• Repair
• Repair
• Interior Design
• About everything
• About plumbing

Hygienic method of hand washing. Rules for the processing of the hands of medical personnel and the skin of patients

HAND TREATMENT- one of the aseptic measures aimed at achieving the 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 substantiated O. p. began to enter into practice from the beginning of the antiseptic era in surgery. Prior to this, cleanliness of hands was not given importance. For the first time, disinfection of hands (chlorine water) was proposed by Holmes (O. W. Holmes, 1843) and I. Semmelweis (1848). J. Lister (1867) promoted O. river. phenol solution as an important part of his antiseptic method. Justified by the discoveries of L. Pasteur (1863) O. p. firmly established in practical surgery.

There are usually many microbes on the skin of the hands, 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. With frequent contamination of the hands and poor care of them, roughening of the skin, the presence of cracks, scratches and abrasions, the infection increases and it is extremely difficult to achieve asepsis of the hands before the operation. Therefore, persons participating in operations must keep their hands clean, avoid contamination of them, especially with pus; with dry skin, hands must be lubricated at night with petroleum jelly or a special cream; nails should be cut short, varnishing them is unacceptable. When doing physical labor, sports, it is advisable to use gloves.

The antiseptic solutions of weak concentration which were applied earlier for O. of river do not have sufficient bactericidal action since the torn away epithelium and a secret of sebaceous glands protect microflora from direct contact with antiseptics. More concentrated solutions cause dermatitis. Therefore at the beginning of an antiseptic era the main attention at O. of river. was given to mechanical cleaning - washing hands with brushes and soap in hot water. However, this mechanical method was not effective enough. Then, after washing, the hands began to be treated with antiseptics, thanks to which it was possible to achieve a relative sterility of the skin surface, but the microbes located in its depths were not subjected to the bactericidal action of disinfectants.

During the operation, they came to the surface of the skin along with sweat and grease. In this regard, the idea arose to use tanning agents in order to compact the surface layers of the skin and for a longer closing of skin pores in order to prevent microbes from reaching the surface.

So three main principles of disinfection of hands were defined: mechanical cleaning, chemical disinfection, skin tanning, on the basis of which various methods of O. were developed. and numerous modifications. Requirements common to all methods were also developed: first of all, the skin of the hands should be treated, especially carefully - the fingers (the area of ​​\u200b\u200bthe joints, nail ridges, spaces under the free edges of the nails), and then the skin of the forearms up to the elbow; applied to O. river. brushes, napkins, tools must be sterile; first, brushes and forearms are treated with a napkin (brush), then with another napkin (brush) - mainly brushes.

Classic Methods

The most famous are the methods of Furbringer, Alfeld and the method of Spasokukotsky-Kochergin.

Furbringer method. After washing warm water with soap (using a brush) for 1 min. hands are rinsed with 80% alcohol (1 min.) and immersed for 1 - 2 minutes. in solution of sublimate (1: 1000).

Alfeld method. Hands are thoroughly washed with soap under running warm water with 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. In various modifications, the washing time was lengthened, it became mandatory to treat the nail folds of the fingers with an alcohol solution of iodine, and a combination of these methods was also proposed.

Spasokukotsky-Kochergin method. A feature of this method is the use of 0.5% ammonia solution for washing hands, 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 min. in everyone. Washed hands are wiped dry with a sterile towel and treated for 5 minutes for the purpose of tanning. ball dipped in alcohol. O. r. found with ammonia wide application in surgical and obstetric-gynecological practice; the method justified itself during the Great Patriotic War as the most simple and reliable. long time it remained the most widespread in our country.

Modern methods

Starting from the middle of the 20th century. many new antiseptic agents for O. were offered. Surfactants turned out to be the most promising, and among them are quaternary ammonium compounds, which have a bacteriostatic and bactericidal effect, as well as wetting and washing properties, ensuring their deep penetration into the skin. When using them, the use of brushes and tanning agents becomes redundant. Thus, the classical 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.

The list of used antiseptics that meet modern requirements is quite extensive and is constantly updated. It includes diocide, novosept, degmicide, oxidizing systems, etc. (USSR); cefiran, rokkal, ammonix T, bio-nal, etc. (USA); cetab, cetavlon (England), etc. Ways of O. river. These antiseptics are simple, do not require much time and special equipment.

Treatment of hands with diocide. Diocide solution (see) at a concentration of 1: 3000-1: 5000 is poured into an enameled basin and treated with a sterile napkin for 2-3 minutes, then dried and for 1-2 minutes. wipe with alcohol.

Treatment of hands with Novosept, degmicide. A solution of novosept (3%) or degmicide (1%) is poured into the pelvis and they rub their hands first with one and then with another foam rubber sponge for 2-3 minutes. Due to the good penetration of the preparations into the depth of the skin, tanning with alcohol is not required.

Wedge, tests of these domestic drugs showed that they have a number of advantages over diocide. The bactericidal activity of finished solutions does not decrease during storage for up to 6 months. "Glove juice" is sterile for 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 occasionally. Store the mixture for no more than a day in a hermetically sealed vessel, in a cool place. For O. river. 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 (tserigel). After preliminary washing of hands with soap and water, 2-3 ml of liquid cerigel is applied to dry skin and within 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 a thin and durable film. To remove the film, hands are washed with 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. river. this solution is diluted in 70% alcohol in a ratio of 1: 40 (it turns out 0.5% alcohol solution). After preliminary washing of hands with soap and water and subsequent drying with a sterile napkin, O. p is produced. cotton swab moistened with gibitan solution for 2-3 minutes.

Hand treatment with ultrasound. The method is based on the use of the combined action of ultrasonic cavitation and a disinfectant (eg, gibitan). After washing under the tap, hands are lowered into a special bath with an antiseptic, an ultrasonic device is turned on; after 60 sec. hands become almost sterile.

Control

According to the order M3 of the USSR O. r. mandatory for all personnel involved in the operation (surgeons, anesthesiologists, resuscitators, operating nurses and anesthetist nurses). Periodically, at least once a week, bacteriol, control of the sterility of the hands of the participants in the operation should be carried out. To obtain swabs with sterile wipes dipped in fiziol. solution, carefully wipe the palms, periungual and interdigital spaces of both hands, then sow on solid and liquid nutrient media. The skin is considered sterile if there is no growth of microorganisms on both solid and liquid media.

Even the most efficient modern ways O. r. do not guarantee absolute sterility. In addition, during the operation, the hands become contaminated with microbes that come to the surface of the skin from the depths of the pores. Therefore, regardless of the applied method, O. p. during the operation, gloves should be used that guarantee sterility (see Medical gloves).

Hand treatment in the field

In the conditions of modern warfare, with the mass admission of victims to the stages of honey. evacuation for O. r. medical staff should use such methods, which take little time, are simple, do not require special equipment and a large amount of water, but at the same time are quite effective in achieving sterility.

When providing first aid, carrying out such manipulations as the imposition of an aseptic dressing, injections of drugs, dressings, O. p. produced according to a simplified method: hands are washed with soap and water, wiped 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. p. 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. of river. (washing under a stream of warm water with soap with a brush or washing with 0.5% ammonia solution).

At the stages of providing qualified and specialized surgical care (in SMEs, OMOs, military field hospitals), it is most expedient to treat the hands with the first rum or according to the methods of Spasokukotsky - Kochergin, Alfeld. The doctor performs the operation in sterile honey. gloves. With an acute shortage of time, O. is most acceptable. pervomyrom, edges provides high efficiency and can be produced 10-12 times faster than with other methods. In addition, this method uses little water.

On the ships use the same ways of O. river, as in military field honey. institutions and departments. Preferred O. r. Pervomour, especially on submarines and a number of ships, where persons who do not have honey are involved in operations. preparation. In the conditions of warships, the value of this method increases, because. working solution pervomura can be prepared using outboard sea water.

At high temperature air, which is often observed in the operational 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, hand sterility control is carried out in the field according to the generally accepted method.

Bibliography: Vishnevsky A. A. and Shraiber M. I. Military field: surgery, M., 1975; Gadzhiev S. A. et al. The use of Pervomur for the treatment of the hands of surgeons, Klin, hir., No. 3, p. 76, 1972; Zhitnyuk ID and Melekhov PA About the accelerated sterilization of surgical materials, processing of hands of the surgeon and the operational field, Voyen.-med. journal, no. 10, p. 75, 1970; Infection in surgery, in the book: 24th Congress. International. about-va hir., under the editorship of. B. V. Petrovsky, vol. 1, p. 21, M., 1972; Kochergin I. G. Preparation of hands of the surgeon and the operational field, M., 1941, bibliogr.; Lytkin M. I. and P about in L. N. To a question of processing of hands of the surgeon, Military. journal, no. 6, p. 22, 1977; Meshalkin E. N. and Milo-vidova M. A. Experience in the use of synthetic agents for the preparation of the hands of surgeons, Khirurgiya, 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 and others, vol. 2, p. 480, M., 1948; Uglov F. G. et al. The use of new antiseptics in the surgical clinic, Khirurgiya, 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; B. A. Katonin (military).

Hand sanitizing is essential for healthcare workers. It can have several levels, and you will learn about each of them from this article.

Hand treatment is carried out different ways depending on the upcoming procedure, as well as the availability of time for the medical staff to provide emergency care or perform planned work.

If urgent intervention is required

The most famous and common way is to treat hands with 96% medical alcohol: it is simply poured onto the skin or wiped with a soaked sterile gauze pad. If there are medical gloves, they are also disinfected with alcohol.

In conditions that do not require urgent intervention, processing is carried out in several stages, which depend on the type of procedure.

From the history

Necessity special processing The hands of health workers were identified as early as the middle of the 19th century, when I.F. Semmelweis drew attention to the fact that almost 30% of patients in the obstetric department die of fever.

He found a connection with the fact that students immediately after the dissection of corpses came to the hospital and worked with patients in the obstetrics and gynecology department, after which a third of the patients died from an unknown infection. Students after work in the morgue simply wiped their hands with handkerchiefs. Semmelweis proposed treatment with a chlorine solution, which reduced the number of deaths by 10 times. But wide recognition for this discovery came to Semmelweis only after his death.

Hand treatment, levels of hand treatment in the past

For some time now, hand treatment methods medical personnel began to be widely discussed. These actions were recognized as mandatory, and they were included in a document called SanPiN. This procedure has evolved from the use of a bleach solution to a modern, accelerated method of applying skin antiseptic solutions, which are accompanied by detailed instructions that are mandatory for any healthcare professional who comes into contact with patients or medical equipment.

Surgical practice requires special care in this aspect. About 40 years ago, a surgeon before an operation had to go through several levels of hand treatment for 25-30 minutes. It all started with a wash running water with soap and a brush, especially carefully it was necessary to clean the periungual areas of the fingers and the interdigital folds. Then there was the stage of washing hands in a sterile basin with sterile water, which was specially distilled for this, after which the third stage followed - the hands were dried with sterile gauze wipes, treated with alcohol, after which the doctor could put on autoclaved sterile gloves.

The same treatment was carried out by nurses who assisted the doctor during the operation. These employees are highly qualified operating nurses and pass the exam for knowledge of septic and antiseptics.

Processing in modern conditions

The levels of treatment of the hands of medical personnel in modern conditions are much less due to the use of much more effective means, which is also of great importance in the prevention of occupational dermatitis in health workers. To prevent dermatitis, a number of measures are proposed to restore the skin after the end of the working day - creams, lotions, balms, baths, etc.

Consider the hygienic level of hand treatment. Its algorithm consists in passing two stages.

The first is the obligatory washing with the use of liquid soap and drying with a disposable napkin.

The second is the use of a skin antiseptic. It is important to wait for the product to dry completely on your hands without wiping.

Cases for mandatory processing

When is the treatment of the hands of a doctor considered mandatory?

• Disinfection is necessary before the examination of each new patient and after his examination.
• Before carrying out any medical manipulation, including contact with the skin or mucous surfaces of a person, as well as using medical instruments or equipment.
• After contact with dressings and secretions of the patient.
• After manipulations with patients with purulent discharge.

Hand treatment levels according to SanPiN

In medical and other medical institutions, special training is provided on the rules for processing hands. Medical workers know the levels of hand treatment by heart, the implementation of prescriptions is brought to automatism, especially where work is carried out with open wounds, operations are performed on the internal organs and joints of patients.

Special rules were developed, enshrined in the leadership of the sanitary epidemiological service. They are mandatory, and a health worker who has not passed the control tests cannot be allowed to perform his duties, and in case of repeated violation of them, he may be deprived of his diploma.

The document "On approval of SanPiN 2.1.3.2630-10" Sanitary and epidemiological requirements for organizations engaged in medical activities "describes in detail the rules in each individual case. They must be studied and observed by each medical worker, all this is carefully monitored.

But no matter how strict the rules are, following them depends only on the conscious desire of the employees themselves to comply with the conditions of asepsis and antisepsis at work. In many ways, the number of complications in patients, sometimes leading even to death, depends on the strict implementation of these rules. A different behavior is completely contrary to the very purpose of the medical service, designed to help people and protect health.

Hand treatment for the prevention of wound infection was first used by the English surgeon J. Lister in 1867. The treatment of the surgeon's hands was carried out by disinfecting them with a solution of carbolic acid (phenol). In addition, Lister used a solution of carbolic acid to irrigate instruments, dressings, and to spray in the air over the surgical field.

Sir Joseph Lister's method (1827-1912) was a triumph of 19th century medicine. In the 21st century, handwashing - this simple method of preventing infections (primarily intestinal ones) - is unfortunately often ignored by both the public and some medical professionals. Meanwhile, Proper and timely processing of hands is the key to the safety of medical staff and patients. .

Hand treatment is divided into three levels:

1. Household level (machining of hands)
2. Hygienic level (treatment of hands using skin antiseptics)
3. Surgical level (a special sequence of manipulations in the treatment of hands, followed by putting on sterile gloves)

1. Machining of hands

The purpose of household level of processing of hands - mechanical removal from the skin of most of the transient microflora (antiseptics are not used).

• after visiting the toilet;
• before eating or before working with food;
• before and after physical contact with the patient;
• with any contamination of the hands.

Required equipment:

1. Liquid dosed neutral soap or individual disposable soap in pieces. It is desirable that the soap does not have a strong odor. Open liquid or bar reusable non-personal soap quickly becomes infected with germs.
2. Napkins measuring 15x15 cm are disposable, clean for getting your hands wet. The use of a towel (even an individual one) is not desirable, because it does not have time to dry out and, moreover, is easily seeded with microbes.

Hand treatment rules:

All jewelry, watches are removed from the hands, as they make it difficult to remove microorganisms. Hands are soaped, then rinsed warm running water and everything repeats from the beginning. It is believed that during the first soaping and rinsing with warm water, microbes are washed off the skin of the hands. Under the influence of warm water and self-massage, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes are washed away from the opened pores.

Warm water makes the hand sanitizer or soap work more effectively, while hot water removes the protective fatty layer from the surface of the hands. In this regard, you should avoid using too hot water for washing your hands.

Hand treatment - the necessary sequence of movements

1. Rub one palm against the other palm in a reciprocating motion.
2. Rub the back surface of the left hand with the right palm, 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 the fingers into a “lock”, rub the palm of the other hand with the back of the bent fingers.
5. Grab the base of the thumb of the left hand between the thumb and forefinger of the right hand, rotational friction. Repeat on the wrist. Change hands.
6. Rub the palm of the left hand with the fingertips in a circular motion. right hand, change hands.

The above manipulations are illustrated on the next page - see EN-1500 diagram. .

It is very important to follow the described handwashing technique, as special studies have shown that routine handwashing certain areas skin (fingertips and their inner surfaces) remain contaminated.

After the last rinse, the hands are wiped dry with a napkin (15x15 cm). The faucets are closed with the same napkin. The napkin is dropped into a container with disinfectant solution for recycling.

In the absence of disposable wipes, it is possible to use pieces of clean cloth, which, after each use, are discarded into special containers and, after disinfection, sent to the laundry. Replacing disposable wipes with electric dryers inappropriate, because with them, there is no rubbing of the skin, which means that there is no removal of detergent residues and desquamation of the epithelium.

2. Hand hygiene

The purpose of hygienic treatment is the destruction of the microflora of the skin with the help of antiseptics (disinfection).

Such hand treatment is carried out:

• before putting on gloves and after removing them;
• before caring for a patient with a weakened immune system or when making rounds in the wards (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 (e.g. blood emergencies).

Required equipment:

1. Napkins size 15x15 cm disposable, clean.
2. 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, etc.)

Hand treatment rules:

Hygienic processing of hands consists of two stages: mechanical cleaning of hands (see above) and disinfection of hands with a skin antiseptic.

After the end of the stage of mechanical cleaning (double soaping and rinsing), the antiseptic is applied to the hands in an amount of at least 3 ml and carefully rubbed into the skin until completely dry(Do not wash your hands.) If the hands were not contaminated (for example, there was no contact with the patient), then the first stage is skipped and an antiseptic can be applied immediately. The sequence of movements when processing hands corresponds to the EN-1500 scheme. Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute.

3. Hand debridement

The goal of the surgical level of hand decontamination is to minimize the risk of violating operational sterility in the event of damage to gloves.

Such 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 or individual disposable soap bars.
2. Napkins size 15x15 cm disposable, sterile.
3. Skin antiseptic.
4. Disposable sterile surgical gloves.

Hand treatment rules:

Hand surgery consists of three stages: mechanical cleaning of hands, disinfection of hands with a skin antiseptic, closing hands with sterile disposable gloves.

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

Brushes are not required. If brushes are still used, sterile, soft, disposable or autoclavable brushes should be used, and brushes should only be used on the periungual area and only for the first brushing of a work shift.

2. After the end of the mechanical cleaning stage, an antiseptic is applied to the hands in portions of 3 ml and, preventing drying, is rubbed into the skin, strictly following the sequence of movements of the EN-1500 scheme. The procedure for applying a skin antiseptic is repeated at least two times, the total consumption of the antiseptic is 10 ml, the total procedure time is 5 minutes.

3. Sterile gloves are put on dry hands only. If the duration of work with gloves is more than 3 hours, the treatment is repeated with a change of gloves.

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

Further in the article Hand treatment

. Three levels of hand treatment: household, hygienic, surgical.

. European Hand Processing Standard, EN-1500: sequence of movements.

. Additional information: skin microflora, prevention of dermatitis.

Hands play a significant role in the transmission of nosocomial pathogens in dentistry. Numerous studies have proven a significant contamination of the hands of medical personnel with microorganisms. In this case, the species composition depends on the characteristics of the work performed.

There are three levels of processing the hands of medical personnel:

normal wash;

hygienic processing of hands;

hand surgery.

Routine hand washing ensures the removal of dirt and transient microflora that gets on the skin of a doctor during contact with a patient or contaminated objects environment. Carried out by thorough hand washing:

before starting work;

before and after physical contact with the patient;

when changing clothes and places of work.

It is necessary to wash twice, because. in this case, the efficiency will be 65 - 70% (with a single dose - 40%). It is better to use liquid soap in disposable dispensers.

When using soap bars, it is necessary to place small bars of soap in special racks with drainage so that the soap dish allows the soap to dry before reuse.

Methodology:

Remove jewelry and watches (because the quality is reduced);

Squeeze out liquid soap from the dispenser with a dry hand or dry soap is taken with a dry hand;

Rub the soap vigorously under running water for at least 30 seconds;

Rinse off soap residue under running water and repeat;

Dry with a disposable paper or individual towel. In medical institutions, it is not recommended to use reusable fabric towels, as well as roll-type towels.

Hand hygiene ensures the removal or destruction of transient (surface) pathogenic or opportunistic microflora in order to prevent its spread through the hands of personnel to surrounding objects and patients served, as well as after manipulations that could lead to contamination of the hands of personnel during examination and treatment of patients. Hygienic disinfection of hands must be carried out by all staff regularly.

Handling includes routine handwashing and the use of disinfectants - skin antiseptics , which, in accordance with the purpose subdivided into groups :

For hygienic treatment of the hands of medical personnel (doctors, nurses, etc.);

For disinfection of the hands of surgeons, operating nurses and other participants in the operation;

For disinfection of the surgical field;

For disinfection of the injection field, etc. (carried out by wiping with a sterile swab moistened with an antiseptic)

To prevent damage to the integrity and elasticity of the skin, skin softening additives should be included in the antiseptic: 1% glycerin, lanolin. Personnel should be warned against wearing rings and using nail polish, as rings and cracked polish make it difficult to remove microorganisms. Manicure can lead to microtrauma that is easily infected.

Skin antiseptics:

Special liquid bactericidal soaps;

Alcohol solutions of skin antiseptics;

Bacterial agents in the form of a gel.

Hygienic treatment of the dentist's hands is carried out before manipulations with gloves (BEFORE and AFTER), after contact with body fluids.

How to use skin antiseptics: 3-5 ml are applied to moistened hands. and rub until dry. If the product is based on alcohols, then the antiseptic is applied to dry hands and rubbed for at least 15 seconds.

Surgical treatment of hands (treatment of the surgeon's hands) provides the most high level purity. It is carried out only with alcohol-containing antiseptics. Processing time is at least 2-5 minutes.

Preparations: AHD-2000, AHD-2000 Special (CJSC Petrospirt, Russia), Dekosept (Bohrer Chemi GmbH, Germany), Lizanin (CJSC Petrospirt, Russia), Sterillium (Bode Chemi GmbH i Co., Germany), etc.

The use of ethyl alcohol to disinfect the hands of a dentist is not advisable, because. its frequent use leads to dryness of the skin of the hands, and in cases of use for disinfection of gloves, it leads to the appearance of microcracks that reduce their barrier function.

Rules for working with gloves:

Gloves are replaced with new ones after each patient's appointment!

Gloves are worn on thoroughly washed hands!

Jewelry and watches must be removed from hands before putting on gloves!

If the doctor uses non-sterile gloves, then after putting them on, gloved hands should be thoroughly washed with soap and treated with an antiseptic solution!

After the gloves are removed, the hands must be thoroughly washed!

Do not touch the mucous membranes of your eyes, nose, mouth, as well as unprotected skin with gloved hands!

Do not leave your workplace with gloves on!

If a glove breaks, take it off immediately, wash your hands thoroughly and put on a new glove!

To maintain the normal condition of the skin of the hands during work, it is recommended:

Wash your hands with water room temperature(about +20°C) before and after taking each patient;

After washing, thoroughly dry the skin of the hands with a dry individual towel (the use of paper towels is recommended);

Do not allow medicinal allergens (antibiotics, novocaine, polymers, components of adhesive systems, etc.) to come into contact with open skin surfaces;

Use neutral grades of soap, for example, "Silk", "Silk with antiseptic";

Treat the skin of the hands before starting work with protective creams, for example

Soften the skin of the hands with nourishing and moisturizing creams, for example

1. General Provisions

1.2. Definition of terms

- Antimicrobial agent- an agent that suppresses the vital activity of microorganisms (disinfectants, antiseptics, sterilants, chemotherapeutic agents, including antibiotics, cleansers, preservatives).

- Antiseptics- chemicals of microbostatic and microbicidal action used for preventive and therapeutic antiseptics of intact and damaged skin and mucous membranes, cavities, wounds.

- Hand sanitizer- an alcohol-based product with or without the addition of other compounds, designed to decontaminate the skin of the hands in order to interrupt the chain of transmission of infection.

- Nosocomial Infection (HAI)- any clinically pronounced disease of an infectious nature that affects the patient as a result of a stay in a hospital or a visit to a medical institution, as well as infections that occur in the personnel of a healthcare institution as a result of their professional activities.

- Hygienic hand antisepsis- this is the treatment of hands by rubbing an antiseptic into the skin of the hands to eliminate transient microorganisms.

- Invasive interventions- the use of devices and devices that overcome the natural barriers of the body, with which the pathogen can penetrate directly into the bloodstream, organs and systems of the patient's body.

- Routine hand washing- the procedure for washing with water and ordinary (without antimicrobial action) soap.

- Irritant contact dermatitis (KD)- discomfort and changes in the condition of the skin, which can manifest itself in dry skin, itching or burning, redness, peeling of the epidermis and the formation of cracks.

- Resident microorganisms- microorganisms that constantly live and multiply on the skin.

- spore-forming bacteria- These are bacteria that have the ability to form special structures covered with a dense shell, they are conditionally called spores, they are highly resistant to the action of many physicochemical factors.

- Transient microorganisms- microorganisms that temporarily enter the surface of human skin upon contact with various living and inanimate objects.

- Surgical hand sanitizer- this is a procedure for rubbing an antimicrobial agent (antiseptic) into the skin of the hands (without the use of water) to eliminate transient microorganisms and reduce the number of resident microorganisms as much as possible.

- Surgical hand washing- this is a hand washing procedure using a special antimicrobial agent to eliminate transient microorganisms and reduce the number of resident microorganisms as much as possible.

1.3. Hand hygiene involves the surgical and hygienic processing of hands, simple washing and protection of the skin of the hands.

1.4. For the hygiene of the hands of medical personnel, antiseptics are used, registered in Ukraine in the prescribed manner.

2. General requirements

2.1. Healthcare staff keep their hands clean. It is recommended that the nails be cut short to fingertip level, without polishing and cracking on the surface of the nails, and without false nails.

2.2. Before processing hands, bracelets, watches, rings are removed.

2.3. Hand hygiene equipment

Tap water.
- Washbasin with cold and hot water and a faucet, which is desirable to operate without the touch of hands.
- Closed containers with taps for water in case of problems with the supply of water.
- Liquid soap with neutral pH.
- Alcoholic antiseptic.
- Antimicrobial detergent.
- Skin care product.
- Non-sterile and sterile disposable towels or wipes.
- Dispensing devices for detergents and disinfectants, skin care products, towels or wipes.
- Containers for used towels and napkins.
- Disposable rubber gloves, non-sterile and sterile.
- Domestic rubber gloves.

2.4. In the room where hand treatment is carried out, the washbasin is located in an easily accessible place, equipped with a tap with cold and hot water and a mixer, which is desirable to be activated without touching the hands, and the water jet should be directed directly into the drain siphon to prevent water splashing.

2.5. It is advisable to install three dispensers near the washbasin:
- with a means for antimicrobial treatment of hands;
- with liquid soap;
- with a skin care product.

2.7. Each handwashing place is equipped, if possible, with dispensers for disposable towels, napkins and a container for used products.

2.9. Do not add the agent to antiseptic dispensers that are not completely empty. All empty containers must be filled aseptically to prevent contamination. It is recommended to use disposable containers.

2.10. Dispensers detergents and skin care products before each new filling, it is recommended to thoroughly wash and disinfect.

2.12. In the absence of a centralized water supply or in the presence of another problem with water, the departments are provided with closed water tanks with taps. Pour into containers boiled water and change it at least once a day. Before the next filling, the containers are thoroughly washed (if necessary, disinfected), rinsed and dried.

3. Hand debridement

Surgical debridement is an important and responsible procedure that is carried out before any surgical intervention in order to prevent infection of the surgical wound of the patient and at the same time protect personnel from infections transmitted through the blood or other secretions of the patient's body. It consists of several stages:
- normal hand washing;
- surgical hand antisepsis, or washing them using a special antimicrobial agent;
- putting on surgical gloves;
- processing of hands after operation;
- skin care.

3.1. Routine hand washing before hand debridement

3.1.1. Routine washing prior to debridement is performed in advance in the ward or lock room of the operating unit, alternatively in the antiseptic hand treatment room, in the preoperative room before the first operation, and then as needed.
Normal washing is intended exclusively for mechanical cleaning of the hands, while dirt, sweat are removed from the hands, spore-forming bacteria are partially washed off, as well as transient microorganisms are partially washed off.

3.1.2. For hand washing, ordinary liquid, powder soap or washing lotion with a neutral pH is used. Priority should be given liquid soap or washing lotion. The use of soap bars is unacceptable.

3.1.4. Given the large number of microorganisms under the nails, mandatory treatment of the subungual zones is recommended. To do this, use special sticks or soft disinfected brushes, preferably disposable.

3.1.5. Hands are washed with warm water. Hot water leads to degreasing and irritation of the skin, as it enhances the penetration of detergents into the epidermis of the skin.

3.1.6. The usual washing technique is as follows:
- hands and forearms are moistened with water, then the detergent is applied so that it covers the entire surface of the hands and forearms. The hands, with the tips of the fingers raised upwards, and the forearms, with the elbows lowered low, should be washed for about one minute. Particular attention should be paid to the treatment of subungual zones, nails, periungual ridges and interdigital zones;

3.2. Surgical hand sanitizer

3.2.1. Surgical hand antiseptics are performed using various alcohol antiseptics by rubbing them into the hands and forearms, including the elbows.

3.2.2. Rubbing the product is carried out in accordance with the developed standard procedure:

If necessary, wash hands with detergent, rinse thoroughly;
- dry your hands thoroughly with a disposable towel;
- using the dispenser (press the lever with your elbow), pour the antiseptic into the deepening of the dry palm;
- first of all, moisten the hands with an antiseptic, then the forearms and elbows;
- rub the antiseptic in separate portions for the time specified by the developer, while holding the hands above the elbows;
- after antiseptic treatment, do not use a towel, wait until the hands are completely dry, put on gloves only on dry hands.

3.2.3. The antiseptic is applied to the hands in portions (1.5 - 3.0 ml), including the elbows and rubbed into the skin for the time specified by the developer. The first portion of the antiseptic is applied only to dry hands.

3.2.4. Throughout the entire time of rubbing the antiseptic, the skin is kept moist from the antiseptic, so the number of servings of the rubbed product and its volume are not strictly regulated.

3.2.5. During the procedure Special attention are given to the standard procedure for the treatment of hands with an antiseptic according to EN 1500.

Each processing step is repeated at least 5 times. When performing the hand treatment technique, the presence of the so-called “critical” areas of the hands that are not sufficiently wetted by the agent is taken into account: thumbs, fingertips, interdigital zones, nails, periungual ridges and subungual zones. The surfaces of the thumb and fingertips are treated most carefully, since they contain the largest number of bacteria.

3.2.6. The last portion of the antiseptic is rubbed until it is completely dry.

3.2.7. Sterile gloves are worn only on dry hands.

3.2.8. After the end of the operation/procedure, the gloves are removed, the hands are treated with an antiseptic for 2 x 30 s, and then with a hand skin care product. If blood or other secretions get on the hands under gloves, these contaminations are first removed with a swab or napkin moistened with an antiseptic, washed with detergent. Then they are thoroughly washed with soap and water and dried with a disposable towel or napkins. After that, the hands are treated with an antiseptic 2 x 30 s.

3.3. Surgical hand washing

Surgical hand washing consists of two phases: phase 1 - normal washing and phase 2 - washing using a special antimicrobial agent.

3.3.1. Phase 1 - normal hand washing - is carried out in accordance with clause 3.1.

3.3.2. Before the beginning of the 2nd phase of surgical washing, the hands, forearms and elbows are moistened with water, except for those products that, according to the developer's instructions, are applied to dry hands, and then water is added.

3.3.3. The antimicrobial detergent in the amounts provided by the developer is applied to the palms and distributed over the surface of the hands, including the elbows.

3.3.4. Hands with fingertips pointing upwards and forearms, with low elbows, are treated with the product for the time specified by the developer of this product.

3.3.5. Throughout the entire time of washing, the hands and forearms are moistened with an antimicrobial detergent, so the amount of the product is not strictly regulated. The hands are kept up all the time.

3.3.6. During washing, follow the sequence of actions in accordance with that specified in p.p. 3.2.2 and 3.2.5.

3.3.7. Hands are dried with a sterile towel or sterile wipes in compliance with the rules of asepsis, starting from the fingertips.

3.3.8. Surgical sterile gloves are worn only on dry hands.

3.3.9. After the operation/procedure, gloves are removed and hands are treated with an antiseptic according to clause 3.2.8.

3.4. If no more than 60 minutes pass between operations, only antiseptic surgical treatment of the hands is performed.

4. Hand hygiene

Hand hygiene includes normal hand washing water with ordinary (non-antimicrobial) soap and hygienic hand sanitizer, i.e. rubbing an alcohol antiseptic, without the use of water, into the skin of the hands in order to reduce the number of microorganisms that are on them.

Requirements for antimicrobial agents and alcohol antiseptics

1. Antimicrobial and antiseptic alcohol-containing rubbing agents must meet the following requirements:
- a wide range of antimicrobial activity in relation to transient ( hygienic treatment hands) and transient and resident microflora (surgical treatment of hands);
- fast action, that is, the duration of the hand treatment procedure should be as short as possible;
- prolonged action (after processing the skin of the hands, the antiseptic should delay the reproduction and reactivation of resident microorganisms for a certain time (3 hours) under medical gloves);
- activity in the presence of organic substrates;
- absence negative impact on the skin;
- the lowest possible dermal resorption;
- absence of toxic, allergenic side effects;
- lack of systemic mutagenic, carcinogenic and teratogenic effects;
- low probability of development of resistance of microorganisms;
- readiness for direct use (do not require advance preparation);
- acceptable consistency and smell;
- easy rinsing from the skin of the hands (for detergent compositions);
- long shelf life.

2. All antimicrobial agents, regardless of the method of their application, must be active against transient bacteria (with the exception of mycobacteria), Candida fungi, and enveloped viruses.

3. Means used in phthisiatric, dermatological, infectious diseases departments should be additionally tested in tests for Mycobacterium terrae (tuberculocidal activity) for use in phthisiatric departments, for Aspergillus niger (fungicidal activity) for use in dermatological departments, for Poliovirus, Adenovirus (virucidal activity) for use in infectious diseases departments if necessary.

The standard procedure during the working day is the antiseptic treatment of hands without the use of water, i.e. rubbing an alcohol antiseptic into the skin of the hands.

4.1. Indications

4.1.1. Routine handwashing using a non-antimicrobial detergent is recommended:
- at the beginning and at the end of the working day;
- before preparing and serving food;
- in all cases, before treatment with an antiseptic, when the hands are clearly contaminated;
- in case of contact with pathogens of enteroviral infections, in the absence of appropriate antiviral agents, it is recommended to mechanically eliminate viruses with prolonged (up to 5 minutes) hand washing;
- in contact with spore microorganisms - prolonged hand washing (at least 2 minutes) to mechanical elimination dispute;
- after using the toilet;
- in all other cases, if there is no risk of infection or special instructions.

4.1.2. Hygiene treatment of hands with the use of alcohol antiseptics is recommended before:
. entrance to aseptic rooms (preoperative, sterilization departments, intensive care units, hemodialysis, etc.);
. performing invasive interventions (installation of catheters, injections, bronchoscopy, endoscopy, etc.);
. activities in which infection of the object is possible (for example, preparing infusions, filling containers with solutions, etc.);
. every direct contact with patients;
. the transition from an infected to an uninfected area of ​​the patient's body;
. contact with sterile material and instruments;
. using gloves.
After:
. contact with contaminated objects, liquids or surfaces (for example, with a urine collection system, contaminated linen, biosubstrates, patient secretions, etc.);
. contact with already introduced drains, catheters or with the place of their introduction;
. every contact with wounds;
. every contact with patients;
. removing gloves;
. toilet use;
. after cleaning the nose (with rhinitis there is a high probability of a viral infection with subsequent isolation of S. aureus).

4.1.3. The statements given are not final. In a number of specific situations, staff takes independent solution. In addition, each healthcare institution can develop its own list of indications, which are included in the nosocomial infection prevention plan, taking into account the specifics of a particular department.

4.2. Regular wash

4.2.1. Normal washing is intended exclusively for mechanical cleaning of the hands, while dirt, sweat are removed from the hands, spore-forming bacteria are partially washed off, and also other transient microorganisms are partially washed off. The procedure is carried out according to p.p. 3.1.2.-3.1.5.

4.2.2. The usual washing technique is as follows:
- moisten the hands with water, then apply the detergent so that it covers the entire surface of the hands and wrists. Hands are washed for about 30 s. Particular attention is paid to the treatment of subungual zones, nails, periungual ridges and interdigital zones;
- after treatment with detergent, hands are thoroughly washed with soap and water and dried with disposable towels or napkins. The last napkin closes the tap with water.

4.3. Hygienic antiseptic

4.3.1. The standard technique for rubbing in an antiseptic includes 6 stages and is presented in paragraph 3.2.5. Each step is repeated at least 5 times.

4.3.2. An antiseptic in an amount of at least 3 ml is poured into the recess of a dry palm and vigorously rubbed into the skin of the hands and wrist for 30 seconds.

4.3.3. During the entire time of rubbing the product, the skin is kept moist from the antiseptic, so the number of servings of the rubbed product is not strictly regulated. The last portion of the antiseptic is rubbed until it is completely dry. Hand wiping is not allowed.

4.3.4. When performing hand treatment, the presence of so-called “critical” areas of the hands that are not sufficiently wetted with an antiseptic are taken into account: thumbs, fingertips, interdigital zones, nails, periungual ridges and subungual zones. The surfaces of the thumb and fingertips are treated most carefully, since they contain the largest number of bacteria.

4.3.5. In the presence of visible contamination of the hands, remove it with a napkin moistened with an antiseptic, and wash hands with detergent. Then they are thoroughly washed with soap and water and dried with a disposable towel or napkins. Close the faucet with the last napkin. After that, the hands are treated with an antiseptic twice for 30 seconds.

5. Use of medical gloves

5.1. The use of gloves does not provide an absolute guarantee of protecting patients and staff from infectious agents.

5.2. The use of medical gloves protects patients and medical personnel from the spread of transient and resident microflora directly through the hands and indirectly through contact with contaminated environmental objects.

5.3. Three types of gloves are recommended for use in medical practice:
- surgical- are used during invasive interventions;
- viewing- provide protection for medical staff when performing many medical procedures;
- household- provide protection for medical staff when processing equipment, contaminated surfaces, instruments, when working with waste from medical institutions, etc.

5.4. Sterile gloves are recommended for:
- in all surgical interventions, to reduce the frequency of punctures, it is recommended to use two gloves put on each other, replace the top glove every 30 minutes. during the operation; it is also recommended to use gloves with a perforation indicator, in which damage to the glove quickly leads to a visible discoloration at the puncture site;
- invasive manipulations (intravenous infusions, biosampling for research, etc.);
- installation of a catheter or conductor through the skin;
- manipulations associated with the contact of sterile instruments with intact mucous membranes (cystoscopy, bladder catheterization);
- vaginal examination;
- bronchoscopy, endoscopy gastrointestinal tract, sanitation of the trachea;
- contact with endotracheal suctions and tracheostomy.

5.5. Non-sterile gloves are recommended for:
- contact with the hoses of artificial respiration apparatuses;
- work with biological material from patients;
- blood sampling;
- carrying out intramuscular, intravenous injections;
- carrying out equipment cleaning and disinfection;
- removal of secrets and vomiting.

5.6. Requirements for medical gloves:
- for operations: latex, neoprene;
- for inspections: latex, tactylone;
- when caring for a patient: latex, polyethylene, polyvinyl chloride;
- use of gloves from fabric under rubber is allowed;
- gloves must be of the appropriate size;
- gloves should provide high tactile sensitivity;
- contain a minimum amount of antigens (latex, latex proteins);
- when choosing medical gloves, it is recommended to take into account possible allergic reactions in the anamnesis of patients to the material from which the gloves are made;
- for pre-sterilization cleaning of sharp medical instruments, it is necessary to use gloves with a textured outer surface.

5.7. Immediately after use, medical gloves are removed and immersed in a disinfectant solution, directly at the point of use of the gloves.

5.8. After disinfection, disposable gloves must be disposed of.

5.9. Rules for the use of medical gloves:
- the use of medical gloves does not create absolute protection and does not preclude compliance with the hand treatment technique, which is used in each individual case immediately after removing the gloves in case of infection;
- disposable gloves are not allowed to be reused, non-sterile gloves are not subject to sterilization;
- gloves should be changed immediately if they are damaged;
- it is not allowed to wash or treat hands with gloves between “clean” and “dirty” manipulations, even for one patient;
- it is not allowed to wear gloves in the department (s) of the hospital;
- Do not use products containing mineral oils, petroleum jelly, lanolin, etc. before putting on gloves, as they can lead to a violation of the strength of the gloves.

5.10. The chemical composition of the glove material can cause immediate and delayed type allergies or contact dermatitis (CD). CD can appear when using gloves made of any material. This is facilitated by: prolonged continuous use of gloves (more than 2 hours), use of gloves powdered inside, use of gloves with existing skin irritation, putting gloves on wet hands, using gloves too often during the working day.

5.11. Mistakes that often occur when using gloves:
- the use of medical disposable gloves when working in the catering department. In these cases, preference should be given to reusable gloves (household);
- improper storage of gloves (in the sun, when low temperatures, contact with gloves of chemicals, etc.);
- putting on gloves on hands moistened with antiseptic residues (additional load on the skin;
- ignoring the need for antiseptic treatment of hands after removing gloves in contact with potentially infectious material;
- the use of surgical gloves for aseptic work, while the use of sterile examination gloves is sufficient for this;
- use of ordinary medical gloves when working with cytostatics (insufficient protection of medical staff;
- insufficient care of the skin of the hands after the use of gloves;
- refusal to wear gloves in situations that at first glance seem safe.

5.12. Reuse of disposable gloves or their disinfection is prohibited. Carrying out hygienic hand antisepsis in disposable gloves is allowed only in situations that require frequent replacement of gloves, for example, when taking blood. In these cases, the gloves must not be punctured or contaminated with blood or other secretions.

5.13. Disinfection of gloves is carried out according to the manufacturer's instructions.

6. Advantages and disadvantages of hand treatment methods

6.1. The effectiveness, practical application and acceptability of hand cleaning depend on the method and associated conditions of hand cleaning that are in place in the health care setting.

6.2. Ordinary washing is ineffective in eliminating both transient and resident microorganisms. At the same time, microorganisms do not die, but with splashes of water they fall on the surface of sinks, clothing of personnel, and surrounding surfaces.

6.3. In the process of washing, secondary contamination of hands with microorganisms from tap water is possible.

6.4. Normal washing has a negative effect on the skin of the hands, since water, especially hot water, and detergent lead to a violation of the surface water-fat layer of the skin, which enhances the penetration of the detergent into the epidermis. Frequent washing with detergent leads to swelling of the skin, damage to the epithelium of the stratum corneum, leaching of fats and natural moisture-containing factors, which can lead to skin irritation and cause KD.

6.5. Hygienic hand antisepsis has several practical advantages compared to washing, which allows it to be recommended for wide practical use.

Advantages of hygienic handrub with alcohol-based hand rubs compared to conventional handwashing

6.6. The errors of hygienic antiseptics include the possible rubbing of an alcohol antiseptic into hands that are wet from the antiseptic, which reduces its effectiveness and skin tolerance.

6.7. Saving antimicrobial agent and reducing exposure time makes any hand sanitizing method ineffective.

7. Possible negative consequences of hand treatment and their prevention

7.1. In case of violation of the requirements of the instructions / guidelines for the use of hand sanitizers and with a careless attitude to preventive skin care, KD may occur.

7.2. The cause of CD can also be:
- frequent use of antimicrobial detergent;
- prolonged use of the same antimicrobial detergent;
- increased sensitivity of the skin to the chemical composition of the funds;
- the presence of skin irritation;
- too frequent normal hand washing, especially with hot water and alkaline or non-softening detergents;
- prolonged work in gloves;
- putting on gloves with wet hands;
- lack of a well-founded skin care system in a medical institution;

7.3. For the prevention of KD, in addition to avoiding the causes of KD according to p.p. 7.1-7.2, it is recommended to fulfill the following basic requirements:
- provide personnel with hand sanitizers that are potentially mild hand skin irritants and yet effective;
- when selecting an antimicrobial agent, take into account its individual acceptability for the skin, smell, consistency, color, ease of use;
- in a medical institution it is recommended to have several means so that employees with increased skin sensitivity have the opportunity to choose a means acceptable to themselves;
- introduce into practice antiseptics made on the basis of alcohol with various emollient additives, since pure alcohols dry the skin of the hands with frequent use;

Properties of an alcohol-based antiseptic

Conduct mandatory periodic briefing on the use of an antimicrobial agent (dose, exposure, processing technique, sequence of actions) and skin care.

8. Hand care

8.1. Hand skin care is an important condition for preventing the transmission of HAI pathogens, because only intact skin can be effectively treated with an antimicrobial agent.

8.2. KD can only be avoided if a skin care system is implemented in the healthcare facility, as there is a potential risk of skin irritation with the use of any antimicrobial agents.

8.3. When choosing a skin care product, the type of skin of the hands and the following properties of the product are taken into account: the ability to maintain the normal state of skin grease, moisture, pH at 5.5, ensuring skin regeneration, good absorption, the ability of the product to give skin elasticity.

8.4. It is recommended to use the type of emulsion that is opposite to the emulsion shell of the skin: emulsions of the O / W (oil / water) type should be used for oily skin, as well as at elevated temperatures and air humidity; for dry skin, it is recommended to use W/O (water/oil) emulsions, especially at low temperature and humidity.

The choice of skin care products depending on its type

8.5. When selecting skin care products, it is important to consider their compatibility with antimicrobial hand sanitizers to prevent creams or lotions from adversely affecting the antimicrobial effect of the product.

8.6. It is advisable to apply a cream or other product on the hands several times during the working day, rub it thoroughly into the skin of dry and clean hands, pay special attention to the treatment of skin areas between the fingers and periungual ridges.