Hand Washing Technique: Steps to Break Away from Infection

The fundamental principle for breaking the chain of infection is to keep it clean and sterile. Hand washing is one of the most well-known and fundamental methods that is still practiced. It is regarded as the essential practice in preventing the spread of infection.

Healthcare providers are not the only ones required to do hand washing. Even the patients and family members are encouraged to learn proper handwashing techniques. Microorganisms may linger on the hands if not washed properly.

There are two preparations for handwashing techniques: (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 handwashing 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 lasts for 15 to 30 seconds. 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 aspects. It is ideal to use a clean paper towel to close the faucet after using it instead of bare hands.

Steps of Hand Washing Technique

• Apply soap or hand wash liquid on hands while covering all surfaces
• Rub both hands, starting by doing it palm to palm
• 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 left hand’s palms, 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 backward—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 through hand washing. According to WHO, there are five significant instances where the nurse or healthcare provider should strictly do hand washing techniques.

1^st Moment: Before Patient Contact

Why: To protect the patient against the microorganisms that are found on the nurse’s hands.
When: Before having any interaction with the patient

Example of patient-nurse interactions:

• Handshakes 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)

2^nd 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 the 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)

3^rd 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 anybody fluids (saliva, vomitus, sputum, urine, blood, feces)
• After contact with specimens or articles containing body fluids ( used bedpans, urinary bottle, sputum cup)

4^th 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

5^th 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