Surgical and hygienic treatment of the hands of medical personnel - space, earth, man. Surgical processing of hands Method of processing the hands of a surgeon with modern methods
The goal is to destroy transient flora to prevent the risk of contamination of the surgical wound when gloves are damaged.
Surgical treatment hands are carried out:
Before surgical interventions;
When puncturing large vessels;
before intubating the patient.
Equipment:
Liquid dispensed soap.
Napkins (15x15) disposable for getting your hands wet.
Napkins (7x7) disposable for the treatment of hands with a skin antiseptic.
Skin antiseptic.
Disposable sterile rubber gloves.
Surgical treatment of the hands consists of two stages:
Stage 1– mechanical cleaning of hands.
Hands are washed with soap for one minute.
Hand washing routine.
Palm to palm;
Right hand over back side left;
Left palm over the back of the right;
nail beds;
Palm to palm, pollen from one hand between the fingers of the other;
Rotational friction of the thumbs;
Rotational friction of the palms.
Each movement is repeated 5 times.
Then the hands are thoroughly rinsed with warm water and blotted dry with a sterile napkin.
Stage 2- disinfection of hands with a skin antiseptic.
80% ethanol solution as a skin antiseptic in surgical hand treatmentnot used.
Technique for treating hands with a skin antiseptic.
Hands are wiped with a napkin (7x7) moistened with a skin antiseptic from the fingertips to the elbow. The nail beds are wiped especially carefully, between the fingers and the base of the thumb. Hands are wiped twice, with different sterile wipes for 1.5 minutes, and in total - 3 minutes.
Gloves are worn only on sterile and dry hands. Gloves are disposable.
After removing gloves, hands are wiped with a napkin (7x7) moistened with a skin antiseptic, then washed with soap, rinsed thoroughly and softened with cream.
When using alcohol-containing skin antiseptics, they can be rubbed 2.5 - 3.0 ml into the skin of the hands and forearms for 5 minutes. until completely dry, then sterile gloves are put on dry hands.
Spring-cleaning.
General cleaning is carried out Once a week or after removing the patient from the ward.
Preparing for a general cleaning.
On the eve of the cleaning, the rags are given for sterilization (8 pcs. - for walls, furniture, refrigerator, floor, 2 pcs each). The marking must be clear.
On the day of cleaning, the furniture is moved away from the walls, medications and food products are taken out of the room.
Sinks and skirting boards are cleaned with a cleaning agent with a brush.
The employee puts on a special clothes marked "for cleaning" - 2 sets.
Rules for putting on clothes:
A) cotton pajamas with fasteners on the back, elastic bands on the sleeves and legs, the blouse is tucked into trousers;
B) cotton-gauze mask or respirator;
B) goggles
D) a large cotton scarf;
D) rubber technical gloves;
E) rubber boots;
G) rubber or oilcloth apron.
At the end of wiping, ultraviolet irradiation (UVR) is carried out. The exposure time depends on the power of the lamp according to the passport and the area of the room. The quartzing mode should be posted in a "visible" place.
After UVR, the room is ventilated until the smell disappears.
Disinfection (disinfection) of quartz lamps.
The lamp is disinfected once every 7 days. The frame is washed like walls during general cleaning with an interval of 15 minutes. 70% ethanol solution.
Toilet rooms. Wiping is carried out as in a treatment room. The toilet bowl is wiped twice with the same disinfectant solution that is used for cleaning in the departments - 3% chloramine or 4% hydrogen peroxide.
For wiping, there should be a kwach, which is disinfected in a 3% solution of chloramine for 60 minutes, 4% hydrogen peroxide - 90 minutes.
Dishes processing.
Order No. 288 of the Ministry of Health of the USSR, 1976 "Sanitary and epidemiological regime in health care facilities."
San PiN 5179-90 MZ USSR 1991 “San. device rules, equipment and operation of hospitals and other healthcare facilities”.
San PiN 2.3.6.959-00 “San-epid. requirements for the organization of public catering "MZ RF, 2000.
Tableware processing
Each honey. the sister takes an obligatory part in feeding the sick. To do this, she puts on a dressing gown or an apron marked M/S for serving food, which is located in the pantry room and is changed every day. Before serving food, the m / s performs a mechanical treatment of hands (hands are washed with soap twice, rinsed thoroughly with warm water and dried with a clean towel, which is changed daily, or with a disposable napkin).
Food must be distributed no later than 2 hours from the moment the food was received at the catering facility.
Food serving temperature:
First courses - 70-75 0 С;
Second courses - 60-65 0 С;
Third courses - not lower than 14 0 С.
At the end of feeding, the dishes are collected by the barmaid and delivered to the washing cupboard, and the nurse wipes the tables and bedside tables twice with an interval of 15 minutes. 1% chloramine solution or 3% hydrogen peroxide solution in the somatic departments or the disinfectant solution that the department operates.
In the buffet room, tableware is emptied of food residues into a food waste container.
Disinfection of food waste.
Waste is boiled for 30 minutes. or covered with dry bleach at the rate of 200g/l - exposure 60 min. and disposed of.
Stages of processing dishes.
In a 2% solution of baking soda (20 g of soda);
In 2% solution of mustard (mustard 20 g + up to 1 liter of water).
In the first container, the dishes are degreased:
Degreasing conditions:
The temperature of degreasing solutions must be at least 50 0 С.
Exposure 30 min.
Dishes in this solution are washed with rags for at least 1 minute, then transferred to a second container.
1% chloramine solution - 60 minutes;
3% solution of H 2 O 2 - 80 min.;
In the second container, the dishes are degreased in disinfectant solutions:
The temperature of the disinfectant solutions is 18-20 0 С.
In the third container, the dishes are rinsed in running water at a temperature of 70-75 0 C until the smell disappears. Due to the high temperature, the dishes are rinsed out of the hose.
Dishes are dried on racks in a vertical position.
Spoons are first degreased and then degreased in an oven at a temperature of 180 0 C for 20 minutes.
Cookware, in which food is delivered to the buffet from the catering department, goes through two stages of processing: degreasing and rinsing and drying upside down on the grates.
2. PROCESSING OF HANDS OF MEDICAL PERSONNEL
Hand treatment - this simple but very important method prevention of 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 influence warm water and self-massage during mechanical treatment, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes from the opened pores are washed off. Warm water contributes to a more effective effect of an antiseptic or soap, while hot water removes a protective fatty layer from the surface of the hands. For this reason, you should avoid using too much hot water for washing hands.
When entering and leaving the intensive care unit or ICU, the staff should clean their hands with a skin antiseptic.
There are three levels of hand treatment:
1.Household level (mechanical processing of hands);
2.Hygienic level (treatment of hands using skin antiseptics);
3.Surgical level (a special sequence of actions when processing hands, increasing the processing time, processing area, followed by putting on sterile gloves).
1. Machining of hands
The purpose of household level of processing of hands - mechanical removal from the skin of most of the transient microflora (antiseptics are not used).
· after visiting the toilet;
· before eating or before working with food;
· before and after physical contact with the patient;
· with any contamination of the hands.
Required equipment:
1.Liquid dosed neutral soap. It is desirable that the soap does not have a strong odor. 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 |
|
Outer side fingers on the opposite palm with fingers crossed |
Circular rubbing of the left thumb in the closed palm of the right hand and vice versa |
Circular rubbing of the closed fingertips of the right hand on the left palm and vice versa |
2. Hand hygiene
The purpose of hygienic treatment is the destruction of resident microflora from the surface of the skin of the hands with the help of antiseptics.
Such hand treatment is carried out:
· before putting on gloves and after removing them;
· before caring for a patient with a weakened immune system or when making rounds in the wards (when it is not possible to wash hands after examining each patient);
· before and after performing invasive procedures, minor surgical procedures, wound care or catheter care;
· after contact with body fluids (e.g. blood emergencies).
Required equipment:
2.Napkins measuring 15x15 cm are disposable, clean (paper or fabric).
3.Skin antiseptic. It is advisable to use alcohol-containing skin antiseptics (70% ethyl alcohol solution; 0.5% solution of chlorhexidine bigluconate in 70% ethyl alcohol, AHD-2000 special, Sterillium, Sterimax, etc.).
Hygienic processing of hands consists of two stages:
1 - mechanical cleaning of hands, followed by drying with disposable wipes;
2 - disinfection of hands with a skin antiseptic.
3 . Surgical treatment of hands
The goal of the surgical level of hand decontamination is to minimize the risk of violating operational sterility in the event of damage to gloves.
Such hand treatment is carried out:
· before surgical interventions;
· before serious invasive procedures (for example, puncture of large vessels).
Required equipment:
1.Liquid dosed pH-neutral soap.
2.Napkins size 15x15 cm disposable, sterile.
3.Skin antiseptic.
4.Disposable sterile surgical gloves.
Hand treatment rules:
Hand surgery consists of three stages:
1 - mechanical cleaning of hands followed by drying,
2 - disinfection of hands with a skin antiseptic twice,
3 - closing hands with sterile disposable gloves.
In contrast to the above-described method of mechanical cleaning on surgical level forearms are included in the processing, for drying are used sterile wipes, but hand washing lasts at least 2 minutes. After drying, the nail beds and periungual ridges are additionally processed with disposable sterile wooden sticks soaked in an antiseptic solution.
Brushes are not required. If brushes are still used, sterile, soft, disposable or autoclavable brushes should be used, and brushes should only be used on the periungual area and only for the first brushing of a work shift.
At the end of the mechanical cleaning stage, an antiseptic is applied to the hands in 3 ml portions and, preventing drying, is rubbed into the skin, strictly observing the sequence of movements. 5 minutes .
Sterile gloves are put on dry hands only. If the duration of work with gloves is more than 3 hours, the treatment of hands is repeated with a change of gloves.
After removing the gloves, the hands are again wiped with a napkin moistened with a skin antiseptic, then washed with soap and moistened with an emollient cream.
Bacteriological control of the effectiveness of processing the hands of personnel.
The washings from the hands of the personnel are made with sterile gauze wipes 5 × 5 cm in size, moistened with a neutralizer. Thoroughly wipe the palms, periungual and interdigital spaces of both hands with a gauze cloth. After sampling, the gauze pad is placed in wide-mouth tubes or flasks with saline and glass beads and shake 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
Surface layer epidermis ( upper layer skin) is completely replaced every 2 weeks. Daily from healthy skin up to 100 million skin scales are exfoliated, of which 10% contain viable bacteria. The microflora of the skin can be divided into two large groups:
1.Resident flora
2.Transient flora
1. Resident microflora are those microorganisms that constantly live and multiply on the skin without causing any diseases. That is, it is a normal flora. The number of resident flora is approximately 10 2 -10 3 per 1 cm 2. The resident flora is represented mainly by coagulase-negative cocci (primarily Staphylococcus epidermidis) and diphtheroids (Corinebacterium spp.). Although Staphylococcus aureus is found in the nose of approximately 20% of healthy people, it rarely colonizes the skin of the hands (unless it is damaged), but in a hospital setting it can be found on the skin of the hands medical staff 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 objects. environment. Transient flora can be represented by much more epidemiologically dangerous microorganisms (E.coli, Klebsiella spp., Pseudomonas spp., Salmonella spp. and other gram-negative bacteria, S.aureus, C. albicans, rotaviruses, etc.), including hospital strains of pathogens of nosocomial infections. Transient microorganisms persist on the skin of the hands a short time(rarely more than 24 hours). They can easily be removed with normal hand washing or destroyed with antiseptics. As long as these microbes remain on the skin, they can be transmitted to patients through contact and contaminate various objects. This circumstance makes the hands of 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.
Surgical hand sanitizer - carried out before operations and any interventions associated with violations of the integrity of the skin.
The classical methods of processing the hands of Alfeld, Furfinger, Spasokukotsky-Kochergin are not currently used.
In accordance with modern requirements, surgical hand antisepsis is carried out in two stages.
Hygienic washing.
Hands are washed under a stream of warm running water using disposable or liquid soap for 1-2 minutes. At the same time, the rule of processing sequence is observed: do not touch less clean skin with the treated areas of the hands. After that, the hands are dried with a sterile cloth or towel.
Note. Do not use brushes to treat the skin of the hands and forearms.
Rules for washing the surgeon's hands:
1) mechanical and chemical processing;
2) exposure to antiseptic agents;
3) tanning.
Mechanical and chemical treatment is carried out by washing hands under a tap with a brush and soap. The use of modern methods allows washing hands simply with soap or liquid detergents(in the absence of household contamination of the hands). Hands are washed in running water with soap (A), re-soaped with soap (B) before brushing the nails (C), forearms are washed in running water with soap (D), the position of the hands and forearms after the final treatment of the hands, in which water flows from the elbows (D), the tap is closed with the elbow (E).
Modern methods of hand treatment do not require special tanning (film-forming antiseptics or antiseptics with a tanning element are used).
Antiseptics used to treat the surgeon's hands must have following properties :
1. have a strong antiseptic effect;
2. be harmless to the skin of the surgeon;
3. be available and cheap.
Classic method hand treatment according to Spasokukotsky - Kochergin:
Consists of washing hands with a 0.5% solution ammonia per exercise for 6 minutes (3 minutes in each pelvis), followed by treatment of the skin of the hands with 96% ethyl alcohol for 2 minutes.
According to the OST, modern antiseptics are used: organic iodine-containing preparations, chlorhexidine, AHD.
Modern methods surgeon's hands:
1. hand treatment with Pervomour (recipe C-4) (using a 2.4% solution prepared ex temporo; hand washing is done in a basin for 1 minute);
2. hand sanitizing with chlorhexidine (a 0.5% alcohol solution is used, hands are treated twice with a swab moistened with an antiseptic for 2-3 minutes);
3. iodopyrone treatment (after preliminary washing of hands with soap and subsequent drying with a sterile napkin, they are treated for 2-3 minutes with cotton swabs moistened with 0.1% iodopyrone solution, then put on a sterile gown, sterile gloves);
4. hand treatment with degmin and degmicide (produced in the pelvis during 5- 7 minutes);
1. General Provisions
1.2. Definition of terms
- Antimicrobial agent- an agent that suppresses the vital activity of microorganisms (disinfectants, antiseptics, sterilants, chemotherapeutic agents, including antibiotics, cleansers, preservatives).
- Antiseptics- chemicals of microbostatic and microbicidal action used for preventive and therapeutic antiseptics of intact and damaged skin and mucous membranes, cavities, wounds.
- Hand sanitizer- an alcohol-based product with or without the addition of other compounds, designed to decontaminate the skin of the hands in order to interrupt the chain of transmission of infection.
- Nosocomial Infection (HAI)- any clinically pronounced disease of an infectious nature that affects the patient as a result of a stay in a hospital or a visit to a medical institution, as well as infections that occur in the personnel of a healthcare institution as a result of their professional activities.
- Hygienic hand antisepsis- this is the treatment of hands by rubbing an antiseptic into the skin of the hands to eliminate transient microorganisms.
- Invasive interventions- the use of devices and devices that overcome the natural barriers of the body, with which the pathogen can penetrate directly into the bloodstream, organs and systems of the patient's body.
- Routine hand washing- the procedure for washing with water and ordinary (without antimicrobial action) soap.
- Irritant contact dermatitis (KD)- discomfort and changes in the condition of the skin, which can manifest itself in dry skin, itching or burning, redness, peeling of the epidermis and the formation of cracks.
- Resident microorganisms- microorganisms that constantly live and multiply on the skin.
- spore-forming bacteria- These are bacteria that have the ability to form special structures covered with a dense shell, they are conditionally called spores, they are highly resistant to the action of many physicochemical factors.
- Transient microorganisms- microorganisms that temporarily enter the surface of human skin upon contact with various living and inanimate objects.
- Surgical hand sanitizer- this is a procedure for rubbing an antimicrobial agent (antiseptic) into the skin of the hands (without the use of water) to eliminate transient microorganisms and reduce the number of resident microorganisms as much as possible.
- Surgical hand washing- this is a hand washing procedure using a special antimicrobial agent to eliminate transient microorganisms and reduce the number of resident microorganisms as much as possible.
1.3. Hand hygiene involves the surgical and hygienic processing of hands, simple washing and protection of the skin of the hands.
1.4. For the hygiene of the hands of medical personnel, antiseptics are used, registered in Ukraine in the prescribed manner.
2. General requirements
2.1. Healthcare staff keep their hands clean. It is recommended that the nails be cut short to fingertip level, without polishing and cracking on the surface of the nails, and without false nails.
2.2. Before processing hands, bracelets, watches, rings are removed.
2.3. Hand hygiene equipment
Tap water.
- Washbasin with cold and hot water and a faucet, which is desirable to operate without the touch of hands.
- Closed containers with taps for water in case of problems with the supply of water.
- Liquid soap with neutral pH.
- Alcoholic antiseptic.
- Antimicrobial detergent.
- Skin care product.
- Non-sterile and sterile disposable towels or wipes.
- Dispensing devices for detergents and disinfectants, skin care products, towels or wipes.
- Containers for used towels and napkins.
- Disposable rubber gloves, non-sterile and sterile.
- Domestic rubber gloves.
2.4. In the room where hand treatment is carried out, the washbasin is located in an easily accessible place, equipped with a tap with cold and hot water and a mixer, which is preferably activated without touching the hands, and the water jet should be directed directly into the drain siphon to prevent water splashing.
2.5. It is advisable to install three dispensers near the washbasin:
- with a means for antimicrobial treatment of hands;
- with liquid soap;
- with a skin care product.
2.7. Each handwashing place is equipped, if possible, with dispensers for disposable towels, napkins and a container for used products.
2.9. Do not add the agent to antiseptic dispensers that are not completely empty. All empty containers must be filled aseptically to prevent contamination. It is recommended to use disposable containers.
2.10. Detergent and skin care dispensers are recommended to be thoroughly washed and disinfected before each new filling.
2.12. In the absence of a centralized water supply or in the presence of another problem with water, the departments are provided with closed water tanks with taps. Boiled water is poured into the container and it is changed at least once a day. Before the next filling, the containers are thoroughly washed (if necessary, disinfected), rinsed and dried.
3. Hand debridement
Surgical debridement is an important and responsible procedure that is carried out before any surgical intervention in order to prevent infection of the surgical wound of the patient and at the same time protect personnel from infections transmitted through the blood or other secretions of the patient's body. It consists of several stages:
- normal hand washing;
- surgical hand antisepsis, or washing them using a special antimicrobial agent;
- putting on surgical gloves;
- processing of hands after operation;
- skin care.
3.1. Routine hand washing before hand debridement
3.1.1. Routine washing prior to debridement is carried out in advance in the ward or lock room of the operating unit, alternatively in the antiseptic hand treatment room, in the preoperative room before the first operation, thereafter as needed.
Normal washing is intended exclusively for mechanical cleaning of the hands, while dirt, sweat are removed from the hands, spore-forming bacteria are partially washed off, and also transient microorganisms are partially washed off.
3.1.2. For hand washing, ordinary liquid, powder soap or washing lotion with a neutral pH is used. Priority should be given liquid soap or washing lotion. The use of soap bars is unacceptable.
3.1.4. Given the large number of microorganisms under the nails, mandatory treatment of the subungual zones is recommended. To do this, use special sticks or soft disinfected brushes, preferably disposable.
3.1.5. Hands are washed with warm water. Hot water leads to degreasing and irritation of the skin, as it enhances the penetration of detergents into the epidermis of the skin.
3.1.6. The usual washing technique is as follows:
- hands and forearms are moistened with water, then the detergent is applied so that it covers the entire surface of the hands and forearms. The hands, with the tips of the fingers raised upwards, and the forearms, with the elbows lowered low, should be washed for about one minute. Particular attention should be paid to the treatment of subungual zones, nails, periungual ridges and interdigital zones;
3.2. Surgical hand sanitizer
3.2.1. Surgical hand antisepsis is carried out using various alcohol antiseptics by rubbing them into the hands and forearms, including the elbows.
3.2.2. Rubbing the product is carried out in accordance with the developed standard procedure:
If necessary, wash hands with detergent, rinse thoroughly;
- dry your hands thoroughly with a disposable towel;
- using the dispenser (press the lever with your elbow), pour the antiseptic into the deepening of the dry palm;
- first of all, moisten the hands with an antiseptic, then the forearms and elbows;
- rub the antiseptic in separate portions for the time specified by the developer, while holding the hands above the elbows;
- after antiseptic treatment, do not use a towel, wait until the hands are completely dry, put on gloves only on dry hands.
3.2.3. The antiseptic is applied to the hands in portions (1.5 - 3.0 ml), including the elbows and rubbed into the skin for the time specified by the developer. The first portion of the antiseptic is applied only to dry hands.
3.2.4. Throughout the entire time of rubbing the antiseptic, the skin is kept moist from the antiseptic, so the number of servings of the rubbed product and its volume are not strictly regulated.
3.2.5. During the procedure, special attention is paid to the standard method of treating hands with an antiseptic according to EN 1500.
Each processing step is repeated at least 5 times. When performing the hand treatment technique, the presence of the so-called “critical” areas of the hands that are not sufficiently wetted by the agent is taken into account: thumbs, fingertips, interdigital zones, nails, periungual ridges and subungual zones. The surfaces of the thumb and fingertips are treated most carefully, since they are concentrated the largest number bacteria.
3.2.6. The last portion of the antiseptic is rubbed until it is completely dry.
3.2.7. Sterile gloves are worn only on dry hands.
3.2.8. After the end of the operation/procedure, the gloves are removed, the hands are treated with an antiseptic for 2 x 30 s, and then with a hand skin care product. If blood or other secretions get on the hands under gloves, these contaminants are first removed with a swab or napkin moistened with an antiseptic, washed with detergent. Then they are thoroughly washed with soap and water and dried with a disposable towel or napkins. After that, the hands are treated with an antiseptic 2 x 30 s.
3.3. Surgical hand washing
Surgical hand washing consists of two phases: phase 1 - normal washing and phase 2 - washing using a special antimicrobial agent.
3.3.1. Phase 1 - normal hand washing - is carried out in accordance with clause 3.1.
3.3.2. Before the beginning of the 2nd phase of surgical washing, the hands, forearms and elbows are moistened with water, except for those products that, according to the instructions of the developer, are applied to dry hands, and then water is added.
3.3.3. The antimicrobial detergent in the amounts provided by the developer is applied to the palms and distributed over the surface of the hands, including the elbows.
3.3.4. Hands with fingertips pointing upwards and forearms with low elbows are treated with the product for the time specified by the developer of this tool.
3.3.5. Throughout the entire time of washing, the hands and forearms are moistened with an antimicrobial detergent, so the amount of the product is not strictly regulated. The hands are kept up all the time.
3.3.6. During washing, follow the sequence of actions in accordance with that specified in p.p. 3.2.2 and 3.2.5.
3.3.7. Hands are dried with a sterile towel or sterile wipes in compliance with the rules of asepsis, starting from the fingertips.
3.3.8. Surgical sterile gloves are worn only on dry hands.
3.3.9. After the operation/procedure, gloves are removed and hands are treated with an antiseptic according to clause 3.2.8.
3.4. If no more than 60 minutes pass between operations, only antiseptic surgical treatment of the hands is performed.
4. Hand hygiene
Hand hygiene includes normal hand washing water with ordinary (non-antimicrobial) soap and hygienic hand sanitizer, i.e. rubbing an alcohol antiseptic, without the use of water, into the skin of the hands in order to reduce the number of microorganisms that are on them.
Requirements for antimicrobial agents and alcohol antiseptics
1. Antimicrobial and antiseptic alcohol-containing rubbing agents must meet the following requirements:
- a wide range of antimicrobial activity in relation to transient (hygienic treatment of hands) and transient and resident microflora (surgical treatment of hands);
- fast action, that is, the duration of the hand treatment procedure should be as short as possible;
- prolonged action (after processing the skin of the hands, the antiseptic must delay the reproduction and reactivation of resident microorganisms for a certain time (3 hours) under medical gloves);
- activity in the presence of organic substrates;
- no negative impact on the skin;
- the lowest possible dermal resorption;
- absence of toxic, allergenic side effects;
- lack of systemic mutagenic, carcinogenic and teratogenic effects;
- low probability of development of resistance of microorganisms;
- readiness for direct use (do not require advance preparation);
- acceptable consistency and smell;
- easy rinsing from the skin of the hands (for detergent compositions);
- long shelf life.
2. All antimicrobial agents, regardless of the method of their application, must be active against transient bacteria (with the exception of mycobacteria), Candida fungi, and enveloped viruses.
3. Means used in phthisiatric, dermatological, infectious diseases departments should be additionally tested in tests for Mycobacterium terrae (tuberculocidal activity) for use in phthisiatric departments, for Aspergillus niger (fungicidal activity) for use in dermatological departments, for Poliovirus, Adenovirus (virucidal activity) for use in infectious diseases departments if necessary.
The standard procedure during the working day is the antiseptic treatment of hands without the use of water, i.e. rubbing an alcohol antiseptic into the skin of the hands.
4.1. Indications
4.1.1. Routine handwashing using a non-antimicrobial detergent is recommended:
- at the beginning and at the end of the working day;
- before preparing and serving food;
- in all cases, before treatment with an antiseptic, when the hands are clearly contaminated;
- in case of contact with pathogens of enterovirus infections, in the absence of appropriate antiviral agents, it is recommended to mechanically eliminate viruses with prolonged (up to 5 minutes) hand washing;
- in contact with spore microorganisms - prolonged hand washing (at least 2 minutes) to mechanical elimination dispute;
- after using the toilet;
- in all other cases, if there is no risk of infection or special instructions.
4.1.2. Hygiene treatment of hands with the use of alcohol antiseptics is recommended before:
. entrance to aseptic rooms (preoperative, sterilization departments, intensive care units, hemodialysis, etc.);
. performing invasive interventions (installation of catheters, injections, bronchoscopy, endoscopy, etc.);
. activities in which infection of the object is possible (for example, preparing infusions, filling containers with solutions, etc.);
. every direct contact with patients;
. the transition from an infected to an uninfected area of the patient's body;
. contact with sterile material and instruments;
. using gloves.
After:
. contact with contaminated objects, liquids or surfaces (for example, with a urine collection system, contaminated linen, biosubstrates, patient secretions, etc.);
. contact with already introduced drains, catheters or with the place of their introduction;
. every contact with wounds;
. every contact with patients;
. removing gloves;
. toilet use;
. after cleaning the nose (with rhinitis there is a high probability of having viral infection followed by isolation of S.aureus).
4.1.3. The statements given are not final. In a number of specific situations, staff takes independent solution. In addition, each healthcare institution can develop its own list of indications, which are included in the nosocomial prevention plan, taking into account the specifics of a particular department.
4.2. Regular wash
4.2.1. Normal washing is intended exclusively for mechanical cleaning of the hands, while dirt, sweat are removed from the hands, spore-forming bacteria are partially washed off, as well as other transient microorganisms. The procedure is carried out according to p.p. 3.1.2.-3.1.5.
4.2.2. The usual washing technique is as follows:
- moisten the hands with water, then apply the detergent so that it covers the entire surface of the hands and wrists. Hands are washed for about 30 s. Particular attention is paid to the treatment of subungual zones, nails, periungual ridges and interdigital zones;
- after treatment with detergent, hands are thoroughly washed with soap and water and dried with disposable towels or napkins. The last napkin closes the tap with water.
4.3. Hygienic antiseptic
4.3.1. The standard technique for rubbing in an antiseptic includes 6 stages and is presented in paragraph 3.2.5. Each step is repeated at least 5 times.
4.3.2. An antiseptic in an amount of at least 3 ml is poured into the recess of a dry palm and vigorously rubbed into the skin of the hands and wrist for 30 seconds.
4.3.3. During the entire time of rubbing the product, the skin is kept moist from the antiseptic, so the number of servings of the rubbed product is not strictly regulated. The last portion of the antiseptic is rubbed until it is completely dry. Hand wiping is not allowed.
4.3.4. When performing hand treatment, the presence of so-called “critical” areas of the hands that are not sufficiently wetted with an antiseptic are taken into account: thumbs, fingertips, interdigital zones, nails, periungual ridges and subungual zones. The surfaces of the thumb and fingertips are treated most carefully, since they contain the largest number of bacteria.
4.3.5. In the presence of visible contamination of the hands, remove it with a napkin moistened with an antiseptic, and wash hands with detergent. Then they are thoroughly washed with soap and water and dried with a disposable towel or napkins. Close the faucet with the last napkin. After that, the hands are treated with an antiseptic twice for 30 seconds.
5. Usage medical gloves
5.1. The use of gloves does not provide an absolute guarantee of protecting patients and staff from infectious agents.
5.2. The use of medical gloves protects patients and medical personnel from the spread of transient and resident microflora directly through the hands and indirectly through contact with contaminated environmental objects.
5.3. Three types of gloves are recommended for use in medical practice:
- surgical- are used during invasive interventions;
- viewing- provide protection for medical staff when performing many medical procedures;
- household- provide protection for medical staff when processing equipment, contaminated surfaces, instruments, when working with waste from medical institutions, etc.
5.4. Sterile gloves are recommended for:
- in all surgical interventions, to reduce the frequency of punctures, it is recommended to use two gloves put on each other, replace the top glove every 30 minutes. during the operation; it is also recommended to use gloves with a perforation indicator, in which damage to the glove quickly leads to a visible discoloration at the puncture site;
- invasive manipulations (intravenous infusions, biosampling for research, etc.);
- installation of a catheter or conductor through the skin;
- manipulations associated with the contact of sterile instruments with intact mucous membranes (cystoscopy, bladder catheterization);
- vaginal examination;
- bronchoscopy, endoscopy of the gastrointestinal tract, tracheal sanitation;
- contact with endotracheal suctions and tracheostomy.
5.5. Non-sterile gloves are recommended for:
- contact with the hoses of artificial respiration apparatuses;
- work with biological material from patients;
- blood sampling;
- carrying out intramuscular, intravenous injections;
- carrying out equipment cleaning and disinfection;
- removal of secrets and vomiting.
5.6. Requirements for medical gloves:
- for operations: latex, neoprene;
- for inspections: latex, tactylone;
- when caring for a patient: latex, polyethylene, polyvinyl chloride;
- use of gloves from fabric under rubber is allowed;
- gloves must be of the appropriate size;
- gloves should provide high tactile sensitivity;
- contain a minimum amount of antigens (latex, latex proteins);
- when choosing medical gloves, it is recommended to take into account possible allergic reactions in the anamnesis of patients to the material from which the gloves are made;
- for pre-sterilization cleaning of sharp medical instruments, it is necessary to use gloves with a textured outer surface.
5.7. Immediately after use, medical gloves are removed and immersed in a disinfectant solution, directly at the point of use of the gloves.
5.8. After disinfection, disposable gloves must be disposed of.
5.9. Rules for the use of medical gloves:
- the use of medical gloves does not create absolute protection and does not preclude compliance with the hand treatment technique, which is used in each individual case immediately after removing the gloves in case of infection;
- disposable gloves are not allowed to be reused, non-sterile gloves are not subject to sterilization;
- gloves should be changed immediately if they are damaged;
- it is not allowed to wash or treat hands with gloves between “clean” and “dirty” manipulations, even for one patient;
- it is not allowed to wear gloves in the department (s) of the hospital;
- Do not use products containing mineral oils, petroleum jelly, lanolin, etc. before putting on gloves, as they can lead to a violation of the strength of the gloves.
5.10. The chemical composition of the glove material can cause immediate and delayed type allergies or contact dermatitis (CD). CD can appear when using gloves made of any material. This is facilitated by: prolonged continuous use of gloves (more than 2 hours), use of gloves powdered inside, use of gloves in case of existing skin irritation, putting on gloves on wet hands, too frequent use gloves during the working day.
5.11. Mistakes that often occur when using gloves:
- the use of medical disposable gloves when working in the catering department. In these cases, gloves should be preferred. reusable(household);
- improper storage of gloves (in the sun, when low temperatures, contact with gloves of chemicals, etc.);
- putting on gloves on hands moistened with antiseptic residues (additional load on the skin;
- ignoring the need for antiseptic treatment of hands after removing gloves in contact with potentially infectious material;
- the use of surgical gloves for aseptic work, while the use of sterile examination gloves is sufficient for this;
- use of ordinary medical gloves when working with cytostatics (insufficient protection of medical staff;
- insufficient care of the skin of the hands after the use of gloves;
- refusal to wear gloves in situations that at first glance seem safe.
5.12. Reuse of disposable gloves or their disinfection is prohibited. Carrying out hygienic hand antisepsis in disposable gloves is allowed only in situations that require frequent replacement of gloves, for example, when taking blood. In these cases, the gloves must not be punctured or contaminated with blood or other secretions.
5.13. Disinfection of gloves is carried out according to the manufacturer's instructions.
6. Advantages and disadvantages of hand treatment methods
6.1. efficiency, practical use and the acceptability of hand cleaning depend on the method and associated conditions of hand cleaning that are in place in the health care facility.
6.2. Ordinary washing is ineffective in eliminating both transient and resident microorganisms. At the same time, microorganisms do not die, but with splashes of water they fall on the surface of sinks, clothing of personnel, and surrounding surfaces.
6.3. In the process of washing, secondary contamination of hands with microorganisms from tap water is possible.
6.4. Normal washing has a negative effect on the skin of the hands, since water, especially hot water, and detergent lead to a violation of the surface water-fat layer of the skin, which enhances the penetration of the detergent into the epidermis. Frequent washing with detergent leads to swelling of the skin, damage to the epithelium of the stratum corneum, leaching of fats and natural moisture-containing factors, which can lead to skin irritation and cause KD.
6.5. Hygienic hand antisepsis has several practical advantages compared to washing, which allows it to be recommended for wide practical use.
Advantages of hygienic handrub with alcohol-based hand rubs compared to conventional handwashing
6.6. The errors of hygienic antiseptics include the possible rubbing of an alcohol antiseptic into hands that are wet from the antiseptic, which reduces its effectiveness and skin tolerance.
6.7. Saving antimicrobial agent and reducing exposure time makes any hand sanitizing method ineffective.
7. Possible Negative consequences hand treatment and prevention
7.1. In case of violation of the requirements of the instructions / guidelines for the use of hand sanitizers and when careless attitude to preventive skin care, KD may occur.
7.2. The cause of CD can also be:
- frequent use of antimicrobial detergent;
- prolonged use of the same antimicrobial detergent;
- increased sensitivity of the skin to the chemical composition of the funds;
- the presence of skin irritation;
- too frequent normal hand washing, especially with hot water and alkaline or non-softening detergents;
- long work gloved;
- putting on gloves with wet hands;
- absence in medical institution sound system of skin care;
7.3. For the prevention of KD, in addition to avoiding the causes of KD according to p.p. 7.1-7.2, it is recommended to fulfill the following basic requirements:
- provide personnel with hand sanitizers that are potentially mild hand skin irritants and yet effective;
- when selecting an antimicrobial agent, take into account its individual acceptability for the skin, smell, consistency, color, ease of use;
- in a medical institution it is recommended to have several means so that employees who have hypersensitivity skin, had the opportunity to choose a remedy acceptable to themselves;
- introduce into practice antiseptics made on the basis of alcohol with various emollient additives, since pure alcohols dry the skin of the hands with frequent use;
Properties of an alcohol-based antiseptic
Indicators |
Action result |
|---|---|
| Spectrum of antimicrobial action | Bactericidal (including antibiotic-resistant strains), fungicidal and virucidal |
| Creation of resistant strains | is absent |
| The rate of detection of antimicrobial activity | 30 s - 1.5 min - 3 min |
| Skin irritation | With prolonged violation of the rules of use, dry skin may occur. |
| Skin lipid retention | Virtually unchanged |
| transdermal water loss | Virtually absent |
| Moisture and skin pH | Virtually no change |
| Protective effect on the skin | The presence of special moisturizing and fat-restoring additives |
| Allergenic and sensitizing effect | Not visible |
| resorption | Is absent |
| distant side effects(mutagenicity, carcinogenicity, teratogenicity, ecotoxicity) | Missing |
| Economic expediency | High |
Conduct mandatory periodic briefing on the use of an antimicrobial agent (dose, exposure, processing technique, sequence of actions) and skin care.
8. Hand care
8.1. Hand skin care is an important condition for preventing the transmission of HAI pathogens, because only intact skin can be effectively treated with an antimicrobial agent.
8.2. KD can only be avoided if a skin care system is implemented in the health care facility, as there is a potential risk of skin irritation with the use of any antimicrobial agent.
8.3. When choosing a skin care product, the type of skin of the hands and the following properties of the product are taken into account: the ability to maintain the normal state of skin grease, moisture, pH at 5.5, ensuring skin regeneration, good absorption, the ability of the product to give skin elasticity.
8.4. It is recommended to use the type of emulsion that is opposite to the emulsion shell of the skin: emulsions of the O / W (oil / water) type should be used for oily skin, as well as at elevated temperature and humidity; For dry skin, W/O (water/oil) emulsions are recommended, especially at low temperature and humidity.
The choice of skin care products depending on its type
8.5. When selecting skin care products, it is important to consider their compatibility with antimicrobial hand sanitizers to prevent creams or lotions from adversely affecting the antimicrobial effect of the product.
8.6. It is advisable to apply a cream or other product on the hands several times during the working day, rub it thoroughly into the skin of dry and clean hands, pay special attention to the treatment of skin areas between the fingers and periungual ridges.
Indications for hand hygiene:
Before direct patient contact
Before putting on sterile gloves and after removing gloves when placing a central intravascular catheter;
Before and after the placement of central intravascular, peripheral vascular and urinary catheters or other invasive devices, if these manipulations do not require surgical intervention;
After contact with the patient's intact skin (for example, when measuring the pulse or blood pressure, shifting the patient, etc.);
After contact with body secrets or excretions, mucous membranes, dressings;
When performing various manipulations to care for a patient after contact with areas of the body contaminated with microorganisms;
After contact with medical equipment and other objects in the immediate vicinity of the patient.
Hand hygiene technique:
With this type of treatment, the use of a skin antiseptic is mandatory. Alcohol-containing and other approved skin antiseptics are used to disinfect hands. Antiseptics are used, including gels in individual packaging (small vials), which are disposed of after use.
When choosing skin antiseptics, detergents and hand skin care products, one should take into account their skin tolerance, the intensity of skin staining, the presence of perfume, etc.
Hygienic treatment of hands with skin 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. When using most alcohol-containing skin antiseptics, pour 2.5 - 5 ml of the drug into the palm of your hand and rub it into the skin of the hands for 2.5 - 3 minutes, repeating the hand washing technique until they are completely dry.
Medical personnel must be provided in sufficient numbers 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 associated with washing and disinfecting them.
Surgical treatment of hands.
Indications for hand surgery:
Before any surgical and equivalent interventions;
Before giving birth.
Surgical hand antisepsis technique:
Before processing the hands of surgeons, remove watches, bracelets, rings, rings.
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), hands are washed with soap in accordance with the hand washing technique, grabbing the skin of the forearms (up to the elbow) and observing the direction of washing - from the fingers to the elbow;
Stage II - treatment of hands, wrists and forearms with a skin antiseptic.
The amount of skin antiseptic required for treatment, the frequency of treatment and its duration are determined in the guidelines / instructions for the use of a particular agent. An indispensable condition for effective hand disinfection is to keep them moist for the recommended treatment time, then do not wipe the hands until they are completely dry.
Sterile gloves are put on immediately after the skin antiseptic has completely dried.
The use of gloves in healthcare facilities has 3 goals:
Gloves reduce the risk of occupational infection of personnel in contact with patients and their biological material;
Gloves reduce the risk of contamination of personnel hands with transient microbes and transmission to patients;
Gloves reduce the risk of infection of patients with microbes of the resident microflora of the hands of medical personnel.
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.
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.
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.
Use of sterile gloves:
To fulfill any surgical interventions and equivalent manipulations;
When carrying out dressings;
When working with intravenous catheters;
When performing lumbar punctures;
When placing a urinary catheter;
During intubation;
When working with any wound surfaces;
During a vaginal examination;
When performing any endoscopic examinations and medical procedures;
When working with sterile material and preparations;
When working with immunocompromised patients.
Use of disinfected gloves (or clean if disposable gloves):
In clinical diagnostic laboratories, bacteriological laboratories, when working with any biological material (blood, urine, cerebrospinal fluid, etc.);
When conducting intramuscular, subcutaneous, intradermal, intravenous and cutaneous injections;
When performing any disinfection work;
When working with cytostatics and other chemicals;
In prosecture when working with any material.
Processing of reusable gloves after use is carried out according to the same scheme as reusable instruments: disinfection - pre-sterilization cleaning - sterilization. For sterilization of gloves, it is advisable to use soft packs in a small configuration (no more than 10 pairs). With this packaging, sterilization of gloves is easier than in biks. Before sterilization, gloves are talcum powder, lined with gauze or paper from the inside, then folded in pairs when unfolded, laying a layer of gauze between the gloves. Each pair is wrapped in gauze or a napkin. In the package, the gloves are unfolded. Sterilization is carried out in an autoclave at 120C - 1.1 atm - 45 minutes.