Nurse Handwashing: History and Advice

Handwashing, also known as hand hygiene, is extremely important when it comes to preventing the spread of infectious diseases both at home and in healthcare settings. While it may sound dramatic, proper handwashing (especially when it comes to nurse handwashing) can mean the difference between life and death. 

History of Nurse Handwashing

The importance of handwashing for human health was not discovered until the mid 19th century. Two pioneers in hand hygiene for nurses — especially for vulnerable people such as mothers who had just given birth and wounded soldiers in war hospitals — were Hungarian physician Ignaz Semmelweis and the founder of modern nursing, Florence Nightingale. 

In the mid 19th century, most people were under the assumption that infections were caused by miasmas, or foul odors. During the Crimean War, Florence Nightingale stepped up to implement nurse handwashing in the war hospital she was working in at the time. Her nurse handwashing practices achieved a significant reduction in infections. In fact, Florence Nightingale was able to successfully reduce the death rate from 42 percent down to just 2 percent by either making hand hygiene improvements herself or by encouraging others around her to do the same. 

Hand Hygiene Today

Many ailments and diseases we face today are spread by not washing or not properly washing the hands with soap and clean, running water. People frequently touch their eyes, nose and mouth without even realizing they are doing so. This touching of the face transfers any germs from the hands into the body, and these germs can make us sick. Germs from unwashed hands can also get into food and drinks we prepare, or onto surfaces that are touched frequently by others such as handrails, doorknobs, or toys. 

According to the United States Centers for Disease Control and Prevention (CDC), proper handwashing can reduce respiratory illness such as colds, the flu, and COVID-19 in the general population by 16-20 percent and reduce diarrheal illnesses by 23-40 percent. 

A study by Harris Interactive found that although 91 percent of adults claim to mostly or always wash their hands after using a public restroom, only 82 percent actually did wash their hands. A PubMed found that 93.2 percent of people did not wash their hands after coughing or sneezing and 86.3 percent did not wash their hands after handling money. 

The World Health Organization (WHO) recommends that people wash their hands before and after certain activities including: after using the toilet, after changing a diaper, before feeding a child or elderly person, before eating, and before and after preparing food — especially when handling raw meat, fish or poultry. 

Handwashing in Healthcare Today

Good hand hygiene for nurses is central to infection prevention, reducing the spreading of germs, and in protecting both patients and healthcare workers. Even though it is a simple practice, it is a critical one that is sometimes overlooked even today. 

The WHO states that nurse handwashing should occur in each of these five key instances: 

1. Before touching a patient
2. Before performing aseptic procedures
3. After exposure to bodily fluids
4. After touching a patient
5. After any contact with a patient’s surroundings

Common barriers that prevent or discourage proper nurse handwashing can include time pressures in fast-paced environments, skin irritations caused by frequent handwashing, and inconvenient placement of skins and access to sanitizers. 

As a nurse, you can encourage proper nurse handwashing by educating others on the importance of hand hygiene, requesting that your facility supply skin-friendly products to reduce irritation, and encourage an accountability culture. 

Proper Handwashing Technique

The CDC recommends adhering to the following steps when washing the hands in order to best prevent the transmission of germs and disease. 

1. Wet the hands with either warm or cold clean, running water. Running water is important for proper handwashing because standing water may become contaminated. Some experts say that warm water may be superior, but the temperature of the water has not been shown to make a significant difference. 
2. Use a generous amount of soap and rub the hands together vigorously to form a lather on the front and backs of the hands as well as between the fingers and under nails. Studies show that people wash more thoroughly when using soap than when using water alone. 
3. Scrub the hands by rubbing them together for a minimum of 20 seconds. This creates friction and helps remove pathogens from the skin.
4. Rinse away soap and germs under running water so as not to recontaminate the hands. 
5. Dry with a clean towel or cloth or allow hands to air dry before touching another object. Wet hands are more easily recontaminated than dry hands. 

The most commonly missed areas in handwashing are the thumb, wrist, the areas between the fingers, and the space under fingernails.

National Handwashing Awareness Week

We’ve come a long way in the prevention and spread of disease and infections when it comes to hand hygiene, and there is still room for improvement. During National Handwashing Awareness Week, we’re bringing attention to the important practice of nurse handwashing and proper handwashing in the general population as a reminder of the importance of good hand hygiene to our health. 

Education is Key to Good Hand Hygiene

One of the best ways to encourage proper handwashing is through community health education. If you’re interested in becoming a community health nurse, there are some entry-level positions available to ADNs, but you’ll likely need to obtain a Bachelor of Science in Nursing (BSN) degree. Achieve provides a flexible, online LPN to BSN program and RN to BSN program that help nurses get the education they need while they continue to work full time and attend to personal commitments. 

> Learn more about flexible, online nursing bridge programs here.

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