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Keeping clean and sterile is the fundamental principle for breaking the chain of infection. One of the most well-known and basic ways yet practiced is hand washing. It is considered as the most important practice to control the spread of infection. The healthcare providers are not the only ones required to do hand washing. Even the patients and the family members are encouraged to learn the proper hand washing techniques. Microorganisms may linger on the hands if not washed properly. There are two preparations for hand washing techniques: with (1) soap and water and (2) alcohol. Both are effective methods and are immensely influenced by sufficient rubbing friction and thoroughness of surfaces covered. Medical asepsis through the hand washing technique is done by lowering both hands below the elbow level. Distal body parts like the hands are considered the dirtiest or most contaminated.

Hand washing is done by running hands through water, soap and friction which last for 15 to 30 seconds for each hand. By doing this technique, dirt and other microorganisms are removed from the surfaces of the hands. Additionally, it is best to include cleaning the hidden parts, such as under the fingernails, to cover all parts.  It is ideal to use clean paper towel, instead of bare hands, to close the faucet after using.

Steps of Hand Washing Technique

  • Turn on the faucet and wet both hands under running water
  • Apply soap or hand wash liquid on hands while covering all surfaces
  • Rub both hands, starting by doing it palm to palmHand-Washing-Technique
  • Next, place the right hand’s palm over the back of the left hand with fingers interlaced. Vice versa.
  • Then, rub both hands, palm to palm, with interlocked fingers.
  • Place the back of the right hand’s fingers inside the palms of the left hand, with interlocked fingers. Vice versa.
  • Clasp the right hand’s thumb inside the left hand’s palm while rubbing rotationally. Vice versa.
  • Clasp the right hand’s fingers on the palm of the left hand while rubbing rotationally forwards and backwards. Vice versa.
  • Finally, rinse both hands thoroughly under running water.
  • Dry hands using a clean towel.

The Five Moments for Hand Hygiene (WHO, 2006)

The World Health Organization devised an approach to prevent the spread of infection by means of hand washing. According to WHO, there are five significant instances where the nurse or healthcare provider should strictly do hand washing technique.

1st Moment: Before Patient Contact

Why: To provide protection to the patient against the microorganisms that are found on the nurse’s hands.Five-Moments-for-Hand-Hygiene
When: Before having any interaction with the patient

Example of patient-nurse interactions:

  • Hand shakes and assistance during ambulation
  • Personal care activity ( bathing, changing linens, putting assistive device)
  • Non-invasive procedures ( taking vital signs, ECG monitoring, physical assessment techniques like chest auscultation)
  •  Non-invasive treatments ( oxygen therapy, application of braces or slings)
  • Oral medication administration
  • Feeding and caring orally
  • Touching any of the patient’s surroundings ( chart and bedside table)

2nd Moment: Before a Procedure

Why: To prevent harmful microorganisms from entering the patient’s body.
When: Procedures

 Examples of Procedures:

  • IV insertion
  • Venipuncture, blood sugar level monitoring, intramuscular, subcutaneous and intradermal injections
  • Medication administration through invasive device ( IV medication and NGT feeding)
  • Medication administration that directly has contact with the mucous membranes ( eye drops and suppository medications)
  • Insertion of an invasive device ( ETT, NGT, urinary catheter)
  • Any procedure or treatment that comes in contact with the patient either with an open wound or exposed mucous membrane ( rectal examination, wound dressing and surgery)

3rd Moment: After a procedure or Body Fluid Exposure Risk

Why: To provide protection for the healthcare provider and surroundings against microorganisms from the patient.
When:

  • After doing any activities as mentioned in Moment 2 examples
  • After exposure to any body fluids (saliva, vomitus, sputum, urine, blood, feces)
  • After contact with specimens or articles containing body fluids ( used bedpans, urinary bottle, sputum cup)

4th Moment: After patient Contact

Why: To provide protection for the healthcare provider and surroundings against microorganisms from the patient.

When:  After doing any activities such as in Moment 1 and 2 examples

5th Moment: After Contact with Patient Surroundings

Why: To provide protection for the healthcare provider and surroundings against microorganisms from the patient.
When: After having any contact with the patient’s immediate environment even without touching the patient directly.

Examples: bed, bedside table, chairs, linens, personal articles

Reference:
World Health Organization,October 2006.

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Being a nurse-writer reflects both my profession and passion for my calling. I believe writing is the greatest way for me to promulgate the insights that I'm best with. Medical-Surgical Nursing and Anatomy & Physiology are my two strongest specializations in the field.