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Hand Hygiene in West African General (Non-ETU) Healthcare Settings

Hand hygiene is the most effective strategy in preventing the spread of dangerous germs like Ebola in the general healthcare setting.

Ebola is transmitted through a non-infected person coming 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 workers.

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

  • Before putting on gloves and wearing PPE on entry to the isolation room/area
  • Before any clean or sterile procedures being 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 alcohol-based hand sanitizer, soap and water, 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

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

Alcohol-based hand sanitizer is the preferred method of routine hand hygiene in healthcare settings when hands are not visibly soiled2, 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 hands3. Such solutions usually contain 60% to 95% ethanol or isopropanol, and they can be produced locally using ingredients available even in lower-resourced settings4. Alcohol-based hand sanitizer should not be used when hands are visibly soiled with dirt, blood, or other body fluids.

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 (i.e., 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 Package. 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 Force [PDF - 56 pages].
  3. Guidelines on Hand Hygiene in Health Care. World Health Organization.
  4. Alcohol-based Handrub Formulation and Production. World Health Organization.