Nurse Base

Remove rings as your facility's policy dictates because they harbor dirt and skin microorganisms. Remove your watch or wear it well above the wrist. Note: Artificial fingernails and nail polish must be kept in good repair to minimize their potential to harbor microorganisms; refer to your facility's policy pertaining to nail polish and artificial nails. Natural nails should be short (less than ¼). The CDC Hand Hygiene Guideline recommends that artificial nails or extenders not be worn when having direct contact with patients at high risk such as, those in intensive care units or the operating room areas.

Wet your hands and wrists with warm water, and apply soap from a dispenser. Don't use bar soap because it allows cross-contamination. Hold your hands below elbow level to prevent water from running up your arms and back down, thus contaminating clean areas. (See Proper handwashing technique, page 118.)

Work up a generous lather by rubbing your hands together vigorously for about 10 seconds. Soap and warm water reduce surface tension and this, aided by friction, loosens surface microorganisms, which wash away in the lather.

Pay special attention to the area under fingernails and around cuticles, and to the thumbs, knuckles, and sides of the fingers and hands because microorganisms thrive in these protected or overlooked areas. If you don't remove your wedding band, move it up and down your finger to clean beneath it.

Avoid splashing water on yourself or the floor because microorganisms spread more easily on wet surfaces and because slippery floors are dangerous. Avoid touching the sink or faucets because they're considered contaminated.

Rinse hands and wrists well because running water flushes suds, soil, soap or detergent, and microorganisms away.

Pat hands and wrists dry with a paper towel. Avoid rubbing, which can cause abrasion and chapping.

If the sink isn't equipped with knee or foot controls, turn off faucets by gripping them with a dry paper towel to avoid recontaminating your hands.

Before participating in any sterile procedure or whenever your hands are grossly contaminated, wash your forearms also, and clean under the fingernails and in and around the cuticles with a fingernail brush, disposable sponge brush, or plastic cuticle stick. Use these softer implements because brushes, metal files, or other hard objects may injure your skin and, if reused, may be a source of contamination.

Follow your facility's policy concerning when to wash with soap and when to use an antiseptic cleaning agent. Typically, you'll wash with soap before coming on duty; before and
after direct or indirect patient contact; before and after performing any bodily functions, such as blowing your nose or using the bathroom; before preparing or serving food; before preparing or administering medications; after removing gloves or other personal protective equipment; and after completing your shift.

Use an antiseptic cleaning agent before performing invasive procedures, wound care, and dressing changes and after contamination. Antiseptics are also recommended for hand washing in isolation rooms, neonate and special care nurseries, and before caring for any highly susceptible patient.

Wash your hands before and after performing patient care or procedures or having contact with contaminated objects, even though you may have worn gloves. Always wash your hands after removing gloves.

Hand hygiene also includes the use of hand rubs or hand sanitizers. An antiseptic hand-rub involves applying an antiseptic hand-rub product (an alcohol-containing preparation designed for application to the hands for reducing the number of viable microorganisms on the hands) to all surfaces of the hands to reduce the number of microorganisms present. The products are also referred to as waterless antiseptic agents because no water is required. Alcohol hand rubs usually contain emollients to prevent drying and chapping of the skin. Hand rubs and sanitizers are appropriate for decontaminating the hands after minimal contamination. A small amount of the hand rub product is applied to all surfaces of the hands by rubbing until the product has dried (usually within 30 seconds).

NURSING ALERT If you're providing care in the patient's home, bring your own supply of soap and disposable paper towels. If running water isn't available, disinfect your hands with an alcohol-based hand sanitizer.