Serial

Recommendations

1

Indications for hand hygiene

a.  Wash hands with soap and water when:

1. Visibly dirty or visibly soiled with blood or other body fluids or after using the toilet (Strong recommendation)

2. If exposure to potential spore-forming pathogens is strongly suspected or proven, including outbreaks of Clostridium difficile (Strong recommendation)

b. Use an alcohol-based handrub as the preferred means for hand antisepsis in all other clinical situations, if hands are not visibly soiled (Strong recommendation)

c. Perform hand hygiene

1. before and after touching the patient (Strong recommendation)

2. before handling an invasive device for patient care, regardless of whether or not gloves are used (Strong recommendation)

3. after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings (Strong recommendation)

4. if moving from a contaminated body site to another body site during care of the same patient (Strong recommendation)

5. after contact with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient after removing sterile or non-sterile gloves (Strong recommendation)

d. Before handling medication or preparing food perform hand hygiene using an alcohol-based handrub or wash hands with soap and water. (Strong recommendation)

2

Hand hygiene technique

a. Apply a palm-full of alcohol-based handrub and cover all surfaces of the hands. Rub hands until dry. (Strong recommendation)

b. When washing hands with soap and water, wet hands with water and apply the amount of product necessary to cover all surfaces. Rinse hands with water and dry thoroughly with a single-use towel. Use clean, running water whenever possible. Make sure towels are not used multiple times or by multiple people. (Strong recommendation)

3

Surgical hand preparation

a. Remove rings, wrist-watch, and bracelets before beginning surgical hand preparation. (Good practice statement) Artificial nails are prohibited. (Strong recommendation)

b. If hands are visibly soiled, wash hands with plain soap before surgical hand preparation. (Conditional recommendation)

c. Remove debris from underneath fingernails using a nail cleaner, preferably under running water. (Good practice statement)

d. Sinks should be designed to reduce the risk of splashes (Good practice statement)

e. Brushes are not recommended for surgical hand preparation. (Conditional recommendation)

f. Surgical hand antisepsis should be performed using either a suitable antimicrobial soap or suitable alcohol-based handrub, preferably with a product ensuring sustained activity, before donning sterile gloves. (Strong recommendation)

g. When performing surgical hand antisepsis using an antimicrobial soap, scrub hands and forearms for the length of time recommended by the manufacturer, typically 2–5 minutes. Long scrub times (e.g. 10 minutes) are not necessary. (Strong recommendation)

h. When using an alcohol-based surgical handrub product with sustained activity, follow the manufacturer’s instructions for application times. Apply the product to dry hands only and allow hands and forearms to dry thoroughly before donning sterile gloves. (Strong recommendation)

4

Use of gloves

a. The use of gloves does not replace the need for hand hygiene by either hand rubbing or handwashing. (Strong recommendation)

5

Selection and handling of hand hygiene agents

a. Provide HCWs with efficacious hand hygiene products that have low irritancy potential. (Strong recommendation)

b. To maximize acceptance of hand hygiene products by HCWs, solicit their input regarding the skin tolerance feel, and fragrance of any products under consideration. (Strong recommendation)

c. When selecting hand hygiene products:

1. determine any known interaction between products used to clean hands, skin care products, and the types of gloves used in the institution. (Good practice statement)

2.  solicit information from manufacturers about the risk of product contamination. (Strong recommendation)

3. ensure that dispensers are accessible at the point of care. (Strong recommendation)

4. ensure that dispenser function adequately and reliably and deliver an appropriate volume of the product. (Good practice statement)

5.  ensure that the dispenser system for alcohol-based handrubs is approved for flammable materials. (Conditional recommendation).

6. solicit and evaluate information from manufacturers regarding any effect that hand lotions, creams, or alcohol-based handrubs may have on the effects of antimicrobial soaps being used in the institution. (Strong recommendation)

d. Do not add soap to a partially empty soap dispenser. If soap dispensers are reused, follow recommended procedures for cleansing. (Strong recommendation)

6

Educational and motivational programs for health-care workers

1. In hand hygiene promotion programs for HCWs, focus specifically on factors currently found to have a significant influence on behaviour, and not solely on the type of hand hygiene products. The strategy should be multifaceted and multimodal and include education and senior executive support for implementation. (Strong recommendation)

2.  Educate HCWs about the type of patient-care activities that can result in hand contamination and about the advantages and disadvantages of various methods used to clean their hands. (Good practice statement)

3. Monitor HCWs’ adherence to recommended hand hygiene practices and provide them with performance feedback. (Strong recommendation)

4. Encourage partnerships between patients, their families, and HCWs to promote hand hygiene in health care settings. (Good practice statement)