Posted by. admin. OCTOBER 31ST, 2011

Two levels of decontamination (processing) hands.

1.Hygienic handling: Removal or destruction of transient microflora, partial destruction of resident microflora.

2.Surgical handling: Complete destruction of transient microflora and a significant amount of resident microflora.

Requirements for medical professionals :

Hands must have intact skin covers, if there are wounds and abrasions, they must be processed by antiseptic and closing by the plaster;

Hands of a medical worker should not have signs of minecraft diseases;

Nails should be clean, short triggered, and not to have a varnish coating (microorganisms accumulate in the cracks);

There should be no rings, perverse, bracelets (because any decorations prevent the full handling of hand and are a place of accumulation of microorganisms).

Requirements for soap:

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

Soap should be simple, without antimicrobial additives;

The slicing soap should be stored in soaps that have a good stock for water, which ensures soap drying;

Preference is given to liquid soap in standard dispensers, because In this case, the contact of the skin of the personnel with soap is excluded, which eliminates its infection;

When using reusable dispensers: add soap to a partially freed dispenser is prohibited. After full release of the dispenser from soap - it is carefully soaked, disinfected, dried and only then, again fill with soap.

Indications for Hygienic Hand Processing:

Before performing any invasive manipulations;

Before work with particularly susceptible (immunocompromic) patients and newborns;

Before and after manipulations with wounds and catheters;

Before putting on and after removing gloves;

After contact with the patient's biological fluids or with objects that have the likelihood of microbial contamination (inspection of the infectious patient, measuring the rectal temperature, etc.).

Man washing the hand.

Hand washing with soap spend under moderate jet comfortable warm water For 1 minute. Hands are abundant with soap and then, consistently carry out 6 standard stages:

After performing all stages of washing, the hands are risen under running water. Next, the hands are wiped with a disposable paper towel or reusable textile napkins of one-time application. Textile napkins are to be washed after each use (used napkins are collected during the shift to the container and sent to the laundry). In the maternity halls and the operating unit, only sterile wipes for wiping hands are used.

Use of skin antiseptic.

In Russia, antiseptics on an alcohol basis are used, which do not require wiping hands after processing. Skin antiseptics are used strictly according to the instructions to the drug used..

When using most alcohol-containing skin antiseptics, 2.5 ml of the drug poured on the palm and rub for 2.5-3 minutes into the skin of the hands, repeating the handwash technique to their complete drying.

1. Remove all rings with hands (deepening on the surface of jewelry are the reproduction of microorganisms).

2. Shift the clock above the wrist or remove them.

3. Areas under the nails cleaned the nail cleaning device under running water.

4. Apply 3-5 ml of liquid soaps or thoroughly straighten your hands with bars soap.

5. Wash hands using the following technique:

Energetic mechanical friction of palms (repeat 5 times);

Right palm with rubric movements washes the back side of the left brush, then the left palm washes the rear of the right brush (repeated 5 times);

Palm to the palm, fingers of one hand in the interfallated intervals of the other (repeat 5 times);

The rear side of the fingers to the palm of the other hand (the fingers are intertwined - repeat 5 times);

Alternating rotational friction of large fingers of one hand with palms of another, palms are compressed (repeated 5 times);

A variable friction of the palm of one hand closed with the fingers of another hand (repeat)

fig.6. Washing hands.

6. Rinse your hands under running water, keep them so that the wrists and brushes are below the level of elbows and to avoid contamination from touching with sink, bathrobe and other objects.

7. Close the crane, take care of it only through a paper towel, as it can be a source of pollution.

8. Seeing the hands with a sterile marlevary cloth.

8. Carefully treat the skin of the hands for 2-3 minutes with 2 tampons, moistened with 70% alcohol or alcohol-containing skin antiseptic, having a virularidal effect (at least one minute per hand) or apply 5-8 ml of 70% ethyl surface Alcohol or alcohol-containing skin antiseptic, having a virulicidal effect and rub into the skin for 2 minutes.

9. Used balls to throw into a disinfection container.

10. Put the gloves according to the action algorithm.

The use of protective specials.

Bathrobes.

With the exception of operating or dressing, where sterile bathrobes are worn to protect the patient, the main goal of the coats to exclude causative agents of infection on clothing and the skin of personnel.

Hatts.

Medical hats securely cover hair, not allowing them to act as a source of pollution.

Aprons.

Rubber and polyethylene aprons are necessary to protect specials. Logging and skin of personnel in the threat of splashing of blood and other and other biological fluids and secretions.

Masks.

The masks are necessary to avoid air-drip transfer of microorganisms, as well as in cases where there is a possibility of entering liquid substances of the human body into the nose or mouth. They are especially important if the personnel is working directly over a large wound surface, such as open surgical wounds or burns, or in procedures with infectious patients, from which the infection can easily pass by air-droplet.

The masks should be replaced every 3-4 h (depends on the profile of the work performed) or when they are moistened during operation. It is impossible to lower the mask on the neck, use again. All masks must fully close the nose and mouth.

Protection for eyes (points, screens).

Protective eye barriers and faces are needed to protect eyes from blood splashes or other liquid discharges. The form of glasses provides complete protection against accidental drops, without limiting the field of view of a specialist. The transparency and smoothness of the lenses ensures the absence of a refractive effect, which allows you to work for a long time without overwork. You can wear with conventional glasses.

Gloves.

Gloves should be put on the lowest possible contact with blood, liquid discharge of the body, mucous membranes or damaged skin patient. The use of gloves is necessary and in cases where there are cuts, damage to the skin or any open wounds on the hands of the medical officer.

Gloves should be changed between contacts with patients. In addition, gloves are changed, if in the patient's maintenance process, a contact with the biological discharge of the patient has occurred.

Sterile gloves are used in operational interventions, carrying dressings, any invasive procedures and therapeutic manipulations.

Disinfected gloves are used in laboratories when working with any biological material of the patient, with disinfectants, cytostatics and other chemical preparations.

Carrying

Purpose:Healing, air disinfection by mechanical way. Providing a barrier for the reproduction of pathogenic flora and the propagation of vibium air-droplet. Air enrichment oxygen Indications:All premises of therapeutic and preventive institutions. The necessary conditions:

regularity of ventilation (no less often 4-5 times a day);

the presence of vents, opening flaps

P / N.	Process preparation process	Justification
1.	Prevent patients who are in the Chamber on the upcoming manipulation and agree on its holding.	Motivation of the patient to cooperate. Compliance with patient rights.
2.	Determine the most suitable method of ventilation (it depends on the season, the presence of forctions, patient states).	Ensuring technicality and correctness of manipulation.
3.	Ask patients who can walk, leave the ward	Ensuring the effectiveness of manipulation
4.	Severely ill patients provide reliable protection from hypothermia: - cut the blanket to snap the head	Maintain protective forces of the body of weakened patients
5.	Open the vents, sash (depending on the season) for 20 minutes. IN summer period They can be kept open around the clock.	Ensuring ventilation, disinfection of air.
6.	Close the window, sash.	Ending manipulation.
7.	Invite patients to the ward.	Ensuring a comfortable condition of patients.

Quartzing

Purpose:Destruction of pathogenic flora as a result of the effects of bactericidal lamp rays Indications:All regime rooms of the LPU. The frequency and duration of quartzing depends on the area of \u200b\u200bthe room (1 W per 1kB M), as well as from the functional load of the room (in the procedural offices, dressing every 4-6h).

The necessary conditions:

regularity of quartzing,

the presence of a stationary or mobile ultraviolet irradiator,

lack of patients and medical perion in the room during quartzing.

P / N.	Procedure preparation process	Justification
1.	Prevent patients and medical staff about the upcoming manipulation and ask to leave the room.	Avoid possible complications. Compliance with patient rights.
2.	Patients who are forced to be indoors during quartzing, ensure eye protection.	Exclude eye damage sensitive to UFO
3.	Include a bactericidal lamp (time regulated)	Disinfection of air
4.	At the end of the work turn off the lamp.	The completion of manipulation.
5.	Invite patients to the ward, medical staff on jobs.	Ensuring a comfortable condition of patients Continuing medical work.

The date and time of the quartzing is registered in specials. Documentation.

Independent work.

Take the task: Conduct the final disinfection of the procedural office

Final disinfection.

An important link of disinfection activities in the LPU is to conduct a final disinfection. In LPU, general cleaning is used as final disinfection. With organization general cleaning It is necessary to divide all the functional premises of the LPU in the category - regime, non-correct and auxiliary.

The category of the mode office includes All rooms in which any invasive manipulations are conducted, processing toolkit, preparation for sterilization, work with sterile tools and material (procedural office, dressing, operables, rodzal, resuscitation chambers), working with biomaterial of patients.

Non-fritteredpremises intended for the stay of patients without the execution of invasive manipulations, as well as for feeding patients and recreation organizations (chambers, buffet, halls, etc.)

The auxiliary includes the premises, Where patients stay underwhere and premises for medical staff (registry, wardrobe, ordinator, etc.).

The day of general cleaning in regime divisions is recommended to choose disinfection mode as aimed at preventing viral hepatitis and fungal infections (in accordance with OST 42-21-2-85). The multiplicity of general cleaning depends on the profile of the division:

In the rank of day or 1 time per day;

Dressing, procedural offices, operational block - 1 time in 7 days;
Conducting general cleaning in regime rooms requires careful selection

working disinfectant, taking into account the most epid-convertible group of microorganisms for this profile of the LPU division. Thus, openers, dressing rooms require activities aimed at the destruction of anaerobic flora, i.e. it is advisable to use 6% of hydrogen peroxide as a disinfectant.

For general and current disinfection, it is necessary to have a specially selected harvesting inventory in sufficient quantities. All cleaning equipment is separated and marked according to the type of cleaning and premises. For the mode offices, individual inventory is isolated, with an appropriate marking, which is stored in place. It is not allowed to replace the inventory and the use of it is not intended. For non-expathed rooms, harvesting equipment should be stored in a separate room. This room includes a place to handle inventory, drying and storage. For storage, buckets, pelvis equip the racks with hygienic coating and the corresponding marking. For mop and brushes, equip special racks that allow separate storage. For vehicles and gloves, it is advisable to have racks that allow you to dry up a soft inventory.

For general and current disinfection, it is necessary to have separate rags. The general cleaning vehicle is not subject to separation over the objects of use and marked only by the icon: for general cleaning (the icon is selected arbitrarily). After use, the rags are disinfected, washing, drying and sterilization. The vehicle is stored for general cleaning in the same laying, in which its sterilization was carried out before use, without taking into account storage time. The laying includes rags and specials. Logs.

The vehicle used for current disinfections is to be processed in two schemes.

Wood processing diagram for current disinfection:

Rafting after processing an object (use)

Disinfection after use

Finished winds to use sterilization

Finished rifle to work (sterility preservation period is not taken into account)

When using the scheme A - The rags are separated by disinfection objects:

Equipment.

1. Sanitary equipment.

2. Surfaces.

3. Working surfaces.

Put the marking and use strictly for its intended purpose.

When choosing a scheme b - the rag is stored in a common packaging, without labeling and used

for disinfection of any objects.

In anyone separately taken in the world, 1.4 million people suffer from hospital infection. Among the hospitalized patients who have a hospital infection range from 5 to 10%. Hand hygiene is the most important measure that contributes to the restriction of the spread of many diseases. Most of the intestinal infections, purulent-septic infections, viral hepatitis and even flu are transmitted through hands. The consequences may be complications in the form of chronic diseases and even a fatal outcome. 80% of all infections are transmitted through unsolicited hands. "Washing hands after contact with the patient and the use of gloves remain the most important infection control measures to prevent cross-contamination of patients who are on IVL (Beria L.A., Beloborodova N.V. Infection in Cardiac surgery. - M.: NCCSH them. A.N. Bakuleva Ramna, 2007, p.103) History: Back in 1199, the doctor and philosopher Moses Maimonide wrote about the need to wash his hands after contact with infectious patients. In 1843, Oliver Unedel Holmes first came to the conclusion that the doctors and the average medical staff infect their patients with "postpartum fever" by means of unwashed hands, and in 1847 Ignac Ambasshelweiss conducted one of the first in the history of epidemiology Analytical epidemiological study and convincingly proved that Deconptamination of hands medical personnel It is an essential procedure that allows you to prevent the emergence of nosocomial infections. Thanks to the introduction of hygienic antiseptics into the practice, in the obstetric hospital, where farms worked, the mortality rate from VBI managed to reduce 10 times. Pirogov N.I (1853) and J. Lister (1867) professed these postulates. However, the practical experience and a huge number of publications devoted to the problem of treating the hands of medical staff show that this problem and after a half hundreds of years after the farmelweiss can not be considered solved. Regulatory documents on handwriting in medicine:

• Sanpin 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations carrying out medical activities"
• WHO management on health care hygiene (World Safety Alliance, 2006)
• Recommendations for washing and antiseptics of hands. Gloves in the infection control system / ed. Academician Raen L.P. Zueva. - SPb, 2006
• Recommendations for the organization of hygiene of the hands of medical workers / Ed. Honored Doctor of the Russian Federation, D.M., prof. Yu.A. Shcherbuk. - St. Petersburg, 2010

Washing hands in medicine. State condition

• Insufficient resources
• Insufficient compliance with hand hygiene requirements

Hand washing in medicine It is among the most important measures to control and prevent transmission of infections in the LPU. Medical staff keep hand hygiene on average less than in 40% of cases. After the toilet, 38% use soap and water, 30% use only water, 32% do not wash their hands. Iv International Conference of Society Specialists in Nursing Infections. Edinburgh, 1998: Question: Why health workers do not wash hands? Answer: Because it is spent on this huge money - no! Because it is too complicated procedure - no! The correct answer - they do not want to waste time !!! The factors that determine the poor observance of the hygiene of the hands, which the health workers reported:

• Hand washing means cause irritation and dryness
• sinks are uncomfortable / mobs not enough
• shortage of soap, towels, etc.
• Often too much employment / lack of time
• Personnel lack / Communion
• First of all, attention should be paid to patients.
• low risk of infection from the patient
• Wearing gloves - the conviction that when wearing gloves washed hands Optionally
• Insufficient knowledge of instructions
• do not think about it / forget
• no positive example of colleagues or guide
• Skeptic attitude
• disagreement with recommendations
• The lack of scientific information on the positive connection between the careful observance of the hygiene of the hands and frequency of nosocomial infections

Washing hands in medicine. Causes of non-fulfillment of rules and conditions for their observance

Causes why the staff does not wash hands:

• Hand washing takes a lot of time
• Lack of soap (54%) and towels (65%)
• one thorough hand washing enough throughout the working day
• Using gloves can replace hand washing (25%, incl. 50% of doctors)
• Hand washing is not necessary if the child gets antibiotics

Additional estimated causes of non-compliance with hand hygiene:

Washing hands in medicine. Prerequisites for compliance with the rules

To perform hand hygiene, it is necessary:

• Development of hand processing algorithms and activities for the implementation of the algorithm in workplaces
• The use of alcohol based antiseptics for rubbing, which is more effective way Disinfection of hands than washing hands with conventional or antibacterial soap
• Providing hand washing conditions
• Improving the motivation and responsibility of health workers by learning on hygiene medical workers

Hand washing algorithm in medicine

The Ploschmed Company invites you to use her developments in the daily activities of medical workers.

Prevent the spread of diseases and microbes is possible with such a simple procedure as hand treatment. Hand processing levels depend on the level of human contact with a potential danger, as well as professional actions implemented by them. The rules of such disinfection should be familiar not only to every professional health worker, but also a simple man.

Types of microflora

What method is handling hands? Hand processing levels depend on the tasks and works that a medical staff performs. Since completely cleaning the skin from pathogenic bacteria is not possible, disinfection should be carried out on an ongoing basis. For general familiarization, it is necessary to bring the basic classification of microflora:

It should be noted that on the skin of the hands there are the most problematic sections, which are quite problematic from such contaminants. These include rollers near the nails and space under the nails, as well as the gaps between the fingers.

The first ways of hand processing appeared and began to be applied in the mid-19th century. So, at first, a solution of phenol was used for disinfection. Currently, several other methods have been practiced.

Classification of skin disinfection

So, how exactly is the classification of such a procedure, how is hand treatment? Hand processing levels are represented by three types of manipulations:

• Normal treatment.
• Hygienic processing.
• Surgical processing.

We will analyze the peculiarities of each method a little more.

First stage

Ordinary washing is the easiest and most affordable method of cleansing. His task is to eliminate dirt and a number of bacteria carrying from dirty surfaces and infected people. Medical specialists wash hands before starting work, after receiving the patient, dressing, as well as the transition to another office or other place of work. For the procedure can be used:

The efficiency of simple washing is no more than 70 percent at double repetition and no more than 40 percent with a single one. Before the procedure, it is recommended to remove all the jewelry and clock, and the cleaning agent thoroughly rub into the skin, then flush and repeat the manipulation. The soap used should not have in the composition of additional flavors or dyes, it should be neutral.

Second step

Processing of the hands of medical staff is often carried out by a hygienic method. It is carried out, as a rule, in the following cases:

Such hygienic treatment implies two stages. In the first stage, a classic washing of hands is carried out, disinfection is added to the second with the help of an alcohol-containing antiseptic.

Hygienic or medical treatment of hands can be carried out with the help of antiseptics of the following types:

• Bactericidal soap (in liquid form).
• Alcohol solutions designed specifically for skin treatment.
• Bactericidal gel.

The remedy without alcohol is applied to wet skin on average in an amount of from 3 to 5 milliliters. The means having an alcohol base are used provided dry skin, rub them up to about 15-20 seconds. The antiseptic is allowed to add a slight amount of glycerol or lanoline to soften the skin and prevent its desiccation.

Third step

It is the third and most total disinfection method. Her holding is relevant for all participants in operational intervention. It is carried out according to the following algorithm:

• Washing hands. It lasts for 2 minutes, after skin treatment, it is necessary to dry it with sterile material.
• Application Antiseptic. With it, hands are processed, wrist brushes, if necessary, forearm. There are special norms in terms of its use, as well as multiplicity of application.

It should be noted that surgical treatment of hands can be carried out exclusively by antiseptics having in the composition of alcohol. These include the following drugs:

Processing with substantial pollution

Separately, it is necessary to touch the question of how the treatment of the hands of the medical staff when the patient's blood appeals on them. If the biological fluid has come directly to the skin, it is required to operate according to the following algorithm:

• Remove the resulting pollution with a napkin.
• Clean the skin with soap and water.
• Dry affected area disposable sterile cloth.
• Twice carry out the alcohol antiseptic processing.

If pollution fell on the surface of the glove, the procedure forces undergo certain changes. They are presented with the following scheme:

• Removing contamination from the material using a disinfecting napkin.
• Washing hands in gloves with water.
• Removing gloves.
• Washing hands with soap, drying.
• Single application antiseptics for hand skin treatment.

There are I. general rules hand handling. They are reduced to the following requirements and recommendations:

Types of drugs

How to choose suitable antiseptics for hand processing? When choosing one or another tool, use the following recommendations:

Of course, medical professionals have specific documents prescribing how hands should be carried out. Hand processing levels determine the type of drug used for disinfection. For example, we will end in more detail on the tools for surgical treatment:

• Alcohols. Optimal solution - ethyl 70%. Perfectly help from gram-positive and competent bacteria, affect individual viruses and mushrooms.
• Solutions based on iodine and alcohol are a wide range of action. Help from bacteria, including tuberculosis pathogens, dispute, viruses, simplest, as well as mushrooms.
• Iodofors. Help from rotovirus, herpes, HIV infection, staphylococci and dispute.
• Chlorhexidine. It has a narrower spectrum of action, aimed at gram-positive bacteria, individual categories of fungi.

Ministry of Health of the Republic of Buryatia State autonomous educational institution

Secondary vocational education

Baikal Basic Medical College of Ministries

Health of the Republic of Buryatia

Kyakhta branch

Topic: Medical Hand Wash Technique

Checked (la):

Performed: Grigoryan A.A

1. General Provisions

Definition of terms.

Antimicrobial remedy, the overwhelming activity of microorganisms (disinfectants, antiseptics, sterilians, chemotherapeutic agents, including antibiotics, cleansing agents, preservatives).

Antiseptics - microbostatic and microbocidal chemicals used for prophylactic and therapeutic antiseptics of intact and damaged skin and mucous covers, cavities, wounds.

Antiseptic for Hands - a means based on alcohol with or without adding other compounds designed to decontaminate the skin of the hands in order to interrupt the infection transmission chain.

National accident infection (VBI) is any clinically pronounced disease of infectious nature, affecting the patient due to hospital stay or visiting a medical institution, as well as infections that arise from health care institutions as a result of their professional activities.

Hygienic antiseptics of hands is handling hands by rubbing the antiseptics into the hands of the hands to eliminate transient microorganisms.

Invasive interventions - the use of devices and devices overcoming the natural barriers of the body, with which the causative agent can penetrate directly into the bloodstream, organs and systems of the patient's body.

Normal hand washing - a water washing procedure with a common (without antimicrobial action) soap.

Irritating contact dermatitis (CD) - the unpleasant sensations and changes in the condition of the skin, which can manifest itself in dryness of the skin, the appearance of itching or burning, redness, peeling of the epidermis and the formation of cracks.

Resident microorganisms are microorganisms that constantly live and multiply on the skin.

Spore-forming bacteria are bacteria with the ability to form special structures covered with a dense shell, they are conventionally called disputes, they are highly resistant to the action of many physicochemical factors.

Transient microorganisms are microorganisms that temporarily fall on the surface of the human skin when contact with various alive and non-residential objects.

Surgical antiseptics of hands is the procedure for rubbing antimicrobial tools (antiseptic) into the skin of the hands (without water use) to eliminate transient microorganisms and the maximum possible reduction in the number of resident microorganisms.

Surgical washing of hands is the procedure for washing hands using a special antimicrobial agent to eliminate transient microorganisms and the maximum possible reduction in the number of resident microorganisms.

Hand hygiene involves surgical and hygienic handling, simple washing and protection of the skin of the hands.

For hygiene of the hands of medical personnel, antiseptic drugs registered in Ukraine are used in the prescribed manner.

2. Proper hand washing

Proper hand washing includes the following steps.

· Moisten your hands with warm running water and apply a liquid soap or use a slicing soap.

· Vigorously tritte hands, at least, 15-20 seconds.

· Thrite all surfaces, including the back side of the palms, wrists, between your fingers and under the nails, if necessary, use a special brush.

· Well rinse your hands with running water.

· Wretched your hands with a clean or disposable towel.

· Use the napkin to turn off the crane.

Proper use of a disinfectant on an alcohol basis.

An alcohol-based disinfectant that does not require water - an excellent alternative to washing hands, especially when soap and water are not available. In fact, such a tool more effectively destroys bacteria and viruses than soap with water. Commercial disinfectants contain ingredients that help prevent dry skin. The use of such products to a greater extent contributes to a decrease in skin dryness and mitigating irritations than washing hands in the usual way.

However, not all disinfectants are the same. Some anhydrous disinfectants do not contain alcohol, which reduces their disinfecting qualities. Therefore, use alcohol-based products only. The Disease Control and Prevention Center recommends choosing products containing at least 60% alcohol.

To use a disinfectant on an alcohol basis:

· Apply approximately ½ teaspoon product on your palm.

· Thrite hands covering all surfaces until they dry.

· However, if your hands are too dirty, wash them with water with soap, if available.

You should wash your hands in such cases:

Unfortunately, it is impossible to protect open hands From the bacteria hitting them, at the same time each of us can limit the spread through the hands of bacteria, viruses and other microorganisms.

Always wash your hands:

· After visiting the toilet.

· After changing diapers. Also wash your hands and face to whom you changed diapers.

· After contact with animals and waste from animals.

· Before and after cooking - especially before, and immediately after contact with raw meat, bird or fish.

· Before eating.

· After cleaning the nose.

· After you sneeze or coughed at your hands.

· Before and after processing wounds or cuts.

· Before and after contact with patient or wounded.

· After contact with the garbage.

· Before installing or removing contact lenses.

· After visiting public toilets, for example, at airports, train stations, bus stations and restaurants.

3. Hazards of dirty hands

Despite the proven use of hand washing, many people do not practice this procedure as often, as it should, even after visiting the toilet. Meanwhile, during the day, we accumulate bacteria on the hands of various sources - direct contact with people, contaminated surfaces, food, animals and waste of their livelihoods. If you do not wash your hands quite often, you can infect yourself with bacteria when you touch the eyes, nose or mouth. You can also extend these bacteria on other people, touching them or surfaces to which they are also touching, for example, to the door handles.

Infectious diseases that are usually distributed through contact with hands include colds, influenza and a number of gastrointestinal disorders, such as infectious diarrhea. Although most people are safely transferred to colds, the flu may be much more serious illness. In some people with influenza, especially the elderly and people with chronic diseases, pneumonia can develop. The combination of influenza with pneumonia is the eighth largest cause of death among Americans. Insufficient hand hygiene also contributes to the development of diseases associated with poor-quality food, such as salmonellosis and dysentery.

4. Hand washing technique

Hand washing technique includes washing hands with warm water with soap or use of a disinfectant on an alcohol basis. Antimicrobial napkins are as effective as soap and water, but inferior in their cleansing properties with disinfectants on an alcohol basis.

IN last years Antibacterial soap becomes more and more popular. However, this soap is no more effective tool To destroy microbes than ordinary soap.

Purpose: decontamination of hands (kill all microorganisms)

Indications:

· Before applying, feeding a patient, food work

· After visiting the toilet

· Before and after patient care

· With any hand pollution

Required equipment: sink, paper napkins Liquid soap with dispenser, paper towel.

Features of execution

Theoretical Justification

I. Preparation for Procedure 1. Remove rings, bracelets, clock

Make it difficult to effectively remove microorganisms

2. Open the crane, adjust the water temperature

Water should be moderately warm

Hot water opens the pores and contributes to the release of microorganisms on the skin surface

II. Conducting procedure 3. Moisten the hands under the water stream

To improve the detergent of soap

4. Apply a liquid soap to the palm

Most preferably, liquid soap in single-use dispensers. Multiple utilization dispensers in time are contaminated: do not add liquid soap into a partially filled dispenser. It should be emptied, wash, dry and only after that fill the fresh portion of soap

To improve the quality of hand washing

5. Fasting liquid soap

Soap foams intense friction of palms for each other

Foam has washing properties

6. Fiction of wrists with circular motions

Removal of contamination with hands

7. Freeding palms: palm to palm

8. friction of the rear brushes

Right palm over the back of the left hand. Left palm over the back of the right hand.

9. Palm to palm, fingers of one hands in the interfallated intervals of the other hand

10. Wash finger tips

Hands are bent and are on another palm (in "Lock")

11. Rotating friction of large fingers

12. Rotating friction palms

III. Ending procedures 13. Wash out soap from hand

Soap is washed off from the hands in the same order as when washing hands

Removal from the hand of soap together with pollution and microorganisms

5. Hand processing is divided into three levels.

· Household level (mechanical handling of hands).

· Hygienic level (Hand processing with skin antiseptics).

· Surgical level (a special sequence of manipulations when processing hands with subsequent dressing of sterile gloves).

6. Hand machining

The purpose of the household hand processing is a mechanical removal from the skin most of the transient microflora (antiseptics are not applied).

After visiting the toilet;

Before meals or before work with food;

Before and after physical contact with the patient;

Required equipment:

Liquid dosage neutral soap or individual disposable soap in pieces. It is desirable that soap does not have a sharp smell. Open liquid or bars reusable non-indisimed soap is rapidly infected with microbes.

15x15 cm napkins are disposable, clean for rolling hands. The use of a towel (even individual) is not desirable, since it does not have time to dry and, moreover, it is easily immaculated by microbes.

Hand processing rules:

Remove all decorations, hours, because they make it difficult to remove microorganisms. Hands are naked, then rinsed with warm running water and everything is repeated first. It is believed that when first washing and rinsing warm water, the microbes are washed off from the skin of the hands. Under the influence of warm water and self-massage of the pores of the skin, they are revealed, so the microbes from the discontinued pores are poured when re-embossed and rinsing.

Warm water contributes to a more efficient effect of antiseptics or soap, while hot water removes a protective fatty-layer from the surface. In this regard, it should be avoided too hot water For washing hands.

Hand processing - the required sequence of movements

Terret one palm about another palm with recurrent movements.

Right palm to rub the rear surface of the left brush, change hands.

Connect the fingers of one hand in the interfallated intervals of the other, rub the inner surfaces of the fingers up and down.

Connect the fingers into the "lock", the back of the bent fingers to rub the palm of the other hand.

Chopping the basis of the thumb on the left hand between large and index fingers of the right hand, rotational friction. Repeat on the wrist. Change hands.

Circular motion to rub the palm of the left brush with the tips of the fingers of the right hand, change hands.

The above manipulations are illustrated on the next page - see the EN-1500 scheme. Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute.

It is very important to comply with the described hand washing techniques, since special studies have shown that during routine hand washing, certain areas of the skin (fingertips and their internal surfaces) remain contaminated.

After the last rinsing of the hand, dry wipes with a napkin (15x15 cm). Water taps closed the same napkin. The napkin is reset into the container with a disinfecting solution for disposal.

In the absence of disposable napkins, it is possible to use pieces of clean fabric, which, after each use, are reset into special containers and after disinfection are sent to the laundry. Replacing disposable napkins on electric dryers is not an idea, because With them, it does not grow skin, and therefore it does not remove the remnants of the detergent substance and the lunch of the epithelium.

7. Hygienic hand treatment

The purpose of hygienic processing is the destruction of skin microflora with antiseptics (disinfection).

Similar hand treatment is carried out:

before dressing gloves and after their removal;

before caring for a patient with a weakened immunity or when carrying around in the wards (when there is no possibility to wash your hands after examining each patient);

before and after the implementation of invasive procedures, small surgical manipulations, the care of the wound or catheter;

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

15x15 cm disposable napkins, clean.

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

Hand processing rules:

Hygienic handling of hands consists of two stages: mechanical cleaning of the hands (see above) and disinfection of the hands of the skin antiseptic.

After the end of the mechanical cleaning step (double wash and rinsing), the antiseptic is applied to the hand of hands in an amount of at least 3 ml and carefully rubs into the skin until complete drying (the hands should not be wiped). If the hands were not contaminated (for example, there was no contact with the patient), then the first stage is skipped and you can immediately apply an antiseptic. The sequence of movements in hand processing corresponds to the EN-1500 scheme. Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute.

Hygienic antiseptic

The standard method of rubbing antiseptics includes 6 stages. Each stage is repeated at least 5 times.

An antiseptic in an amount of at least 3 ml is poured into the deepening of the dry palm and is vigorously rubbed into the skin of the hands and wrist for 30 s.

During the entire time of rubbing the means, the skin is maintained wet from the antiseptic, so the number of portions of the facility is strictly regulated. The last portion of the antiseptics is rubbed to its complete drying. Hand wiping is not allowed.

When machining hands, the presence of so-called "critical" sections of the hands are taken into account, which are not made enough with an antiseptic: thumbs, fingertips, interfallase zones, nails, octal rolling rollers and subnogric zones. The most carefully process the surfaces of the thumb and fingertips, since they are focused on them the greatest number of bacteria.

If there are visible contamination of hands, remove it with a napkin, moistened with an antiseptic, and wash your hands with a detergent. Then they are carefully laundered with water from soap and dried with a disposable towel or napkins. The last napkin closes the crane. After that, the hands are treated with an antiseptic twice to 30 s.

Advantages of hygienic antiseptics of hands with alcohol antiseptics compared to conventional washing

It includes the possible rubbing of the alcohol antiseptic to wet from the antiseptics of the hand, which reduces its efficiency and skin portability.

Saving antimicrobial agents and reducing exposure time makes any method of hand processing ineffective.

Surgical processing of hands

The purpose of the surgical level of hand treatment is to minimize the risk of disorders of the operating sterility in the event of damage to gloves.

Similar hand treatment is carried out:

before operational interventions;

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

Required equipment:

Liquid dosage pH-neutral soap or individual disposable soap in pieces.

15x15 cm disposable napkins, sterile.

Skin antiseptic.

Disposable sterile surgical gloves.

Hand processing rules:

Surgical handling of hands consists of three stages: mechanical cleaning of the hands, disinfection of the hands of the skin antiseptic, the closure of the hands is sterile disposable gloves. In contrast to the above-described method of mechanical cleaning on the surgical level, the processed turns on the forearm, sterile napkins are used for the blocation, and the washing itself lasts at least 2 minutes. After drying, the nail beds and the olkolone rollers are additionally processed with disposable sterile wooden chopsticks, moistened in the antiseptic solution.

Normal hand washing in front of surgical handling

Conventional washing before surgical handling of hands is carried out in advance in the separation or gateway room of the operating unit, alternatively - in the room for antiseptic processing Hands, in a preoperative before the first operation, in the future, if necessary.

Conventional washing is intended exclusively for mechanical cleaning of hands, while contamination is eliminated, sweat, the spore-forming bacteria is partially washed away, and partially transit microorganisms are partially washed.

Surgical antiseptics of the hands

Surgical antiseptics of hands is carried out using various alcohol antiseptics by using them to rub in hand and forearm, including elbow bends.

Rubbing funds are carried out in accordance with the standard procedure developed:

if necessary, wash your hands with a detergent, thoroughly rinse;

thoroughly dry hands with a one-time towel;

with a dispenser (press the elbow on the lever) pour the antiseptic agent into the deepening of the dry palm;

first, moisten the antiseptic agent of hand brushes, then forearm and elbow bends;

an antiseptic agent to individual portions to rub over the time specified by the developer, while brushes should be kept above the elbow folds;

after antiseptic processing, do not use a towel, wait for a complete drying of the hands, dress gloves only on dry hands.

The antiseptic is applied by portions (1.5 - 3.0 ml), including the elbow bends and rub into the skin during the time specified by the developer. The first portion of the antiseptic is applied only on dry hands.

Throughout the time of rubbing the antiseptics, the skin is maintained wet from the antiseptic, so the number of portions of a rubbed means, and its volume is strictly not regulated.

During the procedure, special attention is paid to the standard technique for processing the hands of the hands by the antiseptic according to EN 1500.

Each processing stage is repeated at least 5 times. When carrying out the handling technique, the presence of so-called "critical" sections of the hands is taken into account, which are not wetted enough: thumbs up, fingertips, interfallated zones, nails, octal rollers and subnogric zones. The most carefully process the surfaces of the thumb and fingertips, since they are focused on them the greatest number of bacteria.

Surgical washing hands

Surgical washing of hands consists of two phases: 1 phase - usual washing and 2 phase - washing using a special antimicrobial agent.

phase - ordinary hand washing.

Before you begin 2 phases of surgical washing of handbrushes, the forearm and the elbow bends are wetted with water, except for the means that in the direction of the developer are applied on dry hands, and then water is added.

The antimicrobial detergent in the quantities stipulated by the developer is applied to the palms and distributed over the surface of the hands, including the elbow bends.

Throughout the entire time, the washing of handbrushes and forearm is wetted by antimicrobial detergent, so the amount of means is strictly not regulated. Hand brushes hold up all the time.

Hands dried with a sterile towel or sterile napkins with compliance with the rules of aseptic, starting with the tips of the fingers.

Surgical sterile gloves are worn only on dry hands.

General requirements

Personnel of health care facilities watches the purity of their hands. It is recommended that the nails are briefly cut into the level with the tips of the fingers, without the coating of varnish and cracks on the surface of the nails, without false nails.

Before treating hands, bracelets, clocks, rings are removed.

Hand hygiene equipment.

Tap water.

Wash basin with cold and hot water and a mixer that is desirable to act without touching the hands.

Closed containers with water cranes in the presence of problems with the supply of water.

Liquid soap with neutral pH.

Alcohol antiseptic.

Antimicrobial detergent.

Skin care products.

Non-sterile and sterile disposable towels or napkins.

Dosing devices for detergents and disinfectants, leather care products, towels or napkins.

Capacities for used towels and napkins.

Rubber disposable non-sterile and sterile gloves.

Rubber household gloves.

In the room where the hand treatment is carried out, the washbasin is in an easily accessible place, equip the crane with cold and hot water and the mixer, which is desirable to act without touching the hands, and the water jet should be directed directly to the plum siphon to prevent splashing water.

Near the washbasin, it is advisable to install three dispensers:

with a means for antimicrobial handling of hands;

with liquid soap;

Each place for washing hands, if possible, is equipped with disposable towels, napkins and a capacity for used tools.

It should not be addressed to the dispensers of antiseptics that are not completely emptied. All empty tanks must be filling in aseptic conditions to prevent infection. It is recommended to use disposable containers.

Dispensers detergents And the skin care products before each new filling is recommended thoroughly and disinfect.

In the absence of centralized water supply or in the presence of another problem with water, the separation is provided by closed water tanks with cranes. In the container poured boiled water and change it at least once a day. Before the subsequent filling of the tank is thoroughly clean (if necessary, disinfected), rinsed and dried. Non-sterile gloves are recommended to use when:

contact with hoses of artificial respiratory devices;

work with biological material from patients;

blood fence;

conducting intramuscular, intravenous injections;

cleaning equipment and disinfection;

removing secrets and vomiting.

Requirements for medical gloves:

for operations: latex, neoprene;

for inspections: latex, tactylonial;

when care for the patient: latex, polyethylene, polyvinyl chloride;

it is allowed to use gloves from tissue under rubber;

gloves must be appropriate;

gloves must provide high tactile sensitivity;

to carry out a preservative cleaning of acute medical tools, it is necessary to use gloves with a textured outer surface.

Immediately after use, medical gloves are removed and plunged into a disinfectant solution directly at the place of use of gloves.

After disinfecting a disposable gloves, disposal is recycled.

Terms of Use of Medical Gloves:

the use of medical gloves does not create absolute protection and does not eliminate the observance of hand processing techniques, which is used in each case immediately after removing the gloves in the threat of infection;

disposable gloves are not allowed to use again, non-sterile sterilization gloves are not subject to;

gloves need to be changed immediately if they are damaged;

it is not allowed or handling of hands in gloves between the holding of "clean" and "dirty" manipulations, even in one patient;

it is not allowed to move in gloves in the department (s) of the hospital;

before putting on gloves, it is impossible to use products containing mineral oils, vaselines, lanolin, etc., since they can lead to a violation of glove strength.

The chemical composition of the material of the gloves can cause instant and slow-type allergies or contact dermatitis (CD). CD may appear when using gloves from any material. This contributes: a long continuous stay in gloves (more than 2 hours), use of powdered from the inside gloves, the use of gloves when skin irritation, putting on the gloves to wet hands, too frequent use of gloves during the working day.

Errors that often occur when using gloves:

the use of medical disposable gloves when working in a sophistication. In these cases, preferred reusable gloves (domestic) should be given;

improper storage of gloves (in the sun, at low temperatures, ingress on the gloves of chemicals, etc.);

wearing gloves on the hands moistened by the remnants of the antiseptic.

hand Hand Medical Antiseptic

10. Possible negative consequences Hand handling and their prevention

If you violate the requirements of the instructions / methodological instructions on the use of handling tools and with a negligence attitude to prophylactic skin care, kD may occur.

The cause of the CD may also be:

frequent use of anti microbial detergent;

long-term use of the same anti microbial detergent;

increased skin sensitivity to the chemical composition of funds;

the presence of skin irritation;

too frequently ordinary hand washing, especially with the use of hot water and alkaline detergents or means without softening additives;

wearing gloves on wet hands;

the absence of a reasonable skin care system in a medical institution;

For the prevention of the CD, in addition to avoiding the causes of the CD, it is recommended to perform the following basic requirements:

provide personnel with means for handling hands, which are potentially weak irritants of the skin of the hands and at the same time effective;

when selecting an antimicrobial agent, consider its individual acceptability for skin, smell, consistency, color, ease of use;

implement into the practice of antiseptics, made on the basis of alcohol with with a frequent application, dried the skin of the hands.

11. Alcohol Antiseptic Properties

Indicators	Result of action
Antimicrobial spectrum	Bactericidal (including antibiotic resistant strains), fungicidal and virulicidal
Creation of resistant strains	absent
Antimicrobial Detection rate	30 C - 1.5 min - 3 min
Skin irritation	With prolonged violation of the rules of application may occur dry skin
Holding leather lipids	Practically does not change
Transdermal water loss	Practically absent
Humidity and pH leather	Practically do not change
Protective effect on the skin	Availability of special moisturizing and fatteresting additives
Allergenic and sensitizing action	Not visible
Resorption	Absent
Remote side effects (mutagenicity, carcinogenicity, teratogenicity, ecotoxicity)	Absent
Economic expediency

Conduct a mandatory periodic briefing on the use of antimicrobial agent (dose, exposure, processing technique, sequence of actions) and skin care.

12. Hand Care

Hand skin care is an important condition for the prevention of the transfer of pathogens of the WBI, because only intact skin can be effectively treated with an antimicrobial agent.

CD can be avoided only if the skin care system has been deployed in the health care facility, since when using any antimicrobial means there is a potential risk of skin irritation.

When choosing a skin care medium, the skin type and the following properties of the means are taken into account: the ability to hold the normal body grease, moisture, pH at the level of 5.5, ensuring skin regeneration, good absorption, the ability tools to attach skin elasticity.

It is recommended to use the type of emulsion opposite to the emulsion sheath of the skin: M / B emulsion (oil / water) should be used for oily skin, as well as at elevated temperature and humidity; For dry skin, it is recommended to use emulsions in / m (water / oil), especially at low temperature and humidity.

Choosing skin care products depending on its type

Bibliography

1. Anichkov S.V., Belensky M.L. Pharmacology textbook. - Medgiz Leningrad Association, 1955.

Krylov Yu.F., Bobyv V.M. Hand washing technique. - M.: VKHNMTS MZ of the Russian Federation, 1999. - 352 p.

Kudrin A.N., Skakun N.P. Washing and medicine technique: Medicine series. - M.: Knowledge, 1975

Prozorovsky V.B. Stories about medicine. - M.: Medicine, 1986. - 144 p. - (scientific-poppob. Honey lit.).