Hand Washing: Preventing Spread Of Disease In The Clinical Setting

In this essay, I will talk about my experience with the skill of hand hygiene in clinical practice. First I will explain how I perform the technique and my reasons for doing so using official guidelines such as the World Health Organisation (WHO), and research into hand hygiene to explain and support my method for hand hygiene. As well as supporting my own practice, I will use research to show the importance of hand hygiene in preventing the spread of disease in the clinical setting. Following this, I will explain how my experience with this skill has impacted my knowledge and use of hand hygiene, as well as how it will inform my practice in future clinical placements. Finally, I will conclude my essay by summarising the points I have made about my use of the skill and my continuing use of it in practice.

I perform hand hygiene before and after every interaction with patients or patient areas. Prior to the interaction, I apply alcohol-based gel to my hands. If the interaction involves bodily fluids such as feces, or the patient are in isolation, would perform post-interaction hand hygiene using water and soap or cleansing gel. The procedure I follow for handwashing contains seven steps. Firstly I dampen my hands with water before applying soap to the palm of my hands. I rub my palms together, then rub the back of my hands, followed by rubbing my palms together with my fingers interlaced. Next, I interlock my fingers and rub the back of my fingers with my palms. Following this, I use my palms to rub the thumb of the opposing hand, and finally, I rub my palms with the fingers of the opposing hand.

After following these steps, I will rinse my hands with water and dry them with a paper towel from a dispenser next to the sink. To turn the tap off I would use the towel to avoid re-contaminating my hands.

Hand hygiene is one of the most frequently used skills in nursing and also one of the most important. This is because the nurse's hands are frequently in contact with patients or patient areas, and any pathogenic organisms that may be present. This means a nurse's hands are frequently contaminated and, if not properly cleaned, can easily spread these organisms through the clinical environment (Mehta et al., 2014)

An important factor in proper hand hygiene is knowing when it must occur. To this end, I base my decisions on when to use hand hygiene on Sax. H., et al (2007)'s 'My five moments for hand hygiene' which has since become an important part of the WHO guidelines for hand hygiene (WHO., 2009). These guidelines highlight the importance of hand hygiene for preventing infection and identifies five moments in which it should be used. These moments are; before patient contact, before aseptic task, after body fluid exposure, after patient contact, and after contact with patients' surroundings. Following this guideline prevents a number of negative outcomes, these being; patient cross-contamination & infection, healthcare worker infection & cross-contamination, and environmental contamination (Sax. H et al., 2007).

As well as performing hand hygiene at the right time, it is important to carry out hand hygiene with the proper technique. This is because the improper technique can result in missing areas of the hands, leaving them contaminated and increasing the risk of transferring pathogenic organisms. Areas commonly missed in hand hygiene include the backs of the hands and the thumbs (RCNI., 2016) as well as the tips of and spaces in-between the fingers (WHO., 2006).

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To ensure that my hands are thoroughly cleaned, and that easily missed areas are not left contaminated, I follow the hand hygiene techniques outlined in the 'WHO Guidelines on Hand Hygiene in Health Care' (WHO., 2009). My reason for using the WHO technique is that it ensures the entirety of my hands are decontaminated and can be used with both soap and water as well as hand gel, the only difference being wetting and drying hands. Furthermore, this hand hygiene technique is endorsed by the NHS (NHS., 2016) making it the standard method for hand hygiene in health trusts within the UK. This has the benefit of soap dispensers on hospital wards displaying instructions on how to perform the technique, making it easy for me to remember.

Another important part of hand hygiene in the clinical setting is whether to use Alcohol-based hand sanitizers (ABHS) or soap and water. After interactions with patients such as basic vital observation or assisting a patient in feeding I will use ABHS rather than soap water. This is because, while soap and water are more effective, ABHS is easier and quicker to use while still very capable of cleansing hands of contaminates as long as they are not visibly soiled (NHS., 2016).

Another reason I use ABHS rather than soap and water unless necessary is to prevent eczema/dermatitis. Hamnerius. N et al., 2018 found that handwashing with soap was associated with the development of dermatitis among healthcare workers, while hand disinfectant was not. Furthermore, WHO states that frequent hand washing leads to lipid depletion which in turn causes skin dryness and cracking, damaging the skin and possibly increasing susceptibility to infection (WHO 2009). Based on this evidence I only use soap and water when necessary in order to protect my own health while ensuring I comply with infection prevention standards.

However, sometimes hand sanitizer is not appropriate for hand hygiene. To this extent, I always use soap and water after interacting with patients in situations that expose me to bodily fluids such as cleaning feces or when my hands are visibly soiled. Another occasion in which I will use soap and water is after interacting with a patient in isolation, such as contact or respiratory isolation. Soap and water must be used after possible body fluid contact or when hands are visibly soiled because, while ABHS is effective at killing pathogens, they are not capable of properly removing traces of contaminants such as feces from the skin (Mathur. P., 2011). Soap and water must be used to clean hands after contact with patients in isolation as pathogens such as norovirus have shown resistance to ABHS (Vogel. L., 2011) and reliance on hand sanitizer over soap and water has been shown to increase risks of outbreaks (Blaney et al., 2011).

Prior to placement, I was not fully aware of the full extent of hand hygiene importance in healthcare. Now that my placement is over, whenever I wash my hands I instinctively use the technique promoted by WHO and the NHS even outside of placement and intent to continue to do so. Another important aspect of hand hygiene I have learned is when to carry it out. After my placement and research for this essay, I base my decisions for when to clean my hands on the hospital guidelines as well as Sax. H., 'My five moments for hand hygiene, these being before and after any contact with the patient or patient area. In future placement, in clinical practice, I intend to continue to follow this guideline on when hand hygiene should occur.

Another way this has affected my future practice is deciding whether to use soap and water or hand gel during hand hygiene. In the future, whenever I interact with a patient who is in any sort of isolation, if the interaction involved contact with bodily fluids such as feces or urine, or if my hands are visibly soiled, then I will use soap and water to reduce the risk of my hands remaining contaminated. However, after viewing evidence such as Hamnerius. N et al., 2018, which suggests that overuse of soap and water can lead to dermatitis, I will use ABHS unless the previously mentioned criteria are met in order to protect my own well-being.

In conclusion. Hand hygiene is one of the simplest and most commonly used skills in nursing while also being one of the most important in preventing the spread of pathogenic organisms and infections. To this extent, I follow the WHO promoted technique for hand hygiene to ensure that the entirety of my hands is cleaned when performing the skill. Likewise, by following 'My five moments of hand hygiene' I reduce the risk of spreading contaminates between patients and other patients or staff. My last development of this skill is only to use soap and water when necessary to reduce the risk of developing dermatitis, which will reduce the risk of infection to myself and others. Finally, I will continue to use the approach I have developed to performing hand hygiene based on my experience with it in practice and the supporting knowledge I have obtained while writing this essay.