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Hand Hygiene

3 min read

Hand Hygiene

Key Points

  • Proper hand hygiene is the easiest and most effective way to break infection transmission.
  • Use soap and water when hands are visibly soiled or after exposure to specific spore-forming pathogens.
  • Use facility-approved alcohol-based hand rub (ABHR) when soap-and-water washing is not required.
  • Keep nails short (<0.5 inch), natural, and free of chipped polish to reduce hand-borne pathogen load.

Equipment

  • Facility-approved soap and running water access
  • Clean towels or disposable paper towels
  • Facility-approved ABHR (at least 60% alcohol concentration)

Procedure Steps

  1. Identify the care moment requiring hygiene (before touching patient, before aseptic task, before moving from soiled to clean body site, after body-fluid contact, after touching patient/environment, and after glove removal).
  2. Assess hand condition and exposure type before choosing method.
  3. If hands are visibly soiled, exposed to blood/body fluids, or exposure risk includes C. difficile, norovirus, or Bacillus anthracis, select soap-and-water handwashing.
  4. Before performing hand hygiene, remove jewelry per policy and keep sleeves above wrists.
  5. For soap-and-water method: wet hands with warm running water, keep hands/forearms lower than elbows, and avoid splashing water onto clothing.
  6. Apply approved soap and lather all hand surfaces including palms, backs, between fingers, fingertips, thumbs, wrists, and under nails (use disposable nail cleaner if indicated).
  7. Scrub with friction for at least 20 seconds (or longer per facility policy); complete total handwashing procedure in about 40-60 seconds and repeat full rubbing sequence sufficiently to cover all surfaces.
  8. Keep fingertips pointing downward while rinsing; avoid touching or leaning on sink surfaces and do not shake water off hands.
  9. Dry from fingers toward wrists with clean paper towel or air dryer.
  10. Use a clean/new towel to turn off faucet and discard appropriately to avoid recontamination.
  11. If soap-and-water method is not required, apply enough facility ABHR to fully cover hands/wrists and rub all surfaces for about 20-30 seconds (or per product direction) until fully dry; repeat the full rubbing sequence at least twice and continue until hands are dry.
  12. Use ABHR in view of the resident at care start and care end when appropriate, and do not combine ABHR with soap-and-water in the same hygiene cycle.
  13. Maintain nail policy during care shifts: no artificial nails/tips and no chipped nail polish.

Common Errors

  • Inadequate friction or short scrub time → reduced microorganism removal
  • Missing high-risk surfaces (thumbs, fingertips, wrists, nail areas) → persistent contamination risk
  • Using ABHR when soap-and-water is required → incomplete pathogen removal in critical exposures
  • Not allowing ABHR to air dry fully before touching patient/environment or donning gloves → reduced decontamination effect
  • Shaking water off hands or drying on clothing → recontamination risk
  • Allowing hands to move above elbows or touching sink basin/faucet surfaces during wash → increased recontamination risk
  • Applying too little ABHR or stopping rub before full dryness → reduced antiseptic effect

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