By Carol A. Cates, MSN, MBA, RN
Chief Nursing Officer
Odessa Regional Medical Center
I have a series of pictures in my office of nurses in Great Britain during World War I. When I first became a Chief Nursing Officer (CNO), I wanted to find some pictures for my office that spoke to me of what nursing really means, and I found these photographs. The first is of a nurse making a bed, the second is a nursing ward with the nurse looking cool, clean, and confident in her cap and whites, and the third is a nurse sitting by the bedside of a badly burned soldier.
Nearly 8 years of being a CNO later, those pictures still strike me in the ways that nursing has changed. But even more so, those pictures remind me of the ways nursing has not changed. Cleanliness and a caring hand to hold make a huge difference in patient outcomes.
Handwashing is the first step when it comes to cleanliness. Handwashing isn’t just a big deal in healthcare, handwashing makes a huge difference for everyone when it comes to disease prevention. Handwashing as a preventative practice against infection is largely credited to Florence Nightingale, the mother of modern nursing, beginning back in the 1860’s during the Crimean War. She was able to prove that handwashing decreased infections and deaths among the wounded. She based her theories largely on the 1840’s work of Dr. Ignaz Semmelweis. He noticed that in his hospital, the maternal mortality rate was much nearly three times higher when doctors delivered babies versus when they were delivered by a midwife. He found that the difference was because the doctors went from other patients and even autopsies to their maternal patients, where the midwives only went between maternal patients. When he started having doctors wash their hands before going to the maternal wards, the mortality rate decreased dramatically. Despite his and Florence Nightingale’s work, routine handwashing for surgeons only became a practice starting in the late 1870’s. Even with all the knowledge about the difference handwashing made in preventing disease in healthcare, routine handwashing outside of the health care setting took over 100 years to establish. Routine handwashing outside of healthcare did not become a recommendation until the 1980’s!
Did you know the top two killers of kids around the world are diarrheal disease and pneumonia? According to the Centers for Disease Control and Prevention (CDC), 1.8 million kids under 5 die each year from those two conditions. 1/3 of the diarrhea cases, and 1/5 of the pneumonia cases in kids under 5 could be prevented with handwashing with soap and water after using the toilet. Yet, the world-wide average for handwashing with soap and water after using the toilet is only 19%.
A few other benefits of handwashing. Handwashing and access to soap and schools improves attendance. Good handwashing early in life has been linked to improved child development in some populations. Handwashing helps reduce antibiotic use and subsequent antibiotic resistance. Frequent handwashing prevents many types of eye infections.
There are 7 steps for properly washing your hands. 1) Wet your hands with clean, preferably running, water. 2) Apply enough soap to cover all surfaces of your hands and wrists. 3) Lather and rub your hands together making sure to scrub all surfaces including your fingernails and writs. 4) Scrub for at least 20 seconds. Many smart watches can now detect and time your handwashing. Singing the “Happy Birthday” song in your head twice also takes about 20 seconds. 5) Rinse your hands and wrists under clean, preferably running, water 6) Dry your hands and wrists with a clean towel or let them air-dry. 7) Use a towel to turn off the faucet and open doors. Hand sanitizer is a great option if you can’t handwash because of time or facilities, but it’s not a better option. Hand sanitizer will not help with hands that are obviously soiled. So, in those cases, you will need to find soap and water.
Wash your hands frequently, particularly after using the toilet, after coughing, sneezing, or blowing your nose, when hands look dirty, after working or playing outdoors, before eating and after touching animals or their bedding areas. If you are in a health care setting, it is perfectly okay to ask your caregiver if they have washed their hands. I highly encourage you to do so. Because that hand you may need to hold also needs to be a clean one.
