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Hand hygiene

Introduction

  • The transfer of organisms between humans can occur directly via hands, or indirectly via an environmental source (e.g. clinical equipment, toys, or sinks)
  • It is universally acknowledged that the hands are the principal route by which cross-infection occurs and that hand hygiene is the single most important factor in the control of infection
  • Parents and children/young people should be taught the importance of good hand hygiene

Types of hand hygiene procedures

Routine/social hand wash

Why should a routine/social hand wash be performed?

  • A routine/social hand wash is performed to remove transient micro-organisms and to render the hands socially clean
  • This level of decontamination is sufficient for general social contact and most clinical care activities

Examples of when to perform a routine/social hand wash

  • Before:
    • the beginning of the shift
    • entering clinical areas
    • any patient contact
    • donning gloves
    • clean/aseptic procedures
    • preparing/giving medications
    • preparing, handling, and eating food
    • using a computer keyboard in a clinical area
  • After:
    • any patient contact
    • removal of gloves
    • exposure to blood and/or body fluids
    • the administration of medications
    • contact with patient surroundings
    • handling waste
    • leaving clinical areas
    • hands become visibly soiled
    • visiting the toilet
    • using a computer keyboard in a clinical area
    • the end of a shift

What solution should be used for performing a routine/social hand wash?

  • Liquid soap (plain or antimicrobial):
    • the soap is supplied in disposable cartridges to fit in the wall-mounted dispensers. Cartridges must not be re-used or 'topped-up'
    • bar soap should not be used in clinical areas

How should a routine/social hand wash be performed?

  • Routine/social hand washing should take 40–60 seconds:
    • wet hands under running warm water
    • dispense one dose of soap into cupped hands
    • rub hands palm to palm
    • right palm over the back of the other hand with interlaced fingers and vice versa
    • palm to palm with fingers interlaced
    • back of fingers to opposing palms with fingers interlocked
    • rotational rubbing of left thumb clasped in right palm and vice versa
    • rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa
    • rinse hands with warm water
    • dry thoroughly with a paper towel. Cloth towels must not be used. Jet air and warm air dryers may only be used in non-clinical areas
    • turn off taps using a 'hands-free' technique (e.g. elbows). Where this is not possible, the paper towel used to dry the hands can be used to turn off the tap
    • dispose of the paper towel without re-contaminating hands. Do not touch bin lid with hands

Alcohol hand rub (alcohol gel or foam)

  • Alcohol hand rub can be used on visibly clean hands as an alternative to a routine/social hand wash and is the preferred means for routine hand antisepsis
  • Alcohol hand rub:
    • will not remove dirt and organic matter and can therefore only be used on hands that are not visibly soiled
    • is NOT effective against Clostridium difficile and Norovirus. When caring for a patient with either of these organisms, hands must be washed with soap and water
    • should not be used prior to handling medical gas cylinders because of the risk of ignition
  • Soap and alcohol-based hand rub should not be used concomitantly
  • When applying alcohol hand rub leave to dry naturally on the skin
  • Hands should be washed with soap and water after several consecutive applications of hand rub

Hygienic hand wash

Why should a hygienic hand wash be performed?

  • To remove or destroy transient micro-organisms and to substantially reduce resident micro-organisms during times when aseptic procedures are performed

When should a hygienic hand wash be performed?

  • Before all aseptic procedures

What should be used for performing a hygienic hand wash?

  • An approved antiseptic detergent (e.g. 4% chlorhexidine gluconate or 7.5% povidone iodine)

How should a hygienic hand wash be performed?

The use of gloves

  • The use of gloves does not replace the need for hand hygiene by either hand washing or using alcohol hand rub
  • Gloves must be worn for invasive procedures, contact with sterile sites and non-intact skin/mucous membranes, and all activities that have been assessed as carrying a risk of exposure to blood, body fluids, secretions or excretions, or sharp or contaminated instruments. Some procedures not normally requiring gloves may require gloves when infection is present, e.g. eye care
  • Gloves can have pores that may allow micro-organisms to pass through and hands should be cleaned before and after wearing gloves
  • Gloves should be single-use and changed between dirty and clean procedures and between patients
  • Gloved hands should not be washed or cleaned with alcohol hand rubs or sanitising wipes
  • Sensitivity to natural rubber latex in patients, carers, and healthcare workers must be documented and alternatives to natural rubber latex gloves must be available

Other aspects of hand hygiene

  • Artificial fingernails or extenders should not be worn when having direct contact with patients
  • Natural nails should be kept short (tips less than 0.5 cm long)
  • The wearing of rings and wrist jewellery (including watches and fit tracker bracelets) during health care is strongly discouraged. If religious or cultural influences strongly condition the healthcare worker’s attitude, the wearing of a simple wedding ring (band) during routine care may be acceptable
  • Cuts and abrasions must be covered with waterproof dressing
  • Bare below the elbows—in order to ensure that hands can be easily decontaminated, only clothing that does not go past the elbow should be worn. Suit jackets, long sleeves, wrist watches, bracelets, and rings (other than a plain wedding band) should not be worn

Hand care

  • Contact dermatitis caused by frequent exposure to soaps and cleaners is the most common form of work-related skin disease in nurses and other healthcare professionals

Hand care advice

  • Always wet hands thoroughly before washing
  • Ensure water is warm (neither hot nor cold)
  • Do not use more soap product than recommended by the manufacturer ('One squirt is enough')
  • During hand washing, thoroughly rinse off residual soap
  • Dry hands completely by carefully patting rather than rubbing with a paper towel
  • Donning gloves while hands are still wet from either washing or applying alcohol hand rub increases the risk of skin irritation
  • Use emollient creams regularly, especially before breaks and after finishing work. Ensure all parts of the hand are covered
  • Check your skin for early signs of dermatitis and report concerns to Occupational Health. Early detection can help prevent more serious dermatitis from developing

full guideline available from…
www.gosh.nhs.uk/health-professionals/clinical-guidelines/hand-hygiene

Great Ormond Street Hospital. Hand Hygiene. 
First included: July 2016.