Indications for hand washing and hand antisepsis
Hands that are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids should be washed with a nonantimicrobial (or antimicrobial) soap and water. If hands are not visibly soiled, an alcohol-based hand rub should be used for routine decontamination in all other clinical situations.
Decontaminate hands in the following instances:
- Before having direct contact with patients and after contact with a patient’s intact skin (such as when taking a pulse or blood pressure or lifting a patient)
- After contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings, even if hands are not visibly soiled
- If moving from a contaminated body site to a clean body site during patient care
- After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient
- After removing gloves
- Before eating and after using a restroom
When decontaminating hands with an alcohol-based hand rub, apply the product to the palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Follow the manufacturer’s recommendations regarding the volume of product to use.
When washing hands with soap and water, wet hands first with water, apply the amount of soap recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet.
Multiple-use cloth towels of the hanging or roll type are not recommended for use in healthcare settings.
Surgical hand antisepsis
Remove rings, watches, and bracelets before beginning the surgical hand scrub. Remove debris from underneath fingernails using a nail cleaner under running water. Use either an antimicrobial soap or an alcohol-based hand rub with persistent activity before donning sterile gloves to perform a surgical procedure.
When using an antimicrobial soap, scrub hands and forearms for the length of time recommended by the manufacturer, usually 2 to 6 minutes. Long scrub times (10 minutes) are not necessary.
When using an alcohol-based surgical hand-scrub product with persistent activity, follow the manufacturer’s instructions. Before applying the alcohol solution, prewash hands and forearms with a nonantimicrobial soap and dry them completely. After applying the alcohol-based product as recommended, allow hands and forearms to dry thoroughly before donning sterile gloves.
Other aspects of hand hygiene
Do not wear artificial fingernails or extenders if you will have direct contact with patients at high risk (those in intensive-care units or operating rooms).
Keep natural nail tips less than one-quarter inch long.
Wear gloves when you could come into contact with blood or other potentially infectious materials, mucous membranes, and nonintact skin.
Change gloves during patient care if you are moving from a contaminated body site to a clean body site.
The use of gloves does not eliminate the need for hand hygiene. Likewise, the use of hand hygiene does not eliminate the need for gloves.
Develop and implement a system for measuring improvements in adherence to these hand-hygiene recommendations. Suggested performance indicators include the following:
- Periodic monitoring of hand hygiene adherence and providing feedback to personnel regarding their performance
- Monitoring the volume of alcohol-based hand rub used per 1,000 patient days
- Monitoring adherence to policies pertaining to wearing artificial fingernails or extenders
- Focused assessment of the adequacy of healthcare personnel hand hygiene when outbreaks of infection occur
When evaluating hand-hygiene products for potential use in healthcare facilities, administrators or product selection committees should consider the relative efficacy of antiseptic agents against various pathogens and the acceptability of hand-hygiene products by personnel. Characteristics of a product that can affect acceptance and therefore usage include its smell, consistency, color, and the effect of dryness on hands.
December 2007 AAOS Now
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S. Terry Canale, MD
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