Hand care

Nails should be kept clean and short (ideally, not past the tip of the finger pad), because areas under nails can harbour high concentrations of bacteria, even after handwashing.

Nails and cuticles should be kept smooth because rough surfaces harbour foreign matter and make it harder to clean skin and nails.

The use of nailbrushes is not recommended because brushing can abrade skin. A nail pick can be used if necessary (such as before performing procedures that require surgical hand hygiene and nails are visibly dirty).

Intact skin is an effective natural defence against the entry of pathogens and subsequent infection. Broken skin can be the site of bacterial growth and may facilitate the transmission of infection.

Skin can become dry and dermatitis can develop if handwashing water is too hot or too cold, if too much handwashing solution is used, or if hands are not thoroughly rinsed and dried. Gloves and latex allergy may also contribute to skin problems.

Drying hands after washing, the use of chemically compatible hand creams, and attending to breaks in the skin are essential aspects of hand care. Cuts and abrasions must be covered with water-resistant dressings before commencing or recommencing work. These need to be changed if they become soiled or loose.

If skin irritation occurs, hand hygiene technique should be reviewed. If a staff member develops a persistent skin irritation, or identifies a particular soap, antiseptic agent or alcohol-based product associated with skin irritation, they must consult the practice member with designated responsibility for infection control or work health and safety.

Clinical staff experiencing dermatitis or other skin disorders must seek medical advice before performing any activity that could pose a risk to themselves or to patients.

To combat the drying effects of regular hand cleaning, use suitable aqueous-based emollient hand creams with barrier protection that are compatible with the selected hand-hygiene products.

Emollient hand cream should be applied approximately 2–4 times each working day (including before starting work each day, at least once during the day, and at the end of the working day).

Creams and ointments must not be used:

• before donning gloves, as oil-based preparations may cause latex gloves to deteriorate and can contaminate medical devices such as instruments and equipment
• while reprocessing reusable medical devices, because they can leave a residue that could compromise sterility.