Rules for treating the hands of medical personnel and the skin of patients.
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 hand washing and disinfection, it is necessary to observe following conditions: 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 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 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;
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 and 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, comfortable stream warm water Hands should be vigorously soaped and rubbed together for at least 10 seconds using 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 rotational movements of the thumb of the 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.
Use of gloves.
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.
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.
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.
In order to prevent blood-contact infections, gloves must be worn before any parenteral manipulation of the patient. After removing gloves, perform hand hygiene.
Changing work clothes in the hospital.
4. Personnel are provided with funds personal protection in the 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.
5. 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. Replaceable shoes should be made of non-woven material.
6. Washing of staff clothes should be carried out centrally and separately from the laundry of patients.
7. Change of clothing in surgical and obstetric departments is carried out 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. Changeable clothing and footwear should also be provided for medical personnel of other departments providing advisory and other assistance, as well as for engineering and technical workers.
8. During manipulations on the patient, staff should not take notes, touch the telephone receiver, etc.
Eating is prohibited in the workplace.
It is not allowed to be in medical clothing and shoes outside the medical facility.
Surgical treatment of 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.
Disinfection of patients' skin (injection and surgical sites)
Treatment of the patient's surgical field Before surgery and other manipulations associated with violation of the integrity of the skin (puncture, biopsy), it is preferable to use an antiseptic containing a dye.
Treatment of the injection field involves skin disinfection using an alcohol-containing antiseptic at the injection site (subcutaneous, intramuscular, intravenous) and blood collection.
To treat the elbow bends of donors, the same antiseptics are used as for treating the surgical field.
For sanitizing the skin patients (general or partial) use antiseptics that do not contain alcohol and have disinfectant and detergent properties. Sanitation carried out on the eve of surgery or while caring for the patient.
1. General Provisions
1.2. Definition of terms
- Antimicrobial agent- a means that suppresses the vital activity of microorganisms (disinfectants, antiseptics, sterilants, chemotherapeutic agents, including antibiotics, cleansers, preservatives).
- Antiseptics- chemical substances of microbostatic and microbicidal action, used for preventive and therapeutic antiseptics of intact and damaged skin and mucous membranes, cavities, and wounds.
- Hand sanitizer- an alcohol-based product with or without the addition of other compounds, intended for decontamination of the skin of the hands in order to interrupt the chain of transmission of infection.
- Nosocomial infection (HAI)- any clinically significant disease of an infectious nature that affects a patient as a result of a stay in a hospital or a visit to a medical institution, as well as infections that occur among personnel of a healthcare institution as a result of their professional activities.
- Hygienic hand antisepsis- This is hand treatment 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- washing procedure with water and regular (non-antimicrobial) soap.
- Irritant contact dermatitis (IC)- unpleasant sensations and changes in the condition of the skin, which can manifest themselves in dry skin, itching or burning, redness, peeling of the epidermis and the formation of cracks.
- Resident microorganisms- microorganisms that constantly live and reproduce 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 non-living objects.
- Surgical hand antisepsis- 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 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 hygienic treatment of hands, simple washing and protection of the skin of the hands.
1.4. For hand hygiene, medical personnel use antiseptic agents registered in Ukraine in accordance with the established procedure.
2. General requirements
2.1. Healthcare facility staff keep their hands clean. It is recommended that nails be cut short and level with the tips of the fingers, without varnish or cracks on the surface of the nails, and without false nails.
2.2. Before hand treatment, bracelets, watches, and rings are removed.
2.3. Hand hygiene equipment
Tap water.
- Washbasin with cold and hot water and a mixer, which should preferably be operated without touching hands.
- Closed containers with water taps if there are problems with water supply.
- Liquid soap with neutral pH.
- Alcohol antiseptic.
- Antimicrobial detergent.
- Skin care product.
- Non-sterile and sterile disposable towels or napkins.
- Dispensing devices for detergents, disinfectants, skin care products, towels or napkins.
- Containers for used towels and napkins.
- Disposable rubber gloves, non-sterile and sterile.
- Household rubber gloves.
2.4. In the room where hand washing 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 should preferably be operated without touching hands, and the water stream should be directed directly into the drain siphon to prevent splashing of water.
2.5. It is advisable to install three dispensers near the washbasin:
- with antimicrobial hand treatment;
- with liquid soap;
- with skin care product.
2.7. Each hand washing station, if possible, is equipped with dispensers for disposable towels, napkins and a container for used products.
2.9. Do not add product to antiseptic dispensers that are not completely emptied. All emptied containers must be filled aseptically to prevent contamination. It is recommended to use disposable containers.
2.10. It is recommended that dispensers for detergents and skin care products be thoroughly washed and disinfected before each new refill.
2.12. In the absence of a centralized water supply or in the presence of another problem with water, departments are provided with closed water containers with taps. Pour into containers boiled water and change it at least once a day. Before further filling, the containers are thoroughly washed (disinfected if necessary), rinsed and dried.
3. Surgical treatment of hands
Surgical hand cleaning is an important and responsible procedure that is carried out before any surgical intervention in order to prevent infection of the patient’s surgical wound 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:
- regular washing hands;
- surgical hand antisepsis, or washing them using a special antimicrobial agent;
- putting on surgical gloves;
- hand treatment after surgery;
- hand skin care.
3.1. Routine hand washing before surgical hand preparation
3.1.1. Routine washing before surgical hand treatment is carried out in advance in the department or airlock room of the operating unit, alternatively - in the room for antiseptic hand treatment, in the preoperative room before the first operation, and subsequently - as necessary.
Regular washing is intended exclusively for mechanical cleaning hands, while dirt and sweat are removed from the hands, spore-forming bacteria are partially washed off, as well as partially transient microorganisms.
3.1.2. To wash your hands, use regular liquid, powder soap or washing lotion with a neutral pH. Preference should be given to liquid soap or washing lotion. The use of soap in 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 ones.
3.1.5. Hands are washed 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:
- the hands and forearms are moistened with water, then the detergent is applied so that it covers the entire surface of the hands and forearms. Hands with fingertips raised up and forearms, with elbows low, should be washed for about one minute. Special attention it is necessary to devote attention to the treatment of subungual zones, nails, periungual ridges and interdigital zones;
3.2. Surgical hand antisepsis
3.2.1. Surgical hand antisepsis is carried out using various alcohol antiseptics by rubbing them into the hands and forearms, including the elbows.
3.2.2. Rubbing in the product is carried out in accordance with the developed standard procedure:
If necessary, wash your hands with detergent and rinse thoroughly;
- dry your hands thoroughly with a disposable towel;
- using a dispenser (press the lever with your elbow), pour the antiseptic into the recess of your dry palm;
- first moisten your hands with an antiseptic, then your forearms and elbows;
- rub the antiseptic in separate portions for the time specified by the developer, while keeping the hands above the elbows;
- after antiseptic treatment, do not use a towel, wait until your hands are completely dry, put 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 antiseptic is applied only to dry hands.
3.2.4. Throughout the entire time of rubbing in the antiseptic, the skin is kept moist from the antiseptic, so the number of portions 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 in accordance with EN 1500.
Each stage of processing is repeated at least 5 times. When performing hand treatment techniques, the presence of so-called “critical” areas of the hands that are not sufficiently wetted with the product is taken into account: thumbs, fingertips, interdigital areas, nails, periungual ridges and subungual areas. The surfaces of the thumb and fingertips are treated most thoroughly, since the largest number of bacteria are concentrated on them.
3.2.6. The last portion of the antiseptic is rubbed in until it dries completely.
3.2.7. Sterile gloves are worn only on dry hands.
3.2.8. After the operation/procedure is completed, the gloves are removed, 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 your hands under gloves, these contaminants are first removed with a swab or napkin moistened with an antiseptic, and washed with detergent. Then thoroughly wash with soap and water and dry with a disposable towel or napkins. After this, 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 with 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 starting phase 2 of surgical washing, hands, forearms and elbows are moistened with water, with the exception of those products that, as directed by the developer, are applied to dry hands and then water is added.
3.3.3. An antimicrobial detergent in quantities prescribed 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 upward and forearms with low elbows are treated with the product for the time specified by the developer of this product.
3.3.5. Throughout the washing process, the hands and forearms are moistened with an antimicrobial detergent, so the amount of the product is not strictly regulated. Keep your hands up all the time.
3.3.6. When washing, adhere to the sequence of actions in accordance with that specified in paragraphs. 3.2.2 and 3.2.5.
3.3.7. Hands are dried with a sterile towel or sterile wipes using aseptic technique, starting with 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 and regular (non-antimicrobial) soap and hygienic hand antiseptics, i.e. rubbing an alcohol antiseptic, without using water, into the skin of the hands in order to reduce the number of microorganisms on them.
Requirements for antimicrobial agents and alcohol antiseptics
1. Antimicrobial and antiseptic alcohol-containing rubbing agents must meet the following requirements:
- wide range antimicrobial action against transient (hygienic hand treatment) and transient and resident microflora (surgical hand treatment);
- quick action, that is, the duration of the hand treatment procedure should be as short as possible;
- prolonged action (after treating the skin of the hands, the antiseptic must delay the reproduction and reactivation of resident microorganisms for a certain time (3 hours) under medical gloves);
- activity in the presence of organic substrates;
- no negative effects on the skin;
- the lowest possible dermal resorption;
- absence of toxic, allergenic side effects;
- absence of systemic mutagenic, carcinogenic and teratogenic effects;
- low probability of developing resistance of microorganisms;
- readiness for immediate use (does 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 use, must be active against transient bacteria (with the exception of mycobacteria), fungi of the genus Candida, and enveloped viruses.
3. Products used in phthisiatric, dermatological, and infectious diseases departments must be additionally examined in tests for Mycobacterium terrae (tuberculecidal activity) for use in phthisiological 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 hand antiseptic treatment without the use of water, i.e. rubbing alcohol antiseptic into the skin of the hands.
4.1. Indications
4.1.1. Routine hand washing using a non-antimicrobial detergent is recommended:
- at the beginning and end of the working day;
- before preparing and serving food;
- in all cases, before treatment with an antiseptic, when hands are clearly dirty;
- in case of contact with pathogens of enteroviral infections in the absence of appropriate antiviral agents, it is recommended to mechanically eliminate viruses with prolonged hand washing (up to 5 minutes);
- in case of contact with spore microorganisms - prolonged hand washing (minimum 2 minutes) to mechanically eliminate spores;
- after using the toilet;
- in all other cases, in the absence of a risk of infection or special instructions.
4.1.2. Hand hygiene using 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;
. 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, biological substrates, patient secretions, etc.);
. contact with already inserted drainages, catheters or their insertion site;
. every contact with wounds;
. every contact with patients;
. removing gloves;
. using the toilet;
. 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 given indications are not final. In a number of specific situations, staff takes independent decision. In addition, each healthcare institution can develop its own list of indications, which are included in the plan for the prevention of nosocomial infections, taking into account the specifics of a particular department.
4.2. Regular washing
4.2.1. Regular washing is intended exclusively for mechanical cleaning of hands, while dirt and sweat are removed from the hands, spore-forming bacteria are partially washed off, as well as other transient microorganisms are partially washed away. The procedure is carried out according to paragraphs. 3.1.2.-3.1.5.
4.2.2. The usual washing technique is as follows:
- the hands are moistened with water, then the detergent is applied so that it covers the entire surface of the hands and wrists. Hands are washed for about 30 seconds. 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 is to close the water tap.
4.3. Hygienic antiseptics
4.3.1. The standard method of rubbing in an antiseptic includes 6 stages and is presented in paragraph 3.2.5. Each stage 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 wrists 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 in until it dries completely. Wiping hands is not allowed.
4.3.4. When performing hand treatment, take into account the presence of so-called “critical” areas of the hands that are not sufficiently moistened with an antiseptic: thumbs, fingertips, interdigital areas, nails, periungual ridges and subungual areas. The surfaces of the thumb and fingertips are treated most thoroughly, since the largest number of bacteria are concentrated on them.
4.3.5. If there is visible contamination of your hands, remove it with a napkin moistened with an antiseptic and wash your hands with detergent. Then thoroughly wash with soap and water and dry with a disposable towel or napkins. Close the tap with the last napkin. After this, the hands are treated with an antiseptic twice for 30 seconds.
5. Use of medical gloves
5.1. The use of gloves does not provide an absolute guarantee of protection of 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- used for invasive interventions;
- examination rooms- provide protection for medical staff when performing many medical procedures;
- household- provide protection for medical personnel when processing equipment, contaminated surfaces, instruments, when working with waste from medical institutions, etc.
5.4. Sterile gloves are recommended for use when:
- in all surgical interventions, to reduce the frequency of punctures, it is recommended to use two gloves put on each other, replacing the outer 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, collection of biosamples for research, etc.);
- installation of a catheter or guidewire through the skin;
- manipulations associated with 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 tracheostomies.
5.5. Non-sterile gloves are recommended for use when:
- contact with hoses of artificial respiration devices;
- working with biological material from patients;
- blood sampling;
- carrying out intramuscular, intravenous injections;
- cleaning of equipment and disinfection;
- removal of secretions and vomit.
5.6. Requirements for medical gloves:
- for operations: latex, neoprene;
- for inspections: latex, tactilon;
- when caring for the patient: latex, polyethylene, polyvinyl chloride;
- it is allowed to use fabric gloves under rubber ones;
- gloves must be of the appropriate size;
- gloves must 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 patient’s history 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 place where the gloves are used.
5.8. After disinfection, disposable gloves must be disposed of.
5.9. Rules for using medical gloves:
- the use of medical gloves does not create absolute protection and does not exclude compliance with the hand treatment technique, which is applied in each individual case immediately after removing gloves if there is a threat of infection;
- disposable gloves cannot be reused; non-sterile gloves cannot be sterilized;
- gloves must be changed immediately if they are damaged;
- it is not allowed to wash or treat hands with gloves between “clean” and “dirty” manipulations, even in the same patient;
- moving with gloves in the hospital department(s) is not allowed;
- before putting on gloves, do not use products containing mineral oils, petroleum jelly, lanolin, etc., as they may damage the strength of the gloves.
5.10. The chemical composition of the glove material can cause immediate and delayed allergies or contact dermatitis (CD). CD can occur when using gloves made of any material. This is facilitated by: prolonged continuous use of gloves (more than 2 hours), the use of gloves powdered on the inside, the use of gloves when there is existing skin irritation, putting gloves on wet hands, and using gloves too often during the working day.
5.11. Errors that often occur when using gloves:
- use of medical disposable gloves when working in the catering department. In these cases, preference should be given to reusable (household) gloves;
- improper storage of gloves (in the sun, at low temperatures, contact with gloves chemical substances and so on.);
- putting gloves on hands moistened with antiseptic residues (additional stress on the skin;
- ignoring the need for antiseptic hand treatment after removing gloves in contact with potentially infected 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 for the skin of the hands after using 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 drawing blood. In these cases, the gloves must not be punctured or contaminated with blood or other secretions.
5.13. Disinfection of gloves is carried out according to the manufacturer’s instructions.
6. Advantages and disadvantages of hand treatment methods
6.1. Efficiency, practical use and the acceptability of hand sanitization depend on the method and accompanying conditions of hand sanitization that are available in the health care facility.
6.2. Conventional washing is ineffective in eliminating both transient and resident microorganisms. In this case, microorganisms do not die, but with splashes of water fall on the surface of sinks, staff clothing, and surrounding surfaces.
6.3. During the washing process, secondary contamination of hands with microorganisms from tap water is possible.
6.4. Regular washing has a negative effect on the skin of the hands, since water, especially hot water, and detergent lead to disruption of the surface water-fat layer of the skin, which enhances the penetration of 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 CD.
6.5. Hygienic hand antisepsis has several practical advantages over hand washing, which allows us to recommend it for wide practical use.
Advantages of hygienic hand antisepsis with alcohol antiseptics compared to conventional hand washing
6.6. Errors in hygienic antiseptics include the possible rubbing of alcohol antiseptic into hands that are damp from the antiseptic, which reduces its effectiveness and skin tolerance.
6.7. Saving antimicrobial agents and reducing exposure time makes any method of hand treatment ineffective.
7. Possible negative consequences of hand treatment and their prevention
7.1. In case of violation of the requirements of the instructions/guidelines for the use of hand disinfectants and in case of careless attitude towards preventive care CD may occur behind the skin.
7.2. KD can also be caused by:
- frequent use of antimicrobial detergent;
- long-term use of the same antimicrobial detergent;
- increased skin sensitivity to chemical composition funds;
- presence of skin irritation;
- excessively frequent routine hand washing, especially with hot water and alkaline detergents or detergents without emollients;
- long-term work with gloves;
- putting on gloves on wet hands;
- lack of a sound skin care system in a medical institution;
7.3. For the prevention of CD, in addition to avoiding the causes of CD according to paragraphs. 7.1-7.2, it is recommended to fulfill the following basic requirements:
- provide staff with hand sanitizers that are potentially mild irritants to the skin of the hands and at the same time effective;
- when selecting an antimicrobial agent, take into account its individual suitability for the skin, smell, consistency, color, ease of use;
- in a medical institution it is recommended to have several products so that employees with increased skin sensitivity have the opportunity to choose a product that is acceptable to them;
- introduce into practice antiseptics made on the basis of alcohol with various softening additives, since pure alcohols dry out the skin of the hands with frequent use;
Properties of alcohol-based antiseptics
Indicators |
Result of action |
|---|---|
| Antimicrobial spectrum | Bactericidal (including antibiotic-resistant strains), fungicidal and virucidal |
| Creation of resistant strains | absent |
| Speed of detection of antimicrobial action | 30 s - 1.5 min - 3 min |
| Skin irritation | If the rules of use are not followed for a long time, dry skin may occur. |
| Skin lipid retention | Virtually no change |
| Transdermal water loss | Virtually absent |
| Skin moisture and pH | Virtually no change |
| Protective effect on the skin | Availability of special moisturizing and fat-restoring additives |
| Allergenic and sensitizing effects | Not visible |
| Resorption | Absent |
| Remote side effects(mutagenicity, carcinogenicity, teratogenicity, ecotoxicity) | None |
| Economic expediency | High |
Conduct mandatory periodic instruction on the use of antimicrobial agents (dose, exposure, processing technique, sequence of actions) and skin care.
8. Hand skin care
8.1. Hand skin care is an important condition prevention of transmission of nosocomial 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 a healthcare facility, since when using any antimicrobial agents there is a potential risk of skin irritation.
8.3. When choosing a skin care product, the type of hand skin and the following properties of the product are taken into account: the ability to retain the normal state of skin fatty lubrication, moisture, pH at 5.5, ensuring skin regeneration, good absorption, the ability of the product to give elasticity to the skin.
8.4. It is recommended to use the type of emulsion opposite to the emulsion shell of the skin: O/W (oil/water) emulsions should be used for oily skin, as well as for elevated temperature and air humidity; For dry skin, it is recommended to use W/O (water/oil) emulsions, especially at low temperatures and humidity.
Choosing a skin care product 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 negatively affecting the antimicrobial effect of the product.
8.6. It is advisable to apply cream or other product to your hands several times during the working day, thoroughly rub into the skin of dry and clean hands, paying special attention to the treatment of skin areas between the fingers and periungual ridges.
Hand hygiene for medical personnel includes hand hygiene and hand hygiene for surgeons (as well as other specialists involved in surgical interventions).
Hygienic treatment hands provides two ways:
- washing hands with soap and water (hygienic hand washing) to remove contaminants and reduce the number of microorganisms;
- Hand treatment with an alcohol-based skin antiseptic (hand hygiene) to reduce the number of microorganisms to a safe level.
To achieve effective washing and disinfection of hands, the following conditions must be observed: short-cut nails, no artificial nails, no varnish, no rings, rings or other jewelry on the hands.
To wash your hands, use liquid soap using a dispenser. Dry your hands with an individual disposable towel (napkin).
To disinfect hands, use alcohol-containing and other approved skin antiseptics. Antiseptics are used, including gels in individual packaging (small-volume bottles), which are disposed of after use.
Medical personnel must be provided with... sufficient quantities of effective means for washing and disinfecting hands, as well as hand skin care products (creams, lotions, balms) to reduce the risk of contact dermatitis. When choosing skin antiseptics and detergents, individual tolerance should be taken into account.
Hygienicprocessing Hand skin antiseptic should be used in the following cases:
- before and after direct contact with the patient;
- before putting on gloves and after removing gloves used for a medical procedure, contact with body secretions or excreta, mucous membranes, dressings;
- after contact with the patient’s intact skin (for example, when measuring pulse or blood pressure, shifting the patient, etc.);
- when performing various manipulations to care for the patient;
- 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.
If the skin of your hands is clearly contaminated with secretions, blood, etc., you must wash your hands with soap and water, dry them thoroughly with a disposable towel, and treat them twice with an antiseptic.
Hygienic treatment of hands with a skin antiseptic (without prior washing) 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 effect To effective disinfection of hands is to keep them in wet condition for the recommended treatment time (exposure time disinfectants T va ).
When using a dispenser, a new portion of antiseptic is poured into it after it has been disinfected and washed with water.
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 (nursing nurse departments, intensive care unit), dispensers with skin antiseptic should be placed in places convenient for use by staff (at the entrance to the ward, at the patient’s bedside, etc.). It should be possible to provide healthcare workers with individual small volume dispensers (up to 200 ml) with skin antiseptic.
Gloves must be worn in all cases where contact with blood and other biological substrates, potentially or obviously contaminated with microorganisms, mucous membranes, or damaged skin is possible.
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.
In case of injections, cuts - with violation of the integrity of gloves and contamination of hands with blood, secretions, etc.: wash your hands without removing gloves with soap and water; throw the gloves into waste “B”, squeeze out the blood, wash your hands with soap and treat the wound with 5%: alcohol tincture iodine, cover the damaged areas with adhesive tape.
It is not allowed to use the same pair of gloves during contact (for care) with two or more patients A mi, when moving from one patient to another, or from contaminated microorganisms lesson T ka body To clean.
After removing gloves, perform hand hygiene.
STATE EDUCATIONAL INSTITUTION
HIGHER PROFESSIONAL EDUCATION "NOVOSIBIRSK STATE MEDICAL UNIVERSITY OF THE FEDERAL AGENCY FOR HEALTH AND SOCIAL DEVELOPMENT"
Faculty of Economics and Management
Department of Pedagogy and Psychology
COURSE WORK
by discipline _____ Pedagogy with teaching methods____
on the topic of: "Hand treatment"
Supervisor
_______________________ FULL NAME
- "___"_______________2010
Zinovieva A.R. III course, 2 gr, VSO
"___"_______________2010
NOVOSIBIRSK 2010
Plan:
Introduction
- Skin microflora: resident flora, transient flora;
Hand treatment:
- Social level;
- Hand treatment is the necessary sequence of movements;
- Hygienic level;
Surgical level;
- Possible complications associated with frequent hand cleaning;
- Measures that reduce the likelihood of complications;
Using gloves:
- Sequence of actions when putting on gloves;
- Sequence of actions when removing gloves;
Purpose of the lesson
- Consolidation and generalization of knowledge and skills of proper hand handling in the daily activities of medical personnel.
- Hand treatment levels: social (goals, indications, the necessary conditions, hand washing technique); hygienic (stages, goals, indications, necessary conditions); surgical (stages, goals, indications, necessary conditions, hand washing technique);
Rules and duration of hand treatment at all levels, differences;
Sequence of movements when processing hands;
Possible complications when treating hands and their prevention;
Use of gloves (purposes, indications, contraindications, necessary conditions, possible complications, sequence of actions for putting on and taking off gloves).
- Hand sanitize correctly;
Proper technique for putting on and taking off medical gloves.
Introduction
The most important component of infection safety is preventing the possibility of transmission of microorganisms from patient to medical staff and vice versa.
Infectious diseases of medical personnel associated with professional activities occupy a certain place in the structure of infectious morbidity.
Infection of medical personnel occurs as a result of:
- Natural transmission mechanisms;
Artificial transmission mechanism (i.e. artificial, medically created transmission mechanism - various invasive and therapeutic procedures).
Correct and timely disinfection of the hands of medical personnel is one of the leading measures in the fight against infectious diseases and guarantees the safety of personnel and patients.
Skin microflora
The superficial layer of the epidermis (the top layer of 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:
- Resident flora
Transitory flora
- 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.). Although Staphylococcus aureus is found in the nose in approximately 20% healthy people
- Resident microflora cannot be destroyed by regular hand washing or even antiseptic procedures, although their numbers are 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. Transient microflora - these are those microorganisms that are acquired by medical personnel as a result of contact with infected patients or contaminated objects environment
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 nosocomial infections.
If the integrity of the skin is compromised, then transient microflora can cause an infectious disease (for example, whitlow or erysipelas). 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.
Hand cleaning to prevent wound infection was first used by the English surgeon Joseph Lister in 1867. The surgeon's hands were treated by disinfecting them with a solution of carbolic acid (phenol). In addition, Lister used a solution of carbolic acid to irrigate instruments, dressings, and to spray in the air over the surgical field.
The method of Sir Joseph Lister (1827-1912) was a triumph of 19th century medicine. In the 21st century, hand washing - this simple method of preventing infections (primarily intestinal) - unfortunately, is often ignored by both the population and some medical workers.
Meanwhile, Correct and timely hand cleaning is the key to the safety of medical personnel and patients.
Hand treatment is divided into three levels:
- Household or social level (mechanical hand treatment);
- Hygienic level (hand treatment using skin antiseptics);
- Surgical level (a special sequence of manipulations when treating hands followed by putting on sterile gloves).
- Social level of hand handling
- after visiting the toilet;
before eating or working with food;
before and after physical contact with the patient;
for any contamination of hands.
- Liquid dosed neutral soap or individual disposable soap in pieces. It is desirable that the soap does not have a strong odor. Opened liquid or bar reusable non-individual soap quickly becomes infected with germs.
Napkins measuring 15x15 cm are disposable, clean for blotting 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.
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 the first time you soap and rinse with warm water, germs are washed off from the skin of your hands. Under the influence of warm water and self-massage, the pores of the skin open, so when repeated soaping and rinsing, germs are washed away from the opened pores.
Warm water makes the antiseptic or soap work more effectively, while hot water removes the protective fat layer from the surface of the hands. Therefore, you should avoid using too hot water when washing your hands.
Hand treatment - the necessary sequence of movements:
- Rub one palm against the other palm in a back-and-forth motion (Appendix 1);
Rub the back surface of the left hand with your right palm, change hands (Appendix 2);
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 (Appendix 3);
Connect your fingers into a “lock” and rub the palm of your other hand with the back of your bent fingers (Appendix 4);
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 (Appendix 5);
Rub the palm of your left hand in a circular motion with the fingertips of your right hand, switch hands (Appendix 6).
It is very important to follow the described hand washing technique, since special studies have shown that during routine hand washing, certain areas of the skin (fingertips and their inner surfaces) remain contaminated.
After the last rinse, wipe your hands dry with a napkin (15x15 cm). The same napkin is used to close the water taps. The napkin is dumped into a container with a disinfectant solution for disposal.
In the absence of disposable napkins, it is possible to use pieces of clean cloth, which after each use are thrown into special containers and, after disinfection, sent to the laundry. Replacing disposable napkins with electric dryers is impractical, because... with them there is no rubbing of the skin, which means there is no removal of detergent residues and desquamation of the epithelium.
- Hygienic level of hand treatment
The purpose of hygienic treatment is to destroy skin microflora using antiseptics (disinfection).
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 body fluids (eg blood emergencies).
- Liquid dosed pH-neutral soap or individual disposable soap in pieces.
Napkins measuring 15x15 cm are disposable, clean.
Clean wipes (7x7 cm) for treating hands with skin antiseptics.
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, etc.
Hand treatment rules:
The gloves are disposable.
Hand hygiene consists of two stages: mechanical hand cleaning (see above) and hand disinfection with a skin antiseptic. After completing the mechanical cleaning stage (twice soaping and rinsing), the antiseptic is applied to the hands in an amount of at least 3 ml and carefully rubbed into skin until completely dry(do not wipe your hands). If the hands were not contaminated (for example, there was no contact with the patient), then the first stage is skipped and the antiseptic can be immediately applied. The sequence of movements when processing hands corresponds to
(Appendices 1-6).
etc.................
Microorganisms representing the resident flora live and reproduce on the skin (10-20% of them can be located in the deep layers of the skin, including in the sebaceous and sweat glands, hair follicles).
The resident flora is represented predominantly by coagulase-negative cocci and diphtheroids. Gram-negative bacteria (not counting representatives of the genus Acetiobacter) are rarely resident. Resident microorganisms are difficult to remove or destroy through routine hand washing or even disinfection procedures, although their numbers may be reduced.
Resident microorganisms, as a rule, do not cause nosocomial infections, with the exception of those associated with vascular catheterization. Moreover, normal microflora prevents the colonization of the skin by other microbes. Conditions for achieving effective hand washing and disinfection, their preparation
(Fig. 22): 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.
Rice. 22.
Skin antiseptics for hand treatment - for example: lyzhen, chlorhexidine bigluconate, isosept, allsept, etc., must be in dispensers in appropriate concentrations. In units with a high intensity of patient care and a high workload for staff, dispensers with skin antiseptics 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) with small volumes of skin antiseptic (100-200 ml).
Hand washing (Fig. 23) is the most effective method warnings of nosocomial infections in health care facilities.
Rice. 23.
There are three levels of hand decontamination:
- 1) social (regular hand washing);
- 2) hygienic (disinfection of hands);
- 3) surgical (sterility of surgeons’ hands is achieved for a certain time).
The reasons for the insufficient level of hand treatment of medical personnel, according to some sources, are forgetfulness, lack of awareness of the problem, lack of knowledge, lack of time, skin problems - dryness, dermatitis, etc. All these reasons can lead to the occurrence of nosocomial infections. Junior medical staff treats hands at a social and hygienic level within their competence.
Social level of hand handling
Routine hand washing. It is carried out before starting any work (Table 4).
Goal: remove dirt and temporary (transient) microflora from the skin of the hands by washing twice with soap and water.
Indications: when hands are contaminated, before and after a medical procedure, with or without gloves, when caring for a patient (if the hands are not contaminated with the patient’s biological fluids), before eating, feeding the patient, and after visiting the toilet.
Equipment: liquid soap, neutral, odorless, soap dispenser (dispenser), clock with second hand, warm running water. To dry your hands, use 15x15 disposable wipes and a tap cloth.
It must be remembered that when using a dispenser, a new portion of soap (or antiseptic) is poured into the dispenser after it has been disinfected, washed with running water and dried. Preference should be given to elbow dispensers and photocell dispensers.
Table 4
|
Executing the procedure |
|
|
2. Lather your hands for 30 s, rinsing the soap with water and paying attention to the phalanges and interdigital spaces of the hands, then wash the back and palm of each hand and wash the bases of the thumbs with rotational movements |
Uniform decontamination of the hands is ensured if the surface is soaped thoroughly and evenly. During the first soaping, the bulk of the microflora is washed off, then after exposure to warm water and self-massage, the pores open and microorganisms are washed away from the opened pores. It must be remembered that hot water removes the protective fat layer of the skin. |
|
3. Rinse your hands under running water to remove soap suds, holding your hands so that the water flows into the sink from your forearms or elbows (do not touch the sink). Repeat steps 2 and 3 of the procedure |
|
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Completing the procedure |
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1. Close the tap using a napkin (close the elbow tap with your elbow) |
|
|
2. Dry your hands with a dry, clean personal towel or using a dryer |
According to the principle “from clean to dirty”, i.e. from the fingertips (they should be the cleanest) to the elbow |
Hygienic level of hand treatment (Table 5)
There are two processing methods:
- 1) hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;
- 2) hygienic treatment of hands with a skin antiseptic to reduce the number of microorganisms to a safe level.
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.
Goal: remove or completely destroy transient microflora from hands.
Equipment: liquid soap, soap and skin antiseptic dispensers, clock with second hand, warm running water (35-40 °C), sterile tweezers, cotton balls, napkins; skin antiseptic. Waste disposal container with disinfectant solution.
Execute prerequisites- the same as for social processing of hands. To dry hands, use clean cloth towels or disposable paper napkins; when treating surgeons' hands, use only sterile cloth ones.
It is important to observe the exposure time: hands must be wet from applying the antiseptic for at least 15 s.
Table 5
Hand hygiene technique
|
Rationale |
|
|
Preparation for the procedure |
|
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2. Fold the sleeves of the robe 2/3 of the way up your forearms. |
Dripping water should not get on the sleeves of the robe. |
|
3. Open the tap, adjust the water temperature (35-40 *C) |
Optimal water temperature for hand decontamination |
|
Executing the procedure |
|
|
1. Lather your hands and wash the water tap with soap (the elbow tap is not washed) |
The water tap is being decontaminated |
|
2. Lather your hands for 10 seconds, five to six times according to the scheme (Fig. 24), paying attention to the skin around the nails and the interdigital spaces of the hands. Rinse your hands after each soaping |
Uniform decontamination of hands is ensured if the surface is soaped thoroughly and evenly |
|
3. Rinse your hands under running water to remove soap scum so that the water flows into the sink from your forearms or elbows (do not touch the sink) |
The phalanges of the fingers should remain the cleanest |
Note. If necessary, if there has been contact with the patient’s secretions or blood, hand hygiene is carried out after mechanical cleaning. Then the hands are treated with alcohol-containing or other approved antiseptic from a dosing device in an amount of at least 3 ml recommended by the instructions for use, by rubbing it into the skin of the hands. Particular attention is paid to treating the tips of the fingers, the skin around the nails, and the spaces between the fingers. An indispensable condition for effective disinfection of hands is keeping them moist for the recommended treatment time until completely dry.
Rice. 24.
If there has been no contact with the patient’s secretions or blood, hygienic treatment is carried out with an alcohol-containing antiseptic without prior hand washing (Fig. 25).
Rice. 25.
Surgical level of hand treatment (Table 6)
Goal: to achieve sterility of a nurse’s hands to reduce the risk of wound infection if sterile gloves are accidentally damaged during work.
Indications:
- ? the need to cover a sterile table;
- ? participation in surgery, puncture and other surgical interventions;
- ? participation in childbirth.
Contraindications:
- ? the presence of pustules on the hands and body;
- ? cracks and wounds of the skin;
- ? skin diseases.
Equipment:
- ? liquid soap in a dispenser;
- ? hourglass - 1 min, 3 min.
- ? 0-30 ml of skin alcohol antiseptic;
- ? sterile tray with forceps;
- ? sterile pack with targeted styling.
Mandatory condition: use only alcohol-containing skin antiseptics. The procedure is achieved with the help of an assistant supplying sterile material from sterilization boxes, dispensers with soap and an alcohol solution of an antiseptic.
Hand surgical technique
Table 6
|
Rationale |
|
|
Preparation for the procedure |
|
|
1. Fulfill the mandatory conditions for achieving effective hand washing and disinfection, check the integrity of the skin of the fingers |
There may be skin maceration (damage to the epidermis), which prevents hand decontamination |
|
2. Wash your hands in a simple way |
See social level of hand washing |
|
3. Install the sterilization box (biks), check its suitability, sterilization periods, maintaining sterility, open the sterilization box, check the indicators for sterility, readiness for work, put on a sterile scarf, mask |
Infection safety and control measures are observed |
|
Executing the procedure |
|
|
1. Wash your hands at a hygienic level for 1 minute |
Decontamination of the hands and 2/3 of the forearms is carried out |
|
2. Dry your hands with a sterile Bix towel in the direction from the nail phalanges to the elbow |
Using blotting movements, first with your right hand, then with your left with the dry end of the towel, gradually shifting it, wipe the phalanges of the fingers of one hand, then the other, the outer, then the inner surfaces of the hands, 1/3 forearm, then 2/3 forearms, ending with elbows |
|
3. Treat your hands with an alcohol-based antiseptic solution for 3 minutes, following the sequence of actions (see Fig. 25) |
Dosing devices are used to prevent contamination of the solution |
