quartzing mode should be posted in a "visible" place.
After UVR, the room is ventilated until the smell disappears.
Disinfection (disinfection) of quartz lamps.
The lamp is disinfected once every 7 days. The frame is washed like walls during general cleaning with an interval of 15 minutes. 70% ethanol solution.
Toilet rooms. Wiping is carried out as in a treatment room. The toilet bowl is wiped twice with the same disinfectant solution that is used for cleaning in the departments - 3% chloramine or 4% hydrogen peroxide.
For wiping, there should be a kwach, which is disinfected in a 3% solution of chloramine for 60 minutes, 4% hydrogen peroxide - 90 minutes.
Dishes processing.
Order No. 288 of the Ministry of Health of the USSR, 1976 "Sanitary and epidemiological regime in health care facilities."
San PiN 5179-90 MZ USSR 1991 “San. device rules, equipment and operation of hospitals and other healthcare facilities”.
San PiN 2.3.6.959-00 “San-epid. organization requirements Catering» Ministry of Health of the Russian Federation, 2000.
Tableware processing
Each honey. the sister takes an obligatory part in feeding the sick. To do this, she puts on a dressing gown or apron marked M/S for serving food, which is located in the pantry room and is changed every day. Before serving food, the m / s performs a mechanical treatment of hands (hands are washed with soap twice, rinsed thoroughly with warm water and dried with a clean towel, which is changed daily, or with a disposable napkin).
Food must be distributed no later than 2 hours from the moment the food was received at the catering unit.
Food serving temperature:
First courses - 70-75 0 C;
Second courses - 60-65 0 С;
Third courses - not lower than 14 0 С.
At the end of feeding, the dishes are collected by the barmaid and delivered to the washing cupboard, and the nurse wipes the tables and bedside tables twice with an interval of 15 minutes. 1% chloramine solution or 3% hydrogen peroxide solution in the somatic departments or the disinfectant solution that the department operates.
In the buffet room, tableware is emptied of food residues into a food waste container.
Disinfection of food waste.
Waste is boiled for 30 minutes. or covered with dry bleach at the rate of 200g/l - exposure 60 min. and disposed of.
Stages of processing dishes.
In a 2% solution of baking soda (20 g of soda);
In 2% solution of mustard (mustard 20 g + up to 1 liter of water).
In the first container, the dishes are degreased:
Degreasing conditions:
The temperature of degreasing solutions must be at least 50 0 С.
Exposure 30 min.
Dishes in this solution are washed with rags for at least 1 minute, then transferred to a second container.
1% chloramine solution - 60 minutes;
3% solution of H 2 O 2 - 80 min.;
In the second container, the dishes are degreased in disinfectant solutions:
The temperature of the disinfectant solutions is 18-20 0 С.
In the third container, the dishes are rinsed in running water at a temperature of 70-75 0 C until the smell disappears. Due to the high temperature, the dishes are rinsed out of the hose.
Dishes are dried on racks in a vertical position.
Spoons are first degreased and then degreased in an oven at a temperature of 180 0 C for 20 minutes.
Cookware, in which food is delivered to the buffet from the catering department, goes through two stages of processing: degreasing and rinsing and drying upside down on the grates.
2. PROCESSING OF HANDS OF MEDICAL PERSONNEL
Hand washing is a simple but very important method of preventing HCAI.PCorrect and timely processing of hands is the key to the safety of medical personnel and patients .
Hand preparation rules:
1.Remove rings, watches.
2.Nails must be cut short and no polish is allowed.
3.Roll the long sleeves of the robe over 2/3 of the forearm.
All jewelry, watches are removed from the hands, as they make it difficult to remove microorganisms. Hands are soaped, then rinsed warm running water and everything repeats from the beginning. It is believed that during the first soaping and rinsing warm water microbes are washed off the skin of the hands. Under influence warm water and self-massage during mechanical treatment, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes from the opened pores are washed off. Warm water contributes to a more effective effect of an antiseptic or soap, while hot water removes the protective fatty layer from the surface of the hands. In this regard, you should avoid using too hot water for washing your hands.
When entering and leaving the intensive care unit or ICU, the staff should clean their hands with a skin antiseptic.
There are three levels of hand treatment:
1.Household level (mechanical processing of hands);
2.Hygienic level (treatment of hands using skin antiseptics);
3.Surgical level (a special sequence of actions when processing hands, increasing the processing time, processing area, followed by putting on sterile gloves).
1. Machining of hands
The purpose of household level of processing of hands - mechanical removal from the skin of most of the transient microflora (antiseptics are not used).
· after visiting the toilet;
· before eating or before working with food;
· before and after physical contact with the patient;
· with any contamination of the hands.
Required equipment:
1.Liquid dosed neutral soap. It is desirable that the soap does not have a strong odor. Open liquid soap is quickly infected with microbes, so closed dispensers should be used, and at the end of the contents, process the dispenser, only after processing, fill it with new contents.
2.Napkins measuring 15x15 cm are disposable, clean for drying hands. The use of a towel (even an individual one) is not desirable, because it does not have time to dry and, moreover, is easily seeded with microbes.
Hand treatment - the necessary sequence of movements:
1.Rub one palm against the other palm in a reciprocating motion.
2.Rub the back surface of the left hand with the right palm, 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 into a “lock”, rub the palm of the other hand with the back of the bent fingers.
5.Grab the base of the thumb of the left hand between the thumb and forefinger of the right hand, rotational friction. Repeat on the wrist. Change hands.
6.Rub the palm of the left hand with the fingertips in a circular motion. right hand, change hands.
HAND HYGIENE REGULATIONS
European standard EN-1500
Scheme 4
|
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 hand with fingers crossed |
|
Outer side fingers on the 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 the destruction of resident microflora from the surface of the skin of the hands with the help of antiseptics.
Such hand treatment is carried out:
· before putting on gloves and after removing them;
· before caring for a patient with a weakened immune system or when making rounds in the wards (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 body fluids (e.g. blood emergencies).
Required equipment:
2.Napkins measuring 15x15 cm are 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.).
Hygienic processing of hands consists of two stages:
1 - mechanical cleaning of hands, followed by drying with disposable wipes;
2 - disinfection of hands with a skin antiseptic.
3 . Surgical treatment of hands
The goal of the surgical level of hand decontamination is to minimize the risk of violating operational sterility in the event of damage to gloves.
Such 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.Napkins size 15x15 cm disposable, sterile.
3.Skin antiseptic.
4.Disposable sterile surgical gloves.
Hand treatment rules:
Hand surgery consists of three stages:
1 - mechanical cleaning of hands followed by drying,
2 - disinfection of hands with a skin antiseptic twice,
3 - closing hands with sterile disposable gloves.
Unlike the above method mechanical cleaning at the surgical level, the forearms are included in the treatment; sterile wipes, but hand washing lasts at least 2 minutes. After drying, the nail beds and periungual ridges are additionally processed with disposable sterile wooden sticks soaked in an antiseptic solution.
Brushes are not required. If brushes are still used, sterile, soft, disposable or autoclavable brushes should be used, and brushes should only be used on the periungual area and only for the first brushing of a work shift.
At the end of the mechanical cleaning stage, an antiseptic is applied to the hands in 3 ml portions and, preventing drying, is rubbed into the skin, strictly observing the sequence of movements. 5 minutes .
Sterile gloves are put on dry hands only. If the duration of work with gloves is more than 3 hours, the treatment of hands is repeated with a change of gloves.
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.
Bacteriological control of the effectiveness of processing the hands of personnel.
The washings from the hands of the personnel are made with sterile gauze wipes 5 × 5 cm in size, moistened with a neutralizer. Thoroughly wipe the palms, periungual and interdigital spaces of both hands with a gauze cloth. After sampling, the gauze pad is placed in wide-mouth tubes or flasks with saline and glass beads and shaken for 10 minutes. The liquid is inoculated, incubated for 48 hours at a temperature of + 37 0 C. Accounting for the results: the absence of pathogenic and opportunistic bacteria ( Guidelines 4.2.2942-11).
Dermatitis associated with frequent hand washing
Repeated hand washing may cause skin dryness, cracking and dermatitis in sensitive subjects. A healthcare worker suffering from dermatitis contributes to an increased 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 in handwashing;
· tendencies to avoid handling hands.
Measures that reduce the likelihood of developing dermatitis:
· thoroughly rinsing and drying hands;
· use an adequate amount of antiseptic (avoid excess);
· usage contemporary and various antiseptics;
· obligatory use of moisturizing and emollient creams.
Skin microflora
The surface layer of the epidermis (top layer of the skin) is completely replaced every 2 weeks. Every day, up to 100 million skin scales are peeled from healthy skin, of which 10% contain viable bacteria. The microflora of the skin can be divided into two large groups:
1.Resident flora
2.Transient flora
1. Resident microflora are those microorganisms that constantly live and multiply on the skin without causing any diseases. That is, it is a normal flora. The number of resident flora is approximately 10 2 -10 3 per 1 cm 2. The resident flora is represented mainly by coagulase-negative cocci (primarily Staphylococcus epidermidis) and diphtheroids (Corinebacterium spp.). Although Staphylococcus aureus is found in the nose of about 20% of healthy people, it rarely colonizes the skin of the hands (unless it is damaged), but in a hospital setting it can be found on the skin of the hands medical personnel with no less frequency than in the nose.
The resident microflora cannot be destroyed by ordinary 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 the normal microflora prevents skin colonization 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 easily be removed with normal hand washing or destroyed with antiseptics. As long as 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 broken, then the transient microflora can cause an infectious disease (for example, panaritium or erysipelas). You should be aware that in this case, the use of antiseptics does not make hands safe in terms of infection transmission. Microorganisms (most often staphylococci and beta-hemolytic streptococci) remain with the disease on the skin until a cure occurs.
Microorganisms representing the resident flora live and multiply on the skin (10-20% of them can be found in the deep layers of the skin, including the sebaceous and sweat glands, hair follicles).
The resident flora is represented mainly by coagulase-negative cocci and diphtheroids. Gram-negative bacteria (not counting members of the genus Acte1; obacleg) are rarely resident. Resident microorganisms are difficult to remove or kill with normal handwashing or even disinfection procedures, although their numbers can be reduced.
Resident microorganisms generally do not cause nosocomial infections, except in connection with vascular catheterization. Moreover, the normal microflora prevents colonization of the skin by other microbes.
Conditions to achieve effective washing and disinfection of hands, their preparation(Fig. 22): short cut nails, no nail polish, no artificial nails, no rings, rings, etc. jewelry. Before processing the hands of surgeons, it is also necessary to remove watches, bracelets, etc.
Rice. 22.
To dry hands, clean cloth towels or disposable paper towels are used; when treating the hands of surgeons, only sterile cloth ones are used.
Skin antiseptics for hand treatment - for example: lizhen, chlorhexidine bigluconate, isosept, allsept, etc., should be in dispensers in appropriate concentrations. In subdivisions with a high intensity of patient care and with a high workload on staff, dispensers with skin antiseptics should be placed in places convenient for use by staff (at the entrance to the ward, at the patient's bedside, etc.). It should also be possible to provide medical workers individual containers (bottles) with a skin antiseptic of small volumes (100-200 ml).
Hand washing (Figure 23) is the most effective method prevention of nosocomial infections in healthcare facilities.
Rice. 23.
There are three levels of hand decontamination:
- 1) social (routine handwashing);
- 2) hygienic (disinfection of hands);
- 3) surgical (sterility of the hands of surgeons is achieved for a certain time).
The reasons for the insufficient level of treatment of the hands of medical personnel, according to some sources, are forgetfulness, insufficient awareness of the problem, lack of knowledge, lack of time, skin problems - dryness, dermatitis, etc. All these reasons can lead to the occurrence of nosocomial infections. Junior medical staff processes hands at a social and hygienic level within their competence.
Social level of hand treatment
Regular hand washing. It is carried out before the start of any work (Table 4).
Purpose: to remove dirt and temporary (transient) microflora from the skin of the hands by washing twice with water and soap.
Indications: when hands are dirty, before medical procedure and after its performance, with and without gloves, when caring for the patient (if the hands are not contaminated with the patient's body fluids), before eating, feeding the patient, and also after visiting the toilet.
Equipment: liquid soap, neutral, odorless, soap dispenser (dispenser), clock with a second hand, warm running water. To dry hands, use napkins 15x15 single use, a napkin for a tap.
It must be remembered that when using the dispenser, a new portion of soap (or antiseptic) is poured into the dispenser after it has been disinfected, rinsed with running water and dried. Preference should be given to elbow dispensers and dispensers on photocells.
Table 4
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Performing a procedure |
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2. Lather your hands for 30 seconds, washing off the soap with water and paying attention to the phalanges and interdigital spaces of the hands, then wash the back and palm of each hand and wash the bases of the thumbs with rotational movements |
Uniform decontamination of the hands is ensured if the surface is lathered thoroughly and evenly. At the first soaping, the bulk of the microflora is washed off, then after exposure to warm water and self-massage, the pores open and the microorganisms are washed off from the opened pores. It must be remembered that hot water removes the protective fatty layer of the skin. |
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3. Rinse your hands under running water to remove soap scum, holding your hands so that the water runs into the sink from your forearms or elbows (do not touch the sink). Repeat steps 2 and 3 of the procedure |
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Completion of the procedure |
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1. Close the faucet using a napkin (close the elbow faucet with the movement of the elbow) |
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2. Dry your hands with a dry, clean individual towel or with a dryer |
According to the principle “from clean to dirty”, i.e. from the fingertips (they should be as clean as possible) to the elbow |
Hygienic level of hand treatment (Table 5)
There are two processing methods:
- 1) hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;
- 2) hygienic treatment of hands with a skin antiseptic to reduce the number of microorganisms to a safe level.
Hand hygiene should be carried out in the following cases:
- ? before direct contact with the patient;
- ? after contact with the patient's intact skin (for example, when measuring the pulse or blood pressure);
- ? after contact with secrets or excretions of the body, mucous membranes, dressings;
- ? before performing various manipulations to care for the patient;
- ? after contact with medical equipment and other objects in the immediate vicinity of the patient.
- ? after treatment of patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment.
Purpose: to remove or completely destroy the transient microflora from the hands.
Equipment: liquid soap, soap and skin antiseptic dispensers, a watch with a second hand, warm running water (35-40 ° C), sterile tweezers, cotton balls, napkins; skin antiseptic. Container for waste disposal with disinfectant solution.
Fulfill the mandatory conditions - the same as for the social processing of hands. To dry hands, clean cloth towels or disposable paper towels are used; when treating the hands of surgeons, only sterile cloth ones are used.
It is important to observe the exposure time: hands must be wet from the use of an antiseptic for at least 15 s.
Table 5
Hand hygiene technique
|
Rationale |
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Preparation for the procedure |
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2. Wrap the sleeves of the robe on 2/3 of the forearm |
Draining water should not get on the sleeves of the bathrobe. |
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3. Open the faucet, adjust the water temperature (35-40 * C) |
Optimum water temperature for hand decontamination |
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Performing a procedure |
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1. Lather your hands and wash the faucet with soap (the elbow faucet is not washed) |
Faucet decontamination in progress |
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2. Lather your hands for 10 seconds, five or six times according to the scheme (Fig. 24), paying attention to the skin around the nails and the interdigital spaces of the hands. Rinse hands after each soaping |
Uniform decontamination of the hands is ensured if the surface is lathered thoroughly and evenly |
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3. Rinse your hands under running water to remove soap suds so that the water runs into the sink from your forearms or elbows (do not touch the sink) |
The phalanges of the fingers should remain the cleanest. |
Note. If necessary, if there was contact with the secretions or blood of the patient, hygienic treatment of hands is carried out after mechanical cleaning. Then the hands are treated with an alcohol-containing or other approved antiseptic from a dosing device in an amount of at least 3 ml, recommended by the instructions for use, by rubbing it into the skin of the hands. Special attention pay for the treatment of the fingertips, the skin around the nails, interdigital spaces. An indispensable condition for effective hand disinfection is to keep them moist for the recommended processing time until completely dry.
Rice. 24.
If there was no contact with the secretions or blood of the patient, hygienic treatment is carried out with an alcohol-containing antiseptic without first washing the hands (Fig. 25).
Rice. 25.
Surgical level of hand treatment (Table 6)
Purpose: to achieve the sterility of the nurse's hands to reduce the risk of wound infection in case of accidental damage to sterile gloves during work.
Indications:
- ? the need to cover a sterile table;
- ? participation in the operation, puncture and other surgical intervention;
- ? participation in childbirth.
Contraindications:
- ? the presence of pustules on the hands and body;
- ? cracks and wounds of the skin;
- ? skin diseases.
Equipment:
- ? liquid soap in a dispenser;
- ? hourglass - 1 min, 3 min.
- ? 0-30 ml of skin alcohol antiseptic;
- ? sterile tray with forceps;
- ? sterile bix with targeted styling.
Mandatory condition: use only alcohol-containing skin antiseptics. The procedure is achieved with the help of an assistant supplying sterile material from sterilization boxes, dispensers with soap and an alcohol solution of an antiseptic.
Hand surgery technique
Table 6
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Rationale |
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Preparation for the procedure |
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1. Fulfill the prerequisites for effective hand washing and disinfection, check the integrity of the skin of the fingers |
There may be skin maceration (damage to the epidermis), which prevents hand decontamination |
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2. Wash your hands the easy way |
See the social level of handwashing |
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3. Install the sterilization box (bix), check its validity, sterilization terms, observing sterility, open the bix, check the indicators for sterility, readiness for work, put on a sterile scarf, mask |
Infection safety and control measures are followed |
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Performing a procedure |
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1. Wash hands at a hygienic level for 1 min |
Hands and 2/3 of the forearm are decontaminated |
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2. Wipe hands with a sterile bix towel in the direction from the nail phalanges to the elbow |
With blotting movements, first with the right hand, then with the left dry end of the towel, gradually shifting it, wipe the phalanges of the fingers of one hand, then the other, the outer, then the inner surfaces of the hands, 1/3 of the forearm, then 2/3 of the forearm, ending with the elbows |
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3. Treat hands with an alcohol solution of an antiseptic for 3 minutes, following the sequence of actions (see Fig. 25) |
Dosing devices are used to prevent contamination of the solution |
STATE EDUCATIONAL INSTITUTION
HIGHER PROFESSIONAL EDUCATION "NOVOSIBIRSK STATE MEDICAL UNIVERSITY OF THE FEDERAL AGENCY FOR HEALTH AND SOCIAL DEVELOPMENT"
Faculty of Economics and Management
Department of Pedagogy and Psychology
COURSE WORK
by discipline _____ Pedagogy with teaching methods ____
on the topic: "hand treatment"
Supervisor
_______________________ FULL NAME
- "____" _______________ 2010
Zinovieva A.R. III course, 2 gr, VSO
"____" _______________ 2010
NOVOSIBIRSK 2010
Plan:
Introduction
- Skin microflora: resident flora, transient flora;
Hand treatment:
- Social level;
- Hand processing is a necessary sequence of movements;
- Hygienic level;
Surgical level;
- Possible complications associated with frequent hand washing;
- Measures that reduce the likelihood of complications;
Use of gloves:
- Sequence of actions when putting on gloves;
- The sequence of actions when removing gloves;
Purpose of the lesson
- Consolidation and generalization of knowledge and skills correct processing hands in the daily activities of medical personnel.
- Levels of hand treatment: social (goals, indications, the necessary conditions, hand washing technique); hygienic (stages, goals, indications, necessary conditions); surgical (stages, goals, indications, necessary conditions, hand washing technique);
Rules and duration of hand treatment at all levels, differences;
The sequence of movements in the processing of hands;
Possible complications in the processing of hands and their prevention;
Use of gloves (goals, indications, contraindications, necessary conditions, possible complications, sequence of putting on and taking off gloves).
- Correct handling of hands;
Correctly carry out the technique of putting on and removing medical gloves.
Introduction
The most important component of infectious safety is the prevention of the possibility of transfer of microorganisms from the patient to the medical staff and vice versa.
Infectious diseases of medical staff associated with professional activities occupy a certain place in the structure of infectious morbidity.
Infection of medical personnel occurs as a result of:
- natural transmission mechanisms;
An artificial transmission mechanism (i.e. an artificial transmission mechanism created by medicine - various invasive and therapeutic procedures).
Proper and timely processing of the hands of medical personnel is one of the leading measures in the fight against infectious diseases and a guarantee of the safety of personnel and patients.
Skin microflora
The surface layer of the epidermis (top layer of the skin) is completely replaced every 2 weeks. Every day, up to 100 million skin scales are peeled from healthy skin, of which 10% contain viable bacteria. The microflora of the skin can be divided into two large groups:
- Resident flora
Transient flora
- Resident microflora are those microorganisms that constantly live and multiply on the skin without causing any diseases. That is, it is a normal flora. The number of resident flora is approximately 10 2 -10 3 per 1 cm 2. The resident flora is represented mainly 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), but in hospital conditions it can be found on the skin of the hands of medical personnel with no less frequency than in the nose.
- Transient microflora- These are those microorganisms that are acquired by medical personnel as a result of contact with infected patients or contaminated environmental objects. 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 remain on the skin of the hands for a short time (rarely more than 24 hours). They can easily be removed with normal hand washing or destroyed with antiseptics.
If the integrity of the skin is broken, then the transient microflora can cause an infectious disease (for example, panaritium or erysipelas). You should be aware that in this case, the use of antiseptics does not make hands safe in terms of infection transmission. Microorganisms (most often staphylococci and beta-hemolytic streptococci) remain with the disease on the skin until a cure occurs.
Hand treatment
Hand treatment for the prevention of wound infection was first used by the English surgeon J. Lister in 1867. The treatment of the surgeon's hands was carried out by disinfecting them with a solution of carbolic acid (phenol). In addition, Lister used a solution of carbolic acid to irrigate instruments, dressings, and to spray in the air over the surgical field.
Sir Joseph Lister's method (1827-1912) was a triumph of 19th century medicine. In the 21st century, handwashing - this simple method of preventing infections (primarily intestinal ones) - is unfortunately often ignored by both the public and some medical professionals.
Meanwhile, Correct and timely processing of hands is the key to the safety of medical personnel and patients.
Hand treatment is divided into three levels:
- Household or social level (mechanical processing of hands);
- Hygienic level (treatment of hands using skin antiseptics);
- Surgical level (a special sequence of manipulations in the treatment of hands, followed by putting on sterile gloves).
- Social level of hand treatment
- after visiting the toilet;
before eating or before working with food;
before and after physical contact with the patient;
with any contamination of the hands.
- Liquid dosed neutral soap or individual disposable soap in pieces. It is desirable that the soap does not have a strong odor. Open liquid or bar reusable non-personal soap quickly becomes infected with germs.
Napkins measuring 15x15 cm are disposable, clean for getting your hands wet. The use of a towel (even an individual one) is not desirable, because it does not have time to dry out and, moreover, is easily seeded with microbes.
All jewelry, watches are removed from the hands, as they make it difficult to remove microorganisms. Hands are soaped, then rinsed warm running water and everything repeats from the beginning. It is believed that during the first soaping and rinsing with warm water, microbes are washed off the skin of the hands. Under the influence of warm water and self-massage, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes are washed away from the opened pores.
Warm water makes the hand sanitizer or soap work more effectively, while hot water removes the protective fatty layer from the surface of the hands. In this regard, you should avoid using too hot water for washing your hands.
Hand treatment - the necessary sequence of movements:
- Rub one palm against the other palm with reciprocating movements (Appendix 1);
Rub the back surface of the left hand with the right palm, change hands (Appendix 2);
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 (Appendix 3);
Connect the fingers into a “lock”, rub the palm of the other hand with the back of the bent fingers (Appendix 4);
Grasp the base of the thumb of the left hand between the thumb and index fingers right hand, rotational friction. Repeat on the wrist. Change hands (Appendix 5);
In a circular motion, rub the palm of the left hand with the fingertips of the right hand, change hands (Appendix 6).
It is very important to follow the described handwashing technique, since special studies have shown that during routine handwashing, certain areas of the skin (fingertips and their inner surfaces) remain contaminated.
After the last rinse, the hands are wiped dry with a napkin (15x15 cm). The faucets are closed with the same napkin. The tissue is discarded into a container with a disinfectant solution for disposal.
In the absence of disposable wipes, it is possible to use pieces of clean cloth, which, after each use, are discarded into special containers and, after disinfection, sent to the laundry. Replacing disposable wipes with electric dryers is impractical, because. with them, there is no rubbing of the skin, which means that there is no removal of detergent residues and desquamation of the epithelium.
- Hygienic level of hand treatment
The purpose of hygienic treatment is the destruction of the microflora of the skin with the help of antiseptics (disinfection).
Such hand treatment is carried out:
- before putting on gloves and after removing them;
before caring for a patient with a weakened immune system or when making rounds in the wards (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 body fluids (e.g. blood emergencies).
- Liquid dosed pH-neutral soap or individual disposable soap bars.
Napkins size 15x15 cm disposable, clean.
Napkins are clean (7x7 cm), for the treatment of hands with skin antiseptics.
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, etc.
Gloves are disposable.
Hand treatment rules:
Hygienic processing of hands consists of two stages: mechanical cleaning of hands (see above) and disinfection of hands with a skin antiseptic.
After the end of the stage of mechanical cleaning (double soaping and rinsing), the antiseptic is applied to the hands in an amount of at least 3 ml and carefully rubbed into the skin until completely dry(Do not wash your hands.) If the hands were not contaminated (for example, there was no contact with the patient), then the first stage is skipped and an antiseptic can be applied immediately. The sequence of movements in the processing of hands corresponds to(Appendices 1-6).
etc.................