Hand hygiene
Hand hygiene
Washing the hands is the most effective way to prevent the spread of infection. This section
is broken down into two subsections: the first covers when to wash the hands and the
technique for doing so effectively; the second section discusses hand hygiene equipment,
including soap, nailbrushes and hand washbasins.
When and how to clean the hands
WHEN Hands should be cleaned at the ‘five moments for hand hygiene’:
1. Before touching a patient.
2. Before a clean/aseptic procedure.
3. After exposure to blood/body fluids.
4. After touching a patient.
5. After touching a patient’s surroundings.
More broadly speaking, this includes:
• Before and after handling invasive devices (moments 1, 2 and 3).
• Before and after dressing wounds (moments 1, 2 and 3).
• Before and after contact with immunocompromised patients (moments 1 and 4).
• After contact with equipment contaminated with blood/body fluid (moment 3).
• After contact with blood/body fluid (moment 3).
• After handling used laundry and clinical waste (moment 3).
• After glove removal (moment 3).
• Before leaving the clinical area (moments 4 and 5).
• After using the toilet (not specific to healthcare, but essential).
• Before and after handling food/drink (not specific to healthcare, but essential).
HOW Using the six-step technique for hand washing (below) described by Ayliffe et al.
(1978) should take approximately 15–20 seconds and allows all surfaces of the hands to be
cleaned effectively. The mechanical action of rubbing the hands together is important in
hand washing to dislodge bacteria from the skin’s surface.
Hands should be wet before soap is applied in order to get a better lather and spread of
the soap and to avoid the irritation that can occur when soap is applied directly to the skin,
repeatedly.
1. Rub hands together palm to palm.
2. Rub hands together, palm to palm with fingers interlaced.
3. Rub left hand over right hand with palm of left hand rubbing back of right hand, with
fingers interlaced, and then right hand over left hand with palm of right hand rubbing
back of left hand, with fingers interlaced.
4. Rub fingertips of left hand into right palm and fingertips of right hand into left palm.
5. Rub hands together with backs of fingers to opposing palms.
6. Grip thumb of left hand with right hand and rub in a rotational manner and then repeat
on the other side.
The hands should then be rinsed and dried thoroughly.
Surgical scrubbing/rubbing
Surgical scrubbing/rubbing involves using the six-step technique described above to wash
the hands, including the forearms. An antibacterial soap is used and the process takes
around two minutes.
• Surgical scrubbing/rubbing is essential before donning sterile theatre gowns, gloves, etc.
• All hand and wrist jewellery must be removed.
• Nailbrushes should not be used but nail picks can be used if the nails appear dirty.
Washing the hands is the most effective way to prevent the spread of infection. This section
is broken down into two subsections: the first covers when to wash the hands and the
technique for doing so effectively; the second section discusses hand hygiene equipment,
including soap, nailbrushes and hand washbasins.
When and how to clean the hands
WHEN Hands should be cleaned at the ‘five moments for hand hygiene’:
1. Before touching a patient.
2. Before a clean/aseptic procedure.
3. After exposure to blood/body fluids.
4. After touching a patient.
5. After touching a patient’s surroundings.
More broadly speaking, this includes:
• Before and after handling invasive devices (moments 1, 2 and 3).
• Before and after dressing wounds (moments 1, 2 and 3).
• Before and after contact with immunocompromised patients (moments 1 and 4).
• After contact with equipment contaminated with blood/body fluid (moment 3).
• After contact with blood/body fluid (moment 3).
• After handling used laundry and clinical waste (moment 3).
• After glove removal (moment 3).
• Before leaving the clinical area (moments 4 and 5).
• After using the toilet (not specific to healthcare, but essential).
• Before and after handling food/drink (not specific to healthcare, but essential).
HOW Using the six-step technique for hand washing (below) described by Ayliffe et al.
(1978) should take approximately 15–20 seconds and allows all surfaces of the hands to be
cleaned effectively. The mechanical action of rubbing the hands together is important in
hand washing to dislodge bacteria from the skin’s surface.
Hands should be wet before soap is applied in order to get a better lather and spread of
the soap and to avoid the irritation that can occur when soap is applied directly to the skin,
repeatedly.
1. Rub hands together palm to palm.
2. Rub hands together, palm to palm with fingers interlaced.
3. Rub left hand over right hand with palm of left hand rubbing back of right hand, with
fingers interlaced, and then right hand over left hand with palm of right hand rubbing
back of left hand, with fingers interlaced.
4. Rub fingertips of left hand into right palm and fingertips of right hand into left palm.
5. Rub hands together with backs of fingers to opposing palms.
6. Grip thumb of left hand with right hand and rub in a rotational manner and then repeat
on the other side.
The hands should then be rinsed and dried thoroughly.
Surgical scrubbing/rubbing
Surgical scrubbing/rubbing involves using the six-step technique described above to wash
the hands, including the forearms. An antibacterial soap is used and the process takes
around two minutes.
• Surgical scrubbing/rubbing is essential before donning sterile theatre gowns, gloves, etc.
• All hand and wrist jewellery must be removed.
• Nailbrushes should not be used but nail picks can be used if the nails appear dirty.
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