• Hand hygiene is the most effective method for preventing the transfer of infection between Health care personnel and Patients within the hospital.
• Pathogenic organisms from colonized and infected patients are carried on the hands of the staff and represent an important mode of spread of infection in the hospital.
• Hand hygiene is strongly recommended in the following situations:

1. Before performing invasive procedures.
2. Before caring for particularly susceptible patients (Immunocompromised and isolation category patients).
3. Before and after touching wounds, even if gloves are used.
4. After dealing with the situation during which microbial contamination is likely, even if gloves are used.
5. Before touching the lines and tubes,
6. Between handling of patients and between procedures on the same patient.
7. After handling contaminated articles like urinals, bedpans etc.
8. After removal of gloves,
9. After personal use of the toilet and before and after meals.
10. On joining and after completion of duty shifts.

Social hand washing

• Social hand washing is done with plain soap and water, it removes transient microorganism from moderately soiled hands. It is required:
• Before handling food, eating, and feeding the patient
• After visiting the toilet
• Before and after nursing the patient (e.g. bathing)
• Whenever hands are soiled.

Procedure

• Remove watch and other jewellery, stand away from the sink, and turn on the tap using the elbow. Wet hands from fingertips to elbow, holding up to enable water to run down from the fingers to the elbow.
• Apply liquid soap and scrub each hand with the other, using rotatory movements from the fingertips to the elbows, with special attention to the nails, nail bed and webs of fingers.
• Close the tap with the elbow, taking care not to touch any spot that has been scrubbed.
• Dry with a clean towel beginning with the fingers, hands, proceeding to the wrists and then to forearms.
• Disposable paper towel can also be used for drying (except when preparing for invasive procedures)
• In social hand-washing, vigorous and mechanical friction is applied to all surfaces of hands using liquid soap and water for at least 10 seconds using a defined technique. The hands are rinsed under a stream of water and dried with a paper towel or hand drier. Similarly, in the absence of paper towels, a sterile cloth should be used by individuals to dry their hands. It should be remembered that the towels should not be used for common use and should be discarded after each use into a bag specifically meant for the towels for laundering to reuse. Tissue paper can also be used.

Hygienic hand washing or disinfection

It is a procedure where an antiseptic detergent preparation is used for washing of hands or is disinfected with alcohol. A thorough hand wash may be appropriate if disinfectants are not available.

Procedure

This is hand-washing using disinfection. The agents used are-

a. Aqueous4% Chlorhexidine Solution

• Povidone-iodine/detergent solution containing 0.75%available iodine.
• Wet hands with clean (running) water, apply a cleanser (3-5 ml) depending on the product, or thoroughly lather with soap. Wash the hands for 10-15 seconds, Povidone-iodine all over applying overall hand surface, rinse and dry.

b. Alcohol

• 0.5% Chlorhexidine or Povidone-iodine in 70% Isopropanal ethanol, 60% Isopropanal, or 70% ethanol with emollient (eg.0.5percentage glycerol).

Surgical handing washing

• It is performed with the aim to remove and kill the transient flora and to decrease the resident organisms to prevent the risk of wound contamination when gloves are damaged. Agents are the same as for the hygienic hand washing. A defined technique for decontamination of hands is probably of greater importance than the detergent used.
• Surgical hand washing is done using a disinfectant solution. The hands should be scrubbed with a brush at least twice and should b done for at least 3 minutes. In surgical washing, not only fingers and palms are washed but also hands up to elbow are washed. After washing, the water should not drip down from the unwashed area of the arm to washed hands. To assure this, hands are kept in upright position folded at the elbow. After drying, the Surgeon must put on gown and gloves.

Intensive care unit

Patients in these areas are at a higher risk of infection and hand washing should be overemphasized. The procedure described in the handwashing technique is to be followed.

Refer to Annexure 1- list of Antiseptics

Monitoring hand washing compliance

• Monitoring the hand washing is carried out by the Infection Control Nurses in all the critical care areas.
• The observations are recorded and reported in the Infection Control Committee meetings.