Every time (WHO refers to these as “moments”) in which there is a risk of transmission of microorganisms from healthcare worker hands to a patient or from patient/environment to healthcare workers’ hands is an indication for hand hygiene. The method of hand hygiene in a particular situation can be different.

Hand hygiene in healthcare institutions has to be performed as a part of standard precautions and before invasive procedures.

1. Hand hygiene as a part of standard precautions

Hand hygiene is implemented as the first measure of standard precautions. This can be hand washing (when hands are visibly soiled) or hand rubbing (when hands are not soiled).

The exact detailed indications considered as part of standard precautions are as follows:

A. Wash hands with soap and water when visibly dirty or visibly soiled with blood or other body fluids (IB) or after using the toilet (II). Water for hand washing should be of drinking water quality (IC).

B. If exposure to potential spore-forming pathogens is strongly suspected or proven, including outbreaks of C. difficile, hand washing with soap and water is the preferred means (IB).

C. Use an alcohol-based handrub as the preferred means for routine hand antisepsis in all other clinical situations described in items D (a) to D (f) listed below if hands are not visibly soiled (IA). If an alcohol-based handrub is not available, then  hands should be washed with soap and water (IB). 

D. Perform hand hygiene:

a) before and after touching the patient (IB);

b) before handling an invasive device for patient care, regardless of whether or not gloves are used (IB);

c) after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings (IA);

d) if moving from a contaminated body site to another body site during care of the same patient (IB);

e) after contact with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient (IB);

f) after removing sterile (II) or non-sterile gloves (IB).

The WHO has further developed these considerations into their five moments which is described in another section.

E. Before handling medication or preparing food perform hand hygiene using an alcohol -based handrub or wash hands with either plain or antimicrobial soap and water (IB).

F. Soap and alcohol-based handrub should not be used concomitantly (II).

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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