Hand Washing OSCE - Clinical Skills - Dr Gill

Hello and welcome back to the channel. I've joined myself and Dr James Gill for a video on clinical hygiene if you will. So we're going to have a look at how to wash your hands appropriately. Now when I was at medical school I remember sitting in the lecture on how to go through hand washing and thinking dude I know how to wash my hands I can go to the toilet without but I suppose that's the arrogance of youth if you will. The difference comes when you're in the hospital because fine I say that I've never caused DMV to my family after going to the toilet that's because my family aren't immunocompromised they're not ill they've not got a problem. When you're in the hospital or when you're in a clinical environment you're going to be dealing with patients that are unwell i.e. patients that might be fighting an infection already i.e. the probability of you causing an additional problem to them with infection things is greater so we need to make sure we take extra care with these patients and similarly even in the GP lab again you're seeing patients who are potentially vulnerable patients who are unwell and you are also seeing patients that might have infections so you need to make sure that you are washing your hands between patients to protect the next patient you see but also to protect yourself and again it still sounds relatively academic until you're in the situation where you're caring for a patient on the ward and they've been very difficult to get a cannula into you know it's difficult to provide the patient the medications intravenously that they need and you've had to work ages to get that cannula in and it's hurt the patient because you've had to do so many attempts to get access but the patient has tolerated that they've worked with you to get that cannula in place because they know they need it and it will help them the next day you come back and the area around that cannula has become inflamed it's been it's red there looks like there's an infection in it and you're thinking to yourself could I have done this now the probability is that you haven't done but what we want to do with every single patient interaction is making sure that we are dotting the i's crossing the t's and making sure that we can say that the probability of us bringing a problem to that patient is as low as we can reasonably get it to that end what we want to do is wash our hands however I do appreciate that's not always possible and frequently in the clinical environment we'll gel our hands instead which we'll go through as well but the best is going to be washing why let's say for the sake of argument you've got some grit or dirt or muck on your hands you know you've grabbed a pen from your bag that's got some mud on it or jam or whatever and you can't really see it you know you can't feel any stickiness your hands seem to be fine there's still going to be residue on your hands alcohol gel is effective at killing bacteria and viruses pathogens and things but it's not going to move you know physical dirt and that in itself can be a problem having a good scrub with soap and water is going to do that so it's important that we always view that as you know the hand washing as the thing that we want to aim for but appreciate that when that's not possible we also have a get out of jail free card so let's go through the steps for hand washing and then we'll have a look at gelling our hands as well so first thing is taking off our watch pocketing that and then start the water running I want to make sure that we've got enough soap to certainly cover our hands and then we need to make sure we lather things up nicely so to start off I'm just going to be rubbing backwards and forwards make sure we've got a good lather and I'm going to rub between the actual fingers themselves getting right nicely down in there and I'm doing the back of the hands to start off with then I'm swapping over to go in between the fingers on the front of the hands hands to a curse and I'm rubbing my fingernails against my palms I tend to turn my hands over because I find it I'm covering both more effectively thumbs up but we're not finished so we're going to actually scrub our thumbs over one side and then on the other we really want to focus on the fingernails so they're going to go into the palms of the hand like so giving the palms a good rub and then we want to wash things off hospital taps so closing it with the elbows and then we're going to dry off I'll let you into a secret using hospital taps is about the most doctory I ever felt when I got to medical school but why have we got these weird taps so yes you can turn them on with your hands but then you can also elbow them closed just that why we're keeping our hands nice and clean because everybody is going to touch this with dirty hands yes we're not sterilizing our hands because we're still going to be pulling out the paper to dry things with but this is one use and bin whereas here as I say everybody's going to touch that so it's a after we've just cleaned them okay let's go find some gel so before we go and see a patient we need to make sure that we aren't going to be putting them at risk so means taking off our watches making sure we're bare below the elbow making sure we've not got a tie or anything like that on and in my opinion taking off the lanyard because we don't have that lanyard going through the wash very often we don't want a germ magnet dangling on the patient if we can we want to go and properly wash and soap our hands however that's not always possible in which case we can use the alcohol gel so there's many types of alcohol gel that you can get but ultimately you need to make sure that if it's an alcohol gel that it's at least 60 concentrated 60 alcohol content and that should be sufficient for clinical use but it's not just a case of sticking it on the there are several steps that we need to go through i'm just going to go through those now so that you understand what it is that you need to do before you actually touch a patient on the ward keeping in mind our job is to help the patients and it's definitely to try and minimize harm to the patient and that's a potential harm that we could be doing and cleanliness to our hands is the number one key to that so i like two squirts it doesn't matter if it goes everywhere and that should be enough to cover both hands i'm going to go between the fingers like so and then over the back of the hand making sure i'm covering right in the gaps there with the fingers i'm going to go hand fingernails deep into the hand but you'll notice we haven't covered the thumbs so thumbs out i'm going to do all the way around one and then all the way around the other finally finish off with an additional scrub of the fingertips just going round and round around because we want to make sure we're getting those nails as good as we can and then we're going to wait until the hands are dried so one of the things that can happen is that you can actually end up with some residue on your hands from the alcohol gel now this is you know going to be as clean as we can get it with the alcohol gel but it's one of the reasons i don't like using the if i can and will opt to use soap and water and wash my hands between each patient because i know that they're going to be that much cleaner because this alcohol gel approach will kill germs killed bacteria and hopefully viruses on the hand however it won't do anything with regard to straightforward dirt that would be on the hands so soap and water is always going to be the best option but if you've not got it available then some alcohol gel will be reasonable take care see you in the next one cheerio