Hand Hygiene
Overview
Hand hygiene is the single most effective intervention for preventing healthcare-associated infections. Two methods exist: alcohol-based hand rub (ABHR) and soap-and-water handwashing. ABHR is preferred for most situations because it is faster, more effective against most organisms, and less irritating to skin. Soap and water is required when hands are visibly soiled, after the restroom, and after caring for a patient with C. difficile or norovirus — because alcohol does not kill spores or non-enveloped viruses. Both methods require a minimum of 20 seconds. The WHO defines five moments for hand hygiene, and gloves are never a substitute for it.
Indications
The WHO 5 Moments for Hand Hygiene define when decontamination is required.
Technique
Soap-and-water handwashing (minimum 20 seconds)
- Wet hands, apply soapeven lather distribution
- Lather palm-to-palm
- Backs of hands, interlaced fingerscovers dorsal surfaces
- Interlace fingers palm-to-palminterdigital web spaces
- Rinse under running waterremoves loosened microbes
- Dry with disposable towelprevents recontamination
During — Monitoring
Alcohol-based hand rub vs soap and water
Alcohol-based hand rub
- When preferred
- Routine, visibly clean hands
- C. difficile / norovirus
- Ineffective — no spore kill
- Mechanism
- Denatures protein, disrupts membrane
- Minimum time
- 20 seconds, rub until dry
Soap and water
- When preferred
- Visibly soiled hands
- C. difficile / norovirus
- Required — friction removes spores
- Mechanism
- Mechanical removal under friction
- Minimum time
- 20 seconds of friction
Patient Teaching
Clinical Pearl
Watery diarrhea on antibiotics? Think C. diff — always soap and water, never the alcohol rub. Alcohol cannot kill spores.