# Hand Hygiene

## Overview

Infection Prevention and Control (IPC) during procedures includes the safe management of ‘sharps’, encompasses high-level measures such as health facility design and management, protocol-based measures such as adherence to national and facility level guidelines, and individual actions by each health care provider and ancillary staff member. The health care provider is encouraged to familiarise themselves with their facility’s specific IPC protocols and reporting systems, which is outside the scope of this module.

All clinical procedures pursue the IPC goal of asepsis. The traditional hierarchy of sterile, aseptic, and clean is outdated, poorly-defined and misleading, and is no longer recommended. This module describes how to perform hand washing and hand rubbing. See Scrubbing & Gowning for surgical hand hygiene. Avoid wearing rings at work, false/gel nails, long nails, or nail polish, and protect your skin from local damage.

## Indications

The World Health Organisation recommends five moments of hand hygiene:

1. Before touching a patient

2. Before aseptic procedures

3. After potentially being exposed to body fluids

4. After touching a patient

5. After touching a patient’s surroundings

Hand washing with soap and water is preferred:

1. When your hands are visibly dirty

2. After using the toilet

3. When you suspect your patient has spore-forming pathogens (usually diarrhoea)

4. Routinely when hand rub is not available.

Hand rubbing with alcohol-based hand rub is preferred:

1. Routinely between patients when your hands are not visibly dirty

2. Before any procedure, whether you use gloves or not

3. Between touching a contaminated area and another area of a patient’s body (such as the perineum and then face)

4. After removing gloves

## Hand rub 30sec

1. Apply a palmful of hand rub (at least 70% alcohol, with an emollient) to your hand.

2. Rub your flat palms together.

3. Rub the back of each hand with the palm of the other, fingers interlaced.

4. Rub your palms together, fingers interlaced.

5. Rub the backs of your fingers with your palms by interlocking your hands.

6. Rub each thumb by holding it with the other hand and making twisting movements.

7. Rub the fingertips of each hand in circles on each palm in turn.

8. Wait for your hands to dry—don’t wave them or blow on them.

## Hand wash 60sec

1. Wet your hands with water and apply soap.

2. Rub your flat palms together.

3. Rub the back of each hand with the palm of the other, fingers interlaced.

4. Rub your palms together, fingers interlaced.

5. Rub the backs of your fingers with your palms by interlocking your hands.

6. Rub each thumb by holding it with the other hand and making twisting movements.

7. Rub the fingertips of each hand in circles on each palm in turn.

8. Rinse your hands with water.

9. Use paper towels to dry your hands and to close the tap.

10. Dispose of paper towels.

## Troubleshooting

I cut my finger and now the hand rub burns.

Use a waterproof dressing such as Opsite or Tegaderm, which is washable and will keep your cut covered.

My hands are developing a rash.

Irritant contact dermatitis is common among healthcare workers, especially in winter when skin is naturally dry.

1. Use alcohol-based hand rub rather than soap—it’s less drying.

2. Never wash your hands with hot water.

3. Always dry your hands thoroughly after washing.

4. Never put on gloves with damp hands from rub or water.

5. Never use hand rub and soap and water together.

6. Use hand creams regularly, and apply a thick layer of cream at bedtime.

7. If it persists, seek help from Occupational Health or your clinician.

## References

1. World Health Organisation. Hand Hygiene Technical Reference Manual. 2009a.

2. CDC Hand Hygiene in healthcare settings. 2018. Available at: https://www.cdc.gov/handhygiene/science/index.html

3. World Health Organisation. Collecting, preserving and shipping specimens for the diagnosis of Avian influenza A (H5N1) virus infection, guide for field operations. 2006. Available at: http://www.who.int/csr/resources/publications/surveillance/Annex5.pdf.

4. World Health Organisation. Guidelines on hand hygiene in health care: A summary. 2009b. Available at: http://whqlibdoc.who.int/hq/2009/WHO_IER_PSP_2009.07_eng.pdf