Hand Hygiene - Infection Control

Question 1

___ ___ is the most important and most basic technique in preventing the transmission of infections.

(Astle & Duggleby, 2024, p. 693)

Answer 1

Hand hygiene

(Astle & Duggleby, 2024, p. 693)

Question 2

___ ___ includes using an instant alcohol hand antiseptic before and after providing patient care, handwashing with soap and water when hands are visibly soiled, and performing a surgical scrub when necessary.

(Astle & Duggleby, 2024, p. 693)

Answer 2

Hand hygiene

(Astle & Duggleby, 2024, p. 693)

Question 3

The components of good handwashing include using an adequate amount of soap, ___ the hands together to lather the soap and create friction, and ___ under a stream of water.

[Infection Prevention and Control (IPAC) Canada, 2020a as cited in Astle & Duggleby, 2024, p. 693]

Answer 3

rubbing

rinsing

[Infection Prevention and Control (IPAC) Canada, 2020a as cited in Astle & Duggleby, 2024, p. 693]

Question 4

Which action has a purpose to remove soil and transient organisms from the hands and to reduce total microbial counts over time?

(Astle & Duggleby, 2024, p. 693)

Answer 4

Hand Hygiene

(Astle & Duggleby, 2024, p. 693)

Question 5

Contaminated hands are a prime cause of cross-___.

For example, imagine you are caring for a patient who has excessive pulmonary secretions, and you assist the patient in expectorating mucus and disposing of the tissues in a bedside container.

The patient’s roommate asks you to open containers of food on the meal tray.

You then leave the patient’s room to pour a dose of medication that is to be taken in 5 minutes.

If you fail to perform hand hygiene before opening the containers of food or pouring the medication, organisms from the first patient’s mucus can easily be transmitted to the roommate’s food and to the medication container.

(Astle & Duggleby, 2024, p. 693)

Answer 5

infection

(Astle & Duggleby, 2024, p. 693)

Question 6

Decreased ___ infection rates have been reported with improved hand hygiene adherence.

[Infection Prevention and Control (IPAC) Canada, 2020b as cited in Astle & Duggleby, 2024, p. 693]

Answer 6

nosocomial

[Infection Prevention and Control (IPAC) Canada, 2020b as cited in Astle & Duggleby, 2024, p. 693]

Question 7

The decision of when and what type of hand hygiene should occur depends on the following: the intensity of contact with patients or ___ objects, the degree or amount of ___ that could occur with that contact, the ___ of the patient or the health care worker to infection, and the procedure or activity to be performed.

For example, after prolonged and direct contact with a patient’s wound drainage, the nurse must perform thorough hand hygiene.

(Joint Commission, 2019 as cited in Astle & Duggleby, 2024, p. 693)

Answer 7

contaminated x 2

susceptibility

(Joint Commission, 2019 as cited in Astle & Duggleby, 2024, p. 693)

Question 8

It takes ___–___ seconds to clean hands by washing with soap and water.

If the hands are visibly soiled, more time may be needed.

[Infection Prevention and Control (IPAC) Canada, 2020 as cited in Astle & Duggleby, 2024, p. 693]

Answer 8

40

60

[Infection Prevention and Control (IPAC) Canada, 2020 as cited in Astle & Duggleby, 2024, p. 693]

Question 9

___ handwashing may be performed with plain soap.

Plain soap with water can physically remove a certain level of microbes, but ___ agents are necessary to kill or inhibit microorganisms and reduce the level still further.

[Centers for Disease Control and Prevention (CDC) 2019c as cited in Astle & Duggleby, 2024, p. 693]

Answer 9

Routine

antiseptic

[Centers for Disease Control and Prevention (CDC) 2019c as cited in Astle & Duggleby, 2024, p. 693]

Question 10

Refine

(Astle & Duggleby, 2024, p. 693)

Answer 10

(Astle & Duggleby, 2024, p. 693)

Question 11

Arrange the steps in the correct order:

1. Push wristwatch and long uniform sleeves above wrists. Avoid wearing rings. If worn, remove for the duration of the procedure.
2. Inspect nails for length and presence of artificial acrylics or chipped nail polish.
3. Inspect hands for visible soiling.
4. Inspect surface of hands for breaks or cuts in skin or cuticles. Report and cover lesions before providing patient care.
5. Assess patient’s risk for, or extent of, infection [e.g., white blood cell (WBC) count, extent of open wounds, known medical diagnosis].

(Astle & Duggleby, 2024, p. 693)

Answer 11

4

3

2

5

1

(Astle & Duggleby, 2024, p. 693)

Question 12

Organize the rationales with their corresponding steps.

Steps (1-5):

1. Inspect surface of hands for breaks or cuts in skin or cuticles. Report and cover lesions before providing patient care.
2. Inspect hands for visible soiling.
3. Inspect nails for length and presence of artificial acrylics or chipped nail polish.
4. Assess patient’s risk for, or extent of, infection (e.g., white blood cell [WBC] count, extent of open wounds, known medical diagnosis).
5. Push wristwatch and long uniform sleeves above wrists. Avoid wearing rings. If worn, remove for the duration of the procedure.

Rationales (A-E):

A) Lengthier handwashing is needed if soiling is heavy.

B) Open cuts or wounds can harbor high concentrations of microorganisms. Agency policy may prevent you from caring for high-risk patients. If dermatitis occurs, additional interventions may be needed.

C) Provide complete access to fingers, hands, and wrists. Wearing of rings increases the number of microorganisms on the hands.

D) Use of alcohol-based waterless antiseptic is encouraged if you will be working with patients who are immunosuppressed.

E) Nails should be short and filed because most microbes on hands come from beneath the fingernails. Nails should be free of artificial applications and chipped or old nail polish.

[Centers for Disease Control and Prevention (CDC), 2019c; Joint Commission, 2019 as cited in Astle & Duggleby, 2024, p. 693]

Answer 12

1. B
2. A
3. E
4. D
5. C

[Centers for Disease Control and Prevention (CDC), 2019c; Joint Commission, 2019 as cited in Astle & Duggleby, 2024, p. 693]

Question 13

Arrange the substeps in step number 6. in the correct order:

6. If hands are visibly dirty or contaminated with protein-containing material, use water and plain soap or antimicrobial soap for handwashing:

A) Inspect surfaces of hands for obvious signs of soil or other contaminants.

B) Turn off water with foot or knee pedals. To turn off hand faucet, use a clean, dry paper towel; avoid touching handles with the hand.

C) Work the fingertips on one hand into the palm of the other. Massage soap into nail spaces; repeat with the other hand.
CRITICAL DECISION POINT:Do not tear or cut skin under or around nail.

D) Wet hands and wrists thoroughly under running water. Keep hands and forearms lower than elbows during washing.

E) Avoid splashing water against uniform.

F) Apply a small amount of soap, lathering thoroughly. Soap granules and leaflet preparations may be used.

G) Stand in front of sink, keeping hands and uniform away from sink surface. If hands touch sink during handwashing, repeat procedure.

H) Turn on water. Turn faucet on or push knee pedals laterally or press pedals with foot to regulate flow and temperature.

I) Dry hands thoroughly from fingers to wrists and forearms with a paper towel, single-use cloth, or warm-air dryer.

J) Wash hands using plenty of lather and friction for at least 10 to 15 seconds. Interlace fingers and rub palms and back of hands with circular motion at least five times each. Keep fingertips down to facilitate removal of microorganisms. Rub knuckles of one hand into the palm of the other; repeat with the other hand.

K) Inspect hands for dermatitis or cracked skin.

L) Rinse hands and wrists thoroughly, keeping hands down and elbows up.

M) Rub thumb on one hand with the palm of the other hand; repeat with the other hand.

N) Areas under fingernails are often soiled. Clean them with an orangewood stick or fingernails of the other hand and additional soap.

O) Optional: Repeat steps and extend period of washing if hands are heavily soiled.

P) Regulate flow of water so that temperature is warm.

Q) If paper towel is used, discard it in proper receptacle.

R) If hands are dry or chapped, a small amount of lotion or barrier cream can be applied.

(Astle & Duggleby, 2024, pp. 693, 694, 695, 696)

Answer 13

G

H

E

P

D

F

J

M

C

N

L

O

I

Q

B

R

A

K

(Astle & Duggleby, 2024, pp. 693, 694, 695, 696)

Question 14

Organize the rationales with their corresponding substeps in step 6.:

6. If hands are visibly dirty or contaminated with protein-containing material, use water and plain soap or antimicrobial soap for handwashing:

Substeps (A-P):

A) Stand in front of sink, keeping hands and uniform away from sink surface. If hands touch sink during handwashing, repeat procedure.

B) Avoid splashing water against uniform.

C) Regulate flow of water so that temperature is warm.

D) Wet hands and wrists thoroughly under running water. Keep hands and forearms lower than elbows during washing.

E) Apply a small amount of soap, lathering thoroughly. Soap granules and leaflet preparations may be used.

F) Wash hands using plenty of lather and friction for at least 10 to 15 seconds. Interlace fingers and rub palms and back of hands with circular motion at least five times each. Keep fingertips down to facilitate removal of microorganisms. Rub knuckles of one hand into the palm of the other; repeat with the other hand.

G) Rub thumb on one hand with the palm of the other hand; repeat with the other hand.

H) Work the fingertips on one hand into the palm of the other. Massage soap into nail spaces; repeat with the other hand.

I) Areas under fingernails are often soiled. Clean them with an orangewood stick or fingernails of the other hand and additional soap.
CRITICAL DECISION POINT:Do not tear or cut skin under or around nail.

J) Rinse hands and wrists thoroughly, keeping hands down and elbows up.

K) Dry hands thoroughly from fingers to wrists and forearms with a paper towel, single-use cloth, or warm-air dryer.

L) If paper towel is used, discard it in proper receptacle.

M) Turn off water with foot or knee pedals. To turn off hand faucet, use a clean, dry paper towel; avoid touching handles with the hands.

N) If hands are dry or chapped, a small amount of lotion or barrier cream can be applied.

O) Inspect surfaces of hands for obvious signs of soil or other contaminants.

P) Inspect hands for dermatitis or cracked skin.

Rationales (I-XVIII):

I * Fingertips are frequently missed areas

II * Areas under the nails can be highly contaminated, which increases the risk of infection

III * Hands are the most contaminated parts to be washed. Water flows from the least to most contaminated area, rinsing microorganisms into the sink

IV * Drying from the cleanest (fingertips) to least clean (forearms) area avoids contamination. Drying hands prevents chapping and roughened skin

VI * Prevents transfer of microorganisms

VII * The presence of these conditions indicates complications from excessive handwashing

VIII * Use an agency-provided container of lotion because many lotions may interfere with antimicrobial action or disintegrate gloves

IX * Antimicrobial soaps used exclusively can be drying to hands and can cause skin irritations. The decision of whether to use an antimicrobial soap or alcohol-based hand antiseptic should depend on the procedure to be performed and the patient’s immune status

X * Faucets are contaminated. Using paper towels to touch the faucet prevents contamination of hands

XI * Rinsing mechanically washes away dirt and microorganisms

XII * Inside of sink is a contaminated area. Reaching over the sink increases the risk of touching the edge, which is contaminated

XIII * Warm water removes less of the protective oils than does hot water

XIV * Determine whether handwashing is adequate

XV * Soap cleanses by emulsifying fat and oil and lowering the surface tension of water. Friction and rubbing mechanically loosen and remove dirt and transient bacteria. Interlacing fingers and thumbs and rubbing knuckles ensure that all surfaces are cleansed

XVII * Thumbs are frequently missed areas

XVIII * Microorganisms travel and grow in moisture

(Astle & Duggleby, 2024, pp. 693, 694, 695, 696)

Answer 14

A) XII

B) XVIII

C) XIII

D) III

E) IX

F) XV

G) XVII

H) I

I) II

J) XI

K) IV

L) VI

M) X

N) VIII

O) XIV

P) VII

(Astle & Duggleby, 2024, pp. 693, 694, 695, 696)

Question 15

Arrange the substeps in step number 7. in the correct order:

7. If hands are not visibly soiled, use an alcohol-based waterless antiseptic for routine decontamination of hands in all clinical situations.

A) Rub hands together, covering all surfaces of hands and fingers with antiseptic.

B) If hands are dry or chapped, a small amount of lotion or barrier cream can be applied.

C) Rub hands together for several seconds until alcohol is dry. Allow hands to dry before applying gloves.

D) Apply an ample amount of product to the palm of one hand.

(Astle & Duggleby, 2024, p. 696)

Answer 15

D

A

C

B

(Astle & Duggleby, 2024, p. 696)

Question 16

Organize the rationales with their corresponding substeps in step 7.:

7. If hands are not visibly soiled, use an alcohol-based waterless antiseptic for routine decontamination of hands in all clinical situations.

Substeps (A-D):

A) Apply an ample amount of product to the palm of one hand.

B) Rub hands together, covering all surfaces of hands and fingers with antiseptic.

C) Rub hands together for several seconds until alcohol is dry. Allow hands to dry before applying gloves.

D) If hands are dry or chapped, a small amount of lotion or barrier cream can be applied.

Rationales (I-IV)

I * Use the agency-provided container of lotion, because many lotions may interfere with antimicrobial action or disintegrate gloves

II * Drying ensures full antiseptic effect

III * Enough product is needed to thoroughly cover the hands

IV * Complete coverage of the hands and fingers by using friction ensures antimicrobial effect

(Gammon & Hunt, 2019 as cited in Astle & Duggleby, 2024, p. 696)

Answer 16

A) III

B) IV

C) II

D) I

(Gammon & Hunt, 2019 as cited in Astle & Duggleby, 2024, p. 696)

Question 17

Refine

(Astle & Duggleby, 2024, p. 696)

Answer 17

(Astle & Duggleby, 2024, p. 696)

Question 18

The use of alcohol-based waterless ___ is recommended to improve hand hygiene practices, protect health care workers’ hands, and reduce the transmission of pathogens to patients and personnel in health care settings.

(Joint Commission, 2019 as cited in Astle & Duggleby, 2024, p. 697)

Answer 18

antiseptics

(Joint Commission, 2019 as cited in Astle & Duggleby, 2024, p. 697)

Question 19

___ have excellent germicidal activity and are more effective than either plain soap or antimicrobial soap and water.

[Centers for Disease Control and Prevention (CDC), 2019c as cited in Astle & Duggleby, 2024, p. 697]

Answer 19

Alcohols

[Centers for Disease Control and Prevention (CDC), 2019c as cited in Astle & Duggleby, 2024, p. 697]

Question 20

___ are added to alcohol-based antiseptics to prevent drying of the skin.

(Astle & Duggleby, 2024, p. 697)

Answer 20

Emollients

(Astle & Duggleby, 2024, p. 697)

Question 21

Researchers have found that ___ may be more effective than water because they are used quickly and are available at the bedside.

[Centers for Disease Control and Prevention (CDC), 2019c as cited in Astle & Duggleby, 2024, p. 697]

Answer 21

antiseptics

[Centers for Disease Control and Prevention (CDC), 2019c as cited in Astle & Duggleby, 2024, p. 697]

Question 22

The Centers for Disease Control and Prevention recommends that hands be washed with plain___ when hands are visibly soiled.

If the hands are not visibly soiled, an alcohol-based waterless ___ agent can be used for routine decontamination of hands in all other clinical situations.

[Centers for Disease Control and Prevention (CDC), 2019c as cited in Astle & Duggleby, 2024, p. 697]

Answer 22

soap

antiseptic

[Centers for Disease Control and Prevention (CDC), 2019c as cited in Astle & Duggleby, 2024, p. 697]

Question 23

For indications of when to perform hand hygiene in health care settings, Infection Prevention and Control (IPAC) Canada recommends the following “four moments for hand hygiene”:

1. Before ___ ___ with the patient or the patient’s environment
2. Before ___ ___
3. After ___ ___ exposure risk
4. After ___ with the patient or patient’s environment

[Infection Prevention and Control (IPAC) Canada, 2022 as cited in Astle & Duggleby, 2024, p. 697]

Answer 23

initial contact

aseptic procedures

body fluid

contact

[Infection Prevention and Control (IPAC) Canada, 2022 as cited in Astle & Duggleby, 2024, p. 697]

Question 24

Hands should also be cleaned at the following times:

• Before and after ___ use
• When moving from a contaminated ___ ___ to a clean ___ ___ during patient care
• Before ___ procedures such as preparing, handling, or serving food or medications

(Astle & Duggleby, 2024, p. 697)

Answer 24

glove

body site x 2

clean

(Astle & Duggleby, 2024, p. 697)

Question 25

Alternatively, if ___-based hand rub is not available, health care workers may wash hands in all clinical situations. ## Footnote (US Food and Drug Administration, 2019 as cited in Astle & Duggleby, 2024, p. 697)

Answer 25

alcohol ## Footnote (US Food and Drug Administration, 2019 as cited in Astle & Duggleby, 2024, p. 697)

Question 26

Health care workers are advised to wash their hands with soap and water if patient exposure to ___ ___ (___. ___) is suspected or proven. The physical action of washing and rinsing hands under such circumstances is recommended because alcohol-based hand rub has poor activity against ___. ## Footnote [Centers for Disease Control and Prevention (CDC), 2019a as cited in Astle & Duggleby, 2024, p. 697]

Answer 26

Clostridioides difficile (**C**. **difficile**) spores ## Footnote [Centers for Disease Control and Prevention (CDC), 2019a as cited in Astle & Duggleby, 2024, p. 697]

Question 27

Nurses need to instruct patients and visitors about the proper technique and times for ___ ___. ## Footnote (Astle & Duggleby, 2024, p. 697)

Answer 27

hand hygiene ## Footnote (Astle & Duggleby, 2024, p. 697)

Question 28

Nurses should ensure that patients and visitors understand the importance of cleaning under their nails and that artificial nails should not be worn because they harbour increased numbers of ___. ## Footnote (Astle & Duggleby, 2024, p. 697)

Answer 28

pathogens ## Footnote (Astle & Duggleby, 2024, p. 697)

Question 29

Teaching proper hand hygiene is particularly important if health care is to continue at ___. ## Footnote (Astle & Duggleby, 2024, p. 697)

Answer 29

home ## Footnote (Astle & Duggleby, 2024, p. 697)

Question 30

Patients should wash their hands before ___ or handling ___; after handling ___ equipment, linen, or organic material; and after ___. ## Footnote (Astle & Duggleby, 2024, p. 697)

Answer 30

eating food contaminated elimination ## Footnote (Astle & Duggleby, 2024, p. 697)

Question 31

Visitors are encouraged to wash their hands before ___ or handling ___, after coming in contact with ___ patients, and after handling ___ equipment or organic material. ## Footnote (Astle & Duggleby, 2024, p. 697)

Answer 31

eating food infected contaminated ## Footnote (Astle & Duggleby, 2024, p. 697)

Question 32

Using ___ does not replace the need for hand hygiene. ## Footnote (Astle & Duggleby, 2024, p. 697)

Answer 32

gloves ## Footnote (Astle & Duggleby, 2024, p. 697)

Question 33

Hand hygiene must be performed (before/after) entering the box of gloves, to prevent contamination of the gloves to be used and the rest of the gloves in the box. ## Footnote (Astle & Duggleby, 2024, p. 697)

Answer 33

before ## Footnote (Astle & Duggleby, 2024, p. 697)

Question 34

Gloves may not be completely free of tears or punctures; therefore, hands must also be cleaned before ___ and after ___ gloves. ## Footnote (Astle & Duggleby, 2024, p. 697)

Answer 34

donning doffing ## Footnote (Astle & Duggleby, 2024, p. 697)