Hand Washing

Back to Nursing Practice

Questions Received:

  1. How long should a pre-operative scrub take, by scrubbing practitioners and surgeons?

  2. How effective is hand washing, and could the practice be improved?

  3. Why is hand washing so important in nursing?

Responses:

How long should a pre-operative scrub take, by scrubbing practitioners and surgeons?

10th September 1999

Surgical hand washing or scrubbing should take at least 5 minutes before the first procedure of the day (Garner and Favero, 1985). Scrubs between procedures should take 3 minutes.

During an operation patients are at a high risk of infection because tissues are exposed at the site of the operation. Surgical hand washing reduces the risk of contamination. For a detailed description of the washing procedure together with the rationale for each step see Potter and Perry (1993).

References

How effective is hand-washing, and could the practice be improved?

20th February 2000

Cross-infection in hospital occurs mainly via hand contamination, and there is sound evidence that good hand hygiene leads to a reduced transmission of infectious organisms. However, the effectiveness of hand-washing will depend on the thoroughness with which it is carried out and whether or not asepsis is used (Doebbeling et al, 1992; Voss and Widmer, 1997; Pittet et al, 1999).

Unfortunately, the compliance of practitioners with hand-washing recommendations is generally low (Wenzel and Pfaller, 1991; Hersey and Martin, 1994; Meengs et al, 1994; Sproat and Inglis, 1994; Thompson et al, 1997; Voss and Widmer, 1997; Roberts, Bolton, and Asman, 1998). Studies by Taylor (1978) show that most staff miss some part of the hand surface during hand-washing. Part of the explanation of non-compliance is that frequent hand-washing and the use of agents that irritate and dry the skin give rise to skin problems (Borgatta, Fisher, and Robbins, 1989; Zimakoff et al, 1992; Larson, 1999). Gould (1994) recommends that more attention should be paid to the reasons for non-compliance rather than simply criticising the hand-washing techniques of practitioners. For example, the provision of good quality disposable paper towels can make a significant contribution to good infection control practice (Gould, 1995).

References

Why is hand washing so important in nursing?

29th September 2000

There can be little doubt about the benefits of regular hand washing to patients and clients, nurses and doctors, and the health service as a whole. Nurses engaged in clinical practice are exposed to a wide variety of micro-organisms, and some of these are pathogenic (disease-producing). Much of the work that a nurse undertakes involves close contact with patients and clients (sometimes quite intimate contact is necessary), and the hands can become contaminated. Regular hand washing reduces the risk of infection and cross-infection. Cross-infection - the spread of infection from one individual to another - is a problem that health care personnel are constantly having to address. The variety of procedures that a nurse has to perform during any one shift, coupled with the number of patients/clients that he/she comes into contact with, produce circumstances which can be highly conducive to transmission of micro-organisms. By adopting the correct hand washing procedure, a nurse will be making a positive contribution towards the control of infection.

According to Wilson (1994), the hands should be washed:

Intact skin provides an effective barrier to invasion by pathogenic organisms - it is an important part of the body's external defence mechanisms. The protection afforded by the skin is enhanced by hand washing and the adoption of universal precautions. In this way the practitioner's susceptibility to infection and the risk of spreading infections to other people is reduced. However, it is impossible and probably undesirable to sterilise the skin completely. Even after careful attention to body hygiene the skin's surface will still carry some micro-organisms, although the count will be reduced.

Some antibiotics, notably third generation cephalosporins, are released in the sweat of people receiving treatment, and this may result in some skin bacteria becoming antibiotic-resistant (Coghlan, 2000). Contact by a nurse with a patient's skin bearing such resistant strains could potentially lead to the spread of resistant (possibly multi-resistant) strains of pathogenic organisms. The case for thorough hand washing and drying is therefore compelling.

I remember a consultant bacteriologist saying during a lecture that although it is impossible to see micro-organisms without the aid of the microscope, imagine how our approach would change if we could! For example, it would be possible to see a cluster of Pseudomonas organisms on this surface or a cluster of Staphylococci on that. We could then try to eliminate them or take avoiding action. The fact is we cannot see them, but we still have to take care to prevent their entry into the body or assist the immune system to kill them if they do enter.

Chauduri (1993) reported that the estimated cost of all hospital acquired infections (HAIs) in the UK in 1986 was £111 million, with a total of 950,000 bed days lost. A proportion of HAIs result from poor hand washing techniques. The existence of pathogenic organisms means that elaborate and expensive procedures have to be used for prevention and treatment of infection.

References

Suggested Further Reading

Back to Nursing Practice