Performing Hand Hygiene

CALAMBA DOCTORS’ COLLEGE
Bachelor of Science in Nursing
PERFORMING HAND HYGIENE
Name: __________________________ Date:______________ Score: __________
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
DELEGATION CONSIDERATIONS
 The skill of hand hygiene is performed by all caregivers. Instruct all caregivers to use proper hand hygiene
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
Equipment
Antiseptic hand rub
• Alcohol-based, waterless, antiseptic-containing emollient
Handwashing
• Easy-to-reach sink with warm running water
• Antimicrobial or non-antimicrobial soap
• Paper towels or air dryer
• Disposable nail cleaner (optional)
STEPS/RATIONALE 1 2 3 4
1. Inspect surface of your hands for breaks or cuts in skin or cuticles. Cover any skin
lesions with a dressing before providing care. If lesions are too large to cover, you
may be restricted from direct patient care (CDC, 2002).
Open cuts or wounds can harbor high concentrations of microorganisms. Health care facility
or agency policy often prevents nurses from caring for high-risk patients if open lesions are
present on hands.
2. Inspect hands for visible soiling.

If hands are visibly soiled, use soap and water until soil is removed
3. Inspect condition of nails. Natural tips should be 14 inch from fingertip and
smooth. DO NOT WEAR artificial nails or extensions.
Subungual areas of hands harbor high concentrations of bacteria. Long nails and chipped or
old polish increase the number of bacteria residing on hands. Artificial applications increase
microbial load on hands (Boyce and Pittet, 2008; CDC, 2002)
4. Push wristwatch and long uniform sleeves above wrists. Avoid wearing rings.
Provides complete access to fingers, hands, and wrists. Some studies show that skin
underneath rings carry a higher bacterial load. Gram-negative bacilli, enterobacteria, and
Staphylococcus aureus are more common under rings (Boyce and Pittet, 2008; Fagernes and
Lingaas, 2009).
5 Antiseptic hand rub

a. Apply an ample amount of product to palm of one hand.
Enough product is needed to thoroughly cover the hands.
b. Rub hands together, covering all surfaces of hands and fingers with antiseptic.
Covering all aspects of the hands kills transient bacteria; ensures complete antimicrobial
action.
c. Rub hands together for several seconds until alcohol is dry. Allow hands to dry
before applying gloves.
Provides enough time for antimicrobial solution to work.
CLINICAL DECISION: If hands feel dry after rubbing hands together for 10 to 15
seconds, an insufficient volume of product likely was applied (Boyce et al., 2002).
6. Handwashing using antiseptic soap

a. Stand in front of sink, keeping hands and uniform away from sink surface. (If
hands touch sink during handwashing, repeat process.)
Inside of sink is a contaminated area. Reaching over sink increases risk of touching edge,
which is contaminated.
b. Turn on water. Turn faucet on or push knee pedals laterally or press pedals with
foot to regulate flow and temperature.
Knee pads within the operating room and treatment areas are preferred to prevent hand
contact with faucet. Faucet handles are likely to be contaminated with organic debris and
microorganisms (AORN, 2007).
c. Avoid splashing water against uniform.

Microorganisms travel and grow in moisture.
d. Regulate flow of water so temperature is warm.

Warm water removes less of the protective oils than hot water.
e. Wet hands and wrists thoroughly under running water. Keep hands and forearms
lower than elbows during washing.
Hands are the most contaminated parts to be washed. Water flows from least to most
contaminated area, rinsing microorganisms into the sink.
f. Apply 3 to 5 mL of antiseptic soap and rub hands together vigorously, lathering

thoroughly.
Ensures that all surface areas of the hands and fingers are cleaned.
CLINICAL DECISION: The decision whether to use a nonantimicrobial soap,

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, 2008a).
g. Wash hands using plenty of lather and friction for at least 15 seconds. Interlace
fingers and rub palms and back of hands with circular motion at least 5 times
each. Keep fingertips down to facilitate removal of microorganisms.
Soap cleans by emulsifying fat and oil and lowering surface tension. Friction and rubbing
mechanically loosen and remove dirt and transient bacteria. Interlacing fingers and
thumbs ensures that all surfaces are cleansed. Adequate time is needed to expose skin
surfaces to antimicrobial agent.
h. Areas under fingernails are often soiled. Clean them with fingernails of other
hand and additional soap with an orangewood stick (optional).
Areas under nails are often highly contaminated, which increases the risk of infection for
the nurse or patient.
i. Rinse hands and wrists thoroughly, keeping hands down and elbows up.
Rinsing mechanically washes away dirt and microorganisms.
j. Dry hands thoroughly from fingers to wrists and forearms with paper towel,
single-use cloth, or warm air dryer.
Drying from cleanest (fingertips) to least clean (forearms) area avoids contamination.
Drying hands prevents chapping and roughened skin.
k. If used, discard paper towel in proper receptacle.

Prevents transfer of microorganisms.
l. Turn off water with foot or knee pedals. To turn off hand faucet, using clean, dry
paper towel; avoid touching handles with hands.
Wet towel and hands allow transfer of pathogens from faucet to hands. Faucet handles
are contaminated.
HOME CARE CONSIDERATIONS

• Evaluate the handwashing facilities in the home to determine the potential for contamination, how close the
facilities are to the patient, and available supplies in the area.
• Evaluate the availability of warm running water and soap when conducting home visits and anticipate the need for
alternative handwashing products such as alcohol-based hand rubs and/or detergent-containing towels.
• Instruct the patient and primary caregiver in proper techniques and situations for handwashing.
Remarks:
Grading Rubric
4 - Consistently demonstrates knowledge of the procedure. Able to verbalize and perform with minimal or no
instructor cueing or feedback.
3 - Demonstrates knowledge of the procedure. Able to verbalize and perform with moderate instructor cueing
or feedback.
2 - Inconsistently demonstrates knowledge of the procedure. Not able to verbalize or perform, requires
maximum instructor feedback and cueing
1 - Inconsistently demonstrates knowledge of the procedure. Has no recollection of technique or procedure.
Has demonstrated unsafe patient care, below level of safety.
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CALAMBA DOCTORS’ COLLEGE

Bachelor of Science in Nursing

PERFORMING HAND HYGIENE

Name: ______________ Date: Score:

2. Inspect hands for visible soiling.

5 Antiseptic hand rub

6. Handwashing using antiseptic soap

c. Avoid splashing water against uniform.

d. Regulate flow of water so temperature is warm.

f. Apply 3 to 5 mL of antiseptic soap and rub hands together vigorously, lathering

CLINICAL DECISION: The decision whether to use a nonantimicrobial soap,

k. If used, discard paper towel in proper receptacle.

HOME CARE CONSIDERATIONS

Signature over printed name

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