It is possible to prevent the spread of diseases and germs with the help of such a simple procedure as hand sanitization. Hand sanitizing levels depend on the person's level of exposure to the potential hazard, as well as their professional activities. The rules of such disinfection should be familiar not only to every professional medical worker, but also to a simple layman.

Types of microflora

What is the method of hand treatment? The levels of hand cleaning depend on the tasks and jobs that the healthcare professional performs. Since it is not possible to completely cleanse the skin of pathogenic bacteria, it must be disinfected on an ongoing basis. For general information, it is necessary to give a basic classification of microflora:

It should be noted that on the skin of the hands there are the most problematic areas, which are quite problematic to clean from such contaminants. These include the ridges near the nails and the space under the nails, as well as the spaces between the fingers.

The first methods of processing hands appeared and began to be used in the middle of the 19th century. So, at first, a phenol solution was used for disinfection. Currently, it is customary to practice somewhat different methods.

Classification of skin disinfection methods

So, how exactly is the classification of such a procedure as hand treatment carried out? Hand processing levels are represented by three types of manipulations:

• Normal processing.
• Hygienic treatment.
• Surgical treatment.

Let's analyze the features of each method in a little more detail.

First stage

Ordinary washing is the simplest and most affordable method of cleansing. Its task is to eliminate dirt and a number of bacteria carried from dirty surfaces and infected people. Medical professionals wash their hands before starting work, after receiving a patient, changing clothes, and also after moving to another office or to another place of work. The procedure can be used:

Efficiency easy wash is no more than 70 percent with a double repetition and no more than 40 percent with a single repetition. Before the procedure, it is recommended to remove all jewelry and watches, and thoroughly rub the cleanser into the skin, then rinse completely and repeat the manipulations. The soap used should not contain additional flavors or dyes, it should be neutral.

Second step

The treatment of the hands of medical staff is often carried out by a hygienic method. It is carried out, as a rule, in the following cases:

Such hygienic treatment involves two stages. At the first stage, a classic hand washing is carried out, at the second, disinfection is added with an alcohol-containing antiseptic.

Hygienic or medical treatment of hands can be carried out using the following types of antiseptics:

• Bactericidal soap (in liquid form).
• Alcoholic solutions designed specifically for the treatment of the skin.
• bactericidal gel.

An alcohol-free product is applied to wet skin in an average amount of 3 to 5 milliliters. Alcohol-based products are used on dry skin, they need to be rubbed for about 15-20 seconds. It is allowed to add a small amount of glycerin or lanolin to the antiseptic to soften the skin and prevent it from drying out.

Third step

It is the third and most total method of disinfection. Its implementation is relevant for all participants in the surgical intervention. It is carried out according to the following algorithm:

• Hand washing. It lasts for 2 minutes, after treatment of the skin it is necessary to dry it with a sterile material.
• The use of an antiseptic. With its help, hands, wrists, and, if necessary, forearms are processed. There are special rules for the amount of its use, as well as the frequency of use.

It should be noted that the surgical treatment of hands can be carried out exclusively with antiseptics containing alcohol. These include the following drugs:

Treatment with significant contamination

Separately, it is necessary to touch on the question of how the hands of the medical staff are processed when the patient's blood gets on them. If the biological fluid has got directly on the skin, it is required to act according to the following algorithm:

• Remove the resulting contamination with a napkin.
• Cleanse skin with soap and water.
• Dry the affected area with a disposable sterile cloth.
• Twice to carry out the treatment with alcohol antiseptic.

If contamination has got on the surface of the glove, the procedure undergoes certain changes. They are represented by the following diagram:

• Removal of contamination from the material with a disinfectant wipe.
• Washing gloved hands with water.
• Removing gloves.
• Hand washing with soap, drying.
• Single use of antiseptic for the treatment of the skin of the hands.

There are also general rules hand treatment. They come down to the following requirements and recommendations:

Types of drugs

How to choose the right hand sanitizer? When choosing one or another tool, use the following recommendations:

Of course, medical workers have specific documents prescribing how hand treatment should be carried out. Hand sanitizing levels determine the type of disinfectant used. For example, let us dwell in more detail on the means for surgical treatment:

• Alcohols. Optimal solution- ethyl 70%. Excellent help against gram-positive and gram-negative bacteria, affect individual viruses and fungi.
• Solutions based on iodine and alcohol - a wide spectrum of action. They help against bacteria, including causative agents of tuberculosis, spores, viruses, protozoa, and fungi.
• Iodophors. They help against rotoviruses, herpes, HIV infection, staphylococci and spores.
• Chlorhexidine. It has a narrower spectrum of action, targets gram-positive bacteria, certain categories of fungi.

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

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

1.Social level.

Indications:

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

Equipment:

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

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

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

2. Hygienic level.

Indications:

1. Before and after invasive procedures.
2. Before caring for an immunosuppressed patient.
3. Before and after wound care and use of a urinary catheter.
4. Before dressing 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, wipes.
5. Paper napkins.
6. Paper towel or clean dry cotton towel.
7. Container for disinfection.

Required condition: no damage on the hands.

When washing your hands, you must:

1. Remove rings from fingers, watches, bracelets.
2. Wrap the sleeves of the robe on 2/3 of the forearm.
3. Open the faucet using a paper towel to avoid contact with microorganisms present on the faucet.
4. Wash your hands with soap running water up to 2/3 of the forearm, strictly observing the technique of washing hands (see social level).
5. Rinse hands under running water to remove soap suds.
6. Repeat washing for each hand.
7. Rinse your hands under running water, holding them so that the wrists and hands are above the level of the elbows.
8. Dry your hands with an individual towel (napkin).
9. Using a tissue, turn off the tap.
10. Discard the tissue in a container for disinfection.
11. Apply 3-5 ml of an antiseptic agent on 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 guidelines on the use of an antiseptic.

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

Execution of the procedure:

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

For the treatment of hands, various preparations are used that are approved by the pharmacological committee of the Ministry of Health and Social Development of the Russian Federation.

Places for sanitizing the hands of medical personnel must be equipped in accordance with the requirements of SanPiN 2.1.3.2630-10. In case of violation of the requirements of the specified SanPiN, the Code of Administrative Offenses provides for a number of penalties. For example, for a person who violates these requirements, a fine from 1,000 rubles to 2,000 rubles, and for a medical organization - from 10,000 rubles to 20,000 rubles, or a temporary suspension of activities. Below we will consider how to organize the process of processing the hands of employees.

Treatment of the hands of medical personnel according to SanPiNu

For high-quality treatment of medical personnel according to SanPin, it is necessary that each room be equipped with a washbasin connected to the water supply. A prerequisite is the presence hot water and mixer taps.

"Proper and timely processing of the hands of medical staff, without a doubt, is a guarantee of the safety of both the employees of medical institutions and patients. There is such a thing as infections associated with the provision of medical care (HCAI). And reducing the risk of their occurrence can be considered one of the priorities directions in the work of a clinic of any profile.According to the information of the World Health Organization, out of 100 hospitalized patients, at least 7 are infected with HCAI.

HAIs are often associated with the treatment of the hands of the medical staff of the clinic, because they become the source of pathogenic microorganisms for the patient. Now hand washing by medical personnel or their treatment with skin antiseptics are extremely relevant infection control measures. Moreover, it must be understood that pathogens often appear not only on the surface of infected wounds, but also on areas of absolutely healthy skin.

In the Russian Federation, the rules for processing the hands of medical personnel are defined by SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities." Hand treatment is performed depending on the nature of the medical manipulation performed. Among the mandatory requirements are short-cut nails of an employee without a chemical (lacquer) coating, and the absence of jewelry.

There are two types of disinfection of the hands of medical workers: hygienic treatment of hands and treatment of the hands of surgeons. Naturally, in the second case, the processing is more profound. As for hygienic treatment, it is always required - before any contact with the patient. It, in particular, provides for washing hands with soap, as well as treating them with a skin antiseptic. To wash hands, use liquid soap dispensed with a dispenser, but without too hot water. At the same time, alcohol-based skin antiseptics are considered more effective than water-based antiseptics. Before operations, the surgeon's hands are treated in both ways, and washing in water should last at least two minutes.

The third way to protect the hands of medical staff, as well as prevent HAIs, are medical gloves - this is perhaps one of the most “protected” ways of interacting with patients.

In areas equipped for the treatment of the hands of medical personnel, in addition to washbasins, special devices for use when washing hands with liquid soap and antiseptics. It is necessary to ensure that they always have facilities for washing and processing hands. In addition, hand care products should also be available nearby. Near the washbasin it is necessary to install a bucket that opens with a foot drive. There should also be paper towels.

Dispensers for applying liquid soap and antiseptics should be installed not only near washbasins, but also in other areas accessible to employees. For example, clause 12.4.6 of Ch. I SanPiN 2.1.3.2630–10 indicates that dispensers can be installed at the entrance to the wards, in corridors and locks of departments, at the beds of intensive care and seriously ill patients, on work and manipulation tables.

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Washing the hands of medical personnel according to SanPiN: how to choose a dispenser

In order to process the hands of medical personnel in accordance with SanPiN, clinics have a dispenser - this is a special device for issuing something in a certain amount. These devices should be selected based on needs. For example, the dispenser can be either a mechanical pressure or a wall-mounted one with an elbow drive (with interchangeable pumps) and even a sensor that works without contact. In addition, systems that automatically dispense liquid soap or antiseptic are also considered dispensers.

EXPERT SAYS
Dmitry Gornastolev, chief doctor of the network medical centers"Medscan"

"The global benchmark for patient safety is the JCI standards, specifically the International Patient Safety Goals (IPSG).

In the Russian Federation, the processing of the hands of medical personnel is regulated by SanPiN 2.1.3.2630-10. The nature of the medical manipulation performed requires a certain level of reduction of microbial contamination of the skin. Hygienic or surgical treatment of the hands of medical staff is carried out.

Hygienic processing of hands - medical personnel must clean their hands during the working day and when performing medical procedures.

Surgical treatment of hands - is carried out in cases where the patient is subjected to manipulations accompanied by damage to the skin (invasive manipulations) or surgical methods of treatment are performed, incl. performing a biopsy under the control of computed tomography. This hand treatment differs from the hygienic one in terms of the time required and the technology of the process. Surgical debridement is more thorough and requires a higher degree of skin disinfection to further reduce patient contamination.

The means for processing, as a rule, are the same. And alcohol-based products are more effective.

Hand hygiene allows, in case of an emergency, simply treat your hands with an antiseptic and put on sterile gloves. Surgical treatment of hands in routine practice does not allow this. Such processing is permissible only in military field conditions (and in extremely difficult situations, when every second counts).

Surgical treatment of hands begins with the use of soap and has its own characteristics:

1. hand treatment begins with the fingertips and ends with the forearm;
2. should take at least 5 minutes;
3. the back surface of the hands, interdigital spaces, nail bed, palms, wrist and forearm should be treated;
4. after processing the hands (from the tips to the forearm), the hands are washed again, but only the wrist part, the forearm is no longer processed again;
5. then there is a double treatment with an antiseptic (in the same sequence as when washing with soap);
6. after exposure of the antiseptic to the skin, put on sterile gloves and perform medical manipulations.

Proper hand-cleaning by medical personnel significantly reduces the incidence of infectious complications, reduces the consumption of antibiotics and reduces the cost of hospital care."

Before purchasing a dispenser for multiple use, check the manufacturer's data to ensure that the manufacturer specifies how to clean the dispenser. In the event that the dispenser is intended for filling with an alcohol-containing antiseptic, then a permit is required for its use with flammable materials.

The advantage is a dispenser that works without contact and has a set of disposable cartridges. The device must have an accurate indelible marking with the liquid level, as well as an area for the location of the label with the name of the antiseptic used. The instructions for the dispenser should contain information that it can be used with liquids from various manufacturers and that machine cleaning and disinfection of the dispenser can be performed.

Before refilling the dispenser, be sure to clean and disinfect its container. If the dispenser is partially filled, then do not add a new dose of liquid soap or antiseptic.

In order to control the maintenance procedure of dispensers, it is worth keeping a log - a sample is below.

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

12.4. Hand hygiene

12.4. Hygienic processing of hands.

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

Before direct contact with the patient;

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

After contact with body secrets or excretions, mucous membranes, dressings;

Before performing various manipulations to care for the patient;

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 is carried out in two ways:

Hygienic hand washing with soap and water to remove contaminants and reduce microbial counts;

Hand sanitizing to reduce microbial counts to safe levels.

12.4.3. Liquid soap is used to wash hands using a dispenser (dispenser). Dry hands with an individual towel (napkin), preferably disposable.

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

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

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

12.4.7. Use of gloves.

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

It is a mandatory procedure before performing any action with the patient. For processing, various means and preparations are used that do not require long time-consuming and are approved by the Committee of Pharmacology of the Russian Federation.

What is disinfection for?

Hand hygiene is a disinfecting procedure that prevents, protecting not only the staff, 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 is to undergo surgery. Hygienic treatment of the hands of personnel must be carried out after contact with saliva, as well as blood. Disinfection must be carried out before sterile gloves are put on. You can wash your hands with special soap with an antiseptic effect or wipe the skin with an alcohol-based product.

When to Hygiene

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

1. After the therapy of 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 the mucous membranes of a person, his excretions and
5. After contact with the skin of the patient.
6. Before performing patient care procedures.
7. Before each contact with the patient.

Properly performed hygiene treatment involves washing with soap and running water in order to get rid of dirt and reduce the number of microorganisms. In addition, hand hygiene includes procedures for treating the skin with antiseptic agents that help reduce the number of bacteria to a minimum safe level.

What is used for processing

Soap in liquid form, 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 an increased risk of dermatitis. Be sure to use a towel to turn off a faucet that is not equipped with an elbow drive. In order to dry clean hands, single-use paper towels (or individual fabric ones) should be used.

Hygienic treatment of hands, 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 packaging of the antiseptic. 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 the hands moist for a certain time (usually it is indicated on the product). After hygienic processing of hands is carried out, it is not required to wipe them with a towel.

Equipment for hygiene procedures

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

• Running water.
• which has a neutral pH.
• Washbasin with faucet operated without the touch of the 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 care product.
• Household rubber gloves.
• Urn for used accessories.

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, special mixer. The design of the faucet should be made in such a way that splashing of water is minimal. The hygienic level of hand treatment provides for 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. In one - liquid soap, in the other - an antimicrobial drug, another must be filled with a hand care product.

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

Carrying out algorithm

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

1. Dispenser extrusion required amount liquid soap.
2. Rubbing in palm-to-palm mode.
3. Rubbing one palm of the hand against the back of the other.
4. Rubbing internal surfaces fingers vertically.
5. Rubbing the back of the fingers of the hand folded into a fist, the palm of the second (do the same with the other hand).
6. Rubbing all fingers in circles.
7. Rubbing each palm with fingertips.

Surgical disinfection

Surgical hand disinfection is required to completely remove the flora from the hands: resistant, as well as transistorized. This is done so that the infection cannot be transmitted through the hands. Like hand hygiene, surgical disinfection is performed by washing and wiping. The use of alcohol-based solutions is widespread due to the fast and directional action, optimal skin acceptance 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 the processing of hands at a hygienic level. Algorithm of surgical antisepsis:

1. Wash hands with soap and water for at least two minutes.
2. Dry your hands using a disposable tissue or towel.
3. Treat the hands, forearms, and wrists without wiping the hands afterwards.
4. Wait for the product to dry completely, 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 near each nail with 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 hygienic treatment of hands. The algorithm is the following:

1. Washing hands in room temperature water with liquid soap, drying with a disposable towel.
2. Applying a disinfectant with rubbing movements, which disinfects the hands.
3. With interlaced fingers, massage the backs of the hands.
4. With widely spaced, rub your palms.
5. Rub the product into the thumbs with clenched palms alternately.
6. Rubbing the forearms for a minimum of 2 minutes, a maximum of 3 minutes, processing nails and subungual area.

Each step needs to be repeated 4-5 times. Throughout the procedure, you need to 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 in contact with patients or various contaminated hospital facilities. For processing is used (alcohol solution) in ethyl alcohol (70%). In addition, the following drugs are used:

• "Octenisept".
• Ethyl alcohol with additives that effectively soften the skin.
• "Octeniderm".
• "Hemisept".
• "Higenix".
• "Isopropanol" - 60%.
• "Octeniman".
• "Decosept+".
• "Veltocept".

Before carrying out hygienic treatment, it is imperative to remove all wrist accessories and jewelry. We must not forget about cleaning the 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 the containers for antiseptics and soaps are not disposable, then refilling should be done only after they have been thoroughly disinfected, rinsed with running water and completely dried. It is recommended to use dispensers that work on photocells or those from which the product is squeezed out in an elbow way.

All antiseptics used 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 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 worker with an individual container of a small volume with an antiseptic preparation.