Infection prevention and control guidelines

2. Hand hygiene

Hand-hygiene products

Infection prevention and control guidelines
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Last revised: 18 Aug 2023

Hand-hygiene products

The person with the designated responsibility for infection prevention and control needs to consider:

  • the level of hand-hygiene and corresponding handwashing routines required in each area
  • compatibility of agents used to clean, wash and condition hands
  • hand care – hand-hygiene products containing moisturisers and emollients to protect the hands are usually required, as supermarket-bought products designed for intermittent domestic use may dry the skin.
  • safety issues (eg alcohols are flammable and may also cause irritation if splashed into the eyes)
  • whether all hand-hygiene products are chemically compatible. Practices can consider choosing hand-hygiene products and hand-care products from a range developed by the same manufacturer and formulated for chemical compatibility.

An alcohol-based handrub product is generally preferred to antimicrobial cleanser/soap for aseptic hand hygiene when hands are visibly clean.

The practice’s policy and procedure manual could include specifications and locations of hand-hygiene facilities and protocols, for the benefit of new staff.

Cleaning hands with plain liquid hand soap or detergent wipes, followed by alcohol-based handrub (as recommended in the past), is now not generally recommended due to increasing risk of skin irritation/allergy, particularly if products are not chemically compatible.

 

Alcohol-based handrubs (liquid or gel) are designed to be used without water. They should be used in preference to soap and water for hand hygiene, except when hands are visibly soiled, after using the toilet, before handling food or eating, when the presence of norovirus (or any pathogen resistant to alcohol) is known or suspected.

Hands must be dry before using alcohol-based handrub.1

When used correctly, alcohol-based handrubs designed for routine hand hygiene or surgical hand hygiene are more effective than plain soap or antimicrobial soap and water against many pathogenic microorganisms on hands.

For routine hand-hygiene, use alcohol-based rubs with an alcohol concentration of between 60% and 80% volume per volume ethanol or equivalent and meet the current relevant standard for bactericidal effect of hygienic handrub.

For surgical hand hygiene, use an alcohol-based handrub intended for presurgical hand antisepsis and registered by Therapeutic Goods Administration for that purpose, to ensure it meets the current relevant standard for surgical hand disinfection.

Alcohol-based rubs should be placed at the point of care and also accessible in all areas of the practice, including at reception, to encourage use by administrative staff and patients as well as health professionals. They are also suitable for offsite use (eg during home visits).

Practices must use only products that are approved by the Therapeutic Goods Administration for use as hand hygiene products for healthcare settings. Other alcohol-based handrubs or hand washes marketed as sanitisers for general consumer use are not appropriate for use in clinical settings.

Alcohol-based handrubs must always be used according to product directions.

 

Washing with liquid cleansers is recommended when hands are visibly soiled, after using the toilet, before handling food or eating, or when the presence of norovirus (or any pathogen resistant to alcohol) is known or suspected. These also facilitate mechanical removal of microorganism spores.

Liquid hand cleansers can contain plain soap with moisturiser and emollient (used for routine hand hygiene), or also contain antimicrobial agents such as chlorhexidine or povidone-iodine (used for hand hygiene before surgical aseptic procedures). Skin problems can develop with routine use of antimicrobial soaps. They are not required for routine hand hygiene.

People using chlorhexidine products can develop skin reactions and/or hypersensitivity. If a staff member has an allergy to chlorhexidine, an alternative antimicrobial product, such as povidone-iodine, could be considered. It is also possible that the use of chlorhexidine (as for other disinfectants) in health care might lead to antimicrobial resistance,2 although the mechanism and level of risk is not well understood.3

 

A dispenser with an integrated disposable container and dispensing nozzle is recommended when liquid hand-cleaning agents are used. When empty, the whole unit (container and nozzle) must be safely discarded. Refillable pump containers must not be used in healthcare facilities due to the risk of contamination.

Alcohol-based handrub dispensers should not be placed near heat sources and electric motors.

 

Bar or cake soaps can harbour microorganisms when left wet. They must not be used in general practices and other office-based practices.

 

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