Time:2009-10-03 09:01:58 Source:Author:Click:21418
1 Scope
This standard specifies the management of hand hygiene of medical staff and the basic requirements of hand hygiene, hand hygiene facilities, handwashing and sanitary hand sanitization, surgical hand sanitization, hand sanitation effects of monitoring.
This standard applies to all levels and types of medical institutions.
2 normative references
The following documents in the provisions of this standard through the citation of this standard and become the provisions of this standard. Where the cited documents are dated, all subsequent changes (excluding errata) or revisions are not applicable to this standard, however, the parties to the agreement under this standard are encouraged to study whether the latest version of these documents can be used. Where the cited document is not dated, its latest version applies to this standard.
GB 5749 Hygienic Standard for Drinking Water
3 Terminology and Definitions
The following terms and definitions apply to this standard.
3.1 hand hygiene hand hygiene
The general term for medical personnel hand washing, sanitary hand disinfection and surgical hand disinfection.
3.2 handwashing handwashing
Medical personnel with soap (soap) and flowing water to wash their hands, to remove the hands of skin dirt, debris and part of the process of pathogenic bacteria.
3.3 hygienic hand sanitizing antiseptic handrubbing
The process by which a healthcare worker rubs his or her hands with a quick-drying hand sanitizer to reduce transiently inhabiting germs on the hands.
3.4 Surgical hand disinfection surgical hand antisepsis
Pre-surgical medical personnel wash their hands with soap (soap) and running water, and then use hand sanitizers to remove or kill hand transient bacteria and reduce the process of resident bacteria. The hand sanitizer used may have sustained antimicrobial activity.
3.5 Resident skin flora
Microorganisms that can be isolated from most human skins are persistent and intrinsic to the skin and are not easily removed by mechanical friction. Such as coagulase-negative staphylococci, Corynebacterium species, Propionibacterium spp. and Fusobacterium spp. Generally not pathogenic.
3.6 transient skin flora
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Microorganisms that reside in the surface layer of the skin and are easily removed by routine hand washing. It can be acquired by direct contact with patients or contaminated surfaces, can be readily transmitted by hand, and is closely related to hospital-acquired infections.
3.7 Hand antiseptic agent hand antiseptic agent
Used to disinfect the skin of the hand to reduce the hand skin bacteria disinfectant, such as ethanol, isopropyl alcohol, chlorhexidine, iodophor, etc..
3.7.1 Quick-drying hand sanitizers alcohol-based hand rub
Hand sanitizers containing alcohols and skin-care ingredients. Includes aqueous, gel, and foam types.
3.7.2 Waterless antiseptic agent waterless antiseptic agent
Mainly used for surgical hand disinfection, disinfection of hand disinfectant does not need to rinse with water. Including water, gel and foam type.
3.8 hand hygiene facilities hand hygiene facilities
Facilities for hand washing and hand disinfection, including hand washing sinks, faucets, flowing water, detergents, hand drying supplies, hand sanitizers and so on.
4 Hand hygiene management and basic requirements
4.1 Medical institutions should develop and implement hand hygiene management system, equipped with effective and convenient hand hygiene facilities.
4.2 Medical institutions should regularly carry out full training in hand hygiene, medical staff should master the knowledge of hand hygiene and correct hand hygiene methods, to ensure the effectiveness of hand washing and hand disinfection.
4.3 Medical institutions should strengthen the guidance and supervision of hand hygiene for medical staff, and improve the compliance of hand hygiene for medical staff.
4.4 The effect of hand disinfection should meet the following corresponding requirements:
a) hygienic hand disinfection, monitoring the total number of bacterial colonies should be ≤ 10cfu/cm2.
b) surgical hand disinfection, monitoring the total number of bacterial colonies should be ≤ 5cfu/cm2.
5 hand hygiene facilities
5.1 hand washing and hygienic hand disinfection facilities <
5.1.1 Set up mobile water hand washing facilities.
5.1.2 Operating rooms, delivery rooms, catheterization rooms, laminar flow clean wards, bone marrow transplantation wards, organ transplantation wards, intensive care wards, neonatal rooms, mother and baby rooms, hemodialysis wards, burn wards, infectious diseases, stomatology, disinfection and supply centers, and other key departments should be equipped with non-hand-touch faucets. Conditional medical institutions in the diagnosis and treatment area should be equipped with non-touch faucets.
5.1.3 should be equipped with cleaning agents. Soap should be kept clean and dry. Containers of soap should be disposable, reusable containers should be cleaned and disinfected weekly. Soap turbidity or discoloration of the timely replacement, and clean and disinfect the container.
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5.1.4 Should be equipped with hand drying items or facilities to avoid secondary pollution.
5.1.5 Should be equipped with qualified quick-drying hand sanitizer.
5.1.6 Hand hygiene facilities should be set up to facilitate the use of medical staff.
5.1.7 Hygienic hand sanitizers should meet the following requirements:
a) It should comply with the relevant provisions of the state.
b) It is appropriate to use disposable packaging.
c)Medical personnel should be good acceptability of the selected hand disinfectant, hand disinfectant without odor, no irritation, etc..
5.2 Surgical hand disinfection facilities
5.2.1 should be equipped with a hand-washing sink. Hand-washing pool set up in the operating room near the pool size, height is appropriate to prevent hand-washing water splash, the pool surface should be smooth without dead ends easy to clean. Hand washing pool should be cleaned and disinfected daily.
5.2.2 The number of hand-washing sinks and faucets should be set up according to the number of operating rooms, the number of faucets should be not less than the number of operating rooms, faucet switches should be non-handshake type.
5.2.3 Cleaning agents should be provided and meet the requirements of 5.1.3.
5.2.4 Supplies for cleaning nails shall be provided; rubbing supplies for hand hygiene may be provided. If hand brushes are provided, the bristles should be soft and inspected regularly to eliminate unqualified hand brushes in a timely manner.
5.2.5 Hand sanitizer should obtain the Ministry of Health health permit approval, valid for use.
5.2.6 Hand disinfectant dispenser should be used non-hand touch. Disinfectants should be disposable packaging, reuse of disinfectant containers should be cleaned and disinfected weekly.
5.2.7 Hand drying items should be provided. Hand drying towels should be used by each person, cleaned and sterilized after use; containers of disinfectant towels should be cleaned and sterilized every time.
5.2.8 should be equipped with a timing device, hand washing process and description of the diagram.
6 Hand washing and hygienic hand disinfection
6.1 Hand washing and hygienic hand disinfection should be based on the following principles:
a) When there is blood or other body fluids and other visible contamination of the hands of the naked eye, the hand should be washed with soap (soap) and running water.
b)When there is no visible contamination on the hands, it is advisable to use quick-drying hand sanitizer to sanitize the hands instead of washing them.
6.2 Healthcare workers should choose to wash their hands or use quick-drying hand sanitizers in accordance with the principles of 6.1 in the following situations:
a) Before and after direct contact with each patient, when moving from contaminated to clean areas of the same patient's body.
b) Before and after contact with patients' mucous membranes, broken skin or wounds, and after contact with patients' blood, body fluids, secretions, excretions, wound
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oral dressings and so on.
c) Before and after putting on and taking off isolation gowns and after removing gloves.
d) Before performing aseptic operations and contacting clean, sterile items.
e)After contact with the patient's surroundings and objects.
f)Before handling medications or dispensing meals.
6.3 Healthcare workers should wash their hands followed by hygienic hand sanitization in the following situations:
a) After contact with patient blood, body fluids and secretions, and items contaminated with infectious pathogenic microorganisms.
b)After directly examining, treating, caring for or handling infectious patients' dirt.
6.4 Methods of hand washing for healthcare workers, see Appendix A.
6.5 The following method of sanitizing hygienic hands of healthcare workers should be followed:
a) Take an appropriate amount of quick-drying hand sanitizer in the palm.
b) Strictly follow the steps in Appendix A Handwashing Methods for Medical Personnel A.3 Rub.
c) Ensure that the hand sanitizer completely covers the skin of the hand while rubbing until the hand is dry.
7 Surgical hand disinfection
7.1 Surgical hand disinfection should be based on the following principles:
a) Wash hands first, then disinfect.
b) Surgical hand disinfection should be repeated between surgeries on different patients, when gloves are broken or hands are contaminated.
7.2 Handwashing Methods and Requirements
7.2.1 Before handwashing, hand ornaments should be removed and fingernails should be trimmed to a length not exceeding the fingertips.
7.2.2 Take appropriate amount of detergent to clean both hands, forearms and lower 1/3 of upper arm and rub carefully. When cleaning the hands, care should be taken to clean the dirt under the nails and the folds of the hand skin.
7.2.3 Rinse the hands, forearms, and lower 1/3 of the upper arm under running water.
7.2.4 Dry the hands, forearms, and lower 1/3 of the upper arm with a hand dryer item.
7.3 Surgical hand disinfection methods
7.3.1 Rinse hand disinfection methods Take an appropriate amount of hand disinfectant and apply it to each part of the hands, the forearms, and the lower 1/3 of the upper arm, and Rub carefully for 2min~6min, rinse both hands, forearms and lower 1/3 of upper arm with flowing water, and dry thoroughly with sterile towel. The flowing water should meet the provisions of GB 5749. Special circumstances water quality does not meet the requirements, the surgeon in the gloves before the application of alcohol-based hand disinfectant
agent and then disinfect the hands after wearing gloves. The amount of liquid taken from the hand sanitizer, the kneading time and the method of use follow the instructions for use of the product.
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7.3.2 Non-rinse hand disinfectant method Take the appropriate amount of non-rinse hand disinfectant and apply it to each part of the hands, the forearm and the lower 1/3 of the upper arm, and rub carefully until the disinfectant is dry. The amount of hand sanitizer to be taken, the rubbing time and the method of use follow the instructions for use of the product.
7.4 Precautions
7.4.1 False nails should not be worn and nails and tissues around the nails should be kept clean.
7.4.2 Hands should be kept in front of the chest and above the elbows throughout the hand disinfection process so that water flows from the hands to the elbows.
7.4.3 Handwashing and sanitizing can be done with a sponge, other rubbing supplies, or by rubbing the hands against each other.
7.4.4 After removing surgical gloves postoperatively, hands should be cleaned with soap (soap solution).
7.4.5 Nail-cleaning appliances and rubbing materials such as sponges and hand brushes should be placed in designated containers after use; rubbing materials should be sterilized after use by each person or for single-use; and nail-cleaning materials should be cleaned and sterilized daily.
8 Monitoring of hand hygiene effect
8.1 Monitoring requirements
Medical institutions should carry out quarterly disinfection of the hands of medical staff working in the operating room, labor and delivery room, catheterization room, laminar flow clean wards, bone marrow transplantation ward, organ transplantation wards, intensive care wards, neonatal room, mother and baby room, hemodialysis ward, burn ward, infectious disease department, stomatology department, and other departments. The effect of monitoring; when suspected of hospital infection outbreaks and medical staff hand hygiene related, should be monitored in a timely manner, and the corresponding pathogenic microbial detection.
8.2 Monitoring methods
According to Appendix B.
8.3 Judgment criteria for qualified hand hygiene
The total number of bacterial colonies meets the requirements of 4.4.
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Appendix A
(Normative Appendix)
Methods of hand washing for medical personnel
A.1 Under running water, make the hands fully wet.
A.2 Take an appropriate amount of soap (soap solution) and apply it evenly to the entire palm, back of the hand, fingers, and fingertips.
A.3 Carefully rub your hands for at least 15 seconds, taking care to wash all the skin of your hands, including the backs of your fingers, fingertips and finger joints, following the rubbing steps.
A.3.1 Palms facing each other, fingers together, rubbing each other, see Figure A.1.
A.3.2 Palms and backs of the hands rubbing each other along the finger joints, exchanging, see Figure A.2.
A.3.3 Palms facing each other, hands crossing the finger joints rubbing each other, see Figure A.3.
A.3.4 Bending the fingers so that the knuckles rotate in the palm of the other hand, rubbing the knuckles and fingers, exchanging, see Figure A.2.
A.3.4 Bending the fingers to rotate the knuckles in the other hand, rubbing the knuckles in the palm, exchanging, see Figure A.2.
A.3.5 Hold the left thumb in the right hand and rotate and rub it, see Figure A.5.
A.3.6 Put the tips of the five fingers together in the palm of the other hand and rotate and rub it, see Figure A.6.
A.4 Rinse your hands thoroughly under running water, wipe them dry, and take the appropriate amount of hand lotion for skin care.
Figure A.1 Palm relative rubbing Figure A.2 Fingers crossed, palm to palm back rubbing Figure A.3 Fingers crossed, palm relative rubbing
Figure A.4 Bending finger joints in palm rubbing Figure A.5 Thumb in palm rubbing Figure A.6 Fingertips in palm rubbing
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Appendix B
(Normative Appendix)
Methods for monitoring the effectiveness of hand hygiene
B.1 Sampling time Sampling before contacting patients and carrying out diagnostic and therapeutic activities.
B.2 Sampling method The examinee puts five fingers together, and uses a cotton swab moistened with a sterile eluent containing a corresponding neutralizing agent to wipe the surface of the fingers of both hands from the heel of the finger to the end of the finger back and forth twice, with an area of about 30cm2 on one hand, and rotates the swab at the same time during the process of wiping; the part of the swab that touches the operator is cut off, and put into a test tube of 10 ml of a sterile eluent containing the corresponding neutralizing agent and send it to be examined in a timely manner. The swab is then sent to the hospital for examination.
B.3 Detection method The sampling tube will be shaken on the mixer for 20 seconds or forcefully vibration 80 times, with a sterile pipette to suck 1.0 ml of the sample to be examined inoculated in the sterilized petri dish, each sample inoculated 2 petri dishes, petri dishes added to the dissolved 45 ℃ ~ 48 ℃ of nutrient agar 15 ml ~ 18 ml, pouring while shaking, wait for the solidification of the agar, set in the 36 ℃ ± 1 ℃ incubator culture for 48 h, count the number of colonies. The number of colonies was counted.
Total number of bacterial colonies:
Total number of bacterial colonies (cfu/cm2)=number of colonies on the plate X number of times of dilution/sampling area (cm2)