- The Rationale for Hand Hygiene
- Hand Hygiene Procedures
- Hand Hygiene Links
- Standards & Guidelines
- Education & Teaching Aids
- Publications, Research & References
- Other Information
SAVE LIVES: Clean Your Hands - WHO's global annual campaign...
A Message from the WHO Clean Care is Safer Care Team...
As most of you know, our programme "Clean Care is Safer Care" has expanded its mandate to a number of new infection prevention and control (IPC) topics over the last couple of years, while maintaining hand hygiene promotion at the heart of our work. We have started to work on the prevention of surgical site infections and catheter-related bloodstream infections (CRBSI), injection safety, as well as antimicrobial resistance, with underlying main focus on IPC in developing countries. You will receive a full update on these new activities through our refreshed web pages in the next months. In this edition, in addition to some other announcements, we would like to provide you with an overview of an important European project aimed at reducing CRBSI, in which WHO has participated, entitled PROHIBIT for the "Prevention of Hospital Infections by Intervention & Training".
In this edition:
1. PROHIBIT: a comprehensive study on IPC and CRBSI prevention across Europe
2. Update on the WHO 5 May 2014 global surveys
3. Events, training and information
Please see attached PDF version of the newsletter.
Why is hand hygiene important?
Hand hygiene refers to removing or killing microorganisms (germs) on the hands. When performed correctly, hand hygiene is the single most effective way to prevent the spread of communicable diseases and infections. In health care, hand hygiene is used to eliminate transient microorganisms that have been picked up via contact with patients, contaminated equipment or the environment. Hand hygiene may be performed either by using soap and running water, or with alcohol-based hand rubs.
When should hand hygiene be performed?
In health care, hand hygiene is required:
- Before and after contact with any patient/resident, their body substances or items contaminated by them
- Between different procedures on the same patient/resident
- Before and after performing invasive procedures
- Before preparing, handling, serving or eating food or feeding a patient/resident
- After assisting patients/residents with personal care (e.g. assisting patient to blow nose, toileting or doing wound care)
- Before putting on and after taking off gloves
- After performing personal functions (e.g. using the toilet, blowing your nose)
- When hands come into contact with secretions, excretions, blood and body fluids (use soap and running water whenever hands are visibly soiled)
When should soap and water be used?
The mechanical action of washing, rinsing and drying removes transient bacteria present on the hands. Hand washing with soap and running water must be performed whenever hands are visibly soiled.
Any type of plain soap may be used. However, bar soaps are not acceptable in health care settings except for single patient/resident personal use. If used, bar soap should be kept in a self draining holder that is cleaned thoroughly before new bars are put out. Liquid soap containers should be used until empty and then discarded. Soap containers must not be topped up, as there is a risk of contamination of residual soap. Antibacterial soaps may be used in critical care areas such as ICU, or in other areas where invasive procedures are performed.
When should alcohol-based hand rubs be used?
Alcohol-based hand rubs/gels/rinses are the preferred method for decontaminating hands, provided they contain more than 60% alcohol. They are widely used in health care settings, or in situations where running water is not available. Using alcohol-based hand rub is better than washing hands (even with an antibacterial soap) when hands are not visibly soiled.
Won't frequent hand hygiene dry my skin?
Intact skin is the first line of defence against microorganisms, hence it is important to maintain good skin care. To prevent chafing, wet your hands before applying soap and use a mild lotion soap with warm water; pat rather than rub hands dry; and apply lotion liberally and frequently. Skin lotions should be chosen that will not interfere with glove integrity.
Most alcohol-based hand rubs contain emollients to reduce the incidence of skin irritation. Frequen use of alcohol-based hand rub actually lessens the incidence of skin breakdown, as it does not subject hands to the friction and abrasion involved in hand washing and drying hands.
If an individual develops compromised skin integrity, he/she should be referred to Occupational Health for assessment.
How do I use soap and water?
Good hand hygiene technique is easy to learn. Follow these five simple steps to keeping hands clean:
- Remove hand and arm jewellery and wet your hands with warm (not hot) running water.
- Add soap, and then rub your hands together, making a soapy lather. Do this for at least 15 seconds, being careful not to wash the lather away. Wash the front and back of your hands, as well as between your fingers and under your nails.
- Rinse your hands well under warm running water, using a rubbing motion.
- Wipe and dry hands gently with paper towel. Rubbing vigorously with paper towels can damage the skin.
- Turn off tap using paper towel so that you do not recontaminate your hands.
- Download IPAC Canada's Hand Washing brochure:
Alcohol-based hand rubs should only be used if no visible dirt is present on the hands.
- Remove hand and arm jewellery.
- Apply enough alcohol-based hand rub to make about the size of a quarter onto your hands, enough when you rub your hands together to cover all areas of your hands, including under your nails (1-2 pumps).
- Use a rubbing motion to evenly distribute the alcohol-based hand rub over all surfaces of the hands, particularly between fingers, fingertips, back of hands and base of thumbs.
- Rub hands until your hands feel dry (minimum 15-30 seconds).
- What are some mistakes I should avoid regarding hand hygiene?
- DON'T leave hand jewellery on when performing hand hygiene. Jewellery is very hard to clean and hides bacteria and viruses from the mechanical action of the washing/rubbing.
- DON'T use artificial nails, nail enhancements or long (>3-4mm) nails, as they trap bacteria and are difficult to keep clean.
- DON'T wear chipped nail polish, as bacteria may become trapped along the edges
- DON'T use a single damp cloth to wash a group of patient's/resident's/children's hands.
- DON'T use a standing basin of water to rinse hands.
- DON'T use a common hand towel.
- DON'T use sponges or non-disposable cleaning cloths. Remember that germs thrive on moist surfaces.
- IPAC Canada Position Statement: Hand Hygiene
- Hand Hygiene Practices in Healthcare Settings - Public Health Agency of Canada (PHAC) 2013
- Best Practices for Hand Hygiene in All Health Care Settings - Ontario's Provincial Infectious Diseases Advisory Committee (PIDAC)
- Guideline for Hand Hygiene in Health-Care Settings - Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force
- WHO Guidelines on Hand Hygiene in Health Care (May 2009)
EDUCATION AND TEACHING AIDS
- STOP! Clean your hands Canada's Hand Hygiene campaign developed in conjunction with IPAC Canada, the Canadian Council on Health Services Accreditation, the Canadian Patient Safety Institute and the Public Health Agency of Canada:
- Just Clean Your Hands Ontario's evidence-based hand hygiene program for hospitals and long-term care homes:
- Hand Hygiene Techniques - posters and brochures that show proper hand hygiene technique through pictures:
- Clean Hands: It's What We Do Interactive hand hygiene program developed by the Calgary Health Region. Interactive modules:
- PICNet's Hand Hygiene Resource Page Resources from the Provincial Infection Control Network of British Columbia (PICNet) include:
- SAVE LIVES: Clean Your Hands The World Health Organization's hand hygiene program undertaken as part of the First Patient Safety Global Challenge, Clean Care is Safer Care
- Hopisafe.ch A project of Hôpitaux Universitaires de Genève, focusing on hand hygiene and other incentives to prevent hospital-acquired infections:
- Infection: Don't Pass It On Campaign A project of the U.S. Department of Veterans Affairs, with the messages "Wash your hands" and "Cover your coughs". Many educational materials available, including:
- Germs. Wash your Hands of Them. Scotland's National Hand Hygiene Campaign has useful information, posters and other resources available:
- Centers for Disease Control and Prevention (CDC)
- Public Health
- Handwashing awareness poster (Peel Public Health)
- How to wash your hands (Peel Public Health)
- Hand Washing is a Must! (BC Centers for Disease Control)
- Wash Those Hands! (Lincoln-Lancaster County Health Dep't, Nebraska - posters, table tents, activity sheets and more...)
- Cross-contamination of Gloves When Being Put On
- Scrub Club (Hand hygiene games for kids from NSF International)
- You'll Like Clean Hands Introduces the character Soapy (Dr. John Embil) from the Winnipeg Health Region. Written material and a video are available.
- Hand Hygiene after a Disaster (CDC) Flyers, stickers and handout cards are available for use when handwashing facilities have been interrupted:
- Sudsy;® (IPAC Canada) - hand hygiene video and teaching program
- Materials to Promote Hand Hygiene (U.S. Centers for Disease Control) - posters, buttons
HAND HYGIENE VIDEOS
- WHO: Save Lives: Clean Your Hands
- Government of New Brunswick:
- Centers for Disease Control and Prevention
- New England Journal of Medicine [Longtin, Sax, Allegranzi, Schneider, Pittet - N Engl J Med 2011; 364:e24]
- Deb Canada: 'The WHO 5' Music Video
- Hand Hygiene Resources/References (Public Health Ontario)
- References used for Hopisafe project (see above)
- Measuring Hand Hygiene Adherence: Overcoming the Challenges (U.S. The Joint Commission)
Information for Children & Teachers
- Proper Hand Washing, Teeth Brushing and Other Hygiene Practices
- Henry the Hand
- Gross...You Didn't Wash Your Hands? (MicrobeWorld)
- Hand Hygiene Facts You Should Know (Filters Fast)
- The Scrub Club
- Children's Pack
History of Hand Hygiene
- The National Health Museum Classic Collection: Handwashing
- Ignaz Semmelweis and the Birth of Infection Control (QSHC online)
- Handwashing in Medicine: infrequent use of an ancient practice (Int J Psychosom.)
- A history of hand washing: seven hundred years at a snail's pace (Pharos Alpha Omega Alpha Honor Med Soc.)