PERFORMING MEDICAL HAND WASHING - NCMA 113 (FUNDA)

PERFORMANCE DESCRIPTION
RATING SCALE
4 Consistently demonstrates ability to perform skill with no instructor assistance
cueing.
3 Demonstrates ability to perform skill. Requires instructor verbal cueing.
2 Inconsistently demonstrates ability to perform skill. Requires instructor assistance
and cueing.
1 Unable to perform skill. Demonstrates unsafe patient care.

PROCEDURE 4 3 2 1

PURPOSES:
1. To reduce the risk of transmission of microorganisms to clients.
2. To reduce the risk of cross-contamination among clients.
3. To reduce the risk of transmission of infectious microorganisms to oneself.
ASSESSMENT:
1. Determine the following on the client’s:
• Presence of factors increasing susceptibility to infection and possibility of
undiagnosed infection. (e.g., HIV)
• Use of immunosuppressive medications.
• Recent diagnostic procedures or treatments that penetrated the skin or a
body cavity.
• Current nutritional status.
PLANNING:
• Determine the location of running water and soap.
ASSIGNMENT:
• The skill of hand hygiene is identical to all healthcare providers including
assistive personnel (AP). Healthcare team members are accountable for
themselves and others to implement appropriate hand washing procedures.
EQUIPMENT: Soap - Liquid or Bar Soap Lotion (Optional)
Running Water Clean Nail Wooden Stick (Optional)
Paper Towels
IMPLEMENTATION:
Preparation: Prepare the equipment and assess your hands:
1. Nails should be kept short. Most healthcare agencies do not permit
healthcare workers in direct contact with clients to have any form of
artificial nails. (The CDC guidelines prohibit artificial nails in caring for high-
risk clients, and the WHO guidelines prohibit artificial nails in all settings.
Rationale: Short, natural nails are less likely to harbor microorganisms,
scratch a client or puncture gloves.
 2. Removal of all jewelry is recommended. Rationale: Microorganisms can
lodge in the settings of jewelry and under rings. Removal facilitates proper
cleaning of the hands and forearms.
3. Check hands for breaks in the skin, such as hangnails or cuts. Rationale: A
nurse who has an open sore may require a work assignment with decreased
risk for transmission of infectious organisms due to the chance of acquiring
or passing on an infection.
PERFORMANCE:
1. Introduce self and verify the client’s identity using agency protocol. (This is if
you are washing your hands in the client’s room.) Explain to the client what
you are going to do, why it is necessary.
2. Stand in front of the sink and do not allow your uniform to touch the sink.
Turn on the water and adjust the flow. If possible, adjust the flow so that the
water is warm. Rationale: Warm water removes less of the protective oil of
the skin than hot water.
3. Wet the hands thoroughly by holding them under the running water and
apply soap to the hands.
• 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 to the most contaminated area; the hands are generally
considered more contaminated than the lower arms. Note that this is a
different technique than is used when performing surgical handwashing and
this is performed in the Operating Room.
• Use 4 to 5 ml. (1-2 tsp.) if liquid soap. If it is bar soap, granules or sheets, rub
them firmly between the hands.
4. Thoroughly wash and rinse 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. Perform the World Health Organization (WHO, 2009)
recommendations on the following steps:
a. Right palm over left dorsum with fingers interlaced and vice versa.
b. Palm to palm with fingers interlaced.
c. 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 20 seconds. Rationale: The circular
action creates friction that helps remove microorganisms mechanically.
Interlacing the fingers and thumbs cleans the interdigital spaces.
5. Rub the fingers against the palm of the opposite hand. Rationale: The nails
and fingertips are commonly missed during hand hygiene.
6. Continue with the rotating action down to the opposing wrist and forearm
working to just below the elbow of each extremity.
• Clean under the finger nails using a nail stick. (Optional)
7. Rinse the hands.
8. Thoroughly pat dry the hands and arms. Dry the hands and arms thoroughly
with a paper towel without scrubbing. Rationale: Moist skin becomes
 chapped readily as does dry skin that is rubbed vigorously; chapping
produces lesions.
9. Discard the paper towel in the appropriate container.
10. Turn off the water by using a new paper towel to grasp a hand-operated
control faucet and discard. Rationale: This prevents the nurse from picking
up microorganisms from the faucet handles.
11. Apply hand lotion if desired. Use only agency-approved hand lotions and
dispensers. (Other lotions may make hand hygiene less effective, cause the
breakdown of latex gloves and become contaminated with bacterial if
dispensers are refilled.)
Total: Purposes + 3 + Assessment & Planning=1 + Implementation=3
+ Performance = 11 =18
Total: 18 x 4=72 72/100

Name _____________________________________Score ____________________________

Year and section ____________________________CI Signature_______________________

Reference: Berman, Audrey; Snyder, Shirlee; Frandsen, Geralyn: Fundamentals of Nursing: Concepts, Process, and Practice 11th Edition,
Copyright Pearson Education 2022 / WHO Guidelines,2009 /CDC Guidelines, 2014 Tjs’23