It would seem that such a banal activity as washing hands should not cause any difficulties for children or even more so for adults. But as practice shows, not all of us correctly perform this simple task. Let's take a closer look at why, and most importantly, how to do it correctly in a variety of life situations.
Why do we wash our hands
Even children probably know the answer to this question: this is the only way to remove bacteria from the surface of the skin. However, if you approach this from a psychological point of view, then everything will turn out to be even more interesting, because among the most popular reasons, experts single out getting rid of feelings of guilt, moral growth, washing away bad luck, etc. It is difficult to judge how much this method helps in solving various problems of this kind. Among the main reasons to wash your hands with soap and water, the following reasons are worth highlighting:
- contact with wound surfaces of the body;
- upcoming food contact;
- contact with animals or their feces;
- garbage collection;
- use of contact lenses;
- going to the toilet;
- travel in public transport;
- severe dirt on the palms;
- sneezing or blowing your nose.
Did you know? In the late 18th and early 19th centuries, in Russia, soap was considered an unaffordable luxury for the majority of the common population. To wash their bodies, the villagers used half-baked potatoes and balls made of fern ash.
It's hard to believe, but among all members of a large family there can be only one person who washes his hands correctly.
Most people do not know at all about the rules of washing, which is why the procedure performed will be ineffective. If you don’t believe it, check out the following requirements.
In everyday life at home
If you think that being at home, you are protected from the invasion of microbes on the surface of your body, then you have to be upset: this is far from the case. It is simply impossible to live in absolutely sterile conditions, so you need to wash your hands at any contact with food. For the correct execution of the procedure, it is important to adhere to the following instructions:
If you rinse only your fingers, without paying due attention to the back of your hand, then in the future, germs will quickly spread over the entire surface. Washing hands only at first glance seems like an elementary procedure, but for the proper result it is important not to rush and always use soap.
In medicine according to sanitary standards
Medical workers are more susceptible to attacks by various harmful microorganisms than other people, as they regularly encounter foci of their spread. Moreover, in this case, we are talking not only about your own safety, but also about the safety of other people, who can easily be “rewarded” with the resulting infection.
Important! Depending on the profile of the doctor, in addition to soap, a special antiseptic can also be used, because the instructions for disinfecting the skin are quite extensive.
In the traditional version (during normal cleaning), no disinfectants are used, and the washing procedure itself is as follows:
- First, you need to remove rings and bracelets from your hands, roll up your sleeves.
- Then lather your palms until a dense foam is formed and rinse it off with warm water (it helps to open the pores).
- Repeat the procedure again to completely wash away all pathogenic microorganisms, but now, paying increased attention to the fingers and the spaces between them.
- After washing off the remaining soap with a large amount of water, you need to dry your hands with a paper towel, with which we close the faucet itself, without touching it (when drying, the brushes should be lifted vertically, fingers up).
- too hot water will enhance the cleaning effect, washing off an important protective layer from the surface of the skin;
- when performing treatment before the upcoming medical procedures, wash hands up to the elbows;
- It is advisable to use medium-sized soap pieces, as they are easier to squeeze in the palm of your hand.
For children in kindergarten
If it is easier to keep track of a specific baby at home, then in kindergarten there are much more sources of microbes. After active games with their peers, kids should definitely wash their hands well and only after that sit down at the dinner table. Usually, educators strictly monitor this, and the children themselves in the team are more willing to perform hygiene procedures. The washing process, in this case, involves the following actions:
- We roll up the sleeves on the clothes.
- We open the tap.
- We take a bar of soap and lather our hands.
- We wash off the resulting foam.
- We close the tap with water.
- Shake off our palms and dry them with a towel.
- We roll out the sleeves.
Important!Kids can more easily perceive the necessary information if it is supported visually. That is why it is better for educators to print these instructions in the form of pictures and place them above the washbasins.
Children may not remember the sequence of actions the first time, but together with posters, role-plays and conversations on the topic of proper handwashing, success will soon be guaranteed.
How often should you wash your hands?
The frequency of washing depends on the professional activity and personal characteristics of the person. It is imperative that the procedure must be performed before cooking or eating food, before treating the wound surface, removing or installing contact lenses, and after visiting the toilet, coming into contact with raw foods (especially meat), taking out the trash, covering your nose with your hand while sneezing , and in a number of other cases when contact with microbes was possible. As for the duration of washing, this process should not take less than 20 seconds, with full lathering of the palms.
Why you need to wash your hands after using the toilet
Regardless of what kind of toilet you visited (home or public), hands must be washed without fail. This is one of the most dangerous places in terms of the spread of harmful microorganisms, and you should not think that they multiply only under the rim of the toilet bowl.
By pressing the flush button or opening the toilet door, you are already exposed to infection, and in the future there is every chance to eat microbes along with the next meal or to reward your loved ones with them. Once in the human body, they affect the stomach, intestines and other organs, causing not only indigestion, but also much more serious consequences (for example, the appearance of E. coli or helminthic invasion). It doesn't matter if you are at home or use a public restroom, hands should be washed after using soap.
Did you know?One of the islands in the Aegean Sea (owned by Greece) can rightfully be called soapy. The fact is that the land on Kimolos, when exposed to precipitation, is covered with real foam, therefore local residents use it for washing clothes and washing in baths.
Why wash your hands before eating
"Diseases of unwashed hands" are terrible for both adults and children, but as for the latter, the consequences of eaten microbes can be much worse. Unlike an adult organism, in a child's body less hydrochloric acid is produced, and digestive enzymes are not so active, which makes it easier for viruses and worm eggs to pass from the stomach into the intestines. Further, the high permeability of the intestinal mucosa contributes to the transfer of harmful microorganisms into the blood.
Of course, such an outcome of events is equally undesirable for people of any age, but as for children, even a small amount of microbes that have entered the stomach can cause problems in the work of the gastrointestinal, cardiovascular and even nervous system. Therefore, it is much easier to wash your hands before eating than to treat further ailments.
Can I wash my hands after gel polish (shellac)
Visitors to nail salons often want to wash their palms, and do it immediately after applying the gel polish. Some experts talk about the possibility of peeling off the coating due to the effect of the material with water, while others are convinced that nothing terrible will happen. Probably, the truth is somewhere between these statements, because much depends on the quality of the varnish and the time of its contact with water.
The final adhesion of shellac to the surface of the nail plate occurs only 12 hours after application. In order not to damage the fresh manicure, you need to wait at least a few hours after the end of the procedure with hand washing.
Can I wash my hands with dishwashing liquid
The main ingredients of a standard dishwashing detergent are EDTA, surfactants, dyes, aromatic ingredients and, in some cases, special ingredients that can protect the skin of the hands. However, this is only an approximate list of what can be read on the label, and unscrupulous manufacturers generally prefer to keep silent about some components. That is why, you should not fully trust the inscriptions like "take care of the skin of your hands", "protects against drying out", etc., because in many cases these statements are not supported by anything (there are simply no extracts of all the mentioned plants in the composition).
Detergents can indeed effectively remove dirt, but often it is not worth using this method, especially when it comes to cheap products with a very dubious composition.
Important!When choosing household chemicals, you should always take into account the possibility of individual sensitivity to an individual component of a particular product. Someone can use dishwashing detergent for months not for its intended purpose, but for someone it will be enough several times to get a serious allergy.
Washing hands in a dream: what does it mean
For those people who clearly remember their dreams, their interpretation arouses considerable curiosity, even if in a dream you just wash your hands. In fact, not only the action itself is important, but also individual characteristics (for example, the type of water or the use of another liquid), on which the exact interpretation depends. Consider a few of the most common explanations for such dreams:
- wash under running clean water and soap - to soon participate in the celebration;
- wash your palms with milk - to meet old friends and have fun together;
- to wash with snow - to the realization of what was conceived, the fulfillment of desires;
- if your hands are very dirty and you are trying to wash them without soap, while pressing hard, you will soon have to solve an important problem on your own.
You should not completely trust the dream books, because there are many different interpretations of the same situation, and having been upset (or delighted) in advance, you subconsciously tune yourself to just such an outcome of events.
As for the washing of hands itself, this is undoubtedly a very important ritual that should not be forgotten either in a dream or in real life. Approach this issue carefully, and there will be much less health troubles in your life.
Antiseptic.
Routine hand washing is used in the home after going to the toilet, before eating, before handling food, etc., as well as by healthcare workers with minor hand contamination to remove dirt and transient flora after contact with infected patients and after each examination of patients.
The rules for handling the hands of medical workers are regulated by the decree of the Chief State Sanitary Doctor of the Russian Federation dated May 18, 2010 No. 58 "On the approval of SanPiN 2.1.3.2630-10" Sanitary and epidemiological requirements for organizations carrying out medical activities. "
According to SanPiN (Sanitary Rules and Norms) 2.1.3.2630-10 health workers is to remove or destroy transient microflora and is carried out using antiseptic agents such as soap and skin antiseptic.
At the level of surgical antiseptics, pathogenic microorganisms are removed or destroyed, regardless of their pathogenicity.
Hygienic treatment of hands is carried out:
- 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 secretions or excretions of the body, mucous membranes, dressings;
- before performing various patient care manipulations;
- after contact with medical equipment and other objects in the immediate vicinity of the patient;
- after treatment of patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment.
Hand hygiene standard is used for any injection. Hand hygiene treatment is carried out in two ways: hand washing with antiseptic soap and hand treatment with a skin antiseptic.
1. Washing hands with antiseptic soap
For hygienic hand washing, use a liquid antiseptic soap from a dispenser (dispenser) or individual disposable soap.
Disposable paper napkins (towels) are used to get wet and dry hands.
The used tissue can be used to turn the valve on the surgical sink if it is not equipped with a medical elbow mixer.
Before hygienic disinfection, it is necessary to remove rings, signet rings, bracelets, watches and other jewelry, the wearing of which increases the microbial load of the skin, makes it difficult to remove pathogenic microflora and impede the regulatory.
Keep your nails clean and cut short. Manicure is permissible, however, with a classic manicure, the skin at the base of the nail plate (cuticle) is damaged, and microtrauma becomes infected.
Therefore, it is recommended to do a European manicure, during which not a mechanical method of cutting the cuticle is used, but a variety of gels, liquids, acid and alkaline removers for its unedged removal. The use of artificial nails is prohibited.
It should be borne in mind that the use of varnish can provoke unwanted dermatological reactions, in some cases complicated by the development of secondary infections. However, the varnish coating of the nails does not lead to increased contamination of the hands.
Fashionable craquelure varnish with a cracking effect and simply unkempt hands with cracked varnish, which makes it difficult to remove and destroy pathogenic microflora, are completely unacceptable. Under a layer of dark varnish, it is often difficult to determine the state of the subungual space, so if you do use nail polish, give preference to clear varnishes.
2. Treatment of hands with a skin antiseptic
According to SanPiN 2.1.3.2630-10, it is allowed to hygienically process the hands of health workers without washing them first.
Algorithms (standards) of all epidemiologically significant therapeutic and diagnostic manipulations should include the recommended means and methods of hand treatment when performing the appropriate manipulations.
For hand treatment, it is permissible to use a 0.5% solution of chlorhexidine bigluconate in 70% ethyl alcohol, AHD-2000 special, Sterillium, etc., as well as 70 ° ethyl alcohol.
The use of alcohols of a higher concentration (95%, 96%) produces a tanning effect, preventing the penetration of the drug into the deeper layers of the skin and their disinfection.
Hygienic treatment of hands with a skin antiseptic is carried out by rubbing it into the skin of the hands in the amount recommended by the instructions for use, paying particular attention to the treatment of fingertips, the skin around the nails, between the fingers.
A prerequisite for effective hand disinfection is keeping them moist for the recommended processing time.
When using the dispenser, a new portion of the antiseptic is poured into it after it has been disinfected and rinsed with water.
The amount of antiseptic required for processing, the frequency of processing and its duration are determined by the recommendations set out in the guidelines (instructions) for the use of a particular agent.
Keeping hands moist for the recommended processing time is a must for effective hand disinfection.
Sterile gloves are put on immediately after the antiseptic on the skin of the hands is completely dry.
Medical personnel should be provided with sufficient effective means for washing and disinfecting hands, as well as hand 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.
Funds used in phthisiatric institutions should be additionally investigated in tests for tuberculecidal activity.
Skin antiseptics for treating hands should be readily available at all stages of the diagnostic and treatment process.
In units 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 treating hands should be located in places convenient for staff use (at the entrance to the ward, at the patient's bed and etc.).
It should also provide for the possibility of providing medical workers with individual containers (bottles) of small volumes (up to 200 ml) with a skin antiseptic.
Resolution of the Chief State Sanitary Doctor of the Russian Federation of May 18, 2010 No. 58 "On approval of SanPiN 2.1.3.2630-10" Sanitary and epidemiological requirements for organizations carrying out medical activities "
12. Rules for handling the hands of medical personnel and the skin of patients
12.1 In order to prevent nosocomial infections, the hands of medical workers (hygienic treatment of hands, treatment of the hands of surgeons) and the skin of patients (treatment of the operating and injection fields, elbow folds of donors, sanitization of the skin) are subject to disinfection.
Depending on the performed medical manipulation and the required level of reduction of 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 the implementation of hand hygiene requirements by medical personnel.
12.2 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 and other jewelry on the hands. Before treating the hands of surgeons, it is also necessary to remove watches, bracelets, etc. For drying hands, use clean cloth towels or single-use paper napkins, when treating the hands of surgeons - only sterile tissue.
12.3 Medical personnel should be provided with sufficient effective means for washing and disinfecting hands, as well as hand 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.
12.4 Hygienic treatment of hands.
12.4.1 Hygienic treatment of hands 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 secretions or excretions of the body, mucous membranes, dressings;
Before performing various patient care manipulations;
After contact with medical equipment and other objects in the immediate vicinity of the patient.
After treatment of patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment;
12.4.2 Hand hygiene treatment is carried out in two ways:
Hygienic hand washing with soap and water to remove impurities and reduce the number of microorganisms;
Spraying hands with a skin antiseptic to reduce microbial counts to a safe level.
12.4.3 For washing hands, use liquid soap using a dispenser (dispenser). Wipe your hands with an individual towel (napkin), preferably disposable.
12.4.4 Hygienic treatment of hands with alcohol-containing or other approved antiseptic (without their preliminary 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 fingertips, skin around nails, between fingers ... A prerequisite for effective hand disinfection is keeping them moist for the recommended processing time.
12.4.5 When using the dispenser, a new portion of the 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 treating hands should be readily available at all stages of the diagnostic and treatment process. In units with a high intensity of patient care and with a high workload on staff (intensive care units, etc.), dispensers with skin antiseptics for treating hands should be placed in places convenient for staff use (at the entrance to the ward, at the patient's bedside and etc.). It should also provide for the possibility of providing medical workers with individual containers (bottles) of small volumes (up to 200 ml) with a 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 clearly contaminated with microorganisms, mucous membranes, damaged skin, is possible.
12.4.7.2 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 part of the body contaminated with microorganisms to a clean one. After removing gloves, hand hygiene is performed.
12.4.7.3 When gloves are contaminated with secretions, blood, etc. in order to avoid contamination of hands during their removal, you should remove visible dirt with a swab (napkin) moistened with a solution of a disinfectant (or antiseptic). Remove gloves, immerse them in the solution, then discard. Treat hands with an antiseptic.
12.5 Hand treatment of surgeons.
12.5.1 The treatment of the hands of surgeons is carried out by everyone involved in the conduct of surgical interventions, childbirth, catheterization of the 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 - antiseptic treatment of hands, wrists and forearms.
12.5.2 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 the use of a particular agent. A prerequisite for effective hand disinfection is keeping them moist for the recommended processing time.
12.5.3 Sterile gloves are put on immediately after the antiseptic on the skin of the hands is completely dry.
12.6 Algorithms / standards for all epidemiologically significant therapeutic and diagnostic manipulations should include the recommended means and methods of handling hands when performing the corresponding manipulations.
12.7 It is necessary to constantly monitor the implementation of hand hygiene requirements by medical workers and bring this information to the attention of personnel in order to improve the quality of medical care.
12.8 Skin antiseptics for treating hands should be readily available at all stages of the diagnostic and treatment process. In units with a high intensity of patient care and workload on staff (resuscitation and intensive care units, etc.), dispensers with skin antiseptics for treating hands should be located in places convenient for staff use (at the entrance to the ward, at the patient's bedside, etc. .). It should also provide for the possibility of providing medical workers with individual containers (vials) of small volumes (100-200 ml) with a skin antiseptic.
12.9 Disinfection of the skin of patients
12.9.1 Disinfection of the hands of health-care workers is essential in preventing 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.
12.9.2 To achieve effective disinfection of hands, the following conditions must be observed: short-cut nails, no artificial nails, no rings, rings and other jewelry on the hands. Before treating the hands of surgeons, also remove watches and bracelets. To dry hands, use disposable towels or napkins, when handling the hands of surgeons - only sterile.
12.9.3 Treatment of the patient's operating field before surgery and other manipulations associated with a violation of the integrity of the skin (puncture, biopsy) is preferably carried out with an antiseptic containing a dye.
12.9.4 Treatment of the injection field involves decontamination of the skin with an alcohol-containing antiseptic at the injection site (subcutaneous, intramuscular, intravenous) and blood collection.
12.9.5 The same antiseptics are used for the treatment of the elbow bends of the donors as for the treatment of the operating field.
12.9.6 For the sanitization of the skin of patients (general or partial), antiseptics are used that do not contain alcohols and have disinfecting and detergent properties. Sanitization is carried out on the eve of surgery or when caring for a patient.
It is known that human skin performs a number of important functions, one of which is protection from the effects of harmful environmental factors. The skin, especially the skin of the hands, is constantly inhabited by microorganisms. Intact (intact) human skin, even if it is thoroughly washed, is colonized by microorganisms that can be different for individual skin areas and are relatively constant for each person.
The microflora of human skin is divided into resident and transitory.
Resident (permanent) microflora is represented by bacteria that constantly live and multiply in the skin. These microorganisms colonize the deeper layers of the skin, including the sebaceous, sweat glands and hair follicles, and are represented mainly by coagulase-negative staphylococci (usually Staphylococcus epidermidis) and diphtheroids (Coryntbacterium spp.) In general, the resident microflora in patients does not cause pathological processes however, it can cause an infectious process if it enters the sterile cavities of the human body. Resident microorganisms are almost impossible to remove, but their numbers can be significantly reduced. In the same time sterilization of hands not only impossible, but also undesirable, because the resident microflora prevents the colonization of the skin by more dangerous microorganisms, and also synthesizes fatty acids that have antimicrobial effect.
Transient (temporary) microflora is represented by microorganisms, temporarily settled on the skin of the hands, they colonize the surface layers of the skin and are of the greatest epidemiological significance. Transient microflora can consist of any microorganisms, including pathogenic, including causative agents of nosocomial (nosocomial) infections, such as Escherihia coli, Klebsiella spp, Pseudomonas spp, Salmonella spp., St. Aureus (including MRSA), Candidae albicans, rotaviruses, etc. In case of damage to the skin, including during the use of inadequate methods of washing and disinfecting hands, the transient microflora penetrates deeper into the skin, displacing the resident flora from there.
Hand transmission of microorganisms depends on various conditions, including the type of microorganisms, the possibility of their survival on the hands, the degree of insemination of the skin by microorganisms, etc. In this case, the species composition of the microflora of the skin of the hands of medical personnel depends on the profile of the institution or department and the nature of professional work. According to the Central Research Institute of Epidemiology (Moscow, Corresponding Member of the Russian Academy of Medical Sciences, Professor N. A. Semina, Professor A. P. Kovaleva), the number of nosocomial infections in Russia is 52-60 thousand annually. It has been proven that the cause of infections in hospitals in 50-80% of cases is the hands of medical personnel, that is, hands are one of the key factors in the transmission of pathogenic microorganisms both from medical personnel to patients and vice versa. According to the analysis of statistics from the American Society for Disease Control and Prevention (CDC), about 2 million patients annually receive nosocomial infections during treatment. The so-called nosocomial or hospital, hospital infections are not only the cause of suffering and death of patients. They also cause significant economic damage and cost the US $ 5 billion annually in additional hospitalization costs and expensive antibiotic treatment. All of the above underlines the extreme importance of strict adherence to the principles of hand hygiene.
Hand treatment methods for medical personnel
Hand hygiene is a general term used to define procedures such as routine hand washing, hygienic hand disinfection and surgical hand disinfection.
Routine hand washing- washing hands with water and regular (non-antiseptic) soap.
Hygienic hand disinfection is carried out in order to reduce the number of pathogenic microorganisms on the skin of the hands, it is used in the following cases:
- before direct contact with the patient;
- before performing invasive procedures;
- before and after manipulation of wounds and catheters.
- before and after putting on gloves;
- after contact with body fluids or after possible microbial insemination;
- before procedures for patients with weakened immunity;
- before examining a clean area after contact with a contaminated area of the body, etc.
It has been proven that the cause of infections in hospitals in 50-80% of cases is the hands of medical personnel, that is, hands are one of the key factors in the transmission of pathogenic "microorganisms, both from medical personnel to patients, and vice versa.
Can be performed using special antiseptic formulations during surgical cleaning. There are two methods for hygienic hand disinfection: hygienic hand washing and hand sanitizing (wiping) with an antiseptic.
Hygienic hand washing - it is washing hands with water and soap or other detergent containing an antiseptic preparation. As a result of hygienic washing, most of the transient microflora is removed, however, even with routine washing, some areas of the skin (inner surfaces, fingertips) remain contaminated.
Hand antiseptic is more often used in practice and, according to the results of laboratory tests, is more effective. Hands are wiped with a sufficient amount of an antiseptic agent without adding water to it before and during the procedure (most often this is a drug based on a combination of alcohols with various antiseptic additives) so that the skin remains moist for the required exposure time from 30 to 60, depending on the manufacturer's recommendations ... Most thoroughly, you need to process your nails and fingertips.
Hygienic treatment of hands(using an antiseptic) after performing medical procedures should be carried out before washing, and not vice versa, in order to avoid contamination of the surrounding surfaces by pouring out contaminated water. When caring for patients with infections caused by spore-forming bacteria (for example, Clostridium difficile), using only antiseptics without first washing your hands will not provide reliable decontamination due to the fact that they do not have a sporicidal effect. activity. In such cases, as well as if the skin needs to be cleaned of visible contaminants (including organic), previous hygienic hand washing is mandatory before treating your hands with an antiseptic.
An important condition for the effectiveness of hand hygiene is compliance with the following rules:
- when carrying out hygienic disinfection of hands by rubbing with an alcohol antiseptic, it is necessary to apply the agent to the palm of one hand and rub over the entire surface of the hands and fingers of both hands until they are completely dry.
- when washing hands, you must first moisten them with water, then apply the required amount of the product and wipe your hands thoroughly for at least 15 seconds to treat the entire surface of the hands and fingers, then wash your hands with water and dry them thoroughly with a disposable towel, which is used to close the tap ;
- it is advisable to use small pieces of soap and use lattice-shaped coasters to dry it quickly.
- it is not recommended to use reusable cloth towels.
Surgical hand disinfection- This is the treatment of hands before surgery, which ensures the removal of transient and a decrease in the amount of resident microflora of the hands.
Surgical hand disinfection can be performed using special antiseptic formulations during surgical washing. This method has been used for a long time, and the formulations used have been known for a long time. These are such as treatment with chlorhexidine bigluconate (Gibitan), recipe C-4 (Pervomur), etc. These antiseptic formulations are quite aggressive for the skin, especially considering the frequency of their use by medical personnel who take part in surgical interventions. In addition, the use of special brushes during surgical washing with the use of the aforementioned antiseptic formulations also leads to mechanical damage to the skin, the appearance of microtraumas.
Today, it is promising to use antiseptic agents made on the basis of a combination of alcohols with other antimicrobial additives for the surgical disinfection of hands. Such drugs are characterized by a quick detrimental effect on the microflora, high antimicrobial properties. For surgical hand disinfection, the same preparations can be used as for hygienic disinfection, with the difference being an increase in the amount of antiseptic per treatment (from 6 - 10 ml - the wrists and forearms need additional treatment) and the extension of time and exposure up to five minutes , depending on the manufacturer's recommendations. It is not necessary to use brushes during processing.
In order to reduce the number of microorganisms that multiply on the skin of the hands under gloves, the use of antiseptics with components that provide an antimicrobial effect prolonged over time is quite effective. Reducing the number of resident bacteria in the skin of the hands of members of the surgical team during surgery reduces the risk of bacteria getting into the area of the operating field in cases of piercing or breaking of gloves during surgery.
For effective surgical hand disinfection, you must strictly adhere to the following rules:
- before surgical disinfection, you need to remove rings, rings, watches and bracelets;
- wash hands with water and soap, preferably liquid (using an antiseptic soap is not necessary);
- dry thoroughly with sterile wipes (before starting treatment with an antiseptic, the skin must be absolutely dry, therefore rubbing the antiseptic into moist skin leads to its dilution, a decrease in effective concentration and, as a result, to the impossibility of achieving the desired result.
- during treatment, skin areas should remain moistened with an antiseptic, while the drug is applied to the hands in 3-5 ml portions;
- completely dry the skin before putting on sterile gloves in order to prevent intensive growth of microorganisms, which can occur in the wet layer.
The safest antiseptics available are alcohols, with ethyl alcohol being less irritating than propyl or isopropyl alcohol.
Side effects of antiseptics on the skin of the personnel.
According to various studies, approximately 25% of nursing staff experience symptoms and signs of dermatitis localized on the skin of the hands. Skin irritation associated with the use of an antiseptic soap can be caused by both the antimicrobial agent and other ingredients. Damage to the skin also leads to a change in the composition of its microflora, increasing the frequency of colonization by staphylococci and gram-negative microorganisms.
Of the antiseptics available, alcohols are the safest, while ethyl alcohol is less irritating than n-propyl or isopropyl alcohol. Most often, contact dermatitis is observed with the use of iodoform. Other antiseptics that can cause contact dermatitis are chlorhexidine, chloroxylene, triclosan, and alcohol. However, factors causing contact dermatitis associated with frequent hand washing include: using very hot water for washing, low relative humidity (especially in winter), inadequate use of sunscreens, poor quality paper towels, and latex allergies.
It should be noted that the most common cause of contact allergy when using hand hygiene products is flavors and preservatives, and less often emulsifiers. Liquid soaps, lotions, and creams may contain ingredients that can cause contact allergic reactions in healthcare workers. Alcohol-containing products for hygienic disinfection rarely cause allergic dermatitis, but it should be borne in mind that to enhance the antimicrobial properties, alcohol-containing drugs are combined with various substances, for example, with quaternary ammonium compounds (QAC), lactic acid, chlorhexidine bigluconate, octenidine hydrochloride, etc.
Recently, new antiseptics in the form of gels have been offered on the antiseptic market.
Due to their formulation, such preparations are suitable for antiseptic treatment of skin that is particularly sensitive to irritation.
To prevent contact dermatitis, it is advisable to consider ways to reduce the risk of contact dermatitis, which may include:
- reducing the frequency of use of irritants (especially anionic detergents);
- replacement of agents that have a strong irritant effect with those that are less irritating to the skin;
- training health workers in the correct use of antiseptics;
- providing health workers with skin care products and protective creams.
Reducing the use of hand sanitizers is an undesirable strategy given the poor hand hygiene practices of healthcare workers. The introduction into practice of alcohol-containing antiseptics with emollient additives makes it possible to reduce the frequency of exposure of personnel to irritating substances (soap and detergents).
General approaches to the choice of antiseptic agents
The administration of a medical and preventive institution should take into account that, thanks to the acquisition of more effective antiseptics, the practice of hand hygiene is improving, which means that it is possible to prevent the occurrence of nosocomial infections. The attention of just a few nosocomial infections offsets the additional costs of health care providers associated with the acquisition of more effective hand hygiene products.
When choosing an antiseptic product for hand hygiene, it is necessary to take into account the opinion of personnel of the compatibility of antiseptics with the skin, the frequency of irritation due to their use.
The cost of hand hygiene products should not be the main factor when choosing them, because disinfectants with a low price may not contain highly effective skin care additives that prevent the occurrence of allergies and skin irritations.
Health care-related infections (HAIs) are a major concern in patient safety, which is why prevention of their occurrence should be a priority for healthcare organizations of any profile. According to the World Health Organization, out of 100 hospitalized patients, at least 7 are infected with HAI. Among critically ill patients treated in intensive care units, this figure rises to about 30 cases of HAI per 100 people.
HAIs often arise in situations where the hands of medical workers are the source of pathogenic microorganisms for the patient. Today, hand washing by medical personnel or their treatment with skin antiseptics are the most important infection control measures that can significantly reduce the spread of infections that occur during the treatment and diagnostic process in organizations carrying out medical activities.
History of the issue
The history of hand hygiene of medical personnel goes back to the middle of the 19th century, when the highest mortality due to "postpartum fever" was observed in obstetric clinics in European countries. Septic complications claimed the lives of about 30% of women in labor.
In the medical practice of that time, doctors' enthusiasm for dissecting corpses was widespread. At the same time, after visiting the anatomical theater, the doctors went to the patients without treating their hands, but simply wiping them with a handkerchief.
There were many different theories of the origin of childbirth fever, but only the Viennese doctor Ignaz Philip Semmelweis was able to discover the true reasons for its spread. The 29-year-old doctor suggested that the main cause of postpartum complications is contamination of the hands of medical personnel with cadaveric material. Semmelweis drew attention to the fact that the bleach solution eliminates the smell of putrefaction, which means that it can also destroy the infectious principle present in the corpses. The observational doctor suggested treating the hands of obstetricians with chlorine solution, which led to a 10-fold decrease in mortality in the clinic. Despite this, the discovery of Ignaz Semmelweis was rejected by his contemporaries and received recognition only after his death.
Hand hygiene is a top priority measure that has proven to be highly effective in preventing HAI and the spread of antimicrobial resistance of pathogenic microorganisms. However, even today, the problem of handling the hands of medical personnel cannot be considered fully resolved. Research by WHO has shown that poor hand hygiene compliance among health-care workers is observed in both developed and developing countries.
According to modern concepts, the transmission of HAI pathogens occurs in various ways, but the most common transmission factor is the contaminated hands of medical workers. Wherein infection through the hands of personnel occurs in the presence of a number of the following conditions :
1) the presence of microorganisms on the patient's skin or objects in his immediate environment;
2) contamination of the hands of medical workers with pathogens through direct contact with the patient's skin or surrounding objects;
3) the ability of microorganisms to survive in the hands of medical personnel for at least a few minutes;
4) incorrect performance of the hand treatment procedure or ignoring this procedure after contact with the patient or objects of his immediate environment;
5) direct contact of the contaminated hands of a medical worker with another patient or an object that will come into direct contact with this patient.
Microorganisms associated with the provision of medical care can often be found not only on the surface of infected wounds, but also on areas of completely healthy skin. Every day, about 10 6 skin scales with viable microbes are exfoliated, contaminating patients' underwear and bedding, bedside furniture and other objects. After direct contact with a patient or environmental objects, microorganisms can survive in the hands of medical workers for a fairly long time, most often from 2 to 60 minutes.
The hands of medical personnel can be inhabited by representatives of their own, resident, microflora, as well as contaminated with potential pathogens (transient microflora) during various manipulations, which is of great epidemiological importance. In many cases, the causative agents of purulent-septic infections released from patients are not found anywhere except in the hands of medical workers.
Rules for handling the hands of medical personnel
In the Russian Federation, the rules for handling the hands of medical personnel are regulated by SanPiN 2.1.3.2630-10 "Sanitary and Epidemiological Requirements for Organizations Performing Medical Activities". Depending on the nature of the performed medical manipulation and the required level of reduction of microbial contamination of the skin, medical personnel must carry out hygienic treatment of hands or the so-called treatment of the hands of surgeons.
To achieve an effective level of hand decontamination healthcare professionals must comply with the following requirements :
1. Have short-cut natural nails without varnish.
It should be understood that the use of nail varnish itself does not lead to increased hand contamination, but cracked varnish makes it difficult to remove microorganisms. Dark-colored varnish can hide the state of the subungual space, which leads to inadequate processing. In addition, the use of nail polish can cause unwanted dermatological reactions, often resulting in secondary infection. The procedure for performing a manicure is quite often accompanied by the appearance of microtraumas that can easily become infected. For the same reasons, it is unacceptable for healthcare professionals to wear artificial nails.
2. Do not wear rings, rings and other jewelry on your hands during work. It is also necessary to remove wristwatches, bracelets and other accessories before performing hand surgery.
Hand jewelry can lead to increased skin contamination and difficulty in removing microorganisms, jewelry and jewelry complicate the process of putting on gloves, and also increase the likelihood of damage.
According to SanPiN 2.1.3.2630-10, there are two types of disinfection of the hands of medical workers - hygienic treatment of hands and treatment of the hands of surgeons.
Hygienic treatment of hands must 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 secretions or excretions of the body, mucous membranes, dressings;
Before performing various patient care manipulations;
After contact with medical equipment and other objects in the immediate vicinity of the patient;
After treatment of patients with purulent inflammatory processes, as well as after each contact with contaminated surfaces and equipment.
Exists two ways Hand hygiene: Washing with soap and water to remove impurities and reducing microorganisms, and treating with a skin antiseptic to reduce microorganisms to a safe level.
For washing hands, use liquid soap dispensed with a dispenser. The use of hot water should be avoided as this may increase the risk of dermatitis. If the tap is not equipped with an elbow actuator, a towel must be used to close it. Use individual clean cloth or paper towels, preferably single use, to dry your hands.
Hygienic treatment of hands (without their preliminary washing) with a skin antiseptic 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 fingertips, the skin around the nails and between the fingers. An essential condition for effective hand hygiene keeping them moist for the recommended exposure time. Do not wipe your hands after processing.
For your information
Alcohol-based skin antiseptics show b O higher efficiency in comparison with water-based antiseptics, and therefore their use is preferable in the absence of conditions necessary for washing hands, or in a mode of shortage of working hours.
Hand treatment for surgeons is performed by all medical workers involved in surgical interventions, childbirth and catheterization of the great vessels. Surgical handrub includes two mandatory steps:
1. Washing hands with soap and water for 2 minutes, followed by drying with a sterile cloth towel or napkin.
It is recommended to use hand-held sanitary devices and elbow dispensers at this stage. If brushes are used, which is not a prerequisite, the choice should be made in favor of either sterile soft disposable brushes or brushes that can withstand sterilization by autoclaving. Use brushes only for treating the periungual areas during the first hand disinfection during a work shift.
2. Treatment of hands, wrists and forearms with a skin antiseptic.
Hands should be kept moist for the entire recommended processing time. Do not dry your hands after exposure to a skin antiseptic. The amount of a specific agent required for processing, the time of its exposure and the frequency of application are determined by the recommendations set out in the instructions attached to it. Sterile gloves are put on immediately after the antiseptic on the skin of the hands is completely dry.
For surgical treatment of hands, the same preparations can be used as for hygiene. However, it is very important to use skin antiseptics that have a pronounced residual effect.
Dispensers for soap or skin antiseptic are filled only after they have been disinfected, rinsed with water and dried. Preference should be given to elbow and photocell dispensers.
Skin antiseptics for treating hands should be readily available at all stages of the diagnostic and treatment process. In units with a high intensity of patient care and a high workload on staff, dispensers with skin antiseptics should be located in places convenient for use by medical workers (at the entrance to the ward, at the patient's bedside, etc.). It should also provide for the possibility of providing medical workers with individual vials of skin antiseptic of small volumes (up to 200 ml).
Prevention of occupational dermatitis
Repeated handling of hands in the course of work by medical personnel can lead to irritation of the skin, as well as the occurrence of dermatitis, one of the most widespread occupational diseases of medical workers. The most common skin reaction is irritative contact dermatitis which manifests itself with symptoms such as dryness, irritation, itching, and in some cases cracking of the skin. The second type of skin reaction is allergic contact dermatitis, which is much less common and is an allergy to certain ingredients in handrub. The manifestations and symptoms of allergic contact dermatitis can be varied and range from mild and localized to severe and generalized. In the most severe cases, allergic contact dermatitis can be associated with breathing difficulties and some other symptoms of anaphylaxis.
Irritant contact dermatitis is usually associated with the use of iodophores as skin antiseptics. Other antiseptic ingredients that can cause contact dermatitis, in decreasing incidence, include chlorhexidine, chloroxylenol, triclosan, and alcohols.
Allergic contact dermatitis occurs when you use products containing quaternary ammonium compounds, iodine or iodophores, chlorhexidine, triclosan, chloroxylenol, and alcohols to treat hands.
There is a large amount of data obtained in various studies on the best tolerance of the skin of the hands of alcohol-containing antiseptics.
Allergic reactions and irritation of the skin of the hands of medical personnel cause discomfort, thereby impairing the quality of medical care, and also increase the risk of transmitting HAI pathogens to patients due to the following reasons:
Due to damage to the skin, it is possible to change its resident microflora, colonization by staphylococci or gram-negative microorganisms;
When carrying out the procedure for hygienic or surgical treatment of hands, the required level of reduction in the number of microorganisms is not achieved;
As a result of discomfort and other unpleasant subjective sensations, a healthcare professional who has skin reactions tends to avoid handling the hands.
Advice
In order to prevent the development of dermatitis, medical personnel must observe a number of the following additional recommendations:
1) do not resort to frequent washing of hands with soap immediately before or after using an alcohol-containing product. Washing hands before using an antiseptic is necessary only if there are visible impurities on the skin;
2) when washing your hands, you should avoid using very hot water, as this can lead to skin trauma;
3) when using disposable towels, it is very important to blot the skin rather than rub it to avoid cracking;
4) do not wear gloves after handling your hands until they are completely dry in order to reduce the risk of developing skin irritation;
5) it is necessary to regularly use creams, lotions, balms and other hand care products.
One of basic prevention measures the development of occupational dermatitis in medical workers is to reduce the frequency of exposure to the skin of the hands of soap and other irritating detergents through the widespread introduction into practice of alcohol-based antiseptics containing various emollients. According to WHO recommendations, the use of alcohol-containing hand hygiene products in a medical organization is preferable, provided they are available, since this type of antiseptic has a number of advantages, such as a wide range of antimicrobial activity, including against viruses, short exposure time, good skin tolerance ...
The problem of medical personnel compliance with hand hygiene rules
Numerous epidemiological studies of the adherence (compliance) of medical personnel to the recommended hand hygiene rules show unsatisfactory results. On average, the frequency of compliance by medical personnel with the requirements for hand processing is only 40%, and in some cases it is much lower. An interesting fact is that doctors and nurses are much more likely than nurses to disregard hand antiseptic recommendations. The highest level of compliance is observed on weekends, which is apparently associated with a significant decrease in workload. Lower levels of hand hygiene are reported in intensive care units and during periods of strenuous patient care, while the highest levels are observed in children's wards.
Obvious barriers to proper implementation of recommendations treatment of hands by medical personnel are allergic skin reactions, low availability of hand antiseptics and conditions for its implementation, priority of patient care and medical care, use of gloves, shortage of working hours and high professional workload, forgetfulness of medical workers, lack of basic knowledge of existing requirements, misunderstanding of the role of hand treatment in the prevention of HAI.
Activities to improve hand hygiene practice in a medical organization, there should be broad educational programs among personnel on hand processing, control over the application of the acquired knowledge in professional activities, development of written recommendations on antiseptic treatment when performing various manipulations, reduction of the workload on medical workers, creation of appropriate conditions for hand hygiene , providing staff not only with antiseptics, but also with skin care products, various administrative measures, sanctions, support and encouragement of employees who perform high-quality hand treatment.
The introduction of modern antiseptics, skin care products and hand hygiene equipment, as well as extensive educational programs for medical personnel in organizations engaged in medical activities, is absolutely justified. Data from numerous studies show that the economic costs associated with treating 4-5 cases of moderate HAI exceed the annual budget required for the purchase of hand hygiene products for the entire health care organization.
Medical gloves
Another aspect related to hand hygiene of medical personnel is use of medical gloves... Gloves significantly reduce the likelihood of occupational infection during contact with patients or their secretions, reduce the risk of contamination of the hands of medical personnel with transient microflora and its subsequent transfer to patients, prevent patients from becoming infected with microorganisms that are part of the resident flora of the hands of medical workers. Providing an additional barrier to potentially pathogenic agents, gloves are at the same time a means of protecting both the healthcare professional and the patient.
The use of gloves is an important component of the universal precautions and infection control system in health care facilities. However, medical personnel often neglect to use or change gloves even when there are clear indications for this, which significantly increases the risk of transmission of infection both to the medical professional himself and from one patient to another through the hands of the personnel.
According to the existing requirements of sanitary legislation gloves must be worn in all of the following cases :
There is a possibility of contact with blood or other biological substrates, potentially or clearly contaminated with microorganisms;
There is a possibility of contact with the patient's mucous membranes or damaged skin.
In case of contamination of gloves with blood or other body fluids, to avoid contamination of hands when removing gloves, remove visible contamination with a swab or napkin moistened with a solution of disinfectant or skin antiseptic. Used gloves are disinfected and disposed of together with other medical waste of the appropriate class.
The significant effectiveness of gloves in preventing contamination of the hands of medical personnel and reducing the risk of transmission of microorganisms in the provision of medical care has been confirmed in clinical studies. However, healthcare providers should be aware of the fact that gloves cannot provide complete protection against microbial hand contamination. Microorganisms can penetrate through the smallest defects, pores and holes in the material, as well as get into the hands of personnel during the procedure for removing gloves. The penetration of liquids into the gloves is most often observed in the area of the fingertips, especially the thumb. At the same time, only 30% of medical personnel notice such situations. In connection with these circumstances, before putting on gloves and immediately after taking them off, it is imperative to carry out antiseptic treatment of hands.
Gloves are single-use medical devices and are therefore not recommended to be decontaminated or reworked. This practice should be avoided, including in organizations carrying out medical activities, where the level of material resources is low and the supply of gloves is limited.
There are the following main types of medical gloves:
Examination (diagnostic) gloves;
Surgical gloves with anatomical shape, providing a high-quality wrist girth;
Special purpose (for use in various branches of medicine): orthopedic, ophthalmic, etc.
In order to facilitate the process of donning gloves, manufacturers use various substances. Most often, talcum powder containing starch, magnesium oxide, etc. is used. Do not forget that the use of powdered gloves can lead to a decrease in tactile sensitivity. It is undesirable to get glove powder into the wound area, since cases of postoperative complications due to hypersensitivity reactions in patients have been described. It is not recommended to use powdered gloves in dental practice, as it can cause discomfort in the patient's mouth.
The following requirements apply to medical gloves :
Should fit snugly to the hand throughout the entire time of their use;
Should not cause fatigue in the hands and should be suitable for the size of the healthcare professional's hand;
Must maintain good tactile sensitivity;
The material from which the gloves are made, as well as the substances used for dusting them, must be hypoallergenic.
Compliance with modern requirements for hand hygiene of medical personnel can significantly improve the quality of medical care in health care facilities by significantly reducing the risk of infection of patients with HAI.
Literature
1. Afinogenov G.E., Afinogenova A.G. Modern approaches to hand hygiene of medical personnel // Clinical microbiology and antimicrobial chemotherapy. 2004. T. 6. No. 1. P. 65−91.
2. Hand hygiene and the use of gloves in health care facilities / Ed. Academician of the Russian Academy of Natural SciencesL. P. Zueva... SPb., 2006.33 p.
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Opimakh I.V.The history of antiseptics is a struggle of ideas, ambition, ambitions ... // Medical technologies. Evaluation and selection. 2010. No. 2. S. 74−80.
3. WHO Guidelines on Hand Hygiene in Health Care: Executive Summary, 2013. Mode of Access:http://
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... Date of access: 01.11.2014.
4. SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations carrying out medical activities."
Dubel E.V., head. epidemiological department, doctor-epidemiologist, BUZ VO "Vologda City Hospital No. 1"; Gulakova L. Yu., Chief Nurse, BUZ VO "Vologda City Hospital No. 1"