Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiological studies
Alcohol hand rub—routine hand antisepsis in all clinical situations if hands are not visibly soiled
Soap and water—after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressing
Strongly recommended for implementation and supported by some experimental, clinical, or epidemiological studies and a strong theoretical rationale
Soap and water—when visibly dirty or soiled with blood or other body fluids
Alcohol hand rub/soap and water—if exposure to potential spore-forming pathogens is strongly suspected or proven, including outbreaks of C. difficile
Alcohol hand rub—before and after touching patient
Alcohol hand rub/soap and water—before handling an invasive device for patient care, regardless of whether or not gloves are used
Alcohol hand rub/soap and water—if moving from a contaminated body site to another body site during care of the same patient
Alcohol hand rub—after contact with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient
Alcohol hand rub—after removing sterile or nonsterile gloves
Alcohol hand rub/soap and water—before handling medication or preparing food
Required for implementation as mandated by federal and/or state regulation or standard
Suggested for implementation and supported by suggestive clinical or epidemiological studies or a theoretical rationale or the consensus of a panel of experts
Soap and water—after using the toilet
The WHO recommendations for the hand hygiene technique are as follows:
Alcohol-based hand rub—apply a palmful of required solution and cover all surfaces of the hands. Rub hands until dry.
Soap and water—wet hands with water and apply soap necessary to cover all surfaces. Rinse hands with water and dry thoroughly with a single-use towel. Use clean, running water whenever possible and avoid using hot water, as repeated exposure to hot water may increase the risk of dermatitis.
Surgical Hand Preparation
The WHO recommendations for surgical hand preparation technique are as follows:
Remove rings, wristwatch, and bracelets before beginning surgical hand preparation. Artificial nails are prohibited.
Sinks should be designed to reduce the risk of splashes.
If visibly soiled, wash hands with plain soap before surgical hand preparation. Remove debris from underneath fingernails using a nail cleaner, preferably under running water.
Brushes are not recommended for surgical hand preparation.
If quality of water is not assured in the operating room, surgical hand antisepsis using an alcohol-based hand rub is recommended before donning sterile gloves when performing surgical procedures.
When using an antimicrobial soap, scrub hands and forearms for the length of time recommended by the manufacturer, typically 2–5 min. Long scrub times (e.g., 10 min) are not necessary.
When using an alcohol-based surgical hand rub with sustained activity, follow the manufacturer’s instructions for application times. Apply the product to dry hands only. Do not combine surgical hand scrub and surgical hand rub with alcohol-based products sequentially.
When using an alcohol-based hand rub, use sufficient quantity to keep hands and forearms wet with the hand rub throughout the surgical hand preparation procedure.
After application of the alcohol-based hand rub as recommended, allow hands and forearms to dry thoroughly before donning sterile gloves.
The Use of Gloves
The WHO has laid down various procedures for the use of gloves in order to prevent infection. Two main reasons of wearing medical gloves are (1) to protect hands of health-care workers with blood and other body fluids and (2) to reduce transmission of infection either from patient to patient or through the health-care workers. The following points must be remembered in connection with the use of gloves.
The use of gloves does not replace the need for hand hygiene by either hand rubbing or handwashing.
Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, or non-intact skin will occur.
Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient.
When wearing gloves, change or remove gloves during patient care if moving from a contaminated body site to either another body site (including non-intact skin, mucous membrane, or medical device) within the same patient or the environment.
The reuse of gloves is not recommended. In the case of glove reuse, implement the safest reprocessing method.
Along with the development of the guidelines, the WHO also suggested five implementation strategies. These included (1) a system change that ensures that the necessary infrastructure is in place such as access to safe water, continuous water supply, and availability of soap and towels, (2) training and education reinforcing the value and technique of hand cleaning (my five moments of hand hygiene), (3) periodic evaluation and feedback, (4) placing reminders in the workplaces, and (5) creating a right institutional environment of both awareness and priority.