As you go about your everyday life, germs accumulate on your hands. After you touch your eyes, nose or mouth, germs carried there can cause infections. Frequent hand washing is one of the best ways to avoid getting sick and spreading illness. Show
Good hand hygieneIf you care for babies, older people or sick people, hand washing is especially important because it helps prevent the spread of infections such as COVID-19, colds, the flu and gastroenteritis. Babies and children need to wash their hands too. If your child is too young to stand at a hand basin, you can wash their hands with disposable wipes or a wet, soapy flannel, but always make sure all soap is rinsed off and their hands thoroughly dried. Hand washing is also one of the most important ways to prevent the spread of infection among people in hospital. People’s immune systems are often weakened after illness or surgery, so infections are easy to catch and hard to treat. They may become life-threatening. When to wash your handsWash your hands before touching anything that needs to stay clean, and after touching anything that might contaminate your hands. Examples include:
Hand washing tipsWarm, soapy water is the best option for washing your hands when they are visibly dirty. Follow these simple tips on good hand hygiene. To wash your hands:
Using a waterless hand sanitiserAn alcohol-based hand rub (hand sanitiser) is a good way to clean your hands if you don't have access to soap and water. Hand sanitiser is only effective if your hands have no visible dirt on them. To use hand sanitiser:
Alcohol-based hand sanitiser can be poisonous if swallowed. Follow these tips to keep kids safe around hand sanitiser. Other tips for good hand hygiene
Quality statement 3: Hand decontamination
People receive healthcare from healthcare workers who decontaminate their hands immediately before and after every episode of direct contact or care.
Effective hand decontamination, even after wearing gloves, results in significant reductions in the carriage of potential pathogens on the hands and decreases the incidence of preventable healthcare-associated infections, leading in turn to a reduction in morbidity and mortality. Hand decontamination is considered to have a high impact on outcomes that are important to patients. Although hand hygiene has improved over recent years, remaining misconceptions about this standard principle of infection control are reported and good practice is still not universal.
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
a) Evidence of local arrangements to ensure the availability of facilities for hand decontamination. Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by organisations, for example, from procurement records. b) Evidence of local arrangements to ensure that all healthcare workers receive training in hand decontamination. Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from training records. c) Evidence of local arrangements to ensure that regular local hand hygiene observation audits are undertaken. Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, records of hand hygiene observation audits.
Incidence of healthcare-associated infection. Data source: 2020/21 NHS Outcomes Framework indicator 5.2. Service providers ensure that healthcare workers are trained in effective hand decontamination techniques, and that handrub and handwashing facilities are available so that healthcare workers can decontaminate their hands immediately before and after every episode of direct contact or care. Healthcare workers ensure that they are trained in effective hand decontamination techniques, and that they decontaminate their hands immediately before and after every episode of direct contact or care, even when gloves have been worn. Commissioners ensure that they commission services in which healthcare workers are trained in effective hand decontamination techniques and decontaminate their hands immediately before and after every episode of direct contact or care, and that hand hygiene observation audits are carried out regularly. People receiving healthcare are looked after by healthcare workers who always clean their hands thoroughly (using handrub or soap and water), both immediately before and immediately after coming into contact with the person or carrying out care. Germs are everywhere! They can get onto hands and items we touch during daily activities and make us sick. Cleaning hands at key times with soap and water or hand sanitizer that contains at least 60% alcohol is one of the most important steps you can take to avoid getting sick and spreading germs to those around you. There are important differences between washing hands with soap and water and using hand sanitizer. Soap and water work to remove all types of germs from hands, while sanitizer acts by killing certain germs on the skin. Although alcohol-based hand sanitizers can quickly reduce the number of germs in many situations, they should be used in the right situations. Soap and water are more effective than hand sanitizers at removing certain kinds of germs like norovirus, Cryptosporidium, and Clostridioides difficile, as well as chemicals. Hand sanitizers also may not remove harmful chemicals, such as pesticides and heavy metals like lead. Handwashing reduces the amounts of all types of germs, pesticides, and metals on hands. Knowing when to clean your hands and which method to use will give you the best chance of preventing sickness.
Selection of alcohol-based handrub products is the responsibility of individual health care facilities. It is recommended that alcohol-based handrub products:
Other factors that should also be considered include:
When to use alcohol-based handrubAlcohol-based handrubs should be used (when hands are visibly clean) instead of handwashing because they:
Handwashing is reserved for situations when hands are visibly soiled, or when gloves have not been worn in the care of a patient with Clostridium difficile. Alcohol-based handrubs have excellent antimicrobial activity against gram-positive and gram-negative vegetative bacteria, and good antimicrobial activity against enveloped viruses. Alcohol solutions containing 60-80% alcohol are most effective. It has been well established that alcohols effectively reduce the bacterial counts on hands better than soap and water. Alcohol-based handrubs are more effective against most bacteria and many viruses than either medicated or non-medicated soaps. Alcohol-based handrub is the hand hygiene product of choice for all standard aseptic procedures. Surgical scrub is required for surgical procedures. For definitions on standard versus surgical aseptic technique refer to the Australian Guidelines for the Prevention and Control of Infections in Healthcare. Alcohol-based handrub is also the recommended product for the prevention of intravascular catheter-related infections. Cutaneous absorption of alcoholRecent studies have demonstrated minimal rates of cutaneous alcohol absorption such that there should be no concern for healthcare workers. A study suggested that isopropanol might be less likely to be absorbed than ethanol. Thus, healthcare workers who are concerned about absorption for religious or other reasons may elect to use an alcohol-based handrub that contains isopropanol rather than ethanol. When implementing a hand hygiene campaign with an alcohol-based handrub in a healthcare setting, it is important to provide opportunities for healthcare workers to raise concerns about the use of alcohol-based handrubs for cultural or religious reasons or due to alcohol abuse and help them to understand the evidence underlying its use, and to identify that address their concerns. Alcohol-based handrub placementEnsuring alcohol-based handrub is available at the point-of-care improves hand hygiene compliance. Alcohol-based handrub should be easily accessible, generally within arm's reach of where patient care or treatment is taking place. Dispensers act as a visual cue for hand hygiene behaviour. Placement of alcohol-based handrub needs to be consistent and reliable. Clinical staff should assist with the decision-making process regarding placement of alcohol-based handrub, as they generally best understand the workflow in their area. Where possible, alcohol-based handrub should be placed at the foot of every bed or within each patient cubicle. When designing new healthcare facilities, consideration should be given to appropriate placement of alcohol-based handrubs so that healthcare workers can easily see and reach them. Alcohol-based handrub dispensers should not be placed next to sinks, as this can cause confusion for healthcare workers who may think they need to rinse their hands with water after using alcohol-based handrub. The following locations are suggested for placement of alcohol-based handrub:
A clear decision needs to be made about whose responsibility it is to replace empty alcohol-based handrub bottles. Workplace agreements or job descriptions may need to be changed to accommodate prompt replacement of these bottles. Alcohol-based handrub should never be decanted from one bottle into another as this can cause contamination. Safe placement of alcohol-based handrubThere are a number of risks to patients and staff associated with the use of alcohol-based handrub, however, the benefits far outweigh the risks. A risk assessment should be undertaken and a management plan put in place. This particularly applies to clinical areas that manage patients with alcohol use disorders, and patients at risk of self harm. The following factors should be considered in relation to safe placement of alcohol-based handrub:
Clinical area placement considerationsSpecial consideration is necessary when locating alcohol-based handrub in clinical areas where ingestion or accidental splashing of alcohol-based handrub is a particular risk. The placement of alcohol-based handrub needs to be aligned with the risk assessment of the individual patient or patient population. Such areas include:
Small personal bottles that healthcare workers carry with them may be more appropriate in some of the above areas. Paediatric product placementAlcohol-based handrub can be placed in paediatric wards. The placement of alcohol-based handrub within neonatal intensive care units, special care nurseries, maternity wards and on cots should follow the recommendations for product placement at point-of-care. Placement within general paediatric wards should remain within the point-of-care, except in situations of intellectual impairment or alcohol abuse where the child could unintentionally or intentionally harm themselves. Personal bottles of alcohol-based handrub could be used in any area where alcohol-based handrub cannot be placed at the point-of-care. Limitations of alcohol-based handrubIn some situations washing hands with soap and water is preferable to use of alcohol-based handrub. Bacterial sporesAlcohol has virtually no activity against bacterial spores. Washing hands with soap and water is preferred in this situation because it is the best method of physically removing spores from the hands. However, the vegetative form of Clostridium difficile is highly sensitive to alcohol-based handrub. The November 2018 ASID/AICA position statement on Infection Control Guidelines for Patients with Clostridium difficile Infection (CDI) in Healthcare Settings recommends the primary use of alcohol-based handrub in accordance with the WHO 5 Moments for Hand Hygiene when caring for patients with CDI. Gloves should be used during the care of patients with CDI, to minimise spore contamination, and if hands become soiled, or gloves have not been used, then hands must be washed with soap and water. Non-enveloped (non-lipophilic) virusesAlcohol has a poor activity against some non-enveloped viruses. (for example: rotavirus, norovirus, polio, hepatitis A). However, there is conflicting evidence suggesting that alcohol-based handrub is more effective than soaps in reducing virus titres on finger pads. Thus, in norovirus outbreaks it is usually best to reinforce the use of alcohol-based handrub, unless hands are visibly soiled, in which case handwashing with soap and water is preferred. Other organismsAlcohol has a poor activity against tropical parasites, and protozoan oocysts. Handwashing soap and water is preferred. |