Hand Hygiene
GBMC Corporate Competency
To every patient, every time, we will provide the care that we
would want for our own loved ones.
Health, healing and hope.
Why All the Fuss About Hand Hygiene?
•Clean hands are the single most important factor in
preventing the spread of pathogens (germs) and antibiotic
resistance in healthcare settings.
•Hand hygiene reduces the incidence of healthcare
associated infections (HAIs).
•CDC estimates that each year nearly 2 million patients in
the United States get an infection in hospitals, and about
90,000 of these patients die as a result of their infection.
Hand Transmission – the spread of germs
•Hands are the most common vehicle to transmit health
care associated organisms.
•Germs are spread from person to person by direct contact
or touching.
•Germs are also spread from person to person indirectly
from surfaces and/or equipment.
Hand Transmission: Step 1
(The Lancet Infectious Diseases 2006)
Organisms/germs are present on patient skin and environment
surfaces.
•Organisms/germs are present
on intact areas of some patients’
skin.
•Nearly 1 million skin cells
containing germs are shed daily
from normal skin.
•The patient environment (bed
linen, furniture, objects)
becomes contaminated by
patient germs.
Hand Transmission: Step 2
(The Lancet Infectious Diseases 2006)
Organisms transfer on health care providers’ hands- examples:
•Healthcare workers
contaminate their hands
with germs during “clean”
activities (examination,
lifting patients, taking the
patient’s pulse, blood
pressure, or oral
temperature, picking up an
object in the patient’s room,
etc.).
Hand Transmission: Step 3
(The Lancet Infectious Diseases 2006)
Organisms survival on hands.
•Following contact with patients and/or contaminated
environment, germs can survive on hands for differing lengths
of time (minutes or hours).
•In the absence of hand hygiene, the longer the duration of care,
the higher the degree of hand contamination.
Hand Transmission: Step 4
(The Lancet Infectious Diseases 2006)
Defective hand cleansing results in hands remaining
contaminated.
•Insufficient amount of product, and/or insufficient technique
and duration of hand hygiene action lead to poor hand
cleaning.
•Germs may still be recovered on hands following hand
washing with soap and water, whereas hand sanitizer has
been proven significantly more effective.
Hand Transmission: Step 5
(The Lancet Infectious Diseases 2006)
Contaminated hands cross-transmit organisms.
•In many outbreaks, germs spread between patients and from
the environment to patients through health care providers’
hands.
Recommended Hand Hygiene Technique
•Handrubs (alcohol hand sanitizer):
○Apply to palm of one hand, rub hands together
covering all surfaces until dry.
○Volume needed: based on manufacturer, make sure
that all surface area of hands are covered with
sanitizer.
•Hand washing:
○Wet hands with water, apply soap, rub hands
together for at least 15 seconds.
○Rinse and pat dry with disposable towel.
○Use paper towel to turn off faucet.
Techniques for Performing Hand Hygiene
To clean hands properly:
•Pay special attention to fingertips, between fingers, backs of
hands and base of thumbs.
•Apply lotion to hands frequently after washing.
○Keep nails short and clean
○Remove rings and bracelets
○Do not wear artificial nails
○Remove chipped nail polish
○Make sure that sleeves are rolled up and do not
get wet
Specific Indications for Hand Hygiene
•Before:
○Entering patient’s environment “WASH IN”
○Patient contact
○Donning gloves when inserting a central venous catheter
○Donning gloves when inserting urinary catheters,
peripheral vascular catheters, or other invasive devices that
don’t require surgery
•After:
○Contact with a patient’s skin
○Contact with body fluids or excretions, non-intact skin,
wound dressings
○Removing gloves
○Exiting patient’s environment “WASH OUT”
Selection of Agents for Hand Hygiene
•When hands are visibly dirty, contaminated, or soiled, wash
with non-antimicrobial or antimicrobial soap and water.
•If hands are not visibly soiled, use an alcohol-based hand
rub for routinely decontaminating hands.
•Plain soap is good at reducing bacterial counts but
antimicrobial soap is better, and alcohol-based handrubs
are the best.
Hand Care is Important
•Intact skin is the first line of defense against organisms.
•Organisms can enter skin that is cracked or broken.
•Frequent washing with soap and water can create dry hands.
•If hands are cracked and irritated, contact Employee Health
for an assessment and recommendations.
Alcohol-Based Handrubs:
What Benefits Do They Provide?
•Require less time
•More effective for standard hand washing than soap
•More accessible than sinks
•Reduce bacterial counts on hand
•Improve skin condition
Long Nails and Jewelry Interfere With
Effective Hand Hygiene
NAILS
•Long nails are:
○difficult to clean
○can pierce gloves
○covered with more
germs than short nails
•Artificial nails and nail
enhancements have been
implicated in the transfer of
germs.
JEWELRY
•Rings increase the number of
germs present on hands and
increase the risk of tears in
gloves.
•Eczema often starts under a
ring as irritants may be
trapped under ring causing
irritation.
•Arm jewelry interferes with
the action of hand hygiene.
Artificial Nail “Enhancements”
•NOT ALLOWED for a direct
patient care provider per HR and
IP policies (reference CDC
guidelines since 2002)
•Nail enhancements include:
○Tips
○Acrylic
○Wraps
○Gels
○Overlays/Jewelry ○Nail
○Fiberglass Schlac
•If it doesn’t “grow on its own”
it’s an artificial enhancement!
•Keep natural nail tips less than ¼
inch in length
Gloving
•Wear gloves when contact with blood or other potentially
infectious materials is possible.
•Remove gloves after caring for a patient.
•Do not wear the same pair of gloves for the care of more than
one patient.
•Do not wash gloves.
•Hand Hygiene must occur immediately after glove
removal. Glove use does not prevent the need for hand
cleansing.
Take Home Hand Hygiene Facts!
•Hand Hygiene is the most effective way to prevent the
spread of healthcare associated infections (HAIs).
•Hand Hygiene is the most cost-effective measure to
prevent the spread of germs.
•Wash hands with soap and water for at least 15 seconds
and use warm water.
•Preferably, if hands are not visibly soiled, use the alcohol
based hand sanitizer, as it is more effective than soap and
water and better for your skin.
•Artificial Nail Enhancements are not allowed if GBMC
employee provides patient care.
•Gloves do not prevent the need for hand hygiene.