Lesson number 3                       Topic: «Infectious safety. Nosocomial

infections. Prevention of nosocomial infections"

Prevention of nosocomial infections

Профилактика ВБИ включает в себя:

• Соблюдение санитарно-эпидемиологического режима.

• Соблюдение правил госпитализации пациентов.

• Соблюдение режима питания пациентов.

• Специальная обработка медицинского оборудования.

• Использование специальной одежды, защитных средств.

• Выявление и изоляция инфекционных пациентов.

• Соблюдение правил сбора, хранения, утилизации отходов в лечебно-профилактическом учреждении.

Prevention of nosocomial infections include the following:

• Observance of sanitary-epidemiological regime.

• Observance rules of patients hospitalization.

• Observance rules of the patient's diet.

• Special processing of medical rooms and medical equipment (disinfection and sterilization).

• Constant use of special clothing and protective equipment.

• Identification and isolation of infectious patients.

• Collection, storage and transportation of waste.

МЕДИЦИНСКИЕ ОТХОДЫ.MEDICAL WASTE

CLASS "A". Not dangerous waste It is non-toxic waste, not having contact

with body fluids of patients, infectious patients.

Not dangerous CLASS "A" is formed:1. In the wards in all structural units of

LPU2. In administrative quarters3. in the buffet, in the nutrition unit        4. In the territory of hospital. Territory

infectious, dermatovenerologic, tuberculous  hospitals is exception.

Not dangerous CLASS "A“ is collected in a disposable package (packages, cans) white colour.

CLASS "B". Dangerous waste. Dangerous waste is potentially infected waste, contaminated by secretions and blood of patients.

Places of formation:• Operating rooms• Resuscitation department• Treatment rooms, dressings rooms, manipulation rooms• Infectious and dermatovenerologic departments• Anathomyc-and-pathology department• Microbiological laboratories• Vivarium

Собирают в одноразовую герметичную упаковку (пакеты,баки) жёлтого цвета.

Маркировка - «Опасные отходы. Класс «Б», код подразделения, название ЛПУ, дата, ФИО ответственного за сбор отходов. 5

Dangerous waste CLASS «B» is collected in a disposable hermetic package (packages, cans) yellow colour.

Marking - Dangerous waste. Class «B», code of department, name of the

hospital, date, name of the responsible for collection of waste.

КЛАСС «В».Чрезвычайно опасные отходы.

CLASS «C". Extraordinarily dangerous waste.

Отходы, контактирующие с больными особо опасными инфекциями.

• Места образования:1. отделения для

пациентов с особо опасными и карантинными инфекциями

2. фтизиатрические отделения и больницы

3. микологические больницы

4. материалы от пациентов с анаэробной инфекцией

CLASS «C» is waste contacted with sick of especially dangerous infections.

Places of formation waste CLASS «C»:1. departments for patients with

especially dangerous and quarantine infections

2. tuberculosis hospital and departments3. mycological hospitals4. materials from patients with

anaerobic infection.

Waste CLASS «C» is collected in a disposable hermetic package red colour (packages and hard packing).

Marking - "Extraordinarily dangerous waste. Class C,code of department, name of the hospital, date, name of the responsible for collection of waste.

КЛАСС «Г». Близкие к промышленным.

CLASS "D” - analogous to industrial

Waste CLASS «D» is

• expired medicines,

• used disinfectants,

• waste from pharmaceutical and diagnostic products,

• cytostatic drug and other chemicals,

• mercury-containing objects,

• medical apparatus and equipment.

Waste CLASS «D» is collected in a disposable hermetic package (packages, cans) black colour.

Marking - Waste. Klass D, code of department, name of the hospital, date, name of the responsible for collection of waste.

КЛАСС «Д». РадиоактивныеCLASS «E». Radioactive waste

Waste CLASS «E» is all kinds of waste containing radioactive components.

Places of formation:1. Diagnostic laboratories or departments2. Radioisotope laboratory3. X-ray rooms

Collection, storage and removal waste of this class carry out in accordance with the rules for work with radioactive substances.

Первый этап сбора отходов. The first stage of waste collection.

1. Disposable medical products are collected in a soft hermetic package with marking for each class of waste.

2. Needles and other sharp instruments are collected in a hard package.

3. Wastes of Class "B" and «C» should be exposed to compulsory disinfection before collection in disposable packaging in the places of primary collection

The second stage, the third stage of waste collection, storage and transportation.

Nursing staff transports waste from place of collection in the places temporary storage (Sanitary room) and puts in a hermetic, waterproof container on wheels. Container volume 20 - 50 liters.

Четвёртый этап.Fourth stage.

Transportation of waste from places temporary storage in a specially ground on the territory of treatment-and-prophylactic institutions, equipped by containers (at the end of the working day).

Пятый этап. Утилизация отходов.Fifth stage. Recycling of waste.

Centralized export of waste is carried from the territory of hospital in special machine with closed truck body daily.

Waste CLASS «A» may be buried in ordinary landfills for disposal of hard waste.

Waste CLASS «B» and «C» must be destroyed in special plants for waste neutralization of hospital by thermal methods.

Transportation, waste neutralization and burial waste CLASS «D» is carried out in accordance with hygiene requirements of waste neutralization and burial of toxic industrial waste.

Removal of waste CLASS «E» is carried out in accordance with the rules for work with radioactive substances and other sources of ionizing radiation.

Disinfection• Disinfection - is the destruction of pathogenic and conditionally

pathogenic microorganisms in the air, on-site equipment and medical products in the treatment-and-prophylactic institution.

Objectives of disinfection:

1. Prevention of nosocomial infections (HI).

2. Interruption ways of transmission infection, the destruction of the infectious agent.

ДЕЗИНФЕКЦИИ ПОДЛЕЖАТ

OBJECTof DISINFECTION.

1. Все виды поверхностей в больнице (стены, пол, мебель и другое).

Изделия медицинского назначения.2. Руки медицинского персонала.3. Кожные покровы пациента.4. Предметы ухода за больными.5. Воздух в помещениях.6. Постельные бельё.7. Посуда.8. Медицинские отходы и другие

предметы, которые могут быть факторами

передачи ВБИ.

1. All types of surfaces in hospital (walls, floor, furniture, etc.).

2. Medical products.3. Hands of medical personnel.4. Skin of the patient.5. Objects for nursing.6. Indoor air.7. Bed linen.8. Tableware.9. Medical waste and other objects

that may be factors of transmission of nosocomial infections.

TYPES OF DISINFECTION:

• Preventive disinfection• Focal disinfection

PREVENTIVE DISINFECTION is aimed at preventing the occurrence of infections, in the absence of the focus of infection. It is provided in the treatment-prophylactic institution, is carried out by medical personnel (orderlies, junior medical personnel,

nurses).

Preventive disinfection is carried out in three forms:

1. Preventive planned disinfection is carried out in the hospital continuously; is carried out according to the plan maked accordingly with peculiarity of hospital departments.

2. Preventive disinfection on epidemic indications is carried out with the occurrence of nosocomial infection in one from hospital departments (or in one from chambers). For example, the patient is ill by the influenza in the one ward. Purpose - prevent the spread of infectious agents in other departments.

3. Preventive disinfection on sanitary and hydenic indications is carried out once at the contamination.

Focal disinfectionFocal disinfection (antiepidemic) is carried out in the case of

appearance of infectious disease or at the suspicion on it.  

It is carried out in two forms:1. Focal current disinfection – is conducted constantly in a

treatment-prophylactic institution or at home surrounded by the patient (or Bacillicarrier) after detection in a patient of nosocomial infection and before discharge (or transfer to another Department/hospital).

2. . Focal final disinfection – is carried out once after, after discharge or death, the hospitalization the patient in an infectious hospital.

Methods of disinfection:

1. Mechanical method (soil removal):• wet cleaning rooms and equipment• tapping out of clothes, bedclothes• dust removal, repair of rooms• scrubbing the hands of personnel.2. Chemical method - with using disinfectants.• irrigation• wiping• total immersion• spraying3. Physical method - thermal, most reliable and

harmless to personnel.• using of sunlight• bactericidal lamp• ironing, calcination by high temperature• incineration of waste• boiling• pasteurization

• tyndalization (fractional pasteurization)• air method (in a dry-heat tool cabinet)• steam method (steam treatment -

autoclaving)• processing the objects in special chamber

by high pressure.4.Combined method - a different combination

of physical and chemical methods of disinfection.

5. Biological method - the destruction of pathogens using microbies-antagonists (bacteriophages).

Disinfection efficiency depends on:

1. on the stability of the microorganism2. quantity of microbies3. concentration of disinfectant4. presence of organic substances on the objects (blood, feces,

sputum)5. exposition6. method of processing (wiping, irrigation, total immersion in

disinfectant)7. texture of processed objects

Контроль качества дезинфекции

Quality control of disinfection

1. Visual control – the assessment of sanitary condition of the rooms, result current and general cleaning, at the proper concentration of disinfectants.

2. Chemical control - determination of the concentration of ready disinfectants, express test - paper test-strips and control color scale.

3. Bacteriological control - taking wash-out and inoculation. This analysis is conducted by laboratorian from Hygiene and Epidemiology Center.

Виды дезинфицирующих средств.

Types of disinfectants:

1. Для дезинфекции изделий медицинского назначения

2. Для дезинфекции помещений, предметов обстановки и ухода

за пациентами3. Кожные антисептики 26

1. For disinfection of medical products.

2. For disinfection of rooms, furniture and objects of nursing for patients.

3. Dermal antiseptics.

Requirements for disinfectants:

1. Wide spectrum of actions2. low toxicity3. Good solubility in water4. Activity in small concentrations5. Minimum time of effective exposure6. Stability at the storage (expiration date)7. Convenient transportation8. Disinfectant should not damageprocessed objects.

Safety rules when working with disinfectants1. Proper storage of disinfectants.2. Labelling - the name, appointment, date of manufacture and expiration date.3. Observance the rules of personal hygiene (a special gown, kerchief, respirater,

goggles, rubber gloves, removable shoes)4. Use ventilation at the preparing solutions

First aid for poisoning by disinfectants

1. After contact with skin - wash them immediately with water.2. Eye contact - rinse immediately with water, to inject drops into

the eye (30% albucid, 2% novocaine solution – 1-2 drops.3. In case of irritation of the respiratory tract - to go to another

room or fresh air, rinse the mouth and nasopharynx with water (if necessary appoint hearty, soothing, antitussives remedies).

Disinfection of medical room:

• Wet cleaning of medical rooms involves the processing of flooring, furniture, equipment, window sills, doors.

• Wet cleaning of medical rooms is carried out twice times a day (at least) with the use of detergents and disinfectants.

• General cleaning of functional rooms and wards of the hospital is carried out at least once in a month.

• General cleaning of operating units, dressing, maternity halls, treatment room, sterilization room once a week.

The scheme of the general cleaning of the treatment room:

1. Clear the furniture from the objects (journals, medicines, etc.), take out from the room.2. Turn off and release the refrigerator contents.3. Move away the furniture from the walls to the center of the room.4. Put on protective clothing: gown, kerchief or medical cap, closed shoes, respirator,

goggles, medical gloves.5. Prepare clean labelling inventory and rags.6. Prepare working solutions of the necessary concentration of disinfectant, pour into the

apparatus for irrigation.7. Irrigate with disinfectant furniture, walls, window sills, baseboards, floor, doors.8. Leave on at the time of exposition, include bactericidal lamp.9. Furniture and equipment put into previous place, wipe doubly by rag wetted disinfectant.10 . Carry out repeated irrigation of floor with disinfectant.11. Wash off with running water after exposition.12. Switch on bactericidal lamp. Switch off after exposition.13. Ventilate the room.14. Carry out disinfection of cleaning inventory.15. Make the record of conduction the general cleaning in the «journal of recording general

cleanings» and «journal of registration and control of working bacericidal lamp».

Схема обработки изделий медицинского назначения

Scheme of processing of medical devices

Изделия медицинского назначения

Медицинские предметы ухода

Многоразовые (грелка, термометр и другое)

Одноразовые (перевязочный материал, шприцы и другое)

Дезинфекция Дезинфекция

Утилизация

Медицинский инструментарий

Дезинфекция

Предстерилизационная подготовка

стерилизация

Disinfection medical equipment Scheme of processing of medical equipment

medical equipment (object)

Medical objects of nursing for

patients

Reusable medical equipment (heater, thermometer, etc.)

Disposable medical equipment (bandage

material , syringes and other)

Disinfection  Disinfection 

Utilization

Medical instruments

Disinfection 

Pre-sterilization processing

Sterilization

Disinfection of medical objects of nursing for patients. Method full-immersion (object of care for patients that come into contact with biological fluids) - bedpan, urinal, oilcloth.

Purpose: ensuring infectious safetyEquipment: protective clothing (gown, apron, mask, gloves), used object of

nursing for patients, disinfectant, a container with lid, marking.Algorithm:• Hand processing, to put on protective clothing, gloves.• Pour the disinfectant in container.• Immerse the object of care for patients in solution after use completely. Leave

at the time required for disinfection.• Take off the protective clothing, immerse it in a container for disinfection.• Dress clean gloves and apron after the ending of disinfection.• Rinse the object of care for patients running water.• Dry the object of care for patients, store in a dry place.• Take off the gloves and apron, wash hands.

 

Disinfection of medical objects of nursing for patients. Method of double wiping (object of care for patients that not come into contact with biological fluids) - hot-water, thermometer, ice pack and etc.  

Purpose: ensuring infectious safetyEquipment: protective clothing (gown, apron, ask, gloves), used object of nursing

for patients, rags (cleaning cloth), medical tray, disinfectant, a container with lid, marking.

Algorithm:• Hand processing, to put on protective clothing, gloves.• Put rags in the tray, pour the disinfectant.• Press out the first rag, wipe the object of care for patients.• Put the rag in a container for disinfection.• Press out the second rag, wipe the object of care for patients.• Put the rag in a container for disinfection.• Rinse the object of care for patients running water.• Dry the object of care for patients, store in a dry place.• Take off the gloves and apron, wash hands.

Стандарт дезинфекции шприцев однократного применения.

Ddisinfection disposable syringesОснащение:

• спецодежда (халат, маска, перчатки),

• дезинфицирующее средство,

• 1 емкость (для дезинфекции шприцов),

• 2 емкость (для дезинфекции игл)

• использованный шприц.

Алгоритм:

• Надеть спецодежду, обработать руки, надеть перчатки

• Налить в емкость дезинфицирующее средство

• Набрать в шприц дезинфицирующее средство из 1 емкости

• Отсоединить иглу во 2 емкости безопасным способом. Оставить на время, необходимое для дезинфекции.

• Шприц поместить в 1 емкость. Оставить на время, необходимое для дезинфекции.

• После дезинфекции шприцы укладывают в пакет (маркировка – класс В).

• Использованные иглы из 2 емкости не вынимаются. При заполнении контейнера дезинфицирующее средство сливается, контейнер плотно закрывается крышкой (маркировка – класс В).

• Утилизация.

Equipment:

• protective clothing (gown, mask, gloves),

• disinfectant,

• 1 container (for disinfection of syringes)

• 2 container (for disinfection of needles)

• used syringe.Algorithm:• Hand processing, to put on protective clothing, gloves.• Pour the disinfectant in containers.• Fill  the syringe by disinfectant from 1 container.

• Disconnect the needle in the 2 container in a safe method. Leave at the time required for disinfection.

• Syringe is placed in 1 container. Leave at the time required for disinfection.

• After disinfection the syringes are placed in a package (marking – class B).

• Used needles are not extracted from 2 container.

• When filling the container by needles, pour out the disinfectant, shut down the container with a lid tightly.

• Recycling.

Дезинфекция использованных ватных шариков и перевязочного материала. Метод полного погружения

Disinfection of used cotton balls and bandages. Method full-immersion.

Оснащение: спецодежда (халат, маска, перчатки), дезинфицирующее средство, емкость с крышкой и маркировкой.

Алгоритм:• Надеть спецодежду,

обработать руки, надеть перчатки

• Налить в емкость дезинфицирующее средство

• Погрузить предмет ухода в раствор после использования полностью. Оставить на время, необходимое для дезинфекции.

• Снять защитную одежду, погрузить в емкость для дезинфекции.

• После окончания срока дезинфекции надеть чистые перчатки.

• Поместить ватные шарики в пакет (маркировка – класс В).

• Снять перчатки, вымыть руки.

Equipment: protective clothing (gown, ask, gloves), disinfectant, a container with lid, marking.

Algorithm:• Hand processing, to put on protective clothing, gloves.• Pour the disinfectant in container.• Immerse the cotton balls or bandages in solution after use

completely. Leave at the time required for disinfection.• Take off the protective clothing, immerse it in a container

for disinfection.• To dress clean gloves after the ending of disinfection.• Place the cotton balls in the package (marking – class B).• Take off the gloves, wash hands.

 

The main stages of processing MEDICAL TOOLS:1 stage. disinfection

2 stage. pre-sterilization

3 stage. control of sterilization processing.

4 stage. sterilization.

1 stage. Disinfection of instruments of medical appointment.

Equipment:• disinfectant solution• 1 сontainer (for lavage)• 2 сontainer (for disinfection)• medical trays• instruments after use in assembled formSome solutions allow to wash off and disinfect the tools in 1 сontainer (2 properties at the same time).Indispensable condition - сonduct disinfection immediately after manipulation.Performance the procedure. Algorithm:1. Dress the special clothing (gown, mask, gloves). 2. Prepare a disinfectant solution, pour it in the containers.3. In first сontainer (for lavage) washed the instrument without disassembling. 4. Disassemble all instruments, immerse in 2 сontainer (for disinfection) with disinfectant solution, filling internal

channels of instruments.5. Close the container by lid. Leave at the time required for disinfection.6. Take off the gloves, immerse in a container with disinfectant.7. Put on other gloves, derive the instrument at the end of the exposition time. 8. Put on instrument in the medical tray.9. Wash out the instrument under running water.9. To prepare reusable instruments for further processing (for sterilization).10. Disposable syringes put into packet yellow colour for utilization.11. Pour out used disinfectant in sewerage.12. Take off the gloves and put in disinfectant solution, wash and dry your hands.

2 stage. Pre-sterilization processingIf the instrumentation has been in contact with mucous

membranes and wounds, including operating, the disinfection insufficiently. Sterilization is required. Pre-sterilization processing is carried out before sterilization.

The purpose of pre-sterilization processing - remove all small particles, medicinal products and protein contamination remaining after the operation or manipulation.

Specially prepared solutions uses during pre-sterilization processing.

The solution includes:

• water,

• hydrogen peroxide,

• cleaning agent.

Medical instrumentation are soaked in disassembled, all items are completely submerged in the solution with the filling of all cavities.

Pre-sterilization processing. Algorithm

ОСНАЩЕНИЕ• специальный раствор• лотки • щетка для мытья• емкость с дистиллированной

водой • сухожаровой шкаф

• инструменты после использования в собранном виде

Алгоритм:• Надеть спецодежду (халат, маска,

перчатки)• Приготовить раствор.• Поместить инструменты в

раствор• Обработать инструменты щеткой• Поместить инструменты в лоток• Промыть проточной водой• Ополоснуть инструменты в

дистиллированной воде• Просушить в сухожаровом шкафу

Equipment:• special solution• medical trays

• brush for washing tools

• сontainer with distilled water

• dry-heat Cabinet

• instruments after use in assembled form

Algorithm:• Dress the special clothing (gown, mask, gloves). • Prepare a disinfectant solution• Immerse the instruments in special solution.• Process the instruments by brush.• Wash out the instrument under running water.• Rinse tools in distilled water.• To dry in a dry-heat cabinet.

• To reduce the time of processing surgical instruments can be used are special solutions. They allow perform the disinfection and pre-sterilization processing at the same time.

• The method of physical processing can be used to lighten the work of nurses, reduce the risk of infection contamination, reduce the processing time of surgical instruments.

• For example, apparatus of ultrasound processing.

3 stage. Сontrol of sterilization processing.Quality control disinfection and pre-sterilization processing is carried out daily,

under the guidance of senior nurse (biological and chemical analysis).

• 1 test. Phenolphthalein test – for the presence of detergent (pink coloration).

• 2 test. Amidopyrine test – for the occult blood (blue-green color).

• 3 test. Azopiram test – for the occult blood, for the presence of detergent, chlorine.

If tests on blood or on the remnants of detergents is positive, the medical instruments cleans again (to negative results).

4 stage. Sterilization

• Sterilization - is the destruction of microorganisms and their spores by exposure to physical factors and chemicals matters.

• Medical device and instruments, penetrating into sterile tissue or the vessels, contacting with blood or injectable solutions is "critical" items. They must to undergo sterilization in order to all kinds of microorganisms were destroyed.

МЕТОДЫ СТЕРИЛИЗАЦИИ.

Methods of sterilization.

1. Физический метод - паровой, воздушный,

гласперленовый, инфракрасный, ультрофиолетовый, ультрозвуковой.

2. Химический метод - газовый, плазменный.

Стерилизация изделий медицинского назначения осуществляется в централизованных

стерилизационных отделениях (ЦСО).

1. Physical method:• steam, • air, • glasperlenovy, • ultrasonic,• ultraviolet radiation,• infra-red.2. Chemical method:• chemical solution,• gas. Sterilization of medicine products is

carried out in a centralized sterilization departments.

centralized sterilization departments

В клинической практике чаще всего применяется термический (физический)

In clinical practice most commonly used physical method of sterilization.

• Physical steam method sterilization (аutoclaving) – processing with hot steam under overpressure.

Все медицинские изделия , стерилизуемые паром под давлением, помещают в специальную упаковку:

All products are sterilized by steam under pressure, is put in special packaging:

Стерилизационные упаковки1. Многоразовые

стерилизационные коробки (биксы)

2. Упаковки из двухслойной хлопчатобумажной ткани

3. Крафт-пакеты из плотной бумаги Все 3 вида упаковок маркируют.

Sterilization packaging:1. Reusable metal sterilizing box 2. Package of two layers cotton

cloth3. Kraft paper-bags of dense

paper. All kinds of special packages are

marking.

The notion of autoclaving.

Two regimes of sterilization (for autoclaving) are recommended use in treatment-and-prophylactic institution:

1. First regime sterilization is designed for products of fabric, glass, corrosion-resistant metal. Temperature 132 ° C, pressure of 2 atm, time 20 minutes.

2. Second regime sterilization (sparing regime) is recommended for the products of thin rubber, latex and certain types of polymers. Temperature of 120° C, pressure of 1.1 atmospheric, time 45 minutes.

СТЕРИЛИЗАЦИЯ ГОРЯЧИМ ВОЗДУХОМ (в сухожаровом шкафу).

Hot air sterilization (in a dry-heat cabinet)

Dry-heat method - the influence of dry air; use hot-air-sterilizer with different modifications.

This type of sterilization is recommended for metal products and glass. Temperature - 180 ° C, exposition - 60 min.

Control of sterilization is carried out by indicators of temperature and pressure control.

Conduct a journal of sterilization.

Chemical method - sterilization of chemical solutions.

• This is a helper method because of a medical product cannot be sterilized in the package, after sterilization, the instruments must be rinsed by sterile fluid.

• This method is used for sterilization of thermolabile products from the material.

• For example, eye pipettes, rubber balloon for enemas.

Terms of sterility.

1. Metal sterilizing box without filter - keep 3 days.

2. Metal sterilizing box with filter - 20 days.

3. Package of two layers cotton or kraft paper-bags - to 3 days, in sterile conditions.

• 80% of infections are transmitted by hands.

• Intestinal infection, purulent infection, acute viral hepatitis, even the grippe.

Hand hygiene as a preventive measure against infections.

There are three stage of hand processing:

1 stage . Hygenic washing of hands

2 stage . Hygienic processing of the hands

3 stage . Scrubbing of hands (surgical stage)

Hygenic washing of hands – mechanical processing of hands, washing hands with soap and water - removes most part of the transitory (temporary) microflora from skin   

1 stage is carried out:1. before meals2. before feeding patients3. before work with products4. before and after nursing of the patient5. after visiting the toilet6. for any contamination.

1 stage of hand processing:

2 stage of hand processing:

Hygienic processing of the hands- processing hands with use of skin antiseptics (contributes to a more effective removal of the transitory microflora)    

2 stage is carried out: 1. before and after invasive procedures2. before nursing for the patient with weaken immunity3. before and after care of wound and use urinary catheter4. before and after putting on the glove5. after contact with biological fluids6. before performing various manipulations for nursing for the

patient

SURGICAL scrubbing of hands - scrubbing of hands by any surgical interference

Conduct in two stages, with putting on sterile gloves:

first stage – mechanical scrubbing of hands, wrists and forearms

second stage – scrubbing of hands, wrists and forearms by antiseptic

Algorithm hygenic washing of hands:

Algorithm hygenic washing of hands:

• Moisten hands with water. To take of a little liquid soap, to lather his hands.

• Рosition of the hands - palm to palm. Rub together 10 seconds.

• Рosition - right palm over back of the left hand with intertwined fingers. Rub 10 seconds.

• Рosition - left palm over back of the right hand with intertwined fingers. Rub 10 seconds.

• Рosition of the hands - palm to palm. Rub the interior surface of the fingers. Rub 10 seconds.

• Рosition - the back of the fingers to the palm of the other hand. Rub 10 seconds.

• Rub the thumb with the palm of the other hand by rotational movement.

• Рosition. Circular motion with the tips of the fingers on the palm.

• Repeat each movement not less 5 times.

Technique putting on sterile gloves:Equipment: pack of sterile gloves.

Algorithm:

• 1. Pull out and unfold the package with gloves.

• 2. Take the glove for a top with left hand so that the fingers touched the inner surface of the glove.

• 3. Fingers of the right hand connect and to enter them into a glove.

• 4. Enter the fingers into glove, not breaking her lapel (cuff).

• 5. Enter the 2nd, 3rd and 4th fingers of the right hand under a lapel (cuff) of left glove from the outer side. The first finger of the right hand should be pointing towards the 1-st finger of the left glove.

• 6. Keep the left glove by 2-nd, 3-rd and 4-th fingers the of the right hand vertically. Fingers of the left hand connect and to enter them into a glove.

• 7. Straighten the lapel of left glove, having pulled it on a sleeve.

• Enter the 2nd, 3rd fingers of the left hand under a lapel (cuff) of right glove from the outer side, straighten the lapel of right glove, having pulled it on a sleeve.

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• !!! If one glove was damaged, it is necessary change both, because you can't take off one glove, not contaminating another.

Glove removal: Equipment: pack of sterile gloves.

Algorithm:

• 1. To make a lapel by fingers of the right hand on left glove, touching only of the outer side.

• 2. To make a lapel by fingers of the left hand on right glove, only of the outer side.

• 3. To take off a glove from the left hand, turning inside out, pulling by the lapel.

• 4. Hold the removed glove right hand.

• 5. Take the right glove for the lapel on the inside.

• 6. To take off a glove from the right hand, turning it inside out, pulling by the lapel.

• 7. To place gloves in the container with a disinfectant.