Guideline Summary: Hand Hygiene

Guideline Summary: Hand Hygiene

Guideline Summary: Hand Hygiene PURPOSE To provide guidance for hand hygiene and surgical hand antisepsis in the perioperative setting. Guideline Sum...

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Guideline Summary: Hand Hygiene PURPOSE To provide guidance for hand hygiene and surgical hand antisepsis in the perioperative setting.

Guideline Summary: Hand Hygiene # I

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Recommendation All perioperative team members should maintain healthy fingernail and hand skin condition.

Key Points  Perioperative team members should maintain short, natural fingernails. Fingernail tips should be no longer than 2 mm (0.08 inch).  Artificial fingernails or extenders should not be worn in the perioperative setting.  A multidisciplinary team that includes perioperative RNs, physicians, and infection preventionists should determine whether fingernail polish may be worn in the perioperative setting. o A multidisciplinary team that includes perioperative RNs, physicians, and infection preventionists should determine whether ultraviolet-cured nail polish (eg, gel, Shellac) may be worn in the perioperative setting.  Perioperative team members should take measures to prevent hand dermatitis. o Perioperative team members should use moisturizing skin care products approved by the health care organization. o Hands should be completely dry before gloves are donned. o Water temperature for hand hygiene should be controlled to between 70 F and 80 F (21.1 C and 26.7 C). o In the absence of visible soil, hands should be disinfected with an alcohol-based hand rub product rather than washed with soap and water. o Cotton glove liners may be worn under nonsterile gloves. Sterile cotton glove liners may be worn under sterile gloves. o Single-use cotton glove liners should be discarded after each use. Reusable cotton glove liners should be reprocessed in accordance with the manufacturer’s instructions for use. o The health care organization should provide education to perioperative team members on the recognition and prevention of hand dermatitis. (continued)

http://dx.doi.org/10.1016/j.aorn.2016.12.003 ª AORN, Inc, 2017

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Guideline Summary: Hand Hygiene

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February 2017, Vol. 105, No. 2

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Recommendation

Key Points  The activities of health care personnel with dermatitis, infections, exudative lesions, and nonintact skin should be restricted when these activities pose a risk for transmission of infection to patients and other health care providers. State, federal, and professional guidelines and strategies should be followed to determine the need for work restrictions for health care personnel with bloodborne infections.

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Perioperative team members should not wear jewelry (eg, rings, watches, bracelets) on the hands or wrists.

 Perioperative team members should not wear jewelry on the hands or wrists in patient care areas.

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Perioperative team members should perform hand hygiene.

 Personnel should perform hand hygiene o before and after patient contact, o before performing a clean or sterile task, o after risk for blood or body fluid exposure, o after contact with patient surroundings, o when hands are visibly soiled, and o after using the restroom.  When gloves are worn and hand hygiene is indicated, the gloves should be removed to perform hand hygiene.  Performing a single act of hand hygiene may fulfill multiple indications (eg, opening multiple sterile items sequentially).  In the event that performing hand hygiene would put the patient’s safety at risk, the perioperative team member should weigh the risks and benefits of delaying hand hygiene. o The anesthesia professional may wear two pairs of gloves (ie, double glove), remove the contaminated outer gloves after airway manipulation, and continue patient care until the patient’s status allows for removal of the inner gloves and performance of hand hygiene.  Perioperative personnel should perform hand washing with soap and water o after being exposed to blood or body fluids, o after using the restroom, o when hands are visibly soiled, and o when caring for patients with spore-forming organisms (eg, Clostridium difficile, Bacillus anthracis) or norovirus.  A standardized hand-washing protocol using soap and water should be performed in the following order: 1. Remove jewelry from hands and wrists (eg, rings, watches, bracelets). 2. Adjust running water to a comfortable temperature, avoiding hot water. 3. Wet hands thoroughly with water. 4. Apply the amount of soap needed to cover all surfaces of the hands. 5. Rub hands together vigorously, covering all surfaces of the hands and fingers with soap, for at least 15 seconds.

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Guideline Summary: Hand Hygiene

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Recommendation

Key Points 6. Rinse with water to remove all soap. 7. Dry hands thoroughly with a disposable paper towel. 8. When hands-free controls are not available on the sink, use a clean paper towel to turn off the water.  When hands are not visibly soiled or dirty, hand hygiene should be performed using an alcohol-based hand rub according to the manufacturer’s instructions for use.  A standardized hand hygiene protocol using an alcohol-based hand rub should be performed in the following order: 1. Remove jewelry from hands and wrists (eg, rings, watches, bracelets). 2. Apply the amount of alcohol-based hand rub recommended by the manufacturer to cover all surfaces of the hands. 3. Rub hands together, covering all surfaces of the hands and fingers, until dry.

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Perioperative team members should perform surgical hand antisepsis before donning sterile gowns and gloves for operative and other invasive procedures.

 Surgical hand antisepsis using a surgical hand rub product should be performed according to the manufacturer’s instructions for use.  A standardized surgical hand antisepsis protocol using a surgical hand rub product should be performed in the following order: 1. Remove jewelry from the hands and wrists (eg, rings, watches, bracelets). 2. Don a surgical mask. 3. If hands are visibly soiled, wash hands with soap and water. 4. Remove debris from underneath fingernails using a disposable nail cleaner under running water. 5. Dry hands and arms thoroughly with a disposable paper towel. 6. Apply the surgical hand rub product to the hands and arms according to the manufacturer’s instructions for use (eg, amount, method, time). 7. Allow hands and arms to dry completely before using sterile technique to don a surgical gown and gloves.  Surgical hand antisepsis using a surgical hand scrub product should be performed according to the manufacturer’s instructions for use.  A standardized surgical hand antisepsis protocol using a surgical hand scrub product should be performed in the following order: 1. Remove jewelry from the hands and wrists (eg, rings, watches, bracelets). 2. Don a surgical mask. 3. If hands are visibly soiled, wash hands with soap and water. 4. Remove debris from underneath fingernails using a disposable nail cleaner under running water. (continued)

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Key Points 5. Apply the amount of surgical hand scrub product recommended by the manufacturer to the hands and forearms using a soft, nonabrasive sponge. 6. Visualize each finger, hand, and arm as having four sides. Wash all four sides effectively, keeping the hands elevated. 7. Scrub for the length of time recommended by the manufacturer. The scrub should be timed to allow adequate product contact with skin. 8. For water conservation, turn off water when it is not in use, if possible. 9. Avoid splashing surgical attire. 10. Discard sponges, if used. 11. Rinse hands and arms in one direction, from fingertips to elbows, under running water. 12. Hold hands higher than elbows and away from surgical attire. 13. In the OR or procedure room, dry hands and arms with a sterile towel using sterile technique before donning a surgical gown and gloves.

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A multidisciplinary team should select hand hygiene products to be used in the perioperative setting, following an analysis of product effectiveness, user acceptance, and cost.

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 The multidisciplinary team should include the infection prevention committee or designated authority with specialized knowledge in infection prevention. Committee representatives should include perioperative RNs and other perioperative team members.  The multidisciplinary team should develop a mechanism for product evaluation and selection of hand hygiene products.  The multidisciplinary team should evaluate the safety and efficacy of hand hygiene products. o The multidisciplinary team should select products for hand hygiene and surgical hand antisepsis that meet US Food and Drug Administration requirements. o Nonantimicrobial and antimicrobial soaps may be selected for evaluation. o Soaps containing triclosan should not be selected for evaluation.  The multidisciplinary team should evaluate the compatibility of hand hygiene products with skin care products (eg, lotions, moisturizers) and types of gloves used at the facility.  Cost of hand hygiene products should be evaluated, but cost should not be the primary factor for selection.  End-user evaluations should be conducted to determine acceptability of the hand hygiene and skin care products to perioperative team members. o End-user evaluations should include - skin tolerance, - skin reactions, - ease of use (eg, volume, dry time), - feel (eg, consistency, texture), - color, and - fragrance.

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Recommendation

Guideline Summary: Hand Hygiene

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Key Points  Hand hygiene product dispensers (eg, wall mounted, tabletop, personal) should be evaluated for adequate, reliable function and delivery of the recommended product volume. o Dispensers of alcohol-based hand hygiene products should - release product only when the dispenser is activated, - activate when an object is placed within 4 inches of the sensor, - activate when an object is left in place in the activation zone, - dispense no more product than the amount recommended by the manufacturer for the hand hygiene product, and - be designed to prevent accidental or malicious activation of the dispenser.

Editor’s note: Shellac is a trademark of Creative Nail Design, Inc, San Diego, CA. Reference 1. Guideline for hand hygiene. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2017:29-50. Copyright ª AORN, Inc, 2017. All rights reserved.

AORN has developed this Guideline Summary as a service to AORN members. The summary is intended to be an adjunct to the complete guideline upon which it is based and is not intended to be a replacement for that document. Individuals who are developing and updating organizational policies and procedures should review and reference the full guideline.

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