- The Rationale for Hand Hygiene
- Hand Hygiene Procedures
- Standards & Guidelines
- Education & Teaching Aids
- Posters & Videos
- Other Information
WHO Save Lives: Clean Care for All - It's In Your Hands
Healthcare Excellence Canada (formerly Canadian Patient Safety Institute): Clean Care Conversations
Stop! Clean Your Hands Day (May 5, 2020)
2020 Theme: Clean Hands Matter
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.
- Hand Hygiene E-learning Tool -Infection Prevention and Control Canada and Discovery Campus offer an online hand hygiene education module for healthcare workers and volunteers
How do I use alcohol-based hand rubs?
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 in Health Care Settings (2017)
- Best Practices for Hand Hygiene in All Health Care Settings - Ontario's Provincial Infectious Diseases Advisory Committee (PIDAC) 2014
- Hand Hygiene Practices in Healthcare Settings - Public Health Agency of Canada (PHAC) 2013
- 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)
- 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:
- Alberta Health Services interactive hand hygiene reviewer training 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
- You'll Like Clean Hands Introduces the character Soapy (Dr. John Embil) from the Winnipeg Health Region.
- Hand Hygiene after a Disaster (CDC) Flyers, stickers and handout cards are available for use when handwashing facilities have been interrupted:
- WHO: Save Lives: Clean Your Hands
- Just Clean Your Hands
- Centers for Disease Control and Prevention
- New England Journal of Medicine -Hand Hygiene Video [Longtin, Sax, Allegranzi, Schneider, Pittet - N Engl J Med 2011; 364:e24]
- Proper Hand Washing, Teeth Brushing and Other Hygiene Practices
- Henry the Hand
- Hand Hygiene Facts You Should Know (Filters Fast)
- The Scrub Club
- Children's Pack
- 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.)