The following changes have been made to section 1.2 to reflect changes in the hand hygiene literature reviews

http://www.nipcm.hps.scot.nhs.uk/resources/literature-reviews/standard-infection-control-precautions-literature-reviews/

Before performing hand hygiene:

• 'bracelets or bangles such as the Kara which are worn for religious reasons should be able to be pushed higher up the arm and secured in place);

Skin care:

• 'Warm/tepid water should be used to reduce the risk of dermatitis; hot water should be avoided.
• Pat hands dry thoroughly after hand washing using disposable paper towels; avoid rubbing which may lead to skin irritation/damage.
• Do not use refillable dispensers or provide communal tubs of hand cream in the care setting.

Surgical hand antisepsis:

• Nail brushes should not be used for surgical hand antisepsis.
• Nail picks (single-use) can be used if nails are visibly dirty.
• Soft, non-abrasive, sterile (single-use) sponges may be used to apply antimicrobial liquid soap to the skin if licensed for this purpose.
• ABHR can be used between surgical procedures if licensed for this use or between glove changes if hands are not visibly soiled.