Role of hand hygiene in infection prevention and control

      1. Role of hand hygiene in infection prevention and control

Role of hand hygiene in infection prevention and control

Many respiratory and gastrointestinal infections (eg influenza and gastroenteritis) can be transmitted by hands. Consistent use of effective measures to reduce transmission of microorganisms from hands is an essential element of all infection prevention and control policies.

Microorganisms can be transmitted by healthcare workers’ hands during patient care. Improved hand hygiene can reduce healthcare-associated infections, including those with multi-resistant microorganisms.

Objects and surfaces that patients touch (eg pens, chairs, and door handles) are potential sources of infection. Toys and reading materials (eg magazines and books) may act as fomites (ie part of the chain of transmission of infection), so they should not be provided in practices (including waiting areas and consulting rooms).

Encouraging patients to follow effective hand hygiene practices can decrease microorganism transfer and the risk of healthcare-associated infection.

Methods of hand hygiene suitable for healthcare practices include use of alcohol-based handrubs, washing with neutral liquid soap, and washing with antimicrobial liquid soap, depending on the situation (Table 2.1. Methods of hand hygiene). The use of alcohol-based handrub is now recommended for routine hand hygiene of visibly clean hands, except after using the toilet, before handling or eating food/drink, or when norovirus is present or suspected. Gloves are not a substitute for hand hygiene.

Practices could assess appropriate moments for patient hand hygiene and provide suitable facilities, such as alcohol-based handrubs at the reception desk and in the waiting room.

Table 2.1. Methods of hand hygiene

Level of hygiene Technique Duration of contact with cleansing product Drying When
Routine hand cleaning for hands Alcohol-based rub method:
  1. Check hands are dry and not visibly soiled. If visibly soiled, use soap and water method.
  2. Apply alcohol-based handrub, using the volume recommended in product information.
  3. Rub vigorously over all surfaces of hand, as when washing hands, ensuring solution contacts all surfaces of the hand. Pay particular attention to fingertips, thumbs, and areas between fingers.
  4. Keep rubbing until hands are completely dry.
20–30 seconds until dry  15-20 wet seconds of rubbing is required for alcohol-based handrub. If hands dry before this, an inadequate volume of alcohol-based handrub has been used. Rub hands until dry, without wiping Arriving/leaving work
Entering/leaving clinical areas
Before using computer keyboard or device screens in clinical areas
Before and after patient contact when hands are not visibly soiled
Before putting on gloves and after removing gloves
After touching objects (eg equipment, items around the patient, keyboard, device screens) and the patient environment.
Soap and water method:
  1. Wet hands under tepid water.
  2. Apply plain liquid soap, using the volume recommended in product information.
  3. Rub hands together, ensuring solution contacts all surfaces of the hand. Pay particular attention to fingertips, thumbs, and areas between fingers.
  4. Rinse thoroughly.
  5. Use paper towel to turn off tap (if not hands-free tap).
  6. Pat hands dry with single-use towels.
20 seconds minimum Paper towel As for alcohol-based handrub
In addition:
Before handling food or drink
After going to the toilet
When hands are visibly soiled
 

 
Standard aseptic (clinical) procedures Alcohol-based rub method:
  1. Check hands are dry and not visibly soiled. If visibly soiled, use soap and water method.
  2. Apply alcohol-based handrub, using the volume recommended in product information.
  3. Rub vigorously over all surfaces of hand, as when washing hands, ensuring solution contacts all surfaces of the hand. Pay particular attention to fingertips, thumbs, and areas between fingers.
  4. Keep rubbing until hands are completely dry.
20–30 seconds until dry  15-20 wet seconds of rubbing is required for alcohol-based handrub. If hands dry before this, an inadequate volume of alcohol-based handrub has been used. Rub hands until dry, without wiping Before any procedures that require a ‘no-touch’ technique
Liquid antimicrobial cleanser method:
  1. Wet hands under tepid water.
  2. Apply plain liquid soap, using the volume recommended in product information.
  3. Rub hands together, ensuring solution contacts all surfaces of the hand. Pay particular attention to fingertips, thumbs, and areas between fingers.
  4. Rinse thoroughly.
  5. Use paper towel to turn off tap (if not hands-free tap).
  6. Pat hands dry with single-use towels.
20 seconds minimum Paper towel
Surgical aseptic procedures Surgical handrub method: Product approved by Therapeutic Goods Administration for presurgical hand antisepsis
  1. Remove jewellery. Check hands are dry and not visibly soiled. If visibly soiled, use soap and water method.
  2. Apply alcohol-based handrub, using the volume recommended in product information.
  3. Rub vigorously over all surfaces of hand, as when washing hands, ensuring solution contacts all surfaces of the hand. Pay particular attention to fingertips, thumbs, and areas between fingers.
  4. Keep rubbing until hands are completely dry.
Follow manufacturer’s directions   Before surgical procedures
Liquid antimicrobial cleanser method:
  1. Remove jewellery.
  2. Wet hands and forearms.
  3. Wash with antimicrobial cleanser (4% chlorhexidine or 0.75% detergent-based povidone or 1% aqueous povidone).
  4. Clean under nails only if needed with a nail pick (do not scrub hands with nail brush as they can break the skin and be a source of infection).
  5. Rinse carefully, keeping hands above elbows.
  6. Ask another staff member to turn off taps or use sterile towel (if not hands-free tap).
20 seconds minimum  Total time (all steps): 5 minutes before the first procedure of the day, and 3 minutes for subsequent procedures Sterile disposable paper towels
or
Sterile linen towels