Proper hand hygiene, including washing with soap and water or using alcohol-based hand rubs, is the most effective way to prevent the spread of germs and infections. The document outlines CDC guidelines for hand hygiene, including demonstrating proper handwashing technique in 11 steps and describing situations that require hand hygiene, as well as differences between soap and antimicrobial cleansers and appropriate uses of alcohol-based hand rubs.

1. HAND HYGIENE
Proper Handwashing Techniques

2. OBJECTIVES
• Define proper handwashing.
• List four situations in which hands should
be washed.
• Describe the difference between plain
soaps and antimicrobial cleansers.
• Outline and demonstrate proper
handwashing technique.
• Explain when it is appropriate to use
alcohol-based hand rubs.

3. INTRODUCTION
The Centers for Disease Control and
Prevention (CDC) defines
handwashing as a “vigorous, brief
rubbing together of all surfaces of
lathered hands, followed by rinsing
under a stream of water.”
The simple procedure of washing
hands, when carried out properly, is
the single- most effective means to
prevent the spread of infection or
cross-infection.

4. WHY GOOD HAND
HYGIENE IS
IMPORTANT?
Germs are found in:
➢ Blood, body fluids, secretions or excretions
➢ Animals
➢ Insects
➢ Water
➢ Food
➢ Air
Germs are also found in inanimate objects such as:
➢Counter tops and telephones
➢Personal care items, such as toothbrushes
➢Utensils used for eating and drinking
Germs can be spread through:
➢Direct contact, such as kissing.
➢Coughing, sneezing, talking or laughing.
➢Direct exposure to blood, body fluids, excretions or secretions, such as
through sexual contact or caring for an open wound.

5. WHY GOOD HAND
HYGIENE IS
IMPORTANT?
Germs are especially prevalent in healthcare settings. The spread of these germs
can result in life-threatening and hard to treat infections among the frail and
elderly.
Bacteria and viruses are responsible for outbreaks of foodborne illnesses and
nosocomial infections. Hand hygiene, when done correctly, can help prevent the
spread of bacteria and viruses.
Proper handwashing technique has also been shown to prevent other serious
diseases and infections, such as:
➢Common cold
➢Cytomegalovirus (CMV)
➢Escherichia coli (E-coli)
➢Enterovirus
➢Hepatitis
➢Influenza
➢Respiratory syncytial virus (RSV)
➢Shigellosis
➢Staphylococcal infections
➢Streptococcal disease
➢Typhoid

6. WHEN HANDS
SHOULD BE
WASHED?
To prevent the spread of pathogens
(infection), always wash hands:
➢ Before and after contact with a patient.
➢ Before handling food or eating.
➢ After using the restroom.
➢ After sneezing or coughing.
➢After contact with blood or body fluids,
mucous membranes, secretions or
excretions, even if gloves were worn.
The use of gloves does not replace hand
hygiene because gloves may be cut or torn
during use. Bacteria can multiply quickly on
gloves, and hands may become
contaminated while gloves are being
removed.

7. WHEN HANDS
SHOULD BE
WASHED?
➢ After handling items containing bodily fluids, such
as mucous or urine.
➢ After contact with contaminated items, such as
linens and facility equipment.
➢ After exposure to Bacillus anthracis (the bacterium
which causes Anthrax).
➢ When Bacillus anthracis is proven or suspected, the
physical action of washing and rinsing hands is
recommended because alcohols, chlorhexidine,
iodophors and other antiseptic agents have poor
activity against spores.
➢Whenever hands are visibly soiled with blood or
other body fluids.
➢Whenever there is potential for spread of infection.

8. HANDWASHING
SUPPLIES
To properly wash hands, the following supplies are needed:
➢Hot and cold running water
➢Liquid soap Note: Discard or thoroughly cleanse the soap
container once it is empty. Never add soap to a partially full
container, because microorganisms may collect on liquid soap
containers.
➢Antiseptic solution, if required by the facility’s infection control
program
➢Disposable paper towels
➢Trash receptacle
➢Nail brush (optional)
Because handwashing is the single-most effective means of
reducing the risk of infection or cross-infection, sinks should be
conveniently located throughout the facility and sufficient in
number.
To further reduce the potential for contamination, the use of
handle “blades”, foot pedals, automatic faucets, or other devices
that do not require manual control are recommended.

9. PROCEDURE FOR PROPER
HANDWASHING TECHNIQUE
When it comes to removing germs, how hands are washed is just as important as when hands are washed. Follow this
procedure:
1. Gather handwashing supplies.
2. Stand back from the sink to prevent contamination from splashing.
3. Use a clean dry paper towel to turn on the faucet and to regulate the water for comfort.
4. Wet hands and wrists with running water. Avoid touching the sides of the sink.
5. Apply soap and create a heavy lather, washing at least two to three inches above the wrists and getting soap
under the fingernails and between fingers.
6. Continue washing and lathering for a full 15 seconds. Hold hands so that the flow of water is from the wrist to
fingertips. Note: Dietary staff should wash hands for 20 seconds.
7. With the fingertips of one hand, circle each finger on the opposite hand with a rotary motion from base to top.
8. Clean under nails (a nail brush is helpful, but optional).
9. Rinse well under running water.
10. Dry hands.
Note: If using paper towels to dry hands, activate the lever-operated paper towel dispenser before handwashing. To
dry hands, begin with the forearms and work toward hands and fingertips using a patting motion. If using a hand
blower to dry hands, activate the hand blower with the elbow before use. 11. Use a dry paper towel to turn off the
faucet.

10. ANTIMICROBIAL
CLEANSERS
The skin contains countless microbes and contaminants, some
“transient” and some “resident”. Transient microbes are short-
lived and can usually be removed effectively with plain soap
or other standard detergent.
Resident microbes are always on the skin, usually in the
superficial layers of the epidermis. Some resident microbes,
however, may invade deeper layers of the epidermis and resist
all efforts of removal by plain soap or standard detergents.
To ensure the removal of the more resistant, potentially
infectious microbes, antimicrobial cleaners should be used.

11. ALCOHOL-BASED
HAND RUBS
The use of alcohol-based hand rubs is appropriate under the following conditions:
➢ Before direct contact with patients.
➢ Before donning sterile gloves.
➢ Before performing any non-surgical invasive procedures.
➢ Before preparing or handling medications.
➢ Before handling clean or soiled dressings or gauze pads.
➢ Before moving from a contaminated body to clean another body site.
➢ After contact with a patient’s intact skin
➢ After handling used dressings or contaminated equipment.
➢ After contact with inanimate objects, for example, medical equipment in the
immediate vicinity of the patient.
➢ After removing gloves.
Alcohol-Based Hand Rubs and Fire Safety:
➢ Current national fire codes permit hand-rub dispensers in patient rooms but
prohibit their installation in egress or exit corridors.
➢ Local or state fire code requirements may differ from the national codes;
therefore, facilities are strongly urged to follow local requirements.
Healthcare organizations are encouraged to install dispensers in patient rooms,
treatment rooms, suites and other appropriate locations.
Healthcare facilities should work with local fire marshals to ensure that the
installations are consistent with local fire codes.
Safety Tips! When using alcohol-based hand rubs, CDC recommends that:
➢Hands are rubbed until the alcohol has evaporated and hands are dry.
➢ Alcohol-based hand rubs are stored away from high temperatures or flames, in
accordance with CDC and National Fire Protection Agency recommendations.
➢ Supplies of alcohol-based hand rubs are stored in cabinets or areas approved for
flammable materials.

12. SUMMARY
Handwashing is the single-most
effective way to prevent the spread of
communicable diseases and potentially
fatal infections. The hand hygiene
guidelines outlined here are part of
CDC’s strategy to reduce infections in
healthcare settings and promote patient
safety.