5. Thoroughly rinse hands in a stream of clear, running, warm tap water until all soap residue is removed. This facilitates
suspension and removal of loosened microbes and also the residual hand-washing agent. To avoid recontamination, don't use
a standing basin of water to rinse your hands. Remember that failure to remove soap residue from your hands can result in
6. Avoid recontamination of hands with water and soap from your wrists.
Figure 3: Wearing hand jewelry tends to increase the number of transient bacteria on your hands. Although these hands have
an attractive manicure, the length of the nails appears to be more than recommended (approximately ¼ inch).
7. Gently dry hands with disposable paper towel(s). The towels should be conveniently placed to reduce the possibility of
hand recontamination. Compared to properly dried hands, the number of bacteria found on hands with residual moisture after
washing often is greater. And when hands are wet, the number of micro-organisms transferred after contact with other surfaces
often is much greater (almost double in one study) than when hands are dry. Drying with disposable towels is preferred because
it is quicker than hot-air dispensers. To avoid skin damage from frequent washing, pat your hands with the towel until they
are dry, rather than rubbing them dry. Reusable towels should be avoided because of the high potential for microbial contamination.
It is especially important not to use your clothing to remove residual moisture.
8. To keep clean hands free from recontamination, turn off the faucet with a paper towel. Do not use your bare hands because
the faucet is always considered to be contaminated (Figure 4). Sinks with faucets that can be turned off by means other than
your hands (e.g., foot or knee pedals) and sinks that minimize splash can minimize immediate recontamination.
Figure 4: Do not use your bare hands to turn off water faucets because faucets are likely to be contaminated. Use a disposable
towel to protect your hands from recontamination.
9. Start over if either of your clean hands accidentally touches the faucet or outside of the sink.
10. Discard towels in a waste container of appropriate design without touching it. Remember to open the outer lavatory door
with the towel before tossing it into the receptacle.
11. As needed, use hand lotion to prevent damage to your skin from frequent washing. Use of liquid soaps containing antiseptics
and emollients will help minimize dermatitis. If an antiseptic hand-washing product is used instead of plain soap, check to
see if it is compatible with the hand lotion you have chosen. Appropriate hand-care lotions should be supplied in small, non-refillable
containers and placed in convenient locations.
What is the most effective procedure for antiseptic hand washing by hospital staff?
1. If hands are not visibly soiled, the Centers for Disease Control and Prevention (CDC) recommends routine use of an alcohol-based
hand rub (or antimicrobial soap and water) to decontaminate hands in these instances:
- Before direct contact with patients
- Before donning sterile gloves to insert intravascular catheters, urinary catheters or other invasive devices that do not require
a surgical procedure
- After contact with body fluids or excretions, mucous membranes, non-intact skin and wound dressings.
2. When decontaminating hands with an alcohol-based hand rub, apply product to the palm of one hand and then rub hands together,
covering all surfaces of hands, fingers and thumbs until hands are dry. Follow the manufacturer's recommendations regarding
the amount to use.
More hand-washing caveats
- Hand washing may be indicated more than once in the care of an individual patient, such as after touching septic secretions
in one body site and before proceeding to provide care for another body site in the same patient.
- Subungual areas of hands harbor high concentrations of microbes. Even after hands are properly washed, substantial numbers
of potential pathogens have been found in subungual spaces. To minimize contamination, avoid long fingernails (keep natural
nail tips less than ¼-inch long; Figure 3), artificial nails and chipped or old (more than four days) nail polish because
they further increase the number of transient bacteria.
- A greater number of potentially pathogenic bacteria have been cultured from skin under rings than comparable areas of skin
without rings. Therefore, remove excessive hand jewelry before washing your hands, especially when working with patients at
high risk for nosocomial infections. Although hand-washing may reduce the number of microbes, wearing rings tends to increase
transient bacteria on hands (Figure 3).