Chapter 4: Infection prevention and control
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Hand washing
Evidence‐based approaches
Hand washing involves three important stages: preparation, washing and rinsing, and drying (NHS England and NHSI [82]).
Hands should always be wet under running tepid water before applying soap. This is to allow the soap to lather when the hands are rubbed together. It is the friction and the lather that removes the dirt and debris and moves the transient organisms to the surface so that they can be effectively rinsed away under the running water. Wetting also reduces the risk of skin irritation. The hands should be rubbed for between 15 and 30 seconds with particular attention paid to the thumbs and the tips of the fingers (Figure 4.10).
Figure 4.10 Correct position to wash hands.
It is essential that hands are dried thoroughly after washing; this is because bacteria (especially gram negatives such as E. coli) can multiply on a wet surface, leaving hands contaminated. Good‐quality paper towels are recommended in hospital settings (NHS England and NHSI [82]). Warm air dryers may be effective but are noisy in clinical areas and there are some concerns that they may increase the number of bacteria in the washroom and lead to them spreading (Best et al. [6]).
Hand care
Hands are used continually by healthcare workers, so it is important that they are maintained in a healthy condition. Dry, excoriated skin is more likely to shed micro‐organisms to others and more likely to become contaminated, which may be harmful to the individual. Staff with acute or chronic skin lesions, conditions or reactions, or possible dermatitis, should seek advice from their local occupational health advisor.
Cuts and abrasions must be covered with a water‐impermeable dressing prior to clinical contact. It is especially important that staff with skin lesions that cannot be adequately covered seek advice from the occupational health department as it may not be safe for them to work, especially if they are undertaking high‐risk aseptic procedures (NICE [85]).
Skin damage and dryness often result from frequent use of harsh soap products, application of soap to dry hands, or inadequate rinsing of soap from the hands. It is essential that correct technique is used to minimize this risk. Alcohol‐based sanitizer products may be better for the skin than repeated washing with soap and water, which can remove the skin's natural oils; this is because the alcohol‐based products contain emollients, which are rubbed back into the hands as they are decontaminated.
Hand cream may help to prevent dry and chapped skin. This should be supplied from a dispenser or be for personal use, as communal jars may become contaminated and become a source of infection.
Procedure guideline 4.1
