MEDICAL HANDWASHING It is the cleaning of hands thoroughly to reduce if not to remove all dirt and microorganisms. It is the easiest and the most effective way to prevent the spread of pathogens, since hands are most agile of the body and considered the culprit in the spread of infectious diseases. Purpose of the Procedures: 1. To reduce the number of microrganisms on the hands. 2. To reduce the risk of transmission of microorganisms to clients, 3. To reduce the risk of cross contaminations among clients. 4. To reduce the risk of transmission of infectious organisms to oneself, Materials Needed: 1. Liquid Soap 2. Warm running water 3. Towels 4. Tissues 5. Nail file 6. Non-petroleum based hand moisturizer (optional) EXPECTED BEHAVIOR RATIONALE ASSESSMENT 1, Determine the need for Handwashing should be done in all of handwashing by assessing the following: client’s: a, Present of factors ¥ At the beginning and end of every increasing procedure done. susceptibility to infection and ¥ Before and after prolonged possibility of undiagnosed contact with a client. infection (c.g. HIV) ¥ Before invasive procedure. ¥ Before contact especially with susceptible clients. ¥ Before and after handling client's article or —dressing/equipment used in his are. ¥ After contact with body b. Use of immunosuppressive medications c. Recent diagnostic procedures or treatments that penetrated the skin or a body cavity discharges, even when gloves are worn, <4. Current nutritional status ¥ Anytime you are in doubt about the necessary for handwashing.e. Signs and symptoms indicating the presence of an infection: Localized signs: swelling, redness, pain ot tendemess 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 rate, lack of energy, anorexia, enlarged lymph nodes. PLANNING 2, Determine the location of running water and soap substitute This saves time, effort and prevents the delay of the procedure. IMPLEMENTATION Preparation 3. Assess the hands: a. Nails should be kept short. Short, natural nails are less likely to harbor microorganism, scratch a client, or puncture gloves. b, Remove all jewelries. Microorganisms can lodge in the settings of jewelry and under rings. Removal facilitates proper cleaning of the hands and arms, ¢. Check hands for breaks in the skin. If these are found, they are reported to the Clinical Instructor. A nurse who has open wound/sores may require a work assignment with decreased risk of transmission of infectious organisms due to the chance of acquiring or passing on an infection. Performance 4, Ifyou are washing your hands where the client can observe you, introduce yourself and explain the client what you are going to doand why it is necessary. 5. Stand in front but away from the sink. Flex knees slightly if the sink is low. Uniform should not touch the sink to avoid contamination. 6. Roll sleeves above elbows. Moist clothing facilitates transfer of microorganisms. 7, Tum on the faucet and adjust the flow so that the water is warm ‘Warm running water aids in removing microorganisms without removing excess. skin oils, Hot water, opens skin pores and can cause dryness, chapping of the skin by removing skin oils. Cold water does not make better soapsuds and not effective in removing microorganisms. 8. Wet the hands thoroughly by holding them under the running water. Holds the hands lower than the elbows so that the water flows from the arms to the fingertips. ‘The water should flow from the least contaminated to the most contaminated area; the hands are generally considered more contaminated than the lower arms. ‘The inside of the sink is considered contaminated. 9. Ifthe soap is liquid, apply 4-Sml. If bar soap is used, rinse first the bar soap and rub them firmly between the hands. Using 4-Sml of liquid soap is recommended by the “APIC (Association for Professionals in Infection Control and Epidemiology) Guideline for Handwashing and Hand Antisepsis in Health Care Setting”. The outside layer of the bar soap has microorganism. Outer layer should be washed off first before using 10, Lather arms and hands well. If bar soap is used, drop the bar soap without touching the sink or the soap dish, Microorganisms are suspended in the lather and later rinses off. Sink and soap dish harbors microbes.11, Use firm and 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. You may use nail file in cleaning areas under nails The WHO (2009) recommends these steps: a. Right palm over left dorsum with interlaced fingers and vice versa. b. Palm to palm with fingers interlaced. ¢. Backs of fingers to opposing palms with fingers interlocked. d. Rotational rubbing of left ‘thumb clasped in right palm and vice versa. (continue these motions for about 30 seconds) The circular action creates friction that helps remove microorganism ‘mechanically. Interlacing the fingers and thumbs cleans the interdigital spaces. 12, Rub the fingertips against the palm of the opposite hand, ‘The nails and fingertips are commonly missed during hand hygiene. 13, Rinse hands thoroughly starting from the elbow and move down to the arms ‘The water should flow from the least contaminated to the most contaminated area; the hands are generally considered more contaminated than the lower arms. 14, Resoap your hands. Rewash and rerinse as needed if heavily contaminated. This is done only if hand is heavily contaminated to ensure the removal of microorganisms. 15. Tum off faucet with a paper towel/tissue if not foot operated. To prevent transfer of microbes from faucet to your hands.16, Thoroughly pat dry the hands from fingers to forearm by blotting a towel on the skin without scrubbing. Drying the skin thoroughly prevents chapping. Blotting rather than rubbing helps prevent skin irritation. 17. Apply lotion to the hands if the skin appears dry. (optional) Lotion can keep the skin of the hands and fingers from becoming dry and cracked. 18. Repeat procedure starting step # 7 if the hands touched the sink. If the hands touched the sink, then it becomes contaminated, therefore it requires one to repeat the handwashing procedure. 19. Tidy the sink area and wipe excess. water with a paper towel Moisture allows microorganisms to grow. EVALUATION 20. Strict application of medical asepsis 21. Handwashing procedure performed at recommended time duration. 22, Hands are free of soap and dry. DOCUMENTATION Handwashing is a responsibility of all healthcare providers. It docs not require documentation. RETURN DEMONSTRATION TOOL FOR MEDICAL HANDWASHING Name: Grade: Time Started: ime Ended: Date of RD: Area of Evaluation Rating ‘Comments SKILLS (35%) a]3]2}ijoASSESSMENT 1. Determines the need for handwashing by assessing client's: a, Present of factors increasing susceptibility to infection and possibility of undiagnosed infection (e.g. HIV) b. Use of immunosuppressive medications ¢. Recent diagnostic procedures or treatments that penetrated the skin or a body cavity d. Current nutritional status e. Signs and symptoms indicating the presence of an infection: PLANNING 2. Determine the location of running water and soap substitute IMPLEMENTATION Preparation 3. Assesses the hands: a. Nails should be kept short. b, Removes all jewelries. c. Checks hands for breaks in the skin, If these are found, they are reported tothe — Clinical Instructor. 4, Introduces self and explains the client if washing where the client can observe. 5. Stands in front but away from the sink. Flexes knees slightly if the sink is low.6. Rolls sleeves above elbows. 7. Tums on the faucet and adjust the flow so that the water is warm 8. Wets the hands thoroughly by holding them under the running water, Holds the hands lower than the elbows so that the water flows from the arms to the fingertips, 9, Applies 4-Sml of liquid soap. If bar soap is used, rinse first the bar soap and rub them firmly between the hands. 10, Lather arms and hands well. If bar soap is used, drop the bar soap without touching the sink or the soap dish, 11. Uses firm, rubbing, and circular movements to wash the palm, back and wrist of each hand. The WHO (2009) recommends these steps: a. Right palm over left dorsum with interlaced fingers and vice versa, b. Palm to palm with fingers interlaced, c. Backs of fingers to opposing palms with fingers interlocked. 4. Rotational rubbing of left thumb clasped in right palm and viceversa, 12. Rubs the fingertips against the palm of the opposite hand. 13, Rinses hands thoroughly starting. from the elbow and move down to the arms. 14, Resoap your hands, Rewash and rerinse as needed if heavily contaminated. 15. Tums off faucet with a paper towel/tissue if not foot operated. 16. Thoroughly pat dry the hands from fingers to forearm by blotting a towel on the skin without scrubbing. 17. Tidies the sink area and wipe excess water with a paper towel. EVALUATION: 18, Strict application of medical asepsis. 19, Handwashing procedure performed at recommended time duration. 20. Hands are free of soap and dry. KNOWLEDGE (15%) 1. Gives rationale of the procedure. 2. Explains the elements and mechanics of the procedure 3. Knows the elements ofnursing process as applied 4. States Principles applied in the procedure. ATTITUDE: (10%) 1. Is well groomed 2. Wears prescribed, neat, and clean uniform, 3, Arrives on time for the RD. 4, Speaks to Cl and client tactfully. 5, Minimizes use of energy, time, and effort 6. Utilizes supplies efficiently. 7. Considers client’s safety, privacy, and comfort. 8, Is well organized. 9. Keeps working area clean at all times. 10. Gives high value for aesthetics. Comments: Clinical Instructor’s signature: