Healthy human skin performs a number of extremely important functions, including protection against harmful environmental factors. The skin, especially the surface of the hands, is constantly inhabited by microorganisms. The microflora of human skin is divided into resident and transient.

Resident (permanent) microflora is represented by bacteria that constantly live and reproduce on the skin. In most cases, resident (permanent) microflora does not cause pathological processes in patients if the skin is intact, but it can cause an infectious process if it enters sterile cavities of the human body or if there is damage to the skin. The amount of resident (permanent) microflora can only be reduced, but completely removing it is not only practically impossible but also undesirable and unnecessary.

After all, it participates in creating local skin protection and prevents more dangerous microorganisms from penetrating and colonizing.

Transient (temporary) microflora consists of microorganisms that have temporarily settled on the skin of the hands; they colonize the upper layers of the skin and have the greatest epidemiological significance. Transient (temporary) microflora can consist of various microorganisms, including pathogenic ones, among them causative agents of nosocomial (hospital-acquired) infections. Representatives of transient (temporary) microflora survive on healthy skin for a short time.

When the skin is damaged, including during inadequate moisturizing, washing, or antiseptic procedures of the hands, transient (temporary) microflora penetrates deeper into the skin layers, displacing resident (permanent) microflora from there.

In 1843, Ignaz Semmelweis scientifically proved and confirmed by practical application the importance of the hand decontamination procedure for medical personnel to prevent the occurrence of nosocomial (hospital-acquired) infections. Thanks to the introduction of hygienic antisepsis practice in the maternity inpatient department where Ignaz Semmelweis worked, the mortality rate from hospital-acquired infections was reduced dozens of times.

More than 150 years have passed, but the problem of hand disinfection among healthcare personnel remains relevant.

Can it be denied that the hands of medical workers are an extremely frequent instrument for transferring microorganisms? And the patient who has been weakened by illness or surgery? And if this is an elderly person or a child? How can they resist infections? Infections that could be prevented by a very simple procedure. Hospital infections cause suffering and deaths of hundreds, thousands of patients even in developed countries of Europe and the USA.

Besides, even in the “great America,” hospital-acquired diseases cause economic losses of more than 5 billion dollars annually due to additional hospitalization periods and expensive treatment.

Medical personnel need to wash their hands often and very thoroughly. But the more often and thoroughly they do it, the greater the risk of damage to the skin surface. Moreover, frequent washing of hands with regular liquid or bar soap not only does not reduce the risk but actually increases the likelihood of infection transmission due to dispersion of bacteria from contaminated skin. And medical staff, who perform many procedures, simply do not have enough time to wash their hands properly with detergent.

According to calculations made by Voss and Widmer (1997), to fully comply with recommendations for routine hand washing in an intensive care unit, 16 hours of working time would be required for a medical team consisting of 12 people. Such a situation is unacceptable and unrealistic.

But there is a way out! The use of ready-to-use effective antiseptics. However, despite the availability and simplicity of the method, according to verified research data, medical personnel perform hand antisepsis only in half of the cases when it is prescribed and necessary.

Hygienic hand antisepsis is the treatment of the skin surface of the hands by rubbing antiseptic into the skin to eliminate transient (temporary) microorganisms. This procedure is most prescribed and should be used in healthcare facilities for hand disinfection. Hygienic hand antisepsis is applied in several cases: before entering aseptic rooms (operating rooms, sterilization departments, intensive care units, hemodialysis, etc.); before performing invasive interventions (catheter placement, injections, bronchoscopy, endoscopy, etc.); before activities where infection of the object is possible (e.g., preparing infusions, filling containers with solutions, etc.); at every direct contact with patients; when moving from infected to uninfected areas of the patient's body; contact with sterile materials and instruments; use of gloves; after contact with contaminated objects, fluids, or surfaces; contact with already inserted drains, catheters or their insertion sites; every contact with wounds; every contact with patients; glove removal; use of the restroom; and other cases depending on the situation.

Surgical hand antisepsis is the procedure of rubbing an antimicrobial agent (antiseptic) into the skin of the hands (without using water) to eliminate transient (temporary) microorganisms and to maximally reduce the number of resident (permanent) microorganisms. Surgical hand antisepsis is performed before any surgical intervention to prevent infection of the surgical wound in the patient and simultaneously to protect the staff from infections transmitted through blood or other means.

Today, among antiseptics, the most promising group is considered to be alcohol-based agents, which have the widest spectrum of antimicrobial activity and, most importantly, allow extremely fast and high-quality disinfection. Rightly, the leading role in this group is given to ethyl alcohol. This is related to the exceptional antimicrobial activity of ethanol and propanol. Especially effective are agents based on a combination of ethanol or propanol with other alcohols. Such antiseptics include the agent Inol.

The active ingredient of Inol consists of 75% ethyl alcohol and almost 4% isopropyl alcohol. Special additives are introduced into the Inol formula to soften and care for the hands. Thanks to the main components, Inol has the minimal possible microorganism kill time, no resistance develops to it. It acts on all, even resistant types of bacteria and viruses, and does not cause side effects, reactions, or irritations.

Nowadays, many countries or territories, including those in the Caucasus and Eastern Europe, consider the use of aqueous antiseptics promising, which unlike alcohol-based ones do not have tanning effects on the skin layers and mucous membranes. The aqueous composition of the antiseptic not only does not worsen the water-lipid balance of the skin surface but even stabilizes it, does not dry the hands, and allows regular use of such preparations for a long period of time.

In Ukraine, an MOH-registered and approved preparation based on polyguanidine phosphate — Aquin — is available. The antiseptic Aquin effectively destroys bacteria, including resistant hospital strains, viruses (including causative agents of parenteral infections and viral intestinal diseases), fungi. Polyhexamethylene guanidine phosphate (the active ingredient of Aquin) has a pronounced prolonged antimicrobial effect lasting for a long time (up to 3 hours) even on unprotected skin.

The use of Aquin has a beneficial effect on the hands, softening and improving skin condition. Thanks to its original formula composition, Aquin is also used for antisepsis of mucous membranes and treatment of wounds (especially purulent wounds requiring cleansing).

For a long time, antiseptics based on inorganic iodine have been used in medicine. But iodine compounds called iodophors, especially povidone-iodine (PVP-iodine), are much more active in their antimicrobial properties. This substance has a destructive effect on bacteria, viruses, fungi. PVP-iodine retains high antimicrobial properties even in the presence of blood, plasma, and does not cause resistance development in microorganisms. The antimicrobial effect persists on the skin for a long period after application.

Povidone-iodine is non-toxic during long-term use, practically does not cause reactions or irritations, and does not irritate the skin and mucous membranes. An advantage of PVP-iodine is good solubility in water and detergent properties. Povidone-iodine stimulates healing of skin and mucous membrane injuries, sutures, wounds, burns, and other damages. An interesting feature of povidone-iodine is the enhancement and acceleration of its antimicrobial effect when diluted to certain concentrations.

These properties can be explained by an increase in the proportion of free iodine due to the weakening of bonds with the polymer complex as a result of dilution with water (Guide to Disinfection and Sterilization in Healthcare Facilities, USA, 2008). Such important properties are possessed by the antiseptic Iodiskin, the basis of which is povidone-iodine. Therefore, Iodiskin is indicated for use in antisepsis of hands, skin, mucous membranes, in the same cases as its active substance PVP-iodine.

Not performing hand antisepsis is a huge mistake. Simply to prevent irritation, reactions, dermatitis, and other unpleasant phenomena, it is necessary to carefully choose an antiseptic, use it properly, and follow the treatment technique. For this purpose, a healthcare facility must have not just one or two antiseptics but an arsenal of various agents that will allow personnel to apply not just an antiseptic but choose the antiseptic agent individually suited to their skin.

Taken and adapted from the journal "Chief Medical Nurse."