Rules for hand washing of medical staff are the most important component of the safety of medical care. Rules for treating the hands of medical personnel and the skin of patients Methods for treating the hands of medical personnel Sanpin

There are two levels of hand treatment for medical personnel:

Hand hygiene:

1. hygienic hand washing with soap,

   hygienic treatment of hands with skin antiseptic (without pre-washing).

Treatment of surgeons' hands.

Hand hygiene.

Target: removing contaminants and reducing the number of microorganisms to a safe level (prevention of HAIs).

Indications:

before direct contact with the patient;

after contact with the patient’s intact skin;

before performing various patient care procedures;

after contact with biological media of the body, mucous membranes, dressings;

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

after treating a patient with purulent inflammatory processes;

after each contact with contaminated surfaces and equipment.

Contraindications: individual intolerance to the soap or skin antiseptic used.

Effectiveness conditions:

short-cut nails;

lack of nail polish;

no artificial nails;

lack of jewelry on hands (rings, rings, etc.);

provision of sufficient quantities of effective means for washing and disinfecting hands, as well as products for hand skin care (creams, lotions, balms).

Hygienic hand washing with soap.

Equipment: a sink equipped with a faucet with an elbow (touchless) valve; liquid soap; dispenser for liquid soap (elbow or other non-contact); paper towels (or individual cloth towel); paper towel holder; pedal bin with class A waste bag.

Manipulation algorithm:

Rice. 2. Hygienic hand washing with soap.

Hygienic treatment of hands with skin antiseptic.

Equipment: skin antiseptic approved for use in an elbow dispenser (or other non-contact) or in an individual container.

The issue 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 giving birth died in hospitals. The main cause of death was the so-called puerperal fever. It often happened that doctors went to women giving birth after dissecting corpses. At the same time, they did not treat their hands with anything, but simply wiped them with a handkerchief.

Types of processing

Keeping hands clean is mandatory for all healthcare personnel. Hygiene treatment of medical staff’s hands can be carried out in two ways:

• removing contaminants and reducing the number of microorganisms on the skin of the hands using soap and water;
• the use of special alcohol-containing skin antiseptics, which 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 dried with an individual disposable towel. But disinfection is carried out using skin antiseptics.

According to the rules, medical personnel must always have hand sanitizer available. In addition, they must be provided with creams, balms, and 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 Terms

Every hospital employee should know when the hands of medical staff should be sanitized. 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 excreta or body secretions, dressings, mucous surfaces;
• after contact with intact skin, for example, after measuring blood pressure, pulse, or shifting the patient;
• after working with equipment that is located in close proximity to the patient;
• after treating patients with various purulent-inflammatory processes.

If there is obvious contamination of the skin of the hand with the patient’s blood or secretions, they must first be thoroughly washed with soap and water and dried. After this, they must be treated twice with an antiseptic.

Hand washing technique

Do not forget about the importance of cleansing the skin not only in hospitals, but also in other places. The hand treatment technique remains the same everywhere. Before starting the procedure, you must remove all rings, watches and bracelets. Any foreign objects make it difficult to remove pathogenic microorganisms. It is advisable to wash your hands with moderately warm water.

To increase the effectiveness of the procedure, you must first wet your hands and squeeze liquid soap onto them. The hand processing algorithm looks like this:

1. Lather the soap by vigorously rubbing your palms together.
2. Rub one palm against the other in a back-and-forth motion.
3. Rub the back of your right hand with your left palm and vice versa.
4. Connect the fingers of the right hand and the interdigital spaces of the left, carefully process them.
5. It is also necessary to go through the inner surface of the fingers.
6. Cross your outstretched fingers and rub your palms together.
7. Clasp your hands and walk the backs of your fingers across your palm.
8. Thoroughly rub your thumb in a circular motion; to do this, you need to cover its base with the thumb and forefinger of your other hand.
9. The wrist is treated 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 this wash should be about a minute.

Rules for medical personnel

Every hospital and clinic worker should know how to clean the hands of medical staff. SanPiN (the proper washing diagram is given above) establishes the procedure for not only cleaning the skin, but also for disinfecting it. Healthcare workers should also remember the following requirements:

• short-cut nails without varnish;
• absence of rings, signet rings and other similar jewelry.

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 may cause poor 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.

Performing a manicure itself is associated with microtraumas that can easily become infected. This is one of the reasons why medical professionals are prohibited from wearing false nails.

Any jewelry or costume jewelry can cause the hygienic treatment of the hands of medical staff to become less effective. In addition, they can damage gloves and make putting them on more difficult.

Nuances for surgeons

The treatment of the hands of people participating in surgical interventions is carried out according to a slightly modified scheme. For example, the washing time for them is extended and amounts to 2 minutes. The further algorithm for processing hands is as follows. After mechanical cleaning, it is necessary to dry the skin using a sterile fabric or disposable paper towel.

In addition to washing, treatment with an antiseptic is also important. Attention must be paid not only to the hands, but also to the wrists and forearms. The skin should remain moist during the prescribed treatment time. You cannot wipe your hands; you must wait until the antiseptic has completely dried. Only after this can surgeons put on gloves.

Selection of hygiene products

Many people are now opting for antibacterial soap. But it is important to follow the skin cleansing technique. If done correctly, washing your hands with regular soap will be just as effective. In surgical practice, special means are used for antiseptic hand treatment. The soap contains chlorhexidine gluconate or povidone iodine. These substances can reduce the number of bacteria by 70-80% upon first use and by 99% upon repeated use. Moreover, when using povidone-iodine, the microflora grows faster than when in contact with chlorhexidine.

In order to fully comply with regulatory requirements, hygienic treatment of the hands of medical staff takes place, it is advisable to equip medical institutions with elbow dispensers. They are controlled without the use of hands.

Also in surgical practice, brushes can be used to clean hands, but this is not considered necessary. They must be either sterile for single use or capable of withstanding autoclaving.

Time periods

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

It is mandatory to sanitize the hands of medical staff. SanPin (the washing scheme remains the same) stipulates that skin cleansing before surgical procedures can be carried out using the same means as hygiene.

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

Rules for treating hands with antiseptic

After thoroughly washing the skin of your hands, wrists and forearms, you need to dry them. After this, the established standard for hand treatment for workers in operating rooms requires the use of special disinfectants.

Before this, if necessary, you need to treat the nail beds and periungual folds. For these purposes, use sterile disposable wooden sticks, which must be additionally moistened with an antiseptic.

The disinfectant is applied 2.5 ml to the hands and forearms. One treatment of two hands should require about 10 ml of disinfectant liquid. The antiseptic must be rubbed into the skin according to the same pattern as hand washing, observing the correct sequence of movements.

Only after complete absorption/evaporation of the product can you put on gloves. If the surgical operation lasts more than 3 hours, the treatment is repeated. After all, pathogenic microorganisms can begin to multiply again under gloves.

Final stage

But this is not all levels of hand treatment. It is important to remove gloves after working with gloves and wash your hands with soap. In this case, there is no longer any need to use a disinfectant solution. Washing with liquid soap is sufficient, preferably with a neutral pH.

After cleaning the skin, it is necessary to moisturize it. Various creams and lotions are used for these purposes. Their main purpose is to prevent the drying effect of alcohol-containing disinfectants.

It is also worth noting that hand hygiene in the absence of visible contamination can be performed without washing. In most cases, it is enough to use antiseptic solutions for 30-60 seconds.

Possible complications

It is worth noting that regular use of disinfectants does not have the best effect on the skin of medical workers. There are two main types of reactions that hospital employees encounter. Most often they complain of itching, dryness, irritation, cracks with bleeding. These symptoms can be either minor or significantly affect the general condition of workers.

There is also another type of complications - allergic dermatitis. They occur when there is intolerance to any components of products intended for hand disinfection. Allergic dermatitis can manifest itself in both mild localized and severe generalized forms. In the most advanced cases, they can be combined with respiratory distress syndrome or other manifestations of anaphylaxis.

Prevalence of complications and their prevention

The significance of the problem can be understood by knowing that such hand cleaning practices result in 25% of nurses presenting with signs of dermatitis, and 85% report a history of skin problems.

The irritating effect of antiseptics can be slightly reduced by adding emollients to them. This is one way to reduce the incidence of contact dermatitis. The risk of their occurrence can also be minimized if you use moisturizers that are designed to care for the skin of your hands after each wash.

To prevent the development of complications, do not wash your hands every time before treating them with an antiseptic. It is also important to ensure that gloves are only put on 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 occurrence of contact dermatitis. However, research has failed to confirm their unambiguous effectiveness. Many are stopped by the high price of these creams.

Hygienic treatment of the hands of medical staff: methods, algorithm and preparations

Hygienic treatment of the hands of medical staff is a mandatory procedure before performing any action with the patient. For processing, various means and preparations are used that do not require a lot of time and are approved by the Pharmacology Committee of the Russian Federation.

Why is disinfection needed?

Hand hygiene is a disinfecting procedure that prevents hospital-acquired infections, protecting not only the staff themselves, but also the patients. The purpose of the treatment is to neutralize microbes that are on human skin after contact with an infected object or are part of the natural flora of the skin.

There are two types of procedures: hygienic and surgical hand treatment. The first is mandatory before contacting the patient, especially if he must undergo surgery. Hygienic treatment of personnel's hands must be carried out after contact with saliva and blood. Disinfection must be carried out before sterile gloves are put on. You can wash your hands with a special soap that has an antiseptic effect or wipe your skin with a product containing alcohol.

When to perform hygienic treatment

Hygienic treatment of the hands of medical staff is mandatory in the following situations:

1. After therapy for patients diagnosed with an inflammatory process with the release of pus.
2. After contact with devices and any other object located near the patient.
3. After each contact with contaminated surfaces.
4. After contact with human mucous membranes, human excreta and gauze dressings.
5. After contact with the patient's skin.
6. Before performing casualty care procedures.
7. Before each contact with the patient.

Correctly carried out hygienic treatment involves washing with soap and running water in order to get rid of contaminants and reduce the number of microorganisms. In addition, hand cleaning in a hygienic way also includes procedures for treating the skin with antiseptic agents, which help reduce the number of bacteria to a minimum safe level.

What is used for processing

Liquid soap, which is dispensed using a dispensary, is ideal for washing the hands of medical staff. It is not recommended to use hot water due to the increased risk of dermatitis. Be sure to use a towel to close a faucet that is not equipped with an elbow drive. In order to dry clean hands, you should use disposable paper towels (or individual fabric ones).

Hygienic hand treatment, the algorithm of which includes several simple steps, can be carried out using a skin antiseptic. In this case, pre-washing with soap is not necessary. The product is rubbed into the skin of the hands in the amount indicated on the antiseptic packaging. Particular attention is paid to the fingers, the skin between them and the areas around the nails. A prerequisite for achieving the desired effect is keeping your hands wet for a certain time (usually indicated on the product). After hand hygiene has been carried out, there is no need to dry them with a towel.

Equipment for hygiene procedures

In order for the hygiene procedure to be carried out in accordance with all rules and requirements, the following is necessary:

• Running water.
• Liquid soap with a neutral pH level.
• Washbasin with mixer, operated without the touch of your palms (elbow method).
• Alcohol based antiseptic.
• Disposable towels, both sterile and non-sterile.
• Detergent with antimicrobial action.
• Disposable rubber gloves (sterile or non-sterile).
• Hand skin care product.
• Household rubber gloves.
• Bin for used supplies.

Mandatory requirements

In the room where antimicrobial hand treatment is planned, the washbasin should be located in an accessible place. It is equipped with a tap through which hot and cold water flows, and a special mixer. The faucet must be designed in such a way that splashing water is minimal. The hygienic level of hand treatment involves the maximum reduction in the number of microorganisms on the skin, so it is advisable to install several dispensers with products next to the washbasin. One contains liquid soap, the other contains an antimicrobial drug, and another should be filled with a product that cares for the skin of the hands.

It is not recommended to dry your hands using electric dryers, as they will still remain wet, and the device causes air turbulence, where contaminated particles may be located. All containers with products must be disposable. Hospitals should always have several hand antiseptics on hand, some of which are intended for workers with sensitive skin.

Algorithm

Hand hygiene is mandatory for all healthcare workers. The algorithm for cleansing with soap is as follows:

1. Squeezing out the required amount of liquid soap from the dispenser.
2. Rubbing in palm-to-palm mode.
3. Rubbing one palm of the hand on the back of the other.
4. Rubbing the inner surfaces of the fingers vertically.
5. Rubbing the back of the fingers of the hand folded into a fist onto the palm of the other (do the same with the other hand).
6. Rubbing all fingers in a circular motion.
7. Rubbing each palm with your fingertips.

Surgical disinfection

Surgical hand disinfection is required to completely remove flora from the hands: resistant, as well as transistor. This is done to prevent the infection from being transmitted through hands. Like hand hygiene, surgical disinfection is performed by washing and wiping. The use of alcohol solutions is widespread due to the rapid and targeted action, optimal skin perception of the product, long period of action, and the effect of complete removal of microorganisms.

The process of surgical disinfection includes almost the same steps that involve hand cleaning at a hygienic level. Algorithm for surgical antisepsis:

1. Wash your hands with water and soap for at least two minutes.
2. Dry your hands using a disposable napkin or towel.
3. Treat your hands, forearms, and wrists with an antiseptic, without wiping your hands afterward.
4. Wait for the product to dry completely and put on sterile gloves.

The exposure time of a particular antiseptic drug, its dosage and other important parameters can be read on the product label or in its instructions. The first hand treatment of each work shift should include the stage of cleaning the areas around each nail using a special soft brush - sterile and disposable (or one that has been sterilized by autoclaving).

Antiseptic treatment

An antiseptic solution is one of the main means of combating microorganisms, which includes hand hygiene. The algorithm is as follows:

1. Wash your hands in water at room temperature with liquid soap, dry with a disposable towel.
2. Apply the disinfectant using rubbing movements, which disinfects the hands.
3. With interlaced fingers, massage the backs of your hands.
4. With crossed fingers, widely spaced, rub your palms.
5. Rub the product into your thumbs with clenched palms one at a time.
6. Rubbing the forearms for at least 2 minutes, maximum 3 minutes, treating the nails and subungual area.

Each stage must be repeated 4-5 times. Throughout the entire procedure, you must ensure that your hands do not dry out. If necessary, apply another portion of the disinfectant.

Hand hygiene is a mandatory disinfection process for all medical personnel who come into contact with patients or various contaminated hospital facilities. For processing, chlorhexidine bigluconate (alcohol solution) in ethyl alcohol (70%) is used. In addition, the following drugs are used:

• "Octenisept."
• Ethyl alcohol with additives that effectively soften the skin.
• "Octeniderm".
• "Chemisept."
• "Higenix."
• “Isopropanol” – 60%.
• "Octenman."
• "Dekosept+".
• "Veltosept".

Before carrying out hygienic treatment, be sure to remove all wrist accessories and jewelry. Don't forget to clean your hands with a sterile brush, paying special attention to the nail area. The procedure is carried out once at the beginning of the working day.

Requirements for hygiene products

If antiseptic and soap containers are not disposable, then refilling should only be done after they have been thoroughly disinfected, rinsed under running water and completely dried. It is recommended to use dispensers that operate on photocells or those from which the product is squeezed out using the elbow.

All used antiseptics intended for skin treatment should be readily available at all stages of the treatment process. If the unit is aimed at intensive patient care, then containers with antiseptics should be placed in places that are most convenient for medical personnel, for example, at the patient’s bedside or near the entrance to the hospital ward. It is recommended to provide each employee with an individual small container of antiseptic.

Rules for antiseptic hand treatment drawing

2. HANDS TREATMENT OF MEDICAL STAFF

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

Rules for preparing for hand treatment:

1. Remove rings and watches.

2. Nails must be cut short; polish is not allowed.

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

All jewelry and watches are removed from hands, as they make it difficult to remove microorganisms. Hands are soaped and then rinsed warm running water and everything repeats itself from the beginning. It is believed that the first time you soap and rinse with warm water, germs are washed off from the skin of your hands. Under the influence of warm water and self-massage during mechanical treatment, the pores of the skin open, so when repeated soaping and rinsing, germs are washed away from the opened pores. Warm water makes the antiseptic or soap work more effectively, while hot water removes the protective fat layer from the surface of the hands. Therefore, you should avoid using too hot water to wash your hands.

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

There are three levels of hand treatment:

1. Household level (mechanical hand treatment);

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

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

1. Mechanical treatment of hands

The purpose of household hand treatment is to mechanically remove most of the transient microflora from the skin (antiseptics are not used).

· after visiting the toilet;

· before eating or working with food;

· before and after physical contact with the patient;

· for any contamination of hands.

Required equipment:

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

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

Hand treatment - the necessary sequence of movements:

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

2. Use your right palm to rub the back surface of your left hand, switch hands.

3. Connect the fingers of one hand in the interdigital spaces of the other, rub the inner surfaces of the fingers with up and down movements.

4. Connect your fingers into a “lock” and rub the palm of your other hand with the back of your bent fingers.

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

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

HAND HYGIENIC RULES

European standard E N -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 of hands with fingers crossed

Outer side of fingers on opposite palm with fingers crossed

Circular rubbing of the left thumb in the closed palm of the right hand and vice versa

Circular rubbing of the closed fingertips of the right hand on the left palm and vice versa

2. Hand hygiene

The purpose of hygienic treatment is to destroy resident microflora from the surface of the skin of the hands using antiseptics.

A similar hand treatment is carried out:

· before putting on gloves and after taking them off;

· before caring for a patient with a weakened immune system or during ward rounds (when it is not possible to wash hands after examining each patient);

· before and after performing invasive procedures, minor surgical procedures, wound care or catheter care;

· after contact with biological fluids (for example, emergency situations with blood).

Required equipment:

2. Napkins measuring 15x15 cm, disposable, clean (paper or fabric).

3. Skin antiseptic. It is advisable to use alcohol-containing skin antiseptics (70% ethyl alcohol solution; 0.5% solution of chlorhexidine bigluconate in 70% ethyl alcohol, AHD-2000 special, Sterillium, Sterimax, etc.).

Hand hygiene consists of two stages:

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

2 - disinfection of hands with a skin antiseptic.

3. Surgical treatment of hands

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

A similar hand treatment is carried out:

· before surgical interventions;

· before serious invasive procedures (for example, puncture of large vessels).

Required equipment:

1. Liquid dosed pH-neutral soap.

2. Wipes measuring 15x15 cm are disposable, sterile.

3. Skin antiseptic.

4. Disposable sterile surgical gloves.

Hand treatment rules:

Surgical treatment of hands consists of three stages:

1 - mechanical cleaning of hands followed by drying,

2 - hand disinfection with skin antiseptic twice,

3 - covering hands with sterile disposable gloves.

In contrast to the above-described method of mechanical cleaning at the surgical level, the forearms are included in the treatment; sterile wipes, and itself hand washing lasts at least 2 minutes. After drying, the nail beds and periungual folds are additionally treated with disposable sterile wooden sticks soaked in an antiseptic solution.

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

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

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

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

Bacteriological control of the effectiveness of personnel hand treatment.

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

Dermatitis associated with frequent hand cleaning

Repeated hand cleaning may cause skin dryness, cracking and dermatitis in sensitive subjects. A healthcare worker suffering from dermatitis increases the risk of infection for patients due to:

· the possibility of colonization of damaged skin by pathogenic microorganisms;

Difficulties in adequately reducing the number of microorganisms when washing hands;

Tendency to avoid hand-handling.

Measures to reduce the likelihood of developing dermatitis:

Thorough rinsing and drying of hands;

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

· usage modern and various antiseptics;

· mandatory use of moisturizing and softening creams.

Skin microflora

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

1. Resident flora

2. Transitory flora

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

Resident microflora cannot be destroyed by regular hand washing or even antiseptic procedures, although its numbers are significantly reduced. Sterilization of the skin of the hands is not only impossible, but also undesirable: because normal microflora prevents the colonization of the skin by other, much more dangerous microorganisms, primarily gram-negative bacteria.

2. Transient microflora are those microorganisms that are acquired by medical personnel as a result of contact with infected patients or contaminated environmental objects. Transient flora can be represented by much more epidemiologically dangerous microorganisms (E.coli, Klebsiella spp., Pseudomonas spp., Salmonella spp. and other gram-negative bacteria, S.aureus, C. albicans, rotaviruses, etc.), including hospital strains of pathogens of nosocomial infections. Transient microorganisms remain on the skin of the hands for a short time (rarely more than 24 hours). They can be easily removed by regular hand washing or destroyed by using antiseptics. While these microbes remain on the skin, they can be transmitted to patients through contact and contaminate various objects. This circumstance makes the hands of personnel the most important factor in the transmission of infection.

If the integrity of the skin is compromised, then transient microflora can cause an infectious disease (for example, whitlow or erysipelas). You should be aware that in this case, the use of antiseptics does not make your hands safe from the point of view of transmission of infection. Microorganisms (most often staphylococci and beta-hemolytic streptococci) remain on the skin during the disease until recovery occurs.

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It is known that human skin performs a number of important functions, one of which is protection from harmful environmental factors. The skin, especially the skin of the hands, is constantly populated by microorganisms. Intact (unharmed) human skin, even thoroughly washed, is colonized by microorganisms that can be different for individual areas of the skin and relatively constant for each person.

The microflora of human skin is divided into resident and transient.

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 sebaceous, sweat glands and hair follicles, and are mainly represented by coagulase-negative staphylococci (usually Staphylococcus epidermidis) and diphtheroids (Coryntbacterium spp.). Basically, resident microflora does not cause pathological processes in patients with intact skin, 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 hand sterilization 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 an antimicrobial effect.

Transient (temporary) microflora is represented by microorganisms that temporarily settle on the skin of the hands; they colonize the surface layers of the skin and are of greatest epidemiological significance. Transient microflora can consist of any microorganisms, including pathogenic ones, including pathogens of nosocomial (nosocomial) infections, such as Escherihia coli, Klebsiella spp, Pseudomonas spp, Salmonella spp., St. Aureus (including MRSA), Candidae albicans, rotaviruses, etc. When the skin is damaged, including during the use of inadequate methods of washing and disinfecting hands, the transient microflora penetrates deeper into the skin, displacing the resident flora.

The transmission of microorganisms through the hands 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. At the same time, 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 the 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 an analysis of statistics from the American Society for Disease Control and Prevention (CDC), about 2 million patients annually acquire hospital-acquired infections during treatment. The so-called nosocomial or hospital-acquired infections cause not only the suffering and death of patients. They also cause significant economic damage, costing the United States $5 billion annually in additional hospitalizations and expensive antibiotic treatments. All of the above once again emphasizes the extreme importance of strict adherence to hand hygiene principles.

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- This is washing your hands with water and regular (not antiseptic) soap.

Hygienic hand disinfection carried out to reduce the number of pathogenic microorganisms on the skin of the hands, used in the following cases:

• before direct contact with the patient;
• before performing invasive procedures;
• before and after manipulations with 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 immune systems;
• 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 cleansing. There are two ways to hygienically disinfect hands: hygienic hand washing and treating (wiping) hands with an antiseptic.

Hygienic hand washing - This is hand washing with water and soap or another detergent containing an antiseptic. 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.

Treating hands with antiseptic is more often used in practice and, according to the results of laboratory studies, is more effective. Hands are wiped with a sufficient amount of antiseptic without adding water to it before and during the procedure (most often this is a preparation 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 . In this case, you need to treat your nails and fingertips most carefully.

Hygienic hand treatment(using an antiseptic) after performing medical procedures should be carried out before washing, and not vice versa, in order to avoid contamination of surrounding surfaces by pouring out contaminated water. When caring for patients with infections caused by spore-forming bacteria (eg, Clostridium difficile), using antiseptics alone without first washing hands will not provide reliable decontamination due to the fact that they are not sporicidal. activity. In such cases, as well as if the skin needs to be cleaned of visible contaminants (including organic origin), previous hygienic hand washing is mandatory before treating 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 product 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 your hands, you must first moisten them with water, then apply the required amount of product and thoroughly rub your hands for at least 15 seconds to treat the entire surface of your hands and fingers, then wash your hands with water and dry them thoroughly using a disposable towel, which is used to turn off the tap. ;
• It is advisable to use small pieces of soap and use stands in the form of grids for quick drying.
• It is not recommended to use reusable fabric towels.

Surgical hand disinfection- this is a treatment of hands before surgery, ensuring the removal of transient and reducing the amount of resident microflora of the hands.

Surgical hand disinfection can be performed using special antiseptic formulations during surgical cleansing. This method has been used for a long time, and the recipes used have long been known. These are such as treatment with chlorhexidine digluconate (Gibitan), formulation 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 using the above-mentioned antiseptic formulations during surgical washing also leads to mechanical damage to the skin and the appearance of microtraumas.

Promising today is the use of antiseptics made on the basis of a combination of alcohols with other antimicrobial additives for surgical disinfection of hands. Such drugs are characterized by a rapid detrimental effect on microflora and high antimicrobial properties. For surgical disinfection of hands, 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 - wrists and forearms require additional treatment) and an extension of time and exposure 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 multiplying on the skin of the hands under gloves, the use of antiseptics with components that provide a prolonged antimicrobial effect is quite effective. Reducing the number of resident bacteria on the skin of the hands of members of the surgical team during surgery reduces the risk of bacteria entering the surgical field in cases of puncture or tearing of gloves during surgical interventions.

To effectively carry out surgical hand disinfection, you must strictly adhere to the following rules:

• before surgical disinfection, rings, rings, watches and bracelets must be removed;
• Wash your hands with water and soap, preferably liquid (the use of antiseptic soap is not necessary);
• dry thoroughly using sterile wipes (before starting treatment with an antiseptic, the skin must be completely dry, because rubbing the antiseptic into moistened skin leads to its dilution, a decrease in the effective concentration and, as a result, to the impossibility of achieving the desired result.
• During treatment, the skin areas should remain moisturized with an antiseptic, while the drug is applied to the hands in portions of 3-5 ml;
• completely dry the skin before putting on sterile gloves in order to prevent intensive proliferation of microorganisms, which can occur in the wet layer.

Among the available antiseptics, alcohols are the safest, while ethyl alcohol has a less irritating effect than propyl or isopropyl alcohol.

Side effects of antiseptics on the skin of personnel’s hands.

According to various studies, approximately 25% of nursing staff experience symptoms and signs of dermatitis localized to the skin of the hands. Skin irritation associated with the use of antiseptic soap may be due to both the antimicrobial substance included in its composition and other components. Damage to the skin also leads to changes in the composition of its microflora, increasing the frequency of colonization by staphylococci and gram-negative microorganisms.

Among the available antiseptics, alcohols are the safest, while ethyl alcohol is less irritating than n-propyl or isopropyl alcohol. Most often, contact dermatitis is observed when using iodoform. Other antiseptics that can cause contact dermatitis include chlorhexidine, chloroxylene, triclosan, and alcohol-based products. However, factors that cause contact dermatitis associated with frequent hand washing may include the use of very hot water for washing, low relative humidity (especially in winter), insufficient use of barrier creams, poor quality paper towels and latex allergies.

It is worth noting that most often the cause of contact allergies when using hand hygiene products is fragrances 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 must be borne in mind that to enhance the antimicrobial properties, alcohol-containing preparations are combined with various substances, for example, quaternary ammonium compounds (QAC), lactic acid, chlorhexidine digluconate, octenidine hydrochloride, etc.

Recently, new antiseptics in the form of gels have been offered on the antiseptic market.

Thanks to their formulation, such preparations are suitable for antiseptic treatment of skin that is particularly sensitive to irritation.

To prevent the occurrence of contact dermatitis, it is advisable to consider options for reducing the risk of their occurrence, which may include:

• reducing the frequency of use of irritating agents (especially anionic detergents);
• replacing products that have a strong irritant effect with those that irritate the skin less;
• training health workers in the correct use of antiseptics;
• providing health workers with skin care products and protective creams.

Reducing the frequency of hand antiseptic use is not a desirable strategy given the low level of hand hygiene compliance among HCWs. The introduction into practice of alcohol-containing antiseptics with softening additives can reduce the frequency of exposure of personnel to irritating substances (soaps and detergents).

General approaches to the selection of antiseptics

The administration of a health care facility should take into account that the acquisition of more effective antiseptics improves hand hygiene practices, which means it is possible to prevent the occurrence of hospital-acquired infections. The attention of just a few cases of hospital-acquired infections offsets the additional costs for HCPs associated with purchasing more effective hand hygiene products.

When choosing an antiseptic for hand hygiene, it is necessary to take into account the opinion of the personnel of the compatibility of antiseptics with the skin and the frequency of irritation due to their use.

The cost of hand hygiene products should not be the main factor when choosing them, because low-priced disinfectants may not contain highly effective skin care additives that prevent allergies and skin irritations.

1. General Provisions

1.2. Definition of terms

- Antimicrobial agent- a product that suppresses the vital activity of microorganisms (disinfectants, antiseptics, sterilants, chemotherapeutic agents, including antibiotics, cleansers, preservatives).

- Antiseptics- chemical substances of microbostatic and microbicidal action, used for preventive and therapeutic antiseptics of intact and damaged skin and mucous membranes, cavities, and wounds.

- Hand sanitizer- an alcohol-based product with or without the addition of other compounds, intended for decontamination of the skin of the hands in order to interrupt the chain of transmission of infection.

- Nosocomial infection (HAI)- any clinically significant disease of an infectious nature that affects a patient as a result of a stay in a hospital or a visit to a medical institution, as well as infections that occur among personnel of a healthcare institution as a result of their professional activities.

- Hygienic hand antisepsis- This is hand treatment by rubbing an antiseptic into the skin of the hands to eliminate transient microorganisms.

- Invasive interventions- the use of devices and devices that overcome the natural barriers of the body, with which the pathogen can penetrate directly into the bloodstream, organs and systems of the patient’s body.

- Routine hand washing- washing procedure with water and regular (non-antimicrobial) soap.

- Irritant contact dermatitis (IC)- unpleasant sensations and changes in the condition of the skin, which can manifest themselves in dry skin, itching or burning, redness, peeling of the epidermis and the formation of cracks.

- Resident microorganisms- microorganisms that constantly live and reproduce on the skin.

- Spore-forming bacteria- these are bacteria that have the ability to form special structures covered with a dense shell, they are conventionally called spores, they are highly resistant to the action of many physicochemical factors.

- Transient microorganisms- microorganisms that temporarily enter the surface of human skin upon contact with various living and non-living objects.

- Surgical hand antisepsis- this is a procedure for rubbing an antimicrobial agent (antiseptic) into the skin of the hands (without the use of water) to eliminate transient microorganisms and reduce the number of resident microorganisms as much as possible.

- Surgical hand washing is a hand washing procedure using a special antimicrobial agent to eliminate transient microorganisms and reduce the number of resident microorganisms as much as possible.

1.3. Hand hygiene involves surgical and hygienic treatment of hands, simple washing and protection of the skin of the hands.

1.4. For hand hygiene, medical personnel use antiseptic agents registered in Ukraine in accordance with the established procedure.

2. General requirements

2.1. Healthcare facility staff keep their hands clean. It is recommended that nails be cut short and level with the tips of the fingers, without varnish or cracks on the surface of the nails, and without false nails.

2.2. Before hand treatment, bracelets, watches, and rings are removed.

2.3. Hand hygiene equipment

Tap water.
- Washbasin with cold and hot water and a mixer, which it is advisable to operate without touching your hands.
- Closed containers with water taps if there are problems with water supply.
- Liquid soap with neutral pH.
- Alcohol antiseptic.
- Antimicrobial detergent.
- Skin care product.
- Non-sterile and sterile disposable towels or napkins.
- Dispensing devices for detergents, disinfectants, skin care products, towels or napkins.
- Containers for used towels and napkins.
- Disposable rubber gloves, non-sterile and sterile.
- Household rubber gloves.

2.4. In the room where hand washing is carried out, the washbasin is located in an easily accessible place, equipped with a tap with cold and hot water and a mixer, which should preferably be operated without touching hands, and the water stream should be directed directly into the drain siphon to prevent splashing of water.

2.5. It is advisable to install three dispensers near the washbasin:
- with antimicrobial hand treatment;
- with liquid soap;
- with skin care product.

2.7. Each hand washing station, if possible, is equipped with dispensers for disposable towels, napkins and a container for used products.

2.9. Do not add product to antiseptic dispensers that are not completely emptied. All emptied containers must be filled aseptically to prevent contamination. It is recommended to use disposable containers.

2.10. It is recommended that dispensers for detergents and skin care products be thoroughly washed and disinfected before each new refill.

2.12. In the absence of a centralized water supply or in the presence of another problem with water, departments are provided with closed water containers with taps. Boiled water is poured into the container and changed at least once a day. Before further filling, the containers are thoroughly washed (disinfected if necessary), rinsed and dried.

3. Surgical treatment of hands

Surgical hand cleaning is an important and responsible procedure that is carried out before any surgical intervention in order to prevent infection of the patient’s surgical wound and at the same time protect personnel from infections transmitted through the blood or other secretions of the patient’s body. It consists of several stages:
- regular hand washing;
- surgical hand antisepsis, or washing them using a special antimicrobial agent;
- putting on surgical gloves;
- hand treatment after surgery;
- hand skin care.

3.1. Routine hand washing before surgical hand preparation

3.1.1. Routine washing before surgical hand treatment is carried out in advance in the department or airlock room of the operating unit, alternatively - in the room for antiseptic hand treatment, in the preoperative room before the first operation, and subsequently - as necessary.
Regular washing is intended exclusively for mechanical cleaning of hands, while dirt and sweat are removed from the hands, spore-forming bacteria are partially washed away, as well as partially transient microorganisms.

3.1.2. To wash your hands, use regular liquid or powder soap or washing lotion with a neutral pH. Preference should be given to liquid soap or washing lotion. The use of soap in bars is unacceptable.

3.1.4. Given the large number of microorganisms under the nails, mandatory treatment of the subungual areas is recommended. To do this, use special sticks or soft disinfected brushes, preferably disposable ones.

3.1.5. Hands are washed with warm water. Hot water leads to degreasing and irritation of the skin, as it enhances the penetration of detergents into the epidermis of the skin.

3.1.6. The usual washing technique is as follows:
- the hands and forearms are moistened with water, then the detergent is applied so that it covers the entire surface of the hands and forearms. Hands with fingertips raised up and forearms, with elbows low, should be washed for about one minute. Particular attention should be paid to the treatment of subungual areas, nails, periungual ridges and interdigital areas;

3.2. Surgical hand antisepsis

3.2.1. Surgical hand antisepsis is carried out using various alcohol antiseptics by rubbing them into the hands and forearms, including the elbows.

3.2.2. Rubbing in the product is carried out in accordance with the developed standard procedure:

If necessary, wash your hands with detergent and rinse thoroughly;
- dry your hands thoroughly with a disposable towel;
- using a dispenser (press the lever with your elbow), pour the antiseptic into the recess of your dry palm;
- first moisten your hands with an antiseptic, then your forearms and elbows;
- rub in the antiseptic in separate portions for the time specified by the developer, while keeping the hands above the elbows;
- after antiseptic treatment, do not use a towel, wait until your hands are completely dry, put gloves only on dry hands.

3.2.3. The antiseptic is applied to the hands in portions (1.5 - 3.0 ml), including the elbows, and rubbed into the skin for the time specified by the developer. The first portion of antiseptic is applied only to dry hands.

3.2.4. Throughout the entire time of rubbing in the antiseptic, the skin is kept moist from the antiseptic, so the number of portions of the rubbed product and its volume are not strictly regulated.

3.2.5. During the procedure, special attention is paid to the standard method of treating hands with an antiseptic in accordance with EN 1500.

Each stage of processing is repeated at least 5 times. When performing hand treatment techniques, the presence of so-called “critical” areas of the hands that are not sufficiently wetted with the product is taken into account: thumbs, fingertips, interdigital areas, nails, periungual ridges and subungual areas. The surfaces of the thumb and fingertips are treated most thoroughly, since the largest number of bacteria are concentrated on them.

3.2.6. The last portion of the antiseptic is rubbed in until it dries completely.

3.2.7. Sterile gloves are worn only on dry hands.

3.2.8. After the operation/procedure is completed, the gloves are removed, hands are treated with an antiseptic for 2 x 30 s, and then with a hand skin care product. If blood or other secretions get on your hands under gloves, these contaminants are first removed with a swab or napkin moistened with an antiseptic, and washed with detergent. Then thoroughly wash with soap and water and dry with a disposable towel or napkins. After this, the hands are treated with an antiseptic 2 x 30 s.

3.3. Surgical hand washing

Surgical hand washing consists of two phases: phase 1 - normal washing and phase 2 - washing with a special antimicrobial agent.

3.3.1. Phase 1 - normal hand washing - is carried out in accordance with clause 3.1.

3.3.2. Before starting phase 2 of surgical washing, hands, forearms and elbows are moistened with water, with the exception of those products that, as directed by the developer, are applied to dry hands and then water is added.

3.3.3. An antimicrobial detergent in quantities specified by the developer is applied to the palms and distributed over the surface of the arms, including the elbow creases.

3.3.4. Hands with fingertips pointing upward and forearms with low elbows are treated with the product for the time specified by the developer of this product.

3.3.5. Throughout the washing process, the hands and forearms are moistened with an antimicrobial detergent, so the amount of the product is not strictly regulated. Keep your hands up all the time.

3.3.6. When washing, adhere to the sequence of actions in accordance with that specified in paragraphs. 3.2.2 and 3.2.5.

3.3.7. Hands are dried with a sterile towel or sterile wipes using aseptic technique, starting with the fingertips.

3.3.8. Surgical sterile gloves are worn only on dry hands.

3.3.9. After the operation/procedure, gloves are removed and hands are treated with an antiseptic according to clause 3.2.8.

3.4. If no more than 60 minutes pass between operations, only antiseptic surgical treatment of the hands is performed.

4. Hand hygiene

Hand hygiene includes normal hand washing water and regular (non-antimicrobial) soap and hygienic hand antiseptics, i.e. rubbing an alcohol antiseptic, without using water, into the skin of the hands in order to reduce the number of microorganisms on them.

Requirements for antimicrobial agents and alcohol antiseptics

1. Antimicrobial and antiseptic alcohol-containing rubbing agents must meet the following requirements:
- a wide spectrum of antimicrobial action in relation to transient (hygienic hand treatment) and transient and resident microflora (surgical hand treatment);
- quick action, that is, the duration of the hand treatment procedure should be as short as possible;
- prolonged action (after treating the skin of the hands, the antiseptic must delay the reproduction and reactivation of resident microorganisms for a certain time (3 hours) under medical gloves);
- activity in the presence of organic substrates;
- no negative effects on the skin;
- the lowest possible dermal resorption;
- absence of toxic, allergenic side effects;
- absence of systemic mutagenic, carcinogenic and teratogenic effects;
- low probability of developing resistance of microorganisms;
- readiness for immediate use (does not require advance preparation);
- acceptable consistency and smell;
- easy rinsing from the skin of the hands (for detergent compositions);
- long shelf life.

2. All antimicrobial agents, regardless of the method of their use, must be active against transient bacteria (with the exception of mycobacteria), fungi of the genus Candida, and enveloped viruses.

3. Products used in phthisiatric, dermatological, and infectious diseases departments must be additionally examined in tests for Mycobacterium terrae (tuberculecidal activity) for use in phthisiological departments, for Aspergillus niger (fungicidal activity) for use in dermatological departments, for Poliovirus, Adenovirus (virucidal activity) for use in infectious diseases departments if necessary.

The standard procedure during the working day is hand antiseptic treatment without the use of water, i.e. rubbing alcohol antiseptic into the skin of the hands.

4.1. Indications

4.1.1. Routine hand washing using a non-antimicrobial detergent is recommended:
- at the beginning and end of the working day;
- before preparing and serving food;
- in all cases, before treatment with an antiseptic, when hands are clearly dirty;
- in case of contact with pathogens of enteroviral infections in the absence of appropriate antiviral agents, it is recommended to mechanically eliminate viruses with prolonged hand washing (up to 5 minutes);
- upon contact with spore microorganisms - prolonged hand washing (minimum 2 minutes) to mechanically eliminate spores;
- after using the toilet;
- in all other cases, in the absence of a risk of infection or special instructions.

4.1.2. Hand hygiene using alcohol antiseptics is recommended before:
. entrance to aseptic rooms (preoperative, sterilization departments, intensive care units, hemodialysis, etc.);
. performing invasive interventions (installation of catheters, injections, bronchoscopy, endoscopy, etc.);
. activities in which infection of the object is possible (for example, preparing infusions, filling containers with solutions, etc.);
. every direct contact with patients;
. transition from an infected to an uninfected area of ​​the patient’s body;
. contact with sterile material and instruments;
. using gloves.
After:
. contact with contaminated objects, liquids or surfaces (for example, with a urine collection system, contaminated linen, biosubstrates, patient secretions, etc.);
. contact with already inserted drainages, catheters or their insertion site;
. every contact with wounds;
. every contact with patients;
. removing gloves;
. using the toilet;
. after cleaning the nose (with rhinitis, there is a high probability of a viral infection with subsequent isolation of S.aureus).

4.1.3. The given indications are not final. In a number of specific situations, staff make independent decisions. In addition, each healthcare institution can develop its own list of indications, which are included in the plan for the prevention of nosocomial infections, taking into account the specifics of a particular department.

4.2. Regular washing

4.2.1. Regular washing is intended exclusively for mechanical cleaning of hands, while dirt and sweat are removed from the hands, spore-forming bacteria are partially washed off, as well as other transient microorganisms are partially washed away. The procedure is carried out according to paragraphs. 3.1.2.-3.1.5.

4.2.2. The usual washing technique is as follows:
- the hands are moistened with water, then the detergent is applied so that it covers the entire surface of the hands and wrists. Hands are washed for about 30 seconds. Particular attention is paid to the treatment of subungual zones, nails, periungual ridges and interdigital zones;
- after treatment with detergent, hands are thoroughly washed with soap and water and dried with disposable towels or napkins. The last napkin is to close the water tap.

4.3. Hygienic antiseptics

4.3.1. The standard method of rubbing in an antiseptic includes 6 stages and is presented in paragraph 3.2.5. Each stage is repeated at least 5 times.

4.3.2. An antiseptic in an amount of at least 3 ml is poured into the recess of a dry palm and vigorously rubbed into the skin of the hands and wrists for 30 seconds.

4.3.3. During the entire time of rubbing the product, the skin is kept moist from the antiseptic, so the number of servings of the rubbed product is not strictly regulated. The last portion of the antiseptic is rubbed in until it dries completely. Wiping hands is not allowed.

4.3.4. When performing hand treatment, take into account the presence of so-called “critical” areas of the hands that are not sufficiently moistened with an antiseptic: thumbs, fingertips, interdigital areas, nails, periungual ridges and subungual areas. The surfaces of the thumb and fingertips are treated most thoroughly, since the largest number of bacteria are concentrated on them.

4.3.5. If there is visible contamination of your hands, remove it with a napkin moistened with an antiseptic and wash your hands with detergent. Then thoroughly wash with soap and water and dry with a disposable towel or napkins. Close the tap with the last napkin. After this, the hands are treated with an antiseptic twice for 30 seconds.

5. Use of medical gloves

5.1. The use of gloves does not provide an absolute guarantee of protection of patients and staff from infectious agents.

5.2. The use of medical gloves protects patients and medical personnel from the spread of transient and resident microflora directly through the hands and indirectly through contact with contaminated environmental objects.

5.3. Three types of gloves are recommended for use in medical practice:
- surgical- used for invasive interventions;
- examination rooms- provide protection for medical staff when performing many medical procedures;
- household- provide protection for medical personnel when processing equipment, contaminated surfaces, instruments, when working with waste from medical institutions, etc.

5.4. Sterile gloves are recommended for use when:
- in all surgical interventions, to reduce the frequency of punctures, it is recommended to use two gloves put on each other, replacing the outer glove every 30 minutes. during the operation; It is also recommended to use gloves with a perforation indicator, in which damage to the glove quickly leads to a visible change in color at the puncture site;
- invasive manipulations (intravenous infusions, collection of biosamples for research, etc.);
- installation of a catheter or guidewire through the skin;
- manipulations associated with contact of sterile instruments with intact mucous membranes (cystoscopy, bladder catheterization);
- vaginal examination;
- bronchoscopy, endoscopy of the gastrointestinal tract, tracheal sanitation;
- contact with endotracheal suctions and tracheostomies.

5.5. Non-sterile gloves are recommended for use when:
- contact with hoses of artificial respiration devices;
- working with biological material from patients;
- blood sampling;
- carrying out intramuscular and intravenous injections;
- cleaning of equipment and disinfection;
- removal of secretions and vomit.

5.6. Requirements for medical gloves:
- for operations: latex, neoprene;
- for inspections: latex, tactilon;
- when caring for the patient: latex, polyethylene, polyvinyl chloride;
- it is allowed to use fabric gloves under rubber ones;
- gloves must be of the appropriate size;
- gloves must provide high tactile sensitivity;
- contain a minimum amount of antigens (latex, latex proteins);
- when choosing medical gloves, it is recommended to take into account possible allergic reactions in the patient’s history to the material from which the gloves are made;
- for pre-sterilization cleaning of sharp medical instruments, it is necessary to use gloves with a textured outer surface.

5.7. Immediately after use, medical gloves are removed and immersed in a disinfectant solution directly at the place where the gloves are used.

5.8. After disinfection, disposable gloves must be disposed of.

5.9. Rules for using medical gloves:
- the use of medical gloves does not create absolute protection and does not exclude compliance with the hand treatment technique, which is applied in each individual case immediately after removing gloves if there is a threat of infection;
- disposable gloves cannot be reused; non-sterile gloves cannot be sterilized;
- gloves must be changed immediately if they are damaged;
- it is not allowed to wash or treat hands with gloves between “clean” and “dirty” manipulations, even in the same patient;
- moving with gloves in the hospital department(s) is not allowed;
- before putting on gloves, do not use products containing mineral oils, petroleum jelly, lanolin, etc., as they may damage the strength of the gloves.

5.10. The chemical composition of the glove material can cause immediate and delayed allergies or contact dermatitis (CD). CD can occur when using gloves made of any material. This is facilitated by: prolonged continuous use of gloves (more than 2 hours), the use of gloves powdered on the inside, the use of gloves when there is existing skin irritation, putting gloves on wet hands, and using gloves too often during the working day.

5.11. Errors that often occur when using gloves:
- use of medical disposable gloves when working in the catering department. In these cases, preference should be given to reusable (household) gloves;
- improper storage of gloves (in the sun, at low temperatures, exposure to chemicals on gloves, etc.);
- putting gloves on hands moistened with antiseptic residues (additional stress on the skin;
- ignoring the need for antiseptic hand treatment after removing gloves in contact with potentially infected material;
- the use of surgical gloves for aseptic work, while the use of sterile examination gloves is sufficient for this;
- use of ordinary medical gloves when working with cytostatics (insufficient protection of medical staff;
- insufficient care of the skin of the hands after using gloves;
- refusal to wear gloves in situations that at first glance seem safe.

5.12. Reuse of disposable gloves or their disinfection is prohibited. Carrying out hygienic hand antisepsis in disposable gloves is allowed only in situations that require frequent replacement of gloves, for example, when drawing blood. In these cases, the gloves must not be punctured or contaminated with blood or other secretions.

5.13. Disinfection of gloves is carried out according to the manufacturer’s instructions.

6. Advantages and disadvantages of hand treatment methods

6.1. The effectiveness, practicality, and acceptability of hand sanitization depend on the method and associated reprocessing conditions available in the healthcare facility.

6.2. Conventional washing is ineffective in eliminating both transient and resident microorganisms. In this case, microorganisms do not die, but with splashes of water fall on the surface of sinks, staff clothing, and surrounding surfaces.

6.3. During the washing process, secondary contamination of hands with microorganisms from tap water is possible.

6.4. Regular washing has a negative effect on the skin of the hands, since water, especially hot water, and detergent lead to disruption of the surface water-fat layer of the skin, which enhances the penetration of detergent into the epidermis. Frequent washing with detergent leads to swelling of the skin, damage to the epithelium of the stratum corneum, leaching of fats and natural moisture-containing factors, which can lead to skin irritation and cause CD.

6.5. Hygienic hand antisepsis has several practical advantages over hand washing, which allows us to recommend it for wide practical use.

Advantages of hygienic hand antisepsis with alcohol antiseptics compared to conventional hand washing

6.6. Errors in hygienic antiseptics include the possible rubbing of alcohol antiseptic into hands that are damp from the antiseptic, which reduces its effectiveness and skin tolerance.

6.7. Saving antimicrobial agents and reducing exposure time makes any method of hand treatment ineffective.

7. Possible negative consequences of hand treatment and their prevention

7.1. If the requirements of the instructions/guidelines for the use of hand treatment products are violated and if there is a careless attitude towards preventive skin care, CD may occur.

7.2. KD can also be caused by:
- frequent use of antimicrobial detergent;
- long-term use of the same antimicrobial detergent;
- increased skin sensitivity to the chemical composition of products;
- presence of skin irritation;
- excessively frequent routine hand washing, especially with hot water and alkaline detergents or detergents without emollients;
- long-term work with gloves;
- putting on gloves on wet hands;
- lack of a reasonable skin care system in a medical institution;

7.3. For the prevention of CD, in addition to avoiding the causes of CD according to paragraphs. 7.1-7.2, it is recommended to fulfill the following basic requirements:
- provide staff with hand sanitizers that are potentially mild irritants to the skin of the hands and at the same time effective;
- when selecting an antimicrobial agent, take into account its individual suitability for the skin, smell, consistency, color, ease of use;
- in a medical institution it is recommended to have several products so that employees with increased skin sensitivity have the opportunity to choose a product that is acceptable to them;
- introduce into practice antiseptics made on the basis of alcohol with various softening additives, since pure alcohols dry out the skin of the hands with frequent use;

Properties of alcohol-based antiseptics

Conduct mandatory periodic instruction on the use of antimicrobial agents (dose, exposure, processing technique, sequence of actions) and skin care.

8. Hand skin care

8.1. Hand skin care is an important condition for preventing the transmission of nosocomial pathogens, because only intact skin can be effectively treated with an antimicrobial agent.

8.2. KD can only be avoided if a skin care system is implemented in a healthcare facility, since when using any antimicrobial agents there is a potential risk of skin irritation.

8.3. When choosing a skin care product, the type of hand skin and the following properties of the product are taken into account: the ability to retain the normal state of skin fatty lubrication, moisture, pH at 5.5, ensuring skin regeneration, good absorption, the ability of the product to give elasticity to the skin.

8.4. It is recommended to use the type of emulsion opposite to the emulsion shell of the skin: O/W (oil/water) emulsions should be used for oily skin, as well as at high temperatures and humidity; For dry skin, it is recommended to use W/O (water/oil) emulsions, especially at low temperatures and humidity.

Choosing a skin care product depending on its type

8.5. When selecting skin care products, it is important to consider their compatibility with antimicrobial hand sanitizers to prevent creams or lotions from negatively affecting the antimicrobial effect of the product.

8.6. It is advisable to apply cream or other product to your hands several times during the working day, thoroughly rub into the skin of dry and clean hands, paying special attention to the treatment of skin areas between the fingers and periungual ridges.

1. Remove decay products and microorganisms.
2. Ensure patient infection safety.
3. Ensure a high level of cleanliness and personal hygiene.
4. Retard the development of microorganisms.

Highlight three levels of hand treatment: social, hygienic (disinfection of hands), surgical (sterility of hands is achieved for a certain time).

1. Social level.

Indications:

1. Before eating. 2. Feeding the patient. 3. Working with food products. 4. After visiting the toilet. 5. Before and after patient care.
2. When your hands are dirty.

Equipment:

1. Soap (liquid with dispenser).
2. Paper napkins.
3. Paper towel or clean, dry cotton towel.

Hand washing techniques should be strictly followed. The duration of the procedure is 40-60 seconds.

1. Remove all jewelry.
2. Release your forearms from the sleeves of your robe.
3. Open the water tap using a paper towel to avoid contact with microorganisms present on the tap. Adjust the water temperature.
4. Wet your hands with water.
5. Apply a sufficient amount of soap to the entire surface of your hands.
6. Each movement is repeated 5 times:
7. Rub palm against palm.
8. Run your right hand along the back of your left, intertwining your fingers, and vice versa.
9. Rub palm against palm, interlacing fingers, treating the spaces between the fingers.
10. Clasp your fingers and intertwine them.
11. Rub the thumb of your left hand with your right hand using rotational movements and vice versa.
12. Rub the left hand forward and backward and vice versa with the clenched fingers of your right hand using rotational movements.
13. Rubbing your wrists in a circular motion.
14. Rinse your hands with water.
15. Dry thoroughly with a disposable towel.
16. Close the tap using a towel (napkin).

2.Hygienic level.

Indications:

1. Before and after invasive manipulations.
2. Before caring for an immunocompromised patient.
3. Before and after wound care and urinary catheter use.
4. Before putting on and after removing sterile gloves.
5. After contact with body fluids or after possible microbial contamination.

Equipment:

1. Liquid soap.
2. Clock with second hand.
3. Skin antiseptic: 70 o ethyl alcohol (0.5% alcohol solution of chlorhexidine bigluconate, or other modern skin antiseptic).
4. Sterile: tweezers, cotton balls, napkins.
5. Paper napkins.
6. A paper towel or a clean, dry cotton towel.
7. Container for disinfection.

Required condition: no injuries on hands.

When washing your hands you should:

1. Remove finger rings, watches, and bracelets.
2. Fold the sleeves of the robe over 2/3 of your forearms.
3. Open the water tap using a paper towel to avoid contact with microorganisms present on the tap.
4. Wash your hands with soap and running water up to 2/3 of your forearm, strictly following the hand washing technique (see social level).
5. Rinse your hands under running water to remove soap suds.
6. Repeat washing each hand.
7. Rinse your hands under running water, holding them so that your wrists and hands are above elbow level.
8. Dry your hands with a personal towel (napkin).
9. Using a napkin, close the water tap.
10. Dispose of the napkin into a container for disinfection.
11. Apply 3-5 ml of antiseptic to the palms, treating all surfaces of the hand, following the technique of treating hands with an antiseptic.
12. Exposure when using an alcohol-containing antiseptic is usually 20-30 seconds, but more accurate information should be obtained from the guidelines for using an antiseptic.

Hygienic treatment of hands with a skin antiseptic (without prior washing) is carried out by rubbing it into the skin of the hands in the amount recommended in the instructions for use, paying special attention to the treatment of the fingertips, the skin around the nails, between the fingers. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

3. Surgical level.

Indications:

1. The need to cover a sterile table.
2. Participation in surgery, puncture, childbirth.

Contraindications:

1. Presence of pustules on the hands and body.
2. Cracks and wounds of the skin.
3. Skin diseases.

Mandatory condition: processing is carried out in areas of strict or special sterility.

Performing the procedure:

1. Hand treatment is carried out according to individual instructions for each method.
2. Hand sanitization of personnel involved in the operation is mandatory.

Various preparations approved by the pharmacological committee of the Ministry of Health and Social Development of the Russian Federation are used to treat hands.