pre procedure activities for medical hand washing

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medical hand washing technique steps diagram

This photograph depicts a pedagogical anatomical diagram in the form of a multi-colored wooden hand model, used as a visual aid for teaching proper hand hygiene (HH) techniques. The model is segmented into seven distinct colored regions to represent specific anatomical areas of the hand that require attention during scrubbing or sanitizing: the wrist (dark blue), the palm (red), the thumb (green), the finger webs or base of the fingers (yellow), the back/proximal portions of the fingers (red), and the fingertips (blue). The use of high-contrast colors serves as a mnemonic tool for children or medical students to identify and recall the 'right steps' of hand washing, ensuring total surface coverage. This educational resource is typically utilized in public health interventions or clinical training to demonstrate the complexity of hand topography and the importance of systemic decontamination across all surfaces including the thenar eminence, interdigital spaces, and subungual areas.

This educational image demonstrates World Health Organization (WHO) hand-hygiene protocols through three distinct formats: (a) illustrative diagrams, (b) clear clinical photographs of hand washing, and (c) egocentric/first-person view frames. Row (a) shows standardized hand rubbing techniques: interlacing fingers to clean the backs of fingers, rotational rubbing of the thumb, and rotational rubbing of the fingertips in the opposing palm. Row (b) presents real-world execution of these steps over a clinical sink, showing ideal camera visibility for monitoring hand and arm movements. Row (c) displays perspective challenges where the hands are partially or fully out of the camera view, emphasizing the impact of body size and movement on automated monitoring systems. The visual content focuses on infection control, aseptic technique, and the prevention of cross-contamination in medical and food-handling environments. Key educational concepts include the 12-step hygiene protocol, critical rubbing motions, and the technical requirements for assessing clinical compliance via imaging.

This medical illustration comprises four schematic panels (A-D) detailing the procedural steps of a hand-sewn end-to-side esophagojejunostomy, a critical reconstruction technique in gastrointestinal surgery. Panel A illustrates the anchoring phase, where the jejunal loop is positioned against the esophageal stump and secured using serosal-muscularis interrupted sutures on the posterior aspect. Panel B depicts the preparation of the anastomosis site, showing precise incisions made into both the distal esophagus and the antimesenteric border of the jejunum using a surgical instrument. Panel C demonstrates the closure of the posterior wall of the anastomosis using full-thickness interrupted sutures to ensure a secure mucosal-to-mucosal apposition. Finally, Panel D shows the completion of the anterior wall closure using a full-thickness continuous suture technique, designed to create a watertight seal. This diagram serves as an educational resource for surgical residents and specialists to understand the suture logic and layer-specific targeting required for manual alimentary tract reconstruction.

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Pre-Procedure Activities for Medical Hand Washing

Medical hand washing (hygienic hand wash) is one of the most effective infection control measures. Before performing the actual wash, a defined set of preparatory steps must be completed to ensure the procedure is effective.

1. Personal Preparation (Before Approaching the Sink)

These steps are carried out before touching the sink or any water:

Activity	Rationale
Remove all jewelry - rings, bracelets, wristwatches	Jewelry harbors microorganisms in crevices that soap and water cannot reach
Ensure fingernails are short (should not extend beyond fingertips)	Long nails accumulate pathogens and can tear gloves
Remove nail polish / artificial nails	Cracked polish and artificial nails harbor bacteria and fungi
Roll up sleeves above the wrists / elbows	Ensures forearms and wrists are accessible for washing
Inspect hands and forearms for cuts, abrasions, or skin breaks	Broken skin increases risk of pathogen transmission both ways; cover cuts with waterproof dressings
Check for skin conditions (e.g., dermatitis, eczema)	Broken or inflamed skin reduces effectiveness and may need special guidance

2. Environmental / Equipment Preparation

Before starting, ensure the workspace is ready:

Confirm running water is available - preferably warm water (not hot, to avoid skin damage)
Check that liquid soap or antimicrobial soap is available - enough to cover all hand surfaces
Ensure paper towels or single-use towels are stocked and within reach (you must not touch the dispenser with clean hands after washing)
Ensure the tap can be operated hands-free or with an elbow/foot, or prepare to use a paper towel to turn off the tap after washing
Position yourself close enough to the sink so your hands/arms do not contact the sink basin during washing

3. The WHO 6-Step Hand Washing Sequence (Procedure Itself)

Once pre-procedure activities are complete, the actual hand washing follows the WHO-recommended technique - Park's Textbook of Preventive and Social Medicine:

Step	Action
Step 1	Wet hands with water
Step 2	Apply enough soap to cover all hand surfaces
Step 3	Rub hands palm to palm
Step 4	Rub back of each hand with the palm of the other hand, fingers interlocked
Step 5	Rub palm to palm with fingers interlocked
Step 6	Rub with backs of fingers to opposing palms with fingers interlocked
Step 7	Rub each thumb clasped in opposite hand in a rotational motion
Step 8	Rub fingertips of each hand in opposite palm in a circular motion
Step 9	Rub each wrist with the opposite hand
Step 10	Rinse hands with water
Step 11	Use elbow to turn off tap (to avoid recontamination)
Step 12	Dry thoroughly with a single-use towel

Total duration: 15-30 seconds for a hygienic hand wash; 40-60 seconds for a surgical scrub.

Here is the WHO-illustrated technique from the textbook:

4. Indications - When to Perform Medical Hand Washing

Per WHO "My 5 Moments for Hand Hygiene":

Before touching a patient
Before a clean/aseptic procedure
After body fluid exposure risk
After touching a patient
After touching patient surroundings

5. Key Points for Surgical Hand Scrub (Higher-Level Asepsis)

For surgical procedures, additional pre-scrub activities include:

Don a surgical cap covering all hair
Don a surgical mask before approaching the scrub sink
Open sterile gown and gloves before scrubbing (so hands are not re-contaminated afterward)
Use a sterile brush or pick for under-nail cleaning during the scrub
Scrub for a minimum of 3-5 minutes (institution-dependent)

Source: Park's Textbook of Preventive and Social Medicine - Hand washing technique (Fig. 26, WHO protocol); Harrison's Principles of Internal Medicine 22E - Protective equipment and hand washing.

Articles required for medical hand washing

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Articles (Supplies) Required for Medical Hand Washing

Medical hand washing requires specific agents and equipment to be effective. These fall into two main categories: cleansing agents and supporting equipment.

1. Cleansing Agents

A. Plain (Non-Antimicrobial) Soap and Water

The most basic form; removes visible dirt through detergent effect and mechanical action
Does not greatly reduce bacterial load on its own
Best use: When hands are visibly soiled with blood, body fluids, or proteinaceous material
Critical use: When contamination with Clostridium difficile or Bacillus anthracis is suspected - soap and water is the ONLY effective agent against spores; alcohol does NOT kill spores
Available as: liquid, bar, leaflet, or powdered forms - when using bar soap, small bars with drainage racks are preferred

B. Antimicrobial Soap

Contains antiseptic agents that kill or inhibit transient and resident flora beyond plain soap
Indicated for routine hygienic hand wash in clinical settings and before procedures
More effective than plain soap at reducing bacterial load

C. Alcohol-Based Hand Rub / Gel / Foam (ABHR)

The preferred agent when hands are NOT visibly soiled (per CDC guidelines)
Works by denaturing proteins in microbial cell membranes
Ethanol 60%-95% is most commonly used; more antiviral activity than isopropanol
Effective against: gram-positive and gram-negative bacteria, lipophilic viruses (e.g., HIV, hepatitis B/C), mycobacteria, fungi
Not effective against: bacterial spores (C. diff, anthrax)
Advantages: faster, less skin-drying than repeated soap-and-water washing, effective when sinks are not accessible (e.g., at the anesthesia machine in the OR)

D. Chlorhexidine-Based Products

The CDC agent of choice for hand antisepsis in many clinical settings
Mechanism: cationic bisbiguanide that disrupts cytoplasmic membranes
Active against gram-positive bacteria, lipophilic viruses; somewhat less against gram-negative organisms; minimal against tubercle bacilli
Key advantage: substantial skin persistence (residual antimicrobial activity)
Cautions: may cause corneal damage, ototoxicity, and neurotoxicity if it contacts eyes, ears, or meninges directly; risk of IgE-mediated allergic reactions

E. Iodine / Iodophors (e.g., Povidone-Iodine)

Penetrate cell wall, impair protein synthesis and cell membrane function
Active against gram-positive, gram-negative, some spore-forming bacteria, mycobacteria, viruses, and fungi
Iodophors (iodine + polymer carrier) cause fewer side effects than plain iodine
Disadvantage: relatively poor skin persistence; cause more contact dermatitis than other agents

F. Antimicrobial-Impregnated Wipes

An alternative when water and soap/ABHR are not immediately available
Not a substitute for full hand washing when hands are visibly soiled

2. Supporting Equipment / Articles

Article	Purpose
Running water (warm, not hot)	Wet hands before soaping; rinse off soap/organisms. Hot water increases risk of dermatitis with repeated use
Sink with hands-free / elbow / foot-operated tap	Prevents recontamination of clean hands when turning off the tap
Single-use disposable paper towels	Dry hands thoroughly after washing; also used to turn off faucet to prevent recontamination
Nail brush or nail pick	For under-nail cleaning, especially during surgical scrub; removes organisms from subungual space
Hand lotion / moisturizing cream	Provided to healthcare workers to minimize irritant contact dermatitis from repeated washing; must be checked for compatibility with gloves and antiseptic soaps
Sterile gloves (post-wash)	Donned after hand hygiene for procedures; gloves are NOT a substitute for hand washing
Alcohol-based dispenser (wall-mounted, accessible)	Especially at point of care (e.g., beside anesthesia machine in OR) where sinks are not immediately accessible

3. Summary: Which Agent to Choose?

Situation	Recommended Article
Hands visibly soiled (blood, body fluids)	Antimicrobial soap + water
Hands not visibly soiled (routine patient contact)	Alcohol-based hand rub (preferred)
C. difficile or anthrax contact suspected	Soap and water only (alcohol ineffective against spores)
Before invasive surgical procedure	Chlorhexidine or iodophor surgical scrub
Skin care (frequent washing)	Hand lotion (compatible with antiseptic used)

Sources: Barash, Cullen, and Stoelting's Clinical Anesthesia, 9e (Tables 8-2, 8-3, 8-4 - Hand Hygiene, Hand Hygiene Technique, Skin Care); Campbell's Operative Orthopaedics 15th Ed 2026 (Hand Hygiene section). Based on CDC/HICPAC/SHEA/APIC/IDSA Hand Hygiene Guidelines.

steps of procedure for medical hand washing

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Steps of Procedure for Medical Hand Washing

Medical hand washing follows the WHO 11-step technique using soap and water. The complete procedure takes 40-60 seconds (some sources cite a minimum of 15-30 seconds of rubbing). Each step must be performed methodically to cover all surfaces of both hands.

Step-by-Step Procedure (WHO Technique)

Step 1 - Wet Hands with Water

Turn on the tap (using elbow or foot if possible to avoid contamination). Hold hands under running warm water and wet all surfaces thoroughly before applying soap.

Step 2 - Apply Soap

Apply enough liquid soap (antimicrobial or plain) to cover all surfaces of both hands - palms, back of hands, fingers, thumbs, fingertips, and wrists.

Apply enough soap to cover all hand surfaces

Step 3 - Rub Hands Palm to Palm

Place both palms together and rub vigorously in a circular motion. This cleans the palmar surfaces of both hands.

Step 4 - Rub Back of Each Hand (with Interlocked Fingers)

Place the right palm over the back of the left hand with fingers interlocked and rub. Repeat with the left palm over the back of the right hand. This cleans the dorsal surfaces and interdigital spaces.

Rub back of each hand with palm of other hand, fingers interlocked

Step 5 - Rub Palm to Palm, Fingers Interlocked

Interlock fingers of both hands with palms facing each other and rub back and forth. This cleans the interdigital spaces from the palmar side.

Step 6 - Rub with Back of Fingers to Opposing Palms

Bend fingers of one hand and lock them against the palm of the other hand (knuckle rub). Rub in a back-and-forth motion. This cleans the dorsal surface of the fingers.

Rub with back of fingers to opposing palms with fingers interlocked

Step 7 - Rub Each Thumb in a Rotational Movement

Clasp the left thumb in the right palm and rotate. Repeat for the right thumb in the left palm. This is the most commonly missed area during routine hand washing.

Rub each thumb clasped in opposite hand using a rotational movement

Step 8 - Rub Fingertips in Opposite Palm (Circular Motion)

Cup the fingertips of the right hand and rub them in the left palm in a circular motion. Repeat with left fingertips in right palm. This cleans the subungual (under-nail) areas and fingertip pulps.

Rub tips of fingers in opposite palm in a circular motion

Step 9 - Rub Each Wrist with the Opposite Hand

Grasp the right wrist with the left hand and rub in a circular motion. Repeat for the left wrist with the right hand.

Step 10 - Rinse Hands Thoroughly with Water

Hold hands under running water and rinse off all soap. Keep fingertips pointing downward so rinsed water and organisms flow away from the clean forearms.

Step 11 - Turn Off Tap Using Elbow

Do NOT use bare clean hands to turn off the tap - use your elbow to avoid recontamination of freshly washed hands.

Step 12 - Dry Hands Thoroughly

Dry hands completely using a single-use disposable paper towel, patting from fingertips to wrists. Wet hands transfer organisms more readily than dry hands. Do not use shared cloth towels.

Summary Table

Step	Action	Area Cleaned
1	Wet hands with water	-
2	Apply soap to all surfaces	-
3	Rub palm to palm	Palms
4	Back of hands, fingers interlocked	Dorsum of hands
5	Palm to palm, fingers interlocked	Interdigital spaces (palmar)
6	Back of fingers to opposing palms	Dorsal finger surfaces
7	Rotational rubbing of each thumb	Thumbs (most missed area)
8	Fingertips in opposite palm, circular	Fingertips and subungual areas
9	Each wrist with opposite hand	Wrists
10	Rinse with running water	Removes soap + organisms
11	Use elbow to turn off tap	Prevents recontamination
12	Dry with single-use towel	Prevents transfer of organisms

Key Points

Duration: 40-60 seconds total; minimum 15-30 seconds of active rubbing
Water temperature: Warm (not hot) - repeated hot water increases risk of dermatitis and raises bacterial load on skin
Soap and water is mandatory (not alcohol rub) when hands are visibly soiled or after contact with C. difficile / B. anthracis (spores are not killed by alcohol)
Gloves are not a substitute for hand washing - wash hands after removing gloves as well
Per Campbell's Operative Orthopaedics 15th Ed 2026: scrubbing for 2 minutes is as effective as 5 minutes for surgical hand scrub

Source: Park's Textbook of Preventive and Social Medicine - Fig. 26, Hand washing technique (WHO protocol, ref. 156); Barash, Cullen and Stoelting's Clinical Anesthesia 9e - Table 8-3 Hand Hygiene Technique; Campbell's Operative Orthopaedics 15th Ed 2026 - Hand Washing section.

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