PADRONIZAR COMPETÊNCIAS PARA O CUIDADO CONSISTENTE
Saiba mais sobre Clinical Skills hoje! Padronizar educação e competência de gerenciamento entre enfermeiros, terapeutas e outros profissionais de saúde para assegurar o conhecimento e as habilidades são atuais e refletem as melhores práticas e as diretrizes clínicas mais recentes.
The content in Clinical Skills is evidence based and intended to be a guide to clinical practice. Always follow your organization’s practice.
ALERT
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.
OVERVIEW
Hand hygiene is the most important and most basic component in preventing and controlling the transmission 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.2 Antimicrobial agents or plain soap and water should be used in the following situations:
When hands are visibly dirty
When hands are visibly soiled with blood or other body fluids
After using the bathroom
After exposure or suspected exposure to spore-forming pathogens (e.g., Clostridioides difficile)2
When not contraindicated, alcohol-based products are effective at reducing the presence of microorganisms on the hands.5 Hand sanitizer products do not eliminate all germs.5 Alcohol-based hand rubs may not be performed with maximum effectiveness if the health care team member is wearing a ring or wristwatch.1 Alcohol-based sanitizers should have at least 60% isopropyl alcohol for maximum effectiveness.5 Alcohol-based hand rubs are included in the World Health Organization’s list of essential medicines.7
Natural nails should be kept trimmed to ¼ inch.4 When in direct contact with high-risk patients, artificial nails and nail extenders should not be worn.4 Long fingernails, artificial nails, and chipped nail polish may harbor bacteria. The skin underneath rings harbors more germs than skin without rings.4 More data are needed to make specific recommendations pertaining to jewelry in the healthcare setting. Organization infection control policies may vary and should be reviewed for details regarding the wearing of jewelry.
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.
SUPPLIES
See Supplies tab at the top of the page.
EDUCATION
Give developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, preferred learning style, and overall neurologic and psychosocial state.
Teach the patient, family, and caregivers proper hand hygiene techniques.
Teach the patient, family, and caregivers the reason for hand hygiene.
Teach the patient, family, and caregivers situations in which hand hygiene is required.
Teach the patient, family, and caregivers about the risks for infection with improper hand hygiene.
Explain that the patient, family, and caregivers can play an important role in improving hand hygiene compliance by reminding the health care team member to perform hand hygiene.
Encourage questions and answer them as they arise.
PROCEDURE
Remove hand hygiene supplies from the outer pocket of the nursing bag.
Remove jewelry during hand hygiene. Do not leave jewelry on the patient’s sink, counters, or tables.
Inspect all surfaces of the hands for breaks or cuts in the skin or cuticles.
Push long sleeves up above the wrists.
Hand Hygiene Using a Waterless Alcohol-Based Antiseptic Rub
Dispense an ample amount of alcohol-based product into the palm of one hand.
Rub the hands together, covering all surfaces of hands and fingers with antiseptic rub. Rub the palms of the hands together.
Rub the fingers of one hand over the dorsum of the other hand and interlace the fingers. Repeat with the other hand.
Rub the fingers of each hand over the palmer surface of the other hand and interlace the fingers.
Rub the backs of fingers across the palms of each hand alternately.
Decontaminate the fingertips by rubbing them in the palm of the other hand. Repeat with the other hand.
Clasp each thumb in the palm of the opposite hand and twist.
Rub the hands together until the alcohol is dry. Allow the hands to completely dry before putting on gloves.
Hand Hygiene Using Plain or Antimicrobial Soap, Water, and Disposable Paper Towel
If using soap and water, ask the patient, a family member, or a caregiver where the sink or water source for sanitizing hands is located; take the hand hygiene supplies to this location.
Stand in front of the sink, keeping the hands and clothing away from the sink surfaces.
If the hands touch the sink during handwashing, repeat handwashing.
Turn on the faucets to begin the flow of water.
Avoid splashing water on clothing.
Regulate the flow of water so that the temperature is warm.
Wet the hands and wrists thoroughly under the running water. Keep the hands and forearms lower than the elbows during washing.
Apply an adequate amount of soap in the palm of one hand and rub the hands together to work up a lather.
Use a rotating frictional motion, applying friction to all surfaces of the hands and wrists, including the palms of the hands, between fingers, and around and under the nails. Interlace the fingers and rub up and down. Continue washing for at least 15 seconds.3
Rinse the hands and wrists thoroughly, keeping the hands down and elbows up.
Dry the hands thoroughly with a paper towel.
Discard the paper towel in a trash can.
Turn off the faucet with a clean, dry paper towel. Avoid touching the handles with the hands.
Apply lotion to the hands if needed at the end of the visit. Avoid petroleum-based lotions.
EXPECTED OUTCOMES
Complete cleaning of hands achieved, including under fingernails
No skin irritation from use of soap or an alcohol-based product
UNEXPECTED OUTCOMES
Skin irritation or dermatitis due to repeated use of harsh soaps or alcohol-based products
Incomplete decontamination of hands or areas under fingernails, leading to transmission of organisms
DOCUMENTATION
Patient’s, family’s, and caregivers’ learning and ability to verbalize or demonstrate topics taught
Education
Unexpected outcomes and related interventions
OLDER ADULT CONSIDERATIONS
Older adult patients may have an increased susceptibility to infections.
Older adult patients may have an increased incidence of dry skin and skin breakdown.
Centers for Disease Control and Prevention (CDC). (2024). Handwashing in communities: Clean hands save lives: Show me the science–how to wash your hands. Retrieved January 23, 2025, from
Gall, E., Long, A., Hall, K.K. (2020). Chapter 5: Infections due to other multidrug-resistant organisms. In K.K. Hall and others (Eds.), Making healthcare safer III: A critical analysis of existing and emerging patient safety practices (pp. 5-1-5-89). Rockville, MD: Agency for Healthcare Research and Quality.
