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Hand Hygiene

Hand hygiene is the most important way to prevent the transmission of infection. Therefore, all health workers must familiarise themselves with the recommended hand hygiene technique, and all healthcare facilities must incorporate the guidelines into their practice. In addition, regular hand hygiene compliance audits should be performed and promptly reported to line managers.

Hand Washing

Hand washing is performed using warm water and liquid soap if the hands are visibly dirty or soiled. Hand washing is also recommended for managing patients with Clostridioides difficile infection and other infectious diarrhoeal diseases. After washing, hands must be thoroughly dried using disposable paper towels.

To facilitate effective hand hygiene, health workers should

  • Wear sleeves above the elbows. If wearing long sleeves, these should be “rolled up” above the elbows.
  • Remove any hand or wrist jewellery. Wearing a single wedding ring is permitted. However, it should either be removed (or moved up) during hand hygiene. A religious bangle can be worn but should be moved up the forearm during hand hygiene.
  • Keep nails short, and do not wear artificial nails, nail extensions, gel nails or nail varnish/polish.

The manager in charge of a ward or department should

  • Assess hand hygiene facilities in their clinical areas.
  • Ensure an adequate number of dedicated clinical hand wash sinks with elbow-controlled taps.
  • Ensure ready access to liquid soap and wall-mounted disposable hand towels at each clinical handwashing sink.
  • Routine use of antiseptic handwash (chlorhexidine gluconate, povidone-iodine, etc.) is not. However, it should be used only before performing aseptic procedures (insertion of CVC line, urinary catheters, etc.) or as a surgical scrub before surgical procedures.
  • Ensure that Hand Hygiene posters are placed at each clinical handwashing sink.
 

Clinical handwash basins

  • The healthcare facility should have an adequate number of hand wash basins which should be conveniently and strategically located (away from patients, especially in high-risk areas, neonatal, intensive care, burn units, etc.) in relevant clinical areas.
  • The IPC team should be consulted regarding the location and number of sinks in any new building work or changes to existing wards, units and clinical areas.
  • Handwashing sinks must not be used for the disposal of liquid or the cleaning/rinsing items.
  • Clinical hand wash sinks should have mixer taps, no overflow or plug, and be in a good state.
  • They should be regularly cleaned as per local cleaning guidelines.
 

Skincare

Hand Cream

  • Hand cream: Hands should be moisturised regularly by using emollient hand cream.
  • It is advisable to carry a personal tube of approved hand cream. Where individual tubes are unavailable, multi-dosecontainers must be pump operated and only be filled with a sealed cartridge from the manufacturing company. Do not use or provide communal tubs of hand cream in the care setting.

Skin lesions

  • Cuts and abrasions on the hands must be covered with an impermeable dressing.
  • If a staff member has a skin lesion or a chronic skin condition (eczema, etc.) or experiences skin problems associated with hand hygiene, they should consult the Occupational Health Department or their GP, as severe cases may require a change of clinical duties.

Alcohol-based hand rub

Alcohol-based hand rub (ABHR) products are more effective and require less time than hand washing but should only be used if the hands are physically clean. They must be available for staff near the point of care. Where this is impractical, e.g. within the community, domiciliary care, mental health units etc., personal ABHR dispensers should be used if a handwashing facility is unavailable. Staff may use detergent hand wipes followed by ABHR. If hands are physically dirty, they should be washed at the first opportunity.

ALCOHOL-BASED HAND RUB

  • Use the approved product: EN: European or ATSM (US) norms.
  • The correct concentration: Use an effective compound that contains 60– 80% alcohol (60% v/v n-propanol is approximately equivalent to 70% v/v isopropanol and 80% v/v ethanol).
  • The correct amount to cover all parts of the hand: ~ 3 ml (palm full). If the hands are dry (10 sec), the amount of the product does not have enough volume to disinfect the hands effectively.
  • The recommended duration of the entire procedure for using ABHR is 20– 30 seconds.
  • Use the correct technique to cover all parts of the hands, especially the fingers and thumb.
  • The ‘Five Moments for Hand Hygiene’ guideline from the World Health Organization (WHO) defines the key moments for hand hygiene.

Hand hygiene in the community setting

Staff visiting patients in their homes should practice hand hygiene when entering and leaving. In most instances, using the facilities within the home will be appropriate. However, sometimes it may be necessary to complement or replace this with an alcohol-based hand rub.

Hand hygiene for patients and visitors

Patients: Hands should be washed after using the bathroom or toilet facilities, before eating food, after coughing or sneezing into the hands, after direct contact with pets/animals or when hands are visibly dirty.

Visitors: They should protect themselves and their patients by washing their hands or using an alcohol-based hand rub when entering and leaving the ward/care home.

PHA Hand Hygiene Leaflet

View here

Literature review: Hand hygiene

References