Get a grip on the proper way to wash your hands

Experts come clean on their methods

Everyone in the health care profession should know the importance of proper hand washing as a means of infection control. Even so, there are some gray areas regarding what constitutes proper hand washing, when it should be performed, and by whom. Do hospice workers fall under the same rules as home care aides? Can an antiseptic gel be used in place of soap and water?

We talked to a few experts in the field to get a better grip on the rules for hand washing. Here’s what we learned:

Even speech therapists must comply

"Every employee that enters a patient home should wash his or her hands prior to beginning the visit," according to Kim Stout, RN, BSN, home health director for McAlester (OK) Regional Health Center Home Health. Stout learned this the hard way. "We were given a deficiency by our state surveyor three years ago due to this very thing. Our speech language pathologist did not wash her hands. She did not touch the patient, but the surveyor stated that all home health employees are to wash hands using proper hand-washing techniques." The change in policy to reflect this, she says, has worked well for her agency since its implementation.

Kathy Stockton, RN, BSN, supervisor officer/ performance improvement with Mercy Home Care and Hospice in Nampa, ID, says her agency also implemented a hand-washing policy after a Joint Commission on Accreditation of Healthcare Organizations survey. "It was recommended that we tighten our policy and make it uniform," she explains. "Up until that point, we had one that said nothing much more than you’ll do it,’ but nothing was spelled out."

Since that survey, Mercy Home Health has developed a written, formal policy that spells out exactly who should be washing their hands, when it should be done, and how. The new policy, Stockton explains, is used "for understanding of accountability so that all the staff are held to same standard. It’s important staff understand that infection control is a really big item and that it’s best to be proactive."

Stockton and Stout agree that everyone who enters a patient’s home must wash his or her hands. As for what types of cleansers to use, Stockton says her policy "specifies the preference for soap and water as opposed to gel. You can use gels when there’s no running water, but that’s basically the bottom line. It’s also allowed in cases where the practitioner feels the situation is such that washing hands in the patient’s sink would be totally impractical."

However, using gel instead of soap is generally discouraged, she says. To get around the problems with using a patient’s soap and/or towels, both Stout’s and Stockton’s agencies provide their staff with soap and paper towels. In the case of McAlester Home Care, germicidal hand wipes are provided. Like Mercy Home Care, however, Stout notes that the hand wipes are to be used only in instances where running water is not available.

Staff are required to wash their hands both prior to touching the patient and before leaving the home, Stockton says. "Getting staff to wash their hands with running water before leaving the home is more problematic because they would just as soon use the gel." She says using soap and running water is the biggest obstacle to compliance. "It’s truly the problem child with the nonclinical staff. They understand why. It’s just getting them to do it, and social workers have trouble understanding why it should be done before patient contact."

A good hand-washing policy also will point out that staff members should wash their hands for a minimum of 15 seconds, or about as long as it takes to sing your ABCs. It also should require employees to turn off the faucet using a paper or cloth towel.

For employees who wear a lot of rings on their fingers, care should be taken to clean around and under the jewelry. The same goes for women with long fingernails. Luckily for Stockton, "that’s just not an issue for any of us. I imagine if the hospital with which we are associated implemented a specific policy with respect to this, we would, too, but so far, it’s just not been much of a problem."

As for any advice to agencies looking to revise their hand-washing policies, Stockton says this: "Keep it as simple as you can. You want a policy that you can hold staff to, but on the other hand, you want to make it easy to understand and explain so that there are not too many opportunities for working around it."