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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.
Hand hygiene is the most important and most basic component in the prevention and control of the transmission of infection. When properly performed at the appropriate point of care, hand hygiene is the most effective way to prevent the spread of infection. Hand hygiene is the primary method used by health care team members to reduce the spread of germs or infection between patients and health care team members.undefined#ref2">2 Proper hand hygiene has been shown to significantly reduce infection and colonization rates for multidrug-resistant organisms.6
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). The purpose of hand hygiene is to remove dirt, materials, and microbial organisms picked up by contact with other people or the environment.
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. Washing the hands with soap and water is the only effective way to prevent the spread of spore-forming pathogens.1 Antimicrobial agents or plain soap and water should be used in the following situations:
When not contraindicated, alcohol-based products are considered the gold standard when performing routine patient care because they are more effective than soap at killing germs on the hands.4 Alcohol-based sanitizers should have at least 60% isopropyl alcohol for maximum effectiveness.3
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.
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. In the home setting, the patient, family, and caregivers need to perform hand hygiene and ensure that health care team members do the same.
If rings are replaced after hand hygiene, perform hand hygiene again.
Rationale: Pushing the sleeves up provides complete access to the fingers, hands, and wrists.
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: Rubbing hands until they are dry helps ensure maximum efficacy. If hands dry completely in less than 20 seconds, insufficient product probably was applied.5
Rationale: Sink surfaces may be contaminated; contact with surfaces may transfer contaminates to the skin or clothing.
If the hands touch the sink during handwashing, repeat handwashing.
Rationale: Microorganisms travel and grow in moist environments.
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.
World Health Organization (WHO). (2009). WHO guidelines on hand hygiene in health care. Retrieved February 7, 2022, from https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf?sequence=1 (classic reference)* (Level VII)
Boyce, J.M. and others. (2002). Guideline for hand hygiene in health-care settings: Recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force: Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. Morbidity and Mortality Weekly Report, 51(RR-16), 1-45. (classic reference)* (Level VII)
*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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