The question of the need for hand hygiene by medical personnel was first raised only in the middle of the 19th century. At that time, due to unsanitary conditions in Europe, almost 30% of women in labor died in hospitals. The main cause of death was the so-called postpartum fever. It often happened that doctors went to women giving birth after the preparation of corpses. At the same time, they did not handle their hands, but simply wiped them with a handkerchief.
Types of processing
Keeping your hands clean is a prerequisite for all medical personnel. Hygiene of the hands of medical staff can be carried out in two ways:
- removing contaminants and reducing the number of microorganisms on the skin of the hands with soap and water;
- the use of special alcohol-containing skin antiseptics, which can reduce the number of bacteria on the skin to a minimum level.
Only the second method can be called hygienic hand treatment. The first is only hygienic washing. You need to wash your hands with liquid soap and a dispenser and wipe with an individual disposable towel. But disinfection is carried out using skin antiseptics.
According to the rules, medical personnel should always have funds for hand treatment. In addition, they must be provided with creams, balms, lotions designed for skin care. Indeed, with constant hygienic treatment, the risk of developing contact dermatitis increases. Also, the selection of detergents and antiseptics should be carried out taking into account individual intolerance.
Important Terms
Every hospital employee should know when hygienic hands should be handled. This is necessary in the following situations:
- before and after contact with each patient;
- before and after putting on gloves that are used during medical procedures, contact with excreta or body secrets, dressings, mucous surfaces;
- after contact with intact skin, for example after measuring blood pressure, pulse, transfer of the patient;
- after working with equipment that is located in the immediate vicinity of the patient;
- after treatment of patients with various purulent-inflammatory processes.
If there is a clear contamination of the skin of the hand with blood or secretions of the patient, then first they must be thoroughly washed with soap and water and dried. After that, they must be treated twice with an antiseptic.
Hand Wash Technique
Do not forget about the importance of skin cleansing, not only in hospitals, but also in other places. Hand processing technology remains the same everywhere. Before you begin the procedure, you must remove all the rings, watches and bracelets. Any foreign objects make it difficult to remove pathogens. Hands should be washed with moderately warm water.
To increase the effectiveness of the procedure, first wet your hands and squeeze liquid soap on them . The hand processing algorithm looks like this:
- Foam the soap with intense rubbing of the palms between each other.
- Rub one palm against the other with reciprocating movements.
- Rub the back surface of the right hand with the left palm and dial.
- Connect the fingers of the right hand and the interdigital spaces of the left, carefully process them.
- It is necessary to go through the inner surface of the fingers.
- Cross your spread fingers and rub your palms together.
- Clasp your hands into the lock and walk the back of your fingers in the palm of your hand.
- Rub the thumb thoroughly in a circular motion; for this, its base must be covered with the thumb and forefinger of the other hand.
- The wrist is also processed in a similar way.
- Wipe the palm of your hand with your fingertips in a circular motion.
Each movement should be repeated at least 5 times, and the total duration of such a wash should be about a minute.
Rules for medical staff
Each employee of hospitals and clinics should know how to handle the hands of medical staff. SanPiN (the correct washing scheme is given above) establishes the procedure not only for cleaning the skin, but also for their disinfection. Also, healthcare providers should be aware of the following requirements:
- short cropped nails without varnish;
- lack of rings, rings and other similar jewelry.
Nail polish can cause unwanted dermatological reactions that can lead to secondary infection. In addition, the dark varnish does not allow to assess the degree of purity of the subungual space. This can cause poor quality processing. The most dangerous is cracked varnish. Indeed, in this case, removing microorganisms from the surface of the hands becomes more difficult.
Manicure itself is associated with getting microtraumas that are easy to infect. This is one of the reasons why healthcare providers are forbidden to wear false nails.
Any jewelry or bijouterie can cause the hygienic treatment of the hands of medical staff to become less effective. In addition, gloves can be damaged due to them, and the process of putting them on is complicated.
Nuances for surgeons
The processing of the hands of people involved in surgical interventions is carried out according to a slightly modified scheme. So, for example, the washing time for them is lengthened and is 2 minutes. A further hand processing algorithm is as follows. After mechanical cleaning, it is necessary to drain the skin with a sterile tissue or disposable paper towel.
In addition to washing, antiseptic treatment is important. Attention must be paid not only to the hands, but also to the wrists, forearms. During the specified treatment time, the skin should remain moist. You can’t wipe your hands, you must wait until the antiseptic is completely dry. Only then can surgeons wear gloves.
Hygiene Selection
Many now opt for antibacterial soap. But it is important to follow the technique of cleaning the skin. If everything is done correctly, then washing your hands with regular soap will be just as effective. In surgical practice, special means are used for antiseptic processing of hands. Soap contains chlorhexidine gluconate or povidone iodine. These substances can reduce the number of bacteria by 70-80% during the first use and by 99% during repeated use. Moreover, when using povidone iodine, microflora grows faster than when in contact with chlorhexidine.
In order for hygienic hands to be treated in full compliance with regulatory requirements, it is advisable to equip medical facilities with elbow dispensers. Their management is carried out without the participation of hands.
Also, in practice, brushes can be used to clean hands, but this is not considered mandatory. They must be either sterile disposable or capable of withstanding autoclaving.
Time intervals
In surgical practice, special rules for cleaning the skin are established. After the usual thorough washing according to the established protocol, they should be decontaminated.
Mandatory treatment of the hands of medical staff should be carried out. SanPin (the washing scheme remains the same) provides that skin cleansing before surgical procedures can be carried out using the same means as hygienic.
It is important to remember that throughout the entire period of hand disinfection, they must remain moist. For the procedure, as a rule, it is necessary to use more than 6 ml of antiseptic. As a result of research, it was found that five-minute treatment of the skin is sufficient for the qualitative destruction of bacteria. It was also confirmed that the implementation of this procedure for three minutes reduces the number of microorganisms to an acceptable level.
Rules for treating hands with an antiseptic
After thoroughly washing the skin of the hands, wrists and forearms, it is necessary to dry them. After that, the established standard for the processing of hands for employees of operating units requires the use of special disinfectants.
Before that, if necessary, it is necessary to process the nail bed and periungual rollers. For these purposes, use sterile disposable wooden sticks, which must be additionally moistened with an antiseptic.
A disinfectant is applied 2.5 ml to the hands and forearms. About one ml of disinfectant liquid should be spent on one treatment of two hands. An antiseptic must be rubbed into the skin according to the same pattern as hand washing, in compliance with the correct sequence of movements.
Only after full absorption / evaporation of the product can gloves be worn. If the surgery lasts more than 3 hours, then the treatment is repeated. Indeed, under the gloves, pathogens can again begin to multiply.
Final stage
But these are not all levels of hand processing. It is important to remove them after washing with gloves and wash your hands with soap. In this case, it is no longer necessary to use a disinfectant solution. It is enough to wash with liquid soap, it is desirable that its pH is neutral.
After cleaning the skin, they must be moisturized. For these purposes, various creams, lotions are used. Their main purpose is to prevent the drying effect of alcohol-containing disinfectants.
Separately, it is worth noting that hygienic processing of hands in the absence of visible dirt can be performed without washing. In most cases, it is sufficient to use antiseptic solutions for 30-60 seconds.
Possible complications
It is worth noting that the regular use of disinfectants does not affect the skin of medical workers in the best way. There are two main types of reactions faced by hospital staff. Most often they complain of itching, dryness, irritation, the appearance of cracks with bleeding. These symptoms can be both minor and significantly affect the general condition of workers.
There is also another type of complication - allergic dermatitis. They occur with intolerance to any components of the funds intended for hand disinfection. Allergic dermatitis can occur both in mild localized and in severe generalized form. In the most advanced cases, they can be combined with respiratory distress syndrome or other manifestations of anaphylaxis.
Prevalence of complications and their prevention
You can understand the significance of the problem if you know that such methods of treating hands cause 25% of nurses to treat dermatitis, and 85% report that they had a history of skin problems.
It is possible to slightly reduce the irritating effect of antiseptics if you add emollients to them. This is one way to reduce the incidence of contact dermatitis. Also, the risk of their occurrence can be minimized by using moisturizers after each washing, which are intended for hand skin care.
To prevent the development of complications, do not wash your hands each time before treating them with an antiseptic. In addition, it is important to ensure that gloves are worn only when the skin is completely dry.
Do not neglect the use of moisturizers. On the market you can find special protective creams designed to prevent the occurrence of contact dermatitis. However, the studies failed to confirm their unequivocal effectiveness. Many are stopped by the high price of these creams.