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Hand Hygiene
OVERVIEW:
Hand hygiene is a general term that includes hand washing (using plain soap and water),
antiseptic hand wash (using antimicrobial substances and water), antiseptic hand rub (using alcohol-
based hand rub), and surgical hand antisepsis (using antiseptic hand wash or antiseptic hand rub
preoperatively by surgical personnel to eliminate transient and reduce resident hand flora). When
hands are visibly dirty, wash hands with soap (plain or antimicrobial) and water. If hands are not
visibly soiled, an alcohol-based hand rub may be used.
Hand washing is the rubbing together of all surfaces and crevices of the hands using a soap or
chemical and water. Hand washing is a component of all types of isolation precautions and is the
most basic and effective infection-control measure to prevent and control the transmission of
infectious agents.
The three essential elements of hand washing are soap or chemical, water, and friction. Soaps
that contain antimicrobial agents are frequently used in high-risk areas such as emergency
departments and nurseries. Friction is the most important element of the trio because it physically
removes soil and transient flora.
Hand washing is performed after arriving at work, before leaving work, between client
contacts, after removing gloves, when hands are visibly soiled, before eating, after excretion of
body waste (urination and defecation), after contact with body fluids, before and after performing
invasive procedures, and after handling contaminated equipment. The exact duration of time
required for hand washing depends on the circumstances.
A washing time of 10 to 15 seconds is recommended to remove transient flora from the hands.
High-risk areas, such as nurseries, usually require about a minimum 2-minute hand wash. Soiled
hands usually require more time. According to the CDC Standard Precautions, artificial fingernails
or extenders are not recommended when having direct contact with clients at risk for infection or
with potential adverse outcomes, that is, clients in intensive care or surgery. The CDC recommends
following agency policy regarding wearing non-natural nails when caring for clients other than
those previously mentioned.

ASSESSMENT:
 Assess the environment to establish if facilities are adequate for washing the hands.
Is the water clean? Is soap available? Is there a clean towel to dry hands?
 Assess your hands to determine if they have open cuts, hangnails, broken skin, or
heavily soiled areas.

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 Maintain short natural nails. Short nails harbor fewer microorganisms and do not harm
clients when providing care.

POSSIBLE NURSING DIAGNOSIS:

PLANNING:
Expected Outcomes
The caregiver's hands are washed adequately to remove microorganisms, transient flora, and soiling
from the skin.

Equipment Needed:
 Soap
 Paper or cloth towels
 Sink
 Running water

Implementation:
1. Remove jewelry. Wristwatch may be pushed up above the wrist (mid-forearm). Push sleeves of
uniform or shirt up above the wrist at mid-forearm level. Provides access to skin surfaces for
cleaning. Facilitates cleaning of fingers, hands, and forearms.
2. Assess hands for hangnails, cuts, or breaks in the skin, and areas that are heavily soiled. Intact
skin acts as a barrier to microorganisms. Breaks in skin integrity facilitate development of
infection and should receive extra attention during cleaning.
3. Turn on the water. Adjust the flow and temperature. Temperature of the water should be warm.
Running water removes microorganisms. Warm water removes less of the natural skin oils.
4. Wet hands and lower forearms thoroughly by holding under running water. Keep hands and
forearms in the down position with elbows straight. Avoid splashing water and touching the
sides of the sink or faucet. Water should flow from the least contaminated to the most
contaminated areas of the skin. Hands are considered more contaminated than arms.
Splashing of water facilitates transfer of microorganisms. Touching of any surface during
cleaning contaminates the skin.
5. Apply about 5 mL (1 teaspoon) 'of liquid soap. Lather thoroughly. Lather facilitates removal of
microorganisms. Liquid soap harbors less bacteria than bar soap.
6. Thoroughly rub hands together for about 10 to 15 seconds. Interlace fingers and thumbs and
move back and forth to wash between digits. Wash palms, back of hands, and wrists with firm
rubbing and circular motions (Figure 1). Special attention should be provided to areas such as
the knuckles and fingernails, which are known to harbor organisms (Figure 2). Friction

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mechanically removes microorganisms from the skin surface. Friction loosens dirt from
soiled areas.

Figure 1 Figure 2
7. Rinse with hands in the down position, elbows straight. Rinse in the direction of forearm to wrist
to fingers. Flow of water rinses away dirt and microorganisms.
8. Blot hands and forearms to dry thoroughly. Dry in the direction of fingers to wrist and forearms.
Discard the paper towels in the proper receptacle. Blotting reduces chapping of skin. Drying
from cleanest (hand) to least clean area (forearms) prevents transfer of microorganisms to
cleanest area.
9. Turn off the water faucet with a clean, dry paper towel (Figure 3). Prevents contamination of
clean hands by a less clean faucet.

Figure 3

Alcohol-Based Hand Rub

10. Apply the manufacturer's recommended amount of product to one hand. Amount of rub
required varies by product.
11. Rub hands together, covering hands and fingers on all sides. Spreads rub to cover all aspects
of hands and fingers.
12. Continue rubbing until hands are dry. Allows the alcohol-based hand rub to remove or destroy
transient microorganisms and reduce resident flora.

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EVALUATION:
 The hand hygiene was adequate to control topical flora and infectious agents on the hands.
 The hands were not recontaminated during or shortly after the hand hygiene.

Documentation:
No documentation is needed for routine hand hygiene by the nurse.

Reference:
 White, L.; Duncan, G.; and Baumle, W.: Foundation of Nursing, 3rd ed., 2011,
Australia: CENGAGE, P.P.658-661.