The dentist performs all his main actions with his hands. For this reason, the cleanliness of the dentist's hands is essential. After all, numerous microbes that are 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 in preparing a doctor for work is the sanitization of hands in order to ensure that they do not contain microorganisms that can cause disease.

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

Staphylococci are gram positive
spherical bacteria that, under microscopic examination, resemble bunches of grapes.

Before carrying out 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 cleanse the hands of the bulk of temporary microorganisms. However, this method of sanitization is not enough to remove the permanent inhabitants of the deep layers of the skin.

In view of the risk of infection during various medical procedures, hand hygiene of doctors and other medical workers is strictly regulated. There are rules for processing the hands of medical personnel, determined by the specifics of 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 in preparing a doctor for work

In accordance with the requirements for the cleanliness of the skin, the following hygiene procedures are used in the preparation of medical staff for work:

• Regular hand washing.
• Hygienic disinfection of the skin.
• Surgical disinfection of hands.

Each subsequent of the above methods provides a higher level of skin cleansing from microbiological contaminants.

Simple hand washing

In the case of a 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 hygiene method eliminates dirt and reduces the number of microbes on the skin surface.

Routine hand washing is mandatory in the following situations:

• before the start of food preparation and distribution;
• immediately before eating;
• after the departure of natural needs;
• before contact with the patient and at the end of it;
• before and after patient care activities;
• with any obvious contamination of the skin surface.

Thorough cleaning of hands using detergents removes about ninety-nine percent of temporary microorganisms from the skin. Studies have shown that the formal implementation of this hygienic procedure does not ensure the removal of contaminants 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:

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

During the first procedure, microorganisms are removed from the surface of the skin. Its repetition ensures the elimination of bacteria from the pores opened under the action of water with a temperature above room temperature and from massaging the skin surface.

It is desirable that during cleaning of hands the water is warm, but not hot. Excessively high water temperature leads to washing off the layer of fat that protects the skin surface.

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

What steps to take when washing your hands

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

1. Rubbing palms against each other.
2. Alternately rubbing the back of the hand of one hand with the palm of the other hand.
3. Alternately rubbing the inner surface of the interdigital spaces of one hand with the fingers of the other.
4. Rubbing the palms with the backs of bent fingers connected in a lock.
5. Alternate friction of the base of the thumb of one hand with rotational movements while covering 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.

Rules for processing hands 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 processing hands in medical institutions, it is recommended to use liquid soap poured into disposable bottles. In this case, it is undesirable to fill a bottle with soap in which there is already soap with detergent, as it may be contaminated. It is best if the liquid soap dispenser is equipped with a hermetic pump that prevents microbes and air from the external environment from entering the soap container and ensures that the soap is completely pumped out of the bottle.

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

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

The best option for drying the skin after hygiene treatment is disposable paper towels, which, after washing and drying hands, are used to turn off the faucets and discarded. A clean cloth can also be used, which can be washed after a single 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 undesirable 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 facilities should be conveniently located throughout the healthcare facility. In the wards, as well as in those rooms where diagnostics and procedures related to penetration into the body are carried out, their own washstands should be installed.

What is hygienic disinfection

The purpose of this type of sanitization is to prevent the spread of pathogenic microorganism through the clinic through the hands of medical workers. Hygienic disinfection of the skin 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 with wounds and at the end of them.
2. In case of contact with blood, saliva, mucus, urine or feces of a patient.
3. If there is a possibility of contamination of hands with pathogens through various objects.
4. Before and after work with infectious patients.

The procedure for hygienic hand disinfection includes two stages:

1. Actually hygienic disinfection.

Mechanical processing refers to the usual double washing of hands. Actually hygienic disinfection consists in applying at least three milliliters of an antiseptic agent to the skin. Both ethanol-based disinfectants and aqueous solutions of antiseptics can be used to disinfect the skin surface, the former being more effective.

Hand treatment with Sterillium

During the first stage of the procedure, you can use both ordinary soaps and soaps with an antiseptic additive. After washing hands, a disinfectant solution is applied to the skin and rubbed in movements, each of which is repeated at least five times - until the skin becomes dry. After treating the skin with a disinfectant, you do not need to wipe your hands. The duration of antiseptic treatment should be at least half a minute.

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

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

What is surgical hand disinfection?

This type of hand sanitization is designed to prevent infection of surgical wounds and, accordingly, to prevent the occurrence of postoperative complications caused by the ingress of microbes into tissues. The procedure for surgical decontamination of the skin of the hands includes the following three stages:

1. Mechanical processing of the skin.
2. Treatment of the skin with antiseptic agents.
3. Isolation of the skin from the external environment with sterile disposable gloves.

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

• before surgical operations;
• before complex penetrating manipulations.

Rules for the treatment of hands during surgical disinfection

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

After the first stage of surgical disinfection, ten milliliters of an antiseptic preparation 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 hands. The duration of this stage of the procedure should be five minutes.

Before putting on sterile gloves, the skin must be dry. If the clinician wears gloves for more than three hours, they should again decontaminate their hands surgically and put on a new pair of gloves.

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

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

Staff handwashing or decontamination.

Decontamination- this is the process of removing or destroying microorganisms for the purpose of neutralization and protection - cleaning, disinfection, sterilization.

hand washing- the most important procedure to prevent nosocomial infections. There are 3 levels of hand decontamination: social level, hygienic (disinfection), surgical level.

Social level - washing lightly soiled hands with soap and water, which allows you to remove most transient microorganisms from the skin.

Social processing of hands is carried out:

1. Before eating

2. After going to the toilet

3. Before and after patient care

4. When hands are dirty.

Equipment: liquid soap (soap dish with a grill and a bar of soap), napkins, paper towel.

Preparation for the procedure:

Execution of the procedure:

4. Lather your palms (if using bar soap, rinse it and place it in a soap dish with a wire rack).

5. Wash your hands by vigorously and mechanically rubbing soapy hands together for 10 seconds.

6. Rinse off the soap under running water: hold the arms so that the wrist and hands are below the level of the elbows (in this position, the water flows from the clean area to the dirty area).

Completion of the procedure:

7. Turn off the water tap using a paper towel.

8. Dry your hands with a paper towel (a cloth towel gets damp quickly and is an ingenious breeding ground for organisms).

Note: in the absence of running water, a basin of clean water can be used.

Hygienic level of hand washing.

Equipment: liquid soap (soap dish with a grill and a bar of soap), skin antiseptic, napkins, paper towel.

Hygienic level of hand treatment- this is washing with the use of antiseptic agents. This is a more efficient method of removing and killing microorganisms.

Hygienic treatment of hands is carried out:

1. Before performing invasive procedures

2. Before caring for an immunosuppressed patient.

3. Before and after wound and urinary catheter care.

4. Before dressing and after removing gloves.

5. After contact with body fluids or after possible microbial contamination.

Preparation for the procedure:

1. Remove all rings from your hands, with the exception of the wedding ring (depressions on the surface of jewelry are a breeding ground for microorganisms).

2. Slide the watch above your wrist or take it off. Put in your pocket or attach with a pin to your robe.

3. Open the faucet using a paper towel to avoid contact with microorganisms present on the faucet, adjust the water temperature.

Execution of the procedure:

4. Wet your hands under running water or in a basin of water.

5. Apply 4-5 ml of antiseptic to your hands or lather your hands thoroughly with soap.

6. Wash your hands using the technique:

a) Vigorous mechanical friction of the palms - 10 seconds (repeat 5 times).

b) The right palm washes (disinfects) the back of the left hand with rubbing movements, then the left palm also washes the right, repeat 5 times.

c) The left palm is on the right hand, the fingers are interlaced, repeat 5 times.

d) The fingers of one hand are bent and are on the other palm (fingers are intertwined) - repeat 5 times.

e) Alternating friction of the thumbs of one hand with the palms of the other, palms clenched, repeat 5 times.

f) Variable friction of the palm of one hand with closed fingers of the other hand, repeat 5 times.

7. Rinse your hands under running water, hold them so that the wrist and hands are below the level.

Completion of the procedure.

8. Turn off the faucet with a paper towel.

9. Dry your hands with a paper towel.

Note: if it is not possible to wash hands hygienically with water, you can treat them with 3-5 ml of antiseptic (based on 70% alcohol for 2 minutes).

Gloves.

Clean or sterile, also part of protective clothing. They are worn when:

1. Contact with blood

2. In contact with seminal fluid or vaginal secretions

Hygienic treatment of the surgeon's hands before the operation is a necessary and mandatory procedure in the operating unit of a medical institution. According to the "Sanitary and epidemiological requirements for organizations engaged in medical activities", in the premises of the operating unit, there must be a dispenser with an antiseptic solution, with the help of which surgeons and other medical personnel perform hand hygiene.

Algorithm for processing the hands of surgeons

1. Wash your hands for one minute using liquid detergent.
2. Dry your hands thoroughly with a disposable paper towel.
3. Using an elbow dispenser, apply skin antiseptic to your hands.
4. Within 3-5 minutes, rub the skin antiseptic in small portions, treating first the hands, then the forearms and elbows.
5. Continue working on the forearms and hands, then just the hands. Hands must remain moist throughout the treatment. Rub the second portion of the antiseptic until completely dry.
6. After treatment, dry your hands naturally, do not use towels or electric dryers. Put on medical gloves on completely dry hands.

Hand hygiene instructions

1. Rub your palm with the fingertips of the opposite hand in a circular motion.
2. Rub your palm against your palm.
3. Rub your left hand on the back of your right hand and vice versa.
4. Carefully treat the spaces between the fingers.
5. Take your hands in the lock and rub the back of your bent fingers on the palm of your other hand and vice versa.
6. Rub your thumbs alternately in a circular motion.

Most often, healthcare-associated infections (HAIs) occur in situations where the source of pathogenic microbes for the patient is the hands of medical personnel. Therefore, hand washing and hand hygiene with skin antiseptics are essential infection control measures that reduce the risk of spreading infections during the treatment process.

Our trading company offers hospitals, polyclinics, dispensaries, outpatient clinics, first-aid posts and other medical institutions of various types, antiseptics and dispensers for them; disinfectants for the treatment of hands, surfaces and tools; medical gloves, including for surgical operations; disposable paper towels; wipes and other hospital hygiene products from the world's leading manufacturer - Ecolab.

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, proper and timely hand treatment is the key to the safety of medical staff and patients .

Hand treatment is divided into three levels:

1. Household level (machining of hands)
2. Hygienic level (treatment of hands using skin antiseptics)
3. Surgical level (a special sequence of manipulations in the treatment of hands, followed by putting on sterile gloves)

1. Machining of hands

The purpose of the household level of hand treatment is the mechanical removal of most of the transient microflora from the skin (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 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.
2. 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.

Hand treatment rules:

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

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. In a circular motion, rub the palm of the left hand with the fingertips of the right hand, change hands.

The above manipulations are illustrated on the next page - see EN-1500 diagram. .

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.

2. Hand hygiene

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).

Required equipment:

1. Napkins size 15x15 cm disposable, clean.
2. 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.)

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 when processing hands corresponds to the EN-1500 scheme. Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute.

3. Hand debridement

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 or individual disposable soap bars.
2. Napkins size 15x15 cm disposable, sterile.
3. Skin antiseptic.
4. Disposable sterile surgical gloves.

Hand treatment rules:

Surgical treatment of hands consists of three stages: mechanical cleaning of hands, disinfection of hands with a skin antiseptic, closing hands with sterile disposable gloves.

1. In contrast to the above-described method of 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.

2. After the end of the mechanical cleaning stage, an antiseptic is applied to the hands in portions of 3 ml and, preventing drying, is rubbed into the skin, strictly following the sequence of movements of the EN-1500 scheme. The procedure for applying a skin antiseptic is repeated at least two times, the total consumption of the antiseptic is 10 ml, the total procedure time is 5 minutes.

3. Sterile gloves are put on dry hands only. 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.

Further in the article Hand treatment

. Three levels of hand treatment: household, hygienic, surgical.

. European Hand Processing Standard, EN-1500: sequence of movements.

. Additional information: skin microflora, prevention of dermatitis.

Rules for the processing of hands of medical personnel. SanPiN 2.1.3.2630-10

1. In order to prevent nosocomial infections, the hands of medical workers (hygienic treatment of hands, treatment of the hands of surgeons) and the skin of patients (treatment of the operating and injection fields, elbow folds of donors, sanitization of the skin) are subject to disinfection.

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

2. To achieve effective washing and disinfection of hands, the following conditions must be observed: short-cut nails, no nail polish, no artificial nails, no rings, rings and other jewelry on the hands. Before processing the hands of surgeons, it is also necessary to remove watches, bracelets, etc. Clean cloth towels or single-use paper towels are used to dry the hands, and only sterile cloth ones are used when treating the hands of surgeons.

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

4. Hygienic processing of hands.

4.1. Hand hygiene should be carried out in the following cases:

Before direct contact with the patient;

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

After contact with body secrets or excretions, 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.

4.2. Hand hygiene is carried out in two ways:

Hygienic hand washing with soap and water to remove contaminants and reduce microbial counts;

Hand sanitizing to reduce microbial counts to safe levels.

4.3. Liquid soap is used to wash hands using a dispenser (dispenser). Dry hands with an individual towel (napkin), preferably disposable.

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

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

4.6. 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 a high workload on staff (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 bedside of the patient and etc.). It should also provide for the possibility of providing medical workers with individual containers (vials) of small volumes (up to 200 ml) with skin antiseptic.

4.7. Use of gloves.

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

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

4.7.3. When gloves are contaminated with secretions, blood, etc. in order to avoid contamination of hands in the process of removing them, a swab (napkin) moistened with a solution of a disinfectant (or antiseptic) should be removed to remove visible contamination. Remove gloves, immerse them in the product solution, then discard. Treat hands with an antiseptic.

5. Treatment of the hands of surgeons.

5.1. The processing of the hands of surgeons is carried out by all those involved in the conduct of surgical interventions, childbirth, catheterization of the main vessels. Processing is carried out in two stages: Stage I - washing hands with soap and water for two minutes, and then drying with a sterile towel (napkin); Stage II - antiseptic treatment of the hands, wrists and forearms.

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

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

6. Algorithms/standards for all epidemiologically significant medical and diagnostic manipulations should include recommended means and methods of hand treatment when performing appropriate manipulations.

7. It is necessary to constantly monitor the implementation of hand hygiene requirements by health workers and bring this information to the attention of staff in order to improve the quality of medical care.

8. 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 workload on staff (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 bedside of the patient, etc. .). It should also provide for the possibility of providing medical workers with individual containers (vials) of small volumes (100-200 ml) with skin antiseptic.

9. Disinfection of the skin of patients.

9.1. Decontamination of the hands of healthcare workers is of great importance in preventing the transmission of infection to patients and staff. The main methods of hand disinfection are the hygienic treatment of the hands of medical personnel and the treatment of the hands of surgeons.

9.2. To achieve effective disinfection of hands, the following conditions must be observed: short-cut nails, the absence of artificial nails, the absence of rings, rings and other jewelry on the hands. Before processing the hands of surgeons, also remove watches and bracelets. To dry hands, use single-use towels or napkins; when processing the hands of surgeons, use only sterile ones.

9.3. The processing of the patient's surgical field before surgery and other manipulations associated with violation of the integrity of the skin (punctures, biopsies) is preferably carried out with an antiseptic containing a dye.

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

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

9.6. For sanitary treatment of the skin of patients (general or partial), antiseptics are used that do not contain alcohols, which have disinfecting and washing properties. Sanitary treatment is carried out on the eve of surgery or when caring for a patient.

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 with warm water, microbes are washed off the skin of the hands. Under the influence of 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 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 the household level of hand treatment is the mechanical removal of most of the transient microflora from the skin (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. Opened liquid soap is quickly infected with microbes, so it is necessary to use closed dispensers, 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 out 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.In a circular motion, rub the palm of the left hand with the fingertips of the 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
The outer side of the fingers on the opposite palm with crossed fingers	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:

Surgical treatment of the hands 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.

In contrast to the above-described method of 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 portions of 3 ml 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.). Despite the fact that Staphylococcus aureus is found in the nose of about 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.

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 the colonization of the skin by other, 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 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. 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 personnel the most important factor in the 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.