Caraca, Nathalie Kate D.

Basic Concepts
2018-00223 Skills Laboratory
BSN 1-4 Written Report

Hand Hygiene

o It is considered one of the most effective infection control measures. Clients may harbor
microorganisms that are currently not harmful to them but potentially harmful to another
person or to the same client if they find a portal of entry.
o It is important that both nurses and the clients clean their hands at all times to prevent the
spread of microorganisms that have the potential to be harmful. In addition, health care
workers should cleanse their hands before and after providing care of any kind.

Hand Washing

Purposes

o Reduce the number of microorganisms on the hands

o Reduce the risk of transmission of microorganisms to clients
o Reduce the risk of cross-contamination among clients
o Reduce the risk of transmission of infectious organisms to oneself

Assessment

o Presence of factors increasing susceptibility to infection and possibility of infection that

wasn’t diagnosed
o Recent diagnostic procedures or treatments that the client have undergone which
penetrated the skin or a body cavity
o Client’s current nutritional status
o Signs and symptoms indicating the presence of an infection
 o Localized signs such as swelling, redness, pain or tenderness with palpation or
movement, palpable heat at site, loss of function of affected body part
o Systemic indications such as fever, increased pulse rate and respiratory rate, lack of
energy, anorexia and enlarged lymph nodes

Planning

o Determine the location of running water and soap (or soap substitutes)
o The technique of hand washing is the same for all health care providers, including
unlicensed assistive personnel
o Health care team members are responsible for the implementation of proper hand
washing procedures by themselves and others.

Equipment

o Soap
o Warm running water
o Disposable or sanitized towels

Implementation

Assess the hands

 Nails should be kept short.
Rationale: Short nails are less likely to harbor microorganisms, scratch a
client or puncture gloves.

 Remove all jewelry.

Rationale: Microorganisms can lodge in the settings of jewelry and under
rings. Removal of jewelries facilitates proper cleaning of the hands and
arms.
  Check hands for breaks in the skin, such as hangnails or cuts.
Rationale: Nurse who has open sores may require a work assignment with
decreased risk for transmission of infectious organisms due to the chance
of acquiring and/or passing on an infection.

Hand Washing Procedures:

1. If washing the 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 so that the water is warm.
Five common types of faucet control
a. Hand-operated handles
b. Knee levers: Can be moved using the knew to regulate flow and
temperature
c. Foot pedals: Press with the foot to regulate flow and temperature
d. Elbow controls: Moved with elbows instead of the hands
e. Infrared control: Motion in front of the sensor causes water to start
and stop flowing automatically.
Rationale: Warm water removes less of the protective oil from the skin than hot water.

3. Wet the hands thoroughly by holding them under the running water. Hold the hands
lower than the elbows so that the water flows from the arms to the fingertips.
Rationale: The water should flow from the least contaminated are to the most contaminated one;
the hands are generally considered more contaminated than the lower arms.

4. Apply soap to the hands. If the soap is liquid, apply 2 to 4 mL. If it is a bar soap, granules
or sheets, rub them firmly between the hands.

5. Thoroughly wash the hands. 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. Continue this motion for at least 15
seconds.
Rationale: The circular motion creates friction that helps remove microorganisms mechanically
while interlacing the fingers and thumbs clean the interdigital spaces.

6. Rub the fingertips against the palm of the opposite hand.

Rationale: The nails and fingertips are commonly missed during hand washing.

7. Rinse the hands.

8. Thoroughly dry hands and arms with a paper towel without scrubbing. Discard the paper
towel in the appropriate container.
Rationale: Moist skin becomes chapped readily so as dry skin that is rubbed vigorously;
chapping produces lesions which can be a site for entry of microorganism.

9. Use a new paper towel to grasp a hand-operated control to turn off the water.
Rationale: This will prevent the nurse from picking up microorganisms from the faucet handles.

Evaluation
o There is no traditional evaluation of the effectiveness of the individual nurse’s hand
washing. Institutional quality control departments monitor the occurrence of client
infections and investigate those situations in which health care providers are implicated in
the transmission of infectious organisms.

References:

Kozier, B. & Erb, G. (2008). Fundamentals of Nursing (8th ed., Vol. 1). Jurong, Singapore:
Pearson Education South Asia Pte Ltd.
Potter, P.A., Perry, A.G., Stockert, P.A., & Hall, A.M. (2017). Fundamentals of Nursing (9th
ed.). St. Louis: Elsevier/Mosby.

Taylor, C., Lillis, C., LeMone, P., & Lynn, P. (2008). Fundamentals of Nursing The Art and
Science of Nursing Care (6th ed., Vol. 2). Philippines: Lippincott Williams & Wilkins.