Hand Hygiene: Life and Death is in Your Hands

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After completion of this course you will receive 1 Continuing Education Units
Is this course for me? This course is for RNs, LVNs, GH, ARF, RCFE
Course Synopsis:

   Your hands greet your neighbors, embrace your spouse, caress your children. You care for yourself with your hands. Your hands feed you, brush your teeth, and rub your eyes when you’re tired. You work with your hands. Your hands change bedding, administer medicine, and clean wounds. Your hands have the power to soothe, to comfort, and to heal. However, because you’re a medical professional and/or human services worker, your hands are sometimes exposed to dangerous pathogens. This means that your hands also have the power to harm. Today I’m going to show you how you can mitigate this potential harm and discover for yourself that good health truly is in your hands.

Sample CEU Certificate for ClickPlayCEU

Sample CEU Certificate

Course Objectives: 

Upon completion of this course you will be able to:

  • Gain understanding about the history of infection & infection control practices
  • Uncover the definition and meaning of Standard Precautions
  • Understand the importance of hand hygiene
  • Uncover the reasons why we wash our hands
  • Gain understanding about how to wash hands
  • Understand how to institute & maintain a “Culture of Hygiene”

Total Video Run Time: 54 minutes

Author Profile:

 Donn-Kropp1-288x300Donn Kropp founded CLiCKPLAY Continuing Education University out of a desire to bring others to greater levels of health and wellness. With over ten years of emergency and trauma room experience, Donn brings a seasoned, yet fresh approach to continuing education.

Course Approvals

This course is approved by the following governing boards & organizations:

  • CA Board of Registered Nursing: CA Provider # CEP 15849
  • District of Columbia Board of Nursing: CE Provider #50-14108
  • California Board of Vocational Nursing Provider # V10810
  • Psychiatric Technicians Provider # V10806/li>
  • DSS/CCL Division for Adult Residential Facilities (ARF) Vendor Approval # 2000149-735-2: Course Approval # 149-0106-25472
  • DSS/CCL Division for Residential Facilities for the Elderly (RCFE) Vendor Approval # 2000149-740-2: Course Approval # 149-0106-25473
  • DSS/CCL Division for Group Homes (GH) Vendor Approval # 2000149-730-2: Course Approval # 149-0106-25471
  • Far Northern Regional Center


Hand Hygiene: Life & Death Is in Your Hands

I’m Donn Kropp.Welcome to our course, Hand Hygiene: Life and Death Is In Your Hands. Thanks so much for joining me. Let’s dive right in shall we? You love with your hands. Your hands greet your neighbors, embrace your spouse, caress your children. You care for yourself with your hands. Your hands feed you, brush your teeth, and rub your eyes when you’re tired. You work with your hands. Your hands change bedding, administer medicine, and clean wounds. Your hands have the power to soothe, to comfort, and to heal. However, because you’re a medical professional and/or human services worker, your hands are sometimes exposed to dangerous pathogens. This means that your hands also have the power to harm. Today I’m going to show you how you can mitigate this potential harm and discover for yourself that good health truly is in your hands.

According to the Centers for Disease Control and Prevention, failure of medical and human services workers to adequately perform hand hygiene is the leading cause of Healthcare-Associated Infections, or H-A-I’s. HAIs cause or contribute to  as many as 99,000 deaths in the US, and it’s been reported that nearly one-third of these deaths are preventable. While some of these cases of lethal infection are caused by environmental or other factors, some of them have been traced back to poor hand hygiene. Even though the World Health Organization highlights ICU patients as the most vulnerable to HAIs, with rates of infection ranging between 9% and 37%, workers in every medical and human services environment are encouraged to learn all they can about the risks of cross-transmission. Cross-Transmission is the transfer of healthcare-associated pathogens from one patient or individual to another via our hands.

We need to know and be reminded that our hands play a huge role in the process of infection. I know you are thinking to yourself, I know all this. Well, if we all know it then why don’t we wash our hands each and every time it’s necessary?  Are we lazy? Are we ignorant, or both? Hand hygiene is the practice of hand washing to remove bacteria, fungi, or viruses that might cause harm to you or the individuals under your care. The Centers for Disease Control , the World Health Organization, and the Joint Commission Center for Transforming Healthcare maintain that if you practice sufficient hand hygiene, you are the frontline defense against the cross-transmission of pathogens. So now let’s embark on our journey towards better hand hygiene so that we can bring health & life, not sickness and disease. Before we start go use the restroom and then grab some popcorn but make sure you wash your hands first before making or eating the popcorn because that’s nasty if you don’t wash up.

I’m about to go over the objectives for this class. But before I do I want to tell you the overarching point of this course. Here it is. If you don’t wash your hands properly you can kill someone! Is that too blunt. We work with human beings, right. The whole point of our work is to help people live longer- not kill them. Killing people is actually the exact opposite of what we are supposed to do. Remember we save lives we don’t kill them.  Clean hands are the single most important factor in preventing the spread of pathogens and bad icky germs. I just said icky didn’t I–that’s not a very technical term. Ok. now let’s go over the objectives.The objectives for this course will be to :
Gain understanding about the History of infection & Infection Control Practices
Uncover the definition and meaning of Standard Precautions
Understand the Importance of Hand Hygiene
Uncover the reasons Why We Wash Our hands
Gain understanding about How to Wash Hands
And finally, understand how to Institute & Maintain Hygiene Culture

Did you know that in the 19th and early 20th centuries it was common practice for the same physician to perform an autopsy and then deliver a baby? And that surgeons were not required to change their coats between patients? Yep, in the late 1800s the foul odor of congealing blood saturating a physician’s coat was dubbed “good old surgical stink,” and the more blood there was, the more his skill was revered.While you’re shuddering under these grim images, I must add that neither these esteemed doctors nor their nurses washed their hands between patients. I’m sure it’s no surprise to you, in light of these gruesome facts, that deaths from gangrene, puerperal fever, and other such contagious infections ran high. In the 1820s, as a remedy against the foul odors of morgues, latrines, and hospitals, chemist Antoine-Germain Labarraque developed and marketed a deodorizer out of a sodium hypochlorite solution that sets the stage for hand hygiene in the medical field. Though there was eventual local use of his solution to prevent and treat contagious infections, it wasn’t until the 1840s that Labarraque’s discoveries would begin to affect the habits of medical practitioners.Two surgeons, Ignaz Semmelweis and Oliver Wendell Holmes, independently  discovered a connection between contaminated hands and mortality rates associated with puerperal fever. Puerperal fever was the leading cause of maternal death during and after childbirth at that time. Dr. Holmes, an avid medical reformer working in Boston, Massachusetts, published a paper in 1843 in which he concluded that puerperal fever was transmitted from patient to patient via contact with their physicians. He insisted that a physician exposed to even one case of the deadly fever should burn the clothing he had worn during the delivery, purify his instruments, and cease obstetrics practice for at least six months.

A few years later, Dr. Semmelweis, professor of surgery in Vienna, Austria, came to similar conclusions. He noticed that washing with soap and water was insufficient to remove the stench of the autopsy suite from the hands of his physicians.These same doctors, smelling of death, were often known to head directly to the obstetrics unit after leaving the morgue, just in time to deliver a baby. Semmelweis set out to find a way to reduce the foul odor. He introduced the use of Labarraque’s Solution and asked the physicians to routinely wash their hands with it between all patients whether dead or alive. Imagine his surprise when in 1847, after instituting this hygienic practice, the mortality rates dropped in the obstetrics clinic from a whopping 16% down to a mere 3%! Needless to say, he instituted a policy that any physician or medical student under his supervision was required to sterilize his equipment and his hands with Labarraque’s Solution between every patient. The mortality rates in the clinic remained low thereafter.

The next big breakthrough in hand hygiene practice was made by Sir Joseph Lister, a surgeon at the Glasgow Royal Infirmary in the 1870s. He discovered the antiseptic powers of carbolic acid.  Applying the findings of Louis Pasteur to his medical practice, Dr. Lister began dipping dressings in carbolic acid solutions before applying them to open wounds. His first success came in 1865, when the leg wound of a young boy healed without developing an infection. So convinced was Dr. Lister of his theories that he mandated that all surgeons in his practice wear clean gloves and wash their hands in a solution of 5% carbolic acid before and after performing procedures. He also instructed medical assistants to spray the acid solution into the air of the operating theater and on all surgical instruments after surgery. Though these three pioneers and their successors continued to improve upon methods and means of antisepsis into the 20th century, it would be almost 100 years before formal guidelines would be established for hand hygiene. It wasn’t until 1961 that the first training film demonstrating recommended hand washing techniques was produced by the United States Public Health Service. Can you believe that 1961? Do we have a clip of that original instructional video? We do. Great. Let’s take a look at that real quick.

That was far out. Moving out of the sixties we find that further guidelines were published by the CDC in 1975 and 1985, and by the Association for Professionals in Infection Control (APIC) in 1988. During this period of time, washing with antimicrobial soap and plain water were preferred as the standard of care. Waterless agents, such as alcohol hand rubs, were indicated only in the absence of running water. In 1996, the Healthcare Infection Control Practices Advisory Committee (HICPAC) was the first organization to equate antimicrobial soap and waterless antiseptic agents for use after exposure to patients infected with MRSA (methicillin-resistant staphylococcus aureus) or VRE (vancomycin-resistant enterococci). In 2002, HICPAC released new guidelines which promoted hand rubbing with alcohol as the industry standard for hand hygiene, degrading washing with soap and water for only specific instances. Today, all of these governing bodies agree that alcohol hand rubs are the gold standard in medical hand hygiene practices and that hand washing with antimicrobial soap and water is indicated in only some cases.

Just like the South America rain forests or Galapagos Islands your hands are a varied and complex ecosystem. They’re a community of many living things that interact with each other as well as nonliving components and ever-changing conditions.Your hands are subjected to all types of temperatures, humidity content, chemicals throughout the day. It’s essential that we understand the lay of the land a little so that we can maintain cleanliness and health.  Can you believe these two little guys can be so dangerous? It’s hard to fathom that over 2 million infections and roughly ninety-thousand deaths per year in this country are attributable to these guys. So sad. Let’s take a look at our skin for a little bit. Did you know that our skin is an organ.In fact its the biggest organ we have. It breaths, it sweats, it gets cold and warm, it has feelings. Well, maybe not feelings but its a huge part of our body, literally. Despite what beauty product companies say– your skin’s primary function is not to display your beauty and attract others to you. It’s primary function is to reduce water loss, provide protection against abrasive action and microorganisms, and act as a permeability barrier to the environment. The skin sheds approximately 40,000 dead skin cells every minute, so by the age of 70 the average person will have lost about 105 pounds of skin. Wow, that’s a lot of skin. Our hands can have very different ecosystems depending on the conditions they are subjected to. Unwashed hands contain the natural microflora or resident bacteria, microbes and the transient bacteria from objects that hands come in contact with. When your hands remain unwashed millions and millions of microscopic organisms live, thrive, reproduce and grow. If you rinse your hands with cold water you only get some large particles of dust and bacteria removed, but the majority of pathogens and potential disease causing organisms are still there. If you take it to the next level and wash your hands with soap and water you reduce the number of transient bacteria. If you take it even further and up the ante by using hand-sanitizer. Good choice by the way. Then the hands are sanitized, the growth of the bacteria is stopped and thus, the majority of the bacteria will be gone. Interestingly the effect of sanitizers can vary depending on the type of environment we work in and the normal activities we partake of in our job. The types of organisms and their propensity to reproduce and grow differ depending upon factors such as the length of our nails.Long fingernails are hard to clean and so the germs can hide out and start multiplying in the nice moist dark cracks and crevasses. With that nice imagery in mind, your nails should be kept clean, short, and not extend past the fingertips. But what about artificial nails? Fake fingernails harbor a greater number of pathogens than natural nails. Artificial fingernails directly contribute to the changes in nails that lead to an increase of colonization and transmission of pathogens. Interestingly, artificial nails can lead to a lift in the natural human nail base, thereby, allowing dirt and bacteria the chance to invade and take over. Let’s be careful and mindful about the ecosystems we create in our hands. Our goal is to make our hand ecosystems a uninhabitable place for bad microorganisms. We don’t want our hands to be like the Ritz Carlton Hotel that invites a plethora of organisms to stick around and populate the place.

When you talk about hand hygiene its imperative to mention Standard Precautions. All of our infection control practices hinge on the foundation of these Precautions. So, what are Standard Precautions? In the past you may have heard of universal precautions. I guess that title was too nebulous or intergalactic and too hard to understand because now, we just use the term- Standard Precautions. These  precautions are a set of infection control practices that those of us in the health and human services field should utilize to lower the transmission of microorganisms in the settings we work in. The nice thing about Standard precautions is, if followed, they protect both you and the person you’re taking care of. If you still are having a hard time understanding this concept. Just pretend in your mind that your patient has the bubonic plaque and you have the bubonic plague. Sorry for the graphic imagery. But if you picture this in your mind and treat each other according to this bubonic plague imagery it kind of drives home the importance of maintaining good hygiene practices. If you had the plague would you touch your spouse, child or patient without gloves? Of course you wouldn’t. On the flip side-if your patient had the plague would you not wash your hands after taking care of them? Again, of course you would wash thoroughly.  Now hear me out though- it doesn’t mean you are grossed out by your patient or client or make them feel like they are a diseased wretch. No, you must still honor and display compassion while discreetly and respectfully performing safe effective hygiene practices. Again- You have to have the “bubonic plague” mindset, imagery each and every minute. each and every day and with each and every person so that you stop the spread of infection.

So, what are the components of Standard Precautions? First and foremost these precautions are about utilizing appropriate hand hygiene-which this course is all about. Also Standard Precautions are about utilizing proper Personal Protective Equipment abbreviated PPE. Other aspects of Standard Precautions include the safe use and disposal of sharps.Practicing proper respiratory and cough etiquette. And the treatment and disposal of soiled equipment and materials. We need to make sure that you and I are using standard precautions when caring for patients and clients regardless of their diagnosis and whether or not the patient is known to have a communicable disease or infection. Again- I am going to keep banging this drum- Standard Precautions should be used for all patients, all the time.

Why do we wash our hands? Of course the answer is to get rid of germs, pathogens, dirt and grime. But what’s going on here at a microscopic level? In this section of the course, let’s talk about how your hands have the potential to spread infectious agents to you and the people you serve. There are two types of microflora present on the hands of all of us: Resident and Transient. Resident microflora populate the deep tissue layer of the skin and persist after hand hygiene practices. These microorganisms rarely ever transmit infection. Transient microflora, on the other hand, like hobos, hitch a ride on your hands and may remain viable in the moist warmth of your skin for up to several hours in the absence of good hand sanitation. In a clinic or hospital, it’s highly likely that a number of these hobo germs will culture out to be Staphylococcus, Pseudomonas, or other such insidious pathogens. As a health and humans services worker, you can easily pick up these traveling germs by making direct contact with an infected patient or with contaminated surfaces in the patient’s environment, such as their bedding, clothing, bedside furniture, or monitors positioned close to beds. Even those activities labeled “clean,” such as taking a pulse, repositioning a patient, or taking a blood pressure, have been documented to transmit harmful bacteria onto your hands. It’s these transient microbes that are most frequently implicated in cases of healthcare-associated infections. Cross-transmission is the transfer of infectious pathogens from one patient to another via our hands. According to the CDC, in order for cross-transmission to occur, the following sequence of events must take place: One: Organisms present on the skin or on environmental surfaces near Patient “A” must be transferred to the health worker’s hands. Two: Organisms must be able to survive on the hands for at least several minutes, sometimes longer. Three: The health worker must omit or inadequately perform hand antisepsis. Four: The health worker’s contaminated hands must come in direct contact with Patient B, or in some cases with an inanimate object that will come in direct contact with Patient B.

So, what are the odds of us transmitting harmful organisms to others? Several studies have been conducted to determine just how likely it is for a healthcare worker to pick up some transient pathogens. In one report quoted by the CDC, nurses picked up between 100 and 1,000 colony-forming units shortened to CFU’s of the Klebsiella species.  Klebsiella is a bacteria which is commonly found in normal skin flora. When this microorganism grows out of control, it leads to pneumonia, which is one of the leading healthcare-associated infections reported in the US. In 1991, N. Joel Ehrenkranz and colleagues discovered that despite hand washing with plain soap and water, nurses who touched intact skin in the groin area of a patient for 15 seconds subsequently transmitted gram-negative bacilli to catheter material. Elaine Larson and her fellow researchers concluded in the year 2000 that the number of pathogenic organisms present on intact areas of the skin of some patients can vary from 100 to 106 CFUs/cm2. Wow, we’re getting pretty technical. Also in 2000, Didier Pittet and his partners performed a landmark study at the University of Geneva. They reported that bacterial counts on healthcare workers’ fingertips ranged between 0 and 300 CFU after routine activities. Some of these activities included direct patient contact, wound care, intravascular catheter care, respiratory tract care, and handling patient secretions. They determined that the longer it took to attend to the patient, the greater the number of bacteria were present on the healthcare workers’ hands. There are more studies like these demonstrating that transmission of infectious pathogens does take place from patients to the hands of medical personnel. While most of these studies were not designed to appreciate whether this contamination resulted in transmission to another patient, it stands to reason that implementing proper hand hygiene before and after patient contact would reduce or eliminate any such risk. As you can imagine, if you’re not vigilant about observing proper hand hygiene practices, there are many opportunities throughout your busy shift in which you might possibly transmit harmful pathogens to your patients and clients.

So, why don’t we always wash our hands when dealing with clients and patients. Is there a cultural component, age of caregiver component, education component? Well, it isn’t as easy as it seems to identify the reasons why we aren’t washing our hands. The truth is there are many factors at play here. Evidence does point to generational factors- those who are newer in the healthcare and human services world have had hand washing pounded into their skulls since they started in their profession. On the other hand those who have worked for many years seem to be more meticulous and mindful of infection control practices because the seasoned workers have seen the horrors and effects of infection.  Interestingly we as health and human services workers also have preconceived notions and beliefs about cleanliness. Evidence supports that  hand washing was not always considered to be essential for certain types of physical contact with patients.Tasks that require non-intimate touching of a patient, like in the case of  measuring heart rate or blood pressure or use of inanimate objects such as touching clothing, medication, and clean linen, are less likely to be considered important motivating factors for hand washing.

We perceive the previously mentioned list of tasks to be clean activities or objects compared with tasks involving more‐prolonged physical contact. So basically what’s happening is in our minds we are building a case for what’s clean and for what’s dirty. Some tasks we determine as always dirty like when we are dealing with the groin area, genitals and armpits-this equates to an Emotionally Dirty Task. But others we consider clean and thus may not require a good hand washing. Ah ha! What’s happening is hand washing becomes an emotional issue and practice rather than scientific and evidence based practice.  When we start categorizing dirty and clean we lean on our own feelings- we should all know by now that we can’t trust feelings right. Didn’t your mother tell you that when you went on your first date?  Evidence shows that if a healthcare or human services worker does wash hands after a “supposed” clean procedure like feeling a pulse they don’t wash their hands as long or as effectively as when a “emotionally dirty” task is performed. Interesting, isn’t it? This may be one of the biggest reasons why we have problems with practicing proper hand hygiene. Guys, we must never look through the lenses of our own understanding or feelings about a certain cleanliness and dirtiness of a patient or environment. We need to remain objective and practice proper and effective hand hygiene practices in all cases. Did you get that? Key point alert! Be objective and never deviate from proper practices. Hand washing isn’t a choice- its mandatory. I think that is a good little tagline. Hand washing- it isn’t a choice-its mandatory.Got it! Oh yeah. Its mandatory! I like that. Can we see that again. So, why aren’t we washing our hands. Well, let’s find out.So what did you think of those results. I think we are kind of acting like babies. The sink is 3 feet away instead of 2 feet. I’m too busy. Poor us.  Listen guys-we can do better. Yes, we should advocate for non-caustic soups, more conveniently placed sinks, and better staffing ratios. Yes, all that’s good but what if it isn’t possible. We have to take that extra effort to make our hands clean. Come on people- let’s do this. OK,so maybe you are saying to yourself…but I didn’t touch the patient or client. Why should I practice hand hygiene? Well because bacteria can survive for DAYS on patient care equipment and other surfaces. Surfaces in the care environment – include bed rails, IV pumps, and even computer keyboards – are often contaminated with bacteria. It’s so important to practice hand hygiene after you leave the room or care environment, even if you only touched equipment or other surfaces. So be mindful of that fact that these germs can survive for awhile and they keep getting stronger, smarter and more adaptable to environments. So, lets do our part.

So, now I am going to completely insult your intelligence and show you how to wash your hands. I know you know how but please bare with me. If we were all doing it correctly then I wouldn’t have to show you this but the fact remains. Our hand hygiene sucks so just watch. Can we cue the cheesy early 90’s instructional video music please. Ok. Did everyone get that? If you didn’t go back and watch it in slow motion. SO, maybe you are saying to yourself. I need to improve my hand hand hygiene. Yes, you and I both do so then it begs the questions= when should we practice hand hygiene? The simple answer is all the time. But for simplicity sake lets break it down. First, practice hand hygiene whenever hands are: visibly dirty or contaminated. Before: having contact with patients, putting on gloves, inserting any invasive device manipulating an invasive device. After: having contact with a patient’s skin, having contact with bodily fluids or excretions, non-intact skin, wound dressings, contaminated items, having contact with inanimate objects near a patient or care area and after removing gloves. Did you know we practice hand hygiene about half the time we should. Guys. We have to change this, now! Let’s take some time to talk a little bit about the agents we use for washing our hands. First, I want to mention antimicrobial soap and water. Antimicrobial (Antiseptic) Soap & Water is. Indicated when hands are visibly contaminated or after glove use when exposed to spore-releasing bacteria, such as Clostridium difficult. Soap should contain an antiseptic agent such as triclosan or chlorhexidine gluconate. Use warm, not hot water. Lather and scrub, optimally for 30 to 60 seconds, no less than 15 seconds. The longer the scrubbing the better.
Alcohol is the industry standard for hand hygiene. Here are some good nuggets of information about alcohol and it’s use:
– it Should be used in concentrations of 65 to 95%
-It’s recommended to use at least 3 mL of hand sanitizer infused with alcohol to be effective
-Rubbing for 30 seconds with 70% alcohol kills 99.97% of bacteria; 60 seconds kills 99.99 to 99.999% of bacteria
-it Demonstrates killing action against bacteria such as MRSA, VRE, tuberculosis, various fungi, and some viruses such as  HIV, herpes, RSV, rhinovirus, influenza, and hepatitis.
-Its greatest action is against bacteria; slightly reduced against viruses
-it’s not indicated when hands are soiled
-alcohol isn’t effective against nor-uh-virus or Norwalk type viruses
-alcohol Demonstrates effectiveness against gram-positive and gram-negative vegetative bacteria (MRSA, VRE, Mycobacterium tuberculosis, and various fungi)
-it Demonstrates very poor activity against bacterial spores, protozoan, oocysts, and certain non-enveloped viruses.
-Alcohol Does not have appreciable residual activity, though repeated use can slow regrowth of flora to some degree
-However Infusion with triclosan or chlorohexidine gluconate can result in persistent residual activity

Let’s take a look at Chlorhexidine gluconate abbreviated (CHG). This agent can be infused in antiseptic soap and/or alcohol hand rub. It’s Immediate action is slower than alcohol, but it does offer substantial residual activity, even at lower concentrations which means it keeps killing and killing for a long time. Next to alcohol, CHG packs the most punch. There are some dangers of CHG. It has been known have a toxic effect in the ear. It’s not recommended for contact with eyes, brain tissue, or meninges. Triclosan is another common ingredient. Triclosan is an antimicrobial ingredient contained in a variety of products where it acts to slow or stop the growth of bacteria, fungi, and mildew. It is commonly used in antiseptic soap, alcohol hand rubs, wound dressings and bandages. Its greatest activity is again germs such as MRSA. Remember to mindful of what type of agents you use in your facility and do your own research about what will work best for you and your environment.

Every time you see a series of patients on your floor or visit with one of your clients, you probably follow a similar protocol with each one. By spending a few minutes before your shift analyzing the care activities for each patient, you might find several that you can group together in such a way as to cut down on the number of required hand hygiene indications. You may also discover natural places to pull out your hand sanitizer and rub it in without being conspicuous about it. Remember, your primary job is not only to bring safety and health to your clients but a sense of dignity and respect. You don’t want to start dousing your whole body with sanitizer. It could make your client feel ashamed or dirty. Just be discreet and open about your hand hygiene. If you’re faithful to integrate hand hygiene practices into habitual instances, you’ll be more likely to remember to make time for it during unusual, high-risk tasks. It’s clearly documented in research that with a greater demand for hand hygiene comes a decreased ability for healthcare and human services workers to find the time for it. This is one of the primary reasons why alcohol hand rubs are considered chief in hand decontamination. Whereas washing with soap and water can take one to two full minutes to be effective, rubbing 3 mL of alcohol into your hands for 30 to 60 seconds is sufficient to neutralize almost every kind of infectious agents you might be carrying around with you. Hand rubbing can be done while talking or walking and requires nothing more than easy access to a dispenser. There is less risk of recontamination, since there is no trash to discard and no faucets to turn off. Furthermore, alcohol hand rubs, which are now formulated with skin emollients, are the least likely of all antiseptic agents to cause dermatitis, another deterrent to proper hand washing. I’m sure at one time or another, you’ve experienced the agony of dermatitis; chapped and burning fissures along your knuckles and on the backs of your hands and fingers. At some point, it may have been nearly impossible for you to open and close your hands without that painful sting of cracked skin. When your hands are dry and nearly bleeding, the last thing you want to do is run them under water or rub stinging alcohol on them. Even putting on and taking off gloves can cause agony. It’s for this reason that using the right product for the job and taking appropriate preventative measures to protect your skin are so important. The right product is easy: Alcohol Hand Rubs. Clinical studies have demonstrated that alcohol hand rubs infused with emollients are the least likely among all antiseptic agents to cause dryness and irritation of your skin.

The CDC recommends washing your hands only after five to ten applications of alcohol hand rub. Washing after every application is unnecessary and can cause irritation and dryness of your skin. As I mentioned earlier, alcohol hand rubs will not work when your hands are heavily soiled. In this case you’ll want to wash with antimicrobial soap and warm water, not hot. Another way to combat skin irritation associated with performing proper hand hygiene is to use hand lotions. On the job, you’ll want to choose a water-based lotion, since oil-based products can inhibit the efficacy of certain antimicrobial agents, such as chlorhexidine, and also lead to deterioration of latex gloves. Studies indicate that applying hand cream as little as two times a day can prevent contact dermatitis. Of course, if you’re washing your hands 50 to 100 times a day, you may need to apply it a little more often. Just as finding the right opportunities to disinfect your hands may take a little advanced planning, so you might need some time to determine when it’ll work best for you to apply hand cream. You might consider applying lotion at home before you leave for work. You could also keep a bottle in your car to use just after your shift before you head home. It’s important that you have clean, dry hands before you apply lotion. If you need to apply hand cream in the midst of your shift, do so after sanitizing your hands. You might keep a bottle in your pocket or in your locker. You’ll want to apply it when you can give it sufficient time to soak into your hands before you have to wash or apply hand rub again. Perhaps just before you go on break.

We’ve learned a lot so far in this course. It comes down to a few principles or pillars to create a culture of hygiene. You can create this culture in yourself and amongst the people you work with. The first pillar you need to have in order for hand hygiene to be successful is the Correct Infrastructure. In this case- infrastructure deals with equipment and other environmental factors in the setting you work. Are sinks strategically placed in locations that make it easy to remember and wash? Are sinks the right height, working properly, well lit, etc, Is hand sanitizer or some other antiseptic aid available for use. Ensure that the place you work has the tools and systems available to you so that the work environment is safe and dedicated to high standards of hygiene. A second component or pillar to ushering in a culture of hygiene is education and training. That’s why we produced this class for you. We all need reminding about the importance of hand hygiene and the risks that we pose to others if proper procedures and protocols aren’t followed correctly. Building a strong and genuine institutional safety culture is inherently linked to effective educational interventions. Our recommendation here is that you watch this class every week. Ok not really. How about once a month that sounds good, doesn’t it? A third pillar is providing Friendly Reminders in the workplace. Reminders are key tools to prompt and remind us  about the importance of hand hygiene and the appropriate indications and techniques. For patients, reminders are means of informing them of the standard of care that they should expect from us as well as serving as an educational tool for family and friends when entering and leaving your facility.

Finally, it’s essential to have an evaluation process in order to monitor all your infrastructures, systems, educational programs and reminder literature. Do you have statistics and case studies you can evaluate? Maybe you can take an anonymous survey amongst your peers and coworkers about their hand hygiene practices. If you have data to look at study it and find areas of success and failures. If you have great successes with your hand hygiene programs and compliance then celebrate them. Wahoo! Throw a party or something. If you find failures in compliance then find solutions without punitive and punishing measures. Nobody likes a totalitarian regime that dominates, micromanages and promotes a hostile work environment. So, be very careful about instituting measures that instill fear and use punishment as motivating factors.

You’re now armed with an arsenal of information. You know that your health, and that of your patients and clients, is in your hands. You know when to disinfect your hands, why you must, and how to do it. You’ve learned a whole lot today about how infectious hobo germs have the potential to spread from one patient to another via our hands. You now know when and how to decontaminate your hands and the ways in which practicing proper hand hygiene can protect you and your patients from these hobo germs. You’ve also discovered that by integrating what you’ve learned today, Good Health is in Your Hands. Colleagues, trainees, and other staff watch what you do: Research has shown that the actions of clinicians influence the behavior of others. Show your colleagues that hand hygiene is an important part of quality care. Your patients & clients watch you too: Your actions send a powerful message.Show your patients that you are serious about their health. My final thought of the day- You have to have a culture of safety in your soul. This isn’t something that’s taught. It’s something that’s caught. There needs to be that thing inside you that says no matter what I do or where I go I’ll remain the same. There should be a refrain in your mind that says, “I will practice good infection control practices so that I can help reduce infection and save lives.” Listen, your actions or inactions matter. It shouldn’t make a difference if your boss or peers are monitoring you. Have integrity. Be the same person and follow good and safe practices from the first minute of your long shift to your very last. Thanks and have a great day.

Writers and References

Writer(s)Angela Magnotti Andrews & Donn Kropp, RN, BSN


  •  Association of Professionals in Infection Control and Epidemiology (APIC). “Hand Hygiene for Healthcare Workers.” Brochure sponsored by Kimberly-Clark, 2003.
  • Beggs, Clive B. and Shepherd, Simon J. and Kerr, Kevin G. “Increasing the frequency of hand washing by healthcare workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward.” BMC Infectious Disease 8 (2008): 114.
  • Boyce, John M. and Pittet, Didier. “Guidelines for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force,” last modified October 25, 2002, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm.
  • Joint Comission, The. “Measuring Hand Hygiene Adherence: Overcoming the Challenges.” Monograph authored by The Joint Commission in collaboration with other organizations. Oakbrook Terrace, Illinois, 2009.
  • Joint Commission Center for Transforming Healthcare. “Hand Hygiene Storyboard.” Published on the internet, date unknown. http://www.centerfortransforminghealthcare.org/assets/4/6/hand_hygiene_storyboard.pdf.
  • Klevens, Monina R. and Edwards, Jonathan R. and Richards, Chesley L., and Horan, Teresa C. and Gaynes, Robert P. and Pollock, Daniel A. and Cardo, Denise M. “Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Public Health Reports 122(2), March-April 2007: 160-166.
  • Lister, Joseph. “On the Antiseptic Principle in the Practice of Surgery.” The British Medical Journal 2 (351):245-260, September 21, 1867.
  • Mayo Clinic Staff. “Hand-washing: Do’s and don’ts.” Published on Mayo Clinic’s website on October 15, 2011.
  • http://www.mayoclinic.com/health/hand-washing/HQ00407/.
  • Pollack, Andrews. “Rising Threat of Infections Unfazed by Antibiotics.” New York Times, February 26, 2010.Rotter, M. “Hand washing and hand disinfection.” Hospital epidemiology and infection control 87, 1999.
  • World Health Organization. “WHO Guidelines on Hand Hygiene in Health Care.” Geneva, Switzerland, 2009.
  • Yokoe, Deborah S., et. al. “A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Hospitals.” Infection Control and Hospital Epidemiology, Vol 29, No. S1 (October 2008) (pp. S12-S21).



A Brief History

Length: 8 minutes

This lesson explores the history of germ theory and hand hygiene.

Hand Ecosystem

Length: 4 minutes

This lesson explores the complex and varied ecosystem that exists within our hands.

Conclusion & Final Quiz

Length: 25 minutes

This concludes our course on hand hygiene. Take the final quiz and get your certificate of completion!