Basic Infection Control
Performing Hand Hygiene
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Safety
- Wash your hands with soap and water when your hands are visibly dirty or contaminated with proteinaceous material, blood, or other bodily fluids.
- If your hands are not visibly soiled, use an alcohol-based hand rub.
- Keep natural nails short.
- Do not wear nail polish, long or artificial nails, or nail extenders.
Equipment
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Antiseptic hand rub
Institutional lotion
Easy-to-reach sink with warm running water
Antimicrobial or regular soap
Paper towels or air dryer
PrintableDelegation
The skill of hand hygiene cannot be delegated. It is performed by all caregivers. Tasks are delegated to nursing assistive personnel (NAP) who require appropriate hand hygiene. Be sure to inform NAP of the following:
- Choose an appropriate hand hygiene agent, such as soap or an alcohol-based sanitizer.
- Clean the hands for 15 to 20 seconds.
- Use warm water when using soap and water.
Preparation
- Inspect the surface of your hands for breaks or cuts in the skin or around the cuticles.
- Inspect your hands for visible soiling.
- Inspect the condition of your nails. Natural tips should be no longer than ½ cm, or about ¼ inch, long. Keep your fingernails short, filed, and smooth.
Follow-up
- Inspect the surface of your hands for obvious signs of dirt or other contaminants.
Documentation
- Documentation is not required for hand hygiene.
Review Questions
1. How does soap work?
Creates a sheetlike microscopic barrier between the skin and microorganisms in the environment
Emulsifies fat and oil so that dirt and microorganisms can be mechanically removed- Kills all microorganisms exposed to the lather
- Removes visible soiling but is ineffective in isolating, removing, or killing microorganisms
INCORRECT. Soap does not create a protective barrier. It cleanses by emulsifying fat and oil and lowering surface tension. Friction and rubbing mechanically loosen and remove dirt and transient bacteria.
CORRECT. Soap cleanses by emulsifying fat and oil and lowering surface tension. Friction and rubbing mechanically loosen and remove dirt and transient bacteria.
INCORRECT. Plain soap does not kill microorganisms. Antimicrobial soap may inactivate some surface bacteria but does not kill all bacteria exposed to the lather. Both kinds of soap cleanse the hands primarily by emulsifying fat and oil and lowering surface tension so that dirt and transient bacteria can be mechanically loosened and removed.
INCORRECT. This statement is false. Use of soap and warm water removes visible dirt and proteinaceous material, such as blood and other body fluids. It is also effective in loosening and removing dirt and transient bacteria.
2. What is the primary purpose of appropriate hand hygiene?
- To remove all microorganisms from the hands
- To prevent or control the transmission of infectious microorganisms from any source
- To leave a protective antimicrobial film on the hands
- To minimize exposure to microorganisms on contaminated sinks, medication containers, catheters, and other hard surfaces
INCORRECT. By definition, the removal of all microorganisms from the hands would render the hands sterile. Proper hand hygiene can reduce the number of microorganisms on the skin but cannot eliminate microorganisms entirely.
CORRECT. The purpose of proper hand hygiene is to prevent and/or control the transmission of infection, regardless of the source. Effective infection-control practices aim to break the links in the chain of infection.
INCORRECT. Hand washing with plain or antimicrobial soap aids in the removal of microorganisms but does not leave behind an antimicrobial film or other protective barrier.
INCORRECT. Proper hand hygiene reduces the likelihood of picking up or leaving behind microorganisms on hard surfaces, such as bed rails. Such surfaces, however, are just one kind of reservoir. In fact, infection usually spreads from patient to patient by contact not with hard surfaces, but with health care workers’ hands. The primary purpose of performing hand hygiene is to prevent or control the transmission of infection from any source.
3. In which situation would it be appropriate for the nurse to use an antiseptic hand rub to perform hand hygiene?
- The nurse has dry, cracked skin.
- The nurse’s hands are not visibly soiled.
- The nurse is sensitive to antimicrobial soap.
- The nurse has been exposed to a protein-based contaminant.
INCORRECT. An antiseptic hand rub is not recommended for a health care professional whose skin is dry and cracked.
CORRECT. An antiseptic hand rub may be used only when the nurse’s hands are not visibly soiled.
INCORRECT. An antiseptic hand rub is not recommended if the nurse is sensitive to antimicrobial soap.
INCORRECT. An antiseptic hand rub is not recommended if the nurse has been exposed to a proteinaceous contaminant, such as blood or mucus.
4. The nurse is discussing the guidelines for proper hand hygiene with nursing assistive personnel (NAP). Which statement made by NAP requires follow-up by the nurse?
- “I always perform hand hygiene after I use the computer workstation in the patient’s room.”
- “To prevent dry skin, I avoid using soap and water.”
- “It takes at least 15 seconds of rubbing to wash the hands properly.”
- “I do hand hygiene before and after lifting or moving my patients.”
INCORRECT. It is appropriate to perform hand hygiene after having contact with inanimate objects in the immediate vicinity of a patient. This statement does not require follow-up.
CORRECT. Soap and water should be used to perform hand hygiene when the hands are visibly soiled. Avoiding soap and water in order to prevent dry skin is not appropriate, and the nurse should follow up.
INCORRECT. Hand hygiene using soap and warm water should be performed for at least 15 to 20 seconds, so this statement does not require follow-up.
INCORRECT. Hand hygiene must be performed after any direct contact with the patient, even if the patient’s skin is intact. This statement is therefore appropriate and does not require follow-up.
5. Which patient is at the greatest risk for hospital-acquired infection (HAI)?
- A middle-age female patient receiving chemotherapy for lung cancer
- An older adult male patient who experienced a myocardial infarction 3 days ago
- A young man recovering from bilateral femur fractures and a mild concussion sustained in a car accident
- A young woman with abdominal pain who is scheduled for exploratory surgery in the morning
CORRECT. This patient has immunosuppression as a result of the chemotherapy and is therefore at the greatest risk of contracting an HAI.
INCORRECT. This patient’s age may increase his risk of contracting an HAI, but he does not have the greatest risk for infection of the patients listed.
INCORRECT. Neither the closed fractures nor the concussion would necessarily increase this patient’s risk of infection.
INCORRECT. Although this patient may be at an increased risk of HAI, she does not have the greatest risk for infection of the patients listed.
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