In order to prevent nosocomial infections, the hands of medical workers must be disinfected ( hygienic treatment hands, treatment of surgeons' hands) and skin patients (treatment of surgical and injection fields, elbow bends of donors, sanitary treatment of skin).

Hand hygiene should be an integral part of the system of measures to combat and prevent nosocomial infections in a medical organization.

Algorithms/standards for all epidemiologically significant therapeutic and diagnostic procedures must include recommended means and methods of hand treatment when performing the relevant manipulations.

Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In areas with high patient care intensity and high load for personnel (resuscitation and intensive care units, etc.), dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by personnel (at the entrance to the ward, at the patient’s bedside, etc.). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (100-200 ml) with skin antiseptic

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

Hand hygiene includes two methods:

Hygienic hand washing - washing hands with soap and water to remove contaminants and reduce the number of microorganisms;

Hand hygiene is the treatment of hands with an alcohol-based skin antiseptic to reduce the number of microorganisms to a safe level.

Treatment of surgeons' hands

1. Hygienic hand washing

Indications for hygienic hand washing

For all types normal pollution hands;

Before and after any physical contact with the patient;

Before preparing and serving food, before eating;

After performing certain natural functions of your own body (sneezing, blowing your nose, coughing, going to the toilet, etc.).

Soap requirements:

Soap can be used in any standard form(liquid, solid, granular, powder, etc.);

Bar soap should be stored in magnetic soap dishes that have good water drainage to ensure the soap dries;

Preference is given to liquid soap in standard dispensers (dispensers), because... in this case, contact of the personnel’s skin with soap is excluded, which eliminates their infection;

When using reusable dispensers: Do not add soap to a partially emptied dispenser. After the dispenser is completely emptied of soap, it is thoroughly washed, disinfected, dried and only then refilled with soap.

Hand washing technique.

Hand washing with soap is carried out under a moderate stream comfortably warm water within 10-20 seconds.

Hands are lathered generously with soap and then 6 standard steps are carried out ( There are no requirements for a strict sequence of stages):

rub palm against palm, “lock” movement - washing

nail phalanges

rub the back and sides in a circular motion

surface of fingers thumbs (alternately)

each hand (alternately)

Hand hygiene should be carried out in following cases:

Before direct contact with the patient;

After contact with the patient's intact skin (for example, when measuring pulse or blood pressure);

After contact with body secretions or excreta, mucous membranes, dressings;

Before performing various patient care procedures;

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

After treating patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment.

Hand hygiene is carried out in two ways:

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

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

We remove all jewelry from our hands that makes washing difficult.

Hygienic treatment of hands with alcohol-containing or other approved antiseptic (without prior washing) is carried out by rubbing it into the skin of the hands in the amount recommended in the instructions for use, turning special attention for treating fingertips, skin around nails, between fingers. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time. When using a dispenser, a new portion of antiseptic (or soap) is poured into the dispenser after it has been disinfected, washed with water and dried. Preference should be given to elbow dispensers and photocell dispensers.

The antiseptic is applied to the hands in portions (1.5 - 3.0 ml), including the elbows, and rubbed into the skin for the time specified by the developer. The first portion of antiseptic is applied only to dry hands. Throughout the entire time of rubbing in the antiseptic, the skin is kept moist from the antiseptic, so the number of portions of the rubbed product and its volume are not strictly regulated. During the procedure, special attention is paid to the standard method of treating hands with an antiseptic in accordance with EN 1500.

Palm to palm, including wrists	Right palm on the left back of the hand and left palm on the right back of the hand	Palm to palm of hands with fingers crossed
External side fingers on the opposite palm with fingers crossed	Circular rubbing of the left thumb in a closed palm right hand and vice versa	Circular rubbing of the closed fingertips of the right hand on the left palm and vice versa

Each stage of processing is repeated at least 5 times. When performing hand treatment techniques, the presence of so-called “critical” areas of the hands that are not sufficiently wetted with the product is taken into account: thumbs, fingertips, interdigital areas, nails, periungual ridges and subungual areas. The surfaces of the thumb and fingertips are treated most thoroughly, since they are concentrated greatest number bacteria. The last portion of the antiseptic is rubbed in until it dries completely. Sterile gloves are worn only on dry hands. After the operation/procedure is completed, the gloves are removed, hands are treated with an antiseptic for 2 x 30 s, and then with a hand skin care product. If blood or other secretions get on your hands under gloves, these contaminants are first removed with a swab or napkin moistened with an antiseptic and washed with detergent. Then thoroughly wash with soap and water and dry with a disposable towel or napkins. After this, the hands are treated with an antiseptic 2 x 30 s.

Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In departments with a high intensity of patient care and with a high workload on staff (resuscitation and intensive care units, etc.), dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by staff (at the entrance to the ward, at the patient’s bedside etc.). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (up to 200 ml) with skin antiseptic.

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

Types of processing

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

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

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

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

Important Terms

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

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

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

Hand washing technique

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

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

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

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

Rules for medical personnel

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

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

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

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

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

Nuances for surgeons

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

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

Selection of hygiene products

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

To be in full compliance regulatory requirements The medical staff's hands have undergone hygienic treatment; it is advisable to equip medical institutions to operate them without the use of hands.

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

Time periods

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

IN mandatory The hands of medical staff must be sanitized. SanPin (the washing scheme remains the same) stipulates that skin cleansing before surgical procedures can be carried out using the same means as hygiene.

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

Rules for treating hands with antiseptic

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

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

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

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

Final stage

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

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

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

Possible complications

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

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

Prevalence of complications and their prevention

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

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

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

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

The dentist performs all his main actions with his hands. For this reason, cleanliness of the dentist's hands is of utmost importance. After all, numerous microbes that reside on the skin of unwashed hands, if they get into open wounds, can cause infection with the subsequent development of pathological processes. Therefore, a necessary procedure when preparing a doctor for work is sanitary treatment of hands to ensure the absence of microorganisms on them that can cause disease.

The microflora of the skin includes both microorganisms that constantly live on the skin and bacteria, viruses, protists and fungi that enter the skin surface upon contact with the external environment. It is the temporary inhabitants of the skin of the hands that include Staphylococcus aureus and other dangerous bacteria. The bulk of microorganisms that constantly live on the skin are located in its surface layer. A small part of them (about ten to twenty percent) penetrates into the deep layers of the skin, the ducts of the sebaceous glands and hair follicles.

Staphylococci are gram-positive
spherical bacteria that, when examined microscopically, resemble bunches of grapes.

Before performing surgical procedures, it is necessary to remove both permanent and temporary microflora from the skin of the hands. Regular hand washing with soap makes it possible to clean your hands of the bulk of temporary microorganisms. However, this method sanitization not enough to remove the permanent inhabitants of the deep layers of the skin.

Due to the risk of infection during various medical procedures, hand hygiene of doctors and other medical workers is strictly regulated. There are rules for treating the hands of medical personnel, determined by the specific working conditions and the level of existing risks. So, what are the ways to ensure the required cleanliness of the skin?

Types of hygiene procedures when preparing a doctor for work

In accordance with the requirements for cleanliness of the skin, the following hygiene procedures are applied when preparing medical staff for work:

• Routine hand washing.
• Hygienic disinfection of the skin.
• Surgical hand disinfection.

Each subsequent method provides more high level cleansing the skin of microbiological contaminants.

Simple hand washing

In case of moderate degree of contamination of the skin surface of the hands, ordinary soap and water are used to remove contaminants. Disinfectants are not used. This method hygiene ensures the elimination of dirt and a reduction in the number of microbes on the skin surface.

Routine hand washing is mandatory in the following situations:

• before starting food preparation and dispensing;
• immediately before meals;
• after bowel movements;
• before and after contact with the patient;
• before and after patient care activities;
• for any obvious contamination of the skin surface.

When thoroughly cleaning your hands using detergents, about ninety-nine percent of temporary microorganisms are eliminated from the skin. As studies have shown, the formal implementation of this hygienic procedure does not ensure the removal of contamination from the fingertips, as well as their internal surfaces. Therefore, the rules for hand treatment require the use of a certain washing method, which includes the following actions:

• removing watches and various accessories from hands that interfere with the cleansing of microflora from the skin;
• applying a layer of soap to the skin surface;
• rinsing hands with running warm water;
• repeating the procedure.

When the procedure is performed for the first time, microorganisms are removed from the surface of the skin. Its repetition ensures the elimination of bacteria from pores that have opened under the influence of water at a temperature above room temperature and from massaging the skin surface.

It is advisable to keep the water warm, but not hot, when cleaning your hands. Too high temperature water leads to washing away the layer of fat that protects the skin surface.

Currently, the rules for hand washing of medical personnel require washing hands not in an arbitrary manner, but by performing a certain sequence of movements that corresponds to the accepted European standard.

What actions should you take while washing your hands?

When washing away contaminants from the skin of your hands medical worker must perform the following sequence of movements:

1. Rubbing palms against each other.
2. Alternately rubbing the back of one hand with the palm of the other hand.
3. Alternate rubbing inner surface interdigital spaces of one hand with the fingers of the other.
4. Rubbing the palms with the backs of bent fingers joined into a lock.
5. Alternately rubbing the base of the thumb of one hand rotational movements when grasping it with the index and thumb of the other hand.
6. Rotational rubbing of the wrist of one hand while grasping it with the index and thumb of the other hand.
7. Rubbing the palm of one hand with rotational movements of the fingertips of the other hand.

Hand treatment rules in pictures

Each movement when washing hands should be repeated at least five times. The duration of the entire procedure should be at least half a minute.

What is used for hand washing in clinics

When cleaning hands in medical institutions, it is recommended to use liquid soap poured into disposable bottles. However, it is not advisable to fill a bottle with detergent that already contains soap, as it may become contaminated. It is best if the liquid soap dispenser is equipped with a hermetic pump, which prevents germs and air from the external environment from entering the container with soap, and ensures complete pumping of soap from the bottle.

When using bar soap in medical institutions, the latter should be divided into small portions. Large pieces will remain in a humid environment for too long, as a result of which intensive proliferation of microorganisms may begin in the soap. It is desirable that the design of the soap dish ensures that the bar of soap dries in between hygiene procedures.

What is the best way to dry your hands after washing?

The best option for drying the skin after hygienic treatment is disposable paper towels, which, after washing and drying hands, are used to close taps and thrown away. You can also use a clean cloth that can be washed after one use.
After sanitizing hands in medical institutions, it is undesirable to use electric dryers due to the too low speed of the drying process.

It is not advisable for doctors, nurses and other healthcare workers to wear rings on their hands at work, as such jewelry interferes with the elimination of germs. For the same reason, you should not cover your nails with varnish. Also undesirable are manicure procedures that can lead to the appearance of microscopic wounds that are easily infected during work.

Hand hygiene stations should be conveniently located throughout the health care facility. In the wards, as well as in those rooms where diagnostics and procedures involving penetration into the body are carried out, their own washstands must be installed.

What is hygienic disinfection?

The purpose of this type of sanitization is to prevent the spread of pathogenic microorganisms throughout the clinic through the hands of medical workers. Hygienic skin disinfection is used in the following situations:

Before carrying out manipulations associated with penetration into the body, as well as before starting therapeutic measures with patients who have an increased susceptibility to infections.

1. Before starting work on wounds and upon completion.
2. In case of contact with blood, saliva, mucus, urine or feces of the patient.
3. If there is a possibility of contamination of hands with pathogenic microorganisms through various objects.
4. Before working with infectious patients and after its completion.

The procedure for hygienic hand disinfection includes two stages:

1. Actually hygienic disinfection.

Mechanical processing means regular hand washing twice. Actually, hygienic disinfection consists of applying at least three milliliters of an antiseptic to the skin. To disinfect the skin surface, both ethanol-based disinfectants and aqueous solutions antiseptics, and the former are more effective.

Hand treatment with Sterillium

During the first stage of the procedure, you can use both regular soaps and soaps with an antiseptic additive. After washing your hands, the disinfectant solution is applied to the skin and rubbed in with movements, each of which is repeated at least five times until the skin becomes dry. There is no need to wipe your hands after treating your skin with a disinfectant. The duration of antiseptic treatment should be at least half a minute.

If the skin of your hands was not contaminated before the procedure - for example, the doctor has not yet had contact with the patient - then you can skip pre-washing your hands and immediately apply an antiseptic to the skin.

Antiseptics can have a negative effect on the skin, causing, for example, dryness and cracking. Therefore, the solution used for disinfection must contain glycerin or lanolin.

What is surgical hand disinfection?

This type of hand sanitization is intended to prevent infection of surgical wounds and, accordingly, to prevent the occurrence of postoperative complications caused by microbes entering the tissue. The procedure for surgical disinfection of hand skin includes the following three stages:

1. Mechanical treatment of the skin.
2. Treating the skin with antiseptic agents.
3. Isolate the skin from the external environment with sterile disposable gloves.

The surgical level of hand disinfection is used in the following situations:

• before performing surgical operations;
• before complex penetrating manipulations.

Rules for hand treatment during surgical disinfection

A feature of mechanical cleaning of the skin surface during surgical disinfection is that the skin of not only the doctor’s hands, but also his forearms is subject to cleaning. Drying the skin is done using sterile wipes. The minimum duration of this stage of the procedure is two minutes. After removing moisture from the skin, additional treatment of the nail beds and periungual folds is carried out with special wood sticks and antiseptic agents. Sterile brushes can also be used for this purpose.

After the first stage of surgical disinfection, ten milliliters of an antiseptic drug is applied to the skin of the hands in portions of three milliliters. The applied product must be rubbed into the skin before it dries, using the same sequence of movements as when washing your hands. The duration of this stage of the procedure should be five minutes.

Before putting on sterile gloves the skin must be dry. If a doctor works with gloves on for more than three hours, he must again perform surgical hand disinfection and put on a new pair of gloves.

After work, you need to wipe the skin of your hands with a disinfected napkin, wash your hands with soap, and then apply a cream to the skin that has a softening and moisturizing effect.

To disinfect the surface of the skin, disinfectants can be used, both water-based and alcohol-based. The latter are more preferable. The most common antiseptic formulations are:

Hand hygiene for medical workers - doctors, nurses and other hospital staff is a mandatory procedure.

During it, special means are used, approved by the Russian Pharmacology Committee.

Hands are always sanitized before and after physical contact with the patient.

Skin cleansing is aimed at preventing hospital-acquired infections and eliminating germs and other decay products from hands. It protects the patient and the doctors themselves from infections.

Pay attention!
Hand hygiene for medical staff was introduced back in the 19th century by Dr. Lister Joseph.
This was a breakthrough in medicine and the prevention of infectious diseases. Since then, widespread hand disinfection of medical personnel has been gradually introduced.

Hand hygiene of medical personnel is aimed at ensuring patient safety, because during examination of a patient or during other physical contact, germs can get on the patient.

His immunity is already weakened by the disease, infection with another disease will have an extremely negative impact on his well-being and will delay his recovery.

Regular disinfection and compliance with hand hygiene requirements for medical personnel will protect doctors and nurses themselves from infectious diseases.

Hand hygiene ordinary people involves washing under running water with liquid or bar soap. Then the hands are wiped with a cloth towel, or in rare cases with disposable paper napkins. IN living conditions Such measures will protect against infections.

Doctors and health care workers regularly work with dozens of patients. They not only conduct examinations, but also come into contact with open wounds, perform operations, and deliver babies.

It is necessary to exclude any possibility of infection getting on the patient’s skin (especially in the blood). Therefore, medical hand hygiene includes not only mechanical cleansing, but also treatment with antiseptics even when working with sterile gloves.

Worth noticing! Many people neglect hand hygiene everyday life. In medical practice, such violations are fraught with serious consequences.

Requirements for the cleanliness of medical hands

Any medical professional is familiar with the hygiene algorithm and situations when treatment is necessary. Requirements are established by SanPiN. They indicate how to wash your hands correctly in medicine, the procedure for cleaning and disinfecting hands, fingers and forearms.

You can view the document “WHO Hand Hygiene Guidelines for Health Care Workers.”

In addition to keeping their hands clean, doctors and other medical staff should not paint their nails with nail polish. On contact, it may cause dermatitis in the patient. Dark and cracked polish is the most dangerous; it does not allow you to assess the degree of cleanliness of your nails.

During the manicure procedure, you can easily get cuts and microtraumas, which is associated with the possibility of infection. Also, doctors are not allowed to wear jewelry.

What are the levels of hand hygiene?

Hygiene and hand antisepsis of medical personnel divided into three main types:

1. Mechanical or household– it implies cleansing the hands, eliminating microflora of a transient nature. This is an elementary method of cleansing that does not use antiseptics.
2. Hygienic– disinfection of hands with special preparations (antiseptics). It is used after mechanical cleaning. If there has been no contact with the patient and your hands are not dirty, you can skip household hand treatment and immediately apply a disinfectant to the skin.
3. Surgical– complete removal of any microflora from the hands of medical staff. The method allows you to maintain sterility in the operating room. Surgical disinfection will ensure patient safety if the doctor or nurses' gloves suddenly break.

Mechanical hand washing

This treatment is considered essential for cleaning the hands of medical personnel. It is used in the following situations:

• before and immediately after physical contact between the doctor and the patient;
• the physician must wash his hands after visiting the toilet;
• hands are washed thoroughly before eating;
• for various contaminants.

As a cleanser neutral soap should be used, without a pronounced odor. The tube must be kept closed at all times.

Open liquid soap and non-individual bar soap cannot be used, as it becomes infected with germs and bacteria.

Cleansing rules

1. Remove all jewelry from your hands and fingers, wet your hands under warm running water and soap them, following a special algorithm.
2. Rinse off the soap, lather your hands again and repeat the necessary movements. Repeated cleansing is necessary because initially the germs are washed off the skin and the pores open. During the next wash, bacteria are removed from them.
3. Rinse your hands and dry them with a disposable towel. Typically, classic paper towels are used, measuring 15 by 15. Pieces of fabric can be used, but after one use they should be sent to the laundry for disinfection. Use cloth towels, even individual use forbidden. They may not dry out until next time. A damp surface is beneficial for the growth of bacteria and microbes.

After washing, close the tap with a towel or paper napkin without touching it with clean hands.

The used napkin should be thrown into a special waste bin.

For soap, it is better to stick to liquid dosage. You can also use lumps if it is for individual use. Read below on how to properly wash your hands as a nurse.

Attention! When washing, use only warm running water. Hot water washes off the covers protective layer fat

Hand cleansing algorithm

When washing it is necessary follow the instructions approved by SanPiN. All movements are performed at least five times. Typically machining takes 30 – 60 seconds.

1. Rub one palm against the other, this is done with progressive movements.
2. Rub your left hand (back side) with your right hand. Then vice versa.
3. Spread the fingers of one hand, connect them with the interdigital spaces of the other. Then move your fingers up and down.
4. “Lock” both hands (join them into a lock), with bent fingers, wash the skin of each hand.
5. Use a circular motion to wash the base of your thumb and hand. To do this, clasp your left hand and thumb with the thumb and index fingers of your right hand. Do the same with the other hand.
6. Using the fingertips of your left hand, wash the palm of your right hand in a circular motion.

Pay attention!
The most contaminated areas of the skin of the hands:

• subungual space
• periungual ridges
• fingertips

The most difficult areas of hand skin to wash are:

• interdigital spaces
• thumb notch

Frequency of hand washing of medical staff depends on the department - hand hygiene is carried out as necessary before and after contact with the patient. In the children's department this can be 8 times per hour, in the intensive care unit - 20 times per hour. On average, nurses should wash their hands 5 to 30 times per shift.

Hygienic treatment

This procedure is intended to remove any microflora from the skin of the hands. With this cleaning Antiseptics must be used.

Hygienic treatment includes mechanical cleansing, then an antiseptic is applied to the skin.

After it has completely dried (naturally only), you can begin to work.

Antiseptic should be applied on clean and dry hands. The minimum amount is 3 milliliters. It is rubbed until completely dry. The movements according to which the antiseptic is applied to the skin are similar to the hand washing algorithm described above.

WHO guidelines on hand hygiene indicate 5 most important points when hand hygiene is required:

1. Before contact with the patient;
2. Before the aseptic procedure;
3. After contact with biological fluids;
4. After contact with the patient;
5. After contact with surrounding objects.

Surgical hygiene

Disinfection involves complete removal of any flora from the hands of doctors and other medical personnel. It is carried out before childbirth, operations or punctures. The procedure is also required when preparing the operating table.

The algorithm includes the following stages:

1. It is necessary to prepare your hands, remove rings, bracelets and other jewelry, roll up the sleeves of your robe to the elbows;
2. Next, you need to wash your hands (hands, palms and forearms) with antiseptic soap. Nails are treated with a special brush;
3. Dry your hands with a disposable towel;
4. Apply an antiseptic alcohol solution to the skin and wait until it dries completely;
5. Rub the alcohol-based antiseptic into the skin again and wait until it dries;
6. On final stage Sterile gloves are put on dry hands.

Antiseptic dosage, features of use, time during which it is valid, depend on the specific drug and are indicated in the instructions.

Surgical hand cleansing differs from hygienic hand cleansing in that mechanical washing lasts at least two minutes. Doctors always treat forearms.

After washing, hands are dried only with disposable towels.

Be sure to treat your nails with sterile sticks soaked in antiseptic. Antiseptic Apply twice, total consumption is at least 10 milliliters. The application procedure must be strictly followed.

Attention! After applying the antiseptic, do not use a towel. Hands should dry naturally.

Surgical hand hygiene has its contraindications. It should not be used if there are wounds, injuries, cracks, or ulcers on the skin of the hands.. It is prohibited if you have any skin diseases.

Useful video

How to properly wash your hands in medicine, watch this short but very intelligible video:

Disinfectants

As antiseptics, you should use products that recommended by the Ministry of Health. Alcohol-containing preparations should be used. Typically, doctors use a seventy percent solution of ethyl alcohol or a 0.5% solution of Chlorhexidine Bigluconate (it is diluted in 70% ethyl alcohol). You can disinfect your hands with Chemisept, Octinecept, Hikenix, Veltosept, Octinederm, etc.

Tanks with antiseptic and soap must be disposable. The federal government is talking about this clinical guidelines hand hygiene of medical personnel.

If reusable containers are used, they must be disinfected before refilling.

Important! All containers must have dispensers that squeeze out liquid using the elbow.

Hand hygiene of medical personnel - presentation:

Problems

Allergist Alexey Semenovich Dolgin believes that many problems can be avoided. In almost half of the cases, medical staff do not comply with all WHO recommendations.

“The main mistake is that doctors do not wait until their hands are completely dry after washing. The antiseptic is rubbed into damp skin. And this will definitely lead to irritation.”

Constant hand disinfection inevitably leads to rashes, dermatitis and skin irritation. Most often, allergies are caused by substances that are added to ethyl alcohol: iodine, triclosan, and some ammonium compounds. Experienced surgeons claim that when cleansing with pure ethyl alcohol, allergic reactions were many times less, and the disinfection effect remained high.

Medical personnel are advised not to wash their hands vigorously hot water, use alkaline soap and hard brushes to wash your nails. If you have excessive dryness, you should moisturize your skin. protective equipment(usually before bedtime), avoid aggressive substances. This will help minimize allergic skin reactions.