Surgical hand sanitizer. Department of "Operational Surgery and Topographic Anatomy" Treatment of hands with ammonia

Name of the drug	Processing method
Pervomur (recipe С-4)	Hands are washed with warm tap water with soap (without brushes) for 1 minute, rinse thoroughly with water until the soap is completely removed and wipe dry with a napkin. Then they treat their hands in a basin with the working solution of Pervomour and wipe them with a sterile napkin. In one basin with 3-5 liters of solution, at least 15 people can disinfect their hands.
Chlorhexidine biglucanate	After preliminary washing of hands with soap and subsequent wiping with a sterile napkin, hands are treated with a cotton swab dipped in a 0.5% alcohol solution of chlorhexidine for 2-3 minutes.
Octeniman Octinider	Hands are washed with warm running water and toilet soap for 2 minutes, dry with a sterile cloth. The drug is applied to dry hands in 3 ml (3 to 6 times) and rubbed for 5 minutes, keeping the skin moist.
Sagrocept	Hands are washed with warm running water and toilet soap for 2 minutes, dried with a sterile cloth. Then, 3 ml of sagrosept is applied to each hand and rubbed up to the elbow for 2 minutes, then with a sterile brush, 1 ml of the drug is rubbed into the nail beds for 1 minute, then 2 ml of the drug is rubbed into each hand up to the wrist for 2 minutes.

For hand surgery you can use other skin antiseptics approved for this purpose (Aseptinol C, Degmicid, Plivasept-N, Plivasept blue, Spitaderm, Triformind, etc.).

Ø It is advisable to use wall-mounted dispensers for dosing drugs.

Ø For surgical treatment of hands, the same means are used as for hygienic treatment. The difference lies in the treatment time, the duration of which is 2-3 minutes, which additionally includes the treatment of the wrists and forearms. When using alcohol-containing products, two applications of 5 ml are applied to the hands, rubbing each dry.

Attention! Rings and watches reduce the effectiveness of hand treatment and must be removed beforehand.

Ø For cleaning nails and washing palmar surfaces, it is better to use wipes, they do not injure the skin of the hands.

Ø After washing your hands with soap and water, if possible, treat your hands with an alcohol-containing solution. This enhances the destruction of the resident flora of the skin.

Ø After washing hands and before applying alcohol, wipe dry with a sterile towel.

For infectious safety, the following rules must be strictly observed:

§ When using soap, it must be kept dry (by hanging or stored in a special soap dish) to prevent contamination by some microorganisms that grow in this environment.

§ The liquid soap dispenser must be cleaned regularly and kept clean.

§ Gloves do not provide an impenetrable barrier (20-30% of gloves are damaged during surgery, manipulation, injections), but they reduce the transmission of microorganisms, be sure to use them.

§ In infectious situations, handwashing and the use of gloves is an important measure of the spread of infection to susceptible patients and staff, therefore the same gloves should not be used between “clean” and “dirty” procedures and examination of different patients.

Modern methods of hand treatment before surgery

For the surgical treatment of hands, various preparations are used that are approved by the pharmacological committee of the Ministry of Health and Medical Industry of the Russian Federation.
Hand sanitizers:

• 0.5% solution of chlorhexidine bigluconate
• 2.4% solution of pervomur (performic acid)
• Novosept 5% solution
• 1% degmicide
• tserigel

Hand treatment according to the Spasokukotsky-Kochergin method

This method is based on dissolving fats on the surface of the skin, in the pores of the skin with an alkaline ammonia solution and removing bacteria along with the solution.
Indications: disinfection of hands medical staff involved in the operation.
Equipment:

• 2 enamel basins
• stands for bixes and basins
• bottle with 0.5% ammonia solution;
• vial with 95% ethyl alcohol
• bixes with dressing material and surgical linen installed on stands
• soap disposable
• hourglass (3 min.)

Sequencing
1. Prepare basins.
2. Pour 5 liters of distilled water into the basin and add 25 ml of 0.5% ammonia.
Warm up the solution to 37-38
3. Place an hourglass (3 min.)
4. Prepare a bix with a dressing.
5. Wash hands under running water with soap (disposable) for 1 minute from the nail phalanges to the elbow. Rinse your hands from the nail phalanges to the elbow.
6. Wash hands with sterile wipes in the first basin for 3 minutes. Wash thoroughly
subungual spaces, periungual folds, interdigital spaces, fingers,
palmar and dorsal surfaces of the left hand, then the right hand.
7. Wash thoroughly the left and right wrist, left and right forearm up to the elbow.
8. Wash hands with sterile wipes in the second basin for 3 minutes in the same sequence
body to the middle third of the forearm.
9. Dry your hands with a sterile towel.
10. Treat hands with sterile wipes moistened with 960 ethyl ALCOHOL ~ 1 for 3
minutes.

Note. You can not use this method of processing with individual intolerance
sti antiseptics.

Hand treatment with 0.5% solution of chlorhexidine bigluconate (gibitan)

Gibitan is produced as a 20% aqueous solution in 500 ml glass bottles.
For the treatment of hands, a 0.5% alcohol solution of the drug is used. to obtain a concentration of 0.5%, it must be diluted in a ratio of 1: 40 (1 part of a 20% aqueous solution of chlorhexidine bigluconate and 40 parts of 700 alcohol).

Equipment:

• bottle with 0.5% solution of chlorhexidine bigluconate
• vial with 700 ethyl alcohol
• with dressing material and operating linen, installed on stands;
• soap (disposable)
• hourglass (1-3 min)

Sequencing:
1. Prepare a vial with a 0.5% solution of chlorhexindine bigluconate.
2. Place a bix with dressing material and surgical linen on the stand.
3. Put the hourglass (1 min.), Make soap.
4. Wash hands with soap and water for 1 minute. Wash hands in the following sequence: subungual spaces, periungual ridges, interdigital spaces, fingers, palmar and back surfaces of the left hand, then the right hand, left and right wrist, left and right forearm to the elbow bend.
5. Wash hands under running water to remove soap suds from the nail phalanges to the elbows.
crease.
6. Dry your hands with a sterile towel thrown over your left hand in the following sequence:
fingers of the right hand from the nail phalanges to the base of the fingers;
palmar surface of the right cyst from the base of the fingers to the wrist joint;
back of the hand (in the same sequence);
the inner surface of the right forearm (up to the middle third), then - outer surface forearm;
the inner surface of the right forearm from the middle third to the elbow, then the outer surface of the forearm from the middle third with the capture of the elbow joint.
7. Transfer the bottom of the towel to the dried right hand and dry the left hand in
same sequence"
8. Treat hands with small sterile wipes moistened with 0.5% alcohol solution of chlorhexidine bigluconate, from the nail phalanges to the elbow bend (In the same sequence as washing hands under running water with soap) for 2 minutes
9. Treat hands with small sterile wipes moistened with 0.5% alcohol solution
chlorhexidine bigluconate (in the same sequence), to the middle third of the forearm for 1 minute.

Hand treatment with a solution of 2.4% pervomur (formic acid)

Indication: disinfection of the hands of medical personnel involved in the operation.
Equipment:

• vial with 2.4% Pervomura
• container with 1.0 l of distilled water
• Bixes with operating linen
• soap (disposable)
• hourglass (1 min.)

Sequencing
1. Prepare a bottle with a 2.4% solution of Pervomur - 1000 ml (the solution is prepared and used
on the day of surgery) and diluted in a container with 9 liters of distilled water.
2. Place the bix with surgical linen on the stand.
3. Prepare an hourglass, soap.
4. Wash hands under running water with soap for 1 minute from the nail phalanges of the hands
to the upper third of the forearm.
5. Rinse hands with water to remove soap from the nail phalanges to the forearm.
6. Wipe your hands dry with a sterile towel (from the nail fayang to the forearm alternately

7. Dip your hands in a container with a 2.4% solution of pervomur for one minute.
8. Wipe your hands dry with a sterile towel (from the nail phalanges to the forearm alternately
- right hand, then left).
Note. After the end of the operation, to prevent dry skin and the appearance of
cracks, hands are lubricated with a softening composition or creams.

Hand treatment with cerigel

Indication: accelerated disinfection of hands during surgery in an outpatient setting
lovia.

Equipment:

• vial with cerigel;
• biks with operating linen;
• soap (disposable);
• bottle with 700 ethyl alcohol;
• hourglass (1 min.)

Sequencing
1. Place the bix with surgical linen on the stand.
2. Prepare a vial with cerigel solution, hourglass, soap.
3. Wash hands under running water and soap for 1 minute.
4. Dry hands with a sterile towel (from the nail phalanges to the upper third of the forearm).
5. Pour 3-4 ml of cerigel solution into the palms.
6. Rub the solution over the hands and middle third of the forearms for 10~15 seconds until
film.
Note. The film formed on the skin of the hands is durable and does not allow microorganisms to pass through.
The film is removed with 70° alcohol.
Hand treatment with 5% Novosept solution or 1% degmicide is carried out in the same way as treatment with 0.5% chlorhexidine bigluconate.

Hygiene treatment hands

Hand disinfection

STD symptoms

Unusual discharge from the genitals,
- various outgrowths of the mucous membrane of the external genitalia,
- itching,
- wounds and sores,
- skin rash,
- Pain and burning when urinating.

The type of immunity after syphilis is weak or not at all.

Hands play an important role in the transmission of nosocomial infections in dentistry.

There are three levels of processing the hands of medical personnel:

1. normal wash;
2. hygienic processing of hands;
3. hand surgery.

Routine hand washing ensures the removal of dirt and transient microflora that gets on the skin of a doctor during contact with a patient or contaminated objects environment. Carried out by thorough hand washing:

• before starting work;
• before and after physical contact with the patient;
• when changing clothes and places of work.

It is necessary to wash twice, because. in this case, the efficiency will be 65 - 70% (with a single dose - 40%).

Better to use liquid soap in disposable dispensers.

When using bar soap, it is essential that the soap dish allows the soap to dry before reuse.

Methodology:

1. Remove jewelry and watches (because the quality is reduced);
2. Squeeze out liquid soap from the dispenser with a dry hand or take it with a dry hand dry soap;
3. Rub the soap vigorously under running water for at least 30 seconds;
4. Rinse off soap residue under running water and repeat;
5. Dry with a disposable paper or individual towel.

7. before putting on gloves and after taking them off;

Before caring for a patient with a weakened immune system or during rounds in the wards (when it is not possible to wash hands after examining each patient);

8. before and after performing invasive procedures, minor surgical procedures, wound care or catheter care;

9. after contact with biological fluids (for example, emergencies with blood).

10. Hygienic processing of hands consists of two stages: mechanical hand cleaning and hand disinfection skin antiseptic, After the end of the mechanical cleaning stage (double soaping and rinsing), an antiseptic or Sterillium Gel (Sterillium Comfort Gel)) on the hands in an amount of at least 3 ml and carefully rubbed into the skin until completely dry (do not wipe your hands).

11. 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

12. Each movement is repeated at least Five times.

13. Hand treatment is carried out within 30 seconds - 1 minute.

15. before surgical interventions;

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

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

18. 1. In contrast to the above-described method of mechanical cleaning at the surgical level, the forearms are included in the treatment, sterile wipes are used to get wet, and the hand washing itself lasts at least 2 minutes.

19. After drying, the nail beds and periungual ridges are additionally processed with disposable sterile wooden sticks dipped in an antiseptic solution

20. 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.

21. 2. After the end of the mechanical cleaning stage, an antiseptic is applied to the hands in portions of 3 ml and, preventing drying, is rubbed into the skin, strictly following the sequence of movements.

22. The procedure for applying a skin antiseptic is repeated at least two times, the total consumption of the antiseptic is 10 ml, the total procedure time - 5 minutes.

23. 3. Sterile gloves worn only on dry hands.

24. If the duration of work with gloves is more than 3 hours, the treatment is repeated with a change of gloves.

25. 4. After removing the gloves, the hands are again wiped with a napkin moistened with a skin antiseptic), then washed with soap and moistened with an emollient cream.

Processing the surgeon's hands is one of the stages in preparing the doctor for the operation. It is very important to remove all foreign agents from the skin. This is achieved by mechanical cleaning and washing with people with skin lesions, purulent and inflammatory diseases are not allowed to operate.

Hand washing sequence

The treatment of the surgeon's hands is carried out according to a certain scheme, which is approved by the World Health Organization. Wash your fingers first. Start with inner surface, then go to the rear and only then wash the interdigital spaces, nails and under the nails. The first execution passes left hand, then right.

After the fingers are finished, they move on to the hands. They also start from the palmar surface and gradually move to the rear. After the wrists come the wrists and forearms. Then wash the nails again and under the nails. Now you can start wiping your hands with sterile wipes or towels, keeping the sequence. Before and after wiping, keep your hands raised up so that water does not get on your hands.

Spasokukotsky-Kochergin method

There are different ways of treating the surgeon's hands. This one is considered one of the oldest. It is based on the fact that it dissolves fats from the surface of the skin and mechanically removes bacteria.

To carry it out you will need:

2 enameled dishes;

Stand / table;

0.5% ammonia (25 ml);

95% ethyl alcohol;

Bix with linen;

Purified water is poured into a basin, added and heated to body temperature. Then mark three minutes. During this time, you need to wash your hands with soap and water under running water, treat your hands with clean napkins, moistened first in the first basin, and then in the second. After that, you need to dry your hands with bix linen and at the end wipe your hands with linen soaked in ethyl alcohol.

Treatment with chlorhexidine solution

Methods for processing the hands of a surgeon differ from each other mainly in the preparations that are used for this. In this case, it is 0.5% chlorhexidine or gibitan. For the procedure you will need:

0.5% solution of chlorhexidine;

70% ethyl alcohol;

Bix with sterile linen;

Wash your hands for a minute with soap, starting from the nails and moving towards the forearm. Remove foam under running water, dry hands with sterile linen. Then treat your hands with napkins that are impregnated with chlorhexidine.

Treatment with Pervomur solution

The treatment of the surgeon's hands before the operation can also be carried out with a solution of formic acid, or pervomur. This will require:

2.4% Pervomur solution;

A liter of purified water;

Sterile underwear;

Dissolve pervomur in a liter of water, and then pour another nine liters of liquid into the resulting solution. Then wash your hands with running water and disposable soap, rinse them and hold in vertical position. Wipe dry with a towel or napkin, first the right hand, and then the left. After that, put your hands in a container with pervomur for a minute and wipe dry again.

This solution greatly dries the skin, so after the operation it is necessary to use moisturizing and softening creams.

Zerigel treatment

Treatment of the surgeon's hands in this way is used for outpatient manipulations. This will require the following materials:

Zerigel;

Sterile underwear;

70% alcohol;

First, wash your hands with running water, carefully rinse off the soap and make sure that water does not drip onto the brushes. Dry your hands with a disposable towel from nails to elbow. Pour cerigel into the palms and rub it over the hands and forearm. After the surgical manipulations are performed, it is possible to remove the remnants disinfectant using cotton wool soaked in alcohol.

Treatment with iodopyrone

First, the solution is prepared in an enamel bowl, which has previously been disinfected twice with hot alcohol. Two liters of warm water are poured into it. pure water and add twenty milliliters of lauryl sulfate powder. After it dissolves, iodopyrone is added to the mixture in the amount of forty milliliters. Everything is thoroughly mixed with a glass rod.

Hands are washed with running water, wiped dry with sterile linen, then washed again in the solution for five minutes. After that, wipe dry again and put on sterile gloves.

Furbringer's method

The surgeon thoroughly cleans the hands, nails, subungual spaces, and forearms with a soapy brush for ten minutes. Then he carefully dries his hands with sterile linen, following the sequence: first the hands, then the forearms. After the hands have become completely dry, they are wiped for five minutes with cotton swabs dipped in seventy percent alcohol. But the processing doesn't end there. At the end, it is necessary to use a 0.02% solution of sublimate.

This method is rarely used because it can lead to chronic mercury poisoning.

Treatment of the surgical field

Processing the surgeon's hands in the operating room is not the only way to protect the patient from infection. The skin where the incision will be made is also treated. Recently, a 1% solution of degmine or a 0.5% solution of chlorhexidine has been used for this. Sterile cotton swabs are soaked in any of these solutions, and the patient's skin is wiped twice, with an interval of two minutes.

A substitute for iodine solution can be iodonate, which is a mixture of iodine (45%) and a surfactant. For processing operating field iodonate is diluted forty-five times to obtain a 1% solution. To do this, add 45 parts of distilled water to it. The patient's skin is wiped twice with the resulting liquid. And at the end of the operation, before suturing, the skin is treated again.

Processing the surgeon's hands is considered one of the most important ways to maintain when performing medical manipulations.

The origin of the microbial flora on the hands of medical personnel can be twofold:

1. as a result of contamination of the surface of the skin and
2. permanently located in the depths of the skin.

Thus, when treating hands, it is necessary to destroy the microflora on the surface of the skin and prevent the exit of microbes from the pores. This is achieved by mechanical cleaning, treatment with antiseptic solutions, tanning of the skin.

Persons with damage to the skin of the hands, pustules and inflammatory processes. Fingernails should be cut short. The skin of the hands the night before to maintain elasticity and softness is treated with petroleum jelly or lanolin.

Methods of aseptic processing of hands are divided into two groups: the first includes mechanical cleaning, disinfection and tanning, the second - only tanning of the skin of the hands.

Washing brushes are sterilized by boiling for 30 minutes in saucepans (enamelled), where they are stored. Take out the brushes and serve with a sterile forceps.

Hand washing is carried out in a certain sequence: first, the fingers are brushed, then the palms, back surfaces and go to the forearms. When washing off the soap suds, the hands are held so that the soap is removed first from the hands, and then from the forearms. Soap and a brush should not be placed on the washbasin, they must be held in your hand. Wipe hands sequentially, starting with the hands and moving to the forearms.

There are many ways to handle hands. The choice of one or another method depends on the availability and tolerance of drugs, traditions and habits.

Furbringer's hand treatment method

Furbringer's method: brushes, subungual spaces, forearms are thoroughly washed for 10 minutes, first with one and then with a second sterile brush with soap. Hands are thoroughly dried with a sterile napkin - first the hands, then the forearms, then treated with 70% alcohol for 5 minutes, and then for 3-5 minutes with a 1:200 sublimate solution.

The method is rarely used, since 70% alcohol creates only a short-term tanning effect, sublimate treatment can lead to chronic mercury poisoning.

The method of processing the hands of Spasokukotsky

Spasokukotsky-Kochergin method: wash hands thoroughly warm water with soap for a minute, then the hands are washed in basins with a 0.5% freshly prepared solution of ammonia with a sterile napkin - 3 minutes in one and 3 minutes in another basin. After that, the hands are dried with a sterile towel and treated with alcohol for 5 minutes. Some surgeons additionally treat the fingers with 10% iodine tincture.

The method is effective and widely used, but some people have an individual intolerance to ammonia.

Hand treatment method pervomour

AT last years the method of treating hands with a mixture of hydrogen peroxide and formic acid (pervomur), as well as chlorhexidine bigluconate (gibitan), has become widespread. These substances allow you to quickly and reliably treat your hands.

Hand treatment with Pervomour (recipe C-4). In the process of preparing pervomur, performic acid is formed, which has a bactericidal property. The drug is prepared as follows: 171 ml of 33% hydrogen peroxide solution, 69 ml of 100% formic acid or 81 ml of 85% formic acid solution are poured into a 1 liter flask, and then distilled water is added to a volume of 1 liter. The solution is placed in a refrigerator for 1.5 hours, shaken periodically. For the treatment of hands, the initial solution is diluted 10 times (2.4%). The solution is suitable for a day.

Hands are washed with soap without a brush for 1 minute, rinsed, wiped with a sterile cloth and immersed in pervomur solution for 1 minute to the elbow bends. Hands are wiped dry with a sterile cloth and sterile gloves are put on. During the operation, gloves are washed every 60 minutes in a 2.4% solution of pervomur.

Hand treatment with gibitan

Hand treatment with gibitan (chlorhexidine bigluconate solution). Chlorhexidine is available as a 20% solution in 500 ml bottles. To treat hands with a 0.5% alcohol solution, the main drug is diluted in 70% alcohol based on 500 ml of alcohol 12.5 ml of chlorhexidine.

Hands are washed with warm water and soap, wiped dry with a sterile towel and wiped with a 0.5% alcohol solution of chlorhexidine for 2-3 minutes. Rubbing is performed sequentially, starting with the fingers and ending in the middle of the forearm.

Treatment with iodopyrone

Working solutions of iodopyrone are prepared in an enamel basin, burned twice with hot alcohol. Pour 2 liters of warm water and add (according to the measuring vessel) 20 ml washing powder lauryl sulfate, after the dissolution of which 40 ml of iodopyrone are added. Mix thoroughly with a glass or wooden stick. The solution contains 0.05% free iodine.

Beforehand, hands are washed under the tap with a sterile brush for 1-2 minutes, paying special attention to the periungual spaces, and wiped with a sterile napkin. Then the hands are washed in a solution of iodopyrone for 4-5 minutes, after which they are wiped with a sterile gauze cloth, sterile gloves are put on.

Yu.Hesterenko

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