Hand washing: Policy and procedures

Purpose: To cleanse the hands of germs and prevent contamination between patients and home care personnel.

Policy: All personnel providing direct or indirect care/service will wash their hands in the home prior to contact with the patient.

Personnel also will wash their hands:

  • after gloves are removed*;
  • after taking care of a patient who is infected or colonized with TB or a multidrug-resistant microorganism;
  • when hands are visibly soiled;
  • after using the toilet, blowing the nose, or covering a sneeze;
  • after assisting a patient in using the toilet or changing diapers/protective undergarments;
  • before eating, drinking, handling, or serving food;
  • before leaving the patient’s home, as appropriate to the situation.

Towels, either cloth or paper, and liquid soap will be used if appropriate to the home setting. Waterless hand-washing products may be used if liquid soap and running water are unavailable or when waterless hand washing is more appropriate to the situation (also see "washing without water," below).

GUIDELINES

Washing with water

  • Turn on the water, adjust temperature, and wet hands.
  • Apply the soap and work into a lather using friction, covering the entire hand, top and bottom, for a minimum of 15 seconds.
  • Pay special attention to the nails and between the fingers and the back of hands.
  • Rinse hands thoroughly with running water. Dry hands with a paper towel or clean cloth towel.
  • Turn off faucet with clean paper towel or cloth towel.

Washing without water

  • Use an approved antiseptic hand cleanser and towels or antiseptic towelettes according to instructions.
  • Dry hands with a paper towel or clean cloth towel as need.

Examples of when a waterless antiseptic hand cleanser may be used in lieu of hand washing with soap and water include the following**:

  • during a dressing change for a patient with multiple wounds when the staff member’s gloves are removed several times;
  • after changing gloves to begin wound care at another site;
  • after removing a dirty dressing with nonsterile gloves and applying a sterile dressing with sterile gloves;
  • when patient safety would be comprised if the clinician left the room to wash his/her hands;
  • when the discipline is social worker, chaplain, or dietitian and hands-on care*** is not anticipated during the visit.

Premoistened towelettes or waterless hand-washing products should not be used as a substitute for washing hands with soap and running water when appropriate as described above.

When a waterless product has been used, the staff member must wash his/her hands with soap and running water as soon as feasible thereafter. (Hands should be washed after six or seven hand washes with waterless soap.)*

* Occupational Safety and Health Act, Paragraph (d)(2)(iv)(v).
** Rhinehart E, Friedman M. Infection Control in Home Care. Gaithersburg, MD: Aspen Publishers; 1999.
*** Hands-on care is an assessment, procedure, or treatment that requires physical contact with the patient.

Source: Mercy Home Health & Hospice, Nampa, ID.