How to properly wash hands in medicine: modern requirements for hand hygiene of medical personnel. Preparing the surgeon's hands The method of treating the surgeon's hands with modern disinfectants
METHODOLOGICAL DEVELOPMENT
for teachers to conduct a practical lesson
topic:
"Asepsis. Treatment of the surgeon's hands. Dressing in sterile clothing.
Preparation and processing of the surgical field.
Subject: general surgery
Faculty: Pediatric
Well: III
Lesson type: seminary-practical
Duration: 3 academic hours
Lesson objectives
one). Training:
but). Contribute to the formation of the student's understanding of the essence, features and main provisions of the theory on this topic;
b). Teach the student how to clean the surgeon's hands
in). To teach the student how to process the surgical field
G). Teach the student how to put on a mask, sterile gown and gloves;
e). To study the features of the device and operation of the operating unit and dressing rooms.
2). Educational:
but). Contribute to the formation of student qualities such as diligence, discipline, responsibility, mercy;
b). Assimilation by the student of the principles of medical ethics and deontology;
3). Developing:
but). To develop logical thinking, perseverance in achieving goals, clinical thinking, professionalism.
Motivation block
Asepsis of participants in the operation and the surgical field. Prevention of airborne dust and airborne infection. Methods for processing hands before surgery. Technique and rules for processing hands. Preparation and processing of the surgical field. Dressing in sterile clothing, dressing, wearing and changing rubber gloves. Rules for working under strict aseptic conditions.
Class equipment
1. Basins for washing hands;
3. Solutions of ammonia, pervomur, diocide, iodine, alcohol 96 0 and 70 0, iodonate;
4. Bixes with sterile gowns, sheets, gauze wipes and balls.
Location of the lesson
1. Study room.
2. Preoperative.
3. Operating room.
Intersubject communications
General care of surgical patients
Questions for the lesson
1. Classification of the preparation of the surgeon's hands.
2. What is the method of treating the hands of a surgeon according to Spasokukotsky-Kochergin?
3. Furbringer method.
4. Metol Alfeld.
5. What are the disadvantages of the methods of treating the hands of a surgeon according to Spasokukotsky-Kochergin, Furbringer, Alfeld?
6. Modern methods of processing the surgeon's hands.
7. What methods of processing the surgical field do you know?
8. Preparation of the surgical field for the operation.
9. The essence of the apodactyl method of work.
The student must know
1. Definition of basic concepts on the topic of the lesson;
2. The main modern methods of processing the surgeon's hands; advantages and disadvantages of each method;
3. Stages of processing the surgical field;
4. Rules for dressing a sterile gown, gloves, mask.
The student must be able
1. Treat hands before surgery with basic methods;
2. Process the surgical field with available methods;
3. Wear a mask, sterile gown and gloves;
Plan-chronocard of the lesson
| Lesson stage | Time in min. | Teacher activity | Student activity | Equipment |
| 1. Introduction: introduction teacher | Formulation of the topic, its justification, task, goals | Purpose Assimilation | ||
| 2. Baseline control: student survey | test questions on the topic of the lesson, situational tasks. | Theoretical answers on the topic of the lesson | ||
| 3. Independent work of students | 1 hour 50 minutes | Assistance in practicing the technique of processing the surgeon's hands, the operating field, putting on a sterile gown and gloves. Identification of errors and clarification of the importance of certain techniques. | Practical mastering of the technique of processing the surgeon's hands, the operating field and putting on a sterile gown and gloves. Training work of students in the preoperative and operating rooms | Basins for washing hands, brushes, solutions of ammonia, diocide, iodine, alcohol 96 0 and 70 0, iodonate; biks with sterile gowns, sheets, gauze napkins and balls. |
| 4. Conclusion of the teacher | Joint summing up on the topic of the lesson, the selection of students who have mastered the material well, homework, a mark in the books of practical skills | Students are invited to make appropriate entries in the books of practical skills, familiarity with homework on the following topic. |
Content Presentation educational material
The importance of the condition of the skin of hands, nails and care for them is emphasized. The role of soap, ammonia, washing powders, detergents (novosept) in the process of preparing the surgeon's hands is being studied. Attention is drawn to the mechanism of action of 70 0 and 96 0 ethyl alcohol on the skin of the hands.
The teacher introduces students to the quick methods of preparing the surgeon's hands (tanning with alcohol, the use of diocide, novosept, C 4 solution). The teacher dwells in detail on the method of preparing the surgeon's hands according to Spasokukotsky-Kochergin.
Practical work in the operating room and preoperative. Two orderlies stand out in the group, who prepare basins (sterilization by roasting), prepare working solutions for washing hands. Two operating room nurses are assigned to treat their hands first, preferably modern method(pervomour). Gowns are put on and ready to provide sterile gowns and gloves to surgeons. Students wash their hands in various ways:
· According to Spasokukotsky-Kochergin;
Furbringer;
· Alfeld;
· Diocide;
· Prevomur.
After washing their hands, the “surgeons”, with the help of an operating nurse, put on gowns and gloves; then the operating field is processed:
- According to Filonchikov;
- Iodonate;
- Diocide.
Preparing the surgeon's hands for surgery
The basic principle: “Do not touch the treated areas of the hands less than clean skin and items."
Hand sanitizers must meet the following requirements:
Possess a strong antiseptic effect.
· Be harmless to the skin of the surgeon.
· Be available and cheap.
Stages of processing the surgeon's hands:
one). In the preoperative room, surgeons wash their hands (up to the elbow) in running water with soap for 1 minute (soap twice).
2). Hands are dried with sterile wipes.
3). Then the hands are treated with one of the special methods (see below).
4). In the operating room, the hands are dried with sterile wipes (first, the palmar surface of the hand from the fingertips to the base of the palm, then the back surface in the same direction, and, lastly, the forearms (from the palm to the elbows).
five). After that, the surgeon puts on a sterile gown, processes the operating field and puts on sterile gloves, which he processes with a gauze ball with alcohol for 1 minute.
Methods for treating the surgeon's hands with antiseptics:
one). Hand treatment with C-4 solution(2.4% Pervomur solution) for 1 minute. To prepare 10 liters of solution, 33% hydrogen peroxide (171 ml), 100% formic acid (69 ml) and water (up to 10 liters) are used. In Pervomure, they wash their hands without brushes
2). Hand treatment with 0.5% alcohol solution of chlorhexidine within 2-3 minutes. Hands are treated twice with a swab moistened with chlorhexidine. The only drawback of the method is its duration.
3). Hand treatment with eurosept, AHD, AHD-specialist, AHD-2000 and other antiseptics are now considered the most progressive method. The drugs are produced in special vials. A certain dose is squeezed onto the hands and rubbed into the skin for 2-3 minutes (twice). The disadvantages are the duration and high cost of drugs.
4). Film-forming antiseptics(degmicide, degmin, tserigel) are not currently used, because. they meant performing manipulations without gloves, and this is now strictly prohibited.
five). Previously applied methods ( Spasokukotsky-Kochergin, Furbringer etc.) are not currently used. Of the "old" methods, only Alfred method and only in extreme emergency cases (for example, when you need to perform a tracheostomy). In this case, hands are treated with alcohol, sterile gloves are put on and they are also treated with alcohol.
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 conventionally 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 surgical and hygiene treatment hands, simple washing and protection of the skin of the hands.
1.4. For hand hygiene medical staff use antiseptics 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 the level of the fingertips, without polishing and cracking on the surface of the nails, 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 mixer, which is preferably operated 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, as well as 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. Considering a 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. Wash your hands 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 performed 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 contain the largest number of 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 contaminations 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 developer's instructions, 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 should 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, the staff makes an independent decision. In addition, each healthcare institution can develop its own list of indications, which are included in the nosocomial infection 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 with existing skin irritation, putting gloves on wet hands, using gloves too often 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. The effectiveness, practical application and acceptability of hand cleaning depend on the method and associated conditions of hand cleaning that are in place in the health care setting.
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.
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 benefits compared with washing, which allows us to recommend it for a wide practical application.
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;
- hypersensitivity of the skin to chemical composition funds;
- the presence of skin irritation;
- too frequent normal hand washing, especially with hot water and alkaline or non-softening detergents;
- prolonged work in gloves;
- 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 activity | Bactericidal (including antibiotic-resistant strains), fungicidal and virucidal |
| Creation of resistant strains | missing |
| 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 | Missing |
| 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 care is important condition prevention of 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 healthcare 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 skin type of the hands and following properties means: the ability to maintain the normal state of skin fat lubrication, 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 temperatures and air humidity; for dry skin, it is recommended to use W/O (water/oil) emulsions, 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 surgical treatment hands:
Before any surgical and equivalent interventions;
Before giving birth.
Technique surgical antisepsis hands:
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.
Treatment of the surgeon's hands
Surgeons and operating nurses should carefully monitor the cleanliness and condition of the skin of the hands, avoid direct contact of the hands with purulent or contaminated material, and prevent the formation of burrs, scratches, calluses, and cracks. When performing physical and household work, you must use mittens or gloves. Nails should always be cut short. From repeated treatment with antiseptic solutions, the skin of the hands often becomes rough, thickened, and flaky. Well softens the skin of the hands of a mixture in equal parts of glycerin, ammonia, ethyl alcohol and water.
Before the operation, with any method of processing the hands, they should simply be washed with soap and water. Washing with brushes is an indispensable element in some methods of hand treatment. To do this, it is necessary to install a sink in the preoperative or dressing room, water taps with a hot and cold water. Brushes, boiled and filled with a triple solution, are removed from the jar with a forceps. Enameled basins for treating hands with an antiseptic solution are sterilized by firing. Moisten with a small amount of ethyl alcohol inner surface pelvis and set on fire, turning the pelvis all the time so that all its walls are burned. We also need antiseptic solutions for the treatment of hands and sterile wipes in bix.
Widely used simple and available method treatment of the surgeon's hands according to Spasokukotsky-Kochergin. First, hands are washed in running water with a brush and soap, then with a napkin in a 0.5% solution of ammonia, sequentially in two basins for 3 minutes each. Dry hands with a towel or napkin (sterile) and treat with 96% ethyl alcohol for 2 minutes. The method is quite effective. The skin is usually not irritated.
IN last years new antiseptics - rokkal, degmin, chlorhexidine (gibitan), etc. have been used to treat the surgeon's hands. However, there is now evidence that rokkal has a carcinogenic effect, so it should not be recommended to use it widely.
Convenient 1% solution of degmin. Wash your hands first with warm water and soap, rinse in running water. Then they are treated for 3 minutes with two foam rubber sponges or napkins moistened in a pelvis with a 1% solution of degmin. Wipe hands with a dry sterile towel (napkin). The bactericidal properties of the degmin solution persist for six months. The pharmacy network produces a 30% solution of degmine (degmicide) in 500 ml bottles. Degmicide is diluted 30 times with ordinary drinking water before use.
For processing, chlorhexidine (gibitan) is also used, which is produced in 500 ml vials of a 20% aqueous solution. For hand treatment, it is diluted 40 times with 70% ethyl alcohol to obtain a 0.5% solution. A 1% aqueous solution of chlorhexidine is also used, for which the initial solution is diluted 20 times with distilled or boiled water. First, hands are washed in running water with soap, and then in a basin with 0.5% alcohol or 1% aqueous solution of chlorhexidine for 3 minutes. Dry hands with a sterile towel or napkin. Good hand disinfection is achieved, however, skin itching and dermatitis are sometimes observed.
Widely used, especially in hospitals, hand treatment with Pervomour. The procedure for preparing a working solution of an antiseptic is somewhat complicated. First, 171 ml of a 33% hydrogen peroxide solution and 69 ml of a 100% formic acid solution are mixed with the addition of water to 1 liter. This mixture was placed in a refrigerator for 1 hour. Up to 5 liters of tap water are added to 120 ml of the initial solution - a working solution is obtained in which 15 people's hands can be sequentially treated. The solution is only suitable for 6-8 hours. First, hands are washed in running water, wiped with a clean towel, and then immersed in Pervomura solution for 1 minute and wiped with a sterile cloth. Additional processing alcohol or iodine is not needed.
A very simple and original method of preparing the surgeon's hands with cerigel, a synthetic film-forming antiseptic liquid. In the amount of 3-4 ml, it is carefully rubbed on the skin of the hands and the lower third of the forearms. Then the hands are dried in the air; fingers are spread apart so that when the drug dries, they do not stick together. The resulting film is sterile and prevents direct contact between the skin of the hands and the wound.
After processing the hands in one way or another, put on sterile gloves to keep the asepticity of the hands. During the operation, gloves are periodically treated with antiseptics, especially after the "dirty" stages. Short-term interventions can be performed without the use of gloves, with the exception of purulent operations.
Treatment of the surgical field
The processing of the surgical field on an outpatient basis is often associated with certain difficulties, since interventions have to be performed in emergency cases on contaminated areas, especially on the hand and foot. The skin is first washed with napkins with soap, detergent solution or ammonia (0.5% solution). Fuel oil, fatty contamination is removed with napkins moistened with gasoline. Then the skin is treated with ethyl alcohol and twice with 3-5% alcohol solution of iodine. However, in this solution, when stored for more than 3 months, hydroiodic acid is formed, which, together with iodine, irritates the skin, causing dermatitis or burns.
In recent years, other antiseptic preparations that are not inferior to iodine in terms of effectiveness have been used to treat the surgical field. A 1% solution of degmin is used, in which cotton swabs are abundantly moistened and the skin is thoroughly treated twice. In these cases, the additional use of alcohol or other antiseptics is not required. For a similar purpose, a 0.5% solution of chlorhexidine (water-alcohol) is used, which is used to treat the skin twice with an interval of 2 minutes.
A rational substitute for an alcoholic solution of iodine was iodonate - an aqueous solution of a complex of a surfactant with iodine. The drug contains 4.5% iodine. To process the surgical field, a 1% solution is used, for which the initial iodonate is diluted 4.5 times with distilled water. The skin is smeared twice with this solution before the operation. At the end of the intervention, before suturing, the skin is treated again with the same solution.
Control over the state of asepsis in the operating room and dressing room is carried out by sanitary and epidemiological stations, which periodically produce bacteriological cultures from the treated hands of the surgeon, suture material, tools, dressing material from sterile biks. The surgeon should be interested in the results of these bacteriological studies in order to take timely measures to eliminate deficiencies in sterilization and adherence to the operation mode of the surgical dressing unit.
In accordance with the "Instructions for bacteriological control of the complex of sanitary and hygienic measures in medical institutions" (Appendix No. 2 to the order of the Ministry of Health of the USSR No. 720 dated July 31, 1978), air should be inoculated in the operating room at least once a month. The number of microorganisms in 1 m3 of operating air should not exceed 500-1000. Also, once a month, bacteriological inoculations are made of a piece of napkin, a ball or other material taken from the middle of a sterile bix.
Periodically, swabs are taken from the hands of the surgeon, which are completely processed before the start of the operation. A sterile cotton swab dipped in a sterile isotonic sodium chloride solution is used to wash hands, especially along the edges of the nails, in the interdigital spaces and skin folds. Then these swabs are placed in test tubes with sterile sugar broth. Each batch of suture material sterilized in the department must be subjected to bacteriological control. Without bacteriological research suture material is not allowed. Washouts from sterile instruments are also periodically examined.
Minor surgery. IN AND. Maslov, 1988.
Hand treatment is a technique for preparing hands for operations, dressings and other surgical procedures in order to decontaminate the skin and prevent germs from entering sterile objects and into the wound.
It is impossible to achieve complete sterility of the skin of the hands. Hand treatment can be satisfactory only if the skin of the hands was not contaminated with pus, earth, feces, it does not have cracks, abrasions, scratches, calluses and hangnails. Therefore, the medical staff involved in surgical work, must constantly monitor the skin of the hands, preventing its contamination at work and at home. It is necessary to use hot baths for hands and lubricate the skin of the hands at night with petroleum jelly with lanolin, a mixture of ammonia, glycerin and alcohol in equal amounts or a special cream. Fingernails should be kept short and clean. The basis various ways hand treatment includes mechanical cleaning (washing with water with brushes), disinfection with antiseptic agents and tanning of the skin of the hands.
Brushes used for cleaning hands are kept in soapy water, then boiled in a special vessel. When used, they are taken with a sterile forceps. They wash their hands under running water, opening and closing a specially adapted tap with their elbow (Fig. 1).
When washing hands in a basin, water should be poured into a sterile basin, feeding it, as shown in fig. 2. There is a certain sequence of washing hands: first, they wash the palmar, then the back surface of each finger, interdigital spaces, nail beds and subungual spaces of the left hand (Fig. 3). Same with fingers right hand. Then they wash the palmar and back surfaces of the left and right hands, the wrists of the left and right hands, and finally. In conclusion, the nail beds and subungual spaces of the fingers of both hands are washed again. Wipe hands with a sterile towel or napkin in the same sequence. Before and after wiping, hands are held so that water from the forearms does not fall on the hand (Fig. 4).
Rice. 1. Opening the tap when processing hands. Rice. 2. Proper delivery of the basin for washing hands. Rice. 3. Washing nails. Rice. 4. Correct position hands while wiping them.
With the help of mechanical cleaning and the use of antiseptics, only the surface of the skin can be freed from microbes. Microorganisms are stored in the depths of the ducts of the skin glands, and within a short time after the treatment of the hands, they, together with the flow and fatty lubrication, are released to the surface of the skin and can contaminate the surgical wound. That's why great importance attached to the seal surface layers skin by exposure to tanning agents (alcohol, alcohol solution of iodine, solutions, etc.). The tanning effect of alcohol and other medicines is much more effective if they are applied to dry skin; the tanning effect lasts 20-30 minutes, but quickly disappears if the skin is moisturized. Too active methods of mechanical and chemical action irritate the skin, it coarsens, begins to peel off, which makes it difficult to further process the hands. Of the many methods of hand treatment, the following are the most widely used.
Spasokukotsky-Kochergin method. After washing hands without brushes under running water, they are washed in two sterile basins for 2.5-3 minutes. in each 0.5% freshly prepared warm solution of ammonia, using sterile gauze wipes. Washing in this solution leads to degreasing of the skin of the hands. After that, the hands are wiped dry with a sterile towel and for 5 minutes. treated with 96% alcohol. The nail bed and the ends of the fingers are smeared with a 5% alcohol solution of iodine. When preparing a solution for washing hands, for every 100 ml of hot water, take 0.5 ml of official ammonia (10% solution of Ammonii caustici). Replacing ammonia with others and detergents has not gained distribution.
Furbringer's method (modified). Hands are washed under running water with soap and two sterile brushes for 5 minutes. each, wipe with a sterile towel and process 1-2 minutes. mercuric chloride solution 1: 1000 and 3 min. 96% alcohol. The ends of the fingers are smeared with an alcohol solution of iodine.
Alfeld method. Hands are washed with hot (45°) water and soap for 10 minutes. two sterile brushes, wipe dry and process for 5 minutes. 96% alcohol.
Treatment of hands with diocide: diocide solution 1: 5000 is heated to 40-50 ° and hands are washed with napkins in basins for 3-5 minutes, wiped with a sterile napkin and 1-2 minutes. treated with 96% alcohol. Particularly contaminated hands are washed with a diocide solution 1: 3000.
Hand treatment with ritosept: 2 min. hands are washed with soap and water and a brush, wiped with a sterile towel and treated with gauze napkins moistened with 5-10 ml of ritosept for 3 minutes.
Novosept, degmicide, ayatin, etc. are also used as antiseptics when treating hands. All existing methods hand treatment does not ensure their absolute sterility, so most operations and surgical procedures are performed in rubber gloves(cm. ).
Hand treatment is a set of measures that ensure the disinfection of the hands of the surgeon and his assistants before the operation. Hand treatment is based on general rules asepsis and antiseptics and includes elements of mechanical cleaning, chemical treatment and tanning of hand skin.
Hand treatment methods are divided into 3 groups: 1) preliminary mechanical cleaning of the skin of the hands with water and detergents, exposure to antiseptics and tanning; 2) anhydrous (exposure to antiseptic substances and tanning); 3) based only on tanning. In medical practice, the methods of the 1st group are the most common.
When processing hands, the structural features of the skin of the hands are taken into account; microbes nest in the folds of the skin, at the base of the hair, in the excretory ducts of the sebaceous and sweat glands, under the nails and periungual ridges. To disinfect the skin, it is necessary, firstly, to clean it and, secondly, to make impossible admission contents of cutaneous glands to the surface of the skin. The first is achieved by washing hands with brushes in hot water and soap and other methods of mechanical cleaning. At the same time, the epidermis is loosened and its exfoliating part is removed, the ducts of the sebaceous and sweat glands are cleaned.
After mechanical cleaning of the skin, they proceed to its chemical sterilization. Substances used for this purpose must be harmless to the skin, provide sufficient bactericidal effect on short-term exposure and not cause permanent staining of the skin. Tanning aims to prevent the rejection of the epidermis, cause wrinkling of the skin and thereby block the access of microorganisms from the excretory ducts of the glands. It is usually done with 96° alcohol, although other tanning agents have been proposed. Alcohol treatment combines disinfection and tanning. Diluted alcohol (70-80 °) penetrates deeper into the skin, providing a pronounced antiseptic effect; its tanning effect is insufficient.
Mechanical cleaning of hands with any of the methods that include it is carried out in a certain sequence. With the first brush or in the first water, fingers, palms and back of the hand, forearm to the proximal third are cleaned, then with the second brush or in the second water they do the same, but up to the middle of the forearm. It is necessary to ensure that the water flows down the skin of the hands from the fingers to the elbow, and not vice versa.
According to the old Furbringer method, hands were washed in running water and soap with two brushes, each for 5 minutes, rinsed for 1 minute. in 80° alcohol and immersed for 1–2 min. in a solution of sublimate 1:1000; tanning of the skin was not carried out. Alfeld refused to wash with mercuric chloride and suggested washing hands with a brush and soap in hot water (3-5 minutes) and wiping with 96° alcohol (3-5 minutes).
According to the Spasokukotsky-Kochergin method, which was widely used in the USSR, hands are washed with napkins in a warm 0.5% solution of ammonia, prepared ex tempore in 2 basins for 2.5-3 minutes. in everyone. Weak alkali saponifies fats, removing microorganisms along with them. After that, the hands are dried with a sterile towel and rubbed for 3-5 minutes. cotton or gauze soaked in 96° alcohol. Some surgeons finish the treatment of the hands by smearing the ends of the fingers, especially the nails, with 5% tincture of iodine.
The best results of mechanical cleaning are obtained by washing hands with synthetic surfactants - dry or ointment-like emulsifiers, highly soluble in water and foaming, with high permeability. Sodium alkyl sulfate (Novost powder) is used as a 0.1% solution at a water temperature of 40°C or a 0.2% solution at a water temperature of 20°C. Hands are washed with napkins in two basins, 2 minutes each. in everyone. Diocide can be used at a concentration of 1:5000 (hands are washed with napkins for 5 minutes) or 1:3000 (3 minutes). Treatment of hands with 96 ° alcohol for 3 minutes, as with all methods described.
Of the anhydrous methods, we can mention the methods of Brun (washing hands with 96 ° alcohol for 10 minutes; alcohol is poured into a basin and not rubbed into the skin) and Heisner (washing hands with a 0.1% solution of iodine in gasoline, followed by lubrication with iodine-vaseline. Both of these methods have not gained popularity: the first because of unreliability, the second causes severe dermatitis.Washing hands with solutions of tannin in alcohol (Zabludovsky - Tatarinov) or water (Pokotilo) and solutions of brilliant green (Bakkal) has not become widespread due to the harmful effects of these substances on skin.
With any method of hand treatment, only relative and unstable hand sterility can be achieved, which cannot guarantee the asepsis of the operation. Most reliable application gloves (see. Medical gloves), however, even when operating with gloves, one should not reduce attention to the treatment of hands.
Gloved hands sweat. Sweat that accumulates in gloves (“glove juice”) always contains microorganisms that, when gloves are damaged, enter the wound. To keep gloved hands from sweating, Makeev suggested a liquid containing trinitrotoluene - 1 g, acetone - 7 g, distilled water - 25 ml and glycerin - 5 g. After washing with soap, hands are treated with two napkins moistened with this liquid for 2 and 1 min. However, with frequent use, dry skin develops.
During the operation (especially a long one), it may be necessary to re-treat the hands. Most often, hands are washed with a 0.5% solution of ammonia, and gloves with a 1:1000 sublimate solution, and then the hands and gloves are wiped with alcohol. Do not wipe hands that have not been washed from blood with alcohol, as alcohol fixes blood on the skin. If during the operation gloves have to be changed, then before putting on a new pair of gloves, the surgeon wipes the brushes with alcohol.
In order to avoid contamination of the hands, the surgeon should not bandage purulent wounds or perform other manipulations that threaten contamination of the hands before the operation without gloves.
At home, you should avoid work that contributes to the roughening of the skin of the hands or their contamination with pathogenic microbes, and also protect the hands from injury.
Hand care should be systematic and include softening the skin, trimming hangnails and nails. Nail polish is not allowed. It well preserves the skin by lubricating it after surgery and at bedtime with a cream or liquid of the following composition: alcohol, ammonia and glycerin in equal amounts. If the surgeon has pustules or infected scratches on his hands, he must definitely refuse to participate in the operation.