Handwashing: Assessment

Handwashing •foot pedals.
Purposes: •Elbow controls. Move these with the elbows

instead of the hands.
1.To reduce the number of microorganisms on
the hands. •Infrared control. motion in front of the
sensor causes water to start and stop flowing
2.To reduce the risk of transmission of automatically.
microorganisms to clients.
Wet the hands and wrist thoroughly by holding
3.To reduce the risk of cross contamination them under the running water.
among clients.
Hold the hands lower than the elbows so that
4.To reduce the risk of transmission of the water flows from the arms to the
infectious organisms to oneself. fingertips.
Assessment Apply soap to the hands. If the soap is

liquid, apply 4–5 mL (1 tsp). If it is bar
Determine the client’s: soap, granules, or sheets, rub them firmly
between the hands.
•Presence of factors increasing
susceptibility to infection and possibility Thoroughly wash and rinse hands.
of undiagnosed infection (e.g. HIV)
Use firm rubbing and circular movements to
•Use of immunosuppressive medications wash the palm, back, and wrist of each hand.
Be sure to include the heel of the hand.
•Recent diagnostic procedures or treatments
Interlace the fingers and thumbs, and move
that penetrated the skin or body cavity
the hands back and forth.
•Current nutritional status
The WHO recommended these steps:
Planning
a.Right palm over left dorsum with interlaced
•The location of running water and soap or fingers and vice versa
soap substitutes.
b.Palm to palm with fingers interlaced.
Assemble equipment:
c.Back of fingers to opposing palms with
•Soap fingers interlocked
•Warm, running water d.Rotational rubbing of left thumb clasped in

right palm and vice versa.
•Disposable or sanitized towels/paper towel
Continue this motion for at least 30 seconds.
Implementation
Rub the fingertips against the palm of the
Preparation: opposite hand. Rinse hands.
Assess the hands. Thoroughly pat dry the hands and arms. Dry
hands and arms thoroughly with a paper towel
•Nails should be kept short. or clean hand towel without scrubbing.
•Remove all jewelry. Discard the paper towel in the appropriate

container.
•Check the hands for breaks in the skin, such
as hangnails or cuts. Turn off the water.
Performance: Use a new paper towel to grasp a hand-

operated faucet.
If you are washing your hands where the
client can observe you, introduce yourself
and explain to the client what you are going
to do and why it is necessary.
Turn on the water and be sure to adjust flow

so that water is warm. There are five common
types of faucet controls:
•Hand-operated handles
•knee levers.
1
Variation: Hand Washing Before Sterile •Assemble equipment: Packages of sterile
Skills gloves
Wet the scrub brush and apply a liberal Implementation

amount of antimicrobial soap into your hands
and lather well to 2 inches above the elbow, Preparation:
but hold the hands higher than the elbows
during this hand wash. Let water run from the • Determine the correct size of the sterile
fingertips to the elbows so that the hands gloves. The gloves should be snug but not
become cleaner than the elbows tight.
Using a circular motion, scrub all the •Ensure sterility of the package of gloves.
surfaces of one hand and arm. Start at the
Performance:
fingers. Scrub at least 10 strokes each on
nail, all sides of fingers and both sides of Prior to performing the procedure, introduce
hands. Scrub the arm using 10 strokes each of yourself and verify client’s identity.
the lower, middle, and upper areas of the Explain to the client what you are going to
forearm. Keep arms higher than the elbows. do and why it is necessary and how the client
can cooperate.
Rinse the surgical brush and reapply
antimicrobial soap. Repeat the scrub on the Perform hand hygiene and observe other
second hand and arm. Normally the scrub takes appropriate infection control procedures.
at least 2-6 minutes.
Provide for client’s privacy
After washing and rinsing, use a towel to dry
one hand thoroughly in a rotating motion from Open the outer wrapper and place the inner
the fingers to the elbow. Use a new towel to glove package on a clean dry surface.
dry the other hand and arm.
Open the inner glove package so that the
Apply sterile gloves before touching any glove cuffs are closest to you and carefully
unsterile items. open the flaps of the package so that they do
not fold back over and contaminate the
Evaluation gloves.
Ensure that both hands are clean and dry Put the first glove on the dominant hand.
properly.
Grasp the inner surface of the glove for the
DONNING AND REMOVING STERILE GLOVES (OPEN dominant hand by lifting the folded cuff edge
METHOD) with the thumb and first finger using the
nondominant hand.
Purposes:
Slide your dominant hand into the glove,
1.To enable to handle or touch sterile
keeping your hand and fingers above your
objects freely without contaminating them.
waist and away from your body.
2.To prevent transmission of potentially
Put the second glove on the nondominant hand.
infective organisms from the nurse’s hands to
clients at high risk for infection. Pick up the other glove with the sterile
gloved hand by inserting the fingers under
Assessment
the cuff of the glove.
•Review the client’s record and orders to
Lift the glove up and away from the table and
determine exactly what procedure will be
away from your body.
performed that require sterile gloves.
Slide your nondominant hand into the glove,
•Check the client’s record and ask about
being careful to avoid contact with your
latex allergies. Use nonlatex gloves whenever
gloved hand.
possible.
Adjust both gloves to fit your fingers. If
Planning
necessary, pull the fingers of the gloves
•Think through the procedure. Plan which step down so that no excess is at the finger tips.
need to be completed before applying the
Keep your hands between shoulder and waist
gloves
level infront of you.
•Determine what additional supplies needed
Remove and dispose used gloves. There is no
for the procedures. Have an extra pair of
special technique for removing sterile
gloves available.
gloves. If they are soiled with secretions,
2
remove them by turning them inside out. 7Open the package of sterile gloves.Remove
Perform hand hygiene. the outer wrap from the sterile gloves and
leave the gloves in their inner sterile wrap
Document that sterile technique was used in on the sterile field.
the performance of the procedure.
8Unwrap the sterile gown pack.
Evaluation
Conduct any follow-up indicated during your

9Perform proper hand hygiene.
care of the client. Ensure that adequate
numbers and types of sterile supplies are 10Put on the sterile gown.
available for the next health care provider.
11Grasp the sterile gown at the crease near
Purposes: the neck, hold it away from you, and permit
it to unfold freely without touching
1.To enable to work close to the sterile
anything, including the uniform.
field and handle sterile objects freely.
2.To protect client’s from becoming

contaminated with microorganisms on the 12Put the hands inside the shoulders of the
nurse’s hands, arms and clothing. gown, and work the arms partway into the
sleeves without touching the outside of the
Assessment gown.
•Review the client’s record and orders to Keep the sleeves of the gown above waist
determine exactly what procedure will be level
performed that require sterile gloves.
13Work the hands down the sleeves only to the
•Check the client’s record and ask about proximal edge of the cuffs;
latex allergies. Use nonlatex gloves whenever
possible. 14 Have a coworker grasp the neck ties
without touching the outside of the gown and
Planning pull the gown upward to cover the neckline of
your uniform in front and back. The coworker
•Think through the procedure. Plan which step ties the neck ties.
need to be completed before applying the
gloves Donning Sterile Gloves (Closed Method)
•Determine what additional supplies needed 15Open the sterile wrapper containing the
for the procedures. Always have an extra pair sterile gloves.
of gloves available.
16Open the sterile glove wrapper while the
Assemble equipment: hands are still covered by the sleeves.
Sterile pack containing a sterile gown and

Sterile gloves
17Put the glove on the nondominant hand.
Implementation
Preparation: 18With the dominant hand, pick up the

opposite glove with the thumb and index
Ensure the sterility of the gown and package finger, handling it through the sleeve.
of gloves.
Performance:
19Lay the glove on the opposite gown cuff,
Prior to performing the procedure, introduce thumb side down, with the glove opening
yourself and verify client’s identity. pointed toward the fingers. Position the
Explain to the client what you are going to dominant hand palm upward inside the sleeve.
do and why it is necessary and how the client
can cooperate.
2Use the nondominant hand to grasp the cuff
5 Perform hand hygiene and observe other of the glove through the gown cuff, and
appropriate infection control procedures. firmly anchor it.
21With the dominant hand working through its

6Provide for client’s privacy sleeve, grasp the upper side of the glove’s
cuff, and stretch it over the cuff of the
Applying a Sterile Gown gown.
3
2Pull the sleeve up to draw the cuff over the
wrist as you extend the fingers of the
nondominant hand into the glove’s fingers.
23Put the glove on the dominant hand.
24Place the fingers of the gloved hand under

the cuff of the remaining glove. Place the
glove over the cuff of the second sleeve.
2Extend the fingers into the glove as you

pull the glove up over the cuff.
Completion of Gowning
26Have a coworker hold the waist tie of your

gown, using sterile gloves or a sterile
forceps or drape. Have a coworker take the
two ties at each side of the gown and tie
them at the back of the gown, making sure
that your uniform is completely covered.
27When worn, sterile gowns should be

considered sterile in front from the waist to
the shoulder. The sleeves should be
considered sterile from 2 inches above the
elbow to the cuff, since the arms of a
scrubbed person must move across a sterile
field.
28There is no special technique for removing

sterile attire. If they are soiled, remove
them by turning them inside out.
29If appropriate, document that sterile

technique was used in the performance of the
procedure.
Evaluation
30Conduct any follow-up indicated during your

care of the client. Ensure that adequate
numbers and types of sterile supplies are
available for the next health care provider.

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Handwashing •foot pedals.

Purposes: •Elbow controls. Move these with the elbows

Assessment Apply soap to the hands. If the soap is

•Warm, running water d.Rotational rubbing of left thumb clasped in

•Remove all jewelry. Discard the paper towel in the appropriate

Performance: Use a new paper towel to grasp a hand-

Turn on the water and be sure to adjust flow

Wet the scrub brush and apply a liberal Implementation

Conduct any follow-up indicated during your

2.To protect client’s from becoming

Sterile pack containing a sterile gown and

Preparation: 18With the dominant hand, pick up the

21With the dominant hand working through its

23Put the glove on the dominant hand.

24Place the fingers of the gloved hand under

2Extend the fingers into the glove as you

26Have a coworker hold the waist tie of your

27When worn, sterile gowns should be

28There is no special technique for removing

29If appropriate, document that sterile

30Conduct any follow-up indicated during your

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