2.4 Hand Hygiene

Hand Hygiene Best Practices

Hand hygiene is the most important part of practice for healthcare workers and is the single most effective way to stop the spread of infections; failure to properly perform hand hygiene is the leading cause of hospital associated infections and the spread of antibiotic resistant organisms (ABOs) (BC Centre for Disease Control, 2014; WHO, 2009a). Hand hygiene is a general term used to describe any action of hand cleaning and refers to the removal or destruction of soil, oil, or organic material, as well as the removal of microbial contamination acquired by contact with clients or the environment. Hand hygiene may be performed using an alcohol-based hand rub (ABHR) or soap and water.

Hand Hygiene

Figure 2.4.1 Hands Carry Germs (Image courtesy of tbSMITH/ Flickr) CC BY-NC-ND 2.0

Even if your hands appear clean, they may carry germs. Hands pick up micro-organisms (germs) in several ways. When people who are sick sneeze or cough, the germs that are making them sick are expelled into the air in tiny droplets. If these droplets get onto your hands, and then you touch your mouth, eyes or nose without washing away the germs, you can pick up the infection.

Washing your hands not only prevents you from getting sick, it also reduces the risk of infecting others. If you don’t wash your hands properly before coming into contact with others, you can infect them with the germs on your hands. Other people can also get sick from the germs unwashed hands leave on shared objects like doorknobs, keyboards, and other equipment in the home or workplace.

Hand hygiene is all about keeping your hands clean and the skin healthy. This is done by:

  • Washing your hands with soap and water, or cleaning with alcohol-based hand rub (ABHR).
  • Using moisturizer to protect your skin — this prevents chapping and skin breakdown.
  • Not wearing jewelry or artificial nails — these interfere with cleaning your hands properly, and can harbor germs.
Figure 2.4.2 Hand Jewelry and False Nails hide Germs Depositphotos.com Attributed Free License

Hand Jewelry and False Nails

Hand jewelry such as rings, bracelets, and watches interfere with proper hand cleaning, and can hide germs. You should either not wear these to work or remove them when cleaning your hands. Long nails, false nails, chipped nail polish, and nail jewelry can also harbor germs, which is why most healthcare facilities have policies against healthcare providers wearing them.

Figure 2.4.3 Change Bandages Regularly
Figure 2.4.3 Change Bandages Regularly {Image courtesy of Thom Watson/ Flickr.) Pexels License

Hand Care

It’s important that you keep the skin of your hands in good health, so that it doesn’t become dry or chapped and prone to breakdown. You should use hand lotion to prevent your skin from becoming dry. If you suffer from frequent skin breakdown (dermatitis), you should consult your workplace health or doctor.

If you have a cut on your hand, it’s important to cover it with a bandage so that no germs get into it. Be sure to change the bandage regularly, as you can’t properly clean a bandage, and you don’t want a dirty bandage to become a way for germs to spread!

Proper Methods of Handwashing

Although hand washing might seem like a simple task, you should follow these steps to thoroughly rid your hands of germs.

What Kind of Soap to Use?

  • Use plain soap that does not contain antibacterial agents. Plain soap will remove the dirt and grease that attract bad bacteria.
  • Plain soap will not kill the good bacteria that live on the hands.
  • Using antibacterial products unnecessarily increases the concentration of antibiotics in the water supply and in the environment and increases the risk of ABOs.
  • Liquid soaps are better than bar soaps, because germs can live on bar soaps.
Figure 2.4.4 Liquid Soap Dispenser
Figure 2.4.4 Liquid Soap Dispenser (Image courtesy of Anna Shvets/ Pexels) Pexels license

Steps When Using Soap

  1. Remove any hand or arm jewelry you maybe wearing.
  2. Wet your hands with warm water.
  3. Apply plain soap to your hands and rub together for 20 seconds (the length of time it takes to sing Twinkle Twinkle Little Star or Happy Birthday)
  4. Wash the front and back of your hands, as well as between your fingers and under your nails.
  5. Rinse your hands well for 10 seconds under warm running water, using a rubbing motion.
  6. Wipe and dry your hands gently with a paper towel or a clean towel. Drying them vigorously can damage the skin.
  7. Turn off the tap using the paper towel so that you do not re-contaminate your hands. When using a public bathroom, use the same paper towel to open the door when you leave.
  8. If skin dryness is a problem, use a moisturizing lotion.
Figure 2.4.5 Wash Your Hands Thoroughly (Image courtesy of PxHere) CC0 Public Domain

 Steps When Using Alcohol-based Hand Rub

  1. Alcohol-based hand rubs are quick to use. They are especially convenient when soap and water are not available.
  2. Make sure your hands are dry, as wet hands will dilute the alcohol-based hand product.
  3. Use enough of the product to cover all the surfaces of your hands and fingers.
  4. Rub your hands together until the product has evaporated.
  5. If dry skin is a problem, use a moisturizing lotion.
  6. Alcohol-based hand rubs don’t work if your hands are greasy or visibly dirty. These products don’t clean your hands and are not a substitute for handwashing. If your hands are visibly soiled, it is best to use soap and water.
  7. If it’s not possible to wash with soap and water, use towelettes to remove the soil, then use an alcohol-based hand rub.
Figure 2.4.6 Alcohol-Based Hand Rub  Dispenser (Image courtesy of Amanda Mills, USCDCP/ Pixnio) CC0 1.0 Public Domain

 The following videos presented by the Provincial Infection Control Network of British Columbia (PICNet) demonstrate the techniques for hand hygiene using soapy and water and ABHR.

Soap and Water by Learning Hub (2022) on YouTube

 

Alcohol Based Hand Rub by Learning Hub (2022) on YouTube

 Soap and water, or ABHR?

Figure 2.4.7 Soap or ABHR? (image courtesy of Peggy_Marco/ Pixabay.) Pixabay License

Alcohol-based hand rub (ABHR) is a product containing 60% to 90% alcohol concentration and is recommended for hand hygiene in healthcare settings (CDC, 2012). ABHR is the preferred method of hand hygiene and is more effective than washing hands with soap and water (WHO, 2009a). ABHRs:

  • Kill the majority of germs (including viruses) from hands.
  • Require less time to use than soap and water (20 to 30 seconds).
  • Are easy to use and have high levels of availability at the point of care.
  • Provide better skin tolerability.

ABHR doesn’t remove dirt. If you have handled something that has left your hands soiled (e.g., raw chicken, a soiled diaper), then soap and water needs to be used to remove the soil. Regardless of which method you use, make sure you clean all areas of your hands – palms, backs, fingers, nails… and don’t forget your thumbs!

Wash your hands regularly to prevent spreading infection!

All health care providers are required to perform hand hygiene before and/or after touching any object that comes in contact with the client.

As illustrated in Figure 2.4.8, there are five key moments at which to perform hand hygiene to break the chain of infection when you are working in healthcare,

Figure 2.4.8 Five Moments of Hand Hygiene (Image courtesy of WHO, 2009b.) CC BY-NC-SA 3.0 IGO

Five Moments for Hand Hygiene in Healthcare

  • Before initial contact with each client or items in their environment
  • Before performing an invasive/aseptic procedure
  • After care involving risk of exposure to, or contact with, body fluids
  • After contact or touching the client
  • After contact with a client or their environment
Review: Recall the 5 Moments of Hand Hygiene

Non-Sterile (Clean) Gloves

Both hand hygiene and clean glove use are strategies to prevent transmission of infections through hand contact. In the context of patient care, it makes sense to think of glove use and hand hygiene as complementary strategies to prevent transmission of pathogens. Gloves are critical to prevent the transmission of organisms when hand hygiene alone is not enough in an outbreak such as Clostridium difficile or the norovirus, or when a patient has a suspected or known pathogen. Studies have shown that gloves reduce transmission of microbes from the hands of healthcare workers (PIDAC, 2012). Checklist 2.4.1 provides the correct steps for applying and removing non-sterile gloves.

Non-sterile gloves are single use and should be applied:

  • Before an aseptic procedure
  • When anticipating contact with blood or body fluid, non-intact skin, secretions, excretions, mucous membranes, or equipment or environmental surfaces contaminated with the above blood or body fluids
  • When in contact with a patient or patient equipment or environment during additional precautions

Non-sterile gloves should be removed:

  • If gloves are damaged and integrity is compromised
  • When contact with blood, body fluid, non-intact skin, or mucous membranes has ended
  • When contact with a single patient and that patient’s surrounding or a contaminated body site on a patient has ended
  • When there is an indication for hand hygiene

Checklist 2.4.1: Applying and Removing Non-Sterile Gloves

Disclaimer: Always review and follow your agency policy regarding this specific skill.

Safety considerations:

  • Hands must be clean and dry before putting on gloves. Gloves do not replace the need for hand hygiene.
  • Hand hygiene must be performed every time gloves are removed. Gloves are not completely free of leaks or 100% tear-proof, and hands may become contaminated when gloves are removed.
  • Gloves are for single patient use and must be removed after caring for one patient. Reuse of gloves has been associated with transmission of antibiotic-resistant organisms.
  • Change or remove gloves if moving from a contaminated site to a non-contaminated site on the same person or if touching the environment.
  • Wear gloves that fit properly. Different sizes are available.
  • Gloves must be removed immediately and discarded in a waste bin after the activity for which they were used and before exiting a patient’s environment.
  • Gloves are not required for healthcare activities where contact is limited to intact skin, such as taking blood pressure.
  • Indiscriminate or improper glove use (e.g., wearing gloves all the time) has been linked to transmission of pathogens.
  • Gloves should fit snugly around wrists and hands for use with a gown to provide a better skin barrier.

How to Don (apply) Non-Sterile Gloves

STEP ACTION  ADDITIONAL INFORMATION
1. Perform hand hygiene.
Hand hygiene with ABHR
Figure 2.4.9 Hand hygiene with ABHR (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.
2. Select the appropriate size of non-sterile gloves. Remove gloves one at a time out of the box, touching only the top of the cuff.
Remove gloves from box
Figure 2.4.10 Remove gloves from box (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.
3. Put hand through opening and pull up to the wrist.
Apply first glove
Figure 2.4.11 Apply first glove (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.
4. Repeat procedure with the second hand.
Apply second glove
Figure 2.4.12 Apply second glove (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.
5. Adjust gloves to cover wrists or gown as required. Prevents the contamination of the wrists.
6. Complete care as required.
Non-sterile gloved hands
Figure 2.4.13 Non-sterile gloved hands (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.

How to Doff (remove) Gloves

 
STEPS ACTION Additional Information
1. Grasp glove on the outside about 1/2 inch below the cuff (edge of the glove opening). Do not touch the wrist with the other hand.
Grasp glove on the outside 1/2 inch below the cuff
Figure 2.4.14 Grasp glove on the outside 1/2 inch below the cuff (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.
2. Pull down glove, turning it inside out. Hold the inside-out glove in the gloved hand.
Pull glove off inside out
Figure 2.4.15 Pull glove off (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0. …
... inside out
Figure 2.4.16 … inside out (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.
3. Gather the inside-out glove in the gloved hand.
Gather inside out glove in remaining gloved hand
Figure 2.4.17 Gather inside-out glove in remaining gloved hand (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.
4. Insert finger of the bare hand under the cuff of the gloved hand.
Insert finger under cuff of gloved hand
Figure 2.4.18 Insert finger under cuff of gloved hand (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.
5. Pull down the glove until it is inside out, drawing it over the first glove.
Remove second glove
Figure 2.4.19 Remove second glove (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.
6. Discard gloves in a garbage container. This step reduces the spread of microorganisms.

Discard used non-sterile gloves
Figure 2.4.20 Discard used non-sterile gloves (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.
7. Perform hand hygiene. This step reduces the spread of microorganisms.

Hand hygiene with ABHR
Figure 2.4.21 Hand hygiene with ABHR (Image courtesy of Doyle and McCutcheon, 2015/BCCampus) CC BY 4.0.

(Data sources: Braswell & Spruce, 2012; PIDAC, 2012; Poutanen et al., 2005; PHAC, 2012a; WHO, 2009a.)

Critical Thinking Exercises

  1. Name four factors that decrease the effectiveness of hand hygiene.
  2. What are two ways to reduce or prevent skin irritation with hand hygiene or non-sterile (clean) glove use?

License

Icon for the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License

Personal Care Skills for Health Care Assistants Copyright © 2023 by Tracy Christianson and Kimberly Morris, Thompson Rivers University. is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

Share This Book