The question of the need for hand hygiene by medical personnel was first raised only in the middle of the 19th century. At that time, due to unsanitary conditions in Europe, almost 30% of women in childbirth died in hospitals. The main cause of death was the so-called puerperal fever. It often happened that doctors went to women in labor after dissecting corpses. At the same time, they did not treat their hands with anything, but simply wiped them with a handkerchief.
Types of processing
Keeping hands clean is a must for all medical staff. Hygienic treatment of the hands of medical staff can be carried out in two ways:
- remove impurities and reduce germs on hand skin with soap and water;
- use of special alcohol-containing skin antiseptics, which reduce the number of bacteria on the skin to a minimum level.
Only the second way can be called hygienic processing of hands. The first is just hygienic washing. Wash hands with liquid soap dispenserand dry with an individual disposable towel. But disinfection is carried out using skin antiseptics.
According to the rules, medical personnel must always have hand sanitizers available. In addition, they must be provided with creams, balms, and lotions intended for skin care. Indeed, with constant hygienic treatment, the risk of developing contact dermatitis increases. Also, the selection of detergents and antiseptics should be carried out taking into account individual intolerance.
Important conditions
Every hospital employee should know when the medical staff's hands should be hygienically treated. This is necessary in the following situations:
- before and after contact with each patient;
- before and after putting on gloves that are used during medical procedures, contact with excreta or body secrets, dressings, mucous surfaces;
- after contact with intact skin, for example, after measuring blood pressure, pulse, shifting the patient;
- after working with equipment that is located in close proximity to the patient;
- after treatment of patients with various pyoinflammatory processes.
If there is a clear contamination of the skin of the hand with blood or secretions of the patient, then first they must be thoroughly washed with soap and water and dried. After that, they must be treated twice with an antiseptic agent.
Hand washing technique
Don't forget the importance of cleansing the skin, not only in hospitals, but also in other places. Hand processing technique remains the same everywhere. Before proceeding with the procedure, it is necessary to remove all rings, watches and bracelets. Any foreign objects make it difficult to remove pathogens. It is advisable to wash hands with moderately warm water.
To increase the effectiveness of the procedure, you must first moisten your hands and squeeze liquid soap on them. The hand processing algorithm looks like this:
- Lather the soap with intense friction between the palms of your hands.
- Rub one palm against the other in a reciprocating motion.
- Rub the back of the right hand with the left palm and set off.
- Connect the fingers of the right hand and the interdigital spaces of the left, carefully process them.
- It is necessary to go through the inner surface of the fingers.
- Cross fingers apart and rub palms together.
- Close your hands together and run the back of your fingers across your palm.
- To thoroughly rub the thumb in a circular motion, for this its base must be covered with the thumb and forefinger of the other hand.
- The wrist is processed in a similar way.
- Wipe palm with fingertips in a circular motion.
Each movement should be repeated at least 5 times, and the total duration of such a wash should be about a minute.
Rules for medical staff
Each employee of hospitals and clinics shouldknow how to handle the hands of medical staff. SanPiN (the correct washing scheme is given above) establishes the procedure for not only cleaning the skin, but also disinfecting it. He alth workers should also be aware of the following requirements:
- short nails without polish;
- lack of rings, rings and other similar jewelry.
Nail polish can cause unwanted dermatological reactions that can lead to secondary infections. In addition, dark varnish does not allow assessing the degree of cleanliness of the subungual space. This may result in poor processing. Cracked varnish is considered the most dangerous. Indeed, in this case, it becomes more difficult to remove microorganisms from the surface of the hands.
The very performance of a manicure is associated with microtraumas that are easy to infect. This is one of the reasons why medical professionals are not allowed to wear false nails.
Any jewelry or bijouterie can cause the hygienic treatment of medical staff's hands to become less effective. They can also damage gloves and make putting them on difficult.
Nuances for surgeons
Processing the hands of people involved in surgical interventions is carried out according to a slightly modified scheme. So, for example, the washing time for them is extended and is 2 minutes. The further hand processing algorithm is as follows. After mechanical cleaning, it is necessary to dry the skin with a tissue sterile ordisposable paper towel.
In addition to washing, antiseptic treatment is also important. Attention must be paid not only to the hands, but also to the wrists and forearms. During the specified treatment time, the skin should remain moist. You can not wipe your hands, you must wait until the antiseptic is completely dry. Only then can surgeons put on gloves.
Selection of hygiene products
Many now opt for antibacterial soap. But it is important to follow the technique of cleaning the skin. If done right, hand washing with regular soap will be just as effective. In surgical practice, special means for antiseptic treatment of hands are used. The soap contains chlorhexidine gluconate or povidone-iodine. These substances are able to reduce the number of bacteria by 70-80% at the first application and by 99% at the second application. At the same time, when using povidone-iodine, the microflora grows faster than when in contact with chlorhexidine.
In order for medical staff to process their hands hygienically in full compliance with regulatory requirements, it is advisable to equip medical facilities with elbow dispensers. They are controlled without the participation of the hands.
Also in surgical practice, brushes may be used to clean hands, but this is not considered mandatory. They must be either sterile, disposable or autoclavable.
Time gaps
In surgical practice, there are special rules for cleaning the skin. Afternormal thorough washing according to the established protocol, they should be decontaminated.
The hands of the medical staff must be processed without fail. SanPin (the washing scheme remains the same) provides that skin cleaning before surgical procedures can be carried out using the same means as hygienic.
It is important to remember that during the entire period of disinfection of hands, they must remain wet. For the procedure, as a rule, it is necessary to use more than 6 ml of antiseptic. As a result of research, it was found that for the qualitative destruction of bacteria, a five-minute treatment of the skin is sufficient. It has also been confirmed that performing this procedure for three minutes reduces the number of microorganisms to an acceptable level.
Rules for hand sanitizer treatment
After thoroughly washing the skin of the hands, wrists and forearms, it is necessary to dry them. After that, the established standard for the processing of hands for workers in operating units provides for the need to use special disinfectants.
Before this, if necessary, it is necessary to process the nail beds and periungual ridges. For these purposes, sterile disposable wooden sticks are used, which must be additionally moistened with an antiseptic.
Disinfectant is applied 2.5 ml on the hands and forearms. About 10 ml of disinfectant liquid should be spent on one treatment of two hands. Antiseptic neededrub into the skin in the same way as washing hands, observing the correct sequence of movements.
Only after complete absorption / evaporation of the product, you can wear gloves. If the surgical operation lasts more than 3 hours, then the treatment is repeated. After all, pathogens can begin to multiply under gloves again.
Final stage
But this is not all levels of hand processing. It is important to remove gloves after working and wash your hands with soap and water. In this case, it is no longer necessary to use a disinfectant solution. Washing with liquid soap is enough, it is desirable that its pH is neutral.
After cleaning the skin, they must be moisturized. For these purposes, various creams and lotions are used. Their main purpose is to prevent the drying effect of alcohol-containing disinfectants.
It is worth noting separately that hygienic treatment of hands in the absence of visible contamination can be performed without washing. In most cases, it is enough to use antiseptic solutions for 30-60 seconds.
Possible Complications
It is worth noting that the regular use of disinfectants does not have the best effect on the skin of medical workers. There are two main types of reactions experienced by hospital staff. Most often they complain of itching, dryness, irritation, the appearance of cracks with bleeding. These symptoms can be both minor and significantly affect the general condition.workers.
There is also another type of complications - allergic dermatitis. They occur with intolerance to any components of products intended for hand disinfection. Allergic dermatitis can manifest itself in both mild localized and severe generalized forms. In the most advanced cases, they can be combined with respiratory distress syndrome or other manifestations of anaphylaxis.
Prevalence of complications and their prevention
You can understand the significance of the problem if you know that such methods of handwashing result in 25% of nurses presenting with signs of dermatitis, and 85% reported having a history of skin problems.
You can slightly reduce the irritating effect of antiseptics if you add emollients to them. This is one way to reduce the prevalence of contact dermatitis. Also, the risk of their occurrence can be minimized by using moisturizers that are designed for hand skin care after each wash.
To prevent the development of complications, do not wash your hands every time before treating them with an antiseptic. It is also important to ensure that gloves are only put on when the skin is completely dry.
Do not neglect the use of moisturizers. On the market you can find special protective creams designed to prevent the onset of contact dermatitis. However, studies have not been able to confirm their unequivocalefficiency. Many are stopped by the high price of these creams.
