Hand

Washing / Hand Hygiene

Considered the most effective infection control measures.
It is important that both nurses and and clients hands be cleansed at the following times to prevent
the spread of microorganisms:
Before eating
After using the bedpan or toilet
After the hands have come in contact with any body substances such as sputum or drainage
from a wound
Before giving care of any kind
WHO recommends hand washing under a stream of water for at least 20 seconds using plain granule
soap, soap-filled sheet, or liquid soap when hands are visibly soiled, after using a restroom, aftre
removing gloves, before handling invasive devices (such as intravenous tubing) and after contact
with medical equiment or furniture.

Purposes:
To reduce the number of microorganisms in the hands
To reduce the risk of transmission of microorganisms to clients
To reduce the risk of cross-contamination among clients
To reduce the risk of transmission of infectious organisms to oneself

Assessment
Determine the clients
Presence of factors increasing susceptibility to infection and possibility of undiagnosed infection.
Whether the client uses immunosuppressive medications.
Recent diagnostic procedures or treatments that penetrated the skin or a body cavity.
Current nutritional status.
Signs and symptoms indicating the presence of an infection:
Localized signsswelling; redness; pain or tenderness with palpation or movement; palpable
heat at site; loss of function of affected body part; or presence of exudate.
Systemic indicationsfever; increased pulse and respiratory rates; lack of energy, anorexia; or
enlarged lymph nodes.

Planning
Determine the location of running water and soap or soap substitutes.
Assemble equipment: Soap, Warm, running water, Disposable or sanitized towels

Implementation
Preparation
Assess the hands.
Nails should be kept short.
Short, natural nails are less likely to harbor microorganisms, scratch a client, or puncture gloves.
Most agencies do not permit health care workers in direct contact with clients to have any form of
artificial nails.
Remove all jewelry.
Microorganisms can lodge in the settings of jewelry and under rings. Removal facilitates proper
cleaning of the hands and arms.
Check the hands for breaks in the skin, such as hangnails or cuts.

A nurse who has open sores may require a work assignment with decrease risk of transmission of
infectious organisms due to the chance of acquiring or passing on an infection.

Performance
If you are washing your hands where the client can observe you, explain to the client what you are going
to do and why it is necessary.
Turn on the water, and adjust the flow. There are five common types of faucet controls:
Hand-operated handles
Move knee levers with the knee. to regulate flow and temperature
Press foot pedals with the foot to regulate flow and temperature.
Move elbow controls with the elbows instead of the hands.
For infrared control, motion in front of the sensor causes water to start and stop flowing
automatically.
Be sure to adjust flow so that water is warm. Warm water removes less of the protective oil of the skin
than hot water.
Wet the hands thoroughly by holding them under the running water, and apply soap to the hands.
Hold the hands lower than the elbows so that the water flows from the arms to the fingertips.
The water should flow from the least contaminated to the most contaminated area; the hands are
generally considered more contaminated than the lower hands. Note that this is a different technique
than is used when performing surgical hand washing. Nurses will learn to perform that level of hand
washing if they are working in the operating room.
If the soap is liquid, apply 24 mL (1 tsp). If it is bar soap, granules, or sheets, rub them firmly between
the hands.
Thoroughly wash and rinse the hands.
Use firm rubbing and circular movements to wash the palm, back, and wrist of each hand. Interlace the
fingers and thumbs, and move the hands back and forth. Continue this motion for at least 15 seconds.
The circular action creates friction that helps remove microorganisms mechanically. Interlacing the
fingers and thumbs cleans the interdigital spaces.
Rub the fingertips against the palm of the opposite hand.
The nails and fingertips are commonly missed during hand washing.
Rinse the hands.
Thoroughly pat dry the hands and arms.
Dry hands and arms thoroughly with a paper towel without scrubbing.
Moist skin becomes chapped readily as does dry skin that is rubbed vigorously; chapping produces
lesions.
Discard the paper towel in the appropriate container.
Turn off the water.
Use a new paper towel to grasp a hand-operated control.
This prevents the nurse from picking-up microorganisms from the faucet handles.