The How- To’s of Hand Hygiene

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The How- To’s of Hand Hygiene

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The How-To’s of Hand Hygiene

Training Module 1

AHRQ Pub. No.





Upon completion of this training module, long-term care staff will be able to demonstrate a working knowledge of—

Why hand hygiene is so important to prevent the spread of infections

When and how to perform hand hygiene

Key hand hygiene practices for prevention of health care-associated infections (HAI), particularly catheter-associated urinary tract infections (CAUTI)

Hand Hygiene │ 2



Health Care Workers’ Hands Spread Infections1

1-3 million serious infections estimated to occur every year in U.S. nursing homes

Hand hygiene is one of most important ways to prevent the spread of infections

Hand Hygiene │



Simplifying the Moments for Hand Hygiene2-3

Source: Public Health Ontario

Hand Hygiene │



Alcohol-Based Hand Rub (ABHR)4,5

Hand Hygiene Technique

Apply hand rub to palm of hand

Rub hands together, covering all surfaces

Focus on thumbs, tips of fingers, and under fingernails

Hands are clean when dry

Usually takes about 15-20 seconds; follow manufacturer’s guidance

Source: World Health Organization

Hand Hygiene │



Soap and Water Hand Washing4,6,7

Hand Hygiene Technique

Wet hands with water

Apply soap to palm of hand

Rub hands together, covering all surfaces for at least 15 seconds

Rinse hands with water

Dry hands with paper towel and use towel to turn off faucet

Paper towel prevents hands from being


by faucet handles

Source: World Health Organization

Hand Hygiene │



Notes About Hand Hygiene Products4,7

ABHRs/gels are preferred for hand hygiene when hands are not visibly soiled or dirty

Times when hands should be washed with soap (non-antimicrobial or antimicrobial) and water:

When hands are visibly dirty, contaminated, or soiled

After care of residents with infectious diarrhea

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Efficacy of Hand Hygiene Preparations

in Killing Bacteria7




Plain soap

Antimicrobial soap

Alcohol-based hand rub

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Hand Hygiene and Clostridium difficile (C.diff


Hand hygiene with soap and water is superior at removing the spore form of

C. diff

ABHR is more effective for hand disinfection with

other organisms

No studies linking ABHR use with an increase in

C. diff


Encourage soap and water

after care of residents with acute diarrhea

and use of gowns/gloves to prevent spore contamination of hands

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Important Points About Glove Use7

Gloves play a key role in preventing hand contamination—but do

NOT replace hand hygiene

Change gloves during care when moving from a contaminated body site to a clean body site

Do not wear the same pair of gloves for the care of more than one resident

Remove and discard gloves after use

Do not wash gloves

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Hand Hygiene Before Urinary Catheter Care

Perform hand hygiene and wear gloves immediately before

Placing or removing an indwelling catheterAccessing the drainage system to empty the drainage bag or collect a urine sample


Interacting with the resident or environment before handling the urinary device may contaminate hands

Reaching for gloves with unclean hands may contaminate the glove box and outside of the gloves

Then, gloves will contaminate the urinary catheter or urine collection system

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Hand Hygiene After Urinary Catheter Care

Remove gloves and perform hand hygiene immediately after—

Handling an indwelling catheter

Accessing the drainage system to empty the drainage bag or collect a urine sample


Hand contamination may occur as a result of small undetected holes in gloves

Hand contamination may occur during glove removal

Hand hygiene protects your hands and the environment from being contaminated

Hand Hygiene │



Hand Hygiene Case Scenarios

Let’s chat!

Review the three hand hygiene case scenarios as a group. As you discuss them, think about the following questions:

Does our facility staff experience similar challenges to performing hand hygiene at the appropriate times? Why or why not?

What could our facility do to reduce barriers to hand hygiene?

How can I help support a culture of safety around improving hand hygiene in our facility?

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Mody L, McNeil SA, Sun R, et al. Introduction of a waterless alcohol-based hand rub in a long-term-care facility. Infect Control and Hospital Epidemiology.

2003 Mar;24(3):165-71. PMID: 12683506.

Guide on hand hygiene in outpatient and home-based care and long-term care facilities: A guide to the application of the WHO multimodal hand hygiene improvement strategy and the “My Five Moments For Hand Hygiene” approach. 2012. World Health Organization. Accessed on April 14, 2015.

Just Clean Your Hands educational resources. Ontario Agency for Health Protection and Promotion.

. Accessed on April 14, 2015.

Centers for Disease Control and Prevention. Handy Hygiene in Healthcare Settings.

. Accessed on August 29, 2016.

World Health Organization. WHO







on April 14, 2015.

World Health Organization. WHO







on April 14, 2015.

Boyce JM,


D, Healthcare Infection Control Practices Advisory Committee, et al. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America.



Rep. 2002 Oct 25;51(RR-16):1-45. PMID:12418624.

Pop-Vicas A, Baier R. Healthcare workers’ hands and Clostridium difficile spores: Making progress? Infection Control and Hospital Epidemiology. 2014 Jan;35(1):16–17.Yokoe DS, Anderson DJ,

Berenholtz SM, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Am J Infect Control. 2014 Aug;42(8):820-8. PMID:25087135. Hand Hygiene │ 14


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