Hand Hygiene in Healthcare

Proper hand hygiene is one of the most effective ways to prevent the spread of infection in healthcare settings

Proper hand hygiene is one of the most effective ways to prevent the spread of infection in healthcare settings. Simply put, hand hygiene means cleaning your hands using one of the following methods:

• Handwashing with soap and warm water

• Antiseptic hand wash

• Antiseptic hand rub such as Alcohol-Based Hand Sanitizer (ABHS), including foam or gel

• Surgical hand antisepsis

Cleaning your hands reduces the spread of potentially dangerous microorganisms to patients and lowers the risk of healthcare worker colonization or infection from germs acquired during patient care.

Why Hand Hygiene Matters in Healthcare Settings

Healthcare providers have frequent contact with patients, equipment, and surfaces that may carry infectious organisms. Effective hand hygiene helps:

• Prevent healthcare-associated infections (HAIs)

• Protect patients, visitors, and staff

• Reduce the spread of bacteria, viruses, and spores

• Support compliance with CDC and OSHA guidelines

Two Primary Methods of Hand Hygiene

Alcohol-Based Hand Sanitizers (ABHS)

Alcohol-Based Hand Sanitizers are the preferred method for cleaning hands in most clinical situations. They are the most effective products for reducing the number of germs on the hands of healthcare providers when hands are not visibly soiled.

Use ABHS:

• Immediately before touching a patient

• Before performing an aseptic task, such as placing an indwelling device

• Before moving from a soiled body site to a clean body site on the same patient

• After touching a patient or the patient’s immediate environment

• After contact with blood, body fluids, or contaminated surfaces

• Immediately after removing gloves

How to use ABHS properly:

• Apply product to hands

• Rub hands together, covering all surfaces

• Continue rubbing until hands are dry

• This process should take approximately 20 seconds

Handwashing With Soap and Water

Wash hands with soap and warm running water when:

• Hands are visibly dirty or soiled

• Before eating

• After using the restroom

• After caring for a person with known or suspected infectious diarrhea

• After known or suspected exposure to spores such as C. difficile or Bacillus anthracis

Proper handwashing steps:

• Wet hands with warm running water

• Apply the recommended amount of soap

• Rub hands vigorously for at least 15 to 20 seconds, covering all surfaces

• Rinse thoroughly with warm water

• Dry hands using disposable towels

• Use the towel to turn off the faucet

• Avoid hot water above 106°F to prevent skin irritation and dryness

Surgical Hand Hygiene and Antisepsis

Surgical hand antisepsis is required before donning sterile gloves for surgical or invasive procedures.

Best practices include:

• Remove rings, watches, and bracelets before beginning

• Clean underneath fingernails using a nail cleaner and warm running water

• Use either an antimicrobial soap or an ABHS with persistent activity

• Scrub hands and forearms for the time recommended by the manufacturer, typically 2 to 6 minutes

• Longer scrub times are not necessary

• When using alcohol-based surgical hand products, follow manufacturer instructions carefully

• Prewash hands and forearms with non-antimicrobial soap and dry completely before applying alcohol-based products

• Allow hands and forearms to dry thoroughly before donning sterile gloves

• Double gloving is recommended for invasive procedures with increased risk of blood exposure

Reducing resident skin flora on the hands of the surgical team lowers the risk of bacteria entering the surgical field if gloves become punctured or torn.

Fingernails and Jewelry: Hidden Infection Risks

Fingernails and jewelry can interfere with effective hand hygiene.

Key considerations:

• Germs can live under artificial fingernails before and after handwashing or ABHS use

• Artificial fingernails or extensions should not be worn when caring for high-risk patients

• Keep natural nail tips less than ¼ inch long

• Studies show higher levels of germs on skin underneath rings compared to fingers without rings

Skin Care for Healthcare Workers

Because healthcare providers perform hand hygiene more frequently than the general public, skin health can be impacted. Cracked or damaged skin increases infection risk.

Routine skin care recommendations:

• Use lotions or creams as needed to prevent dryness

• Delay subsequent hand hygiene for at least 5 minutes after applying skin care products when feasible

Supporting Compliance Through Training and Policies

Consistent hand hygiene practices are essential for patient safety, regulatory compliance, and infection prevention. Ongoing training, audits, and clear policies help reinforce proper techniques and reduce risk.

At Compliance Alliance, we perform hand hygiene assessments for all our infection control clients to ensure staff compliance, identify improvement opportunities, and provide actionable feedback. These assessments help healthcare organizations maintain high standards and reduce the risk of healthcare-associated infections.

Need help improving hand hygiene compliance at your facility?

Our medical consulting team supports healthcare organizations with infection prevention programs, staff training, and regulatory compliance guidance. Contact us to learn how we can help strengthen your hand hygiene practices.