Antiseptic processing of skin

Description:

It is known that skin of the person performs a number of the major functions, one of which is protection against influence of harmful factors of the environment. Skin, especially skin of hands, is constantly populated with microorganisms. Intact (safe) skin of the person, even carefully washed up, is colonized by microorganisms which can be various for certain sites of skin and rather constant for each person.

Microflora of skin of the person shares on resident and tranzitorny.

Resident (constant) microflora is presented by bacteria which constantly live and breed in integuments. These microorganisms colonize deeper layers of integuments, including grease, sweat glands and hair follicles, and are presented generally stafilokokkama koagulazonegativnima (more often than Staphylococcus epidermidis) and difteroidama (Coryntbacterium spp.) Generally resident microflora does not cause pathological processes in patients at the unimpaired skin, however can become the reason of infectious process at hit in sterile cavities of a human body. Resident microorganisms cannot almost be removed, however their number can be reduced significantly. At the same time sterilization of hands is not simply impossible, but also it is undesirable, resident microflora warns settling of skin more dangerous microorganisms, and also synthesizes the fatty acids having antimicrobic action.

Tranzitorny (temporary) microflora is presented by microorganisms, temporarily lodged on skin of hands, they colonize blankets of skin and have the greatest epidemiological value. Tranzitorny microflora can consist of any microorganisms, including pathogenic including causative agents of nozokomialny (intrahospital) infections, such as Escherihia coli, Klebsiella spp, Pseudomonas spp, Salmonella spp., St. Aureus (including MRSA), Candidae albicans, rotaviruses, etc. At damage of integuments including during use of inadequate methods of a sink and disinfection of hands, tranzitorny microflora gets into skin more deeply, forcing out resident flora from there.

Transfer of microorganisms through hands depends on various conditions, including on a species of microorganisms, a possibility of their survival on hands, extent of insemination of integuments microorganisms etc. At the same time species composition of microflora of skin of hands of medical personnel depends on a profile of an institution or department and the nature of professional work. According to Central Research and Development Institute of epidemiology (Moscow, the member correspondent of the Russian Academy of Medical Science, professor N. A. Syomina, professor A. P. Kovalyova), the quantity of intrahospital infections in Russia makes 52-60 thousand annually. It is proved that hands of medical personnel are an origin of infections in hospitals in 50-80% of cases, that is hands are one of key factors in transfer of pathogenic microorganisms as from medical personnel to patients, and on the contrary. By results of the analysis of statistics of the American society of control and prevention of diseases (CDC), about 2 million patients annually get intrahospital infections during treatment. So-called nozokomialny or hospital, hospital infections are the reason not only sufferings and the death of patients. They also cause significant economic damage and the USA costs 5 billion dollars annually for expenses on additional hospitalization and expensive treatment by antibiotics. Everything stated once again emphasizes extreme importance of strict observance of the principles of hygiene of hands.

Methods of processing of hands of medical personnel.

Hygiene of hands –  the general term used for definition of such procedures as usual washing of hands, hygienic disinfection of hands and surgical disinfection of hands.

Usual washing of hands is a washing of hands by means of water and usual (not antiseptic) soap.

Hygienic disinfection of hands is carried out for the purpose of reduction of quantity of pathogenic microorganisms on skin of hands, applied in the following cases:

    * before direct contact with the patient;
    * before implementation of invasive procedures;
    * before manipulations with wounds and catheters.
    * before clothing of gloves;
    * after contact with biological liquids of an organism or after possible microbic insemination;
    * before procedures to patients with the weakened immunity;
    * before inspection of the pure site after contact from a kontaminirovana a body part, etc.

It is proved that hands of medical personnel are an origin of infections in hospitals in 50-80% of cases, that is hands are one of key factors in transfer pathogenic "microorganisms as from medical personnel to patients, and on the contrary.

Surgical disinfection of hands can be carried out with use of special antiseptic compoundings during surgical washing. There are two ways of hygienic disinfection of hands: hygienic washing of hands and processing (wiping) of hands antiseptic agent.

Hygienic washing of hands is a washing of hands by means of water and soap or other detergent containing antiseptic drug. As a result of hygienic washing the most part of tranzitorny microflora is removed, however even at routine washing some sites of skin (internal surfaces, finger-tips) remain kontaminirovana.

Processing of hands an antiseptic agent is more often put into practice and by results of laboratory researches is more effective. Hands wipe with enough an antiseptic agent without addition of water to it prior to the beginning of and during the procedure (most often it is drug on the basis of a combination of alcohols with various antiseptic additives) that skin remained wet during necessary time of exposure from 30 to 60 depending on recommendations of the producer. Most carefully at the same time it is necessary to process nails and finger-tips.

Hygienic processings of hands (with use of an antiseptic agent) after performance of medical manipulations it has to be carried out before washing, and not vice versa, to avoid contamination of surrounding surfaces pouring out of the contaminated water. At care of patients with the infections caused spore-forming bacteria (for example, Clostridium difficile), use only of antiseptic agents without preliminary washing of hands will not provide reliable decontamination because they have no sporotsidny. activities. In such cases and also if skin needs to be cleared of visible contaminations (including an organic origin), the previous hygienic washing of hands is an antiseptic agent, obligatory before processing of hands.

Important condition of efficiency of hygienic processing of hands is observance of the following rules:

    * when carrying out hygienic disinfection of hands by rubbing it is necessary to apply with a spirit antiseptic agent means on a palm of one hand and to pound on all surface of brushes and fingers of both hands before their full drying.
    * when washing hands they at first should be moistened with water, then to cause necessary quantity of means and to carefully wipe hands at least during 15 with to process all surface of brushes and fingers, then to wash up hands water and carefully to dry up them by means of a one-time towel which to use for closing of the crane;
    * it is reasonable to use small pieces of soap and to apply supports in the form of lattices to its bystry drying.
    * it is not recommended to use reusable towels from fabrics.

Surgical disinfection of hands is a processing of hands before an operative measure, providing removal tranzitorny and reduction of quantity of resident microflora of hands.

Surgical disinfection of hands can be carried out with use of special antiseptic compoundings during surgical washing. Such way is applied already long time, and the used compoundings are known long ago. These are such as processing hlorgeksidiny biglyukonaty (Gibitan), a compounding of S-4 (Pervomur), etc. The specified antiseptic compoundings rather aggressive for skin, especially considering the frequency of use by their medical personnel which take part in operative measures. Besides, leads to mechanical injuries of skin, emergence of microtraumas also use during surgical washing of special brushes using above-mentioned antiseptic compoundings.

Use for surgical disinfection of hands of the antiseptic agents made on the basis of a combination of alcohols with other antimicrobic additives is perspective for today. Such drugs are characterized by bystry adverse effect on microflora, high antimicrobic properties. For surgical disinfection of hands the same drugs, as for hygienic disinfection can be used, at the same time the difference consists in increase in quantity of an antiseptic agent at one processing (from 6 - 10 ml – wrists and forearms need additional processing) and extension of times and exposure up to five minutes, is dependent on recommendations of the producer. During processing  it is not obligatory to use brushes.

For the purpose of reduction of quantity of the microorganisms breeding on skin of hands under gloves use of antiseptic agents with components which provide the antimicrobic action prolonged in time is quite effective. Reduction of quantity of resident bacteria of skin of hands at members of surgical crew during operation reduces risk of hit of bacteria by the site of a surgery field in cases piercing or a breaking of gloves during operative measures.

For effective carrying out surgical disinfection of hands it is necessary to follow the following rules strictly:

    * before surgical disinfection it is necessary to remove rings, rings, hours and bracelets;
    * to wash hands with water with soap, it is desirable liquid (use of antiseptic soap is not obligatory);
    * to dry carefully by means of sterile napkins (before processing by an antiseptic agent skin has to be absolutely dry therefore rubbing in of an antiseptic agent in the moistened skin leads to its cultivation, decrease in effective concentration and as a result - to impossibility of achievement of desirable result.
    * during processing sites of skin have to remain moistened with an antiseptic agent, at the same time drug is applied on hands in the portions on 3-5 ml;
    * to completely dry up skin before clothing of sterile gloves for the purpose of the prevention of intensive reproduction of microorganisms that can occur in a wet layer.

From available antiseptic agents the safest are alcohols, at the same time to alcohol is inherent less irritant action, than propyl or isopropyl to alcohol.

Side effect of antiseptic agents on skin of hands of personnel.

According to various researches, about 25% of nursing staff feel symptoms and symptoms of dermatitis with localization on skin of hands. The irritation of skin connected with use of antiseptic soap can be caused as the antimicrobic substance which is its part and other components. Also leads injuries of skin to change of structure of its microflora, increasing the frequency of colonization of a stafilokokkama and gram-negative microorganisms.

From available antiseptic agents the safest are alcohols, at the same time ethyl alcohol is inherent smaller irritating action, than n-propyl or isopropyl - m alcohol. Most often contact dermatitis is observed when using an iodoform. Others of antiseptic agents which can cause contact dermatitis: хлоргексидин, chlorxyflax, triclosan and alcohol-containing means. However the following can be factors, the contact dermatitis causing emergence connected with frequent washing of hands: use for washing of very hot water, low relative humidity of air (especially during the winter period), insufficient use of protective creams, poor quality of paper towels and an allergy to latex.

It is worth noticing what most often is the reason of a contact allergy when using means for hygiene of hands fragrances and preservatives, and is more rare - emulsifiers. Liquid soap, lotions and creams may contain the ingredients capable to cause contact allergic reactions in medics. Alcohol-containing means for hygienic disinfection seldom become the reason of allergic dermatitis, but it is necessary to consider that for strengthening of antimicrobic properties alcohol-containing drugs combine with various substances, for example, with the quarternary ammonium connections (QAC), lactic acid, a hlorgeksidin biglyukonaty, to an oktenidin a hydrochloride etc.

Recently in the market of antiseptic agents new antiseptic agents in the form of gels are offered.

Thanks to their compounding such drugs are suitable for antiseptic processings of skin, especially sensitive to irritations.

For prevention of developing of contact dermatitis it is reasonable to consider the possibilities of reduction of risk of their emergence which can treat:

    * reduction of frequency of use of revellents (especially anion detergents);
    * replacement of the means having strong irritant action on those that irritate skin less;
    * training of medics in the correct use of antiseptic agents;
    * providing medics with conditioning agents behind skin and protective creams.

Reduction of frequency of use of antiseptic agents for hygiene of hands is undesirable strategy, considering the low level of respect for hygiene of hands by medics. Implementation in practice of alcohol-containing antiseptic agents with the softening  additives allows to reduce the frequency of impact on personnel of the irritating substances (soap and detergents).

General approaches to the choice of antiseptic agents

Administration of treatment and prevention facility has to take into account that thanks to acquisition of more effective antiseptic agents practice of hygiene of hands improves, so, it is possible to prevent developing of intrahospital infections. The attention of only several cases of intrahospital infections compensates the additional expenses of LPZ connected with acquisition of more effective remedies for hygiene of hands.

At the choice of an antiseptic agent for hygiene of hands needs to consider the opinion of personnel of compatibility of antiseptic agents with skin, frequency of emergence of irritations owing to their use.

The cost of means for hygiene of hands should not be a major factor at their choice, disinfectants with low price may contain not the highly effective additives on care of skin preventing developing of an allergy, irritations of covers of skin.

Cost value of antiseptic agents depends also on the price of actively active ingredients, especially alcohols, antimicrobic additives which are their part and can have different extent of cleaning and other important characteristics, at last also influence quality of means.

It is necessary to remember that it is desirable to apply the corresponding various antiseptic agents to processing of hands, an injection and surgery field. When developing a compounding of antiseptic agents for hands special additives on care of skin are added to them, are very necessary at constant routine use, but are undesirable and are even harmful when processing skin of patients before injections, manipulations.