TABLE 3

World Health Organization Recommendations for Hand Hygiene

• Wash hands with soap and water when visibly dirty or soiled with blood or other body fluids (IB) or after using the toilet (II).
• Use of an alcohol-based hand rub for all routine antisepsis is recommended for all clinical settings if the hands are not soiled (IA). If an alcohol-based hand rub is not obtainable, wash hands with soap and water (IB). Brushes are no longer recommended (even for surgical scrubs) (IB).
• Perform hand hygiene:
 ○ Before and after touching the patient (IB).
 ○ Before handling an invasive device for patient care, regardless of whether gloves are worn (IB).
 ○ After contact with body fluids or excretions, mucous membranes, nonintact skin, or wound dressings (IA).
 ○ If moving from a contaminated body site to another body site during care of the same patient (IB).
 ○ After contact with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient (IB).
 ○ After removing sterile (II) or nonsterile gloves (IB).
• Selection and handling of hand hygiene agents:
 ○ Provide products with a low irritancy potential (IB).
 ○ To maximize acceptance of hand hygiene products by health care workers, solicit input regarding the skin tolerance, feel, and fragrance of any products under consideration (IB).
 ○ Determine any known interaction between products used to clean hands, skin care products, and the types of gloves used in the institution (II).
 ○ Ensure that dispensers are accessible at point of care (IB).
 ○ Provide alternative hand hygiene products for health care workers with confirmed allergies or adverse reactions to standard products (II).
 ○ When alcohol-based hand rub is available in the health care facility, use of antimicrobial soap is not recommended (II).
 ○ Soap and alcohol-based hand rub should not be used concomitantly (II).
• Use of gloves:
 ○ The use of gloves does not replace the need for hand hygiene (IB).
 ○ Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, or nonintact skin will occur (IC).
 ○ Remove gloves after caring for a patient. Do not wear the same pair of gloves for more than 1 patient (IB).
 ○ Change or remove gloves during patient care if moving from a contaminated body site to either another body site (including nonintact skin, mucous membrane, or medical device) within the same patient or the environment (II).
• Other aspects of hand hygiene:
 ○ Do not wear artificial fingernails or extenders when having direct contact with the patient (IA).
 ○ Keep natural nails short.
• Hand hygiene promotion programs:
 ○ In hand hygiene–promotion programs for health care workers, focus specifically on factors currently found to have a significant influence on behavior and not solely on the type of hand hygiene product. The strategy should be multifaceted and multimodal and include education and senior executive support for implementation (IA).
 ○ Educate health care workers about the type of patient-care activities that can result in hand contamination and about the advantages and disadvantages of various methods used to clean their hands (II).
 ○ Monitor health care workers’ adherence to recommended hand hygiene practices and provide them with performance feedback (IA).
 ○ Encourage partnerships between patients, their families, and health care workers to promote hand hygiene in the health care setting (II).