Q: When do I need to perform hand hygiene?
A: Hands must be cleansed immediately before and after patient contact. If hands are visibly
dirty, visibly soiled with blood or other body fluids, hands need to be washed with plain or
anti-microbial soap to remove these organic substances.
Hand hygiene must be performed in the following situations:

 When starting and finishing work;

 Before applying gloves

 After gloves are removed;

 Immediately prior to patient care procedures;

 Between care procedures

 Immediately after every patient contact;

 If contaminated with body substances, or any contact with body substances

 Following contact with non intact skin, and/or abnormal skin conditions (e.g. rashes)

 Following contact with mucous membranes (e.g. blowing nose, sneezing or coughing
into hands)

 Before eating

 After going to the toilet

 After smoking

 Prior to food preparation, preparing infant formula, administering medication or
feeding

 After touching inanimate objects that are likely to be contaminated (e.g. computer
keyboards, medical record notes, telephones, doors and hand rails);

 After toileting a patient and touching associated inanimate objects that are likely to
be contaminated (e.g. urinals and bed pans)

 After touching animals

 Whenever hands are visibly soiled.
Q: How should I conduct hand hygiene?
A: There are four methods of hand cleaning:

 Routine/Social –10 to 15 seconds using a plain liquid soap and cool or warm water
to remove transient organisms. Pat dry gently with paper towel

 Procedural –60 seconds using an antiseptic liquid soap and cool or warm water,
prior to invasive and aseptic procedures. Pat dry gently with paper towel

 Surgical –5 minutes using an antiseptic liquid soap and water, prior to first operative
procedure for day then 3 minutes prior to subsequent procedures.

 Water free skin cleanser –Such as alcohol hand rubs, gels or foams. Pour solution
into the palm of a cupped hand, dip fingertips into solution and then rub thoroughly
into hands and wrists, covering backs of hands, fingertips, thumbs and nail beds.
Continue rubbing for approximately 15 seconds and allow the product to dry on the
hands. Do not rinse or wipe off.
Q: When should I use soap and water to perform hand hygiene and not an alcoholbased hand rub?
A: If hands are visibly dirty, visibly soiled with blood or other body fluids, washing hands with
plain or anti-microbial soap is required for removing these organic substances.
The same is advised when following known or suspected exposure to clostridium Difficile.
Washing with soap and water is preferred because it is the best method of physically
removing spores from the hands. Alcohols, Chlorhexidine, Iodophors and other antiseptic
agents have shown poor activity against spores.
Q: What are the advantages to using alcohol-based hand rubs to perform hand
hygiene?
A: Alcohol based hand rubs require less time to perform hand hygiene when compared to
regular hand washing procedures with a liquid soap and water. Pump bottles are more
easily accessible than sinks and is a fast acting cleanser. Alcohol-based hand rubs are less
likely to cause irritation to the skin when used repeatedly in comparison to soap and water
hand washing techniques.
Q: What are the advantages to alcohol chlorhexidine hand rub over alcohol hand rub?
A: Regrowth of bacteria on the skin occurs slowly after use of alcohol-based hand
antiseptics¹. The addition of chlorhexidine to alcohol demonstrates persistent effect for at
least three hours after application and is of advantage where there is extended time
between applications. Alcohol-based hand rub on its own does not have this persistence.
However this does not reduce the need to perform hand hygiene before and after any direct
patient care or after handling of any blood or body substance or contaminated equipment.
Q: How long do micro organisms last on hands?
A: In health facilities, many surfaces are often contaminated with micro organisms, and all
health facility staff hands may serve as vectors for cross infection.
The survival of most micro organisms on surfaces is dependant on various environmental
conditions in health facilities, such as humidity, temperature, inoculum and presence of
organic matter. Even taking these conditions into consideration, some micro organisms may
well survive or persist on surfaced for months.²
For example, Staphylococcus aureus including MRSA can persist on surfaces from 7 days
to 7 months, Clostridium difficile (spores) for 5 months, Rotavirus from 6 to 60 days, E. coli
from 1.5 hours to 16 months, Candida albicans from 1 to 120 days and influenza virus for 1
to 2 days.
___________________________
¹Boyce J, Pittet D, 2002, Guideline for Hand Hygiene in Health Care Settings: Recommendations of the Health Care Infection
Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDC Hand hygiene Task Force, Infection Control and Hospital
Epidemiology, 23(12):S3-S41.
²Kramer A, Schwebke I, Kampf G 2006, How Long Do Nosocomial Pathogens Persist on Inanimate Surfaces? A systematic
review. BMC Infectious Diseases 6:130
Th e main route of transmission of micro organisms in a health care facility is on the hands of
health care workers to the patient and their associated environment. Overwhelmingly, the
international and national evidence of low compliance with hand hygiene is significant.
Hence the risk in not practicing hand hygiene before and after patient contact is to reduce
the transient effects from contaminated surfaces to hands should not be ignored.
Q: My hands are dry and cracked and sometimes they sting when I apply an alcoholbased hand rub. How do I care for my skin while performing hand hygiene?
A: Stinging demonstrates pre-damaged epidermal tissue, most commonly caused by the
frequent use of harsh soaps, unseen breaks in the skin and/or techniques that cause
irritations by drying and damaging the skin. The use of an alcohol-based hand rub may lead
to an improvement in the condition of your hands because it contains an emollient.
Emollients do not remove skin lipids and do not require rinsing or wiping. In addition, when
performing hand hygiene with soap and water take care to rinse thoroughly in warm or cold
water, and pat dry gently - do not use hot water. It is also useful to protect hands while
working at home by wearing gloves when using cleaning products and using hand creams.
Q: What should I do if my skin has cuts or abrasions?
A: Skin that is intact, without cuts, abrasions or lesion, is a natural defence against infection.
Health care workers should cover cuts and abrasion on exposed skin with a water-resistant
occlusive dressing which should be changed as necessary or when the dressing becomes
soiled, loose, damp or damaged.
Skin conditions or lesions on the hands of health care workers that cannot be covered with a
water-resistant occlusive dressing (or gloves to protect the abrasion when procedures are
conducted), should be assessed by a designated health professional and/or medical
practitioner. Temporary redeployment of staff may be necessary based on the advice of the
employee’
s medical practitioner or ‘
staff health’
service. Health care workers may need to
have an assessment of their hands using the ‘
Hand Hygiene and Skin Sensitivity
Assessment Package’
.
(http://www.cec.health.nsw.gov.au/campaigns/cleanhandssavelives/documents/actioncheckl
istskinsensitivity.pdf)
To support hand care, liquid soap and skin cleaning solutions should be pH friendly to skin
(pH 5.5-7). This will assist reduction in damage to the natural acid mantle covering the skin
surface and reduce damage caused by drying of the skin that is repeatedly cleaned.
Hands can be protected from chaffing by the regular use of non-oil based moisturising
creams or lotions.
Q: Does it matter if my hands are wet when I apply the alcohol-based hand rub?
A: Yes, having wet hands dilutes the solution thus decreasing its effectiveness. It is
important that the solution is applied to dry hands, rubbed thoroughly onto the entire surface
of your hands including finger tips and thumbs and allowed to dry naturally.
Q: Can I use my own moisturising cream that I have brought from home?
A: No, many hand creams may inactivate alcohol hand rubs and antiseptic hand cleansers.
The products supplied by your hospital have been chosen for their compatibility with alcohol
based hand rubs and antiseptic hand cleansers.
A pump pack should be used for dispensing moisturising creams or lotions. If a cream or
lotion cannot be dispensed by a measured dose pump dispenser, then a single use
applicator or single use spatular should be used.
Q: Why do I have to decontaminate my hands after removing my gloves?
A: The use of gloves does not eliminate the need for hand washing or cleaning. Hands
should be washed or cleaned after removal and disposal of gloves. Gloves are worn as a
barrier to protect the wearer’
s hands from decontamination or to prevent the transfer of
organisms already on the hands.³
Gloves will decrease the number of micro organisms you acquire on your hands, but will not
totally prevent them and cannot be guaranteed to provide complete protection against viral
or bacterial contamination of the hands during glove removal.
Q: Can I wear artificial nails, hand or wrist jewellery when having direct contact with
patients?
A: Laboratory staff and staff involved in direct patient care, sterilizing services must not wear
artificial nails, nail extenders or any nail enhancements (e.g. painting, varnish or nail art).
Chipped nail polish may support the growth of larger numbers of organisms on fingernails.
Outbreaks have been attributed to long natural and artificial nails. Personnel wearing
artificial nails also have been epidemiologically linked to several outbreaks of infections in
hospitals. Natural finger nails should be less than 0.5cm long.
Hand and wrist jewellery should be kept to a minimum for direct patient care. Rings with
large or multiple setting or detailed scrollwork should not be worn during direct patient
contact. Wrist jewellery must be removed for all invasive procedures. Wrist bands made of
cloth, wood or leather than cannot be easily removed for patient activity should not be worn
in the clinical environment. Studies have demonstrated that skin underneath rings is more
heavily colonized with micro organisms.
_________________________________________
³New South Wales Department of Health, 2002, NSW Health Infection Control Policy, NSW Government Directive, p 11-12