Purpose
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To prevent the transmission of microorganisms from patient to patient and from inanimate surfaces to patients by the hands of all healthcare providers.
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Audience
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All employees of UTMB hospitals and clinics, contract workers, volunteers, and students
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Policy
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• Hand hygiene shall be practiced before and after each patient
contact (even if gloves are worn). All employees are required to
wash, rinse, and dry their hands or apply an alcohol hand rub before
beginning work, after using the rest room and prior to leaving work.
• For routine patient care (contacts) liquid lotion soap in the dispenser shall be used for handwashing.
• Antiseptic (antimicrobial) handwashing products or alcohol hand rub shall be used for hand hygiene prior to performance of high risk procedures such as insertion or manipulation of an invasive device or minor surgical procedures. Hand hygiene will be performed after contact with patients or their environment.
• An alcohol hand rub, may be used for hand hygiene in place of an antimicrobial soap handwash. Hands that are grossly contaminated must be washed with lotion soap prior to hand disinfection with an alcohol hand rub.
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• Gloves shall be worn when exposure to blood or any other body fluids, excretions or secretions is likely.
• For a given patient, site care shall start at the cleanest site (e.g., mouth care) and progress to the dirtiest site (e.g., urinary catheter care). When going from a dirty site to a clean site, hands shall be washed or an alcohol hand rub applied between sites.
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Routine handwashing procedure
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• Use warm water to wet the hands.
• Apply lotion soap.
• Work up a good lather.
• Apply with vigorous contact on all surfaces of the hands.
• Wash hands for at least 15 seconds.
• Rinse, avoid splashing.
• Keep hands down so that run off will go into the sink and not down the arm.
• Dry well with paper towels and use the paper towels to turn off the faucet.
• Discard the paper towels into the appropriate container.
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Hand antiseptics
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• For hand washing, substitute an antimicrobial soap for the lotion soap.
• An alcohol hand rub may be substituted for antimicrobial soap. The following technique should be used:
- If hands are visibly soiled, wash hands with lotion soap prior to application of alcohol hand rub.
- Apply enough alcohol hand rub to cover the entire surface of hands and fingers.
- Rub the solution vigorously into hands until dry.
- Use of alcohol hand rubs may result in a sticky residue on the hands. Wash with lotion soap periodically to remove the hand rub residue.
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Fingernails
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Healthcare workers with direct patient contact must maintain their fingernails so that the tips of the nails do not extend past the ends of their fingers. The nail surface should remain smooth. Artificial nails/wraps or acrylic overlays are not permitted. Nail polish must not be chipped or cracked.
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Hand antisepsis prior to surgical procedures
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Healthcare workers who participate in surgical procedures must either perform a surgical scrub with an antimicrobial soap or hand and arm disinfection with an alcohol rub prior to donning sterile gloves and a sterile gown (see policy 1.46 Guideline for Prevention of Surgical Site Infections). If hands and arms are not grossly contaminated between cases, an alcohol rub may again be applied to hands and arms in place of a surgical scrub. If, at any time, hands are contaminated, they must be washed with an antiseptic soap and water or washed with lotion soap and water followed by application of an alcohol hand rub.
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Note
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Bottles and other large containers of hand lotions may become contaminated with pathogenic organisms. Therefore, only small disposable bottles or packets of lotions shall be used.
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Allergic contact dermatitis associated with hand hygiene products.
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Allergic reactions to products applied to the skin may present as delayed type reactions or less commonly as immediate reactions. If a HCW suspects allergic contact dermatitis, they will be instructed to go to the Employee Health Center and fill out a Hand Dermatitis Documentation form (see attached). The HCW will be assessed by the Employee Health physician. If allergic contact dermatitis is diagnosed, the healthcare worker will take the form to Materials Management whereby another hand hygiene product will be issued.
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Reference
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Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/ IDSA Hand Hygiene Task Force. MMWR 2002; 51 (No. RR-16):1-45.
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