How long should the nurse rub the hands together when using soap and water?

This article describes when and how to wash your hands effectively. Healthcare-associated infections are a risk to patients and service users, and nurses have a duty of care to protect these individuals from preventable infections. Nurses should practise good infection prevention, the basis of which is effective hand hygiene.

The nurse should understand the importance of handwashing for infection prevention.

The nurse should know when to wash their hands and the steps involved in effective handwashing using soap and water or hand cleansing using alcohol hand gel.

Reflective activity

Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of:

The circumstances in which is it not appropriate to use alcohol hand gel and why.

The reasons why adherence to recommended hand hygiene practice might be low in modern healthcare settings.

The ‘five moments for hand hygiene’ described by the World Health Organization and the risks of hand contamination.

Subscribers can upload their reflective accounts at:rcni.com/portfolio.

Nursing Standard. 30, 3, 34-36. doi: 10.7748/ns.30.3.34.e9691

m.d.hillier@salford.ac.uk

All articles are subject to external double-blind peer review and checked for plagiarism using automated software.

As you go about your everyday life, germs accumulate on your hands. After you touch your eyes, nose or mouth, germs carried there can cause infections. Frequent hand washing is one of the best ways to avoid getting sick and spreading illness.

Good hand hygiene

If you care for babies, older people or sick people, hand washing is especially important because it helps prevent the spread of infections such as COVID-19, colds, the flu and gastroenteritis.

Babies and children need to wash their hands too. If your child is too young to stand at a hand basin, you can wash their hands with disposable wipes or a wet, soapy flannel, but always make sure all soap is rinsed off and their hands thoroughly dried.

Hand washing is also one of the most important ways to prevent the spread of infection among people in hospital. People’s immune systems are often weakened after illness or surgery, so infections are easy to catch and hard to treat. They may become life-threatening.

When to wash your hands

Wash your hands before touching anything that needs to stay clean, and after touching anything that might contaminate your hands.

Examples include:

• when your hands are visibly dirty
• after going to the toilet
• after helping a child go to the toilet, or changing a nappy
• after handling rubbish, household or garden chemicals, or anything that could be contaminated
• before you prepare or eat food
• after touching raw meat
• after blowing your nose or sneezing, or wiping a child’s nose
• after patting an animal
• after cleaning up blood, vomit or other body fluids
• after cleaning the bathroom
• before and after you visit a sick person in hospital
• before and after touching a wound, cut or rash
• before breastfeeding or feeding a child
• before giving medication or applying ointment
• when holding a sick child

Hand washing tips

Warm, soapy water is the best option for washing your hands when they are visibly dirty. Follow these simple tips on good hand hygiene.

To wash your hands:

1. Wet hands with running water [preferably warm].
2. Apply soap or liquid soap – enough to cover all of your hands. Normal soap is just as good as antibacterial soap.
3. Rub your hands together for at least 20 seconds.
4. Make sure you cover all surfaces, including the backs of your hands and in between your fingers.
5. Rinse hands, making sure you remove all soap, and turn off the tap using the towel or paper towel.
6. Dry your hands thoroughly with a paper towel, a clean hand towel or an air dryer if you are in a public toilet.

Using a waterless hand sanitiser

An alcohol-based hand rub [hand sanitiser] is a good way to clean your hands if you don't have access to soap and water. Hand sanitiser is only effective if your hands have no visible dirt on them.

To use hand sanitiser:

1. Put about half a teaspoon of the product in the palm of your hand, rub your hands together, covering all the surfaces of your hand, including between your fingers.
2. Keep rubbing until your hands are dry [about 20 to 30 seconds].

Alcohol-based hand sanitiser can be poisonous if swallowed. Follow these tips to keep kids safe around hand sanitiser.