New Delhi | Dr RP Ram: Handwashing with soap and water has been considered a measure of personal hygiene for centuries and has been generally embedded in religious and cultural habits. Nevertheless, the link between handwashing and the spread of disease was established only two centuries ago, although this can be considered as relatively early with respect to the discoveries of Pasteur and Lister that occurred decades later.

Defective hand cleansing (e.g. use of an insufficient amount of product and/or insufficient duration of hand hygiene action) leads to poor hand decontamination. Obviously, when Health Care Workers fail to clean their hands during the sequence of care of a single patient and/or between patients’ contact, a microbial transfer is likely to occur.

Hand hygiene is the primary measure proven to be effective in preventing infection and the spread of antimicrobial resistance. However, it has been shown that people encounter difficulties in complying with hand hygiene indications at different levels.

There is convincing evidence that improved hand hygiene through multimodal implementation strategies can reduce infection rates.

In addition, although not reporting infection rates several studies showed a sustained decrease in the incidence of multidrug-resistant bacterial isolates and patient colonisation following the implementation of hand hygiene improvement strategies.

An economic analysis of the “clean your hands” hand hygiene promotional campaign conducted in England and Wales concluded that the programme would be cost-beneficial if Infection rates were decreased by as little as 0.1 per cent.

When to perform Hand Hygiene?

A. Wash hands with soap and water when visibly contaminated or visibly soiled with blood or other body fluids or after using the toilet.

B. If exposure to potential spore-forming pathogens is strongly suspected or proven, including outbreaks of C. difficile, hand washing with soap and water is the preferred means.

C. Use an alcohol-based hand rub as the preferred means for routine hand antisepsis in all other clinical situations described in items D(a) to D(f) listed below if hands are not visibly soiled .If alcohol-based hand rub is not obtainable, wash hands with soap and water.

D. Perform hand hygiene:
a) before and after touching the patient
b) before handling an invasive device for patient care, regardless of whether or not gloves are used
c) after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings
d) if moving from a contaminated body site to another body site during care of the same patient
e) after contact with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient
f) after removing sterile or non-sterile gloves

E. Before handling medication or preparing food to perform hand hygiene using an alcohol-based hand rub or wash hands with either plain or antimicrobial soap and water

F. Soap and alcohol-based hand rub should not be used concomitantly

Hand Hygiene Steps with Alcohol Based Formulation

Duration of the entire procedure: 20-30 seconds

Hand Hygiene Technique with Soap and Water

Duration of the entire procedure: 40-60 seconds


* Include information regarding hand-care practices designed to reduce the risk of irritant contact dermatitis and other skin damage in education programmes for HCWs.

* Provide alternative hand hygiene products for HCWs with confirmed allergies or adverse reactions to standard products used in the health-care setting.

* Provide HCWs with hand lotions or creams to minimize the occurrence of irritant contact dermatitis associated with hand antisepsis or handwashing

* When alcohol-based hand rub is available in the health-care facility for hygienic hand antisepsis, the use of antimicrobial soap is not recommended.

* Soap and alcohol-based hand rub should not be used concomitantly.


* The use of gloves does not replace the need for hand hygiene by either hand rubbing or handwashing.

* Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes or non-intact skin will occur.

* Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient.

* When wearing gloves, change or remove gloves during patient care if moving from a contaminated body site to either another body site (including non-intact skin, mucous membrane or medical device) within the same patient or the environment.

* The reuse of gloves is not recommended. In the case of glove reuse, implement the safest reprocessing method.


1. Do not wear artificial fingernails or extenders when having direct contact with patients.

2. Keep natural nails short (tips less than 0.5 cm long or approximately ¼ inch)

(Disclaimer: The above article has been written by Dr RP Ram, Consultant General Medicine & Head DNB, Jaslok Hospital & Research Centre.)

Posted By: Aalok Sensharma