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Tanya RN,BSN
onMarch 23, 2024
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Performing Medical Hand Washing

4 min read

Definition

Hand washing is a vigorous, brief rubbing together of all surfaces of hands lathered in soap followed by rinsing under a stream of water.

Indications

  1. Before contact with patients who are susceptible to infection (e.g., newborn infants or immunosuppressed patients).
  2. After caring an infected patient.
  3. After touching organic material.
  4. Before performing invasive procedures, such as administration of injection, catheterization, and suctioning.
  5. Before and after handling wound dressing or touching open wounds.
  6. After handling contaminated equipment.
  7. Between contacts with different patients in high-risk units.

Purposes

  1. To remove dirt and transient organisms from the hands and to reduce total microbial counts.
  2. To protect nursing personnel from pathogenic organisms.

Articles

  1. Warm running water.
  2. Antimicrobial/regular soap.
  3. Paper towels/hand drier.

Procedure

          NURSING ACTIONS                  RATIONALE
1.Inspect surface of hands for breaks/cuts in skin or cuticle. Report and cover any lesion if present before providing patient care.Open cuts/wounds can harbor high concentrations of microorganisms. O pen wounds serve as a portal for entry of microorganisms.  
2.Inspect hands for heavy soiling.Requires lengthier hand washing.  
3.Inspect the fingernail length.Nails should be short because most microbes on hands come from beneath the fingernails.
4.Remove wristwatch and roll up long uniform sleeves above the wristwatch. Remove all jewelry from hands, such as ring, watch, and bracelet.Provides complete access to fingers, hands, and wrist. Wearing rings increases the number of microorganisms on hands.  
5.Stand in front of the sink, keeping hands and uniform away from the sink surface.The sink is contaminated. Reaching over the sink increases risk of touching the contaminated edges.  
6.Turn on water. Avoid splashing of water against the uniform.  Microorganisms travel and grow in moisture.
7.Regulate flow of water and make sure the water is warm.  Warm water removes less of the protective oils than cold water.
8.Wet the hands and wrists thoroughly under running water. Keep hands and forearms lower than elbows while washing.Hands are the most contaminated parts to be washed. Water flows from the least to the most contaminated area.  
9.Apply a small amount of soap or antiseptic, lathering thoroughly.  Use of antiseptics can lead to dryness and skin irritation in hands.
10.Wash hands using plenty of lather and friction for at least 10-15 seconds following the steps listed below, with each motion for at least 5 times. Wet your hands and apply the soap.   Rub your palms together.   Rub the back of both hands.    Interface fingers and rub your hands together.   Interlock fingers and rub the back of fingers of both hands. Rub the thumb in a rotating manner followed by the area between index finger and thumb for both hands.  Soap cleanses by emulsifying the fat and oil, thus lowering the surface tension.
Friction and rubbing mechanically loosen and remove dirt. Interlacing fingers and thumbs ensures entire surface is cleaned. Knuckles and
fingernails harbor microorganisms.
11.While cleaning the fingertips, clean them with fingernails of other handArea under the nails can be highly contaminated, which increases the
 risk of infection for the patients.  
12.Rinse both hands and wrists thoroughly, keeping hands down and elbows up.  Rinsing from cleanest to least clean area avoids contamination.
13.Tun off water faucet using elbow or paper towel.  Avoid contamination of cleansed hands.
14.Dry hands thoroughly from finger to wrist and to forearm with paper towel.  Drying from cleanest to less clean area avoids contamination.
15.Discard used paper towel.Prevents transfer of microorganisms.

5 MOMENTS OF HAND HYGIENE

1   BEFORE PATIENT    CONTACT  WHEN? Clean your hands before touching a patient when approaching him/her.  
EXAMPLES: Shaking hands, helping a patient to move around, clinical examination.  
2   BEFORE ASEPTIC    TASK  WHEN? Clean your hands immediately before any aseptic task.    
EXAMPLES: Oral/dental care, secretion aspiration wound dressing, catheter insertion, preparation of food medications.  
3 AFTER BODY FLUID EXPOSURE RISK  WHEN? Clean your hands immediately after an exposure risk to body fluids (and after glove removal)
EXAMPLES: Oral/dental care, secretion aspiration, drawing and manipulating blood, clearing up urine, feces, handing waste.
4 AFTER PATIENT
   CONTACT		WHEN? Clean your hands after touching a patient and her/his immediate surroundings, when leaving the patient’s side.  
EXAMPLES: Shaking hands, helping a patient to move around, clinical examination.  
5    AFTER CONTACT     WITH PATIENT
SURROUNDINGS		  WHEN? Clean your hands after touching and object furniture in the patient’s immediate surroundings when leaving-even if the patient has not been touched.  
EXAMPLES: Changing bed linen, perfusion speed adjustment.
Special Considerations
  • Use antimicrobial soap before invasive procedures.
  • Avoid artificial nails and keep natural nails short.
  • Moisturize regularly to prevent skin breakdown.

REFERENCES

  1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
  2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
  3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
  4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
  5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
  6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
  7. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
  8. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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Author

Tanya RN,BSN
onMarch 23, 2024
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