AN
ASSIGNMENT
ON
FOUNDATIONS OF NURSING:
HAND WASHING TECHNIQUES
(PRESENTATION)
WRITTEN BY
GROUP 12
DEPARTMENT OF NURSING SCIENCE
FACULTY OF ALLIED MEDICAL SCIENCE
COLLEGE OF MEDICAL SCIENCE
UNIVERSITY OF CALABAR
SUBMITTED TO
MRS. PHILOMENA ATEH OBAJI
DEPARTMENT OF NURSING SCIENCE
IN PARTIAL FUFILLMENT OF THE COURSE REQUIREMENT FOR
NSC 211/201
MEMBERS OF GROUP 12
408 ODEY GRACE LEHI 24/022145485
409 ODEY JANET ECHAKA 24/022145486
410 ODOH VICTOR MMESOMA 24/022145487
411 ODOR EBUBE PROMISE 24/022145488
412 OFOEGBU FAVOUR NGOZIKA 24/022145490
413 OFORAH CHIAMAKA JENNIFER 24/022145491
414 OFORDI ARINZE VALERIAN 24/022145492
415 OFORKA CRYSTAL UJUNWA 24/022145493
416 OGAR JOEL INAKU 24/022145496
417 OGBA ANYA PRECIOUS UZUMMA 24/022145497
418 OGBE MARVELLOUS WEYINMI 24/022145498
419 OGBE NTINA OKAM 24/022145499
420 OGBODO MMESOMA NORAH 24/022145500
421 OGBONNA BLESSING 24/022145501
422 OGBONNA UGONNA ELIZABETH 24/022145502
423 OGBONNA WISDOM CHIMAOBI 24/022145503
424 OGBONNAYA PRECIOUS CHISOM 24/022145504
425 OGBU PECULIAR ENUWA 24/022145505
426 OGBUEHI CHIDERA MIRACLE 24/022145506
427 OGU HENRIETTA CHINWE 24/022145507
428 OGUERI DIVINE CHIMAMAKA 24/022145508
429 OGUEZUONU-NDUBUIZU ROSEMARY UGONNA 24/022145510
430 OGUNJOBI ENIOLA ELIZABETH 24/022145511
431 OHAGWA AMARACHI STEPHANIE 24/022145512
432 OHAGWA FAVOUR UGOCHINYERE 24/022145513
433 OHAMAZUE MIRACLE TOCHUKWU 24/022145514
434 OJEABULU ANGELA 24/022145515
435 OJEH OMOLERE KELLYANN 24/022145516
436 OJOTO EBERECHUKWU IJEOMA 24/022145517
437 OJU ACHIEVER USANG 24/022145518
438 OKACHE FIDELIA AGIDA 24/022145519
439 OKAFOR ALVINA CHETACHI 24/022145520
440 OKAFOR CHIOMA CHRISTIANA 24/022145522
441 OKAFOR CHISOM FRANCISCA 24/022145523
442 OKAFOR MARY EZINNE 24/022145525
443 OKAFOR PRAISE ADAOBI 24/022145526
444 OKAFOR VANESSA AMARACHI 24/022145527
INTRODUCTION
Hand hygiene is the single most important measure to reduce healthcare associated
infections[HAIS] it plays a significant role in maintaining personal hygiene, preventing the spread
of illnesses and promoting public health. Proper hand hygiene saves millions of lives yearly and
remains the cheapest, easiest and most effective measures to stop the spread of diseases.
Despite this, compliance among health care workers [HCWs] remains below 50% in many
facilities worldwide. This is largely due to persistent myths and technical errors as well as poor
background knowledge.
In nursing proper, hand hygiene is not just a skill, it is a lifesaving procedure that protects
both patients and healthcare workers from preventable infections. Understanding and practicing
the correct hand washing technique is a key responsibility for all nursing professionals. Our
presentation will cover the history importance, techniques, materials needed, myths and
measure barriers to effective handwashing
HISTORY OF HAND WASHING AND ITS DISCOVERY
Hand washing has been a part of human hygiene practices for thousands of years, before
scientific knowledge existed, it was mainly cultural and religious with ancient civilizations like
Egypt, Greece and Rome practicing basic hygiene using water and sometimes oils, but the link
between handwashing and disease prevention wasn’t understood.
Pre Ignaz pioneers
1. Girolamo Fracastoro (1546) theorized that infection could be spread by direct and
indirect contact including through hands and clothes
2. John Burton in 1751 stated that puerperal fever was a contagious disease
3. Alexander Gordon in 1795 described cases of puerperal sepsis and advocated for
hand washing to prevent it.
4. Oliver Wendell Holmes in 1843 theorized that physicians transmitted puerperal
fever from one patient to another via unwashed hands
IGNAZ SEMMELWEIS (1847): A Hungarian doctor who discovered how hand washing
dramatically reduced maternal deaths.
In 1847, Jakob kolletschka (1803-1847), one of semmelweis colleague, died after having
pricked his finger with the knife that was being used in the autopsy, developing the same
symptoms of puerperal fever, semmelweis noted the similarity between these circumstances and
he postulated that cadaverous particles from the morgue were to blame and that such particles
on the hands of doctors were making their way also into woman's bodies during childbirth.
He noticed that hand washing with chlorinated lime significantly reduced deaths from puerperal
fever (it is a bacterial infection that occurs in women after childbirth or miscarriage) in childbirth.
Therefore, he required students and doctors to wash their hands in a chlorinated lime solution
before every patient contact and in particular after leaving the autopsy room. Although he was
initially ignored until the Germ theory gained ground (by Pasteur Lister). His findings form the
foundation of modern infection prevention worldwide. He is the father of hand hygiene.
Hand washing may look simple today, but in the 1800s it was the ground breaking discovery that
saved lives.
Florence Nightingale: A British nurse during the Crimean war (1853-1856) put in place
rigorous hygiene practice in the British army hospitals at Scutar, Italy. At a time when many
believed infections were caused by “miasmas” (foul odors). Her focus on a healthy environment,
including clean air, clean water, effective sewage and general cleanliness, reduced infections
significantly. Her work laid the foundation for modern nursing and emphasized environmental
health as an indispensable requirement for patient recovery. Florence Nightingale wrote in her
book about nursing; Every nurse ought to be careful to wash her hands very frequently during
the day, if her face too, so much the better”
Louis Pasteur (1822-1895): during his investigation in the 1860 states the germ theory
stating that certain diseases are caused by the invasion of the body microorganisms -The 1861
publication of Pasteur's germ theory of diseases was a turning point in the development but
advances took many years to take effect
Joseph Lister: Introduced antiseptic surgery using carbolic acid to sterilize instrument and
wounds which further validated the germ theory and the importance of cleanliness in medical
procedures.
Now in the 21st century: The world Health Organization (WHO) introduced its multimodal
hand hygiene strategy to improve compliance through a combination of factors like education,
system changes and performance feedback especially during outbreaks like SARS-Severe Acute
Respiratory Syndrome (2003), Ebola (2014), COVID-19(2020). The widespread adoption of these
early hygiene practices took over a century. Today hygiene practice in nursing and health care
are evidence based and central to infection control guided by organizations like World Health
Organization (WHO) and the Centers for Disease Control and prevention (CDC).
MEANING OF HAND WASHING
Hand washing is the act of cleansing hands with soap and water or an alcohol based hand
sanitizer to remove dirt, microorganisms and other substances. The term “Hand Washing” is a
crucial habit that needs to be adopted in our daily lives, as it plays a significant role in maintaining
personal hygiene and preventing the spread of illnesses.
According to the World Health Organization (WHO), hand washing with soap and water can
reduce the risk of diarrhea diseases by up to 30% and respiratory infection by up to 20%. it is one
of the most important things you can do to prevent illness and stop germs from spreading.
IMPORTANCE OF HAND WASHING
Do you know that the simple act of hand washing with soap can potentially save more
lives globally than any single vaccine or medical intervention? Hand washing can impact our life’s
daily for the better and below are just a few of its many importance:
1. Prevents infections (germs and microorganisms)
2. Reduce illness transmission
3. Protects vulnerable population as it helps safe guard children, elderly or those with
weakened immune system.
4. Reduces antibiotic resistance
5. Improves/maintain personal hygiene
WHY HAND WASHING MATTERS
Hand washing is a crucial aspect of infection control, as it effectively removes pathogens,
including bacteria, viruses and fungi from the hands thereby reducing the risk of transmission in
patients, healthcare workers and the community
How Germs Spread
1. Germs (bacteria, viruses, fungi) are transferred mainly through contact transmission
(touching contaminated surfaces, shaking hands, touching face).
2. Droplet transmission occurs when someone coughs/sneezes into their hands and touches
objects afterward.
3. Everyday objects like phones, door handles, money, hospital equipment, and keyboards
can harbor pathogens for hours to days.
4. Poor hand hygiene makes the hands a vehicle for disease transmission from one person
to another.
Infections Prevented by Hand Washing
1. Respiratory infections: common cold, influenza, COVID-19.
2. Gastrointestinal infections: diarrheal diseases (e.g., E. coli, Salmonella, Shigella,
Rotavirus).
3. Hospital-acquired infections: MRSA, Clostridioides difficile.
4. Skin infections: fungal infections, Staphylococcal infections.
5. Regular hand washing reduces cross-contamination, especially in healthcare settings,
food handling, and childcare environments.
Statistical Evidence
1. Proper hand washing with soap can reduce diarrheal diseases by up to 40%.
2. It can reduce respiratory infections by about 20–25%.
3. WHO reports that effective hand hygiene can prevent over 50% of avoidable healthcare-
associated infections.
4. Studies show that healthcare workers practicing correct hand hygiene significantly reduce
patient morbidity and mortality.
WHEN TO WASH OUR HANDS
WHO “Five Moments for Hand Hygiene”
The World Health Organization (WHO) specifies five essential moments when hand hygiene
should be performed to minimize the spread of infection:
1. Before touching a patient – to prevent transmission of harmful microorganisms to the patient.
2. Before clean or aseptic procedures – such as administering injections, preparing medications,
or dressing wounds.
3. After exposure to body fluids – including blood, secretions, or other potentially infectious
materials.
4. After touching a patient – to avoid transferring germs to oneself, surfaces, or others.
5. After touching patient surroundings – including bed rails, medical equipment, and nearby
surfaces.
Everyday Triggers for Handwashing
Hand hygiene is important in routine daily activities to reduce microbial transmission. Key
moments include:
1. After using the toilet.
2. Before preparing, serving, or consuming food.
3. After coughing, sneezing, or blowing the nose.
4. After handling animals or animal waste.
5. After touching garbage or dirty surfaces.
6. When hands are visibly dirty or sticky.
7. After returning from public spaces such as school, markets, or public transport.
Special Situations Requiring Enhanced Hand Hygiene
1. Handwashing is also critical in situations with increased risk of infection.
2. During disease outbreaks, such as influenza or gastrointestinal infections.
3. Before and after caring for someone who is sick, especially those with respiratory or diarrheal
symptoms.
4. Before and after treating wounds, cuts, or applying dressings.
5. After changing diapers or cleaning up after a child who has used the handling.
6. After handling raw meat, poultry, fish, or eggs during cooking.
7. After contacting high-touch public surfaces, such as elevator buttons, ATM keypads, and door
handles.
TYPES OF HAND WASHING TECHNIQUES AND PROPER HAND WASHING
TECHNIQUES
Types of Handwashing Techniques
1. Social / Routine Handwashing
Definition: Basic hand washing with soap and water to remove dirt, organic material, and
transient microorganisms. Used in: General public, before eating, after using the toilet,
before/after routine care in healthcare.
Advantages
1. Removes visible dirt and most transient microorganisms.
2. Reduces spread of common infections.
3. Simple and inexpensive.
Disadvantages
1. Less effective against some pathogens (e.g., spores).
2. Requires clean running water.
3. Technique errors reduce effectiveness.
2. Hygienic / Antiseptic Handwashing
Definition: Handwashing with antimicrobial soap (e.g., chlorhexidine, iodine-based soap).
Used in: Healthcare settings before procedures, when caring for vulnerable patients, or during
outbreaks.
Advantages
1. More effective in reducing bacterial load than routine washing.
2. Provides some residual antimicrobial activity (depending on product).
3. Useful when soap and water alone are not enough.
Disadvantages
1. Can cause skin irritation with frequent use.
2. More expensive than regular soap.
3. Not always necessary for non-clinical use.
3. Hand Rubbing with Alcohol-Based Hand Sanitizer (ABHR)
Definition: Cleaning hands by applying an alcohol-based formulation (60–95% alcohol).
Advantages
1. Very effective at killing most bacteria, viruses, and fungi.
2. Quick (20–30 seconds).
3. No water required—good for low-water settings.
4. Minimal skin irritation compared to antiseptic soap.
Disadvantages
1. Ineffective on visibly dirty or greasy hands.
2. Ineffective against certain organisms (e.g., norovirus, C. difficile spores).
3. Flammable; requires safe storage.
4. Can be harmful if ingested (children risk).
4. Surgical Handwashing / Surgical Hand Scrub
Definition: A prolonged technique using antimicrobial soap or alcohol-based surgical rub before
surgical procedures.
Advantages
1. Dramatically reduces resident and transient flora.
2. Provides long-lasting antimicrobial protection during surgery.
Disadvantages
1. Time-consuming compared to other methods.
2. May cause skin dryness and irritation.
3. Requires specialized products and training.
Proper Hand-Washing Technique (WHO Standard – 40–60 seconds)
1. Wet hands with clean, running water (warm or cold), then apply enough soap to cover all hand
surfaces.
2. Rub palms together to create lather.
3. Right palm over left dorsum and left palm over right dorsum with fingers interlaced.
4. Palm to palm with fingers interlaced to clean between the fingers.
5. Backs of fingers to opposing palms with fingers interlocked.
6. Rotational rubbing of both thumbs clasped in the opposite hand.
7. Rotational rubbing on palms using fingertips to clean under the nails.
8. Rinse hands thoroughly under clean, running water.
9. Dry hands with a clean towel or air dryer.
10. Use the towel to turn off the tap to avoid re-contamination
However, it is important to note that:
o The entire process should take 40–60 seconds with soap and water.
o Use alcohol-based hand sanitizer (60–70% alcohol) only when hands are not visibly soiled.
o Keep nails short and avoid wearing rings or bracelets when providing clinical care, as they harbour
microorganisms.
Materials Needed for Proper Hand
1. Soap: Washing Soap is essential for removing dirt, grease, and germs from your hands.
Whether it's bar soap or liquid soap, both are effective.
The types of soap Include:
- Liquid soap is often preferred in public settings because it’s more hygienic—multiple users
can access it without contamination.
- Bar soap works just as well, provided it’s stored properly—kept dry and not left in standing
water.
- Antibacterial soap is typically reserved for hospitals or high-risk environments. For everyday
use, regular soap is perfectly sufficient
2. Clean Water: Water is crucial for rinsing away loosened dirt, soap, and germs.
- Running water is ideal because it washes contaminants off your hands completely.
- If running water isn’t available, clean stored water from a container with a tap is a good
alternative—just make sure the water source stays uncontaminated.
- Temperature doesn’t matter much—cold or warm water are equally effective. Warm
water may simply feel more pleasant. Without clean water, even the best soap can’t do its job
properly—residue and germs may remain on your skin
3. Towels and Hand Dryers: Drying your hands is just as important as washing them—
germs spread more easily on wet skin.
- Disposable paper towels are the most hygienic option. They’re single-use and reduce
the risk of recontamination.
- Clean cloth towels are suitable for home use, but they must be washed frequently to
prevent germ buildup.
- Air dryers are common in public restrooms. They eliminate the need for contact, but it’s
best to avoid touching surfaces afterward. Thorough drying helps maintain clean hands and
prevents the spread of germs.
4. Hand Sanitizer: it is a convenient alternative when soap and water aren’t available.
- Choose a sanitizer with at least 60% alcohol to ensure it’s effective against most germs.
- It’s especially useful in schools, hospitals, markets, or while traveling.
- However, it does not remove visible dirt or grease—in such cases, hand washing is still
necessary.
Common Myths and Mistakes
1) Misconception About Alcohol-Based Hand Rubs/Sanitizers (ABHRs): In
healthcare/hospital, many workers believe sanitizers are universally superior and can
replace handwashing in all situations. This is a dangerous myth that contributes directly
to outbreaks. ABHRs are ineffective against spore-forming organisms. E.g. (Clostridioides
difficile)
2) Insufficient Duration of Hand Procedure: WHO recommends 20-30 secs for hand
sanitizer and 40-60secs for hand washing with soaps in healthcare settings. Observational
studies consistently show average duration is 9-15 seconds. However, many people wash
for less than 7seconds which is not enough to remove pathogens effectively.
3) Missing Key Hand Area: Fluorescent marker studies in hospital repeatedly show the same
areas are missed in 80-95% of hand hygiene events. The areas which harbors the highest
microbial load after patient contacts are:
a. Thumbs
b. Finger tips and Nail beds
c. Interdigital spaces
d. Wrists
e. Back of hands
Barriers to Effective Hand Washing
1. Lack of Facilities: Some environments lack running water, soap, or hand-drying materials,
making effective handwashing difficult. Poorly maintained sinks, broken taps, or long
distances from work areas discourage people from washing their hands.
2. Time Constraints: People often skip hand washing because they feel too busy or are under
work pressure.
Health workers in particular experience high workloads, leading to reduced compliance with
proper hand hygiene.
3. Skin Irritation Issues: Frequent washing or use of harsh soaps can cause dryness, cracking, and
dermatitis, making hand washing uncomfortable.
Individuals with sensitive skin may avoid washing hands regularly to prevent irritation.
4. Behavioral Factors: Forgetfulness, laziness, or lack of awareness of the importance of hand
washing reduce compliance. Some people underestimate risks because they cannot see germs,
so they do not feel the need to wash hands.
Cultural habits and personal attitudes also influence hand-washing behavior.
CONCLUSION
Hand washing remains one of the most effective, simplest, and cheapest measures for preventing
infections and promoting patient safety in healthcare settings. Its importance has been repeatedly proven
from the early discoveries of pioneers like Ignaz Semmelweis and Florence Nightingale to modern
evidence-based guidelines by the WHO and CDC. Proper hand hygiene breaks the chain of infection,
protects both patients and healthcare workers, and reduces the spread of life-threatening diseases within
hospitals and the community.
Understanding when, why, and how to wash hands correctly is a core responsibility of every nursing
professional. With the right technique, appropriate materials, and consistent practice, hand washing
significantly reduces healthcare-associated infections and improves overall public health outcomes.
Therefore, maintaining strict hand hygiene is not just a routine task—it is a vital nursing practice that saves
lives and upholds the highest standards of patient care.
REFERENCES
World Health Organization. (2009). WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety
Challenge—Clean Care is Safer Care. World Health Organization. 2. Centers for Disease Control and Prevention.
(2020). When and How to Wash Your Hands. U.S. Department of Health and Human Services. 3. Boyce, J. M., & Pittet,
D. (2002). Guideline for Hand Hygiene in Health-Care Settings. Morbidity and Mortality Weekly Report, 51(RR-16), 1–
45. 4. World Health Organization. (2006). Five Moments for Hand Hygiene. WHO Patient Safety Initiative.
WorldHealth Organization (2020). Hand Hygiene: Why, How, and When to WashHands.- Centers for Disease Control
and Prevention (2023). Handwashing: Clean Hands Save Lives.- UNICEF(2016). Water, Sanitation, and Hygiene
(WASH) in Schools. World Health Organization (WHO, 2009). Guidelines on Hand Hygiene in Health Care. Pittet, D. et
al. (2000). Compliance with handwashing in a teaching hospital. Annals of Internal [Link], E. (1999). Skin
reactions related to hand hygiene practices. American Journal of Infection Control.
CDC (Centers for Disease Control and Prevention, 2020). Hand Hygiene in Healthcare Settings