Running head: HAND HYGIENE
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Hand Hygiene as Evidence Based Practice
Jordan Lentz
Ferris State University
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Hand Hygiene as Evidence Based Practice
Evidence-based practice in nursing is defined as “a problem-solving approach to making
clinical decisions, using the best evidence available” (Taylor, Lillis, LeMone, & Lynn, 2011, p.
78). The definition explains that all healthcare providers should incorporate the safest and the
most recent evidence-based practice to see high patient satisfaction outcomes. Evidence-based
practice (EBP) is very important in all healthcare settings because it ensures the patient is
receiving the safest and best quality nursing care. Nurses should want to gain the skills and
knowledge to give quality nursing care based on using EBP. Evidence-based practice is a skill
set all healthcare providers should be continually be updating their knowledge on.
Hand washing is taught at a very early age and is forced into everyone’s brain. Most
people don’t realize how important hand washing is in their daily lives, but it can reduce the
spread of illness and infection drastically. There have been many studies on hand washing and
the techniques that work the best to reduce infection and illness. It is the healthcare provider’s
responsibility to ensure the patients are in the safest healing environment.
Technique
Not only is hand washing important but the technique the healthcare providers use is also
a very significant part. Hand washing is trying to remove as many microorganisms as possible
because organisms can grow and multiply on human hands (LeTexier, July 1, 2000). The proper
technique for hand washing is a combination of the right soap, scrubbing action and proper
drying skills. The soap plays an important part because it can reduce nosocomial infections by
25% when the soap had an antiseptic (LeTexier, July 1, 2000). The proper scrubbing action plays
an important role in hand washing as well and healthcare providers need to know the proper
scrubbing motion and the correct length of time. The proper ways to wash hands is by using at
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least one teaspoon of soap and scrub the hands for at least 15 seconds but if they are obviously
soiled they must be scrubbed longer (Taylor et al., 2011). While scrubbing in a firm and circular
motion, be sure to wash one more inch above the dirty area and wash under the nails (Taylor et
al., 2011).The next step is drying but there are also different techniques that work better for
drying. The different techniques are using paper towels, air drying, hot air dryers and jet air
dryers. Using air dryers are good for the environment but they create a lot of air currents and
often are contaminated so they redistribute the microorganisms around the room (Huang, Ma, &
Stack, 2012). Air dryers can be noisy and are not recommended in healthcare settings because
the patients need a calm healing environment. The best drying technique is using paper towel
because it is the most hygienic and creates significantly less air currents (Huang, Ma, & Stack,
2012). Hand drying is important because if water is left on the hands it makes the transfer of
bacteria easier from one person to the next (Huang et al., 2012). Proper hand drying needs to be
looked at more closely to help reduce healthcare costs because paper towel is expensive to
environment and hospitals.
Statistics
Hand washing is crucial in reducing and preventing the spread of antibioticresistant organisms (AROs) such as methicillin-resistant Staphylococcus aureus (MRSA) and
vancomycin-resistant Enterococci (VRE). In one study hospital acquired infections that were
caused by AROs cost $1.3 billion dollars in the United States (LeTexier, July 1, 2000). That is a
lot of money to waste on infection and illness that could have been prevented with proper hand
washing. The Center for Disease Control and Prevention (CDC) estimates there are over 2.4
million nosocomial infections in the United States every year (LeTexier, July 1, 2000).
Nosocomial infections take the lives of more than 30,000 people in a year and cost more than 4.5
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billion in care and treatment (LeTexier, July 1, 2000). The prevention of hospital-associated
infections are a major threat for all healthcare providers because they are life threatening and
very expensive for the hospital to treat. Medicare and Medicaid will not reimburse hospitals for
certain hospital-acquired infections. One example would be urinary tract infections due to not
using proper sterile technique. Another example would be surgical site infections. For the
hospital to get reimbursed from Medicare and Medicaid the hospital must report whether these
infections happened in any of their admitted patients (Taylor et al., 2011). The statistics are
overwhelming and all healthcare providers need to take a stand to reduce the spread of hospital
acquired infections.
Infection Control
Hand washing is one of the best ways to control infection and illness. There are naturally
microorganisms present on everyone some are harmful and some are not (Taylor et al., 2011).
The Chain of Infection diagram illustrates how infections are spread and this process includes an
infectious agent, reservoir, and portal of exit, means of transmission, portals of entry and a
susceptible host (Taylor et al., 2011). At every step in the diagram there is a way to break the
chain of infection and the simplest way is everyone washes their hands especially healthcare
providers.
Nursing staff play a very important role in reducing the spread of infection and illness
because they come into contact with patients and family members frequently. The nursing
process for infection control includes assessing, diagnosing, outcome identification and planning
and implementing (Taylor et al., 2011). Assessing begins with early detection and finds out the
patients immunizations records and previous infections (Taylor et al., 2011). Diagnosing begins
with a nursing diagnosis that reflects the patient’s symptoms (Taylor et al., 2011). The nurse will
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help outcome identification and planning by looking at the assessment information and the
infections characteristics (Taylor et al., 2011). They will then work with patient to help prevent
and control the infection by explaining proper and effective hand washing (Taylor et al., 2011).
Nurses will implement ways to control infection such as practicing asepsis technique (Taylor et
al., 2011). The nurse helps significantly reduce the spread of infection by having effective hand
washing skills.
Pros and Cons
Hand washing is very effective in removing the microorganisms from the hands but
everyone who works in the healthcare setting needs to actively participate in proper hand
washing. Hand washing is only effective if everyone participates and demonstrates the proper
washing and drying techniques. “Hand washing by medical professionals occurs at only 30% of
the ideal rate”(LeTexier, July 1, 2000). Hand washing needs to be part of the education and
training to reduce infection and illness among all healthcare facilities. Another con is antiseptic
is actually better in removing some antibiotic-resistance organisms and should be used in highrisk areas such as the intensive care unit and burn units(LeTexier, July 1, 2000). The one very
positive quality of hand washing is that if hands are visibly soiled then soap and water are the
best option because it removes more dirt and grime then antiseptic. Implementing evidencebased practice in healthcare settings sets the stage for reducing the spread of infection and
illness.
Conclusion
Evidence-based practice in healthcare facilities is a must to prevent the spread of illness
and infection. It is also very important because it promotes using the best practice to give
patients safe and quality healthcare. A con to hand washing is that all the healthcare providers
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need to actively participate in proper hand washing education and training. Healthcare providers
need to keep up to date information on the best hand washing and drying techniques because
having good hand washing skills can save lives. Nurses act as primary care givers and are an
important part in preventing, controlling and teaching patients about how to break the chain of
infection.
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References
Huang, C., Ma, W., & Stack, S. (2012). The hygienic efficacy of different hand-drying methods:
a review of the evidence. Mayo Clinic Proceedings, 87, 791.
http://dx.doi.org/2012.02.019
LeTexier, R. (July 1, 2000). Preventing Infection through hand washing. Retrieved from
http://www.infectioncontroltoday.com/articles/2000/07/preventing-infection-throughhandwashing.aspx
Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of Nursing (7th ed.).
Philadelphia, PA: Lippincott-Raven.