Hygienic treatment of the hands of medical staff sanpin scheme. Surgical processing of hands. High level of hand hygiene compliance

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Hand sanitizing of staff is mandatory. For the treatment of hands in a dental clinic, various preparations are used that are approved by the Pharmacological Committee of the Ministry of Health of the Russian Federation, which do not require long time costs. Hand disinfection is one of the effective measures to prevent nosocomial infections and to protect not only medical staff, but also patients. Distinguish between hygienic and surgical disinfection. Hygienic hand disinfection aims to neutralize microbes that are on the skin after contact with an infected object or are part of the skin's natural flora.

Hygienic hand disinfection necessary in the following cases: before and after contact with a patient who is to undergo surgery, after contact with blood, saliva. Such disinfection is carried out before putting on sterile gloves. For this purpose, rubbing the skin with an alcohol-containing antiseptic or washing with antiseptic soap is used.

aim surgical hand disinfection is the removal of transient flora and resistant flora from the hands to prevent transmission of infection through the hands. Surgical disinfection is also carried out in two ways: wiping and washing. Alcoholic solutions are the most convenient and effective, as they have a fast action, a wide range of effects on microorganisms, are well perceived by the skin, and have a duration of action.

The sequence of actions for surgical hand disinfection with alcohol skin antiseptics is shown in the figure.

Hand treatment with alcohol-based skin antiseptic
Rub the antiseptic for hygienic processing of hands! Wash your hands only if visible contamination is present!

Hand washing technique with soap and water
Wash your hands only if visible contamination is present! In all other cases, rub the antiseptic!

Hands are washed in warm running water (hands and forearms) with soap for 2 minutes, then wiped with a sterile gauze or towel.

The disinfectant is applied to the palms and rubbing palm on palm disinfects the palmar surfaces.
The right palm with rubbing movements disinfects the back of the left hand, and the left hand - the back of the right hand. The fingers are intertwined.
Palm on palm with crossed fingers wide apart.
Interlace your fingers in a castle.
Alternate rubbing of the thumbs with the clenched palms of the opposite hand.
Alternate rubbing of the palms with the fingers of the opposite palm.
Forearm processing.

The duration of treatment is 2-3 minutes, special attention is paid to the nails and subungual areas.

The movements of each stage are repeated five times, constantly making sure that the hands remain wet during the entire treatment. If necessary, use a new portion of the disinfectant solution. Currently, an alcohol solution of 0.5% chlorhexidine bigluconate in 70% ethyl alcohol, Octeniderm, Octeniman, Octenisept, Veltosept, AHD 2000 special, Dekocept plus, 60% isopropanol, 70% ethyl alcohol with skin softening additives, etc. is used for hand treatment. .

The presence of rings and watches is unacceptable, sterile brushes are used only for nails and are used only once at the beginning of the working day.

Putting on and removing sterile gloves is also carried out in a certain sequence:

Treatment of the surgical field or injection site. To treat the skin or mucous membrane of the surgical field, iodonate, iodopyrone, chlorhexidine bigluconate are used. It is forbidden to use tincture of iodine, as it causes a burn.

"Practical Guide to Surgical Dentistry"
A.V. Vyazmitina

The hygiene of the hands of medical workers - doctors, nurses and other hospital staff is a mandatory procedure.

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

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

Cleansing the skin is aimed at preventing nosocomial infections, removing microbes and other decay products from the hands. It provides protection to the patient and the physicians themselves from infections.

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

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

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

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

Hand hygiene for ordinary people involves washing under running water using liquid or bar soap. Then the hands are wiped with a cloth towel, in rare cases with disposable paper napkins. At home, such activities will protect against infections.

Doctors and medical workers regularly work with dozens of patients. They conduct not only examinations, but also contact with open wounds, perform operations, and take birth.

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

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

Requirements for the cleanliness of the hands of doctors

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

You can get acquainted with the document “WHO guidelines on hand hygiene for health care workers” .

In addition to keeping their hands clean, doctors and other medical staff should not paint their nails with varnish. On contact, it can cause dermatitis in the patient. The most dangerous is dark and cracked varnish, it does not allow you to assess the degree of cleanliness of the nails.

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

What are the levels of hand hygiene

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

Mechanical or household- it means cleansing the hands, eliminating the microflora of a transient nature. This is an elementary method of cleansing, in which antiseptic agents are not used.
Hygienic– disinfection of hands with special preparations (antiseptics). It is used after mechanical cleaning. If there was no contact with the patient, and the hands are not contaminated, then you can skip the household treatment of the hands and immediately apply a disinfectant to the skin.
Surgical- complete removal of any microflora from the hands of medical staff. The method allows to maintain sterility in the operating room. Surgical disinfection will ensure patient safety if gloves are torn by doctors or nurses.

Mechanical hand washing

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

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

As a cleanser neutral soap should be used without a pronounced odor. The tube must be permanently closed.

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

Cleansing Rules

Remove all jewelry from the hands and fingers, wet your hands under warm running water and lather them, guided by a special algorithm.
Rinse off the soap, lather your hands again and repeat the necessary movements. Re-cleansing is necessary, because initially the microbes are washed off the skin and the pores open. During the next wash, bacteria are removed from them.
Rinse your hands and dry them with a disposable towel. Classic paper towels are usually used, 15 by 15 in size. Pieces of cloth are allowed, but after a single use they should be sent to the laundry for disinfection. The use of cloth towels, even individual use is prohibited. They may not dry out until the next time. A wet surface is beneficial for the reproduction of bacteria and microbes.

After washing, the tap should be closed with a towel or paper towel, without touching it with clean hands.

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

As a soap, it is better to stop at a liquid dosed product. You can also use lumpy, if it is for individual use. How to wash your hands as a nurse read below.

Attention! When washing, use only warm running water. Hot water washes away the protective layer of fat from the skin.

Hand cleansing algorithm

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

Rub one palm against the other, this is done with progressive movements.
Rub your left hand (back side) with your right hand. Then vice versa.
Spread the fingers of one hand, connect them with the interdigital spaces of the other. Then move your fingers up and down.
“Lock” both hands (connect them to the lock), wash the skin of each hand with bent fingers.
Wash the base of the thumb and hand with circular motions. To do this, grasp the left hand and thumb with the thumb and forefinger of the right hand. Do the same with the other hand.
Wash the palm of your right hand with the fingertips of your left hand in a circular motion.

Note!
The most contaminated areas of the skin of the hands:

subungual space
periungual folds
fingertips

The most difficult to wash areas of the skin of the hands:

interdigital spaces
notch of the thumb

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

Hygiene treatment

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

Hygiene treatment includes mechanical cleaning, then an antiseptic is applied to the skin.

After its final drying (only in a natural way), you can start working.

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

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

Before contact with the patient;
Before aseptic procedure;
After contact with body fluids;
After contact with the patient;
After contact with surrounding objects.

Surgical hygiene

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

The algorithm includes the following steps:

It is necessary to prepare hands, remove rings, bracelets and other jewelry, roll up the sleeves of the robe to the elbow;
Next, you need to wash your hands (hands, palms and forearms) with antiseptic soap. Nails are treated with a special brush;
Dry hands dry with a disposable towel;
An antiseptic alcohol solution should be applied to the skin, wait until it dries completely;
Rub the alcohol antiseptic into the skin again, wait until it dries;
At the final stage, sterile gloves are put on dry hands.

Dosage of the antiseptic, features of use, time during which it is valid, drug dependent. and are listed in the instructions.

Surgical hand cleaning differs from hygienic hand washing in that mechanical washing lasts at least two minutes. Doctors must process the forearms.

After washing, hands get wet only with disposable towels.

Be sure to treat the nails with sterile sticks that are dipped in an antiseptic. The antiseptic is applied twice, the total consumption is at least 10 milliliters. The application procedure must be strictly followed.

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

Surgical hand hygiene has its contraindications. It can not be used if there are wounds, injuries, cracks, abscesses on the skin of the hands.. It is prohibited in the presence of any skin diseases.

Useful video

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

Disinfectants

Antiseptics should be used as recommended by the Ministry of Health. Alcohol-containing preparations should be used. Usually, doctors use a seventy percent solution of ethyl alcohol or a 0.5% solution of Chlorhexidine Bigluconate (it is diluted in 70% ethyl alcohol). You can disinfect your hands with Hemisept, Oktinesept, Hickenix, Veltosept, Octinederm, etc.

Reservoirs with antiseptic and soap should be disposable. This is evidenced by the federal clinical guidelines for hand hygiene of medical personnel.

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

Important! All tanks must have dispensers that squeeze out the liquid in an elbow way.

Hand hygiene of medical personnel - presentation:

Problems

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

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

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

Medical personnel are advised not to wash their hands with very hot water, use alkaline soaps and hard brushes for washing nails. In case of excessive dryness, moisturize the skin with protective agents (usually before going to bed), and avoid aggressive substances. This will help minimize allergic skin reactions.

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Judgments

Developers:	Approved	Signature of the head of the MO
	Approval date	(the date)
	Agreed	Quality manager's signature
	Date of approval	(the date)
	Responsible for execution	Signature of the head of the structural unit
	put into action	(the date)
	The person in charge of the procedure	(job title)

Definition

Hand hygiene is the main measure to reduce the prevalence of infections. There are three levels of hand treatment: social, hygienic (disinfection of the hands) and surgical (sterility of the hands is achieved for a certain time).

Purpose: to remove the microflora from the surface of the hands by a mechanical method. Ensure the safety of patients and staff.

Indications:

· before and after eating, feeding the patient;

· after visiting the toilet;

· before and after patient care, unless the hands are contaminated with the patient's bodily fluids.

Note: in contact with infectious patients in all of the above cases, hand hygiene is recommended.

Mandatory condition: healthy skin of the hands, short-cut nails, without varnishing.

Purpose: to ensure the decontamination of hands at a hygienic level.

Indications:

· before donning and after removing gloves;

· after contact with body fluids and after possible microbial contamination;

· before and after caring for an immunocompromised patient

· during examinations, or invasive procedures.

Prerequisite: no injuries on the hands.

Hand treatment method: antiseptic, in their absence - 0.5% alcohol solution of chlorhexidine bigluconate.

Purpose: to achieve the sterility of the hands of medical personnel.

Indications:

· the need to cover a sterile table.

· participation in the operation, puncture.

· participation in childbirth.

Contraindications:

· the presence of pustules on the hands and body.

· skin cracks and wounds.

· skin diseases.

Mandatory condition: work is carried out in strict regime areas in order to fulfill the asepsis regime.

Resources

1) liquid soap with dispenser, elbow dispenser, disposable wipes (individual towel, electric dryer);

2) liquid soap, antiseptic, sterile - tweezers, cotton balls, wipes, class A medical waste disposal container;

3) liquid soap, antiseptic or 0.5% alcohol solution of chlorhexidine bigluconate 20-30 ml., sterile tray with forceps, sterile bix with laying for setting a sterile table.

3) Documentation

1) A visual aid on the technique of processing hands;

2) results of observation of hand hygiene practices;

3) hand hygiene indicators (number of trained, good practice).

Procedures:

Social (usual) level of hand treatment

Preparation for the procedure

· Remove jewelry, watches, check the integrity of the skin of the hands.

· Roll up the sleeves of the robe to the elbow.

· Open the tap, adjust the water temperature (35-40C).

Performing a procedure

· Lather your hands and wash the faucet with soap (the elbow faucet is not washed).

· Wash hands with soap and running water up to 2/3 of the forearm for 30 seconds, paying attention to the phalanges and interdigital spaces of the hands, then wash the back and palm of each hand and with rotational movements - the base of the thumbs (according to the diagram).

Note: Hold your hands with your fingers up so that the water runs into the sink from your elbows. The phalanges of the fingers should remain the cleanest.

Repeat washing in the same sequence.

End of procedure

· Close the faucet using a napkin (close the elbow faucet with your elbow).

· Dry hands with a dry, clean individual towel or dryer.

Hygienic level of hand treatment

Preparation for the procedure:

· Remove rings from fingers.

· Wrap the sleeves of the dressing gown up to 2/3 of the forearm, remove the watch.

Performing a procedure

· Wash hands with soap and running water up to 2/3 of the forearm, paying special attention to the phalanges and interdigital space of the hands for 10 seconds.

· Rinse hands with running water to remove soap suds.

· Repeat washing each hand up to 5-6 times.

· Dry hands with a tissue and discard the tissue in a class A medical waste container.

· Treat your hands with an antiseptic.

Hand treatment at the surgical level

The procedure is achieved with the help of an assistant supplying sterile material from the bix in compliance with the rules of asepsis.

Preparation for the procedure

The assistant (nurse) preliminarily conducts the following:

· Wash your hands in the usual way.

· Put a sterile bix with linen, strengthen it, check the labeling.

· Open the bix with the pedal.

· Remove sterility indicators, assess their condition.

· Take a sterile kerchief (cap) from the bix using a forceps, then a mask, put them on.

· Put the forceps in the tray.

Medical staff/team members before surgery:

· Wash your hands with soap and running water up to the elbow bend for 1 minute, paying attention to the phalanges and interdigital spaces of the hands according to the scheme.

· Rinse hands with running water to remove soap suds from the nail phalanges to the elbow.

· Dry your hands with a sterile towel.

· Treat each hand with small sterile wipes, an antiseptic or 0.5% alcohol solution of chlorhexidine from the nail phalanges to the elbow bend twice for 3 minutes.

· Wear sterile clothing and gloves.

Standardized Hand Treatment Technique


1. Squeeze out one serving of alcohol-based disinfectant from the dispenser (3 ml per palm)	2. Rub one palm against the other.	3. Wrists.

4. Rub the palm of your right hand on the surface of your left hand; and rub the palm of your left hand on the surface of your right hand.	5. Rub your palms together and between your fingers.	6. Rub the fingers of your right hand on the palm of your left hand; rub the fingers of your right hand on the palm of your left hand.
		Need to have alcohol on hand for at least 30 seconds.
7. Rub the palm of the right hand around the thumb of the left hand; Rub the palm of your left hand around your right thumb. Don't forget your fingertip.	8. Rub the fingertips of the right hand on the palm of the left hand; rub the fingertips of your left hand on the palm of your right hand.

Change Registration Sheet

	No. of the section, paragraph of the standard in which the change was made	Date of change	Name of the person who made the change

Unfortunately, adults quite often neglect hand washing, guided by various considerations: fear of accelerated skin aging from constant contact with water and degreasing agents (mainly women), lack of comfortable conditions for such a procedure under certain working conditions, or simply - not giving importance of this procedure. Compliance with the rule alone - "wash your hands before eating and after going to the toilet" is not enough and it is recommended to wash your hands much more often.

This issue is particularly acute at public catering, trade and children's institutions. To employees of similar institutions particularly stringent requirements are imposed, tk. the health of hundreds of people depends on how scrupulously they observe the rules of hand hygiene. But even those who cannot be blamed for not following these rules do not always do it right.

We remind you of the main points that are recommended to be followed when carrying out the hand washing procedure.

Food production personnel must wash and, if necessary, disinfect their hands: before any food handling, immediately after using the toilet or blowing their nose, and after handling potentially contaminated material.
Fingernails must be clean and trimmed.
The hygiene of food production personnel also includes the organization of a sanitary lock - a system consisting of blocks for cleaning shoes, washing and disinfecting hands.
Wash-stands should be equipped with liquid soap, skin antiseptic, disposable paper towels, a waste bin with a foot-operated device, and instructions for washing hands.
Hand sanitizers should be readily available at all stages of the workflow.

Hand hygiene algorithm:

Point one. Remove jewelry from your hands (rings, bracelets that fall below the wrist, etc.).
Point two. Turn on the faucet, wash your hands with soap.
Point three . Lather your hands again (both inside and outside, between your fingers), rinse the soap off your hands.
Point four. Dry with an electric towel or dry your hands, preferably with a disposable towel.
If necessary, apply a skin antiseptic to dried hands in accordance with the instructions for use.

It's important to know:

- just wet and not thoroughly washed hands - this is a wonderful breeding ground for microbes, so - do not save soap and do not be lazy to lather it well on the skin of your hands; - the effectiveness of soap when treating skin is the greater, the greater its foaming;
- hand towels or wipes must be clean and dry. They should be changed as often as possible.

The rules are simple, but, for some reason, few people strive to observe them with special care, and after all, its effectiveness directly depends on how well the hands were soaped or how carefully they were wiped at the end of the procedure.

In toilet rooms, bactericidal liquid soap is poured into dispensers.

This increases protective measures, destroys pathogenic microorganisms, fungi, and prevents the occurrence of epidemics. Sprays with disinfectants are effectively used to treat the hands of workers serving food or waiters working in conditions of lack of free time.

The memo was prepared by L.S. Goncharova, an employee of the Department of Civil Defense and V of the Center for Hygiene and Epidemiology in the Kaliningrad Region.