Hand hygiene is nothing new in healthcare. It has become increasingly important throughout the COVID-19 pandemic.  

As a wound care nurse, you know hand hygiene is essential in preventing infections when providing patient care.

If you provide care outside of the traditional clinical settings, such as a hospital or a wound care clinic, you know how difficult it can be to maintain good hand hygiene. Without running water, gloves or sanitizer, the risk of infection or its spread is evident. 

One researcher’s concern about practicing wound care in non-traditional settings prompted her to explore how hand hygiene could be improved. She reviewed the before and after care given by street nurses as a 2019 master’s degree capstone project at the University of San Francisco.

Summary of the research 

A street nurse team consisting of two RNs working in Sacramento, Calif., provide a plethora of services to the city’s homeless, including wound care. 

The nurses faced obstacles in performing hand hygiene immediately before and after providing care. The initial rate of their compliance was 20%. 

By introducing a few simple changes to their care, the compliance rate climbed to 90%. The changes included introducing the use of a separate “caddy” for wound care supplies.  

Before the separate caddy, all medical and wound care supplies, and case management resources were contained in one backpack. With an easy-to-carry caddy, a large pump bottle of hand sanitizer could be placed in it with easy access when needed. 

Before providing care to a patient, the caddy could be easily placed on the ground atop a “disposable under-pad” so the nurse could perform hand hygiene immediately before and after providing care.  

A second change was to provide the homeless patients with a small bottle of hand sanitizer for their personal use, avoiding the need of an RN to leave her sanitizer with a particular patient. 

When providing the patient with his or her own bottle of sanitizer, nurses were able to improve education of the patients about wound self-care and the importance of using sanitizer before and after care.  

According to the research, the patients seemed more receptive to performing self-care—and doing it properly—with their own sanitizer. 

The RNs also experienced an increase in their own job satisfaction by:

  • Reducing stress
  • Lessening the weight of their backpacks
  • Increasing the efficiency of wound care responsibilities

How does this help your practice? 

This study directly applies to you if you practice wound care nursing in the Peace Corps, Indian Health Service, Global Nurse Initiative, Doctors Without Borders, or volunteer in any of these groups.

Rethinking the way you provide wound care in non-traditional settings can result in better care for your patients while increasing your sense of accomplishment in professional practice. 

As the author of the research, Amanda Ramos Sandoval, stated “the need to think creatively when working in the field (is vital).” 

And despite being out in the field, wound care clinicians must adhere to hand hygiene.

Your patients most likely will never file a suit against you for not adhering to established standards of hand hygiene that result in a worsening of their current wound infection.

However, your compliance with the ethics of nursing care is a requirement you should never ignore.

Home health nurses also face difficult practice issues in relation to hand hygiene, depending on their assignments. Some face homes with running water, but not hot water. Others might visit homes with no running water. 

In a 2016 article for the UK magazine Nursing in Practice, home health nurse Linda Nazarko wrote that she always carries hand sanitizer, liquid soap, and paper towels in her home care bag. 

One of the first things she does when she opens a wound care case in the home is to assess the hand-washing facilities.   

If running water is not available, hand sanitizer is used before and after wound care.   

She also suggests scheduling visits that require wound care as the last appointment of the morning or afternoon. This allows her to return to the agency office and use good hand hygiene procedures with soap and water.  

Adherence to hand hygiene

If you work in more traditional settings, this study is also applicable. Did you know the lack of compliance among healthcare providers is prevalent worldwide? 

Healthcare providers’ adherence to recommended hand hygiene procedures is variable, with “mean baseline rates from 5% to 89%, and an overall average of 38.7%,” according to the World Health Organization’s “WHO Guidelines on Hand Hygiene in Health Care: A Summary.”

These rates are alarming, but what is more worrisome is that the low compliance places patients’ safety at risk.

If the risk results in a cross-contamination of their current wound, or an exposure of bacteria to another patient’s wound, you might find yourself named as a defendant in a professional negligence lawsuit.   

The allegations against you would be that you caused the infections because of your breach of the standard of care and practice as a wound care nurse in regard to hand hygiene.  

If you think such allegations are a remote possibility, check out one class action case already filed against a nursing home and their nursing staff and other employees for not following standards of care and practice during the pandemic in Estate of Maglioni, et al. v. Andover Subacute Rehab Center, et al.

In addition, many articles on the legal liability of healthcare providers during the pandemic can be found online. One example is “Health Care Provider Liability During the Covid-19 Pandemic: Ways to Ensure Protection.”

A complaint filed with your state board of nursing for not complying with your nurse practice act requirements, or those of the rules administering the act, can result in a disciplinary proceeding. 

Remember that a professional negligence suit can name you as a defendant. Plus, your state board of nursing might take disciplinary action against you, which may result in nurse experts in wound care testifying to the standard of care of hand hygiene and whether you adhered to it. 

Standards of care

Standards of care used by the nurse expert might well include the WHO and standards established by your wound care professional associations. 

Though you might be fortunate to have all the necessary supplies to practice good hand hygiene—gloves, running water, sanitizer—you might not always do so immediately before and after providing wound care to patients.   

Best practices dictate hand hygiene immediately before beginning wound care and immediately after it is completed, not waiting until you get to your next patient to begin hand hygiene.

Many interruptions can deter your good intentions to practice required hand hygiene, such as a:

Remember that in the setting you practice, using gloves during wound care is not a substitute for hand hygiene. The Center for Disease Control and Prevention recommends that hand hygiene occur before putting gloves on and then again immediately after removing them.

WHO’s slogan, “Clean Care is Safer Care” is simple but mighty, not only in its application to patient care but decreasing your potential liability as well.

Take our course on Skin and Wound Management to learn more.

Nancy J. Brent, MS, JD, RN

Nancy J. Brent, MS, JD, RN, our legal information columnist, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Brent’s posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

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