The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [95]
Hand wash basin
Liquid soap
Paper towels
Domestic waste bin
Preprocedure
Action Rationale
1 Remove any rings, bracelets and wristwatch still worn and roll up sleeves. (Note: It is good practice to remove all hand and wrist jewellery and roll up sleeves before entering any clinical area and the English Department of Health has instructed NHS trusts to implement a ‘bare below the elbows’ dress code.) Jewellery inhibits good handwashing. Dirt and bacteria can remain beneath jewellery after handwashing. Long sleeves prevent washing of wrists and will easily become contaminated and a route of transmission of micro-organisms (DH 2010c, C).
2 Cover cuts and abrasions on hands with waterproof dressing. Cuts and abrasions can become contaminated with bacteria and cannot be easily cleaned. Repeated handwashing can worsen an injury (WHO 2009, C). Breaks in the skin will allow the entry of potential pathogens.
3 Remove nail varnish and artificial nails (most uniform policies and dress codes prohibit these). Nails must also be short and clean. Long and false nails and imperfections in nail polish harbour dirt and bacteria that are not effectively removed by handwashing (WHO 2009, C).
Procedure
4 Turn on the taps and where possible direct the water flow away from the plughole. Run the water at a flow rate that prevents splashing. Plugholes are often contaminated with micro-organisms that could be transferred to the environment or the user if splashing occurs (NHS Estates 2001, C).
5 Run the water until hand hot. Warm water is more pleasant to wash with than cold so handwashing is more likely to be carried out effectively. E
Water that is too hot could cause scalding. Soap is more effective in breaking down dirt and organic matter when used with hand-hot water (DH 2001, C).
6 Wet the surface of hands and wrists. Soap applied directly onto dry hands may damage the skin. E
The water will also quickly mix with the soap to speed up handwashing.
7 Apply liquid soap and water to all surfaces of the hands. Liquid soap is very effective in removing dirt, organic material and any loosely adherent transient flora. Tablets of soap can become contaminated, potentially transferring micro-organisms from one user to another, but may be used if liquid soap is unavailable (DH 2001, C). To ensure all surfaces of the hands are cleaned. E
8 Rub hands together for a minimum of 10–15 seconds, with particular attention to between the fingers and the tips of fingers and thumbs (see Action Figure 8a). The areas that are most frequently missed through poor hand hygiene technique are shown in Action Figure 8b. To ensure all surfaces of the hands are cleaned. Areas that are missed can be a source of cross-infection (Fraise and Bradley 2009, E).
9 Rinse soap thoroughly off hands. Soap residue can lead to irritation and damage to the skin. Damaged skin does not provide a barrier to infection for the healthcare worker and can become colonized with potentially pathogenic bacteria, leading to cross-infection (DH 2001, C).
10 Turn off the taps using your wrist or elbow. If the taps are not lever-type, turn them off using a paper hand towel to prevent contact. To avoid re-contaminating the hands. E
Postprocedure
11 Dry hands thoroughly with a disposable paper towel from a towel dispenser. Damp hands encourage the multiplication of bacteria and can potentially become sore (DH 2001, C).
12 Dispose of used paper towels in a black bag in a foot-operated waste bin. Paper towels used to dry the hands are normally non-hazardous and can be disposed of via the domestic waste stream (DH 2006a, C). Using a foot-operated waste bin prevents contamination of the hands. E
Action Figure 8a 1. Rub hands palm to palm. 2. Rub back of each hand with palm of other hand with fingers interlaced. 3. Rub palm to palm with fingers interlaced. Rub with back of fingers to opposing palms with fingers interlocked. Rub tips of fingers. Rub tips of fingers in opposite palm in a circular motion. 4. Rub each thumb clasped in opposite hand using a rotational movement. 5.