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Hand hygiene: Clinical skills notes

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Notes

Infection control

Hand Hygiene

INTRODUCTION
When providing client care, consistent, proper, and meticulous hand hygiene is the single easiest and most effective practice to reduce the risk of transmission of infection to and from the client. Hand hygiene mainly includes handwashing with soap and water and using an alcohol-based hand rub.

Figure 1: Reduces risk of infection transmission. A. Risk of Infection B. Types of hand hygiene

WHEN TO PERFORM HAND HYGIENE
Depending on your facility’s policy, you may need to perform hand hygiene at different times. In any case, it’s important to at least perform hand hygiene:
  • upon entering and leaving a client’s room 
  • before and after every contact with a client in general 

You should also perform hand hygiene:
  • before and after applying personal protective equipment, like gloves
  • after handling any waste
  • after exposure to items or surfaces that could possibly be contaminated with blood, body fluids, secretions, or excretions
  • after contact with non-intact skin, mucous membranes, or wound dressings
  • before and after handling a client’s meal or drink
  • before entering the room where clean supplies are maintained
  • before touching clean clothing or linen
  • after helping a client back from the bathroom
  • upon entering and leaving the facility
  • before and after drinking, eating, or smoking
  • before and after putting in contact lenses
  • before and after doing your make-up or fixing your hair
  • after picking something off the floor
  • after using the bathroom
  • after coughing, sneezing, or using a tissue
GENERAL CONSIDERATIONS
  • Pay special attention to the places where pathogens can easily hide and the places that can be frequently missed, like the back of your hands, between the fingers, and under or around your nails
    • To help with this, keep your fingernails short; wear no nail polish, artificial nails, acrylics, or wraps; and remove jewelry, including rings and bracelets
  • Practicing hand hygiene frequently might cause the hands to become dry and cracked, which will create openings for microbes. This can be prevented by applying a facility-approved hand lotion or cream afterward
Figure 2: Frequently missed areas in hand hygiene.
HANDWASHING VS ALCOHOL-BASED HAND RUBS
Washing your hands with soap and water and using an alcohol-based rub or sanitizer are mostly interchangeable. However, you must wash your hands with soap and water if:  
  • you have visible dirt, blood, or body secretions on your hands
  • you're working with a client who has Clostridium difficile or another spore-producing pathogen
HANDWASHING WITH SOAP AND WATER
First, gather the supplies you’ll need, including:
  • soap or the handwashing agent chosen by your facility 
  • clean paper towels
  • a nail brush, orange stick, and hand lotion or cream if needed 
Figure 3: Supplies for handwashing with soap and water.

Procedure

  1. Approach the sink. Do not let your hands, body, or clothes come in contact with it at any time (Fig. 4a)
  2. Roll up your sleeves and remove or push up your watch if you are wearing one. You can then turn on the warm water with a clean paper towel; using warm water when washing your hands helps to protect the oils in your skin. Dispose of the paper towel safely and according to your facility’s policy (Fig. 4b) 
  3. Place your wrists and hands under the running water and keep your fingers directed downwards. Make sure your hands are lower than your elbows so that dirty water doesn’t run up and contaminate your forearms (Fig. 4c) 
  4. Apply some soap to one of your hands and lather it in between your fingers and under your fingernails. You could also use a nail brush or orange stick to clean under your nails if needed; don't forget to scrub your thumbs, too. Continue to scrub for 20 seconds or more. It may help to sing the “ABCs” twice; that's how long it should take (Fig. 4d)
  5. Rinse your hands and dry them with a clean paper towel, starting from your fingertips and moving up the arm. Dispose of the paper towel safely and according to your facility’s policy (Fig. 4e)
  6. Grab another clean paper towel to turn the tap off and discard it in the same way (Fig. 4f)
  7. Optionally, apply some hand lotion or cream to prevent your hands from drying out (Fig. 4g)
  8. Make sure not to touch anything upon leaving the room, like the doorknob (Fig. 4h)
Figure 4: Handwashing with soap and water procedure.
ALCOHOL-BASED HAND RUBS OR SANITIZERS
  1. Apply ample product to your hands (Fig.5a)
  2. Spread it over the palms, on the top of your hands, as well as in between your fingers and under your fingernails (Fig.5b)
  3. Continue to rub until your hands are completely dry (Fig.5c)
Figure 5: Handwashing with alcohol-based hand rubs or sanitizers procedure.