WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...
WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...
WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...
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<str<strong>on</strong>g>WHO</str<strong>on</strong>g> GUIDELINES ON HAND HYGIENE IN HEALTH CARE<br />
Rank<strong>in</strong>g system for evidence<br />
The c<strong>on</strong>sensus recommendati<strong>on</strong>s listed below (Part II, Secti<strong>on</strong>s 1–9) are categorized accord<strong>in</strong>g to the CDC/<br />
HICPAC system, adapted as follows:<br />
Category IA.<br />
Category IB.<br />
Category IC.<br />
Category II.<br />
Str<strong>on</strong>gly recommended for implementati<strong>on</strong> and str<strong>on</strong>gly supported by well-designed<br />
experimental, cl<strong>in</strong>ical, or epidemiological studies<br />
Str<strong>on</strong>gly recommended for implementati<strong>on</strong> and supported by some experimental, cl<strong>in</strong>ical, or<br />
epidemiological studies and a str<strong>on</strong>g theoretical rati<strong>on</strong>ale.<br />
Required for implementati<strong>on</strong>, as mandated by federal and/or state regulati<strong>on</strong> or standard.<br />
Suggested for implementati<strong>on</strong> and supported by suggestive cl<strong>in</strong>ical or epidemiological<br />
studies or a theoretical rati<strong>on</strong>ale or a c<strong>on</strong>sensus by a panel of experts.<br />
1. Indicati<strong>on</strong>s for hand hygiene<br />
A. Wash hands with soap and water when visibly dirty or<br />
visibly soiled with blood or other body fluids (IB) or after<br />
us<strong>in</strong>g the toilet (II). 179,248,249,287,339,899,1001-1005<br />
B. If exposure to potential spore-form<strong>in</strong>g pathogens is str<strong>on</strong>gly<br />
suspected or proven, <strong>in</strong>clud<strong>in</strong>g outbreaks of Clostridium<br />
difficile, hand wash<strong>in</strong>g with soap and water is the preferred<br />
means (IB). 419-421,432<br />
C. Use an alcohol-based handrub as the preferred means<br />
for rout<strong>in</strong>e hand antisepsis <strong>in</strong> all other cl<strong>in</strong>ical situati<strong>on</strong>s<br />
described <strong>in</strong> items D(a) to D(f) listed below, if hands are<br />
not visibly soiled (IA). 60,221,329,333,484-487,665 If alcohol-based<br />
handrub is not obta<strong>in</strong>able, wash hands with soap and water<br />
(IB). 60,195,196<br />
D. Perform hand hygiene:<br />
a. before and after touch<strong>in</strong>g the patient (IB); 50,52,73,88,110,114,<br />
121,125,126,1006<br />
b. before handl<strong>in</strong>g an <strong>in</strong>vasive device for patient care,<br />
regardless of whether or not gloves are used (IB); 1007<br />
c. after c<strong>on</strong>tact with body fluids or excreti<strong>on</strong>s, mucous<br />
membranes, n<strong>on</strong>-<strong>in</strong>tact sk<strong>in</strong>, or wound dress<strong>in</strong>gs<br />
(IA); 50,125,127,179<br />
d. if mov<strong>in</strong>g from a c<strong>on</strong>tam<strong>in</strong>ated body site to another<br />
body site dur<strong>in</strong>g care of the same patient (IB); 73,88,125-127<br />
e. after c<strong>on</strong>tact with <strong>in</strong>animate surfaces and objects<br />
(<strong>in</strong>clud<strong>in</strong>g medical equipment) <strong>in</strong> the immediate vic<strong>in</strong>ity<br />
of the patient (IB); 73,111,112,114,125-127,129,130<br />
f. after remov<strong>in</strong>g sterile (II) or n<strong>on</strong>-sterile gloves<br />
(IB). 73,123,139,520,1008<br />
E. Before handl<strong>in</strong>g medicati<strong>on</strong> or prepar<strong>in</strong>g food perform hand<br />
hygiene us<strong>in</strong>g an alcohol-based handrub or wash hands<br />
with either pla<strong>in</strong> or antimicrobial soap and water (IB). 1001-1004<br />
F. Soap and alcohol-based handrub should not be used<br />
c<strong>on</strong>comitantly (II). 617,1009<br />
2. <strong>Hand</strong> hygiene technique<br />
A. Apply a palmful of alcohol-based handrub and cover all<br />
surfaces of the hands. Rub hands until dry (IB). 201,814 (The<br />
technique for handrubb<strong>in</strong>g is illustrated <strong>in</strong> Figure II.1)<br />
B. When wash<strong>in</strong>g hands with soap and water, wet hands with<br />
water and apply the amount of product necessary to cover<br />
all surfaces. R<strong>in</strong>se hands with water and dry thoroughly<br />
with a s<strong>in</strong>gle-use towel. Use clean, runn<strong>in</strong>g water whenever<br />
possible. Avoid us<strong>in</strong>g hot water, as repeated exposure to<br />
hot water may <strong>in</strong>crease the risk of dermatitis (IB). 255,586,587<br />
Use towel to turn off tap/faucet (IB). 151,220,222,1010,1011 Dry hands<br />
thoroughly us<strong>in</strong>g a method that does not rec<strong>on</strong>tam<strong>in</strong>ate<br />
hands. Make sure towels are not used multiple times<br />
or by multiple people (IB). 75,115,257,671 (The technique for<br />
handwash<strong>in</strong>g is illustrated <strong>in</strong> Figure II.2).<br />
C. Liquid, bar, leaf or powdered forms of soap are acceptable.<br />
When bar soap is used, small bars of soap <strong>in</strong> racks that<br />
facilitate dra<strong>in</strong>age should be used to allow the bars to dry<br />
(II). 265,266,640,1012-1015<br />
3. Recommendati<strong>on</strong>s for surgical hand preparati<strong>on</strong><br />
A. Remove r<strong>in</strong>gs, wrist-watch, and bracelets before beg<strong>in</strong>n<strong>in</strong>g<br />
surgical hand preparati<strong>on</strong> (II). 962,965,966,968,1016 Artificial nails<br />
are prohibited (IB). 154,167,534,974,977<br />
B. S<strong>in</strong>ks should be designed to reduce the risk of splashes<br />
(II). 235,552<br />
C. If hands are visibly soiled, wash hands with pla<strong>in</strong> soap<br />
before surgical hand preparati<strong>on</strong> (II). Remove debris from<br />
underneath f<strong>in</strong>gernails us<strong>in</strong>g a nail cleaner, preferably under<br />
runn<strong>in</strong>g water (II). 63<br />
D. Brushes are not recommended for surgical hand<br />
preparati<strong>on</strong> (IB). 247,261,463,511,545-547<br />
152