7. Gloves:
Gloves do not replace the
need for hand cleansing with
rubs or soap and water (IB).
Gloves protect staff from blood and body fluids,
non-intact skin and mucous membranes (IC).
Remove gloves after caring for a patient. Do not use
the same pair of gloves for more than one patient (IB).
Change or remove gloves if moving
from a contaminated body site to a
clean site on the same patient (II).
Avoid the reuse of gloves (IB)
See Information Sheet 6; Glove Use
http://www.who.int/patientsafety/challenge/en/
the procedure. Allow to dry thoroughly
before donning sterile gloves (IB).
Do not combine surgical hand scrub
and surgical hand rub with alcoholbased products sequentially (II)
9. Fingernails:
Do not wear artificial fingernails or
extenders for direct patient contact (IA).
Keep natural nails short (0.5 cm long) (II).
Ranking for evidence:
CATEGORY IA:Strongly recommended for implementation
and strongly supported by well-designed
experimental, clinical or epidemiological studies.
CATEGORY IB:Strongly recommended for implementation and
8.S urgical Hand
Preparation:
If hands are visibly soiled, wash
with soap and water (II).
Remove jewellery (IB).
Use either an antimicrobial soap or alcohol-based
handrub before donning sterile gloves (IB).
Where water quality is not assured, use an alcoholbased handrub before donning sterile gloves (II).
When using soap, scrub for 2-5 minutes as
recommended by the manufacturer (IB).
When using alcohol rub, follow the manufacturer’s
recommendations using enough to keep the
hands and forearms wet with the rub during
supported by some experimental, clinical, or
epidemiological studies and a strong theoretical
rationale.
CATEGORY IC:Required for implementation, as mandated by
federal and/or state regulation or standard.
CATEGORY II: Suggested for implementation and supported by
suggestive clinical or epidemiological studies or
a theoretical rationale or a consensus by a panel
of experts.
To view the full Guidelines and an Executive Summary:
www.who.int/gpsc/en/index.html
October 2006, version 1.
WHO welcomes comments and feedback on this leaflet, suggestions should be
sent to the Secretariat of the World Alliance for Patient Safety, EIP/HDS, World
Alliance for Patient Safety, World Health Organization, Avenue Appia 20, CH1211 Geneva 27, Switzerland [email protected]
All reasonable precautions have been taken by the World Health Organization
to verify the information contained in this document. However, the published
material is being distributed without warranty of any kind, either expressed or
implied. The responsibility for the interpretation and use of the material lies with
the reader. In no event shall the World Health Organization be liable for damages
arising from its use.
WHO acknowledges the Hôpitaux Universitaires de Genève (HUG),
in particular the members of the Infection Control Programme,
for their active participation in developing this material.
1. Specific recommendations
for health care facility
administrators:
I
MULT
L
MODA Y
EG
STRAT
Key factors of importance for successful strategies:
• Access to a safe continuous water supply at all
taps/faucets and the necessary facilities to perform
handwashing (IB);
• A readily accessible alcohol-based hand rub
at the point of patient care (IA);
• Alternative products for staff with allergies or adverse
reactions and hand creams/lotions for skin care.
Hand hygiene adherence as a health care facility
priority that requires appropriate leadership,
administrative support and financial resources (IB).
IMPLEMENTATION STRATEGY
A multidisciplinary, multifaceted programme
to improve adherence of health-care workers
to recommended hand hygiene practices (IB).
2. Education and
motivation of staff:
Behaviour change is the key
to improving practice.
Multifaceted strategies are the most effective approach
to increase hand hygiene. Actively participate in the
strategies implemented by your institution.
Be aware of the ease and speed of hand contamination
following care activities (II).
Participate in staff compliance monitoring and feedback
(IA).
Encourage patient partnerships to promote hand
hygiene (II).
3. Choice of Product:
Products should be effective
and have a low likelihood
of causing irritation (IB).
• Before and after having direct contact with
patients (IB);
• After removing gloves (IB);
• Before handling an invasive device for patient care,
regardless of whether or not gloves are used (IB);
6aXd]da
Staff should be included in choosing products taking
account of feel, fragrance and skin tolerance (IB).
Handrub dispensers should be available
at the point of patient care (IB).
Handrub dispensers should function adequately.
4. Skin Care:
Perform hand hygiene:
• After contact with body fluids or excretions, mucous
membranes, non-intact skin, or wound dressings (IA);
• If moving from a contaminated body site to a clean
body site during patient care (IB);
• After contact with inanimate objects (including
medical equipment) in the immediate vicinity of
the patient (IB).
6. How:
Alcohol-based handrub: apply
8G:6B
Hand lotions and creams
should be used to minimize
irritant contact dermatitis (IA).
Staff with allergies or adverse reactions
should use alternative products (II).
5. When:
Wash with soap and water when
hands look soiled or if exposure to
potential spore-forming microbes
is suspected (IB) or after using the restroom (II).
Use an alcohol-based handrub for all other clinical
situations, particularly before and after direct contact
with patients (IA).
a palm-full of the rub and cover all
surfaces of the hand; rub together until
the hands are dry (The WHO ”HOW” posters illustrate
the correct technique).
Soap and water: wet the hands first and apply enough
soap to cover all surfaces of the hands (The WHO
”HOW” posters illustrate the correct technique).
Make sure the hands are dry and towels are not
used repeatedly or by multiple people (IB).
Water: healthcare settings are encouraged to ensure
that water is available for hand hygiene, BUT in
settings without easy access to water, efforts should
be made to make available alcohol- based hand rubs
as a priority. Alcohol rubs can be made in-house
using the WHO formulation (see Information Sheet 5
www.who.int/gpsc/en/index.html )