Field Epidemiology Manual Wiki

Hand hygiene for patients and visitors

Last modified at 4/25/2016 4:13 PM by Vladimir Prikazsky

Hand hygiene for patients

The patient comes to the hospital for diagnosis and treatment of their various conditions, some of which may decrease  his/her immune defence mechanisms e.g. broken skin or mucous membranes, polymorph white blood cell deficiencies, acquired B and T lymphocyte disorders.

Microorganisms that may be acquired during the hospital stay may cause HAI and so it is essential that EVERY healthcare workers understands that they have a duty of care to make the healthcare environment as safe as possible.  The mainstay of the required measures is to perform effective hand hygiene each and every time it is indicated. The challenges are not just to establish an environment when this exists but to then sustain it.  However, an important adjunct to this approach is to ensure that patients also realise that there are expectations of them.

There are few important rules for hand hygiene of patients which should be communicated (often best done by means of a leaflet together with a verbal explanation): 

  1. Hands should be washed before any food is eaten.
  2. Hands must be washed after using the toilet and after conducting personal hygiene.
  3. Patients who are in isolation must wash their hands every time they leave their isolation area.
  4. If hands are visibly soiled or if they have an infection /colonization with C. difficile such patients should wash their hands under running water using liquid soap and then wipes them with paper towels.
  5. Otherwise patients may perform hand hygiene with alcohol rub hand preparations. 

Hand hygiene for visitors

Visitors are rarely a source of infection for patients, but sometimes even community microorganisms can be harmful. This especially applies to viruses, such as during the flu season or when there are norovirus outbreaks. 
Also, the hospital microorganisms that can be transmitted on to the hands of visitors, can sometimes harm visitors. 

Therefore, it is important for visitors to also perform hand hygiene following these rules:

  1. Visitors should wash their hands if soiled or use  alcoholic rub preparation if their hands are not soiled before contact with the patient and after contact with patients whom they visited.
  2. Visitors should not touch other patients who are in the same room as the patient whom they have visited. 


Link to IC/HH Core competencies:Area 4 Infection control activities: Domain Elaborating infection control intervention ICA 1-2


1. Cleanyourhands Campaign. London: National Patient Safety Agency, 2007.

2. McGuckin M, waterman R, Porten L et al. Patient education model for increasing handwashing compliance. Am J Infect Control 1999;27:309-14.

3. Munoz-Price LS, Banach DB, Bearman G, Gould JM, Leekha S, Morgan DJ, Palmore TN, Rupp ME, Weber DJ, Wiemken TL. Isolation precautions for visitors. Infect Control Hosp Epidemiol. 2015 Jul;36(7):747-58. doi: 10.1017/ice.2015.67.