HAND HYGIENE

The hand hygiene is the most effective basic technique in preventing and controlling the transmission of
infection.

Four techniques of hand hygiene:

1. Hand Washing
 Vigorous, brief rubbing of all surfaces of lathered hands together, followed by rinsing under a
stream of warm water for 15 seconds.
 Does not kill microorganisms.
 Removes microorganisms mechanically and rinsing with water.
2. Antiseptic Hand Wash
 Washing hands with warm water and soap (antiseptic agent).
 May kill bacteria and some viruses.
3. Antiseptic Hand Rub
 Applying antiseptic hand rub to reduce the number of microorganisms present.
 Ethanol-based antiseptics containing 60% to 90% alcohol.
4. Surgical Hand Asepsis (RLE Skills Lab Level 3 prior to OR area exposure)
 An antiseptic hand wash or hand-rub technique performed before surgery to eliminate transient
and reduce resident hand flora.

HAND HYGIENE GUIDELINES (WHO, 2009):

1. Wash hands when:
 Visibly dirty
 Soiled with blood and other body fluids
 Before eating
 After using the toilet
 Exposed to spore-forming microorganisms (e.g., C. difficile, Bacillus anthracis, or Norovirus)
2. When hands are not visibly soiled, use alcohol based antiseptics in the following situations:
 Before, after, and between direct patient contact
 Before putting on sterile gloves and before inserting invasive devices
 After contact with body fluids or excretions, mucous membranes, non-intact skin, and wound
dressings
 When moving from a contaminated to a clean body site during care
 After contact with surfaces or objects in the patient’s room
 After removing gloves

DELEGATION CONSIDERATIONS
Hand Washing
The skill of hand hygiene is performed by all caregivers. Instruct all caregivers to use proper hand hygiene.

EQUIPMENT
1. Antiseptic hand rub
a. Alcohol-based, waterless, antiseptic-containing emollient
2. Hand washing
a. Easy-to-reach sink with warm running water
b. Antimicrobial or non-antimicrobial soap
c. Paper towels or air dryer
d. Disposable nail cleaner (optional) (e.g., nail file, orangewood stick, toothpick)
 Satisfactory
Excellent

Practice
Needs
Antiseptic Hand Rub

5 3 1 Procedure Rationale Comments

1. Inspect hands for visible
soiling, breaks, or cuts. Cover
Open cuts can harbor
skin lesions before providing
microorganisms; soiled hands may
care. If lesions are too large,
carry microorganism.
direct patient care is
restricted.
2. Inspect fingernails. Fingernails
Harbor high concentrations of
must be short. Remove
microorganisms; increase
artificial nails, extenders, or
microbial load on hands.
polish.
3. Push wristwatch and long
Complete access to fingers, hands,
uniform sleeves above the
and wrists.
wrists. Avoid wearing rings.
4. Apply ample amount to palm
To thoroughly cover the hands.
of one hand.
5. Rub hands together, covering Kills transient bacteria; ensures
all surfaces. complete antimicrobial action.
6. Rub for several seconds until Provides enough time for the
alcohol is completely dry. solution to be effective.

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 Satisfactory
Excellent

Practice
Needs
Hand washing with Antiseptic

5 3 1 Procedure Rationale Comments

1. Inspect hands for visible
soiling, breaks, or cuts. Cover
Open cuts can harbor
skin lesions before providing
microorganisms; soiled hands may
care. If lesions are too large,
carry microorganism.
direct patient care is
restricted.
2. Inspect fingernails. Fingernails
Harbor high concentrations of
must be short. Remove
microorganisms; increase
artificial nails, extenders, or
microbial load on hands.
polish.
3. Push wristwatch and long
Complete access to fingers, hands,
uniform sleeves above the
and wrists.
wrists. Avoid wearing rings.
The edge and inside of the sink
4. Stand in front of sink, keeping
are contaminated; reaching over
hands and uniform away from
the sink increases risk of touching
the sink surface.
and contamination.
5. Turn on water with knee or
Knee and foot pedals prevent
foot pedal. For hand faucet,
hand contact with faucet. Faucet
use paper towel to turn on
handles are likely to be
the faucet. Discard paper
contaminated.
towel in proper receptacle.
6. Avoid splashing water against Microorganisms travel and grow
uniform. in moisture.
7. Regulate flow of water so Warm water removes less
temperature is warm. protective oils.
8. Wet hands and wrist Hands are the most contaminated
thoroughly. Keep hands and part; water flows from least to
forearms lower than elbows most contaminated area, rinsing
during washing. microorganisms into the sink.
9. Apply antiseptic soap and rub
hands together vigorously,
lathering thoroughly. For
Ensure hands and fingers’ surface
liquid soap apply 3 to 5 ml.
area are cleaned.
For bar soap rub firmly
between hands (rinse bar
soap before returning).
10. Wash hands using plenty of
lather and friction for at least
Soap cleans by emulsifying fat and
15 seconds. Rub hands palm
oil and lowering surface tension.
to palm. Rub back of each
Friction and rubbing mechanically
hand with palm of other hand
loosen and remove dirt and
with fingers interlaced. Rub
transient bacteria. Interlacing
palm to palm with fingers
fingers and thumbs ensures that
interlaced. Rub with back of
all surfaces are cleansed.
fingers to opposing palms
Adequate time is needed to
with fingers interlocked. Rub
expose skin surfaces to
each thumb clasped in
antimicrobial agent.
opposite hand using a
rotational movement. Rub tips
 of fingers in opposite palm in
a circular motion. Rub each
wrist with opposite hand.
11. Clean under fingernails with
Areas under nails are often
fingernails of other hand or
contaminated, which increases
with disposable nail cleaner
the risk of infection.
(optional).
12. Rinse hands and wrists
Washes away dirt and
thoroughly, keeping hands
microorganisms.
lower than elbows.
13. Dry hands thoroughly from Drying from cleanest to least clean
fingers to wrists and forearms area avoids contamination;
with paper towel, single-use prevents chapping and roughened
cloth, or warm air dryer. skin.
14. Discard paper towel in proper Prevents transfer of
receptacle. microorganisms.
15. Turn off water. For hand
Wet towel and hands allow
faucet use clean, dry paper
transfer of pathogens from faucet
towel; avoid touching handles
to hands. Faucet handles are
with hands. Discard paper
contaminated.
towel in proper receptacle.

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APPLYING STERILE GLOVES
Sterile gloves are an additional barrier to bacterial transfer. There are two gloving methods: open and closed.

Open Gloving
 For general nursing units before procedure such as:
 Dressing changes
 Urinary catheter insertions
 Preparation of sterile field
 Parenteral procedures

Closed Gloving (RLE Skills Lab Level 3 prior to OR area exposure)

 Performed after donning a sterile gown
 Practiced in operating rooms and special treatment areas

DELEGATION CONSIDERATIONS
Open Gloving
The skill of open gloving can be delegated when personnel are trained to perform a sterile procedure.

EQUIPMENT
1. Open Gloving
a. Sterile gloves (proper size)
Satisfactory
Excellent

Practice
Needs

Open Gloving

5 3 1 Procedure Rationale Comments

1. Perform thorough hand Removes microorganisms and
hygiene. reduces transmission of infection.
2. Remove outer glove package
Prevents inner glove package from
wrapper by carefully
accidentally opening and touching
separating and peeling apart
contaminated objects.
sides.
3. Grasp inner package and lay it
on clean, flat surface just Sterile object held below waist is
above waist level. Open contaminated. Inner surface of
package, keeping gloves on glove package is sterile.
wrappers inside surface.
4. Identify right and left glove.
Proper identification of gloves
Each glove has cuff
prevents contamination by
approximately 5 cm (2 in.)
improper fit. Gloving of dominant
wide. Glove dominant hand
hand first improves dexterity.
first.
5. With thumb and fist two
fingers of non-dominant hand. Inner edge of cuff lies against skin
Touch only inside surface of and thus is not sterile.
glove.
6. Carefully pull glove over
dominant hand, leaving cuff
and being sure that it does If outer surface of glove touches
not roll up wrist. Be sure that hand or wrist, it is contaminated.
thumb and fingers are in
proper spaces.
7. With gloved dominant hand, Cuff protects gloved fingers.
slip fingers underneath cuff of Sterile touching sterile prevents
 second glove. glove contamination.
8. Carefully pull second glove
over non-dominant hand. Do
not allow fingers and thumb
Contact of gloved hand with
of gloved dominant hand to
exposed hand results in
touch any part of exposed
contamination.
non-dominant hand. Keep
thumb of dominant hand
abducted back.
9. After second glove is on,
interlock fingers of gloved Prevents accidental
hands and hold away from contamination from hand
body above waist level until movement.
beginning procedure.
10. Glove disposal. Grasp outside
of one cuff with other gloved
hand. Avoid touching wrist.
Minimizes contamination of
Pull halfway down palm of
underlying skin.
hand. Take thumb of half-
ungloved hand and place
under cuff of other glove.
11. Pull glove off, turning it inside Outside of glove does not touch
out. Discard in receptacle. skin surface.
12. Take fingers of bare hand and
tuck inside remaining glove
Minimizes contamination.
cuff. Peel glove off, inside out.
Discard in receptacle.

Total Score Student Nurse Clinical Instructor