Hygiene procedures: procedure. Hygienic care for bedridden patients

0

And although personal hygiene includes rules that are very important for preserving and strengthening human health, the short duration of the first space flights allowed, and the complexity of the implementation of hygienic procedures forced, the crews of the first ships to be deprived of personal hygiene standards familiar to earthly conditions.

The basic requirements of personal hygiene to keep skin and hair, mouth and teeth, clothes and shoes, bedding and other household items clean could only be partially met due to the short duration of flights. However, even in such conditions these limitations do not go unnoticed. One of the most powerful desires of astronauts when returning to earth is to take a hot shower.

As the duration of flights increases and long-term orbital and planetary stations are created, the importance of personal hygiene in the overall complex of medical and biological support for space flights increases immeasurably. Moreover, due to the specific conditions on board space objects, hygiene procedures acquire a breadth and scale that far exceed the level characteristic of human existence on earth.

Features of the external environment in the cabins of spacecraft and flight factors unusual for humans can lead to changes in the physiological indicators of the human body, which will manifest themselves in metabolic disturbances, a decrease in the level of the body’s defenses, etc. If we assume that all these phenomena will occur against the background of changes in the quantitative and species composition of the microbial flora surrounding a person, then personal hygiene measures acquire a multi-purpose purpose.

At the same time, one cannot ignore the fact that personal hygiene procedures usually easily performed on earth during space flight will be associated with solving a number of very complex technical problems. Significant difficulties in equipping spacecraft compartments with sanitary facilities, in providing crew members with a sufficient amount of water, detergents (detergents) and other personal hygiene products, as well as the need to collect, preserve or regenerate flush and household water in conditions of weightlessness leave a significant imprint on technical solution to personal hygiene issues.

At the same time, ideas about the required volume and frequency of personal hygiene procedures that are familiar to terrestrial conditions will require amendments that take into account the peculiarities of sanitary and hygienic conditions in closed spaces of spacecraft.

It is quite obvious that, in quantitative and qualitative terms, the nature of the pollution here has some peculiarities due to the unique conditions for the physiology of the skin: limited human mobility, the unusual state of the autonomic nervous system and endocrine apparatus, high neuropsychic stress, a special water and food ration, etc. .

The peculiarities of physiological and hygienic conditions in the cabins of spacecraft, aggravated by the technical difficulties of creating sanitary and household devices, lead to the need to develop some new, perhaps slightly different from earthly, recommendations for a rational regime of hygienic measures and the definition of a set of means intended to comply with the rules personal hygiene.

Naturally, the task set can be fully and successfully solved only if all aspects of the influence of unusual factors of space flight on the human body in general and on its skin in particular are studied.

Of particular interest for personal hygiene is the study of sanitary and hygienic conditions in the cabins of spacecraft, clinical, physiological and biochemical indicators of the condition of the skin and oral cavity of a person, determining the nature and degree of contamination of his skin and clothing with waste products and microbial flora.

Personal hygiene of astronauts

The seemingly modest issues of human personal hygiene on board a spacecraft for a long time remained in the background in the huge program of biomedical research that was carried out in the first decade of space exploration.

This situation was explained primarily by the fact that the researchers faced

More important problems associated with elucidating the fundamental possibility of human survival when exposed to extreme factors of space flight.

And although personal hygiene includes rules that are very important for preserving and strengthening human health, the short duration of the first space flights made it possible, and the complexity of implementing hygienic

Sanitary and hygienic conditions in spacecraft cabins.

Characteristics of pollution and their sources

The main influence on the formation of sanitary and hygienic conditions in the cabins of spacecraft is the fact that these premises are completely protected from any contamination from the outside.

In small, isolated, pre-thoroughly cleaned and disinfected rooms with a supply of conditioned air, external contamination of the skin and clothing of astronauts will be determined by dust generated from clothing, shoes, bedding and equipment covering materials, food debris, particles of feces or urine accidentally entering cabin when using sewerage

devices. However, the main ones under these conditions will be endogenous pollution, the source of which is the human body - his skin. Secretions of sweat and sebaceous glands, rejected particles of epithelium, and particles of hair will make up a significant part of the pollution of the environment, skin and clothing of astronauts.

In table Table 2 shows research data to determine the amount of endogenous pollution in the spacecraft cabin.

Table 2. Mass and volume of waste in the confined space of the cabin of a highly maneuverable manned spacecraft (per person/day)

Among the gaseous products emitted by humans, substances such as ammonia, carbon monoxide and dioxide, saturated, unsaturated and aromatic hydrocarbons, various aldehydes, ketones, lower fatty acids, alcohols and esters were found - up to 21 compounds in total. Many of these substances can be toxic because they enter the atmosphere in fairly large quantities. At the same time, some authors emphasize that a significant part of harmful impurities appears as a result of the destruction of secretion products of the human sweat and sebaceous glands, and draw attention to the great importance of hygiene procedures in this aspect.

Studies to determine the microbial contamination of the environment in the cabins of spacecraft and their simulators have shown that humans are the main supplier of microbial aerosols. The increase in the number of microorganisms in the air occurs mainly due to coccal microflora (staphylococcus aureus and cutaneous staphylococcus, b-hemolytic streptococcus, etc.).

During the Apollo 7 and Apollo 8 flights, it was discovered that changes were occurring in the bacterial and fungal flora, which included primarily the exchange of microorganisms between crew members and increased growth of gram-positive microorganisms such as Staphylococcus aureus and b-streptococcus, with some inhibition of the growth of anaerobic microflora. These data indicate that spaceflight conditions may lead to the dominance of microbes whose growth would be suppressed under normal conditions.

In the atmosphere of the cabin of the Gemini 10 spacecraft before launch, bacteria common to the air were found, contained in dust, on skin and in waste products. After the flight, only microorganisms that were usually found only in dust were found.

One of the effective methods for disinfecting the air environment of a spacecraft cabin is air filtration through bacterial filters installed in the gaseous environment regeneration system. However, a reduction in the level of microbial contamination of the air can apparently be achieved by a rational regime of hygiene procedures, i.e., timely removal of microorganisms from the surface of the skin.

Condition of the skin and its contamination

Research carried out in various scientific centers made it possible to substantiate the need for certain hygienic procedures and assess their significance in the overall chain of medical and biological support for space flights. These studies made it possible to study the condition of the skin and oral cavity of a person under conditions of prolonged deprivation of his usual volume of hygiene procedures.

Already the first experiments confirmed the obvious position that depriving a civilized person of the opportunity to observe basic rules of personal hygiene, even for a short period of time, leads to unwanted neuropsychic stress, although there were no noticeable deviations in objective indicators of the condition of the skin. cover. Almost all subjects, after 10-12 days of the experiment, noted a great desire to take a bath and change their underwear, to “really” wash themselves. This desire usually haunts the subjects throughout the entire experiment, the duration of which is more than two weeks. It appears on the 7-10th day, when subjects most often begin to notice itching of the scalp and an unpleasant odor from the laundry and body. The subjects complain that they feel “lousy” and “contaminated.”

When assessing living conditions in an experimental chamber, the indicator “lack of water for washing” is rated by testers as one of the four most irritating factors of life in a confined space of small volume. In contrast, when subjects were allowed to use detergents and change clothes, soiling and odor ranked 15th and 16th among the 19 irritants assessed, respectively.

Clinical observations of the condition of the skin and oral cavity show that only in isolated cases are minor skin reactions observed in subjects. The sedentary lifestyle of the subjects leads to a sharp decrease in the process of exfoliation of keratinized scales of the epidermis in the area of ​​the plantar surface of the feet, as a result of which a pronounced layering of horny masses is observed on these surfaces. Some subjects have vulgar skin diseases, among which the main place belongs to ostiofolliculitis. Ostiofolliculitis is localized mainly in the area of ​​the buttocks and thighs, i.e. in places of greatest pressure, friction and moisturizing of the skin. Ostiofolliculitis was observed on the skin of the face and neck in subjects who wore headsets for several days. Dermatitis is detected only in places where biotelemetric sensors are applied. Isolated cases of the appearance of boils are a consequence of complications of acne and ostiofolliculitis. It is indicated that the occurrence of skin diseases cannot be attributed solely to restrictions in carrying out hygienic measures.

Thus, numerous studies indicate that depriving a person for a long period of time of the opportunity to carry out full hygienic procedures does not lead to any serious complications in the clinical condition of the skin. Only a few subjects experienced dry skin, especially the scalp, as well as irritation of the skin in areas where electrodes were constantly worn. Increased itching of the whole body is observed only at high ambient temperatures.

During the flights of the Apollo 7 and Apollo 8 spacecraft, as well as during the flights of the Gemini spacecraft, only minor disturbances in the condition of the skin of the astronauts were noted, expressed in seborrheic changes on the scalp and face.

The only cause of some concern is the condition of the oral cavity and teeth. The lack of usual hygienic oral care usually leads to a sharp deterioration in the condition of the teeth and mucous membrane. Bad breath appears, plaque on the teeth increases, staining occurs, and gingivitis of varying degrees develops.

Studies of physiological and biochemical parameters of the skin of the subjects do not reveal any significant changes in the functional state of the skin. The sebaceous secretory function of the skin is not impaired. The level of the lipid saturation layer of the skin surface and the rate of its restoration change little during the experiments.

The shift in pH of the skin surface to the acidic side, discovered in separate experiments, does not indicate biochemical changes in the skin, but is a consequence of the appearance of low molecular weight free fatty acids in the composition of skin contaminants,

formed as a result of destruction of the secretion of the sebaceous glands.

The study of skin bactericidal activity during long-term experiments indicates a gradual decrease. The bactericidal index of the skin of the forearm, which was 90-95 units in the initial state on the iron, after 30 days of the experiment decreases to 60-70 units. According to other researchers, the bactericidal properties of the skin during the experiment remain at the initial level and only during the aftereffect period is there a tendency towards a slight decrease. Despite the fact that the studies conducted have not obtained sufficiently convincing data on a decrease in the bactericidal function of the skin, there is every reason to expect that in real long-duration flights we may encounter this negative phenomenon.

Exposure to such extreme factors of space flight as nutrition, traumatic shock, extensive body irradiation, hypersecretion and hyposecretion of hormones leads to a decrease in the body's resistance to infection, to a decrease in its immune resistance, including, possibly, a decrease in the bactericidal function of the skin.

A study of the nature and degree of contamination of the surface of the skin and underwear showed that these contaminations mainly consist of waste products of the human body - secretions of the sebaceous and sweat glands, particles of the epidermis, lost hair, as well as dust from clothing and microbial cells.

The average daily total contamination of skin and clothing with chlorides under the conditions of a separate experiment ranged from 117 to 403 mg/day, and with organic substances - from 335 to 886 mg O 2 /day. The amount of skin surface lipids (saturation layer) in certain areas of the back and chest was only slightly higher than the level typical for these areas of the skin under normal conditions.

This circumstance indicates, on the one hand, the sufficient sorption properties of underwear and its good cleansing effect, and on the other hand, the normal state of the sebaceous secretory function of the skin.

The fabrics of linen and clothing absorb about 90% of chlorides and up to 80% of organic substances. The ability of clothing to cleanse the skin of waste products depends both on the type of fabric used and on the design features of the underwear.

Of great importance for justifying personal hygiene measures are the data obtained by studying the nature of changes in the chemical composition of contaminants that have been on the surface of the skin for a long time.

Under the influence of air oxygen, moisture and enzymes secreted by the skin and microorganisms, the main part of the contaminants - lipids of the skin surface (secret of the sebaceous glands) undergo significant changes. At the same time, the acid number of lipids increases and the saponification number and iodine number decrease.

Esters of higher fatty acids and saturated compounds that are part of the pollution are destroyed with the formation of free lower and higher fatty acids, which in turn leads to a shift in the pH of the contaminated skin surface to the acidic side, especially in areas with increased sebum production. The latter circumstance can be regarded from a hygienic point of view as positive, since with an increase in the acidity of the skin surface, an environment unfavorable for the development of microbial flora is created.

A study of the dynamics of microbial contamination of the skin surface under the conditions of spacecraft cabin simulators shows that the level of skin contamination usually increases only in the first 2-3 weeks of the experiment. In the subsequent period, the growth of the number of microorganisms in most areas of the skin stops. In areas of the skin in the chest, back, and head, stabilization of the microflora occurs when the number of microorganisms exceeds the original by 2.0/3.5 times. On the skin of the plantar surface of the feet, in the groin area and on the buttocks, there is a tendency to increase the level of contamination even when the initial level has already been exceeded by 7-12 times. In the forearm area, no pronounced increase in the level of microbial contamination was observed during the experiments. In studies involving eight subjects in a simulator under 28-day exposure to factors simulating flight, no changes in the species composition of microorganisms were noted. All subjects remained healthy; there was no decrease in resistance to infection throughout the entire observation period.

During the 14-day space flight under the Gemini program, no noticeable changes were detected in the microbial composition of the skin. Crew members of the Gemini 7 spacecraft showered daily with hexachlorophene soap and sulsen shampoo during the two-week pre-flight period. In bacterial cultures taken from some areas of the skin and from the throat before and after the flight, an increase in the number of microbes of fecal flora in the perineal area and a decrease in the number of microbes in the throat mucosa were found. The results of the test for the presence of fungi were negative. There were no significant differences in the composition of microorganisms and the exchange of microflora between crew members.

A significant increase in microbial populations on the skin during a long-term experiment was observed only in isolated cases, which, apparently, is a consequence of the influence of some random circumstances and features of the research methodology.

The species composition of the microbial flora on the surface of the skin and in underwear was characterized mainly by saprophytic species: cutaneous and Staphylococcus aureus, diphtheroid bacilli and sarcina. In some cases, hemolytic forms of staphylococci were noted.

An increase in the number of yeast-like fungi of the genus Candida, which has some signs of pathogenicity, was found in the oral cavity. In some cases, streptococci (S. faecalis, S. salivarius, S. mitis) were isolated from the mouth and throat, and various types of anaerobes were isolated from the throat and anus.

It should be noted that the level of microbial contamination must be considered not only as a function of the body's resistance, but also as a function of the environment that is created on the skin and in underwear as a result of changes in the chemical composition of skin surface lipids. In this regard, areas of the body with increased sweat production but low sebum production - the armpits, groin area, and feet - find themselves in the most unfavorable conditions. The highest levels of microbial flora are recorded in these areas.

The amount of microflora and its species composition on the shaved part of the head, ears, nose, forearm, chest, back, and umbilical fossa indicate that the listed areas of the body are not critical with regard to hygiene requirements. Favorable conditions are created for the population of microbes on the skin in the underwear space only when sweating, after washing and changing clothes.

The appearance of an environment with bactericidal properties on the surface of the skin contaminated with lipids (pH shift to the acidic side) gives rise to the seemingly paradoxical assumption that unlimited washing of the skin, which removes all the production of the sebaceous glands, is not a rational measure and is not indifferent to the protective function of the skin. In relation to the conditions of human stay in the cabins of spaceships, there is every reason to abandon the basic hygienic rule - the more often you wash, the better. Moreover, given the positive role of symbiont microflora in the formation of the protective mechanisms of the human body, the need for active influence on the saprophytic microbial flora through hygiene procedures can be considered doubtful. An imbalance of this microflora can cause dysbiosis and lead to a decrease in the body's resistance.

In this regard, when developing a set of hygienic measures for spacecraft crew members, one should take a differentiated approach to a procedure so familiar to terrestrial conditions.

The need to provide crew members with the opportunity to carry out full hygienic procedures is beyond doubt, despite the relatively favorable clinical and functional condition of the skin and its mild contamination with a limited hygiene regime under experimental conditions in spacecraft cabin simulators. The versatility of aspects of personal hygiene in the specific conditions of space flight somewhat shifts the main focus of these activities and expands their motivation. The need for hygienic procedures is dictated not only and not so much by hygienic and physiological, but mainly by psycho-aesthetic, epidemiological and, possibly, toxicological aspects.

The unique way of life of astronauts should not be deprived of an important link in the habits and attitudes of earthly life, which of course is compliance with the rules and procedures of personal hygiene.

Without fulfilling this provision, it is impossible to talk about creating acceptable living conditions and the necessary comfort in the spacecraft cabin.

When formulating in general terms the requirements for hygienic procedures and personal hygiene products in space flight conditions, the following basic provisions must be taken into account:

1) hygiene procedures and personal hygiene products aimed at maintaining cleanliness of the body and oral cavity should contribute to the normal functioning of the skin, oral mucosa and teeth. Refreshing and cleansing the skin from endogenous and exogenous contaminants, personal hygiene products should maintain the biochemical and physiological constants of the skin and its appendages at an optimal level, and also have a bacteriostatic effect in relation to automicroflora;

2) systematic long-term use of personal hygiene products should not cause painful conditions in the human body, unpleasant subjective sensations, changes in skin color, the appearance of pigment spots and hyperkeratosis on it. Products should not sensitize the skin to ultraviolet and ionizing radiation;

3) personal hygiene products should not contain toxic, potent substances or allergens. They must be odorless and not produce gaseous products that could create explosive or fire hazardous concentrations in the ship’s cabin;

4) the use of personal hygiene products should be possible in conditions of weightlessness and when life support systems are functioning on board the ship.

Obviously, these requirements can only be finally formulated in relation to the means for a specific case, based on the duration of the flight, conditions in the cabin and its technical equipment.

Scope of hygiene procedures,

their classification and types of personal hygiene products

When choosing one or another mode of hygienic measures, the main criteria are the flight duration of the spacecraft or station and their technical equipment. Naturally, depending on the duration of the flight, the volume of hygiene procedures and the completeness of their solutions on board the ship will vary significantly. One thing is certain - for any space flight of any duration, procedures for hygienic care of the skin and oral cavity must first of all be provided.

For short-term flights (up to 10 days), these procedures may be limited to only cleaning exposed skin and deodorizing the mouth.

For flights lasting two to four weeks, full body hygiene with a change of underwear, beard and mustache shaving, and more thorough oral care must be provided.

On flights lasting more than 4-5 weeks, it becomes necessary to trim fingernails and toenails and care for scalp hair.

By analogy with personal hygiene in everyday life, these procedures can be divided into daily and periodic.

The first type should include procedures designed to replace our daily toilet, morning and evening washing, washing hands before eating and after using a sewage disposal device, i.e. hygienic cleaning of exposed areas of the skin, shaving the beard, cleaning and deodorizing the oral cavity.

Procedures of the second type are designed to replace the usual shower, bath and visit to the hairdresser. These include full body hygiene and hair cutting.

Naturally, each of these procedures, although simple to perform on earth, in space flight conditions requires solving complex technical problems or replacing it with some other procedure.

Classifying these hygienic measures according to their purpose, we can divide them into four main procedures: complete sanitary and hygienic treatment of the body; hygienic treatment of individual areas of the skin; oral hygiene; hair cutting, shaving and nail care.

In order to provide a clearer and more detailed description of these procedures, we will consider each of them separately.

Complete sanitary and hygienic treatment of the body

The main requirement for sanitary and hygienic treatment of the body is the removal of natural metabolic products from the surface of the skin, as well as particles of dirt, food debris and microbial cells. After treatment, the skin should be dry and clean, its biochemical and physiological constants should remain at normal levels.

Taking into account the peculiarities of sanitary and hygienic conditions in spacecraft cabins, the main attention when choosing a method should be paid to the psychological factor. Ideally, the chosen method and the personal hygiene products used should leave after the hygienic procedure not only a feeling of cleanliness of the body, but also a feeling of “refreshment,” psychological comfort and relaxation.

The methods that are currently being considered involve the use for these purposes of various napkins, towels and sponges moistened with special detergents or cleaning solutions.

On flights lasting up to 3-5 weeks, periodic (at least once every 5-6 days) use of these products (combined with changing linen) provides a sufficient hygienic effect, theoretically equivalent to washing in the shower. However, in the psychological aspect, the use of such means leaves much to be desired. Body treatment, instead of a pleasant and refreshing procedure for taking a shower, turns into the tedious prosaic task of “wiping” the body.

More promising for creating psychological comfort and familiar earthly conditions on board a spacecraft are methods of sanitary and hygienic treatment of the body using automatic sponges and special shower units. The most convenient, effective and acceptable is the shower method of complete body treatment. Regular use of a shower during a long space flight will help maintain a sense of psychological comfort and relieve a significant part of the emotional stress of astronauts. But significant technical difficulties and the need for large weight and energy resources make it possible to create such installations only on ships and stations with long flight durations.

One of the options for complete sanitary and hygienic treatment using an automatic sponge is shown in Fig. 1.

The sponge device consists of an applicator held by a handle, which delivers a metered portion of water and detergent that reaches the surface of the skin through the pores of the sponge. The sponge on the applicator is placed in a ring surrounding it, designed to suction the solution from the surface of the skin. Full sanitary and hygienic treatment with minimal washing efficiency was carried out within 22 minutes. However, despite the fact that this device was almost 2.8 times lighter than a shower installation, it, like other methods, was inferior in the psychological aspect.

In Fig. Figure 2 shows one of the options for a promising method of complete treatment using a shower unit. The shower unit measures approximately 76 cm in diameter (30 inches) and 204 cm in length (80 inches). A naked person enters the unit and secures himself with straps to maintain a certain position while bathing. Warm water flows through the shower screen of the device, which the astronaut holds in his hands. Water is removed from the artificial atmosphere of the cabin using a separator. The shower device dissolves the detergent and supplies the solution through the shower net. The surface of the body can be dried with a blowing fan, followed by wiping with a dry towel. Drying the body can also be done by sucking out droplets of water through a sponge. Using a stream of warm air after removing residual water speeds up the drying process. A zero-gravity shower installation is expected to require approximately 1.89 liters of water per minute for the entire wash period (4 min).

Developed for the American orbital station Skylab, the shower installation consists of two cylindrical flanges and a transparent jacket made of Beta fabric with stiffening rings.

One of the flanges (rings) is permanently attached to the floor in the utility compartment, and the second, during operation, is attached to the ceiling using quick-release clamps. The spray head and suction head are attached to the ceiling flange, and flexible hoses with quick-release couplings are also attached.

Rice. 1. Automatic sponge circuit

1 - fan,

2 - water separator,

3 - pump,

4 - filter,

5 - flexible hose,

6 - supply of detergent,

7 - cabin air,

8 - sponge applicator

Rice. 2. Shower installation diagram

1 - general canister,

2 - shower installation,

3 - fixing stirrups,

4 - hot water,

5 - cold water,

6 - detergent,

7 - pump,

8 - water separator and filter,

9 - water into the water system,

10 - timer

The shower receives water from the onboard water supply system. This water is stored and consumed from a special water module, which has a capacity of 2.72 kg. The water module functions normally at a pressure of 517-1292 mmHg. Art. The module receives 1.81 kg of hot water (60° C) from the heater and additionally cold water. All this mouth

The new device produces a water flow of 200-800 ml/min for 3 minutes.

The used water is collected and returned by a suction head to a manifold with replaceable plastic bags. These bags can be removed through an airlock into a vacuum without fear of tearing them.

Skylab's shower facility allows each astronaut to shower at least once a week throughout the flight.

If for one reason or another the shower method of complete sanitary and hygienic treatment of the body is not suitable, then moistened wipes and reusable or disposable towels will be a replacement. In this case, devices must be provided for the secure storage of used wipes in the cabin or their removal from the spacecraft.

Hygienic treatment of individual areas of the skin

This type of hygiene procedures is designed to replace daily washing in earthly conditions. This includes cleaning the skin of the face and hands after and before bedtime, after using sewage disposal devices and before eating, as well as periodic (once every 2-3 days) wiping critical hygienic areas of the body (armpits, groin area, feet and etc.).

In ordinary life, there are many methods for sanitary and hygienic treatment of limited areas of human skin. This means wiping the skin with various colognes, lotions, creams and treatment with disinfectant solutions, and ultraviolet irradiation. However, the only practical solution to this problem in space flight conditions is to wipe the skin with special moistened, reusable and disposable wipes.

This type of napkin was used quite successfully in long-term experiments on the ground, as well as together with cloth towels for wiping dry during flights under the Gemini and Apollo programs. For space flights in these programs, small wipes measuring 8.9 X 10 cm (3.5 X 6 inches) were used, moistened with an antiseptic solution of hyamine 1620 and packaged with the astronauts' food rations. A similar method of treating exposed areas of the skin was used on flights under the Vostok and Soyuz programs.

The method of using napkins for hygiene procedures in these conditions turned out to be the most acceptable. It allows you to clean and refresh the skin quite well and keep the skin in a hygienically satisfactory condition.

In addition, after proper use, the wipes can be used to wipe various surfaces of cabin equipment.

Oral hygiene

Oral hygiene occupies one of the central places among hygienic procedures. And this is no coincidence, since the main task of oral hygiene is to eliminate local factors that contribute to the development of caries, periodontal disease, diseases of the mucous membrane, and the appearance of bad breath. The condition of the entire organism as a whole largely depends on the normal state of the oral cavity, because such important functions as receiving, crushing and partially chemical processing of food are carried out in the oral cavity.

The oral cavity is a reservoir of a huge number of microorganisms. The microflora of the oral cavity is divided into permanent and random. The permanent composition is dominated by facultative anaerobic a- and y-streptococci, strictly anaerobic bacteria, actinomycetes and spirochetes. The oral cavity-specific composition of the permanent microflora is supported by evolutionarily developed relationships of symbiosis and antagonism between microbial species and the action of the body's defenses. Some pathological processes in the oral cavity are accompanied by pronounced changes in the composition of the permanent microflora. Thus, with ulcerative-necrotic lesions of the oral mucosa, all strict anaerobes (fusobacteria, spirochetes, vibrios) multiply intensively, with dental caries - anaerobes and lactic acid bacteria.

Random microflora includes microorganisms of other mucous membranes and skin, saprophytes of the external environment and pathogenic microbes.

Group D streptococci (enterococci), b-hemolytic streptococci of group

A, C, F and G, pathogenic staphylococci, measles bacteria, Candida and Nocardia fungi, herpes viruses, epidemic paratitis and measles.

The permanent flora of the oral cavity serves as a biological barrier due to antagonism with many types of microbes penetrating from the outside. The destruction of this barrier through certain influences (for example, the use of antibiotics, bactericides, etc.) leads to intensive reproduction of random forms of flora resistant to these influences. “Drug-induced” lesions of the mucous membrane occur, the culprits of which are most often fungi (Candida), enterococci and gram-negative intestinal bacteria.

With a decrease in the resistance of oral tissues and a change in the reactivity of the body as a whole, the pathogenic properties of some representatives of the symbiotic microflora may appear.

Chronic inflammatory processes in the oral cavity can cause allergic reactions in the body and contribute to focal infections, which most often occur as chronic intoxication.

All this becomes especially important when practicing hygienic measures for the oral cavity during flight conditions on board a spacecraft.

It is known that oral hygiene consists of regular brushing of teeth and rinsing the mouth. For this, various toothbrushes, toothpastes and powders, toothpicks, elixirs, rinses, etc. are usually used.

The results of long-term experiments in simulators of spacecraft cabins showed that the greatest clinical changes are observed in the condition of the teeth.

In table Table 3 provides data on assessing the effectiveness of various oral hygiene procedures in a series of long-term experiments.

As can be seen from the data above, the greatest effect is achieved by using a toothbrush and toothpaste. Carrying out partial hygienic procedures usually led to the development of gingivitis of varying degrees in all subjects. Bleeding gums in some subjects developed three weeks from the start of the experiment and persisted throughout the experiment.

Table 3. Evaluation of the effectiveness of oral hygiene procedures in various experiments

In space flights under the Gemini program, cleaning the oral cavity was done with a toothbrush and chewing gum. During flights on the Apollo spacecraft, crew members were provided with small tubes (about 56.5 g) of toothpaste and toothbrushes. According to the daily routine, teeth were brushed after each meal in order to prevent the formation of plaque on the teeth and the development of gingivitis.

For long duration space flights, only the most effective procedures can be recommended, which include the use of a toothbrush and toothpaste. In this case, electric toothbrushes with forced supply of liquid toothpaste can be offered, which will ensure the collection of washing liquid through a special oral air suction system for removing used water.

Hair cutting, beard and mustache shaving, nail care

Hygienic hair care procedures consist of periodically cutting the hair on the head, shaving the beard and mustache.

The lifespan of hair ranges from several months (for vellus hair) to 2-6 years (for long hair) and is associated with the time of year, gender and age of the person. From the scalp of an adult, 25-100 hairs in the telogen phase fall out every day.

The length of the human long hair growth cycle (anagen phase) ranges from 2 to 6 years. On average, hair located on the top of the head grows by 0.35 mm daily, on the chin - 0.38 mm, in the armpits - 0.3 mm, in the eyebrow area - 0.16 mm. In women, hair grows faster on the top of the head, in men - in the armpits. Hair grows faster in summer than in winter.

It is noted that the amount of permissible beard and hair growth is determined by both cultural habits and professional considerations. There comes a time when growing hair causes discomfort and can lead to the development of direct irritation due to the difficulty of normal vision.

It has been established that after a 5-6 week stay in a closed volume of simulating spacecraft cabins, subjects have a desire to trim their hair and mustache and trim their beard. In the conditions of ground-based experiments, growing a beard did not cause any particular complications.

Considering the difficulties of carrying out hygienic procedures and the specific sanitary and hygienic conditions in the cabins of spacecraft, during long flights the recommendations of hygienists will oblige astronauts to have a short haircut and shave their beard and mustache.

The main problem of hygienic hair care during space flight is preventing particles of cut or shaved hair from entering the cabin atmosphere.

Special electric razors have been developed with suction to catch cut hair particles. However, regular safety razors and shaving cream turned out to be the most acceptable. During space flights under the Soyuz and Apollo programs, crew members used regular safety razors and shaving cream applied to the skin of the face with fingers without a brush. After shaving, razors were wiped dry with napkins, and hair particles remained fixed with cream and did not pollute the atmosphere of the cabin.

Hair cutting on the head on long flights can be done electrically.

ical or pneumatic clippers equipped with a suction and hose for removing cut hair into a waste collection system.

Hygienic nail care consists of timely trimming the nail plates of the fingers and toes.

The nail plate consists of flat, polygonal horny scales. The growth rate of nails is strictly individual and depends on the person’s age, body condition, profession, etc. Complete renewal of fingernails occurs within 95-115 days. Within one day, the nail grows by 0.1-0.2 mm.

Studies have shown that in half of the subjects, after four weeks of the experiment, the fingernails grow to such a length that they begin to interfere with work operations and disrupt the writing process.

The need to trim toenails usually occurs 6-7 weeks after the start of the experiment.

In spacecraft and manned stations with a flight duration of more than 4-5 weeks, it is necessary to provide for the possibility of cutting fingernails and collecting cut scales (particles). For these purposes, special sealed boxes equipped with a suction air system and connected to a solid waste collection can be used. Boxes must be equipped with openings with cuffs that tighten the arm or leg and allow nail trimming inside the box. In order to save space in the ship's cabin, the box can be made in the form of a folding system.

As one of the possible methods of nail care, regular filing of nails with manicure files can be suggested. However, in this case, the procedure will need to be carried out much more often (every 2-3 days) and carried out near the air intake of the air conditioning system, equipped with a filter for collecting nail flakes.

Concluding our consideration of the issues of providing astronauts with flight clothing and personal hygiene products, it should be emphasized that their discussion was based on data obtained in ground experiments lasting no more than 90 days and in short-term space flights. However, even now we can say with sufficient certainty that for flights of significantly longer duration (from 100 to 500 days or more), the fundamental solution to these problems is unlikely to undergo radical changes. We can say with absolute confidence that successful long-term flights are possible only if conditions are provided in the living and working compartments of spacecraft that would create the necessary comfort and convenience. In this regard, the issues of providing astronauts with flight clothing and personal hygiene products play an important role.

Technical designs of ships for long-term flights should provide for the possibility of carrying out on board a full range of personal hygiene procedures, washing clothes and washing the body, repairing clothing and storing supplies of personal hygiene products and sets of flight clothing, since optimal living conditions will have a positive impact on the overall performance of astronauts -operators and will allow them to successfully complete the flight mission.

Proper skin care consists primarily of keeping it clean at all times. To do this, you need to regularly wash the entire skin with soap and water at least once a week. Depending on how dirty the skin is, washing can be done even every day.

When washing the body with soap and water, the skin is cleansed from sebum and sweat, from dust and dirt, from various substances that a person comes into contact with at work, from microbes that have fallen on the skin - pathogens of diseases, and finally, from horny tissues that have not yet fallen off the surface of the skin. scales. Under the influence of warm, and especially hot water, the sweat glands begin to work intensively, and then metabolic products - waste products - are removed from the body. Under the influence of water and rubbing, blood circulation in the skin increases, its tissue, nerves, glands and hair are better and more abundantly washed with blood and nourished. Metabolism in the body increases, which improves health. At the same time, both the condition of the skin and its appearance improves.

Water temperature for water procedures. For water procedures, both warm and cold water are used. Cold means water at room temperature or slightly lower. To keep your skin clean, you should use warm or even slightly hot water, which better washes away dirt and cleanses the skin. Cold water in the form of cold baths, washes and rubdowns is used to strengthen the body and harden and keep the skin in a healthy, fresh state.

Hygiene procedures with cold water. Cold water procedures are supposed to be taken in a state where a person feels slightly warmed up. The water should be at room temperature or slightly colder. The procedure lasts from several seconds to one minute. After this, vigorously rub the entire body with a dry towel until a feeling of pleasant warmth is felt, then quickly get dressed and make moderate movements. Cold water procedures can be taken only by those people who tolerate them well - who quickly experience reddening of the skin, a feeling of pleasant warmth and good health after them. If after taking such a procedure the skin turns pale and blue, and the person is slightly chilled, then you should abstain from cold water procedures or take them carefully.

Bathing. It is very useful to swim in the sea or river, it improves health, strengthens the body and keeps the skin in good cosmetic condition. Swimming in the open air is very useful, since the effect of water is combined with the influence of sunlight and fresh, clean air.

It should be remembered that regular use of cold water can cause dry and hard skin in some people.

Water quality. For washing, ablutions and other hygienic procedures, you should use soft water. This water does not contain lime and magnesium salts and does not irritate the skin. Soft water is rain, snow, and partly river water. When using this water, the soap lathers easily, which ensures good cleansing of the skin.

Water that contains lime and magnesium salts is hard. Washing with such water makes the skin tight, dry, rough and unsightly. Prolonged use of hard water can lead to skin irritation, especially for people whose facial skin is dry and thin. Therefore, you should not use hard water for hygiene procedures.

Any hard water (well water, from springs) becomes soft if it is boiled for a long time. Hard water can be made soft by adding baking soda to it at the rate of 1-2 teaspoons per basin of water or 1-2 tablespoons of borax.

Rubbing the patient.

If the patient cannot take a bath or shower, he is given a wet rubdown.
Preparation for the procedure:
First, the patient is explained what procedure will be performed, and they try to involve him to some extent in participating in it.
Then prepare the equipment:
. if necessary, a screen is installed to isolate the patient from others;
. large, approximately 220 * 140 cm, oilcloth;
. gloves and an apron for the person performing the procedure;
. body shampoo;
. a basin with water at a temperature of 35-37 degrees;
. shampoo and soap mitt;
. sheet and towel.
Procedure:
1. The patient is fenced off with a screen, an apron and gloves are put on.
2. An oilcloth is placed under the patient’s body.
3. Place a basin with warm water next to the bed.
4. Wipe parts of the patient’s body in the following order: neck, chest, stomach, arms, back, buttocks, legs, groin area, perineum. When wiping any part of the body with a damp mitten moistened with water and shampoo diluted in it, rinse the mitten and wipe again. The washed part of the body should be thoroughly rubbed with a towel and covered with a sheet so that the patient does not become hypothermic.
5. Remove the oilcloth, put clean underwear on the patient, take away the water, remove the apron and gloves.
After the procedure, you should always make sure that the patient feels well and that there is no cooling or deterioration in health.

Washing feet.

Bedridden patients cannot wash their feet on their own, so the procedure is performed by a nurse. The essence of the procedure is explained to the patient, and consent should be obtained for it.
Prepare the equipment: gloves, oilcloth, a basin with water at a temperature of 35-37 degrees, body shampoo, a terry towel.
The patient can lie or sit during the procedure.

Treatment of skin folds.

Patients, especially those who are overweight and prone to sweating, should frequently wash the folds of skin under the mammary glands and on the abdomen, groin folds and axillary areas to prevent diaper rash. Through damaged skin due to diaper rash, microbes can penetrate into an already weakened body. Especially if there is increased skin moisture, limited motor activity, urinary and fecal incontinence, and the patient’s inability to act independently.
The patient should be explained why regular inspections of problematic areas are carried out.
Procedure:
. remind the patient about the need for the procedure;
. inspect all of the above problematic folds and depressions;
. prepare powder, a basin of water, put on gloves;
. wash problem areas and dry them thoroughly with a terry towel;
. show the patient a container with powder, read its name aloud, then open the jar and powder the skin through small holes with shaking movements;
If the patient is contraindicated from taking a bath or shower, wipe the patient with a cotton swab moistened with a solution of fruit or wine vinegar (50 g per liter of water), warm camphor alcohol or warm water. The skin is wiped dry and, if necessary, powdered with powder.

Washing the patient.

It is carried out both for hygienic purposes and to increase the vitality and improve the patient’s well-being. It is carried out in cases where motor activity is absent or independent skills are lost.
The patient is explained how the procedure will be performed, asked about the desired water temperature, and told about the sequence of movements.
. Prepare a mitten, a basin, water at the desired temperature, and a towel.
. They wash their hands.
. Put a mitten on your hand, moisten it with water and squeeze it out.
. Use a damp mitten to wipe the patient's face, ears, and neck.
. Dry the skin with a towel.
. They take away the water and wash their hands.
You should make sure that the patient is not inconvenienced. If he himself wants to take part in washing, encourage the desire for self-care.

Oral hygiene.

This is an important part of care: after all, many patients cannot clean the oral cavity on their own, especially if they contain stationary or removable dentures.
During the procedure, the patient sits or reclines. His chest is covered with waterproof material. Rinsing is done using a special mug with a removable individual tip or a rubber balloon. First, the oral cavity is treated with a weak solution of sodium bicarbonate (baking soda) - 1 tbsp. for 1 liter of water. The cheek is held with a wide spatula so that the stream of liquid can be directed to the back of the jaws, through the interdental spaces - into the oral cavity. A mug is brought to the patient into which he can spit. The entire mouth is then treated with a pale pink sodium bicarbonate solution.
Rinsing is carried out in the morning (along with washing) after each meal and before going to bed. Removable dentures must be removed and processed. They are washed in front of the patient with a toothbrush with toothpaste or soap, rinsed, and then put in place.

Shaving.

It helps create emotional comfort and makes washing your face easier.
You should prepare:
. napkin;
. latex gloves;
. an individual electric razor or safety razor, a brush and shaving cream (if the patient has aftershave cream, they take that out too);
. a bowl of warm water;
. towel.
The essence of the procedure is explained to the patient. He should be in a semi-sitting position.
Performing the procedure:
1. Bring a bowl of water (heated to about 40 degrees), lay out the equipment, and put on gloves.
2. The napkin is moistened, wrung out and applied to the patient’s face for 1-2 minutes.
3. After removing the napkin, the patient’s face is either shaved with an electric razor, or after applying foam (cream) with a brush, shaving is performed, while the free hand slightly stretches the skin in the direction opposite to the movements of the razor.
4. The face is wiped with a damp cloth, then dry; at the patient’s request, after shaving cream is applied to the facial skin.
5. Equipment is taken away, gloves are removed, hands are washed.

Washing head.

It is carried out by a nurse when the patient’s motor activity is limited or independent skills are lost. The essence of the procedure should be explained to the patient.
Preparation for the procedure:
. a headrest is installed or the upper headboard is removed, the patient is placed comfortably;
. gloves, a basin and a jug are prepared;
. Shampoo and terry towel are placed nearby.
The head is moistened, shampoo is applied to the hair with massaging movements, carefully so as not to wet the patient, the water is drained from the jug and the hair is washed. Then they are immediately wrapped in a terry towel and dried thoroughly so that the patient does not catch a cold. Then comb it with an individual comb. If there are no contraindications, your hair should be washed at least once a week.

Haircut.

The patient is explained what procedure will be performed. Then the equipment is prepared:
. oilcloth apron and gloves;
. ethanol (70% solution);
. scissors and individual comb;
. hair clipper;
. brush for sweeping the head and neck;
. basin for burning hair and matches.
Performing the procedure:
1. Put on an apron and gloves.
2. The patient is seated on a stool or couch covered with oilcloth. The patient's shoulders are covered with a sheet or hairdresser's peignoir.
3. Pull up a table with the equipment laid out.
4. Women's hair is cut with scissors and a comb; men's hair is cut with a machine. If there is a skin disease or nits are noticed when examining the patient’s head, the patient bends over and the procedure is performed over the basin.
5. Remove the peignoir from the shoulders and place the patient comfortably.
6. Take the basin out of the room and burn the hair.
7. Remove apron and gloves, wash hands.

Nail care.

This is important both from the point of view of hygiene and safety of the patient, and in order to improve his mood.
If the patient cannot cut his nails himself, this procedure is performed by a nurse. Just be sure to explain to the patient the essence of the procedure.
To trim your fingernails, you need: a bowl of water with liquid soap added; rubber gloves, individual scissors, hand cream. To trim your toenails, you need a basin (water with liquid soap), individual nail clippers, and foot cream. There should also be a disinfectant on hand to treat possible wounds caused by haircuts.
The patient's hands (or feet) are placed in warm soapy water for 2-3 minutes. One hand (foot) is placed on a towel, dried, the nails are cut one by one with scissors or tweezers. After the haircut, you should dry the skin again and treat your hands (feet) with cream. Fingernails are cut oval, toenails are cut crosswise. If the skin is accidentally damaged, it is lubricated with an antiseptic.
You can then remove the gloves and wash your hands.

The rules of a woman’s personal hygiene are related to the physiological characteristics of the female body. This means that, along with generally accepted principles of personal hygiene, additional rules are required throughout life. These additional rules should be followed starting from an early age of the girl, in order to prevent various inflammatory diseases of the reproductive system.

Rules of feminine hygiene

All representatives of the fair sex know that underwear should be changed regularly. In addition, daily genital hygiene procedures should be performed. They should be washed with clean, soft, warm water. Moreover, the stream of water must be directed from front to back, and not vice versa. Toilet paper should also be used in this direction.

This is very important, as it helps prevent infections, such as E. coli, from getting into the vagina. This microorganism often causes inflammation of the female genital organs.

The modern world is characterized by poor ecology, which largely contributes to the emergence of various diseases and weakened immunity. Therefore, do not rely on chance, follow the basic rules. When taking water procedures, try to ensure that the soap or gel you use does not get into the vagina. They can have a detrimental effect on the natural flora of the mucous membrane, which provokes the occurrence of an inflammatory process.

On the days of menstruation, do not forget to wash your genitals more often with clean, preferably boiled water, without soap. There should be at least 3-4 such procedures per day. These days, the inner surface of the uterus is extremely sensitive and vulnerable. It can easily become infected. Therefore, during these days, refrain from swimming in open water and do not visit the sauna or swimming pool. Take a shower daily, morning and evening. Sex is also undesirable these days.

However, intimate hygiene of a woman’s genital organs is not only about carrying out daily water procedures. Sex education also applies to these rules. It’s no secret that a huge part of gynecological diseases is associated with a woman’s frequent change of sexual partners. And it is very sad that young girls often end up in prison for these reasons. Therefore, it is necessary to explain the norms of moral education, as well as talk about some aspects of sexual life, in order to protect a young girl from wrong steps, and therefore from many sexually transmitted diseases.

Another common cause of inflammatory diseases of the female genital area is hypothermia. The modern girl is more concerned about how she looks than whether she is dressed warmly. Youth fashion dictates its own style: short jackets, low-rise jeans or short skirts with thin tights. The results of blindly following fashion is inflammation of the appendages.

Therefore, it is very important from childhood to instill in a girl not only a taste for fashion and the ability to navigate it, but also respect for her health. We need to teach her how to properly combine fashion and the necessary care for her health.

You should know that any inflammatory disease of the female genital area very easily becomes chronic. This guarantees the appearance of severe, persistent pain, taking medications, sometimes painful procedures and endless queues to the doctor. To avoid all this, you need to remember that a woman’s personal hygiene is above all else. Everyone knows them without exception, but each one approaches them in its own way, often incorrectly. For example, often women's diseases are directly related to the use of low-quality sanitary pads, tampons, and wearing synthetic underwear. And this is also very important for maintaining a woman’s health.

Which sanitary pads to choose?

Modern trade offers a great variety of sanitary pads from different manufacturers and companies. Such products for daily use are in great demand as they help maintain cleanliness and freshness all day long. However, it is very important to carefully choose them.

When purchasing, make sure that the absorbent liner of such a pad is made of natural material. The top layer should also be made of natural, hygienically clean material that is safe for women's health. High-quality pads allow the skin to “breathe”, keeping it from inflammation and diaper rash. This is especially true in hot weather, when sweating increases. Therefore, you should approach the purchase of this delicate product correctly.

Women who have undergone various operations, such as cesarean section, or after childbirth require special personal hygiene products. A real breakthrough in this direction can be called the appearance on the shelves of diapers specifically designed for adults. They solve the delicate problems of women after undergoing operations. They can also be worn by pregnant women in case of urinary incontinence. A woman’s body can respond negatively to various irritants, so it is important to choose hypoallergenic hygiene products.

You should also adjust the choice of hygiene products according to your age, because over time, a woman’s skin type can change dramatically.

To maintain your health for many years, strictly follow these simple rules throughout your life. They are not advisory, but mandatory. From childhood, explain to your daughters all the consequences of improper self-care. This will save them from many health problems in the future.

Often the seriously ill person you are caring for at home is completely helpless. Days go by, the patient becomes weaker, and your problems caring for him accumulate.

And one of the problems of care, which is complex in nature, is various hygiene procedures. They must be carried out without fail, since untidiness and dirt lead to the development of infections and complications of the underlying disease. For the patient himself, everything connected with untidiness is, as a rule, painful, but he cannot always complain about it, being ashamed or not wanting to once again burden the person who is caring for him. Therefore, dear nurses, please be attentive to your charges, take pity on them and do everything possible in a timely manner to make your patient feel good. And we continue to tell you how to provide care, presenting it in a simple form.

How to clean a patient's nose?

Mucus and dust gradually accumulate in the nose, which combine to form crusts. In an unkempt patient, they can be so large that they make breathing difficult.

To soften the crusts, cotton flagella (turundas) moistened with petroleum jelly are inserted into the nostrils with rotational movements to a depth of 1.5-2 cm and left for 1-3 minutes. Then, using the same movements, the turundas with softened crusts are removed. If necessary, the procedure is repeated using dry turundas.

Mucus and pus from the nasal passages can be removed with a cotton swab soaked in Vaseline, menthol, peach or some other oil. It is also possible to use a weak saline solution prepared at the rate of 1 hour to rinse the nose. l. salt per 1 liter of boiled water, as well as infusions of chamomile and linden blossom.

How to put medicinal drops into the nose and lubricate it?

If the patient is sitting or in a semi-sitting position, then his head should be tilted back slightly, and if he is lying on his back, then his head should be turned to one side and then to the other.

Examine the patient's nasal passages and, if necessary, clean them. Take the drops prescribed by the doctor into a pipette, insert the pipette into the nostril 1-1.5 cm, squeeze out the drops and press the wing of the nose against the nasal septum with a cotton ball for 1-2 minutes so that they are absorbed into the nasal mucosa. The medicinal ointment is injected into the nose using a turunda.

Carry out procedures with the patient’s nose with clean hands, using sterile care items (cotton wool, pipettes, etc.).

How to wash your eyelids?

Often the patient’s eyes begin to fester. This is especially noticeable in the morning, when eyelashes can even stick together with discharge from the eyes.

To wash the eyelids, I used traditional medicine - a decoction of eucalyptus leaves (3 tsp per glass of water) filtered through a thick cloth and an infusion of chamomile and calendula (1 tbsp per glass of water). I did the procedure 3 times a day, especially carefully in the morning, removing all the crusts.

You can also wash your eyelids with a solution of furatsilin (1:5000).

Rinsing should be done with gentle cleansing movements using a cotton swab soaked in a healing solution. Movements should be directed from the inner corner of the eye (located near the nose) to the outer.

All care items must be very clean, cotton wool must be sterile, and hands must be thoroughly washed.

How to instill medicinal drops into the eyes?

The drops prescribed by the doctor are dripped into the patient’s eyes with a sterile (boiled) pipette. When doing this procedure, exercise maximum caution, that is, try not to touch the eyeball with the pipette. Pull the lower eyelid with your finger, drop the required number of drops behind it and, with the eye closed, press the inner corner of the eye with a cotton swab for 1-2 minutes. This is done to ensure that the medicine does not leave the eye through the tear duct. Blot the leaked tear with a sterile napkin.

How to care for a patient's ears?

The patient's ears should be washed daily with soap during the morning toilet.

In addition, it is necessary to periodically clear the ear canals of wax accumulated in them. This cannot be done with sharp objects. Ears are cleaned with special sticks sold in pharmacies. If a small amount of wax in the ears has dried there, then, pulling back the earlobe, drop a few drops of 3% hydrogen peroxide into it, wait 2-3 minutes, insert a gauze pad into the ear canal with rotational movements and remove the softened wax.

The resulting large wax plugs, which lead to hearing loss, are removed by a nurse or doctor, whom you can call to the bedridden patient’s home.