A nurse is preparing to perform hand hygiene. Which of the following actions should the nurse take?

A. Vigorous friction is the most critical component of hand hygiene because it mechanically loosens and removes transient microorganisms, soil, and organic matter from the skin. The nurse should rub the palms, the backs of the hands, and between the fingers for at least 15 to 20 seconds. Proper friction ensures that all surfaces are thoroughly decontaminated before the nurse engages in any clinical care. B. Applying only one small drop of liquid soap may be insufficient to create the necessary lather to cover all surfaces of the hands and wrists. To be effective, the nurse must use an adequate volume of antiseptic or plain soap as recommended by the manufacturer to ensure complete coverage. Insufficient soap leads to inadequate emulsification of fats and oils that harbor pathogens on the skin. C. Water that is "really hot" can damage the skin's natural protective barrier, leading to dermatitis and increased colonization by bacteria. Hot water also increases the risk of thermal injury and skin sensitivity with frequent washing. The nurse should use comfortably warm water, which is effective for promoting the action of the soap without causing excessive dryness or irritation to the epidermis. D. Rubbing the hands and arms roughly to dry can cause micro-abrasions and skin breakdown, which provides a portal of entry for infectious agents. Instead, the nurse should pat the skin dry using a clean disposable towel, starting from the fingers and moving toward the forearms. Gentle drying preserves skin integrity and prevents the development of chronic skin conditions associated with frequent hand hygiene.