Which of the following actions should a medical assistant take during handwashing

The Core Infection Prevention and Control Practices for Safe Care Delivery in All Healthcare Settings recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) include the following strong recommendations for hand hygiene in healthcare settings.

Healthcare personnel should use an alcohol-based hand rub or wash with soap and water for the following clinical indications:

• Immediately before touching a patient
• Before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices
• Before moving from work on a soiled body site to a clean body site on the same patient
• After touching a patient or the patient’s immediate environment
• After contact with blood, body fluids, or contaminated surfaces
• Immediately after glove removal

Healthcare facilities should:

• Require healthcare personnel to perform hand hygiene in accordance with Centers for Disease Control and Prevention (CDC) recommendations
• Ensure that healthcare personnel perform hand hygiene with soap and water when hands are visibly soiled
• Ensure that supplies necessary for adherence to hand hygiene are readily accessible in all areas where patient care is being delivered

Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. Hand rubs are generally less irritating to hands and, in the absence of a sink, are an effective method of cleaning hands.

Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings –Recommendations of the HICPAC

While it is true that some pathogens are not destroyed by regular soap and water, those that survive are surrounded by the soap molecules and are washed away in the rinse water. Antibacterial soaps are typically considered to be unnecessary for most purposes. The exception may be in a hospital where situations are present (e.g., before invasive procedures, when caring for immuno-compromised patients, critical care areas, intensive care nurseries, etc.). Antibacterial agents should be chosen carefully based on their active ingredients and characteristics, and when persistent antibacterial or antimicrobial activity on the hands is desired.

When there is no soap or water available, one alternative is to use hand sanitizers or waterless hand scrubs. Some of these products are made of ethyl alcohol mixed with emollients (skin softeners) and other agents. They are often available as a gel, or on wipes or towelettes. Alcohol-based hand sanitizers should contain at least 60% alcohol to be effective. Sanitizers do not eliminate all types of pathogens. Hand sanitizers may have odours which may be irritating to some users.

When using a hand sanitizer:

• Apply suggested amount to the palm of one hand based on the manufacturer's recommendation.
• Rub hands together.
• Spread and rub the product over your hands and fingers until your hands are dry.
• Use enough product to cover all of your hands and fingers.

Alcohol-based hand sanitizers are the preferred method for healthcare providers when the hands are not visibly soiled. The sanitizers can also be used by paramedics, home care attendants, or other mobile workers where hand washing facilities are not available. These alcohol-based hand sanitizers (with at least 60% alcohol) are also recommended for the general public during a pandemic. However, these agents are not effective when the hands are heavily contaminated with dirt, blood, or other organic materials. Hand washing with soap and water is recommended when hands are visibly soiled.

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