Proses Keperawatan Mencuci Tangan
Setiap klien dapat mempunyai mikroorganisme yang saat ini tidak membahayakan klien, tetapi dapat membahayakan orang lain atau klien itu sendiri jika mikroorganisme tersebut menemukan jalan masuk pada bagian tubuh yang lain. Mencuci tangan merupakan hal yang penting pada setiap lingkungan tempat klien dirawat, termasuk rumah sakit. Mencuci tangan adalah tindakan yang paling efektif untuk mengontrol infeksi nosokomial (infeksi yang berasal dari rumah sakit) dan didefinisikan sebagai “menggosok seluruh permukaan kedua tangan yang bersabun/berbusa dengan kuat secara bersamaan” (Garner &Favero, 1998).
Waktu Mencuci Tangan
Kecuali pada situasi darurat
Sebelum
- Prosedur invasif
- Merawat klien yang rentan seperti bayi baru lahir
- dan penurunan kekebalan tubuh
- Merawat luka
- Menyediakan makanan
Setelah
- Merawat luka
- Menangani benda yang terkontaminasi seperti
- pispot atau linen basah
- Merawat klien yang terinfeksi
- Melepas sarung tangan
Antara
- Merawat individu klien
Catatan: mencuci tangan berlebihan dengan sabun dan
deterjen beberapa kali setiap jam dapat merusak kulit
dan dapat meningkatkan penyebaran mikroorganisme
(Metules 2000).
PENGKAJIAN
Tentukan hal berikut pada klien:
- Risiko terinfeksi
- Sedang mendapat terapi obat yang menekan sistem kekebalan tubuh
- Baru saja menjalani prosedur diagnostik atau penatalaksanaan yang menembus kulit atau rongga tubuh
- Status nutrisi saat ini
PERENCANAAN
Tentukan lokasi bak cuci atau keran air dan sabun ztau
pengganti sabun.
Pendelegasian
Teknik mencuci tangan berlaku sama pada semua te-naga kesehatan, termasuk UAP. Anggota tim kesehat-an harus bertanggung gugat dalam melaksanakan prosedur mencuci tangan yang tepat.
IMPLEMENTASI
Perlengkapan
- Sabun, busa sabun, gel sanitizer berisi benzalko-nium klorida atau alkohol.
- Air hangat yang mengalir (hanya untuk sabun)
- Handuk (hanya untuk sabun dan air)
Persiapan
Kaji keadaan tangan.
- Kuku harus tetap pendek. Kuku yang pendek, alami mengandung lebih sedikit mikroorganisme, tidak melukai klien, atau tidak melubangi sarung tangan.
- Lepaskan semua perhiasan. Mikroorganisme dapat menyangkut di ikatan perhiasan dan di bawah cincin. Melepaskan perhiasan memudah-kan dalam membersihkan tangan dan lengan dengan baik.
- Periksa adanya luka pada kulit tangan, seperti kuku yang rusak atau luka. Perawat yang mem-punyai luka terbuka mungkin membutuhkan tugas dengan risiko penyebaran organisme infeksius yang rendah.
Pelaksanaan
- Jika memungkinkan, jelaskan kepada klien apa yang akan dilakukan, mengapa hal tersebut perlu dilakukan, dan bagaimana klien dapat bekerja sama. Diskusikan bagaimana hasilnya dapat digunakan dalam merencanakan perawatan/terapi selanjutnya.
- Nyalakan air dan atur alirannya.
Ada lima tipe kontrol keran yang umum:- Gagang yang diatur dengan tangan.
- Pengungkit-lutut. Gerakkan alat ini dengan lutut untuk mengatur aliran dan temperatur air.
- Pedal kaki. Tekan alat ini dengan kaki untuk mengatur aliran dan temperatur air.
- Pengontrol-siku. Gerakkan alat ini dengan siku, bukan dengan tangan.
- Pengontrol dengan sinar inframerah. Gerakan di depan sensor menyebabkan air mengalir dan berhenti mengalir secara otomatis.
- Atur aliran sehingga air hangat. Airhangat menghilangkan sedikit minyak pelindung kulit dibandingkan air panas.
- Basahi tangan seluruhnya dengan meletakkannya di bawah aliran air, dan sabuni tangan.
- Pertahankan posisi tangan lebih rendah daripada siku sehingga air mengalir dari lengan hingga ujung jari. Air harus mengalir dari area dengan tingkat kontaminasi rendah ke area dengan kontaminasi lebih tinggi.
- Tangan umumnya lebih terkontaminasi daripada lengan bawah.
- Jika menggunakan sabun cair, tuangkan 2 sampai 4 ml (1 sdt). Jika sabun batangan, butiran, atau lembaran, gosokkan sabun di antara kedua telapak tangan.
- Cuci dan bilas tangan secara seksama.
- Gunakan gerakan memutar, menyikat dengan kuat untuk mencuci telapak, punggung, dan pergelangan tiap tangan. Kaitkan jari-jari dan ibu jari, dan gerakkan tangan ke depan dan ke belakang. Lanjutkan gerakan ini selama 10 detik. Gerakan memutar membantu membersihkan tangan dari mikroorganisme secara mekanik. Mengaitkan jari-jari dan ibu jari akan membersihkan sela-sela jari.
- Gosok ujung jari pada telapak tangan lain. Kuku dan ujung jari biasanya terlupakan selama mencuci tangan (Gould, 1997).
Bilas kedua tangan.
- Keringkan tangan dan lengan secara seksama.
- Keringkan seluruh tangan dan lengan dengan handuk kertas. Kulit yang basah mudah pecah-pecah; kulit yang pecah-pecah dapat menimbulkan lesi.
- Buang handuk kertas yang telah digunakan pada tempat yang disediakan.
- Keringkan seluruh tangan dan lengan dengan handuk kertas. Kulit yang basah mudah pecah-pecah; kulit yang pecah-pecah dapat menimbulkan lesi.
- Matikan aliran air.
- Gunakan handuk kertas baru untuk memegang keran yang dijalankan. Hal ini mencegah perawat kontak dengan mikroorganisme di gagang keran.
Variasi : Mencuci Tangan Sebelum Melakukan Teknik Steril
- Gunakan sabun dan cuci tangan seperti yang dijelaskan pada langkah keempat, tetapi pertahankan letak tangan lebih tinggi daripada siku selama mencuci tangan. Basahi tangan dan lengan bawah di bawah aliran air, biarkan air mengalir dari ujung jari hingga siku sehingga tangan menjadi lebih bersih daripada siku. Dengan cara ini, air mengalir dari area yang sekarang memilikin kontaminasi lebih rendah ke area yang kontaminasinya lebih tinggi.
- Setelah mencuci dan membilas tangan, gunakan handuk untuk mengeringkan satu tangan secara seksama dengan gerakan memutar dari jari ke siku. Gunakan handuk yang baru untuk membersihkan tangan dan lengan yang lain. Handuk yang bersih mencegah penyebaran mikroorganisme dari satu siku (area yang kurang bersih) ke tangan lain (area yang lebih bersih).
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