Hand Hygiene

This essay will examine and compare the different methods of hand washing in the perioperative environment and how hand washing influences the prevention of healthcare acquired infections (HCAIs). It will show the importance of washing hands thoroughly to remove bacteria to prevent HCAIs. It will include the differences between the surgical hand wash, the social hand wash and the use of alcohol rubs. According to Pirie (2010) hand hygiene is very important to perioperative practice and over the years has become more important for health care workers.

Muralidhar and Muralidhar (2007) indicated that HCAIs are a major problem to patients and the health services as a whole; HCAIs are increasing and hospitals are struggling to maintain high standards of hygiene to keep out HCAIs. A health care worker has a variety of pathogens, including bacteria, viruses and fungi on their hands; some of these are harmless whilst others can be serious to patients that are in hospital (Resources, 2008). The pathogens which are of most concern include; Methicillin Resistant Staphylococcus Aureus (MRSA), Vancomycin Resistant Enterococcus (VRE), Clostridium Difficile and Influenza Virus (Resources, 2008).

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Health Protection Agency (2010) stated that HCAIs are more than likely to travel from one person to another through skin to skin contamination for example, touching a patient’s hand and then moving on to another patient without washing the hands. Parliamentary Office of Science and Technology (2005:1) ‘estimate that 9% of in-patients have an HCAI at any one time, equivalent to at least 300,000 HCAIs per year in the UK. HCAIs may cause 5,000 deaths and contribute to over 15,000 deaths per year in the UK’.

Damani (2003) specified that keeping good hand hygiene is important because a lot of everyday jobs that are carried out involve using hands; this makes them the main source of HCAIs. Breaking the chain of infection is difficult; however specific measures can be taken to minimise the risk of spreading infections in hospitals (Coyne et al, 2010). They can be minimised by using standard precautions such as, wearing correct personal protective equipment (PPE) and appropriate hand washing is used for example, social hand wash or surgical hand wash and safe disposal of sharps and waste (Coyne et al, 2010).

The Royal College of Nursing (2012) articulates, that the hands of health care staff will always have bacteria on them, although their own bacteria might not be harmful, other bacteria could have attached from completing daily tasks. It is not possible to ‘sterilise’ hands but, the bacteria that has attached can be reduced significantly through good hand hygiene (The Royal College of Nursing 2012).

According to Weston (2008) social hand washing is a routine where soap and water are used to remove soil and possible cross contamination, this is done on a daily basis before and after patient contact, before and after handling patient’s property, food and for personal hygiene. The social hand wash can be described as a forceful, quick time of rubbing both hands together, which is then covered with soap before rinsing under fresh water (Weston, 2008). Hands should be socially clean before a surgical hand wash has been undertaken (Pirie, 2010).

Goodman & Spry (2009) stated that a surgical hand wash should follow the hospitals policy which should say the method and the agent which is going to be used. According to Tanner et al, 2008 (cited in The Association for Perioperative Practice 2010) ‘The purpose of the surgical scrub is to remove or destroy transient microorganisms and prevent the growth of resident microorganisms’. The surgical hand wash can be effective for a few hours, therefore preventing HCAIs in the operating theatre (Tanner et al 2007).

Surgical hand wash is more forceful and lengthy than a social hand wash (Stainton, 2009). Stainton (2009) also described the surgical hand wash technique where the hands, nails and forearms are washed with an antiseptic soap; it is based from the fingertip to at least 5cm above the elbow. There are a few differences between the social hand wash and the surgical hand wash, the social hand wash takes less time and is focussed around the hands whereas the surgical hand wash takes longer and includes a larger surface area, also different solutions are used. Denham, 2007) Kampf and Ostermyer (2011, cited in Ghorbani et al 2011:67) have concluded that ‘alcoholic solutions are more effective than other solutions’. Alcohol based rub has a few benefits over soap and water and can be used without having a fresh supply of water, there is also no need for sinks and it is easier to perform (Timby, 2009). CCAR (2007) states that the use of alcohol hand rub requires less time and acts faster because it can be used whilst walking, this means staff can use their time more efficiently.

CCAR (2007:1) also specified a method of how to use the alcohol rub – all jewellery must be removed (jewellery is difficult to clean and bacteria will still be lingering on it), hands need to be visibly clean, if they are not then the social hand wash needs to be completed, ‘1 to 2 pumps’ of the alcohol rub should be enough to cover the hands. This should then be spread over all surfaces of the hands, making sure finger tips, between fingers, back of hands and base of thumbs are covered because these are sometimes missed (CCAR 2007). This essay has shown the importance of hand hygiene in a healthcare setting and how to minimise HCAIs.

I have identified the different methods which can be used to reduce bacteria in the perioperative setting – surgical hand wash, social hand wash and alcohol based rub. These methods have been explained and compared with each other to show the differences between them. It is clear from Ghorbani et al, 2012 (cited in Wilson, 2012) that hand hygiene is a major factor of minimising the contamination of microorganisms. This essay also shows how hand hygiene influences HCAIs and the best way to minimise the risk to the patients of receiving infections such as MRSA.

According to Institution for Healthcare (2011) by using the correct hand hygiene it can prevent the patient or healthcare worker from getting an infection. Healthcare & Professions Council (2012) states that ‘you must take appropriate precautions to protect your service users and yourself from infection’ this applies to all health care professions.


Association of Perioperative Practice. (2010) ‘Surgical Hand Antisepsis’ Surgical Hand Antisepsis. (1) pp. 1-2 CCAR: Hand Hygiene for Health Care Settings. (2007) Infection Prevention and Control Best Practices. http://www. phac-aspc. gc. a [Accessed 21 May 2013] Coyne, I. Timmins, F. Neil, F. (2010) Clinical Skills in Children’s Nursing. New York: Oxford University Press Damani, N. (2003) Manual of Infection Prevention and Control. 3rd ed. New York: Oxford University Press Denham, J. (2001) ‘Surgical Hand Washing/Disinfection’ Journal of Hospital Infection. pp 21-37 Ghorbani, A. Shahrokhi, A. Soltani, Z. Molapour, A. Shafikhani, M. (2012) ‘Comparison of Surgical Hand and Alcohol Surgical Hand Rub on Reducing Hand Microbial Burden’ Journal of Perioperative Practice. 22 (2). pp 67-70 Goodman, T & Spry, C. (2009) Essential of Perioperative Nursing. th ed. Burlington: Jones & Bartlett Learning Health Care and Professions Council (2012)

Standards of Conduct, Performance and Ethics. You must deal fairly and safely with the risks of infection. http://www. hpc-uk. org/ [Accessed 26 May 2013] Institution for Healthcare Environment (2011) ‘How –to Guide: Improving Hand Hygiene’ http://www. shea-online. org [Accessed 26 may 2013] Murakidhar, V & Murakidhar, S. (2007) Hospital Acquired Infections. New Delhi: Anshan National Protection Agency (2010) General Information on Health Care Associated Infection (HCAI) Public Health England. ttp://www. hpa. org. uk/ [Accessed 21 May 2013] Parliamentary Office of Science and Technology. (2005) ‘Infection control on Healthcare Setting’ Post Note. 247. pp 1-4 Pirie, S. (2010)’ Hand Washing and Surgical Hand Antisepsis’ Journal of perioperative Care. 20 (5). pp 169-172 Resources, J. C. (2008) Hand Hygiene. Illinois: Joint Commission on Accreditation of Healthcare Organizations The Royal College of Nursing. (2012). Wipe it Out One Chance to Get it Right. Essential Practice for Infection Prevention and Control. http://www. rcn. org. uk/ [Accessed 21 May 2013] Stainton, K.

Hughson, J. Funnell, R. Koutoukidis, G. Lawrence, K. (2009) Tabbners Nursing Care: Theory and Practice. Australia: Elsevier. Tanner, J. Blunsden, C. Fakis, A. ‘National Survey of Hand Antisepsis Practices’ Journal of Perioperative Practice. pp 28-36 Timby, B. K. (2009) Fundamental Nursing Skills and Concepts. 9th ed. Malaysia: Wolters Kluwer Lippincott Williams & Wilkins Weston, D. (2008) Infection Prevention and Control. West Sussex: John Wiley & Sons Ltd Wilson, R. (2012) ‘Minimising the Spread of Infection in the Operating Department’ Journal of Perioperative Practice. 22 (6). pp 185-188

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