Hand Hygiene for BSc Nursing 2nd Year
(KUHS/INC Syllabus)
1 Introduction to Hand Hygiene
Hand hygiene is a fundamental practice in infection control within healthcare settings.
It is the most effective measure to prevent healthcare-associated infections (HAIs) by
interrupting the chain of infection. For BSc Nursing students under the Kerala Univer-
sity of Health Sciences (KUHS) and Indian Nursing Council (INC) curriculum, master-
ing hand hygiene is essential for ensuring safe and high-quality patient care.
2 Importance in Infection Control
Hand hygiene prevents the transmission of pathogens, including bacteria, viruses, and
fungi, which can spread through direct contact, contaminated surfaces, or medical
equipment. According to the World Health Organization (WHO), proper hand hygiene
can reduce HAIs by up to 50%. Key benefits include:
• Breaking the Chain of Infection: Hands are a primary mode of transmission for
pathogens such as Staphylococcus aureus, Escherichia coli, and Pseudomonas
aeruginosa.
• Protecting Patients and Healthcare Workers: Reduces cross-contamination
risks among patients, healthcare staff, and visitors.
• Compliance with Standards: Adheres to INC and WHO guidelines for infection
control in clinical practice.
3 Types of Hand Hygiene
Hand hygiene practices vary based on the clinical context:
1. Routine Hand Washing: Uses soap and water to remove dirt, organic material,
and transient microorganisms.
2. Antiseptic Hand Washing: Employs antimicrobial soap for enhanced disinfec-
tion, typically before invasive procedures.
3. Alcohol-Based Hand Rub: A rapid method using sanitizers with at least 60%
alcohol when hands are not visibly soiled.
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4. Surgical Hand Scrub: A thorough procedure using antiseptic solutions before
surgical interventions to eliminate transient and reduce resident flora.
4 Procedure for Hand Washing
The WHOs “5 Moments for Hand Hygiene” guide when hand hygiene is critical:
1. Before touching a patient.
2. Before clean/aseptic procedures.
3. After body fluid exposure risk.
4. After touching a patient.
5. After touching patient surroundings.
4.1 Steps for Effective Hand Washing
1. Preparation: Remove jewelry, roll up sleeves, and ensure nails are short.
2. Wetting Hands: Wet hands with clean, running water (warm or cold).
3. Applying Soap: Use sufficient soap to cover all hand surfaces.
4. Scrubbing: Rub hands palm to palm, backs of hands, between fingers, under
nails, and wrists for at least 20 seconds.
5. Rinsing: Rinse thoroughly under running water to remove soap and debris.
6. Drying: Use a clean, disposable towel or air dryer to dry hands completely.
7. Turning Off Faucet: Use a towel to turn off the faucet to avoid recontamination.
Duration: 40–60 seconds for routine hand washing.
5 Use of Alcohol-Based Hand Rub
• When to Use: When hands are not visibly soiled, for rapid disinfection.
• Procedure:
1. Dispense 2–3 mL of alcohol-based hand rub into the palm.
2. Rub hands together, covering all surfaces, including fingers and wrists.
3. Continue rubbing until hands are dry (15–20 seconds).
• Advantages: Faster, more convenient, and effective against most pathogens.
• Limitations: Ineffective against Clostridium difficile spores and certain non-
enveloped viruses (e.g., norovirus).
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6 Common Microorganisms and Hand Hygiene
Hand hygiene targets both transient and resident flora:
• Transient Flora: Microorganisms like Staphylococcus aureus, Escherichia coli,
and Klebsiella pneumoniae, acquired from the environment or patients. These
are easily removed by hand washing or sanitizing.
• Resident Flora: Normal skin flora, such as Staphylococcus epidermidis, which
are harder to remove but less likely to cause infections.
• Pathogens of Concern: Methicillin-resistant Staphylococcus aureus (MRSA),
Clostridium difficile, and multidrug-resistant organisms (MDROs) require strict
adherence to hand hygiene protocols.
7 Guidelines and Protocols
• WHO Guidelines: Emphasize the “5 Moments” and standardized hand hygiene
techniques.
• CDC Recommendations: Promote alcohol-based hand rubs as the preferred
method in most clinical situations unless hands are visibly soiled.
• INC and KUHS Standards: Require nursing students to demonstrate compe-
tency in hand hygiene during clinical training, adhering to infection control poli-
cies.
• Personal Protective Equipment (PPE): Hand hygiene is mandatory before don-
ning and after doffing PPE to prevent contamination.
8 Practical Applications in Nursing
• Clinical Practice: Nurses must perform hand hygiene before and after patient
contact, during medication administration, and when handling invasive devices
(e.g., catheters, IV lines).
• Patient Education: Educate patients and families on hand hygiene to prevent
community-acquired infections.
• Infection Control Audits: Nurses participate in monitoring compliance with
hand hygiene protocols in healthcare facilities.
• Preventing HAIs: Proper hand hygiene reduces the incidence of HAIs, such as
urinary tract infections, surgical site infections, and ventilator-associated pneu-
monia.
9 Conclusion
Hand hygiene is a critical skill for BSc Nursing students, forming the foundation of
infection control in healthcare settings. By adhering to standardized procedures and
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guidelines, nurses can significantly reduce the risk of HAIs, ensuring patient safety
and quality care. Regular practice and adherence to protocols are essential for clinical
competency as per KUHS and INC standards.
