Surgical and hygienic treatment of the hands of medical personnel. Hand hygiene as one of the important infection control measures in healthcare organizations

STATE EDUCATIONAL INSTITUTION
HIGHER PROFESSIONAL EDUCATION "NOVOSIBIRSK STATE MEDICAL UNIVERSITY OF THE FEDERAL AGENCY FOR HEALTH AND SOCIAL DEVELOPMENT"

Faculty of Economics and Management
Department of Pedagogy and Psychology

COURSE WORK

by discipline _____ Pedagogy with teaching methods ____

on the topic: "hand treatment"

Supervisor
_______________________ FULL NAME

"____" _______________ 2010

Performer student
Zinovieva A.R. III course, 2 gr, VSO

"____" _______________ 2010

NOVOSIBIRSK 2010

Plan:

Introduction

Skin microflora: resident flora, transient flora;

Social level;

Hand processing is a necessary sequence of movements;

Hygienic level;

Surgical level;

Possible complications associated with frequent hand washing;

Measures that reduce the likelihood of complications;

Use of gloves:

Sequence of actions when putting on gloves;

The sequence of actions when removing gloves;

Conclusion

Purpose of the lesson

Consolidation and generalization of knowledge and skills correct processing hands in daily activities medical personnel.

The nurse should know :

Levels of hand treatment: social (goals, indications, necessary conditions, hand washing technique); hygienic (stages, goals, indications, necessary conditions); surgical (stages, goals, indications, necessary conditions, hand washing technique);

Rules and duration of hand treatment at all levels, differences;

The sequence of movements in the processing of hands;

Possible complications in the processing of hands and their prevention;

Use of gloves (goals, indications, contraindications, necessary conditions, possible complications, the sequence of actions for putting on and taking off gloves).

Nurse for your own safety and the safety of the patient should be able :

Correct handling of hands;

Correctly carry out the technique of putting on and removing medical gloves.

Introduction

The most important component of infectious safety is the prevention of the possibility of transmitting microorganisms from the patient to the medical staff and vice versa.

Infectious diseases of medical staff associated with professional activities occupy a certain place in the structure of infectious morbidity.

Infection of medical personnel occurs as a result of:

natural transmission mechanisms;

An artificial transmission mechanism (i.e. an artificial transmission mechanism created by medicine - various invasive and therapeutic procedures).

Infected hands play a significant role in the transmission of infectious agents. Numerous studies have proven a significant contamination of the hands of medical personnel with microorganisms. At the same time, the species composition of the microflora depends on the characteristics of the work performed.

Proper and timely treatment of the hands of medical personnel is one of the leading measures in the fight against infectious diseases and ensuring the safety of staff and patients.

Skin microflora

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

Resident flora

Transient flora

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

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

Transient microflora are those microorganisms that are acquired by medical personnel as a result of contact with infected patients or contaminated objects environment. Transient flora can be represented by much more epidemiologically dangerous microorganisms (E.coli, Klebsiella spp., Pseudomonas spp., Salmonella spp. and other gram-negative bacteria, S.aureus, C. albicans, rotaviruses, etc.), including hospital strains of pathogens of nosocomial infections. Transient microorganisms persist on the skin of the hands a short time(rarely more than 24 hours). They can easily be removed with normal hand washing or destroyed with antiseptics.

As long as these microbes remain on the skin, they can be transmitted to patients through contact and contaminate various objects. This circumstance makes the hands of personnel the most important factor in the transmission of nosocomial infection.

If the integrity of the skin is violated, then the transient microflora can cause an infectious disease (for example, panaritium or erysipelas). You should be aware that in this case, the use of antiseptics does not make hands safe in terms of infection transmission. Microorganisms (most often staphylococci and beta-hemolytic streptococci) remain with the disease on the skin until a cure occurs.

Hand treatment

Hand treatment for the prevention of wound infection was first used by the English surgeon J. Lister in 1867. The treatment of the surgeon's hands was carried out by disinfecting them with a solution of carbolic acid (phenol). In addition, Lister used a solution of carbolic acid to irrigate instruments, dressings, and to spray in the air over the surgical field.

Sir Joseph Lister's method (1827-1912) was a triumph of 19th century medicine. In the 21st century, handwashing - this simple method of preventing infections (primarily intestinal ones) - is unfortunately often ignored by both the public and some medical professionals.

Meanwhile, Correct and timely processing of hands is the key to the safety of medical personnel and patients.

Hand treatment is divided into three levels:

Household or social level (mechanical processing of hands);

Hygienic level (treatment of hands using skin antiseptics);

Surgical level (a special sequence of manipulations in the treatment of hands, followed by putting on sterile gloves).

Social level of hand treatment

The goal of the social level of hand treatment is mechanical removal from the skin of most of the transient microflora (antiseptics are not used).

after visiting the toilet;

before eating or before working with food;

before and after physical contact with the patient;

with any contamination of the hands.

Required equipment:

Liquid dosed neutral soap or individual disposable soap in pieces. It is desirable that the soap does not have a strong odor. Open liquid or bar reusable non-personal soap quickly becomes infected with germs.

Napkins measuring 15x15 cm are disposable, clean for getting your hands wet. The use of a towel (even an individual one) is not desirable, because it does not have time to dry and, moreover, is easily seeded with microbes.

Hand treatment rules:

All jewelry, watches are removed from the hands, as they make it difficult to remove microorganisms. Hands are soaped, then rinsed warm running water and everything repeats from the beginning. It is believed that during the first soaping and rinsing with warm water, microbes 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 hand sanitizer 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.
Hand treatment - the necessary sequence of movements:

Rub one palm against the other palm with reciprocating movements (Appendix 1);

Rub the back surface of the left hand with the right palm, change hands (Appendix 2);

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 (Appendix 3);

Connect the fingers into a “lock”, rub the palm of the other hand with the back of the bent fingers (Appendix 4);

Cover the base thumb left hand between large and index fingers right hand, rotational friction. Repeat on the wrist. Change hands (Appendix 5);

Rub the palm of the left hand with the fingertips in a circular motion. right hand, change hands (Appendix 6).

Each movement is repeated at least 5 times. Hand treatment is carried out within 1 minute(30 s for each hand).

It is very important to follow the described handwashing technique, since special studies have shown that during routine handwashing, certain areas of the skin (fingertips and their inner surfaces) remain contaminated.
After the last rinse, the hands are wiped dry with a napkin (15x15 cm). The faucets are closed with the same napkin. The napkin is dropped into a container with disinfectant solution for recycling.
In the absence of disposable wipes, it is possible to use pieces of clean cloth, which, after each use, are discarded into special containers and, after disinfection, sent to the laundry. Replacing disposable wipes with electric dryers is impractical, because. with them, there is no rubbing of the skin, which means that there is no removal of detergent residues and desquamation of the epithelium.

Hygienic level of hand treatment

The purpose of hygienic treatment is the destruction of the microflora of the skin with the help of antiseptics (disinfection).

Such hand treatment is carried out:

before putting on gloves and after removing them;

before caring for a patient with a weakened immune system or when making rounds in the wards (when it is not possible to wash hands after examining each patient);

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

after contact with body fluids (e.g. blood emergencies).

Required equipment:

Liquid dosed pH-neutral soap or individual disposable soap bars.

Napkins size 15x15 cm disposable, clean.

Napkins are clean (7x7 cm), for treating hands with skin antiseptics.

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

Gloves are disposable.

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 stage of mechanical cleaning (double soaping and rinsing), the antiseptic is applied to the hands in an amount of at least 3 ml and carefully rubbed into the skin until completely dry(Do not wash 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. The sequence of movements in the processing of hands corresponds to(Appendices 1-6).
etc.................

Maintaining hygiene and cleanliness is a guarantee of health in all spheres of life. If a we are talking about medicine, then the cleanliness of hands should be an inalienable rule, because the life of both the entire medical staff and the patient depends on such a trifle at first glance. The nurse is obliged to ensure that the condition of her hands is satisfactory and meets the medical standards of public health. It is important to get rid of micro cracks, burrs, clean nails and remove any, if any. Why is this so important, and what are the requirements?

In order for all staff to comply with the European medical standard, it is important for each employee to tell about the existing requirements for the disinfection of hands, instruments and other medical devices. For nurses, there are separate rules for caring for hands, these include the following requirements:

do not paint or glue artificial nails
nails should be neatly trimmed and cleaned
it is not recommended to wear bracelets, watches, rings or any other Jewelry, as they are sources of bacteria and microbes

It was found that it is non-observance of hands among doctors and nurses that contributes to the development and rapid spread of nosocomial infectious agents throughout the clinic. Touching with unclean hands manipulation tools, devices, patient care items, devices for taking tests, technical equipment, clothing, and even medical waste can adversely affect the health of the patient and all those in the hospital for a long period of time.

To prevent the spread of microorganisms and reduce the risk of infection through hands, there are rules and means of disinfection. These recommendations must be followed by any hospital employee, especially those who work closely with sources of infection and infected patients.

In medicine, several methods have been developed for disinfecting the hands of all medical staff:

hand washing with soapy water and ordinary water, without the use of additional products
washing hands with antiseptic hygiene products
surgical disinfection standards

Surgical Disinfection Rules

Surgery is an area where neglect of hand hygiene can cost a patient's life. Hand treatment is carried out in such situations:

Before any type of surgery
During invasive procedures such as vascular puncture

Of course, the doctor and all assistants during the operation wear disposable sterile gloves on their hands, but this does not give the right to forget about hygienic protective equipment and hand treatment.

Surgical treatment includes not only the disinfection of the hand, but also the entire arm up to the forearm. The specified parts of the body are washed under a tap with warm water, antiseptic agents are used, liquid soap, disposable wipes and sterile towels. Movement and sequence is carried out according to the local standard specified in the medical sanitary book.

Modern methods of disinfection

Medicine is moving forward and disinfection techniques are improving every day. At the moment, a mixture is widely used, which includes the following components: distilled water and formic acid. The solution is made daily, stored in enamelware. Hands are immediately washed with ordinary soap, and then washed with this solution for a couple of minutes (the part from the hand to the elbow is processed for 30 seconds, the rest of the time the hand itself is washed). Hands are wiped with a napkin and dried.

Another way is disinfection with chlorhexidine, which is initially diluted with 70% medical alcohol (dosage one to forty). The processing procedure takes about three minutes.

Iodopyron is also used for hygienic treatment of the hands of medical staff. The whole process follows a similar pattern: hands are washed with soapy water, then nails, fingers and other areas are disinfected with cotton swabs.

Ultrasonic treatment. The hands are lowered into a special one through which ultrasonic waves pass. Processing takes less than a minute.

All methods are good, it is only important not to neglect the general recommendations.

So, hand disinfection in medicine plays an important role. It is not enough to simply wash your hands with water. The treatment of the brush is carried out in different ways, various hygiene products are used, depending on the situation. neglect elementary rules can lead to negative consequences, from which not only patients, but also medical personnel will suffer.

Jun 22, 2017 Violetta Doctor

Is an mandatory procedure before taking any action with the patient. Used for processing various means and drugs that do not require a long investment of time 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:

After the therapy of patients diagnosed with an inflammatory process with the release of pus.
After contact with devices and any other object located near the patient.
After each contact with contaminated surfaces.
After contact with the mucous membranes of a person, his excretions and
After contact with skin sick.
Before performing patient care procedures.
Before each contact with the patient.

Proper hygiene treatment involves washing with soap and running water in order to get rid of contaminants and reduce the number of microorganisms. In addition, the treatment of hands in a hygienic way is the procedure for treating the skin with antiseptic agents, which help to 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 should be filled with a hand care product.

It is not recommended to dry hands with electric type dryers, as they will still remain damp, and the device causes air turbulence, 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 intended for workers with sensitive skin.

Carrying out algorithm

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

Dispenser extrusion required amount liquid soap.
Rubbing in palm-to-palm mode.
Rubbing one palm of the hand against the back of the other.
Rubbing internal surfaces fingers vertically.
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).
Rubbing all fingers in circles.
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 duration 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:

Wash hands with soap and water for at least two minutes.
Dry your hands using a disposable tissue or towel.
Treat the hands, forearms, and wrists without wiping the hands afterwards.
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

Antiseptic solution is one of the main means of combating microorganisms, which includes hygienic treatment of hands. The algorithm is the following:

Washing hands in water room temperature with liquid soap, drying with a disposable towel.
Applying a disinfectant with rubbing movements, which disinfects the hands.
With interlaced fingers, massage the backs of the hands.
With widely spaced, rub your palms.
Rub the product into the thumbs with clenched palms alternately.
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 hands with a sterile brush, giving Special attention 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 focused on 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.

End of procedure.

Execution of a procedure.

Social level of hand treatment

Levels of treatment of the hands of a medical worker

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

Target: remove microflora from the surface of the hands mechanically. Ensure the safety of patients and staff.

Indications:

Before and after performing medical procedures with and without gloves;

Before and after eating, feeding the patient;

After visiting the toilet;

Before and after patient care, unless hands are contaminated with the patient's bodily fluids.

Equipment: laundry soap (liquid) for single use, a watch with a second hand, warm running water, sterile wipes on a tray, an individual towel (electric dryer).

Required condition: healthy skin of the hands, nails no more than 1 mm, without varnishing. Before the procedure, clean under the nails, wash under running water.

Preparation for the procedure.

Remove the rings from the fingers, check the integrity of the skin of the HAND .
Wrap the sleeves of the dressing gown up to the elbow, remove the watch.
Open the tap, adjust the water temperature (35-40 °).

1. Soap your hands and wash the faucet with soap (the elbow faucet is not washed, if a bar of soap is used, wash it, put it on a clean napkin or in a lattice soap dish).

2. Wash hands with soap and running water up to 2/3 of the forearm for 30 seconds, paying attention to the phalanges and interdigital spaces of the hands, then wash the back and palm of each hand and rotate the base of the thumbs.

Note: this time is sufficient for decontamination of hands at a social level, if the surface of the skin of the hands is lathered thoroughly and dirty areas of the skin of the hands are not left.

3. Rinse hands under running water to remove soap suds.

Note: hold your hands with your fingers up so that the water runs into the sink from your elbows (do not touch the sink). The phalanges of the fingers should remain the cleanest.

4. Repeat hand washing in the same sequence.

1. Close the faucet using a napkin (close the elbow faucet with the movement of the elbow).

2. Dry hands with a dry, clean individual towel or dryer.

Target: ensuring decontamination of hands at a hygienic level.

Indications:

Ø before putting on and after removing gloves;

Ø after contact with body fluids and after possible microbial contamination;

Ø before caring for an immunocompromised patient.

Ø before and after contact with infectious patients of known or suspected etiology;

Ø after contact with secretions of patients (pus, blood, sputum, feces, urine, etc.);

Ø before and after manual, instrumental examinations and interventions not related to penetration into sterile cavities;

Ø after visiting the box in infectious diseases hospitals and departments;

Ø after visiting the toilet;

Ø before going home.

Equipment: bactericidal soap, watch with a second hand, warm running water, sterile: tweezers, cotton balls, napkins, a container for discarding disinfectant.

Required condition: absence of skin lesions on the hands.

Stages	Notes
Preparation for the procedure
one . Remove rings from fingers.	Preparation for processing the necessary surface of the hand.
2. Wrap the sleeves of the dressing gown on 2/3 of the forearm, remove the watch.	Ensuring the infectious safety of the nurse.
3. Open the tap.	Running water is used.
Performing a procedure
one . Wash hands with soap and running water up to 2/3 of the forearm, paying attention to the phalanges and interdigital spaces of the hands for 10 seconds.	Ensuring the greatest degree of decontamination of the fingers, observing the principle of surface treatment "from clean to dirty".
2. Rinse hands under running water to remove soap suds.
3. Repeat washing each hand up to 5-6 times.
Completion of the procedure
one . Dry your hands with a tissue.	Ensuring infectious safety.
2. Throw the wipe into a container with disinfectant.
3. Turn off the faucet using a sterile cloth, or ask an assistant to do this.

Note: with absence necessary conditions for hygienic hand washing, you can treat them with 3-5 ml of antiseptic for 2 minutes.

Nails should be cut short and not painted. It is also necessary to take care of the hair, which must be neatly combed and tucked away under a medical cap. It is important to keep clean not only the hands and the whole body, but also the oral cavity and nasopharynx. Teeth should be brushed 2 times a day (at night and in the morning after meals) and rinse your mouth after eating.

Compliance with the rules of personal hygiene of medical personnel, and disinfection of hands is regulated by Decree No. 71 of the Chief State Sanitary Doctor of the Ministry of Health of the Republic of Belarus dated 11.07.2003. "On approval and implementation of sanitary rules".

Hygienic antisepsis of the skin of the hands is carried out in order to remove and destroy the transient population of microorganisms.

Indications for hygienic hand antisepsis:

Before and after contact with infectious patients (patients with AIDS, viral hepatitis, dysentery, staphylococcal infection, etc.);

After contact with secretions of patients (pus, blood, sputum, feces, urine, etc.);

Before and after manual and instrumental examinations and interventions not related to penetration into sterile cavities;

After visiting boxing in infectious diseases hospitals and departments;

After visiting the toilet;

Before leaving home.

Stages of hygienic antisepsis of the skin of the hands:

1. Apply 3 ml of antiseptic on the hands and rub thoroughly into the palmar, back and interdigital surfaces of the skin of the hands for 1 minute until the antiseptic is completely dry.

2. When heavy pollution biomaterials (blood, mucus, pus, etc.), first remove the contamination with a sterile cotton-gauze swab or gauze napkin moistened with a skin antiseptic. Then apply 3 ml of antiseptic to the hands and rub until completely dry (at least 30 seconds), then wash your hands with soap and running water.

The scheme of processing the hands of medical personnel

According to the European standard EN1500, the treatment of the skin of the hands of medical personnel should be carried out according to the following scheme:

Rub palm on palm (Fig. 1, a);

Rub with left hand back side right hand, and vice versa (Fig. 1, b);

Rub the palms with crossed, outstretched fingers (Fig. 2);

Rub the back of the bent fingers on the palm of the other hand (Fig. 3);

Alternately in a circular motion rub the thumbs (Fig. 4);

Rub the palms with the fingertips of the other hand alternately in multidirectional circular motions.

Every day, nurses deal with a huge number of chemicals, which can cause general and local changes in the body. Chemicals can enter the body through the respiratory tract in the form of dust or vapors, be absorbed through the skin, mucous membranes. Their impact can take the form skin reactions, dizziness, headaches, etc. Separate results of exposure can be miscarriages, infertility, diseases of various organs. The most common manifestation of exposure to chemicals in a nurse is irritation and inflammation of the skin and mucous membranes - occupational dermatitis. Nurses are at risk because of the need frequent washing hands and exposure to pharmacological preparations, disinfectants and even rubber gloves.

Dermatitis can cause:

Ø primary irritants (chlorine- and phenol-containing disinfectants) cause inflammation of the skin only at the site of direct contact with the substance;

Ø sensitizers (antibiotics, antibacterial soap, etc.) cause an allergic reaction in the form of dermatitis or proceed even more severely (swelling of the lips, eyelids, face, nausea, vomiting).

Hands play a significant role in the transmission of nosocomial pathogens in dentistry. Numerous studies have proven a significant contamination of the hands of medical personnel with microorganisms. In this case, the species composition depends on the characteristics of the work performed.

There are three levels of processing the hands of medical personnel:

normal wash;

hygienic processing of hands;

hand surgery.

Routine hand washing ensures the removal of dirt and transient microflora that gets on the doctor's skin during contact with the patient or contaminated environmental objects. Carried out by thorough hand washing:

before starting work;

before and after physical contact with the patient;

when changing clothes and places of work.

It is necessary to wash twice, because. in this case, the efficiency will be 65 - 70% (with a single dose - 40%). It is better to use liquid soap in disposable dispensers.

When using soap bars, it is necessary to place small bars of soap in special racks with drainage so that the soap dish ensures that the soap dries before reuse.

Methodology:

Remove jewelry and watches (because the quality is reduced);

Squeeze out liquid soap from the dispenser with a dry hand or dry soap is taken with a dry hand;

Rub the soap vigorously under running water for at least 30 seconds;

Rinse off soap residue under running water and repeat;

Dry with a disposable paper or individual towel. In medical institutions, it is not recommended to use reusable fabric towels, as well as roll-type towels.

Hand hygiene ensures the removal or destruction of transient (surface) pathogenic or opportunistic microflora in order to prevent its spread through the hands of personnel to surrounding objects and patients served, as well as after manipulations that could lead to contamination of the hands of personnel during examination and treatment of patients. Hygienic disinfection of hands must be carried out by all staff regularly.

Handling includes routine handwashing and the use of disinfectants - skin antiseptics , which, in accordance with the purpose subdivided into groups :

For hygienic treatment of the hands of medical personnel (doctors, nurses, etc.);

For disinfection of the hands of surgeons, operating nurses and other participants in the operation;

For disinfection of the surgical field;

For disinfection of the injection field, etc. (carried out by wiping with a sterile swab moistened with an antiseptic)

To prevent damage to the integrity and elasticity of the skin, skin softening additives should be included in the antiseptic: 1% glycerin, lanolin. Personnel should be warned against wearing rings and using nail polish, as rings and cracked polish make it difficult to remove microorganisms. Manicure can lead to microtrauma that is easily infected.

Skin antiseptics:

Special liquid bactericidal soaps;

Alcohol solutions of skin antiseptics;

Bacterial agents in the form of a gel.

Hygienic treatment of the dentist's hands is carried out before manipulations with gloves (BEFORE and AFTER), after contact with body fluids.

How to use skin antiseptics: 3-5 ml are applied to moistened hands. and rub until dry. If the product is based on alcohols, then the antiseptic is applied to dry hands and rubbed for at least 15 seconds.

Surgical treatment of hands (treatment of the surgeon's hands) provides the most high level purity. It is carried out only with alcohol-containing antiseptics. Processing time is at least 2-5 minutes.

Products: AHD-2000, AHD-2000 Special (CJSC Petrospirt, Russia), Decosept (Bohrer Chemi GmbH, Germany), Lizanin (CJSC Petrospirt, Russia), Sterillium (Bode Chemi GmbH i Co., Germany), etc.

The use of ethyl alcohol to disinfect the hands of a dentist is not advisable, because. its frequent use leads to dryness of the skin of the hands, and in cases of use for disinfection of gloves, it leads to the appearance of microcracks that reduce their barrier function.

Rules for working with gloves:

Gloves are replaced with new ones after each patient's appointment!

Gloves are worn on thoroughly washed hands!

Jewelry and watches must be removed from hands before putting on gloves!

If the doctor uses non-sterile gloves, then after putting them on, gloved hands should be thoroughly washed with soap and treated with an antiseptic solution!

After the gloves are removed, the hands must be thoroughly washed!

Do not touch the mucous membranes of your eyes, nose, mouth, as well as unprotected skin with gloved hands!

Do not leave your workplace with gloves on!

If a glove breaks, take it off immediately, wash your hands thoroughly and put on a new glove!

To maintain the normal condition of the skin of the hands during work, it is recommended:

Wash hands with room temperature water (about +20°C) before and after each patient;

After washing, thoroughly dry the skin of the hands with a dry individual towel (the use of paper towels is recommended);

Do not allow medicinal allergens (antibiotics, novocaine, polymers, components of adhesive systems, etc.) to come into contact with open skin surfaces;

Use neutral grades of soap, for example, "Silk", "Silk with antiseptic";

Treat the skin of the hands before starting work with protective creams, for example

Soften the skin of the hands with nourishing and moisturizing creams, for example