RECOMMENDATIONS

1. In surgical hand wash, its important to make that the workers of the health to go to the washstands and not the technique that is used or the agent that is selected.

2. Its important to become conscious about the benefits of carrying out an appropriate surgical hand wash and the sanitation in each activity that we carry out with our patients, for this reason the coordinators of areas they should motivate their personnel and to look for that the recommendations are continued for handling of patient, using the resources within their reach as the example.
3. The crossed transmission of microorganisms able to be infected can present of patient to patient, and occasionally also you the professional can be affected or what is worse her family.



4. Until the present the microorganisms have generated multiple defense mechanisms, being made more and more resistant, BUT NONE has GENERATED RESISTANCE TO SURGICAL HAND WASH.

TECHNICAL OF SURGICAL HAND WASH

Surgical hand wash is the simplest, economic and important procedure, for the prevention of the Infections on hospitals, being able to reduce until in 50%, when it is carried out the procedure in an appropriate way for all the officials.

TO CLINICAL HAND WASH

OBJECTIVES: To remove the dirt, the organic material

and to diminish the concentration of bacteria or transitory

flora, acquired by recent contact with patients.

TECHNIQUE:
•Uses water and antimicrobial liquid soap
•To wet the hands with water, use 1 soap application, to scrub

vigorously for 10-15."
•To cover all the surfaces of hands, fingers and fingernails, arriving up to 10 cm below the pleat of the dolls.
•To Rinse with abundant water
•The hands dried off with disposable paper towels.
•For the closing of the key uses the same towel.
•The total time for the procedure is of approximately 30” seconds

SUITABLE SITUATIONS:

•When arriving and when leaving the hospital.
•Before and after the following procedures:
•Invasive procedure like placement of an outlying vascular catheter, urinal catheter or taking of samples, etc.
•To Measure central nervous pressure or monitoring of pressure vascular
•Cure of wounded.
•Preparation of parenteral solutions.

•To administer parenteral medications
•To aspire secretions of breathing roads.
•To administer and/or to manipulate blood and their derived
•Before and after being potentially in contact with patient infected.
•After making use sanitarium cough, to sneeze or to clean the nose

•Before the contact with patient with alterations in humoral or cellular immunity or with alterations of the integrity of the skin and mucous (burnt, escaras, wounded), or with extreme ages.

SURGICAL HANDWASH

OBJECTIVES:To diminish the concentration of bactteries of the flora resident and to remove the transitory flora completely, acquired by recent contact with patie

TECHNIQUE:
•Was used water and antimicrobial liquid soap (Clorhexidine).
•The key was worked with pedal or with the elbow or photoelectric cell.
•To wet the hands with water, to apply the soap, to rub vigorously for a period of five (5) minutes in the first laundry and of three (3) minutes in the following laundries.
•To Cover all the surfaces of hands and fingers, arriving until above the pleat of the elbows
•To Rinse with abundant water
• During the procedure is recommended to maintain the arms up favoring the glide toward the elbows.
•Was used sterile compress for the drying of hands, fingers and arm.

SUITABLE SITUATIONS
•Before each surgery
•Before each invasive procedure with incision in skin

SOLVE ANTISEPTIC

In accordance with the specifications of the FDA the substances that are used as anti-microbial agents are:

Alcohols + glycerine:
Most of the solutions with base alcoholic use isoprophanol, ethanol, n-propanol or combinations of two products in concentrations of 65 to 90%. it Possesses the time of quicker beginning action; it is not good to eliminate the dirt.

Clorhexidine:
Preparations of clorhexidine gluconate, in concentrations of the 0.5 to 1.0%. It Possesses a period of beginning action intermission and a lingering residual effect; Six (6) hours. It is inhibited by non ionic surfactant, inorganic and organic anions.
Clorhoxylenol:
Fenolic substance with a halogenous substitute knows effectiveness it is good although its biggest strength this in its little absorption through the skin. Their concentration should be between 0.3 and 3.75%.

Iodine:
It is recognized as an excellent ones antiseptic but he/she can it generates irritation of the skin. The solutions with iodine are presented like an alternative but they require a concentration of 8% in soaps and of 10% in disinfectant solutions.

Triclosán:
Non ionic substance that acts as antimicrobial to the being integrated in soaps in concentration from 0.2 to 2%.

DEFINITION OF TERMS

TRANSITORY FLORA: Organisms that have been acquired recently by the contact with another person or object. They are acquired through the contact with the patients or infected personnel or colonized or with the polluted surfaces. The organisms vary and they depend on their origin. And coli, Pseudomonas, Serratia, Staphylococcus aureus, Bacillus negative gram, Klebsiella and pneumoniae are temporarily in the workers' of the health hands. These organisms survive in the skin for several periods (from some minutes until several hours or days)

FLORA RESIDENT: organisms that live and they multiply in the skin and they vary of a person to other, they are in general, of low virulence and in strange occasions they cause infections located in the skin. Most of the organisms residents are in the superficial layers of the skin, approximately of 10% to 20% live in the deep epidermal layers and in general they are not pathogens. Among the organisms considered as flora resident the Staphilococus of negative coagulase they are included.

ANTI-MICROBIAL SOAP: Soap that an agent anti-microbial associate contains.

SOCIAL HAND WASH: Is defined as a rub brief of all the surfaces of the hands with soap, followed by mouthwash to the jet of water. Their objective is to remove the dirt,

CLINICAL LAUNDRY: Is defined as a rub brief and energetic of all the surfaces of the hands with anti-microbial solution, followed by rinse of to the jet of water. It looks for to remove the dirt, the organic material and to diminish the concentration of the transitory flora, acquired by recent contact with patient or fómites.

SANITIZACION: The sanitation is defined as a rub brief with antiseptic solution starting from alcohol and emollient, looking for to destroy the microorganisms of the transitory, acquired bacterial flora recently for direct contact with patients, relatives or fómites and to diminish the flora resident. Provided the hands are clean and without contamination with organic material.

SURGICAL HANDWASH: Is defined as a rub energetic of all the surfaces of the hands until the elbows with antimicrobial solution, followed by mouthwash to the jet of water. It looks for to eliminate, the transitory flora and to diminish the concentration of bactteries of the flora resident.

(E. Larson, Ek KretzaR. Compliance with hand washing and barrier precautions. J. Hospital Infection 1995)

PHYSIOLOGY

The skin consists of two layers:

The epidermis is the superior layer that consists of a layer it horns and a germinative layer. The layer horns well-known as Stratum corneum it is formed by cells died in scale form that continually they are flaked because of the friction, as these cells are removed they are replaced by bigger active cells of the germinative layer.

The dermis is located under the epidermis and it is formed by a fibrous matter and thick that stores hair follicles, oily glands and receivers of pressure

(Boyce Jhon M., Pittet Dider. CDC. Guidelines for hand hygiene in health care setting. 2002)

HISTORY OF SURGICAL HAND WASH

For generations the hand wash with water and soap has been considered as part of the personal hygiene. One of the first ones in recognizing the value of the hand wash to maintain a good health a Jewish doctor whose name was Musaiba Maimum was, better acquaintance as Maimonides.

In 1199, he gave this lesson: "Never forget to wash their hands after playing a sick person". The concept of hygiene of the hands arises in the XIX century; when in 1822 a French pharmacist demonstrated that the solutions with chlorine eradicated the entirety of the scents associated with the bodies.

Ignaz PhilIip Semmelweis, was the first one in proving the importance of the hand wash scientifically with antiseptic. It published the results of the studies in 1861, 662 years after the writings of Maimonides.

In 1878, Luis Pasteur presents its report “Theory of the germs and its application in the medicine and the surgery”; during the following years the scientists continued identifying bactteries and its relationship later with the illness.

In 1961 the service for the health it publishes of the United States, it produces a movie with the recommendations and techniques for the hand wash recommended for the workers of health.