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Carry alcohol-based hand rubbing solutions, small containers of liquid soap, and disposable paper towels to every home visit. Never use the patient's personal bar or liquid soap or cloth towels because these may be contaminated.
Avoid using water in homes with potentially contaminated water sources.
Wearing gloves does not replace the need to perform hand hygiene.
Avoid acrylic nails and excessive jewelry; these may retain infectious organisms.
Research indicates that for hand hygiene to be effective, it must be performed at the times and places where transmission of organisms is most likely to occur—the point of care.5 Hand hygiene, properly performed at the appropriate point of care, is recognized as one of the most effective ways to prevent the spread of infection. The Centers for Disease Control and Prevention (CDC),1 the World Health Organization (WHO),7 and The Joint Commission4 have embraced hand hygiene as a standard of practice and critical component in infection control across health care settings, including the home setting.
Hand hygiene is a general term that refers to handwashing (with plain soap and water), antiseptic handwashing (with soap containing an antiseptic agent and water), antiseptic hand rubbing (rubbing an antiseptic agent, usually alcohol, on all surfaces of the hand), or surgical hand antisepsis (washing or rubbing with an antiseptic agent preoperatively).1 The purpose of hand hygiene is to remove dirt, materials, and microbial organisms picked up by contact with other people or the environment. Merely rinsing hands under water or quickly rubbing them with alcohol is not sufficient to prevent the spread of infection. Proper hand hygiene requires using the right agent for the circumstances (soap, water, and a disposable towel, or an alcohol-based rub) and mechanical rubbing of all surfaces for a sufficient length of time.8 Although both methods of hand decontamination are effective if performed properly, a few smaller studies show rubbing with alcohol-based agents keeps microorganisms from returning to the skin for a slightly longer time.8 The key is to choose the right method for the right circumstance and to perform hand hygiene correctly whenever it is indicated. Antimicrobial agents or plain soap and water should be used in the following situations:7
When not contraindicated, alcohol-based products are considered the gold standard when performing routine patient care because they reduce bacterial counts more effectively than soap and water. An alcohol-based hand rub should be used for routinely decontaminating hands in situations other than those previously listed.7
There is an increase in the number of bacteria colonized under jewelry such as rings and watches. Long fingernails, artificial nails, and chipped nail polish also harbor bacteria. Therefore, health care personnel should refrain from wearing rings and other jewelry when providing care and should keep fingernails well-trimmed, natural (no artificial nails or extenders), and polish free. If jewelry is worn, it must be removed before performing hand hygiene.7
Regardless of the health care setting or the method used, hand hygiene is a requisite skill that every health care professional must perform at key times. These include before and after patient contact, after contact with blood or body fluids, after contact with contaminated surfaces, and before donning and after removing gloves. In the home setting, the patient and caregivers need to perform hand hygiene and ensure the home health nurse does the same.2
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If rings are replaced after hand hygiene, perform hand hygiene again.
Rationale: An adequate amount of product is needed to thoroughly cover the hands.
Rationale: Many microorganisms on the hands come from the subungual region (beneath the fingernails).
Rationale: Rub hands until they are dry to ensure maximum efficacy. If hands dry completely in less than 20 seconds, insufficient product probably was applied.
Rationale: Sink surfaces may be contaminated; contact with surfaces may transfer contaminates to skin or clothing.
If the hands touch the sink during handwashing, repeat handwashing.
Rationale: Microorganisms travel and grow in moisture.
Rationale: Warm water removes less of the protective oils on hands than hot water.
Rationale: Hands are the most contaminated parts to wash. Water should flow from the least to the most contaminated area, rinsing microorganisms into the sink.
Rationale: Soap cleanses by emulsifying fat and oil and lowering surface tension. Friction and rubbing mechanically loosen and remove dirt and transient bacteria. Interlacing the fingers and thumbs ensures that all surfaces are cleansed.
Rationale: Rinsing mechanically washes away dirt and microorganisms.
Rationale: Lotion helps minimize skin dryness.
*In these skills, a "classic" reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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