Simple and effective hand washing rules. How to conduct a quick and effective course in sanitation and hygiene training for cooks at your enterprise Selection of hygiene products

2. HANDS TREATMENT OF MEDICAL STAFF

Hand sanitizing is a simple but very important method of preventing HAIs.PCorrect and timely hand washing is the key to the safety of medical personnel and patients .

Rules for preparing for hand treatment:

1.Remove rings and watches.

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

3.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 fatty layer from the surface of the hands. In this regard, you should avoid consuming too much hot water for washing hands.

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

There are three levels of hand treatment:

1.Household level (mechanical 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 the household level of hand treatment is mechanical removal from the skin of most of the transient microflora (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, treat the dispenser, and only fill it with new contents after treatment.

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.

Hand treatment - the necessary sequence of movements:

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

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

3.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.

4.Place your fingers in a “lock” and rub the palm of your other hand with the back of your bent fingers.

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

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

HAND HYGIENIC RULES

European standard EN -1500

Scheme 4


Palm to palm, including wrists	Right palm to left back side brushes and left palm on the right back of the hand	Palm to palm of hands with fingers crossed

Outer side fingers on the opposite palm with fingers crossed	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

Target hygienic treatment- destruction of resident microflora from the surface of the skin of the hands using antiseptics.

A similar hand treatment is carried out:

· 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 biological fluids (for example, emergency situations with blood).

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% solution ethyl alcohol; 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 treatment is to minimize the risk of disruption operational sterility in case of damage to gloves.

A similar hand treatment is carried out:

· 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.

Unlike the method described above mechanical cleaning at the surgical level, the forearms are included in the treatment; they are used for drying 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 gauze pad Place in wide-necked test tubes or flasks with saline solution and glass beads and shake 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 ( upper layer 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. Skin microflora can be divided into two large groups:

1.Resident flora

2.Transitory flora

1. Resident microflora- 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.). Although Staphylococcus aureus is found in the nose in approximately 20% 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 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. Transient microorganisms remain on the skin of the hands for a short time (rarely more than 24 hours). They can be easily removed by regular hand washing or destroyed by using antiseptics. While these microbes remain on the skin, they can be transmitted to patients through contact and contaminate various objects. This circumstance makes the hands of the staff the most important factor transmission of infection.

If the integrity of the skin is compromised, then transient microflora can cause infection(for example, felon or mug). You should be aware that in this case, the use of antiseptics does not make your hands safe from the point of view of transmission of infection. Microorganisms (most often staphylococci and beta-hemolytic streptococci) remain on the skin during the disease until recovery occurs.

Hand washing is one of the most effective hygiene procedures. It is accessible to anyone and prevents the mass spread of infectious disease pathogens. Significantly reduces the risk of intestinal and viral infections.

Hand hygiene with soap has a wide spectrum of protection.

It shows significant preventive results and is on par with vaccination. How to wash your hands correctly modern conditions we will tell you in this article

In a number of situations it is necessary mandatory hand washing hygiene with soap. Among them, the following points stand out:

before working with food (especially carefully before and after cutting meat);
before eating;
after visiting any public places: shops, playgrounds, buses and other transport;
after touching money, the maximum amount of bacteria accumulates on it;
after physical contact with animals or their waste;
after the apartment has been cleaned;
if there is any obvious contamination on the hands;
before and after any medical procedure: wound treatment, dressing, massage;
before putting in dentures or lenses;
after returning home from any walk, even if you did not visit public places, since in any case, you touched the elevator button, railings or front door handle;
after contact with sick people (especially those with infections);
if you sneeze or cough, cover your mouth with your hand. Bacteria will settle on the palm, they must be washed off so as not to infect other people.

It is important! A sick person must practice hand hygiene more diligently and more often to prevent the infection from spreading to others.

There is no specific time period when hand washing is required. In addition to the above cases, hygiene should be done when you consider it necessary(for example: you touched foreign object and are afraid of getting infected).

Hand hygiene algorithm

Experts say that only 5% of the total population washes their hands correctly. A significant portion of residents neglect the rules or do not know them at all.

A procedure performed poorly will not give the desired effect.

The algorithm for proper washing is as follows:

Open the tap to warm water.
Wet your hands and lather them with soap. Wash your palms, hands, and fingers thoroughly. Pay attention to the skin between your fingers and nails. You can also use special nail brushes.
Wash your hands for 20 seconds or longer, then rinse off the soap with plenty of water.
IN in public places turn off the faucet using your elbow (if possible) or a paper towel. At home, use your hand (if you don’t have an elbow faucet), but during the washing process, rinse the faucet handle as well.
Dry your hands with a personal towel.

Attention! Do not forget to regularly wash the tap, mixer and other plumbing fixtures in your apartment with disinfectants.

How to wash children's hands with soap

Through dirty hands a significant number of infections are transmitted. Children love to touch everything around them and then put their fingers in their mouths.

Regular hand washing will be the main prevention of viral and intestinal diseases.

Pediatricians advise using the following algorithm:

roll up the child’s sleeves, remove jewelry from his hands (maybe the child is wearing jewelry);
turn on warm water, lather your palms, fingers, wrists, and the spaces between your fingers;
wash your hands for 20 seconds, then rinse with warm water;
wipe the skin dry.

To involve your baby in a regular procedure You can use some tricks:

Show by personal example how to wash your hands. This will be the most effective method;
let the child will choose get yourself some soap, a soap dish, a bright and cheerful towel;
explain to your child how turn the water on and off correctly, teach him to regulate the temperature;
come up with fabulous properties inherent in soap. For example: it can bestow beauty or make you bold and strong;
Buy and read a fun book about baby hygiene. The book must be written specifically for children.

Useful video: how to wash hands correctly for children

In the video, puppet characters tell how to wash your hands before eating

It is important! If the washing place is inconvenient for the child, then equip it with a small chair so that the child can stand on his own and wash his hands.

Don't use germicidal soap too often, although advertising repeats its benefits. It not only washes away harmful bacteria, but also the entire microflora that protects the body from infections. Use this soap when there are wounds, cracks and other damage on the skin.
If the skin If you are prone to allergic rashes, then buy ordinary toilet soap without additives or strong odors. It is best to use baby soap.
For oily skin use any cosmetic or toilet soap, and when dry– varieties containing lanolin or vegetable oils(they restore the fat layer).
All jewelry should be removed before washing– bracelets and rings. They make the process of cleaning hands and drying difficult. The skin under jewelry is difficult to wash; a significant portion of pathogenic microbes remains on it.
Always use soap or foam. The more foam, the better the skin is cleansed. Rinse soapy hands big amount water.
Use it individual cloth towel and change it, as often as possible.
Hands wash for at least twenty seconds. It is best to wash them in warm water, as hot water dries out the skin.
In public places close the tap with your elbow(if equipped with an elbow mixer) or paper napkin, which was used to wipe hands to avoid contact with the dirty surface of the mixer.

IMPORTANT! Remember to dry your hands thoroughly. Wet skin is a wonderful breeding ground for germs.

Hand hygiene according to WHO

Clean hands of medical personnel guarantee a high degree of safety for both weakened patients and the doctors themselves. The World Health Organization has developed a number of requirements that correspond to high-quality hand hygiene for medical personnel. Professor Didier Pittet, who works at the University of Geneva, Faculty of Medicine, says:

– Cleanliness is the key to safe medical care.

Stands out The five main requirements for hand hygiene according to WHO are:

before contact with the patient;
after the end of physical contact with the patient;
before a crime to any medical procedures;
after contact with any things that the patient might have come into contact with;
after contact with biological secretions: blood, saliva, feces.

There are two particularly dangerous zones: patient area - it includes all objects that the patient touches (bed linen, dishes, clothes) and the area medical institution where the patient lies.

Both the medical staff and the patients themselves must practice increased hand hygiene with soap and water, coming into contact with any things in the ward or hospital.

The patient can catch any other infectious disease, and the doctor's immunity can weaken and succumb to the disease from any infection.

Useful video: hand washing technique according to WHO

Watch video instructions on how to properly wash your hands:

How to wash your hands without soap and water

There are often situations when You need to wash your hands, and there is no water tap or soap nearby. This can happen on the road, in the forest, on the beach, or just in an apartment when the water is turned off without warning.

In these cases, they will help with special cleansers. It is advisable to have some of them at home, in your purse or car.

Cleansing wet wipes– every woman has them. They take up little space (they are convenient to carry in your purse). They will help you quickly remove dirt from your hands. There are wipes with a bactericidal effect, some varieties allow you to remove makeup from your face.
Hand cleaners. They can be packaged in different packaging, with or without dispensers. Cleaners are sold in small and large volumes and come in the form of gel, lotion, cream or foam. They are best stored in the car. They are specially designed to remove dirt from your hands on the road. Cope with technical oil, dust and dirt. Fixed assets: “Rukomoy”, “ABRO”, “EXTREME”, “Clean Hands”.

Cleaning products are sold in automotive stores. Read the label carefully before purchasing. Choose cleaners that are recommended by health authorities.

Disinfectants. These can be any antiseptics, but the alcohol content must be at least 60%. They disinfect well and will help if there are no visible contaminants (dirt or fuel oil) on your hands.

Attention! Alcohol-containing products are powerless if your hands are too dirty. Antiseptics actively fight invisible bacteria.

Useful video

Our hands constantly interact with environment. Every day people touch hundreds of things that may contain pathogenic microbes. Hand washing – important aspect hygiene. It must be observed by both children and adults. Regular hand washing with soap helps prevent all infectious diseases.

In the course of research, scientists have found out where the maximum number of bacteria, including harmful ones, live on the human body. The leaders turned out to be, oddly enough, hair and - quite predictably! - Hands. With proper hand hygiene, the risk of serious diseases entering the body through bacteria is reduced.

Why wash?

It has been established that approximately 840 thousand are hidden in the hands of the average person. various types microorganisms. Most of them are located under the nails, on the sides of the palms, as well as in skin folds - where moisture and heat are retained. And this company is growing all the time. Scientists have calculated that on average, the hands of a person working in an office throughout the day come into contact with 10,000,000 different bacteria that live on door handles, handrails of public transport, packaged products in a supermarket, paper and metal money, etc. Moreover, these bacteria - The creatures are tenacious and can easily migrate from the limbs of one clerk to the palms of his colleague, spreading, among other things, all sorts of infections.

And there is a lot of infection. According to experts from the World Health Organization, dirty palms claim at least several thousand lives every year: people die from dysentery or other infections literally transmitted from hand to hand. So regular washing upper limbs- this is not only a boring event, but also, possibly, saving someone’s life.

How to wash? Step-by-step instruction.

It may seem funny, but physiologists say that many people simply do not know how to wash their hands properly. Meanwhile, there are quite clear instructions in this regard. Check: are you “cleaning your feathers” correctly?

Step #1: Open the water tap.
Step #2: Apply soap (preferably liquid) to your hands and lather them thoroughly.
Step #3: Lather the faucet handle.
Step #4: Wash the faucet handle and remove any foam from your hands.
Step No. 5: repeat the procedure of soaping your hands again, carefully treating your palms from the inside, sides and back.
Step No. 6: treat your nails, trying to “rub” soap suds under them as much as possible.
Step #7: Massage the skin with foam for at least 20-30 seconds.
Step #8: Rinse off the soap thoroughly.
Step #9: Close the tap.
Step #10: Dry your hands with a towel or blow dry them.

Or an option for proper hand washing in the picture:

A few nuances

Washing without soap is useless. Water is not able to destroy microbes, therefore, by rinsing your palms under the tap, you will only get rid of physically visible contaminants.

The more foam the soap produces, the better. Foam is a bubble of air surrounded by films of soap molecules (surfactants), which perform the main function of removing dirt. In other words, soap foam mechanically removes dirt.

WHO statisticians claim that a third of the world's inhabitants wash their hands with soap - the rest, at best, limit themselves to rinsing.

You can use sand and ashes to wash your hands. These substances are a good alternative to soap: their alkaline composition is excellent in fighting bacteria. This washing option is even included in the recommendations of the World Health Organization.

The water should be warm(25-40 °C). In colder liquids, soap will not be as effective against bacteria. And hot “ash-two-o” is not good at all: it dries out and damages the skin, increasing the risk of harmful bacteria penetrating under it.

Be sure to wipe(or dry) your hands dry. According to research results, microbes cling to damp skin much more actively than to dry skin. Therefore, if, after washing your hands, you immediately grasp the door handle, a decent colony of bacteria will instantly settle on it; if the same operation is carried out with a dry hand, then there will be much less bacteria on it.

Don't skimp on washing. Doctors recommend “bathing” your palms no more than once every 2-3 hours. The fact is that in addition to pathogenic bacteria, our hands contain useful microelements that protect our body. If you wash too often, there is a risk of thinning the skin and destroying them. In addition, frequent contact with detergents can cause cracks in the skin, through which infections can enter the body.

Video about proper washing hands:

Hand washing has a beneficial effect on the psyche. According to psychologists, our subconscious perceives this hygienic procedure as cleansing from physical and moral-spiritual dirt. Therefore, regular hand washing helps increase optimism and improve mood.

Target:

mechanical removal of transient microflora;

ensuring cleanliness and hygiene.

Indications:

before and after examination of the patient;

before and after performing various procedures;

before preparing and serving food, before eating;

after visiting the toilet;

after blowing your nose.

The necessary conditions:

elbow tap in the treatment room, dressing room, operating unit and at the nurse's station in the neonatal department, tap with wings at the ward station, in the outpatient reception room, etc., warm water;

bar or liquid soap with a dispenser;

an individual towel, changed at least every 6 hours, disposable napkins or an electric dryer.

PROCESS

Check the integrity of the skin, remove watches and jewelry from your hands.

Open the tap.

Lather your hands and wash the tap handles with soap.

Moisturize your hands and forearms.

Lather your hands generously with soap twice and thoroughly rub them together, starting from the tips of the fingers, then the spaces between the fingers, the back and palm of the hand, and with rotational movements at the base of the thumbs.

Hold your hands so that your hands are above your elbows, without touching the sink.

Rinse off the foam from the soap (if it is bar soap) and place it in a soap dish with bars.

Rinse your hands with warm running water until all soap is removed, allowing the water to flow freely down your hand from the cleanest area.

Close the tap.

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

Throw disposable wipes into a special container and then destroy them.

19. Hand hygiene (level 2)

Target: ensuring infectious safety of patients and staff:

security high level cleanliness and hygiene;

remove decay products and microorganisms from nails, hands and forearms;

temporarily reduce the amount of resident microflora;

briefly delay the development of microorganisms.

Indications: aseptic invasive procedures.

The necessary conditions:

healthy and intact hand skin, nails protruding no more than 1 mm beyond the fingertips, without varnish, no jewelry on the hands;

elbow tap in the treatment room, dressing room, operating unit and at the nurse's station in the neonatal department, warm water, bar or liquid soap with a dispenser;

70% alcohol or alcohol-containing skin antiseptics, approved for use in the Russian Federation in the manner prescribed by law;

disposable wipes, tampons, sterile gloves.

PROCESS

Clean the areas under the nails with a nail cleaner under running water.

Wash wet hands thoroughly with soap and water.

When washing your hands, rub thoroughly and hold in such a way as to avoid contamination from touching the sink, robe and other objects.

Dry your hands with a sterile gauze pad.

Thoroughly treat the skin of your hands for 2-3 minutes with swabs moistened with 70% alcohol or an alcohol-containing skin antiseptic.

Throw the used balls into a container.

Wear sterile gloves.

After finishing work, remove gloves, wash hands and apply softening cream.

Hand treatment. The most important “tool” of a dentist is his hands. Correct and timely hand cleaning is the key to the safety of medical personnel and patients. That's why great importance attached to hand washing, systematic disinfection, hand care, as well as wearing gloves to protect and protect the skin from infections.

Hand treatment was first used to prevent wound infection by the English surgeon J. Lister in 1867. Hand treatment was carried out with a solution of carbolic acid (phenol).

The microflora of the skin of the hands is represented by permanent and temporary (transient) microorganisms. Permanent microorganisms live and multiply on the skin (Staphylococcus epidermidis, etc.), while transient microorganisms (Staphylococcus aureus, Escherechia coli) are the result of contact with the patient. About 80-90% of resident microorganisms are found in the superficial layers of the skin and 10-20% are found in the deep layers of the skin (in the sebaceous and sweat glands and hair follicles). The use of soap during hand washing allows you to remove most transient flora. It is impossible to remove persistent microorganisms from the deep layers of the skin with normal hand washing.

When developing an infection control program in a healthcare facility, clear indications and algorithms for treating the hands of medical staff should be developed, based on the characteristics of the diagnostic and treatment process in the departments, the specifics of the patient population and the characteristic microbial spectrum of the department.

Types of contacts in hospitals, ranked according to the risk of hand contamination, are as follows (in order of increasing risk):

1. Contact with clean, disinfected or sterilized objects.

2. Objects that have not been in contact with patients (food, medications, etc.).

3. Objects with which patients have minimal contact (furniture, etc.).

4. Objects that were in close contact with uninfected patients (bed linen, etc.).

5. Patients who are not a source of infection during procedures characterized by minimal contact (pulse measurement, blood pressure and so on.).

6. Objects that are suspected of being contaminated, especially wet objects.

7. Objects that were in close contact with patients who are sources of infection (bed linen, etc.).

8. Any secretions, excreta or other body fluids of an uninfected patient.

9. Secrets, excreta or other body fluids from known infected patients.

10. Foci of infection.

1. Routine hand washing

Washing moderately soiled hands plain soap and water (antiseptics are not used). The purpose of routine hand washing is to remove dirt and reduce the amount of bacteria on the skin of the hands. Routine hand washing is required before preparing and serving food, before eating, after visiting the toilet, before and after caring for the patient (washing, preparing bed, etc.), in all cases where hands are visibly dirty.

Thorough hand washing with detergent removes up to 99% of transient microflora from the surface of the hands. At the same time, it is very important to follow a certain hand washing technique, since special studies have shown that during formal hand washing, the fingertips and fingertips remain contaminated. internal surfaces. Hand treatment rules:

All jewelry and watches are removed from hands, as they make it difficult to remove microorganisms. Hands are soaped, then rinsed with warm running water and everything is repeated again. It is believed that the first time you soap and rinse with warm water, germs are washed away from the skin of your hands. Under the influence of warm water and self-massage, the pores of the skin open, so when repeated soaping and rinsing, germs are washed away from the opened pores.

Warm water makes the antiseptic or soap work more effectively, 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.

The sequence of movements when processing hands must comply with the European standard EN-1500:

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

2. Right palm rub the back surface of the left hand, change hands.

3. 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.

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

5. 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.

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

7. Each movement is repeated at least 5 times. Hand treatment is carried out for 30 seconds - 1 minute.

For hand washing, it is most preferable to use liquid soap in dispensers with single-use bottles: liquid soap “Nonsid” (Erisan company, Finland), “Vaza-soft” (Lizoform St. Petersburg company). Do not add soap to a partially emptied dispenser bottle due to possible contamination. For example, Dispenso-pac dispensers from Erisan can be considered acceptable for health care facilities, with a sealed dosing pump device that prevents the possible entry of microorganisms and replacement air into the packaging. Pumping device ensures complete emptying of the packaging.
If you use soap in bars, you need to use small fragments so that individual pieces do not remain long time in a humid environment that supports the growth of microorganisms. It is recommended to use soap dishes that allow the soap to dry between individual handwashing episodes. You need to dry your hands with a paper (ideally) towel, which you then use to turn off the tap. With absence paper towels pieces of clean cloth measuring approximately 30 x 30 cm can be used to personal use. After each use, these towels should be disposed of in designated containers to be sent to the laundry. Electric dryers are not effective enough because they dry the skin too slowly.
Personnel should be cautioned against wearing rings or wearing nail polish, as rings and cracked polish make it difficult to remove microorganisms. Manicure (especially manipulations in the nail bed area) can lead to microtraumas that are easily infected. Hand washing facilities should be conveniently located throughout the hospital. In particular, it must be installed directly in the room where diagnostic or penetrating procedures are carried out, as well as in each ward or at the exit from it.

2. Hygienic disinfection (antiseptic) of hands

Designed to interrupt the process of transmission of infection through the hands of institutional staff from patient to patient and from patients to staff and should be carried out in the following cases:

Before performing invasive procedures; before working with particularly susceptible patients; before and after manipulations with wounds and catheters; after contact with the patient’s secretions;

In all cases of probable microbial contamination from inanimate objects;

Before and after working with a patient. Hand treatment rules:

Hand hygiene consists of two stages: mechanical cleaning of hands (see above) and disinfection of hands with a skin antiseptic. After completing the mechanical cleaning stage (twice soaping and rinsing), the antiseptic is applied to the hands in an amount of at least 3 ml. In the case of hygienic disinfection, preparations containing antiseptic detergents are used for washing hands, and hands are also disinfected with alcohols. When using antiseptic soaps and detergents, hands are moistened, after which 3 ml of an alcohol-containing preparation (for example, Isosept, Spitaderm, AHD-2000 Special, Lizanin, Biotenside, Manopronto) is applied to the skin and thoroughly rub into the skin until completely dry (do not wipe your hands). If the hands were not contaminated (for example, there was no contact with the patient), then the first stage is skipped and the antiseptic can be immediately applied. Each movement is repeated at least 5 times. Hand treatment is carried out for 30 seconds - 1 minute. Alcohol formulations are more effective than aqueous solutions of antiseptics, however, in cases of severe contamination of hands, they should first be thoroughly washed with water, liquid or antiseptic soap. Alcohol compositions are particularly preferred in cases where adequate hand washing facilities are not available or where the required time for washing is not available.

To prevent damage to the integrity and elasticity of the skin, skin softening additives (1% glycerin, lanolin) should be included in the antiseptic, if they are not already contained in commercial preparations.

3. Surgical hand disinfection

It is carried out for any surgical interventions accompanied by a violation of the integrity of the patient’s skin, to prevent the introduction of microorganisms into the surgical wound and the occurrence of infectious postoperative complications. 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.

Similar processing hands is carried out:

Before surgical interventions;

Before major invasive procedures (for example, puncture of large vessels).

Hand treatment rules:

1. Unlike the method of mechanical cleaning described above, at the surgical level the forearms are included in the treatment, sterile napkins are used for blotting, and hand washing itself lasts at least 2 minutes. After
After drying, the nail beds and periungual folds are additionally treated with disposable sterile wooden sticks soaked in an antiseptic solution. Brushes are not necessary. If brushes are used, use sterile soft brushes that are disposable or can withstand autoclaving, and should only be used for periungual areas and only for the first brush of a work shift.

2. After completing the mechanical cleaning stage, an antiseptic (Allsept Pro, Spitaderm, Sterillium, Octeniderm, etc.) is applied to the hands in 3 ml portions and, without allowing drying, rubbed into the skin, strictly observing the sequence of movements of the EN-1500 diagram. 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 (table).

Table. Stages surgical disinfection hands

Two types of antiseptics are used to treat hands: water, with the addition of surfactants (surfactants) and alcohol (table).

Table. Antiseptic agents used for hygiene and surgical treatment hands

Alcohol products are more effective. They can be used for quick hand hygiene. The group of alcohol-containing skin antiseptics includes:

0.5% alcohol solution of chlorhexidine in 70% ethyl alcohol;

60% isopropanol solution or 70% ethyl alcohol solution with additives,

Hand skin softeners (for example, 0.5% glycerin);

Manopronto-extra - complex isopropyl alcohols(60%) with hand skin softening additives and lemon scent;

Biotenside - 0.5% solution of chlorhexidine in a complex of alcohols (ethyl and isopropyl, with hand skin softening additives and lemon flavor.

Water-based antiseptics:

4% solution of chlorhexidine bigluconate;

Povidone-iodine (solution containing 0.75% iodine).