Second main indication for hand hygiene is before invasive procedures. Invasive procedures in this sense include surgery (surgical hand preparation) and some other procedures, notably, insertion of central vascular catheter.
Hand hygiene as a part of insertion of a central vascular catheter is the same as surgical hand preparation except only hands are disinfected, with no wrists and forearms.
Link to IC/HH Core competencies: Area 4 Infection control activities: Domain Elaborating infection control intervention ICA 1-2
Reference: WHO Guidelines on Hand Hygiene in Health Care. World Health Organization 2009 WHO/IER/PSP/2009.07 http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf