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2 ways of hygienic processing of hands. Hand hygiene

1 AREA OF USE
In addition to the existing ones, this instruction establishes a unified methodology for hygienic and surgical antisepsis of the skin of the hands of medical personnel.
The instruction is intended for personnel of medical and preventive, sanitary and epidemiological institutions of the Republic of Belarus, and can also be used in pharmaceutical, food, municipal and other areas where it is necessary to maintain microbiological cleanliness of hands.
2. INTRODUCTION
This instruction applies to methods, methods and means of processing the skin of the hands and individual topographic areas of the human body before invasive interventions.
The hands of healthcare workers involved in healthcare delivery can be a factor in the transmission of pathogenic and opportunistic microbes. The microflora of the skin of the hands is represented by two populations: resident and transient. The resident (permanent) microflora lives in the stratum corneum of the skin, sebaceous and sweat glands, hair follicles and is represented by epidermal staphylococci, diphtheroids, propionibacteria, etc. The species and quantitative composition of the population of the resident microflora is relatively stable and to a certain extent forms the barrier function of the skin. In the area of the periungual folds and interdigital spaces, in addition to the above microorganisms, vegetate Staphylococcus aureus, akinetobacteria, Pseudomonas, Escherichia coli, Klebsiella.
These biotopes for the listed groups of bacteria are the natural habitat.
Transient microflora enters the skin during work as a result of contact with infected patients or contaminated objects environment and remains on the skin of the hands for up to 24 hours. It is represented by obligate and conditionally pathogenic microorganisms (E. coli, Klebsiella, Pseudomonas, Salmonella, Candida, adeno- and rotaviruses, etc.), characteristic of a certain profile of a medical institution.
Mechanical impact on the stratum corneum of the skin, leading to a violation of the stability of the population of the resident microflora (the use of hard brushes, alkaline soap for washing hands, aggressive antiseptics, the absence of emollient additives in alcohol-containing antiseptics) contributes to the development of skin dysbacteriosis. The manifestation of the latter is the predominance of gram-negative opportunistic microflora in the resident population, including hospital strains resistant to antibiotics, antiseptics and disinfectants. As a result, the hands of medical workers can be not only a factor in the transmission of these microorganisms, but also their reservoir.
While transient microorganisms can be mechanically removed from the skin of the hands by routine handwashing or destroyed by the use of antiseptics, it is almost impossible for a resident population of microorganisms to be completely removed or destroyed by conventional handwashing or antiseptic treatment. Sterilization of the skin of the hands is not only impossible, but also undesirable, since the preservation of the stratum corneum and the relative stability of the resident population of microflora prevents the colonization of the skin by other, much more dangerous microorganisms, primarily gram-negative bacteria.
In this regard, in Western European countries, traumatic, long-term, ancestral methods of processing hands (according to Alfeld-Furbringer, Spasokukotsky-Kochergin) have been radically changed and improved.
Of the many existing methods of hand skin disinfection, only one has the qualifications of the European standard and is duly registered as the “European Norm 1500” (EN 1500). According to the regulation of the European Committee for Standardization, this norm is followed in Belgium, Denmark, Germany, Finland, France, Greece, Ireland, Iceland, Italy, Luxembourg, the Netherlands, Norway, Austria, Portugal, Sweden, Switzerland, Spain, the Czech Republic, Great Britain.
This technique is the most optimal for hygienic and surgical hand antisepsis of healthcare facility personnel and does not require constant bacteriological monitoring of the effectiveness of disinfection.
3. HYGIENIC ANTISEPTICS OF THE SKIN OF THE HAND
3.1. Hygienic hand antisepsis involves the removal or destruction of a transient population of microorganisms.
3.2. Indications for hygienic hand antisepsis:
- before and after contact with infectious patients of known or suspected etiology (patients with AIDS, viral hepatitis, dysentery, staphylococcal infection, etc.);
- contact with the 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 the box in infectious diseases hospitals and departments;
- after visiting the toilet;
- before going home.
3.3.
3.3.1. The antiseptic is applied to the hands in an amount of 3 ml and carefully rubbed into the palmar, back and interdigital surfaces of the skin of the hands for 30-60 seconds in accordance with the attached scheme (Appendix 1) until completely dry;
3.3.2. In case of severe contamination with biomaterials (blood, mucus, pus, etc.), contamination is first removed with a sterile cotton-gauze swab or gauze napkin moistened with a skin antiseptic. Then 3 ml of an antiseptic is applied to the hands and rubbed into the skin of the interdigital areas, palmar and dorsal surfaces until completely dry, but not less than 30 seconds, after which they are washed with running water and soap.
4. SURGICAL ANTISEPTICS OF THE SKIN OF THE HAND
4.1. Surgical antisepsis of the skin of the hands involves the removal or destruction of the transient and the reduction of the permanent population of microflora to subinfective doses.
4.2. Indications for surgical antisepsis of the skin of the hands: manipulations 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.).
4.3. :
4.3.1. Within 2 minutes, the hands and forearms are washed without brushes under warm running water with neutral liquid soap (hygienic washing), which helps to remove contaminants and reduces the amount of transient microflora on the hands of medical personnel).
4.3.2. The hands and forearms are dried with a sterile napkin.
4.3.3. For 5 minutes, carefully rub the antiseptic in portions of 2.5 - 3 ml into the skin of the hands and forearms according to the standard method, preventing the skin from drying out (Appendix 1). The total consumption of antiseptic - in accordance with the instructions for the drug.
4.3.4. Air dry hands.
4.3.5. Sterile gloves are put on dry hands.
4.3.6. After carrying out surgical procedures and removing gloves, hands are washed with warm water and liquid soap for 2 minutes. To prevent the drying effect of alcohols, a cream is applied for 1 to 3 minutes.
5. REQUIREMENTS FOR HYGIENIC AND SURGICAL ANTISEPTICS
- rub the antiseptic only into dry skin;
- use an adequate amount of antiseptic for the level of processing (avoid excess), for which it is necessary to use elbow dispensers;
- do not use napkins, sponges, tampons, other foreign objects for applying the drug;
- alternate the use of antiseptics containing active substances with different mechanisms of antimicrobial action;
- careful execution of the processing technique;
- observe the sequence of actions, the dosage of the drug and the exposure of the treatment at each stage.
6. REQUIREMENTS FOR ANTISEPTICS FOR HYGIENIC AND SURGICAL TREATMENT OF THE SKIN
Antiseptics for hygienic and surgical treatment of the skin of the hands should provide:
– a wide range and enough high level antimicrobial action (bacterium-, tuberculo-, viruli-, fungicidal);
- the speed of achieving a disinfecting effect (with a hygienic antiseptic - 30 seconds - 1 minute, with a surgical one - 5 minutes);
- the absence of skin-irritating, allergenic, general toxic effects;
– remanent (residual) action (for surgical antisepsis);
- slow development of resistance of microorganisms to drugs;
- economic accessibility.
Currently, the group of alcohol-based antiseptics based on ethanol, ethanol compositions with other alcohols (isopropanol, propanol, butanediol) and other actively active ingredients– biguanides, quaternary ammonium compounds, etc.

LIST OF USED LITERATURE AND REGULATORY DOCUMENTS

1. Krasilnikov A.P. Handbook of antiseptics. Mn., 1995
2. Krasilnikov A.P. Microbiological dictionary-reference book. Mn. 1999
3. Test methods for antimicrobial activity of prophylactic antiseptic preparations. Guidelines N 11-13-1-97 of 01/16/1997
4. Noble W.K. Microbiology of human skin. Moscow “Medicine”, 1986
5. Fundamentals of infection control. American International Health Alliance. Under the editorship of Burganskaya E.A. Washington, 1997
6. SanPiN 21-112-99. Sanitary regulations and norms. Normative indicators of safety and effectiveness of disinfectants. Minsk, 1999
7. Shcherbo A.P. Hospital hygiene. St. Petersburg, 2000
8. Desinfektionsmittel Liste der DGHM. – Wiesbaden, mhp-Verlag Gmbh, 2000
9. European standard - EN 1500. Hygienische Handedesinfection European Committee for Standardization.

Posted by admin on October 31st, 2011

Two levels of decontamination (treatment) of hands.

1.Hand hygiene: removal or destruction of transient microflora, partial destruction of resident microflora.

2.Surgical treatment of hands: complete destruction of transient microflora and a significant amount of resident microflora.

Requirements for the hands of a medical worker :

Hands must be intact skin, in the presence of wounds and abrasions, they must be treated with an antiseptic and closed with a band-aid;

The hands of a medical worker should not show signs of pustular diseases;

Nails should be clean, cut short, and not have a varnish coating (microorganisms accumulate in the cracks of the varnish);

There should be no rings, rings, bracelets on the hands (because any jewelry prevents the full processing of hands and is a place of accumulation of microorganisms).

Soap Requirements:

Soap can be used in any standard form (liquid, solid, granular, powder, etc.);

Soap should be plain, without antimicrobial additives;

Bar soap should be stored in soap dishes that have good water drainage to ensure that the soap dries;

Preference is given to liquid soap in standard dispensers, because. in this case, contact of the skin of personnel with soap is excluded, which excludes its infection;

When using reusable dispensers: do not add soap to a partially empty dispenser. After the dispenser is completely freed from soap, it is thoroughly washed, disinfected, dried, and only then refilled with soap.

Indications for hand hygiene:

Before performing any invasive procedures;

Before working with particularly susceptible (immune-compromised) patients and newborns;

Before and after manipulations with wounds and catheters;

Before donning and after removing gloves;

After contact with the patient's biological fluids or with objects that are likely to be contaminated by microbes (examination of an infectious patient, measurement of rectal temperature, etc.).

Hand washing technique.

Hand washing with soap is carried out under a moderate stream of comfortably warm water for 1 minute. Hands are abundantly lathered with soap and then, sequentially, 6 standard steps are carried out:

After completing all stages of washing, hands are rinsed abundantly under running water. Then the hands are wiped dry with a disposable paper towel or disposable reusable textile napkins. Textile napkins must be washed after each use (used napkins are collected during the shift in a container and sent to the laundry). In the delivery rooms and operating room, only sterile hand wipes are used.

Using a skin antiseptic.

In Russia, healthcare facilities use alcohol-based antiseptics that do not require wiping hands after treatment. Skin antiseptics are used strictly according to the instructions for the drug used..

When using most alcohol-containing skin antiseptics, pour 2.5-5 ml of the drug into the palm of your hand and rub it into the skin of the hands for 2.5-3 minutes, repeating the hand washing technique until they are completely dry.

At any given moment, 1.4 million people in the world suffer from nosocomial infections. Among those hospitalized, the number of patients with nosocomial infection ranges from 5 to 10%. Hand hygiene is the most important measure to help limit the spread of many diseases. Most intestinal infections, purulent-septic infections, viral hepatitis and even influenza are transmitted through the hands. The consequences can be complications in the form of chronic diseases and even death. 80% of all infections are transmitted through undisinfected hands. “Handwashing after contact with a patient and the use of gloves remain the most important infection control measures to prevent cross-contamination of patients on mechanical ventilation” (Bokeria L.A., Beloborodova N.V. Infection in cardiac surgery. - M .: NTSSSH im. AN Bakuleva RAMS, 2007, p.103) History: Back in 1199, the physician and philosopher Moses Maimonides wrote about the need to wash hands after contact with an infectious patient. In 1843, Oliver Wendell Holmes first came to the conclusion that doctors and nursing staff infect their patients with "puerperal fever" through unwashed hands, and in 1847 Ignaz Semmelweis conducted one of the first analytical epidemiological studies in the history of epidemiology and convincingly proved that decontamination of the hands of medical personnel is the most important procedure to prevent the occurrence of nosocomial infections. Thanks to the introduction of hygienic antiseptics into practice, in the obstetric hospital where Semmelweis worked, the mortality rate from nosocomial infections was reduced by 10 times. Pirogov N.I. (1853) and J. Lister (1867) professed these postulates. However, practical experience and a huge number of publications devoted to the problem of processing the hands of medical staff show that this problem cannot be considered solved even one and a half hundred years after Semmelweis. Regulatory documents on hand washing in medicine:

SanPiN 2.1.3.2630-10 "SANITARY AND EPIDEMIOLOGICAL REQUIREMENTS FOR ORGANIZATIONS CARRYING OUT MEDICAL ACTIVITIES"
WHO guidelines for hand hygiene in health care (World Alliance for Patient Safety, 2006)
Recommendations for washing and antiseptic hands. Gloves in the system of infection control / Ed. Academician of the Russian Academy of Natural Sciences L.P. Zueva. - St. Petersburg, 2006
Recommendations for the organization of hand hygiene of medical workers / Ed. Honored Doctor of the Russian Federation, MD, prof. Yu.A. Shcherbuk. - St. Petersburg, 2010

Hand washing in medicine. Problem Status

insufficient resources
insufficient adherence to hand hygiene requirements

Hand washing in medicine is among the most important events on the control and prevention of transmission of infections in healthcare facilities. Healthcare workers practice hand hygiene on average less than 40% of the time. After going to the toilet, 38% use soap and water, 30% use only water, and 32% do not wash their hands. IV International Conference of the Society of Nosocomial Infection Specialists. Edinburgh, 1998: Question: Why don't health workers wash their hands? Answer: because a lot of money is spent on it - no! Because it is too complicated procedure - no! The correct answer is they don't want to waste their time!!! Factors contributing to poor hand hygiene practices reported by health workers themselves:

hand washing products cause irritation and dryness
sinks are located inconveniently / there are not enough sinks
lack of soap, towels, etc.
often too busy/lack of time
department understaffing/overcrowding
Patients should be prioritized
low risk of infection from the patient
wearing gloves - the belief that it is not necessary to wash your hands when wearing gloves
insufficient knowledge of instructions
do not think about it / forget
no positive example of colleagues or management
skepticism
disagreement with the recommendations
lack of scientific information on a positive association between meticulous hand hygiene and nosocomial infections

Hand washing in medicine. Reasons for non-compliance with the rules and conditions for their compliance

Reasons why staff do not wash their hands:

washing hands takes a long time
lack of soap (54%) and towels (65%)
one thorough hand washing is enough for a working day
use of gloves can replace handwashing (25%, including 50% of doctors)
hand washing is not necessary if the child is receiving antibiotics

Additional suspected reasons for poor hand hygiene:

Hand washing in medicine. Prerequisites for compliance with the rules

Hand hygiene requires:

development of algorithms for processing hands and carrying out activities to implement the algorithm in the workplace
the use of alcohol-based antiseptics for rubbing, which is more effective way disinfecting hands than hand washing with regular or antibacterial soap
provision of conditions for washing hands
increasing the motivation and responsibility of health workers through hygiene training for health workers

Hand washing algorithm in medicine

ProbleskMed offers you to use its achievements in the daily activities of medical workers.

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. Lather 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 flows 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 put 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. In case of severe contamination with 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 the left palm on the back of the 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);

Rub the thumbs alternately in a circular motion (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 that 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 effects may manifest as 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 due to the need for frequent handwashing and exposure to pharmaceuticals, 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).

There are two levels of treatment of the hands of medical personnel:

Hygienic processing of hands:

hygienic hand washing with soap,
hygienic treatment of hands with a skin antiseptic (without pre-washing them).

Treatment of the hands of surgeons.

Hygienic processing of hands.

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

Indications:

before direct contact with the patient;

after contact with the patient's intact skin;

before performing various manipulations to care for the patient;

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

after contact with medical equipment and other objects in the immediate vicinity of the patient;

after treatment of a patient with purulent inflammatory processes;

after each contact with contaminated surfaces and equipment.

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

Efficiency conditions:

short cut nails;

lack of nail polish;

lack of artificial nails;

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

providing in sufficient quantities effective means for washing and disinfecting hands, as well as means for caring for the skin of hands (creams, lotions, balms).

Hygienic hand washing with soap.

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

Manipulation algorithm:

Stages	Rationale
1. Preparation for the procedure
1.1. Check the conditions necessary for effective handwashing.
1.2. Prepare everything you need.
1.3. Stand in front of the sink, trying not to touch its surface with your hands and clothes.	Prevention of hand and clothing contamination.
1.4. Turn on the water and adjust the water temperature to a comfortable value (35-40 ° C).	Optimal temperature for hand decontamination and prevention of dermatitis.
2. Performing the procedure (Fig. 2)
2.1. Wet hands with water.	manipulation efficiency.
2.2. Apply soap to the palm of your hand using an elbow dispenser (or any other).	Prevention of hand contamination.
2.3. Rub palm on palm.	Ensuring uniform decontamination of the hands.
2.4. Rub your right hand on the back of your left hand and vice versa.
2.5. Treat the interdigital spaces: rub the palms with crossed, outspread fingers.
2.6. Connect the fingers in the castle, rub the back of the bent fingers on the palm of the other hand.
2.7. Rub the thumbs alternately in a circular motion.
2.8. Rub the palm with the fingertips of the opposite hand in multidirectional circular motions.
2.9. Wash off the soap with running water. Note: liquid soap dose and treatment time according to the instructions for use.	manipulation efficiency.
3. End of procedure
3.1. Turn off the water with an elbow tap.
3.2. Dry your hands with a paper towel (individual cloth).	Efficiency of manipulation, prevention of contact dermatitis.
3.3. Dispose of the paper towel in the pedal bin with Class A waste bag without touching it.	Proper handling of Class A medical waste. Prevention of hand recontamination.
Note: if the sink does not have a touchless faucet, dry hands first, then close the faucet using the nurse's hand-drying paper towel.