Chemical treatment of hands. Rules for the processing of the hands of medical staff - the most important component of the safety of medical care
Places for sanitizing the hands of medical personnel must be equipped in accordance with the requirements of SanPiN 2.1.3.2630-10. In case of violation of the requirements of the specified SanPiN, the Code of Administrative Offenses provides for a number of penalties. For example, for a person who violates these requirements, a fine from 1,000 rubles to 2,000 rubles, and for a medical organization - from 10,000 rubles to 20,000 rubles, or a temporary suspension of activities. Below we will consider how to organize the process of processing the hands of employees.
Treatment of the hands of medical personnel according to SanPiNu
For quality processing according to SanPin, it is necessary for each room to be equipped with a washbasin connected to the water supply. Required condition- Availability hot water and mixer taps.
In those rooms for which a special operating procedure is provided, it is required to install sinks equipped with a mixer with an elbow drive.
"Proper and timely processing of the hands of medical staff, without a doubt, is a guarantee of the safety of both the employees of medical institutions and patients. There is such a thing as infections associated with the provision of medical care(ISMP). And reducing the risk of their occurrence can be considered one of the priorities in the work of a clinic of any profile. According to the World Health Organization, out of 100 hospitalized patients, at least 7 are infected with HCAI.
HAIs are often associated with the treatment of the hands of the medical staff of the clinic, because they become the source of pathogenic microorganisms for the patient. Now hand washing by medical personnel or their treatment with skin antiseptics are extremely relevant infection control measures. Moreover, it must be understood that pathogens often appear not only on the surface of infected wounds, but also on areas of absolutely healthy skin.
In the Russian Federation, the rules for processing the hands of medical personnel are defined by SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities." Hand treatment is performed depending on the nature of the medical manipulation performed. Among the mandatory requirements are short-cut nails of an employee without a chemical (lacquer) coating, and the absence of jewelry.
There are two types of disinfection of the hands of medical workers: hygienic treatment of hands and treatment of the hands of surgeons. Naturally, in the second case, the processing is more profound. As for hygienic treatment, it is always required - before any contact with the patient. It, in particular, provides for washing hands with soap, as well as treating them with a skin antiseptic. Use for hand washing liquid soap dispensed with a dispenser, but without too hot water. At the same time, alcohol-based skin antiseptics are considered more effective than antiseptics based on alcohol. water based. Before operations, the surgeon's hands are treated in both ways, and washing in water should last at least two minutes.
The third way to protect the hands of medical staff, as well as prevent HAIs, are medical gloves - this is perhaps one of the most “protected” ways of interacting with patients.
In areas equipped for the treatment of the hands of medical personnel, in addition to washbasins, special devices should be provided for the use of liquid soap and antiseptics when washing hands. It is necessary to ensure that they always have facilities for washing and processing hands. In addition, hand care products should also be available nearby. Near the washbasin it is necessary to install a bucket that opens with a foot drive. There should also be paper towels.
Dispensers for applying liquid soap and antiseptics should be installed not only near washbasins, but also in other areas accessible to employees. For example, clause 12.4.6 of Ch. I SanPiN 2.1.3.2630–10 indicates that dispensers can be installed at the entrance to the wards, in corridors and locks of departments, at the beds of intensive care and seriously ill patients, on work and manipulation tables.
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Washing the hands of medical personnel according to SanPiN: how to choose a dispenser
In order to process the hands of medical personnel according to SanPin, clinics have a dispenser - this is a special device for issuing something in a certain amount. These devices should be selected based on needs. For example, the dispenser can be either a mechanical pressure or a wall-mounted one with an elbow drive (with interchangeable pumps) and even a sensor that works without contact. In addition, systems that automatically dispense liquid soap or antiseptic are also considered dispensers.
EXPERT SAYS
Dmitry Gornastolev, chief physician of the network of medical centers "Medscan"
"The global benchmark for patient safety is the JCI standards, specifically the International Patient Safety Goals (IPSG).
In the Russian Federation, the processing of the hands of medical personnel is regulated by SanPin 2.1.3.2630-10. The nature of the medical manipulation performed requires a certain level of reduction of microbial contamination of the skin. Hygienic or surgical treatment of the hands of medical staff is carried out.
Hygienic processing of hands - medical personnel must clean their hands during the working day and when performing medical procedures.
Surgical treatment hands - is carried out in cases where the patient is subjected to manipulations accompanied by damage to the skin (invasive manipulations) or surgical methods of treatment are performed, incl. performing a biopsy under the control of computed tomography. This hand treatment differs from the hygienic one in terms of the time required and the technology of the process. Surgical debridement is more thorough and requires a higher degree of skin disinfection to further reduce patient contamination.
The means for processing, as a rule, are the same. And alcohol-based products are more effective.
Hand hygiene allows, in case of an emergency, to simply treat the hands with an antiseptic and put on sterile gloves. Surgical treatment of hands in routine practice does not allow this. Such processing is permissible only in military field conditions (and in extremely difficult situations, when every second counts).
Surgical treatment of hands begins with the use of soap and has its own characteristics:
- hand treatment begins with the fingertips and ends with the forearm;
- should take at least 5 minutes;
- the back surface of the hands, interdigital spaces, nail bed, palms, wrist and forearm should be treated;
- after processing the hands (from the tips to the forearm), the hands are washed again, but only the wrist part, the forearm is no longer processed again;
- then there is a double treatment with an antiseptic (in the same sequence as when washing with soap);
- after exposure of the antiseptic to the skin, put on sterile gloves and perform medical manipulations.
Proper hand-cleaning by medical personnel significantly reduces the incidence of infectious complications, reduces the consumption of antibiotics and reduces the cost of hospital care."
Before purchasing a dispenser for multiple use, check the manufacturer's data to ensure that the manufacturer specifies how to clean the dispenser. In the event that the dispenser is intended for filling with an alcohol-containing antiseptic, then a permit is required for its use with flammable materials.
The advantage is a dispenser that works without contact and has a set of disposable cartridges. The device must have an accurate indelible marking with the liquid level, as well as an area for the location of the label with the name of the antiseptic used. The instructions for the dispenser should contain information that it can be used with liquids from various manufacturers and that machine cleaning and disinfection of the dispenser can be performed.
Before refilling the dispenser, be sure to clean and disinfect its container. If the dispenser is partially filled, then do not add a new dose of liquid soap or antiseptic.
In order to control the maintenance procedure of dispensers, it is worth keeping a log - a sample is below.
Filonov V.P., Doctor of Medical Sciences, Professor,
Dolgin A.S.,
CJSC "BelAseptika"
According to the World Health Organization (WHO), healthcare-associated infections (HCAIs) are a major patient safety problem, and their prevention should be a priority for healthcare facilities and institutions committed to providing safer healthcare.
Hand hygiene is a first line intervention that has proven effective in preventing HCAI and the spread of antimicrobial resistance.
The history of antiseptics is associated with the names of the Hungarian obstetrician Ignaz Philipp Semmelweis and the English surgeon Joseph Lister, who scientifically substantiated and put antiseptics into practice as a method of treating and preventing the development of suppurative processes, sepsis. So, Semmelweis, on the basis of many years of observation, came to the conclusion that puerperal fever, which gave high mortality, is caused by ptomaine transmitted through the hands of medical staff. He conducted one of the first analytical epidemiological studies in the history of epidemiology and convincingly proved that the decontamination of the hands of medical personnel is the most important procedure to prevent the occurrence of nosocomial infections. Thanks to the introduction of antiseptics into practice in the obstetric hospital where Semmelweis worked, the death rate from nosocomial infections was reduced by 10 times.
Practical experience and a huge number of publications devoted to the issues of processing the hands of medical staff show that this problem, even more than one and a half hundred years after Semmelweis, cannot be considered solved and remains relevant. Currently, according to WHO, up to 80% of HAIs are transmitted through the hands of healthcare workers.
Proper hand hygiene of healthcare workers is the most important, simplest, and least expensive way to reduce the incidence of HCAI, as well as the spread of antibiotic-resistant strains of pathogens, and to prevent the occurrence of infectious diseases in healthcare organizations.
Hand skin treatment includes a number of complementary methods (levels): hand washing, hygienic and surgical hand skin antisepsis, each of which plays a role in preventing infections.
It should be noted that all these methods to some extent affect the microflora of the skin of the hands - resident (permanent) or transient (temporary). Microorganisms of the resident flora are located under the surface cells of the stratum corneum of the epithelium; this is the normal human microflora. Transient microflora enters the skin of the hands as a result of work and contact with infected patients or contaminated objects environment, remains on the skin for up to 24 hours, and its species composition is directly dependent on the profile of the healthcare organization and is associated with the nature of the health worker's activity. Most often, these microorganisms are associated with HAIs, and are represented by pathogenic microorganisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), polydrug-resistant gram-negative bacteria, fungi of the Candida genus, clostridia.
The transient microflora is epidemiologically the most significant. So, if the skin is damaged, in particular during the use of inadequate methods of hand treatment (use of hard brushes, alkaline soap, hot water, excessively unreasonable use of hand washing instead of antiseptics), the transient microflora penetrates deeper into the skin, displaces the permanent microflora from there, disrupting its stability, which in turn leads to the development of dysbacteriosis. In this case, the hands of medical workers become not only a factor in the transmission of opportunistic and pathogenic microorganisms, but also their reservoir. Unlike resident, transient microflora is completely removed during antiseptic treatment.
Recommendations for hand hygiene are set out in the relevant WHO Guidelines. General recommendations for hand hygiene of medical personnel are as follows:
1. Wash your hands with soap and water when they are visibly soiled, stained with blood or other body fluids, or after going to the toilet.
2. If exposure to a potential spore-forming pathogen is high (suspected or proven), including cases of C. difficile outbreaks, handwashing with soap and water is the preferred measure.
3. Use alcohol-based handrub as the preferred routine antiseptic measure in all other clinical situations listed in step 4, unless hands are visibly contaminated. If alcohol-based hand rub is not available, wash your hands with soap and water.
4. Practice hand hygiene:
before and after contact with the patient;
before touching an invasive patient care device, whether or not you are wearing gloves;
after contact with body fluids or secretions, mucous membranes, damaged skin or wound dressings;
if, when examining a patient, you move from a contaminated area of \u200b\u200bthe body to an uncontaminated one;
after contact with objects (including medical equipment) from the immediate environment of the patient;
after removing sterile or non-sterile gloves.
5. Before handling medications or preparing food, perform hand hygiene using an alcohol-based hand rub or wash your hands with plain or antimicrobial soap and water.
6. Soap and alcohol-based hand sanitizer should not be used at the same time.
At the same time, WHO states that the highest frequency of compliance by medical workers with recommended hygiene measures in best case is up to 60%. WHO experts identify the main factors associated with insufficient adherence to hand washing: the status of a doctor (compliance with hand hygiene is less common than that of nursing staff); work in intensive care, work in the surgical department; work in emergency care, work in anesthesiology; working during the week (compared to working on weekends); shortage of staff (surplus of patients); wearing gloves; a large number of indications for hand hygiene within an hour of patient care after contact with objects external environment in the environment of the patient, for example, with equipment; before contact with environmental objects in the environment of the patient, etc.
Speaking about the three levels of hand treatment (hygienic washing, hygienic antiseptic, surgical antiseptic), it should be noted that their goal is not to replace each other, but to complement each other. Thus, hand washing allows mechanical cleaning of organic and inorganic contaminants and only partially removes transient microflora from the skin. At the same time, in healthcare organizations for hygienic handwashing, soaps that will cause the least harm to the skin, while providing the maximum effect, should be used. These are liquid, pH-neutral soaps containing bactericidal and fungicidal components, as well as additives softening and moisturizing the skin. At the same time, it is necessary to pay close attention to the hand treatment technique and its duration, which should be 40-60 seconds, as well as the hand drying procedure. On the one hand, complete and proper drying of the skin of the hands after washing prevents the occurrence of dermatitis during the subsequent use of alcohol-containing antiseptics, and on the other hand, it is an important condition for proper decontamination. Currently carried out in different countries Studies (including those by an accredited laboratory of CJSC "BelAseptika") show that microbiological contamination of the skin of the hands, after going to the toilet, washing hands and using an electric towel, does not decrease, but increases by 50%. Indicators of microbiological contamination of the skin of hands in persons who washed their hands after going to the toilet and used a paper (disposable) towel are reduced by almost 3 times, and in those who additionally apply antiseptic gel up to 10 times.
Therefore, the use of disposable paper towels for drying hands compared to electric towels is much more optimal in epidemiological terms. The additional use of antimicrobial hand gels is the most promising solution. This practice can provide both greater convenience, and protection of the skin of the hands, and the effectiveness of processing.
The procedure for hand antisepsis in our country is currently defined by the Instruction “Hygienic and Surgical Antisepsis of the Skin of the Hands of Medical Personnel”, approved by the Chief State Sanitary Doctor of the Republic of Belarus on September 5, 2001 N 113-0801 and fully complies with the international standard EN-1500.
Hygienic antisepsis of the skin of the hands aims to destroy the transient microflora of the skin.
At the same time, the treatment procedure itself includes applying an antiseptic to the hands in an amount of 3 ml and carefully rubbing it into the palmar, back and interdigital surfaces of the skin of the hands for 30-60 seconds until completely dry, strictly observing the sequence of movements according to European standard processing EN-1500.
For implementation right choice drugs, often difficult due to the abundance of offers on domestic market, it is necessary to consistently take into account their key properties: the presence of a wide spectrum of antimicrobial activity, the absence of an allergic and irritating effect on the skin, registration as a drug, cost-effectiveness. At the same time, the use of alcohol-based antiseptics, the most effective against HCAI pathogens and compatible with the skin, is also recognized by WHO as the “gold standard”. The use of such antiseptics is one of the main key points in the hygiene of the hands of medical workers.
According to the Law of the Republic of Belarus "On medicines ah” antiseptics in our country are classified as medicines, and therefore undergo clinical trials confirming their safety and are produced at enterprises that have implemented and certified the Good Manufacturing Practice (GMP) system at the Ministry of Health. The water used for the production of antiseptic medicines is purified at reverse osmosis plants, and the finished antiseptic itself is microfiltered before bottling, which eliminates the presence of any infectious agents in it. It is this approach to ensuring production quality antiseptics allowed today to reduce the exposure of hygienic antiseptics, in comparison with the previously accepted. At present, some drugs have been confirmed to be effective with a 12 second hygienic antiseptic (Septocid-synergy, Septocid R+).
Along with this, the use of "aqueous" alcohol-free solutions of antiseptics in healthcare organizations is not as effective, convenient and safe. So, components such as triclosan, HOURS can cause allergic reactions. Guanidine film can contribute to the formation of biofilms in cases where the skin of the hands of a health worker is unhealthy, there are signs of dysbacteriosis, violation of the integrity skin presence of infection. In addition, the 5-7 minute "stickiness" of the skin of the hands that occurs after the use of alcohol-free antiseptics also reduces the convenience of their use, especially when using gloves. Alcohol-containing antiseptics, according to WHO recommendations, are the most reliable in this regard. The concentration of alcohols (ethyl, isopropyl) in the range from 60% to 80% allows you to achieve maximum efficiency. In addition, the advantage of antiseptics over the usual 70% alcohol is that they contain special emollients that neutralize the drying effect of alcohols.
Surgical antisepsis of the skin of the hands ensures the destruction of transient microflora and reduces the amount of resident microflora to a subinfectious level and is carried out during medical procedures associated with contact (direct or indirect) with the internal sterile environments of the body (catheterization of central venous vessels, punctures of joints, cavities, surgical interventions, etc.). .d.).
In progress professional activity health care workers, the skin may lose its ability to perform a barrier function - it becomes irritated, dry and cracked. The most common staff reactions are contact dermatitis and allergic reactions. Experts believe that 2/3 of all skin problems occur due to improper skin care, including the application of alcohol-containing antiseptics to wet hands. Regular and intensive skin care using creams, lotions, balms at the workplace, such as for example: Dermagent C, Dermagent P, is a preventive measure against occupational dermatoses.
To ensure the prevention of HCAI in healthcare organizations, it is necessary to carry out targeted work to increase the adherence to hand hygiene among medical staff. Special attention should be paid by the administration of the institution to the effective learning medical personnel using interactive technologies and ensuring the availability of alcohol antiseptics for medical workers at points of medical care.
Administration support and encouragement for good hand hygiene, development of an audit system for the use of alcohol-based hand rubs, and monitoring of hand hygiene compliance may be most effective in promoting adherence to handwashing among healthcare workers. Commitment to hand hygiene of the older generation of medical workers also influences the formation of commitment among young employees, interns and students.
Combining the efforts of medical workers, the administration of healthcare organizations, specialists from hygiene and epidemiology centers, teachers of educational institutions in the step-by-step implementation and formation of a sustainable hand washing practice, as well as their own example, will allow instilling a simple and effective practice of hand hygiene into everyday activities in the provision of medical care in real and future generations of health workers, thereby ensuring the stable safety of medical care.
Hand sanitizing of staff is mandatory. For the treatment of hands in a dental clinic, various preparations are used that are approved by the Pharmacological Committee of the Ministry of Health of the Russian Federation, which do not require long time costs. Hand disinfection is one of the effective measures to prevent nosocomial infection and to protect not only medical staff, but also patients. Distinguish between hygienic and surgical disinfection. Hygienic hand disinfection aims to neutralize microbes that are on the skin after contact with an infected object or that are part of the skin's natural flora.
Hygienic hand disinfection necessary in the following cases: before and after contact with a patient who is to undergo surgery, after contact with blood, saliva. Such disinfection is carried out before putting on sterile gloves. For this purpose, rubbing the skin with an alcohol-containing antiseptic or washing with antiseptic soap is used.
aim surgical hand disinfection is the removal of transient flora and resistant flora from the hands to prevent transmission of infection through the hands. Surgical disinfection is also carried out in two ways: wiping and washing. Alcoholic solutions are the most convenient and effective, as they have a fast action, a wide range of effects on microorganisms, are well perceived by the skin, and have a duration of action.
The sequence of actions for surgical hand disinfection with alcohol skin antiseptics is shown in the figure.
Hand treatment with alcohol-based skin antiseptic
Rub the antiseptic for hygienic processing of hands! Wash your hands only if visible contamination is present!
Hand washing technique with soap and water
Wash your hands only if visible contamination is present! In all other cases, rub the antiseptic!
Hands are washed in warm running water (hands and forearms) with soap for 2 minutes, then wiped with a sterile gauze or towel.
The disinfectant is applied to the palms and rubbing palm on palm disinfects the palmar surfaces.
The right palm with rubbing movements disinfects the back of the left hand, and the left hand - the back of the right hand. The fingers are intertwined.
Palm on palm with crossed fingers wide apart.
Interlace your fingers in a castle.
Alternate rubbing of the thumbs with the clenched palms of the opposite hand.
Alternate rubbing of the palms with the fingers of the opposite palm.
Forearm processing.
Processing time - 2-3 minutes, Special attention give nails and subungual areas.
The movements of each stage are repeated five times, constantly making sure that the hands remain wet during the entire treatment. If necessary, use a new portion of the disinfectant solution. Currently, an alcohol solution of 0.5% chlorhexidine bigluconate in 70% ethyl alcohol, Octeniderm, Octeniman, Octenisept, Veltosept, AHD 2000 special, Dekosept plus, 60% isopropanol, 70% is used for hand treatment. ethanol with skin softening additives, etc.
The presence of rings and watches is unacceptable, sterile brushes are used only for nails and are used only once at the beginning of the working day.
Putting on and removing sterile gloves is also carried out in a certain sequence:
Treatment of the surgical field or injection site. To treat the skin or mucous membrane of the surgical field, iodonate, iodopyrone, chlorhexidine bigluconate are used. It is forbidden to use tincture of iodine, as it causes a burn.
"Practical guide in surgical dentistry"
A.V. Vyazmitina
Social Hand Treatment Standard
Target: removal of dirt and transient flora from the contaminating skin of the hands of medical personnel as a result of contact with patients or environmental objects; ensuring the infectious safety of the patient and staff.
Indications: before distributing food, feeding the patient; after visiting the toilet; before and after patient care, unless the hands are contaminated with the patient's bodily fluids.
cook: liquid soap in disposable dispensers; clock with a second hand, paper towels.
Action algorithm:
1. Remove rings, rings, watches and other jewelry from your fingers, check the integrity of the skin of your hands.
2. Wrap the sleeves of the robe on 2/3 of the forearm.
3. Open the faucet with a paper towel and adjust the water temperature (35°-40°C), thereby preventing hand contact with microorganisms located on the faucet.
4.
Wash your hands with soap and running water up to 2/3 of the forearm for 30 seconds, paying attention to the phalanges, interdigital spaces of the hands, then wash the back and palm of each hand and rotate the base of the thumbs (this time is enough to decontaminate the hands on a social level if the surface of the skin of the hands is lathered thoroughly and dirty areas of the skin of the hands are not left).
5. Rinse your hands under running water to remove soap scum (hold your hands with your fingers up so that the water runs into the sink from your elbows, without touching the sink. The phalanges of your fingers should remain the cleanest).
6. Close the elbow valve by moving your elbow.
7. Dry your hands paper towel, if an elbow tap is not available, close the edges with a paper towel.
Standard "Processing of hands at a hygienic level"
Target:
Indications: before and after performing invasive procedures; before putting on and after removing gloves, after contact with body fluids and after possible microbial contamination; before caring for an immunocompromised patient.
cook: liquid soap in dispensers; 70% ethyl alcohol, watch with second hand, warm water, paper towel, safe disposal container (SDF).
Action algorithm:
1. Remove rings, rings, watches and other jewelry from your fingers.
2. Check the integrity of the skin of the hands.
3. Wrap the sleeves of the robe on 2/3 of the forearm.
4. Open the faucet with a paper towel and adjust the water temperature (35°-40°C), thereby preventing hand contact with microorganisms. located on the crane.
5. Under a moderate stream of warm water, lather your hands vigorously until
2/3 forearms and wash your hands in next sequence:
- palm on palm;
Each movement is repeated at least 5 times within 10 seconds.
6. Rinse your hands under running water. warm water until the soap is completely removed, holding the arms so that the wrists and hands are above the level of the elbows (in this position, water flows from the clean area to the dirty one).
7. Turn off the faucet with your right or left elbow.
8. Dry your hands with a paper towel.
If no elbow faucet is available, close the faucet with a paper towel.
Note:
- Without necessary conditions for hygienic washing of hands, you can treat them with an antiseptic;
- apply to dry hands 3-5
ml of antiseptic and rub it on the skin of the hands until dry. Do not dry your hands after handling! It is also important to observe the exposure time - hands must be wet from the antiseptic for at least 15 seconds;
- the principle of surface treatment "from clean to dirty" is observed. Washed hands should not touch foreign objects.
1.3. Standard "Hygienic treatment of hands with antiseptic"
Target: removal or destruction of transient microflora, ensuring the infectious safety of the patient and staff.
Indications: before injection, catheterization. operation
Contraindications: the presence of pustules on the hands and body, cracks and wounds of the skin, skin diseases.
cook; skin antiseptic for the treatment of hands of medical personnel
Action algorithm:
1. Decontaminate hands at a hygienic level (see standard).
2. Dry your hands with a paper towel.
3. Apply 3-5 ml of antiseptic on the palms and rub it into the skin for 30 seconds in the following sequence:
- palm on palm
- right palm on the back of the left hand and vice versa;
- palm to palm, fingers of one hand in the interdigital spaces of the other;
- the back of the fingers of the right hand along the palm of the left hand and vice versa;
- rotational friction of the thumbs;
- with the tips of the fingers of the left hand gathered together about right palm circular motion and vice versa.
4. Ensure that the antiseptic is completely dry on the skin of the hands.
Note: before using a new antiseptic, it is necessary to study the guidelines for it.
1.4. Sterile Gloving Standard
Target: ensuring the infectious safety of the patient and staff.
- gloves reduce the risk of occupational infection when in contact with patients or their secretions;
- gloves reduce the risk of contamination of the hands of personnel with transient pathogens and their subsequent transmission to patients,
- gloves reduce the risk of infection of patients with microbes that are part of the resident flora of the hands of healthcare workers.
Indications: when performing invasive procedures, in contact with any biological fluid, in case of violation of the integrity of the skin, both of the patient and the medical worker, during endoscopic examinations and manipulations; in clinical - diagnostic, bacteriological laboratories when working with material from patients, when performing injections, when caring for a patient.
cook: gloves in sterile packaging, safe disposal container (SDF).
Action algorithm:
1. Decontaminate your hands at a hygienic level, treat your hands with an antiseptic.
2. Take gloves in a sterile package, unfold.
3. Take the right hand glove by the lapel with your left hand so that your fingers do not touch the inner surface of the lapel of the glove.
4. Close the fingers of the right hand and insert them into the glove.
5. Open the fingers of the right hand and pull the glove over them without breaking its lapel.
6. Insert the 2nd, 3rd and 4th fingers of the right hand, already wearing a glove, under the lapel of the left glove so that the 1st finger of the right hand is directed towards the 1st finger on the left glove.
7. Hold the left glove vertically with the 2nd, 3rd and 4th fingers of the right hand.
8. Close the fingers of your left hand and insert them into the glove.
9. Open the fingers of the left hand and pull the glove over them without disturbing its lapel.
10. Straighten the lapel of the left glove by pulling it over the sleeve, then on the right with the help of the 2nd and 3rd fingers, bringing them under the tucked edge of the glove.
Note: If one glove is damaged, you must immediately change both, because you cannot remove one glove without contaminating the other.
1.5. Standard "Removal of gloves"
Action algorithm:
1. With the fingers of your right hand in a glove, make a lapel on the left glove, touching it only outer side.
2. With the fingers of your left hand in a glove, make a lapel on the right glove, touching it only from the outside.
3. Remove the glove from the left hand, turning it inside out.
4. Hold the glove removed from the left hand by the lapel in the right hand.
5.
With your left hand, take the glove on your right hand by the lapel from the inside.
6. Remove the glove from the right hand, turning it inside out.
7. Place both gloves (left inside right) into the KBU.
The composition of the cleaning solution
3. Completely immerse disassembled medical devices in the cleaning solution for 15 minutes, after filling the cavities and channels with the solution, close the lid.
4. Treat each item with a ruff (gauze swab) in the cleaning solution for 0.5 minutes (pass the cleaning solution through the channels).
5.
Place the medical supplies in the tray.
6. Rinse each product under running water for 10 minutes, passing water through the channels, cavities of the products.
7. Carry out a quality control of the pre-sterilization cleaning with an azopyram test. Control is subjected to 1% of simultaneously processed products of the same name per day, but not less than 3-5 units.
8. Prepare the working solution of the azopyram reagent (the working reagent can be used for 2 hours after preparation).
9. Apply the working reagent with a “reagent” pipette to medical devices (on the body, channels and cavities, places of contact with biological fluids).
10. Hold medical devices over cotton or tissue, observing the color of the dripping reagent.
11. Evaluate the result of the azopyram test.
Ear care standard
Target: observance of the patient's personal hygiene, disease prevention, prevention of hearing loss due to sulfur accumulation, instillation of a medicinal substance.
Indications: serious condition of the patient, the presence of sulfur in the ear canal.
Contraindications: inflammatory processes in the auricle, external auditory canal.
Prepare: sterile: tray, pipette, tweezers, beaker, cotton turundas, napkins, gloves, 3% hydrogen peroxide solution, soap solution, containers with disinfectant solutions, KBU.
Action algorithm:
1. Explain the procedure to the patient, get his consent.
3. Prepare a container with soap solutions.
4. Tilt the patient's head in the direction opposite to the treated ear, substitute the tray.
5. Dampen the washcloth in warm soapy water and wipe the auricle, dry with a dry cloth (to remove dirt).
6. Pour into a sterile beaker, preheated in a water bath (T 0 - 36 0 - 37 0 C) 3% hydrogen peroxide solution.
7. Take a cotton turunda with tweezers in your right hand and moisten it with a 3% hydrogen peroxide solution, and with your left hand pull the auricle back and top to align the ear canal and insert the turunda with rotational movements into the external auditory canal to a depth of no more than 1 cm for 2-3 minutes.
8. Insert dry turunda with light rotational movements into the external auditory canal to a depth of not more than 1 cm and leave for 2-3 minutes.
9. Remove the turunda with rotational movements from the external auditory canal - the removal of secretions and sulfur from the auditory canal is ensured.
10. Treat the other ear canal in the same sequence.
11. Remove gloves.
12. Place used gloves, turundas, wipes in KBU, tweezers, beaker in containers with disinfectant solutions.
13. Wash and dry your hands.
Note: when processing the ears, cotton should not be wound on hard objects, injury to the ear canal is possible.
Action algorithm:
1. Explain to the patient the purpose of the procedure, get his consent.
2. Decontaminate hands at a hygienic level, put on gloves.
3. Spread an oilcloth under the patient.
4. Pour warm water into the basin.
5. Expose the patient's upper body.
6. Moisten a napkin, part of a towel or a cloth mitten in warm water, lightly squeeze out excess water.
7. Wipe the patient's skin in the following sequence: face, chin, behind the ears, neck, arms, chest, folds under the mammary glands, armpits.
8. Dry the patient's body in the same sequence with the dry end of the towel and cover with a sheet.
9. Treat the back, live, hips, legs in the same way.
10. Trim your fingernails.
11. Change underwear and bedding (if necessary).
12. Remove gloves.
13. Wash and dry your hands.
Action algorithm:
1. Wash the head of a seriously ill person in bed.
2. Give your head an elevated position, i.e. put a special headrest or roll up a mattress and tuck it under the patient's head, lay an oilcloth on it.
3. Tilt the patient's head back at neck level.
4. Place a basin of warm water on a stool at the head end of the bed at the level of the patient's neck.
5.
Moisten the head of the patient with a jet of water, lather the hair, massage the scalp thoroughly.
6. Wash your hair from the front of your head back with soap or shampoo.
7. Rinse your hair and wring it dry with a towel.
8. Comb your hair with a fine comb daily, short hair should be combed from roots to ends, and long hair is divided into strands and combed slowly from ends to roots, being careful not to pull them out.
9. Put a clean cotton scarf over your head.
10. Lower the headrest, remove all care items, straighten the mattress.
11. Place used care items in a disinfectant solution.
Note:
- a seriously ill patient (in the absence of contraindications) should be washed once a week. The optimal device for this procedure is a special headrest, but the bed must also have a removable backrest, which greatly facilitates this time-consuming procedure;
- women comb their hair daily with a fine comb;
- men's hair is cut short;
- a fine comb dipped in a 6% vinegar solution combs out dandruff and dust well.
Ship delivery standard
Target: providing physiological administration to the patient.
Indication: used for patients on strict bed and bed rest when emptying the intestines and bladder. cook: disinfected vessel, oilcloth, diaper, gloves, diaper, water, toilet paper, disinfectant container, KBU.
Action algorithm:
1. Explain to the patient the purpose and course of the procedure, obtain his consent,
2. Rinse the vessel with warm water, leaving some water in it.
3. Separate the patient with a screen from others, remove or fold the blanket to the waist, place an oilcloth under the patient's pelvis, and a diaper on top.
4. Decontaminate hands at a hygienic level, put on gloves.
5. Help the patient turn on his side, bend his legs slightly at the knees and spread them apart at the hips.
6. Move your left hand from the side under the sacrum, helping the patient raise the pelvis.
7. With your right hand, move the vessel under the patient's buttocks so that his perineum is above the opening of the vessel, while moving the diaper to the lower back.
8. Cover the patient with a blanket or sheet and leave him alone.
9. At the end of the act of defecation, slightly turn the patient to one side, holding the vessel right hand, remove it from under the patient.
10. Wipe the anal area with toilet paper. Place the paper in the vessel. If necessary, wash the patient, dry the perineum.
11. Remove the vessel, oilcloth, diaper and screen. Change the sheet if necessary.
12.
Help the patient to lie down comfortably, cover with a blanket .
13.
Cover the vessel with a diaper or oilcloth and take it to toilet room.
14.
Pour the contents of the vessel into the toilet bowl, rinse it with hot water .
15.
Immerse the vessel in a container with a disinfectant solution, discard gloves in
KBU.
16.
Wash and dry your hands.
Dedicated fluid
9. Record the amount of liquid drunk and injected into the body on the record sheet.
Injected fluid
10. At 6:00 am the next day, the patient submits the registration sheet to the nurse.
The difference between the amount of liquid drunk and the daily amount of the night is the value of the body's water balance.
The nurse must:
- Ensure that the patient can perform a fluid count.
- Ensure that the patient has not taken diuretics for 3 days prior to the study.
- Tell the patient how much fluid should be excreted in the urine normally.
- Explain to the patient percentage water in food products to facilitate accounting of the introduced liquid (not only the water content in food is taken into account, but also the introduced parenteral solutions).
- Solid foods can contain 60 to 80% water.
- Not only urine, but also vomit, feces of the patient are subject to accounting for the amount of excreted fluid.
- The nurse calculates the number of entered and withdrawn nights per day.
The percentage of fluid excretion is determined (80% of the normal amount of fluid excretion).
amount of urine excreted x 100
Removal percentage =
amount of fluid injected
Calculate the water balance accounting using the following formula:
multiply the total amount of urine excreted per day by 0.8 (80%) = the amount of night that should normally be excreted.
Compare the amount of excreted fluid with the amount of calculated fluid in the norm.
- The water balance is considered negative if less liquid is released than calculated.
- The water balance is considered positive if more liquid is allocated than calculated.
- Make entries in the water balance sheet and evaluate it.
Result evaluation:
80% - 5-10% - excretion rate (-10-15% - in the hot season; + 10-15%
- in cold weather;
- positive water balance (>90%) indicates the effectiveness of treatment and convergence of edema (reaction to diuretics or unloading diets);
- negative water balance (10%) indicates an increase in edema or an ineffective dose of diuretics.
I.IX. Punctures.
1.84. Standard "Preparation of the patient and medical instruments for pleural puncture (thoracentesis, thoracentesis)".
Target: diagnostic: study of the nature of the pleural cavity; therapeutic: the introduction of drugs into the cavity.
Indications: traumatic hemothorax, pneumothorax, spontaneous valvular pneumothorax, respiratory diseases (croupous pneumonia, pleurisy, pulmonary empyema, tuberculosis, lung cancer, etc.).
Contraindications: increased bleeding, skin diseases (pyoderma, herpes zoster, chest burns, acute heart failure.
Prepare: sterile: cotton balls, gauze pads, diapers, needles for intravenous and s / c injections, puncture needles 10 cm long and 1 - 1.5 mm in diameter, syringes 5, 10, 20, 50 ml, tweezers, 0, 5% solution of novocaine, 5% alcohol solution of iodine, alcohol 70%, clip; cleol, adhesive plaster, 2 x-rays of the chest, sterile container for pleural fluid, container with disinfectant solution, referral to the laboratory, anaphylactic shock kit, gloves, CBU.
Action algorithm:
2. Seat the patient, stripped to the waist, on a chair facing his back, ask him to lean on the back of the chair with one hand, and put the other (from the side of the pathological process localization) behind his head.
3. Ask the patient to slightly tilt the trunk in the direction opposite to where the doctor will perform the puncture.
4. Pleural puncture is performed only by a doctor, a nurse assists him.
5. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.
6. Treat the intended puncture site with 5% alcohol solution of iodine, then with 70% alcohol solution and again with iodine.
7. Give the doctor a syringe with a 0.5% solution of novocaine for infiltration anesthesia of the intercostal muscles, pleura.
8. A puncture is made in the VII-VII intercostal space along the upper edge of the underlying rib, since the neurovascular bundle passes along the lower edge of the rib and intercostal vessels can be damaged.
9. The doctor inserts a puncture needle into the pleural cavity and pumps out the contents into a syringe.
10. Substitute a container for the extracted liquid.
11. Release the contents of the syringe into a sterile jar (test tube) for laboratory testing.
12. Give the doctor a syringe with the collected antibiotic for injection into the pleural cavity.
13. After removing the needle, treat the puncture site with a 5% alcohol solution of iodine.
14. Apply a sterile napkin to the puncture site, fix with adhesive plaster or glue.
15. Perform a tight bandage of the chest with sheets to slow the exudation of fluid into the pleural cavity and prevent the development of collapse.
16. Remove gloves, wash and dry hands.
17. Used disposable syringes, gloves, cotton balls, wipes, put in the KBU, puncture needle in a container with disinfectant.
18. Monitor the patient's well-being, the state of the bandage, count his pulse, measure blood pressure.
19. Escort the patient to the room on a stretcher, lying on his stomach.
20. Warn the patient about the need to stay in bed for 2 hours after the manipulation.
21. Send the received biological material for analysis to the laboratory with a referral.
Note:
When removing more than 1 liter of fluid from the pleural cavity at once, there is a high risk of collapse;
Delivery of pleural fluid to the laboratory should be carried out without delay in order to avoid the destruction of enzymes and cellular elements;
When the needle enters the pleural cavity, there is a feeling of "failure" into the free space.
1.85. Standard "Preparation of the patient and medical instruments for abdominal puncture (laparocentesis)".
Target: diagnostic: laboratory study of ascitic fluid.
Therapeutic: removal of accumulated fluid from the abdominal cavity with ascites.
Indications: ascites, with malignant neoplasms of the abdominal cavity, chronic hepatitis and cirrhosis of the liver, chronic cardiovascular insufficiency.
Contraindications: severe hypotension, adhesive process in the abdominal cavity, severe flatulence.
Prepare: sterile: cotton balls, gloves, trocar, scalpel, syringes 5, 10, 20 ml, wipes, jar with a lid; 0.5% solution of novocaine, 5% iodine solution, 70% alcohol, container for extracted liquid, basin, test tubes; a wide towel or sheet, adhesive plaster, a kit for helping with anaphylactic shock, a container with a disinfectant solution, a referral for research, dressings, tweezers, CBU.
Action algorithm:
1. Inform the patient about the upcoming study and obtain his consent.
2. On the morning of the examination, give the patient a cleansing enema until the effect of "clean water".
3. Immediately before the manipulation, ask the patient to empty the bladder.
4. Ask the patient to sit on a chair, leaning on its back. Cover the patient's legs with oilcloth.
5. Decontaminate your hands hygienically, treat them with a skin antiseptic, put on gloves.
6. Give the doctor a 5% alcohol solution of iodine, then a 70% alcohol solution to treat the skin between the navel and pubis.
7. Give the doctor a syringe with a 0.5% solution of novocaine for layer-by-layer infiltration anesthesia of soft tissues. A puncture during laparocentesis is made along the midline of the anterior abdominal wall at an equal distance between the navel and the pubis, retreating 2-3 cm to the side.
8. The doctor cuts the skin with a scalpel, pushes the trocar through the thickness of the abdominal wall with drilling movements with his right hand, then removes the stylet and ascitic fluid begins to flow through the cannula under pressure.
9. Place a container (basin or bucket) in front of the patient for fluid flowing from the abdominal cavity.
10. Type in a sterile jar 20 - 50 ml of liquid for laboratory testing (bacteriological and cytological).
11. Place a sterile sheet or wide towel under the patient's lower abdomen, the ends of which should be held by a nurse. Tighten the abdomen with a sheet or towel covering it above or below the puncture site.
12. With a wide towel or sheet, periodically tighten the patient's anterior abdominal wall as fluid is removed.
13. After the end of the procedure, the cannula should be removed, the wound should be sutured with a skin suture and treated with a 5% iodine solution, and an aseptic dressing should be applied.
14. Remove gloves, wash and dry hands.
15. Put the used tools in a disinfectant solution, put gloves, cotton balls, syringes in the KBU.
16. Determine the patient's pulse, measure blood pressure.
17. Transport the patient to the room on a stretcher.
18. Warn the patient to stay in bed for 2 hours after the manipulation (to avoid hemodynamic disorders).
19. Send the received biological material for analysis to the laboratory.
Note:
When carrying out the manipulation, strictly observe the rules of asepsis;
With the rapid withdrawal of fluid, collapse and fainting may develop due to a drop in intra-abdominal and intrathoracic pressure and a redistribution of circulating blood.
1.86. Standard "Preparation of the patient and medical instruments for spinal puncture (lumbar)".
Target: diagnostic (for the study of cerebrospinal fluid) and therapeutic (for the introduction of antibiotics, etc.).
Indications: meningitis.
cook: sterile: syringes with needles (5 ml, 10 ml, 20 ml), puncture needle with mandrel, tweezers, wipes and cotton balls, tray, nutrient medium, test tubes, gloves; manometric tube, 70% alcohol, 5% alcohol solution of iodine, 0.5% novocaine solution, adhesive plaster, KBU.
Action algorithm:
1. Inform the patient about the upcoming procedure and obtain consent.
2. The puncture is performed by a doctor under conditions of strict observance of the rules of asepsis.
3. Escort the patient to the treatment room.
4. Lay the patient on the right side closer to the edge of the couch without a pillow, tilt the head forward to the chest, bend the legs as much as possible at the knees and pull them to the stomach (the back should arch in an arc).
5. Slip through left hand under the patient's side, hold the patient's legs with your right hand to fix the position given to the back. During the puncture, another assistant fixes the patient's head.
6. A puncture is made between the III and IV lumbar vertebrae.
8. Treat the skin at the puncture site with 5% iodine solution, then with 70% alcohol solution.
9. Draw a 0.5% solution of novocaine into the syringe and give it to the doctor for infiltration anesthesia of soft tissues, and then a puncture needle with a mandrel on the tray.
10. Collect 10 ml of cerebrospinal fluid in a test tube, write a referral and send to the clinical laboratory.
11. Collect 2-5 ml of cerebrospinal fluid in a culture tube for bacteriological examination. Write a referral and send the biological material to the bacteriological laboratory.
12. Give the doctor a manometric tube to determine the CSF pressure.
13. After removing the puncture needle, treat the puncture site with a 5% alcohol solution of iodine.
14. Apply a sterile napkin to the puncture site, seal with adhesive tape.
15. Lay the patient on his stomach and take him on a stretcher to the ward.
16. Lay the patient on the bed without a pillow in the prone position for 2 hours.
17. Monitor the patient's condition during the day.
18. Remove gloves.
19. Place syringes, cotton balls, gloves in the KBU, place the used tools in a disinfectant solution.
20. Wash and dry.
1.87. Standard "Preparation of the patient and medical instruments for sterile puncture".
Target: diagnostic: bone marrow examination to establish or confirm the diagnosis of blood diseases.
Indications: diseases of the hematopoietic system.
Contraindications: myocardial infarction, asthma attacks, extensive burns, skin diseases, thrombocytopenia.
cook: sterile: tray, syringes 10 - 20 ml, Kassirsky's puncture needle, glass slides 8 - 10 pieces, cotton and gauze balls, forceps, tweezers, gloves, 70% alcohol, 5% alcohol solution of iodine; adhesive plaster, sterile dressing material, KBU.
Action algorithm:
1. Inform the patient about the upcoming study and obtain his consent.
2. Sternal puncture is performed by a doctor in a treatment room.
3. The sternum is punctured at the level of the III-IV intercostal space.
4. The nurse assists the doctor during the manipulation.
5. Invite the patient to the treatment room.
6. Have the patient undress to the waist. Help him lie down on the couch, on his back without a pillow.
7. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.
8. Treat the anterior surface of the patient's chest, from the collarbone to the gastric region, with a sterile cotton ball moistened with 5% iodine solution, and then 2 times with 70% alcohol.
9. Perform layer-by-layer infiltration anesthesia of soft tissues with 2% novocaine solution up to 2 ml in the center of the sternum at the level of III-IV intercostal spaces.
10. Give the doctor a puncture needle of Kassirsky, setting the shield-limiter on 13 - 15 mm of the tip of the needle, then a sterile syringe.
11. The doctor pierces the outer plate of the sternum. The hand feels the failure of the needle, taking out the mandrin, a 20.0 ml syringe is attached to the needle and 0.5 - 1 ml of bone marrow is sucked into it, which is poured onto a glass slide.
12. Dry the slides.
13. After removing the needle, treat the puncture site with 5% alcohol solution of iodine or 70% alcohol solution and apply a sterile bandage, fix with adhesive tape.
14. Remove gloves.
15. Dispose of used gloves, syringes and cotton balls in the KBU.
16. Wash your hands with soap and dry.
17. Escort the patient to the room.
18. Send the slides with a referral to the laboratory after the material has dried.
Note: Kassirsky's needle is a short thick-walled needle with a mandrel and a shield that protects against too deep penetration needles.
1.88. Standard "Preparation of the patient and medical instruments for joint puncture".
Target: diagnostic: determination of the nature of the contents of the joint; therapeutic: removal of effusion, washing of the joint cavity, introduction of medicinal substances into the joint.
Indications: diseases of the joints, intra-articular fractures, hemoarthritis.
Contraindications: purulent inflammation of the skin at the puncture site.
Prepare: sterile: puncture needle 7-10 cm long, syringes 10, 20 ml, tweezers, gauze swabs; aseptic dressing, napkins, gloves, tray, 5% alcohol solution of iodine, 70% alcohol solution, 0.5% novocaine solution, test tubes, KBU.
Action algorithm:
1. The puncture is performed by a doctor in the treatment room in strict compliance with the rules of asepsis.
2. Inform the patient about the upcoming study and obtain his consent.
3. Decontaminate your hands at a hygienic level, treat them with a skin antiseptic, put on gloves.
4. Ask the patient to sit comfortably in a chair or take a comfortable position.
5. Give the doctor a 5% alcohol solution of iodine, then a solution of 70% alcohol to treat the proposed puncture site, a syringe with a 0.5% solution of novocaine for infiltration anesthesia.
6. The doctor with his left hand covers the joint at the puncture site and squeezes the effusion to the puncture site.
7. The needle is inserted into the joint and the effusion is collected with a syringe.
8. Pour the first portion of the contents from the syringe into the test tube without touching the walls of the laboratory test tube.
9. After the puncture, antibiotics and steroid hormones are injected into the joint cavity.
10. After removing the needle, lubricate the puncture site with a 5% alcohol solution of iodine and apply an aseptic dressing.
11. Place the used syringes, wipes, gloves, gauze swabs in the CBU, the puncture needle in the disinfectant.
12. Remove gloves, wash and dry hands.
I.XII. "Preparation of the patient for laboratory and instrumental methods of research."
Standard "Preparing the patient for fibrogastroduodenoscopy"
Target: provide high-quality preparation for the study; visual examination of the mucous membrane of the esophagus, stomach and duodenum
Prepare: sterile gastroscope, towel; research direction.
EGD is performed by a doctor, a nurse assists.
Action algorithm:
1. Explain to the patient the purpose and course of the upcoming study and obtain his consent.
2. Swipe psychological preparation patient.
3. Inform the patient that the study is carried out in the morning on an empty stomach. Exclude food, water, medications; don't smoke, don't brush your teeth.
4. Provide the patient with a light dinner the night before no later than 18 hours, after dinner the patient should not eat or drink.
5.
Make sure that the patient removes removable dentures before the examination.
6. Warn the patient that during the endoscopy he should not speak and swallow saliva (the patient spits saliva into a towel or napkin).
7. Escort the patient to the endoscopy room with a towel, medical history, referral to the appointed time.
8. Accompany the patient to the ward after the examination and ask him not to eat for 1-1.5 hours until the act of swallowing is fully restored; no smoking.
Note:
-
remedication s / c is not carried out, because. changes the state of the organ under study;
- when taking material for a biopsy - food is served to the patient only in a cold form.
Standard "Preparing the patient for colonoscopy"
Colonoscopy - This is an instrumental method for examining high-lying sections of the large intestine using a flexible endoscope probe.
Diagnostic value of the method: Colonoscopy allows direct
Hand hygiene of medical personnel includes hygiene treatment hands and treatment of the hands of surgeons (as well as other specialists involved in surgical interventions).
Hygiene treatment hands provides two ways:
- washing hands with soap and water (hygienic handwashing) to remove contaminants and reduce microbial counts;
- cleaning hands with an alcohol-based skin antiseptic (hand sanitizer) to reduce the number of microorganisms to a safe level.
To achieve effective washing and disinfection of hands, the following conditions must be observed: short-cut nails, no artificial nails, no varnish, no rings, rings and other jewelry on the hands.
Liquid soap is used to wash hands using a dispenser (dispenser). Wipe hands with an individual single-use towel (napkin).
Alcohol-containing and other approved skin antiseptics are used to disinfect hands. Antiseptics are used, including gels in individual packaging (small vials), which are disposed of after use.
Medical personnel must be provided, c. sufficient, effective means for washing and disinfecting hands, as well as hand skin care products (creams, lotions, balms) to reduce the risk of contact dermatitis. When choosing skin antiseptics, detergents, individual tolerance should be taken into account.
hygienicprocessing hands with a skin antiseptic should be carried out in the following cases:
- before and after direct contact with the patient;
- before putting on gloves and after removing gloves used for medical procedures, contact with body secrets or excretions, mucous membranes, dressings;
- after contact with the patient's intact skin (for example, when measuring the pulse or blood pressure, shifting the patient, etc.);
- when performing various manipulations to care for the patient;
- after contact with medical equipment and other objects in the immediate vicinity of the patient;
- after treatment of patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment.
In case of obvious contamination of the skin of the hands with secretions, blood, etc., it is necessary to wash the hands with soap and water, dry thoroughly with a disposable towel, treat twice with an antiseptic.
Hygienic treatment of hands with a skin antiseptic (without their preliminary washing) is carried out by rubbing it into the skin of the hands in the amount recommended by the instructions for use, paying special attention to the treatment of the fingertips, the skin around the nails, between the fingers. An indispensable condition for effe To effective disinfection of hands is to maintain them in wet condition within the recommended processing time (exposure time disinfectants T wa ).
When using the dispenser, a new portion of the antiseptic is poured into it after it has been disinfected and rinsed with water.
Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In subdivisions with a high intensity of patient care and with a high workload on staff (RNM, ICU departments), dispensers with skin antiseptic should be placed in places convenient for use by staff (at the entrance to the ward, at the bedside of the patient, etc.). healthcare workers with individual dispensers of small volumes (up to 200 ml) with a skin antiseptic.
Gloves must be worn in all cases where contact with blood and other biological substrates, potentially or obviously contaminated microorganisms, mucous membranes, and damaged skin is possible.
When gloves are contaminated with secretions, blood, etc. in order to avoid contamination of hands in the process of removing them, remove visible contamination with a swab (napkin) moistened with a solution of disinfectant or antiseptic. Remove gloves, immerse them in the product solution, then discard. Treat hands with an antiseptic.
In case of injections, cuts - with violation of the integrity of gloves and contamination of hands with blood, secretions, etc.: wash hands without removing gloves with soap and water; discard the gloves to waste "B", squeeze out the blood, wash your hands with soap and treat the wound 5%: alcohol tincture iodine, seal the damaged areas with adhesive tape.
Do not use the same pair of gloves for contact (for care) with two or more patients A mi, when moving from one patient to another, or from contaminated microorganisms uchas T ka body To clean.
After removing gloves, hand hygiene is carried out.
