The technique of putting on and removing non-sterile gloves (examination). How to use medical gloves correctly? How to wear medical gloves

Regional state budgetary educational institution SPO

Krasnoyarsk Basic Medical College

named after V.M. Krutovsky"

ALGORITHMS

Professional activity

nurses

Study guide for students

medical college

Krasnoyarsk 2011

Compilers: Chairman of the CMC "Fundamentals of Nursing" Madan A.I., teacher of the discipline "Fundamentals of Nursing" Borodaeva N.V.

Approved at a meeting of the CMC "Fundamentals of Nursing" and at a meeting of the methodological Council of the college.

Reviewer: Chief Nursing Specialist of the Administration's Health Department Krasnoyarsk Territory. Tolstikhina L.G.

Algorithms professional activity designed for students of medical colleges and students of medical schools.

Introduction 5
I Infection control. Infection safety 6
1.1	Hygienic level of hand treatment
1.2	Putting on gloves (in factory packaging)
1.3	Putting on sterile gloves (2 options)
1.4	Rules for removing used gloves (I option)
1.5	Rules for removing sterile gloves (Option II)
1.6	Preparing gloves for sterilization
1.7	Placement of material in bix for sterilization
1.8	Rules for working with bix (unloading biks)
1.9	Putting on a sterile gown
1.10	Covering the sterile table by the procedural nurse
1.11	Packaging for steam sterilizers and terms of preservation of sterilization
1.12	Air sterilization packaging and sterilization shelf life
1.13	Sterilization efficiency control
1.14	Sterilization Control Methods
1.15	spring-cleaning treatment room
1.16	Current cleaning of premises
1.17	Taking the contents of the pharynx for bacteriological examination
1.18	Taking nasal contents for bacteriological examination
II Medical procedures and manipulations 29
2.1	Oxygen therapy through a nasal catheter
2.2	Cleansing enema
2.3	oil enema
2.4	Hypertonic enema
2.5	Siphon enema
2.6	Gas tube
2.7	Gastric lavage with a thick probe
2.8	Taking gastric contents to study the secretory function of the stomach (method of Veretenov, Novikov, Myasoedov)
2.9	duodenal sounding
2.10	catheterization Bladder women
2.11	Male bladder catheterization
2.12	Nasal powder injection
2.13	The introduction of ointment for the lower eyelid with a glass rod
2.14	The introduction of ointment for the lower eyelid from a tube
2.15	Instillation of drops in the eyes
2.16	Instillation of drops in the ear
2.17	Instillation of drops in the nose
2.18	The introduction of ointment into the nose
2.19	Applying an ice pack
2.20	Heating pad application
2.21	Staging mustard plasters
2.22	Canning
2.23	Applying a warm compress
III Injections 76
3.1	Assembling the syringe from the sterile table
3.2	Collecting a syringe from a craft bag
3.3	Nurse actions when using a disposable syringe
3.4	Kit medicinal product from a vial
3.5	Ampoule drug kit
3.6	Intradermal injections
3.7	Subcutaneous injections
3.8	Intramuscular injections
3.9	Intravenous injections
3.10	Intravenous drip administration of fluids using a disposable system
3.11	Taking blood from a vein for biochemical research
3.12	Administration of drug solutions through a connected catheter
List of sources used

INTRODUCTION

Algorithms for the professional activity of nurses are drawn up in order to comply with uniform requirements for teaching students of medical colleges and medical schools of the region, as well as for practicing nurses.

The value of the textbook is that it meets the requirements of the State Educational Standard in the specialty 0406 "Nursing", 0407 "General Medicine".

Algorithms are developed in three directions:

1. Infection safety, infection control.

2. Medical procedures and manipulations.

3. Injections.

What is new is that they reflect modern requirements

such as preparing the patient for manipulation, the order of performance and completion of the procedure.

The algorithms themselves are simple, accessible and understandable for students.

NOTE: some manipulations (hygienic level of hand treatment, putting on sterile gloves and a sterile gown, duodenal sounding) can be performed in another way.

I Infection control. Infection safety

1.1 HAND HYGIENE

Target: remove microorganisms, ensure the infectious safety of the patient, ensure high level cleanliness and personal hygiene.

Indications: before putting on and removing gloves, after contact with body fluids, after possible microbial contamination, before caring for an immunocompromised patient.

Equipment:

Soap (liquid or bar) disposable;

Skin antiseptic;

Napkins (individual towel);

Paper napkins.

Preparation for the procedure:

1. The nurse takes off her rings and watches.

2. Opens the water faucet paper napkin, regulates the water temperature.

Execution of the procedure:

3. Wet hands under running water and lather abundantly from the periphery to the center (i.e. from the fingertips to ½ of the forearm), washes thoroughly.

4. Soap washes off under running water in the same direction, and lathers a second time, washes using the steps of hand treatment:

a) friction of the palms;

b) the right palm with rubbing movements washes the back of the left hand, the left - the back of the right (fingers are intertwined);

c) palm on palm with crossed fingers wide apart;

d) the fingers of one hand are bent and are on the other palm (closed in the lock);

e) alternating rubbing of the thumbs with opposite

palms. The palms are clenched;

f) alternate friction of the palms with closed fingers of the opposite palm.

Sterile gloves in the package;

Scissors;

Sterile tray;

Skin antiseptic;

Execution sequence:

1. The nurse washes her hands, dries them, treats them with a skin antiseptic.

2. The nurse opens the outer package with scissors and removes the inner package with tweezers.

3. Puts the package in a sterile tray (on the diaper) and opens it with your hands.

4. Takes both gloves simultaneously in the right (left) hand.

5. Keeps them on weight, at the level of the belt, puts them on in turn, without unfolding "cuffs".

6. Puts on a glove on the left (right) hand, pulling it, straightens the “cuffs” on the sleeve of the robe.

7. With his left hand in a glove, he puts on a glove on his right hand, unfolding the “cuff” on the sleeve of the robe.

8. Treats gloves with an antiseptic (to remove talc).

Note!

The action can be started not with the right, but with the left glove,

those. at your convenience.

PUTTING ON STERILE GLOVES

process	justification
1. Take gloves in sterile packaging, unfold; 2. Take the glove for the right hand by the lapel so that the fingers do not touch the inner surface of the glove;	Ensuring sterility
3. Close the fingers of the right hand and insert them into the glove;	Ensuring sterility
4. Put on a glove without breaking its lapel, opening the fingers of the right hand;	Ensuring sterility
Take the glove for the left hand with the second, third and fourth fingers of the right hand (gloved) by the lapel so that the fingers do not touch the inner surface of the glove;	Ensuring sterility
Close the fingers of the left hand and insert them into the glove; Straighten the cuffs on the left, then right gloves, pulling them over the sleeve.	Ensuring sterility

Rules for removing sterile gloves

IF ONE GLOVE IS DAMAGED, BOTH SHOULD BE CHANGED IMMEDIATELY, BECAUSE ONE GLOVE CANNOT BE REMOVED,

WITHOUT POLLUTING ANOTHER

process	justification
1. Take the fingers of the right hand in the glove by the lapel on the left glove, touching it from the outside, make a lapel;	Gown sleeve infection prevention
2. Take the fingers of the left hand in the glove by the lapel on the right glove, touching it from the outside, make a lapel;	Compliance with sterility. Ensuring infectious safety.
3. Remove the glove from the left hand, turning it inside out and holding the lapel in the right hand;	Compliance with sterility. Ensuring infectious safety
With your left hand, take the glove on your right hand by the lapel with inside and remove, turning it inside out (the left glove was inside the right one) .	When removing gloves, touching the outer surface of used gloves causes infection of the skin of personnel

Dressing preparation technique

Dressings are called tissues and other products that are used in surgical practice to drain the wound, stop bleeding, remove wound contents and apply bandages.

dressing material requirements

It is good to suck up the wound discharge, i.e. have a high degree of hygroscopicity
Dries quickly by evaporating moisture
Soft and elastic fit to the body, not have a large mass
Do not lose these qualities when sterilizing with steam under pressure
Do not irritate body tissues;

The main type of dressing material is gauze and cotton wool

Remember: When preparing any kind of dressing, be sure to tuck the edges of the gauze inward.

For nurse use of gloves is a required skill. Carrying out manipulations, patient care is carried out only in gloves according to existing standards.

Remember what is unacceptable usage the same gloves for manipulation or care of two and more patients. Even if gloved hands are washed and disinfected. Treatment of gloves with alcohol-containing solutions is also unacceptable due to the destruction of the protective layer.

After carrying out manipulations for the care of one patient, gloves should be removed and immersed in a disinfectant solution for disinfection. With the subsequent disposal of disposable products.

Rules for putting on sterile gloves

, treat them with an antiseptic, dry completely.
Take sterile tweezers, get them gloves from the factory packaging or bix. Lay the gloves out on a sterile table, palm side up.
Move the edges of the gloves with sterile tweezers in the form of a cuff. With the thumb and forefinger of the left hand, grab the turned edge from the inside and pull the glove over the right hand.
With the fingers of the right hand in a glove, bring the second glove under the lapel and pull it over left hand.
Bend the folded edges of the gloves sequentially on both hands. The edges of the gloves should completely cover the cuffs of the sterile gown.

Rules for removing medical gloves

If gloves are contaminated with blood or other body fluids, before removing them, they should be treated with a cloth moistened with a disinfectant solution.

With the fingers of the right hand in a glove, grab the edge of the glove on the outside of the left hand. Remove the glove from the left hand with a vigorous movement, turning it inside out.
Insert the thumb of the left hand (already without a glove) inside the glove on the right hand. Remove the glove from the right hand with a vigorous movement, also turning it inside out.
After use, immerse gloves in a container with a disinfectant solution.
Wash and sanitize hands.

The nurse must be able to choose use of gloves taking into account the peculiarities of the manipulation and information about the infection of the patient (sterile surgical, non-sterile diagnostic, single use, increased risk).

How to put on and take off sterile surgical gloves - photo.

Sterile gloves are designed to protect the patient and healthcare worker from mutual contamination.

Before putting on gloves:

Choose the right glove size for you. If you use gloves that are not the correct size, they may tear.
Pick up the package with a pair of sterile gloves, make sure it is intact. Torn packaging does not guarantee the sterility of gloves.
Check the size and date of manufacture indicated on each individual package.
Prepare your skin wash your hands thoroughly with soap.
Keep your hands in sterile gloves bent at the elbows and raised forward at a level above the waist.
Attention! All manipulations with putting on gloves should be carried out keeping your hands on weight in front of you.

Algorithm for putting on sterile gloves:

1. Open the outer package - pull the top edges in different directions (or gently tear the top edge of the package).

2. Position the inner glove pack in front of you so that the letters "L" (left) and "R" (right) are in the correct position relative to your hands.

3. Gently pull the outer edges of the package ("tails") to the sides, without touching inner part gloves packaging. In front of you will be left and right gloves.

After completing this step and before donning gloves, disinfect hands with antiseptic and wait for them to dry completely.

4. Visually check that the gloves are not torn or upside down and that their "thumbs" are in the correct position for easy donning.

5. Gently take the first glove by the lapel (the upper edge of the turned-down cuff), without touching its outer (sterile) side and without touching the second glove.

6. Gather the fingers of the other hand together and thread them into the glove. Open your fingers inside the glove and position them properly. After putting on a glove, temporarily leave the lapel of its cuff not deployed.

7. With a gloved hand, take the second surgical glove by sliding your fingers under its lapel. Fingers in a sterile glove should not touch the inner lapel of the second glove, so all manipulations must be carried out very carefully.

8. Put the second sterile glove on your hand without touching the skin of the forearm with your fingers and straighten its lapel. When using a sterile gown, the cuff of the glove should fit snugly around the cuff of the sterile gown.

9. Next, you need to straighten the edge of the first glove, picking it up by the lapel and not touching the skin of the hand. When using a sterile gown, the glove is put on the cuff of the gown and should fit snugly around it.

10. Now you can pull the gloves more tightly on your fingers so that the gloves fit snugly around the entire working area of \u200b\u200bthe hands.

11. Do not touch with hands in sterile gloves to any objects of the external environment, contact with which is an indication for changing gloves.

How to remove used gloves

1. Grasp the fingers of one gloved hand outer part cuffs on the other glove and make a secure lapel.

2. The same action must be repeated with the second glove, making a safe lapel on it.

3. Remove the glove from one hand by pulling it off by the lapel and turning it inside out.

4. With your free hand, remove the second glove by the safety collar, turning it inside out so that the first glove is inside the second.

You can buy sterile and non-sterile medical gloves in our company.

3.5.1. Disinfectology

Guidelines MP 3.5.1.0113-16
“Use of gloves for the prevention of healthcare-associated infections in healthcare organizations”
(approved by the Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Chief State Sanitary Doctor of the Russian Federation on September 2, 2016)

1 area of use

1.1. real guidelines contain General requirements requirements for the selection and use of single-use medical gloves to reduce the risk of infections associated with the provision of medical care (HCAI) and occupational diseases of personnel of medical organizations.

2. General information

2.1. Single use medical gloves are designed to protect the hands of medical personnel and create a barrier between the patient and medical workers in the performance of their professional duties.

2.2. Modern medical gloves are personal protective equipment for the hands of medical personnel. The use of gloves in medical organizations is a mandatory requirement.

2.3. Medical gloves are ready-made disposable products and cannot be reused.

2.4. Medical gloves must meet the requirements that ensure their protective (barrier) and consumer properties:

Impermeability to microorganisms;

Tightness (no through defects);

Strength;

Safety for the health of the patient and medical personnel;

Convenience/comfort;

Quality packaging and labeling;

Ease of disposal;

Functionality.

2.5. Modern medical gloves differ in the characteristics of the material from which they are made, its chemical composition, production and processing technologies, as well as the possibilities of targeted use.

2.6. Medical workers should know the basic properties and performance characteristics of various types / types of gloves, understand how to use them correctly, taking into account functional properties and the presence of epidemiological risk.

3. Classification of medical gloves

3.1. Depending on the degree of invasiveness and the risk of infection of patients during a medical procedure / manipulation, medical gloves used are divided into 2 main groups: surgical and diagnostic / examination.

3.1.1. Surgical gloves are used during surgical interventions. They must be sterile, repeat the anatomical shape of the hands, divided into right and left, in some cases have an elongated cuff () and have a combination of characteristics that provide high strength gloves.

3.1.2. Diagnostic/examination gloves are used in non-invasive and invasive diagnostic and therapeutic procedures and manipulations, as well as in the handling of contaminated medical devices. They can be sterile or non-sterile, do not have an anatomical shape and a long cuff.

3.2. Surgical gloves according to their intended purpose are divided into universal (standard) and specialized gloves with additional properties.

3.2.1. Universal surgical gloves meet the basic requirements for surgical gloves: they have a long cuff, medium thickness, high tightness and strength in accordance with the values specified in GOST 52238-2004 for surgical gloves.

3.2.2. Specialized surgical gloves, along with the basic characteristics, have a number of additional properties that meet the requirements of various areas of surgery:

Microsurgical thin gloves providing enhanced tactile sensitivity;

Orthopedic gloves of the increased durability;

Obstetric gloves with an extended cuff;

Radioprotective gloves;

Gloves resistant to chemicals(cytostatics, disinfectants, etc.);

Gloves for operations with an increased epidemiological risk of infection:

double gloves;

double gloves with puncture indication;

gloves with internal antibacterial coating;

"chain" gloves.

3.3. Depending on the material from which they are made, medical gloves can be of two types:

Natural rubber latex gloves (latex gloves);

Synthetic polymer gloves (synthetic gloves).

3.3.1. Latex gloves are highly elastic and durable, but cannot be used if a patient or medical worker is allergic to natural latex proteins, or in contact with chemically aggressive substances.

3.3.2. Synthetic gloves are used when a medical worker is allergic to natural latex proteins, as well as in contact with chemically aggressive substances. For medical purposes are used:

Polyisoprene gloves;

Polychloroprene (neoprene) gloves;

Nitrile gloves;

Vinyl gloves.

3.4. The inner surface of medical gloves should prevent them from sticking together during storage and facilitate putting on gloves. Depending on the method of processing the inner surface, medical gloves are divided into:

Powdered;

Powder free;

Processed with a polymer coating (polyurethane, silicone, etc.).

3.5. Medical gloves may vary in texture of the outer surface. Depending on the processing method, gloves may have:

Smooth surface;

Texture pattern applied to any area or to the entire surface of the glove;

Microtextured surface.

3.6. The shape (design) of medical gloves can be:

Anatomical (thumb opposes the plane of the palm, gloves are divided into right and left);

Non-anatomical or flat (the thumb is located in the plane of the palm, the gloves do not have a division into the right and left hands).

3.7. Medical gloves differ in the way the edge of the cuff is processed:

Cut-off cuff (with and without anti-slip band);

The edge of the cuff is rolled up (with and without anti-slip strip).

3.8. Medical gloves vary in size. The size scale for surgical gloves includes 10 standard sizes - from 5.0 to 9.5. The size scale of diagnostic gloves includes 5 sizes - from XS to XL.

4. Choice of medical gloves

4.1. Medical gloves must be worn:

In all cases where contact with blood or other biological substrates, potentially or obviously contaminated with microorganisms, is possible;

On contact with mucous membranes;

In contact with damaged skin;

When using piercing and cutting tools;

When carrying out invasive diagnostic and therapeutic manipulations.

4.2. Before choosing gloves, it is necessary to assess the nature of the procedures performed, infectious, mechanical, chemical, radiation risks, as well as the possibility of developing skin diseases and pathological reactions to the material of the gloves. The algorithm for selecting medical gloves in accordance with the classification can be divided into several stages:

Choosing the type of gloves depending on the degree of invasiveness and epidemiological danger of the procedure being performed (surgical or diagnostic);

The choice of the type of gloves for the intended purpose (specialization of gloves for various types surgical interventions);

The choice of material for the manufacture of gloves;

Selection according to the method of processing the inner surface of the gloves;

Choice according to the texture of the outer surface of the gloves;

The choice of gloves according to the shape and method of processing the edge of the cuff;

Choice of gloves by size.

4.3. When performing all types of surgical interventions, medical workers must use sterile surgical gloves.

4.4. When performing non-invasive diagnostic procedures, intradermal, subcutaneous and intramuscular injections, when working with implanted ports of vascular devices (catheters), capillary blood sampling, peripheral vein catheterization, blood sampling from peripheral veins and the introduction medicines into peripheral veins, when working in clinical diagnostic, bacteriological laboratories, as well as when handling contaminated medical instruments and materials, it is recommended to use non-sterile diagnostic gloves.

4.5. When inserting a sterile device into sterile cavities of the body, placing a central vascular catheter, changing the dressing and other manipulations with it, lumbar puncture, joint puncture, etc., sterile diagnostic or surgical gloves should be used.

4.6. When choosing the type of surgical gloves, it is necessary to take into account the special conditions of the type of surgical intervention, which can be satisfied due to the additional properties of the gloves:

Microsurgical thin gloves with a microtextured surface to improve the holding properties of microsurgical instruments are used in surgical interventions requiring increased tactile sensitivity;

Gloves with an elongated cuff (the length of the glove reaches 450 mm) are used during manipulations in obstetrics and gynecology, as well as during urological and proctological interventions;

Orthopedic gloves with increased thickness and strength are used during manipulations in traumatology and orthopedics;

Radioprotective latex surgical gloves, which provide radiation protection against scattered X-ray radiation, can significantly reduce the dose load on the skin of the hands. They should be used during operations in radiosurgery, interventions using hybrid technologies with intraoperative diagnostics and navigation, angiography, etc.;

Chemical resistant synthetic gloves made from nitrile or polychloroprene for maximum resistance to chemicals. They should be used in cases where bone cement is used during surgical interventions, chemotherapy is performed;

Gloves for operations with an increased risk of infection and damage to the gloves. The risk of damage to gloves depends on the urgency, duration and complexity of the operation, as well as the experience of the medical staff. Situations with an increased risk of infection include any emergency surgical interventions and invasive procedures, as well as surgical interventions and invasive procedures performed on patients with infectious diseases. In order to protect the hands of medical personnel during operations with an increased risk of infection, the following should be used:

double gloves

(Two pairs of gloves worn one on top of the other significantly reduce the risk of puncture and contamination of the hands of medical personnel);

double gloves with puncture indication

(Similar to simple double gloves, the indication system significantly reduces the risk of a through puncture and provides a higher degree of protection by quickly visualizing the damage: the lower glove differs from the upper one in color and size, and the liquid penetrating between the gloves during a puncture forms a contrast stain. Timely detection puncture and glove replacement significantly reduce the time of contact with the patient's blood and reduce the risk of infection of the healthcare worker);

gloves with an internal antibacterial coating (The internal coating of such gloves contains an antiseptic);

"chain" gloves

(Used as additional protection with gloves made of latex or other elastic materials during surgical interventions where there is a high risk of cuts. This type gloves protect against cuts, but do not provide puncture protection).

4.7. When choosing the material of medical gloves, its properties should be taken into account. Natural latex has a pronounced elasticity and strength, which provides high barrier properties of latex gloves.

4.8. Polyisoprene is the synthetic material closest in structure and properties to natural latex. It has high elasticity and strength and is used to make surgical gloves.

4.9. Vinyl has the least elasticity and strength of all materials used in the manufacture of medical gloves, so it is used only for the manufacture of diagnostic gloves. Vinyl gloves can be used during simple, short-term procedures with low material stress. Vinyl gloves are oil resistant.

4.10. Polychloroprene and nitrile are highly resistant to chemical aggressive substances, therefore, when working with bone cement, cytostatics, disinfectants, alcohols, etc. you should choose gloves from these materials. Polychloroprene is more elastic and is more commonly used for surgical gloves. Nitrile has low elongation, so it is more often used for the manufacture of diagnostic gloves.

4.11. The treatment of the inner surface of the gloves is used to prevent sticking of gloves during storage, as well as to facilitate putting on gloves. For this purpose, the following are used:

Dusting is the treatment of the inner surface of gloves with powdered substances (corn starch, zinc oxide). A significant disadvantage of this method is high risk complications associated with the ingress of powder into the surgical wound, into the air of the premises and on the hands of medical personnel;

Smoothing the inner surface by chemical means without powdering - this method processing can lead to a decrease in the elasticity and extensibility of gloves;

Finishing the inner surface of the gloves polymer coatings(polyurethane, silicone, polyacrylate, etc.) further enhances the barrier properties of medical gloves.

4.12. In order to reduce the risk of postoperative complications in patients (adhesions, granulomas, keloid scars, etc.) and contact dermatitis in medical personnel in medical organizations, it is recommended to use powder-free gloves.

4.13. Modification of the outer surface of the gloves affects the degree of their adhesion to tools and other surfaces, as well as the tactile sensitivity of the fingers in gloves. The outer surface of the gloves can be smooth, microtextured, or have a visible texture pattern applied to some area or the entire surface of the glove.

4.14. Gloves with a smooth surface are thinner than textured ones and provide greater tactile sensitivity. They are suitable for most medical procedures.

4.15. Gloves with a textured or micro-textured surface provide a more secure grip on tools, are less slippery and are designed for manipulation using small or heavy tools or objects with a smooth, slippery surface.

4.16. The shape and method of processing the edge of the cuff do not affect the protective functions of medical gloves, their choice depends on the subjective preferences of medical workers.

4.17. The edge of medical gloves can be cut off or rolled up. The roller on the glove provides a more reliable fixation of the cuff on the forearm. An adhesive strip can be used to better hold the cut edge.

4.18. In order to ensure comfort and accuracy when working with gloves, it is necessary to choose the right size gloves.

4.19. To determine the size of medical gloves, you need to measure the circumference of the palm without the thumb in its widest part (when measuring, do not overtighten the palm) and find the value of the glove size corresponding to the circumference of the palm using a special size table ().

5. Rules for the use of medical gloves

5.1. Proper use of medical gloves provides protection for the hands of medical workers.

5.2. Before putting on non-sterile or sterile gloves, hygienic treatment of hands or treatment of surgeons' hands, respectively, is carried out. Gloves are put on only after the antiseptic has completely dried on the skin of the hands.

5.3. After removing gloves, hygienic treatment of the skin of the hands with antiseptics is carried out.

5.4. It is forbidden to use the same pair of disposable gloves when performing medical manipulations on several patients, as well as when performing medical manipulations on one patient, but in different anatomical areas that differ in the composition of the microflora.

5.5. Sterile gloves must be used in any aseptic (sterile) procedures, during which contact with sterile areas / cavities of the body is possible, as well as contact with the wound surface of the skin and mucous membranes.

5.6. Non-sterile gloves should be used in cases of risk of contact of medical workers with blood, other biological fluids, damaged skin and mucous membranes, with medical devices contaminated with body fluids.

5.7. Non-sterile gloves should always be used as a standard precaution when working with patients infected and/or colonized with resistant organisms (Gram-negative bacteria resistant to 3 or more classes of antibiotics, carbapenem resistant, MRSA, vancomycin-resistant enterococcus) and patients with pseudomembranous colitis. caused by Clostridium difficile, and persons infected with viruses that cause bloodborne infections (HBV, HCV, HIV, etc.).

5.8. Gloves can be omitted in situations of contact with intact skin, with environmental objects.

5.9. Gloves during manipulations are not recommended to be treated with antiseptic and disinfectants, as this adversely affects their tightness and can lead to increased permeability.

6. Technique for donning medical gloves

6.1. Putting on non-sterile gloves does not require the use of excessive force to avoid compromising their integrity. When using non-sterile gloves, you should pre-hygiene your hands (treat your hands with a skin antiseptic or wash them with soap and water).

6.2. The use of gloves is not a substitute for disinfecting hands with skin antiseptics.

6.3. Medical workers put on sterile gloves on their hands before surgical interventions (or other aseptic manipulations), having previously completed the technology for processing the hands of surgeons.

6.4. It is necessary to strictly observe the rules for putting on gloves so as not to violate the sterility of their working surface.

6.5. The algorithm for putting on surgical gloves (if the leading hand is right (right-handed specialists)) ():

Open the individual outer package of sterile gloves (away from the sterile table), remove (“shake out”) the inner envelope with gloves from it onto a sterile surface;

Open the inner envelope with sterile tweezers;

First, the glove is put on the dominant (right) hand;

With the thumb and forefinger of the left hand, grab the edge of the cuff of the right glove turned inside out and put it on the right hand without touching the outer sterile surface of the glove. The cuff remains inverted;

Place the fingers of the right hand, on which the glove is already worn, under the lapel of the cuff of the left glove and put it on the left hand, without touching the skin and the wrong side of the cuff;

Straighten the cuff of the left glove on the dressing gown in a circular motion. The cuff of the glove should overlap the cuff of the sleeve of the gown by 5-10 cm;

Only after that, unfold the inverted edge of the cuff of the right glove in similar circular motions.

6.6. In order to maintain maximum sterility of the gloves, the surgeons involved in the operation are helped to put on the gloves by the operating sister.

7. Features of work in surgical gloves

7.1. Hands in sterile gloves should not be lowered below the sterile surfaces of the instrumental and operating tables.

7.2. It is not recommended to treat gloves with alcohol-containing and other antiseptic agents before the start of the operation and during work, as they increase the porosity / permeability of the glove material and create conditions for microorganisms to overcome the protective barrier.

7.3. To maintain an optimal level of protection, gloves should be changed every 60-120 minutes, depending on the nature of the surgical intervention. Before putting on new gloves, it is necessary to treat the hands with an alcohol-containing antiseptic.

7.4. Gloves should be replaced in the following situations:

after damage (puncture);

after the discovery of a defect;

after an accidental electric shock from an electrosurgical instrument;

at hit (absorption) under a glove of any liquid;

when stickiness appears;

when you feel the appearance of "glove juice";

during the transition from the "dirty" stage of the operation to the "clean" one.

7.5. If one glove is damaged, both must be replaced.

7.6. When replacing gloves after removing them from the hands, hands should be treated with a skin antiseptic. Put on a new pair of gloves on dry hands.

8. Technique for removing medical gloves

8.1. Remove used gloves carefully, avoiding splashing from the surfaces of the glove, which can lead to microbial contamination of hands and the environment.

8.2. The algorithm for removing medical gloves is as follows (if the leading hand is right (right-handed specialists) ():

Take the cuff on the left glove from the outside with the fingers of the right hand in the glove, make a lapel;

In the same way, make a lapel on the right glove with your left hand;

Remove the glove from the left hand, turning it inside out and leave it, holding the lapel, in the right hand;

With the left hand, remove the glove from the right hand, turning it inside out and dipping the glove from the left hand into it;

Immerse both gloves in a container with a disinfectant solution for disinfection or in a disposable container for temporary storage of class B waste for the purpose of subsequent centralized disinfection / neutralization.

8.3. After finishing work and removing gloves, it is necessary to carry out hygienic treatment of hands.

8.4. Disposable gloves after use are subject to decontamination / neutralization as medical waste of the appropriate class (usually classes B or C, in some cases D or D).

8.5. To prevent dryness and adverse effects on the skin of the hands, medical professionals are advised to always use a professional nourishing hand cream.

9. Storage of medical gloves

9.1. Gloves must be stored properly, as improper storage can lead to deterioration in the quality of the gloves.

9.2. Medical gloves should be delivered to the warehouse of a medical organization in a transport package. Gloves are moved to departments in clean group packages containing a certain number of gloves of the same size.

9.3. Sterile medical gloves must be additionally packed in double individual packaging (inner wrap and outer strong sealed packaging to maintain sterility).

9.4. Packaging of gloves must be labeled in accordance with the requirements of GOST.

9.5. Medical gloves should be stored in a well-ventilated area, away from sources of heat, sun rays, direct exposure to light sources and electrical equipment, at a temperature not exceeding 25°C (excessive heating can lead to a loss of elasticity and elasticity of the material), at a humidity of not more than 65% (if the storage temperature drops below 10°C, condensation may occur). If the storage temperature is below 10°C, the gloves should be warmed to 25°C before use, otherwise problems may arise due to temporary loss of elasticity.

9.6. Do not expose gloves to ozone; its source in medical organizations can be mercury lamps, electric motors, fluorescent lamps, x-ray machines, electrosurgical and lifting equipment. Ozone accelerates the aging of elastic materials, enhancing oxidative processes in them. Typical ozone damage to gloves looks like small cuts and discoloration.

9.7. Medical gloves are used within the expiration date if the integrity of the individual packaging of gloves is not violated.

10. Normative references

1. the federal law dated March 30, 1999 No. 52-FZ “On the sanitary and epidemiological well-being of the population”.

2. Federal Law No. 323-F3 of November 21, 2011 "On the Fundamentals of Protecting the Health of Citizens in Russian Federation"

3. Decree of the Government of the Russian Federation dated July 24, 2000 No. 554 “On Approval of the Regulations on the State Sanitary and Epidemiological Service of the Russian Federation and the Regulations on State Sanitary and Epidemiological Rationing”.

4. The national concept for the prevention of infections associated with the provision of medical care (approved by the Chief State Sanitary Doctor of the Russian Federation on November 6, 2011).

5. Sanitary and epidemiological rules and regulations SanPiN 2.1.7.2790-10 "Sanitary and epidemiological requirements for the management of medical waste."

6. Sanitary and epidemiological rules and regulations SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities."

7. Sanitary and epidemiological rules SP 3.1.3263-15 "Prevention of infectious diseases during endoscopic interventions".

8. Sanitary and epidemiological rules SP 3.1.5.2826-10 "Prevention of HIV infection".

9. Sanitary and epidemiological rules SP 3.3.2342-08 "Ensuring the safety of immunization".

10. “Guidelines for the hygienic assessment of factors in the working environment and the labor process. Criteria and classification of working conditions. R 2.2.2006-05.

11. MP 2.2.9.2242-07 “The state of employees in connection with the state of the production environment. Hygienic and epidemiological requirements for the working conditions of medical workers performing work associated with the risk of infectious diseases.

12. GOST R 52238-2004 (ISO 10282:2002). National standard of the Russian Federation. “Surgical gloves made of rubber latex are sterile disposable. Specification".

13. GOST R 52239-2004. National standard of the Russian Federation. "Medical diagnostic disposable gloves".

14. GOST ISO 10993.10-2011. Interstate standard. “Medical products. Evaluation of the biological effect of medical devices. Part 10. Study of irritant and sensitizing effects.

15. GOST R ISO 2859-1-2007. National standard of the Russian Federation. "Statistical Methods of the Attribute Inspection Procedure" Part 1. Sampling plans for successive lots based on an acceptable level of quality.

16. GOST R 52623.4-2015. National standard of the Russian Federation. "Technologies for performing simple medical services of invasive interventions".

17. EN 455 European standards on medical gloves for single use.

18. ASTM D 3577 (09el) Standard Specification for Rubber Surgical Gloves.

19. ISO 10282-1:2014 Single-use sterile rubber surgical gloves.

20. IS 10993-10:2010 Biological evaluation of medical devices. Part 10: Tests for irritation and skin sensitization.

21. "Good Manufacturing Practice for Medical Products (GMP)".

22. "Rules for the organization of clean production and quality control of medical products made of polymers, woven and non-woven materials in contact with blood" PR 64-05-001-2002.

23. Decree of the Government of the Russian Federation of December 27, 2012 No. 1416 “On Approval of the Rules for the State Registration of Medical Devices”.

24. WHO guidelines for hand hygiene in health care. WHO/IER/PSP/2009.07. World Health Organization, 2013

Annex 1

Sizes of medical gloves

A. Surgical gloves

1. Surgical gloves, depending on the length of the third finger, the width of the wrist and hand, have the following standard sizes: 5, 5,5, 6, 6,5, 7, 7,5, 8, 8,5, 9, 9,5.

Tab. 1. Size scale of surgical gloves

Wrist circumference, cm	14	15	16	17	19	20	22	23	24	25
Glove size	5	5.5	6	6.5	7	7.5	8	8.5	9	9.5

2. The length of surgical gloves, depending on the size, is 250-280 mm, obstetric gloves - 450 mm.

B. Diagnostic (examination) gloves

1. Dimensions of diagnostic (examination) gloves

Available in the following sizes:

Extra small (X-S) - fits sizes 5 - 6

Small (S) - corresponds to the size 6.5 - 7 (according to GOST 3-88);

Medium (M) - corresponds to sizes 7 - and 7.5

Large (L) - fits sizes 8 - 8.5

Extra large (XL) - fit sizes 9 - 10.

Tab. 3. Size scale of diagnostic gloves

Glove size	Glove Palm Width (mm)	Glove length (mm)
XS (5-6)		240 - 245
S(6-7)		240 - 245
M (7-8)		240 - 245
L(8-9)		240 - 245
XL (9-10)		240 - 245

Appendix 2

Technique for donning medical gloves

How to wear gloves correctly?

Technique for putting on sterile gloves with the help of an assistant
	Open the outer packaging of sterile gloves in advance, before hand treatment. An assistant wearing sterile gloves takes out gloves from a sterile package and gives them to the surgeon, opening the glove with both hands.		The surgeon carefully puts his hand inside the glove, without touching its outer surface and the assistant's gloves.

An assistant helps put on both gloves. The surgeon can then adjust them himself so that the glove fits snugly around the hand. The cuff of the gown should cover part of the wrist, as the knitted fabric does not have protective properties.
Sterile glove donning technique

Open the outer packaging with gloves before you begin to clean your hands,		Unpack the package and start washing your hands and applying antiseptic.

Treated hands remain in the sleeves of a sterile gown. Carefully take the glove through the dressing gown and bring it to the other hand, gradually sticking the hand inward,		Then, slowly inserting your fingers into the glove, gently, helping with your other hand, put it on your left hand, holding the glove by the inside-out cuff of the glove.

Prying the cuffs from the inside with your fingers, straighten them in turn on both hands.
		Part of the sleeve should be inside the glove, it is desirable that the cuff slightly covers the arm below the wrist. The length of the gown sleeve must be such that the sleeve does not pull out of the glove when moving.

Annex 3

Technique for removing medical gloves

How to properly remove gloves?

Used gloves are removed carefully, without splashing biological contaminants that may be on and inside the gloves. How to properly remove gloves

Prying on the outer edge, pull the first glove down while turning it inside out.

Then, holding the removed glove in a fist, with a non-gloved hand, pry off the glove on the other hand from the inside, without touching its outer side. Turn the glove inside out and dispose of according to accepted rules and regulations,