Antiseptic treatment of medical staff's hands. Surgical treatment of hands

Rules for hand treatment of medical personnel. SanPiN 2.1.3.2630-10

1. In order to prevent nosocomial infections, the hands of medical workers are subject to disinfection (hygienic treatment of hands, disinfection of surgeons’ hands) and the skin of patients (treatment of surgical and injection fields, elbow bends of donors, sanitary treatment of the skin).

Depending on the medical procedure being performed and the required level of reduction in microbial contamination of the skin of the hands, medical personnel perform hygienic treatment of hands or treatment of the hands of surgeons. The administration organizes training and monitoring of compliance with hand hygiene requirements by medical personnel.

2. To achieve effective washing and disinfection of hands, the following conditions must be observed: short-cut nails, no nail polish, no artificial nails, no rings, rings or other jewelry on the hands. Before treating surgeons' hands, it is also necessary to remove watches, bracelets, etc. To dry hands, use clean cloth towels or disposable paper napkins; when treating surgeons' hands, use only sterile cloth ones.

3. Medical personnel should be provided with sufficient quantities of effective means for washing and disinfecting hands, as well as hand skin care products (creams, lotions, balms, etc.) to reduce the risk of contact dermatitis. When choosing skin antiseptics, detergents and hand care products, individual tolerance should be taken into account.

4. Hand hygiene.

4.1. 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 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.

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.

4.3. To wash your hands, use liquid soap using a dispenser.

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 for effective hand disinfection is keeping them moist for the recommended treatment time.

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.

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.

4.7. Use of gloves.

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.

4.7.2. It is not allowed to use the same pair of gloves when in contact (for care) with two or more patients, when moving from one patient to another, or from a body area contaminated with microorganisms to a clean one. After removing gloves, perform hand hygiene.

4.7.3. When gloves become contaminated with secretions, blood, etc. To avoid contamination of your hands during the process of removing them, you should use a swab (napkin) moistened with a solution of a disinfectant (or antiseptic) to remove visible dirt. Remove gloves, immerse them in the product solution, then discard. Treat your hands with an antiseptic.

5.1. Surgeons' hands are treated by everyone involved in surgical interventions, childbirth, and catheterization of great vessels.

The treatment is carried out in two stages: Stage I - washing hands with soap and water for two minutes, and then drying with a sterile towel (napkin); Stage II - treatment of hands, wrists and forearms with an antiseptic.

5.2. The amount of antiseptic required for treatment, the frequency of treatment and its duration are determined by the recommendations set out in the guidelines/instructions for use of a particular product.

An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

5.3. Sterile gloves are put on immediately after the antiseptic has completely dried on the skin of the hands.

6. Algorithms/standards for all epidemiologically significant therapeutic and diagnostic procedures must include recommended means and methods of hand treatment when performing the relevant manipulations.

7. It is necessary to constantly monitor the compliance with hand hygiene requirements by medical workers and bring this information to the attention of personnel in order to improve the quality of medical care.

8. 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 staff workload (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, etc. .). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (100-200 ml) with skin antiseptic.

9.2. To achieve effective hand disinfection, the following conditions must be observed: short-cut nails, no artificial nails, no rings, rings or other jewelry on the hands.

Before treating surgeons' hands, also remove watches and bracelets. To dry your hands, use disposable towels or napkins; when treating surgeons’ hands, use only sterile ones.

9.3. It is preferable to treat the patient's surgical field before surgery and other manipulations associated with violation of the integrity of the skin (puncture, biopsy) with an antiseptic containing a dye.

9.4. Treatment of the injection field involves disinfecting the skin using an alcohol-containing antiseptic at the injection site (subcutaneous, intramuscular, intravenous) and drawing blood.

9.5. To treat the elbow bends of donors, the same antiseptics are used as for treating the surgical field.

9.6. For sanitary treatment of patients' skin (general or partial), antiseptics that do not contain alcohol and have disinfecting and cleaning properties are used. Sanitation is carried out on the eve of surgery or when caring for the patient.Hand sanitizing is a simple but very important method of preventing HAIs.P .

Correct and timely hand washing is the key to the safety of medical personnel and patients

1.Rules for preparing for hand treatment:

2.Remove rings and watches.

3.Nails must be cut short and no polish is allowed.

Fold the long sleeves of the robe over 2/3 of your forearms. All jewelry and watches are removed from hands, as they make it difficult to remove microorganisms. Hands are soaped and then rinsed warm running water and everything repeats itself from the beginning

. It is believed that the first time you soap and rinse with warm water, germs are washed off from the skin of your hands. Under the influence of warm water and self-massage during mechanical treatment, the pores of the skin open, so when repeated soaping and rinsing, germs are washed away from the opened pores. Warm water contributes to a more effective effect of the antiseptic or soap, while hot water removes the protective fat layer from the surface of the hands. Therefore, you should avoid using too hot water when washing your hands.

When entering and exiting the intensive care unit or intensive care unit, personnel must treat their hands with a skin antiseptic.

1.There are three levels of hand treatment:

2.Hygienic level (hand treatment using skin antiseptics);

3.Surgical level (special sequence of actions when treating hands, increasing treatment time, treatment area, followed by putting on sterile gloves).

1. Mechanical treatment of hands

The purpose of household hand treatment is to mechanically remove most of the transient microflora from the skin (antiseptics are not used).

· after visiting the toilet;

· before eating or working with food;

· before and after physical contact with the patient;

· for any contamination of hands.

Required equipment:

1.Liquid dosed neutral soap. It is desirable that the soap does not have a strong odor. Open liquid soap quickly becomes infected with microbes, so you need to use closed dispensers, and after finishing the contents, process the dispenser, and only fill it with new contents after processing.

2.Disposable, clean, 15x15 cm napkins for drying hands.

Using a towel (even an individual one) is not advisable, because it does not have time to dry and, moreover, is easily contaminated with germs.

1.Hand treatment - the necessary sequence of movements:

2.Rub one palm against the other palm in a back-and-forth motion.

3.Rub the back of your left hand with your right palm and switch hands.

4.Connect the fingers of one hand in the interdigital spaces of the other, rub the inner surfaces of the fingers with up and down movements.

5.Connect your fingers into a “lock” and rub the palm of your other hand with the back of your bent fingers.

6.Cover the base of the thumb of the left hand between the thumb and index finger of the right hand, rotational friction. Repeat on the wrist.

Change hands.

Rub the palm of your left hand in a circular motion with the fingertips of your right hand, switch hands.

HAND HYGIENIC RULES

Circular rubbing of the left thumb in the closed palm of the right hand and vice versa

Circular rubbing of the closed fingertips of the right hand on the left palm and vice versa

2. Hand hygiene

· before putting on gloves and after taking them off;

· before caring for an immunocompromised patient or during ward rounds (when it is not possible to wash hands after examining each patient);

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

· after contact with body fluids (eg blood emergencies).

Required equipment:

2.Napkins measuring 15x15 cm are disposable, clean (paper or fabric).

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

Hand hygiene consists of two stages:

1 - mechanical cleaning of hands followed by drying with disposable napkins;

2 - hand disinfection with skin antiseptic.

3 . Surgical treatment of hands

The purpose of the surgical level of hand cleaning is to minimize the risk of disruption of surgical sterility in the event of glove damage.

2. Hand hygiene

· before surgical interventions;

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

Required equipment:

1.Liquid dosed pH-neutral soap.

2.Wipes measuring 15x15 cm are disposable, sterile.

3.Skin antiseptic.

4.Disposable sterile surgical gloves.

Hand treatment rules:

Surgical treatment of hands consists of three stages:

1 - mechanical cleaning of hands followed by drying,

2 - hand disinfection with skin antiseptic twice,

3 - covering hands with sterile disposable gloves.

In contrast to the above-described method of mechanical cleaning at the surgical level, the forearms are included in the treatment; sterile wipes, and itself hand washing lasts at least 2 minutes. After drying, the nail beds and periungual folds are additionally treated with disposable sterile wooden sticks soaked in an antiseptic solution.

It is not necessary to use brushes. If brushes are used, sterile, soft, single-use or autoclave-resistant brushes should be used only for periungual areas and only for the first brush of a work shift.

At the end of the mechanical cleaning stage, an antiseptic is applied to the hands in 3 ml portions and, without allowing drying, rubbed into the skin, strictly observing the sequence of movements. The procedure for applying a skin antiseptic is repeated at least twice, the total consumption of the antiseptic is 10 ml, the total procedure time is 5 minutes .

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

After removing the gloves, hands are wiped again with a cloth moistened with a skin antiseptic, then washed with soap and moisturized with an emollient cream.

Bacteriological control of the effectiveness of personnel hand treatment.

Washings from the hands of personnel are carried out using sterile gauze wipes measuring 5x5 cm, soaked in a neutralizer. Using a gauze napkin, thoroughly wipe the palms, periungual and interdigital spaces of both hands. After sampling, the gauze pad is placed in wide-necked test tubes or flasks with saline solution and glass beads and shaken for 10 minutes. The liquid is inoculated and incubated for 48 hours at a temperature of + 37 0 C. Recording of results: absence of pathogenic and opportunistic bacteria (Guidelines 4.2.2942-11).

Dermatitis associated with frequent hand cleaning

Repeated hand cleaning may cause skin dryness, cracking and dermatitis in sensitive subjects. A healthcare worker suffering from dermatitis increases the risk of infection for patients due to:

· the possibility of colonization of damaged skin by pathogenic microorganisms;

· difficulties in adequately reducing the number of microorganisms when washing hands;

· tendencies to avoid hand-handling.

Measures to reduce the likelihood of developing dermatitis:

· thoroughly rinsing and drying hands;

· using an adequate amount of antiseptic (avoid excess);

· usage modern and various antiseptics;

· mandatory use of moisturizing and softening creams.

Skin microflora

The superficial layer of the epidermis (the top layer of skin) is completely replaced every 2 weeks. Every day, up to 100 million skin flakes are shed from healthy skin, of which 10% contain viable bacteria.

1.Skin microflora can be divided into two large groups:

2.Resident flora

Transitory flora- these are those microorganisms that constantly live and multiply on the skin without causing any diseases. That is, this is normal flora.

The number of resident flora is approximately 10 2 -10 3 per 1 cm 2. The resident flora is represented predominantly by coagulase-negative cocci (primarily Staphylococcus epidermidis) and diphtheroids (Corinebacterium spp.). Despite the fact that Staphylococcus aureus is found in the nose of approximately 20% of healthy people, it rarely colonizes the skin of the hands (if it is not damaged), however, in hospital conditions it can be found on the skin of the hands of medical personnel with no less frequency than in the nose.

Resident microflora cannot be destroyed by regular hand washing or even antiseptic procedures, although its numbers are significantly reduced. Sterilization of the skin of the hands is not only impossible, but also undesirable: because normal microflora prevents the colonization of the skin by other, much more dangerous microorganisms, primarily gram-negative bacteria. 2. Transient microflora

are those microorganisms that are acquired by medical personnel as a result of contact with infected patients or contaminated environmental objects. Transient flora can be represented by much more epidemiologically dangerous microorganisms (E.coli, Klebsiella spp., Pseudomonas spp., Salmonella spp. and other gram-negative bacteria, S.aureus, C. albicans, rotaviruses, etc.), including hospital strains of pathogens of nosocomial infections.

The dentist performs all his main actions with his hands. For this reason, cleanliness of the dentist's hands is of utmost importance. After all, numerous microbes that reside on the skin of unwashed hands, if they get into open wounds, can cause infection with the subsequent development of pathological processes. Therefore, a necessary procedure when preparing a doctor for work is sanitary treatment of hands to ensure the absence of microorganisms on them 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 of the above methods provides a higher level of skin cleansing from 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 hygienic procedure does not ensure the removal of contamination 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 to keep the water warm, but not hot, when cleaning your hands. Too high a water temperature 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. Alternately rubbing the inner surface of the interdigital spaces of one hand with the fingers of the other.
4. Rubbing the palms with the backs of bent fingers joined into a lock.
5. Alternately rubbing the base of the thumb of 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 a bottle with detergent that already contains soap, as it may become contaminated. It is best if the liquid soap dispenser is equipped with a hermetic pump, which prevents microbes and air from the external environment from entering the container with soap, and ensures 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 the health care facility. 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.

Mechanical processing means regular 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 of antiseptics can be used, 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 treatment of the nail beds and periungual folds is carried out 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.

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

Staff hand washing or decontamination.

Decontamination is the process of removing or destroying microorganisms for the purpose of neutralization and protection - cleaning, disinfection, sterilization.

Hand washing– the most important procedure to prevent nosocomial infections. There are 3 levels of hand decontamination: social level, hygienic (disinfection), surgical level.

Social level – washing lightly contaminated hands with soap and water, which removes most transient microorganisms from the skin.

Social hand treatment is carried out:

1. Before eating

2. After going to the toilet

3. Before and after patient care

4. When your hands are dirty.

Equipment: liquid soap (soap dish with wire rack and a bar of soap), napkins, paper towel.

Preparation for the procedure:

Performing the procedure:

4. Lather your palms (if using bar soap, rinse and place in a soap dish with a wire rack).

5. Wash your hands by vigorously and mechanically rubbing your soaped palms together for 10 seconds.

6. Rinse off the soap under running water: hold your arms so that your wrists and hands are below elbow level (in this position, the water flows from the clean area to the dirty area).

Completing the procedure:

7. Close the water tap using a paper napkin.

8. Dry your hands with a paper towel (a cloth towel quickly becomes damp and is an ingenious breeding ground for organisms).

Note: If running water is not available, a basin of clean water can be used.

Hygienic level of hand washing.

Equipment: liquid soap (soap dish with wire rack and a bar of soap), skin antiseptic, napkins, paper towel.

Hygienic level of hand treatment– This is washing using antiseptic agents. This is a more effective method of removing and killing microorganisms.

Hand hygiene is carried out:

1. Before performing invasive procedures

2. Before caring for an immunocompromised patient.

3. Before and after care of the wound and urinary catheter.

4. Before putting on and after taking off gloves.

5. After contact with body fluids or after possible microbial contamination.

Preparation for the procedure:

1. Remove all rings from your hands, with the exception of the wedding ring (the depressions on the surface of jewelry are breeding grounds for microorganisms).

2. Move the watch above your wrist or remove it. Place in your pocket or pin to your robe.

3. Open the water tap, using a paper napkin to avoid contact with microorganisms present on the tap, adjust the water temperature.

Performing the procedure:

4. Wet your hands under running water or in a bowl of water.

5. Apply 4-5 ml of antiseptic to your hands or thoroughly wash your hands with soap.

6. Wash your hands using the following technique:

a) Vigorous mechanical friction of the palms - 10 seconds (repeat 5 times).

b) The right palm washes (disinfects) the back of the left hand with rubbing movements, then the left palm also washes the right one, repeat 5 times.

c) The left palm is on the right hand, fingers intertwined, repeat 5 times.

d) The fingers of one hand are bent and are on the other palm (fingers intertwined) - repeat 5 times.

e) Alternately rubbing the thumbs of one hand with the palms of the other, palms clenched, repeat 5 times.

f) Alternating friction of the palm of one hand with the closed fingers of the other hand, repeat 5 times.

7. Rinse your hands under running water, holding them so that your wrist and hands are below the level.

Completion of the procedure.

8. Close the tap with a paper towel.

9. Dry your hands with a paper towel.

Note: if hygienic hand washing with water is not possible, you can treat them with 3-5 ml of antiseptic (based on 70% alcohol for 2 minutes).

Gloves.

Clean or sterile, also part of protective clothing. They are worn when:

1. Contact with blood

2. In contact with seminal fluid or vaginal secretions

Any involves preparation and direct decontamination (removal of contaminants). The nurse's hands should be well-groomed, free of inflammation, hangnails and microcracks.

Nails must be neatly trimmed and not varnished. The skin edge of the nail bed should not be cut off due to the risk of microtrauma and inflammation. Artificial nails on a nurse's hands are not acceptable. Before it startsTo carry out manipulations, wristwatches and jewelry must be removed.

Preparing a nurse's hands for treatment

• We remove watches and jewelry.
• We examine the hands for inflammation and skin damage.
• If there are wounds or signs of skin inflammation, we inform the senior nurse.
• If there are minor injuries and local inflammation, we cover the problem areas of the skin with an adhesive plaster and put on a finger guard.

Mechanical treatment of a nurse's hands

Normal hand washing is carried out with liquid soap from a dispenser, and in case of its absence, with a simple bar soap. Manipulation rooms must be equipped with elbow-controlled mixers.

After preparing your hands, moisten them with warm water, soap your palms, the backs of your hands, the spaces between your fingers and nail beds.

Vigorously three hands touching each other:

1. palm on palm;
2. right palm on the back of the left hand and vice versa;
3. we clasp our hands with the fingers spread and the three inner surfaces of the fingers with up and down movements;
4. fold your hand into a fist and use the back of the fingers of one hand to rub the palm of the other hand (repeat for each hand);
5. clench your hand into a fist and grasp the finger of the other hand, three fingers in a circular motion - repeat with each finger on both hands;
6. three palms of one hand with the fingertips of the other, then change hands.

Each action must last at least 30 seconds. After washing, we dry our hands with a disposable towel or a cloth one, which is immediately removed from circulation.

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Hygienic antiseptic treatment of nurse's hands

1. Preparing hands for processing.
2. Washing hands with antiseptic soap.
3. Hand treatment with water or alcohol antiseptic in accordance with the instructions for use. Drying with a towel after treatment with an antiseptic is NOT ALLOWED.

Surgical treatment of nurse's hands

1. Hand preparation.
2. Wash hands, wrists, and forearms with regular or antiseptic soap. Nails are treated with brushes.
3. Drying hands with a sterile cloth.
4. Applying an alcohol solution of a skin antiseptic, rubbing it into the skin until completely dry (aqueous solutions of antiseptics DO NOT APPLY).
5. Repeated application and rubbing of alcohol-based antiseptic, followed by drying WITHOUT TOWEL DRYING.
6. Putting sterile gloves on dry hands.