Guidelines on Hand Hygiene for Healthcare Workers from the World Health Organization

Share this article:
Hand Hygiene Indications

Indications for hand hygiene are as follows:


•    Wash hands with soap and water when visibly dirty, when soiled with blood or other body fluids, or after using the toilet.

•    Hand washing with soap and water is preferred when exposure to potential spore-forming pathogens, such as Clostridium difficile, is strongly suspected or proven.

•    In all other clinical situations, use an alcohol-based handrub as the
preferred means for routine hand antisepsis, if hands are not visibly soiled. Wash hands with soap and water if alcohol-based hand-rub is not available.

•    Hand hygiene is needed before and after touching the patient; before touching an invasive device used for patient care, whether gloves are used; after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings; if moving from a contaminated body site to another body site on the same patient; after touching inanimate surfaces and objects in the immediate vicinity; and after removing gloves.

•    Hand hygiene is needed before handling medication or preparing food using an alcohol-based hand-rub or hand washing with water and either plain or antimicrobial soap.

•    Soap and alcohol-based hand-rub should not be used together.

Hand Hygiene Techniques

Specific recommendations for hand hygiene technique are as follows:


•    Rub a palmful of alcohol-based hand-rub over all hand surfaces until dry.

•    When washing hands, wet hands with water and apply enough soap to cover all surfaces; rinse hands with water and dry thoroughly with a single-use towel. Whenever possible, use clean, running water. Avoid hot water, which may increase the risk for dermatitis.

•    Use the towel to turn off the tap or faucet, and do not reuse the towel.

•    Liquid, bar, leaf, or powdered soap is acceptable; bars should be small and placed in racks that allow drainage.

Surgical Hand Preparation

Specific recommendations for surgical hand preparation are as follows:


•    Before beginning surgical hand preparation, remove jewelry. Artificial nails are prohibited.

•    Sinks should be designed to reduce the risk for splashes.

•    Visibly soiled hands should be washed with plain soap before surgical hand preparation, and a nail cleaner should be used to remove debris from underneath the fingernails, preferably under running water.

•    Brushes are not recommended.

•    Before donning sterile gloves, surgical hand antisepsis should be performed with a suitable antimicrobial soap or alcohol-based hand-rub, preferably one that ensures sustained activity. Alcohol-based handrub should be used when quality of water is not assured.

•    When using an antimicrobial soap, scrub hands and forearms for the length of time recommended by the maker, usually 2 to 5 minutes.

•    When using an alcohol-based surgical handrub, follow the maker's instructions; apply to dry hands only; do not combine with alcohol-based products sequentially; use enough product to keep hands and forearms wet throughout surgical hand preparation; and allow hands and forearms to dry thoroughly before donning sterile gloves.

Selecting Hand Hygiene Agents

Some specific recommendations for selection and handling of hand hygiene agents are as follows:


•    Provide effective hand hygiene products with low potential to cause irritation.

•    Ask for HCW input regarding skin tolerance, feel, and fragrance of any products being considered.

•    Determine any known interaction between products used for cleaning hands, skin care products, and gloves used in the institution.

•    Provide appropriate, accessible, well-functioning, clean dispensers at the point of care, and do not add soap or alcohol-based formulations to a partially empty dispenser.

Skin Care Recommendations

Some specific recommendations for skin care are as follows:


•    Educate HCWs about hand-care practices designed to reduce the risk for irritant contact dermatitis and other skin damage.

•    Provide alternative hand hygiene products for HCWs with confirmed allergies to standard products.

•    Provide HCWs with hand lotions or creams to reduce the risk for irritant contact dermatitis.

•    Use of antimicrobial soap is not recommended when alcohol-based handrub is available. Soap and alcohol-based hand-rub should not be used together.

Recommendations for Glove Use

Some specific recommendations for use of gloves are as follows:


•    Glove use does not replace the need for hand hygiene.

•    Gloves are recommended in situations in which contact with blood or other potentially infectious materials is likely.

•    Remove gloves after caring for a patient, and do not reuse.

•    Change or remove gloves if moving from a contaminated body site to either another body site within the same patient or the environment.

WHO Guidelines on Hand Hygiene in Health Care. May 2009.
Share this article:

More in News

Dignity Award Gold won by Archie Hendricks Sr. SNF

Dignity Award Gold won by Archie Hendricks Sr. ...

A skilled nursing facility that sits on a Native American reservation has taken Gold in the Dignity category for the third annual McKnight's Excellence in Technology Awards.

Therapeutic program reverses Alzheimer's memory loss, UCLA researcher says

An intensive therapy regimen involving medication, diet and behavioral changes successfully reversed Alzheimer's-related memory loss in a first-of-its-kind trial, according to findings out of the University of California, Los Angeles.

Employee cleared of sexual assault charges wins $1 million defamation suit against ...

A former assisted living worker in South Carolina has received a $1 million award after being falsely accused of trying to sexually assault a resident, according to local news sources.