Frequently Asked Questions - Hand Hygiene
- What is hand hygiene?
- What are indications for hand hygiene?
- What are the different types of hand hygiene?
- How should hand care products be stored?
- Do hand lotions affect the integrity of gloves?
Hand hygiene is a general term that applies to routine hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis.
Hand hygiene substantially reduces potential pathogens on the hands and is considered a primary measure for reducing the risk of transmitting organisms to patients and health care personnel (HCP). Hospital-based studies have shown that noncompliance with hand hygiene practices is associated with health care-associated infections, the spread of multi-resistant organisms, and has been a major contributor to outbreaks. Studies also have shown that the prevalence of health care-associated infections decreased as hand hygiene measures improved.
Indications for hand hygiene include the following:
- Before and after treating each patient (e.g., before glove placement and after glove removal).
- After barehanded touching of inanimate objects likely to be contaminated by blood, saliva, or respiratory secretions.
- Before leaving the dental operatory.
- When hands are visibly soiled.Before regloving, after removing gloves that are torn, cut, or punctured.
- For oral surgical procedures, perform surgical hand antisepsis before donning sterile surgical gloves.
|Routine Handwash||Water and non-antimicrobial soap (i.e., plain soap1)||Remove soil and transient2 microorganisms||All surfaces of the hands and fingers||15 seconds3|
|Antiseptic handwash||Water and antimicrobial soap (e.g., chlorhexidine, iodine and iodophors, chloroxylenol [PCMX], triclosan)||Remove or destroy transient microorganisms and reduce resident5 flora (persistent activity)8||All surfaces of the hands and fingers||15 seconds3|
|Antiseptic handrub||Alcohol-based handrub4||Remove or destroy transient microorganisms and reduce resident5 flora (persistent activity)8||All surfaces of the hands and fingers||Until the hands are dry|
|Surgical Antisepsis||Water and antimicrobial soap (e.g., chlorhexidine, iodine and iodophors, chloroxylenol [PCMX], triclosan)||Remove or destroy transient microorganisms and reduce resident flora (persistent activity)||Hands and forearms6||2–6 minutes|
|Water and non-antimicrobial soap (i.e., plain soap1) followed by an alcohol-based surgical hand scrub product with persistent activity||Follow manufacturer instructions for surgical hand scrub product with persistent activity7|
Hand care products, including plain (non-antimicrobial) soap and antiseptic products, can become contaminated or support the growth of microorganisms. Liquid products should be stored in closed containers and dispensed from either disposable containers or containers that are washed and dried thoroughly before refilling. Soap should not be added to a partially empty dispenser, because this practice of "topping off" might lead to bacterial contamination of soap and negate the beneficial effect of hand cleaning and disinfection. Store and dispense products according to manufacturer's instructions.Top of Page
Petroleum-based lotion formulations can weaken latex gloves and increase permeability. However, lotions are often recommended to ease the dryness resulting from frequent hand washing and more recently to prevent dermatitis resulting from glove use. Yes, the primary defense against infection and transmission of pathogens is healthy unbroken skin. Frequent hand washing with soaps and antiseptic agents can cause chronic irritant contact dermatitis among dental health care personnel. Damage to the skin changes skin flora, resulting in more frequent colonization by staphylococci and gram-negative bacteria. The potential of detergents to cause skin irritation can vary considerably, but can be reduced by adding emollients. Lotions that contain petroleum or other oil emollients should only be used at the end of the workday. If using lotions during the workday, select a water-based product. At the time of product selection, information should be obtained from the manufacturer regarding interaction between gloves, lotions, dental materials, and antimicrobial products.Top of Page
Association of Operating Room Nurses (AORN). Recommended Practices for Hand Hygiene in the Perioperative Setting. Perioperative Standards and Recommended Practices Edited by Ramona Conner, Lisa Spruce, Byron Burlingame, Bonnie Denholm, Mary J. Ogg, and Sharon A. Van Wicklin. Vol. 1. 2013.
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Larson EL, Norton Hughes CA, Pyrak JD, Sparks SM, Cagatay EU, Bartkus JM. Changes in bacterial flora associated with skin damage on hands of health care personnel. Am J Infect Control 1998;26:513–521.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, the Hospital Infection Control Practices Advisory Committee. Guideline for the prevention of surgical site infection [PDF–271K], 1999. Infect Control Hosp Epidemiol 1999;20:247–280.
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Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, Perneger TV et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.
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- Pathogenic organisms have been found on or around bar soap during and after use. Using liquid soap with hands-free controls for dispensing is preferable.
- Transient microorganisms often acquired by health care personnel during direct contact with patients or contaminated environmental surfaces. Transient microorganisms most frequently associated with health care-associated infections and are more amenable to removal by routine hand washing than resident flora.
- Time reported as effective in removing most transient flora from the skin. For most procedures, a vigorous, brief (at least 15 seconds) rubbing together of all surfaces of premoistened lathered hands and fingers followed by rinsing under a stream of cool or tepid water is recommended. Hands should always be dried thoroughly before donning gloves.
- Resident flora are species of microorganisms that are always present on or in the body; not easily removed by mechanical friction; and less likely to be associated with health-care-associated infections.
- Waterless products (e.g., alcohol-based hand rub) are especially useful when water facilities are unavailable (e.g., during dental screenings in schools) or during boil-water advisories. Alcohol-based hand rubs should not be used in the presence of visible soil or organic material.
- Removal of all jewelry, washing as described above, holding the hands above the elbows during final rinsing, and drying the hands with sterile towels.
- Before beginning surgical hand scrub, remove all arm jewelry and any hand jewelry that may make donning gloves more difficult, cause gloves to tear more readily, or interfere with glove usage (e.g., ability to wear the correct-sized glove or altered glove integrity).
- Persistent activity. Prolonged or extended activity that prevents or inhibits proliferation or survival of microorganisms after application of a product. Previously, this property was sometimes terms residual activity.Back to
- Page last reviewed: October 25, 2013
- Page last updated: October 25, 2013
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