Hand & Head Hygiene

Washing our hands is something we, as nurses, do many many times during the shift. Hand hygiene has become a fundamental activity to effectively prevent hospital associated infections.

There is evidence however that although we are improving our compliance with hand washing (that is, the number of washes per the number of actual opportunities), there remains room to improve on the fidelity (that is, the actual effectiveness or quality of the activity itself).

The main area for improvement seems to be the duration of the hand washing.
The recommenced duration of a hand wash should be 40–60 seconds.
Using an alcohol based hand rub should take 20–30 seconds.

20 to 60 seconds is probably a lot longer than you think when you are immersed in the kinetics of a typical shift. We need to slow down.

Wash your hands. Take a mental break.

By combining the activity of proper hand washing with personal mental hygiene, we open multiple opportunities during the shift to take a circuit-break from the buildup of overlaid tasks and distracting interruptions.
A few moments to slow down, relax and reset ourselves.

Developing a habit of slowing down the hand-wash event is good for our hands and good for our heads.

My friend Paul McNamara has written more about this here.

So, here’s the idea: if you’re going to do hand hygiene dozens of times a day anyway, don’t just do it for your patients: do it for yourself too. We’re not cold callous reptilian clinicians, we’re educated warm-blooded mammals who do emotional labour. We need to nurture ourselves if we are to safely continue to nurture others. –Paul McNamara

How to practice HAND & HEAD HYGIENE.

For a few moments we are away from all the rush and pressure as we stand alone at the sink moving our hands under the water.
It is one of the few moments during a typical shift that we are not in motion (at least not physically). This is a great opportunity to touch base with our state of mind and settle into the experience of mindfulness.

As you step up to wash your hands take a deep breath. Hand-washing is now a trigger to quiet your mind of all the thoughts racing around up there in your nurse head, and focus on this particular task.

handwash1

During the process of hand washing focus on your breath, just as you do during your meditation session. Again, the goal is not to slow or control you breath, but simply to become aware of it. To inhabit it.

Check that you are breathing down into your abdomen. Not just shallow breathing into the top of your chest.

Open your awareness to the sensations of the water on your hands. Experience its temperature, its slipperiness, the sensations as it tumbles amongst your fingers and over your hands.

Feel the soap as you apply it and lather it into your hands.Be aware of the sensations of contact between your hands and fingers and they interlace and rub against each other. Inhabit the feelings down in your fingers and hands as they move.

Maintain awareness of your breath throughout. If you want a specific guide on this, you want to be concentrating about 30% on your breath and 70% on the awareness of the hand- washing.

Continue to cultivate awareness as you rinse your hands and dry them. Really get into the whole activity. Remember it is going to take at least 30-60 seconds.

If your are really super crazy busy…it might need to take longer.

As you finish drying your hands, complete the exercise by returning your awareness to focus on your breath.

Now return your focus to your clinical activities.

Done.


Reference:

  1. “Hand Hygiene Australia – Fact Sheets”. 2016. Hha.Org.Au. http://www.hha.org.au/forconsumers/factsheets.aspx.
  2. Korhonen, Anne, Helena Ojanperä, Teija Puhto, Raija Järvinen, Pirjo Kejonen, and Arja Holopainen. 2015. “Adherence To Hand Hygiene Guidelines – Significance Of Measuring Fidelity”. Journal Of Clinical Nursing 24 (21–22): 3197–3205. doi:10.1111/jocn.12969.
  3. McNamara, Paul. 2016. “Hand Hygiene And Mindful Moments”. Meta4rn. https://meta4rn.com/2016/11/26/hygiene/.

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