Hand Hygiene in Healthcare Settings

Introduction to Hand Hygiene

The World Health Organization defines 5 critical moments when healthcare workers must perform hand hygiene to interrupt microbial transmission during patient care, as outlined by the World Health Organization 1, 2

Healthcare workers should decontaminate hands before touching a patient to protect the patient from harmful microorganisms carried on their hands, as recommended by the World Health Organization 1, 2
Decontaminate hands before clean/aseptic procedures, such as inserting central lines or urinary catheters, to prevent introduction of pathogens into sterile body sites, according to the World Health Organization 1, 2, 3
Hands should be decontaminated after body fluid exposure risk, such as contact with body fluids or mucous membranes, to protect oneself and the healthcare environment from patient microorganisms, as stated by the World Health Organization 1, 2, 3
Decontaminate hands after touching a patient, including contact with intact skin, to protect oneself and the healthcare environment from patient microorganisms, as recommended by the World Health Organization 1, 2, 3
Hands should be decontaminated after touching patient surroundings, including inanimate objects and medical equipment, to protect oneself and the healthcare environment from patient microorganisms, according to the World Health Organization 1, 2, 3

For alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces, until hands are completely dry, as recommended by the World Health Organization 1, 2, 4
When using soap and water, wet hands first, apply manufacturer-recommended amount of soap, and rub hands together vigorously for at least 15 seconds, covering all surfaces, as stated by the World Health Organization and the American Academy of Pediatrics 1, 2, 5, 6

Always decontaminate hands immediately after removing gloves, as gloves do not provide complete protection and hands can become contaminated during glove removal, according to the World Health Organization 1, 2, 3, 7
Decontaminate hands when moving from a contaminated body site to a clean body site during patient care to prevent cross-contamination on the same patient, as recommended by the World Health Organization 1, 2, 3

The CDC/HICPAC guideline establishes that alcohol-based hand rubs achieve 3.5 log₁₀ bacterial reduction after 30 seconds of application, which is the reference standard for efficacy testing 8
The CDC/HICPAC guideline explicitly states that alcohol-based hand rubs are NOT only effective if applied for >60 seconds, confirming that 30 seconds is sufficient 9, 10
The CDC recommends applying 3 mL of alcohol-based hand rub and rubbing hands together covering all surfaces for at least 20-30 seconds or until hands are completely dry, whichever is longer, to achieve 4.0-5.0 log₁₀ bacterial reduction 8
The CDC guideline provides effective virucidal activity against enveloped viruses within 30 seconds 8
The CDC recommends that 10 seconds is insufficient for bacterial reduction, while some viral inactivation occurs rapidly 8

The Centers for Disease Control and Prevention (CDC) recommends alcohol-based hand rubs (ABHRs) as the primary method for routine hand hygiene in healthcare settings, used for 20-30 seconds until hands are dry, except when hands are visibly soiled or after suspected exposure to bacterial spores 11, 12

The CDC recommends using ABHRs before any clean or aseptic procedure, including insertion of urinary catheters, intravascular catheters, central lines, or other invasive devices 11, 12
The CDC advises against using ABHRs when hands are visibly soiled, as soap and water handwashing is required, and also against using ABHRs for suspected or proven exposure to bacterial spores, as ABHRs have poor activity against spores 11, 12

The CDC states that ABHRs are highly effective at 20-30 seconds, and the myth that ABHRs require >60 seconds is false 11, 12

ABHRs have excellent activity against gram-positive bacteria, gram-negative bacteria, mycobacteria, fungi, and enveloped viruses, but poor activity against bacterial spores, such as C. difficile and Bacillus species 11, 12

ABHRs are more effective in reducing bacteria than plain soap and water handwashing, and they require significantly less time to apply 11, 12
ABHRs can be placed at point of care without need for sinks, making them more accessible than traditional handwashing facilities 11, 12
ABHRs cause less skin irritation and dryness than soap and water when formulated with emollients 11, 12

The CDC recommends providing individual containers of ABHR to each healthcare worker for personal use, making ABHRs more accessible than handwashing facilities, and providing regular feedback to personnel regarding their hand hygiene adherence and performance 11, 12
The CDC also recommends supplying hand lotions or creams to prevent and treat occupational hand dermatitis 11, 12

ABHRs are appropriate for preoperative surgical hand preparation and have not been associated with increased surgical site infections 11, 12
A 5-minute scrub is as effective as a 10-minute scrub for reducing bacterial counts, and brushes or sponges are not required when using ABHRs for surgical hand preparation 11, 12
Hand hygiene is always necessary, even when gloves are worn, as gloves do not eliminate the need for hand hygiene 11, 12