What do you use to treat your hands? Hygienic treatment of the hands of medical staff: methods, algorithm and preparations. Hand treatment methods
The goal is to destroy transient flora to prevent the risk of contamination of the surgical wound when gloves are damaged.
Surgical treatment of hands is carried out:
Before surgical interventions;
For puncture of large vessels;
Before intubating the patient.
Equipment:
Liquid dosed soap.
Disposable napkins (15x15) for blotting hands.
Disposable wipes (7x7) for treating hands with skin antiseptic.
Skin antiseptic.
Disposable sterile rubber gloves.
Surgical treatment of hands consists of two stages:
Stage 1– mechanical cleaning hands
Hands are washed with soap for one minute.
Hand washing procedure.
Palm to palm;
Right palm over back side left;
The left palm is over the back of the right;
Nail beds;
Palm to palm, pollen from one hand in the interdigital spaces of the other;
Rotational friction of thumbs;
Rotational friction of the palms.
Each movement is repeated 5 times.
Then the hands are thoroughly rinsed with warm water and blotted dry with a sterile cloth.
Stage 2– disinfection of hands with skin antiseptic.
80% ethyl alcohol solution as a skin antiseptic for surgical treatment of hands not used.
Technique for treating hands with skin antiseptic.
Hands are wiped with a napkin (7x7) moistened with a skin antiseptic from the fingertips to the elbow. The nail beds, between the fingers and the base of the thumb are especially thoroughly wiped. Hands are wiped twice, with different sterile wipes for 1.5 minutes, for a total of 3 minutes.
Gloves should only be worn on sterile and dry hands. The gloves are disposable.
After removing the gloves, hands are wiped with a napkin (7x7) moistened with a skin antiseptic, then washed with soap, rinsed thoroughly and softened with cream.
When using alcohol-containing skin antiseptics, you can rub 2.5 - 3.0 ml of them into the skin of the hands and forearms for 5 minutes. until completely dry, then put sterile gloves on dry hands.
Spring-cleaning.
General cleaning is carried out Once a week or after removing the patient from the ward.
Preparing for general cleaning.
On the eve of cleaning, rags are given for sterilization (8 pieces - for walls, furniture, refrigerator, floor, 2 pieces each). The markings must be clear.
On the day of cleaning, the furniture is moved away from the walls, medications and food products are removed from the premises.
Sinks and baseboards are washed with a cleaning product and a brush.
The employee puts on a special clothes marked “for cleaning” - 2 sets.
Rules for wearing special clothes:
A) cotton pajamas with fasteners on the back, elastic bands on the sleeves and legs, the blouse is tucked into the trousers;
B) cotton-gauze mask or respirator;
B) safety glasses;
D) large cotton scarf;
D) rubber technical gloves;
E) rubber boots;
G) rubber or oilcloth apron.
Upon completion of wiping, it is carried out ultraviolet irradiation(Ural Federal District). The irradiation time depends on the power of the lamp according to the passport and the area of the room. The quartz mode should be posted in a “visible” place.
After UV irradiation, the room is ventilated until the smell disappears.
Disinfection (disinfection) of quartz lamps.
The lamp is disinfected once every 7 days. The frame is washed like walls during general cleaning at intervals of 15 minutes. 70% ethyl alcohol solution.
Toilet rooms. Wiping is carried out as in treatment room. The toilet is wiped twice with the same disinfectant solution used for cleaning departments - 3% chloramine or 4% hydrogen peroxide.
To wipe, there must be a kvach, which is disinfected in a 3% chloramine solution for 60 minutes, 4% hydrogen peroxide for 90 minutes.
Handling dishes.
Order No. 288 of the USSR Ministry of Health, 1976 “Sanitary and epidemiological regime in health care facilities.”
San PiN 5179-90 Ministry of Health of the USSR 1991 “San. device rules, equipment and operation of hospitals and other health care facilities.”
San PiN 2.3.6.959-00 “San-epid. requirements for the organization Catering» Ministry of Health of the Russian Federation, 2000.
Processing tableware
Each honey the sister takes an obligatory part in feeding the patients. To do this, she puts on a robe or apron marked M\C for distributing food,” which is located in the pantry room and changes every day. Before distributing food, the m/s performs mechanical treatment of hands (hands are washed with soap twice, thoroughly rinsed with warm water and wiped dry with a clean towel, which is changed daily, or a disposable napkin).
Food must be distributed no later than 2 hours from the moment the food is received at the catering unit.
Temperature of food when serving food:
First courses – 70-75 0 C;
Second courses – 60-65 0 C;
Third courses – not lower than 14 0 C.
At the end of feeding, the dishes are collected by the barmaid and delivered to the buffet washing room, and the nurse wipes the tables and bedside tables twice with an interval of 15 minutes. 1% chloramine solution or 3% hydrogen peroxide solution in somatic departments or the disinfectant solution that the department uses.
In the pantry room, tableware is removed from food debris into a food waste container.
Disinfection of food waste.
The waste is boiled for 30 minutes. or fall asleep dry bleach at the rate of 200 g/l – exposure 60 minutes. and is disposed of.
Stages of processing dishes.
In 2% solution baking soda(20 g soda);
In a 2% mustard solution (20 g mustard + up to 1 liter of water).
In the first container, the dishes are degreased:
Degreasing conditions:
The temperature of degreasing solutions must be at least 50 0 C.
Exposure 30 min.
The dishes in this solution are washed with a rag for at least 1 minute, then transferred to a second container.
1% chloramine solution – 60 minutes;
3% solution of H 2 O 2 – 80 minutes;
In the second container, the dishes are degreased in disinfectant solutions:
The temperature of the disinfectant solution is 18-20 0 C.
In the third container, the dishes are rinsed in running water at a temperature of 70-75 0 C until the smell disappears. Due to the high temperature, the dishes are rinsed with a hose.
Dishes are dried on wire racks in a vertical position.
The spoons are first degreased and then degreased in the oven at a temperature of 180 0 C - 20 minutes.
Kitchen utensils, in which food is delivered to the buffet from the catering unit, undergo two stages of processing: degreasing and rinsing, and are dried upside down on wire racks.
Surgical hand antisepsis - carried out before operations and any interventions associated with violations of the integrity of the skin.
Classic methods Alfeld, Führfinger, Spasokukotsky-Kochergin hand treatments are not currently used.
In accordance with modern requirements, surgical hand antisepsis is carried out in two stages.
Hygienic washing.
Hands are washed under warm running water using a disposable or liquid soap within 1-2 minutes. In this case, the rule of processing sequence is observed: do not touch less clean skin with the treated areas of the hands. After which the hands are dried with a sterile napkin or towel.
Note. Do not use brushes on the skin of the hands and forearms.
Surgeon's hand washing rules:
1) mechanical and chemical treatment;
2) exposure to antiseptic agents;
3) tanning.
Mechanical and chemical treatment is carried out by washing hands under the tap with a brush and soap. The use of modern methods allows washing hands simply with soap or using liquid detergents (in the absence of household contamination of hands). Hands are washed in running water with soap (A), re-soaped with soap (B) before brushing nails (C), and forearms are washed in running water with soap (D), the position of the hands and forearms after final processing hands, in which water flows from the elbows (D), the tap is closed with the elbow (E).
Modern methods of hand treatment do not require special tanning (film-forming antiseptics or antiseptics with a tanning element are used).
Antiseptics used to treat the surgeon's hands must have the following properties:
1. have a strong antiseptic effect;
2. be harmless to the surgeon’s skin;
3. be accessible and cheap.
Classic method of hand treatment according to Spasokukotsky - Kochergin:
It consists of washing your hands with a 0.5% solution of ammonia for 6 minutes (3 minutes in each basin), followed by treating the skin of your hands with 96% ethyl alcohol within 2 minutes.
According to OST they apply modern antiseptics: organic iodine-containing preparations, chlorhexidine, ACD.
Modern methods of treating surgeon's hands:
1. hand treatment with pervomur (formulation C-4) (a 2.4% solution prepared ex temporo is used; hand washing is done in a basin for 1 minute);
2. hand treatment with chlorhexidine (a 0.5% alcohol solution is used, hands are treated twice with a swab moistened with an antiseptic for 2-3 minutes);
3. iodopirone treatment (after preliminary washing of hands with soap and subsequent drying with a sterile napkin, they are treated for 2-3 minutes with cotton swabs moistened with 0.1% iodopyrone solution, then put on a sterile gown and sterile gloves);
4. hand treatment with degmin and degmicide (produced in the pelvis during 5- 7 minutes);
Alfeld method:
Wash with soap and brushes, dry, 2 basins for 5 minutes, 96% alcohol
Bruno method:
10 minutes 96% alcohol, without preliminary mechanical treatment.
Furbringer method:
10 minutes washing with soap and brushes, drying, 4 minutes treatment with 70% alcohol, sublimate 1:1000.
Zabludovsky method:
5% alcohol solution of tannin.
Spasokukotsky-Kochergin method:
It can be used as a forced method when it is not possible to apply modern methods. Wash with soap and brushes for 10 minutes, dry, mechanically clean hands with a 0.5% ammonia solution. Hands are washed in two basins for 3 minutes with a napkin; perform a sequence of movements, starting with the fingers of the left hand. In the first basin, hands are washed up to the elbows, in the second – up to the border of the upper and middle third of the forearm. At the end of washing your hands, rinse them with an ammonia solution and lift your hands up so that drops of water flow down to your elbows. The skin of the hands is dried with sterile wipes: first, both hands, then successively the lower and middle third of the forearms. Neutralize the skin with wipes moistened with 96% alcohol, treating the hands and the lower third of the forearms twice for 2.5 minutes, then the ends of the fingers and nail folds; nail beds and folds of the skin of the fingers are lubricated with a 5% alcohol solution of iodine.
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.
A similar hand treatment is carried out:
before surgical interventions;
before serious invasive procedures (for example, puncture of large vessels).
Required equipment:
Liquid dosed pH-neutral soap or individual disposable soap in pieces.
Wipes measuring 15x15 cm are disposable, sterile.
Skin antiseptic.
Disposable sterile surgical gloves.
Hand treatment rules:
Surgical treatment of hands consists of three stages: mechanical cleaning of hands, disinfection of hands with a skin antiseptic, covering of hands with sterile disposable gloves.
1. Unlike 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.
Sterile soft brushes that are disposable or capable of withstanding autoclaving should be used, and brushes should only be used for treating periungual areas and only for the first treatment during a work shift.
2. After completing 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 skin antiseptic is repeated at least twice, total consumption antiseptic - 10 ml, total procedure time - 5 minutes.
3. Sterile gloves are worn only on dry hands. When working with gloves for more than 3 hours, the treatment is repeated with a change of gloves.
4. After removing the gloves, hands are wiped again with a napkin moistened with a skin antiseptic, then washed with soap and moisturized with an emollient cream.
Preparing the surgeon's hands for surgery does not pursue sterilization of the skin of the hands, but:
Minimize the number of germs on your hands;
Prevent the entry of microbes from deep within the hands during surgery.
Main stages of all methods:
1. mechanical cleaning;
2. degreasing;
3. disinfection or disinfection;
4. tanning.
Hand washing for culture should be done once every 15 days.
Classic methods of treating surgeon's hands:
A) Führbringer method:
1) wash your hands in warm water with a brush and soap for 10 minutes
2) rinse with 80% alcohol for 1 minute
3) immerse your hands in a solution of sublimate 1:1000 for 1-2 minutes
b) Alfeld method:
1) wash your hands with soap and two sterile brushes under running warm water (1 brush – for 5 minutes)
2) dry your hands with a sterile cloth
3) treat with a gauze ball with 96% alcohol for 5 minutes
4) lubricate your fingertips with a weak alcohol iodine tincture
V) Spasokukotsky-Kochergin method:
1) wash your hands in two enamel basins with a 0.5% warm solution of NH 4 OH for 3 minutes in each
2) wipe your hands dry with a sterile cloth
3) treat your hands with a gauze swab with 96% alcohol for 5 minutes
Modern method treatment of surgeon's hands (EN-1500):
1) wash your hands with warm water and soap for 2 minutes, then dry your hands with a sterile cloth
2) treat the nail beds and periungual areas with disposable sterile wooden sticks moistened with an antiseptic
3) apply the antiseptic to the skin of the hands and forearms in portions, rubbing thoroughly:
a) rub palm against palm
b) rub your left palm over the back of your right and vice versa
c) rub your palms with crossed fingers spread out for at least one minute
d) rub the back of your bent fingers across the palm of your other hand
d) alternately rub your thumbs in a circular motion
f) alternately rub your palms with the fingertips of the opposite hand in multidirectional circular movements
For one treatment, 10 ml of antiseptic.
After the antiseptic has completely evaporated, put on sterile gloves.
The following antiseptic solutions are used to treat hands:
a) Pervomur S-4 (2.4% or 4.8%)
b) cerigel
c) chlorhexidine digluconate (gibitan)
d) septocide.
Preparation surgical field (5% iodine solution is prohibited):
1% iodonate solution;
1% iodine-pyrone;
0.5% alcohol solution of chlorhexidine
Rokkal 2 minutes;
Pervomur 1 minute.
Grossich-F. method:
The surgical field is extensively processed three times;
Let's get laid surgical linen;
We process immediately before the cut;
During the operation when changing linen;
Before suturing the skin;
After suturing.
When disinfecting the air in the operating room, ventilation, air conditioning, UV irradiation, spraying of antiseptics (hydrogen peroxide), and filtration are used.
500 microbial bodies in one cubic meter allowed at the time of operation, by the end should not exceed 3000 per cubic meter.
General treatment of the operating room - 6% hydrogen peroxide solution preliminary and 3% current.
Sterilization of surgical instruments carried out in several stages - first, pre-sterilization preparation is carried out: mechanical cleaning, immersion for 1 hour in 3% chloramine, rinsing with water, drying. The sterilization method depends on the type of instrument V:
Non-cutting instruments (tweezers, clamps) are sterilized in an autoclave or dry heat oven. Disposable instruments are sterilized by radiation. IN as a last resort it is possible to boil in a 2% soda solution for 30 minutes. Instruments contaminated with pus are boiled for 45 minutes.
· Cutting and piercing instruments (needles, scalpels) are sterilized by soaking in an antiseptic solution. Best methods in this case are gas and radiation sterilization. Thermal methods(boiling, dry heat sterilization) lead to dulling of instruments and can be used only in extreme cases when it is impossible to use other methods.
· Rubber and plastic instruments (catheters, probes) are sterilized by autoclaving or (as a last resort) boiled for 15 minutes. Disposable products are subjected to radiation sterilization in factories.
· Gloves are sterilized in an autoclave at a temperature of 130 o C and a pressure of 1 atmosphere for 30 minutes. Before sterilization, each glove is sprinkled with talc and wrapped in a separate gauze napkin. IN Lately disposable gloves sterilized by radiation in the factory are increasingly being used.
· Optical equipment is sterilized in formalin vapor for 48 hours. Endoscopes can also be sterilized by immersion in alcohol, chlorhexidine or sidex.
· Operating linen (gowns, sheets) and dressing (gauze balls, tampons, napkins, turunds) are sterilized in an autoclave at a temperature of 130 o C and a pressure of 1 atmosphere for 1 hour (or at a pressure of 2 atmospheres for 30 minutes). After washing, the laundry is sterilized by first placing it in a Schimmelbusch container. Bix is considered sterile for 3 days after sterilization.
Types of bix styling:
1). The universal installation of bix is divided into sectors, each of which is filled with a specific type of material.
2). Purposeful placement in the bix contains all the instruments, dressings and linen necessary for a specific operation.
3). Type laying is used for a large number of operations: a certain type of material is placed in each block.
Recently, disposable dressings and surgical linens have appeared, sterilized by radiation in the factory.
HAND TREATMENT- one of the aseptic measures aimed at achieving sterility of the hands of the surgeon and other participants in the operation, ensuring the prevention of contact infection of the surgical wound.
Story
Scientifically based O. r. began to come into practice from the beginning of the antiseptic era in surgery. Before this, hand cleanliness was not given importance. For the first time hand disinfection ( chlorine water) were proposed by Holmes (O. W. Holmes, 1843) and I. Semmelweis (1848). J. Lister (1867) promoted O. r. phenol solution as an important part of its antiseptic method. Substantiated by the discoveries of L. Pasteur (1863) Or. firmly established in practical surgery.
The skin of the hands usually contains many microbes, which are found not only on the surface, in folds, cracks, but also in the hair follicles, sweat and sebaceous glands, and especially under the nails. If your hands get dirty frequently and poor care behind them, roughening of the skin, the presence of cracks, scratches and abrasions, the infection rate increases and it can be extremely difficult to achieve asepticity of the hands before surgery. Therefore, persons participating in operations must keep their hands clean and avoid contamination, especially with pus; If your skin is dry, your hands should be lubricated with Vaseline or a special cream at night; Nails must be cut short and coating them with varnish is unacceptable. When engaging in physical labor or sports, it is advisable to use gloves.
Low-concentration antiseptic solutions, previously used for OR, do not have a sufficient bactericidal effect, since the sloughing epithelium and the secretion of the sebaceous glands protect the microflora from direct contact with antiseptics. More concentrated solutions cause dermatitis. Therefore, at the beginning of the antiseptic era, the main attention in O. r. was given to mechanical cleaning - washing hands with brushes and soap in hot water. However this mechanical method turned out to be insufficiently effective. Then, after washing, hands began to be treated with antiseptics, thanks to which it was possible to achieve relative sterility of the surface of the skin, but the microbes located deep in it were not subject to the bactericidal effect of disinfectants.
During the operation, they came to the surface of the skin along with sweat and fatty lubricant. In this regard, the idea arose to use tanning agents to thicken the surface layers of the skin and close the skin pores for a longer period of time, in order to prevent microbes from reaching the surface.
Thus, three basic principles of hand disinfection were determined: mechanical cleaning, chemical disinfection, tanning of leather, on the basis of which they were developed various ways O. r. and their numerous modifications. Requirements common to all methods were developed: first of all, the skin of the hands should be treated, especially carefully the fingers (the area of the joints, the ridges of the nails, the spaces under the free edges of the nails), and then the skin of the forearms to the elbow; used for O. r. brushes, napkins, instruments must be sterile; First, the hands and forearms are treated with a napkin (brush), then with another napkin (brush) - mainly the hands.
Classic methods
The most famous methods are those of Furbringer, Alfeld and the Spasokukotsky-Kochergin method.
Furbringer method. After washing with warm water and soap (using a brush) for 1 minute. hands are rinsed with 80% alcohol (1 min.) and immersed for 1 - 2 minutes. in a solution of sublimate (1: 1000).
Alfeld's method. Hands are thoroughly washed with soap under running warm water using a brush for 10 minutes, and then wiped dry with a sterile towel and treated for 5 minutes. 96% alcohol.
The methods of Furbringer and Alfeld subsequently underwent great changes. Various modifications extended the washing time, it became mandatory to treat the nail folds of the fingers with an alcohol solution of iodine, and a combination of these methods was proposed.
The Spasokukotsky-Kochergin method. A special feature of this method is the use of 0.5% ammonia solution for hand washing, which has a good degreasing effect. Hands are washed in a freshly prepared solution (0.5 ml of official 10% ammonia for every 100 ml hot water) gauze napkins in two basins, 3 minutes each. in everyone. Washed hands are wiped dry with a sterile towel and treated for 5 minutes for tanning purposes. ball soaked in alcohol. O. r. ammonia has found wide application in surgical and obstetric-gynecological practice; the method justified itself during the Great Patriotic War as the simplest and most reliable. Long time it remained the most common in our country.
Modern methods
Since the middle of the 20th century. many new antiseptics for O. r. were proposed. The most promising are surfactants, and among them are quaternary ammonium compounds, which have bacteriostatic and bactericidal effects, as well as wetting and washing properties that provide deep penetration them into the skin. When using them, the use of brushes and tanning agents becomes unnecessary. Thus, the classic triad (mechanical cleaning, chemical disinfection, tanning), which required various effects on the skin, is replaced by a single effect that ensures deep and long-term sterility of the hands.
List of used antiseptics that meet modern requirements, is quite extensive and is constantly being updated. It includes diocide, novosept, degmicide, oxidative systems, etc. (USSR); cefiran, rokkal, ammonix T, bio-nal, etc. (USA); cetab, cetavlon (England), etc. Methods of O. r. These antiseptics are simple, do not require much time and special equipment.
Hand treatment with diocide. Diocide solution (see) in a concentration of 1: 3000-1: 5000 is poured into an enamel basin and, using a sterile napkin, the hands are treated with it for 2-3 minutes, then dried and for 1 - 2 minutes. wipe with alcohol.
Hand treatment with novosept, degmicide. A solution of novosept (3%) or degmicide (1%) is poured into a basin and the hands are wiped with it, first with one and then with another foam sponge for 2-3 minutes. Thanks to good penetration preparations deep into the leather, tanning with alcohol is not required.
Wedge, tests of these domestic drugs have shown that they have a number of advantages over diocide. The bactericidal properties of prepared solutions do not decrease during storage for up to 6 months. “Glove juice” turns out to be sterile within 5-6 hours. Degmicide has a more pronounced antimicrobial effect than Novosept.
Hand treatment with a mixture of hydrogen peroxide and formic acid solutions(pervomur, C - 4). 170 ml of 30-33% hydrogen peroxide and 69 ml of 100% (or 81 ml of 85%) formic acid are poured into a glass vessel, after which the vessel is placed in cold water for 1 - I1/* hours and shake periodically. Store the mixture for no more than a day in a hermetically sealed container in a cool place. For O. r. use 2.4% or 4.8% solution of this mixture, which is obtained by adding up to 10 or 5 liters of tap or distilled water, respectively.
First, hands are washed with soap and water without a brush for 1 minute, wiped dry with a sterile cloth, then treated with 2.4% per-vomur solution in an enamel basin for 1 minute. and wipe again.
Hand treatment with cetylpyridine chloride in a film-forming composition (Cerigel). After pre-washing your hands with soap and water, apply 2-3 ml of liquid Zerigel to dry skin for 8-10 seconds. rub thoroughly so that it evenly covers the palmar and dorsal surfaces, interdigital spaces, periungual beds and the lower third of the forearms. Hands are dried with air from a running fan for 2-3 minutes, after which they are covered with thin and durable film. To remove the film, wash your hands hot water, dried and treated with alcohol.
Hand treatment with chlorhexidine bigluconate(gibitan), Gibitan is produced in 20% solution in glass containers of 500 ml. For O. r. this solution is diluted in 70% alcohol in a ratio of 1:40 (the result is a 0.5% alcohol solution). After preliminary washing of hands with soap and water and subsequent drying with a sterile napkin, O. r. with a cotton swab moistened with gibitan solution for 2-3 minutes.
Ultrasound treatment of hands. The method is based on the use of the combined action of ultrasonic cavitation and disinfectant(eg gibitana). After washing under the tap, hands are immersed in special bath with antiseptic, include ultrasound machine; after 60 sec. hands become almost sterile.
Control
According to the order of M3 of the USSR O. r. mandatory for all personnel involved in the operation (surgeons, anesthesiologists-resuscitators, operating nurses and anesthetists). Periodically, at least once a week, bacterial testing should be carried out to control the sterility of the hands of the participants in the operation. To obtain washes, use sterile wipes soaked in physiol. solution, thoroughly wipe the palms, periungual and interdigital spaces of both hands, then inoculate on solid and liquid nutrient media. Skin is considered sterile when there is no growth of microorganisms on either solid or liquid media.
Even the most effective modern methods O. r. do not guarantee absolute sterility. In addition, during the operation, the hands become contaminated with microbes that emerge from the depths of the pores to the surface of the skin. Therefore, regardless of the method used, O. r. During the operation, you should use gloves that guarantee sterility (see Medical gloves).
Hand treatment in military field conditions
In the conditions of modern war, with the mass arrival of victims at the medical stages. evacuation for O. r. medical staff should use methods that take little time, are simple, do not require special equipment and large quantity water, but at the same time quite effective in achieving sterility.
When rendering up to medical care, performing such manipulations as applying an aseptic dressing, injections medicines, dressings, O. r. produced according to a simplified method: hands are washed with soap and water, dried with a clean towel and treated with a swab moistened with alcohol. Manipulations are performed using sterile instruments, without touching the wound with hands, and sterile materials.
At the stage of providing first aid when performing such manipulations as novocaine blockade, intravenous infusion, capillary puncture of the bladder, etc., O. r. carried out according to the simplified method described above, supplemented by lubricating the ends of the fingers with an alcohol solution of iodine. Surgical operations(Tracheostomy, ligation of a bleeding vessel visible in the wound, cutting off a non-viable limb hanging on a flap) the doctor performs in sterile honey. gloves after preliminary O. r. (wash under running warm water and soap with a brush or wash with 0.5% ammonia solution).
At the stages of providing qualified and specialized surgical care(in SMEs, OMO, military field hospitals) it is most advisable to treat hands first with rum or according to the methods of Spasokukotsky - Kochergin, Alfeld. The doctor performs the operation in sterile medical equipment. gloves. In case of acute shortage of time, O. r. is most acceptable. First Murom, the edge provides high efficiency and can be produced 10-12 times faster than with other methods. In addition, this method uses little water.
On ships they use the same methods of OR. as in military field medical services. institutions and departments. Preferred O. r. first, especially on submarines and a number of ships, where persons who do not have honey are involved in participation in operations. preparation. In the conditions of warships, the value of this method increases, because... working solution Pervomura can be prepared using seawater.
At high temperature air, which is often observed in the operating compartment of a submarine, it can be difficult to work with rubber gloves due to profuse sweating. In these cases, it is permissible, as an exception, to operate without gloves, periodically treating the hands first with pervomur and then with alcohol.
Bacteriol, control of hand sterility is carried out in field conditions according to generally accepted methods.
Bibliography: Vishnevsky A. A. and Shreiber M. I. Military field: surgery, M., 1975; Gadzhiev S. A. et al. The use of the drug pervomur for treating the hands of surgeons, Klin, hir., No. 3, p. 76, 1972; Zhitnyuk I. D. and Melekhov P. A. About accelerated sterilization surgical materials, treatment of the surgeon’s hands and the surgical field, Military Med. zhurn., No. 10, p. 75, 1970; Infection in surgery, in the book: 24th congress. International. Society of Surgeons, ed. B.V. Petrovsky, vol. 1, p. 21, M., 1972; Kochergin I.G. Preparation of the surgeon’s hands and the operating field, M., 1941, bibliogr.; Lytkin M.I. and P o-p about in L.N. On the issue of treating the surgeon’s hands, Voen.-med. zhurn., No. 6, p. 22, 1977; Meshalkin E. N. and Milovidova M. A. Experience in the use of synthetic agents for preparing the hands of surgeons, Surgery, No. 7, p. 99, 1960; Spasokukotsky S.I. How and when to wash hands in surgical practice, Proceedings of Acad. S. I. Spasokukotsky, ed. A. N. Bakuleva et al., vol. 2, p. 480, M., 1948; Uglov F. G. et al. The use of new antiseptic agents in the surgical clinic, Surgery, No. 5, p. 3, 1969; Shvarts A., Perry J. and Birch J. Surfactants and detergents, trans. from English, M., 1960; A h 1 f e 1 d F. Die Desinfection des Fingers und der Hand vor geburtshiilflichen Untersuchungen und Eingriffen, Dtsch. med. Wschr., S. 851, 1895; Fiirb ringer P. Untersuchungen und Yorschriften iiber die Desinfektion der Hande des Arztes, Wiesbaden, 1888; H e u s n e r, tfber Jodbenzindesinfektion, Zbl. Chir., Bd 33, S. 209, 1906; Richter J.u. Mielke U. Untersuchungen zur chirurgischen Handedesinfe-ktion mit dem Praparat Fesia-cito, ibid., Bd 103, S. 364, 1978.
V. G. Karpenko, V. P. Samofalov; V. A. Katonin (military).
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