WS/T 313-2019Specification of hand hygiene for healthcare workers (English PDF)

5.1 Hand washing and sanitizing facilities

5.1.1 Medical institutions should set up mobile water washing and sanitation hand disinfection facilities that are compatible with the diagnosis and treatment work, and are convenient for medical staff to use.

5.1.2 The hand hygiene facilities of the intensive care unit at the time of new construction and reconstruction should meet the requirements of WS/T 509.

5.1.3 Operation department (room), delivery room, catheter room, clean laminar flow disease area, bone marrow transplant disease area, organ transplant disease area, neonatal room, mother Infant room, hemodialysis center (room), burn ward, infectious disease department, stomatology department, disinfection supply center, laboratory department, endoscopy center (Rooms) and other high-risk infection departments and treatment rooms, dressing rooms, injection rooms should be equipped with non-touch faucets.

5.1.4 Conditional medical institutions should be equipped with non-touch faucets in the diagnosis and treatment area.

5.1.5 Shampoo (soap) should be provided and meet the following requirements.

a) The container for hand sanitizer should be disposable.

b) Reusable hand sanitizer containers should be cleaned and disinfected regularly.

c) Replace hand sanitizer when it becomes turbid or discolored, and clean and disinfect the container.

d) The soap used should be kept clean and dry.

5.1.6 Should be equipped with dry hand supplies or facilities.

5.1.7 Medical personnel have a good acceptance of the selected hand disinfectant.

5.1.8 Disposable packaging for hand disinfectants should be used.

5.2 Surgical hand disinfection facilities

5.2.1 Special hand sinks shall be provided. The sink is located near the operating room. The sink is suitable in size and height to prevent the flushing water from splashing.

The surface is smooth without dead corners and easy to clean. The sink should be cleaned and disinfected daily.

5.2.2 The number of wash basins and faucets should be set reasonably according to the number of operating rooms. Each 2 to 4 operating rooms should be provided with a separate hand basin.

The number of faucets is not less than the number of operating rooms, and the faucet switch should be non-touch.

5.2.3 Hand sanitizers that meet the requirements of 5.1.5 a), 5.1.5 b), and 5.1.5 c) shall be provided.

5.2.4 Supplies for cleaning nails should be provided.

5.2.5 Can be equipped with hand hygiene products. If equipped with a hand brush, the bristles of the hand brush are soft.

5.2.6 Dispensers for hand disinfectants should be non-touch.

5.2.7 Disposable hand disinfectants should be packaged in a single package.

5.2.8 Reusable disinfectant containers should be cleaned and disinfected at least weekly.

5.2.9 The disinfection method for washing hands should be equipped with dry hand supplies and meet the following requirements.

a) After sterilizing hands, use sterilized cloth towels to dry hands.

b) Reusable cloth towels should be washed, sterilized and stored according to relevant requirements after use.

c) The packing material for the cloth towel can be used for one time. If the reusable container is used, it should be cleaned and sterilized every time.

It takes more than 24h.

5.2.10 Timing devices and surgical hand hygiene flow charts should be provided.

6.1 Indications for hand washing and sanitation

6.1.1 Medical personnel should wash their hands and/or use hand sanitizers for sanitary hand disinfection in the following situations.

a) Before touching the patient.

b) Before cleaning and aseptic procedures, including before invasive procedures.

c) Exposure to the patient's body fluid risks, including contact with the patient's mucosa, damaged skin or wounds, blood, body fluids, secretions, excreta, After the wound dressing.

d) After touching the patient.

e) After touching the patient's surroundings, including after contacting the surfaces of medical related instruments, appliances and other objects around the patient.

6.1.2 Wash your hands in the following situations.

a) When there is visible contamination such as blood or other body fluids in the hands.

b) Possible contact with pathogenic microorganisms such as Clostridium difficile and enterovirus that are not sensitive to quick-drying hand disinfectants.

6.1.3 When there is no visible contamination of the hands, hand sanitizer should be used to sanitize the hands.

6.1.4 Medical staff should wash their hands before sanitizing hands in the following cases.

a) After contact with the blood, body fluids and secretions of patients with infectious diseases and items contaminated with infectious pathogenic microorganisms.

b) Directly after examination, treatment, care or treatment of infectious disease patients' infectious diseases.

6.2 Hand washing and sanitizing methods

6.2.1 For methods of washing hands of medical staff, see Appendix A.

6.2.2 Sanitary hand disinfection of medical personnel follows the following methods.

a) Take an appropriate amount of hand sanitizer on the palm and apply it evenly.

b) Perform rubbing according to the procedures in Appendix A. A.3.

c) Rub until hands are dry.

6.3 Hand Sanitizer Selection

Quick-drying hand sanitizer is preferred for sanitary hand disinfection. Other hand sanitizers can be used for allergic people; for some intestinal diseases that are not sensitive to ethanol in the case of a viral infection, other effective hand disinfectants should be selected.

6.4 Notes

Wearing gloves is not a substitute for hand hygiene. Hand hygiene should be performed after removing gloves.

8.1 Monitoring requirements

8.1.1 Medical institutions should regularly monitor and report on hand hygiene compliance of medical personnel, and compliance monitoring should indicate the rate of hand hygiene compliance.

The calculation method of the hand hygiene compliance rate is. hand hygiene compliance rate = number of hand hygiene execution opportunities/number of hand hygiene execution opportunities × 100%.

8.1.2 Medical institutions should perform quarterly operations on the surgical department (room), delivery room, catheter room, clean laminar flow disease area, bone marrow transplant disease area, and organ transplant.

Ward, intensive care unit, neonatal room, mother-infant room, hemodialysis center (room), burn ward, infectious disease ward, mouth Medical staff working in departments such as the department of endoscopy, center (room), etc., monitor the effectiveness of hand hygiene disinfection. When Suspected Hospital Outbreaks and Medical Care when personnel's hand hygiene is concerned, they should be monitored in a timely manner, and the corresponding pathogenic microorganisms should be detected.

The sample method follows the requirements of GB 15982.

8.2 Monitoring methods

8.2.1 For monitoring methods of hand hygiene compliance, see Appendix D.

8.2.2 To monitor the effect of hand hygiene and disinfection, use the following methods.

a) Pouring culture method. Sampling and cultivation methods are performed in accordance with the requirements of GB 15982.

b) Smear culture method. The sampling method complies with the requirements of GB 15982; after testing, the sampling tube is fully oscillated and then diluted separately 0.2 mL of multiple eluent was inoculated on the surface of two ordinary agar plates, spread evenly with a sterilized L rod, and left at 36 ° C ± 1 ° Incubate for 48 hours in an incubator and count the number of colonies.

c) The results of the disinfection effect shall be determined in accordance with the requirements of 4.5.

Appendix A

(Normative appendix) Medical staff washing their hands A.1 Get your hands wet under running water.

A.2 Take an appropriate amount of hand sanitizer (soap) and apply evenly to the entire palm, back of the hand, fingers and fingers.

A.3 Rub your hands carefully for at least 15s, and wash all the skin of your hands, including the back of your fingers, fingertips, and finger seams.

No particular order of steps).

A.3.1 Palms facing each other, fingers close together, rubbing each other, see Figure A.1.

A.3.2 The palms of the hands rub against each other along the back of the fingers, and the exchange is performed, as shown in Figure A.2.

A.3.3 The palms are facing each other, and the fingers between the hands are rubbed against each other, as shown in Figure A.3.

A.3.4 Bend your fingers so that the joint rotates and rubs in the palm of the other hand. The exchange is performed, as shown in Figure A.4.

A.3.5 Hold the thumb of the left hand in the right hand, rotate and rub it, and exchange it, as shown in Figure A.5.

A.3.6 Put the tips of five fingers close together on the palm of the other hand to rotate and knead, and exchange, as shown in Figure A.6.

A.4 Rinse hands thoroughly under running water, wipe them dry, and take appropriate hand lotion for skin care.

A.5 Paper towels should be used for drying.

Figure A.1 Palms facing each other, fingers close together rubbing each other Figure A.2 Palms rubbing against the back of the fingers along the finger seams

Figure A.4 Bend finger joints on palm and rotate and rub Figure A.5 Thumbs rotate on palm and rub Figure A.6 Five fingers close together, fingertips rotate and rub on palm

Appendix B

(Normative appendix) Disinfection method for surgical irrigation hand B.1 Complete surgical hand washing in accordance with 7.2 Surgical hand washing methods and requirements.

B.2 Apply an appropriate amount of hand sanitizer to each part of the hands, lower 1/3 of the forearm and upper arm, and rub carefully for 3 to 5 minutes.

B.3 Rinse hands, forearms and lower 1/3 of the lower arm in one direction from the fingertips to the elbows under flowing water, and dry thoroughly with a sterilized cloth towel.

B.4 The flushing water shall meet the requirements of GB 5749. When the quality of the rinsing water does not meet the requirements, the surgeon should use quick-drying hands before wearing gloves.

Poison disinfects hands.

B.5 The volume of liquid disinfection, rubbing time and usage method of the hand disinfectant should follow the instructions of the product.

Appendix C

(Normative appendix) Surgical hands-free disinfection method C.1 Complete surgical hand washing in accordance with 7.2 Surgical hand washing methods and requirements.

C.2 Place an appropriate amount of hand sanitizer on the left palm.

C.3 Immerse the right fingertip in hand disinfectant (>=5s), see Figure C.1.

C.4 Apply hand sanitizer to the right hand and forearm to the lower third of the upper arm. Make sure to use a circular motion to surround the forearm to the lower third of the upper arm.

The poison completely covers the skin area, continue rubbing for 10s to 15s until the disinfectant is dry, see Figures C.2 to C.5.

C.5 Take an appropriate amount of hand sanitizer and place it on the right palm.

C.6 Repeat C.3 and C.4 with the left hand.

C.7 Take an appropriate amount of hand sanitizer and place it on the palm.

C.8 Rub your hands up to your wrists. Follow the steps in A.3.1 to A.3.5 in Appendix A for hand washing by medical staff.

Dry hands.

C.9 The volume of liquid disinfection, rubbing time, and usage method of the hand sanitizer follow the instructions of the product.

Figure C.1 Figure C.2 Figure C.3

Figure C.4 Figure C.5

Appendix D

(Informative appendix) Hand hygiene compliance monitoring methods D.1 Using direct observation method In daily medical care activities, when the observation object is not informed, the observation object is randomly selected, observed and recorded Medical staff 's hand hygiene timing and performance, and calculated hand hygiene compliance rate to assess hand hygiene compliance.

D.2 Observers are observed by specially trained observers.

D.3 Observation time and scope According to the needs of evaluating hand hygiene compliance, select a representative observation area and time period;

The duration should not exceed 20 min.

D.4 Observation content Design the monitoring content and form before observation, mainly including.

a) Record the observation date and start and end time, observation place (hospital name, ward name, etc.) and observers for each observation.

b) Record each hand hygiene opportunity observed, including the type of person being observed (doctor, nurse, caregiver, etc.), hand hygiene indications, Whether to implement hand hygiene and methods of hand hygiene.

c) You can observe other contents at the same time, such as. the wearing of gloves, the correctness of hand hygiene methods and the reasons for errors.

d) Observers can observe up to 3 medical staff at the same time. It is not advisable to observe more than 3 hand hygiene opportunities for one medical staff at a time.

D.5 Calculate hand hygiene compliance rate and provide feedback.

Hand hygiene compliance rate = Number of timings for performing hand hygiene/Number of timings for performing hand hygiene × 100% D.6 Advantages. Observe detailed information, such as hand washing, sanitizing hand sanitization, use of gloves, rubbing methods, and factors affecting the effectiveness of disinfection.

D.7 Disadvantages. heavy workload, time consuming, need for qualified observers, selection bias, Hawthorne effect and observer bias.