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[The U.S. Department of Health, Education and Welfare,
Public Health Service, Presents]
[Handwashing in Patient Care]
[Narrator:] Hands play an active and vital role in
in our everyday living.
They help to express tender devotion to our loved ones.
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To handle and care for the many objects around us.
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And to minister to our own personal needs.
But as useful as hands are, they can also
serve as vehicles for spreading disease agents.
From person to person
and from place to place.
The danger of spreading infectious organisms
is especially great when caring for the sick and debilitated,
whether in the hospital or in the home.
Not only are sick individuals highly susceptible to infection,
they also serve as sources of disease agents,
even though the signs and symptoms
of infection may not be apparent.
When caring for the sick, the simplest way to prevent
the spread of agents
is to conscientiously practice handwashing
based on the fundamental principals of medical asepsis.
The aim of this technique is to reduce the number
of pathogenic organisms.
It must not be confused with surgical asepsis,
where elimination of all organisms is the goal.
The primary principle of medical asepsis involves mechanical removal
of dirt and microorganisms from the skin.
To carry out this principle in handwashing,
certain essentials are required.
Running water.
Soaps and related compounds.
And friction.
Running water is an important element,
since it acts to flush foreign material off the hands.
The water temperature should be that
which is comfortable to the skin.
While very hot water may destroy some organisms,
it can also cause chafing and breaks in the skin,
thereby affording harborage for pathogenic microorganisms.
Infection may then incur, thus increasing the danger
of hands as spreaders of disease.
Soaps and related compounds, due to their detergent properties
are also effective in the mechanical cleansing of hands.
Soap lather permits water to penetrate the skin pores
and wash away dirt and other foreign matter.
Friction is still another aid in mechanical removal of organisms,
and is produced by vigorously rubbing together the hands and fingers.
Where frequent handwashing is necessary,
brushes are not generally recommended,
since they tend to injure and excoriate the skin.
Chemical destruction of microorganisms or disinfection,
is a means of obtaining medical asepsis in handwashing.
It must be borne in mind, however,
that some chemicals will injure the hands.
There are several soaps and detergents containing chemicals
like hexachlorophene in specific strengths
which serve to inhibit the growth of bacteria,
without producing damage to the skin.
Finally, the length and the frequency of the hand wash
is an important consideration in achieving medical asepsis.
Before and after caring for each patient,
a thorough hand wash should be carried out.
This is also important at intervals during patient care
when there is danger of spreading organisms
from one part of the body to another.
The length of the hand wash depends upon the degree
of suspected hand contamination,
the use of soap or detergent,
and the vigor of friction applied.
One to two minutes is generally recommended.
The demonstration to follow involves a handwashing procedure
that can be used primarily in hospitals equipped
with foot-controlled water faucets and liquid soap dispensers.
First, it is important that patient care personnel
distinguish between the clean and the contaminated objects
in the facility.
In this procedure we will consider the clean objects to be:
Hand lotion.
Paper towels.
Foot-operated soap dispenser.
And water faucet.
They will be touched only with clean hands.
The contaminated objects are the sink bowl
and the used nail-cleaning sticks.
During the hand wash, the nurse should use body mechanics
which will permit comfortable operation of the foot pedals
and prevent her uniform from touching the contaminated sink.
Her position should be such that the soap lather
and rinse water will fall
into the bowl and not on the floor.
Before the hand wash, all jewelry
except a plain wedding band,
should be removed from the hands and wrists.
Fingernails should be well-groomed,
and nail polish should not be worn.
These precautionary measures will eliminate
additional harborage areas for microorganisms.
The area to be washed should extend about one inch
beyond the line of contamination.
In this case, the mid-forearm.
First, with the foot pedal turn on the water
and wet the hands thoroughly.
Next, apply liquid soap from the dispenser,
working up a good lather by rubbing together
the palmar and dorsal surfaces.
ten or more friction motions are suggested.
With the fingers interlaced,
continue with about ten more friction motions.
After a repeat rubbing of the palmars,
rinse the hands thoroughly,
allowing the water to flow off the sides.
Next, wet one forearm,
and from the soap dispenser, apply liquid soap.
Work up a lather employing a rotary friction motion.
Now wet the other forearm
and repeat the lathering as before.
Rinse both hands and forearms, allowing the water
to flow from the fingertips to the elbow.
Once again soap the hands and work up another lather.
With an orange stick, or the blunt end of a toothpick,
clean all fingernails carefully,
rinsing the toothpick after each finger.
The blunt end is used since it lessens the possibility
of injuring the soft tissues under the nails.
It may not always be necessary to clean the nails
each time the hands are washed.
When finished, discard the toothpick
and continue rubbing the hands with a friction motion.
Now give both hands and forearms a complete and final rinse.
With a paper towel, dry both hands and one forearm
from wrist to elbow using a patting motion.
With a clean towel, again dry both hands and the other forearm.
Use additional towels as needed.
To complete the hand washing procedure,
always apply a lotion to the hands and forearms.
This helps keep the skin soft and free from chapping.
Many handwashing facilities frequently do not have
foot-operated water faucets and soap dispensers.
In such cases, hand-operated faucets and cake soaps are used.
These require a slight modification of the handwashing procedure.
The faucet handles and the soap are considered to be contaminated.
They should not be touched with clean hands.
First, wet the hands thoroughly.
Take the cake of soap and work up a generous lather,
using the same friction motion as demonstrated earlier.
Retain the soap in the hands throughout the procedure.
Rinse the hands, again allowing the water
to flow off the sides.
Now, wet and soap each forearm.
Transfer the soap from hand-to-hand
between each lathering operation.
After a thorough rinse of each forearm,
soap the hands once again.
Holding the soap by the fingertips, rinse,
and let drop into soap container.
Continue washing the hands and cleaning the nails,
ending the procedure with a drying of both hands and forearms.
With the last paper towel, turn off the water faucets.
The towel will prevent recontamination of the hands
by the faucet handles.
In caring for sick and debilitated patients,
it may not always be possible to carry out handwashing procedures
in which the principles of medical asepsis can be applied.
In such cases, improvised methods are necessary
in order to remove as much dirt and contamination as possible.
For example, when caring for a patient in isolation,
and where running water from a faucet is not available in the room,
an assistant may pour water over the hands during the hand wash.
In some situations, it may be necessary to wash
in a soap solution or other chemical.
This method, however, is undesirable since mechanical removal
of organisms by running water cannot be achieved.
Emergencies may arise where there is no water available.
Here, swabbing or rinsing the hands with 70 percent alcohol
may provide a relative measure of cleanliness.
As expedients, these improvised measures should be used only
in emergency or disaster situations.
A more desirable handwashing
should be carried out as soon as possible.
A conscientious practice of hand washing,
whether done in the hospital,
the home, or under emergency conditions,
is a vital function in providing safer nursing care
for the sick and debilitated.
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It is considered one of the most effective means
for preventing and controlling the spread of disease-producing organisms.
Although specific procedures and techniques of handwashing may vary,
the basic principals of medical asepsis should remain constant.
If the details of the procedures are kept simple and practical,
effective handwashing can be performed.