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hand hygiene for health workers


  • Micro-organisms are transmitted from one patient to another via a healthcare worker's hands (HCW) in 5 sequential steps1):
    • organisms on patient's skin or shed onto surrounding objects (fomites)
    • organisms transferred to HCW's hands
    • organisms capable of surviving at least several minutes on HCW's hands
    • organisms not cleared from HCW's hands - inadequate or inappropriate washing
    • organisms transmitted to another patient via HCW's hands or objects they touch
  • 5 moments of hand hygiene targets:2)
    • cross-colonisation of patients
    • endogenous and exogenous infection in patients
    • infection in HCWs
    • cross-colonisation of the healthcare environment including HCWs.

The 5 Moments of Hand Hygiene

  1. Before touching a patient
  2. Before a procedure
  3. After a procedure or body fluid exposure risk
  4. After touching a patient
  5. After touching a patient's surroundings

The 2 Zones

Patient Zone

  • the patient and the patient's immediate surroundings
  • hand hygiene should be performed:
    • on entering the patient zone (eg. AFTER closing the curtains)
    • between touching the patient and touching the critical sites on the same patient (e.g. IV site and drain sites)
    • before leaving the patient zone
  • any equipment brought into the patient zone should be cleaned before and after each patient use eg. stethoscope, BP cuff, tourniquet, chairs, etc.

Healthcare Zone

  • everything outside the patient zone
  • patient bed curtains are outside the patient zone and assumed to be contaminated
    • Perform Hand hygiene between touching the curtains and touching the patient
    • Perform Hand hygiene between touching the patient and touching the curtains to avoid further contamination of curtains

Hand hygiene technique

visibly clean hands

  • alcohol based hand rub is sufficient - rub hands until completely dry

soiled hands

  • soap and water wash then thorough drying


  • colonising bacteria can be found on 30% of hands of HCW's despite use of gloves
  • thus hand hygiene BEFORE AND AFTER wearing gloves 3)
  • gloves must be changed:
    • between episodes of care with different patients
    • during single patient care of different body sites
    • if required to use keyboards, etc which are moved from room to room
  • use STERILE gloves if surgical aseptic non-touch technique (ANTT) required

Finger nails and Hand Jewelry

  • WHO Consensus recommendations are that HCWs do not wear artificial nails or extenders when having direct contact with patients and natural nails should be kept short (<0.4cm long) 4)
  • Artificial, painted and chipped nails should not be worn in clinical areas as they can harbour microorganisms and are linked with outbreaks of infections 5)
  • WHO recommendations strongly discourage the wearing of hand and wrist jewellery:6)
    • inhibits correct hand hygiene
    • skin underneath rings are more likely to be heavily colonised
    • jewelry increases numbers and species of organisms on hands

Preventing hand hygiene induced occupational contact dermatitis

  • 3 main types of contact dermatitis:
    • irritant contact dermatitis (ICD)
      • usually caused by either:
        • repeated exposure to irritants (soap, antiseptics, hot water)
        • drying with paper towels
        • sweating from prolonged use of gloves
        • glove powder
        • low humidity
      • most often starts as dryness in webspaces and needs to be addressed early to prevent infection and transmission of infections
      • resolution may take months
      • prevention:
        • alcohol based hand washing reduces risk compared to soap (or antiseptics) and water wash (especially hot water) and dry paper towels
    • allergic contact dermatitis (ACD)
      • delayed onset hours or days after contact
      • may complicate ICD
      • common causes:
        • rubber glove ingredients such as thiurams and carbamates
        • preservatives such as methylisothiazolinone (MI), formaldehyde and formaldehyde releasing preservatives used in products such as skin cleansers
        • hand cleansing ingredients such as coconut diethanolamide
        • fragrances
        • colophony (rosin) is the usual cause of sticking plaster allergies in patients
        • rarely, chlorhexidine
      • patch testing by dermatologists may be useful
    • contact urticaria
      • immediate onset allergy within minutes
      • common causes:
        • latex especially powdered latex gloves which provides increased exposure to the latex
      • may be diagnosed by IgE blood test or by prick testing
      • treatment is avoidance of all latex products:
        • use nitrile gloves or PVC gloves
  • general preventative measures:
    • apply a fragrant free skin moisturising cream to help to restore the skin barrier
    • alcohol based hand washing reduces risk compared to soap (or antiseptics) and water wash (especially hot water) and dry paper towels
    • use of a non-fragranced soap substitute at home, avoid liquid soaps which generally have perfumes or MI
    • appropriate glove use, including at home gardening or washing dishes
    • avoid allergens
  • early recognition and referral
    • report skin issues to management
    • follow skin care measures at work and at home
    • see GP for possible topical corticosteroid Rx
    • if not settling, see a dermatologist for testing
1) , 6)
World Health Organisation. WHO Guidelines on Hand Hygiene in Health Care. In: World Alliance for Patient Safety, editor. First Global Patient Safety Challenge Clean Care is Safer Care. 1 ed. Geneva: World Health Organisation Press; 2009.
Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D. 'My five moments for hand hygiene': a user-centred design approach to understand, train, monitor and report hand hygiene. The Journal Of Hospital Infection. 2007;67(1):9-21.
Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva CL, Donaldson L, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. The Lancet Infectious Diseases. 2006 Oct;6(10):641-52.
Bissett L. Skin care: an essential component of hand hygiene and infection control. Br J Nurs. 2007 Sep 13-27;16(16):976-81.
Baumgardner CA, Maragos CS, Walz J, Larson E. Effects of nail polish on microbial growth of fingernails. Dispelling sacred cows. Aorn J. 1993 Jul;58(1):84-8.]]
hand_hygiene.txt · Last modified: 2021/05/10 12:51 by gary1