1. Hand Hygiene
Hand Hygiene is the single most important measure in preventing and
reducing cross infection and is the responsibility of all individuals involved in
the provision of health care.
The term “Hand Hygiene” refers to hand decontamination with either
1. Alcohol based products (gels, foams or rubs) that do not require the use of
water.
2. Plain liquid soap and water
3. Antiseptic soap and water.
Preparation for Hand Hygiene
1. Hand care is important, because skin that is intact (no cuts or abrasions) is a
natural defence against infection.

All cuts and abrasions must be covered with a water-resistant occlusive
dressing and changed as necessary.

Water- resistant dressings must be available.
2. To minimise “chapping” of hands, use warm water and pat hands dry rather than
rubbing them.
3. Healthcare workers with damaged skin of their hands e.g. weeping dermatitis or
persistent exfoliative skin lesions should not carry out direct patient/client care
and should seek medical/occupational advice.
4. Jewellery should be restricted to one flat/wedding ring.
5. Finger nails should be kept short, smooth, clean and free of nail varnish and false
nails.
6. Nail brushes for staff hand hygiene are not recommended.
7. Shirts and uniforms should have short or turned up sleeves. Cardigans are not
permitted during direct care.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 4 of 36
When?
My Five Moments for Hand hygiene in Healthcare settings
Definitions
Patient Zone
The patient zone is defined as including the patient and some
surfaces/items in his /her surroundings that are temporarily and
exclusively dedicated to him/her i.e all items touched directly or
indirectly by the patient or touched by the HCW while delivering
care. This area becomes contaminated by the patients own
microbiological flora
Healthcare zone
All surfaces outside of the patient’s zone including other patients,
their zones and the wider healthcare environment. It is expected to
be contaminated by a wide variety of microorganisms including
multi drug resistant organisms
Performance of Hand Hygiene between these two geographically distinct
areas helps prevent the transmission of microorganisms.
Critical sites
Point of care
Sites within the patient zone which are associated with a higher
risk of infection. For example medical devices i.e. PEG site or risk of
exposure to body fluids i.e. taking blood sample or handling
incontinence wear.
Exactly where the care action takes place and is defined as the
place where the three elements come together; the patient, the
HCW and the care or treatment involving the patients.
Moments for Hand Hygiene in Out Patients, GP, Clinics, Home –based and
Long term care facilities
Definitions & Key differences
Patient Zone
Healthcare zone
Critical sites
Point of care
Where residents are semi independent and live in a community they will
have shared living space or rooms and will move about within the facility.
Therefore there is no distinct difference between the patient and
healthcare zone.
The patient zone will only apply where the resident is cared for
exclusively in a dedicated space with dedicated equipment e.g. bedside.
In the home setting the patient and their home is considered the patient
zone.
In out patients the patient him/her self is considered the patient zone as
the space and equipment used is not exclusively dedicated to the patient
for any prolonged period.
In home care what the HCW brings into the home in considered the
healthcare zone
In residential the healthcare zone only applies where the resident is
cared for exclusively in a dedicated space with dedicated equipment e.g.
bedside.
Sites with in the patient zone which are associated with a higher risk of
infection. For example medical devices i.e. PEG site or risk of exposure to
body fluids i.e. taking blood sample or handling incontinence wear.
Exactly where the care action takes place and is defined as the place
where three elements come together;the patient, the HCW and the care
or treatment involving the patients
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 5 of 36
MOMENTS FOR HAND HYGIENE IN LONG TERM CARE FACILTY
1.
2.
3.
4.
4 Moments for Hand
Hygiene
Before touching a resident
Before Clean/Aseptic
Procedures
After contact with body
fluids
After touching a resident
5 Moments for Hand
Hygiene
1. Before touching a patient
2. Before Clean/Aseptic
Procedures
3. After contact with body
fluids
4. After touching a patient
5. After touching the patients
surroundings
In LTCF
 where residents are mainly cared for in a dedicated space with dedicated
equipment the five moments for hand hygiene apply.
 where residents are semi autonomous, they may have their own room or shared
accommodation but also move within the facility, the four moments for hand
hygiene apply only to situations where healthcare is delivered to residents e.g.
vital sign checks.
 the four or five moments for hand hygiene recommendations do not cover any
social contacts with or among LTCF residents unrelated to healthcare delivery
i.e. shaking hands.
My Moments for Hand Hygiene in the Outpatients Setting
In outpatient settings Moment Five after touching the patient’s surroundings only
applies, where the patient is placed for a certain amount of time in a dedicated space
with dedicated equipment e.g. dental care settings, wound care clinics. In this case the
surfaces and items in the patients surroundings will become contaminated and
therefore require cleaning and decontamination once the patient has left.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 6 of 36
Vaccination Clinics
Moments for Hand Hygiene
in Clinics
4 Moments
1. Before touching a patient
2. Before Clean/Aseptic
Procedures
3. After contact with body
fluids
4. After touching a patient
Dental Clinics
Moments for Hand hygiene
5 Moments
1. Before touching a patient
2. Before Clean/Aseptic
Procedures
3. After contact with body
fluids
4. After touching a patient
5. After touching the patients
surroundings
Hand hygiene should also be performed in a range of other situations including
 When hands are visibly contaminated with dirt, soil or organic material.
 Before and after each work shift or work break.
 Before putting on and after removing protective clothing.
 After using the toilet, nose blowing, covering a sneeze, or whenever hands
become visibly soiled.
 Before eating, drinking or preparing food for oneself or a client.
 After handling raw food and before handling cooked or ready to eat food.
 After cleaning duties.
 After handling waste food or waste bins.
 On entering and before leaving clinical areas.
 On entering and leaving client’s homes.
How?
Hands can be cleaned by using an alcohol hand rub product or by washing with
soap and water. A six step technique is advised for both products as outlined in the
posters in appendix 3.1
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 7 of 36
Alcohol Hand Rub (AHR) products – are the preferred method for hand hygiene in
all clinical areas, because of their superior microbiocidal activity, reduced drying of the
skin, and convenience. They should only be used on visibly clean hands (WHO 2009)
In the following circumstances, liquid soap must be used
 When hands are visibly soiled
 In clinical situations where there is potential for the spread of alcohol-resistant
organisms such as Norovirus, Clostridium difficile or organisms that cause
diarrhoea (SARI 2005 , NICE 2011)
(AHR products are becoming available which have greater efficacy against viruses)
Points to remember when using alcohol hand rub products
1. Alcohol hand rub technique is performed in the same way as handwashing except
that all surfaces need only be covered once.(Refer to Six Step Technique)
2. Apply an adequate volume to ensure the hand rub comes in contact with all
surfaces of the hands.
3. Rub hands covering all surfaces once using the six step technique then continue
rubbing hands until dry minimum 20-30 seconds.
4. Alcohol products with added emollients may result in an excessive build up of
emollients; therefore hands should be washed with soap and water after several
consecutive applications of alcohol hand rub.
Note: The use of alcohol based hand rubs have introduced a risk of fire and poisoning
however the benefits outweigh the risk provided adequate control measures are put in
place. Please refer to Technical Services Department HSE (Cork & Kerry) Fire & Safety
Note on Alcohol Based Hand –Rub. HN12.2 Circulated September 2009.
Handwashing
Handwashing should always be carried out when hands are visibly soiled and should be
performed as follows:
 Wet hands under warm running water up to the wrists.
 Apply the cleanser/liquid soap. Lather it evenly covering all areas of the hands,
including the thumbs, fingertips, and palms and in between the fingers, rubbing
backwards and forwards at every stroke for several strokes. Ref to Six Step
Technique
 Do not place hands under running water whilst lathering solution.
 Rinse off thoroughly under running water.
 Dry thoroughly with a paper towel patting your hands, taking special care
between the fingers.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 8 of 36
Refer to the Hand Hygiene for Staff HSE South (Long term care and Community
Services) 2010 in Appendix 3.3
Products to use for hand hygiene
Alcohol hand rubs are the preferred product for hand hygiene in clinical settings
when hands are visibly clean. For optimal compliance with hand hygiene, handrubs
should be readily available; products should be available at point of care, either
through dispensers which are easily accessible at the point of care or in small bottles
for staff to carry on their person.
Optimal concentration of alcohol is 60-70%. Products with added emollients are
recognized as superior.
Liquid soap should be used for all routine/social handwashing and is acceptable for
general social contact and most clinical care activities. Disposable cartridge type refills
in closed wall mounted units with an integral nozzle are preferred. If non-disposable
reservoirs are used, these must never be topped up, the inside of the containers must
be washed and dried before re-filling. Bar soap is not recommended.
Bactericidal liquid soaps Chlorhexidine 4% w/v (e.g. Hibiscrub/Hydrex) can be
used as an antiseptic handwash:
 Before carrying out invasive procedures
 In the event of an outbreak of an infection as advised by IPCN.
Clinical Hand Hygiene Facilities in healthcare settings should comply with
HTM64 Sanitary appliances, contact your local IPCN for advice.
Hand Hygiene in the Home
In the home setting, choosing the appropriate method of hand hygiene will be
influenced by the assessment of
1. what is appropriate for the episode of care,
2. the available resources and
3. what is practically possible.
In order to ensure that hand hygiene is carried out in a client's home, the following
practice options are suggested:
 Where clean running water and liquid soap are available and access to the sink
is clear, kitchen towel maybe used, where this is not available healthcare
workers should carry paper towels to use in the client's home.
 When soap is not available, the healthcare worker should carry a supply of liquid
soap and hand towels.
 If access to hand washing facilities is limited or unsuitable, the healthcare
worker should carry an alcohol hand rub.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 9 of 36

Alcohol hand rubs should be used in homes where clients require high levels of
care such as care of invasive devices particularly when hand hygiene facilities
are not available at the point of care in the home. (Refer to Fire & Safety Note
on Alcohol Based Hand –Rub. HN12.2)
Hand Hygiene and Skin Care
Health care workers are required to clean their hands frequently to reduce the
transmission of micro-organisms. Hand hygiene up to 30 times a shift is not unusual.
Proposed methods for reducing adverse effects of hand hygiene agents





Handcare should be carried out by all healthcare staff to keep hands in good
condition and prevent skin damage.
A hand lotion or cream should be used to help replace the skins oils lost through
frequent hand hygiene. (Epi-shield is the skin protector currently recommended
by the Occupational Health Department - HSE South)
Use of products, which cause or exacerbate rashes, cracking or soreness of the
hands, should be stopped immediately and seek occupational health advice.
Avoid the prolonged use or inappropriate use of gloves e.g. gloves worn when
making beds which are not contaminated with blood or body fluids.
Health care management should promote the use of good quality hand hygiene
products including alcohol hand rub with added emollients, good quality paper
towels, nitrile gloves, perfume free detergents and hand lotions/creams.
Please refer to Appendix 3.4 “Hand Care for Healthcare Staff” available from HSE
South Occupational Health Department
Hand Hygiene for Residents/Clients
Clients and residents should be informed of
 The importance of practicing hand hygiene
 The timing i.e. after toileting and before meals. HCWs should assist those
residents unable to perform hand hygiene independently (e.g. using hand
wipes).
 When it is appropriate to use liquid soap and water or alcohol handrub.
Please refer to the leaflet Hand Hygiene for Residents and Visitors (Long term
care and Community Services, HSE South 2010) appendix 3.5
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 10 of 36