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 occur in situations where the patient's hands are the source of pathogenic microorganisms medical professionals... Today, hand washing by medical personnel or their treatment with skin antiseptics are the most important measures of infection control, which 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 obstetric clinics European countries the highest mortality due to "postpartum fever" was observed. 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 about the origin of childbirth fever, but open true reasons only the Viennese physician Ignaz Philip Semmelweis succeeded in spreading it. 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. An observant 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 that has proven high efficiency in the prevention of 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 conducted by WHO has shown that poor hand hygiene compliance among health-care workers is observed in both developed and developing countries.

According to modern ideas HAI pathogens are transmitted in a variety of ways, but the most common transmission factor is the contaminated hands of health care 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 the underwear and linens patients, bedside furniture and other objects. After direct contact with a patient or objects of the environment, microorganisms can survive on the hands of medical workers for quite a 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 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. Varnish dark colors can hide the state of the subungual space, which leads to insufficient quality 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. Before carrying out surgical treatment of hands, it is also necessary to remove Wrist Watch, bracelets and other accessories.

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 their 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.

Exist two ways Hand hygiene: Washing with soap and water to remove impurities and reducing microorganisms, and applying a skin antiseptic to reduce microorganisms to a safe level.

Use for hand washing liquid soap dispensed with a dispenser. Use should be avoided hot water 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. Individual clean cloth or paper towels, preferably disposable, are used to dry 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, giving Special attention fingertips, the skin around the nails and between the toes. An important condition 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 antiseptics for water based, in connection with which their use is preferable in the absence of conditions necessary for washing hands, or in the 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 hand antisepsis includes two mandatory steps:

1. Washing hands with soap and water for 2 minutes, followed by drying with a sterile cloth towel or napkin.

On the this stage It is recommended to use sanitary fittings and elbow dispensers, which can be operated hands-free. In the case of using brushes, which is not a prerequisite should opt for either sterile soft disposable brushes or brushes that can withstand 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 should be filled only after they have been disinfected, rinsed with water and dried. Preference should be given to elbow dispensers 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 high workload on staff, dispensers with skin antiseptics should be placed 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 accompanied by 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 deteriorating 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 with 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.

Tips

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 hands with soap immediately before or after using an alcohol-based product. Washing your hands before using an antiseptic is necessary only if there is visible contamination on the skin;
2) when washing your hands, you should avoid using very hot water, since this can lead to trauma to the skin;
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 health care workers is to reduce the frequency of exposure to the skin of the hands of soap and other irritants detergents through the widespread introduction into practice of alcohol-based antiseptics containing various emollients. According to the WHO recommendations, the use of alcohol-containing hand hygiene products in a medical organization is preferable, subject to their availability, since given view antiseptics has a number of advantages, such as a wide spectrum 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 even much lower. An interesting fact is that doctors and nurses are much more likely than nurses to disregard hand antiseptic recommendations. Most high level 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 on the treatment of hands by medical personnel are skin allergic reactions, low availability of hand antiseptics and conditions for its implementation, priority of patient care and medical care measures, 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 the handling of hands, control over the application of the acquired knowledge in professional activity, development of written recommendations on antiseptic treatment when performing various manipulations, reducing the workload for medical workers, creating proper 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 the processing of hands with high quality.

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. Numerous studies show that the economic costs associated with treating 4-5 moderate HAI cases exceed the annual budget required for the purchase of hand hygiene products for the entire healthcare 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 worker 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 during the provision of medical care has been confirmed in clinical research... However, healthcare providers should be aware of the fact that gloves cannot provide full protection from microbial contamination of hands. 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 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 removing them, 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 industries medicine): orthopedic, ophthalmic, etc.

In order to facilitate the process of putting on 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 to dust 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.
2. Opimakh I.V.The history of antiseptics is a struggle of ideas, ambition, ambition ... // Medical technology... Evaluation and selection. 2010. No. 2. S. 74−80.
3. WHO guidelines on hand hygiene in health care: summary, 2013. Mode of access:http:// www. who. int/ gpsc/5 may/ tools/9789241597906/ ru/ ... 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"

Hand hygiene treatment 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.

Hand hygiene treatment is carried out in two ways:

Hygienic wash hands with soap and water to remove dirt and reduce the number of microorganisms;

Treating hands with a skin antiseptic to reduce microbial counts to a safe level.

Remove all jewelry that makes washing difficult from your hands.

Hygienic treatment of hands with an 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, 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 (or soap) is poured into the dispenser after it has been disinfected, rinsed with water and dried. Preference should be given to elbow dispensers and photocell dispensers.

The antiseptic is applied to the hands in portions (1.5-3.0 ml), including the elbows, and rubbed into the skin for the time specified by the developer. The first portion of the antiseptic is applied only to dry hands. Throughout the entire time of rubbing in the antiseptic, the skin is kept moist from the antiseptic, therefore, the number of servings of the rubbed in, and its volume are not strictly regulated. During the procedure, special attention is paid to the standard method of treating the hands with an antiseptic according to EN 1500.

Palm to palm, including wrists	Right palm on the left back of the hand and left palm on the right back of the hand	Palm to palm with fingers crossed
Outside of fingers on opposite palm with fingers crossed	Circular rubbing of the left thumb in a closed palm right hand and vice versa	Circular rubbing of the closed fingertips of the right hand on the left palm and vice versa

Each stage of processing is repeated at least 5 times. When performing the hand treatment technique, the presence of so-called "critical" parts of the hands, which are not sufficiently wetted by the product, is taken into account: thumbs, fingertips, interdigital zones, nails, periungual ridges and subungual zones. The surfaces of the thumb and the tips of the fingers are most carefully treated, since these are the largest concentrations of bacteria. The last portion of the antiseptic is rubbed in until it is completely dry. Sterile gloves should only be worn on dry hands. After the end of the operation / procedure, the gloves are removed, the hands are treated with an antiseptic for 2 x 30 s, and then with a hand skin care product. If blood or other secretions get on the hands under the gloves, these contaminants are first removed with a swab or napkin moistened with an antiseptic, washed with detergent. Then they are thoroughly washed with water to remove soap and dried with a disposable towel or napkins. After that, the hands are treated with an antiseptic 2 x 30 s.

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 placed in places convenient for staff use (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 a skin antiseptic.

The question of the need for hand hygiene by medical personnel was first raised only in the middle of the 19th century. At that time, due to unsanitary conditions in Europe, almost 30% of women in labor died in hospitals. The main cause of death was the so-called postpartum fever. It often happened that doctors went to women in labor after dissecting corpses. At the same time, they did not process their hands with anything, but simply wiped them with a handkerchief.

Types of processing

Keeping hands clean is a must for all medical personnel. Hygienic treatment of medical staff's hands can be carried out in two ways:

• removing impurities and reducing the number of microorganisms on the skin of the hands with soap and water;
• the use of special alcohol-containing skin antiseptics, which can reduce the number of bacteria on the skin to a minimum level.

Only the second method can be called hand hygiene. The first is just hygienic washing. Hands should be washed with liquid soap with a dispenser and wiped off with an individual disposable towel. But disinfection is carried out using skin antiseptics.

According to the rules, medical personnel should always have hand care products available. In addition, they must be provided with creams, balms, lotions intended for skin care. Indeed, with constant hygienic treatment, the risk of developing contact dermatitis increases. Also, the selection of detergents and antiseptics should be carried out taking into account individual intolerance.

Important conditions

Each hospital employee should know when to perform hand hygiene treatment for medical staff. This is necessary in the following situations:

• before and after contact with each patient;
• before and after putting on gloves that are used during medical procedures, contact with excretions or secretions of the body, dressings, mucous surfaces;
• after contact with intact skin, for example, after measuring blood pressure, pulse, transferring the patient;
• after working with equipment that is located in the immediate vicinity of the patient;
• after treatment of patients with various purulent-inflammatory processes.

If there is a clear contamination of the skin of the hand with blood or secretions from the patient, then first they must be thoroughly washed with soap and water and dried. After that, they must be treated twice with an antiseptic.

Hand washing technique

Don't forget the importance of cleansing your skin, not only in hospitals, but elsewhere as well. Hand processing technique remains the same everywhere. Before proceeding with the procedure, it is necessary to remove all rings, watches and bracelets. Any foreign objects make it difficult to remove pathogenic microorganisms. It is advisable to wash your hands with lukewarm water.

To increase the effectiveness of the procedure, you must first moisten your hands and squeeze them out.The algorithm for processing hands looks like this:

1. Foam the soap by rubbing the palms together intensively.
2. Rub one palm against the other in a reciprocating motion.
3. Rub the back of the right hand with the left palm and set.
4. Connect the fingers of the right hand and the interdigital spaces of the left, carefully process them.
5. It is also necessary to pass the inner surface of the fingers.
6. Cross your spread fingers and rub your palms together.
7. Fasten and walk with the back of your fingers on the palm of your hand.
8. Thoroughly rub the thumb in a circular motion, for this, its base must be covered with the thumb and forefinger the other hand.
9. The wrist is processed in a similar way.
10. Rub your palm with your fingertips in a circular motion.

Each movement should be repeated at least 5 times, and the total duration of such a wash should be about a minute.

Rules for medical personnel

Every worker in hospitals and clinics should know how to handle the hands of medical staff. SanPiN (scheme correct washing given above) establishes a procedure not only for cleaning the skin, but also for disinfecting them. Also, health workers should remember the following requirements:

• short cut nails without varnish;
• lack of rings, rings and other similar ornaments.

Nail polish can cause unwanted dermatological reactions that can lead to secondary infection. In addition, dark varnish does not allow assessing the degree of cleanliness of the subungual space. This can cause poor quality processing. Cracked varnish is considered the most dangerous. Indeed, in this case, it becomes more difficult to remove microorganisms from the surface of the hands.

The very execution of a manicure is associated with the receipt of microtraumas that are easy to infect. This is one of the reasons why medical professionals are prohibited from wearing false nails.

Any jewelry or bijouterie can make the hygienic treatment of medical staff's hands less effective. They can also damage the gloves and make donning difficult.

Nuances for surgeons

The processing of the hands of people involved in surgical interventions is carried out according to a slightly modified scheme. So, for example, the washing time for them is lengthened and is 2 minutes. The further algorithm for hand processing is as follows. After mechanical cleaning, it is necessary to dry the skin with a sterile tissue or disposable paper towel.

In addition to washing, antiseptic treatment is also important. Attention must be paid not only to the hands, but also to the wrists and forearms. During the specified processing time, the skin must remain moist. You cannot wipe your hands, you must wait until the antiseptic is completely dry. Only then can surgeons put on gloves.

Selection of hygiene products

Many now opt for antibacterial soaps. But it is important to follow the technique of cleaning the skin. If done correctly, hand washing with regular soap will be just as effective. In surgical practice, they use special means for antiseptic treatment of hands. The soap contains chlorhexidine gluconate or povidone iodine. These substances are able to reduce the number of bacteria by 70-80% on the first application and by 99% on repeated use. At the same time, when using povidone-iodine, the microflora grows faster than when in contact with chlorhexidine.

To be in full compliance regulatory requirements the treatment of the hands of the medical staff was carried out hygienic, it is desirable to equip the medical facilities. They are controlled without the participation of the hands.

Also in surgical practice, brushes can be used to clean the hands, but this is not considered mandatory. They must be either sterile, disposable, or autoclavable.

Time intervals

In surgical practice, special rules have been established for cleaning the skin. After the usual thorough washing according to the established protocol, they should be decontaminated.

The processing of the hands of the medical staff must be carried out without fail. SanPin (the washing scheme remains the same) provides that cleaning the skin before surgical procedures can be carried out using the same means as hygienic.

It is important to remember that throughout the entire period of hand disinfection, they must remain moist. For the procedure, as a rule, it is necessary to use more than 6 ml of antiseptic. As a result of the research, it was found that for the qualitative destruction of bacteria, a five-minute treatment of the skin is sufficient. It was also confirmed that performing this procedure for three minutes reduces the number of microorganisms to an acceptable level.

Hand antiseptic rules

After thoroughly washing the skin of the hands, wrists and forearms, dry them. After that, the established standard for hand treatment for workers in operating units requires the use of special disinfectants.

Before this, if necessary, it is necessary to process the nail beds and periungual ridges. For these purposes, sterile disposable wooden sticks are used, which must be additionally moistened with an antiseptic.

Disinfectant is applied in 2.5 ml to the hands and forearms. One treatment of two hands should consume about 10 ml of disinfectant liquid. The antiseptic must be rubbed into the skin in the same way as for washing hands, observing correct sequence movements.

Gloves can be worn only after complete absorption / evaporation of the product. If it lasts more than 3 hours, then the treatment is repeated. After all, pathogens can begin to multiply under gloves.

The final stage

But these are not all the levels of hand processing. It is important to remove gloves after working with gloves and wash your hands with soap and water. In this case, it is no longer necessary to use a disinfectant solution. Washing with liquid soap is sufficient, it is desirable that its pH is neutral.

After cleaning the skin, they must be moistened. For these purposes, various creams and lotions are used. Their main purpose is to prevent the drying effect of alcohol-containing disinfectants.

Separately, it should be noted that the hygienic treatment of hands in the absence of visible contamination can be performed without washing. In most cases, it is sufficient to use antiseptic solutions for 30-60 seconds.

Possible complications

It should be noted that the regular use of disinfectants is not the best the best way affects the skin of healthcare workers. There are two main types of reactions experienced by hospital staff. Most often, they complain of itching, dryness, irritation, cracks with bleeding. These symptoms can be both minor and noticeably affect the general condition of workers.

There is also another type of complication - allergic dermatitis. They are found in cases of intolerance to any components of hand sanitizers. Allergic dermatitis can manifest itself in both a mild localized and severe generalized form. In the most advanced cases, they can be combined with respiratory distress syndrome or other manifestations of anaphylaxis.

The prevalence of complications and their prevention

You can understand the significance of the problem if you know that such hand treatment methods lead to the fact that 25% of nurses are treated with signs of dermatitis, and 85% reported that they had a history of skin problems.

You can slightly reduce the irritating effect of antiseptics by adding emollients to them. This is one way to reduce the prevalence of contact dermatitis. Also, the risk of their occurrence can be minimized by using moisturizers that are designed to care for the skin of the hands after each wash.

To prevent the development of complications, you should not wash your hands every time before treating them with an antiseptic. In addition, it is important to ensure that gloves are only worn when the skin is completely dry.

Do not neglect the use of moisturizers. On the market you can find special protective creams designed to prevent the appearance of contact dermatitis. However, as a result of studies, it was not possible to confirm their unequivocal effectiveness. Many are stopped by the high price of these creams.

Resolution of the Chief State Sanitary Doctor of the Russian Federation of 05/18/2010 N 58 (as amended on 06/10/2016) "On the approval of SanPiN 2.1.3.2630-10" Sanitary and epidemiological requirements for organizations carrying out medical activities "(together with ...

12.4. Hygienic treatment of hands

12.4. Hygienic treatment of hands.

12.4.1. Hand hygiene treatment 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 contaminants and reduce the number of microorganisms;

Treating 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 an 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, the skin around the nails, between the 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, rinsed 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 (resuscitation and 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 be possible to provide 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.

Target household level hand treatments - mechanical removal from the skin of most of the transient microflora (antiseptics are not used).

A similar hand treatment is carried out:

• after using the toilet;
• before eating or before handling food;
• before and after physical contact with the patient;
• with any contamination of hands.

Necessary equipment:

1. Liquid dosed neutral soap or individual disposable soap in bars. It is desirable that the soap does not have a pungent odor. Opened liquid or bar soap, reusable non-personalized soap quickly becomes infected with microbes.
2. Disposable wipes 15x15 cm in size, clean for getting hands wet. The use of a towel (even an individual one) is not advisable, since it does not have time to dry out and, moreover, is easily contaminated with microbes.

Hand processing rules:

All jewelry and watches are removed from the hands, since they make it difficult to remove microorganisms. Hands are soaped, then rinsed with warm running water and everything is repeated from the beginning. It is believed that the first time you soap and rinse with warm water, germs are washed off the skin of your hands. Under the influence of warm water and self-massage, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes are washed away from the opened pores.

Warm water makes the antiseptic or soap more effective, while hot water removes the protective grease layer from the surface of the hands. Therefore, you should avoid using too hot water for washing your hands.

Hand treatment - the necessary sequence of movements

1. Rub one palm on the other palm in a reciprocating motion.

1. Right palm rub the back of the left hand, change hands.
2. Connect the fingers of one hand in the interdigital spaces of the other, rub inner surfaces fingers up and down.
3. Connect the fingers in a "lock", rub the palm of the other hand with the back of the bent fingers.
4. Grasp the base of the left thumb between the thumb and forefinger of the right hand, rotational friction. Repeat on wrist. Change hands.
5. Rub the palm of the left hand with the fingertips of the right hand in a circular motion, change hands.

Each movement is repeated at least 5 times. Hand processing is carried out within 30 seconds - 1 minute.

It is very important to follow the described hand washing technique, as 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, hands are wiped dry with a napkin (15x15 cm). The water taps are closed with the same napkin. The napkin is dropped into a container with a disinfectant solution for disposal.

In the absence of disposable wipes, it is possible to use pieces of clean cloth, which after each use are thrown into special containers and, after disinfection, are sent to the laundry. Replacing disposable wipes with electric dryers is impractical because they do not rub the skin, which means that there is no removal of the residues of the detergent and desquamation of the epithelium.