UNION CHRISTIAN COLLEGE

Widdoes St., Brgy II, San Fernando City, La Union

School of Health Sciences
SY _________________

PERFORMING HAND HYGINE USING SOAP AND WATER(HANDWASHING)

Handwashing remains the best method to decontaminate hands.

Handwashing, as opposed to hand
hygiene with an alcohol-based rub, is required (CDC, 2002a):
• When hands are visibly dirty
• When hands are visibly soiled with or in contact with blood or other body
fluids
• Before eating and after using the restroom
• If exposure to certain organisms, such as those causing anthrax or
Clostridium difficile, is known
or suspected. (Other agents have poor activity against these organisms.)

EQUIPMENT • Antimicrobial or non-antimicrobial soap (if in bar form,

soap must be placed on a soap rack)
• Paper towels
• Oil-free lotion (optional)

ASSESSMENT Assess for any of the above requirements for handwashing. If

no requirements are fulfilled, thecaregiver has the option of
decontaminating hands with soap and water or using an
alcohol-based hand rub.

NURSING
DIAGNOSIS Determine the related factors for the nursing diagnoses
based on the patient’s current status. An
appropriate nursing diagnosis is Risk for Infection. Many
other nursing diagnoses also may requirethe use of this skill.

OUTCOME IDENTIFICATION AND PLANNING

The expected outcome to achieve when performing handwashing is
that the hands will be free ofvisible soiling and transient
microorganisms will be eliminated. Other outcomes may be
appropriatedepending on the specific nursing diagnosis identified
for the patient.

IMPLEMENTATION

ACTION
1. Gather the necessary supplies.
Stand in front of the sink. Donot
allow your clothing to touch the
sink during the washing
procedure.
2. Remove jewelry, if possible, and
secure in a safe place.A plain
RATIONALE
 The sink is considered
contaminated. Clothing may carry
organisms from place to place.
 Removal of jewelry facilitates
proper cleansing.
Microorganismsmay accumulate in
 wedding band may remain in
place.
3. Turn on water and adjust force
Regulate the temperatureuntil
the water is warm.
4. Wet the hands and wrist area.
Keep hands lower than elbowsto
allow water to flow toward
fingertips.
5. Use about 1 teaspoon liquid
soap from dispenser or rinse bar
of soap and lather thoroughly.
Cover all areas ofhands with the
soap product. Rinse soap bar
again and returnto soap rack.
6. With firm rubbing and circular
motions, wash the palms
andbacks of the hands, each
finger, the areas between the
fingersand the knuckles, wrists,
and forearms. Wash atleast 1
inch above area of
contamination.If hands are
notvisibly soiled, wash to 1 inch
above the wrists.
7. Continue this friction motion for
at least 15 seconds.
8. Use fingernails of the opposite
hand or a clean
orangewoodstick to clean under
fingernails.
9. Rinse thoroughly with water
flowing toward fingertips.
10. Pat hands dry with a
paper towel, beginning with the
fingersand moving upward
toward forearms, and discard it
settings of jewelry. If jewelry was
worn duringcare, it should be left
on during handwashing.
 Water splashed from the
contaminated sink will
contaminateclothing. Warm water
is more comfortable and is less
likely toopen pores and remove oils
from the skin. Organisms can
lodgein roughened and broken
areas of chapped skin.
 Water should flow from the cleaner
area toward the more
contaminatedarea. Hands are more
contaminated than forearms.
 Rinsing the soap before and after
use removes the lather, whichmay
contain microorganisms
 Friction caused by firm rubbing
and circular motions helps toloosen
dirt and organisms that can lodge
between the fingers,in skin crevices
of knuckles, on the palms and
backs of thehands, and on the
wrists and forearms. Cleaning less
contaminatedareas (forearms and
wrists) after hands are clean
preventsspreading microorganisms
from the hands to the forearms
andwrists.
 Length of handwashing is
determined by degree of
contamination.
 Area under nails has a high
microorganism count, and
organismsmay remain under the
nails, where they can grow and be
spreadto other persons.
 Running water rinses
microorganisms and dirt into the
sink.
 Patting the skin dry prevents
chapping. Dry hands first
becausethey are considered the
cleanest and least contaminated
 immediately.Use another clean
towel to turn off the faucet.
Discardtowel immediately
without touching other clean
hand.
area.Turning the faucet off with a
clean paper towel protects theclean
hands from contact with a soiled
surface.

11. Use oil-free lotion on  Oil-free lotion helps to keep the

hands if desired. skin soft and prevents chapping.It
is best applied after patient care is
complete and from small,personal
containers. Oil-based lotions
should be avoidedbecause they can
cause deterioration of gloves.

EVALUATION The expected outcome is met when the hands are free
of visible soiling and transient microorganisms
are eliminated.

DOCUMENTATION The performance of handwashing is not generally

documented.

SPECIAL
CONSIDERATIONS
General Considerations
• An antimicrobial soap product is recommended for use
with handwashing before participating in
an invasive procedure and after exposure to blood or body
fluids. The length of the scrub will
vary based on need.

• Liquid or bar soap, granules, or leaflets are all acceptable

forms of non-antimicrobial soap.

Home Care Considerations

• Home care providers should consider bringing their own
liquid soap and disposable paper towels
into the home for washing and drying their hands instead of
using potentially contaminated bar
soap and towels in the patient’s home (Grossman
&DeBartolomeo, 2008).
• Proper hand hygiene before leaving a home and
immediately upon entering another home is
imperative (McGoldrick&Rhinehart, 2007).

EVIDENCE FOR
PRACTICE Prevention of healthcare-associated infections is a major
challenge for healthcare providers. Hand
hygiene is regarded as an effective preventive measure. This
procedure is still not performed consistentlyin healthcare
settings, however (Institute for Healthcare Improvement,
2006a).