Hygienic processing of hands of medical personnel algorithm. Washing hands at a social, hygienic, surgical level

Filonov V.P., Doctor of Medical Sciences, Professor,

Dolgin A.S.,

CJSC "BelAseptika"

According to the World Health Organization (hereinafter - WHO), infections associated with the provision of medical care(hereinafter referred to as HCAI) are a major patient safety issue and their prevention should be a priority for medical institutions and institutions charged with providing safer health care.
Hand hygiene is a first line intervention that has proven effective in preventing HCAI and the spread of antimicrobial resistance.

The history of antiseptics is associated with the names of the Hungarian obstetrician Ignaz Philipp Semmelweis and the English surgeon Joseph Lister, who scientifically substantiated and put antiseptics into practice as a method of treating and preventing the development of suppurative processes, sepsis. So, Semmelweis, on the basis of many years of observations, came to the conclusion that puerperal fever, which gave high mortality, is caused by cadaveric poison transmitted through the hands of medical staff. He conducted one of the first analytical epidemiological studies in the history of epidemiology and convincingly proved that the decontamination of the hands of medical personnel is the most important procedure to prevent the occurrence of nosocomial infections. Thanks to the introduction of antiseptics into practice in the obstetric hospital where Semmelweis worked, the death rate from nosocomial infections was reduced by 10 times.

Practical experience and a huge number of publications devoted to the issues of processing the hands of medical staff show that this problem, even more than one and a half hundred years after Semmelweis, cannot be considered solved and remains relevant. Currently, according to WHO, up to 80% of HAIs are transmitted through the hands of healthcare workers.
Proper hand hygiene of healthcare workers is the most important, simplest and least expensive way to reduce the incidence of HCAI, as well as the spread of antibiotic resistant strains of pathogens, and to prevent the occurrence of infectious diseases in healthcare organizations.

Hand skin treatment includes a number of complementary methods (levels): hand washing, hygienic and surgical hand skin antisepsis, each of which plays a role in preventing infections.

It should be noted that all these methods to some extent affect the microflora of the skin of the hands - resident (permanent) or transient (temporary). Microorganisms of the resident flora are located under the surface cells of the stratum corneum of the epithelium; this is the normal human microflora. Transient microflora enters the skin of the hands as a result of work and contact with infected patients or contaminated objects environment, remains on the skin for up to 24 hours, and its species composition is directly dependent on the profile of the healthcare organization and is associated with the nature of the health worker's activity. Most often, these microorganisms are associated with HAIs, and are represented by pathogenic microorganisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), polydrug-resistant gram-negative bacteria, fungi of the Candida genus, clostridia.
The transient microflora is epidemiologically the most significant. Yes, if damaged skin, in particular during the use of inadequate methods of hand treatment (use of hard brushes, alkaline soap, hot water, excessively unreasonable use of hand washing instead of antiseptics), the transient microflora penetrates deeper into the skin, displaces the permanent microflora from there, violating its stability, which in turn turn leads to the development of dysbacteriosis. In this case, the hands of medical workers become not only a factor in the transmission of opportunistic and pathogenic microorganisms, but also their reservoir. Unlike the resident, the transient microflora is completely removed during antiseptic treatment.

Recommendations for hand hygiene are set out in the relevant WHO Guidelines. General recommendations to the hygiene of the hands of medical personnel are reduced to the following positions:
1. Wash your hands with soap and water when they are visibly soiled, stained with blood or other body fluids, or after going to the toilet.
2. If exposure to a potential spore-forming pathogen is high (suspected or proven), including cases of C. difficile outbreaks, handwashing with soap and water is the preferred measure.
3. Use alcohol-based handrub as the preferred routine antiseptic measure in all other clinical situations listed in step 4, unless hands are visibly contaminated. If alcohol-based hand rub is not available, wash your hands with soap and water.
4. Practice hand hygiene:
before and after contact with the patient;
before touching an invasive patient care device, whether or not you are wearing gloves;
after contact with body fluids or secretions, mucous membranes, damaged skin or wound dressings;
if, when examining a patient, you move from a contaminated area of \u200b\u200bthe body to an uncontaminated one;
after contact with objects (including medical equipment) from the immediate environment of the patient;
after removing sterile or non-sterile gloves.
5. Before handling medication or preparing food, perform hand hygiene using an alcohol-based hand rub or wash your hands with plain or antimicrobial soap and water.
6. Soap and alcohol-based hand sanitizer should not be used at the same time.

At the same time, WHO states that the highest frequency of compliance by medical workers with recommended hygiene measures in best case is up to 60%. WHO experts identify the main factors associated with insufficient adherence to hand washing: the status of a doctor (compliance with hand hygiene is less common than among nursing staff); work in intensive care, work in the surgical department; work in emergency care, work in anesthesiology; working during the week (compared to working on weekends); shortage of staff (surplus of patients); wearing gloves; a large number of indications for hand hygiene within an hour of patient care after contact with objects external environment in the environment of the patient, for example, with equipment; before contact with environmental objects in the environment of the patient, etc.

Speaking about the three levels of hand treatment (hygienic washing, hygienic antiseptic, surgical antiseptic), it should be noted that their goal is not to replace each other, but to complement each other. Thus, hand washing allows mechanical cleaning of organic and inorganic contaminants and only partially removes transient microflora from the skin. At the same time, in healthcare organizations, for hygienic handwashing, soaps should be used that will cause the least harm to the skin, while providing maximum effect. These are liquid, pH-neutral soaps containing bactericidal and fungicidal components, as well as additives softening and moisturizing the skin. At the same time, it is necessary to pay close attention to the hand treatment technique and its duration, which should be 40-60 seconds, as well as the hand drying procedure. On the one hand, complete and proper drying of the skin of the hands after washing prevents the occurrence of dermatitis during the subsequent use of alcohol-containing antiseptics, and on the other hand, it is an important condition for proper decontamination. Currently carried out in different countries studies (including those by an accredited laboratory of CJSC "BelAseptika") show that microbiological contamination of the skin of the hands, after going to the toilet, washing hands and using an electric towel, does not decrease, but increases by 50%. Indicators of microbiological contamination of the skin of hands in persons who washed their hands after going to the toilet and used a paper (disposable) towel are reduced by almost 3 times, and in those who additionally apply antiseptic gel up to 10 times.

Therefore, the use of disposable paper towels for drying hands compared to electric towels is much more optimal in epidemiological terms. The additional use of antimicrobial hand gels is the most promising solution. This practice can provide both greater convenience, and protection of the skin of the hands, and the effectiveness of processing.

The procedure for conducting hand antisepsis in our country is currently defined by the Instruction "Hygienic and surgical antisepsis of the skin of the hands of medical personnel", approved by the Chief State Sanitary Doctor of the Republic of Belarus on September 5, 2001 N 113-0801 and fully complies with the international standard EN-1500.
Hygienic antisepsis of the skin of the hands aims to destroy the transient microflora of the skin.
At the same time, the treatment procedure itself includes applying an antiseptic to the hands in an amount of 3 ml and thoroughly rubbing it into the palmar, back and interdigital surfaces of the skin of the hands for 30-60 seconds until completely dry, strictly following the sequence of movements according to the European processing standard EN-1500.

In order to make the right choice of drugs, which is often difficult due to the abundance of offers on the domestic market, it is necessary to consistently take into account their key properties: the presence of a wide spectrum of antimicrobial activity, the absence of allergic and irritating effects on the skin, registration as a drug, cost-effectiveness. At the same time, the use of alcohol-based antiseptics, the most effective against HCAI pathogens and compatible with the skin, is also recognized by WHO as the “gold standard”. The use of such antiseptics is one of the main key points in the hygiene of the hands of medical workers.

According to the Law of the Republic of Belarus "On medicines ah" antiseptics in our country are classified as medicines, and therefore undergo clinical trials confirming their safety and are produced at enterprises that have implemented and certified a system of proper industrial practice(GMP). The water used for the production of antiseptic medicines is purified at reverse osmosis plants, and the finished antiseptic itself is microfiltered before bottling, which eliminates the presence of any infectious agents in it. It is this approach to ensuring the production of high-quality antiseptics that has made it possible today to reduce the exposure of hygienic antiseptics, compared to the previously accepted one. At present, some drugs have been confirmed to be effective with a 12 second hygienic antiseptic (Septocid-synergy, Septocid R+).

Along with this, the use of "aqueous" alcohol-free solutions of antiseptics in healthcare organizations is not as effective, convenient and safe. So, components such as triclosan, HOURS can cause allergic reactions. Guanidine film can contribute to the formation of biofilms in cases where the skin of the health worker's hands is unhealthy, there are signs of dysbacteriosis, violation of the integrity of the skin, the presence of infection. In addition, the 5-7 minute "stickiness" of the skin of the hands that occurs after the use of alcohol-free antiseptics also reduces the convenience of their use, especially when using gloves. Alcohol-containing antiseptics, according to WHO recommendations, are the most reliable in this regard. The concentration of alcohols (ethyl, isopropyl) in the range from 60% to 80% allows you to achieve maximum efficiency. In addition, the advantage of antiseptics over the usual 70% alcohol is that they contain special emollients that neutralize the drying effect of alcohols.

Surgical antisepsis of the skin of the hands ensures the destruction of transient microflora and reduces the amount of resident microflora to a subinfectious level and is carried out during medical procedures associated with contact (direct or indirect) with the internal sterile environments of the body (catheterization of central venous vessels, punctures of joints, cavities, surgical interventions, etc. .d.).

During professional activity health care workers, the skin may lose its ability to perform a barrier function - it becomes irritated, dry and cracked. The most common staff reactions are contact dermatitis and allergic reactions. Experts believe that 2/3 of all skin problems occur due to improper skin care, including the application of alcohol-containing antiseptics to wet hands. Regular and intensive skin care using creams, lotions, balms at the workplace, such as for example: Dermagent C, Dermagent P, is a preventive measure against occupational dermatoses.

To ensure the prevention of HCAI in healthcare organizations, it is necessary to carry out targeted work to increase the adherence to hand hygiene among medical staff. Special attention should be paid by the administration of the institution to the effective learning medical personnel using interactive technologies and ensuring that alcohol-based hand sanitizers are available to healthcare workers at points of care.

Administration support and encouragement for good hand hygiene, development of an audit system for the use of alcohol-based hand rubs, and monitoring of hand hygiene compliance may be most effective in promoting adherence to handwashing among healthcare workers. Commitment to hand hygiene of the older generation of medical workers also influences the formation of commitment among young employees, interns and students.

Combining the efforts of medical workers, the administration of healthcare organizations, specialists from hygiene and epidemiology centers, teachers of educational institutions in the step-by-step implementation and formation of a sustainable hand treatment practice, as well as own example, will allow simple and effective hand hygiene practices to be instilled into the daily practice of health care delivery by present and future generations of health workers, thereby ensuring the continued safety of health care delivery.

Hand processing. The most important "tool" of the dentist are the hands. Proper and timely processing of hands is the key to the safety of medical personnel and patients. So great importance attached to washing hands, systematic disinfection, hand care, as well as wearing gloves to protect and protect the skin from infections.

For the first time, hand treatment for the prevention of wound infection was used by the English surgeon J. Lister in 1867. Hand treatment was carried out with a solution of carbolic acid (phenol).

The microflora of the skin of the hands is represented by permanent and temporary (transient) microorganisms. Permanent microorganisms live and multiply on the skin (Staphylococcus epidermidis, etc.), while transient ones (Staphylococcus aureus, Escherichia coli) are the result of contact with the patient. About 80-90% of permanent microorganisms are in the superficial layers of the skin and 10-20% are in the deep layers of the skin (in the sebaceous and sweat glands and hair follicles). The use of soap in the process of washing hands allows you to remove most of the transient flora. Permanent microorganisms cannot be removed from the deep layers of the skin with ordinary hand washing.

When developing an infection control program in health care facilities, clear indications and algorithms for treating the hands of medical staff should be developed, based on the characteristics of the diagnostic and treatment process in departments, the specifics of the patient population and the characteristic microbial spectrum of the department.

Types of contact in the hospital, ranked according to the risk of hand contamination, are as follows (in order of increasing risk):

1. Contact with clean, disinfected or sterilized objects.

2. Objects not in contact with patients (food, medicines, etc.).

3. Objects with which patients have minimal contact (furniture, etc.).

4. Objects that have been in close contact with non-infected patients (bedding, etc.).

5. Patients who are not the source of infection during procedures characterized by minimal contact (measuring the pulse, blood pressure etc.).

6. Objects that are likely to be contaminated, especially wet objects.

7. Objects that were in close contact with patients that are sources of infection (bed linen, etc.).

8. Any secrets, excretions or other body fluids of an uninfected patient.

9. Secrets, excretions, or other body fluids from known infected patients.

10. Foci of infection.

1. Regular hand washing

Washing moderately soiled hands with plain soap and water (antiseptics are not used). The purpose of regular hand washing is to remove dirt and reduce the amount of bacteria found on the skin of the hands. Routine handwashing is mandatory before preparing and distributing food, before eating, after going to the toilet, before and after patient care (washing, making bed, etc.), in all cases when the hands are visibly dirty.

Thorough hand washing with detergent removes up to 99% of transient microflora from the surface of the hands. At the same time, it is very important to observe a certain hand washing technique, since special studies have shown that during formal hand washing, fingertips and their inner surfaces remain contaminated. Hand treatment rules:

All jewelry, watches are removed from the hands, as they make it difficult to remove microorganisms. Hands are lathered, then rinsed with warm running water and everything repeats again. It is believed that during the first lathering and rinsing with warm water, germs are washed off the skin of the hands. Under influence warm water and self-massage, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes are washed away from the opened pores.

Warm water makes the antiseptic or soap work more effectively, while hot water removes the protective fatty layer from the surface of the hands. In this regard, you should avoid using too hot water for washing your hands.

The sequence of movements when processing hands must comply with the European standard EN-1500:

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

2. right palm rub the back surface of the left hand, change 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 the fingers into a "lock", rub the palm of the other hand with the back of the bent fingers.

5. Grasp the base of the thumb of the left hand between the thumb and forefinger of the right hand, rotational friction. Repeat on the wrist. Change hands.

6. Roundabout rub the palm of the left hand with the fingertips of the right hand, change hands.

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

For washing hands, it is most preferable to use liquid soap in dispensers with single-use bottles liquid soap "Nonsid" (firm "Erisan", Finland), "Vase-soft" (firm "Lysoform SPb"). Do not add soap to a partially empty dispenser bottle due to their possible contamination. Acceptable for health facilities can be considered, for example, Dispenso-pac dispensers from Erisan, with a sealed dosing pump device that prevents the possible ingress of microorganisms and substituting air into the package. The pumping device ensures complete emptying of the package.
If soap bars are used, small fragments of them should be used so that individual bars do not remain for a long time in a humid environment that supports the growth of microorganisms. It is recommended to use soap dishes that allow the soap to dry between separate handwashing episodes. Hands should be dried with a paper (ideally) towel, which then turn off the tap. In the absence of paper towels, pieces of clean cloth, approximately 30 x 30 cm in size, can be used for individual use. After each use, these towels should be discarded in the containers specially designed for them and sent to the laundry. Electric dryers are not effective enough as they dry the skin too slowly.
Personnel should be cautioned against wearing rings and using nail polish, as rings and cracked polish make it difficult to remove microorganisms. Manicure (especially manipulations in the area of the nail bed) can lead to microtraumas that are easily infected. Hand washing facilities should be conveniently located throughout the hospital. In particular, it should be installed directly in the room where diagnostic or penetrating procedures are performed, as well as in each ward or at the exit from it.

2. Hygienic disinfection (antiseptic) of hands

It is intended to interrupt the process of transmission of infection through the hands of the staff of institutions from patient to patient and from patients to staff and should be carried out in the following cases:

Before performing invasive procedures; before working with particularly susceptible patients; before and after manipulations with wounds and catheters; after contact with the secretions of the patient;

In all cases of probable microbial contamination from inanimate objects;

Before and after working with a patient. Hand treatment rules:

Hygienic processing of hands consists of two stages: mechanical cleaning of hands (see above) and disinfection of hands with a skin antiseptic. After the end of the mechanical cleaning stage (double soaping and rinsing), the antiseptic is applied to the hands in an amount of at least 3 ml. In the case of hygienic disinfection, preparations containing antiseptic detergents are used for washing hands, and hands are also disinfected with alcohols. When using antiseptic soaps and detergents, the hands are moistened, after which 3 ml of an alcohol-containing preparation is applied to the skin (for example, Isosept, Spitaderm, AHD-2000 Special, Lizanin, Biotenzid, Manopronto) and carefully rubbed into the skin until completely dry (do not wipe your hands). If the hands were not contaminated (for example, there was no contact with the patient), then the first stage is skipped and an antiseptic can be applied immediately. Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute. Alcohol formulations are more effective than aqueous solutions of antiseptics, however, in cases heavy pollution hands should be washed thoroughly with water, liquid or antiseptic soap. Alcoholic compositions are particularly preferred also in the absence of adequate conditions for washing hands or in the absence of the necessary time for washing.

To prevent damage to the integrity and elasticity of the skin, skin softening additives (1% glycerin, lanolin) should be included in the antiseptic, if they are not already contained in commercial preparations.

3. Surgical hand disinfection

It is carried out during any surgical interventions, accompanied by a violation of the integrity of the patient's skin, to prevent the introduction of microorganisms into the surgical wound and the occurrence of infectious postoperative complications. Surgical treatment of hands consists of three stages: mechanical cleaning of hands, disinfection of hands with a skin antiseptic, closing hands with sterile disposable gloves.

Such hand treatment is carried out:

Before surgical interventions;

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

Hand treatment rules:

1. In contrast to the mechanical cleaning method described above, at the surgical level, the forearms are included in the treatment, sterile wipes are used for blotting, and the hand washing itself lasts at least 2 minutes. After
drying, the nail beds and periungual ridges are additionally treated with disposable sterile wooden sticks soaked in an antiseptic solution. Brushes are not required. If brushes are used, use sterile, soft, disposable or autoclavable brushes, and brushes should only be used on the periungual area and only for the first brushing of a work shift.

2. After the end of the mechanical cleaning stage, an antiseptic (Allcept Pro, Spitaderm, Sterillium, Octeniderm, etc.) is applied to the hands in 3 ml portions and, preventing drying, is rubbed into the skin, strictly following the sequence of movements of the EN-1500 scheme. The procedure for applying a skin antiseptic is repeated at least two times, the total consumption of the antiseptic is 10 ml, the total procedure time is 5 minutes.

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

4. After removing the gloves, the hands are again wiped with a napkin moistened with a skin antiseptic, then washed with soap and moistened with an emollient cream (table).

Table. Stages of surgical hand disinfection

Two types of antiseptics are used for hand treatment: water, with the addition of surface-active substances (surfactants) and alcohol (table).

Table. Antiseptics used for hygienic and surgical treatment of hands

Alcohol products are more effective. They can be used for fast hygienic treatment hands The group of alcohol-containing skin antiseptics includes:

0.5% alcohol solution of chlorhexidine in 70% ethanol;

60% isopropanol solution or 70% ethanol solution with additives,

Softening the skin of the hands (for example, 0.5% glycerin);

Manopronto-extra - a complex of isopropyl alcohols (60%) with additives softening the skin of the hands and lemon fragrance;

Biotenzid - 0.5% solution of chlorhexidine in a complex of alcohols (ethyl and isopropyl, with additives softening the skin of the hands and lemon flavor.

Antiseptics for water based:

4% solution of chlorhexidine bigluconate;

Povidone-iodine (solution containing 0.75% iodine).

Microorganisms representing the resident flora live and multiply on the skin (10-20% of them can be found in the deep layers of the skin, including the sebaceous and sweat glands, hair follicles).

The resident flora is represented mainly by coagulase-negative cocci and diphtheroids. Gram-negative bacteria (not counting members of the genus Acte1; obacleg) are rarely resident. Resident microorganisms are difficult to remove or kill with normal handwashing or even disinfection procedures, although their numbers can be reduced.

Resident microorganisms generally do not cause nosocomial infections, except in connection with vascular catheterization. Moreover, the normal microflora prevents colonization of the skin by other microbes.

Conditions for achieving effective washing and disinfection of hands, their preparation(Fig. 22): short cut nails, no nail polish, no artificial nails, no rings, rings or other jewelry on the hands. Before processing the hands of surgeons, it is also necessary to remove watches, bracelets, etc.

Rice. 22.

To dry hands, clean cloth towels or disposable paper towels are used; when treating the hands of surgeons, only sterile cloth ones are used.

Skin antiseptics for hand treatment - for example: lizhen, chlorhexidine bigluconate, isosept, allsept, etc., should be in dispensers in appropriate concentrations. In subdivisions with a high intensity of patient care and with a high workload on staff, dispensers with skin antiseptics should be placed in places convenient for use by staff (at the entrance to the ward, at the patient's bedside, etc.). It should also provide for the possibility of providing medical workers with individual containers (bottles) with small volumes of skin antiseptic (100-200 ml).

Handwashing (Fig. 23) is the most effective method of preventing nosocomial infections in healthcare facilities.

Rice. 23.

There are three levels of hand decontamination:

1) social (routine handwashing);
2) hygienic (disinfection of hands);
3) surgical (sterility of the hands of surgeons is achieved for a certain time).

According to some sources, the reasons for the insufficient level of processing of the hands of medical personnel are forgetfulness, insufficient awareness of the problem, lack of knowledge, lack of time, skin problems - dryness, dermatitis, etc. All these reasons can lead to the occurrence of nosocomial infections. Junior medical staff processes hands at a social and hygienic level within their competence.

Social level of hand treatment

Regular hand washing. It is carried out before the start of any work (Table 4).

Purpose: to remove dirt and temporary (transient) microflora from the skin of the hands by washing twice with water and soap.

Indications: when hands are dirty, before medical procedure and after its performance, with and without gloves, when caring for the patient (if the hands are not contaminated with the patient's body fluids), before eating, feeding the patient, and also after visiting the toilet.

Equipment: liquid soap, neutral, odorless, soap dispenser (dispenser), clock with a second hand, warm running water. To dry hands, use napkins 15x15 single use, a napkin for a tap.

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

Table 4

Performing a procedure

2. Lather your hands for 30 seconds, washing off the soap with water and paying attention to the phalanges and interdigital spaces of the hands, then wash the back and palm of each hand and wash the bases of the thumbs with rotational movements	Uniform decontamination of the hands is ensured if the surface is lathered thoroughly and evenly. At the first soaping, the bulk of the microflora is washed off, then after exposure to warm water and self-massage, the pores open and the microorganisms are washed off from the opened pores. It must be remembered that hot water removes the protective fatty layer of the skin.
3. Rinse your hands under running water to remove soap scum, holding your hands so that the water runs into the sink from your forearms or elbows (do not touch the sink). Repeat steps 2 and 3 of the procedure
Completion of the procedure
1. Close the faucet using a napkin (close the elbow faucet with the movement of the elbow)
2. Dry your hands with a dry, clean individual towel or with a dryer	According to the principle “from clean to dirty”, i.e. from the fingertips (they should be as clean as possible) to the elbow

Hygienic level of hand treatment (Table 5)

There are two processing methods:

1) hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;
2) hygienic treatment of hands with a skin antiseptic to reduce the number of microorganisms to a safe level.

Hand hygiene should be carried out in the following cases:

? before direct contact with the patient;
? after contact with the patient's intact skin (for example, when measuring the pulse or blood pressure);
? after contact with secrets or excretions of the body, 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.

Purpose: to remove or completely destroy the transient microflora from the hands.

Equipment: liquid soap, soap and skin antiseptic dispensers, a watch with a second hand, warm running water (35-40 ° C), sterile tweezers, cotton balls, napkins; skin antiseptic. Container for waste disposal with disinfectant solution.

Fulfill the mandatory conditions - the same as for the social processing of hands. To dry hands, clean cloth towels or disposable paper towels are used; when treating the hands of surgeons, only sterile cloth ones are used.

It is important to observe the exposure time: hands must be wet from the use of an antiseptic for at least 15 s.

Table 5

Hand hygiene technique

	Rationale
Preparation for the procedure

2. Wrap the sleeves of the robe on 2/3 of the forearm	Draining water should not get on the sleeves of the bathrobe.
3. Open the faucet, adjust the water temperature (35-40 * C)	Optimum water temperature for hand decontamination
Performing a procedure
1. Lather your hands and wash the faucet with soap (the elbow faucet is not washed)	Faucet decontamination in progress
2. Lather your hands for 10 seconds, five or six times according to the scheme (Fig. 24), paying attention to the skin around the nails and the interdigital spaces of the hands. Rinse hands after each soaping	Uniform decontamination of the hands is ensured if the surface is lathered thoroughly and evenly
3. Rinse your hands under running water to remove soap suds so that the water runs into the sink from your forearms or elbows (do not touch the sink)	The phalanges of the fingers should remain the cleanest.

Note. If necessary, if there was contact with the secretions or blood of the patient, hygienic treatment of hands is carried out after mechanical cleaning. Then the hands are treated with an alcohol-containing or other approved antiseptic from a dosing device in an amount of at least 3 ml, recommended by the instructions for use, by rubbing it into the skin of the hands. Particular attention is paid to the treatment of fingertips, skin around the nails, interdigital spaces. An indispensable condition for effective disinfection of hands is to keep them moist for the recommended processing time until completely dry.

Rice. 24.

If there was no contact with the secretions or blood of the patient, hygienic treatment is carried out with an alcohol-containing antiseptic without first washing the hands (Fig. 25).

Rice. 25.

Surgical level of hand treatment (Table 6)

Purpose: to achieve the sterility of the nurse's hands to reduce the risk of wound infection in case of accidental damage to sterile gloves during work.

Indications:

? the need to cover a sterile table;
? participation in the operation, puncture and other surgical intervention;
? participation in childbirth.

Contraindications:

? the presence of pustules on the hands and body;
? cracks and wounds of the skin;
? skin diseases.

Equipment:

? liquid soap in a dispenser;
? hourglass - 1 min, 3 min.
? 0-30 ml of skin alcohol antiseptic;
? sterile tray with forceps;
? sterile bix with targeted styling.

Mandatory condition: use only alcohol-containing skin antiseptics. The procedure is achieved with the help of an assistant supplying sterile material from sterilization boxes, dispensers with soap and an alcohol solution of an antiseptic.

Hand surgery technique

Table 6

	Rationale
Preparation for the procedure
1. Fulfill the prerequisites for effective hand washing and disinfection, check the integrity of the skin of the fingers	There may be skin maceration (damage to the epidermis), which prevents hand decontamination
2. Wash your hands the easy way	See the social level of handwashing
3. Install the sterilization box (bix), check its validity, sterilization terms, observing sterility, open the bix, check the indicators for sterility, readiness for work, put on a sterile scarf, mask	Infection safety and control measures are followed
Performing a procedure
1. Wash hands at a hygienic level for 1 min	Hands and 2/3 of the forearm are decontaminated
2. Wipe hands with a sterile bix towel in the direction from the nail phalanges to the elbow	Wetting motions first right hand, then with the left dry end of the towel gradually shifting it, wipe the phalanges of the fingers of one hand, then the other, the outer, then the inner surfaces of the hands, 1/3 of the forearm, then 2/3 of the forearm, ending with the elbows
3. Treat hands with an alcohol solution of an antiseptic for 3 minutes, following the sequence of actions (see Fig. 25)	Dosing devices are used to prevent contamination of the solution

Health care-associated infections (HAIs) are a major concern in ensuring patient safety, which is why preventing their occurrence should be a priority for healthcare organizations of any profile. According to the World Health Organization, out of 100 hospitalized patients, at least 7 become infected with HCAI. Among seriously ill patients treated in intensive care units, this rate rises to approximately 30 cases of HCAI per 100 people.

HAIs often occur in situations where the source of pathogenic microorganisms for the patient is the hands of medical workers. Today, hand washing by medical personnel or their treatment with skin antiseptics are the most important infection control measures that can significantly reduce the spread of infections that occur during the diagnostic and treatment process in organizations that carry out medical activity.

Background

The history of hand hygiene of medical personnel goes back to the middle of the 19th century, when the highest mortality rate due to "puerperal fever" was observed in obstetric clinics in European countries. Septic complications claimed the lives of about 30% of women in labor.
In the medical practice of that time, physicians were widely fascinated by the dissection of corpses. At the same time, after visiting the anatomical theater, the doctors went to the patients without treating their hands, but simply wiping them with a handkerchief.
There were many different theories of the origin of puerperal fever, but only the Viennese doctor Ignaz Philipp Semmelweis managed to discover the true causes of its spread. The 29-year-old doctor suggested that the main cause of postpartum complications was the contamination of the hands of medical personnel with cadaveric material. Semmelweis noticed that the bleach solution eliminates the smell of decay, which means that it can also destroy the infectious principle present in the corpses. The observant doctor suggested treating the hands of obstetricians with a chlorine solution, which led to a 10-fold decrease in mortality in the clinic. Despite this, the discovery of Ignaz Semmelweis was rejected by contemporaries and received recognition only after his death.

Hand hygiene is a first line measure that has proven high efficiency in the prevention of HCAI and the spread of antimicrobial resistance of pathogenic microorganisms. However, even today the problem of processing the hands of medical personnel cannot be considered fully resolved. Research conducted by WHO has shown that poor hand hygiene practices among health workers are observed in both developed and developing countries.

According to modern concepts, the transmission of HCAI pathogens occurs in various ways, but the most common transmission factor is the contaminated hands of medical workers. Wherein infection through the hands of personnel occurs in the presence of a number of the following conditions :

1) the presence of microorganisms on the skin of the patient or objects of his immediate environment;

2) contamination of the hands of medical workers with pathogens through direct contact with the patient's skin or surrounding objects;

3) the ability of microorganisms to survive on the hands of medical personnel for at least a few minutes;

4) incorrect performance of the hand treatment procedure or ignoring this procedure after contact with the patient or objects of his immediate environment;

5) direct contact of the contaminated hands of a medical worker with another patient or an object that will come into direct contact with this patient.

Microorganisms associated with the provision of medical care can often be found not only on the surface of infected wounds, but also on areas of absolutely healthy skin. Every day, about 10 6 skin scales with viable microbes are shed off, contaminating patients' underwear and bed linen, bedside furniture and other objects. After direct contact with a patient or environmental objects, microorganisms can survive on the hands of healthcare workers for quite a long time, most often from 2 to 60 minutes.

The hands of medical personnel can be inhabited by representatives of their own, resident, microflora, as well as contaminated with potential pathogens (transient microflora) during various manipulations, which is of great epidemiological significance. In many cases, pathogens of purulent-septic infections released from patients are not found anywhere except in the hands of medical workers.

Rules for processing the hands of medical personnel

AT Russian Federation the rules for processing the hands of medical personnel are regulated by SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities". Depending on the nature of the medical manipulation performed and the required level of reduction of microbial contamination of the skin, medical personnel should perform hand hygiene or the so-called surgical hand treatment.

To achieve an effective level of hand skin disinfection healthcare workers must comply with the following requirements :

1. Have short cut natural nails without varnish.

It should be understood that the use of nail polish itself does not lead to increased contamination of the hands, however, cracked varnish makes it difficult to remove microorganisms. varnish dark colors can hide the state of the subungual space, which leads to insufficient quality processing. In addition, the use of nail polish can cause unwanted dermatological reactions, which often result in secondary infection. The procedure for performing a manicure is often accompanied by the appearance of microtraumas that can easily become infected. For the same reasons, medical professionals should not wear artificial nails.

2. Do not wear rings, rings and other jewelry on your hands during work. It is also necessary to remove watches, bracelets and other accessories before performing surgical treatment of the hands.

Jewelry on the hands can lead to increased contamination of the skin and make it difficult to remove microorganisms, jewelry and Jewelry complicate the process of putting on gloves, and also increase the likelihood of damage to them.

According to SanPiN 2.1.3.2630-10, there are two types of disinfection of the hands of medical workers - hygienic treatment of hands and treatment of surgeons' hands.

Hygienic treatment of hands must be carried out in the following cases:

Before direct contact with the patient;

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

After contact with 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, as well as after each contact with contaminated surfaces and equipment.

Exist two ways hand hygiene: washing with soap and water to remove dirt and reduce the number of microorganisms, and using a skin antiseptic to reduce the number of microorganisms to a safe level.

To wash hands, use liquid soap dispensed with a dispenser. Hot water should be avoided as this may increase the risk of dermatitis. If the faucet is not equipped with an elbow drive, you must use a towel to close it. To dry hands, use individual clean cloth or paper towels, preferably single use.

Hygienic treatment of hands (without prior washing) with a skin antiseptic is carried out by rubbing it into the skin of the hands in the amount recommended by the instructions for use, paying special attention to the fingertips, the skin around the nails and between the fingers. An important condition effective hand hygiene is to keep them moist for the recommended exposure time. Do not wash your hands after handling.

Note

Alcohol-based skin antiseptics show b about greater effectiveness than water-based antiseptics, and therefore their use is preferable in the absence of the conditions necessary for washing hands, or in the mode of working hours deficit.

Processing the hands of surgeons is performed by all medical workers involved in surgical interventions, childbirth and catheterization of the main vessels. Surgical hand sanitizer includes two required steps:

1. Washing hands with soap and water for 2 minutes, then drying with a sterile cloth towel or tissue.

On the this stage it is recommended to use sanitary devices and elbow dispensers, which are controlled without the help of the hands. If brushes are used, which is not a prerequisite, a choice should be made in favor of either sterile soft disposable brushes or brushes capable of withstanding autoclaving sterilization. Brushes should only be used to treat the periungual areas during the first disinfection of hands during the work shift.

2. Treatment with a skin antiseptic of the hands, wrists and forearms.

Keep hands moist for the entire recommended treatment time. After exposure to a skin antiseptic, do not wipe your hands. The amount of a particular agent required for processing, the time of its exposure and the frequency of application are determined by the recommendations set forth in the instructions attached to it. Sterile gloves are put on immediately after the antiseptic has completely dried on the skin of the hands.

For surgical treatment of hands, the same preparations can be used as for hygiene. However, it is very important to use skin antiseptics that have a pronounced residual effect.

Soap or skin antiseptic dispensers are filled only after they have been disinfected, rinsed with water and dried. Preference should be given to elbow dispensers and dispensers operating on photocells.

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

Prevention of occupational dermatitis

Repeated processing of hands during the performance of work duties by medical personnel can lead to irritation of the skin, as well as the occurrence of dermatitis, one of the most widespread occupational diseases of medical workers. The most common skin reaction is irritant contact dermatitis, which is manifested by symptoms such as dryness, irritation, itching, and in some cases cracking of the skin. The second type of skin reaction is allergic contact dermatitis, which is much less common and is an allergy to certain ingredients in the product used for hand sanitizer. The manifestations and symptoms of allergic contact dermatitis can be varied and range from mild and localized to severe and generalized. In the most severe cases, allergic contact dermatitis may be accompanied by difficulty breathing and some other symptoms of anaphylaxis.

Irritant contact dermatitis is usually associated with the use of iodophors as skin antiseptics. Other antiseptic ingredients that can cause contact dermatitis, in decreasing frequency of cases, include chlorhexidine, chlorxylenol, triclosan and alcohols.

Allergic contact dermatitis occurs when using hand sanitizers containing quaternary ammonium compounds, iodine or iodophors, chlorhexidine, triclosan, chlorxylenol, and alcohols.

There is a large amount of data obtained in various studies on the best skin tolerance of alcohol-containing hand sanitizers.

Allergic reactions and irritation of the skin of the hands of medical personnel cause discomfort, thereby worsening the quality of medical care, and also increase the risk of transmitting HCAI pathogens to patients due to the following reasons:

Due to damage to the skin, a change in its resident microflora, colonization by staphylococci or gram-negative microorganisms is possible;

During the procedure of hygienic or surgical treatment of hands, the required level of reduction in the number of microorganisms is not achieved;

As a result of discomfort and other unpleasant subjective sensations, there is a tendency for a healthcare worker experiencing skin reactions to avoid handling hands.

Adviсe

In order to prevent the development of dermatitis, medical personnel must observe a number of the following additional recommendations:
1) do not resort to frequent washing hands with soap immediately before or after using an alcohol-based product. Washing hands before treating with an antiseptic is only necessary if there are visible contamination on the skin;
2) when washing hands, avoid using very hot water, as this can lead to skin injury;
3) when using disposable towels, it is very important to blot the skin rather than rub it to avoid cracking;
4) do not wear gloves after handling hands until they are completely dry in order to reduce the risk of developing skin irritation;
5) it is necessary to regularly use creams, lotions, balms and other hand skin care products.

One of basic prevention measures development of occupational dermatitis in healthcare workers is a decrease in the frequency of exposure to the skin of the hands of soap and other irritants detergents through the widespread introduction of alcohol-based antiseptics containing various emollient additives into practice. According to WHO recommendations, the use of medical organization alcohol-containing hand hygiene products are preferred if they are available, since this type of antiseptics has a number of advantages, such as a wide range of antimicrobial activity, including against viruses, short exposure time, and good skin tolerance.

The problem of compliance with hand hygiene rules by medical personnel

Numerous epidemiological studies of adherence (compliance) of medical personnel to the recommended hand hygiene rules show unsatisfactory results. On average, the frequency of compliance by medical staff with the requirements for hand washing is only 40%, and in some cases even much lower. An interesting fact is that doctors and nurses are much more likely than nurses to follow recommendations on hand antisepsis. Most high level Compliance is observed during the weekend, which seems to be associated with a significant decrease in the workload. Lower levels of hand hygiene are recorded in intensive care units and during periods of busy caregiving, while the highest level is observed in pediatric wards.

Obvious barriers to proper implementation of recommendations for the treatment of hands by medical personnel are skin allergic reactions, low availability of hand antiseptics and conditions for its implementation, the priority of measures for patient care and medical care, the use of gloves, lack of working time and high professional workload, forgetfulness of medical workers, lack of elementary knowledge of existing requirements, misunderstanding of the role of hand treatment in the prevention of HCAI.

Activities to improve hand hygiene practices in a medical organization, there should be extensive educational programs among personnel on hand treatment, control over the application of acquired knowledge in professional activities, development of written recommendations on antiseptic treatment when performing various manipulations, reducing the workload for medical workers, creating appropriate conditions for hand hygiene , providing staff not only with antiseptics, but also with skin care products, various administrative measures, sanctions, support and encouragement for employees who perform high-quality hand treatment.

The introduction of modern antiseptics, skin care products and hand hygiene equipment, as well as extensive educational programs for medical personnel, is absolutely justified in medical organizations. Data from numerous studies show that the economic costs associated with treating 4-5 cases of moderate HCAI exceed the annual budget required to purchase hand hygiene products for the entire health care organization (HPE).

Medical gloves

Another aspect related to the hygiene of the hands of medical personnel is use of medical gloves. Gloves significantly reduce the likelihood of occupational infection upon contact with patients or their secretions, reduce the risk of contamination of the hands of medical personnel with transient microflora and its subsequent transmission to patients, and prevent infection of patients with microorganisms that are part of the resident flora of the hands of medical workers. By creating an additional barrier to potentially pathogenic agents, gloves are at the same time a means of protecting both the medical worker and the patient.

The use of gloves is important component system of universal precautions and infection control in healthcare facilities. However, medical personnel often neglect to use or change gloves, even when there is a clear indication for this, which significantly increases the risk of transmission of infection both to the medical worker himself and from one patient to another through the hands of the personnel.

According to the existing requirements of sanitary legislation gloves must be worn in all of the following cases :

There is a possibility of contact with blood or other biological substrates, potentially or obviously contaminated with microorganisms;

There is a possibility of contact with mucous membranes or damaged skin of the patient.

In case of contamination of gloves with blood or other body fluids, in order to avoid contamination of hands during the removal of gloves, remove visible contamination with a swab or tissue moistened with a solution of a disinfectant or skin antiseptic. Used gloves are disinfected and disposed of with other medical waste of the appropriate class.

The significant effectiveness of gloves in preventing contamination of the hands of medical personnel and reducing the risk of transmission of microorganisms during the provision of medical care has been confirmed in clinical studies. However, healthcare professionals should be aware that gloves cannot provide full protection from microbial contamination of hands. Microorganisms are able to penetrate through the smallest defects, pores and holes in the material, as well as get on the hands of personnel during the procedure for removing gloves. The penetration of liquids into gloves is most often observed in the area of the fingertips, especially the thumb. At the same time, only 30% of medical personnel notice such situations. In connection with these circumstances, before putting on gloves and immediately after removing them, it is imperative to carry out antiseptic treatment of hands.

Gloves are single-use medical devices, so decontamination and reprocessing are not recommended. This practice should be avoided, including in medical organizations where the level of material resources is low and the supply of gloves is limited.

There are the following main types of medical gloves:

Examination (diagnostic) gloves;

Surgical gloves with an anatomical shape, providing a high-quality wrist circumference;

Special purpose (for use in various industries medicine): orthopedic, ophthalmic, etc.

In order to facilitate the process of putting on gloves, manufacturers use various substances. Most often, talc, starch-containing powder, magnesium oxide, etc. are used. It should not be forgotten that the use of powdered gloves can lead to a decrease in tactile sensitivity. It is undesirable to get glove powder into the wound area, since cases of postoperative complications due to hypersensitivity reactions in patients are described. The use of powdered gloves in dental practice is also not recommended, since this can cause discomfort in the patient's oral cavity.

Requirements for medical gloves :

Should fit snugly to the hand throughout the entire time of their use;

Should not cause fatigue of the hands and correspond to the size of the hand of a medical worker;

Must retain good tactile sensitivity;

The material from which the gloves are made, as well as the substances used to dust them, must be hypoallergenic.

Compliance with modern requirements for hand hygiene of medical personnel can significantly improve the quality of medical care in healthcare facilities by significantly reducing the risk of infection in patients with HCAI.

Literature

1. Afinogenov G. E., Afinogenova A. G. Modern approaches to hand hygiene of medical personnel // Clinical microbiology and antimicrobial chemotherapy. 2004. V. 6. No. 1. S. 65−91.
2. Hand hygiene and the use of gloves in healthcare facilities / Ed. Academician of the Russian Academy of Natural SciencesL. P. Zueva. SPb., 2006. 33 p.
2. Opimakh I.V.The history of antiseptics is a struggle of ideas, ambitions, ambitions... // Medical Technologies. Evaluation and choice. 2010. No. 2. S. 74−80.
3. WHO guidelines on hand hygiene in health care: summary, 2013. Access mode:http:// www. who. int/ gpsc/5 may/ tools/9789241597906/ en/ . Date of access: 01.11.2014.
4. SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities."

Dubel E. V., head. epidemiological department, epidemiologist of the BUZ VO "Vologda City Hospital No. 1"; Gulakova L. Yu., Chief Nurse, Vologda City Hospital No. 1

The goal is to destroy transient flora to prevent the risk of contamination of the surgical wound when gloves are damaged.

Surgical treatment of hands is carried out:

Before surgical interventions;

When puncturing large vessels;

before intubating the patient.

Equipment:

Liquid dispensed soap.

Napkins (15x15) disposable for getting your hands wet.

Napkins (7x7) disposable for the treatment of hands with a skin antiseptic.

Skin antiseptic.

Disposable sterile rubber gloves.

Surgical treatment of the hands consists of two stages:

Stage 1– mechanical cleaning of hands.

Hands are washed with soap for one minute.

Hand washing routine.

Palm to palm;

Right palm over the back of the left;

Left palm over the back of the right;

nail beds;

Palm to palm, pollen from one hand between the fingers of the other;

Rotational friction of the thumbs;

Rotational friction of the palms.

Each movement is repeated 5 times.

Then the hands are thoroughly rinsed with warm water and blotted dry with a sterile napkin.

Stage 2- disinfection of hands with a skin antiseptic.

80% ethanol solution as a skin antiseptic in surgical treatment of hands not used.

Technique for treating hands with a skin antiseptic.

Hands are wiped with a napkin (7x7) moistened with a skin antiseptic from the fingertips to the elbow. The nail beds are wiped especially carefully, between the fingers and the base of the thumb. Hands are wiped twice, with different sterile wipes for 1.5 minutes, and in total - 3 minutes.

Gloves are worn only on sterile and dry hands. Gloves are disposable.

After removing gloves, hands are wiped with a napkin (7x7) moistened with a skin antiseptic, then washed with soap, rinsed thoroughly and softened with cream.

When using alcohol-containing skin antiseptics, they can be rubbed 2.5 - 3.0 ml into the skin of the hands and forearms for 5 minutes. until completely dry, then sterile gloves are put on dry hands.

Spring-cleaning.

General cleaning is carried out Once a week or after removing the patient from the ward.

Preparing for a general cleaning.

On the eve of the cleaning, the rags are given for sterilization (8 pcs. - for walls, furniture, refrigerator, floor, 2 pcs each). The marking must be clear.

On the day of cleaning, the furniture is moved away from the walls, medications and food products are taken out of the room.

Sinks and skirting boards are cleaned with a cleaning agent with a brush.

The employee puts on a special clothes marked "for cleaning" - 2 sets.

Rules for putting on clothes:

A) cotton pajamas with fasteners on the back, elastic bands on the sleeves and legs, the blouse is tucked into trousers;

B) cotton-gauze mask or respirator;

B) goggles

D) a large cotton scarf;

D) rubber technical gloves;

E) rubber boots;

G) rubber or oilcloth apron.

At the end of wiping, ultraviolet irradiation (UVR) is carried out. The exposure time depends on the power of the lamp according to the passport and the area of the room. The quartzing mode should be posted in a "visible" place.

After UVR, the room is ventilated until the smell disappears.

Disinfection (disinfection) of quartz lamps.

The lamp is disinfected once every 7 days. The frame is washed like walls during general cleaning with an interval of 15 minutes. 70% ethanol solution.

Toilet rooms. Wiping is carried out as in a treatment room. The toilet bowl is wiped twice with the same disinfectant solution that is used for cleaning in the departments - 3% chloramine or 4% hydrogen peroxide.

For wiping, there should be a kwach, which is disinfected in a 3% solution of chloramine for 60 minutes, 4% hydrogen peroxide - 90 minutes.

Dishes processing.

Order No. 288 of the Ministry of Health of the USSR, 1976 "Sanitary and epidemiological regime in health care facilities."

San PiN 5179-90 MZ USSR 1991 “San. device rules, equipment and operation of hospitals and other healthcare facilities”.

San PiN 2.3.6.959-00 “San-epid. requirements for the organization of public catering "MZ RF, 2000.

Tableware processing

Each honey. the sister takes an obligatory part in feeding the sick. To do this, she puts on a dressing gown or an apron marked M/S for serving food, which is located in the pantry room and is changed every day. Before serving food, the m / s performs a mechanical treatment of hands (hands are washed with soap twice, rinsed thoroughly with warm water and dried with a clean towel, which is changed daily, or with a disposable napkin).

Food must be distributed no later than 2 hours from the moment the food was received at the catering facility.

Food serving temperature:

First courses - 70-75 0 C;

Second courses - 60-65 0 С;

Third courses - not lower than 14 0 С.

At the end of feeding, the dishes are collected by the barmaid and delivered to the washing cupboard, and the nurse wipes the tables and bedside tables twice with an interval of 15 minutes. 1% chloramine solution or 3% hydrogen peroxide solution in the somatic departments or the disinfectant solution that the department operates.

In the buffet room, tableware is emptied of food residues into a food waste container.

Disinfection of food waste.

Waste is boiled for 30 minutes. or covered with dry bleach at the rate of 200g/l - exposure 60 min. and disposed of.

Stages of processing dishes.

In the first container, the dishes are degreased:

In a 2% solution of baking soda (20 g of soda);
In 2% solution of mustard (mustard 20 g + up to 1 liter of water).

Degreasing conditions:

The temperature of degreasing solutions must be at least 50 0 С.

Exposure 30 min.

Dishes in this solution are washed with rags for at least 1 minute, then transferred to a second container.

In the second container, the dishes are degreased in disinfectant solutions:

1% chloramine solution - 60 minutes;
3% solution of H 2 O 2 - 80 min.;

The temperature of the disinfectant solutions is 18-20 0 С.

In the third container, the dishes are rinsed in running water at a temperature of 70-75 0 C until the smell disappears. Due to the high temperature, the dishes are rinsed out of the hose.

Dishes are dried on racks in a vertical position.

Spoons are first degreased and then degreased in an oven at a temperature of 180 0 C for 20 minutes.

Cookware, in which food is delivered to the buffet from the catering department, goes through two stages of processing: degreasing and rinsing and drying upside down on the grates.

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