Of all the measures used to reduce the transmission of disease, Hand Hygiene has been shown to be the most effective, most convenient, and easiest to perform. It is also the most often neglected or improperly performed measure. While hand-washing is old news, Hand Hygiene is a relatively new idea. Properly "performed" Hand Hygiene involves both handwashing and "hand awareness." Awareness of: 1) What the hands were doing before (were in a clean or soiled area, performing a clean or sterile procedure, or performing a task that might have contaminated the hands) and 2) What the hands will be doing next (entering a clean or soiled area, performing a clean or sterile procedure, or performing a task that will result in hand contamination). In other words, anticipating and preparing for what contaminated material the hands may be exposed to.
Hand awareness is especially important when the hands are gloved. Gloves used by health care workers (HCWs) in the performance of patient care are very thin and sustain microscopic tears easily. To ensure the best protection, HCWs should protect gloved hands from unnecessary contact with environmental surfaces and guard them from tearing. Besides protecting the HCW from contamination, gloves can also protect contaminated areas, e.g. wounds, from additional contamination. "Cross contamination" occurs when pathogens are moved or transmitted from an infected area to a non-infected area where they can cause harm. Therefore, change gloves and wash hands during patient care if the hands move from a contaminated body-site (e.g., perineal area) to a clean body-site. Washing hands after doffing gloves can remove soilage or germs that may have passed through the gloves to the hands.
Wash hands with either soap and water or an alcohol-based sanitizer. According to the Centers for Disease Control and Prevention (CDC) Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 "...alcohol based products for hand disinfection are preferred over antimicrobial or plain soap and water because of their superior microbiocidal activity, reduced drying of the skin, and convenience." The Food and Drug Administration (FDA) recommends alcohol-based hand sanitizers have a concentration of 60% to 95% ethanol or isopropanol, the concentration range of greatest germicidal efficacy. However, soap and water is still preferred for a) removing visible soilage with blood or body fluids, b) visible contamination with proteinaceous material, c) any contact with spores, e.g. Clostridium difficile, d) during a gastrointestinal infection outbreaks, and e) food preparation.
Other Key Hand Hygiene Concepts
- Wear little or no jewelry on the hands. The fewer and simpler the jewelry the fewer places for germs to hide and the easier it is to clean and scrub the hands well.
- Acrylic or artificial nails are not recommended for those involved in direct patient care, as these can add places on the hands where germs can hide.
- Use plain or antimicrobial liquid soap NOT bar soap. If plain soap is used to wash hands that were visibly soiled, decontaminate the hands with an alcohol sanitizer.
- Scrub hands for at least 20 seconds when using soap and water. Scrub hands until dry when using a waterless product.
- Wash and scrub all surfaces of the hands. Don't forget fingernails, thumbs, index fingers, wrists, and back of the hands.
- Have clean paper towels ready before handwashing and dry the hands well.
- Moisturizing lotion can help keep the hands healthy. Frequent handwashing with soap and water can result in dry skin, which can compromise skin integrity and provide additional places for germs to hide. While the moisturizers in alcohol sanitizers protect the skin from drying, these moisturizers should be washed off periodically with soap and water to prevent build-up on the hands. Heavy layers of emollients on the hands can add areas where germs can hide.