This standard is formulated according to the Law of People's Republic of China (PRC) on the Prevention and Control of Infectious Diseases and the Measures for the Administration of Hospital Infection.
Appendices a to b are normative appendices.
This standard was put forward by the professional committee of hospital infection control standards of the Ministry of Health.
Hand hygiene standard for medical staff
1 range
This standard stipulates the management and basic requirements, hand hygiene facilities, hand washing disinfection, surgical hand disinfection and hand hygiene effect monitoring of medical staff.
This standard is applicable to all kinds of medical institutions at all levels.
2 normative reference documents
The clauses in the following documents become the clauses of this standard by reference. All dated reference documents and all subsequent editions (excluding errata) or revisions are not applicable to this standard. However, parties who have reached an agreement according to this standard are encouraged to study whether the latest versions of these documents can be used. For undated reference documents, the latest edition is applicable to this standard.
GB 5749 Hygienic standard for drinking water
3 Terms and definitions
The following terms and definitions apply to this standard.
3. 1 Hand hygiene Hand hygiene
Hand washing by medical staff, sanitary hand disinfection and surgical hand disinfection are collectively referred to.
3.2 Wash your hands
The process of medical staff washing their hands with soap and tap water to remove dirt, debris and some pathogenic bacteria.
3.3 Disinfection of sanitary hand rubbing
Medical staff wiped their hands with quick-drying hand disinfectant to reduce the process of temporary growth of bacteria in their hands.
3.4 surgical hand disinfection
Before the operation, the medical staff washed their hands with soap (soap solution) and running water, and then used hand disinfectant to remove or kill the temporary bacteria in their hands and reduce the permanent bacteria. The hand disinfectant used can have continuous antibacterial activity.
3.5 Resident skin flora
Microorganisms that can be separated from most of human skin are persistent resident bacteria on the skin and are not easy to be removed by mechanical friction. Such as coagulase-negative staphylococci, coryneform bacteria, propionibacterium, Acinetobacter, etc. Under normal circumstances, it is not pathogenic.
3.6 Temporary skin flora
Microorganisms living on the skin surface can be easily removed by routine hand washing. It can be obtained by direct contact with patients or contaminated surfaces, and can also be transmitted by hand at any time, which is closely related to hospital infection.
3.7 hand disinfectant
Disinfectants used for hand skin disinfection to reduce hand skin bacteria, such as ethanol, isopropanol, chlorhexidine, iodophor, etc.
3.7. 1 quick hand-drying disinfectant alcohol wipes hands
Hand disinfectants containing alcohol and skin care ingredients include aqua, gel and foam.
3.8 Hand hygiene facilities
Hand washing and hand disinfection facilities, including sink, faucet, tap water, detergent, hand dryer, hand disinfectant, etc.
4 management and basic requirements of hand hygiene
4. 1 Medical institutions should formulate and implement hand hygiene management systems and equip them with effective and convenient hand hygiene facilities.
4.2 Medical institutions should regularly conduct hand hygiene training for all staff, and medical staff should master hand hygiene knowledge and correct hand hygiene methods to ensure the effect of hand washing and hand disinfection.
WS/T3 13-2009
4.3 Medical institutions should strengthen the guidance and supervision on the work of medical staff, and improve the compliance of hand hygiene of medical staff.
4.4 Hand disinfection effect shall meet the following requirements:
A) disinfect the virus by hand, and the total number of colonies monitored should be ≤ 10cfu/㎝2.
B) The operating hands should be disinfected, and the total number of colonies monitored should be ≤5cfu/㎝2.
5 hand hygiene facilities
5. 1 hand washing and hand disinfection facilities
5. 1. 1 Set running water hand washing facilities.
5. 1.2 key departments such as operating room, delivery room, catheter room, laminar flow clean ward, bone marrow transplant ward, organ transplant ward, intensive care unit, newborn room, maternal and infant room, hemodialysis ward, burn ward, infection department, stomatology department, disinfection supply center, etc. Non-contact faucets shall be provided. Conditional medical institutions should be equipped with non-touch faucets in the diagnosis and treatment area.
5. 1.3 should be equipped with cleaning agent. Soap should be kept clean and dry. The container for soap solution should be disposable, and the reusable container should be cleaned and disinfected every week. When the soap solution is turbid or discolored, it should be replaced in time, and the container should be cleaned and disinfected.
5. 1.4 provide dry goods or facilities to avoid secondary pollution.
5. 1.5 Qualified quick-drying hand disinfectant shall be provided.
5. 1.6 hand hygiene facilities convenient for medical personnel should be set up.
5. 1.7 hand sanitizer shall meet the following requirements:
A) It shall comply with relevant national regulations.
B) Disposable packaging should be used.
C) Medical personnel should have good acceptability to the hand disinfectant selected, and the hand disinfectant has no peculiar smell or irritation.
5.2 Surgical hand disinfection facilities
5.2. 1 should be equipped with a sink. The wash basin is set near the operating room, and the size and height of the basin are appropriate to prevent the hand washing water from splashing out, and the surface of the basin should be smooth without dead angles, which is convenient for cleaning. The sink should be cleaned and disinfected every day.
5.2.2 The number of sinks and faucets should be set according to the number of operating rooms, and the number of faucets should be no less than that of operating rooms. The faucet switch should be non-touching.
5.2.3 Cleaning agents shall be provided and meet the requirements of 5. 1.3.
5.2.4 Nail cleaning products shall be provided; Can be equipped with hand hygiene rubbing supplies. If equipped with a hand brush, the brush hand should be soft, check it regularly, and eliminate the unqualified hand brush in time.
5.2.5 Hand disinfectants shall be approved by the Ministry of Health and used within the validity period.
5.2.6 The liquid outlet of hand disinfectant should be non-contact. Disinfectants should be packaged once, and containers of reused disinfectants should be cleaned and disinfected every week.
5.2.7 Dry goods shall be provided. Dry towels should be used by everyone, and cleaned and disinfected after use; Containers containing sterilized towels should be cleaned and disinfected every time.
5.2.8 Timing device, hand washing process and explanatory diagram shall be provided.
6 Hand washing and hand disinfection
6. 1 Hand washing and sanitary hand disinfection should follow the following principles:
A) When there is visible pollution, such as blood or other body fluids, wash your hands with soap (soap liquid) and running water.
B) When there is no visible pollution on hands, it is advisable to disinfect hands with quick-drying hand disinfectant instead of washing hands.
6.2 Under the following circumstances, medical personnel should choose to wash their hands or use quick-drying hand disinfectant according to the principle of 6. 1:
A) Before and after direct contact with each patient, when moving from a contaminated part of the same patient's body to a clean part.
B) Before and after contact with the patient's mucosa, damaged skin or wound, after contact with the patient's blood, body fluids, secretions, excreta, wound dressing, etc.
C) Before and after wearing isolation gown, after taking off gloves.
D) Before aseptic operation and contact with clean aseptic articles.
E) After contact with patients' surroundings and objects.
F) Before handling drugs or meals.
6.3 Medical personnel should wash their hands before hand hygiene disinfection in the following cases:
A) After contact with blood, body fluids and secretions of patients and articles contaminated by infectious pathogenic microorganisms.
B) After direct examination, treatment, care or treatment of the pollutants infecting patients.
6.4 See Appendix A for the method of hand washing for medical staff.
6.5 disinfection should follow the following methods:
A) Apply a proper amount of quick-drying hand sanitizer to the palm of your hand.
B) Scrubbing shall be carried out in strict accordance with Appendix A, Methods of Washing Hands for Medical Personnel and scrubbing steps.
C) When scrubbing, ensure that the hand disinfectant completely covers the skin of the hand until the hand is dry.
7 surgical hand disinfection
7. 1 surgical hand disinfection should follow the following principles:
A) Wash your hands first, and then disinfect them.
B) Between operations of different patients, when the gloves are damaged or the hands are contaminated, the operating hands should be disinfected again.
7.2 hand washing methods and requirements
7.2. 1 Before washing your hands, you should take off your jewelry and trim your nails, and the length should not exceed your fingertips.
7.2.2 Take a proper amount of detergent to clean hands, forearms and under upper arms 1/3, and knead carefully. When washing your hands, you should pay attention to cleaning the dirt under your nails and wrinkles on your hands.
7.2.3 Wash hands with running water, under forearms and upper and lower arms 1/3.
7.2.4 Dry hands, dry forearms and forearms.
7.3 surgical hand disinfection method
7.3. 1 hand washing disinfection method Apply a proper amount of hand disinfectant to the hands, forearms and upper arms, and knead carefully for 2-6 min. Rinse hands, forearms and upper arms with running water, and thoroughly dry sterile towels. The flowing water shall meet the requirements of GB 5749. Under special circumstances, when the water quality can't meet the requirements, the surgeon should disinfect his hands with alcohol hand disinfectant before wearing gloves. The amount of liquid taken, rubbing time and usage of hand disinfectant shall be carried out according to the product instructions.
7.3.2 Hand-free disinfection method: Apply a proper amount of hand-free disinfectant to hands, forearms and upper arms, and carefully knead until the disinfectant is dry. The amount of liquid taken, rubbing time and usage of hand disinfectant should follow the product instructions.
7.4 Preventive measures
7.4. 1 Don't wear fake nails, and keep your nails and surrounding tissues clean.
7.4.2 During the whole hand disinfection process, keep your hands on your chest and above your elbows, so that water can flow from your hands to your elbows.
7.4.3 When washing hands for disinfection, sponges, other rubbing objects or hands can be used to rub against each other.
7.4.4 After removing surgical gloves after operation, wash hands with soap (soap solution).
7.4.5 After use, nail cleaning appliances and hand-wiping appliances such as sponges and hand brushes should be placed in designated containers; Rubbing supplies should be disinfected or used once per person; Nail cleaning products should be cleaned and disinfected every day.
Monitoring of hand hygiene effect
8. 1 monitoring requirements
Medical institutions should monitor the disinfection effect of the hands of medical staff working in operating rooms, delivery rooms, catheter rooms, laminar flow clean wards, bone marrow transplant wards, organ transplant wards, intensive care units, neonatal rooms, maternal and child rooms, hemodialysis wards, burn wards, infectious diseases departments, stomatology departments and other departments every quarter; When it is suspected that the outbreak of nosocomial infection is related to the hand hygiene of medical staff, it should be monitored in time and the corresponding pathogenic microorganisms should be detected.
8.2 Monitoring method
According to appendix B.
8.3 Criteria for judging qualified hand hygiene
The total number of bacterial colonies meets the requirements of 4.4.
Appendix a
(normative appendix)
Hand washing methods of medical staff
A. 1 Under running water, let your hands be fully wet.
A.2 Take a proper amount of soap (soap solution) and evenly spread it on the whole palm, back of hand, fingers and fingertips.
A.3 Rub your hands carefully for at least 15 seconds, and pay attention to cleaning all the skin of your hands, including the back of your fingers, fingertips and fingers. The specific kneading steps are as follows:
A.3. 1 palms are opposite, fingers are close together, and they rub against each other, as shown in figure A. 1.
A.3.2 palms are facing each other, and fingers with hands crossed rub and exchange with each other, as shown in Figure A.2. ..
A.3.3 palms facing each other, hands crossed and fingers rubbed, as shown in Figure A.3. ..
A.3.4 Bend your fingers, make the joints rotate, and rub them in the palm of the other hand for exchange, as shown in Figure A.4. ..
A.3.5 Hold the left thumb with the right hand to rotate, rub and exchange, as shown in Figure A.5. ..
A.3.6 Put five fingertips together in the palm of the other hand, rotate, knead and exchange, as shown in Figure A.6. ..
A.4 Wash your hands thoroughly under running water, dry them, and take a proper amount of hand cream for skin care.
Appendix b
(normative appendix)
Monitoring method of hand hygiene effect
B. 1 sampling time: sample before contact with patients and medical activities.
B.2 Sampling method: put the five fingers of the examinee together, and rub the cotton swab from heel to fingertips twice, with the area of one hand about 30cm2 ~ 2, and rotate the cotton swab at the same time during the rubbing process; Cut off the part of the cotton swab that contacts the operator, put it into a 10ml sterile eluent test tube with corresponding neutralizer, and send it for inspection in time.
B.3 Detection method: Shake the sampling tube on the mixer for 20 seconds or shake it violently for 80 times, suck 65438±0.0ml of the same sample with a sterile straw and inoculate it into a sterilization plate, inoculate 2 plates for each sample, add 65,438 05 ml ~ 65,438 ml of nutrient agar dissolved at 45℃ ~ 48℃ to the plate, and shake it evenly while pouring.
Calculation method of total bacterial colonies;
Total number of bacterial colonies (cfu/cm2)= number of plate colonies × dilution multiple/sampling area (cm2) (formula B. 1).