Appendix
to the Ministry of Health of the Russian Federation
and the Federal Compulsory Medical Insurance Fund
dated August 31, 2012 N 111/179
Scroll
invalid 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 Pharmaceutical Academy as the head organization in the direction of research work" Organization of drug supply in the CHI system "and on holding a competition of territorial programs "Organization of drug supply in the system of compulsory medical insurance";
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 of November 23, 1999 N 421/98 "On measures to implement the Decree of the Government of the Russian Federation of October 26, 1999 N 1194 "On the Program of State Guarantees for Providing Citizens of the Russian Federation with Free medical care";
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 of October 6, 2000 N 365/79 "On the procedure for considering agreements on the organization of medical care for 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 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 of April 4, 2003 N 145/21 "On Amendments to the Order of the Ministry of Health of Russia and the Compulsory Medical Insurance Fund of March 19, 2001 N 79/17".
Document overview
A number of acts of the Ministry of Health of Russia and FFOMS were recognized as invalid.
They dealt with the appointment of SPCPA as the lead organization in the direction of research work "Organization of drug supply in the CHI system" (order of 1997), the organization of work on standardization in health care (dated 1998), and measures to implement the Program work on the creation and development of a system of standardization in healthcare (from 2000)
The procedure for considering agreements on the organization of medical care for the population (order of 2000) does not work either.
In addition, the order dated 2001, devoted to agreements between the Ministry, the Fund and the executive authorities of the constituent entities of the Federation on issues of providing the population with medical care, has become invalid.
Lost their relevance and measures to implement the decree of the Government of the Russian Federation of 1999 on the Program of state guarantees to provide Russians with free medical care (order of 1999).
Hand processing. The most important "tool" of the dentist are the hands. Proper and timely processing of hands 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.
For the first time, hand treatment for the prevention of wound infection was used 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 ones (Staphylococcus aureus, Escherichia coli) are the result of contact with the patient. About 80-90% of permanent microorganisms are in the superficial layers of the skin and 10-20% are in the deep layers of the skin (in the sebaceous and sweat glands and hair follicles). The use of soap in the process of washing hands allows you to remove most of the transient flora. Permanent microorganisms cannot be removed from the deep layers of the skin with ordinary hand washing.
When developing an infection control program in health care facilities, 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 departments, the specifics of the patient population and the characteristic microbial spectrum of the department.
Types of contact in the hospital, 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 not in contact with patients (food, medicines, etc.).
3. Objects with which patients have minimal contact (furniture, etc.).
4. Objects that have been in close contact with non-infected patients (bedding, etc.).
5. Patients who are not the source of infection, during procedures characterized by minimal contact (measuring the pulse, blood pressure, etc.).
6. Objects that are likely to be contaminated, especially wet objects.
7. Objects that were in close contact with patients that are sources of infection (bed linen, etc.).
8. Any secrets, excretions or other body fluids of an uninfected patient.
9. Secrets, excretions, or other body fluids from known infected patients.
10. Foci of infection.
1. Regular hand washing
Washing moderately soiled hands with plain soap and water (antiseptics are not used). The purpose of regular hand washing is to remove dirt and reduce the amount of bacteria found on the skin of the hands. Routine handwashing is mandatory before preparing and distributing food, before eating, after going to the toilet, before and after patient care (washing, making bed, etc.), in all cases when the 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 observe a certain hand washing technique, since special studies have shown that during formal hand washing, fingertips and their inner surfaces remain contaminated. Hand treatment rules:
All jewelry, watches are removed from the hands, as they make it difficult to remove microorganisms. Hands are lathered, then rinsed with warm running water and everything is repeated anew. It is believed that during the first lathering and rinsing with warm water, germs are washed off the skin of the hands. Under the influence of warm water and self-massage, the pores of the skin open, therefore, with repeated soaping and rinsing, microbes from the opened pores are washed off.
Warm water makes the antiseptic or soap work more effectively, while hot water removes the protective fatty layer from the surface of the hands. In this regard, you should avoid using too hot water for washing your hands.
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 reciprocating motion.
2. With the right palm, rub the back surface of the left hand, change hands.
3. Connect the fingers of one hand in the interdigital spaces of the other, rub the inner surfaces of the fingers with up and down movements.
4. Connect the fingers into a "lock", rub the palm of the other hand with the back of the bent fingers.
5. Grasp the base of the thumb of the left hand between the thumb and forefinger of the right hand, rotational friction. Repeat on the wrist. Change hands.
6. In a circular motion, rub the palm of the left hand with the fingertips of the right hand, change hands.
7. Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute.
For washing hands, it is most preferable to use liquid soap in dispensers with single-use bottles liquid soap "Nonsid" (firm "Erisan", Finland), "Vase-soft" (firm "Lyzoform SPb"). Do not add soap to a partially empty dispenser bottle due to their possible contamination. Acceptable for health facilities can be considered, for example, Dispenso-pac dispensers from Erisan, with a sealed dosing pump device that prevents the possible ingress of microorganisms and substituting air into the package. The pumping device ensures complete emptying of the package.
If soap bars are used, small fragments of them should be used so that individual bars do not remain for a long 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 separate handwashing episodes. Hands should be dried with a paper (ideally) towel, which then turn off the tap. In the absence of paper towels, pieces of clean cloth measuring approximately 30 x 30 cm can be used for individual use. After each use, these towels should be discarded in the containers specially designed for them and sent to the laundry. Electric dryers are not effective enough as they dry the skin too slowly.
Personnel should be cautioned against wearing rings and using nail polish, as rings and cracked polish make it difficult to remove microorganisms. Manicure (especially manipulations in the area of the nail bed) can lead to microtraumas that are easily infected. Hand washing facilities should be conveniently located throughout the hospital. In particular, it should be installed directly in the room where diagnostic or penetrating procedures are performed, as well as in each ward or at the exit from it.
2. Hygienic disinfection (antiseptic) of hands
It is intended to interrupt the process of transmission of infection through the hands of the staff of institutions 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 secretions of the patient;
In all cases of probable microbial contamination from inanimate objects;
Before and after working with a patient. Hand treatment rules:
Hygienic processing of hands consists of two stages: mechanical cleaning of hands (see above) and disinfection of hands with a skin antiseptic. After the end of the mechanical cleaning stage (double 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, the hands are moistened, after which 3 ml of an alcohol-containing preparation is applied to the skin (for example, Isosept, Spitaderm, AHD-2000 Special, Lizanin, Biotenzid, Manopronto) and carefully rubbed 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 an antiseptic can be applied immediately. Each movement is repeated at least 5 times. Hand treatment is carried out within 30 seconds - 1 minute. Alcohol formulations are more effective than aqueous solutions of antiseptics, however, in cases of severe contamination of the hands, they should be thoroughly washed with water, liquid or antiseptic soap beforehand. Alcoholic compositions are particularly preferred also in the absence of adequate conditions for washing hands or in the absence of the necessary time for washing.
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 during 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, closing hands with sterile disposable gloves.
Such hand treatment is carried out:
Before surgical interventions;
Before serious invasive procedures (for example, puncture of large vessels).
Hand treatment rules:
1. In contrast to the mechanical cleaning method described above, at the surgical level, the forearms are included in the treatment, sterile wipes are used for blotting, and the hand washing itself lasts at least 2 minutes. After
drying, the nail beds and periungual ridges are additionally processed with disposable sterile wooden sticks soaked in an antiseptic solution. Brushes are not required. If brushes are used, use sterile, soft, disposable or autoclavable brushes, and brushes should only be used on the periungual area and only for the first brushing of a work shift.
2. After the end of the mechanical cleaning stage, an antiseptic (Allcept Pro, Spitaderm, Sterillium, Octeniderm, etc.) is applied to the hands in 3 ml portions and, preventing drying, is rubbed into the skin, strictly following the sequence of movements of the EN-1500 scheme. The procedure for applying a skin antiseptic is repeated at least two times, the total consumption of the antiseptic is 10 ml, the total procedure time is 5 minutes.
3. Sterile gloves are worn only on dry hands. If the duration of work with gloves is more than 3 hours, the treatment is repeated with a change of gloves.
4. After removing the gloves, the hands are again wiped with a napkin moistened with a skin antiseptic, then washed with soap and moistened with an emollient cream (table).
Table. Stages of surgical hand disinfection
Two types of antiseptics are used for hand treatment: water, with the addition of surface-active substances (surfactants) and alcohol (table).
Table. Antiseptics 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% ethanol;
60% isopropanol solution or 70% ethanol solution with additives,
Softening the skin of the hands (for example, 0.5% glycerin);
Manopronto-extra - a complex of isopropyl alcohols (60%) with additives softening the skin of the hands and lemon fragrance;
Biotenzid - 0.5% solution of chlorhexidine in a complex of alcohols (ethyl and isopropyl, with additives softening the skin of the hands and lemon flavor.
Water-based antiseptics:
4% solution of chlorhexidine bigluconate;
Povidone-iodine (solution containing 0.75% iodine).
Maintaining hygiene and cleanliness is a guarantee of health in all spheres of life. If we are talking about medicine, then the cleanliness of hands should be an inalienable rule, because the life of both the entire medical staff and the patient depends on such a trifle at first glance. The nurse is obliged to ensure that the condition of her hands is satisfactory and meets the medical standards of public health. It is important to get rid of micro cracks, burrs, clean nails and remove any, if any. Why is this so important, and what are the requirements?
In order for all staff to comply with the European medical standard, it is important for each employee to tell about the existing requirements for the disinfection of hands, instruments and other medical devices. For nurses, there are separate rules for caring for hands, these include the following requirements:
- do not paint or glue artificial nails
- nails should be neatly trimmed and cleaned
- it is not recommended to wear bracelets, watches, rings or any other jewelry on your hands, as they are sources of bacteria and germs
It was found that it is non-observance of hands among doctors and nurses that contributes to the development and rapid spread of nosocomial infectious agents throughout the clinic. Touching with unclean hands manipulation tools, devices, patient care items, testing devices, technical equipment, clothing, and even medical waste can adversely affect the health of the patient and all those in the hospital for a long period of time.
To prevent the spread of microorganisms and reduce the risk of infection through hands, there are rules and means of disinfection. These recommendations must be followed by any hospital employee, especially those who work closely with sources of infection and infected patients.
In medicine, several methods have been developed for disinfecting the hands of all medical staff:
- hand washing with soapy water and ordinary water, without the use of additional products
- washing hands with antiseptic hygiene products
- surgical disinfection standards
Cosmetic and folk remedies for hair care
However, there are rules for washing hands in this way. It has been observed that in frequent cases, after processing the skin of the hands, many bacteria remain on the inner surface and fingertips. To avoid this, you must follow the following recommendations:
- To begin with, you need to remove all unnecessary items: watches, jewelry, other little things that contribute to the reproduction of microorganisms.
- The next step is to lather your hands, so that the soap penetrates all areas.
- Wash off the foam under running warm water.
- Repeat the procedure several times.
When the washing procedure is performed for the first time, dirt and bacteria on the surface of the skin are removed from the hands. With repeated treatment with warm water, the pores of the skin open, and the cleaning is carried out deeper. It is useful when soaping to do a light self-massage.
Cold water is less useful in this case, because it is the elevated temperature that allows soap or other hygiene product to penetrate deep into the skin and remove a thick fat layer from both hands. Hot water is also not suitable, it can only lead to a negative result.
Surgical Disinfection Rules
Surgery is an area where neglect of hand hygiene can cost a patient's life. Hand treatment is carried out in such situations:
- Before any type of surgery
- During invasive procedures such as vascular puncture
Of course, the doctor and all assistants wear disposable sterile gloves during the operation, but this does not give the right to forget about hygienic protective equipment and hand treatment.
Next, the usual cleaning of the hands is carried out again and three milligrams of an antiseptic agent is applied, and it is rubbed into the fabric and skin in a circular motion. It is advisable to carry out this whole process several times. The maximum is used up to ten milligrams of antiseptic. The duration of processing takes no more than five minutes.
After the procedure or operation has been completed, sterile gloves are thrown away, and the skin of the hands is washed with soap and treated with a lotion or cream, preferably made from natural substances.
Modern methods of disinfection
Medicine is moving forward and disinfection techniques are improving every day. At the moment, a mixture is widely used, which includes the following components: distilled water and formic acid. The solution is made daily, stored in an enamel bowl. Hands are immediately washed with ordinary soap, and then washed with this solution for a couple of minutes (the part from the hand to the elbow is processed for 30 seconds, the rest of the time the hand itself is washed). Hands are wiped with a napkin and dried.
Another way is disinfection with chlorhexidine, which is initially diluted with 70% medical alcohol (dosage one to forty). The processing procedure takes about three minutes.
Iodopyron is also used for hygienic treatment of the hands of medical staff. The whole process follows a similar pattern: hands are washed with soapy water, then nails, fingers and other areas are disinfected with cotton swabs.
Ultrasonic treatment. The hands are lowered into a special one through which ultrasonic waves pass. Processing takes less than a minute.
All methods are good, it is only important not to neglect the general recommendations.
So, hand disinfection in medicine plays an important role. It is not enough to simply wash your hands with water. The treatment of the brush is carried out in different ways, various hygiene products are used, depending on the situation. Neglect of elementary rules can lead to negative consequences from which not only patients, but also medical personnel will suffer.
Jun 22, 2017 Violetta Doctor
The key to infection control is the proper cleaning of healthcare workers' hands. We will tell you about the hand washing technique, its features, and give you a step-by-step hand washing algorithm.
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 when performing 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 sanitizing methods for medical staff?
The effectiveness, practical application and acceptability of hand treatment depend on the method and accompanying treatment conditions that exist in a medical organization.
In order to interrupt possible routes of transmission of microorganisms through the hands and reduce the risk of infections associated with the provision of healthcare, 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 the hands.
The hands of healthcare workers are a major factor in the transmission of healthcare-associated infections (HAIs). In this connection, hand hygiene is a necessary measure and an important factor in infection control (IC) in a medical organization to ensure the safety of patients and the health workers themselves.
Types of hand treatment
There are three types of processing of hands of employees of medical organizations:
- household level (washing hands with soap and water without the use of antiseptics);
- hygienic level (treatment of hands with the use of skin antiseptic);
- surgical level (with subsequent donning of gloves).
Social level of hand treatment
Hand hygiene
Hand treatment with antiseptic carried out in the following cases:
Hand treatment steps:
- washing hands with soap and water;
- disinfection of hands with a skin antiseptic.
Algorithm for processing hands using an antiseptic:
- wash hands with soap and water (in accordance with the above handwashing algorithm);
- apply an antiseptic on the hands in an amount of at least 3 ml and carefully 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).
Hands are treated with warm running water, liquid soap and antiseptics in bottles with an elbow dispenser, disposable towels or disposable wipes. Do not add liquid soap and antiseptic to a partially empty bottle. Used as an antiseptic
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