Hand Hygiene: Preparations


Preparations Used for Hand Hygiene
Plain soap (Non-Antimicrobial) is available in various forms. Their cleaning activity can be attributed to their detergent properties, which result in removal of dirt, soil, and various organic substances from the hands. Plain soaps have minimal, if any, antimicrobial activity. However, hand hygiene with plain (lotion) soap can remove loosely adherent transient flora. A 15 second friction handwash reduces bacterial counts on the skin. Plain soap can be used for routine patient contact. The following technique should be applied:
  • Use warm water to wet the hands
  • Apply lotion soap
  • Work up a good lather
  • Apply with vigorous contact on all surfaces of the hands
  • Wash hands for at least 10-15 seconds
  • Rinse, avoid splashing
  • Keep hands down so that run off will go into the sink and not down the arm
  • Dry well with paper towel and use the paper towel to turn off the faucet
  • Discard the towels into the appropriate container

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Chlorhexidine gluconate (antimicrobial soap) removes soil and debris and significantly reduces both transient and resident bacteria on the hands. Chlorhexidine gluconate can be used:

  • Prior to invasive procedures, whether or not sterile gloves are worn
  • Before and after contact with wounds, whether surgical, traumatic, or associated with an intravenous device and whether or not gloves are worn
  • Between all patient contact with a source that is likely to be contaminated with virulent microorganisms or hospital pathogens such as an object or device contaminated with secretions or excretions from patients

The procedure for washing with an antimicrobial soap is the same as plain (lotion) soap.

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Triclosan (antimicrobial soap) may be substituted for those allergic to chlorhexidine gluconate (same technique as plain (lotion) soap).

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Alcohols contain either isopropanol, ethanol, n-propanol, or a combination of two of these products. The antimicrobial activity of alcohols can be attributed to their ability to denature proteins. Alcohols are not appropriate for use when hands are visibly soiled. Alcohol hand rub (alcohol gel) may be substituted for antimicrobial soap. The following technique should be used:

  • If hands are visibly soiled, wash hands with plain (lotion) soap prior to application of alcohol hand rub (alcohol gel)
  • Apply enough alcohol hand rub to cover the entire surface of hands and fingers
  • Rub the solution vigorously into hands until dry
  • Use of alcohol hand rubs may result in a sticky residue on hands. Wash with plain (lotion) soap periodically to remove the gel residue.

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Surgical Hand Antisepsis should be performed by healthcare workers who participate in surgical intervention of a patient. The products available for hand hygiene include 4% chlorhexidene gluconate, betadine (10% povidone-iodine), and 3M Avagard (chlorhexidene gluconate 1% solution and ethyl alcohol 61% w/w).
Antiseptic preparations intended for use as surgical hand scrubs are evaluated for their ability to reduce the number of bacteria released from hands at different times, including:

  • immediately after scrubbing,
  • after wearing surgical gloves for 6 hours (i.e., persistent activity), and
  • after multiple applications over 5 days (i.e., cumulative activity).

Immediate and persistent activity is considered the most important in determining the efficacy of the product. U.S. guidelines recommend that agents used for surgical hand scrubs should substantially reduce microorganisms on intact skin, contain a nonirritating antimicrobial preparation, have broad-spectrum activity, and be fast-acting and persistent.
Healthcare workers must either perform a surgical scrub with an antimicrobial soap or hand disinfection with an alcohol gel prior to donning sterile gloves and a sterile gown. If hands are not grossly contaminated between cases, disinfection with alcohol gel is appropriate. If at any time hands are contaminated, they must be washed with an antiseptic or washed with soap and water followed by an alcohol gel disinfectant. The technique for surgical hand antisepsis is as follows:

  • Remove all jewelry on hands and wrists (includes rings and watches)
  • If hands are visibly soiled, wash with soap and water and then dry
  • Clean under each fingernail using a nail stick (fingernails should be even with the tips of the fingers)
  • Follow instructions for use of one of three above agents

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3M Avagard

  • Wash hands if visibly soiled
  • Clean under the nails with nail stick
  • Dispense one pump (2ml) into the palm of one hand
  • Dip the fingertips of the opposite hand into the gel and work it under the nails
  • Spread the remaining lotion over the hand and up to just above the elbow
  • Using another 2ml of gel, repeat with the other hand
  • Dispense another 2ml of gel into either hand and reapply to all aspects of both hands and up to the wrist
  • Allow to dry before donning gloves

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4% Chlorhexidene Gluconate or Betadine (10% povidone iodine)

  • Wet hands with water
  • Dispense 2-3ml of antiseptic into hand
  • Dip the fingertips of the opposite hand into the antiseptic and work it under the nails using a nail stick
  • Spread the remaining antiseptic over the hand and up to just above the elbow
  • Using another 2-3ml, repeat the same process with the other hand and spread up the arm to just above the elbow
  • Dispense another 2ml of antiseptic into either hand and reapply to all aspects of both hands up to the wrist
  • Rinse both hands to elbows with water
  • Keep hands up and elbows down
  • Dry with sterile towels

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Vital Links


POP Initiative


Hand Hygiene Training PowerPoint

Hand Hygiene Posters:Hand Hygiene Posters

Before/ After Gloves
Use Soap When...
Alcohol-based Sanitizeer
Entering & Exiting Patient Room