Hand Hygiene in Non-U.S. General Healthcare Settings

Ebola is transmitted when a noninfected person comes into direct contact with the blood or body fluids of an infected person. The virus in blood and body fluids can enter the body through broken skin or mucous membranes in the eyes, nose, or mouth. In most cases, it is thought that exposure happens by touching the face with contaminated hands.

Hand hygiene is a primary component of Standard Precautions that provides a basic level of patient safety and protection for healthcare personnel, and is an effective strategy in preventing the spread of dangerous germs like Ebola in the general healthcare setting.

In healthcare settings where Ebola is present, hand hygiene should be performed1

  • Before putting on gloves and wearing personal protective equipment (PPE) on entry to the isolation room/area.
  • Before any clean or sterile procedures are performed on a patient.
  • After any exposure risk or actual exposure with the patient’s blood and body fluids.
  • After touching (even potentially) contaminated surfaces/items/equipment in the patient’s surroundings.
  • After removal of PPE, upon leaving the care area.

Hand hygiene may be performed with soap and water, alcohol-based hand sanitizer, or, in settings where neither is locally available, a mild (0.05%) chlorine solution. Recommendations and considerations for each method are described below.

Alcohol-based Hand Sanitizer

Alcohol-based hand sanitizer is the preferred method of routine hand hygiene in healthcare settings when hands are not visibly soiled.2, 3 This is because of its ability to kill germs like Ebola. It is quick to apply to

hands and to air dry, and it is gentler to the skin during frequent use than even soap and water. CDC defines alcohol-based hand sanitizer as an alcohol-containing preparation designed for application to the hands for reducing the number of viable microorganisms on the hands.3 Such solutions usually contain 60% to 95% ethanol or isopropanol, and they can be produced locally using ingredients available even in lower-resourced settings.4 Alcohol-based hand sanitizer should not be used when hands are visibly soiled with dirt, blood, or other body fluids.

Hands are the main way germs like Ebola are transmitted during health care, either between patients or from the patient to the healthcare personnel. Correct hand hygiene reduces the number of germs on the hands and limits the opportunity for spread.

Soap and Water

Use soap and water when hands are visibly soiled with dirt, blood, or other body fluids and as an alternative to alcohol-based hand sanitizer. Although antimicrobial soaps are often used in some healthcare settings, it has not been proven to offer benefit over washing hands with plain soap (non-antimicrobial) and water.

Mild Chlorine Solution

In settings where neither alcohol-based hand rub nor soap and water are available, mild chlorine solution (0.05%) may be considered for hand hygiene. Repeated use of 0.05% chlorine solution for hand hygiene may cause skin irritation.


  1. Infection Prevention and Control (IPC) Guidance Summary: Ebola Guidance Packageexternal icon. World Health Organization.
  2. Guidelines for Hand Hygiene in Healthcare Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Forcepdf icon[PDF – 56 pages].
  3. Guidelines on Hand Hygiene in Health Careexternal icon. World Health Organization.
  4. Alcohol-based Handrub Formulation and Productionexternal icon. World Health Organization.

Hand Hygiene Resources