Nurses and other health professionals are expected to attend to hand hygiene about eleventy seven times a day. The WHO and HHA recommend 5 moments for hand hygiene: before touching a patient, before clean/aseptic procedures, after body fluid exposure/risk, after touching a patient, and after touching patient surroundings. 57.4% of Australia’s nurses/midwives are hospital/ward-based [source], they’re doing A LOT of hand hygiene. 

On top of that, while they’re going about their business and busyness, ward-based nurses are interrupted 10 times an hour [source]. Yep, every 6 minutes there’s something or somebody distracting us from our tasks and thoughts. Dangerously disorderly much? Hopefully that doesn’t happen to neurosurgeons, commercial airline pilots, tattoo artists or Batman.
Especially Batman. 

So, here’s the idea: if you’re going to do hand hygiene dozens of times a day anyway, don’t just do it for your patients: do it for yourself too. We’re not cold callous reptilian clinicians, we’re educated warm-blooded mammals who do emotional labour. We need to nurture ourselves if we are to safely continue to nurture others.

Turn the 5 moments of hand hygiene into mindful moments. Make the 5 moments for hand hygiene 5 moments for head hygiene too. Yes, clean hands save lives – let’s not forget that clear heads save lives too!

Come up with a process/script that works for you, maybe something a bit like this: 

Mindful Moment (The 30-Second Handrub Version) 

1. Step towards the pump bottle with intent. This is my mindful moment. I’m taking a brief break. 
2. Squirt enough to squish. 
3. The rub is slippery at first. Frictionless fingers feel fine.
4. Feel the product texture and temperature. The rub is cooler than the air. The rub is cooler than my fingers. It feels nice. 
5. Start with cleaning. The first half of my hand hygiene routine is about rubbing stuff off. Let the stuff I want to get rid of float away. 
6. Move on to restoration, healing. The second half of my hand hygiene routine is about rubbing in resilience and health. Let the stuff that sustains me seep into my skin. 
7. Check in on the breathing. The slower and deeper the better. If the breathing or the brain are running too fast, slow down and repeat steps 5 and 6. 
8. There’s no rush. Slowly scan the surroundings. With any luck someone from infection control is watching. 
9. Smile.
10. Breathing slowly, its time let the air rinse off the residue. 
11. One more slow breath. Its time to get back to work. 

Mindful Minute (The 60-Second Handwash Version)

1. Step towards the sink with intent. This is my mindful minute. I’m taking a brief break. 
2. Let the water flow.
3. Feel the water flowing over both hands. The water’s warmer than the air. The water’s warmer than my fingers. It feels nice. 
4. Add soap. It’s slippery. Frictionless fingers feel fine.
5. Start with cleaning. The first half of your hand hygiene routine is about washing stuff away. Let the stuff you need to get rid of flow down the drain. Let it flow away. 
6. Move on to restoration, healing. The second half of my hand hygiene routine is about rubbing in resilience and health. Let the stuff that sustains me seep into my skin. 
7. Check in on the breathing. The slower and deeper the better. If the breathing or the brain are running too fast, slow down and repeat steps 5 and 6. 
8. There’s no rush. Slowly scan the surroundings. With any luck someone from infection control is watching. 
9. Smile.
10. Breathing slowly, its time rinse both hands. 
11. Breathing slowly, its time to thoroughly dry both hands together. 
12. Throw the towel in the bin.
13. One more slow breath. Its time to get back to work. 

Acknowledgements & Context

This is not my original idea. I first stumbled across the idea of combining hand hygiene with head hygiene via Ian Miller‘s November 2013 blog post “mindfulness during handwashing”: http://thenursepath.com/2013/11/18/mindfulnurse-day-8/. I’ve been using the idea myself and suggesting it to colleagues and students ever since. When I left the clinical environment for a few months, I found myself really missing intentionally punctuating my day with mindful moments. Since returning to clinical practice I’ve come to appreciate the strategy even more than I did when I first started using it 3 years ago.

So why am I blogging about it too? Why now? Well, on Monday I attended the Australasian College for Infection Prevention and Control 2016 conference to chat about Twitter [link to that presentation here. Also, check-out the #ACIPC16 hashtag here and here]. Luckily I was there for the opening plenary sessions, and was pleasantly surprised at the emotional/psychological literacy that was being displayed and advocated for. The opening presentations by Peter Collignon, Mary Dixon Woods and Didier Pittet all went to some lengths to emphasise the importance of emotional intelligence, constructive communication and building relationships. It was really impressive stuff; giving the hand hygiene and mindful moments idea a remix is my way to give recognition/thanks to the #ACIPC16 conference delegates and organisers.

Just so you know, a quick google search reveals that others have also thought of using hand hygiene as a mindful moment, eg this paper:

Gilmartin, Heather. (2016) Use hand cleaning to prompt mindfulness in clinic: A regular prompt for reflection could reduce distraction. BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i13 (Published 04 January 2016)

and this video:

There are others too. Do you think using hand hygiene as a mindful moment could become mainstream?

End

That’s it. As always your comments are welcome via the space below.

May you hands be clean and your head be clear! 🙂 

Paul McNamara, 26 November 2016

Short URL: meta4RN.com/hygiene