4 Hand Hygiene

When to clean hands

Hand hygiene means cleaning hands with soap and water or an alcohol-based hand rub. It is a core infection-prevention practice that reduces the transfer of microorganisms between healthcare workers, patients, and the care environment when performed at the right moments.

Perform hand hygiene:

• Immediately before touching a patient, including before routine contact such as taking a pulse.

• Before an aseptic task, such as inserting a catheter or handling an invasive device.

• When moving from a soiled body site to a clean body site on the same patient.

• After touching a patient or the patient’s immediate surroundings.

• After contact with blood, body fluids, or contaminated surfaces.

• Immediately after removing gloves.

Choosing a hand-cleaning method

For most routine clinical situations, use an alcohol-based hand rub (ABHR) when hands are not visibly soiled. ABHR is convenient at the point of care and is generally less irritating to skin than frequent washing.

Use soap and water when hands are visibly dirty or contaminated with blood or body fluids. Soap and water are also recommended before eating, after using the restroom, and during outbreaks of C. difficile or norovirus, consistent with CDC guidance and facility policy. Follow facility instructions for specific organisms and outbreak conditions.

Using alcohol-based hand rub

Apply enough product to cover all hand surfaces. Rub the palms, backs of hands, between the fingers, thumbs, fingertips, and around the nails. Continue rubbing until the hands are completely dry—about 20 seconds for typical use.

Do not wipe or rinse off the product before it dries. Using too little product, or missing the thumbs, fingertips, or spaces between the fingers, can leave areas inadequately cleaned.

Washing with soap and water

1. Wet hands and apply soap.

2. Rub all hand surfaces and fingers vigorously, including between the fingers, thumbs, fingertips, and around the nails. CDC recommends at least 15 seconds of rubbing; follow facility instructions if they specify a duration.

3. Rinse under running water.

4. Dry with a disposable towel; use the towel to turn off the faucet when appropriate.

Gloves and hand hygiene

Gloves do not replace hand hygiene. Clean hands before putting on gloves when indicated, and always perform hand hygiene after removing them. Gloves can be contaminated or have unnoticed defects, so wearing them does not remove the need to clean hands.

Change gloves when moving from a contaminated task or body site to a clean one. When moving from a soiled body site to a clean body site on the same patient, perform hand hygiene and change gloves if gloves are being used.

Common compliance errors

Common errors include skipping hand hygiene because gloves were worn, or cleaning hands only on room entry or exit while missing other indicated moments. Hand hygiene is required at each indicated moment, not only when hands look dirty.

Other errors include using ABHR on visibly soiled hands instead of washing with soap and water; applying too little ABHR or stopping before hands are dry; and missing the thumbs, fingertips, or spaces between the fingers. Touching contaminated surfaces after cleaning hands and before a clean or aseptic task can also compromise hand cleanliness.