The topic of hand hygiene has always been important for healthcare workers. It can have a big impact on your health, your patient’s health, and even the health of your family. While handwashing may not seem like a big deal, keep in mind that hand hygiene is the foundation of many healthcare infection control programs. Below you will get a reminder about proper hand washing steps including an answer to the question: “how long should you wash your hands?”
Over the past few years paramedics, emergency medical technicians (EMTs) and other healthcare workers have gotten bad press because of poor handwashing practices. They have even found increased infection rates among patients transported by ALS ambulances.
The 2015 study Hand Washing Practices Among Emergency Medical Services Providers concluded that pre-hospital providers do have poor hand hygiene. They also stated there is a need for interventions to improve EMS handwashing. JEMS also featured an article about a hand hygiene study that was done by paramedic students. The students observed paramedic’s hand washing habits, and the results are disturbing.
EMS Hand Hygiene
If you are the kind of EMT who thinks that handwashing is over rated and no big deal, you need to change your mindset. This kind of thinking is short sighted and it gives EMTs a bad name. The good news is, you are here now and hopefully the information found here will motivate a change in your handwashing habits.
Here is an interesting video with some helpful information on handwashing.
Wash Your Hands Video
A simple change EMS can make is to recognize that body substance isolation (BSI), gloves and hand hygiene are not just about protecting you, the medical provider. They are also for protecting your patients.
Do you remember saying BSI and Scene Safe constantly throughout school and at testing stations? If you were only thinking about protecting yourself, it’s time to expand your understanding of BSI and why healthcare workers wear gloves. Hand hygiene is the first step in disease prevention and EMS as a whole needs to do a better job at it.
Infection control is part of an EMTs job, and developing a habit of good hygiene can help you be a better EMT. Also, EMS who want to be taken more seriously should demonstrate a basic understanding of handwashing as disease prevention. When EMTs drop off patients in the ED and do quick six second hand washes in the sink, it shows misunderstanding and a lack of knowledge.
Handwashing – An Easy Skill to Improve
Ok, now that it’s clear how important hand hygiene is and that EMS has a problem using proper hand washing techniques, lets get to some good news. This is an easy problem to solve!
You can begin working on it today and soon you will be able to wash your hands like an expert. Handwashing is a skill that you can excel in with very little practice. In nursing school handwashing was not just a topic we were taught, it was a skill test we had to pass.
They used that UV glow stuff on our hands and we had to show proper hand washing and then pass the blacklight test. Seeing the glow test was first time I understood that quick soap and water handwashing didn’t actually clean my hands.
Not only is hand hygiene something you can become proficient in quickly, it’s also a skill you will constantly be using to help your patients and yourself.
Proper hand washing is one of the simplest, least expensive things you can do to prevent the spread of healthcare related infections. Hand hygiene is also a significant contributor to patient safety. This means as an EMT, you are putting a patient at risk if you don’t wash your hands between patients.
The fastest way to cure an infection is by preventing it from happening in the first place.
Hand Hygiene and handwashing Explained
The terms hand hygiene and handwashing are frequently used here. It’s important to note that every time I use the phrase “wash your hands”, it doesn’t mean go find a sink with soap and water. Using a hand sanitizer is also considered washing your hands.
Hand hygiene for paramedics, EMTs and other EMS includes using any of the following methods to clean or wash your hands.
Handwashing using soap and water
Antiseptic hand wash or lotions (waterless)
Alcohol based gel hand sanitizer
Alcohol based foam hand sanitizer
Other approved antiseptic hand rubs
Some EMS have the misguided idea that wearing gloves means they don’t need to use proper hand washing techniques. This is the “I wear gloves so I’m safe” attitude. The first problem with that mentality is that handwashing isn’t just to keep the healthcare worker safe. It is also about preventing the spread of infection and disease to patients.
Second, gloves are meant to be used in addition to handwashing, not instead of. Using gloves does not provide complete protection. During routine patient care it’s common to touch items and spread the germs from your gloves onto equipment like your stethoscope, blood pressure cuff, pen, clipboard, pulse ox, etc. Everything that comes in contact with your gloves or with the patient and the patient’s immediate environment is no longer clean.
Another common misconception is that disease causing bacteria can only be found in bodily fluids like feces, urine, blood and open wounds. However, MRSA bacteria colonization has been found at various sites on patient’s bodies. Not just in fluids.
This includes innocuous sites like the wrists, hands and forehead. Skin to skin contact during a typical patient encounter can easily transmit bacteria onto EMS workers. Added to this risk is the exposure from touching door knobs, the patient’s belongings and other contaminated items.
Hand Washing Steps Using Soap and Water
Here are the recommended hand washing steps when using a sink with soap and water to wash your hands. These hand washing steps are the same for healthcare workers and everyone else. Try to get in the habit of good handwashing whether you are at work or using the bathroom at a movie theater. EMS have been known to have issues with hand hygiene both on and off work.
√ Wet hands under running water and apply soap.
√ Work soap into a rich lather, working it onto the backs of hands and in between each finger. It’s important to get soap under nails and onto fingertips. (These are places germs can hide and may survive improper handwashing.)
√ Rub hands together vigorously for at least 15-20 seconds covering all surfaces before rinsing.
√ Rinse thoroughly under clean running water that’s at a comfortable temperature. Avoid hot water because it can lead to dermatitis and cause hand cracking, which can put you more at risk for disease transmission.
√ Dry with paper towel by gently patting hands and use a paper towel to turn off the water. Don’t touch the handle with your hands.
Alcohol based sanitizers are the preferred hand hygiene method for EMS when hands aren’t visibly soiled. (Unless there was exposure to a pathogen like Clostridium Difficile) (C-diff).
When Should You Wash With Soap and Water?
The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) both recommend washing hands with soap and water when they are visibly soiled with blood or other bodily fluids. Here is a list of recommended times to wash your hands with soap and water.
- When hands are visibly soiled.
- After suspected or known exposure to infectious diarrhea.
- If you suspect clostridium difficile (c-diff).
- Before eating.
- After using restroom.
- Suspected or known exposure to other serious pathogens.
Use the following tips for help with proper hand washing when using soap and water.
→ Use the palm of one hand to rub the back of your other hand. Do this to clean the back of each hand.
→ Take each thumb and rub them in the palm of your other hand, making small circles. This helps clean the thumbs.
→ Place your palms against each other and slide the fingers of each hand through each other, rubbing them up and down. This helps clean between the fingers.
→ Don’t forget to clean both wrists.
Hand Washing Steps Using Alcohol Based Hand Sanitizers
The CDC recommends an alcohol based hand sanitizer for routinely sanitizing hands if they are not visibly soiled. When following the hand washing steps with a hand sanitizer, it’s good to know that how well the sanitizer works is directly related to how much sanitizer is applied to your hands.
√ Apply the sanitizer into the palm of one hand. Dispense enough to thoroughly cover hands.
√ Rub hands together covering the backs of hands, wrists, between fingers and under fingernails.
√ Rub the sanitizer into hands until it’s completely gone and hands are dry – about 15-20 seconds.
Some areas that healthcare workers often miss when using hand sanitizers are:
• Between the fingers
• The fingertips
• The thumbs
Pay attention the next time you clean your hands and see if these areas get missed.
Why are alcohol based sanitizers the preferred method for healthcare workers?
→ They are faster.
→ Are more accessible than sinks, you can even carry them in your pockets.
→ Are more effective than soap and water at killing potentially deadly germs.
→ Decrease the bacteria count on EMS worker’s hands.
→ Can cause less irritation and dryness than soap and water.
How Long Should You Wash Your Hands?
Hand hygiene recommendations say to spend at least 15 – 20 seconds rubbing hands together vigorously with soap and water. However, the CDC says to pay attention to the “at least” portion of the handwashing recommendation and focus on spending as long as it takes to get your hands clean. In general they say 20 seconds is about the time it takes to sing the Happy Birthday song twice.
Benefits of Handwashing
√ Reduces the risk of spreading infectious bacteria to patients and causing potentially deadly complications later on.
√ Reduces the risk of EMS personnel acquiring infections from patient.
√ Prevents spreading flu and other illness’ from person to person.
√ Creates a safer work environment. This is especially important for EMTs working on an ambulance together.
√ Prevents common eye infections including pink eye and styes.
√ Decreases the bacteria you bring home to family and friends. Proper hand washing will dramatically decrease the bacteria count on your hands. These bacteria can live for days and get transferred to your household and family members. Wash your hands when you finish out a shift so you don’t bring weird germs home.
→ According to the CDC, hand hygiene in healthcare settings can prevent the spread of potentially fatal infections from: patient to healthcare worker, healthcare worker to patient, and even patient to patient.
→ Alcohol based hand sanitizers do not cause antibiotic resistance. Alcohols can denature proteins and kill germs differently than antibiotics. They do it too quickly for germs to adapt or develop any sort of resistance.
→ If exposure to a pathogen like C-difficile is possible, the CDC recommends using soap and water over a hand sanitizer. This is because C-diff forms spores that are not killed by sanitizers and they need to be washed away with soap and water.
→ Hand sanitizers that are alcohol based with at least 60%-95% alcohol are able to most effectively denature proteins. This is why alcohol based hand sanitizers are the recommendation for infection control.
→ The CDC recommends using an alcohol based hand sanitizer for healthcare workers to routinely clean hands, as long as they aren’t visibly soiled.
Wash Your Hands More
Overall EMS need to be washing their hands more often. Here is a list of times when it’s a good idea to wash your hands while at work. To summarize the list, wash your hands more than you are now and maybe even more than you think is necessary.
When to Wash Your Hands:
• After each patient assessment, procedure or contact.
• After removing gloves.
• Before touching a patient: Includes having direct contact with patients like taking pulse, bp, lifting and transferring any patient.
• After contact with blood, body fluids, wounds and excretions. This includes dressings from wounds.
• After using the restroom.
• Before any clean aseptic procedure.
• After touching inanimate objects in the immediate patient environment.
• After body fluid exposure or risk.
• Before preparing or eating food.
• After you blow your nose, cough or sneeze into your hands.
• After use of objects that harbor bacteria. These can be the ambulance steering wheel, seat belt, stethoscope, blood pressure cuff, cell phone, gurney, buckles, etc. If you haven’t cleaned it, assume that it’s dirty.
• Consider washing your hands at some point after shaking hands with people.
This doesn’t mean stop what you are doing, abandon your patient and go wash your hands. Use common sense when following the above hand hygiene guidelines and you will be a safe and competent provider of care.
For example, in a situation where you arrive on scene and take a patient’s pulse and blood pressure, but leave without transporting the patient. Make sure to do your hand hygiene when getting back in the ambulance. Don’t go to the next call without using a hand sanitizer or soap and water. On the other hand, if you stay with the patient you can continue your assessment without stopping to sanitize after taking the BP.
Follow the hand hygiene and infection control guidelines in your area while using common sense to make decisions and you will be ahead of the game.
Gloves and Hand Hygiene
Wearing gloves is not a substitute for proper hand washing, in fact dirty gloves can actually soil hands if removed incorrectly. Here are some recommendations for safely using gloves while preventing the spread of infectious diseases.
→ Always wash your hands after removing gloves.
→ Wear the correct size glove to prevent tears.
→ Apply gloves before coming in contact with open wounds, fluids, or mucous membranes.
→ Change to clean gloves if moving from contaminated area to a clean area like the patient’s face.
→ Never wear the same pair of gloves for more than one patient.
→ Change gloves if they become ripped or damaged.
→ Change gloves if they get soiled with blood or body fluids once your task is finished.
Something as simple and proper hand washing can make a significant difference in outcomes for your patients. If you’re approaching patients with dirty hands you are putting them at risk for infection and disease. Handwashing and hand hygiene are fairly simple steps all EMS can take to improve patient care and provide infection control.
→ Interested in other EMT skills? Go to our Guide to Lung Sounds.
→ Need new boots? Heres a How to Guide & Top 10 EMS Boots.
→ Have NREMT Testing soon? Check out Psychomotor Exam Tips.
Christina Beutler is the creator of EMT Training Base. She is a former EMT and a current Registered Nurse. Christina’s path changed after taking a Basic First Aid class while in Community College, and a career in healthcare opened up. Working as an Emergency Medical Technician led to a passion for nursing and a job working in the Intensive Care Unit and Critical Care Unit right out of Nursing School. To learn more about Christina’s story, head over to the About page.