1: Hand hygiene techniques

Hand Hygiene Techniques

Hand hygiene is the cornerstone of infection prevention, critical for breaking the chain of transmission in healthcare. It directly reduces healthcare-associated infections (HAIs) and protects both patients and providers. Two primary methods are used: handwashing with soap/water and alcohol-based hand rub (ABHR).

When to Use Each Method

• Soap and Water:
  • When hands are visibly soiled, contaminated with blood/body fluids, or after contact with Clostridioides difficile (spore-forming bacteria resistant to alcohol).
  • Before eating, after restroom use, or if exposure to potential spore-forming pathogens is suspected.
• ABHR (≥60% alcohol):
  • For routine decontamination before/after patient contact, after touching surfaces near patients, or before aseptic procedures.
  • Exception: Not effective against C. diff spores or norovirus.

Technique: Soap and Water (40–60 seconds)

1. Wet hands with clean, running water.
2. Apply soap (antimicrobial preferred for clinical settings).
3. Lather vigorously, covering all surfaces:
   • Rub palms together.
   • Interlace fingers to clean between them.
   • Scrub backs of hands, thumbs (rotational rubbing), fingertips (against palms), and under nails.
4. Scrub for ≥20 seconds.
5. Rinse thoroughly with water flowing from wrists to fingertips.
6. Dry hands with a single-use towel; use the towel to turn off the faucet.

Technique: Alcohol-Based Hand Rub (20–30 seconds)

1. Apply a palmful of ABHR (enough to cover all surfaces).
2. Rub hands together, ensuring coverage of:
   • Palms, backs of hands, and interdigital spaces.
   • Thumbs (clasped rotationally).
   • Fingertips (scrubbed into palms).
   • Wrists.
3. Continue rubbing until hands are completely dry.

Key Considerations

• Jewelry: Remove rings/watches (microbes accumulate underneath). If non-removable, move during cleaning.
• Nails: Keep natural nails short (<0.5 cm). Avoid artificial nails/chipped polish (harbor pathogens).
• Skin Integrity: Report cuts or dermatitis; damaged skin increases infection risk.
• WHO’s "5 Moments": Perform hand hygiene:
  1. Before touching a patient.
  2. Before clean/aseptic procedures.
  3. After body fluid exposure.
  4. After touching a patient.
  5. After touching patient surroundings.
• Gloves: Never substitute for hand hygiene. Perform hand hygiene immediately after removal.

Effectiveness

Proper technique is non-negotiable. Studies show 30–40% of HAIs result from poor hand hygiene compliance. ABHR reduces bacterial counts faster than soap, but mechanical removal of debris via handwashing remains irreplaceable for visible soiling.