Routine hand washing

Regular hand washing involves using plain soap that does not contain special antimicrobial ingredients.

It is important to practice proper hand-washing techniques, as studies have shown that routine hand-washing leaves certain areas of the skin (such as the tips and insides of the fingers) contaminated.

Remove rings, rings and other jewelry as they make it difficult effective removal microorganisms.

Under a moderate stream of comfortably warm water, hands should be vigorously soaped and rubbed together for at least 10 seconds in accordance with the method presented in the figure, and then rinsed. It should be remembered that the most commonly missed places are thumbs and the dorsum of the fingers and hands.

Dry your hands with a paper towel and then turn off the tap. Even if paper towels are expensive for a medical facility, you should not, as is often practiced, use a shared towel, which usually does not change throughout the day, or even several days. 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 towel containers to be sent to the laundry room. Electric dryers are useless in a hospital because the drying process takes a very long time and contributes to the development of dry skin, and is excessively noisy.

Each movement is repeated at least 5 times

Soap selection

Hand washing soap can be used in bar, liquid, granule, and powder form.

Liquid soap in single use dispensers is most preferable. When using reusable dispensers, be aware that they may become contaminated over time, so do not add liquid soap to a partially filled dispenser. It should be emptied, washed, dried and only then filled with a fresh portion of soap.

If bar soap is used, it is advisable to use soap dishes that allow the soap to dry between individual hand-washing episodes, preferably magnetic ones.

Soap in granule or powder form is usually more expensive, but can extend the duration of hand washing by requiring the powder or granules to be thoroughly rubbed.

Criteria for choosing a soap should include: acceptability by medical personnel, type of packaging or dispenser, allergic reactions, incidence of dermatitis, cost.

Hygienic hand antisepsis

Hygienic antiseptics involves the use of antiseptic drugs, i.e. drugs that have antimicrobial activity and, very importantly, are intended for use on the skin.

When using special antiseptic soaps and detergents (containing, for example, 4% chlorhexidine or 7.5% povidone iodine), hands are moistened, after which 3-5 ml of the drug is applied. In this case, follow the washing technique shown in the figure.

If alcohol is used antiseptic drugs(containing, for example, 70% ethyl alcohol, 45–60% isopropanol, or 0.5% alcohol solution of chlorhexidine), then 3–5 ml of the product should be applied to dry hands and rubbed in following the technique shown in the figure, until dry. Do not wipe your hands after treatment! It is also important to observe the exposure time: hands must be wet from the antiseptic for at least 15 seconds.

It should be emphasized that alcohol formulations are more effective than aqueous solutions of antiseptics, therefore, only in cases of obvious contamination of hands should they be washed first. Alcohol-based formulations are especially preferred when adequate handwashing facilities are not available or when sufficient time is not available.

Surgical disinfection (antiseptic) of hands

There are many methods of surgical hand antisepsis. Many of them are cumbersome rituals, the disadvantages of which are the traumatic nature, the duration of treatment, the short duration of the residual antimicrobial effect, the use of tampons, sponges, brushes, etc. for the application of antiseptics.

According to modern scientific ideas, the same drugs can be used for surgical hand antisepsis as for hygienic antiseptics. The fundamental difference lies only in the treatment time, which extends to 2–3 minutes, and the inclusion of wrists and forearms in the treatment. In addition, during surgical antisepsis it is very important to use drugs that have a pronounced residual effect.

Modern technology of surgical antisepsis

Hands are washed with water and soap, preferably liquid soap (it is recommended to use sanitary devices and elbow dispensers, the operation of which does not require the use of hands). It is not necessary to use antiseptic soap at this stage.

Brushes are not necessary. If brushes are used, sterile, soft brushes that are disposable or can withstand autoclaving should be used and should only be used for periungual areas.

Brushes are used only for the first treatment during a work shift.

After washing, hands must be thoroughly dried using sterile towels (wipes). Rubbing an antiseptic into wet skin reduces its concentration and increases the drying time after treatment with antiseptics.

After drying, rub 3-5 ml of alcohol antiseptic into the skin of the hands twice (sometimes three times, but in any case the treatment process lasts at least 2–2.5 minutes) until completely dry. Sterile gloves are immediately put on dry hands.

In order to prevent nosocomial infections, the hands of medical workers must be disinfected ( hygienic treatment hands, treatment of surgeons' hands) and the skin of patients (treatment of surgical and injection fields, elbow bends of donors, sanitary treatment of the skin). Depending on the medical procedure being performed and the required level of reduction in microbial contamination of the skin of the hands, medical personnel perform hygienic treatment of hands or treatment of the hands of surgeons. The administration organizes training and monitoring of compliance with hand hygiene requirements by medical personnel.

To achieve effective hand washing and disinfection, the following conditions must be observed: short-cut nails, no nail polish, no artificial nails, no rings, signet rings, etc. jewelry. Before treating surgeons' hands, it is also necessary to remove watches, bracelets, etc. To dry hands, use clean cloth towels or disposable paper napkins; when treating surgeons' hands, use only sterile cloth ones.

Medical personnel should be provided with sufficient quantities of effective means for washing and disinfecting hands, as well as hand skin care products (creams, lotions, balms, etc.) to reduce the risk of contact dermatitis. When choosing skin antiseptics, detergents and hand skin care products, individual tolerance should be taken into account.

Hand hygiene.

Hand hygiene should be carried out in the following cases:

before direct contact with the patient;

after contact with the patient's intact skin (for example, when measuring pulse or blood pressure);

after contact with body secretions or excreta, mucous membranes, dressings;

before performing various patient care procedures;

after contact with medical equipment and other objects located in close proximity to the patient;

after treating patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment.

Hand hygiene is carried out in two ways:

hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;

treating hands with a skin antiseptic to reduce the number of microorganisms to a safe level.

To wash your hands, use liquid soap using a dispenser. Dry your hands with an individual towel (napkin), preferably disposable.

Hygienic treatment of hands with alcohol-containing or other approved antiseptic (without prior washing) is carried out by rubbing it into the skin of the hands in the amount recommended in 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 effective hand disinfection is keeping them moist for the recommended treatment time.

When using a dispenser, a new portion of antiseptic (or soap) is poured into the dispenser after it has been disinfected, washed with water and dried. Preference should be given to elbow dispensers and photocell dispensers.

Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In departments with a high intensity of patient care and with a high workload on staff (resuscitation and intensive care units, etc.), dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by staff (at the entrance to the ward, at the patient’s bedside etc.). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (up to 200 ml) with skin antiseptic.

1. General provisions

1.2. Definition of terms

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

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

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

- Nosocomial infection (HAI)- any clinically significant disease of an infectious nature that affects a patient as a result of staying in a hospital or visiting a medical institution, as well as infections that occur among personnel of a healthcare institution as a result of their professional activities.

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

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

- Routine hand washing- washing procedure with water and regular (non-antimicrobial) soap.

- Irritant contact dermatitis (IC) - discomfort and changes in skin condition, which may manifest as dry skin, itching or burning, redness, peeling of the epidermis and cracking.

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

- Spore-forming bacteria- these are bacteria that have the ability to form special structures covered with a dense shell; they are conventionally called spores; they are highly resistant to the action of many physicochemical factors.

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

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

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

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

1.4. For hand hygiene, medical personnel use antiseptic agents registered in Ukraine in accordance with the established procedure.

2. General requirements

2.1. Healthcare facility staff keep their hands clean. It is recommended that nails be cut short and level with the tips of the fingers, without varnish or cracks on the surface of the nails, and without false nails.

2.2. Before hand treatment, bracelets, watches, and rings are removed.

2.3. Hand hygiene equipment

Tap water.
- Washbasin with cold and hot water and a mixer, which it is advisable to operate without touching your hands.
- Closed containers with water taps if there are problems with water supply.
- Liquid soap with neutral pH.
- Alcohol antiseptic.
- Antimicrobial detergent.
- Skin care product.
- Non-sterile and sterile disposable towels or napkins.
- Dosing devices for detergents and disinfectants, skin care products, towels or wipes.
- Containers for used towels and napkins.
- Disposable rubber gloves, non-sterile and sterile.
- Household rubber gloves.

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

2.5. It is advisable to install three dispensers near the washbasin:
- with antimicrobial hand treatment;
- with liquid soap;
- with skin care product.

2.7. Each hand washing station, if possible, is equipped with dispensers for disposable towels, napkins and a container for used products.

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

2.10. It is recommended that dispensers for detergents and skin care products be thoroughly washed and disinfected before each new refill.

2.12. In the absence of a centralized water supply or in the presence of another problem with water, departments are provided with closed water containers with taps. Boiled water is poured into the container and changed at least once a day. Before further filling, the containers are thoroughly washed (disinfected if necessary), rinsed and dried.

3. Surgical treatment of hands

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

3.1. Routine hand washing before surgical hand preparation

3.1.1. Routine washing of hands before surgical treatment is carried out in advance in the department or airlock room of the operating unit, alternatively - in the recovery room. antiseptic treatment hands, in the preoperative room before the first operation, in the future - as necessary.
Conventional washing is intended exclusively for mechanical cleaning of hands, while dirt and sweat are removed from the hands, spore-forming bacteria are partially washed away, as well as partially transient microorganisms.

3.1.2. To wash your hands, use regular liquid or powder soap or washing lotion with a neutral pH. Preference should be given to liquid soap or washing lotion. The use of soap in bars is unacceptable.

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

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

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

3.2. Surgical hand antisepsis

3.2.1. Surgical hand antisepsis is carried out using various alcohol antiseptics by rubbing them into the hands and forearms, including the elbows.

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

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

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

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

3.2.5. During the procedure, special attention is paid to the standard method of treating hands with an antiseptic in accordance with EN 1500.

Each stage of processing is repeated at least 5 times. When performing hand treatment techniques, the presence of so-called “critical” areas of the hands that are not sufficiently wetted with the product is taken into account: thumbs, fingertips, interdigital areas, nails, periungual ridges and subungual areas. Surfaces are treated most thoroughly thumb and fingertips, since they contain the largest number of bacteria.

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

3.2.7. Sterile gloves are worn only on dry hands.

3.2.8. After the operation/procedure is completed, the gloves are removed, hands are treated with an antiseptic for 2 x 30 s, and then with a hand skin care product. If blood or other secretions get on your hands under gloves, these contaminants are first removed with a swab or napkin moistened with an antiseptic, and washed with detergent. Then thoroughly wash with soap and water and dry with a disposable towel or napkins. After this, the hands are treated with an antiseptic 2 x 30 s.

3.3. Surgical hand washing

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

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

3.3.2. Before starting phase 2 of surgical washing, hands, forearms and elbows are moistened with water, with the exception of those products that, as directed by the developer, are applied to dry hands and then water is added.

3.3.3. An antimicrobial detergent in quantities specified by the developer is applied to the palms and distributed over the surface of the arms, including the elbow creases.

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

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

3.3.6. When washing, adhere to the sequence of actions in accordance with those specified in paragraphs. 3.2.2 and 3.2.5.

3.3.7. Hands are dried with a sterile towel or sterile wipes using aseptic technique, starting with the fingertips.

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

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

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

4. Hand hygiene

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

Requirements for antimicrobial agents and alcohol antiseptics

1. Antimicrobial and antiseptic alcohol-containing rubbing agents must meet the following requirements:
- wide range antimicrobial action against transient (hygienic hand treatment) and transient and resident microflora (surgical hand treatment);
- fast action, that is, the duration of the hand treatment procedure should be as short as possible;
- prolonged action (after treating the skin of the hands, the antiseptic must delay the reproduction and reactivation of resident microorganisms for a certain time (3 hours) under medical gloves);
- activity in the presence of organic substrates;
- no negative effects on the skin;
- the lowest possible dermal resorption;
- absence of toxic, allergenic side effects;
- absence of systemic mutagenic, carcinogenic and teratogenic effects;
- low probability of developing resistance of microorganisms;
- readiness for immediate use (does not require advance preparation);
- acceptable consistency and smell;
- easy rinsing from the skin of the hands (for detergent compositions);
- long shelf life.

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

3. Products used in phthisiatric, dermatological, infectious diseases departments must be additionally examined in tests for Mycobacterium terrae (tuberculecidal activity) for use in phthisiological departments, for Aspergillus niger (fungicidal activity) for use in dermatological departments, for Poliovirus, Adenovirus (virucidal activity) for use in infectious diseases departments if necessary.

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

4.1. Indications

4.1.1. Routine hand washing using a non-antimicrobial detergent is recommended:
- at the beginning and end of the working day;
- before preparing and serving food;
- in all cases, before treatment with an antiseptic, when hands are clearly dirty;
- in case of contact with pathogens of enteroviral infections in the absence of appropriate antiviral agents, it is recommended to mechanically eliminate viruses with prolonged hand washing (up to 5 minutes);
- in case of contact with spore microorganisms - prolonged hand washing (minimum 2 minutes) to mechanically eliminate spores;
- after using the toilet;
- in all other cases, in the absence of a risk of infection or special instructions.

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

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

4.2. Regular washing

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

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

4.3. Hygienic antiseptics

4.3.1. The standard method of rubbing in an antiseptic includes 6 stages and is presented in paragraph 3.2.5. Each stage is repeated at least 5 times.

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

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

4.3.4. When performing hand treatment, take into account the presence of so-called “critical” areas of the hands that are not sufficiently moistened with an antiseptic: thumbs, fingertips, interdigital areas, nails, periungual ridges and subungual areas. The surfaces of the thumb and fingertips are treated most thoroughly, since the largest number of bacteria are concentrated on them.

4.3.5. If there is visible contamination of your hands, remove it with a napkin moistened with an antiseptic and wash your hands with detergent. Then thoroughly wash with soap and water and dry with a disposable towel or napkins. Close the tap with the last napkin. After this, the hands are treated with an antiseptic twice for 30 seconds.

5. Use of medical gloves

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

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

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

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

5.5. Non-sterile gloves are recommended for use when:
- contact with hoses of artificial respiration devices;
- working with biological material from patients;
- blood sampling;
- carrying out intramuscular, intravenous injections;
- cleaning of equipment and disinfection;
- removal of secretions and vomit.

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

5.7. Immediately after use, medical gloves are removed and immersed in a disinfectant solution directly at the place where the gloves are used.

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

5.9. Rules for using medical gloves:
- the use of medical gloves does not create absolute protection and does not exclude compliance with the hand treatment technique, which is applied in each individual case immediately after removing gloves if there is a threat of infection;
- disposable gloves cannot be reused; non-sterile gloves cannot be sterilized;
- gloves must be changed immediately if they are damaged;
- it is not allowed to wash or treat hands with gloves between “clean” and “dirty” manipulations, even in the same patient;
- moving with gloves in the hospital department(s) is not allowed;
- before putting on gloves, do not use products containing mineral oils, petroleum jelly, lanolin, etc., as they may damage the strength of the gloves.

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

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

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

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

6. Advantages and disadvantages of hand treatment methods

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

6.2. Conventional washing is ineffective in eliminating both transient and resident microorganisms. In this case, microorganisms do not die, but with splashes of water fall on the surface of sinks, staff clothing, and surrounding surfaces.

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

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

6.5. Hygienic hand antisepsis has several practical advantages over hand washing, which allows us to recommend it for wide practical use.

Advantages of hygienic hand antisepsis with alcohol antiseptics compared to conventional hand washing

6.6. Errors in hygienic antiseptics include the possible rubbing of alcohol antiseptic into hands that are damp from the antiseptic, which reduces its effectiveness and skin tolerance.

6.7. Saving antimicrobial agents and reducing exposure time makes any method of hand treatment ineffective.

7. Possible negative consequences Hand treatment and prevention

7.1. If the requirements of the instructions/guidelines for the use of hand treatment products are violated and if there is a careless attitude towards preventive skin care, CD may occur.

7.2. KD can also be caused by:
- frequent use of antimicrobial detergent;
- long-term use of the same antimicrobial detergent;
- increased skin sensitivity to chemical composition funds;
- presence of skin irritation;
- excessively frequent routine hand washing, especially with hot water and alkaline detergents or detergents without emollients;
- long-term work with gloves;
- putting on gloves on wet hands;
- lack of a sound skin care system in a medical institution;

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

Properties of alcohol-based antiseptics

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

8. Hand skin care

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

8.2. KD can only be avoided if a skin care system is implemented in a healthcare facility, since when using any antimicrobial agents there is a potential risk of skin irritation.

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

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

Choosing a skin care product depending on its type

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

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