Order 111 hand washing. Hand washing technique in medicine: sequence of movements

Approve the attached changes that are being made to the procedure for issuing permission to conduct clinical trial medicinal product for medical use, approved by order of the Ministry of Health and social development Russian Federation dated August 26, 2010 N 748n (registered by the Ministry of Justice of the Russian Federation on August 31, 2010, registration N 18317).

Minister
IN AND. SKVORTSOVA

APPROVED
order of the Ministry of Health
Russian Federation
dated March 13, 2015 N 111n

CHANGES THAT ARE INTRODUCED TO THE PROCEDURE FOR ISSUING AN AUTHORIZATION TO CONDUCT A CLINICAL STUDY OF A DRUG FOR MEDICAL USE, APPROVED BY ORDER OF THE MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION N74 OF 26 AUGUST 08 2014

1. In the first paragraph of clause 5 the words "Ministry of Health and Social Development of the Russian Federation" shall be replaced by the words "Ministry of Health of the Russian Federation".

"2) a copy of the compulsory life and health insurance contract for patients participating in a clinical trial of a medicinal product for medical use, concluded in accordance with the Model Rules for Compulsory Life and Health Insurance of a Patient Participating in Clinical Trials of a Medicinal Product, approved by the Decree of the Government of the Russian Federation dated September 13 2010 N 714<*>, indicating the maximum number of patients participating in a clinical trial of a medicinal product for medical use;";

<*L>Collection of Legislation of the Russian Federation, 2010, N 38, art. 4832; 2011, N 22, Art. 3171; 2012, N 37, art. 5002.

b) supplement with subparagraphs 3 and 4 of the following content:

"3) information about medical organizations in which clinical trials of a medicinal product for medical use are supposed to be conducted (full and abbreviated names, legal form, location and place of business, telephone, telefax, address Email medical organization);

4) the expected timing of the clinical trial of the medicinal product for medical use.".

"7) a document compiled by the manufacturer of the medicinal product and containing indicators (characteristics) of the medicinal product produced for clinical trials;

8) information on payments and compensations to patients (healthy volunteers, patients) involved in clinical trials of the medicinal product for medical use, bioequivalence and (or) therapeutic equivalence studies.".

a) in the first paragraph, the words "in paragraphs 6 and 7" shall be replaced by the words "in paragraph 6", the words "Ministry of Health and Social Development of the Russian Federation" shall be replaced by the words "Ministry of Health of the Russian Federation";

5. Add paragraph 8.1 with the following content:

"8.1. In the event of obtaining permission to conduct an international multicenter clinical trial of a medicinal product or a post-registration clinical trial of a medicinal product, the Department of the Ministry of Health of the Russian Federation responsible for issuing the authorization:

1) within a period not exceeding five working days from the date of acceptance of the application for the issuance of a permit and the documents specified in paragraph 7 of this Procedure:

checks the completeness and reliability of the information contained in the documents submitted by the applicant. If the information contained in the materials submitted by the applicant is revealed to be unreliable, the Ministry of Health of the Russian Federation sends the applicant a request for clarification of the specified information. This request may be submitted to the authorized representative of the applicant in person against receipt, sent by registered mail or transmitted electronically via telecommunication channels. If this request is sent by registered mail, it is considered received after six days from the date of sending the registered letter;

makes a decision to conduct an examination of documents to obtain permission to conduct an international multicenter clinical trial of a medicinal product or a post-registration clinical trial of a medicinal product and ethical examination, or to refuse to conduct these examinations;

notifies the applicant in writing about sending the documents for the specified examinations or about the refusal to send the documents for examinations, indicating the reasons for such refusal;

2) within a period not exceeding five working days from the date of receipt of the results of the examinations specified in paragraph three of subparagraph 1 of this paragraph: makes a decision to issue permission to conduct an international multicenter clinical trial of a medicinal product or a post-registration clinical trial of a medicinal product or to refuse to issue an appropriate permissions;

issues a permit to the applicant or notifies the applicant in writing of the refusal to issue a permit, indicating the reasons for such refusal.".

The hygiene of the hands of medical workers - doctors, nurses and other hospital staff is a mandatory procedure.

During it, special means are used, approved by the Committee of Pharmacology of Russia.

Hands are always treated before and after physical contact with the patient.

Cleansing the skin is aimed at preventing nosocomial infections, removing microbes and other decay products from the hands. It provides protection to the patient and the physicians themselves from infections.

Note!
Hand hygiene of medical staff was introduced back in the 19th century by Dr. Joseph Lister.
It was a breakthrough in medicine and prevention infectious diseases. Since then, widespread disinfection of the hands of medical personnel has been gradually introduced.

Hand hygiene of medical personnel is aimed at ensuring patient safety, because during the examination of the patient or during other physical contact, microbes can get on the patient.

His immunity is already weakened by the disease, infection with another disease will have an extremely negative impact on well-being, delay recovery.

Regular disinfection and compliance with the requirements for hand hygiene of medical personnel protect doctors and nurses themselves from infectious diseases.

Hand hygiene for ordinary people involves washing under running water using liquid or bar soap. Then the hands are wiped with a cloth towel, in rare cases with disposable paper napkins. At home, such activities will protect against infections.

Doctors and medical workers regularly work with dozens of patients. They conduct not only examinations, but also contact with open wounds, perform operations, and take birth.

It is necessary to exclude any possibility of infection on the patient's skin (especially in the blood). Therefore, the hygiene of the hands of physicians includes not only mechanical cleaning, but also treatment with antiseptics even when working with sterile gloves.

Worth noticing! Many people neglect hand hygiene in everyday life. In medical practice, such violations are fraught with serious consequences.

Requirements for the cleanliness of the hands of doctors

Any medical worker Familiar with the hygiene algorithm and situations where treatment is necessary. Requirements set by SanPiN. They indicate how to wash your hands in medicine, the procedure for cleaning and disinfecting the hands, fingers and forearms.

You can get acquainted with the document “WHO hand hygiene guidelines for health care workers” .

In addition to keeping their hands clean, doctors and other medical staff should not paint their nails with varnish. On contact, it can cause dermatitis in the patient. The most dangerous is dark and cracked varnish, it does not allow you to assess the degree of cleanliness of the nails.

During the manicure procedure, you can easily get cuts and microtraumas, which is associated with the possibility of infection. Doctors are also not allowed to wear jewelry.

What are the levels of hand hygiene

Hygiene and antisepsis of hands of medical personnel is divided into three main types:

Mechanical or household- it means cleansing the hands, eliminating the microflora of a transient nature. This is an elementary method of cleansing, in which antiseptic agents are not used.
Hygienic– disinfection of hands with special preparations (antiseptics). It is used after mechanical cleaning. If there was no contact with the patient, and the hands are not contaminated, then you can skip the household treatment of the hands and immediately apply a disinfectant to the skin.
Surgical- complete removal of any microflora from the hands of medical staff. The method allows to maintain sterility in the operating room. Surgical disinfection will ensure patient safety if gloves are torn by doctors or nurses.

Mechanical hand washing

This treatment is considered essential for cleaning the hands of medical personnel. It is used in the following situations:

before physical contact between the doctor and the patient and immediately after it;
the physician must wash their hands after visiting the toilet;
hands are washed thoroughly before eating;
with various contaminants.

As a cleanser neutral soap should be used without a pronounced odor. The tube must be permanently closed.

Open liquid soap and non-individual bar soap cannot be used, as they become infected with germs and bacteria.

Cleansing Rules

Remove all jewelry from the hands and fingers, wet your hands under warm running water and lather them, guided by a special algorithm.
Rinse off the soap, lather your hands again and repeat the necessary movements. Re-cleansing is necessary, since initially the microbes are washed off skin and open the pores. During the next wash, bacteria are removed from them.
Rinse your hands and dry them with a disposable towel. Classic paper towels are usually used, 15 by 15 in size. Pieces of cloth are allowed, but after a single use they should be sent to the laundry for disinfection. The use of cloth towels, even individual use is prohibited. They may not dry out until the next time. A wet surface is beneficial for the reproduction of bacteria and microbes.

After washing, the tap should be closed with a towel or paper towel, without touching it with clean hands.

The used napkin should be thrown into a special waste bucket.

As a soap, it is better to stop at a liquid dosed product. You can also use lumpy, if it is for individual use. How to wash your hands as a nurse read below.

Attention! When washing, use only warm running water. Hot water washes away the protective layer of fat from the skin.

Hand cleansing algorithm

When washing it is necessary follow the instructions approved by SanPiN. All movements are performed at least five times. Typically, machining takes 30 - 60 seconds.

Rub one palm against the other, this is done with progressive movements.
Rub your left hand (back side) with your right hand. Then vice versa.
Spread the fingers of one hand, connect them with the interdigital spaces of the other. Then move your fingers up and down.
“Lock” both hands (connect them to the lock), wash the skin of each hand with bent fingers.
Wash the bases with circular motions thumb and brushes. To do this, grab your thumb and forefinger right hand left hand and thumb. Do the same with the other hand.
Wash the palm of your right hand with the fingertips of your left hand in a circular motion.

Note!
The most contaminated areas of the skin of the hands:

subungual space
periungual folds
fingertips

The most difficult to wash areas of the skin of the hands:

interdigital spaces
notch of the thumb

Handwashing frequency of medical staff depends on the department - hand hygiene is carried out as necessary before and after contact with the patient. In the children's department, this can be 8 times per hour, in intensive care - 20 times per hour. On average, nurses should wash their hands 5 to 30 times per shift.

Hygiene treatment

This procedure is designed to remove any microflora from the skin of the hands. With this cleaning antiseptics must be used.

Hygiene treatment includes mechanical cleaning, then an antiseptic is applied to the skin.

After its final drying (only in a natural way), you can start working.

Antiseptic should be applied on clean and dry hands. The minimum amount is 3 milliliters. It is rubbed until completely dry. The movements according to which the antiseptic is applied to the skin are similar to the hand washing algorithm described above.

The WHO guidelines on hand hygiene indicate 5 most important points when hand hygiene is required:

Before contact with the patient;
Before aseptic procedure;
After contact with body fluids;
After contact with the patient;
After contact with surrounding objects.

Surgical hygiene

Disinfection involves complete removal of any flora from the hands of doctors and other medical personnel. It is carried out before childbirth, operations or punctures. The procedure is also required in case of preparation of the operating table.

The algorithm includes the following steps:

It is necessary to prepare hands, remove rings, bracelets and other jewelry, roll up the sleeves of the robe to the elbow;
Then you need to wash your hands (hands, palms and forearms) with antiseptic soap. Nails are treated with a special brush;
Dry hands dry with a disposable towel;
An antiseptic alcohol solution should be applied to the skin, wait until it dries completely;
Rub the alcohol antiseptic into the skin again, wait until it dries;
At the final stage, sterile gloves are put on dry hands.

Dosage of the antiseptic, features of use, time during which it is valid, drug dependent. and are listed in the instructions.

Surgical hand cleaning differs from hygienic hand washing in that mechanical washing lasts at least two minutes. Doctors must process the forearms.

After washing, hands get wet only with disposable towels.

Be sure to treat the nails with sterile sticks that are dipped in an antiseptic. The antiseptic is applied twice, the total consumption is at least 10 milliliters. The application procedure must be strictly followed.

Attention! After applying the antiseptic, you can not use a towel. Hands should dry naturally.

Surgical hand hygiene has its contraindications. It can not be used if there are wounds, injuries, cracks, abscesses on the skin of the hands.. It is prohibited in the presence of any skin diseases.

Useful video

How to wash your hands in medicine, see this short but very intelligible video:

Disinfectants

Antiseptics should be used as recommended by the Ministry of Health. Alcohol-containing preparations should be used. Doctors usually use seventy percentage solution ethyl alcohol or 0.5% solution of Chlorhexidine Bigluconate (it is diluted in 70% ethyl alcohol). You can disinfect your hands with Hemisept, Oktinesept, Hickenix, Veltosept, Octinederm, etc.

Reservoirs with antiseptic and soap should be disposable. The federal government is talking about it. clinical guidelines hand hygiene of medical personnel.

If reusable containers are used, they must be disinfected before refilling.

Important! All tanks must have dispensers that squeeze out the liquid in an elbow way.

Hand hygiene of medical personnel - presentation:

Problems

Allergist Aleksey Semenovich Dolgin believes that many problems can be avoided. In almost half of the cases, the medical staff does not comply with all WHO recommendations.

“The main mistake is that doctors do not wait until their hands are completely dry after washing. The antiseptic is rubbed into wet skin. And that will definitely lead to irritation.”

Constant hand disinfection inevitably leads to rashes, dermatitis and skin irritation. Most often, allergies are caused by agents that are added to ethyl alcohol: iodine, triclosan, and some ammonium compounds. Surgeons with experience claim that when cleansing with pure ethyl alcohol allergic reactions was many times less, and the effect of disinfection remained high.

Medical personnel are advised not to wash their hands with very hot water, use alkaline soap and hard brushes for washing nails. In case of excessive dryness, moisturize the skin with protective agents (usually before going to bed), and avoid aggressive substances. This will help minimize allergic skin reactions.

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1. General Provisions

3. The main factor in the transmission and spread of pathogens of nosocomial infections in medical organizations 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, appliances, patient care items, sanitary equipment, linen, clothes, products medical purpose, dressings, medical waste, etc.).

5. There are three ways to handle the hands of employees of medical organizations:

washing hands with soap and water without the use of antiseptics;

2. Washing hands with soap and water without the use of antiseptics

1) before working with food, preparing and serving food;

3) after visiting the toilet;

4) before and after taking care of the patient, when there is no direct contact with the patient (change of bed linen, cleaning of the room, etc.);

SOP Hand hygiene program

This article provides an example of an SOP for a Hand Hygiene Program.

SOP Hand Hygiene Program

Base:

Order of the Chairman of the Committee for State Sanitary and Epidemiological Surveillance of the Ministry of Health of the Republic of Kazakhstan dated April 23, 2013 No. 111 "Methodological recommendations for the treatment of hands of employees of medical organizations of the Republic of Kazakhstan".

Definition:

To ensure effective hand treatment, the following conditions must be met: trimmed nails, no nail polish, no artificial nails, no hands jewelry and hours.

Resources:

Hand washing is used:

warm running water;
liquid soap in bottles with a dispenser;
disposable towels or disposable wipes.

Do not add liquid soap to a partially empty bottle.

Documentation:

hand hygiene program;
instruction "Surgical treatment of hands";
hand washing technique (photo).

Procedures:

There are three ways to handle the hands of employees of medical organizations:

1. Washing hands with soap and water without the use of antiseptics.

2. Hand treatment with an antiseptic.

3. Surgical hand disinfection.

Washing hands with soap and water without the use of antiseptics

Hand washing with soap and water without the use of antiseptics is carried out in the following cases:

For washing hands, use warm running water, liquid soap in bottles with a dispenser, disposable towels or disposable wipes. Do not add liquid soap to a partially empty bottle.

Hand washing sequence:

2) wet hands with water;

3) apply soap to wet hands;

4) carry out processing in accordance with the European standard EN-1500 (appendix to these guidelines);

6) throw the towel into a container or container for collecting waste.

Hand treatment with antiseptic

Hand treatment with antiseptic is carried out in the following cases:

Hand sanitizer is a two step process:

washing hands with soap;
disinfection of hands with a skin antiseptic.

The sequence of actions when processing hands using an antiseptic:

1) wash hands with soap and water in accordance with these guidelines;

2) 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. As an antiseptic, disinfectants approved for use in the Republic of Kazakhstan are used.

Surgical hand disinfection

before any surgical intervention;
before serious invasive procedures (for example, puncture of large vessels).

by about hand washing of medical staff

organizations of the Republic of Kazakhstan

4. To interrupt possible ways transfer of microorganisms through the hands and reduce the risk of nosocomial infections, it is necessary to treat the hands of employees of medical organizations in all cases where there is a real or potential likelihood of contamination.

hand treatment with antiseptic;

surgical hand disinfection.

2. Washing hands with soap and water without the use of antiseptics

6) in all cases where the hands are clearly contaminated.

7. For washing hands, use warm running water, liquid soap in bottles with a dispenser, disposable towels or disposable wipes. Do not add liquid soap to a partially empty bottle.

8. The sequence of actions when washing hands:

1) open the water tap;

4) carry out processing in accordance with the European standard EN-1500 (appendix to these guidelines);

5) dry hands with a disposable towel or disposable napkin;

3. Hand treatment with antiseptic

9. Hand treatment with an antiseptic is carried out in the following cases:

1) before and after performing invasive procedures;

2) before and after manipulations with damage to the integrity of the patient's skin;

3) before and after manipulations with wounds and catheters;

4) after contact with blood and other biological fluids, secretions of the patient;

6) before examining newborns .

10. Hand sanitizing consists of two steps: washing hands with soap and water (according to paragraph 8) and disinfecting hands with a skin antiseptic.

11. The sequence of actions when processing hands using an antiseptic:

1) wash hands with soap and water in accordance with paragraph 8 of these guidelines;

12. 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. As an antiseptic, disinfectants approved for use in the Republic of Kazakhstan are used.

4. Surgical hand disinfection

13. Surgical disinfection of hands is carried out in the following cases:

1) before any surgical interventions;

2) before serious invasive procedures (for example, puncture of large vessels).

14. Surgical hand disinfection consists of three stages: mechanical cleaning of hands, disinfection of hands with a skin antiseptic, covering hands with sterile disposable gloves.

15. During surgical disinfection of hands, forearms are included in the treatment, warm running water, liquid soap and antiseptics in bottles with an elbow dispenser, sterile towels or sterile wipes are used.

16. During surgical disinfection, the hands and forearms are washed with warm water and liquid soap following the sequence of movements according to the EN-1500 standard and dried with a sterile towel or sterile napkin. Then the nail beds and periungual ridges are treated with disposable sterile wooden sticks soaked in an antiseptic solution. Brushes are not required. If brushes are still used, then sterile soft brushes should be used, while brushes should be used only for the treatment of the periungual areas and only for the first treatment during the work shift.

After the end of the mechanical cleaning stage, an antiseptic is applied to the hands in 3 ml portions and immediately rubbed into the skin, strictly following the sequence of movements according to the EN-1500 standard. The procedure for applying a skin antiseptic is repeated 2 times, the total consumption of an antiseptic is 10 ml, total time procedures - 5 minutes.

After the operation (procedure) is completed, gloves are removed, hands are washed with liquid soap and a nourishing cream or lotion is applied.

Medical order 111 rk

Order of the Ministry of Health and Social Development of the Republic of Kazakhstan No. 19 dated August 22, 2014 “On approval of the Instructions for organizing and implementing

6 Apr 2015 . Ministry for Investments and Development of the Republic of Kazakhstan. 111, Order of the Minister of Internal Affairs of the Republic of Kazakhstan dated.

Code of the Republic of Kazakhstan dated September 18, 2009 No. 193-IV “On the health of the people and the system. Law of the Republic of Kazakhstan dated 11/16/15. 111-V (see old ed.); .

Ministry of Health of the Republic of Kazakhstan. Ministry of Health of the Republic of Kazakhstan. INN.

In pursuance of the Laws of the Republic of Kazakhstan dated June 7, 1999 N 389-1 "On Education", dated May 19, 1997 N 111-1 "On the protection of the health of citizens in the Republic

MINISTRY OF HEALTH OF THE REPUBLIC OF KOMI ORDER dated February 3, 2000 N 2/33 ON INTRODUCING CHANGES AND ADDITIONS TO ORDERS OF THE MOH RK DATED 18.11.97 N 185 § 1, DATED 09.07.98 N 111-R AND ORDER.

March 28, 2014 . Ministry of Health of the Republic of Kazakhstan. 111 Astana. loading. . On orders of the Ministry of Health 759 for medical rehabilitation ”and 44 on.

Recommendations for the processing of hands of employees of medical organizations of the Republic of Kazakhstan Order of the Chairman of the Committee for State Sanitary and Epidemiological Surveillance of the Ministry of Health of the Republic of Kazakhstan dated April 23, 2013 No. 111.

Order dated July 23, 2012 No. 1001PR/111P/133PR. Consider invalid the order of the Ministry of Health of the Republic of Kalmykia dated.

Ministry of Health of the Komi Republic. Order. dated July 9, 1998 N 111-r. On the approval of the level of unproductive costs in the calculation of the function of a medical position.

24 May 2013 . Instructions for the hygienic treatment of the hands of medical personnel - Duration: 2:23. NMIC DGOI them. Dmitry Rogachev 61,510 views.

Oct 12, 2016 . The number of applications per 1 thousand population. III quarter. 2016 - 1.3 per 1 thousand. In accordance with the order of the Ministry of Health of the Republic of Kazakhstan dated June 21, 2016.

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2. To ensure effective hand treatment, the following conditions must be observed: trimmed nails, no nail polish, no artificial nails, no jewelry and watches on hands.

6. Washing hands with soap and water without the use of antiseptics is carried out in the following cases:

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order 111 of 04/23/2013 - Afn.kz Information Search Base order of the Ministry of Health of the Republic of Kazakhstan 111 of 04/23/2013 on the processing of hands of medical employees.

Order. Chairman. Committee of the State Sanitary and Epidemiological Surveillance of the Ministry of Health of the Republic of Kazakhstan dated. April 23, 2013 No. 111 “On approval of guidelines for the processing of hands of employees of medical organizations. Republic of Kazakhstan". Illustrated instructions for.

2 Apr 2014 . . performance of official duties, employees and employees of the federal fire service of the State Fire Service or members of their families, approved by order of the EMERCOM of Russia dated 23.04. 2013 N 280 ″ (Registered in the Ministry of Justice of Russia on 04/24/2014 N .

Approved. Order of the Chairman of the Committee. state sanitary

Oct 5, 2017 . The article provides guidelines for the treatment of hands of employees of medical organizations of the Republic of Kazakhstan, approved by order of the Ministry of Health of the Republic of Kazakhstan dated April 23, 2013 No. 111.

Order of April 23, 2013 No. 111. On the appointment of responsible persons for monitoring the holding of public events.

08/03/2017, 111-P, On approval of the adjusted investment program of Lukoil-Energoseti LLC of the city of Kogalym in the field of heat supply for 2016-2019, Order of the Department of Housing and Communal Services and Energy of the Khanty-Mansiysk Autonomous Okrug - Yugra. 06/29/2017 .

The Directory contains calculations for the distribution of orders and directives in accordance with the order of the Minister of Defense of the Russian Federation dated April 23, 2013 No. 333dsp. Registration numbers of the Ministry of Defense in joint regulatory legal acts are in bold. In connection with.

Orders of the Ministry of Sports of the Republic of Kazakhstan. 2018. Order No. 01-12/94 dated April 3, 2018 “On the assignment and confirmation of sports categories” Order No. 01-12/74 dated March 19, 2018 “On the assignment and confirmation of sports categories” Order No. 01-12/49 dated 02/20/2018 "On the assignment and confirmation of sports categories."

Order pk 111 of 23. Wipe hands with an individual towel with a napkin, preferably disposable. Surface Finish: Smooth.

EUR / KZT - 400.2. RUB / KZT - 5.77. Ministry of Justice of the Republic of Kazakhstan Legal information service free call 119.

order of the Ministry of Health of the Republic of Kazakhstan 111 dated 23042013 for the processing of the hands of medical staff - pass a free test at Aetern Processing the hands of medical staff.

Washing hands with soap and water without the use of antiseptics is carried out in the following cases: 1) before working with food, preparing and distributing food; 2) before meals.

Minister of Health of the Republic of Kazakhstan dated 5 . medical services at the PHC level, according to Appendix 2 to the order of the Ministry of Health of the Republic of Kazakhstan No. 479: 1) admission. individual card of a pregnant woman and a puerperal in the form No. 111 / y; . Wash hands according to hand washing technique.

Supervision of the Ministry of Health of the Republic of Kazakhstan dated April 23, 2013 No. 111 Guidelines for the processing of hands

Orders of the Ministry of Health Government programs. In accordance with subparagraph 2) of Article 6 of the Code of the Republic of Kazakhstan dated 18. 111. When evaluating the effectiveness of anti-pediculosis measures. allocate for washing hands of personnel and do not use for other purposes.

Ministry of Health of the Russian Federation. improving hand hygiene standards and practices in health care, . (iv) simple handwashing or hand sanitizing should be. 111. Neonatal department. The overall decrease in HCAI rates (from 11 to 8.2 infections per 1000.

Ministry of Health. Republic of Kazakhstan. dated April 23, 2013. No. 111. Guidelines.

The use of soap in the process of washing hands allows you to remove most of the transient flora. Remove from the deep layers of the skin permanent.

27 Feb 2015 . This Order shall enter into force upon the expiration of ten calendar days. a separate sink for washing hands and a sink for processing tools. 23. . 111. As part of the children's department, it is provided.

Since 1969, Deputy Head of the TsML, from 1970 to 1993 - Head of the TsML of the Ministry of Defense of the Russian Federation and Chief Forensic Expert of the USSR Ministry of Defense - Tomilin V.V.

344000, Rostov region, Rostov-on-Don, st. Lermontovskaya, 60

Before the start of the Great Patriotic War in the structure of the Red Army there was no forensic medical examination. Expert issues in the interests of military justice were resolved by military pathologists and civilian forensic doctors.

681000, Khabarovsk Territory, Komsomolsk-on-Amur, Puteyskaya street, 91

630017, Novosibirsk region, Novosibirsk, Military town No. 1, bldg. twenty

In March 1943, on the basis of the Directive of the General Staff of the Red Army (No. org/6/133213), the Central Forensic Laboratory of the Red Army (CSML) was established. The reorganization and placement of personnel was completed by June 1943.

443099, Samara region, Samara, st. Venceka, 48

191124, St. Petersburg, St. Petersburg, Suvorovsky pr., 63

620001, Sverdlovsk region, Yekaterinburg, st. Decembrists, 85

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111 Main State Center for Forensic Medical and Forensic Expertise of the Ministry of Defense of the Russian Federation

683015, Kamchatka Territory, Petropalovsk-Kamchatsky-15, st. Ammonalnaya Pad, 1, OSME

2) protocols for the diagnosis and treatment of diseases in accordance with Appendix 2 to this order;

5. To impose control over the execution of this order on the Vice-Minister of Health of the Republic of Kazakhstan Omarov K.T.

4. Recognize the order as invalid and. about. Minister of Health of the Republic of Kazakhstan dated December 30, 2005 No. 655 "On approval of periodic protocols for diagnosis and treatment".

program of reform and development of health care of the Republic of Kazakhstan for 2005-2010, approved by the Decree of the Government of the Republic of Kazakhstan dated October 13, 2004 No. 1050, I ORDER:

preventive work of the Ministry of Health of the Republic of Kazakhstan (Ismailov Zh.K.), RSE "Institute for Health Development" of the Ministry of Health of the Republic of Kazakhstan (Birtanov E.A.) to ensure the implementation of activities in accordance with the approved plan.

1) distribution of protocols for the diagnosis and treatment of diseases in accordance with the needs of medical organizations;

3) an action plan for the implementation of protocols for the diagnosis and treatment of diseases for 2008 in accordance with Appendix 3 to this order.

1) a list of protocols for the diagnosis and treatment of diseases in accordance with Appendix 1 to this order;

2. The Committee for Control in the Sphere of Provision of Medical Services of the Ministry of Health of the Republic of Kazakhstan (Musin E. M.), the Department of Medical -

3. Heads of health departments of regions, cities of Astana and Almaty (as agreed) and republican health organizations to ensure:

In pursuance of paragraph 53 of the Action Plan for the implementation of the State

2) introduction of protocols for the diagnosis and treatment of diseases in accordance with the action plan approved by this order, from January 1, 2008.

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Order 111 mz rk 2013

Department of Allergology and Pulmonology

Department of Anesthesiology, Intensive Care and intensive care №1

Department of radiation and physical methods of diagnostics and physiotherapy

Department of Nephrology and Gastroenterology

Patient Support

Compulsory social health insurance

Rules for the appeal of citizens to the ambulance service medical care

The employees of the maternity ward are glad to welcome you within the walls of our institution!

The obstetrics service of the SHMBH is represented by the following departments:

– maternity block – 6 maternity rooms

– department of physiology for 40 beds

– wards for pregnant women with pathology for 5 beds

— children's department for 40 beds

– neonatal pathology department for 5 beds

– department of anesthesiology and resuscitation for 4 beds

– Department of gynecology for 20 beds;

— day hospital at the department of gynecology for 7 beds.

– clinical and biochemical round-the-clock laboratory

On the basis of the maternity ward, a course of obstetrics and gynecology of the MKTU named after A.I. HA. Yasawi, together with the Department of Obstetrics and Gynecology, a Coordinating Council was created.

The work of the obstetrics service is carried out according to the orders:

1. Order of the Ministry of Health of the Republic of Kazakhstan No. 498 dated 07.07.2010 “On approval of the Rules for the provision inpatient care in medical organizations for the protection of maternal and child health.

2. Order of the Ministry of Health of the Republic of Kazakhstan No. 349 dated 15.08.06. “On approval of sanitary and epidemiological rules and norms. Sanitary and epidemiological requirements for working conditions and medical support during infection control for nosocomial infections in medical organizations of the Republic of Kazakhstan.

3. Order of the Ministry of Health of the Republic of Kazakhstan No. 626 dated 30.10.09. “On indications and rules for termination of pregnancy in the Republic of Kazakhstan”, other orders of the Ministry of Health of the Republic of Kazakhstan and OHS, instructions and guidelines governing our section of work.

5. Decrees of the Government of the Republic of Kazakhstan No. 1472 dated December 6, 2011 "On approval of the Rules for the provision of hospital substitution care"

6. Order of the Ministry of National Economy of the Republic of Kazakhstan No. 194 dated 12.03.15. Sanitary rules "Sanitary and epidemiological requirements for the organization and implementation of sanitary and anti-epidemic (preventive) measures to prevent infectious diseases"

7. Order No. 2136 dated 15.12.09 "On approval of the rules for ensuring and receiving by citizens a guaranteed volume of free medical care."

10. Order of the Ministry of Health and Social Development of the Republic of Kazakhstan No. 627 dated July 28, 2015 “On approval of the rules for reimbursement of costs to healthcare organizations at the expense of budgetary funds”.

11. Order No. 457 dated 19.07.12. UZ SKR "On organizations of emergency surgical and gynecological care".

12. Order of the MZRK No. 452 of 07/03/2012 Laying and algorithms, evaluation sheets for emergency conditions. "Algorithm for the examination of women of childbearing age at the level of primary health care".

13. Order No. 824 of 01.11.2013 "On the monitoring of postpartum hemorrhage".

14. Order of the Ministry of Health of the Republic of Kazakhstan dated June 9, 2011 No. 372 “On approval of the Regulations on organizations providing anesthetic and resuscitation care to the population of the Republic of Kazakhstan”.

15. Order of the Ministry of Health of the Republic of Kazakhstan No. 111 dated April 23, 2013 “On approval of guidelines for the treatment of hands of employees of medical organizations of the Republic of Kazakhstan.

16. Order of the Ministry of Health of the Republic of Kazakhstan dated September 1, 2010 No. 691 “On approval of algorithms for actions in case of emergency”.

17. Order of the Ministry of Health of the Republic of Kazakhstan dated May 28, 2010 No. 388 "Criteria for the prevention of maternal and infant death."

18. Order of the Ministry of Health of the Republic of Kazakhstan dated 07.05.2010 No. 325 “On approval of the Instructions for improving the regionalization of perinatal care in the Republic of Kazakhstan”.

19. Order of UZ UKO dated 11.09.17. No. 707 "Regulations on the regionalization of perinatal care".

20. Order No. 131 of February 25, 2015 "On the organization and implementation of preventive work against especially dangerous infections."

21. Order of the Ministry of Health of the Republic of Kazakhstan dated June 9, 2011 No. 372 “On Approval of the Regulations on Organizations Providing Anesthesiology and Resuscitation Care to the Population of the Republic of Kazakhstan”.

The composition of doctors working in the maternity ward.

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. That's why great importance attached to washing hands, 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 (epidermal staphylococcus, etc.), and transient ( Staphylococcus aureus, 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. Roundabout 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 pieces do not remain. 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

Conducted at any surgical interventions accompanied by a violation of the integrity of the patient's skin, to prevent the entry 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 hygiene and surgical treatment hands

More efficient alcohol products. 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).

A key factor in adherence to infection control is the proper cleaning of the hands of healthcare workers. 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?

Efficiency, practical use and the acceptability of hand treatment depend on the method and accompanying conditions of treatment 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).