Is it normal for HH nurses to not wash hands with soap and water?

[guest1143647]

I am a nurse new to home health visits (but not HH, as I worked private duty/shift work in the home)

ALL of the HH nurses I observed while precepting did not wash their hands with soap and water. They just used hand sanitizer. In facilities and in PDN we are taught to wash our hands at start of care and after using hand sanitizer three times. But HH nurses use sanitizer all of the time.

When I work in the home as a Pdn, I ALWAYS washed my hands and use hand sanitizer if needed. 

What prevents HH nurses from washing their hands? We could carry soap and paper towels. Most people in my area have running water.

I am genuinely curious if other HH nurses wash their hands in the patient's home using soap and water?

[amoLucia]

Just a thought - the HH nurse would be washing her hands over the homeowner's pots/pans/dishes etc that are laying in the sink.

What was on her hands that are now on my eating implements?

[soontoretire2020, BSN]

How about maybe the clean pots and pans shouldn't be in the sink? Or the nurse could go to the bathroom to wash her hands. Of course some people's bathrooms can be gross. Depends on the home. 

[amoLucia]

soontoretire -

It's NOT that I'm being sloppy or lazy by leaving dishes in my sink. I am semi-handicapped and I need my walker to hold onto for dear life! Balancing without holding on is difficult & unsafe.

I have a HHA who helps with domestic things - like vacuuming. I can't push my vacuum due to its weight & bulkiness. She helps with my laundry and trash. And a slew of other tasks that I just can't manage by myself.

If I had my druthers, I'd PREFER being capable of doing more for myself.

So your comment kinda zinged being hurtful.

 

[NRSKarenRN, BSN, RN]

Yes.   Soap and water only required for C-diff; otherwise alcohol based sanitizer being used by HH  nurses.  Can't tell you how many times in prior years went to use kitchen/BR sink and roaches everywhere when tap turned on.

[guest1143647]

10 hours ago, NRSKarenRN said:

Yes.   Soap and water only required for C-diff; otherwise alcohol based sanitizer being used by HH  nurses.  Can't tell you how many times in prior years went to use kitchen/BR sink and roaches everywhere when tap turned on.

We deal with that stuff in private duty,yet somehow we still wash our hands.

15 hours ago, amoLucia said:

soontoretire -

It's NOT that I'm being sloppy or lazy by leaving dishes in my sink. I am semi-handicapped and I need my walker to hold onto for dear life! Balancing without holding on is difficult & unsafe.

I have a HHA who helps with domestic things - like vacuuming. I can't push my vacuum due to its weight & bulkiness. She helps with my laundry and trash. And a slew of other tasks that I just can't manage by myself.

If I had my druthers, I'd PREFER being capable of doing more for myself.

So your comment kinda zinged being hurtful.

 

Does your HHA wash his or hands in the sink?

[NRSKarenRN, BSN, RN]

This guidance has led to alcohol-based handrubs at patient point of contact preferred over soap and water in outpatient setting.

WHO 2012

Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities

Quote

The introduction of alcohol-based handrubs (ABHRs) at the point of care overcomes some important barriers to best hand hygiene practices, such as lack of time, lack of facilities and optimal agents, poor tolerability of hand hygiene products, or the inconvenient location of sinks and dispensers. ABHRs should be used as the preferred means for routine hand hygiene in healthcare,1,57 including outpatient settings, for the following reasons: their broad antimicrobial spectrum compared to other agents; shorter time (20-30 seconds) for effective antimicrobial decontamination; better skin tolerability; and their potential for higher accessibility at the point of care.

Studies have found that alcohol-based hand sanitizers are   superior because they reduce bacterial counts more effectively than soap and water   -- considered the gold standard now. in home care.    Old school, I still used soap and water before/after caring for husbands wound care last year -alcohol gel between different sites.   Dab lotion applied  to hands afterwards.    Since COVID-19, least amount of exposure to high touch surfaces, like bathroom sinks, advisable.

2020 Elsevier: Hand Hygiene(Home Health Care) -CE

Quote

...Proper hand hygiene requires using the right agent for the circumstances (soap, water, and a disposable towel, or an alcohol-based rub) and mechanical rubbing of all surfaces for a sufficient length of time.8 Although both methods of hand decontamination are effective if performed properly, a few smaller studies show rubbing with alcohol-based agents keeps microorganisms from returning to the skin for a slightly longer time.8 The key is to choose the right method for the right circumstance and to perform hand hygiene correctly whenever it is indicated. Antimicrobial agents or plain soap and water should be used in the following situations:7• When hands are visibly dirty or soiled with blood or other body fluids •After using the bathroom•After exposure or suspected exposure to spore-forming pathogens (e.g., Clostridium difficile). When not contraindicated, alcohol-based products are considered the gold standard when performing routine patient care because they reduce bacterial counts more effectively than soap and water. ...

 

[guest1143647]

That is interesting,and I do know hand sanitizer is more effective than hand washing. 

My home care agency with private duty requires us to wash our hands over using hand sanitizer. 

I wonder what HH visiting nurses were doing at the start of the pandemic when hand sanitizer was hard to find?

[NRSKarenRN, BSN, RN]

My prior HH agency was pushing alcohol based hand sanitizer for years, part of nurses + therapists supply box --which they can request refills as needed with some extras in our supply cabinet.

[Kitiger, RN]

On 4/1/2021 at 2:30 PM, amoLucia said:

It's NOT that I'm being sloppy or lazy by leaving dishes in my sink. I am semi-handicapped and I need my walker to hold onto for dear life! Balancing without holding on is difficult & unsafe.

I have a HHA who helps with domestic things - like vacuuming. I can't push my vacuum due to its weight & bulkiness. She helps with my laundry and trash. And a slew of other tasks that I just can't manage by myself.

If I had my druthers, I'd PREFER being capable of doing more for myself.

So your comment kinda zinged being hurtful.

 

Thank you. I appreciate it when you give your point of view. I learned a lot when my mother got to the point where she needed help from people other than myself. It bothered me that she wouldn't tell the aide what they were doing wrong. She told me that she would not report them because they -the aides - might make her pay.

When I realized that she was not given the opportunity to use the bathroom all day long, from 11am to bedtime, I talked to the charge nurse on 3-11. I just pointed out that we know how she won't ask for help, but "Did you know that she never gets a chance to use the bathroom on your shift until bedtime?" He fixed it. ?

When her 100 days ran out, and Medicare no longer paid for her rehab, the Physical Therapist decided she didn't need PT anymore. That was the whole reason that she was in the nursing home.

We brought her home.

[guest1143647]

On 4/2/2021 at 9:32 AM, NRSKarenRN said:

This guidance has led to alcohol-based handrubs at patient point of contact preferred over soap and water in outpatient setting.

 

I see. Now that I think about it,most patients in private duty do not have disposable paper towels. Most only have a cloth towel or nothing at all,and agency does not supply paper towels. I almost never use the cloth hand towels. I just use tissue paper. 

[9kidsmomRN]

On 3/29/2021 at 5:01 AM, Runsoncoffee99 said:

we are taught to wash our hands at start of care and after using hand sanitizer three times.

Why are you going to wash 3 times? If done correctly you use either soap and water for 20-30 seconds (also in someone’s house what is there for drying—might not have appropriate towel/paper towels) or appropriate amount of 70% alcohol sanitizer for 20 seconds. Use PPE properly as well, and you will be fine.