Hand hygiene

Hand hygiene includes handwashing, antiseptic handwash, antiseptic hand rub, and surgical hand antisepsis. Handwashing removes dirt and microorganisms using plain soap and water but does not kill all organisms. Antiseptic handwash uses warm water with an antiseptic agent that may be bactericidal or virucidal. Antiseptic hand rub reduces microorganism numbers, while surgical hand antisepsis eliminates transient flora and reduces resident hand flora.

Hand hygiene is the cornerstone of aseptic techniques and the most effective approach for preventing and controlling infection transmission. By performing hand hygiene at the right moments using appropriate techniques, hands become clean and safe, preventing infectious organisms from transmitting to patients or healthcare workers. This practice directly breaks the chain of infection and reduces disease risk across all healthcare settings.

Healthcare workers must practice hand hygiene just before touching a patient, before performing aseptic tasks or working with invasive devices, before switching from a soiled to a clean body site on a patient, after contacting a patient or their surroundings, and following exposure to blood or bodily fluids. Hand hygiene is also required immediately after glove removal, regardless of whether gloves were sterile or non-sterile.

Handwashing involves fast, vigorous rubbing motions across all hand parts with lathered surfaces, followed by 15 seconds of rinsing under water. This mechanical action physically removes microorganisms from the skin and rinses them away with water. However, handwashing does not kill microorganisms; it simply displaces and eliminates them from hand surfaces through the cleansing process.

Ethanol-based hand antiseptics containing 70% to 90% alcohol are the most effective against common pathogens found on hands. These antiseptic hand rubs decrease the number of microorganisms present on hand surfaces. They are particularly useful in high-infection-risk settings, such as when hands are visibly soiled with blood and body fluids or when exposed to spore-forming microorganisms.

Surgical hand antisepsis is an integral part of surgical preparation that eliminates transient microorganisms and reduces resident hand flora. The most currently used antiseptics are chlorhexidine and povidone-iodine, applied with a sponge and brush. This technique involves coating from the elbow to the fingers and can take up to three minutes, depending on hospital protocol.

Hand hygiene must be practiced before handling invasive devices for patient care regardless of glove use, and immediately after removing sterile or non-sterile gloves. This ensures that microorganisms are not transferred from hands to patients or equipment. Gloves alone do not eliminate the need for proper hand hygiene, as they can become contaminated or develop microscopic tears during use.