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Hand Washing Policy for Medical students

By Dr. Ramaz Mitaishvili

Our hands are the source of many infections. To ourselves and other healthy adults, the bacteria that is carried on our
hands does not pose a problem, but to anyone whose immune system is compromised, the result can be overwhelming
infection - and sometimes death.
PATIENT CARE PROCEDURES Handwashing And Use of Gloves
COMPETENCY: All students must read and understand the policy/practice guidelines.
Any licensed staff currently checked-off in this skill may serve as a preceptor.
I. Outcome Goal:
Proper Handwashing and Us e of Gloves.
Policy:
General. Handwashing is essential for the prevention of infection and the control of cross-infection between
personnel and patients. All personnel providing direct patient care or having any physical contact with patients
or their equipment shall always practice handwashing frequently. This shall include, but is not limited to:
a. At start of duty.
b. Between contacts with different patients in special care units.
c. Before and after any physical contact with patient's equipment or patient's personal articles that are
likely to be contaminated with virulent microorganisms or hospital pathogens, such as an object or
device contaminated with secretions or excretions, e.g., urinary catheter systems, endotracheal tubes,
etc.
d. Before and after any procedure with patients and the collection of specimens, e.g., dressing
changes, urine, or blood specimens.
e. Whenever hands become dirty.
f. After personal use of the toilet.
g. Prior to and after eating.
h. Whenever one has coughed, sneezed, or blown his nose.
i. At the end of duty.
2. Specific
a. Definitions
(1) Routine Handwashing: Handwashing using a liquid soap, lasting 10-15 seconds, and
accomplished on a routine basis including, but not limited to the following:
(a) Between patients contacts.
(b) After use of toilet.
(c) After blowing nose or sneezing.
(d) Prior to and after each emptying of urinary drainage bags.
(2) Invasive Procedure Preparation: A 30-second handwashing (outside of the operating room)
using an iodophor or chlorhexidine, including the fingers, between the fingers, hands, wrists to
mid-forearm to be accomplished prior to any invasive procedure to include, but not limited to,
the following:
(a) Catheterization.
(b) Tracheostomy care.
(c) I.V. therapy and invasive line insertion.
(d) Dressing changes/wound irrigations.
(e) Catheter irrigation.
b. Handwashing Procedure. It is always preferable to wash hands under warm running water using soap
from a dispenser.
(1) Use an antiseptic, such as an iodophor or chlorhexidine prior to all invasive procedures.
(2) Bar soaps are discouraged because receptacles for the bar produce an ideal environment
for growth of microorganisms.
(3) A lotion soap should be used for routine handwashing.
(4) Soap dispensers are Not to be refilled by pouring soap into dispensers. Self-contained
cartridges of soap are used for refills, to prevent contamination of the soap.
(a) Wet hands and apply a sufficient amount of soap to obtain a good lather (five cc's
for lotion soap). The briefest acceptable duration of handwashing is 10-15 seconds
but one-half to one-minute is preferred. These times apply to between patient
contacts.
(b) Be careful to wash fingernails and between fingers.
(c) Rinse thoroughly and dry hands with individual paper towels.
(d) Turn off faucet using a clean, dry paper towel.
(e) Invasive procedure preparation outside of the operating room with a duration of at
least 30 seconds should be carried out prior to any procedures such as dressing
change, catheterizations, tracheostomy manipulation, and vascular access procedures.
(f) It is important to keep hands clean and pliable. Chapped or rough skin is difficult to
keep free of contamination. Use of lotion, if needed, is suggested. Lotion shall be from
a small, individual, nonrefillable container. (Shared hand lotion containers tend to
become contaminated, and hand lotion is an excellent medium for bacterial growth.)
c. Hand Degerming With Waterless Hand Cleaner:
(1) A waterless hand cleaner may be used appropriately in the following instances, providing
there is no gross or visible contamination on the hands, i.e., blood, feces, pus:
(a) between linen change
(b) following oral or rectal temperature procedures between patients on doctors'
rounds
(2) Waterless hand cleansers (alcohol based only) should be used only in areas without sinks.
d. Use of Gloves
(1) The wearing of gloves DOES NOT negate the need for handwashing.
(2) Recent studies have demonstrated that, during use, gloves fail to prevent organisms from
migrating through to skin surfaces.
(3) These studies also indicate that vinyl gloves fail more often than latex gloves. Latex gloves,
therefore, should be used for patient care procedures.
(4) Gloves should Never be washed. This also causes them to fail and allows migration of
organisms to the skin.
(5) A pair of gloves should be donned just before starting a task or procedure and removed
immediately when the task or procedure is completed.
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