How to Perform Hand Hygiene with Soap and Water

Learn how to perform hand hygiene with soap and water.

Handwashing is performed routinely by healthcare workers to help prevent the spread of germs. It is essential that nurses use proper technique when performing hand hygiene.

There are two ways to perform hand hygiene. This can be achieved by either using soap and water or an alcohol-based handrub (also called hand sanitizer or hand gel).

When should you perform hand hygiene?

Hand hygiene is ALWAYS performed:

before and after patient care
after coming into contact with any type of body fluid or open wound
after touching any object that is near a patient (hand railing, bedside table etc.)
after removing gloves
prior to eating
after using the bathroom

Now there are situations where you would use ONLY soap and water rather than an alcohol-based handrub. So, when MUST you use only soap and water to perform hand hygiene rather than an alcohol-based handrub?

According to the CDC.gov guidelines, you would use soap and water when:

hands are visibly dirty
after known or suspected exposure to Clostridium difficile (c. diff), if your facility is experiencing an outbreak or higher endemic rates
after known or suspected exposure to patients with infectious diarrhea during norovirus outbreaks
if exposure to Bacillus anthracis (anthrax) is suspected or proven
before eating
after using a restroom

(“Healthcare Providers | Hand Hygiene | CDC”, 2018)

How to Perform Hand Hygiene using Soap and Water

Supplies: soap, paper towels, and running water

Note: It’s best not to wear jewelry during patient care because it can harbor germs. Always check with your facilities protocols about their policy on jewelry because some areas like surgery may prohibit employees from wearing jewelry. If you can wear jewelry and it was worn during patient care (like a wedding band) keep it on during hand hygiene and make sure you clean the band and skin underneath. If you remove the band prior to handwashing and then put in back on after your hands are clean, you just recontaminated your hands.

Turn on the water (be very careful not to let your scrubs or lab coat touch the sink…it is very dirty). Some sinks have faucet handles while others are sensor-based or use a pedal. Turn on the water accordingly.
- Water should be warm (NOT too HOT this can damage the skin and dry it out)
Wet the wrists and hands and be sure to hold your hands lower than your elbows because you don’t want to spread the germs on your hands upward. Remember the hands are the lowest and dirtiest part during hand hygiene, and if you elevate the hands upward, all the germs on the hands will spread upward.
Put soap on your hands and wrists. This should be about 1 teaspoon, which is equal to 5 milliliters of soap. Most soap dispensers in the hospital are automative and will properly dispense the amount of soap you need to perform hand hygiene.
Lather the hands and wrists with the soap.
Scrubs the soap onto the hands by using circular/rotational motions on the following areas (NOTE: you want to cover all the areas of the hands, especially the small cervices because this is where bacteria like to hide). You will do this for 20 seconds:
- Palms
- Back of hands
- Thumbs and Fingers
- Between the fingers
- Knuckles
- Fingernails: pay special attention to this area by individually cleaning under the fingernails
- Wrist: go at least 1 inch ABOVE the wrist or the contamination
Rinse the soap off by allowing the water to flow downward off the hand (not upward) and be careful not to touch the sink.
Use a paper towel to dry the hands by dabbing each hand with the paper towel. Don’t rub it back and forth. This can damage the top layer of skin and lead to skin breakdown.
Once hands are dry, discard this paper towel. Use another paper towel that is dry to turn off the water (this step doesn’t apply if you are using a sensor-based sink or one with on and off foot pedals).
- WHY do you need to use another paper towel rather than the one you used to dry your hands? If you use the wet paper towel you just used to dry your hands, the germs from the dirty faucet handle may transfer through the wet paper towel to your clean hands.
Discard this towel.