Phlebotomy Technician Article: The importance of hand washing:
Prepared by: Marie-Louise Cronjé, Phlebotomy Learnership Facilitator
(Registered Nurse: General, Psychiatric, Community Health and Midwifery)
Quality Control by: Karmishtha Hutheram, Phlebotomy Learnership Facilitator
(Registered Nurse: General Nursing)
It is statistically proven that sixty percent of all South Africans do not wash their hands
with soap and water. This compares poorly to other countries, even India. Soap acts as
a ‘vaccine’ against a wide range of diseases and neglecting to wash your hands –
especially after having gone to the toilet, is tempting fate. A single gram of human
faeces can contain 10 million viruses and one million bacteria and is the main source of
diarrhoeal pathogens. Poor hand washing practices may lead to diseases like typhoid,
cholera and the more common gastro-enteric infections.
Washing hands with soap and water can also reduce the risk of respiratory infections by
as much as 70%.
It is even more important for the healthcare worker to adhere to hand washing practices
and techniques. Hospitals and waiting rooms have a natural concentration of organisms
due the presence of patients with various diseases.
In America alone, two million healthcare-associated infections causes nearly 88 000
deaths every year. The shocking truth is that most come from the hands of healthcare
personnel.
So why are there poor hand washing practices, especially in the health care sector?
Self-reported factors for poor adherence with hand hygiene:
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Hand washing agents cause irritation and dryness to the skin
Sinks are inconveniently located or there are no sinks to wash hands
Lack of soap and paper towels
Personnel is too busy or there is insufficient time to wash hands
There is a low risk of acquiring infection from patients (for example: routine
bloods on an outpatient with no visible illness or disease)
Why is hand washing so important in a health care setting?
Chain of Infection

The transmission of infection requires a series of links that must occur. The chain
starts with a reservoir for the pathogen which includes animals, humans,
equipment, food or water. Through blood or other excretions, the pathogen finds
a pathway from the reservoir to enter a susceptible host, such as an elderly
human.
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Breaking the Chain
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Using aseptic methods such as isopropyl alcohol pads, hand washing and
wearing gloves, phlebotomists can stop the transmission by inhibiting growth, or
killing the microorganism altogether.
Skin preparations has been a controversial subject as it has been acknowledged that
wiping the skin with an alcohol swab disturbs the skin flora and causes discomfort for
the patient. Normally clean skin is all that is required. Asepsis (the absence of the
micro-organisms that produce sepsis or septic disease) is vital when performing
venepuncture as the skin is breached and a device is introduced into a sterile
circulatory system.
The two main sources of microbial contamination are:
 The handsz of the phlebotomist
 The skin of the patient
Good hand washing and drying techniques are therefore essential on the part of the
phlebotomist.
According to guidelines and protocols, healthcare personnel must wash their hands
between every patient.
The guide to good hand hygiene:
There are two methods of hand hygiene: hand washing and hand sanitation. Each
method has its appropriate application.
Hand washing means:
 Using soap and water to wash: when you hands are visibly soiled
Hand sanitation means:
 Using waterless hand rubs (for example and Alcohol based hand cleaner such
as Hibitane, D-germ, Gemstar, etc) when your hands are visibly clean.
Important point to remember:
There is a clear differentiation between hand washing and hand sanitation for nonsterile procedures and the aseptic technique. The aseptic technique (not discussed
here), is always used for sterile procedures such as the collection of blood cultures.
Proper hand washing:
The guideline states that hands should be washed with a non-antimicrobial soap such
as Hibiscrub (active ingredient is Chlorhexidine Gluconate) and water.
Important point to remember:
Antimicrobial is the general term for any product or ingredient that kills or inhibits bacteria,
viruses, and molds.
Antibacterials, on the other hand, are ONLY effective against bacteria. So if you are looking to
kill viruses, such as the flu, antimicrobial is the way to go.
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Washing your hands frequently prevents the spread of disease-causing germs. It's not
enough to just run water over your hands. Following these eight hand washing steps
will ensure your hands are properly cleaned and sanitised.
Hand washing technique:
Step in the procedure:
Reason for this step:
1. When washing hands, ensure that you do
not touch the sink with your arms or
clothes.
The sink may be contaminated
2. Turn on the faucet and thoroughly wet
hands under warm running water.
Water should not be too hot or too cold and
hands should be wet before applying soap.
This is to prevent hands and skin from
getting dry, chapped or cracked from
frequent hand washing.
3. Apply the antibacterial / antimicrobial soap
into your hand palms and work up a lather
A good lather is needed to reach all surfaces
of the hands.
4. Scrub all surfaces of the hands, including
the areas between the fingers and around
the knuckles as well as underneath your
fingernails
Scrubbing is necessary to dislodge microorganisms from surfaces, especially
between fingers, around knuckles and
underneath fingernails
5. Rub your hands together vigorously
Friction helps loosen dead skin, dirt, debris
and microorganisms. The scrubbing and
rubbing part of the hand washing procedure
(step 4 & 5) should take at least 15 seconds.
6. Rinse your hands in a downward motion
from the wrists down to the fingertips
Rinsing with the hands held downward
allows contaminants to be flushed from the
hands and fingers into the sink and prevents
it flowing back up the arm or wrist.
7. Dry hands with a clean paper towel
Hands must be dried thoroughly and gently
to prevent chapping or cracking. Avoid using
reusable bathroom towels, as they can be a
source of contamination
8. Use a clean paper towel to turn off the
faucet unless it is foot or motion activated.
Clean hands should not touch contaminated
faucet handles.
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When decontaminating hands with an alcohol-based hand rub, apply the product to the
palm of one hand and rubbing hands together until dry. Ensure that all the surfaces of
hands and fingers are covered.
Your skin is the first line of defense against infections. Remember to:
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Cover cuts, scratches and any rashes with a water proof dressing / plaster
Keep wounds clean
Not pick sores
Not touch open wounds
Wear gloves when working in the garden
Wear gloves when doing dishes, especially if you are prone to skin allergies
Keep nails short at all times
Limit jewelry worn to work – your jewelry should not inhibit you hand hygiene
Not bite your fingernails
Never work with chipped nail polish
There is no better example of an industry in which hygiene is important than health
care. The reason that doctors and nurses do not stay sick all the time despite being
around contagious people every day is partially due to rigidly enforced hand-washing
practices.
Always assume that every person is potentially infected with an organism that could be
transmitted in the health care setting. Perform hand hygiene:

Before having direct contact with patients.
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Between different procedures on the same patient.
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Frequently during the day as a measure of good infection control
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After contact with blood, body fluids or excretions, mucous membranes, broken
skin or wound dressings.
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After contact with a patient’s intact skin (when taking a pulse, blood pressure or
when lifting a patient)
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After contact with any objects (including medial equipment) in the immediate
vicinity of the patient.
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Before and after eating, drinking or smoking
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After visits to the toilet.
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After removing gloves.
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After coughing and/or sneezing.
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Questions:
1. Poor hand washing may lead to diseases like:
a. Typhoid
b. Cholera
c. Gastro-enteritis
d. All of the above
2. Two of the main sources of microbial contamination are:
a.
Dirty equipment
b.
Hands of the phlebotomist
c.
Skin of the patient
d.
b&c
3.
4.
Hand washing means:
a.
Using waterless hand rubs when your hands are visibly clean
b.
Using soap and water when your hands are visibly soiled
c.
Neither a or b
d.
a&b
Antimicrobial is the general term for any product that:
a. Is only effective against bacteria
b. Kills or inhibits bacteria, viruses and moulds
c. Is only effective against moulds
d. Is only effective against viruses
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5.
The reason why hands are vigorously rubbed together when washed,
is:
a. Friction helps loosen dead skin, dirt, debris and micro-organisms
b. This activates the soap particles
c. To warm the hands before touching the patient
d. No particular reason
6.
7.
Self reported factors for poor adherence of hand hygiene:
a.
Lack of soap and paper towels
b.
Lack of self discipline
c.
Lack of knowledge
d.
All of the above
When rinsing hands, you must do so in a downward motion to:
a. Reach all surfaces of the hands
b. Allows contaminants to be flushed from the hands and prevent it flowing back up
the wrists
c. To prevent chapping and cracking of the skin
d. Dislodge micro-organisms from all surfaces of the hands, especially fingers,
knuckles and fingernails
8. When you have a cut, scratch or sore on your hands, you have to:
a. Clean hands with an alcohol-based hand rub after every patient
b. Cover with a water proof dressing or plaster
c. Keep wounds clean at all times
d. Wear gloves at all times
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9. Hand hygiene should be performed:
a. After contact with blood, body fluids or excretions
b. After visits to the toilet
c. Before and after eating
d. All of the above
10. According to guidelines and protocols, healthcare personnel must:
a. Wash their hands between every patient
b. Wash their hands only after your last patient
c. Wash their hands only when they enter the unit
d. Wash their hands when they can see visible contamination
Resources:
1.
http://www.health24.com/new/Enviro_Health
2.
www.hha.org.au
3.
www.oxfordshirepct.nhs.uk/about-us/.../252Phlebotomy Handbook.p...
4.
http://www.ehow.com
5.
Phlebotomy Learnership Curriculum Guide Unit Standard ID: 252401: Comply with Safety
Requirements in the Medical Pathology or Blood Transfusion Field – page 68 – 69
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