Order 111 Kazakh hand washing algorithm. How to properly wash hands in medicine: modern requirements for hand hygiene of medical personnel

Hand hygiene for medical workers - doctors, nurses and other hospital staff is a mandatory procedure.

During it, special means are used, approved by the Russian Pharmacology Committee.

Hands are always sanitized before and after physical contact with the patient.

Skin cleansing is aimed at preventing hospital-acquired infections and removing germs and other decay products from hands. It protects the patient and the doctors themselves from infections.

Note!
Hand hygiene for medical staff was introduced back in the 19th century by Dr. Lister Joseph.
This was a breakthrough in medicine and the prevention of infectious diseases. Since then, widespread disinfection of the hands of medical personnel has been gradually introduced.

Hand hygiene of medical personnel is aimed at ensuring patient safety, because during examination of a patient or during other physical contact, germs can get on the patient.

His immunity is already weakened by the disease, infection with another disease will have an extremely negative impact on his well-being and will delay his recovery.

Regular disinfection and compliance with hand hygiene requirements for medical personnel will protect doctors and nurses themselves from infectious diseases.

Hand hygiene for ordinary people involves washing under running water with liquid or bar soap. Then the hands are wiped with a cloth towel, or in rare cases with disposable paper napkins. In domestic conditions, such measures will protect against infections.

Doctors and health care workers regularly work with dozens of patients. They not only conduct examinations, but also come into contact with open wounds, perform operations, and deliver babies.

It is necessary to exclude any possibility of infection getting on the patient’s skin (especially in the blood). Therefore, medical hand hygiene includes not only mechanical cleansing, but also treatment with antiseptics even when working with sterile gloves.

Worth noticing! Many people neglect hand hygiene in everyday life. In medical practice, such violations are fraught with serious consequences.

Requirements for the cleanliness of medical hands

Any medical professional is familiar with the hygiene algorithm and situations when treatment is necessary. Requirements are established by SanPiN. They indicate how to wash your hands correctly in medicine, the procedure for cleaning and disinfecting hands, fingers and forearms.

You can view the document “WHO Hand Hygiene Guidelines for Health Care Workers.”

In addition to keeping their hands clean, doctors and other medical staff should not paint their nails with nail polish. On contact, it may cause dermatitis in the patient. Dark and cracked polish is the most dangerous; it does not allow you to assess the degree of cleanliness of your nails.

During the manicure procedure, you can easily get cuts and microtraumas, which is associated with the possibility of infection. Also, doctors are not allowed to wear jewelry.

What are the levels of hand hygiene?

Hygiene and hand antisepsis of medical personnel divided into three main types:

Mechanical or household– it implies cleansing the hands, eliminating microflora of a transient nature. This is an elementary method of cleansing that does not use antiseptics.
Hygienic– disinfection of hands with special preparations (antiseptics). It is used after mechanical cleaning. If there has been no contact with the patient and your hands are not dirty, you can skip household hand treatment and immediately apply a disinfectant to the skin.
Surgical– complete removal of any microflora from the hands of medical staff. The method allows you to maintain sterility in the operating room. Surgical disinfection will ensure patient safety if the doctor or nurses' gloves suddenly break.

Mechanical hand washing

This treatment is considered essential for cleaning the hands of medical personnel. It is used in the following situations:

before physical contact between the doctor and the patient and immediately after it;
the physician must wash his hands after visiting the toilet;
hands are washed thoroughly before eating;
for various contaminants.

As a cleanser neutral soap should be used, without a pronounced odor. The tube must be kept closed at all times.

Open liquid soap and non-individual bar soap cannot be used, as it becomes infected with germs and bacteria.

Cleansing rules

Remove all jewelry from your hands and fingers, wet your hands under warm running water and soap them, following a special algorithm.
Rinse off the soap, lather your hands again and repeat the necessary movements. Repeated cleansing is necessary because initially the germs are washed away from the skin and the pores open. During the next wash, bacteria are removed from them.
Rinse your hands and dry them with a disposable towel. Typically, classic paper towels are used, measuring 15 by 15. Pieces of fabric can be used, but after one use they should be sent to the laundry for disinfection. The use of fabric towels, even individual use, is prohibited. They may not dry out until next time. A damp surface is beneficial for the growth of bacteria and microbes.

After washing, close the tap with a towel or paper napkin without touching it with clean hands.

The used napkin should be thrown into a special waste bin.

For soap, it is better to stick to liquid dosage. You can also use lumps if it is for individual use. Read below on how to properly wash your hands as a nurse.

Attention! When washing, use only warm running water. Hot water washes away the protective layer of fat from the skin.

Hand cleansing algorithm

When washing it is necessary follow the instructions approved by SanPiN. All movements are performed at least five times. Typically machining takes 30 – 60 seconds.

Rub one palm against the other, this is done with progressive movements.
Rub your left hand (back side) with your right hand. Then vice versa.
Spread the fingers of one hand, connect them with the interdigital spaces of the other. Then move your fingers up and down.
“Lock” both hands (join them into a lock), with bent fingers, wash the skin of each hand.
Use a circular motion to wash the base of your thumb and hand. To do this, clasp your left hand and thumb with the thumb and index fingers of your right hand. Do the same with the other hand.
Using the fingertips of your left hand, wash the palm of your right hand in a circular motion.

Note!
The most contaminated areas of the skin of the hands:

subungual space
periungual ridges
fingertips

The most difficult areas of hand skin to wash are:

interdigital spaces
thumb notch

Frequency of hand washing for medical staff depends on the department - hand hygiene is carried out as necessary before and after contact with the patient. In the children's department this can be 8 times per hour, in the intensive care unit - 20 times per hour. On average, nurses should wash their hands 5 to 30 times per shift.

Hygienic treatment

This procedure is intended to remove any microflora from the skin of the hands. With this cleaning Antiseptics must be used.

Hygienic treatment includes mechanical cleansing, then an antiseptic is applied to the skin.

After it has completely dried (naturally only), you can begin to work.

Antiseptic should be applied on clean and dry hands. The minimum amount is 3 milliliters. It is rubbed until completely dry. The movements according to which the antiseptic is applied to the skin are similar to the hand washing algorithm described above.

WHO guidelines on hand hygiene indicate 5 most important points when hand hygiene is required:

Before contact with the patient;
Before the aseptic procedure;
After contact with biological fluids;
After contact with the patient;
After contact with surrounding objects.

Surgical hygiene

Disinfection involves complete removal of any flora from the hands of doctors and other medical personnel. It is carried out before childbirth, operations or punctures. The procedure is also required when preparing the operating table.

The algorithm includes the following stages:

It is necessary to prepare your hands, remove rings, bracelets and other jewelry, roll up the sleeves of your robe to the elbows;
Next, you need to wash your hands (hands, palms and forearms) with antiseptic soap. Nails are treated with a special brush;
Dry your hands with a disposable towel;
Apply an antiseptic alcohol solution to the skin and wait until it dries completely;
Rub the alcohol-based antiseptic into the skin again and wait until it dries;
At the final stage, sterile gloves are put on dry hands.

Antiseptic dosage, features of use, time during which it is valid, depend on the specific drug and are indicated in the instructions.

Surgical hand cleansing differs from hygienic hand cleansing in that mechanical washing lasts at least two minutes. Doctors always treat forearms.

After washing, hands are dried only with disposable towels.

Be sure to treat your nails with sterile sticks soaked in antiseptic. The antiseptic is applied twice, the total consumption is at least 10 milliliters. The application procedure must be strictly followed.

Attention! After applying the antiseptic, do not use a towel. Hands should dry naturally.

Surgical hand hygiene has its contraindications. It should not be used if there are wounds, injuries, cracks, or ulcers on the skin of the hands.. It is prohibited if you have any skin diseases.

Useful video

How to properly wash your hands in medicine, watch this short but very intelligible video:

Disinfectants

As antiseptics, you should use products that recommended by the Ministry of Health. Alcohol-containing preparations should be used. Typically, doctors use a seventy percent solution of ethyl alcohol or a 0.5% solution of Chlorhexidine Bigluconate (it is diluted in 70% ethyl alcohol). You can disinfect your hands with Chemisept, Octinecept, Hikenix, Veltosept, Octinederm, etc.

Tanks with antiseptic and soap must be disposable. This is evidenced by federal clinical recommendations for hand hygiene of medical personnel.

If reusable containers are used, they must be disinfected before refilling.

Important! All containers must have dispensers that squeeze out liquid using the elbow.

Hand hygiene of medical personnel - presentation:

Problems

Allergist Alexey Semenovich Dolgin believes that many problems can be avoided. In almost half of the cases, medical staff do not comply with all WHO recommendations.

“The main mistake is that doctors do not wait until their hands are completely dry after washing. The antiseptic is rubbed into damp skin. And this will definitely lead to irritation.”

Constant hand disinfection inevitably leads to rashes, dermatitis and skin irritation. Most often, allergies are caused by substances that are added to ethyl alcohol: iodine, triclosan, and some ammonium compounds. Experienced surgeons claim that when cleansing with pure ethyl alcohol, allergic reactions were many times less, and the disinfection effect remained high.

Medical personnel are not recommended to wash their hands with very hot water, use alkaline soap or hard brushes to wash nails. If excessive dryness occurs, you should moisturize your skin with protective products (usually before bedtime), and avoid aggressive substances. This will help minimize allergic skin reactions.

Application
to the Ministry of Health of the Russian Federation
and the Federal Compulsory Medical Insurance Fund
dated August 31, 2012 N 111/179

Scroll
expired orders of the Ministry of Health of the Russian Federation and the Federal Compulsory Medical Insurance Fund

1. Order of the Ministry of Health of the Russian Federation and the Federal Compulsory Medical Insurance Fund dated January 10, 1997 N 6/1 “On the appointment of the St. Petersburg Chemical and Pharmaceutical Academy as the parent organization in the direction of research work “Organization of drug provision in the compulsory medical insurance system” and on holding a competition of territorial programs “Organization of drug provision in the compulsory health insurance system”;

2. Order of the Ministry of Health of the Russian Federation and the Federal Compulsory Medical Insurance Fund dated January 19, 1998 N 12/2 “On the organization of work on standardization in healthcare”;

3. Order of the Ministry of Health of the Russian Federation and the Federal Compulsory Medical Insurance Fund dated November 23, 1999 N 421/98 “On measures to implement the Decree of the Government of the Russian Federation dated October 26, 1999 N 1194 “On the State Guarantee Program for providing citizens of the Russian Federation with free medical assistance";

4. Order of the Ministry of Health of the Russian Federation and the Federal Compulsory Medical Insurance Fund dated January 24, 2000 N 23/3 “On measures to implement the Work Program for the creation and development of a standardization system in healthcare”;

5. Order of the Ministry of Health of the Russian Federation and the Federal Compulsory Medical Insurance Fund dated October 6, 2000 N 365/79 “On the procedure for reviewing agreements on the organization of medical care to the population”;

6. Order of the Ministry of Health of the Russian Federation and the Federal Compulsory Medical Insurance Fund dated March 19, 2001 N 79/17 “On agreements between the Ministry of Health of the Russian Federation, the Federal Compulsory Medical Insurance Fund and the executive authorities of the constituent entities of the Russian Federation on issues of providing the population with medical care ";

7. Order of the Ministry of Health of the Russian Federation and the Federal Compulsory Medical Insurance Fund dated April 4, 2003 N 145/21 “On amendments to the order of the Ministry of Health of Russia and the Compulsory Medical Insurance Fund dated March 19, 2001 N 79/17.”

Document overview

A number of acts of the Russian Ministry of Health and the Federal Compulsory Medical Insurance Fund have been declared invalid.

They talked about the appointment of SPHFA as the lead organization in the direction of research work “Organization of drug provision in the compulsory medical insurance system” (order of 1997), on the organization of work on standardization in healthcare (from 1998), and on measures to implement the Program work on the creation and development of a standardization system in healthcare (from 2000)

The procedure for reviewing agreements on the organization of medical care for the population does not apply (order dated 2000).

In addition, the order of 2001 on agreements between the Ministry, the Fund and the executive authorities of the constituent entities of the Federation on the provision of medical care to the population has become invalid.

Measures to implement the 1999 Decree of the Government of the Russian Federation on the Program of State Guarantees for Providing Russians with Free Medical Care (order of 1999) have also lost their relevance.

Proper hand sanitization of healthcare workers is key to maintaining infection control. We will tell you about the hand washing technique, its features, and give you a step-by-step algorithm for washing your hands.

The main factor in the transmission and spread of infectious agents associated with the provision of medical care are the hands of medical personnel, the contamination of which occurs during manipulations or in contact with various objects of the hospital environment (surfaces of devices, instruments, patient care items, sanitary equipment, linen, clothing , medical products, dressings, medical waste, etc.).

On a note!
What are the advantages and disadvantages of hand treatment methods for healthcare personnel?

The effectiveness, practicality, and acceptability of hand sanitization depend on the method and associated hand sanitization conditions available in the healthcare organization.

To interrupt possible routes of transmission of microorganisms through hands and reduce the risk of infections associated with the provision of medical care, it is necessary to clean the hands of healthcare workers in all cases where there is a real or potential possibility of contamination.

trimmed nails,
lack of nail polish,
no artificial nails,
lack of jewelry and watches on hands.

The hands of healthcare workers are a major factor in the transmission of healthcare-associated infections (HAIs). In this regard, compliance with hand hygiene is a necessary measure and an important factor of infection control (IC) in a medical organization to maintain the safety of patients and health workers themselves.

Types of hand treatment

There are three types of hand treatment for employees of medical organizations:

household level (washing hands with soap and water without using antiseptics);
hygienic level (hand treatment using skin antiseptic);
surgical level (followed by putting on gloves).

Social level of hand handling

Hand hygiene

Hand treatment using antiseptic carried out in the following cases:

Hand treatment steps:

washing hands with soap and water;
hand disinfection with skin antiseptic.

Hand treatment algorithm using antiseptic:

wash your hands with soap and water (in accordance with the above hand washing algorithm);
apply an antiseptic to your hands in an amount of at least 3 ml and thoroughly rub into the skin until completely dry, following the sequence of movements according to the EN-1500 standard (do not wipe your hands after applying the antiseptic).

To clean hands, use warm running water, liquid soap and antiseptics in bottles with an elbow dispenser, disposable towels or disposable napkins. Do not add liquid soap or antiseptic to a partially emptied bottle. Used as an antiseptic

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

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

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

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

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

1. Contact with clean, disinfected or sterilized objects.

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

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

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

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

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

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

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

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

10. Foci of infection.

1. Routine hand washing

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

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

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

Warm water makes the antiseptic or soap work more effectively, while hot water removes the protective fat layer from the surface of the hands. Therefore, you should avoid using too hot water when washing your hands.

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

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

2. Use your right palm to rub the back surface of your left hand, switch hands.

3. Connect the fingers of one hand in the interdigital spaces of the other, rub the inner surfaces of the fingers with up and down movements.

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

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

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

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

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

2. Hygienic disinfection (antiseptic) of hands

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

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

In all cases of probable microbial contamination from inanimate objects;

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

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

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

3. Surgical hand disinfection

It is carried out for any surgical interventions accompanied by a violation of the integrity of the patient’s skin, to prevent the introduction of microorganisms into the surgical wound and the occurrence of infectious postoperative complications. Surgical treatment of hands consists of three stages: mechanical cleaning of hands, disinfection of hands with a skin antiseptic, covering of hands with sterile disposable gloves.

A similar hand treatment is carried out:

Before surgical interventions;

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

Hand treatment rules:

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

2. After completing the mechanical cleaning stage, an antiseptic (Allsept Pro, Spitaderm, Sterillium, Octeniderm, etc.) is applied to the hands in 3 ml portions and, without allowing drying, rubbed into the skin, strictly observing the sequence of movements of the EN-1500 diagram. The procedure for applying skin antiseptic is repeated at least twice, the total consumption of antiseptic is 10 ml, the total procedure time is 5 minutes.

3. Sterile gloves are worn only on dry hands. When working with gloves for more than 3 hours, the treatment is repeated with a change of gloves.

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

Table. Stages of surgical hand disinfection

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

Table. Antiseptic agents used for hygienic and surgical treatment of hands

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

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

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

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

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

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

Water-based antiseptics:

4% solution of chlorhexidine bigluconate;

Povidone-iodine (solution containing 0.75% iodine).