Hands processing

Treatment of hands - methods of preparation of hands for operations, dressings and other surgical procedures with the aim of disinfection of skin and prevent germs sterile items and in the wound.
Full sterility of the skin to achieve the impossible. Hands processing can be satisfactory only if the skin had not been contaminated with pus, earth, faeces, there are no cracks, grazes, scratches, corns and burrs. So the medical staff involved in surgery must constantly monitor the skin, preventing its pollution at work and at home. Requires the use of hot baths for hands and the smooth skin of her hands on the night of vaseline with lanolin, a mixture of ammonia, glycerin and alcohol in equal quantities or with a special cream. Nails should be kept short and clean. The basis for various processing methods laid hands mechanical cleaning (washing of water with brushes), disinfection antiseptics and tanning of the skin.
Brushes used for treatment of hand, kept in a soap solution, then boiled in a special vessel. When consuming take them with sterile forceps. Wash hands under running water, opening and closing specially adapted faucet elbow (Fig. 1).
When washing hands in a basin should water (or the solution of ammonia in the processing of the hands of the method of Spasokukotskogo - Kochergina, see below) pour into a sterile pelvis, submitting it, as shown in Fig. 2. There is a sequence of hand washing: first wash hand, then back surface of each finger, interdigital spaces nail bed and subungual space left hand (Fig. 3). Also process the fingers of the right hand. Then wash Palmar and dorsal surface of a brush of the left and right hands, wrists left and right hands and finally, forearm. In conclusion, once again wash the nail bed and subungual space fingers of both hands. Wipe hands sterile towel or cloth in the same sequence. Before and after wiping his hand so that the water forearms did not get a brush (Fig. 4).
With the help of mechanical treatment and application of antiseptics managed to free from germs only the surface of the skin. Deep in the ducts skin glands are saved microorganisms, and after a short time after treatment of hands they, along with the flow and fatty greasing allocated to the skin surface and can contaminate the operating wound. Therefore, great importance is attached to seal the surface layers of the skin through exposure to tanning substances (alcohol, iodine alcohol solution, the solution of tannin and other). Tanning effect of alcohol and other drugs is much more effective if they are applied to dry skin; the effect of tanning lasts 20-30 minutes, just return if the skin is moistened. Too active methods of mechanical and chemical effects irritate the skin, it thickens and starts to peel, which makes it difficult to further processing hands. Of the many methods of processing the hands of the most widespread are the following.
The Way Of Spasokukotskogo - Kochergina. After washing hands without brush under a jet of water them wash in two sterile basins 2.5-3 minutes in each 0,5% freshly prepared with a warm solution of ammonia, using sterile gauze napkins. Washing in this solution results in defatting of the skin. After this hand wipe dry with a sterile towel and within 5 minutes handle 96% alcohol. The nail bed and the ends of the fingers smeared 5% alcoholic iodine solution. At preparation of a solution for washing hands on each 100 ml of hot water take 0.5 ml official ammonia (10% solution Ammonii caustici). Replacement of ammonia other alkalis and detergents not widespread.
The way of Furbringer (modified). Hands washed under running water with soap two sterile brush for 5 minutes each, wipe with a sterile towel and process 1-2 minutes a corrosive sublimate solution 1 : 1000 and 3 minutes 96% alcohol. The ends of the fingers smeared alcoholic iodine solution.
The Way Of Alfeld. Hand wash with hot (45 degrees) with soap and water 10 minutes two sterile brush, wipe dry and treated for 5 minutes 96% alcohol.
Treatment of hands with dicedom: solution of dicida 1 : 5000 heated up to 40-50 degrees and wash their hands napkins in the basins 3-5 minutes, wipe with a sterile napkin and 1-2 minutes handle 96% alcohol. Particularly contaminated hands washed with a solution of dicida 1 : 3000.
Treatment of hands with retseptam: 2 minutes wash hands with soap and water and a brush, wipe with a sterile towel and process gauze napkin moistened 5 to 10 ml rotosept, for 3 minutes
As antiseptics while processing hands applied also novosept, degecid, Atin etc. All existing methods of treatment of hands do not provide their absolute sterility, so most of the operations and surgical procedures performed in rubber gloves (see medical Gloves).

Hands processing complex of measures ensuring the disinfection of the hands of the surgeon and his assistant before surgery. Hands processing is based on the General rules of aseptics and antiseptics, and includes elements of mechanical cleaning, chemical treatment and tanned hand skin.
Methods O. R. divided into 3 groups: 1) preliminary mechanical treatment of skin with water and detergents, environmental impacts, antiseptics and tanning; 2) anhydrous (impact antiseptic substances and tanning);3) based only on tanning. In medical practice, the most common methods of the 1st group.
When O. p. peculiarities of the structure of the skin; germs are nesting in the folds of skin at the base of the hair, in the excretory duct of the sebaceous and sweat glands, nails And okolonogtevogo rollers. For disinfection of the skin it is necessary, first, to cleanse it, and, secondly, to make it impossible to receive content skin glands on the skin surface. The first is achieved by washing hands with brush, hot water and soap and other means of mechanical treatment. This is loosened the epidermis and removed exfoliating part of it, to purify sebaceous and sweat glands.
After mechanical cleaning of the skin begin to its chemical sterilization. Used for this purpose substances should be harmless to the skin, to provide sufficient bactericidal effect in the short-term impact and do not lead to permanent staining of the skin. Tanning has the purpose to prevent rejection of the epidermis, cause wrinkling of the skin and thus to block the access of micro-organisms of the ductless glands. It is usually done 96 grades alcohol, though there were other tanning funds. Treatment alcohol combines disinfection and tanning. Diluted alcohol (70-80 degrees) penetrates deeper into the skin, providing antiseptic effect; tanning same effect it insufficient.
Mechanical cleaning of hands at any of including its methods is performed in a certain sequence. The first brush or in the first clean water fingers, palm and back of the hand, forearm to the proximal third, then second brush or in the second water do the same thing, but until the middle of the forearm. It is necessary to watch, that water flowed on the skin of hands from fingertips to elbow, and not Vice versa.
According to the old method of Furbringer hands washed in running water with soap and two brushes, each 5 minutes, rinsed within 1 minutes at 80 degrees alcohol and immersed in 1-2 minutes in a solution of sublimate 1:1000; tanning not been conducted. Alfeld refused to wash the sublimate and offered to wash their hands brush with soap and hot water (3-5 minutes) and RUB 96 grades alcohol (3 - 5 minutes).
Method Spasokukotskogo - Kochergina, received in the USSR wide application, hands wash cloths in a warm 0.5% solution of ammonia, prepared ex tempore 2 basins 2.5-3 minutes each. Weak alkali amylee fats, removing together with them microorganisms. After this hand is dry with a sterile towel and wipe 3-5 minutes cotton wool or gauze soaked in 96 degree of alcohol. Some surgeons have completed the processing of hands, lubricating ends of the fingers, especially nails, 5% tincture of iodine.

The best results mechanical cleaning gives handwashing synthetic surface-active substances - dry or greasy emulsifiers, soluble in water and foaming with high permeability. Alkylsulfate sodium (powder "News") are used in the form of 0.1% solution at a water temperature of 40 degrees or 0.2% solution at a temperature of 20 degrees. Hand wash cloths in the two basins, 2 minutes each. DIACID can be applied at a concentration of 1:5000 (hand wash wipes 5 minutes) or 1:3000 (3 minutes). Hands processing 96 grades alcohol for 3 minutes, as if all of the described methods.
Of anhydrous can be mentioned methods Brun (handwashing 96 grades alcohol within 10 minutes; alcohol is poured into a bowl and not rubbed into the skin) and Hasner (handwashing 0.1% solution of iodine in gasoline with subsequent lubrication iodine-vaseline. Both of these methods are not widely used: the first because of the insecurity, the second causes severe dermatitis. Hand washing solution of tannin in alcohol (Zabludovskij - Tatarinova) or water (Pokotilo) and solutions brilliant green (buccal) has not become widespread because of the harmful effects of these substances on the skin.
With any method of treatment of hands can be achieved only relative and unstable sterility hand, cannot guarantee aceptic operations. The most reliable use of gloves (see medical Gloves), however, even in gloves, cannot be reduced attention to O. R.
Hands in gloves sweat. The sweat accumulating in gloves ("glove juice"), always contains microorganisms which when damaged gloves fall into the wound. To hand in gloves are not sweating, Makeev offered a liquid containing TNT - 1 year, acetone - 7 g distilled water - 25 ml and glycerin - 5, After washing by hand soap handle two napkin moistened in this fluid, for 2 and 1 min. However, when the frequency of its application is developing dry skin.
During the operation (especially long-term) may be necessary to re O. R. Often wash hands with 0,5% solution of ammonia, and gloves - corrosive sublimate solution 1:1000, and then the hands and gloves wipe alcohol. It should not be cleaned with alcohol is not washed from blood hands, so as alcohol captures the blood on the skin. If in the process of operation gloves must be changed, before putting on a new pair of gloves, a surgeon rubs hands with alcohol.
In order to avoid contamination of the hands of the surgeon must not before operation without gloves to bandage purulent wounds or any other manipulation that threatens contamination of the hands.
At home avoid work, contributing to the coarsening of the skin or their contamination with pathogenic microbes, as well as to protect hands from injury.
Hand care must be systematic and include skin softening, cutting burrs and nails. To cover the nail varnish is unacceptable. It keeps the skin lubrication her after the surgery and before bedtime cream or liquid following composition: alcohol, ammonia and glycerin in equal amounts. If the hands of the surgeon has pustules or infected scratches, it must refuse participation in the operation.

Fig. 1. Opening of a crane while processing hands. Fig. 2. Proper submission of the basin for washing hands. Fig. 3. Wash nails. Fig. 4. Proper hand position when wiping.