Resolution of the Chief State Sanitary Doctor of the Russian Federation dated May 18, 2010 N 58 (as amended on June 10, 2016) “On approval of SanPiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities” (together with...

12.4. Hygienic treatment hands

12.4. Hand hygiene.

12.4.1. Hand hygiene should be carried out in following cases:

Before direct contact with the patient;

After contact with intact skin of the patient (for example, when measuring pulse or blood pressure);

After contact with body secretions or excreta, mucous membranes, dressings;

Before performing various patient care procedures;

After contact with medical equipment and other objects located in close proximity to the patient;

After treating patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment.

12.4.2. Hand hygiene is carried out in two ways:

Hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;

Treating hands with a skin antiseptic to reduce the number of microorganisms to a safe level.

12.4.3. Used for hand washing liquid soap using a dispenser. Dry your hands with an individual towel (napkin), preferably disposable.

12.4.4. Hygienic treatment of hands with alcohol-containing or other approved antiseptic (without prior washing) is carried out by rubbing it into the skin of the hands in the amount recommended in the instructions for use, turning special attention for treating fingertips, skin around nails, between fingers. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

12.4.5. When using a dispenser, a new portion of antiseptic (or soap) is poured into the dispenser after it has been disinfected, washed with water and dried. Preference should be given to elbow dispensers and photocell dispensers.

12.4.6. Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In departments with high intensity of patient care and high workload on staff (intensive care units and intensive care etc.) dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by staff (at the entrance to the ward, at the patient’s bedside, etc.). It should also be possible to provide medical workers individual containers (bottles) of small volumes (up to 200 ml) with skin antiseptic.

12.4.7. Use of gloves.

12.4.7.1. Gloves must be worn in all cases where contact with blood or other biological substrates, potentially or obviously contaminated with microorganisms, mucous membranes, or damaged skin is possible.

1. In order to prevent nosocomial infections, the hands of medical workers (hygienic treatment of hands, disinfection of surgeons’ hands) and the skin of patients (treatment of surgical and injection fields, donor elbows, sanitary treatment of the skin) must be disinfected.

Depending on the medical procedure being performed and the required level of reducing microbial contamination of the skin of the hands, medical personnel perform hand hygiene or surgical hand treatment. The administration organizes training and monitoring of compliance with hand hygiene requirements by medical personnel.

2. To achieve effective washing and disinfection of hands, the following conditions must be observed: short-cut nails, no nail polish, no artificial nails, no rings, signet rings, etc. jewelry. Before treating surgeons' hands, it is also necessary to remove watches, bracelets, etc. To dry hands, use clean cloth towels or paper napkins single use, with hand treatment surgeons - only sterile tissue.

3. 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. When choosing skin antiseptics, detergents and hand skin care products, individual tolerance should be taken into account.

Hand hygiene.

Hand hygiene should be carried out in the following cases:

Before direct contact with the patient;

After contact with the patient's intact skin (for example, when measuring pulse or blood pressure);

After contact with body secretions or excreta, mucous membranes, dressings;

Before performing various patient care procedures;

After contact with medical equipment and other objects located in close proximity to the patient.

After treating patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment;

Hand hygiene is carried out in two ways:

Hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;

Treating hands with a skin antiseptic to reduce the number of microorganisms to a safe level.

1. To wash your hands, use liquid soap using a dispenser. Dry your hands with an individual towel (napkin), preferably disposable.

2. Hygienic treatment of hands with alcohol-containing or other approved antiseptic (without prior washing) is carried out by rubbing it into the skin of the hands in the amount recommended in the instructions for use, paying special attention to the treatment of the fingertips, the skin around the nails, between the fingers.

3. When using a dispenser, a new portion of antiseptic (or soap) is poured into the dispenser after it has been disinfected, washed with water and dried. Preference should be given to elbow dispensers and photocell dispensers.

4. Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In departments with a high intensity of patient care and with a high workload on staff (resuscitation and intensive care units, etc.), dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by staff (at the entrance to the ward, at the patient’s bedside etc.). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (up to 200 ml) with skin antiseptic.

1. Remove rings, rings and other jewelry, because they make it difficult effective removal microorganisms.

2. Under a moderate stream of comfortable warm water, hands should be vigorously soaped and rubbed together for at least 10 seconds according to the following method:

Rub your hands palm to palm;

Right palm on top of the back of the left palm and vice versa;

Palm to palm, fingers crossed;

Place your fingers in a lock and rub your fingers together;

Friction with rotary movements of the thumb right hand, held in the left palm and vice versa;

Friction with rotational movements back and forth with the fingers of the right hand clenched into a pinch on the left palm and vice versa.

3. Rinse your hands under running water.

4. Dry your hands with a paper towel and then turn off the tap.

5. If an alcohol-containing antiseptic was applied to your hands, then instead of steps 3.4, wait for the antiseptic on your hands to dry completely.

Changing work clothes in the hospital.

Personnel are provided with funds personal protection V required quantity and appropriate sizes (gloves, masks, shields, respirators, aprons, etc.) depending on the profile of the department and the nature of the work performed.

Medical personnel must be provided with sets of replacement clothing: gowns, caps, replacement shoes in accordance with the equipment sheet, but not less than 3 sets of special clothing per worker.

In the operating room, doctors and other persons involved in the operation must work in sterile gowns, gloves and masks. Replacement shoes must be made from nonwoven fabric.

Washing of staff clothes should be carried out centrally and separately from the laundry of patients.

Clothing is changed in the surgical and obstetric departments daily and when soiled. In therapeutic institutions - 2 times a week and when soiled. Replaceable footwear for personnel working in rooms with aseptic conditions must be made of non-woven material that can be disinfected. Change of clothes and shoes should also be provided for medical personnel other departments providing advisory and other assistance, as well as for engineering and technical workers.

During manipulations with the patient, staff should not take notes, touch the telephone receiver, etc.

Eating is prohibited in the workplace.

It is not allowed to wear medical clothing and shoes outside the medical facility.

Surgical debridement hands

Surgeons' hands are treated by everyone involved in surgical interventions, childbirth, and catheterization of great vessels. 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);

Stage II - treatment of hands, wrists and forearms with an antiseptic.

The amount of antiseptic required for treatment, the frequency of treatment and its duration are determined by the recommendations set out in the guidelines/instructions for use of a particular product. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

Sterile gloves are put on immediately after the antiseptic has completely dried on the skin of the hands.

Classic methods of treating surgeon's hands:

The following antiseptic solutions are used to treat hands:

a) Pervomur S-4 (2.4% or 4.8%)

Pervomur is used throughout the day. Before use, mix 17.1 ml of 33% hydrogen peroxide and 6.9 ml of 100% formic acid. Place the reagent in the refrigerator for 1 hour, shaking alternately. Before use, the mixture is poured into a basin of water up to 10 liters. Wash your hands in a basin with the prepared solution for 1 minute. Dry your hands and put on gloves.

b) cerigel

Apply 4 ml of Cerigel to your hands. Rubs for 10-15 seconds. A film forms on your hands.

c) chlorhexidine bigluconate (hibitan) – 0.5% alcohol solution.

Hands are treated with two napkins generously soaked in cerigel for 2 minutes each.

Types of processing according to SanPiN

There are different levels and methods of disinfection (see table), but not all experts appreciate these techniques, and are often limited to simple rinsing.

Type of processing	Purpose of the processing method	When to use
Hand hygiene for medical personnel: washing with soap and water	Removing contaminants. Removal of transient microflora.	There is visible contamination of hands. Hands are contaminated with blood or other body fluids. Contact with a patient with a confirmed or suspected infection that is caused by Cl. difficille (causative agent of pseudomembranous colitis). Before eating. After visiting the toilet, coughing, sneezing, etc.
Hand hygiene using antiseptic	Destruction of transient microflora	Before and after contact with the patient. Before and after contact with an invasive device (central or peripheral venous catheter, urinary catheter, breathing circuit, drainage, etc.). After contact with biological fluids. When moving from a contaminated area of ​​the body to a non-contaminated one. After contact with objects from the patient’s immediate environment. Before handling medications, preparing or serving food. Before and after using protective gloves.
Surgical treatment of the hands of medical staff	The purpose of surgical treatment of the hands of medical personnel: Removing contaminants. Destruction of transient microflora. Decrease in the number of resident microflora	Before surgical interventions, childbirth, catheterization of great vessels, etc. Stage 1 - wash your hands with soap and water for two minutes, and then dry with a sterile cloth. Stage II - treatment of hands, wrists and forearms with an alcohol-containing antiseptic

HYGIENIC TREATMENT OF THE HAND OF MEDICAL STAFF: ALGORITHM

The goal with this method is to remove any visible contaminants, as well as transient microflora. This is necessary in order to exclude the possibility of transferring such microflora to other healthcare workers and patients.

3 requirements for hygienic hand washing according to SanPin:

• Before starting, the doctor must remove jewelry and watches - under them accumulation large number microbes;
• The specialist’s nails should be cut short, and it is undesirable to have varnish on them.
• The sleeves of the medical gown must be rolled up 2/3 so that they do not interfere.

SanPiN requirements require thorough soaping. After this, they are washed with running warm water and the procedure is repeated. This is due to the fact that with a single wash, dirt and harmful microorganisms are removed only from the skin of the hands. When the doctor rinses the soap with warm water, the pores open, allowing any remaining germs to be removed.

SANITARY RULES

Hand treatment of medical personnel: algorithm

Mechanical technology according to this algorithm of actions makes it possible to minimize contamination by various dangerous bacteria and dirt without the use of additional devices. This method is used before/after eating and visiting the toilet, before performing procedures on the patient.

To use this method you will need:

• a clean napkin that can be used to dry the skin;
• liquid soap, preferably without a strong perfumed odor. It is important that all stages of processing are hygienic, so soap with a closed dispenser is suitable for the procedure.

The technique itself consists of several basic techniques:

• one palm rubs against the other with smooth movements;
• in turn, the palm of one hand rubs the hands and back of the hand of the other;
• the fingers of one are connected to the interdigital spaces of the other, internal surfaces fingers are processed with up and down movements;
• the palm is gathered into a lock, while the bent fingers of one hand rub the palm of the other;
• rotational friction, which cleanses the surfaces of the hands and wrists;
• in a circular motion, the palm of one hand touches the fingertips of the other, after which they change.

Washing method with soap and water

Washing with soap and water is a basic way to prevent the spread of nosocomial infections, which helps stop the further transmission of pathogens of dangerous diseases.

When washing, employees often skip areas of brushes:

• thumbs;
• spaces between fingers;
• fingertips, which are most often contaminated with dangerous microorganisms to a greater extent, because most actions are performed by them.

When using soap frequently, it is important to observe basic principles skin care.

Hand processing algorithm

The hand treatment of medical personnel is shown in the diagram below.

Requirements for hand treatment of personnel. Hygienic washing technique

Types of hand treatment for medical personnel and specific technological techniques are determined by the purpose of the upcoming treatment and the types of services, work, and activities to be performed.

The basic technological methods for treating the skin of personnel’s hands and the requirements for the rules of implementation are established in section 12 of Chapter I of SanPiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities”:

• hygienic washing is carried out for the purpose of mechanical removal, washing away dirt and transient microflora;
• hygienic treatment is carried out with the aim of reducing the number of transient microflora by at least 95% of the original;
• surgical treatment is carried out with the aim of destroying resident and transient microflora up to 100%.

Attention: methodological recommendations on disinfection of skin, approved. Ministry of Health of the Russian Federation December 18, 2003 N 11-7/16-09, as well as the WHO Guidelines “WHO Guidelines for Hand Hygiene in medical institutions. World Health Organization, 2009", it is recommended to use solid or liquid soap without antimicrobial additives for hygienic hand washing of personnel.

Use dispensers or other devices (dispensers) for liquid soap that allow for mechanical supply; for soap in bars - small individual packaging, or soap dishes with magnetic suspension, allowing it to dry between uses. When choosing soap, be guided by the preferences of medical personnel, including those related to the incidence of dermatitis and allergic reactions.

Personnel are obliged to monitor the condition of their hands (presence of scratches, cracks, macerations), nails (cut short to the level of the fingertips and microcracks on the surface), not to use false nails or varnish, and to remove bracelets, watches, and rings before treating hands.

Hygienic hand washing technique is carried out before preparing, serving and eating food; after performing “dirty” procedures (cleaning rooms, changing clothes for patients, visiting the toilet) and any other contamination of hands.

When washing hands hygienically with soap and water, you should:

• 1. Wet your hands with warm water (hot water increases the risk of dermatitis).
• 2. Lather up wet hands Enough soap to cover the entire surface of your hand. Lather with the resulting soap suds water tap.
• 3. Wash your hands for about 40-60 seconds, alternately wiping the palm surfaces, the back surfaces of the hands, changing their position; the inner surfaces of the fingers, interlacing and bending their fingers, thumbs in a circular motion, forward and backward, and ending with rubbing the palms in a circular motion with the fingertips of the opposite hand.
• 4. Pay special attention to the treatment of subungual areas, nails, periungual ridges and interdigital areas.
• 5. Thoroughly wash off the soap suds from your hands and faucets, avoiding splashing water and contact with the faucet and sink.
• 6. Dry your hands with a disposable towel (or a personal towel). Use the same towel to turn off the tap. To prevent the occurrence of contact dermatitis, it is recommended to thoroughly rinse and dry your hands when washing with water and soap, and at the end of the work shift use emollients and moisturizers to care for the skin of your hands.

It is not recommended to use electric hand dryers, since it is impossible to completely remove the remnants of detergent and desquamated epithelium (there is no such important function of the towel as rubbing the skin), and also because of the inevitable turbulence of air containing polluting particles.

• Correspondents for the fragment
• Bookmark
• View bookmarks
• Add a comment
• Court decisions

Developers:	Approved	Signature of the head of the Ministry of Defense
	Approval date	(date)
	Agreed	Quality Manager Signature
	Date of approval	(date)
	Responsible for execution	Signature of the head of the structural unit
	Put into effect	(date)
	Person responsible for carrying out the procedure	(job title)

Definition

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

Goal: remove microflora from the surface of the hands mechanical method. Ensure infection safety of patients and staff.

Indications:

· before and after meals, feeding the patient;

· after visiting the toilet;

· before and after caring for the patient, unless hands are contaminated with the patient's body fluids.

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

Mandatory condition: healthy hand skin, short-cut nails, no varnish.

Goal: ensuring hand decontamination at a hygienic level.

Indications:

· before putting on and after taking off gloves;

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

· before and after caring for an immunocompromised patient

· during examinations or invasive procedures.

Required condition: no injuries on hands.

Method of hand treatment: with an antiseptic, if none is available - with a 0.5% alcohol solution of chlorhexidine digluconate.

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

Indications:

· the need to cover a sterile table.

· participation in surgery, puncture.

· participation in childbirth.

Contraindications:

· the presence of pustules on the hands and body.

· cracks and wounds of the skin.

· skin diseases.

Mandatory condition: work is carried out in high security areas in order to comply with the aseptic regime.

Resources

1) liquid soap with a dispenser, an elbow dispenser, disposable napkins (individual towel, electric dryer);

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

3) liquid soap, antiseptic or 0.5% alcohol solution of chlorhexidine digluconate 20-30 ml., sterile tray with forceps, sterile tray with placement for covering a sterile table.

3) Documentation

1) Visual aid on hand treatment techniques;

2) results of observations of hand hygiene practices;

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

Procedures:

Social (usual) level of hand handling

Preparation for the procedure

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

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

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

Executing the procedure

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

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

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

Repeat washing in the same sequence.

End of the procedure

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

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

Hygienic level of hand treatment

Preparation for the procedure:

· Remove the rings from your fingers.

· Roll the sleeves of the robe up to 2/3 of the forearm, take off the watch.

Executing the procedure

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

· Rinse your hands with running water to remove soap suds.

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

· Dry your hands with a tissue and dispose of the tissue in a Class A medical waste container.

· Treat your hands with antiseptic.

Hand treatment at surgical level

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

Preparation for the procedure

The assistant (nurse) first does the following:

· Wash your hands as usual.

· Place a sterile container with linen, strengthen it, check the markings.

· Open the bix using the pedal.

· Remove sterility indicators and assess their condition.

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

· Place the forceps in the tray.

To medical staff/team members before surgery:

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

· Rinse your hands with running water to remove soap scum. nail phalanges to the elbow bend.

· Dry your hands with a sterile towel.

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

· Wear sterile clothing and gloves.

Standardized hand treatment technique

1. Squeeze one portion of alcohol-containing liquid from the dispenser disinfectant(3 ml per palm)	2. Rub one palm against the other.	3. Wrists.
4. Rub the palm of your right hand over the surface of your left hand; and rub the palm of your left hand over the surface of your right hand.	5. Rub your palms together and between your fingers.	6. Rub the fingers of your right hand over the palm of your left hand; Rub the fingers of your right hand over the palm of your left hand.
		It is necessary to have alcohol on your hands at least 30 seconds.
7. Rub the palm of your right hand around your left thumb; Rub the palm of your left hand around your right thumb. Don't forget your fingertip.	8. Rub the fingertips of your right hand on the palm of your left hand; Rub the fingertips of your left hand on the palm of your right hand.

Change registration sheet

	No. of the section, paragraph of the standard to which the change was made	Date of change	Full name of the person who made the changes

Rules for hand treatment of medical personnel. SanPiN 2.1.3.2630-10

1. In order to prevent nosocomial infections, the hands of medical workers (hygienic treatment of hands, disinfection of surgeons’ hands) and the skin of patients (treatment of surgical and injection fields, donor elbows, sanitary treatment of the skin) must be disinfected.

Depending on the medical procedure being performed and the required level of reduction in microbial contamination of the skin of the hands, medical personnel perform hygienic treatment of hands or treatment of the hands of surgeons. The administration organizes training and monitoring of compliance with hand hygiene requirements by medical personnel.

2. To achieve effective washing and disinfection of hands, the following conditions must be observed: short-cut nails, no nail polish, no artificial nails, no rings, rings or other jewelry on the hands. Before treating surgeons' hands, it is also necessary to remove watches, bracelets, etc. To dry hands, use clean cloth towels or disposable paper napkins; when treating surgeons' hands, use only sterile cloth ones.

3. Medical personnel should be provided with sufficient quantities of 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. When choosing skin antiseptics, detergents and hand care products, individual tolerance should be taken into account.

4. Hand hygiene.

4.1. Hand hygiene should be carried out in the following cases:

Before direct contact with the patient;

After contact with the patient's intact skin (for example, when measuring pulse or blood pressure);

After contact with body secretions or excreta, mucous membranes, dressings;

Before performing various patient care procedures;

After contact with medical equipment and other objects located in close proximity to the patient;

After treating patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment.

4.2. Hand hygiene is carried out in two ways:

Hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;

Treating hands with a skin antiseptic to reduce the number of microorganisms to a safe level.

4.3. To wash your hands, use liquid soap using a dispenser. Dry your hands with an individual towel (napkin), preferably disposable.

4.4. Hygienic treatment of hands with alcohol-containing or other approved antiseptic (without prior washing) is carried out by rubbing it into the skin of the hands in the amount recommended in 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.

4.5. When using a dispenser, a new portion of antiseptic (or soap) is poured into the dispenser after it has been disinfected, washed with water and dried. Preference should be given to elbow dispensers and photocell dispensers.

4.6. Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In departments with a high intensity of patient care and with a high workload on staff (resuscitation and intensive care units, etc.), dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by staff (at the entrance to the ward, at the patient’s bedside etc.). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (up to 200 ml) with skin antiseptic.

4.7. Use of gloves.

4.7.1. Gloves must be worn in all cases where contact with blood or other biological substrates, potentially or obviously contaminated with microorganisms, mucous membranes, or damaged skin is possible.

4.7.2. 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 body area contaminated with microorganisms to a clean one. After removing gloves, perform hand hygiene.

4.7.3. When gloves become contaminated with secretions, blood, etc. To avoid contamination of your hands during the process of removing them, you should use a swab (napkin) moistened with a solution of a disinfectant (or antiseptic) to remove visible dirt. Remove gloves, immerse them in the product solution, then discard. Treat your hands with an antiseptic.

5. Treatment of surgeons' hands.

5.1. Surgeons' hands are treated by everyone involved in surgical interventions, childbirth, and catheterization of great vessels. The treatment 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); Stage II - treatment of hands, wrists and forearms with an antiseptic.

5.2. The amount of antiseptic required for treatment, the frequency of treatment and its duration are determined by the recommendations set out in the guidelines/instructions for use of a particular product. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

5.3. Sterile gloves are put on immediately after the antiseptic has completely dried on the skin of the hands.

6. Algorithms/standards for all epidemiologically significant therapeutic and diagnostic procedures must include recommended means and methods of hand treatment when performing the relevant manipulations.

7. It is necessary to constantly monitor compliance with hand hygiene requirements by medical workers and bring this information to the attention of staff in order to improve the quality of medical care.

8. Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In departments with a high intensity of patient care and staff workload (resuscitation and intensive care units, etc.), dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by staff (at the entrance to the ward, at the patient’s bedside, etc. .). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (100-200 ml) with skin antiseptic.

9. Disinfection of patients' skin.

9.1. Disinfection of the hands of medical workers has great value in preventing the transmission of infection to patients and staff. The main methods of hand disinfection are hygienic treatment of the hands of medical personnel and treatment of the hands of surgeons.

9.2. To achieve effective hand disinfection, the following conditions must be observed: short-cut nails, no artificial nails, no rings, rings or other jewelry on the hands. Before treating surgeons' hands, also remove watches and bracelets. To dry your hands, use disposable towels or napkins; when treating surgeons’ hands, use only sterile ones.

9.3. It is preferable to treat the patient's surgical field before surgery and other manipulations associated with violation of the integrity of the skin (puncture, biopsy) with an antiseptic containing a dye.

9.4. Treatment of the injection field involves disinfecting the skin using an alcohol-containing antiseptic at the injection site (subcutaneous, intramuscular, intravenous) and drawing blood.

9.5. To treat the elbow bends of donors, the same antiseptics are used as for treating the surgical field.

9.6. For sanitary treatment of patients' skin (general or partial), antiseptics that do not contain alcohol and have disinfectant and cleaning properties. Sanitation is carried out on the eve of surgery or when caring for the patient.

Hand sanitizing is a simple but very important method of preventing HAIs.PCorrect and timely hand washing is the key to the safety of medical personnel and patients .

Rules for preparing for hand treatment:

1.Remove rings and watches.

2.Nails must be cut short and no polish is allowed.

3.Fold the long sleeves of the robe over 2/3 of your forearms.

All jewelry and watches are removed from hands, as they make it difficult to remove microorganisms. Hands are soaped and then rinsed warm running water and everything repeats itself from the beginning. It is believed that during the first soaping and rinsing warm water germs are washed off from the skin of the hands. Under the influence warm water and self-massage during mechanical treatment, the pores of the skin open, so when repeated soaping and rinsing, germs are washed away from the opened pores. Warm water promotes a more effective effect of the antiseptic or soap, while hot water removes the protective fat layer from the surface of the hands. In this regard, you should avoid consuming too much hot water for washing hands.

When entering and exiting the intensive care unit or intensive care unit, personnel must treat their hands with a skin antiseptic.

There are three levels of hand treatment:

1.Household level (mechanical hand treatment);

2.Hygienic level (hand treatment using skin antiseptics);

3.Surgical level (special sequence of actions when treating hands, increasing treatment time, treatment area, followed by putting on sterile gloves).

1. Mechanical treatment of hands

The purpose of the household level of hand treatment is mechanical removal from the skin of most of the transient microflora (antiseptics are not used).

· after visiting the toilet;

· before eating or working with food;

· before and after physical contact with the patient;

· for any contamination of hands.

Required equipment:

1.Liquid dosed neutral soap. It is desirable that the soap does not have a strong odor. Open liquid soap quickly becomes infected with microbes, so you need to use closed dispensers, and after finishing the contents, process the dispenser, and only fill it with new contents after processing.

2.Disposable, clean, 15x15 cm napkins for drying hands. Using a towel (even an individual one) is not advisable, because it does not have time to dry and, moreover, is easily contaminated with germs.

Hand treatment - the necessary sequence of movements:

1.Rub one palm against the other palm in a back-and-forth motion.

2.Rub the back of your left hand with your right palm and switch 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 your fingers into a “lock” and rub the palm of your other hand with the back of your bent fingers.

5.Cover the base of the thumb of the left hand between the thumb and index finger of the right hand, rotational friction. Repeat on the wrist. Change hands.

6.Rub the palm of your left hand in a circular motion with the fingertips of your right hand, switch hands.

HAND HYGIENIC RULES

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 hands with fingers crossed
Outer side of fingers on 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 to destroy resident microflora from the surface of the skin of the hands using antiseptics.

A similar hand treatment is carried out:

· before putting on gloves and after taking them off;

· before caring for an immunocompromised patient or during ward rounds (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 biological fluids (for example, emergency situations with blood).

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.).

Hand hygiene consists of two stages:

1 - mechanical cleaning of hands followed by drying with disposable napkins;

2 - hand disinfection with skin antiseptic.

3 . Surgical treatment of hands

The purpose of the surgical level of hand cleaning is to minimize the risk of disruption of surgical sterility in the event of glove damage.

A similar 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.Wipes measuring 15x15 cm are disposable, sterile.

3.Skin antiseptic.

4.Disposable sterile surgical gloves.

Hand treatment rules:

Surgical treatment of hands consists of three stages:

1 - mechanical cleaning of hands followed by drying,

2 - hand disinfection with skin antiseptic twice,

3 - covering hands with sterile disposable gloves.

Unlike the method described above mechanical cleaning at the surgical level, the forearms are included in the treatment; they are used for drying sterile wipes, and itself hand washing lasts at least 2 minutes. After drying, the nail beds and periungual folds are additionally treated with disposable sterile wooden chopsticks, soaked in an antiseptic solution.

It is not necessary to use brushes. If brushes are used, sterile, soft, single-use or autoclave-resistant brushes should be used only for periungual areas and only for the first brush of a work shift.

At the end of the mechanical cleaning stage, an antiseptic is applied to the hands in 3 ml portions and, without allowing drying, rubbed into the skin, strictly observing the sequence of movements. The procedure for applying a skin antiseptic is repeated at least twice, the total consumption of the antiseptic is 10 ml, the total procedure time is 5 minutes.

Sterile gloves are worn only on dry hands. If you work with gloves for more than 3 hours, hand treatment is repeated with a change of gloves.

After removing the gloves, hands are wiped again with a cloth moistened with a skin antiseptic, then washed with soap and moisturized with an emollient cream.

Bacteriological control of the effectiveness of personnel hand treatment.

Washings from the hands of personnel are carried out using sterile gauze wipes measuring 5x5 cm, soaked in a neutralizer. Using a gauze napkin, thoroughly wipe the palms, periungual and interdigital spaces of both hands. After sampling, the gauze pad is placed in wide-necked test tubes or flasks with saline solution and glass beads and shaken for 10 minutes. The liquid is inoculated and incubated for 48 hours at a temperature of + 37 0 C. Recording of results: absence of pathogenic and opportunistic bacteria ( Guidelines 4.2.2942-11).

Dermatitis associated with frequent hand cleaning

Repeated hand cleaning may cause skin dryness, cracking and dermatitis in sensitive subjects. A healthcare worker suffering from dermatitis increases the 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 when washing hands;

· tendencies to avoid hand-handling.

Measures to reduce the likelihood of developing dermatitis:

· thoroughly rinsing and drying hands;

· using an adequate amount of antiseptic (avoid excess);

· usage modern and various antiseptics;

· mandatory use of moisturizing and softening creams.

Skin microflora

The superficial layer of the epidermis ( top layer skin) is completely replaced every 2 weeks. Every day, up to 100 million skin flakes are shed from healthy skin, of which 10% contain viable bacteria. Skin microflora can be divided into two large groups:

1.Resident flora

2.Transitory flora

1. Resident microflora- these are those microorganisms that constantly live and multiply on the skin without causing any diseases. That is, this is normal flora. The number of resident flora is approximately 10 2 -10 3 per 1 cm 2. The resident flora is represented predominantly by coagulase-negative cocci (primarily Staphylococcus epidermidis) and diphtheroids (Corinebacterium spp.). Despite the fact that Staphylococcus aureus is found in the nose of approximately 20% of healthy people, it rarely colonizes the skin of the hands (if it is not damaged), however, in hospital conditions it can be found on the skin of the hands of medical personnel with no less frequency than in the nose.

Resident microflora cannot be destroyed using regular washing hands or even antiseptic procedures, although its number is significantly reduced. Sterilization of the skin of the hands is not only impossible, but also undesirable: because 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 remain on the skin of the hands for a short time (rarely more than 24 hours). They can be easily removed by regular hand washing or destroyed by using antiseptics. While 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 compromised, then transient microflora can cause infectious disease(for example, felon or mug). You should be aware that in this case, the use of antiseptics does not make your hands safe from the point of view of transmission of infection. Microorganisms (most often staphylococci and beta-hemolytic streptococci) remain on the skin during the disease until recovery occurs.