Hand hygiene is one of the most effective ways to prevent the spread of infections in healthcare settings, homes, and communities. It helps reduce the transmission of harmful microorganisms from hands to patients, surfaces, and medical equipment.
The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend strict hand hygiene practices for healthcare workers, patients, and visitors to prevent Healthcare-Associated Infections (HAIs).
Types of Hand Hygiene
Hand hygiene is categorized based on the level of cleaning required to remove or kill microorganisms. The main types of hand hygiene include:
1. Social Hand Hygiene (Routine Hand Washing)
Definition:
Social hand hygiene refers to basic handwashing with soap and water to remove visible dirt, organic matter, and transient microorganisms from the hands.
Purpose:
Reduces general microbial contamination.
Prevents common infections (e.g., cold, flu, foodborne illnesses).
Maintains personal cleanliness.
When to Perform Social Hand Hygiene:
Before eating, cooking, or handling food.
After using the toilet.
After coughing, sneezing, or touching the face.
After handling money or public objects.
Before and after touching wounds or bandages.
How to Perform Social Hand Hygiene:
Wet hands with clean water.
Apply soap and rub hands together for at least 40-60 seconds.
Scrub all parts of the hands, including palms, back of hands, between fingers, and under nails.
Rinse hands thoroughly under running water.
Dry hands completely using a clean towel or air dryer.
2. Antiseptic Hand Hygiene
Definition:
Antiseptic hand hygiene uses antimicrobial soap or an alcohol-based hand rub (ABHR) to kill pathogenic microorganisms.
Purpose:
Provides a higher level of hand disinfection than routine handwashing.
Reduces transient and some resident bacteria on hands.
Prevents the spread of infections in healthcare and public settings.
When to Perform Antiseptic Hand Hygiene:
Before and after contact with sick individuals.
Before and after dressing wounds or giving injections.
After handling contaminated objects.
In outbreak situations (e.g., flu, norovirus, COVID-19).
Before wearing sterile gloves for aseptic procedures.
How to Perform Antiseptic Hand Hygiene:
Use an alcohol-based hand rub (at least 60% alcohol).
Apply a sufficient amount (3-5 ml) to cover both hands.
Rub hands together for 20-30 seconds until dry.
Ensure all hand surfaces are covered, including palms, back of hands, fingers, and nails.
Note: If hands are visibly soiled, use soap and water instead of alcohol-based hand rubs.
3. Surgical Hand Hygiene (Surgical Hand Antisepsis)
Definition:
Surgical hand hygiene is a highly sterile process that removes transient microorganisms and reduces resident bacteria on hands before surgical procedures.
Purpose:
Ensures sterile conditions in the operating room (OR).
Prevents surgical site infections (SSIs).
Reduces bacterial load on hands and arms.
When to Perform Surgical Hand Hygiene:
Before all surgical procedures.
Before invasive procedures in sterile environments.
How to Perform Surgical Hand Hygiene:
Remove jewelry, watches, and rings.
Wet hands and forearms with clean running water.
Apply an antimicrobial surgical scrub (e.g., chlorhexidine, povidone-iodine).
Scrub hands, fingers, nails, and forearms for at least 2-5 minutes.
Rinse hands thoroughly under running water.
Dry with a sterile towel using a blotting motion.
Wear sterile surgical gloves without touching non-sterile surfaces.
WHO’s Five Moments for Hand Hygiene
The World Health Organization (WHO) emphasizes five key moments when healthcare workers must perform hand hygiene:
Before touching a patient – Prevents transferring germs to the patient.
Before clean/aseptic procedures – Reduces the risk of introducing infections.
After body fluid exposure – Prevents contamination from blood, urine, or secretions.
After touching a patient – Avoids spreading germs to surroundings.
After touching patient surroundings – Reduces contamination of surfaces and equipment.
Best Practices for Effective Hand Hygiene
Use alcohol-based hand rubs for routine disinfection when hands are not visibly soiled.
Wash hands with soap and water when hands are visibly dirty or after exposure to bodily fluids.
Keep fingernails short and clean to prevent microbial buildup.
Avoid artificial nails and excessive jewelry, which can harbor bacteria.
Encourage hand hygiene compliance in healthcare settings through regular audits and education.
Challenges in Hand Hygiene Compliance
Lack of Awareness – Healthcare workers may not always recognize the importance of hand hygiene.
Time Constraints – High patient workload can reduce compliance.
Skin Irritation – Frequent washing can cause dryness; using moisturizers can help.
Insufficient Supplies – Lack of access to soap, water, or hand rubs affects compliance.
Solutions:
Regular training on hand hygiene importance.
Strategic placement of hand hygiene stations.
Using alcohol-based rubs to save time.
Providing hand moisturizers to prevent skin irritation.
Hand Washing and Use of Alcohol Hand Rub
Introduction
Hand hygiene is one of the most effective methods for preventing infections in healthcare settings and daily life. Proper hand hygiene reduces the transmission of harmful microorganisms and helps prevent Healthcare-Associated Infections (HAIs), foodborne illnesses, and respiratory infections.
The two main methods of hand hygiene recommended by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) are:
Hand Washing (Soap and Water)
Alcohol-Based Hand Rub (ABHR)
Each method has specific indications depending on the level of contamination and the presence of visible dirt.
1. Hand Washing (Soap and Water)
Definition:
Hand washing is the process of removing dirt, organic material, and microorganisms using soap and running water. It is the preferred method when hands are visibly soiled or contaminated with bodily fluids.
Purpose of Hand Washing:
Removes visible dirt, organic matter, and grease.
Eliminates transient microorganisms from the skin.
Reduces the risk of gastrointestinal and respiratory infections.
Prevents the spread of pathogens in healthcare and community settings.
When to Perform Hand Washing:
Before and after eating or preparing food.
After using the toilet.
After coughing, sneezing, or blowing the nose.
After handling waste, garbage, or dirty objects.
Before and after caring for a patient or wound.
After exposure to blood, urine, or bodily fluids.
Before and after handling medical equipment or invasive devices.
After touching animals or animal waste.
Steps for Proper Hand Washing (WHO Guidelines):
Wet hands with clean running water (warm or cold).
Apply soap to cover all surfaces of the hands.
Rub hands together for at least 40-60 seconds, ensuring all areas are cleaned:
Palm to palm.
Back of hands.
Between fingers.
Backs of fingers against palms.
Thumbs and fingertips.
Wrists.
Rinse hands thoroughly under running water.
Dry hands completely using a clean towel or air dryer.
Use a towel to turn off the tap to prevent recontamination.
Best Practices for Effective Hand Washing:
Always use liquid soap in healthcare settings (avoid bar soaps as they can harbor bacteria).
Ensure clean running water is available.
Use foot-operated or sensor-based taps where possible.
Use disposable paper towels to dry hands.
2. Use of Alcohol-Based Hand Rub (ABHR)
Definition:
Alcohol-based hand rub (ABHR) is a fast and effective method of hand hygiene that kills most bacteria, viruses, and fungi without the need for water. It is the preferred method for routine hand hygiene in healthcare settings unless hands are visibly soiled.
Composition of Alcohol-Based Hand Rubs:
Ethanol (60-95%) or Isopropanol (70-90%) – Main active ingredient for microbial killing.
Emollients and moisturizers – Prevents skin dryness.
Gelling agents – Improve application consistency.
Purpose of Alcohol-Based Hand Rub:
Provides rapid disinfection of hands.
Kills most bacteria and viruses within 20-30 seconds.
Reduces skin irritation compared to frequent soap-and-water washing.
Improves hand hygiene compliance in healthcare settings.
When to Use Alcohol-Based Hand Rub:
Before and after patient contact (if hands are not visibly soiled).
Before aseptic procedures (e.g., catheter insertion, IV placement).
After touching contaminated surfaces in patient areas.
Before wearing sterile gloves.
After removing gloves.
Between handling different patients.
After touching hospital equipment (e.g., monitors, IV pumps).
Steps for Proper Use of Alcohol-Based Hand Rub (WHO Guidelines):
Apply a palmful (3-5 ml) of alcohol-based hand rub.
Rub hands together for at least 20-30 seconds, ensuring all surfaces are covered:
Palm to palm.
Back of hands.
Between fingers.
Backs of fingers against palms.
Thumbs and fingertips.
Wrists.
Rub hands until dry (do not wipe off or rinse).
Ensure complete coverage of hands and fingers.
Best Practices for Effective Alcohol-Based Hand Rub Use:
Use enough product to keep hands wet for at least 20 seconds.
Allow hands to air dry completely before touching objects.
Do not rinse or wipe hands after applying hand rub.
Store ABHR in well-ventilated areas away from heat sources (flammable material).
Comparison: Hand Washing vs. Alcohol-Based Hand Rub
Feature
Hand Washing (Soap & Water)
Alcohol-Based Hand Rub (ABHR)
Effectiveness
Removes dirt and kills microorganisms
Kills most bacteria and viruses
Use When
Hands are visibly soiled
Hands are not visibly soiled
Time Required
40-60 seconds
20-30 seconds
Need for Water?
Yes
No
Residue on Hands
None
May leave a slight residue
Kills C. difficile & Norovirus?
Yes
No (requires soap & water)
Skin Irritation Risk
Low (if moisturizers are used)
Low (contains emollients)
Hand Hygiene Compliance in Healthcare
WHO’s Five Moments for Hand Hygiene
The WHO recommends hand hygiene at five critical moments in patient care:
Before touching a patient – Prevents transmission from healthcare workers to patients.
Before aseptic procedures – Reduces risk of introducing infections.
After body fluid exposure risk – Prevents cross-contamination.
After touching a patient – Avoids transferring microorganisms to the environment.
After touching patient surroundings – Reduces risk of surface contamination.
Challenges in Hand Hygiene Compliance:
Lack of awareness among healthcare workers.
Time constraints in emergency settings.
Insufficient supply of hand hygiene products.
Skin irritation from frequent washing.
Negligence and poor training.
Solutions to Improve Compliance:
Regular training and education on hand hygiene importance.
Strategic placement of hand rub dispensers in patient care areas.
Use of reminders and posters in healthcare facilities.
Hand hygiene audits to monitor compliance.
Use of alcohol-based rubs to reduce handwashing frequency.
Moments of Hand Hygiene (WHO’s Five Moments for Hand Hygiene)
Introduction
Hand hygiene is a critical infection prevention measure that significantly reduces Healthcare-Associated Infections (HAIs). The World Health Organization (WHO) introduced the Five Moments for Hand Hygiene to ensure healthcare workers (HCWs) clean their hands at the most crucial times during patient care.
Proper hand hygiene at these moments prevents the transmission of infectious agents, protects patients, healthcare workers, and the environment, and reduces antimicrobial resistance (AMR).
WHO’s Five Moments for Hand Hygiene
1. Before Touching a Patient
Why?
Prevents germs from HCWs’ hands transferring to patients.
Reduces the risk of healthcare-associated infections (HAIs).
Protects patients with weak immune systems (e.g., ICU, oncology, neonatal units).
Examples:
Before shaking hands or providing direct patient care.
Before taking vital signs (BP, temperature, pulse, oxygen saturation).
Before physical examinations or adjusting patient positioning.
Hand Hygiene Method:
Use alcohol-based hand rub (ABHR) if hands are not visibly soiled.
Wash with soap and water if hands are visibly dirty or contaminated.
2. Before Aseptic Procedures
Why?
Prevents introducing harmful microorganisms into the patient’s body.
Protects patients during invasive procedures.
Examples:
Before placing a urinary catheter, IV line, or endotracheal tube.
Before dressing wounds or performing surgical site care.
Before inserting medical devices (e.g., ventilators, feeding tubes, dialysis catheters).
Hand Hygiene Method:
Surgical hand hygiene before surgical procedures.
Use alcohol-based hand rub before non-surgical aseptic procedures.
Use soap and water if hands are visibly contaminated.
3. After Body Fluid Exposure Risk
Why?
Protects healthcare workers from potential infection exposure.
Prevents cross-contamination between patients and surroundings.
Examples:
After handling blood, urine, feces, or other body fluids.
After suctioning airways, changing wound dressings, or handling used PPE.
After handling specimens (e.g., blood cultures, urine samples).
Hand Hygiene Method:
Wash with soap and water if hands are contaminated with blood or bodily fluids.
Use alcohol-based hand rub if hands are not visibly soiled.
4. After Touching a Patient
Why?
Prevents germs from being transferred to HCWs’ hands and then spread to the environment.
Protects other patients and healthcare workers from infection.
Examples:
After assisting a patient with mobility (e.g., repositioning, helping to sit up).
After physical examination (e.g., palpation, checking the pulse).
After touching a patient’s clothing, bed linens, or skin.
Hand Hygiene Method:
Use alcohol-based hand rub immediately after patient contact.
Wash with soap and water if hands are visibly contaminated.
5. After Touching Patient Surroundings
Why?
Surfaces near infected patients can harbor pathogens.
Prevents cross-contamination from objects to other patients or HCWs.
Examples:
After touching patient bedside equipment (e.g., IV pumps, monitors, oxygen masks).
After handling patient charts, wheelchairs, or infusion stands.
After touching frequently used items like call bells, bedside tables, or bedrails.
Hand Hygiene Method:
Use alcohol-based hand rub for routine cleaning.
Wash with soap and water if surfaces are visibly dirty or contaminated.
Additional Hand Hygiene Moments in Special Cases
While the Five Moments for Hand Hygiene cover most patient care scenarios, some additional moments require hand hygiene, such as:
Before preparing or administering medication.
Before and after using gloves (gloves are not a substitute for hand hygiene).
After handling food trays or feeding patients.
After using mobile phones or documentation equipment in clinical areas.
Best Practices for Effective Hand Hygiene
Use the right technique – Follow WHO’s handwashing steps (40-60 seconds) or alcohol hand rub method (20-30 seconds).
Ensure full coverage – Cover palms, backs of hands, between fingers, fingertips, and wrists.
Choose the right method:
Alcohol-based hand rub for routine patient care.
Soap and water when hands are visibly soiled or after exposure to bodily fluids.
Keep nails short and clean – Avoid artificial nails and excessive jewelry.
Encourage hand hygiene compliance – Use posters, training, and hand hygiene audits in healthcare settings.
WHO Hand Hygiene Promotion
Introduction
The World Health Organization (WHO) promotes hand hygiene as one of the most effective ways to prevent Healthcare-Associated Infections (HAIs) and the spread of antimicrobial resistance (AMR). WHO launched the Global Hand Hygiene Campaign to improve hand hygiene compliance among healthcare workers, patients, and the public.
The key initiative of WHO’s hand hygiene promotion is the “SAVE LIVES: Clean Your Hands” campaign, which emphasizes the importance of hand hygiene in infection prevention and patient safety.
WHO’s Global Hand Hygiene Promotion Campaign
1. “SAVE LIVES: Clean Your Hands” Initiative
Launched in 2009, this initiative is part of the WHO’s First Global Patient Safety Challenge: Clean Care is Safer Care. The campaign focuses on:
Encouraging healthcare facilities worldwide to improve hand hygiene.
Reducing HAIs through proper hand hygiene practices.
Promoting institutional commitment to infection prevention and control (IPC).
2. WHO’s Annual Global Hand Hygiene Day
Every year on May 5th, WHO observes Global Hand Hygiene Day to:
Raise awareness about hand hygiene in healthcare settings.
Encourage healthcare workers to follow WHO hand hygiene protocols.
Promote continuous improvement in hand hygiene practices.
Key WHO Hand Hygiene Promotion Strategies
1. WHO’s Five Moments for Hand Hygiene
WHO introduced Five Moments for Hand Hygiene to ensure that healthcare workers clean their hands at the most critical times:
Before touching a patient.
Before clean/aseptic procedures.
After body fluid exposure risk.
After touching a patient.
After touching patient surroundings.
These moments prevent the spread of infection between patients, healthcare workers, and the hospital environment.
2. WHO’s Multimodal Hand Hygiene Improvement Strategy
WHO recommends a five-step multimodal strategy for effective hand hygiene implementation in healthcare settings:
A. System Change
Ensure easy access to hand hygiene stations (soap, water, and alcohol-based hand rubs).
Improve infrastructure (e.g., installing hand hygiene stations at entry/exit points, patient rooms, and ICUs).
Provide hand hygiene resources in all clinical areas.
B. Training and Education
Conduct regular hand hygiene training for healthcare workers.
Use posters, videos, and workshops to reinforce knowledge.
Educate patients and visitors on hand hygiene importance.
C. Monitoring and Feedback
Perform regular hand hygiene audits.
Use direct observation, electronic monitoring, and self-assessment tools.
Provide real-time feedback to healthcare workers on their hand hygiene compliance.
D. Workplace Safety Culture
Encourage leaders and hospital management to support hand hygiene programs.
Recognize and reward good hand hygiene practices.
Implement peer-to-peer accountability for hand hygiene compliance.
E. Visual Reminders and Communications
Display hand hygiene posters in healthcare settings.
Use digital screens and mobile alerts to remind workers.
Engage in social media campaigns to spread awareness.
3. WHO’s Hand Hygiene Self-Assessment Framework (HHSAF)
WHO developed the Hand Hygiene Self-Assessment Framework (HHSAF) to help hospitals:
Evaluate their hand hygiene compliance levels.
Identify gaps in hand hygiene practices.
Develop action plans for improvement.
Hospitals are ranked into four levels based on their hand hygiene performance:
Inadequate – No formal hand hygiene policies or implementation.
Basic – Some hand hygiene activities but not fully integrated.
Intermediate – Well-developed hand hygiene program but needs improvement.
Advanced – Highly structured and fully implemented hand hygiene program.
4. WHO Guidelines on Hand Hygiene in Healthcare (2009)
WHO’s 2009 Hand Hygiene Guidelines provide detailed recommendations on:
When to use alcohol-based hand rubs vs. soap and water.
How to properly perform hand hygiene using the WHO technique.
Best practices for surgical hand antisepsis.
Strategies for improving hand hygiene compliance in hospitals.
Key recommendations include:
Alcohol-based hand rubs should be the preferred method for routine hand hygiene unless hands are visibly soiled.
Soap and water should be used for:
Hands visibly contaminated with blood or body fluids.
Clostridium difficile and norovirus outbreaks.
After using the toilet.
Hand hygiene infrastructure should be improved to support compliance.
WHO’s “My 5 Moments for Hand Hygiene” Posters and Tools
WHO provides visual resources and toolkits to help healthcare workers remember key hand hygiene moments. These include:
Posters illustrating the Five Moments for Hand Hygiene.
Guidelines on the proper technique for hand washing and alcohol-based hand rub use.
Training materials for hospitals and healthcare workers.
Educational videos and online courses on hand hygiene best practices.
Challenges in Hand Hygiene Compliance and WHO Solutions
Challenges:
Lack of awareness among healthcare workers.
Insufficient access to soap, water, or alcohol-based hand rubs.
Time constraints in emergency situations.
Skin irritation from frequent handwashing.
Poor organizational commitment to infection prevention.
WHO’s Solutions:
Regular training and awareness campaigns.
Ensuring easy access to hand hygiene facilities.
Encouraging alcohol-based hand rub use to save time.
Providing skin-friendly hand hygiene products.
Leadership commitment and workplace safety culture improvements.
Impact of WHO’s Hand Hygiene Promotion
Significant reduction in HAIs when WHO guidelines are followed.
Better compliance among healthcare workers in hospitals with structured hand hygiene programs.
Lower transmission of antimicrobial-resistant pathogens.
Improved patient safety and overall healthcare quality.