Send your good work in the knowledge base is simple. Use the form below

Good work to site">

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Posted on http://www.allbest.ru/

Posted on http://www.allbest.ru/

GOU SPO "TULA REGIONAL MEDICAL COLLEGE"

DEPARTMENT OF POSTGRADUATE EDUCATION

TEST

Rules for the treatment of hands of medical staff, hygienic treatment of hands

CYCLE OF PROFESSIONAL RETRAINING FOR THE SPECIALTY "NURSING"

Performed by: Pluzhnikov Sergey Vladimirovich

Introduction

1. Historical information

2. Microflora of the skin of the hands

3. Resident microflora

4. Transient microflora

Bibliography

Introduction

Hands are one of the main factors in the transmission of HAI pathogens. Transient pathogenic or conditionally pathogenic microflora, opportunistic microbes are transmitted through the hands of personnel. Possible contamination of the surgical wound and representatives of the resident microflora of the skin

1. Historical information

For the first time, hand treatment with a solution of carbolic acid (phenol) for the prevention of wound infection was used by the English surgeon Joseph Lister in 1867. D. Lister's method (1827 - 1912) became a triumph of medicine in the 19th century.

Robert Koch (1843 - 1910) - German microbiologist, one of the founders of modern bacteriology and epidemiology

In his publications, Koch developed the principles of "obtaining evidence that a particular microorganism causes certain diseases." These principles still underlie medical microbiology.

Hand hygiene is a first line measure that has proven high efficiency in the prevention of nosocomial infections 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 adherence to hand hygiene practices by health workers occurs in both developed and developing countries.

According to modern concepts, the transmission of HAI pathogens occurs in various ways, but the most common transmission factor is the contaminated hands of medical workers. In this case, 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.

2. Microflora of the skin of the hands

I. Resident (normal) microflora - these are microorganisms that constantly live and multiply on the skin.

II. Transient microflora is a non-colonizing microflora acquired by medical personnel in the course of work as a result of contact with infected environmental objects.

1. Pathogenic microflora is a microflora that causes a clinically significant disease in healthy people.

2. Conditionally pathogenic microflora is a microflora that causes a disease only in the presence of a specific predisposing factor.

3. Microbes - opportunists - this is a microflora that causes a generalized disease only in patients with a pronounced decrease in immunity.

3. Resident microflora

Resident microflora stimulates the formation of antibodies and prevents the colonization of the skin by gram-negative microorganisms. It lives in the stratum corneum of the skin, is located in the hair follicles, sebaceous, sweat glands, in the area of ​​\u200b\u200bthe nail folds, under the nails, between the fingers.

It is mainly represented by cocci: epidermal and other types of staphylococci, diphtheroids, propionibacteria.

It cannot be completely removed with normal hand washing and antiseptic treatment.

4. Transient microflora

It is represented mainly by microorganisms that are in the external environment of the institution, epidemiologically dangerous:

pathogenic microorganisms (salmonella, shigella, rotaviruses, hepatitis A viruses, etc.);

conditionally pathogenic microorganisms:

Gram-positive (staphylococcus aureus and epidermal);

Gram-negative (E. coli, Klebsiella, Pseudomonas);

Mushrooms (candida, aspergillus).

It remains on the hands for no more than 24 hours and can be removed by normal hand washing and treatment with antiseptics.

The most contaminated areas of the skin of the hands are:

subungual space;

Periungual rollers;

Finger pads.

The most difficult to wash areas are:

subungual space;

Interdigital spaces;

Thumb notch.

Hand disinfection is one of the most effective measures to prevent nosocomial infections and to protect patients and medical staff from infection. The basis for the prevention of nosocomial infections is a hygienic culture and epidemiological preparedness at all stages of work.

5. Rules for the processing of the hands of medical personnel

To achieve effective hand washing and disinfection, the following conditions must be met:

1. clean, short cut nails, no nail polish, no artificial nails; well-groomed (without cracks and burrs) hands, unedged (European) manicure;

2. the absence of rings, rings and other jewelry on the hands; before processing the hands of surgeons, it is also necessary to remove watches, bracelets, etc.;

3. application liquid soap using a dispenser;

4. use for drying the hands of clean individual cloth towels or disposable paper napkins, when processing the hands of surgeons - only sterile cloth ones.

6. Hygiene treatment hands

Hygienic treatment of hands with a skin antiseptic should be carried out in the following cases:

Before direct contact with the patient;

Before putting on sterile gloves and after removing gloves when placing a central intravascular catheter;

Before and after the placement of central intravascular, peripheral vascular and urinary catheters or other invasive devices, if these manipulations do not require surgical intervention;

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

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

When performing various manipulations to care for a patient after contact with areas of the body contaminated with microorganisms;

After contact with medical equipment and other objects in the immediate vicinity of the patient.

Hand hygiene is carried out in two ways:

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

Hand sanitizing to reduce microbial counts to safe levels.

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

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

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

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

7. Technique for treating hands with an alcohol-containing skin antiseptic

Rub the antiseptic for hygienic processing of hands! Wash your hands only if visible contamination is present!

8. Hand washing technique with soap and water

The duration of treatment is 2-3 minutes, special attention is paid to the nails and subungual areas.

The movements of each stage are repeated five times, constantly making sure that the hands remain wet during the entire treatment. If necessary, use a new portion of the disinfectant solution. Currently, an alcohol solution of 0.5% chlorhexidine bigluconate in 70% ethyl alcohol, Octeniderm, Octeniman, Octenisept, Veltosept, AHD 2000 special, Dekosept plus, 60% isopropanol, 70% ethyl alcohol with skin softening additives, etc. is used for hand treatment. .

Recently, studies have emerged that prove that watches, pens and mobile phones of healthcare workers are also breeding grounds for germs.

Thus, hand hygiene is an integral part of the system of measures for the prevention of nosocomial infection in a medical organization.

infection hand antiseptic

Bibliography

Afinogenov G.E., Afinogenova A.G. Modern approaches to hand hygiene of medical personnel // Clinical microbiology and antimicrobial chemotherapy. 2004. V. 6. No. 1.

Opimakh I.V. The history of antiseptics is a struggle of ideas, ambitions, ambitions... // Medical Technologies. Evaluation and choice.

WHO guidelines on hand hygiene in health care: summary, 2013.

SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations carrying out medical activity».

Hosted on Allbest.ru

...

Similar Documents

Hand skin microflora: resident and transistorized. Types of hand treatment: household, hygienic and surgical. Types of microorganisms on the skin. Preparation of hands for hygiene procedures. Wash sequence. Requirements for skin antiseptics.

presentation, added 01/14/2015


Products used for hand hygiene of medical personnel: disinfectants, antiseptics, sterilants, chemotherapeutic agents, antibiotics, cleaning agents and preservatives. Possible Negative consequences hand treatment and prevention.

term paper, added 03/31/2013


Sanitary and hygienic processing of products representing an epidemiological hazard. Thermal, radiation and chemical sterilization. Treatment of medical equipment with water vapor, dry hot air, infrared radiation.

presentation, added 10/20/2016


principles of asepsis. Sources and ways of infection of the surgical wound. Measures to reduce bacterial contamination of the air. Methods and stages of sterilization. Treatment of the surgeon's hands. Ways to control sterility. Rules for processing the surgical field.

presentation, added 11/09/2014


Correct and timely processing of hands as a guarantee of the safety of medical personnel and patients. Hand treatment levels: household, hygienic, surgical. Basic requirements for hand sanitizers. European standard for hand treatment EN-1500.

presentation, added 06/24/2014


Requirements for the implementation of hygienic and surgical antiseptics for the treatment of the hands of medical workers, and the technique for its implementation. general characteristics multiple myeloma, description of its symptoms and clinical manifestations. Diagnosis, treatment and prognosis.

abstract, added 02/27/2014


Characteristics of the city clinical hospital. Hygienic assessment of the location and work of the admissions department. Sanitary improvement of the therapeutic department. Organization of meals for patients. Working conditions of a medical worker.

control work, added 03/02/2009


Rules for wearing a medical cap, gown, shoes. Requirements for personal underwear, clothing. Hygienic principles of behavior of medical staff outside the walls of the hospital. Hygiene of premises for medical staff. Requirements for medical staff when visiting the operating room, dressing room

abstract, added 08/07/2009


Name of positions related to middle and junior medical personnel. Hygienic requirements for the working conditions of medical staff. Obligations of a midwife, paramedic, nurse, dental technician, laboratory assistant, physical therapy instructor.

presentation, added 02/11/2014


The concept of disinfection, its types, methods, means and equipment. Basic orders for the sanitary and anti-epidemic regime. Types of control of the suitability of disinfectants. Levels and rules for processing hands. How to put on and take off sterile gloves.

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 usually 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).

Hand washing (Figure 23) is the most effective method prevention of 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).

The reasons for the insufficient level of treatment of the hands of medical personnel, according to some sources, 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 contaminated, before and after the treatment procedure, 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 after going to the toilet.

Equipment: liquid soap, neutral, odorless, soap dispenser (dispenser), watch 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. During the first lathering, 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. Special attention pay for the treatment of the fingertips, the 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

Hand treatment standard social level»

Target: removal of dirt and transient flora from the contaminating skin of the hands of medical personnel as a result of contact with patients or environmental objects; ensuring the infectious safety of the patient and staff.

Indications: before distributing food, feeding the patient; after visiting the toilet; before and after patient care, unless the hands are contaminated with the patient's bodily fluids.
cook: liquid soap in disposable dispensers; clock with a second hand, paper towels.

Action algorithm:
1. Remove rings, rings, watches and other jewelry from your fingers, check the integrity of the skin of your hands.
2. Wrap the sleeves of the robe on 2/3 of the forearm.
3. Open the faucet with a paper towel and adjust the water temperature (35°-40°C), thereby preventing hand contact with microorganisms located on the faucet.
4. Wash hands with soap and running water up to 2/3 of the forearm for 30 seconds, paying attention to the phalanges, interdigital spaces of the hands, then wash the back and palm of each hand and rotate the base of the thumbs (this time is enough to decontaminate the hands on 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).
5. Rinse your hands under running water to remove soap scum (hold your hands with your fingers up so that the water runs into the sink from your elbows, without touching the sink. The phalanges of your fingers should remain cleanest).
6. Close the elbow valve by moving your elbow.
7. Dry your hands with a paper towel, in the absence of an elbow tap, close the edges with a paper towel.

Standard "Processing of hands at a hygienic level"

Target:
Indications: before and after performing invasive procedures; before putting on and after removing gloves, after contact with body fluids and after possible microbial contamination; before caring for an immunocompromised patient.
cook: liquid soap in dispensers; 70% ethanol, watch with second hand, warm water, paper towel, safe disposal container (SDF).

Action algorithm:
1. Remove rings, rings, watches and other jewelry from your fingers.
2. Check the integrity of the skin of the hands.
3. Wrap the sleeves of the robe on 2/3 of the forearm.
4. Open the faucet with a paper towel and adjust the water temperature (35°-40°C), thereby preventing hand contact with microorganisms. located on the crane.
5. Under a moderate stream of warm water, lather your hands vigorously until
2/3 forearms and wash your hands in the following sequence:
- palm on palm;

Each movement is repeated at least 5 times within 10 seconds.
6. Rinse your hands under running water. warm water until the soap is completely removed, holding the arms so that the wrists and hands are above the level of the elbows (in this position, water flows from the clean area to the dirty one).
7. Turn off the faucet with your right or left elbow.
8. Dry your hands with a paper towel.
If no elbow faucet is available, close the faucet with a paper towel.
Note:
- with absence necessary conditions for hygienic washing of hands, you can treat them with an antiseptic;
- apply to dry hands 3-5 ml of antiseptic and rub it on the skin of the hands until dry. Do not dry your hands after handling! It is also important to observe the exposure time - hands must be wet from the antiseptic for at least 15 seconds;
- the principle of surface treatment "from clean to dirty" is observed. Washed hands should not touch foreign objects.

1.3. Standard "Hygienic treatment of hands with antiseptic"

Target: removal or destruction of transient microflora, ensuring the infectious safety of the patient and staff.

Indications: before injection, catheterization. operation

Contraindications: the presence of pustules on the hands and body, cracks and wounds of the skin, skin diseases.

cook; skin antiseptic for the treatment of hands of medical personnel

Action algorithm:
1. Decontaminate hands at a hygienic level (see standard).
2. Dry your hands with a paper towel.
3. Apply 3-5 ml of antiseptic on the palms and rub it into the skin for 30 seconds in the following sequence:
- palm on palm
- right palm on the back of the left hand and vice versa;
- palm to palm, fingers of one hand in the interdigital spaces of the other;
- back sides fingers of the right hand along the palm of the left hand and vice versa;
- rotational friction of the thumbs;
- with the tips of the fingers of the left hand gathered together about right palm in a circular motion and vice versa.
4. Ensure that the antiseptic is completely dry on the skin of the hands.

Note: before using a new antiseptic, it is necessary to study the guidelines for it.

1.4. Sterile Gloving Standard
Target: ensuring the infectious safety of the patient and staff.
- gloves reduce the risk of occupational infection when in contact with patients or their secretions;
- gloves reduce the risk of contamination of the hands of personnel with transient pathogens and their subsequent transmission to patients,
- gloves reduce the risk of infecting patients with microbes that are part of the resident flora of the hands of healthcare workers.
Indications: when performing invasive procedures, in contact with any biological fluid, in violation of the integrity of the skin, both of the patient and the medical worker, during endoscopic examinations and manipulations; in clinical - diagnostic, bacteriological laboratories when working with material from patients, when performing injections, when caring for a patient.
cook: gloves in sterile packaging, safe disposal container (SDF).

Action algorithm:
1. Decontaminate your hands at a hygienic level, treat your hands with an antiseptic.
2. Take gloves in a sterile package, unfold.
3. Take the glove for the right hand by the lapel with the left hand so that the fingers do not touch inner surface lapel glove.
4. Close the fingers of the right hand and insert them into the glove.

5. Open the fingers of the right hand and pull the glove over them without breaking its lapel.
6. Insert the 2nd, 3rd and 4th fingers of the right hand, already wearing a glove, under the lapel of the left glove so that the 1st finger of the right hand is directed towards the 1st finger on the left glove.
7. Hold the left glove vertically with the 2nd, 3rd and 4th fingers of the right hand.
8. Close the fingers of your left hand and insert them into the glove.
9. Open the fingers of the left hand and pull the glove over them without disturbing its lapel.
10. Straighten the lapel of the left glove by pulling it over the sleeve, then on the right with the help of the 2nd and 3rd fingers, bringing them under the tucked edge of the glove.

Note: If one glove is damaged, you must immediately change both, because you cannot remove one glove without contaminating the other.

1.5. Standard "Removal of gloves"

Action algorithm:
1. With the fingers of your right hand in a glove, make a lapel on the left glove, touching it only on the outside.
2. With the fingers of your left hand in a glove, make a lapel on the right glove, touching it only from the outside.
3. Remove the glove from the left hand, turning it inside out.
4. Hold the glove removed from the left hand by the lapel in the right hand.
5. With your left hand, take the glove on your right hand by the lapel from the inside.
6. Remove the glove from the right hand, turning it inside out.
7. Place both gloves (left inside right) into the KBU.

The composition of the cleaning solution

3. Completely immerse disassembled medical devices in the cleaning solution for 15 minutes, after filling the cavities and channels with the solution, close the lid.
4. Treat each item with a ruff (gauze swab) in the cleaning solution for 0.5 minutes (pass the cleaning solution through the channels).
5. Place the medical supplies in the tray.
6. Rinse each product under running water for 10 minutes, passing water through the channels, cavities of the products.
7. Carry out a quality control of the pre-sterilization cleaning with an azopyram test. Control is subjected to 1% of simultaneously processed products of the same name per day, but not less than 3-5 units.

8. Prepare a working solution of the azopyram reagent (the working reagent should be used for 2 hours after preparation).
9. Apply the working reagent with a “reagent” pipette to medical devices (on the body, channels and cavities, places of contact with biological fluids).
10. Hold medical devices over cotton or tissue, observing the color of the dripping reagent.
11. Evaluate the result of the azopyram test.

Ear care standard

Target: observance of the patient's personal hygiene, disease prevention, prevention of hearing loss due to sulfur accumulation, instillation of a medicinal substance.

Indications: serious condition of the patient, the presence of sulfur in the ear canal.
Contraindications: inflammatory processes in the auricle, external auditory canal.

Prepare: sterile: tray, pipette, tweezers, beaker, cotton turundas, napkins, gloves, 3% hydrogen peroxide solution, soap solution, containers with disinfectant solutions, KBU.

Action algorithm:

1. Explain the procedure to the patient, get his consent.

3. Prepare a container with soap solutions.

4. Tilt the patient's head in the direction opposite to the treated ear, substitute the tray.

5. Moisten a cloth with warm soapy water and wipe the auricle, dry with a dry cloth (to remove dirt).

6. Pour into a sterile beaker, preheated in a water bath (T 0 - 36 0 - 37 0 C) 3% hydrogen peroxide solution.

7. Take a cotton turunda with tweezers in your right hand and moisten it with a 3% hydrogen peroxide solution, and with your left hand pull the auricle back and top to align the auditory canal and insert the turunda with rotational movements into the external auditory canal to a depth of no more than 1 cm for 2 - 3 minutes.

8. Insert dry turunda with light rotational movements into the external auditory canal to a depth of not more than 1 cm and leave for 2-3 minutes.

9. Remove the turunda with rotational movements from the external auditory canal - the removal of secretions and sulfur from the auditory canal is ensured.

10. Treat the other ear canal in the same sequence.

11. Remove gloves.

12. Place used gloves, turundas, wipes in KBU, tweezers, beaker in containers with disinfectant solutions.

13. Wash and dry your hands.

Note: when processing the ears, cotton should not be wound on hard objects, injury to the ear canal is possible.

Action algorithm:

1. Explain to the patient the purpose of the procedure, get his consent.

2. Decontaminate hands at a hygienic level, put on gloves.

3. Spread an oilcloth under the patient.

4. Pour warm water into the basin.

5. Expose the patient's upper body.

6. Moisten a napkin, part of a towel or a cloth mitten in warm water, wring out excess water slightly.

7. Wipe the patient's skin in the following sequence: face, chin, behind the ears, neck, arms, chest, folds under the mammary glands, armpits.

8. Dry the patient's body in the same sequence with the dry end of the towel and cover with a sheet.

9. Treat the back, live, hips, legs in the same way.

10. Trim your fingernails.

11. Change underwear and bedding (if necessary).

12. Remove gloves.

13. Wash and dry your hands.

Action algorithm:

1. Wash the head of a seriously ill person in bed.
2. Give your head an elevated position, i.e. put a special headrest or roll up a mattress and tuck it under the patient's head, lay an oilcloth on it.
3. Tilt the patient's head back at neck level.
4. Place a bowl of warm water on a stool at the head end of the bed at the level of the patient's neck.
5. Moisten the head of the patient with a jet of water, lather the hair, massage the scalp thoroughly.
6. Wash your hair from the front of your head back with soap or shampoo.
7. Rinse your hair and wring it dry with a towel.
8. Comb your hair with a fine comb daily, short hair should be combed from roots to ends, and long hair is divided into strands and combed slowly from ends to roots, being careful not to pull them out.
9. Put a clean cotton scarf over your head.
10. Lower the headrest, remove all care items, straighten the mattress.
11. Place used care items in a disinfectant solution.
Note:
- a seriously ill patient (in the absence of contraindications) should be washed once a week. The optimal device for this procedure is a special headrest, but the bed must also be with a removable backrest, which greatly facilitates this time-consuming procedure;
- women comb their hair daily with a fine comb;
- men's hair is cut short;
- a fine comb dipped in a 6% vinegar solution combs out dandruff and dust well.

Ship delivery standard

Target: providing physiological administration to the patient.
Indication: used for patients on strict bed and bed rest when emptying the intestines and bladder. cook: disinfected vessel, oilcloth, diaper, gloves, diaper, water, toilet paper, disinfectant container, KBU.
Action algorithm:
1. Explain to the patient the purpose and course of the procedure, obtain his consent,
2. Rinse the vessel with warm water, leaving some water in it.
3. Separate the patient with a screen from others, remove or fold the blanket to the waist, place an oilcloth under the patient's pelvis, and a diaper on top.
4. Decontaminate hands at a hygienic level, put on gloves.
5. Help the patient turn on his side, bend his legs slightly at the knees and spread them apart at the hips.
6. Move your left hand from the side under the sacrum, helping the patient raise the pelvis.

7. With your right hand, move the vessel under the patient's buttocks so that his perineum is above the opening of the vessel, while moving the diaper to the lower back.
8. Cover the patient with a blanket or sheet and leave him alone.

9. At the end of the act of defecation, slightly turn the patient to one side, holding the vessel with your right hand, remove it from under the patient.
10. Wipe the anal area with toilet paper. Place the paper in the vessel. If necessary, wash the patient, dry the perineum.
11. Remove the vessel, oilcloth, diaper and screen. Change the sheet if necessary.
12. Help the patient to lie down comfortably, cover with a blanket .
13. Cover the vessel with a diaper or oilcloth and take it to the toilet room.
14. Pour the contents of the vessel into the toilet bowl, rinse it with hot water .
15. Immerse the vessel in a container with a disinfectant solution, discard gloves in
KBU.
16. Wash and dry your hands.

Dedicated liquid

9. Record the amount of liquid drunk and injected into the body on the record sheet.

Injected fluid

10. At 6:00 am the next day, the patient submits the registration sheet to the nurse.

The difference between the amount of liquid drunk and the daily amount of the night is the value of the body's water balance.
The nurse must:
- Ensure that the patient can perform a fluid count.
- Ensure that the patient has not taken diuretics for 3 days prior to the study.
- Tell the patient how much fluid should be excreted in the urine normally.
- Explain to the patient the approximate percentage of water in food to facilitate the accounting of the introduced fluid (not only the water content of the food is taken into account, but also the parenteral solutions introduced).
- Solid foods can contain 60 to 80% water.
- Not only urine, but also vomit, feces of the patient are subject to accounting for the amount of excreted fluid.
- The nurse calculates the number of entered and withdrawn nights per day.
The percentage of fluid excretion is determined (80% of the normal amount of fluid excretion).
amount of urine excreted x 100

Removal percentage =
amount of fluid injected

Calculate the water balance accounting using the following formula:
multiply the total amount of urine excreted per day by 0.8 (80%) = the amount of night that should normally be excreted.

Compare the amount of excreted fluid with the amount of calculated fluid in the norm.
- The water balance is considered negative if less liquid is released than calculated.
- The water balance is considered positive if more liquid is allocated than calculated.
- Make entries in the water balance sheet and evaluate it.

Result evaluation:

80% - 5-10% - excretion rate (-10-15% - in the hot season; + 10-15%
- in cold weather;
- positive water balance (>90%) indicates the effectiveness of treatment and convergence of edema (reaction to diuretics or unloading diets);
- negative water balance (10%) indicates an increase in edema or an ineffective dose of diuretics.

I.IX. Punctures.

1.84. Standard "Preparation of the patient and medical instruments for pleural puncture (thoracentesis, thoracentesis)".

Target: diagnostic: study of the nature of the pleural cavity; therapeutic: introduction into the cavity medicines.

Indications: traumatic hemothorax, pneumothorax, spontaneous valvular pneumothorax, respiratory diseases (lobar pneumonia, pleurisy, empyema, tuberculosis, lung cancer, etc.).

Contraindications: increased bleeding, skin diseases (pyoderma, herpes zoster, chest burns, acute heart failure.

Prepare: sterile: cotton balls, gauze pads, diapers, needles for intravenous and s / c injections, puncture needles 10 cm long and 1 - 1.5 mm in diameter, syringes 5, 10, 20, 50 ml, tweezers, 0, 5% solution of novocaine, 5% alcohol solution of iodine, alcohol 70%, clip; cleol, adhesive plaster, 2 x-rays of the chest, sterile container for pleural fluid, container with disinfectant solution, referral to the laboratory, anaphylactic shock kit, gloves, CBU.

Action algorithm:

2. Seat the patient, stripped to the waist, on a chair facing his back, ask him to lean on the back of the chair with one hand, and put the other (from the side of the pathological process localization) behind his head.

3. Ask the patient to slightly tilt the trunk in the direction opposite to where the doctor will perform the puncture.

4. Pleural puncture is performed only by a doctor, a nurse assists him.

5. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.

6. Treat the intended puncture site with 5% alcohol solution of iodine, then with 70% alcohol solution and again with iodine.

7. Give the doctor a syringe with a 0.5% solution of novocaine for infiltration anesthesia of the intercostal muscles, pleura.

8. A puncture is made in the VII - VII intercostal space along the upper edge of the underlying rib, since the neurovascular bundle passes along the lower edge of the rib and intercostal vessels can be damaged.

9. The doctor inserts a puncture needle into the pleural cavity and pumps out the contents into a syringe.

10. Substitute a container for the extracted liquid.

11. Release the contents of the syringe into a sterile jar (test tube) for laboratory research.

12. Give the doctor a syringe with the collected antibiotic for injection into the pleural cavity.

13. After removing the needle, treat the puncture site with a 5% alcohol solution of iodine.

14. Apply a sterile napkin to the puncture site, fix with adhesive plaster or glue.

15. Perform a tight bandage of the chest with sheets to slow the exudation of fluid into the pleural cavity and prevent the development of collapse.

16. Remove gloves, wash and dry hands.

17. Used disposable syringes, gloves, cotton balls, put napkins in the KBU, puncture needle in a container with disinfectant.

18. Monitor the patient's well-being, the state of the bandage, count his pulse, measure blood pressure.

19. Escort the patient to the room on a stretcher, lying on his stomach.

20. Warn the patient about the need to stay in bed for 2 hours after the manipulation.

21. Send the received biological material for analysis to the laboratory with a referral.

Note:

When removing more than 1 liter of fluid from the pleural cavity at once, there is a high risk of collapse;

Delivery of pleural fluid to the laboratory should be carried out without delay in order to avoid the destruction of enzymes and cellular elements;

When the needle enters the pleural cavity, there is a feeling of "failure" into the free space.

1.85. Standard "Preparation of the patient and medical instruments for abdominal puncture (laparocentesis)".

Target: diagnostic: laboratory study of ascitic fluid.

Therapeutic: removal of accumulated fluid from the abdominal cavity with ascites.

Indications: ascites, with malignant neoplasms of the abdominal cavity, chronic hepatitis and cirrhosis of the liver, chronic cardiovascular insufficiency.

Contraindications: severe hypotension, adhesive process in the abdominal cavity, severe flatulence.

Prepare: sterile: cotton balls, gloves, trocar, scalpel, syringes 5, 10, 20 ml, wipes, jar with a lid; 0.5% solution of novocaine, 5% iodine solution, alcohol 70%, container for extracted liquid, basin, test tubes; a wide towel or sheet, adhesive plaster, a kit for helping with anaphylactic shock, a container with a disinfectant solution, a referral for research, dressings, tweezers, CBU.

Action algorithm:

1. Inform the patient about the upcoming study and obtain his consent.

2. On the morning of the examination, give the patient a cleansing enema until the effect of "clean water".

3. Immediately before the manipulation, ask the patient to empty the bladder.

4. Ask the patient to sit on a chair, leaning on its back. Cover the patient's legs with oilcloth.

5. Decontaminate your hands hygienically, treat them with a skin antiseptic, put on gloves.

6. Give the doctor a 5% alcohol solution of iodine, then a 70% alcohol solution to treat the skin between the navel and pubis.

7. Give the doctor a syringe with a 0.5% solution of novocaine for layer-by-layer infiltration anesthesia of soft tissues. A puncture during laparocentesis is made along the midline of the anterior abdominal wall at an equal distance between the navel and the pubis, retreating 2-3 cm to the side.

8. The doctor cuts the skin with a scalpel, pushes the trocar through the thickness of the abdominal wall with drilling movements with his right hand, then removes the stylet and ascitic fluid begins to flow through the cannula under pressure.

9. Place a container (basin or bucket) in front of the patient for fluid flowing from the abdominal cavity.

10. Type in a sterile jar 20 - 50 ml of liquid for laboratory testing (bacteriological and cytological).

11. Place a sterile sheet or wide towel under the patient's lower abdomen, the ends of which should be held by a nurse. Tighten the abdomen with a sheet or towel covering it above or below the puncture site.

12. With a wide towel or sheet, periodically tighten the patient's anterior abdominal wall as fluid is removed.

13. After the end of the procedure, the cannula should be removed, the wound should be sutured with a skin suture and treated with a 5% iodine solution, and an aseptic dressing should be applied.

14. Remove gloves, wash and dry hands.

15. Put the used tools in a disinfectant solution, put gloves, cotton balls, syringes in the KBU.

16. Determine the patient's pulse, measure blood pressure.

17. Transport the patient to the room on a stretcher.

18. Warn the patient to stay in bed for 2 hours after the manipulation (to avoid hemodynamic disorders).

19. Send the received biological material for analysis to the laboratory.

Note:

When carrying out the manipulation, strictly observe the rules of asepsis;

With the rapid removal of fluid, collapse and fainting may develop due to a drop in intra-abdominal and intrathoracic pressure and redistribution of circulating blood.

1.86. Standard "Preparation of the patient and medical instruments for spinal puncture (lumbar)".

Target: diagnostic (for the study of cerebrospinal fluid) and therapeutic (for the introduction of antibiotics, etc.).

Indications: meningitis.

cook: sterile: syringes with needles (5 ml, 10 ml, 20 ml), puncture needle with mandrel, tweezers, wipes and cotton balls, tray, nutrient medium, test tubes, gloves; manometric tube, 70% alcohol, 5% alcohol solution of iodine, 0.5% novocaine solution, adhesive plaster, KBU.

Action algorithm:

1. Inform the patient about the upcoming procedure and obtain consent.

2. The puncture is performed by a doctor under conditions of strict observance of the rules of asepsis.

3. Escort the patient to the treatment room.

4. Lay the patient on the right side closer to the edge of the couch without a pillow, tilt the head forward to the chest, bend the legs as much as possible at the knees and pull them to the stomach (the back should arch in an arc).

5. Slip through left hand under the patient's side, hold the patient's legs with your right hand to fix the position given to the back. During the puncture, another assistant fixes the patient's head.

6. A puncture is made between the III and IV lumbar vertebrae.

8. Treat the skin at the puncture site with 5% iodine solution, then with 70% alcohol solution.

9. Draw a 0.5% solution of novocaine into the syringe and give it to the doctor for infiltration anesthesia of soft tissues, and then a puncture needle with a mandrel on the tray.

10. Collect 10 ml of cerebrospinal fluid in a test tube, write a referral and send to the clinical laboratory.

11. Collect 2-5 ml of cerebrospinal fluid in a culture tube for bacteriological examination. Write a referral and send the biological material to the bacteriological laboratory.

12. Give the doctor a manometric tube to determine the CSF pressure.

13. After removing the puncture needle, treat the puncture site with a 5% alcohol solution of iodine.

14. Apply a sterile napkin to the puncture site, seal with adhesive tape.

15. Lay the patient on his stomach and take him on a stretcher to the ward.

16. Lay the patient on the bed without a pillow in the prone position for 2 hours.

17. Monitor the patient's condition during the day.

18. Remove gloves.

19. Place syringes, cotton balls, gloves in the KBU, place the used tools in a disinfectant solution.

20. Wash and dry.

1.87. Standard "Preparation of the patient and medical instruments for sterile puncture".

Target: diagnostic: bone marrow examination to establish or confirm the diagnosis of blood diseases.

Indications: diseases of the hematopoietic system.

Contraindications: myocardial infarction, asthma attacks, extensive burns, skin diseases, thrombocytopenia.

cook: sterile: tray, syringes 10 - 20 ml, Kassirsky's puncture needle, glass slides 8 - 10 pieces, cotton and gauze balls, forceps, tweezers, gloves, 70% alcohol, 5% alcohol solution of iodine; adhesive plaster, sterile dressing material, KBU.

Action algorithm:

1. Inform the patient about the upcoming study and obtain his consent.

2. Sternal puncture is performed by a doctor in a treatment room.

3. The sternum is punctured at the level of the III-IV intercostal space.

4. The nurse assists the doctor during the manipulation.

5. Invite the patient to the treatment room.

6. Have the patient undress to the waist. Help him lie down on the couch, on his back without a pillow.

7. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.

8. Treat the anterior surface of the patient's chest, from the collarbone to the gastric region, with a sterile cotton ball moistened with 5% iodine solution, and then 2 times with 70% alcohol.

9. Perform layer-by-layer infiltration anesthesia of soft tissues with 2% novocaine solution up to 2 ml in the center of the sternum at the level of III-IV intercostal spaces.

10. Give the doctor a puncture needle of Kassirsky, setting the shield-limiter on the 13 - 15 mm tip of the needle, then a sterile syringe.

11. The doctor pierces the outer plate of the sternum. The hand feels the failure of the needle, taking out the mandrin, a 20.0 ml syringe is attached to the needle and 0.5 - 1 ml of bone marrow is sucked into it, which is poured onto a glass slide.

12. Dry the slides.

13. After removing the needle, treat the puncture site with 5% alcohol solution of iodine or 70% alcohol solution and apply a sterile bandage, fix with adhesive tape.

14. Remove gloves.

15. Dispose of used gloves, syringes and cotton balls in the KBU.

16. Wash your hands with soap and dry.

17. Escort the patient to the room.

18. Send the slides with a referral to the laboratory after the material has dried.

Note: Kassirsky's needle is a short thick-walled needle with a mandrel and a shield that prevents the needle from penetrating too deep.

1.88. Standard "Preparation of the patient and medical instruments for joint puncture".

Target: diagnostic: determination of the nature of the contents of the joint; therapeutic: removal of effusion, washing of the joint cavity, introduction of medicinal substances into the joint.

Indications: diseases of the joints, intra-articular fractures, hemoarthritis.

Contraindications: purulent inflammation of the skin at the puncture site.

Prepare: sterile: puncture needle 7-10 cm long, syringes 10, 20 ml, tweezers, gauze swabs; aseptic dressing, napkins, gloves, tray, 5% alcohol solution of iodine, 70% alcohol solution, 0.5% novocaine solution, test tubes, KBU.

Action algorithm:

1. The puncture is performed by a doctor in the treatment room in strict compliance with the rules of asepsis.

2. Inform the patient about the upcoming study and obtain his consent.

3. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.

4. Ask the patient to sit comfortably in a chair or take a comfortable position.

5. Give the doctor a 5% alcohol solution of iodine, then a solution of 70% alcohol to treat the proposed puncture site, a syringe with a 0.5% solution of novocaine for infiltration anesthesia.

6. The doctor with his left hand covers the joint at the puncture site and squeezes the effusion to the puncture site.

7. The needle is inserted into the joint and the effusion is collected with a syringe.

8. Pour the first portion of the contents from the syringe into the test tube without touching the walls of the laboratory test tube.

9. After the puncture, antibiotics and steroid hormones are injected into the joint cavity.

10. After removing the needle, lubricate the puncture site with a 5% alcohol solution of iodine and apply an aseptic dressing.

11. Place the used syringes, wipes, gloves, gauze swabs in the CBU, the puncture needle in the disinfectant.

12. Remove gloves, wash and dry hands.

I.XII. "Preparation of the patient for laboratory and instrumental methods of research."

Standard "Preparing the patient for fibrogastroduodenoscopy"

Target: provide high-quality preparation for the study; visual examination of the mucous membrane of the esophagus, stomach and duodenum
Prepare: sterile gastroscope, towel; research direction.
EGD is performed by a doctor, a nurse assists.
Action algorithm:
1. Explain to the patient the purpose and course of the upcoming study and obtain his consent.
2. Conduct psychological preparation of the patient.
3. Inform the patient that the study is carried out in the morning on an empty stomach. Avoid food, water, medicines; don't smoke, don't brush your teeth.
4. Provide the patient with a light dinner the night before no later than 18 hours, after dinner the patient should not eat or drink.
5. Make sure that the patient removes removable dentures before the examination.
6. Warn the patient that during the endoscopy he should not speak and swallow saliva (the patient spits saliva into a towel or napkin).
7. Escort the patient to the endoscopy room with a towel, medical history, referral to the appointed time.
8. Accompany the patient to the ward after the examination and ask him not to eat for 1-1.5 hours until the act of swallowing is fully restored; Do not smoke.
Note:
- remedication s / c is not carried out, because. changes the state of the organ under study;
- when taking material for a biopsy - food is served to the patient only in a cold form.

Standard "Preparing the patient for colonoscopy"

Colonoscopy - This is an instrumental method for examining high-lying sections of the large intestine using a flexible endoscope probe.
Diagnostic value of the method: Colonoscopy allows direct

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

Dolgin A.S.,

CJSC "BelAseptika"

According to the World Health Organization (hereinafter - WHO), healthcare-associated infections (hereinafter - HCAI) are a major patient safety problem, and their prevention should be a priority for medical institutions and institutions that are obliged to provide safer medical 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. The transient microflora gets on the skin of the hands as a result of work and contact with infected patients or contaminated environmental objects, 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. So, if the skin is damaged, in particular during the use of inadequate hand treatment methods (use of hard brushes, alkaline soap, hot water, excessively unreasonable use of hand washing instead of antiseptics) transient microflora penetrates deeper into the skin, displaces permanent microflora from there, violating its stability, which in 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 resident, 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 medications 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 with the subsequent use of alcohol-containing antiseptics, and on the other hand, it is important condition 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 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.

For implementation right choice drugs, often difficult due to the abundance of proposals 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”, 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.).

In the process 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 the availability of alcohol antiseptics for medical workers at points of medical 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 sanitizing is essential for healthcare workers. It can have several levels, and you will learn about each of them from this article.

Hand treatment is carried out different ways depending on the upcoming procedure, as well as the availability of time for the medical staff to provide emergency care or perform planned work.

If urgent intervention is required

The most famous and common way is to treat hands with 96% medical alcohol: it is simply poured onto the skin or wiped with a soaked sterile gauze pad. If there are medical gloves, they are also disinfected with alcohol.

In conditions that do not require urgent intervention, processing is carried out in several stages, which depend on the type of procedure.

From the history

The need for special treatment of the hands of health workers emerged in the middle of the 19th century, when I.F. Semmelweis drew attention to the fact that almost 30% of patients in the obstetric department die of fever.

He found a connection with the fact that students immediately after the dissection of corpses came to the hospital and worked with patients in the obstetrics and gynecology department, after which a third of the patients died from an unknown infection. Students after work in the morgue simply wiped their hands with handkerchiefs. Semmelweis proposed treatment with a chlorine solution, which reduced the number of deaths by 10 times. But wide recognition for this discovery came to Semmelweis only after his death.

Hand treatment, levels of hand treatment in the past

For some time now, methods of processing the hands of medical personnel have been widely discussed. These actions were recognized as mandatory, and they were included in a document called SanPiN. This procedure has evolved from the application of a bleach solution to the modern accelerated method of treatment with skin antiseptic solutions, which are accompanied by detailed instructions, which is mandatory for any healthcare worker who comes into contact with patients or equipment for the provision of medical care.

Surgical practice requires special care in this aspect. About 40 years ago, a surgeon before an operation had to go through several levels of hand treatment for 25-30 minutes. It all started with washing under running water with soap and a brush, especially carefully it was necessary to clean the periungual areas of the fingers and interdigital folds. Then there was the stage of washing hands in a sterile basin with sterile water, which was specially distilled for this purpose, after which the third stage followed - the hands were dried with sterile gauze wipes, treated with alcohol, after which the doctor could put on autoclaved sterile gloves.

The same treatment was carried out by nurses who assisted the doctor during the operation. These employees are highly qualified operating nurses and pass the exam for knowledge of septic and antiseptic.

Processing in modern conditions

The levels of treatment of the hands of medical personnel in modern conditions are much less due to the use of much more effective means, which also has great importance in the prevention of occupational dermatitis in healthcare workers. To prevent dermatitis, a number of measures are proposed to restore the skin after the end of the working day - creams, lotions, balms, baths, etc.

Consider the hygienic level of hand treatment. Its algorithm consists in passing two stages.

The first is the obligatory washing with the use of liquid soap and drying with a disposable napkin.

The second is the use of a skin antiseptic. It is important to wait for the product to dry completely on your hands without wiping.

Cases for mandatory processing

When is the treatment of the hands of a doctor considered mandatory?

• Disinfection is necessary before the examination of each new patient and after his examination.
• Before carrying out any medical manipulation, including contact with the skin or mucous surfaces of a person, as well as using medical instruments or hardware.
• After contact with dressings and secretions of the patient.
• After manipulations with patients with purulent discharge.

Hand treatment levels according to SanPiN

in medical and other medical institutions special training in the rules of processing hands. Medical workers know the levels of hand treatment by heart, the implementation of prescriptions is brought to automatism, especially where work is carried out with open wounds, operations are performed on the internal organs and joints of patients.

Special rules were developed, enshrined in the leadership of the sanitary epidemiological service. They are mandatory, and a health worker who has not passed the control tests cannot be allowed to perform his duties, and in case of repeated violation of them, he may be deprived of his diploma.

The document "On approval of SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities" describes in detail the rules in each individual case. They must be studied and observed by each medical worker, all this is carefully monitored.

But no matter how strict the rules are, following them depends only on the conscious desire of the employees themselves to comply with the conditions of asepsis and antisepsis at work. In many respects, the number of complications in patients, sometimes leading even to death, depends on the strict implementation of these rules. A different behavior is completely contrary to the very purpose of the medical service, designed to help people and protect health.