MISAMIS UNIVERSITY

Ozamiz City 7200, Philippines

Tel No. +63 88 521-0367 / Telefax No. +63 88 521-2917
E-mail Address: mu@mu.edu.ph

CERTIFIED: ISO 9001:2015 Risk Management System– _DNVGL, Australia Pty Ltd.
ACCREDITED: Philippine Association of Colleges and Universities Commission on Accreditation (PACUCOA)

Hand Hygiene
(Alcohol-Based Hand Rub and Handwashing)

According to Centers for Disease Control and Prevention (CDC, n.d.), “Hand hygiene is a way of
cleaning one’s hands that substantially reduces potential pathogens (harmful microorganisms)
on the hands. Hand hygiene is considered a primary measure for reducing the risk of
transmitting infection among patients and health care personnel. Hand hygiene procedures
include the use of alcohol-based hand rubs (containing 60%–95% alcohol) and hand washing
with soap and water.”

Hand Hygiene Technique with Alcohol-Based Formulation

Prior to procedure:
1. Ensure all equipment are available and within reach.
2. Equipment: alcohol hand rub.

Steps Nursing Considerations/Additional Information

1. Apply a palmful of the product in a
cupped hand, covering all surfaces.
2. Rub hands palm to palm.

3. Right palm over left dorsum with

interlaced fingers and vice versa.

4. Palm to palm with fingers interlaced.

5. Backs of fingers to opposing palms with

fingers interlocked.

6. Rotational rubbing of left thumb clasped

in right palm and vice versa.
7. Rotational rubbing, backwards and
forwards with clasped fingers of right hand
in left palm and vice versa.

8. Once dry, your hands are safe.

Hand Hygiene with Soap and Water

PURPOSES
• To reduce the number of microorganisms on the hands
• To reduce the risk of transmission of microorganisms to clients
• To reduce the risk of cross contamination among clients
• To reduce the risk of transmission of infectious organisms to oneself
ASSESSMENT
Determine the client’s:
• Presence of factors increasing susceptibility to infection and possibility of undiagnosed infection
(e.g., HIV)
• Use of immunosuppressive medications
• Recent diagnostic procedures or treatments that penetrated the skin or a body cavity
• Current nutritional status
• Signs and symptoms indicating the presence of an infection:
• Localized signs: swelling, redness, pain or tenderness with palpation or movement,
palpable heat at site, loss of function of affected body part, presence of exudate
• Systemic indications: fever, increased pulse and respiratory rates, lack of energy, anorexia,
enlarged lymph nodes
PLANNING
Determine the location of running water and soap or soap substitutes.

Equipment
• Soap
• Warm running water
• Paper towels
IMPLEMENTATION

Preparation
Assess the hands:
• Nails should be kept short. Most agencies
do not permit health care workers in direct
contact with clients to have any form of
artificial nails. The CDC guidelines prohibit
artificial nails in caring for high-risk clients,
and the WHO guidelines prohibit artificial
nails in all settings.
• Removal of all jewelry is recommended.
Rationale: Short, natural nails are less likely
to harbor microorganisms, scratch a client, or
puncture gloves.
Rationale: Although the research is controversial,
microorganisms can lodge in the settings of
jewelry and under rings. Removal facilitates proper
cleaning of the hands and arms.

Rationale: A nurse who has open sores may

require a work assignment with decreased risk for
transmission of infectious organisms due to the
chance of acquiring or passing on an infection.

• Check hands for breaks in the skin, such

as hangnails or cuts.

Performance
1. If you are washing your hands where the
client can observe you, introduce yourself
and explain to the client what you are going
to do and why it is necessary.

2. Turn on the water and adjust the flow. 1

• There are five common types of faucet
controls:
a. Hand-operated handles.
b. Knee levers.
c. Foot pedals.
d. Elbow controls. Move these with the
elbows instead of
the hands.
e. Infrared control. Motion in front of the
sensor causes water
to start and stop flowing automatically.

• Adjust the flow so that the water is warm. Rationale: Warm water removes less of the
protective oil of the skin than hot water.

3. Wet the hands thoroughly by holding Rationale: The water should flow from the least
them under the running water and apply contaminated to the most contaminated area; the
soap to the hands. 3 hands are generally considered more contaminated
than the lower arms. Note that this is a different
• Hold the hands lower than the elbows so technique than is used when performing surgical
that the water hand washing. Nurses will learn to perform that
flows from the arms to the fingertips. level of hand washing if they are working in the
operating room.
• If the soap is liquid, apply 4 to 5 mL (1
tsp). If it is bar soap, granules, or sheets, rub
them firmly between the hands.
4. Thoroughly wash and rinse the hands. 8
• Use firm, rubbing, and circular
movements to wash the palm, back, and
wrist of each hand. Be sure to include the
heel of the hand. Interlace the fingers and
thumbs, and move the hands back and forth.

The WHO (2009) recommends these steps:

a. Right palm over left dorsum with 2
interlaced fingers and vice versa
b. Palm to palm with fingers interlaced 4
c. Backs of fingers to opposing palms with Rationale: The circular action creates friction that
fingers interlocked 6 helps remove microorganisms mechanically.
d. Rotational rubbing of left thumb clasped Interlacing the fingers and thumbs cleans the
in right palm and vice versa. 5 interdigital spaces.
Continue these motions for about 30
seconds.

• Rub the fingertips against the palm of the Rationale: The nails and fingertips are commonly
opposite hand. missed during hand hygiene.

• Rinse the hands.

5. Thoroughly pat dry the hands and arms.
• Dry hands and arms thoroughly with a Rationale: Moist skin becomes chapped readily as
paper towel without does dry skin that is rubbed vigorously; chapping
scrubbing. produces lesions.
• Discard the paper towel in the appropriate
container. 7
6. Turn off the water. Rationale: This prevents the nurse from picking up
• Use a new paper towel to grasp a hand- microorganisms from the faucet handles.
operated control. 9
 7. Apply hand lotion if desired. Use only Rationale: Hand lotions are important to prevent
agency-approved hand lotions and skin dryness and irritation.
dispensers. Other lotions may make hand
hygiene less effective, cause the breakdown
of latex gloves, and become contaminated
with bacteria if dispensers are 10
refilled.

Special considerations:
Indications for hand hygiene

A. Wash hands with soap and water when visibly dirty or visibly soiled with blood or other body
fluids or after using the toilet.
B. If exposure to potential spore-forming pathogens is strongly suspected or proven, including
outbreaks of C. difficile, hand washing with soap and water is the preferred means.
C. Use an alcohol-based hand rub as the preferred means for routine hand antisepsis in all other
clinical situations described in items D (a) to D (f) listed below if hands are not visibly soiled. If
alcohol-based hand rub is not obtainable, wash hands with soap and water.
D. Perform hand hygiene:
a) before and after touching the patient.
b) before handling an invasive device for patient care, regardless of whether or not gloves
are used.
c) after contact with body fluids or excretions, mucous membranes, non-intact skin, or
wound dressings.
d) if moving from a contaminated body site to another body site during care of the same
patient.
e) after contact with inanimate surfaces and objects (including medical equipment) in the
immediate vicinity of the patient.
f) after removing sterile or non-sterile gloves.
E. Before handling medication or preparing food, perform hand hygiene using an alcohol-based
hand rub or wash hands with either plain or antimicrobial soap and water.
F. Soap and alcohol-based hand rub should not be used concomitantly.

Disclaimer: Always review and follow the assigned hospital policy regarding this specific skill.

References:
Berman, A. Snyder, S., & Frandsen G. (2016). Kozier and Erb’s fundamentals of nursing:
concepts, process, and practice. Pearson Education, Inc. pp. 614-616
CDC. (n.d.). Hand Hygiene. https://www.cdc.gov/oralhealth/infectioncontrol/faqs/hand-
hygiene.html

WHO. (2009). WHO guidelines on hand hygiene in health care: a summary.

https://www.who.int/gpsc/5may/tools/who_guidelines-handhygiene_summary.pdf