This document provides information on proper hand hygiene techniques for healthcare workers. It discusses that bacterial flora normally resides on hands, including transient bacteria that can be removed by thorough hand washing and resident bacteria that are more deeply attached. The document outlines hand cleaning processes that should be followed, including scrubbing for 3-5 minutes with fingernail cleaning and jewelry removal. It recommends hand washing after patient contact and using hand sanitizers that kill 99.9% of bacteria. The policy requires hand washing in specific situations and limits artificial nails for direct patient care workers.

2. INTRODUCTION
 Hand hygiene is the easiest way to prevent infection.
The rate of infection is steadily increasing in hospitals
and communities. Therefore, the purpose of this
learning module is to provide infection control
practices and proper hand washing techniques.

3. DIRECTIONS
 After viewing the information provided, the healthcare
professional will be able to establish and effectively
develop hand washing techniques.

4. BACTERIAL FLORA ON HANDS
 Bacterial flora resides on hands. The bacteria can be
transient or resident. According to Smeltzer and Bare
(2000), transient bacteria are usually due to activities
of daily living and can be found under one’s fingernails
and on the surface of one’s hands. This type of
bacteria can be removed by thorough hand-washing.
Staphylococcus is normal flora of the skin.

5. BACTERIAL FLORA ON HANDS
 Transient flora: Transient flora colonizes the
superficial layers of the skin and may be removed by
practicing good hand antisepsis. Healthcare workers
often acquire transient floras during direct contact
with patients or contact with contaminated
environmental surfaces within close proximity of a
patient. Transient flora are the organisms most
frequently associated with healthcare-associated
infections.

6. BACTERIAL FLORA ON HANDS
 Resident flora: Resident flora are attached to deeper
layers of the skin and are more resistant to removal.

7. HAND CLEANSERS
 Antimicrobial Soap
 Antiseptic Hand Rub/Foam

8. FACTS
 According to RN journal (2001), hand sanitizers work
for up to six hours. It kills 99.9% of bacteria in fifteen
seconds. In addition, Purell contains sixty-two percent
ethyl alcohol and kills 99.9% of bacteria. However, the
duration of effectiveness is unknown. Dial instant
sanitizer also kills 99.9% of bacteria and duration is
unknown (Schiff, 2001).

9. PROCESS
 Each employee must begin and end the shift with a
three to five minute scrub of the hands.
 The employee must clean under the fingernails and in
the creases of the hands.
 The employee must remove jewelry and watches to
perform an appropriate scrub.

10. PROCESS CONT.
 For hand washing, lathered hands should be rubbed
together for ten to fifteen seconds then rinse under the
stream of water before and after patient care, glove
removal, and any invasive procedures.
 In addition to hand washing, employees should
sanitize their hands at the patient’s doorway and/or
bed and before patient contact.
 Hand sanitizers can be used up to 10 times before
washing hands.

11. POLICY
 Hand washing is required when:
• hands are visibly dirty or soiled with any body substance
• after removing gloves that are visibly dirty or soiled with
any body substance
• after contact with body fluids, secretions or
excretions, mucous membranes, non-intact skin and
wound dressings
• Before eating and after using a restroom

12. POLICY CONT.
 Fingernails
 All health care workers including non-supervisory an
supervisory personnel who regularly or occasionally
provide direct, hands-on care to patients will not wear
artificial nails or extenders
 Natural nails are to be less than ¼ inch in length from
the tip of the finger. this length will allow a healthcare
worker to thoroughly clean beneath nails and will not
cause glove tears

13. POLICY CONT.
 Fingernails Cont.
 Nail polish, if worn, must be in good repair without
cracks or chips

14. POLICY
 Education:
 Annual education on Hand Hygiene will be provided by
Infection Control
 Infection Control Representative will provide
consultation and educational services as needed and
review and enforce policy

15. POST TEST
 1. The hand washing process should last 3-5 seconds. T or F
 2. The most common bacteria found on the hands are resident bacteria. T or F
 3. Jewelry and watches should be left on while washing hands. T or F
 4. An appropriate scrub lasts about 3-5 minutes. T or F
 5. Cleaning under the fingernails is not necessary for the hand washing
process. T or F
 6. Hand sanitizers replace hand washing. T or F
 7. All nurses practice good hand washing techniques. T or F

16. REFERENCES
 O’Boyle, C. A., Henly, S. J., & Duckett, L. J. (2001). Nurses’
Motivation to Wash Their Hands: A Standardized
Measurement Approach. Applied Nursing
Research, 14, 136-145.
 Schiff, L. (2001). Hand Cleansers. RN 64, 65-66, 68-70.
 Smeltzer, S. C., & Bare, B.G. (2000). Management of
patients with infectious diseases. Brunner and Suddarth’s
Textbook of Medical-Surgical Nursing 9th ed. (p. 1878).
Lippincott Williams & Wilkins.
 Taylor, C., Lillis, C., & LeMone, P. (2001). Asepsis.
Fundamentals of Nursing 4th ed. (p. 541). Lippincott
Williams & Wilkins.

17. REFERENCES CONT.
 Department of Veterans Affairs (2013). Hand Hygiene policy.
 James Emery, “Washing hands (before shot)” March, 7 2008 via
Flickr, Creative Commons Attribution
http://www.flickr.com/photos/emeryjl/2327539982/
 Jar, “Wash your hands” September 5, 2010 via Flickr, Creative
Commons Attribution
http://www.flickr.com/photos/jariceiii/4960522015/
 Carl Glover, “Nursing” August 23, 2011 via Flickr, Creative
Commons Attribution
http://www.flickr.com/photos/34239598@N00/6420116185/
 Niaid_Flickr, “Methicillin-Resistant staphyloc0ccus (MRSA)
Bacteria” February 6 2012 via Flickr, Creative Commons
Attribution http://www.flickr.com/photos/niaid/6830393029/

18. REFERENCES CONT.
 Derrick Coetzee, “Purell hand sanitizer gel in bottle”
February 18, 2013 via Flickr, Creative Commons Attribution
http://www.flickr.com/photos/dcoetzee/8487014501/
 Horia Varlan, “Colorful bars of soap on white towel”
November 6, 2008 via Flickr, Creative Commons
Attribution
http://www.flickr.com/photos/horiavarlan/4263958356/
 Niaid_Flickr, “Staphylococcus epidermis Bacteria” April
12, 2011 via Flickr, Creative Commons Attribution
http://www.flickr.com/photos/niaid/5613984108/
 Mark Turnauckas, “Hand Washing Howto” April 19, 2011 via
Flickr, Creative Commons Attribution
http://www.flickr.com/photos/marktee/5647531215/

19. REFERENCES
 Katie Brady, “Nails” February 21, 2010 via Flickr,
Creative Commons Attribution
http://www.flickr.com/photos/cliche/4468016400/