The physiotherapy or rehabilitation centers receive dozens of patients at the end of the day and, some of them, have a somewhat delicate state of health.
That is why, although these centers are not considered as high risk as hospitals, they also have very specific hygiene needs and different from those of any other space.
In this guide we highlight the basic points and the products necessary to guarantee hygiene in physiotherapy centers and well-being, not only for patients, but also for professionals.

Hand hygiene, basic to avoid nosocomial infections
The hands of physiotherapists are your main work tool. And hence they run the risk of becoming a vehicle for the transmission of germs.
It is especially important that physiotherapy professionals wash their hands with soap and water before and after receiving each patient.
In addition, hand washing can also be completed with the application of hydroalcoholic gel for complete disinfection.
This action provides greater security to the patient and also to the workers.

Hand Medic Cream for hand hydration
A physical therapist washes his hands many times at the end of the day. This, in addition to the wear they suffer during the entire workday, usually leads to skin wear.

The stretcher paper, the king of consultation
The stretcher paper is usually one of the most demanded hygiene products in a consultation or physiotherapy center.
This element, which acts as a protection, is totally necessary and essential, since it prevents the surface of the stretcher from getting stained or contaminated and leads to major problems for patients.
It is considered strictly necessary to replace each piece of stretcher paper each time you change patients.
In this article you can consult some guidelines that will help you choose stretcher paper.

Soft and absorbent cellulose for the body

Physiotherapists work with gels and creams that are applied to the patients’ bodies and that usually leave a feeling of later fat.
Therefore it is common to see them remove these remains with cellulose. It is recommended to use papers with great absorption and especially soft to avoid skin irritations that cause the patient to feel uncomfortable.
How do we know when a paper is absorbent? The number of layers plays an important role, but it is not the only factor to take into account, since the weight of each layer in particular also intervenes. The greater the weight and the number of layers, the more absorbent and resistant the paper will be.
To guarantee the smoothness of cellulose, we will opt for virgin fiber compositions instead of recycled paper and, if possible, with a tissue finish.

Equip the center with the appropriate bins
As we can see, if we add the waste of stretcher paper with that of cellulose for drying the body, a physiotherapy center generates a lot of waste at the end of the day.
Therefore, we must have bins or containers large enough to accommodate such quantities. But, above all, it is important that they present a hygienic opening and structure.
This fact translates into the incorporation of a pedal so as not to have to touch the surface when opening the bin, in addition to a lid, so that the used paper waste is “protected” and does not pose a risk in terms of environmental pollution .

Some tasks that are carried out in physiotherapy or rehabilitation centers require the use of gloves.
This product is especially useful when there is a presence of wounds, since it prevents direct contact with the skin but without losing sensitivity.

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The skin is normally colonized, and different areas of skin have different rates of bacterial colonies measured as: cfu / cm2; In the RN the areas of greatest colonization are: perineal-inguinal, umbilical, axillary, cervical, and lower limbs. In contrast, health workers are hands.

It was only in 1938, that the skin flora was categorized into:

FLORA TRANSITORIA: recently acquired (pollution); These bacteria can be acquired from colonized patients: E. coli, Cocos (+) MR, Candidas, MR Enterococci and Gram Bacilli (-) MR. They usually survive a limited period of time and are located in the superficial layers, for which they can be removed with hand washing by mechanical drag. It is more frequently associated with cross infection.

RESIDENT FLORA: they are persistent or permanent microorganisms in the skin of most people, include Staphylococcus C (-), corinebacterium, Diphteroids, these survive and multiply in deep layers. On some occasions Staphilococcus Aureus or Candidas spp are incorporated when the skin is injured, being difficult to eradicate and becoming an important source of contamination and transmission.

The skin is a dynamic structure with three important functions: a) reduce water loss, b) the body’s first protective barrier against infections and abrasions and c) act as a permeable barrier.

Its structure in premature RNs is not fully developed; in them we observe that the stratum corneum does not exist or is limited to 1 or 2 cell layers, preventing it from fulfilling the first two functions; the epidermis is thin and easily exposed to lacerations and irritating substances that alter its weak integrity; Only the dermis and the hypodermis are better developed in them.

The alteration of the integrity can be of nutritional cause, by disruption (puncture-laceration), by extraction of lipids and corneal layer (acetone-adhesives) or by irritating chemical substances (solvents-detergents); Not only does it affect the RN but also the personnel who sanitize their hands frequently and their normalization requires from 6 hours to 7 days.

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The factors identified that influence the reduction of adherence to hand washing are:

1. Categories of workers: technicians, doctors, nurse (in that order), male sex;
2. Hospital area: minor in NICU,
3. Time of day and week: less on weekends,
4. Type and intensity of patient care: the greater the contact the less adhesion,
5. Activities with risk of contamination, use of gloves and nightgown, greater risk less adherence.
6. The reasons of the health staff for low adherence were related to skin irritation, inaccessibility of the dispenser, interference in the relationship with the patient, the patient perceived as a priority, use of gloves, loss of time, ignorance of the guidelines, overwork (inadequate nurse-patient relationship) and insufficient time, ignorance of the impact of proper hand hygiene on nosocomial infection.

Skin irritation is the most important barrier to hand hygiene; the greater the washing, the pH of the skin increases, the lipid content is reduced, the loss of trans-epidermal water and bacterial colonization increases. The use of alcohol gels, which add to the bactericidal power of alcohol emollient substances, are less irritating and better tolerated than soapy solutions, keep the skin protected and reduce bacterial development.

A complex and dynamic change in behavior to achieve greater adherence includes the combination of education, motivation and systematic information coupled with the perception of possible alternatives.

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1. The hand disinfection effect should meet the following requirements:

a) Sanitary hand cleaning, the total number of bacterial colonies monitored should be ≤10cfu/cm2

b) Surgical hand disinfection, the total number of bacterial colonies monitored should be ≤ 5cfu/cm2

2. Concept of sanitary hand disinfection and surgical hand disinfection

a) What is hygienic hand disinfection? Refers to the medical staff using quick-drying hand disinfectant to rub both hands to reduce the process of temporary hand-dwelling bacteria.

b) Surgical hand disinfection? Before the operation, the medical staff washes the hands with soap (soap) and running water, and then removes or kills the temporary bacteria and reduces the resident bacteria by hand disinfectant. The hand sanitizer used can have sustained antibacterial activity.

3. Hand washing and sanitation hand disinfection should follow the following principles:

a) Wash hands with soap (soap) and running water when there is visible contamination of the hands such as blood or other body fluids.

b) When there is no visible contamination of the hand, it is advisable to use a quick-drying hand disinfectant to disinfect the hands instead of washing hands.

4. Medical staff should wash their hands first in the following situations, and then disinfect the hands:

a) After contact with the patient’s blood, body fluids and secretions, and items contaminated with infectious pathogenic microorganisms.

b) After directly inspecting, treating, caring for or treating the infected patient’s dirt.

5. Hand hygiene monitoring sampling time and method:

a) Sampling time is sampled before contacting the patient and conducting a diagnosis and treatment activity.

b) Sampling method The subject is close to the fingers, and the cotton swab soaked with the sterile eluate containing the corresponding neutralizing agent is rubbed twice from the finger to the fingertip on the double-finger surface, one hand is coated. The rubbing area is about 30cm2, and the cotton swab is rotated at the same time during the rubbing process; the cotton swab is cut off from the operator’s part, and 10 ml of the sterile eluent test tube containing the corresponding neutralizing agent is put into the test tube, and the test is promptly sent.

Hand hygiene and effect monitoring analysis

There is no standard for monitoring the total number of bacterial colonies after washing hands in the “Health Code for Medical Staff Hand”.

In the Prevention and Control of Infection in Primary Care Institutions, the advantage of hand disinfectant is that it can kill potential pathogens more effectively than running water soap. The monitoring shows that the bacterial count is significantly reduced, and the time required is shorter and more convenient. Liquid and running water can improve skin allergies and dryness. Frequent hand washing and hand disinfection can cause skin damage. The hand washing effect is better than the hand sanitization effect, and the hand disinfection effect monitoring is superior to the hand washing effect.

Based on the above analysis, there is no monitoring standard for running water washing national regulations, and there are monitoring standards for hand disinfection regulations. At the same time, in order to increase hand hygiene compliance and ensure hand hygiene, there is no visible pollution in the hands (except for C. difficile infection). It is recommended to use hand sanitizer for hand hygiene.

Although the hand hygiene effect monitoring after washing hands is not routinely carried out, it is possible to check from time to time to understand the effect of washing hands and the contamination of hand washing water. Therefore, it is not recommended to routinely monitor the hand hygiene after washing hands.

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One of the most effective ways to prevent the spread of germs in the office is to make sure that there are more than enough hand sanitizers available for use. Hand sanitizers are quick draw solutions for being “too busy to thoroughly wash hands” and come in handy when soap and water aren’t readily available. They encourage healthy hygiene habits for workspaces, large and small, as they kill various strains of germs, viruses, and bacteria.

Sickness and illness usually spike during the winter months making it an excellent time to evaluate what kinds of hand sanitizer are best to use and have on hand in the office.

Hand sanitizers reduce the spread of germs and bacteria

For hand sanitizers to effectively kill germs and bacteria strains, they need to contain at least 60% alcohol and they need to be used correctly.

For this reason, alcohol-based sanitizers are suggested for areas where coworkers regularly congregate so that the risk of spreading germs is reduced. It’s also a good idea to have touch-free dispensers in the breakrooms and restrooms and bottles with pumps strategically located in areas where employees communally use equipment and supplies.

There are two types of alcohol used in hand sanitizers:

Ethyl alcohol

The first is ethyl alcohol. Ethyl alcohol is also known as a grain alcohol. It’s the stuff that acts as a solvent for cleaning products and petroleum gasoline. It’s also the stuff that’s added to alcoholic beverages. As the key ingredient in most hand sanitizers, ethyl alcohol usually accounts for almost all of the active ingredient.

1. Isopropyl alcohol

   The other sometimes inactive ingredient in hand sanitizers is isopropyl alcohol. Isopropyl is what is known as a synthetic chemical compound. When mixed with water it becomes the stuff that cleanses external mishaps like cuts and scrapes, acting as an antiseptic. Antiseptics attempt to destroy the regeneration that causes germs and viruses to cluster, slowing their growth process and ultimately limiting advancement.

2. Alcohol free hand sanitizers for winter and cold seasons

   There are some hand sanitizers that contain an antibiotic compound calledbenzalkonium chloride instead of alcohol. The substance, acting as an antimicrobial preservative, is made up of an organic saline property that makes it easy to trap bacteria and germs. It is often used in contact lens solutions, skin antiseptics, cosmetics, and antibacterial soaps because it does not absorb into the skin, rather it acts on the surface. Because it acts on the surface of the skin, it keeps germs and bacteria from penetrating and that is what wards off illness. That makes benzalkonium chloride non-toxic, non-irritating, and safe for nearly all regular skin types.

3. Best winter hand sanitizers for different skin types

   To reduce dry skin in the winter, it’s important to use the best hand sanitizer for the person’s skin type:

   Normal skin – winter hand sanitizer with glycerin

   Most all hand sanitizers include glycerin. Glycerin is a moisturizing preservative that is naturally derived from plant oils. Its incorporation sometimes makes hand sanitizers feel sticky but it actually helps to keep them from being excessively drying, acting as a sealant and making it safe for nearly all skin types. Even though most hand sanitizers have glycerin in them, those who suffer from dry skin may need a bit more of a moisturizing compound. That’s where aloe can be effective.

   Normal to dry skin – winter hand sanitizer with aloe

   Aloe is an often used ingredient because of its ability to extract moisture from the air, making it healing and deeply conditioning. If there are employees in the office that tend to have normal to dry skin, then an option with aloe could be the best fit.

   Dry skin in the winter – hand sanitizer with vitamin E

   There are also hand sanitizers that contain vitamin E. Vitamin E acts as an antioxidant and protects skin from dryness and cracking. It restores the natural elasticity in our skin making it a good choice for those who have much dryer skin in the winter. There are hand sanitizers that have aloe and vitamin E in them so those who suffer from dry, cracking skin could find comfort using these kinds.

   Very dry or sensitive skin in winter months – Non-alcohol hand sanitizer or fragrance-free hand sanitizer with lotion

   For those with sensitive skin, they could try alcohol free and fragrance free hand sanitizers as mentioned above. Another good universal option for very dry skin is a hand sanitizer that contains lotion. Hand sanitizers with lotion can work well for most all skin types and are economical, remedying the need to have both a hand sanitizer and lotion on hand.

4. Scented hand sanitizers for a pick me up in winter months

   If a pick me up is what the office could use then there are some hand sanitizers that are scented. Scented hand sanitizers tend to be popular because of their rich and poignant smells. They have the same active ingredients and also contain fragrance. It can be revitalizing to squirt a few pumps and inhale a refreshingly pleasant scent in the middle of the day or after a meeting or lunch which is why most offices have at least one or two options available. The fragrance of this hand sanitizer is reminiscent of spring and this one is a foam hand sanitizer with a clean linen scent. Since scented solutions contain actual fragrance they should be considered for spaces where the employees don’t have allergies or are prone to migraine headaches. They aren’t good choices for those with sensitive or problem skin so a good alternative for those individuals are natural choices.

5. Winter-suitable hand sanitizers that use natural solutions

   Natural hand sanitizers are those deemed as such because they often feature plant-based alcohols and skin-conditioning essential oils. Natural hand sanitizers still use ethyl alcohol but the alcohol is fermented differently, helping it to maintain its natural chemical composition. Together with essential oils, the two key ingredients easily absorb into the skin making them less drying. These solutions are good because they are produced with sustainably sourced ingredients and non-toxic (paraben and preservative free).

6. How to best use hand sanitizer in the winter

   With all kinds of hand sanitizers, it is a good idea to use a quarter sized amount, rub the front and back of the hands together as if washing and be sure to make contact with the areas under the nails and on the nail beds. The hand sanitizer should then be allowed to dry.

   Alcohol-based hand sanitizers can be drying to the skin, no matter what skin type one may have. A good rule of thumb is to use no more than two pumps two times a day.

7. Winter hand sanitizers for personal use

   A trial size hand sanitizer is good to have on-hand in a purse or coat pocket for personal use. Hand sanitizing wipes are another personal, portable solution that include just enough liquid for quick use and tend to be a favorite in break and lunch rooms. (They come in handy for sticky lunches and catered lunches that include outside guests). Spray-on trial sizes are also quick remedies that are portable and convenient.

   All in all, it’s useful to first find out what some of the existing skin and health concerns might be for those in the office and order accordingly. Once the shipment arrives, it’s a good idea to remind everyone that proper use goes much further than not.

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“Everything we interact with every day is full of bacteria, a cell phone, for example, has 30 times more bacteria than a toilet, there are bacteria, viruses and disease-causing parasites,” said the pediatric infectologist in a release.

In the framework of the World Handwashing Day, which is celebrated on October 15, the specialist said that people are in daily contact with objects such as computer keyboards, ATMs, coins and bills, among other objects that are incubators of bacteria

“These can endanger our health if we do not have a proper cleaning habit in our hands. In fact, in one hand they have been able to identify between 104 and 109 different types of bacteria,” he said.

Children, especially when having outdoor activities, contact with animals, toys and other things have a higher risk of getting an infection such as diarrhea, which can be complicated due to dehydration.

“When a person does not wash their hands with soap and water, they can transmit bacteria, parasites and viruses, either by direct contact, that is, by touching another person, or indirectly, by touching surfaces,” he added.

That is why he asked for extreme care, washing his hands for at least a minute so that washing is efficient and reducing the risk of gastrointestinal diseases and doing it before, during and after preparing food, caring for someone sick, going to the bathroom, changing diapers , sneeze and touch pets.

“If, despite washing our hands, we notice some type of infection, it is important to see a doctor as this is the best way to identify the cause of our problem and determine the best treatment to solve it,” Morayta Ramírez concluded.

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