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From hand-washing to hand hygiene

Monday April 28, 2014
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There has been an emphasis on the importance of proper hand-washing for healthcare providers since the Nightingale era. As recently as the middle of the 20th century, however, proper hand-washing often entailed little more than the use of a water basin outside the room of a patient who was on isolation precautions.

I remember taking care of a teenager with meningitis in such a room when I was a student in a large city hospital. I can still remember washing my hands in the basin outside the door when the parents arrived to see their child.

Before the 1980s, standard precautions as we know them did not exist. We did not use gloves unless we were involved in a sterile procedure. With the onset of AIDS, everyone became more aware of the need for infection control. I still have fond memories of an instructor who insisted that anything dropped on the floor (pencils, pens, lipstick, etc.) had to be wiped down with an alcohol sponge before it could be used again. She carried out her mission faithfully! We students made sure we had a pocketful of alcohol wipes before attending her classes.

Even the hairdresser who came to cut and wash patients’ hair at a rehabilitation facility where I worked had to be instructed in hand-washing and infection control techniques to prevent contamination. People had the mindset that if you had to use precautions in any way, there must be something terribly wrong with the patient. They did not understand that these were preventive measures for everyone. We appropriately used the term “universal precautions,” but the hairdresser did not want to have anything to do with this process and unfortunately opted not to come to the facility anymore.

Nursing students have learned the basic skill of hand-washing for decades and will continue to do so. Scientific advances have made the process more convenient with the advent of alcohol-based hand rubs that do not require water. The term hand hygiene is used for the practice of maintaining infection control through hand-washing or hand-rubbing.

Since nursing care is an evidence-based practice, there must be facts to support hand rubbing as an effective procedure. The CDC’s guideline on “Hand Hygiene in Healthcare Settings” (www.cdc.gov/handhygiene) presents details and figures supporting the practice of hand-rubbing.

It is reasonable to expect even more changes and scientific advances. “We’re not sure what the future holds,” said John Jernigan, MD, MS, a medical epidemiologist and director of the Office of Healthcare Associated Infections Prevention Research and Evaluation at the CDC. “The benefit of agents that have persistent effect could be an area of study. Novel and effective approaches to measuring adherence to hand hygiene may also be important.”

The early hygiene teachings of Florence Nightingale remain true and can continue to benefit those of us who desire to follow in her footsteps today. Soap and water are good for good health.

— Geraldine Hannon, RN, MEd, with Alli Lankford, SN
Dutchess BOCES LPN Program
Poughkeepsie, N.Y.


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