The Core Infection Prevention and Control Practices for Safe Care Delivery in All Healthcare Settings recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) include the following strong recommendations for hand hygiene in healthcare settings.
Healthcare personnel should use an alcohol-based hand rub or wash with soap and water for the following clinical indications:
- Immediately before touching a patient
- Before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices
- Before moving from work on a soiled body site to a clean body site on the same patient
- After touching a patient or the patient’s immediate environment
- After contact with blood, body fluids, or contaminated surfaces
- Immediately after glove removal
Healthcare facilities should:
- Require healthcare personnel to perform hand hygiene in accordance with Centers for Disease Control and Prevention (CDC) recommendations
- Ensure that healthcare personnel perform hand hygiene with soap and water when hands are visibly soiled
- Ensure that supplies necessary for adherence to hand hygiene are readily accessible in all areas where patient care is being delivered
Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. Hand rubs are generally less irritating to hands and, in the absence of a sink, are an effective method of cleaning hands.
Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings –Recommendations of the HICPAC
Clean Hands Count for Healthcare Providers
Protect yourself and your patients from potentially deadly germs by cleaning your hands. Be sure you clean your hands the right way at the right times.
Introduction to Hand Hygiene
Hand Hygiene means cleaning your hands by using either handwashing (washing hands with soap and water), antiseptic hand wash, antiseptic hand rub (i.e. alcohol-based hand sanitizer including foam or gel), or surgical hand antisepsis
Cleaning your hands reduces:
- The spread of potentially deadly germs to patients
- The risk of healthcare provider colonization or infection caused by germs acquired from the patient
- Alcohol-based hand sanitizers are the most effective products for reducing the number of germs on the hands of healthcare providers.
- Alcohol-based hand sanitizers are the preferred method for cleaning your hands in most clinical situations.
- Wash your hands with soap and water whenever they are visibly dirty, before eating, and after using the restroom.
During Routine Patient Care:
Use an Alcohol-Based Hand Sanitizer
Use an Alcohol-Based Hand Sanitizer
- Immediately before touching a patient
Wash with Soap and Water
- When hands are visibly soiled
Use an Alcohol-Based Hand Sanitizer
- Before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices
Wash with Soap and Water
- After caring for a person with known or suspected infectious diarrhea
Use an Alcohol-Based Hand Sanitizer
- Before moving from work on a soiled body site to a clean body site on the same patient
Wash with Soap and Water
- After known or suspected exposure to spores (e.g. B. anthracis, C difficile outbreaks)
Use an Alcohol-Based Hand Sanitizer
- After touching a patient or the patient’s immediate environment
Use an Alcohol-Based Hand Sanitizer
- After contact with blood, body fluids or contaminated surfaces
Use an Alcohol-Based Hand Sanitizer
- Immediately after glove removal
When and How to Perform Hand Hygiene
The safety of refilling or “topping off” containers of ABHS has not been well studied. ABHS is an FDA regulated over-the counter drug and should be stored and dispensed in a manner that ensures safety and effectiveness. Potential safety risks that may be associated with refilling or “topping off” containers of ABHS include inadvertent contamination, reduced effectiveness from the evaporation of alcohol, and irritant effects from mixing formulations. Therefore, refilling or “topping off” ABHS dispensers should only be considered in accordance with manufacturer’s guidance and FDA regulations. Refilling or “topping off” containers of liquid soap has been associated with outbreaks of pathogenic bacteria. The 2002 Guidelines for Hand Hygiene in Healthcare Settings recommends that soap should not be added to partially empty soap dispensers.
Multiple opportunities for hand hygiene may occur during a single care episode. Following are the clinical indications for hand hygiene:
Use an Alcohol-Based Hand Sanitizer
Use an Alcohol-Based Hand Sanitizer
- Immediately before touching a patient
Wash with Soap and Water
- When hands are visibly soiled
Use an Alcohol-Based Hand Sanitizer
- Before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices
Wash with Soap and Water
- After caring for a person with known or suspected infectious diarrhea
Use an Alcohol-Based Hand Sanitizer
- Before moving from work on a soiled body site to a clean body site on the same patient
Wash with Soap and Water
- After known or suspected exposure to spores (e.g. B. anthracis, C difficile outbreaks)
Use an Alcohol-Based Hand Sanitizer
- After touching a patient or the patient’s immediate environment
Use an Alcohol-Based Hand Sanitizer
- After contact with blood, body fluids or contaminated surfaces
Use an Alcohol-Based Hand Sanitizer
- Immediately after glove removal
When using alcohol-based hand sanitizer:
- Put product on hands and rub hands together
- Cover all surfaces until hands feel dry
- This should take around 20 seconds
- The CDC Guideline for Hand Hygiene in Healthcare Settings pdf icon[PDF – 1.3 MB] recommends:
- When cleaning your hands with soap and water, wet your hands first with water, apply the amount of product recommended by the manufacturer to your hands, and rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers.
- Rinse your hands with water and use disposable towels to dry. Use towel to turn off the faucet.
- Avoid using hot water, to prevent drying of skin.
- Other entities have recommended that cleaning your hands with soap and water should take around 20 seconds.
- Either time is acceptable. The focus should be on cleaning your hands at the right times.
Glove Use
- Wear gloves, according to Standard Precautions, when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, potentially contaminated skin or contaminated equipment could occur.
- Gloves are not a substitute for hand hygiene.
- If your task requires gloves, perform hand hygiene prior to donning gloves, before touching the patient or the patient environment.
- Perform hand hygiene immediately after removing gloves.
- Change gloves and perform hand hygiene during patient care, if
- gloves become damaged,
- gloves become visibly soiled with blood or body fluids following a task,
- moving from work on a soiled body site to a clean body site on the same patient or if another clinical indication for hand hygiene occurs.
- Never wear the same pair of gloves in the care of more than one patient.
- Carefully remove gloves to prevent hand contamination.
Hand Hygiene for Surgery
- Remove rings, watches, and bracelets before beginning the surgical hand scrub
- Remove debris from underneath fingernails using a nail cleaner under running water
- Performing surgical hand antisepsis using either an antimicrobial soap or an alcohol-based hand sanitizer with persistent activity is recommended before donning sterile gloves when performing surgical procedures
- When performing surgical hand antisepsis using an antimicrobial soap, scrub hands and forearms for the length of time recommended by the manufacturer, usually 2–6 minutes.
- Long scrub times (e.g., 10 minutes) are not necessary
- When using an alcohol-based surgical hand-scrub product with persistent activity, follow the manufacturer’s instructions
- Before applying the alcohol solution, prewash hands and forearms with a non-antimicrobial soap and dry hands and forearms completely
- After application of the alcohol-based product as recommended, allow hands and forearms to dry thoroughly before donning sterile gloves
- Double gloving is advised during invasive procedures, such as surgery, that pose an increased risk of blood exposure
- Bacteria on the hands of surgeons can cause wound infections if introduced into the operative field during surgery
- Rapid multiplication of bacteria occurs under surgical gloves if hands are washed with a non-antimicrobial soap
- Bacterial growth is slowed after preoperative scrubbing with an antiseptic agent
- Reducing resident skin flora on the hands of the surgical team for the duration of a procedure reduces the risk of bacteria being released into the surgical field if gloves become punctured or torn during surgery
Skin and Nail Care
- Lotions and creams can prevent and decrease skin dryness that happens from cleaning your hands
- Use only hand lotions approved by your healthcare facility because they won’t interfere with hand sanitizing products
- Germs can live under artificial fingernails both before and after using an alcohol-based hand sanitizer and handwashing
- It is recommended that healthcare providers do not wear artificial fingernails or extensions when having direct contact with patients at high risk (e.g., those in intensive-care units or operating rooms)
- Keep natural nail tips less than ¼ inch long
- Some studies have shown that skin underneath rings contains more germs than comparable areas of skin on fingers without rings
- Further studies are needed to determine if wearing rings results in an increased spread of potentially deadly germs