HAND HYGIENE *

Effective Date: 
Thu, 01/01/2004
Reviewed: 
Mon, 04/16/2018
Revised: 
Mon, 04/16/2018
Policy: 

PURPOSE:    To decrease the risk of transmission of infection by appropriate hand hygiene.

POLICY:       Handwashing/hand hygiene is generally considered the most important single procedure for preventing healthcare-associated infections.  Antiseptics control or kill microorganisms contaminating skin and other superficial tissues and are sometimes composed of the same chemicals that are used for disinfection of inanimate objects.  Although antiseptics and other handwashing/hand hygiene agents do not sterilize the skin, they can reduce microbial contamination depending on the type and the amount of contamination, the agent used, the presence of residual activity and the handwashing/hand hygiene technique followed.

1.      All personnel and medical staff comply with the recommended hand washing and hand-hygiene guidelines.

2.      Hand hygiene stations are conveniently located throughout the patient care areas and are kept well-stocked. Alcohol-based hand cleaner containers are located throughout the SHC in clinical as well as public access areas to encourage all staff as well as patients and visitors to clean their hands often.

3.      The health care worker practices hand hygiene at their discretion as well as in the following guideline:

In the absence of a true emergency, personnel and medical staff members should always wash their hands or practice hand-hygiene;

a)     Before beginning work;

b)     Before and after touching a patient or performing a patient procedure;

c)      Before performing invasive procedures;

d)     Before and after touching wounds, whether surgical, traumatic, or associated with an invasive device;

e)      After potential microbial contamination of hands is likely, especially those involving contact with mucous membranes, blood or body fluids, secretions, or excretions;

f)       After touching inanimate sources that are likely to be contaminated with infectious waste (e.g., urine specimen containers, pathology samples, etc);

               g)      After taking care of an infected patient or one who is suspected of being infectious;

               h)      Before and after eating;

               i)        Before and after handling used equipment;

               j)        Before and after using the restroom;

               k)      As soon as possible after removal of gloves or other personal protective equipment;

               l)        At any time there is doubt about the necessity for doing so;

              m)    Before leaving work.

Additional Notes

  • In the absence of particulate matter the health care worker at the SHC may choose whether they use soap and water or the alcohol-based gel for the purpose of hand hygiene.
  • Fingernails should be short, clean and well groomed.  This decreases accumulation of bacteria under and around nails.
Procedure: 

1.      HANDWASHING   

When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, and in case of a patient with a spore-forming organism (e.g., C. difficile), or with suspected norovirus, after going to the restroom, and before eating, perform hand hygiene with either a non-antimicrobial soap and water or an antimicrobial soap and water.

  1. Turn on water to a comfortable warm temperature.
  2. Moisten hands with soap and water and make a heavy lather.
  3. Wash well under running water for a minimum of 40 seconds, using a rotary motion and friction.
  4. Rinse hands well under running water.
  5. Dry hands with a clean paper towel. Use the paper towel to turn off the faucet, then discard.

2.  WATERLESS HANDWASHING PRODUCTS

If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all clinical situations other than those listed under “Handwashing” above.

  1. When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry.
  2. Follow the manufacturer’s recommendations regarding the volume of product to use.

ReferenceCDC Guideline for Hand Hygiene in Health-Care Settings, MMWR, Oct. 25, 2002.

Key Points: 

DEFINITIONS

Hand washing, as it pertains to the UCSC SHC, is defined as the act of removing particulate matter, soil, proteins, oils, and pathogens from the surface of the hands and wrists through the use of soap, water, and friction. The main medical purpose of washing hands is to cleanse the hands of pathogens (including bacteria and viruses) and chemicals which can cause personal harm or disease. Hand washing protects best against diseases transmitted through fecal-oral routes (such as many stomach influenzas, noroviruses and C. difficille) and direct physical contact (such as impetigo).  The application of water alone is inefficient and ineffective for cleaning skin because water is often unable to remove fats, oils, and proteins, which are components of organic soil. Therefore, removal of microorganisms from skin requires the addition of soaps or detergents to warm water.

Though there are many kinds of soaps on the market today,  research has indicated that plain soaps are as effective as consumer-grade anti-bacterial soaps containing triclosan in preventing illness and removing bacteria from the hands.  It is concluded then that hand washing with plain soaps, detergent soaps, and anti-microbial soaps are all equally effective and when a gel containing at least 60% alcohol (ethanol or isopropanol) is used correctly following the washing procedure.

Alcohol Gels or alcohol-based rubs are commercial preparations containing a synergistic combination of an emollient and preservatives have been developed and evaluated for immediate and prolonged activity against transient bacteria. It is well documented that the alcohol-based hand cleaner is 100% effective in rapidly killing pathogens including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium in vitro.  The alcohol gels produce a significant reduction in microbial count within 15 seconds and studies have shown that there is a prolonged pathogenic affect.  Alcohol rub sanitizers containing 70% alcohol kill 99.9% of the bacteria on hands 30 seconds after application and 99.99 to 99.999% of the bacteria on hands 1 minute after application.

NOTE:  Even in the absence of particulate matter on the hands, hand washing is imperative after 10 uses of the alcohol-based gel as a build-up of emollients, humectants, or thickening agents hinders the gel’s effectiveness.