Actual handwashing vs. sanitizer

[quazar]

I have noticed for a while that I am one of the few nurses who usually washes her hands with soap and water before and after patient contact, rather than using the hand sanitizer. Most (not all, but most) of my coworkers use a squirt of hand sanitizer and only wash hands if visibly soiled. I don't wash every time, say if I'm going in to just quickly adjust the fetal monitor, then I will just do a squirt of the sanitizer. However, when I am going in to do a full assessment, or of course to do anything invasive, absolutely I am washing my hands.

Once, when orienting to a new hospital, my preceptor actually told me to stop washing my hands "so much" and that I "only needed" to use the hand sanitizer outside the doors and in the rooms. I just sort of let that go in one ear and out the other, and whenever she wasn't with me, I washed my hands like I usually do.

From what I can tell from the CDC guidelines, sanitizer is supposed to be used in the absence of soap and water, but then I hear infection control nurses say you can use it interchangeably except of course with GI viruses which require hand washing.

What is your practice? ETA: I'm wondering if I'm overdoing it, and maybe the other nurses are right and I could be using the hand sanitizer instead of hand washing except for with invasive procedures?

[ottersloveoysters]

Our policy is hand washing with soap and water for the following: visibly dirty hands, after using the bathroom, before eating and after caring for patient on precautions for c. diff. Hand sanitizer for all other contact.

I have been told in the past that our hand sanitizer has moisturizers to be gentler on skin so it is easier on the hands that soap and water.

[quazar]

Our policy is hand washing with soap and water for the following: visibly dirty hands, after using the bathroom, before eating and after caring for patient on precautions for c. diff. Hand sanitizer for all other contact.

I have been told in the past that our hand sanitizer has moisturizers to be gentler on skin so it is easier on the hands that soap and water.

Thank you, this is helpful. I appreciate it.

[Asystole RN]

In the most recent CDC Blood Stream Infection Guidelines, 2011, it says on page 12 it says to wash hands or use hand sanitizer, category 1B.

If you like to wash you hands then wash your hands. Most people I know use hand sanitizer simply because hand washing can be hard on the hands. I personally prefer washing because I hate the residue most sanitizer leaves on the skin but after washing a bazillion times I have to be careful that my hands do not dry out too much which would lead to skin cracking.

Hand washing or sanitizer, do either or but at least do something. Better than most Docs can say.

[Here.I.Stand, BSN, RN]

Our policy is hand washing with soap and water for the following: visibly dirty hands, after using the bathroom, before eating and after caring for patient on precautions for c. diff. Hand sanitizer for all other contact.

I have been told in the past that our hand sanitizer has moisturizers to be gentler on skin so it is easier on the hands that soap and water.

This. My hands became extremely red, raw, and riddled with tiny cracks when I hand-washed...particularly in the winter when our air is so dry. If I remember correctly, the skin breakdown ran from my 2nd knuckles to the middle of my hands, including between my fingers; and the thumb area all the way to my wrist. Donning gloves was excruciating.

I don't have time to run to the nurse's station to apply the approved hand cream after every single wash.

So unless my hands are visibly soiled or it's a C. diff patient, sanitizer it is.

[sallyrnrrt, ADN, RN]

I prefer to wash, but I might also carry small container of "approved moisturizer lotion....but, I prefer hand washing in most all circumstances....

[trep]

Do whatever makes you feel better. I personally only wash when visibly soiled, after bathroom/eating, or perhaps when on precautions, otherwise it's hand sanitizer all the way. It takes a long time to wash effectively, and messing with water and drying is a lot more of a hassle than a simple squirt of sanitizer. From what I learned in school, the research shows they are equally effective (some sources actually site hand sanitizer as more effective) except when it comes to bacteria with endospores, such as c. diff.

[nursel56]

I prefer the soap and water route, too. A while back I delved into the research behind the guidelines and the results indicated sanitizer was more effective than soap and water. I have to admit that with me it's a psychological thing. where my hands sort of feel icky even if I can't see anything.

If I had quazar's preceptor I'd be sneaking in a hand wash here and there, when she wasn't looking. Don't know why, but that scenario cracks me up.

[CardiacDork, MSN, RN]

I like washing my hands any chance I get. I love the nice clean feel and I always follow up with hand moisturizer because itchy red hands are NO Bueno :)

[quazar]

I have to admit that with me it's a psychological thing. where my hands sort of feel icky even if I can't see anything.

Yes! Totally this! It really is a psychological thing I guess.

[madricka, BSN, RN]

When I started at my hospital the IP&C team advised us to use hand sanitizer more frequently because it is more effective and less harsh on the hands (hand cracks not only hurt, invite infection, but can harbor microorganisms that can be transmitted to patients). We were also advised to do a full hand wash once for every 10 hand sanitizer uses (at least) since residue from the sanitizer can build up, make your hands sticky & cause problems when applying gloves (they can tear more easily if there is a substance on your hands) -- I believe they also said sanitizer becomes less effective once you hit 10 uses. As others have mentioned, if hands are visibly soiled or you have cared for a patient with CDiff then you should do a soap/water scrub (I also do this if I've come out of isolation after using hand sanitizer).

I think all facilities have policies on hand hygiene? Of course, this leads into the bigger issue of hand/wrist jewelry, nail polish and artificial nails. Some would argue it doesn't matter if you hand wash/sanitize if you have a lot of stuff on your hands. Our hospital has a "nothing below the elbows" policy (& bare, natural nails only). Amazing how many people get hyper about this kind of thing.

[djh123]

I don't do either one often enough, but am doing more lately. I use the hand sanitizer more than soap/water only because it's quicker, but I prefer soap/water because it feels cleaner ... I don't like that chemical-y, slightly greasy feeling that the sanitizer leaves you with.