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Medical gloves are a necessary consumable item for any medical institution, be it a paramedic and midwifery station or a large clinic. In this article we will tell you how to use medical gloves correctly.

One of the most important rules– compliance necessary conditions asepsis. Before putting on medical gloves (whether examination gloves or surgical gloves), you must thoroughly wash your hands and then treat them with an antiseptic solution. Put on gloves after the skin of your hands is completely dry. This rule does not apply to doctors working in emergency medical care teams. In extreme situations, work at the scene of an accident, disaster, metro station, and so on, the gloves are taken out of the pack and put on the hands.

Disposable medical gloves must not be used to perform multiple procedures on one patient. This is due to the fact that millions of bacteria live on the human body, and the composition of the flora varies different areas very different. Accordingly, complications may arise even with a simple procedure for drawing blood from a finger. After use, disposable gloves must be removed and hands should be treated again with an antiseptic solution. Used gloves are disposed of as Class B medical waste (potentially hazardous).

Worn in cases where there is a risk of contact with biological fluids, damaged skin and mucous membranes, as well as in contact with medical instruments contaminated with biological fluids, for example, processing probes, washing tracheostomy, caring for patients in anesthesiology and intensive care units.

Non-sterile gloves are also used in infectious diseases departments when working with patients infected with resistant (that is, antibiotic-resistant) microorganisms and patients with HIV. Non-sterile gloves should not be pulled too tightly while putting them on, otherwise they may tear. The use of gloves is not necessary when in contact with intact skin or surrounding objects (for example, in the case of an examination by a physician in an outpatient treatment facility).

How to use sterile gloves correctly?

(including obstetric, surgical) are used where complete asepsis is required. These are operating rooms, maternity hospitals, treatment rooms, dressing rooms, burn departments, and so on. It should be remembered that wearing sterile gloves is not a substitute for hand disinfection with skin antiseptics. Before putting on sterile gloves, hands must be thoroughly washed and treated with a skin antiseptic.

If we are talking about surgical intervention, then the hands are treated according to the surgeon’s hand treatment technology. The scheme has been approved by the World Health Organization. First you should wash your fingers, starting with inner surface, then the rear, then the spaces between the toes, legs and under the nails. First wash the left hand, then the right. After this, the hands and forearms are treated. Start by washing your palms, then the backs of your hands, then your wrists, then your forearms. Finally, wash your nails and under your nails again. Hands are dried with sterile wipes, following the same sequence as when washing hands. Before and after wiping, keep your hands raised up so that water does not get on your hands.

After washing, hands are treated with various antiseptic solutions, for example, chlorhexidine wipes. After the hands are washed, sterile gloves are put on according to the following algorithm (with the help of the operating nurse):

1. Away from the sterile table, the individual packaging of sterile gloves is opened. Then the inner envelope with gloves is shaken out onto a sterile surface.

2. Using sterile tweezers, open the inner packaging.

3. First, the glove is put on the right hand, then on the left.

4. The glove cuff should cover the robe cuff by 5-10 cm.

When should gloves be replaced immediately?

In case of puncture, rupture or defect;
If there is accidental contact with an electrosurgical instrument (for example, an electrocoagulator);
If liquid gets under the glove;
When “glove juice” appears (secret of the sweat and sebaceous glands, which may contain microorganisms. If the glove is torn or punctured, they can infect the wound);
When stickiness appears;
During the transition from the “dirty” stage of the operation to the “clean” one (for example, when excision of festering tissue).

Important! When replacing gloves, it is necessary to treat your hands with an antiseptic.

How to properly remove gloves?

After completion of the operation, sterile gloves are removed as follows. With your right hand, grab the cuff of your left glove and remove it from your hand, turning it inside out. The right glove is removed in the same way. After this, the gloves are placed in a container with a disinfectant solution for Class B waste for subsequent disinfection.

After removing the gloves, hands are washed again and treated with antiseptic solutions. To prevent the skin of your hands from drying out, it is recommended to use a nourishing cream.

For a nurse use of gloves is a required skill. Manipulations and patient care are carried out only with gloves in accordance with existing standards.

It should be remembered that it is unacceptable usage the same ones gloves for manipulation or care of two or more patients. Even if gloved hands have been washed and disinfected. Treating gloves with alcohol-containing solutions is also unacceptable due to the destruction of the protective layer.

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

Rules for putting on sterile gloves

• , treat them with an antiseptic and dry completely.
• Take sterile tweezers and remove the gloves from the original packaging or box. Place the gloves on a sterile table, palm side up.
• Pull back the edges of the gloves with sterile tweezers in the form of a cuff. Using the thumb and forefinger of your left hand, grab the folded edge from the inside and pull the glove over your right hand.
• Place the gloved fingers of your right hand under the lapel of the second glove and pull it over your left hand.
• Bend the curved 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 biological fluids, before removing them, they should be treated with a cloth moistened with a disinfectant solution.

• Using the gloved fingers of your right hand, grab the outside edge of the glove on your left hand. Remove the glove from your left hand with a vigorous movement, turning it inside out.
• Place the thumb of your left hand (without the glove) inside the glove on right hand. Remove the glove from your right hand with a vigorous movement, also turning it inside out.
• After use, immerse gloves in a container with disinfectant solution.
• Wash and perform hygienic hand antiseptics.

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

3.5.1. Disinfectology

Methodological recommendations MP 3.5.1.0113-16
“Use of gloves to prevent healthcare-associated infections in healthcare settings”
(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. These guidelines contain general requirements for the selection and use of disposable medical gloves to reduce the risk of healthcare-associated infections (HAIs) and occupational diseases among personnel of medical organizations.

2. General information

2.1. Disposable medical gloves are designed to protect the hands of medical personnel and create a barrier between the patient and medical workers when performing 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 finished products single use and cannot be reused.

2.4. Medical gloves must meet the requirements ensuring 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;

High-quality packaging and labeling;

Easy to recycle;

Functionality.

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

2.6. Medical workers must know the basic properties and performance characteristics of various types/types of gloves, understand how to use them correctly, taking into account the 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, the 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 with division into right and left, in some cases have an elongated cuff () and have a combination of characteristics that ensure high strength of the gloves.

3.1.2. Diagnostic/examination gloves are used for non-invasive and invasive diagnostic and therapeutic procedures and manipulations, as well as for handling contaminated medical devices. They can be sterile or non-sterile and do not have an anatomical shape or 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 basic characteristics, have a number of additional properties that meet the requirements various areas surgery:

Microsurgical thin gloves providing increased tactile sensitivity;

High-strength orthopedic gloves;

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 indicator;

gloves with internal antibacterial coating;

"chainmail" gloves.

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

Gloves made of natural rubber latex (latex gloves);

Gloves made of synthetic polymers (synthetic gloves).

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

3.3.2. Synthetic gloves are used if a medical worker is allergic to natural latex proteins, as well as when coming into contact with chemically aggressive substances. For medical purposes the following 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 make it easier to put on gloves. Depending on the method of processing the inner surface, medical gloves are divided into:

Powdered;

Powder-free;

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

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

Smooth surface;

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

Microtextured surface.

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

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

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

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

Cuff with cut edge (with or without anti-slip stripe);

The edge of the cuff is rolled up (with or without an 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 for diagnostic gloves includes 5 sizes - from XS to XL.

4. Selecting 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;

Upon contact with mucous membranes;

In contact with damaged skin;

When using piercing and cutting instruments;

When carrying out invasive diagnostic and therapeutic procedures.

4.2. Before choosing gloves, it is necessary to evaluate 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 glove material. The algorithm for selecting medical gloves in accordance with the classification can be divided into several stages:

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

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

Choice of material for making gloves;

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

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

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

Selecting gloves by size.

4.3. When performing all types of surgical interventions, healthcare 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 collection, catheterization of peripheral veins, blood collection from peripheral veins and administration medicines into peripheral veins, when working in clinical diagnostic and bacteriological laboratories, as well as when processing contaminated medical instruments and materials, it is recommended to use non-sterile diagnostic gloves.

4.5. When introducing a sterile device into sterile body cavities, placing a central vascular catheter, changing a bandage 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 you need to take into account special conditions type of surgical intervention that can be satisfied due to the additional properties of gloves:

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

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

Orthopedic gloves, which have increased thickness and strength, are used during manipulations in traumatology and orthopedics;

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

Chemo-resistant synthetic gloves made from nitrile or polychloroprene provide maximum resistance to exposure chemicals. They should be used in cases where bone cement is used during surgical interventions or 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 surgical procedure, as well as experience medical workers. Situations with an increased risk of infection include any emergency surgery and invasive procedures, as well as surgeries 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, one on top of the other, significantly reduces the risk of through-puncture and contamination of the hands of medical personnel);

double gloves with puncture indicator

(Similar to simple double gloves, the indicator system significantly reduces the risk of through-puncture and provides a higher degree of protection by quickly visualizing the damage: the lower glove is a different color and size from the upper glove, and the liquid that penetrates between the gloves when punctured creates a contrasting stain. Timely detection puncturing and changing gloves significantly reduces the time of contact with the patient’s blood and reduces the risk of infection of a medical worker);

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

"chainmail" gloves

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

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

4.8. Polyisoprene is the closest in structure and properties to natural latex synthetic material. 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 production 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 stress on the material. Vinyl gloves are oil resistant.

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

4.11. Treatment of the inner surface of gloves is used to prevent gloves from sticking together during storage, as well as to make gloves easier to put on. For this purpose the following are used:

Powdering is the treatment of the inner surface of gloves with powdery substances (corn starch, zinc oxide). A significant disadvantage of this method is the high risk of complications associated with powder getting into the surgical wound, into the indoor air and onto the hands of medical personnel;

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

Treatment of the inner surface of gloves with 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, it is recommended to use powder-free gloves in medical organizations.

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

4.14. Gloves with smooth surface thinner than textured ones and provide higher 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 handling 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 trimmed 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 secure the cut edge.

4.18. In order to ensure comfort and accuracy when working with gloves, it is necessary to select the correct 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 glove size corresponding to the circumference of the palm using a special size table ().

5. Rules for the use of medical gloves

5.1. Correct Application Medical gloves provide protection for the hands of medical workers.

5.2. Before putting on non-sterile or sterile gloves, hand hygiene or surgical hand disinfection is performed, respectively. Gloves are put on only after the antiseptic has completely dried on the skin of the hands.

5.3. After removing the gloves, the skin of the hands is hygienically treated with antiseptics.

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

5.5. Sterile gloves must be used for any aseptic (sterile) procedures that may involve contact with sterile areas/cavities of the body, as well as contact with the wound surface of the skin and mucous membranes.

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

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

5.8. Gloves may not be used in situations of contact with intact skin or environmental objects.

5.9. It is not recommended to treat gloves with antiseptics and disinfectants during manipulations, as this negatively affects their tightness and can lead to increased permeability.

6. Technique for putting on 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 first perform hand hygiene (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 sterile gloves on their hands before surgical interventions (or other aseptic manipulation), having previously completed the technology for cleaning the hands of surgeons.

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

6.5. Algorithm for putting on surgical gloves (if the dominant hand is the right (right-handed specialists)) ():

Open the individual outer packaging 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 your left hand, grab the edge of the cuff of your right glove turned inside out and put it on your right hand without touching the outer sterile surface of the glove. The cuff remains turned out;

Place the fingers of the right hand, which are already wearing a glove, under the lapel of the cuff of the left glove and put it on the left hand, without touching the skin and the underside of the cuff;

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

Only after this, unfold the inverted edge of the cuff of the right glove using similar circular movements.

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 nurse.

7. Features of working with surgical gloves

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

7.2. It is not recommended to treat gloves with alcohol-containing and other antiseptic agents before 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 must be changed every 60-120 minutes, depending on the nature of the surgical intervention. Before putting on new gloves, you must treat your hands with an alcohol-based antiseptic.

7.4. Gloves should be replaced in the following situations:

after damage (puncture);

after detection of a defect;

after an accidental electrical shock from an electrosurgical instrument;

if any liquid gets (absorbs) under the glove;

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 your hands, you should treat your hands with a skin antiseptic. Put a new pair of gloves on dry hands.

8. Technique for removing medical gloves

8.1. Used gloves should be removed carefully, avoiding splashes from the surfaces of the gloves, which may cause microbial contamination of the hands and the environment.

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

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

Using the same pattern, make a lapel on the right glove with your left hand;

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

With your left hand, remove the glove from your right hand, turning it inside out and immersing the glove from your 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/disposal.

8.3. After completing work and removing gloves, it is necessary to perform hand hygiene.

8.4. After use, disposable gloves 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 undesirable effects on the skin of the hands, healthcare workers are recommended to always use a professional nourishing hand cream.

9. Storing medical gloves

9.1. It is necessary to store gloves correctly, as improper storage can lead to a decrease in the quality of the gloves.

9.2. Medical gloves must arrive at the warehouse medical organization in transport packaging. Gloves are transported to the departments in clean group packages containing a certain number of gloves of the same size.

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

9.4. The packaging of gloves must be marked in accordance with GOST requirements.

9.5. Medical gloves should be stored in a well-ventilated area, away from heat sources, sunlight, direct exposure to light sources and electrical equipment, at a temperature not exceeding 25°C (excessive heating can lead to loss of elasticity and elasticity of the material), at a humidity of no 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 difficulties may arise due to temporary loss of elasticity.

9.6. Avoid exposing gloves to ozone; its sources 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 appears as small cuts and discolored areas.

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

10. Normative references

1. Federal Law of March 30, 1999 No. 52-FZ “On the sanitary and epidemiological welfare of the population.”

2. Federal Law of November 21, 2011 No. 323-F3 “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 Standardization.”

4. 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. “Guide to the hygienic assessment of working environment factors and labor process. Criteria and classification of working conditions." R 2.2.2006-05.

11. MP 2.2.9.2242-07 “State of workers in connection with the state of the production environment. Hygienic and epidemiological requirements for 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, sterile, disposable. Specification".

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

14. GOST ISO 10993.10-2011. Interstate standard. “Medical products. Assessment of the biological effects 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 for Alternate Attribute Inspection Procedures” 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 and 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 Medicinal Products (GMP).”

22. “Rules for organizing clean production and quality control of medical products made of polymers, woven and non-woven materials that have contact with blood” PR 64-05-001-2002.

23. Decree of the Government of the Russian Federation dated December 27, 2012 No. 1416 “On approval of the Rules state registration medical products."

24. WHO guidelines on hand hygiene in healthcare. WHO/IER/PSP/2009.07. World Health Organization, 2013

Annex 1

Sizes of medical gloves

A. Surgical gloves

1. Depending on the length of the third finger, the width of the wrist and hand, surgical gloves have the following standard sizes: 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5.

Table 1. Size scale for surgical gloves

Hand girth, 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 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) - fits sizes 9 - 10.

Table 3. Diagnostic gloves size scale

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 putting on 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 cleaning your hands. An assistant wearing sterile gloves takes the gloves out of the sterile packaging and hands them to the surgeon, opening the glove with both hands.		The surgeon carefully inserts his hand inside the glove without touching its outer surface and the assistant’s gloves.
An assistant helps you put on both gloves. The surgeon can then adjust them himself so that the glove fits snugly on the hand. The cuff of the robe should cover part of the wrist, since knitted fabric does not have protective properties
Technique for donning sterile gloves yourself
Open the outer packaging of the gloves before starting to clean your hands.		Unwrap the package and start washing your hands and applying sanitizer.
Treated hands remain in the sleeves of a sterile gown. Carefully take the glove through your robe and bring it to your other hand, gradually pushing your hand inside,		Then, slowly inserting your fingers into the glove, carefully, helping with the other hand, put it on your left hand, holding the glove by the turned-out cuff of the glove.
Using your fingers to pry up the cuffs from the inside, straighten them in turn on both hands.
		Part of the sleeve should be inside the glove, preferably with the cuff slightly covering the hand below the wrist. The sleeve length of the robe should be such that the sleeve does not pull out of the glove when moving.

Appendix 3

Technique for removing medical gloves

How to remove gloves correctly?

Used gloves are removed carefully, without splashing biological contaminants that may be on or inside the gloves. How to remove gloves correctly
Using the outer edge, pull the first glove down while turning it inside out.
Then, holding the removed glove in your fist, use your ungloved hand to pry the glove on the other hand from the inside, without touching its outer side. Turn the glove inside out and dispose of it in accordance with accepted standards and regulations,

Document overview

Equipment: industrial packaging of sterile gloves, manipulation table.

Manipulation algorithm:

Stages	Rationale
1. Preparation for the procedure
1.1.	Treat hands to a hygienic level (hands should be dry at the end of treatment).
Prevention of HAIs. Efficiency of manipulation.
1.3.	Open and unfold the package with gloves on the manipulation table.
Efficiency of manipulation.
2. Performing the procedure (Fig. 4)	2.1. 2.1.
Take the glove for the right hand by the lapel with your left hand so that your fingers do not touch the outer (working) surface of the gloves.
Preventing contamination.
2.2.
Close the fingers of your right hand and insert them into the glove.
2.3.
Open the fingers of your right hand and pull the glove over your fingers without breaking its cuff.
2.4.	2.1.
Place the 2nd, 3rd, 4th fingers of the right hand, already wearing a glove, under the lapel of the left hand, so that the 1st finger of the right hand is directed towards the 1st finger on the left glove. 2.5.

Hold the left glove vertically with the 2nd, 3rd and 4th fingers of the right hand.

2.6.

Close the fingers of your left hand and insert it into the glove.

3. End of the procedure

3.1.

Straighten the lapel at the beginning on the left glove, pulling it over the sleeve; then on the right, using the 2nd and 3rd fingers, bringing them under the folded edge of the glove.

Note:

if the nurse is left-handed, then she begins the manipulation by putting the glove on her left hand - with her right hand.

Equipment: Rice. 4. Putting on sterile gloves.

Manipulation algorithm:

Stages	Rationale
1. Preparation for the procedure
Removing used gloves.	Indications for removing gloves:
damage to gloves;
ending contact with blood and other body fluids or damaged skin or mucous membranes;	completion of work with disinfectants, PSO, sterilants, cytostatics, hormonal creams, etc.; Indications for removing gloves:
completion of work with medical waste;
if necessary, perform hand hygiene.
container with disinfectant solution, bag for class B medical waste, class B medical waste container.
1.1.
When gloves become contaminated with secretions, blood, etc. To avoid contamination of hands during the process of removing them, use a swab (napkin) moistened with a solution of a disinfectant in a concentration corresponding to viral hepatitis or an antiseptic to remove visible dirt. If the gloves are not contaminated, the nurse immediately begins to remove them.
2.7.
Open the fingers of your right hand and pull the glove over your fingers without breaking its cuff.
Remove the glove from your right hand by turning it inside out.	3.1. Place the gloves in a container with a disinfectant solution or in a bag for medical waste of class B tucked into a container for waste of a similar class in accordance with the standards adopted in a medical organization.

Proper handling of Class B medical waste.

Rice. 5. Removal of used gloves.

Stavropol 2013

I SEMESTER

INFECTION SAFETY.

INFECTION CONTROL

HANDS DECONTAMINATION LEVELS	Social	Hygienic
Surgical Washing moderately dirty hands with plain soap and water removes most temporary microorganisms from the skin. Social processing is carried out: Before meals Before feeding patients Before working with food After visiting the toilet Before and after patient care After any hand contamination	Before and after contact with objects that may be infected Processing is carried out for at least 30 seconds Hand washing with antiseptic agents helps remove temporary microorganisms more effectively. Hygienic treatment is carried out: Before performing invasive procedures Before caring for immunocompromised patients Before and after wound and urinary catheter care	Before putting on gloves and after taking them off After contact with a patient's body fluids or after possible contamination of the hands Hygienic treatment includes the following steps: hand washing and antiseptic treatment.

Antiseptic treatment is carried out for at least 2 minutes

Equipment: It is carried out before any surgical intervention and involves

special treatment	hands The same antiseptic agents are used as for hygienic treatment. A certain method of hand disinfection is used.
HAND WASHING TECHNIQUES	water, liquid soap, disposable towel or napkin
Stages	Rationale
1. Roll up the sleeves above the elbow, remove watches, bracelets and rings	Ensuring effective removal of microorganisms
2. Open the tap and adjust the temperature and water pressure	Comfortable manipulation, preventing water splashing
3. Wet your hands under running water, thoroughly and generously soap your palms, applying soap from the dispenser Ensuring the effectiveness of manipulation 4. Vigorously rub your palms together, repeating the steps 5 times	Required condition
6. Carefully process the palms with crossed fingers spread out (fingers of one hand in the interdigital spaces of the other), repeat 5 times, make a “lock”	Ensuring the effectiveness of processing interdigital spaces and phalanges
7. Rub the thumbs of one hand with the palms of the other, performing rotational movements, repeat 5 times	Required condition
8. Friction with rotational movements, the fingers of one hand clenched into a pinch on the palm of the other, repeat 5 times	Treatment of palm folds
9. Wash your hands under running water, holding them so that the wrists and hands are higher than the elbows and the water flows from the clean area to the dirty one	Required condition
10. Dry your hands with a disposable napkin	Required condition
11. Close the tap using your elbows if you have an elbow-controlled faucet or a napkin.	End of manipulation

To achieve a hygienic level, hands are treated with an antiseptic in the same sequence, for at least 2 minutes.

WEARING STERILE GLOVES

Indications: performing invasive manipulations with possible contact with biological fluid.

Contraindications: allergic reaction to latex.

Equipment: running water, soap with dispenser, sterile wipes, antiseptic, sterile gloves, class “A” and “B” waste.

Sequencing: TREAT YOUR HANDS AT A HYGIENIC LEVEL

Unfold the package of stamps

1. Take the right glove by the lapel with your left hand so that your fingers do not touch the outer surface of the gloves
2. Close the fingers of your right hand and insert them into the glove. Open your fingers and pull the glove over them without disturbing the lapel
3. Place the 2nd, 3rd, 4th and 5th fingers of the right hand under the lapel of the left glove so that the 1st finger of the right hand is directed towards the 1st finger on the left glove
4. Hold the left glove 2,3, and 4 fingers of your right hand vertically. Close the fingers of your left hand and insert them into the glove.
5. Straighten the lapel on the left glove, then on the right one using 2 and 3 fingers, bringing them under the lapel

REMOVING GLOVES

1. Using the gloved fingers of your right hand, make a flap on the left glove, touching it only from the outside
2. Using the fingers of your left hand, make a cuff on the right glove, touching it only from the outside
3. Remove the glove from your left hand, turning it inside out and holding it by the lapel.
4. Hold the left glove in the palm of the right hand
5. With your left hand, take the glove on your right hand by the lapel from the inside and remove the glove, turning it inside out, the left glove should be inside the right
6. Place both gloves in a container with disinfectant solution. TREAT YOUR HANDS AT A HYGIENIC LEVEL

ORDER No. 408

From 07/17/1989

“On measures to reduce the incidence of viral hepatitis in the country”

Ø Viral hepatitis is a group of infectious diseases with predominant liver damage, occurring with severe intoxication, jaundice, and hemorrhages.

Ø There are hepatitis A, B, C, D, E.

Ø Hepatitis A, E is transmitted by water, food, contact and household routes, the incubation period is 7-35 days, it affects mainly children and adults in areas with impaired water supply (Central Asia), the last 7-10 days of the incubation period are most contagious.

Ø Hepatitis B, C, D is transmitted by blood, sexually, transplacentally, the incubation period is 6 weeks - 6 months, it affects mainly health workers in contact with Hbs carriers, drug addicts, prostitutes, patients with massive blood transfusions, the most contagious 2-8 weeks before manifestations of the disease.

Ø Stages of disinfection for hepatitis - current and final.

1. Cover the discharge of a patient with hepatitis A and E with dry bleach.

60 minutes at a rate of 1:5, for hepatitis B and C - for 90 minutes.

2. After use, immerse patients’ dishes in a 1% chloramine solution

for 60 minutes or 3% solution for 30 minutes.

3. Before washing, immerse the laundry for 2 hours in a solution of 3% chloramine from

calculating 1 liter of solution per 5 kg of laundry.

4. Immerse care items in a 1% chloramine solution for 60 minutes or in 3%

chloramine solution - for 30 minutes.

5. Bedding after the patient is discharged is subjected to

processing in a disinfection chamber.

6. Premises, furniture, equipment should be treated 1%

chloramine solution at least 2 times a day when carrying out wet

7. Fill the garbage with a 10% bleach solution.

8. Cover blood waste with dry bleach at a ratio of 1:5.

9. After use, immerse rubber gloves in a 3% solution.

chloramine for 60 minutes.

10.Wipe the hands of personnel with a 0.5% chloramine solution, then wash with running water and soap, dry and treat with 70% alcohol.

Subsequently, this order was supplemented by orders No. 245 (1991), No. 123 (2003) and the Sanitary Rules “Prevention of Viral Hepatitis”.

ORDER No. 223

Order No. 288 (03.23.76)

On approval of instructions on the sanitary and anti-epidemic regime of hospitals and on the procedure for the implementation by bodies and institutions of the sanitary and epidemiological service of state sanitary supervision over the sanitary condition of medical institutions.

I. General provisions.

1. This Instruction intended for chief doctors and staff of hospitals, clinics, maternity hospitals, clinics, institutes and other medical and preventive institutions.

2. The organization and implementation of a set of sanitary and hygienic measures are aimed at preventing and combating nosocomial infections caused by various pathogenic and conditionally pathogenic microorganisms (staphylococci, Klebsiella, Pseudomonas aeruginosa, Proteus and others).

3. Sanitary and anti-epidemic regime in infectious diseases hospitals and infectious diseases departments general hospitals is established in accordance with the current Instructions on the regime of infectious diseases hospitals and infectious diseases departments of general city hospitals; in surgical departments - in accordance with the Temporary Guidelines for organizing and implementing a set of sanitary and hygienic measures in surgical departments.

4. Responsibility for organizing and carrying out a set of sanitary and hygienic measures in the hospital rests with the chief physician of the medical institution.

5. Senior nurse The department instructs nursing and junior medical personnel on the implementation of a set of sanitary and anti-epidemic measures in the department (hospital).

II. Sanitary and hygienic regime in the reception department.

6. The doctor examines everyone entering the emergency department for the timely identification of patients suspected of an infectious disease, their immediate isolation and transfer to the appropriate infectious diseases hospitals (departments).

7. For this purpose, patients’ skin and pharynx are examined, and their temperature is measured. Wooden spatulas are destroyed after one-time use, and metal spatulas are boiled for 15 minutes. Thermometers are placed entirely in a vessel with a disinfectant solution.

8. The patient is examined on a couch covered with oilcloth; After each patient is admitted, the oilcloth is wiped with a rag moistened with a disinfectant solution.

9. If a patient is detected with a suspected infectious disease, the furniture and objects that the patient came into contact with, as well as the room where he was, are subjected to disinfection.

10. When examining a patient in the emergency department, you must pay attention to the presence of lice. If pediculosis is detected, the patient, the room and objects with which the patient has been in contact are subject to special disinfestation treatment. Each patient who has been diagnosed with lice is reported to the sanitary and epidemiological station at the patient’s place of residence; make a corresponding note in the medical history.

11. The patient in the emergency department undergoes complete sanitary treatment: takes a shower or bath (as directed by the doctor); cuts nails, etc. For washing, the patient receives a disinfected washcloth.

12. Sanitation is carried out in a specially designated room, in which a access system must be observed, excluding counter flows of patients.

13. After passing sanitization the patient receives clean hospital linen, a robe (pajamas), and slippers.

Note: With the permission of the chief physician medical institution, the patient is allowed to use his own underwear, which must be changed strictly according to the institution’s schedule.

14. Transportation of infectious patients from the emergency room to the departments is carried out on a specially designated gurney.

15. The patient’s clothes and shoes are placed in an individual bag. The bags are stored on racks in a specially designated room.

16. The emergency department is provided with a sufficient amount of:

a) bath soap;

b) washcloths for personal use, the number of which is determined by the daily capacity of the medical institution;

c) utensils for separate storage of clean and used washcloths. Utensils for washcloths must be labeled “clean” and “used”;

d) hair clipper, straight razor or safety razor, fine comb;

e) nail clippers or scissors;

f) cotton wool, tweezers, denatured alcohol;

g) tips for enemas and utensils for their disinfection and storage in a clean form with appropriate markings;

h) buckets with tight-fitting lids, a galvanized iron baking sheet;

i) detergents, disinfectants and disinfestants.

17. After each use, washcloths for washing patients, baths, hair clippers, combs, razors and razors, nail clippers and scissors, tweezers, enema tips, spittoons, bedpans and urinals are disinfected according to the regimes.

18. To wash your hands, use laundry soap (2 times soaping) in small packaging (for single use). After examining a patient with an infectious disease or suspected infection, hands are disinfected for 2 minutes with a 0.2% solution of chloramine or a 0.1% solution (peracetic acid) of Dezoxon-1.

19. Wearing medical personnel Caps that completely cover your hair are a must.

20. The reception area is cleaned at least 2 times a day using a wet method using disinfectants. The cleaning equipment of the reception department is marked. A bucket and a rag are kept in the restroom, intended for washing floors only in the restroom. For washing doors, window frames, window sills, etc. There should be separate rags stored in another place. The use of this equipment for other purposes is strictly prohibited. After use, cleaning material is disinfected.

III. Sanitary and hygienic regime in the departments.

21. Before the patient enters the room, the bed, bedside table, and bedpan stand are wiped with a rag moistened with a disinfectant solution. The bed is being made bedding, having undergone chamber processing according to the regime for vegetative forms.

22. The patient is given individual care items: a spittoon, a sippy cup, a mug or glass, a bedpan, etc., which are thoroughly washed after use. After the patient is discharged, personal care items are disinfected.

23. Upon admission to the hospital, the patient is given the right to take personal hygiene items into the room.

24. Patients with pediculosis, initially treated in the emergency room, are taken under special supervision and subjected to repeated treatment in the department until they are completely lice-free.

25. Each patient takes a hygienic bath in the department at least once every 7-10 days (if there are no medical contraindications to this).

26. Underwear and bed linen are changed at least once every 7-10 days (after taking a bath and, in addition, linen is changed every time it gets dirty).

27. When changing underwear and bed linen, it is carefully collected in cotton bags or in containers with a lid. It is prohibited to throw used laundry onto the floor into open receptacles. Sorting and dismantling of dirty linen is carried out in a specially designated room. After changing linen, the floor and objects in the room are wiped with a rag soaked in a disinfectant solution.

28. Patients are provided with free hairdresser services:

a) shaving at least 2 times a week;

b) hair cutting according to indications.

The hairdresser's compliance with the required regimen is monitored by the department's senior nurse.

Order No. 720

“Improving medical care for patients with purulent

HYGIENIC BATH

INDICATIONS: deficiency of self-care, sanitization

CONTRAINDICATIONS: severe condition of the patient (hypertension, bleeding), after anti-pediculosis treatment.

PROBLEMS: negative attitude, psychomotor agitation

COMPLICATIONS: deterioration of the patient's condition, injury

EQUIPMENT: water, soap, towel, gloves, waterproof apron, shampoo, terry mitten or washcloth, ladle, comb, diaper, containers with disinfectant solutions, water thermometer, medical documentation. waste class “A”, “B”, pen,

STAGE	JUSTIFICATION
Explain the procedure to the patient and obtain his consent.
Fill the bath with water T 36-37 g C, use a water thermometer to measure	Mandatory condition, prevention of complications
Warn the patient about possible unpleasant sensations (shortness of breath, palpitations) and the need to immediately notify the medical officer about this	Prevention of complications
Holding the patient by the elbows, help him get into the bath	Injury prevention
Sit the patient in the bath, the water should reach the xiphoid process, place a footrest	Injury prevention
Assist with washing if necessary	Self-care deficiency
Put on an apron	Infection safety
Wash sequentially: head, torso, upper and lower limbs, groin area and perineum, using a terry mitten or washcloth	Manipulation condition
Help the patient stand up in the bathroom, cover his shoulders with a towel and help him get out	Manipulation conditions, injury prevention
Help dry yourself, carefully check the dryness of folds and interdigital spaces	Prevention of diaper rash
Help get dressed, comb your hair, put on your shoes. Ask about how you are feeling.	Self-care deficiency
Put on gloves, disinfect the bath, remove the apron and gloves, and disinfect. Wash and dry your hands. Complete documentation

HYGIENIC SHOWER

INDICATIONS: sanitization

CONTRAINDICATIONS: patient's serious condition

PROBLEMS: refusal of manipulation, deterioration of condition, lack of self-care

COMPLICATIONS: deterioration, injury

EQUIPMENT: water, soap, towel, gloves, waterproof apron, shampoo, washcloth, towels, diaper, comb, containers with disinfectant solutions, bag for collecting laundry, medical documentation, class “A”, “B” waste, pen,

STEPS	JUSTIFICATION
Explain the procedure to the patient and obtain consent for it.	Patient's right to information
Wear a waterproof apron. Adjust water pressure and temperature	Infectious safety, manipulation conditions, ensuring comfort
Help the patient undress and get into the shower or sit on a bathtub seat	Injury prevention
Help, if necessary, wash sequentially: head, torso, upper and lower extremities, groin area and perineum.	Self-care deficiency
Turn off the water, cover the patient's shoulders with a towel and help him get out of the shower or bath.	Injury prevention
Help to wipe dry, pay special attention to folds and interdigital spaces.	Prevention of diaper rash
Help the patient get dressed, comb his hair and put on shoes. Ask about your health	Deficiency of self-care, prevention of complications
Carry out disinfection, remove the apron and treat, place gloves in a disinfectant solution, wash and dry your hands, complete documentation	SER requirements and documentation rules

The method of washing is determined by the doctor. The presence of a medical officer during sanitization is mandatory. If your condition worsens while taking a hygienic bath or shower (dizziness, palpitations, heart pain, pallor, etc.), you must stop the procedure, inform the doctor about the worsening condition and begin providing first aid.

MEASUREMENT OF PATIENT GROWTH

Purpose: assessment of physical development.

Indications: admission to hospital, preventive examinations.

Equipment: running water, liquid soap, towel, antiseptic, height meter, pen, medical history.

Problem: The patient cannot stand.

special treatment	hands The same antiseptic agents are used as for hygienic treatment. A certain method of hand disinfection is used.
I. Preparation for the procedure: 1. Collect information about the patient. Kindly introduce yourself to him. Clarify how to contact him if the nurse sees the patient for the first time. Explain to the patient the course of the upcoming procedure and obtain consent. Assess the patient's ability to participate in the procedure.	Establishing contact with the patient. Ensuring the patient’s psychological preparation for the upcoming procedure. Respect for patient rights.
2. Prepare a stadiometer: place an oilcloth or disposable pad under your feet.	Invite the patient to take off his shoes, relax, and for women with high hairstyles, let their hair down.
Ensuring the prevention of nosocomial infections.	II. Performing the procedure: 3. Invite the patient to stand on the stadiometer platform with his back to the stand with the scale so that he touches it with three points (heels, buttocks and interscapular space).
Ensuring reliable indicators.	4. Stand to the right or left of the patient.
5. Slightly tilt the patient’s head so that the upper edge of the external auditory canal and the lower edge of the orbit are located in one line, parallel to the floor.	II. Performing the procedure: 3. Invite the patient to stand on the stadiometer platform with his back to the stand with the scale so that he touches it with three points (heels, buttocks and interscapular space).
6. Lower the tablet onto the patient’s head. Fix the tablet, ask the patient to lower his head, then help him get off the stadiometer. Determine the indicators by counting along the bottom edge.	Providing conditions for obtaining results.
Ensuring a protective regime.	7. Report the obtained data to the patient.
Ensuring patient rights.	III. Completion of the procedure 8. Record the obtained data in the medical history.

Ensuring continuity of nursing care. Note.

If the patient cannot stand, the measurement is taken in a sitting position. The patient should be offered a chair. The fixation points will be the sacrum and interscapular space. Measure your height while sitting. Record the results.

Diet No. 1a.

Indications for use: exacerbation of peptic ulcer during the first 8-10 days of treatment and bleeding, exacerbation of gastritis with increased secretion, burn of the esophagus.

Purpose of prescription: maximum sparing of the stomach with the exception of chemical, mechanical and thermal irritants. General characteristics: exclude substances that stimulate the secretion of gastric juice. Food is given mainly in liquid and semi-liquid form.

Calorie intake is limited mainly through carbohydrates. Table salt is limited.

Calorie content and composition: proteins 80g, of which at least 50g are of animal origin, fats 80-90g, carbohydrates 200g, calories 2000.

Diet: frequent meals (every 2-3 hours) in small portions, milk or cream at night.

Diet No. 1b. Indications for use: the purpose of use and general characteristics are the same as for diet No. 1a. But to the products indicated in the characteristics of diet No. 1a, their crackers are added white bread

, dry biscuit, pureed cottage cheese from the dairy. Increase the amount of meat and fish steamed dishes.

Calories and composition: proteins 100g, fats 100g, carbohydrates 300g, calorie content 2600.

Diet: frequent meals (every 2-3 hours) in small portions, milk or cream at night.

Diet No. 1.

Indications for use: peptic ulcer in the stage of subsided exacerbation, with scarring of the ulcer, as well as during remission for 2-3 months. Gastritis with increased secretion during an exacerbation. Purpose of administration: sparing the stomach and duodenum

General characteristics: exclude substances that stimulate gastric secretion (strong broths from fish and meat, mushrooms, fried, fatty foods, coffee, savory snacks, brown bread, vegetable fiber, alcoholic beverages, unprocessed vegetables). Food is given mainly pureed, steamed or boiled. Table salt is limited.

Calories and composition: proteins 100g, fats 100g, carbohydrates 400g, calorie content 3000.

Diet: frequent meals (6 times a day), milk, cream or fresh kefir before bedtime.

Diet No. 2.

Indications for use: chronic gastritis with secretory insufficiency, chronic enterocolitis without exacerbation, disorder of the masticatory apparatus. The recovery period after surgery and after an acute infection, as well as in cases where moderate sparing of the gastrointestinal tract is indicated.

Purpose of prescription: to promote the normalization of the secret and motor functions of the stomach and intestines, moderate mechanical sparing of the gastrointestinal tract.

General characteristics: a physiologically complete diet with the preservation of extractives and other substances that stimulate the secretion of gastric juice and do not irritate the gastric mucosa. Meat with coarse connective tissue and products containing plant fiber are given mainly in crushed form. Leguminous plants are excluded.

Calorie content and composition: proteins 80-100g, fats 80-100g, carbohydrates 400, calorie content 3000. Vitamin C - 100 mg, other vitamins - in increased quantities.

Diet No. 3.

Indications for use: constipation, caused by poor nutrition, as well as those arising from a decrease in the excitability of the neuromuscular apparatus of the intestines.

Purpose of administration: strengthening intestinal peristalsis by including mechanical, chemical and thermal irritants in food.

General characteristics: a variety of foods are prescribed, including those rich in coarse plant fiber and promoting intestinal peristalsis (dairy products, vegetables, raw vegetable salads, fresh berries and fruits, sauerkraut, buckwheat and pearl barley porridge, fried meat in pieces, fatty fish, eggs hard-boiled, honey, figs, cold fruit and vegetable soups, carbonated drinks). Limit foods that inhibit intestinal motility: pureed and finely ground foods, hot dishes and drinks, pureed porridge, jelly, cocoa, strong tea. Table salt is added in increased quantities.

Calorie content and composition: proteins 100-120g, fats 100-120g, carbohydrates 400-450g, calorie content 3000-3500.

The diet is normal.

Diet No. 4.

Indications for use: gastroenteroscolitis, acute enterocolitis and exacerbation of chronic diseases, dysentery in the acute period, condition after intestinal surgery.

Purpose of prescription: significant sparing of the intestines, exclusion of foods that increase intestinal motility and fermentation in the intestines.

General characteristics: a diet with calorie restriction due to carbohydrates and fats. Proteins are within the lower limit of the physiological norm. Avoid milk, natural coffee, juices, spices, processed cheese, products containing vegetable fiber (beets, cabbage, turnips, spinach, sorrel), pickles, and smoked foods. The diet is prescribed for a period of no more than 5-7 days.

Calorie content and composition: protein 80g, fat 70g, carbohydrates 50g, calorie content 2000. Vitamin C - 100 mg. The amount of B vitamins and others missing in food products is replenished with vitamin preparations.

Diet: eating 5-6 times a day in limited quantities. Free liquid 1.5 liters in the form of hot tea, broth, rosehip decoction.

Diet No. 4b.

Indications for use: chronic enterocolitis during a period of moderate exacerbation when intestinal disease is combined with damage to the stomach, dysentery during the period of subsidence of acute phenomena.

Purpose of purpose: provision good nutrition during a period of moderate exacerbation of chronic enterocolitis, helping to reduce the inflammatory state and normalize dysfunction of the gastrointestinal tract.

General characteristics: in a physiologically complete diet, the content of carbohydrates and table salt is moderately limited. Avoid products that mechanically and chemically irritate the intestinal mucosa and enhance fermentation processes and rotting in it. Products containing coarse plant fiber (mashed vegetables, prunes, apples, stale white bread) are introduced into the diet.

Calorie content and composition: proteins 100-120g, fats 100g, carbohydrates 300-350g, calorie content 2600-2900.

Diet: meals 5-6 times a day.

Diet No. 5a.

Indications for use: acute cholecystitis or exacerbation of chronic, acute pancreatitis or exacerbation of chronic, chronic cholecystitis in the presence of peptic ulcer, 5-6 days after operations on the biliary tract.

Purpose of administration: to promote the restoration of impaired liver function, accumulation of glycogen in the liver, stimulation of liver function, bile secretion, limitation of mechanical irritation of the stomach and intestines.

General characteristics: diet with limited fat, proteins and carbohydrates – within normal limits; the content of lipotropic factors is increased. Extractive substances and fat breakdown products obtained during frying are excluded. All dishes are prepared from mashed products, boiled or steamed.

Diet No. 5.

Indications for use: chronic diseases of the liver and biliary tract– cholecystitis, hepatitis, cirrhosis of the liver without exacerbation of the process and in the absence of diseases of the stomach and intestines, Botkin’s disease in the recovery stage.

Purpose of prescription: to promote the restoration of impaired liver function.

General characteristics: a diet with a physiological norm of proteins, a slight increase in carbohydrates, a moderate restriction of fats and the exclusion of foods rich in cholesterol. Culinary processing with the exclusion of nitrogenous extractives, purines and fat breakdown products obtained during frying. Mushrooms, spinach, sorrel, spices, cocoa, chocolate, cranberries, and currants are also excluded. A diet with an increased amount of lipotropic factors and vitamins. Table salt up to 10-12g.

Calorie content and composition: proteins 80-100g, fats 60-70g, carbohydrates 450-500g, calorie content 2800-2900. For patients with fat metabolism disorders, carbohydrates are limited.

Diet: frequent meals (every 2-2.5 hours) and plenty of drinking up to 2 liters of warm liquid.

Diet No. 6.

Indications for use: gout and uric acid diathesis, erythremia, etc., when exclusion of meat and fish products is indicated.

Purpose of administration: to promote the normalization of purine metabolism and reduce the endogenous formation of uric acid.

General characteristics: exclusion of fats and foods rich in purine compounds (lard, lamb and beef fat, liver, kidneys, brains, sprats, fried meat and fish and their strong broths, sauces, sorrel, spinach, green peas, chocolate, cocoa, coffee , alcoholic drinks). Foods containing alkaline radicals are introduced (vegetables, fruits, berries, milk), and table salt is moderately limited.

Calorie content and composition: proteins 80-100g, fats 80g, carbohydrates 400g, calories 2700. For patients with fat metabolism disorders, carbohydrates are limited.

Diet: eating 5 times a day, drinking plenty of fluids up to 2-2.5 liters of liquid in the form of tea, fruit and berry juices, alkaline waters.

Diet No. 7a.

Indications for use: acute glomerulonephritis, after rice-apple, potato or sugar days, chronic nephritis in the stage of renal failure.

Purpose of prescription: to create conditions that are as gentle as possible on the kidneys, the effect of limiting table salt on hypertension and edema.

General characteristics: diet with severe protein restriction. Fats and carbohydrates within the physiological norm, salt, hyposodium diet (food without salt, salt-free bread is specially baked). The sodium content in food is 400 mg, which corresponds to 1000 mg ( 1d) table salt. For patients with insufficient renal function in the presence of azothermia, table salt is added as prescribed by the attending physician. Patients are allowed to give as much fluid as urine excreted in the previous day. Culinary processing of products - without mechanical sparing. Vegetables, fruits, and berries are introduced in sufficient quantities, some in raw form.

Calorie content and composition: proteins 5-30g, fats 80-100g, carbohydrates 400-450g, calories 2500-2600. Vitamin C and B vitamins are administered in increased amounts.

Diet: eating 5 times a day.

Diet No. 7b.

Indications for use: acute nephritis after diet No. 7a, exacerbation of chronic nephritis with edema, high blood pressure, but with preserved renal function.

Purpose of appointment: the same as with diet No. 7a.

General characteristics: the content of fats and carbohydrates is within the physiological norm. The amount of proteins compared to diet No. 7a has been increased to 45-50 adding boiled meat or boiled fish and 200g of milk or kefir. Otherwise, in terms of the set of products and the nature of culinary processing, the diet is the same as No. 7a. The content of table salt in products increases to 1.5 g.

Calories and composition: proteins 45-50g, fats 100g, carbohydrates 450-500g, calories 3000.

Diet No. 7.

Indications for use: acute nephritis during the recovery period, chronic nephritis with subtle changes in urine sediment, nephropathy in pregnancy, hypertension and other cases when a salt-free diet is necessary.

Purpose of prescription: moderate sparing of kidney function. Impact on increased arterial pressure and swelling.

General characteristics: salt-free, in terms of the set of products and the nature of culinary processing, it is the same as diet No. 7a and 7b, but the amount of protein increases to 80 g adding boiled meat or fish, as well as cottage cheese. Exclude legumes, strong meat broth, cakes and creams, carbonated and alcoholic drinks, fried meat, beer.

Calories and composition: proteins 80g, fats 100g, carbohydrates 400-500g, calories 2800-3200. The content of table salt in products is about 6-7g. Vitamins C, P, and group B are prescribed in increased quantities. For patients with renal amyloidosis with preserved renal function and patients with nephrosis, diet No. 7 is prescribed with an increased content of proteins up to 140 g, polyunsaturated fatty acids and vitamins.

Diet No. 8.

Indications for use: obesity in the absence of diseases of the digestive organs, liver and cardiovascular system that require special diets.

Purpose of use: impact on metabolism to prevent and eliminate excess fat deposition.

General characteristics: restriction of food calories, mainly due to carbohydrates and partly due to fats, protein content is higher than the physiological norm. Vegetables and fruits in sufficient quantities. Limit table salt, exclude flavorings and nitrogenous extractive substances that stimulate appetite, fatty meats, flour and pasta, pickles, smoked meats, chocolate, cocoa, instead of sugar - xylitol, sorbitol. Moderately limit the introduction of free fluid(1000 ml), potatoes, white bread.

Calorie content and composition: proteins 100-120g, fats 60-70g, carbohydrates 180-200g, calories 1800-1850. Vitamin C in increased quantities, other vitamins within the physiological norm.

Diet: frequent meals of low-calorie food with sufficient volume, eliminating the feeling of hunger.

Diet No. 9.

Indications for use: diabetes mellitus in the absence of acidosis and concomitant diseases of internal organs.

Purpose of administration: creating conditions that maintain a positive carbohydrate balance, preventing lipid metabolism disorders.