Around the patient

• Before touching a patient
• Before and after clean/aseptic procedure
• After body fluid exposure
• After touching a patient
• After touching patient surroundings

Five moments of care

Around the ward

• On arrival at and before leaving a ward or department
• After visiting the toilet
• Before serving/preparing food or drinks
• After any activity or contact that potentially results in hands becoming contaminated
• On entering and leaving an isolation cubicle
• After removal of gloves

Alcohol hand rub

• Effective method of hand decontamination on visibly clean hands
• not recommended when hands are visibly dirty
• Do not use alcohol hand rub alone after caring for patients (or their equipment and environment) with suspected or known infectious diarrhoea
• such as Clostridium difficile or Norovirus
• regardless of whether gloves are worn

Soap and water

• Removes dirt, organic matter and transient flora by mechanical action
• Use hand washing with liquid soap and water
• when hands are visibly dirty or visibly soiled with body fluids or other organic matter
• when caring for patients with suspected or confirmed diarrhoea and/or vomiting
• patients with and during outbreaks of Clostridium difficile or Norovirus
• after several consecutive applications of alcohol hand rub
• after visiting the toilet
• Liquid soap alone does not provide sufficient hand disinfection before invasive procedures and surgery

Special situations

Aseptic non touch technique (ANTT)

• Before starting, wash hands with liquid soap followed by alcohol hand rub
• If required during procedure, use alcohol hand rub

Prolonged reduction in micro-organisms

• In surgery, some invasive procedures or in outbreak situations, use preparations containing antiseptic
• chlorhexidine, povidone iodine

• Bare below elbow for all staff working within clinical areas
• no sleeves below elbow
• no wrist watches, wrist jewellery or plaster casts/wrist splints
• Do not wear false nails, nail extensions, gel nails or nail varnish
• Keep nails short and clean
• Before clinical work shift begins, remove stoned rings, wrist watches or other wrist jewellery
• Cover cuts and abrasions on hands and arms with waterproof dressings

Washing with soap and water

• Turn on taps using elbows if possible
• Wet hands under warm running water
• Apply soap or antiseptic detergent
• Lather well
• Rub vigorously for a minimum of 10–15 sec
• pay particular attention to tips of fingers, thumbs and between fingers
• Use technique that covers all surfaces of hands and wrists
• Rinse thoroughly
• Turn off taps using elbow where applicable
• some taps are sensor operated
• Dry hands with a disposable paper towel
• hand dryers are not recommended in clinical areas
• Dispose of paper towel in bin using foot operated mechanism
• prevent contamination of hands

Using alcohol-based hand gel

• Apply alcohol-based gel
• pay particular attention to tips of fingers, thumbs and between fingers
• Rub hands together until solution has evaporated and hands are dry
• ensure all areas of hands and wrists are covered and rub hands together

• Apply an emollient hand cream regularly
• If any lesions or recurrent skin infections, or if any decontamination product causes skin irritation, contact occupational health team