Hand hygiene guidelines
VP Safety Institute,
in Wall Street Journal program on "Improving Hand Hygiene"
Improving hand hygiene: An international collaboration
May 5, 2010, 2-3 p.m. EST
Dr. John Boyce will review strategies and resources for improving hand hygiene. Read More
Join the WHO global initiative: SAVE LIVES: Clean Your Hands. Register your hospital.
- I Wanna Wash My Hands - Henry Ford hospital
- Soap-water, sanitizers
- Healthcare settings
- CDC -Catholic Health Partners - Premier research
- CDC hand hygiene guideline
- Tools, resources for hand hygiene
- Reducing fire risk with safe use of ABHR; surgical skin preps
Hand washing, also referred to as hand hygiene, is one of the best ways to avoid getting sick and spreading infections to others, in the home, at work, at school, when traveling, or in a healthcare setting. The attention to prevention of H1N1 influenza has helped propel this "simple" measure into the spotlight as a new habit to stay healthy and prevent the spread of infections like flu, colds or intestinal illnesses. Hand washing requires only soap and water or an alcohol-based hand sanitizer that doesn't even require water to use. Public health experts are hoping that everyone would adopt the habit of always cleaning hands when preparing food, eating, using the toilet, changing a diaper, or touching a sick or injured person. Special hand hygiene guidelines are available for healthcare professionals that provide the scientific evidence for the effectiveness of hand hygiene.
Hand hygiene is accomplished by either hand washing using soap and water, or hand sanitizing by rubbing hands with alcohol-based hand rubs (ABHR). Hand washing with soap and water when hands are visibly soiled is still the gold standard. However, in most all other situations, the use of ABHR and its ease of use and convenience has dramatically improved hand hygiene in all settings, including healthcare, where hand hygiene has been shown to reduce the risk of healthcare-associated infections.
The public can purchase soap and sanitizers in the grocery or convenience stores and small, conveniently sized alcohol hand sanitizers can be kept literally anywhere. In the healthcare setting, larger volume containers of alcohol hand sanitizers are stored and dispensed, requiring compliance with special procedures and fire codes. Refer to section on Alcohol-based hand rubs (ABHRS).
Hand hygiene by healthcare personnel is seen as the most important strategy to prevent patient-to-patient transmission of healthcare-associated infection (HAI) in any healthcare setting. Consumers seeking medical care are increasingly aware of hand hygiene as one of the key measures to prevent healthcare associated infections and recognize their need to partner with caregivers' practices to help improve the frequency of hand hygiene, often less than optimal.
All health care professionals know the importance of hand hygiene to prevent spread of infection, but also recognize that they sometimes forget to wash their hands in an often rushed and busy clinical environment. They also welcome reminders (e.g., visual or auditory prompts, signage) which have been shown to increase hand hygiene compliance. Research has also shown that multiple techniques are needed to improve compliance, and reminders from patients are among them. This Web site offers many resources such as guidelines below and resources with more tools.
A recent study was done to evaluate the success of a new video developed by CDC that is designed to educate patients about hand hygiene and empower them to ask their caregiver to wash their hands. This video, Hand Hygiene Saves Lives, was evaluated in 17 Catholic Healthcare Partner (CHP) hospitals in collaboration with CDC and Premier. The results showed that the Hand Hygiene Saves Lives video appear to be a promising method for empowering patients to ask their care provider to perform hand hygiene and may improve hand hygiene adherence in healthcare settings.
This video demonstrates how patients can approach staff about hand hygiene in a non-confrontational manner. This free, five-minute video focuses on patient and staff attitudes, and shows how patients can comfortably ask their caregiver to wash or clean their hands before providing hands-on care if they haven't seen them do so. This patient and staff training tool is ideally suited for viewing on public healthcare broadcasting sites throughout the facility, such as lobbies or waiting rooms and is available in English and Spanish. It teaches two key points to hospital patients and visitors to help prevent infections: the importance of practicing hand hygiene while in the hospital and that it is appropriate to ask or remind their healthcare providers to practice hand hygiene as well.
Among the most comprehensive and evidence-based guidelines for hand antisepsis and hand hygiene to reduce healthcare-associated infections is the one developed by the Centers for Disease Control and Prevention (CDC), entitled: Guideline for Hand Hygiene in Healthcare Settings (2002). The guideline includes reviews of research on the efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use, value of multidisciplinary hand hygiene promotion programs, and role of alcohol-based hand rubs in improving hand-hygiene practices. Also covered in the guidance is the use of surgical hand antiseptics, hand lotions or creams, jewelry, gloving, and wearing of artificial fingernails. Ultimately, the CDC urges that adherence to recommended hand hygiene practices should become part of a culture of patient safety.
- Download a summary of the Guideline for Hand Hygiene in Healthcare Settings.
- Download the complete 494-page Guideline for Hand Hygiene in Healthcare Settings.
- Download CDC hand hygiene fact sheet
Because of the importance of hand hygiene to prevent healthcare associated infections, many organizations, including the CDC, have developed tools and resources for healthcare staff, families, and children, to help educate and promote hand hygiene. These tools include books, posters, buttons, stickers, videos, and slide programs. Visit our resource section and view a selection of tools available from a variety of public, professional, consumer, healthcare organizations and clinicians, the CDC, and the World Health Organization (WHO).
ABHR The concern about a potential fire hazard with the placement and storage of dispensers of alcohol-based formulations of hand sanitizers prompted a multi-year collaboration to address all the conflicts in life safety codes among groups such as the National Fire Safety Association (NFPA) and the International Code Council (ICC) which develops the International Fire Code (IFC). The codes are enforced by regulators such as the Centers for Medicare and Medicaid Services (CMS) and accrediting groups, such as, The Joint Commission (TJC). By 2007 all groups had completed their changes and CMS and TJC now specify the proper conditions for placement and storage of dispensers for rooms and exit corridors.
Surgical skin preps There has also been concern about the safe use of alcohol-based surgical skin preps on patients in the operating room where there may be an occasional opportunity for spark from electrocautery, especially when used in an oxygen-enriched environment. This concern required changes in Life Safety Code language coupled with a requirement for compliance with CMS guidance on practices for safe use to permit clinicians to continue using solutions considered essential to reduce risk of surgical site infection.
ABHR archives Given the continued interest in the topic, an archive is being provided that includes the history, details on changes in codes and regulations, and news stories from Premier SafetyShare news. See the download section.
- ABHR archives