20th July 2023
HAND HYGIENE
Hand hygiene is the single most effective action to reduce healthcare
associated infections.
Hand hygiene is a general term referring to any action of hand cleansing.
Hand hygiene results in a reduction of microorganisms on hands.
The 5 Moments for Hand Hygiene are:
1. Before touching a patient
2. Before a procedure
3. After a procedure or body fluid exposure risk
4. After touching a patient
5. After touching a patient's surroundings
Hand hygiene includes:
Applying an alcohol-based handrub to the surface of the hands (including liquids, gels
and foams)
OR
Washing hands with the use of water and soap or a soap solution, either non-
antimicrobial or antimicrobial
What Can I Use for Hand Hygiene?
When your hands are visibly clean When your hands are visibly soiled
Hand rubbing with an alcohol-based handrub Hand wash with soap and water
Hand Wash Guide
Appropriate glove use
Gloves do not provide complete protection against hand contamination. Microorganisms
may gain access to the healthcare workers' hands via small defects in gloves, or by
contamination of the hands during glove removal. Microorganisms colonising patients may
be recovered from the hands of ~ 30% of health care workers who wear gloves during
patient contact (1).
When should gloves be worn?
When there is a risk of contamination of the healthcare workers hands with blood or body
fluids
Where indicated by local infection control policy, for example with transmission based
precautions
When should gloves be changed?
Between episodes of care for different patients, to prevent transmission of microoganisms
During the care of a single patient, to prevent cross-contamination of body sites
Hand hygiene is required with glove use:
Hand hygiene should be performed before putting on gloves
Hand hygiene should be performed after removing gloves
Gloves should be removed to perform hand hygiene during the care for a single patient as
indicated by the 5 Moments for Hand Hygiene
Single use gloves should not be washed, but discarded.
Clean your hands:
1. Before you touch your client/patient/resident
For example before you assist a patient to move, before giving oral medications
2. Immediately before a procedure
For example prior to donning gloves before a procedure where there is a high risk for
microorganism transmission e.g. to provide dental care, emptying a catheter
3. Immediately after a procedure or body fluid exposure
For example after attending a dressing in clients home, pack up all clinical waste & clean
hands before touching anything else
4. After touching a client/patient/resident
For example after touching a client and before touching any of your own equipment that
you have brought to them
5. After touching the client's/patient's/resident's surroundings
For example after leaving the client's house, after wiping down the treatment chair
You may need to use personal bottles of alcohol-based handrub to enable the 5 Moments to
be carried out correctly in every situation.
Good Skin Care
Good skin care is vital for the prevention and management of occupational contact
dermatitis and eczema. Skin care involves several different components, and it is a package
of treatment where all aspects are important:
The most important treatment for contact dermatitis of the hands is to apply a skin
moisturising cream, which helps to restore the skin barrier. While greasy, thick, fragrance-
free moisturising creams are optimal.
Use of alcohol-based handrubs reduces the amount of hand washing, which is associated
with exposure to warm water, skin cleansers and paper towels: all skin irritants.
Healthcare workers occasionally report stinging with alcohol rubs, but this is not an allergic
reaction, and is often indicative of underlying irritant contact dermatitis which needs
treatment. In fact allergic contact dermatitis to alcohol-based handrubs is extremely rare,
and is much less common than allergic contact dermatitis to conventional hospital hand
cleansers.
At home, use of a non-fragranced soap substitute is preferable. Avoid liquid soaps which
are often perfumed and may contain MI, and bar soaps which are often alkaline and
irritating to the skin.
Appropriate glove use is important, particularly at home to decrease exposure to skin
irritants, such as when dishwashing or gardening.
Avoidance of allergens is important, so in cases of persistent dermatitis, thorough clinical
assessment incorporating patch testing should be performed. Alternative allergen-free
options should be adopted, such as accelerator-free nitrile gloves.
Hand Hygiene Before Touching a Patient
When
Perform Hand Hygiene on entering the patient’s zone before touching the patient
Why
To protect the patient against acquiring foreign organisms from the hands of the healthcare
worker.
HAND HYGIENE BEFORE: EXAMPLES:
Shaking hands, Assisting a patient to move, Allied health
interventions, Touching any invasive medical device
Touching a patient in any way connected to the patient ([Link] pump, indwelling
catheter)
Bathing, Dressing, Brushing hair, Putting on personal
Any personal care activities aids such as glasses
Taking a pulse, Blood pressure, Oxygen saturation,
Chest auscultation, Abdominal palpation, Applying ECG
Any non-invasive observations
electrodes, CTG
Applying an oxygen mask or nasal cannula, Fitting
slings/braces, Application of incontinence aids (including
Any non-invasive treatment
condom drainage)
Preparation and administration Oral medications, Nebulised medications
of oral medications
Feeding a patient, Brushing teeth or dentures
Oral care and feeding
Contacts with a patient’s Bedside table, Medical chart
surroundings before, during &
After any of the above
Hand Hygiene Immediately Before a Procedure
When
Immediately before a procedure. Once Hand Hygiene has been performed, nothing else in
the patient’s environment should be touched prior to the procedure starting
Why
To protect the patient from potential pathogens (including their own) from entering their
body during a procedure
In detail:
HAND HYGIENE BEFORE: EXAMPLES:
Insertion of a needle into a Venipuncture, Blood glucose level, Arterial blood gas,
patients skin, or into an invasive Subcutaneous or Intramuscular injections, IV flush
medical device
Preparation and administration
of any medications given via an
IV medication, NGT feeds, PEG feeds, Baby tube feeds,
invasive medical device,
Dressing Trolley
Preparation of a sterile field
Administration of medications
where there is direct contact Eye drop instillation, Suppository insertion, Vaginal
with mucous membranes pessary
Procedures involving the following:
ETT, Tracheostomy, Nasopharyngeal airways,
Insertion of, or disruption to, Suctioning of airways, Urinary catheter,
the circuit of an invasive medical Colostomy/ileostomy, Vascular access systems, Invasive
device monitoring devices, Wound drains, PEG tubes, NGT,
Secretion aspiration
Any assessment, treatment and Wound dressings, Burns dressings, Surgical procedures,
patient care where contact is Digital rectal examination, invasive obstetric and
made with non-intact skin or gynaecological examinations and procedures, Digital
mucous membranes. examination of a newborn’s palate
Hand Hygiene Immediately After a Procedure or Body Fluid Exposure Risk
When
Hand hygiene immediately after a procedure or body fluid exposure risk as hands could be
contaminated with body fluid
Even if you have had gloves on you should still perform hand hygiene after removing them as
gloves are not always a complete impermeable barrier. Hands may also have been
contaminated in the process of removing the gloves.
Why
To protect yourself and the healthcare surroundings from becoming contaminated with
potential pathogens
In detail:
HAND HYGIENE AFTER:EXAMPLES:
After any procedure See hand hygiene Before a Procedure
