Proper hand hygiene is one of the most crucial infection prevention measures in healthcare settings. For nurses, who are in constant contact with patients and medical equipment, understanding and practicing correct hand washing and sanitising techniques is essential to minimize the risk of healthcare-associated infections (HAIs). This training ensures that nurses know when and how to clean their hands effectively to protect both patients and themselves.
Objectives of Hand Hygiene Training for Nurses
- To understand the importance of proper hand hygiene in preventing the spread of infections.
- To master the correct techniques for hand washing and hand sanitising.
- To know when to wash hands and when to use hand sanitizer in different healthcare scenarios.
- To integrate hand hygiene practices into daily routines and critical moments of patient care.
1. Importance of Hand Hygiene for Nurses
- Prevention of HAIs: Hand hygiene reduces the risk of transmitting infectious agents from nurse to patient or between patients, which is critical in preventing HAIs.
- Protection for Healthcare Workers: Proper hand hygiene also helps protect nurses from acquiring infections, especially when handling biohazards or infectious materials.
- Regulatory Compliance: Following hand hygiene protocols ensures that the healthcare facility remains compliant with infection control standards set by regulatory bodies like the WHO and CDC.
2. When Should Nurses Perform Hand Hygiene?
Nurses should practice hand hygiene at these critical moments (following the WHO’s 5 Moments for Hand Hygiene):
- Before touching a patient: To protect the patient from any harmful germs carried by the nurse.
- Before performing aseptic tasks: Such as catheter insertions, wound care, or handling intravenous equipment.
- After exposure to body fluids: Whether or not gloves were worn.
- After touching a patient: To prevent the nurse from carrying any germs picked up during patient care.
- After touching patient surroundings: Even if the patient has not been touched directly, surfaces such as bed rails or medical equipment can harbor germs.
Additional moments include:
- Before preparing or administering medication.
- After using the restroom or assisting a patient with toileting.
- After removing gloves: Gloves can become contaminated and are not a substitute for proper hand hygiene.
3. How to Wash Hands: Step-by-Step Guide
Hand washing with soap and water is necessary when hands are visibly soiled, or when dealing with pathogens like Clostridium difficile or norovirus, which hand sanitizers may not eliminate effectively.
Step-by-Step Hand Washing Procedure (According to WHO)
- Wet hands: Wet your hands with clean, running water (preferably warm) and apply enough soap to cover all surfaces of the hands.
- Lather soap: Rub hands together to create a lather. Be sure to cover the entire surface, including:
- Palms
- Backs of hands
- Between fingers
- Under fingernails
- Wrists
- Thumbs
- Scrub for at least 20 seconds: Scrubbing all surfaces of your hands for a minimum of 20 seconds is essential for removing germs. A useful way to time this is by humming the “Happy Birthday” song twice.
- Rinse hands: Rinse thoroughly under clean, running water, ensuring all soap and contaminants are washed away.
- Dry hands: Dry your hands using a clean towel or air dryer. In healthcare settings, use disposable paper towels to avoid contamination.
- Turn off the tap using a paper towel: To avoid recontaminating your hands by touching the faucet.
4. Hand Sanitising: Step-by-Step Guide
Hand sanitizers are effective for killing most germs when hands are not visibly dirty. Nurses should use an alcohol-based hand sanitizer with at least 60% alcohol.
Step-by-Step Hand Sanitising Procedure
- Apply sanitizer: Dispense an adequate amount of sanitizer (about a dime-sized amount) onto one palm.
- Rub hands together: Rub both palms together and ensure the sanitizer covers all surfaces of the hands, just as you would with soap:
- Palms
- Backs of hands
- Between fingers
- Fingertips and under nails
- Thumbs
- Wrists
- Rub for 20-30 seconds: Keep rubbing until hands are dry. Do not wipe or rinse off the sanitizer, as it needs time to kill the germs.
5. Techniques for Effective Training
To ensure nurses are following proper hand hygiene protocols, healthcare facilities should incorporate these methods into training:
Practical Demonstrations
- UV Gel Demonstrations: Use UV gel (such as GlitterBug or Glo Germ) to demonstrate the effectiveness of hand hygiene. Nurses apply the gel to their hands, wash or sanitize as usual, then check their hands under a UV light. Any remaining glow reveals missed areas.
Role Play
- Have nurses practice hand hygiene during simulated patient care scenarios. This reinforces the critical moments for hand hygiene and the importance of thorough techniques.
Auditing and Feedback
- Regularly audit hand hygiene practices, using direct observation or automated monitoring systems. Provide constructive feedback to nurses based on the results, and offer follow-up training if needed.
6. Common Hand Hygiene Mistakes to Avoid
- Not scrubbing for long enough: Ensure nurses understand that 20 seconds of scrubbing is the minimum.
- Missing key areas: Fingers, thumbs, and under the nails are commonly missed areas.
- Over-reliance on gloves: Remind nurses that gloves can’t replace proper hand washing or sanitising.
- Touching surfaces after cleaning hands: Teach nurses to avoid touching potentially contaminated surfaces, such as door handles, immediately after washing or sanitising their hands.
7. Importance of Ongoing Hand Hygiene Training
Hand hygiene training should not be a one-time event. Ongoing education, refreshers, and regular monitoring are key to ensuring compliance and maintaining high standards of infection prevention. Encourage a culture where hand hygiene is a priority, and where nurses hold each other accountable for following best practices.
Conclusion
Hand washing and sanitising are fundamental to infection control in healthcare. By training nurses on the proper techniques, critical moments for hand hygiene, and providing practical demonstrations, healthcare facilities can significantly reduce the risk of HAIs and promote a safer environment for both patients and staff.
