© IFIC:2008
Hand Hygiene
BASIC CONCEPTS OF INFECTION CONTROL
International Federation of
Infection Control
© IFIC:2008
Objectives
Skin flora
Impact of hand hygiene (HH) in
healthcare-associated infections (HAI)
Techniques of HH
Compliance
Recommendations
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Background
Personal hygiene and environmental
cleaning associated with less illness
and death
Ignaz Semmelweis (1846) demonstrated
that washing hands with antiseptic
solution reduced mortality due to
puerperal endometritis
Other researchers demonstrated that
healthcare workers (HCWs) can
transmit infections through
contaminated hands
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Background
Hands are the most frequent route of transmission
for pathogens in healthcare settings
There have been changes in hand hygiene based
on rationale or evidence (mainly products)
The main problem is how to improve compliance
Compliance is generally low
Compliance averages 40%-60%
Combined strategies to improve compliance
Education
Supervision
Alcohol based products
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Skin Flora
Transient
Superficial layers of the skin
Often acquired by HCWs during contact with patients
Easily transmitted by contact
Most frequently associated with HAI
Resident
Lives permanently in the deeper layers of the skin (epidermis)
More resistant to removal
Unlikely to be associated with infections
(except in surgery)
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Skin Flora
Hands of HCWs may become colonised or infected
with pathogens (e.g., S. aureus, Gram-negative bacilli, or yeast)
Transmitted like transient flora - constitutes a serious danger
within hospitals
Damaged or diseased skin allows multiplication of flora
Most dangerous of all situations
HCWs with uncovered skin lesions should not have
direct contact with patients
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Techniques for Washing and
Decontamination
Fingernails, nail polish and artificial nails
Nails must be kept short and clean
Chipped nail polish support adhesion of microorganisms
Artificial nails implicated in outbreaks and should be avoided
Jewelry
Rings, bracelets and wrist watches may not be worn
Skin underneath jewelry and watches more heavily colonised
Impossible to clean skin adequately when covered by jewelry
Rings and watches make donning gloves difficult
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Washing and Decontamination
Gloves
Use for the chosen task
Remove immediately after task
Reduce the risk of transmission of HAI from the hands
of personnel by 70-80 %
Protects HCWs hands from patient’s flora and
infectious body fluids
Do not provide total protection or replace hand hygiene
Microorganisms can contaminate the HCWs hands via
small defects in the gloves or during glove removal
Hand hygiene always must occur after glove removal
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Hand Hygiene Technique
Soap and water
Rub – covering all
surfaces of hands and
fingers
Rinse with water
Dry with disposable towel
Use towel to turn off
faucet
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Hand Hygiene Technique
Alcohol-based hand rub
Apply sufficient volume
to the palm of one hand
and rub hands together
Cover all surfaces and
fingers, rub until hands
are dry
Covering the whole
surface of the hands is
important
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Improving Compliance
Have a clear written policy
Should be followed by all HCWs
Easy access to hand hygiene facilities
On-going promotion campaigns to increase
awareness of all staff including the executive
level
Monitor technique and provide performance
feedback
Careful selection of products
Staff will not use products damaging to their
skin or difficult to use
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Basic Recommendations
If hands not visibly soiled, use an alcohol-based
hand rub for routine antisepsis
Wash hands before starting work, entering the
operating room, eating, after using a restroom
and when hands are visibly soiled
Keep nails shorts and clean
Do not wear artificial fingernails, nail polish or jewelry
Do not wash or disinfect gloves between uses on
different patients
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Basic Recommendations
Multiple-use cloth towels not recommended
Liquid soaps in dispensers preferred
Do not add soap to a partially empty liquid
soap dispenser
Hand hygiene products should have low
irritancy
Ask personnel for input regarding the tolerance
of any products
For surgical scrub - preferably use an alcoholbased
hand rub
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Basic Recommendations
Use hand lotions frequently to minimize
irritant contact dermatitis
Encourage personnel to report any adverse
event related to a hand hygiene product to
the infection control person and to the
Occupational Health Department
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Surgical Hand-Scrub
When using an alcohol-based product,
pre-wash with soap once a day before
starting surgery and when hands are
soiled (glove perforation) or sweaty
Brushes are not necessary and can be a
source of contamination
Hand washing immediately prior to every rub
does not improve its efficacy
Scrub for 1-5 minutes according to the
manufacturer’s recommendation
After application, rub till hands are dry
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Improving Hand Hygiene
Educate personnel continuously
Administrative support and financial
resources
Readily available alcohol-based hand rub
Provide HCWs with alcohol-based handrub
in individual pocket-sized
containers
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Improving Hand Hygiene
Provide HCWs with hand lotions or creams
especially in critical areas
Provide diagrams on how to use a rub
Monitor HCWs' adherence with local
recommendations and provide feedback
Evaluate adherence to hand hygiene using
a performance indicator
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Key Points
Hand hygiene is the most important way to
prevent HAIs
Long nails, polish, rings, bracelets and wrist
watches should not be worn
All personnel should follow hand hygiene
guidelines
Alcoholic hand rub is a safe method to reduce
skin flora
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Key Points
Alcoholic hand rub can replace handwashing
and surgical scrub if hands are not visibly
soiled
Gloves should only be worn for specific tasks
Continuous education and regular audits can
improve hand hygiene compliance
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References and Further Reading
Centers for Disease Control and Prevention (CDC).
Hand Hygiene in Healthcare Settings [online]. 2002
[cited 2007 August 10]. Available from: URL:
http://www.cdc.gov/handhygiene/
Dutch Working Party Infection Control (WIP), WIP
Guidelines Hand hygiene [online]. 2004 [cited 2007
August 10]. Available from: URL: www.wip.nl
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References and Further Reading
World Health Organization. WHO Guidelines on hand
hygiene in health care. (advanced draft) [online]. 2005
[cited 2007 August 10]. Available from: URL:
http://www.who.int/patientsafety/events/05/HH_en.pdf
Ministry of Health and Long term Care of Ontario. PIDAC
Provincial Infectious Diseases Advisory Committee Fact
Sheet Hand hygiene [online]. 2006 [cited 2007 August
10]. Available from: URL:
http://www.health.gov.on.ca/english/providers/program/p
ubhealth/handwashing/hw_about.html
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