PERFORMING MEDICAL HANDWRITING

Definition:

Handwriting is a vigorous,brief rubbing together of all surface of hands lathered in soap followed by
rinsing under a stream of water

Indications:

1) Before contact with patients who are susceptible to infection (eg: newborn infants or
immunosuppressed patients).

2) After caring for an infected patient.

3) After touching organic material

4) Before performinf invasive proceedures such as adminstration of injection,catheterization and

suctioning.

5) Before and after handling dressing or touching open wounds

6) After handling contaminated equipment.

7) Between contacts with different patients in high-risk units.

Purposes:

1) To remove diet and trasient organisms from the hands and to reduce total microbial counts.

2) To protect nursing personnel from pathogenic organisms.

Articles:

1) Warm running water.

2) Antimicrobial / regular soap

3) Paper towels/ hand drier

Proceedure:

NURSING ACTION RATIONALE

1. Inspect surface of hands for breaks / cuts in
skin or cuticle. Report and cover lesions before
providing patient care.
2. Inspect hands for heavy soiling
3. Inspect nails for length
4. Assess patients risk for infection
5. Remove wrist watch and push long uniform
sleeves abovee wrist watch. Remove all jewellery
from handssuch as ring, watch and bracelet etc.
6. Stand in front of the sink, keeping hands and
uniform away from sink surfaces.
7. Turn on water. Avoid splashing water against
uniform.
8. Regulate flow of water and make sure that the
water is warm.
9. Wet hands and wrists thoroughly under
running water. Keep hands and forearms lower
than elbows during washing.
10. Apply a small amount of soap
antiseptic,lathering thoroughly.
11. Wash hands using plenty of lather and
friction for at least 10-15 seconds. Interface
fingers and rub palms and back of hands with
circular motion for at least 5 times each. Special
attention should be provided to areas such as
knuckles and fingernails.
12. Area underlying fingernails are often soiled.
Clean them with fingernails of other hand and
use additional soap if required.
13. Rinse hands and wrists thoroughly keeeping
hands down and elbows up.
14. Turn off water faucet using paper towel.
15. Dry hands thoroughly from finger to wrst and
to forearm with paper towel.
Open cuts / wounds can harbour high
concentration of micro- organisms open wound
serve as a portal for entry of microorganisms.
Requires lengthiee hand-washing
Nails should be short because most microbes on
hands come from beneath the fingernails.
Use of antimicrobial soap is encouraged when
caring for patients who are at risk for infection.
Eg: immunosuppressed patients
Provides complete access to fingers, hands and
wrist. Wearing of rings an increases the number
of microorganisms on hands
Inside of sink is a contaminated area. Reaching
over sink increases risk of touching edge, which is
contaminated
Microorganisms travel and grow in moisture
Warm water removes less of the protective oils
than cold water.
Hands are the most contaminated parts to be
washed. Water flows from least to most
conatminated are, rinsing micro-organisms from
the sink.
or Use of antiseptic exclusively can be drying to
hands and can cause skin irritation
Soap cleanses by emulsifying fat and oil thus
lowering surface tension. Friction and rubbing
mechanically loosen and remove dirt. Interlacing
fingers and thumbs ensures that all surfaces are
cleansed. Knuckles and fingernails harbour
microorganisms.
Are under nails can be highly contaminated
which will increase the risk of infection for the
nurse or the patient
Rinsing from cleanest to least clean area avoids
contamination
Drying from cleanest to least clean area avoids
contamination
16. Discard used towel Prevents transfer of microorganisms

PERFORMING A SURGICAL SCRUB

Definition

Surgical handwriting is a procedure by which dirt and microorganisms are destroyed and removed
from hands and fingers bby chemical action and mechanical friction.

Purposes:

1. To remove dirt transient microorganisms from hands

2. To reduce the risk of transmission of microorganisms to patients

3. To reduce the risk of cross infection among patients

4. To reduce the risk of trannsmission of infections agents to oneself

5. To prevent the intragenic infections

Articles:

1. Soap/antiseptic lotion

2. Running warm water

3. Nail brush in antiseptic lotion

4. Towels (sterile)

5. Mask and cap

Procedure:

NURSING ACTION RATIONALE

1. Ensure that the nails are short. Remove Short nails are less likely to harbour
artificial nail, if any. organisms,scratch the patient or puncture gloves.

2. Remove nail polish Nail polish harbour microorganisms

3. Inspect hands for abrasions,cuts or open These conditions increase likelihood of more
lesions microorganisms residing on skin surfaces

4. Remove jewellery of any type Microorganisms accumulate in jewellery

5. After medical handwash, wear cap and mask

6. Turn on water using knee/foot/elbow

7. Wet hhands and arms under running Water flows from fingertips to elbows. Fingertips
lukewarm water and lather with soap/detergent are considered to be cleansed than the elbows.
to scum above the elows (hands need to be
raised , held above tthe elbows at all time ). use
firm circular movements to wash palms, back of
hands,wrists,forearms and interdigital spaces for
20-25 seconds

8. Rinse, hands and arises thoroughly under Rinsing removes transient bacteria forn hands
running water

9. Clean under nail of both hands with nail Removes dirt and microorganisms
pick/nail brush

10. Scrub nails of each hand with 15 strokes using

anti- microbial agent

11. Holding the brush perpendicular scrub palm, Scrubbing loosens resident bacteria that adhere
each side of thumb and fingers and posterior side to skin surfaces
of handwith 10 strokes each.

12. Scrub from wrist to 5cm above each elbow Scrubbing is performed from cleaner area to less
that is lower arm, upper arm and ante cubital clean are (upper arms)
fossa to marrginal area above elbos

13. Entire scrub should last for 5-10 minutes Scrubbing time can be lengthened according to
agency policy / according to the degree of
contamination of hands

14. Discard brush and rinse hands from fingertips

to elbows
15. Take care not to touch the tap or the sides of Tap and sides of sink are considered to be
the sink during the procedure contaminated

16. Use a sterile towel to dry one hand moving Drying prevents chapping and facilitates donning
from fingers to elbow . Dry from cleanest to least of gloves
clean area

17. Repeat drying of the other hand using a

different a towel. Use one side to dry one hand
and reverse side for the other hand, if only one
towel is available.

18. Discard towel

19. Proceed with sterile gowning

PERFORMING MAKING AND STERILE GOWNING

Definition:

This procedure is the wearing of mask and a specially stitched gown in the operation theatre to
maintain asepsis and to protect the nurse from contaminating herself and others around her.

Purposes:

1. To prevent dispersal of droplets from wearer to environment and the patient.

2. To prevent the contamination the sterile field

3. To enhance easy handling of the sterile equipment

Articles Required:
1. Articles for the surgical and washing.

2. Sterile cheattle forceps in a container of disinfectant solutions.

3. Sterile drums containing masks and sterile gowns

Procedure:

Masking

Nursing action Rationale

1. After performing surgical handwashing take

the sterile mask handed to you by the circulating
nurse. Hold it by top two strings,keeping top
edge above bridge of nose

2. Tie both top strings at back of head above ears

3. Tie the two lower strings snugly around neck

well under the chin

4. Gently pinch upper portion of mask around Ensure proper fitting

bridge of nose

Gowning :

NURSING ACTION RATIONALE

1. Grasp the sterile gown at the crease near the Prevents gown from becoming unsterile
neck,hold it away from yourself and permit it to
unfold freely without touching anything including
the unform

2. Hold the gown at the shoulder level from Protects the outer portion of gown from
inside and put each hand directly into the arm contamination
hole

3. Extend the arms and hold hand upward at

shoulder level while putting through the arm hole

4. The circulating nurse pulls back the gown from Prevents conatmination from the outer portion
inside. So that the upper limbs go into the of gown
sleeves. The circulating nurse ties the gown frm
the bag

5. The waist ties are loosened by the scrub nurse The waist flapcover the back,preventing
and flap brought around the waist by the use of
cheattle forceps held by the circulating nurse and contamination of the area when turning around
it is tied

Removal of gown and mask :

Gown:

NURSING ACTION RATIONALE

1. Untie strings at the back of the gown. Remove Prevents contact with contentment portion of
gown, folding inside out cover outside of gown gown.

2. Dipose gown into designated receptable

Mask:

1. Wash hands. Untie lower strings first, then the Avoids contact of the contaminated portion of
top strings and pull mask away from face mask to our body

2. Hold mask by strings and discard into

appropriate receptable.

PERFORMING STERILE GLOWING

DEFINITION

Gloving is defined as the donning of a pair of sterile gloves to protect one’s own hands from
pathogenic microorganisms and to avoid contamination of a sterile area by hand

Purposes:

1. To protect the nurse from pathogenic microorganisms

2. To handle sterile articles without contamination

Articles Required:

Soap/ antiseptic detergent, running warm wate,nail brush in antiseptic lotion,towels(sterile) mask and
cap. A pair of sterile surgical gloves.

Procedure [Donning of gloves]:

NURSING ACTION RATIONALE

1. Perform through surgical handwashing and dry Handwashing deters the spread of
hands using sterile towel microorganisms. Gloves are easier to don when
hands are dry.

2. The circulating nurses remove the outer glove Prevents inner glove package from accidentally
package by carefully seperating and peeling apart opening and touching contaminated objects.
the sides. Scrubbed nurse pulls out the inner
glove pack taking care not to touch the outer one

3. Grasp inner package and lay it on clean,flat Sterile object held below waist is contaminated.
surface just above waist level. Open Inner surface of glove packae is sterile.
package,keeping gloves on wrapper’s inside
surface.

4. If gloves are not pre-powdered,take packet of

powder and apply lightly to hands over sink
orwaste basket.

5. Identify right and left glove. Each glove has a Proper identification of gloves prevents
cuff of approximately 5cm(2 inches)wide. Glove contamination by improper fit. Gloving of
dominant hand first. dominant hand first improves ddexterity.

6. With thumb and first two fingers of non - Inner edge of cuff will lie against skin and thus it
dominant hand. Towel only the inside surface of is not sterile
gloves.

7. Carefully pull glove over dominant hand Prevents tearing the glove material,guiding the
making sure the thumb and fingers fit into the fingers into proper places facilitates gloving
proper spaces of the glove.

8. With the gloved dominant hand, slip in fingers If gloves outer surface touches hand /wrist,then
under the cuff of the outer glove. Keep thumb of it is contaminated. Cuff protects gloved fingers
glove dominant hand abducted back to avoid maintaining sterility
touching of exposed non gloved hand

9. Carefully slip the on to your non- domiinant

hand making sure that the fingers slip into the
proper spaces
10. With gloved hands, interlock fingers to fit the Promotes proper fit over the fingers
gloves onto each fingers.

Removal of gloves:

1. Remove the first glove by grasping it on its This keeps the soiled parts of the used gloves
palms surface taking care to avoid touching from touching the skin of the wrist/hand
wrists.

2. Pull the first glove completely off by inverting

or rolling the glove inside out

3. Continue to hold the inverted remove glove by

the fingers of the remaining glove hands. Place
the first two fingers of the bare hand inside the
cuff of the second glove

4. Pull the second glove off to the fingers by The soiled part of gloves and folded to the inside
turning it inside out this pulls the first glove to reduce the chance of transferring any
inside the second glove microorganisms by direct contact

5. Using the bare hand continue to remove the

second glove, which is now inside out and
dispose off the gloves in the waste receptacle

6. Wash hands

Bibliography:

1. Jacob Annamma, Rekha R.Clinical Nursing Procedures The Art of Nursing Practice . 2 nd Edition.

Jaypee publication. New Delhi;2007. Page no:489-492;476-478;146-148.