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Infection Control

Frequently Asked Questions - Hand Hygiene

What is hand hygiene?

Hand hygiene is a general term that applies to routine hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis.

What are indications for hand hygiene?

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.
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What are the different types of hand hygiene?

Methods Agent Purpose Area Duration
Routine HandwashWater and non-antimicrobial soap (i.e., plain soap1)Remove soil and transient2 microorganismsAll surfaces of the hands and fingers15 seconds3
Antiseptic handwashWater 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 fingers15 seconds3
Antiseptic handrubAlcohol-based handrub4Remove or destroy transient microorganisms and reduce resident5 flora (persistent activity)8 All surfaces of the hands and fingersUntil the hands are dry
Surgical AntisepsisWater 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 forearms62–6 minutes
Water and non-antimicrobial soap (i.e., plain soap1) followed by an alcohol-based surgical hand scrub product with persistent activityFollow manufacturer instructions for surgical hand scrub product with persistent activity7
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How should hand care products be stored?

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.

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Do hand lotions affect the integrity of gloves?

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.

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Selected References and Additional Resources

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.

Ayliffe GAJ, Fraise AP, Geddes AM, Mitchell K, eds. Control of hospital infections: A practical handbook, 4th ed. London: Arnold, 2000;115–118.

Casewell M, Phillips I. Hands as route of transmission for Klebsiella species. Br Med J 1977;2:1315–1317.

CDC Update: Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health care settings. MMWR 1988; 37:377–382, 387–388.

CDC. Recommendations for prevention of HIV transmission in health care settings. MMWR 1987;36(No. 2S):1S–18S.

CDC. Guideline for hand hygiene in health care settings: Recommendations of the Health Care Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(No. RR-16).

De Haan P, Meester HHM, Bruynzeel DP. Irritancy of alcohols. In: van der Valk, PGM, Mailbach HI, eds. The Irritant Contact Dermatitis Syndrome. New York: CRC Press, 1996:65–70.

Grohskopf LA, Roth VR, Feikin DR, Arduino MJ, Carson LA, Tokars JI et al. Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center. N Engl J Med 2001;344:1491–1497.

Guidelines for Infection Control in Dental Health-Care Settings, 2003. MMWR, December 19, 2003:52(RR-17);1–61.

Kabara JJ, Brady MB. Contamination of bar soaps under "in-use" conditions. Journal of Environmental Pathology, Toxicology & Oncology 1984;5:1–14.

Larson EL, 1992, 1993, and 1994 Association for Professionals in Infection Control and Epidemiology Guidelines Committee. APIC guideline for hand washing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–269.

Larson E, Anderson JK, Barendale L. Effects of a protective foam on scrubbing and gloving. Am J Infect Control 1993;21:297–301.

Larson EL, Early E, Cloonan P, Sugrue S, Parides M. An organizational climate intervention associated with increased hand washing and decreased nosocomial infections. Behav Med 2000;26:14–22.

Larson E, Leyden JJ, McGinley KJ, Grove GL, Talbot GH. Physiologic and microbiologic changes in skin related to frequent hand washing. Infect Control 1986;7:59–63.

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.

Ojajarvi J. The importance of soap selection for routine hygiene in hospital. J Hyg (Camb) 1981;86:275–283.

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.

Rotter M. Hand washing and hand disinfection. In: Mayhall, C.G., ed. Hospital epidemiology and infection control. Philadelphia: Lippincott Williams & Wilkins, 2004:1727–46.

Sautter RL, Mattman LH, Legaspi RC. Serratia marcescens meningitis associated with a contaminated benzalkonium chloride solution. Infect Control 1984;5:223–225.

Steere AC, Mallison GF. Handwashing practices for the prevention of nosocomial infections. Ann Intern Med 1975;83:683–690.
US Department of Labor, Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries; final rule. Federal Register 2001;66:5317–5325. Updated from and including 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; final rule. Federal Register 1991;56:64003–64182. Accessed 9/21/09.

US Department of Labor, Occupational Safety and Health Administration. Enforcement procedures for the occupational exposure to bloodborne pathogens. Washington, DC: US Department of Labor, Occupational Safety and Health Administration, 2001; Directive Number. CPL 02-02-069. Accessed 9/21/09.

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  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Removal of all jewelry, washing as described above, holding the hands above the elbows during final rinsing, and drying the hands with sterile towels.
  7. 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).
  8. 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

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