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

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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.
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