Hand Hygiene (Hand Washing)
HAND HYGIENE (HAND WASHING)
1. Hand Hygiene: Medical Technique
Definitions
• It is the act of cleaning one’s hands to
remove soiling, grease, microorganisms
or other unwanted substances.
• Medical Hand Hygiene refers to Hygiene
practices related to medical procedures.
Goals:
• To cleanse the hands of pathogen /
microorganisms and chemicals which
can cause harm.
• To prevent possible transfer of
microorganisms.
• To reduce risk of cross contamination
among patients.
• To maintain hands free of visible
soiling.
Equipment:
• For antiseptic hand rub
Alcohol-based, waterless, antiseptic-
containing emollient
• For Handwashing
easy-to-reach sink with running water
Antimicrobial or non-antimicrobial soap
Paper towels or air dryer
Disposable nail cleaner (optional)
Critical to Remember
• The skill of hand hygiene is performed by all
health care workers and caregivers. Instruct all
health care workers and caregivers to use
proper hygiene.
• If soap and water are not available, hand
sanitizer that is at least 60% alcohol can
be used instead, unless hands are visibly
excessively dirty or greasy.
• Contaminated hands of health care workers are a
primary source of infection transmission in health
care settings. It is recommended that health care
workers have well-trimmed nails and refrain from
wearing nail polish or artificial nails to reduce
microorganism transmission.
STEP RATIONALE
1. Inspect surface of your hands Open cut wounds can harbor high
for breaks or cuts in skin or concentrations of
cuticles. Cover any skin lesions microorganisms. Health care
with a dressing before providing facility or agency policy often
care . If lesions are too large to prevents nurses from caring for
cover, you may be restricted high-risk patients if open lesions
from direct patient care. are present on hands.
2. Inspect hands for visible If hands are visibly soiled, you will
soiling. use soap and water until soil is
removed.
3. Inspect condition of nails. Subungual areas of hands harbor
Natural tips need to be less than high concentrations of bacteria.
¼ inch long and free of artificial Long nails and chipped or old
nails, extends , or polish polish increase the number of
(especially , cracked polish). bacteria residing on hands.
Check agency policy. Artificial applications increase
microbial load on hands.
4. Push wristwatch and Provides complete access to
long uniform sleeves fingers, hands and wrists.
above wrists. Avoid Some studies show that skin
wearing rings. underneath rings carry a
higher bacterial load. Gram-
negative bacilli,
enterobacteria, and
Staphylococcus aureus are
more common under
rings(Messano, 2013)
Antiseptic Hand Rub
5. Antiseptic Hand Rub
a. Following manufacturer Enough product is needed to
directions apply an thoroughly cover the hands.
amount of product to
palm of one hand.
b. Rub hands together, Covering all aspects of the
covering all surfaces of hands kills transient bacteria.
hands and fingers with Ensures complete antimicrobial
antiseptic. action.
c. Rub hands together for
several seconds until Provides enough time for
alcohol is completely antimicrobial solution to be
dry. Allow hands to dry effective.
before applying gloves.
NOTE:
If hands feel dry after
rubbing hands
together for 10 to 15
seconds, an
insufficient volume of
product likely was
applied.
HANDWASHING WITH ANTISEPTIC SOAP
6. HANDWASHING WITH ANTISEPTIC SOAP
a. Stand in front of sink , Inside sink is a
keeping hands and contaminated area.
uniform away from sink Reaching over sink
surface. (If hands touch increases risk of touching
sink during handwashing , edge, which is
repeat process) contaminated.
b. Turn on water. Turn faucet
on or push knee pedals
laterally or press pedals Knee pedals within the
with foot to regulate flow operating room and
and temperature. treatment areas are
preferred to prevent hand
contact with faucet. Faucet
handles are likely to be
contaminated with organic
debris and microorganisms.
(AORN, 2014).
c. Avoid splashing water Microorganisms travel
against uniform. and grow in moisture.
Warm water removes less
d. Regulate flow of water so of the protective oils than
temperature is warm. hot water.
e. Wet hands and wrists Hands are the most
thoroughly under running contaminated parts to be
washed. Water flows from
water. Keep hands and
least to most contaminated
forearms lower than elbows area, rinsing microorganisms
during washing. into the sink.
Ensures that all surface
f. Apply 3 o 5 ml of antiseptic areas of the hands and
soap and rub hands together fingers are cleaned.
vigorously, lathering
thoroughly.
NOTE:
The decision whether to use
a non-antimicrobial soap, or
alcohol-based hand
antiseptic depends on the
procedure, the patient’s
immune status, and the
type of infection the patient
has (CDC, 2020).
g. Wash hands using plenty Soap cleans by emulsifying
of lather and friction for at fat and oil and lowering
least 15 seconds . Interface surface tension. Friction and
fingers and rub palms and rubbing mechanically loosen
back of hands with circular and remove dirt and
motion at least 5 times each. transient bacteria.
Keep fingernails down to Interfacing fingers and
facilitate removal of thumbs ensures that all
microorganisms. surfaces are cleansed.
Adequate time is needed to
expose skin surfaces to
antimicrobial agent.
h. Areas under fingernails
are often soiled. Clean them Areas under nails are often
with fingernails of other highly contaminated, which
hand and additional soap increase the risk of
with an orangewood stick infections for the nurse or
(optional). patient.
i. Rinse hands and wrists Rinsing mechanically washes
thoroughly, keeping away dirt and
hands down and elbows microorganisms.
up.
j. Dry hands thoroughly from Drying from cleanest
fingers to wrists and (fingertips) to least clean
forearms with paper towel , (forearms) area avoids
single- use cloth , or warm contamination. Drying hands
air dryer. prevents chapping and
roughened skin.
Prevents transfer of
k. If used, discard paper microorganisms.
towel in proper receptacle.
Wet towel and hands allow
l. Turn off water with foot or transfer of pathogens from
knee pedals. To turn off faucet to hands . Faucet
hand faucet, use clean , dry handles are contaminated.
paper towel ; avoid touching
handles with hands.
Hand Hygiene : Surgical
Technique
Hand Hygiene : Surgical Technique
(Surgical Hand Scrub)
Definitions:
* The act of washing the fingernails,
hands, and forearms with a
bactericidal soap or solution in a
prescribed manner for a specific
period before a surgical procedure.
Goal
:
* To remove as many
microorganisms from the
hands as possible before
the sterile procedure.
Equipment:
• Sink with knee or foot controls
• Antimicrobial soap
• Surgical scrub brush
• Plastic nail stick or sterile nail cleaner
• Sterile towel for drying
STEP RATIONALE
1. Be sure fingernails are Long nails and nail polish
short, clean, and increase number of bacteria
healthy. Nail polish residing on nails.
should be removed.
2. Remove rings. Apply
Rings can harbor
surgical shoe covers, cap, microorganisms. Applying attire
facemask, and protective after handwashing would
eye wear. contaminate hands.
3. Wash and rinse hands To remove gross contamination
for initial wash. and transient microorganisms.
4. Open disposable brush Antimicrobial soap reduces
impregnated with microorganisms. Warm water
antimicrobial soap, decreases drying of hands.
adjust water temperature
to warm using knee or
foot control lever.
Movement of water and dirt will
5. Wet hands and arms.
flow from hands to less clean
Keep hands above
areas, thus preventing
elbows.
contamination of the hands
during scrub.
6. Use nail stick or
The nails can harbor significant
cleaner to clean under
bacteria and need to be cleaned
nails of both hands.
thoroughly.
Anatomic Timed Scrub:
7. Wet scrub brush or apply Antibacterial soap assists in
antibacterial soap if not removing transient and
already impregnated in the resident microorganisms.
brush.
8. Anatomic Timed Scrub: Ensures that all surfaces will
starting with fingertips, be systematically scrubbed
scrub each anatomic area to remove transient
(nails, fingers each side and microorganisms.
web space, palmar surface,
dorsal surface and forearm)
for around 5 minutes. Scrub
vigorously using vertical
strokes, repeat with other
hand.
9. Counted brush stoke Ensures that all surfaces
method: will be systematically
Starting with fingertips, scrubbed to remove
scrub each anatomic transient
area( same as in step microorganisms.
no. 8) for the
designated number of
strokes according to
agency policy. Scrub
vigorously using vertical
strokes.
10. Rinse hands Prevents contamination
thoroughly under warm of the hands from the
running water, holding dirtier areas.
hands upward. This is to
allow water to drain
towards the flexed
NOTE:
Do not touch anything before and after
rinsing hands. Touching nonsterile objects
would mean the surgical scrub would need
to be repeated.
11. Keep hands held Prevents contamination
upward to allow water of hands before
to drip from the hands gloving.
to the elbow. Dry hands
with sterile towel.
DONNING AND REMOVING STERILE
GLOVES
( OPEN GLOVING)
DONNING AND REMOVING STERILE
GLOVES
( OPEN GLOVING)
Definition:
It is wearing and removing gloves
aseptically.
Goal:
To apply and remove gloves without
contamination.
Equipment:
• Packaged sterile gloves in correct
size
- (S, M, L, XL)
• Flat working surface
STEPS RATIONALE
A. Applying Gloves
1. Remove jewelry, • Rings may tear the glove
particularly rings. and may harbor
microorganisms.
2. Wash Hands • Clean hands reduce the
number of microorganisms
that could be transmitted if
gloves accidentally
puncture or tear.
3. Peel off outside wrapper as • This protects inner
directed by manufacturer package from inadvertently
(peel sides apart) opening and contaminating
the gloves.
4. Lay inner package on clean, • Objects below waist level
flat surface about waist level. are considered
Open wrapper from the contaminated. Inner
outside keeping gloves on surface of wrapper is
inside surface. considered sterile.
5. Grasp first glove by inside * Inner edge of cuff unfolds
edge of cuff with thumb and against skin of hand and is
first two fingers of the non- not sterile once applied.
dominant hand. Hold hands Contamination occurs if
above waist; insert dominant ungloved hand contacts
hand into glove. Adjust gloved hands.
fingers inside glove after both
gloves are on.
6. Slip gloved hand (four * Sterile cuff protects
fingers with thumb up) fingers of gloved hand from
underneath second gloved being contaminated.
cuff and pull over non-
dominant hand.
Critical to remember: put
gloves on the dominant hand
first, then on the non-
7. Keeping hands above waist, * This prevents potential
adjust glove fit, touching only contamination while ensuring a
sterile areas. smooth fit over fingers.
REMOVING GLOVES
B. REMOVING GLOVES
8. Wash gloved hands first. * To reduce the number of
microorganisms that could
contaminate the hands.
9. With dominant hand, grasp * After use, outer surface of
outer surface of non-dominant gloves is contaminated and
glove just below thumb. Peel could transfer microorganisms
off glove inside out, without to the nurse’s wrist.
touching exposed wrist.
10. Place ungloved hand under * Folding contaminated glove
thumb side of second cuff and surfaces toward the inside
peel off toward the fingers minimizes the chance of
holding first glove inside second transfer of microorganisms.
glove. Discard into appropriate
receptacle.
11. Wash hands. * Minimizes transmission of
microorganisms.
Critical to Remember : Use “ glove-
to-glove” , “skin-to-skin” technique
when removing gloves.
Safety alert: Wash hands before and
after removing gloves to prevent
contamination of hands.
Short Quizzes:
1. It is also called hand hygiene?
a. Antiseptic hand rub
b. Medical technique
c. Surgical hand scrub
d. Hand sanitizer
2.It is an act of washing the fingernails,
hands, and forearms with a bactericidal
soap or solution in a prescribed manner for
a specific period before a surgical
procedure.
a. Surgical scrub brush
b. Surgical hand scrub
c. Hand hygiene
d. Handwashing with antiseptic soap
3. It is wearing and removing gloves
aseptically.
a. Donning a sterile gown and closed
gloving
b.Donning and removing sterile gloves
(open gloves)
c. Handwashing
d.Hand hygiene
4. It is also called a surgical technique?
a. Surgical hand scrub
b. Surgical procedure
c. Medical technique
d. Surgical scrub brush
5. It refers to hygiene practices related to
medical procedures.
a. Surgical technique
b. Medical hand hygiene
c. Medical technique
d. Hand hygiene
6. It is the act of cleaning one’s hands
to remove soiling, grease,
microorganisms or other unwanted
substances.
a. Medical technique
b. Surgical hand scrub
c. Medical hand hygiene
d. Surgical scrub brush
7. What is the main goal of surgical
technique?
a. To reduce risk of cross contamination
among patients.
b. To remove as many microorganisms
from hands as possible before the
sterile procedure.
c. To prevent possible transfer of
microorganisms.
d. To maintain hands free of visible
soiling.
8. How many percent of alcohol in hand
sanitizer we use?
a. 70%
b. 60%
c. 50%
d. 80%
9. What is the main goal of donning and
removing sterile gloves(open gloves)?
10.Give at least 3 main goal of medical
technique.
13. How many minutes in Anatomic
Timed Scrub that we should do the
procedure?
a. 4 minutes
b. 6 minutes
c. 5 minutes
d. 3 minutes
14. What is the rationale why we need to
do the handwashing before and after the
procedure?
15. What is the rationale why we
do the Counted brush stroke
method in surgical technique?
a. Ensures that all surfaces will be
systematically scrubbed to remove
transient microorganisms.
b. Prevents transfer of
microorganisms
c. To prevent possible transfer of
microorganisms
