Clinical handwash basins (CHBs) (Figure 4.9) should be available in sufficient numbers such that a healthcare worker does not have to walk too far to decontaminate the hands. In a hospital, a CHB would be expected for roughly every 4–6 beds. While it is important to have an appropriate number of CHBs to allow easy access to hand washing, it should be noted that if they are poorly sited and underutilized they may become a risk for infection. This is because organisms such as Legionella pneumophilia can build up in underused pipework – a so‐called ‘dead leg’. Any water outlet that is not in regular use should be flushed at least twice a week to reduce this risk. Consideration should be given to removal (back to the circulating pipework) of any underused outlets. In some circumstances, point‐of‐use filters may be employed to ensure water leaving the tap is clean (Garvey et al. [42], Vonberg et al. [116]).

CHBs should be used solely by clinical staff for hand hygiene. They should have taps that can be turned on and off without using the hands; that is, they should be non‐touch or lever operated (NHS England and NHSI [82]). They should not have plugs (to encourage hand washing under running water) or overflows. Water should be able to drain freely and quickly to discourage growth of microbes from drains (Aranega‐Bou et al. [4], Walker and Moore [119]). CHBs should not be used for the disposal of wash water, intravenous fluids, drugs or beverages as this encourages the growth of harmful organisms such as Pseudomonas aeruginosa (Garvey et al. [42], Kotay et al. [71], Loveday et al. [73]). Basins that are also used by patients may require plugs, which will require careful management with some client groups to reduce the risk of flooding. In all cases, the taps should be positioned so that water does not fall directly into the outflow as this may lead to splashes containing organisms from within the drain, which has been implicated in outbreaks of infection (Aranega‐Bou et al. [4], Walker et al. [118], Wise [130]). Taps should be of a mixer type that allows the temperature to be set before hand washing starts. Access to basins must be unobstructed by any furniture or equipment to ensure that they can easily be accessed whenever required.

Liquid soap dispensers should be positioned close to handwash basins and care should be taken to ensure that soap cannot drip onto the floor from the dispenser and cause a slip hazard. Soap should be simple and unscented to minimize the risk of adverse reactions from frequent use. There is no advantage to using soap or detergents containing antimicrobial agents for routine hand washing. Antiseptic preparations may carry a higher risk of adverse reactions. Bar soap should not be used as the wet bar can grow micro‐organisms between uses. For surgical scrub or hand antisepsis, the most commonly used preparations contain either chlorhexidine or povidone‐iodine; both reduce bacterial counts significantly but chlorhexidine has a residual effect that may reduce rapid regrowth.

A paper towel dispenser should be fixed to the wall close to each handwash basin. Hand towels should be of adequate quality to ensure that hands are completely dried by the proper use of one or two towels. To conveniently dispose of these towels, a suitable bin with a pedal‐operated lid should be positioned close to the basin, but not so that it obstructs access to the basin (WHO [124]).

Alcohol‐based hand sanitizers should be available at the point of care in every clinical area for use immediately before care and between different care activities on the same patient. Dispensers may be attached to the patient's bed or bedside locker, and free‐standing pump‐top bottles can be used where appropriate, such as on the desk in a room used for outpatient clinics. Dispensers should not be sited close to sinks unless this is unavoidable because of the risk of confusion with soap and the risk of adding organic material to the drains (Kotay et al. [71]). Smaller sized personal‐issue bottles are appropriate where there is a risk that alcohol‐based handrub may be accidentally or deliberately drunk, such as in paediatric areas or when caring for a patient with alcohol dependency (NPSA [87]).