Hand Hygiene Guideline Adherence

Guidelines:

• Hand hygiene and surgical hand antisepsis are effective, efficient methods to prevent infections in the perioperative setting
  • Perioperative team members should perform appropriate hand hygiene:
    • Before and after direct patient contact
      • Assessing a patient, confirming a site marking, positioning a patient, completing surgical skin preparation
    • Before completing a clean or sterile task
      • Before opening sterile supplies to create a sterile field
      • Preparing medications and delivering them to the sterile field
      • Performing or assisting with regional anesthesia procedures
  • After removing PPE
  • After coming into contact with patient-related medical equipment
• Wearing gloves does not negate the need for performing hand hygiene

Considerations:

• Hand hygiene protocol: Maintenance of healthy hands and fingernails
  • Moisturizing skin care products that are compatible with other hand hygiene products (soap, alcohol-based hand rub) and gloves used at their facility
  • Use of an alcohol-based hand rub when hands are not visibly soiled can help prevent the development of contact dermatitis and bacterial colonization from repeat washing of hands in hot water
  • Maintaining natural, short fingernails
    • No longer than 2mm
    • Follow facility policies and procedures for nail polish guidelines
  • Avoid hand and wrist jewelry in patient care areas

Nurse’s role:

• Awareness of personal behaviors that can cause hand contamination and cross-contamination
• Perform appropriate hand hygiene
• Perform surgical hand antisepsis before donning sterile gowns and gloves for operative and other invasive procedures
  • Follow manufacturer’s IFU
  • Should not be performed using a brush due to skin damage and increase in bacterial shedding from hands
• Maintain healthy fingernails
  • No longer than 2mm
  • No artificial fingernails or extenders
  • Nail polish per facility policy
• Maintain healthy skin condition by taking measures to prevent hand dermatitis
  • Using moisturizing products approved by facility
  • Water temperature for hand hygiene between 70–80 degrees F
  • Completely dry hands before donning gloves
  • Use alcohol-based hand rub unless soap when appropriate, less irritating than soap and water
• Hand/wrist jewelry per facility policy
• Maintain surveillance and vigilance with hand hygiene practices for self and interdisciplinary team

Pitfalls:

• The CDC estimates that healthcare workers complete the hand hygiene process less than 50% of the time that it is indicated.
• Failure to perform proper hand hygiene provides an opportunity for potential infection transmission.
• Hand hygiene failure includes more than omission and can include:
  • Using the wrong product
  • Applying the product improperly
  • Performing abbreviated hand hygiene

Examples:

• Hand-Washing
  • Remove hand and wrist jewelry
  • Verify water is at a comfortable temperature (70-80 degrees F)
  • Wet hands thoroughly
  • Apply enough soap to cover all hand surfaces
  • Rub hands together for 15 seconds to distribute soap to all hand and finger surfaces
  • Rinse hands with water
  • Dry hands thoroughly with a paper towel
  • If faucet is not automatic, turn off using a clean paper towel
• Alcohol-Based Rub
  • Remove hand and wrist jewelry
  • Adhere to manufacturer’s IFU
  • Rub hands and fingers together until dry. All hand and finger surfaces should be covered with product during this process
• Surgical Hand Antisepsis
  • Remove jewelry
  • Don a face mask before beginning
  • Select appropriate scrub solution
  • Perform a correctly timed and sequenced surgical scrub
  • Follow the manufacturer’s IFU

Linchpins (Key Points):

• Perform appropriate hand hygiene
• Maintain vigilance and adherence to hand hygiene
• Follow manufacturer’s IFU
• Follow facility’s policies and procedures