Hand Hygiene

Standard Operating Procedure
For
Hand Hygiene
1. Procedures
1.1. Hand Decontamination
1.1.1. Types of Decontamination
•
•
•
•
Social/routine hand-washing
Antiseptic hand decontamination
Antiseptic hand washing
Surgical hand decontamination
1.1.2. Choice of Cleansing Agents
•
•
•
Liquid soap
Alcohol hand rub
Antiseptic Cleansing agents (substance name and current trade names are as
follows) :
o Chlorhexidine gluconate - current trade name is “Hibiscrub”
o Povidone iodine - current trade name is “Betadine” surgical scrub
o Triclosan– current trade name is “Aquasept”
1.1.3. Preparation of the Hands prior to Decontamination
•
•
•
•
•
•
Remove all rings except plain wedding bands
Remove wrist watches/bracelets
Roll up long sleeves to the elbow or remove long-sleeved clothing
Keep nails short and clean
Do not wear nail varnish/artificial nails
Cover all cuts/abrasions with a water-proof dressing
1.1.4. When to Decontaminate the Hands
Different methods of hand decontamination are acceptable. Each of the following
headings describes when each method may be employed:
Janice Mackay
Infection Control Team
Review Date May 2014
1.1.4.1.
Social/Routine Hand-washing (using soap and water)
It is essential that a social/routine hand wash is performed:
•
•
•
•
•
•
•
On arrival for duty
After personal use of the toilet
After blowing/wiping your nose
Before preparing, handling or eating food
After removing gloves or protective clothing
Whenever the hands are visibly dirty
After leaving your work area
(This list is not exhaustive)
1.1.4.2.
Antiseptic Hand Decontamination
Alcohol hand rub should be applied to socially clean hands:
•
Immediately before and after every episode of direct patient contact (including
manual handling, toileting, bathing etc) or any activity that potentially results in
hand contamination
• After bed making
• Before and after undertaking clinical procedures
• Before and after manipulation of invasive devices e.g. Intravenous/arterial
lines, urethral/pubic catheters, drainage tubes, naso-gastric tubes,
Percutaneous Endoscopic Gastrostomy (PEG) tubes
• Before and after emptying urine/other drainage bags
• Before and after performing aseptic procedures
• After attending to patients in source isolation
• Before attending to patients in protective isolation
• After handling contaminated laundry or waste
(This list is not exhaustive)
1.1.4.3.
Antiseptic Hand Washing
Using antiseptic cleansing agents
Antiseptic hand washing should be performed:
•
Immediately before and after every episode of direct patient contact/care
(including manual handling, toileting, bathing etc) or any activity that
potentially results in hand contamination
• After bed making
• Before and after undertaking clinical procedures
• Before taking blood for blood cultures
• Before and after manipulation of invasive devices e.g. Intravenous/arterial
lines, urethral/pubic catheters, drainage tubes, naso-gastric tubes,
Percutaneous Endoscopic Gastrostomy (PEG) tubes
• Before and after emptying urine/other drainage bags
• Before and after performing aseptic procedures
• After attending to patients in source isolation
• Before attending to patients in protective isolation
• After handling contaminated laundry or waste
(This list is not exhaustive)
Janice Mackay
Infection Control Team
Review Date May 2014
1.1.4.4.
Surgical Hand Washing
Using antiseptic cleansing agents
Surgical hand washing (surgical scrub) is essential:
•
Prior to all surgical procedures
1.2. Decontamination Procedures
1.2.1. Social Hand Washing
•
•
•
•
•
•
•
•
•
Turn the water to a temperature comfortable to the hands
Wet hands under running water
Apply liquid soap
Using vigorous friction to produce a lather, wash the hands and wrists for 15
seconds covering all surfaces, including the back and front of the hands,
thumbs, fingertips, between the fingers (move ring towards the knuckle
and wash thoroughly underneath and then move it back) and the wrists
(Appendix 5)
Rinse all areas of the hands (including underneath ring) thoroughly under
running water, holding hands higher than the elbows
Use elbows/wrists to turn off taps
Dry hands and wrists thoroughly using two disposable soft white paper
towels
If taps are not elbow/wrist controlled, turn taps off with paper towel
Dispose of paper towels in pedal operated household waste bin
1.2.2. Antiseptic Hand Decontamination
Using Alcohol hand rub
•
•
•
•
Hands must be socially clean and not visibly soiled
Dispense one or two applications of alcohol rub onto hand
Rub hands together vigorously ensuring that all areas of the hands, including
underneath ring, are covered (Appendix 5)
The whole process should take at least 15 seconds
Janice Mackay
Infection Control Team
Review Date May 2014
1.2.3. Antiseptic Hand Washing
Using antiseptic cleansing agents
•
•
•
•
•
•
•
•
•
Turn the water to a temperature comfortable to the hands
Wet hands under running water
Apply antiseptic based detergent
Using vigorous friction to produce a lather, wash the hands and wrists for 15
seconds covering all surfaces, including the back and front of the hands,
thumbs, fingertips, between the fingers (move ring towards the knuckle
and wash thoroughly underneath and then move it back) and the wrists
(Appendix 5)
Rinse all areas of the hands (including underneath ring) thoroughly under
running water, holding hands higher than the elbows
Use elbows/wrists to turn off taps
Dry hands and wrists thoroughly using two soft white disposable paper
towels
If taps are not elbow/wrist controlled, turn taps off with paper towel
Dispose of paper towels in pedal operated household waste
1.2.4. Surgical Hand Washing
Using antiseptic cleansing agents
1.2.4.1.
•
•
•
•
•
•
•
General points
The tap must be adjusted so that the water is comfortably warm and running
at a steady pace (splashing of clothing and the floor must be kept to a
minimum)
The hands, wrists and forearms must be rinsed under the running water to
ensure they are wet prior to applying antiseptic skin cleanser
Use a sterile nailbrush to scrub the fingernails only
An elbow must be used to dispense the antiseptic skin cleanser and to turn
the taps off
First scrub of the day should last 5 minutes
Between cases scrub should last 3 minutes i.e. if the same nurse is scrubbing
for consecutive cases and gloves are not removed until immediately prior to
scrubbing
If nurses scrub for alternate cases, scrub should last 5 minutes
Janice Mackay
Infection Control Team
Review Date May 2014
1.2.4.2.
First minute
•
•
•
•
•
•
•
•
Surgical scrub procedure
Dispense cleanser into palm and rubbing palm-to-palm work the cleanser to a
lather
Rub right palm over back of left hand and vice versa, interlace fingers while
rubbing
Rub palm to palm with fingers interlaced
Clasp hands with backs of fingers to opposing palms, interlock fingers and rub
rotationally
Rotate fingers and thumb of right hand in palm of left hand and vice versa
Clasp right thumb in left palm rub rotationally and vice versa
Rub palm to palm
Rinse hands thoroughly from fingertips to wrists under the running water
keeping the hands elevated
Second minute
•
•
•
Use elbow to dispense more cleanser
Rub palm to palm working the cleanser to a lather, rub wrists and forearms up
to the elbows
Rinse thoroughly from fingertips to elbows under the running water keeping
the hands elevated throughout
Third minute
•
•
•
Dispense cleanser onto a sterile nailbrush (opened by circulating nurse)
Clean and scrub fingernails of left hand, rinse and repeat for right hand
Rinse thoroughly from fingertips to elbows under the running water keeping
the hands elevated throughout
Fourth minute
Carry out hand wash as per second minute
Fifth minute
•
•
•
•
•
Carry out hand wash as per first minute
Turn off tap with elbow
Keep hands elevated and let any excess water run down from elbows into the
sink
Holding one of the sterile towels away from the body use the top half in a
circular motion to dry one hand, use the other half in a circular motion to dry
the wrist and forearm up to the elbow – do not rub backwards and forwards drop the towel into the bin
Repeat with the other towel for the other hand
Janice Mackay
Infection Control Team
Review Date May 2014
1.3. Skin Care
The skin has two layers. The outer layer is the epidermis, which has no blood supply
and practically no nerve supply. It is nourished by lymph from the blood vessels in
the underlying dermis.
The surface scales of the epidermis are constantly being rubbed off by friction and
are continually renewed as the deep cells multiply and are driven up to the surface.
Nerve endings in the skin are mainly sensory and give the sensations of touch, heat,
cold and pain.
1.3.1. Functions of the Skin
•
•
•
•
•
•
•
Regulates body temperature
Secretes waste products
Is the organ of touch and other senses
Keeps out bacteria due to its dry scaly outer surface
Secretes sebum
Protects the body by its pigment from the harmful effect of the sun’s rays
Produces vitamin D through the action of ultraviolet rays
1.3.2. Caring for your Skin
•
•
•
•
•
•
•
•
•
Wet hands before applying soap
Always rinse and dry hands thoroughly
Wash hands thoroughly with soap and water after approx. every 5
applications of Alcohol Rub
Contact the Occupational Health team in the event of any concerns or
problems
Seek professional advice for skin problems
Use preparations containing emollients
Apply hand cream regularly
Wear disposable gloves as part of standard precautions
Do not wear latex gloves if you are sensitive to latex
Janice Mackay
Infection Control Team
Review Date May 2014

Download Report