Hand Hygiene and Handwashing

What It Is

Handwashing is cleaning the hands with liquid, with or without soap, to remove dirt and microorganisms. It is the most effective measure for reducing the transmission of infectious disease. It sits under hand hygiene, which the World Health Organization defines as a general term covering handwashing, antiseptic handwash, antiseptic hand rub, and surgical hand antisepsis.

Terms

• Hand hygiene. General term for handwashing, antiseptic handwash, antiseptic hand rub, or surgical hand antisepsis.
• Handwashing. Washing with plain (non-antimicrobial) soap and water.
• Antiseptic handwash. Washing with antimicrobial soap and water.
• Surgical hand antisepsis. The surgical hand scrub, to remove as many microorganisms as possible before a sterile procedure.

Key Concepts

• Use running water in a sink that drains, not a basin.
• Use soap, antibacterial if needed.
• Rub your hands together vigorously for at least 15 seconds, about 20 seconds start to finish, covering all surfaces (CDC).
• Long nails and jewelry trap germs. Keep nails short. If you wear a ring, wash it on rather than removing it.
• Use disposable paper towels, not cloth, so each is used once.
• Treat the faucet as dirty: turn it off with a paper towel when there is no sensor or foot pedal.
• Use soap dispensers until empty, then wash before refilling.

Purpose

• Prevent infection.
• Avoid picking up and transmitting pathogenic microorganisms.

Types of Hand Hygiene

• Routine handwash. Water and non-antimicrobial soap to remove soil and transient microorganisms.
• Antiseptic handwash. Water and antimicrobial soap (e.g., chlorhexidine, iodine and iodophors, chloroxylenol [PCMX], triclosan) to remove or destroy transient microorganisms and reduce resident flora.
• Antiseptic handrub. Alcohol-based handrub.
• Surgical antisepsis. Water and antimicrobial soap (e.g., chlorhexidine, iodine and iodophors, chloroxylenol [PCMX], triclosan) to remove or destroy transient microorganisms and reduce resident flora. Recommended duration is 2-6 minutes.

The Five Moments for Hand Hygiene (WHO)

1. Before patient contact.
2. Before an antiseptic task.
3. After body fluid exposure risk.
4. After patient contact.
5. After contact with patient surroundings.

Supplies

• Soap or detergent
• Warm running water
• Paper towels
• Alcohol
• Optional: antiseptic cleaner, fingernail brush, plastic cuticle stick

Procedures

Antiseptic Handrub (alcohol-based)

1. Remove jewelry.
2. Apply the manufacturer-recommended amount of alcohol-based product into a cupped hand.
3. Rub palm to palm.
4. Right palm over left dorsum with interlaced fingers, and vice versa.
5. Palm to palm with fingers interlaced.
6. Backs of fingers to opposing palms with fingers interlaced.
7. Rotational rubbing of the left thumb clasped in the right palm, and vice versa.
8. Rotational rubbing, backward and forward, with clasped fingers of the right hand in the left palm, and vice versa.
9. Rub until dry before continuing care. Do not rub off excess product.

Antiseptic Handwash (clean technique)

1. Gather supplies and stand at the sink.
2. Wet hands and wrists, keeping hands lower than elbows so water flows toward the fingertips.
3. Cover all surfaces with soap.
4. With firm, circular friction, wash the palms, backs, each finger, knuckles, wrists, and forearms. Keep it up for 30 seconds.
5. Rinse with water flowing toward the fingertips.
6. Pat dry from fingers up to forearms with a paper towel and discard it immediately.
7. With no sensor or foot pedal, use a clean paper towel to turn off the faucet.

Surgical Antisepsis (sterile technique)

1. Remove all jewelry.
2. Wet hands with sterile water close to body temperature.
3. Wash with antimicrobial soap and/or povidone-iodine.
4. Clean subungual areas with a nail file.
5. Scrub each side of each finger, between the fingers, and the backs and fronts of the hands for at least 4 minutes.
6. Scrub the hands, keeping the hand higher than the arm so bacteria-laden soap and water do not run back onto the hands.
7. Rinse hands and arms in one direction only, fingertips to elbow.
8. Walk to the operating room holding hands above the elbows.
9. Dry with a sterile towel using aseptic technique.

Frequently Asked Questions

When should you use soap and water instead of hand sanitizer? Wash with soap and water when hands are visibly dirty or soiled with blood or body fluids, and after using the restroom. Use an alcohol-based hand rub for routine hand antisepsis when hands are not visibly soiled (CDC).

How long should you wash your hands? Rub all surfaces vigorously for at least 15 seconds with soap and water, about 20 seconds start to finish. With an alcohol-based rub, cover all surfaces until the hands are dry, which takes around 20 seconds (CDC).

What strength of alcohol sanitizer is effective? An alcohol-based hand rub should contain at least 60% alcohol to reliably kill germs on the hands (CDC).

How often do nurses perform hand hygiene? Healthcare personnel may need to clean their hands up to 100 times in a single shift, which is why technique and skin care both matter (CDC).

Why treat the faucet as contaminated? Hands recontaminate on a dirty faucet handle. Turn it off with a paper towel where there is no sensor or foot pedal, and use single-use paper towels rather than cloth.

Does jewelry affect hand hygiene? Yes. Rings and long nails trap microorganisms and make hands harder to clean. Keep nails short and wash a ring in place rather than removing it at the sink.