Hand decontamination

Good hand hygiene is one of the most important methods of controlling the spread of infections in the healthcare environment. Your local hand decontamination policy should provide details of when and how you should decontaminate your hands. All healthcare workers should receive training in hand decontamination methods. If you require further information, please contact your Infection Control Team.

The Department of Health has published the ‘essential steps to safe, clean care’. This is a delivery programme which aims to reduce healthcare associated infections, including MRSA. The ‘essential steps’ programme provides tools and guidance to support different organisations and settings, including residential and nursing homes, as they work towards reducing and eradicating healthcare associated infections. Click here for more information on the ‘essential steps’ programme.

As part of the ‘essential steps to safe, clean care’ programme, the Department of Health has launched a specific step relating to preventing the spread of infection. The aim of this document is to reduce the risk of microbial contamination in everyday practice and to ensure there is a managed environment that minimises the risk of infection to patients, clients, staff and visitor. Please click here for further information.

Choice of hand cleansing agents

Soap

For routine hand washing, soap and water is sufficient². Bars of soap are unsuitable for use in healthcare environments. Liquid soap containing an added emollient, provided in wall-mounted dispensers, is preferred.

Soap and water is unsuitable for use in situations where a higher level of skin decontamination is required, e.g. before performing surgical or other invasive procedures. Agents used for surgical hand washing should substantially reduce microbes on intact skin, contain a non-irritating antimicrobial preparation, have broad-spectrum activity, be fast acting and persistent³.

Alcohol-based preparations

You can use alcohol hand rubs and gels for routine hand cleansing and surgical hand cleansing, provided your hands are not visibly dirty. Alcohol does not remove dirt. Most alcohol-based preparations contain isopropanol, ethanol (ethyl alcohol), n-propanol, or a combination of these. Alcohol-based products that contain 60 to 95 % w/w alcohol are preferred⁴. Higher concentrations are less effective because alcohol cannot denature proteins easily without water. Frequent use of alcohol products can dry the skin unless an emollient or another skin conditioning ingredient is included in the formulation.

Table 1: Characteristics of alcohol-based preparations

Aqueous antiseptic solutions

There are various aqueous antiseptic solutions available that you can use with water to decontaminate your hands (following a risk assessment and according to local policy). However, only the following antiseptics are used routinely in the UK:

Products that contain these antiseptics all have some persistent activity on the skin but they are generally slower acting than alcohol-based products.

Antiseptics that are used on the skin are not suitable for hard surfaces and should not be used to clean equipment.

Table 2: Characteristics of aqueous antiseptic solutions²

Hand drying

Always dry your hands thoroughly (and forearms if washed) using good quality disposable paper towels. Paper towels are quicker and more thorough than hot air dryers, which are not recommended for clinical areas as they are noisy, take longer to dry hands, and can only be used by one person at a time. Use sterile towels prior to performing surgical procedures. Communal cloth towels are not suitable for use in healthcare environments⁵.

Click here for information on a hand hygiene poster from the NHS.

Asepsis

Asepsis is the method used to prevent microbial contamination during invasive procedures or care of breaches in the skin⁷. Aseptic techniques are the methods developed to ensure that only uncontaminated equipment and fluids make contact with sterile or susceptible sites.

The steps required to achieve an aseptic technique depend on the procedure to be undertaken and the setting. A risk assessment prior to the procedure may be necessary to define requirements⁷.

Clean technique

A clean technique is a modified aseptic technique. The use of sterile equipment and environments is not as crucial as it is for asepsis. As with an aseptic technique, the clean technique also employs a no touch technique, i.e. you do not touch the ends of sterile connections or other items that will touch the susceptible site. However, you can wear clean, rather than sterile, gloves unless you need to handle sterile items. You should only use a clean technique following a risk assessment by a qualified healthcare professional⁷.

Skin disinfection (antisepsis)

Skin disinfection is defined as the reduction of the number of microbes present on the patient’s body prior to performing a procedure in order to reduce the risk of infection. Appropriate patient skin preparation is required prior to undertaking all invasive procedures (i.e. surgical procedures and insertion of devices such as needles). The aim of skin preparation is to remove transient microbes and reduce resident skin flora.

Following any required pre-operative body washing, and immediately prior to the procedure, swab the device insertion site or surgical site as appropriate with antiseptic solution. Refer to your local policy for guidance on appropriate antiseptic solutions. The antiseptic solution should be fast acting and have prolonged antibacterial activity (e.g. 70% isopropyl alcohol, 0.5% chlorhexidine, 70% povidone-iodine). You must allow alcohol-based preparations to dry thoroughly to ensure effectiveness and to prevent ignition during electrosurgery. Where possible, use single-use packs of solution for skin antisepsis rather than multi-use bottles.

Pre-operative body washing

In some cases, the patient may be required to take a pre-operative shower or bath or have the appropriate body part cleansed (e.g. prior to surgery, insertion of a urinary catheter, central vascular catheter). Unmedicated soap and water is sufficient for this task. Pre-operative skin shaving may be required to make surgery, and suture and dressing removal easier. If shaving is necessary, do it immediately prior to surgery. The use of clippers with single-use disposable blades or depilatory creams is preferred. Always refer to your local policy and seek advice from your Infection Control Team if in doubt.