SESSION 1: FN 100:FOUNDATIONS & BASIC PRINCIPLES OF NURSING

SR GOTFRIDA RN,BSN, MSc-NED & PhD

Student
 SESSION 2: HAND WASHING DURING PROVISION OF SUPPORTIVE
SERVICES

By the end of this session students are expected to be able to:

• Define the terms hand hygiene and hand washing
• List types of hand hygiene
• Explain the indication of hand washing
• Describe importance/purpose of hand washing
• Demonstrate hand washing
 INTRODUCTION ON HAND WASHING

• Handwashing is the act of cleaning one’s hands with the use of any liquid
with or without soap for the purpose of removing dirt or microorganisms.
• It is the most effective measure in reducing the risk of transmitting
infectious diseases
 DEFINITION OF TERMS
• Hand Hygiene. It is a general term that applies to hand washing, antiseptic
hand wash, antiseptic hand rub, or surgical hand antisepsis
o Hand hygiene are practices that are intended to prevent hand-borne
infections by removing dirt and debris and inhibiting or killing
microorganisms on skin.
o Hand hygiene includes care of hands, nails and skin.
 
• Hand Washing. It is defined as the washing of hands with plain (i.e., non-
antimicrobial) soap and water.

o This is the process of which mechanically removes soil and debris from skin
and reduces the number of transient microorganisms
Brainstorming
• Outline types of hand hygiene
 TYPES OF HAND HYGIENE

Hand washing is usually limited to hands and wrists; the hands are washed for
a minimum of 10 – 15 seconds with soap (plain or antimicrobial) and water.
Hand antisepsis/decontamination

• A term that applies to hand washing with an antimicrobial soap and water.

• Hand antisepsis removes or destroys transient micro-organisms and confers a

prolonged effect.

• It may be carried out in one of the following two ways:

o Wash hands and forearms with antimicrobial soap and water, for 15-30 seconds.
o Decontaminate hands with a waterless, alcohol-based hand gel or hand rub for
15-30 seconds.
o This is appropriate for hands that are not soiled with protein matter or fat.
• Use of water and antimicrobial soap (e.g., chlorhexidine,
chloroxylenol ,triclosan) or the purpose of removing or destroying
transient microorganisms and reduce resident flora.
Surgical hand antisepsis
• Commonly called as a surgical hand scrub. This is to remove as many
microorganisms from the hands as possible before the sterile procedure.

• Surgical hand antisepsis removes or destroys transient micro-organisms and

confers a prolonged effect.

• The hands and forearms are washed thoroughly with an antiseptic soap for a
minimum of 2-6 minutes.

• The hands are dried using a sterile towel.

• Surgical hand antisepsis is required before performing invasive procedures.
• By using water and antimicrobial soap (e.g., chlorhexidine, iodine and
iodophors, chloroxylenol ,triclosan) for the purpose of removing or
destroying transient microorganisms and reduce resident flora.
 PRINCIPLES AND CONCEPTS SURROUNDING HAND
HYGIENE

• You must use running water in a sink that drains out instead of using a
basin.
• You may use soap from a Touch Free Soap Dispenser or antibacterial soap if
necessary.
• You must rub your hands against each other for at least 30 seconds to
facilitate removal of microorganisms.
• Long nails and jewelry trap germs. It is best to keep fingernails short.
• If you wear a ring, it is better not to remove the ring before hand washing so
that it can be washed too.

• It is always better to use disposable paper towels than to use cloth towel when
drying hands to ensure that you can only use those once.

• The faucet/stopcock is always considered dirty and it is recommended to turn

it off using a paper towel in the absence of the ideal sensor or foot pedal.

• Dispensers of soap should be used until completely empty.

• Once emptied, it should be washed before refilled.

Brainstorming
• What are the purpose for hand washing?
Purposes
• The purposes of hand hygiene are:
• Hand washing can prevent infection
• Avoid pathogenic microorganisms and to avoid transmitting them
microorganisms.
• To protect the patient against harmful pathogens carried on
healtcareworkers hands or present on his/her own skin
• To protect self and the healthcare environment from harmful pathogens
 Hand washing may also be used for routinely decontaminating hands in
the following clinical situations
o Before having direct contact with patients
o Before inserting indwelling urinary catheters, peripheral vascular
catheters, or other invasive devices that do not require a surgical
procedure
o After contact with a patient’s intact skin (e.g., when taking a pulse or
blood pressure, and lifting a patient)
o After contact with body fluids or excretions, mucous membranes, non-intact skin,
and wound dressings, even if hands are not visibly soiled

o When moving from a contaminated body site to a clean body site during patient
care

o After contact with inanimate objects (including medical equipment) in the

immediate vicinity of the patient

o After removing gloves

 INDICATORS OF HAND HYGIENE

According to the World Health

Organization (WHO), there are Five
Moments for Hand Hygiene:
• Before Patient Contact.
• Before and Antiseptic Task.
• After Body Fluid Exposure Risk.
• After Touching a patient .
• After Contact with Patient
Surroundings.
DISCUSSION

Small group discussion 5 student each ( 10minutes)

Explain when and why we should wash our hands on this time ?
• Before Patient Contact.
• Before and Antiseptic Task.
• After Body Fluid Exposure Risk.
• After touching patient.
• After Contact with Patient Surroundings
 Supplies equipment or materials needed for hand washing

The following materials or equipment are needed to perform hand

washing:
• Soap or detergent
• Warm running water
• Paper towels
• Alcohol
• Optional: Antiseptic cleaner, fingernail brush, plastic cuticle stick
 Procedures for different hand hygiene methods

Step-by-step guide for different hand hygiene methods:

Antiseptic Handrub
• The use of alcohol-based handrub.
• Ensure jewelers has been removed
• Apply quantity of alcohol-based hand hygiene product as per
manufacturer’s recommendations into cupped hand.
• Rub hands palm to palm
• Right palm over left dorsum with interlaced fingers and vice versa.
 CONT…

• Palm to palm with fingers interlaced

• Backs of fingers to opposing palms with fingers interlaced

• Rotational rubbing of left thumb clasped in right palm and vice versa

• Rotational rubbing, backwards and forwards with clasped fingers of right

hand in left palm and vice versa

• Rubbing hands together until hands are dry before continuing with patient
care, do not rub off excess product
 PROCDURE FOR HANDRUB
When decontaminating hands with an alcohol-based handrub use an amount of
alcohol-based handrub sufficient to cover all surfaces of hands.
1.Apply handrub to palm of one hand.
2.Rub hands together covering all surfaces of hands and fingers.
3.Rub until handrub is absorbed.
The purpose of surgical hand scrub is to:
• Remove debris and transient microorganisms from the nails, hands, and
forearms
• Reduce the resident microbial count to a minimum, and
• Inhibit rapid rebound growth of microorganisms
Antiseptic Hand washing
Also known as clean technique, includes procedures used to reduce the
number of organisms on hands.
• Gather the necessary supplies.
• Stand in front of the sink.
• Wet the hands and wrist area.
• Keep hands lower than elbows to allow water to flow towards the
fingertips.
• Cover all areas of hands with soap.
• With firm rubbing and circular motions, wash the palms and backs of the
hands, each finger, the knuckles, wrists, and forearms. Continue this friction
motion for 30 seconds.

• Rinse thoroughly with water flowing towards the fingertips.

• Pat hands dry, beginning with the fingers and moving upward towards
forearms, with a paper towel and discard immediately.

• In the absence of sensors or foot pedal, use another clean paper towel to
turn off the faucet.
 Procedure for Antiseptic Hand washing

Preparation Check List

• Keep nails short - most bacteria on the hands come from beneath the nails
• Do not wear nail varnish or false nails
• Do not wear ridged/stoned rings
• Remove wrist watches and roll up or remove long sleeved clothing
 Sequence of events

• Wet hands under running water.

• Dispense soap/antiseptic (5mls approx.) into a cupped hand
• Hand wash for 10-15 seconds vigorously and thoroughly without adding
more water.
• Rinse hands thoroughly under running water.
• Dry hands properly with a disposable towel.
• Drying is equally as important as washing – bacteria thrive in moisture
Six step hand washing technique
Each step consists of five strokes forward and five
backward
Surgical Antisepsis
• Also known as sterile technique, prevents contamination of an open
wound, serves to isolate the operative area from the unsterile
environment, and maintains a sterile field for surgery.
1.Remove all pieces of jewelry.
2.Wet hands using sterile water with water closest to your body
temperature.
3.Wash hands using antimicrobial soap and/or povidone-iodine.
4.Clean subungual areas with a nail file.
• Scrub each side of each finger, between the fingers, and the backs and fronts of the
hands for at least 4 minutes.

• Proceed to scrub the hands, keeping the hand higher than the arm at all times to
prevent bacteria-laden soap and water from contaminating the hands.

• Rinse hands and arms by passing them through the flowing water in one direction
only, from fingertips to elbow.

• Proceed to the operating room holding hands above elbows.

• Dry hands and arms using sterile towel observing aseptic technique.
 How to Perform Hand Hygiene with Soap and Water (Hand washing)

• Hand washing involves the use of soap and water to physically remove
microorganisms from your hands.
• Hand hygiene with water requires soap to dissolve fatty materials and
facilitate their subsequent flushing and rinsing with water.
• Soap must be rubbed on all surfaces of both hands followed by thorough
rinsing and drying.
Brainstorming
• There are situations where you would use ONLY soap and water rather than an
alcohol-based handrub.
• So, when MUST you use only soap and water to perform hand hygiene rather
than an alcohol-based handrub?
According to the CDC.gov guidelines, you would use soap and water when:
• Hands are visibly dirty
• After known or suspected exposure to clostridium bacteria, if your facility is
experiencing an outbreak or higher endemic rates. E.g COVID19, EBOLA
AND HIV
• After known or suspected exposure to patients with infectious diarrhea
during outbreaks
• If exposure to bacillus (anthrax) is suspected or proven
• Before eating
• After using a restroom
 STEPS /PROCEDURE FOR HAND WASHING WITH WATER AND SOAP

• Step 1: Wet your hands.

• Make sure that you're using running water of at least 100 degrees Fahrenheit
and that you've removed any jewelry (e.g., rings or bracelets) before you
begin because they can trap germs.

Step 2: Apply soap to your hands

• Remove your hands from the water and use a squirt of soap to remove soil
and transient microorganisms from your skin.
Step 3: Rub your palms together.

• With hands still out of the water, rub palm to palm for about five seconds to
create a rich lather.
Step 4: Rub your hands over each other.
• Massage the back of your left hand over your right palm for three seconds to
spread the soap.
• Repeat the above process with your left palm on the back of your right hand.
Step 5: Interlace your fingers.

• Rub your palms over one another, this time interlacing your fingers.
• Keeping your fingers interlaced, run the backs of your fingers along
the back of the opposing hand.
• Do this for three seconds.
Step 6: Scrub your thumbs.
• Rub your right thumb with your left hand, clasping it tightly while
rotating for three seconds. Repeat the above with your left thumb.
Step 7: Rub fingertips against palms.
• Using the fingers of your right hand, rub your left palm in a circling motion for
three seconds, going both clockwise and counterclockwise.
• Repeat the above process with your left fingers and right palm.

Step 8: Rinse your hands.

• Once you've been cleaning for 20 to 30 seconds, rinse the soap off your
hands until the water runs clear and you don't see suds/ bubbles.
• When you're finished, use a paper towel to turn off the faucet.
• Because you've touched it with dirty hands, there's a good chance that it's
harboring the bacteria and germs you just washed off.
Step 9: Dry your hands.
• Dry your hands with paper towels or a hand dryer rather than a cloth towel,
which collects bacteria.
• Also, be sure not to wipe your hands on your scrubs.
STEPS FOR HANDWASHING BY WATERAND SOAP
 Common Errors when Washing Hands with Soap and Water

• Not using enough soap to cover all surfaces of the hands and wrists.
• Not using friction when washing hands.
• Not washing hands long enough. Should be a minimum of 20 seconds.
• Skipping steps (e.g., fingernails, wrists, back of hands, thumbs).
• Not removing all soap from hands and wrists. 
• Shaking water off your hands. 
• Not thoroughly drying your hands.
• Drying your hands from wrists to fingers or in both directions. 
 Key Points
• Hand hygiene is one of the most effective measures to reduce the
occurrence of Healthcare associated infections.

• Good hand hygiene saves lives and reduces the strain on our healthcare
system.

• It takes less than one minute to properly wash hands using soap and water

 
Evaluation
• What is hand washing
• What are the indications for hand washing?
• Why hand washing is important?
• Read more in the WHO on how to wash hands with soap and water

REFERENCES
• Caroline, B.R. & Mary, T.K. 2011. Textbook of Basic Nursing. 10th ed. New
York: Lippincott Williams & Wilkins.
• 2. Lois, W., Gena, D. & Wendy, B. 2011. Foundations of Basic Nursing. 3rd.
ed. New York: Cengage Learning.
THANK YOU FOR
PARTICIPATION