Please note that the term ‘alcohol-based hand rub (ABHR)’ has now been updated to ‘hand rub’.  A hand rub (alcohol or non-alcohol based) can be used if it meets the required standards. Please see further information in the hand hygiene products literature review.

Hand hygiene is considered an important practice in reducing the transmission of infectious agents which cause infections.

Adherence with the following points is essential to ensure effective hand hygiene: 

• expose forearms (be bare below the elbows)
• remove all hand/wrist jewellery including any embedded jewellery (a single, plain metal finger ring or ring dosimeter (radiation ring) is permitted but should be removed (or manipulated) during hand hygiene). Bracelets or bangles such as the Kara which are worn for religious reasons should be able to be pushed higher up the arm and secured in place to enable effective hand hygiene which includes the wrists
• ensure fingernails are kept clean, short and that no artificial nails or nail products are being worn
• cover all cuts or abrasions with a waterproof dressing

Hand washing should be extended to forearms if there has been exposure of forearms to blood and/or body fluids.

Hand washing sinks should only be used for undertaking washing and should not be used as a disposal route for any other liquids. (think-sink-think-splash-think-safety)

To perform hand hygiene: hand rubbing

• hand rubs should be readily available for staff as near to point of care delivery as possible. Where this is not practical, personal hand rub dispensers should be used
• apply a sufficient volume of hand rub to cover all surfaces of the hands to ensure effective hand hygiene
• hand rub manufacturer’s instructions should be followed for the volume of hand rub recommended to provide adequate coverage for the hands. In the absence of manufacturer’s instructions, volumes of approximately 3ml are recommended to ensure full coverage
• hand rub dispensers (cartridges/bottles) should not be refilled and should be replaced when empty or if  has exceeded the shelf life or expiry date that has been recommended by the manufacturer

The World Health Organization’s ‘4 moments for hand hygiene’ should be used to highlight the key indications for hand hygiene within the care home. 

Some additional examples of hand hygiene moments include, but are not limited to:

• after touching a resident’s immediate surroundings
• before handling medication
• before preparing food
• before donning (putting on) and after doffing (taking off) PPE
• after visiting the toilet
• between carrying out different care activities on the same resident
• after cleaning and disinfection procedures
• after handling used linen
• after handling waste (including used PPE)

It is important that residents are encouraged and supported to perform hand hygiene particularly after using the toilet and before consuming food and drink.

To perform hand hygiene: Hand Washing

Hands should be washed with antimicrobial liquid soap and water if/when:

• they are visibly soiled or dirty
• they are potentially contaminated with blood, other body fluids or excretions
• caring for a resident with vomiting or diarrhoeal illness
• caring for a resident with a suspected or known gastro-intestinal infection such as norovirus or a spore forming organism such as  Clostridioides difficile 

Note:

Hands should be washed with warm/tepid water to mitigate the risk of dermatitis associated with repeated exposures to hot water and to maximise hand washing compliance. Compliance may be compromised where water is too hot or too cold.

Hands should be dried thoroughly following hand washing using a soft, absorbent, disposable paper towel from a dispenser which is located close to the sink but beyond the risk of splash contamination.

The use of antimicrobial hand wipes is only permitted where there is no access to running water. Staff should perform hand hygiene using hand rub immediately after using the hand wipes and perform hand hygiene with soap and water at the first available opportunity.

In all other circumstances use hand rub for routine hand hygiene. 

Skin care

• Hand rubs should contain emollients in their formulation.
• Pat hands dry after hand washing using disposable paper towels. Avoid rubbing which may lead to skin irritation/damage.
• Use an emollient hand cream during breaks and when off duty. These should be applied all over the hands including between the fingers and the back of the hands.
• Staff with skin problems should seek advice from the local occupational health department if available or their GP.
• Barrier creams should not be used in the workplace.

Do not use refillable containers or communal tubs of hand cream in the care home setting.

Resources

 

Read the hand hygiene literature reviews to find out more about the evidence base for hand hygiene.

 

To make sure you clean your hands properly you should follow the steps in the poster ‘How to hand rub step by step images’ and ‘How to hand wash step by step images’. This poster can be printed off and displayed throughout the care home to ensure that all staff and visitors are aware of and practice this hand hygiene method when required in the care home.