Indications for hand hygiene
Use an alcohol-based hand rub for all clinical situations where hands are visibly clean.
Wash with soap and water when hands are visibly dirty or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids, or if exposure to potential spore forming organisms is strongly suspected or proven, or after using the bathroom.
How do I perform hand hygiene?
Hand hygiene is a general term referring to any action of hand cleansing, which includes:
- Applying an alcohol-based handrub to the surface of hands (including liquids, gels and foams)
- Washing hands with water and either antimicrobial or non-antimicrobial soap or soap solution.
The World Health Organization (WHO) has developed the following posters on performing hand hygiene:
Glove use and hand hygiene
Wearing gloves does not replace the need for hand hygiene, as gloves do not provide complete protection against hand contamination. Microorganisms may gain access to the healthcare workers' hands via small defects in gloves, or by contamination of the hands during glove removal.
Gloves should be worn:
- When there is a risk of contamination of the healthcare workers hands with blood or body fluids
- Where indicated by local infection control policy, for example with transmission based precautions
Gloves should be changed:
- Between episodes of care for different patients, to prevent transmission of microorganisms
- During the care of a single patient, to prevent cross-transmission of body sites
Hand hygiene is required with glove use:
- Hand hygiene should be performed before putting on gloves
- Hand hygiene should be performed after removing gloves
- Gloves should be removed to perform hand hygiene during the care for a single patient as indicated by the 5 Moments for Hand Hygiene
- Single use gloves should be discarded after each use.
Hand hygiene products and gloves should be made available inside isolation/contact precaution rooms to allow for appropriate hand hygiene to occur during the care of a patient.
Prolonged and indiscriminate use of gloves should be avoided as it may cause adverse reactions and skin sensitivity.
For further information on glove use refer to the Australian Guidelines for the Prevention and Control of Infection in Healthcare.
Hand care issues
Intact skin is a first line defence against infection. Damaged skin can not only lead to infection in the host, but can also harbour higher numbers of microorganisms than intact skin and increase the risk of transmission to others.
The management of hand care problems associated with the use of hand hygiene products requires early recognition and a systematic approach to ensure success.
There are two major types of skin reactions associated with hand hygiene:
- Irritant contact dermatitis, which includes symptoms that can vary from mild to debilitating, including dryness, irritation, itching, and even cracking and bleeding
- Allergic contact dermatitis, which is rare and represents an allergy to some ingredient in a hand hygiene product. In its most serious form allergic contact dermatitis may be associated with symptoms of anaphylaxis.
The majority of skin problems among healthcare workers that are related to hand hygiene are due to irritant contact dermatitis. Irritant contact dermatitis is primarily due to frequent and repeated use of hand hygiene products; especially soaps, other detergents, and paper towel use, which result in skin drying. The initial use of alcohol-based handrubs among such healthcare workers often results in a stinging sensation. However, recent studies have suggested that the ongoing use of emollient-containing alcohol-based handrub leads to improvement in irritant contact dermatitis in approximately 70% of affected healthcare workers. Also, the use of an oil-containing lotion or a barrier cream three times a shift can substantially protect the hands of vulnerable healthcare workers against drying and chemical irritation, preventing skin breakdown.
It is important to ensure that the selected alcohol-based handrub, soaps, and moisturising lotions are chemically compatible to minimise skin reactions among staff.
Factors that may contribute to dermatitis include:
- Fragrances and preservatives, which commonly cause of contact allergies
- Washing hands regularly with soap and water immediately before or after using an alcohol-based handrub, which is unnecessary
- Donning gloves while hands are still wet from either handwashing or applying alcohol-based handrub, which increases the risk of skin irritation
- Using hot water for handwashing
- Failure to use supplementary moisturisers
- Quality of paper towels.
Strategies for minimising occupational hand dermatitis include:
- Use of a hand hygiene product that contains skin emollient to minimise the risk of skin irritation and drying
- Educating staff on the correct use of hand hygiene products
- Educating staff on caring for their hands, including the regular use of skin moisturisers both at work and at home
- Providing a supportive attitude towards staff with skin problems.
Alcohol-based handrub produces the lowest incidence of irritant contact dermatitis of all the hand hygiene products currently available. True allergy to alcohol-based handrub is rare, and allergy to alcohol alone has not been reported.
Healthcare workers should be encouraged to notify the hand hygiene lead if skin irritation occurs following the use of alcohol-based handrub. All hospitals should have access to referral for follow up for healthcare workers with persistent skin problems. For example: an occupational dermatologist, local doctor, or emergency department. WHO consensus recommendations on skin care are included in Appendix 6 of the National Hand Hygiene Initiative User Manual.