Cleaning the hands of medical personnel is simple, but effective method preventing the development of nosocomial infections.

In the article we will tell you what type of processing and algorithm to use in accordance with the requirements of SanPiN.

In addition, this is a guarantee of health safety for both patients and medical workers.

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From the article you will learn

Types of processing

There are different levels and methods of disinfection (see table), but not all experts appreciate these techniques, and are often limited to simple rinsing.

Open a new SOP by medical treatment hands from the experts of the Chief Nurse System. For each type, a clear and clear algorithm was identified.

	What is it used for?	When is it carried out?
Using water and soap	1. Removal of visible contaminants. 2. Removing dangerous bacteria	When hands are contaminated, including with body fluids or blood. When a doctor interacted with a patient potentially infected with an infection transmitted by the pathogen Cl. Difficille; After sneezing or coughing; After visiting the toilet, performing hygiene procedures; Before eating.
Using antiseptic	Destruction of any potentially dangerous microorganisms	When interacting with medical devices intended for various interventions; Before/after interaction with the patient; After contact with biological fluids; After contact with the patient's belongings; When examining a clean area of ​​the patient’s body after an infected area; Before working with food; Before using medical gloves and after using them.
Surgical	Aimed at getting rid of visible contaminants and destroying dangerous bacteria, as well as reducing the number of dangerous microflora.	Before performing any surgical procedures, including minimally invasive ones, as well as catheterizations, etc. It is carried out in several stages and involves special equipment using special means.

Hygienic treatment of the hands of medical staff: algorithm

The goal with this method is to remove any visible contaminants, as well as transient microflora.

This is necessary in order to exclude the possibility of transferring such microflora to other healthcare workers and patients.

3 requirements for hygienic hand washing according to SanPin:

1. Before starting, the doctor must remove jewelry and watches - a large number of microbes accumulate under them;
2. The specialist’s nails should be cut short, and it is undesirable to have varnish on them.
3. The sleeves of the medical gown must be rolled up 2/3 so that they do not interfere.

SanPiN requirements require careful soaping. After this they are washed with running water warm water, and the procedure is repeated.

This is due to the fact that with a single wash, dirt and harmful microorganisms are removed only from the skin of the hands. When the doctor rinses the soap with warm water, the pores open, allowing any remaining germs to be removed.

The hand treatment of medical personnel is shown in the diagram below.

Calculator: calculation of antiseptic for treating the hands of the dressing team

Use the online calculator to calculate the need for alcohol-containing antiseptics for cleaning the hands of members of the dressing team, for bandaging and disinfecting wounds. The calculator was developed by specialists from the Chief Nurse System.

Surgical treatment: algorithm

This is a routine, mandatory procedure before any interventions are performed on patients.

The entire process consists of a number of steps, as well as several techniques and skills that allow you to achieve effective and high-quality cleaning.

Processing is carried out in a specially designated place. It should have a sink with a mixer with hot and cold water.

Scheme for hand treatment of medical personnel

Purpose of hand debridement

Main and fundamental goal surgical treatment– remove dangerous microflora from the doctor’s skin that can be transferred to the patient during surgery.

Processing stages

At the first stage, the doctor should thoroughly wash the area of ​​the hands and forearms with soap.

For this purpose it is used warm water from the tap, under which the skin is washed with regular soap for 2-3 minutes. When the doctor is finished, he should use a sterile wipe to dry the skin.

At the second stage the skin is treated with a special antiseptic.

An alcohol-based antiseptic is applied to the dry skin of the wrists, forearms and hands. During the entire application period it is important to use sufficient quantity means to keep the skin moist until the end of the procedure.

When the steps are completed, the doctor puts on sterile gloves and can begin the operation.

Hand treatment methods

It would seem, what difficulties can arise when performing such a simple manipulation? In fact, everything is not so simple; in certain situations, hands should be treated according to strict rules using hand sanitizers. In general, there are several levels of hand treatment, which have their own characteristics:

• Hygienic;
• Surgical.

Preference is given to one method or another depending on the task at hand.

Routine hand washing

The household level of treatment involves mechanical cleansing of hands with water and soap, which allows you to remove dirt, sweat and partially microflora from the skin. In this case, it is preferable to use soap with a dispenser, for example, “Amber” liquid soap or “Septolite” antibacterial soap. In medical practice, it is worth using an elbow dispenser for soap and antiseptics, which prevents re-contamination of hands.

Routine hand washing is carried out in the following situations:

1. After visiting the toilet;
2. Before eating;
3. Before working with food products;
4. When contacting a patient (client);
5. At various contaminants hands

Regular hand washing is an absolutely simple procedure. First of all, you need to remove jewelry from your hands. Next, wet your hands with water and apply soap liberally. Rub your soapy hands vigorously for thirty seconds. Then the hands are washed with water and dried with a towel.

Hand hygiene

This type of hand treatment involves better cleansing of the skin using soap and antiseptics. This method is used during medical procedures, after contact with biological fluids, etc.

Hygienic treatment is carried out in two successive stages. The first stage is washing your hands with soap, and they do it according to the following scheme:

1. Rub your soapy palms together.
2. Use your palm to rub the back of the other hand, then change hands.
3. Interlace your fingers and rub the skin between the fingers.
4. Place your fingers together and rub the palm of your other hand with bent fingers.
5. Grab the first finger of the hand with the other hand and rub it around, repeat the manipulation on the wrist. Change hands.
6. Use your fingers to rub the palm of your other hand in a circle. Change hands.

Each of these movements is performed five times. The entire procedure should take one minute. Upon completion, hands are washed with water and blotted with a disposable towel.

The second stage is the disinfection of the skin with antiseptic agents, for example, skin antiseptics and Septolite antiseptic gel. So, squeeze out a portion of the antiseptic onto the palm of your hand and thoroughly rub it into the skin. Wherein Special attention It is necessary to pay attention to the treatment of nails, subungual space and interdigital spaces.

Surgical treatment of hands

The purpose of surgical hand treatment is to minimize microbial contamination of the skin of the hands, which will prevent infection of patients (clients). Medical staff resort to this method of hand treatment before performing surgical interventions.

The first stage of treatment consists of washing hands and forearms with soap according to the scheme described above for two minutes, followed by blotting with sterile napkins.
The second stage is a thorough treatment of the hands and forearms with antiseptics. To do this, squeeze a portion of antiseptic onto the palm of your hand and rub it into the skin for five minutes. In this case, it is necessary to squeeze out new portions of the antiseptic so that your hands are constantly wet. Upon completion of hand treatment, put on sterile gloves and begin the operation.

End of the procedure.

Execution of the procedure.

Social level of hand handling

Hand treatment levels for healthcare workers

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

Target: remove microflora from the surface of the hands using a mechanical method. Ensure infection safety of patients and staff.

Indications:

Before and after performing treatment procedures with and without gloves;

Before and after eating, feeding the patient;

After visiting the toilet;

Before and after caring for the patient, as long as the hands are not contaminated with the patient's body fluids.

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

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

Preparing for the procedure.

1. Remove the rings from your fingers, check the integrity of the skin of your HANDS .
2. Roll up the sleeves of the robe to the elbows, take off your watch.
3. Open the tap, adjust the water temperature (35-40°).

1. Lather your hands and wash water tap with soap (the elbow tap is not washed; if you use a bar of soap, wash it and place it on a clean napkin or in a lattice soap dish).

2. Wash your 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 thumbs hands

Note: this time is sufficient for decontamination of hands at a social level, if the surface of the skin of the hands is washed thoroughly and no dirty areas of the skin of the hands are left.

3. Rinse your 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 tap using a napkin (close the elbow tap with your elbow).

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

Target: ensuring hand decontamination at a hygienic level.

Indications:

Ø before putting on and after taking off gloves;

Ø after contact with biological fluids of the body 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 patient secretions (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 leaving home.

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

Required condition: no skin damage on hands.

Stages	Notes
Preparation for the procedure
1 . Remove the rings from your fingers.	Preparation for processing the required surface of the hand.
2. Fold the sleeves of the robe 2/3 of the way up your forearms and take off your watch.	Ensuring infection safety for nurses.
3. Open the tap.	Running water is used.
Executing the procedure
1 . Wash your 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 fingers, adhering to the principle of surface treatment “from clean to dirty.”
2. Rinse your hands under running water to remove soap suds.
3. Repeat washing each hand up to 5-6 times.
Completing the procedure
1 . Dry your hands with a napkin.	Ensuring infection safety.
2. Throw the napkin into a container with disinfectant solution.
3. Close the tap using a sterile cloth, or ask an assistant to do this.

Note: Without 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 your hair, which should be neatly combed and tucked under a medical cap. It is important to keep not only your hands and entire body clean, but also your mouth and nasopharynx. You should brush your teeth 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 hand disinfection is regulated by Resolution No. 71 of the Chief State Sanitary Doctor of the Ministry of Health of the Republic of Belarus dated July 11, 2003. “On the approval and implementation of sanitary rules.”

Hygienic hand skin antiseptics are carried out with the aim of removing and destroying 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 patient secretions (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 leaving home.

Stages of hygienic hand skin antiseptics:

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

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

Scheme for hand treatment 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 your palm against your palm (Fig. 1, a);

Rub your left palm along the back of your right hand, and vice versa (Fig. 1, b);

Rub your palms with crossed fingers spread out (Fig. 2);

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

Rub your thumbs alternately in a circular motion (Fig. 4);

Alternately rub your palms with the fingertips of the other hand in multidirectional circular movements.

Every day, nurses deal with a huge amount of chemicals, which can cause general and local changes in the body. Chemicals can enter the body through the respiratory tract in the form of dust or vapor, or be absorbed through the skin and mucous membranes. Their effects can manifest themselves in the form of skin reactions, dizziness, headaches, etc. Individual results of exposure may include miscarriages, infertility, and diseases of various organs. The most common manifestation of exposure to chemicals in nurses is irritation and inflammation of the skin and mucous membranes - occupational dermatitis. Nurses are exposed to this risk because of the need frequent washing hands and exposure to pharmacological agents, disinfectants and even rubber gloves.

Dermatitis can cause:

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

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

The dentist performs all his main actions with his hands. For this reason, the cleanliness of the dentist's hands has vital importance. After all, numerous microbes that reside on the skin of unwashed hands, if they get into open wounds, can cause infection with subsequent development pathological processes. Because necessary procedure When preparing a doctor for work, he sanitizes his hands to ensure that they are free of microorganisms that can cause disease.

The microflora of the skin includes both microorganisms that constantly live on the skin and bacteria, viruses, protists and fungi that enter the skin surface upon contact with the external environment. It is the temporary inhabitants of the skin of the hands that include Staphylococcus aureus and other dangerous bacteria. The bulk of microorganisms that constantly live on the skin are located in its surface layer. A small part of them (about ten to twenty percent) penetrates into the deep layers of the skin, the ducts of the sebaceous glands and hair follicles.

Staphylococci are gram-positive
spherical bacteria that, when examined microscopically, resemble bunches of grapes.

Before performing surgical procedures, it is necessary to remove both permanent and temporary microflora from the skin of the hands. Regular hand washing with soap makes it possible to clean your hands of the bulk of temporary microorganisms. However, this method of sanitization is not enough to remove the permanent inhabitants of the deep layers of the skin.

Due to the risk of infection during various medical procedures, hand hygiene of doctors and other medical workers is strictly regulated. There are rules for treating the hands of medical personnel, determined by the specific working conditions and the level of existing risks. So, what are the ways to ensure the required cleanliness of the skin?

Types of hygiene procedures when preparing a doctor for work

In accordance with the requirements for cleanliness of the skin, the following hygiene procedures are applied when preparing medical staff for work:

• Routine hand washing.
• Hygienic disinfection of the skin.
• Surgical hand disinfection.

Each subsequent method provides more high level cleansing the skin of microbiological contaminants.

Simple hand washing

In case of moderate contamination of the skin surface of the hands, ordinary soap and water are used to remove contaminants. Disinfectants are not used. This hygiene method eliminates dirt and reduces the number of microbes on the skin surface.

Routine hand washing is mandatory in the following situations:

• before starting food preparation and dispensing;
• immediately before meals;
• after bowel movements;
• before and after contact with the patient;
• before and after patient care activities;
• for any obvious contamination of the skin surface.

When thoroughly cleaning your hands using detergents, about ninety-nine percent of temporary microorganisms are eliminated from the skin. As studies have shown, the formal implementation of this hygiene procedure does not ensure the removal of contaminants from the fingertips, as well as their internal surfaces. Therefore, the rules for hand treatment require the use of a certain washing method, which includes the following actions:

• removing watches and various accessories from hands that interfere with the cleansing of microflora from the skin;
• applying a layer of soap to the skin surface;
• rinsing hands with running warm water;
• repeating the procedure.

When the procedure is performed for the first time, microorganisms are removed from the surface of the skin. Its repetition ensures the elimination of bacteria from pores that have opened under the influence of water at a temperature above room temperature and from massaging the skin surface.

It is advisable that the water be warm, but not hot, when cleaning your hands. Too heat water leads to washing away the layer of fat that protects the skin surface.

Currently, the rules for hand washing of medical personnel require washing hands not randomly, but by performing a certain sequence of movements that corresponds to the accepted European standard.

What actions should you take while washing your hands?

When washing off contaminants from the skin of the hands, a medical worker must perform the following sequence of movements:

1. Rubbing palms against each other.
2. Alternately rubbing the back of one hand with the palm of the other hand.
3. Alternate rubbing inner surface interdigital spaces of one hand with the fingers of the other.
4. Friction of the palms with the backs of bent fingers connected into a lock.
5. Alternating base friction thumb one hand with rotational movements while covering it with the index and thumb of the other hand.
6. Rotational rubbing of the wrist of one hand while grasping it with the index and thumb of the other hand.
7. Rubbing the palm of one hand with rotational movements of the fingertips of the other hand.

Hand treatment rules in pictures

Each movement when washing hands should be repeated at least five times. The duration of the entire procedure should be at least half a minute.

What is used for hand washing in clinics

When cleaning hands in medical institutions, it is recommended to use liquid soap poured into disposable bottles. However, it is not advisable to fill detergent a bottle that already contains soap, as it may be contaminated. It is best if the liquid soap dispenser is equipped with a sealed pump, which prevents germs and air from entering the container with soap. external environment, and ensuring complete pumping of soap from the bottle.

When using bar soap in medical institutions, the latter should be divided into small portions. Large pieces will remain in a humid environment for too long, as a result of which intensive proliferation of microorganisms may begin in the soap. It is desirable that the design of the soap dish ensures that the bar of soap dries in between hygiene procedures.

What is the best way to dry your hands after washing?

The best option for drying the skin after hygienic treatment is disposable paper towels, which, after washing and drying hands, are used to close the taps and thrown away. You can also use a clean cloth that can be washed after one use.
After sanitizing hands in medical institutions, it is undesirable to use electric dryers due to the too low speed of the drying process.

It is not advisable for doctors, nurses and other healthcare workers to wear rings on their hands at work, as such jewelry interferes with the elimination of germs. For the same reason, you should not cover your nails with varnish. Also undesirable are manicure procedures that can lead to the appearance of microscopic wounds that are easily infected during work.

Hand hygiene stations should be conveniently located throughout medical institution. In the wards, as well as in those rooms where diagnostics and procedures involving penetration into the body are carried out, their own washstands must be installed.

What is hygienic disinfection?

The purpose of this type of sanitization is to prevent the spread of pathogenic microorganisms throughout the clinic through the hands of medical workers. Hygienic skin disinfection is used in the following situations:

Before carrying out manipulations associated with penetration into the body, as well as before starting therapeutic measures with patients who have an increased susceptibility to infections.

1. Before starting work on wounds and upon completion.
2. In case of contact with blood, saliva, mucus, urine or feces of the patient.
3. If there is a possibility of contamination of hands with pathogenic microorganisms through various objects.
4. Before working with infectious patients and after its completion.

The procedure for hygienic hand disinfection includes two stages:

1. Actually hygienic disinfection.

Under machining This means routine hand washing twice. Actually, hygienic disinfection consists of applying at least three milliliters of an antiseptic to the skin. To disinfect the skin surface, both ethanol-based disinfectants and aqueous solutions antiseptics, and the former are more effective.

Hand treatment with Sterillium

During the first stage of the procedure, you can use both regular soaps and soaps with an antiseptic additive. After washing your hands, the disinfectant solution is applied to the skin and rubbed in with movements, each of which is repeated at least five times until the skin becomes dry. There is no need to wipe your hands after treating your skin with a disinfectant. The duration of antiseptic treatment should be at least half a minute.

If the skin of your hands was not contaminated before the procedure - for example, the doctor has not yet had contact with the patient - then you can skip pre-washing your hands and immediately apply an antiseptic to the skin.

Antiseptics can have a negative effect on the skin, causing, for example, dryness and cracking. Therefore, the solution used for disinfection must contain glycerin or lanolin.

What is surgical hand disinfection?

This type of hand sanitization is intended to prevent infection of surgical wounds and, accordingly, to prevent the occurrence of postoperative complications caused by microbes entering the tissue. The procedure for surgical disinfection of hand skin includes the following three stages:

1. Mechanical treatment of the skin.
2. Treating the skin with antiseptic agents.
3. Isolate the skin from the external environment with sterile disposable gloves.

The surgical level of hand disinfection is used in the following situations:

• before performing surgical operations;
• before complex penetrating manipulations.

Rules for hand treatment during surgical disinfection

A feature of mechanical cleaning of the skin surface during surgical disinfection is that the skin of not only the doctor’s hands, but also his forearms is subject to cleaning. Drying the skin is done using sterile wipes. The minimum duration of this stage of the procedure is two minutes. After removing moisture from the skin, additional processing nail beds and periungual folds with special wood sticks and antiseptic agents. Sterile brushes can also be used for this purpose.

After the first stage of surgical disinfection, ten milliliters of an antiseptic drug is applied to the skin of the hands in portions of three milliliters. The applied product must be rubbed into the skin before it dries, using the same sequence of movements as when washing your hands. The duration of this stage of the procedure should be five minutes.

Before putting on sterile gloves the skin must be dry. If a doctor works with gloves on for more than three hours, he must again perform surgical hand disinfection and put on a new pair of gloves.

After work, you need to wipe the skin of your hands with a disinfected napkin, wash your hands with soap, and then apply a cream to the skin that has a softening and moisturizing effect.

To disinfect the surface of the skin, disinfectants can be used, both water-based and alcohol-based. The latter are more preferable. The most common antiseptic formulations are:

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

12.4. Hand hygiene

12.4. Hand hygiene.

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

Before direct contact with the patient;

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

After contact with body secretions or excreta, mucous membranes, dressings;

Before performing various patient care procedures;

After contact with medical equipment and other objects located in close proximity to the patient;

After treating patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment.

12.4.2. Hand hygiene is carried out in two ways:

Hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;

Treating hands with a skin antiseptic to reduce the number of microorganisms to a safe level.

12.4.3. To wash your hands, use liquid soap using a dispenser. Dry your hands with an individual towel (napkin), preferably disposable.

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

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

12.4.6. 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 (resuscitation and 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 patient’s bedside and etc.). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (up to 200 ml) with skin antiseptic.

12.4.7. Use of gloves.

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