Hand hygiene methods

Hand hygiene is considered the cornerstone of infection prevention and control.

Healthcare workers have three choices for hand decontamination:

1. Hand wash;
2. Hand disinfection;
3. Surgical hand wash and hand disinfection or surgical hand wash with medicated soap.

In the literature, the following terms can be found:

• Social hand wash (cleansing hands with plain, non-medicated soap;
• The hygienic (Europe) or antiseptic (United States) hand wash (cleansing hands with antimicrobial or medicated soap and tap water), also called the “scrub”;
• Hygienic hand disinfection (Europe) (application of an alcohol-based hand rub and rubbing until the hands are dry.

Hand hygiene targets the hand’s transient microbial flora, be they (primarily) bacteria, viruses or fungi.

Total bacteria counts on healthcare workers' hands have ranged from 3.9 x 104 to 4.6 x 104.

Bacteria can survive on hand from minutes to hours, e.g. S.aureus, for up to 150 min.

Viruses can survive on hand from minutes to hours, e.g. Rotavirus, for up to 260 min.

Methods

Hand wash

Hand disinfection is to be performed as the preferred choice when hands are visibly clean or dry. Hand washing is to be performed when hands are visibly soiled and wet.

Hand disinfection with an alcohol-based hand rub can reduce transient bacteria by 2.6 to 6.8 log 10 units.

Alcohol works by denaturation and coagulation of proteins, lyse the bacterial cells and disrupts cellular metabolism. This either inactivates or kills the micro-organisms.

The effect depends on the concentration and type of alcohol, formulation, application time and the rubbing process. Link to the product - %, type of alcohol and texture (liquid, foam, gel).

How to disinfect hands:

• Apply enough hand rub to cover hands and wrists;
• Mechanically rub palms between fingers, fingertips, thumbs, thumb web, the upper surface and sides of hands and wrists for 20-30 seconds until hands are dry.

Watch here how to disinfect your hands correctly.

Hand disinfection

Hand washing with plain non-medicated soap has no antimicrobial activity. Still, the process and the physical drying with towels physically remove but does not inactivate microbes from the hand as shown above. However, the hand wash procedure in itself carries the inherent danger of possible re-contamination by splash-back from the sink to the hands, the surrounding environment and health care workers’ clothes. The soap can get contaminated and lead to contamination of hands.

Hand washing can lead to damage to the skin's barrier function and cause dryness and irritation. Hence it is important to consider the use of emollients by staff.

How to wash hands:

1. Wet hands and wrists with clean tepid tap water;
2. Apply an amount of soap that enables complete coverage of the hands and wrists;
3. Mechanically wash palms, between fingers, fingertips, thumbs, thumb web, top and sides of hands and wrist for 15 seconds;
4. Rinse with clean tepid tap water;
5. Dispose of the hand towel – without contaminating the hands.
6. Dry hands, wrists and forearms with clean soft, absorbent single-use towel;
7. Hand wash should be followed by hand disinfection if a reduction of microorganisms similar to hand disinfection is needed.

Watch here how to wash your hands correctly

Surgical hand antisepsis

Surgical hand antisepsis must be performed before invasive/surgical procedures.

Surgical hand antisepsis is known in the literature as:

• Surgical hand antisepsis using a plain non -medicated soap and followed by alcohol-based hand rub with persistent activity; or
• Surgical hand antisepsis using a medicated/antimicrobial soap.

Surgical hand antisepsis using a plain non-medicated soap and followed by alcohol-based hand rub with persistent activity.

Surgical hand wash must be performed before the first invasive procedure or when hands and underarms are visible soiled or wet between invasive/surgical procedures.

Surgical hand disinfection must be performed on dry hands and forearms after surgical hand wash or when hands are visible clean and dry between invasive/surgical procedures.

Nail cleaner or - brushes are only to be used when hands or nails are visible soiled.

How to perform surgical hand wash:

1. Wet hands, wrists and forearms with clean tepid tap water;
2. Apply an amount of plain soap sufficient to cover hands, wrists and forearms;
3. Mechanically wash palms, between fingers, finger tips, thumbs, thumb-web, tops and sides of hands, wrists and underarms;
4. Rinse from fingertips to elbow with clean tepid tap water;
5. Dry hands, wrist and forearms with clean soft absorbent single use towel.

How to perform surgical hand disinfection:

1. Apply sufficient hand rub to cover hands, wrist and forearms;
2. Mechanically rub palms, between fingers, finger tips, thumbs, thumb webs, tops and sides of hands, wrist and forearms till hands are dry. It might be necessary to apply the hand rub more than once.

Surgical hand antisepsis using a medicated/antimicrobial soap:

1. Wet hands, wrists and forearms with clean tepid tap water;
2. Apply an amount of medicated/antimicrobial soap sufficient to cover hands, wrists and forearms;
3. Mechanically scrub palms, between fingers, finger tips, thumbs, thumb-web, tops and sides of hands, wrists and underarms;
4. Scrubbing length must follow the recommendation of the manufacturer, usually 2-6 minutes;
5. Rinse from fingertips to elbow with clean tepid tap water;
6. Dry hands, wrist and forearms with clean soft absorbent single use towel.

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References

• Kampf G and Kramer A. Epidemiological background of hand hygiene and evaluation of the most important agens for scrubs and rubs. Clin. Microbiol. Rev. 2004, 17 (4):863

CDC. Guideline for Hand Hygiene in Health-Care Settings, MMWR October 25, 2002 / 51(RR16);1-44 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm

• WHO WHO Guidelines on Hand Hygiene in Health Care, 2009 http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf
• Statens Serum Institut. Important information on hand hygiene, Copenhagen http://www.ssi.moch.dk/goto.php?target=pg_1424

Contributor

• Vladimir Prikazsky