Hand Hygiene

Question 1

Definition of hand hygiene

Answer 1

Use of handrub or hand washing to reduce the number of bacteria on the hands (NICE)

The most important thing to do to prevent the spread of infection (RCN)

Hand decontamination will remove almost all transient bacteria e.g. E.coli but not resident bacteria

Question 2

Types of hand decontamination

Answer 2

Social/Routine - render hands clean and remove microorganisms - use of liquid soap for at least 15 seconds

Hygienic/Clinical - prior to aseptic technique, as social but using approved antiseptic hand cleanser, removes transient microorganisms (minimum 15 seconds but as per trust policy)

Surgical hand wash - prior to operating theatre

Question 3

Indications for hand washing

Answer 3

Before and after direct contact with a woman or baby (skin or bodily fluids)
Before administering medication
When making beds or handling equipment
When hands look or feel dirty
Before and after eating or preparing food for others
After using toilet
After contact with soiled or contaminated equipment
After removing gloves
Prior to aseptic technique

Question 4

5 moments of hand hygiene at Point of Contact (WHO)

Answer 4

Before touching patient
Before aseptic procedure
After body fluid exposure risk
After patient contact 
After contact with patient surroundings

Question 5

Hard/arm precautions

Answer 5

Remove nail polish/artificial nails
Nails short and clean - can harbour dirt and bacteria
Nail polish can crack - contamination if falls in wound
Nail polish can harbour bacteria in microscopic imperfections
Nail brushes can damage skin - results in increased shedding of bacteria on hands
Hands moisturised to avoid broken skin
No watches, one plain ring
Cover cuts and abrasions with medical plasters
Arms bare below elbows
Report any skin conditions to OH

Question 6

Handwashing procedure

Answer 6

1. Wet hands
2. Apply soap
3. Rub palm to palm
4. Rub right hand over back of left and vice versa
5. Interlace fingers
6. Rub backs with opposite palms
7. Thumbs
8. Fingertips on palms
9. Rinse hands
10. Dry each hand with separate paper towel
11. Turn off tap with elbow

Question 7

Surgical scrub

Answer 7

Cleansing - hand held higher than elbow prevents decontamination of the hand by bacteria-laden soap/water from the wrists, forearm and elbow

Rinsing - hands and arms pass through water in one direction from fingertips to elbows

Once in theatre hands held above elbows

Question 8

When can alcohol-based hand rubs be used?

Answer 8

When hands are visibly clean

Quick and convenient
Not fully effective against viral infections - c.diff, norovirus
Not used after glove removal - hand wash

Question 9

What is asepsis?

Answer 9

The state of being free from disease-causing microorganisms such as pathogenic bacteria, viruses, fungi and parasites)

Refers to practices used to promote or induce asepsis in an operative field of surgery or medicine to prevent infection, in NHS this is known as the aseptic none touch technique (ANTT)

Question 10

Types of asepsis

Answer 10

Clean surface - wiped by clinical wipe to remove dust and soil

Medical asepsis/clean technique - non-touch technique which acknowledges that some items may be non-sterile but aims to reduce the risk of pathogenic microorganisms

Surgical asepsis/sterile technique - requires an aseptic field which is usually covered by sterile towels or hold sterile instruments -aims to remove all pathogens