INFECTION PREVENTION: Keeping It Clean: The Basics of Hand Hygiene

HAND HYGIENE IS the single most important procedure for preventing infection. To protect your patients from healthcare-acquired infections, you must perform hand hygiene routinely and thoroughly before and after patient-care procedures. Clean and healthy hands with intact skin, short fingernails, and no rings minimize the risk of contamination. There are two ways to perform hand hygiene-hand washing and hand sanitizing. Let's review the basics for each.

It's a wash

Washing with soap (plain or antimicrobial) and water is appropriate when your hands are visibly soiled, contaminated with blood or body fluids, before eating, and after using the bathroom. To wash your hands effectively with soap and water:

* Remove any rings per your facility's policy because they harbor dirt and skin microorganisms. Remove your watch or wear it well above the wrist. Artificial fingernails and chipped nail polish can harbor microorganisms, so refer to your facility's policy regarding whether they are acceptable. Keep your natural nails short.

* Wet your hands and wrists with warm water, and apply soap from a dispenser. Don't use bar soap because it allows cross-contamination. Hold your hands below elbow level to prevent water from running up your arms and back down, thus contaminating clean areas.

* Rub your hands together vigorously for about 15 seconds. Soap and warm water reduce surface tension; aided by friction, this loosens surface microorganisms that will wash away in the lather.

* Pay special attention to the areas under fingernails and around cuticles, and to the thumbs, knuckles, and sides of the fingers and hands. If you don't remove your wedding band, move it up and down your finger to clean beneath it.

* Avoid splashing water on yourself or the floor because microorganisms spread more easily on wet surfaces and because slippery floors are dangerous. Avoid touching the sink or faucets because they're considered contaminated.

* Rinse hands and wrists well because running water flushes suds, soil, soap or detergent, and microorganisms away.

* Pat hands and wrists dry with a paper towel. Avoid rubbing, which can cause abrasion and chapping.

* Turn off faucets by gripping them with a dry paper towel to avoid recontaminating your hands.

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Rub the germs away

Guidelines developed by the CDC (http://www.cdc.gov/handhygiene ) and infection-control organizations recommend that healthcare workers use an alcohol-based hand rub (a gel, rinse, or foam) to clean hands between patient contact, as long as hands aren't visibly dirty. Many studies have shown that alcohol-based hand rubs are more effective than soap in reducing the number of bacteria on hands. Using an alcohol-based hand rub is appropriate for use before and after having direct contact with a patient's intact skin; after contact with body fluids, wounds, or broken skin; after touching equipment or furniture near the patient; and after removing gloves. To clean your hands effectively with an alcohol-based hand rub:

* Apply the alcohol-based product (follow the manufacturer's guidelines for the amount) to the palm of one hand, and rub your hands together.

* Cover all surfaces of your hands and fingers, including the areas around and under your fingernails.

* Continue rubbing your hands together until the alcohol-based hand rub dries.

Follow the rules

Follow CDC guidelines and your facility's policy concerning when to wash with soap and when to use an alcohol-based hand rub. Don't use an alcohol-based hand rub if contact with items contaminated with Clostridium difficile or Bacillus anthracis occurs. These organisms can form spores, and alcohol won't kill them. Wash your hands with soap and water instead.

Selected references

Centers for Disease Control and Prevention. Guideline for hand hygiene in healthcare settings. http://www.cdc.gov/handhygiene .

Lippincott's Visual Encyclopedia of Clinical Skills. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:225–226.

Source :

LPN2009
March/April 2009
Volume 5 Number 2
Pages 9 - 10

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