How to Wash Hands at Home and in Health Care

Ensure Family’s and Medical Workers’ Hands are Clean to Stop Flu

Oct 21, 2009

Washing Hands Can Help Stop the Spread of Flu, Mensatic at Morguefile.com

One of the best ways to prevent the spread of flu at home is by washing hands frequently and well. Your health care workers should especially be doing the same thing.

According to the Centers for Disease Control and Prevention, 41 states reported 4,958 laboratory-confirmed 2009 H1N1 (“swine flu”) hospitalizations between August 30, 2009 and Oct. 10, 2009. The spread of the virus is thought to occur in the same way seasonal flu spreads – mainly from person to person through coughing or sneezing by people with flu. People also might be infected by touching a surface or object with flu viruses on it and then touching their nose or mouth. That's why regularly washing hands is so important.

At home, washing hands can prevent illnesses from spreading from one family member to another and even throughout a community. Family members at home should wash their hands before cooking and eating, after handling uncooked meat, and after using the bathroom, coughing, sneezing, blowing their nose or changing diapers. The CDC recommends washing hands with soap and warm water for 15 to 20 seconds (imagine singing “Happy Birthday” twice to a friend) or using alcohol-based disposable hand wipes or gel sanitizers available in drug stores or supermarkets.

It’s especially important that medical workers wash their hands between patients. In the health care setting – such as hospitals, medical clinics, dental clinics and nursing homes – thorough hand washing can prevent fatal infections from spreading from patient to patient or from patient to health care worker, and vice versa. When visiting a clinic, try to keep an eye out to make sure the health care workers you deal with are following the right steps.

Washing Hands in the Health Care Setting

Health care workers who use gloves should wash their hands and thoroughly dry them before they put their gloves on. They also should wash their hands immediately after they remove gloves, according to certified dental assistants Doni L. Bird and Debbie S. Robinson, the writers of Torres and Ehrlich Modern Dental Assisting. That’s because gloves could contain small, unobvious tears or could be torn during use, and hands could become contaminated while removing the gloves. Also, bacteria can multiply quickly in moist environments underneath gloves.

Here are a few steps to properly wash hands before placing gloves on (if possible, employees should wash their hands in front of their patient):

Remove all jewelry, including watches and rings (they are difficult to clean and can puncture gloves).
Use a “hands-free” faucet that is activated electronically or with foot pedals. If this isn’t available, use a paper towel to grasp the faucets to turn them on and off.
Allow the hands to become wet, apply soap and lather using a circular motion with friction while holding the fingertips downward. If this is the first hand washing of the day, it’s wise to use a nailbrush or orange stick to remove debris from nails. (Make sure nonantimicrobial or antimicrobial liquid soap is used rather than bar soap, which can transmit contamination.)
Vigorously rub together the lathered hands under a stream of water to remove surface debris. Then, apply more soap and vigorously rub together lathered hands for a minimum of 10 seconds under a stream of water to remove residual debris and tenacious microorganisms under the free edges of the fingernails.
Rinse the hands with cool water, which closes pores.
Use a paper towel to dry the hands and forearms thoroughly. Then use a clean paper towel to turn off the faucet if the faucet isn’t “hands-free.” (If health care workers inadvertently touch contaminated objects or surfaces while their hands are exposed, they should wash their hands again.)

For surgical hand cleaning, the CDC recommends using an antimicrobial soap and scrubbing hands and forearms for the length of time recommended by the manufacturer, usually two to six minutes. The Association of Operating Room Nurses recommends five to 10 minutes.

Using an Alcohol-Based Hand Rub

When using an alcohol-based rub, apply the product to the palm of one hand and rub the hands together, covering all surfaces of the hands and fingers until hands are dry. One can use an alcohol-based, waterless hand rub if the hands are not visibly soiled. The CDC recommends using this type of hand rub routinely to decontaminate in several clinical situations (and to do hand washing if rubs aren’t available):

Before donning sterile gloves when inserting central intravascular catheters
Before performing nonsurgical invasive procedures (for example, urinary catheter insertion or nasotracheal suctioning)
After contact with body fluids or excretions, mucous membranes, nonintact skin and wound dressings
When moving from a contaminated body site to a clean body site during client care
After contact with inanimate objects near the client

For surgical procedures, employees should perform a surgical scrub using soap and water, dry their hands and apply an alcohol-based surgical hand rub with persistent activity. Before applying the alcohol solution, prewash hands and forearms with a nonantimicrobial soap, and dry the hands and forearms completely. After applying the solution, allow hands and forearms to dry completely before donning sterile gloves.

Also, note that antimicrobial-impregnated wipes (for example, towelettes) are not a substitute for using an alcohol-based hand rub or antimicrobial soap. It's good to also know that alcohol-based products available in gels, foams or rinses actually are more effective than plain soap or even an antimicrobial hand wash (concentrations of 60 to 95 percent are the most effective, while higher concentrations are actually less effective).

In summary, whenever possible, good hand washing habits and the use of alcohol-based rubs both at home and in the medical setting can keep the H1N1 flu - and any flu virus - at bay.

Sources:

Bird, Doni L. and Robinson, Debbie S. “Hand Hygiene.” Torres and Ehrlich Modern Dental Assisting, Ninth Edition, Elsevier Inc. 2009, pp: 275-278

Centers for Disease Control and Prevention (Retrieved 21 October 2009). “Wash Your Hands” and “2009 H1N1 Flu (Swine Flu)”