Please note that the term ‘alcohol-based hand rub (ABHR)’ has now been updated to ‘hand rub’.  A hand rub (alcohol or non-alcohol based) can be used if it meets the required standards. Please see further information in the hand hygiene products literature review.

The most important thing you can do to prevent the spread of infection in a care home is to keep your hands clean. This is called hand hygiene.

Hand washing sinks should only be used for hand hygiene and should not be used for the disposal of other liquids (See Appendix 3 of Pseudomonas Guidance for further information).

 

 

Before performing hand hygiene:

• expose forearms (known as bare below the elbows)
• remove all hand/wrist jewellery including any embedded jewellery (a single, plain metal finger ring or ring dosimeter (radiation ring) is permitted but should be removed (or manipulated) during 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 to enable effective hand hygiene which includes the wrists
• ensure fingernails are clean, short and that artificial nails or nail products are not worn
• cover all cuts or abrasions with a waterproof dressing

Hand washing should be extended to the forearms if there has been exposure of forearms to blood and/or body fluids.

To perform hand hygiene:

• hand rub should be available for staff as near to point of resident care as possible. Where this is not practical, personal hand rub dispensers should be used
• application of sufficient volume of hand rub to cover all surfaces of the hands is important to ensure effective hand hygiene
• manufacturer’s instructions should be followed for the volume of hand rub required to provide adequate coverage for the hands. In the absence of manufacturer’s instructions, volumes of approximately 3ml are recommended to ensure full coverage
• wall mounted or personal hand rub dispensers (cartridges/bottles) should not be refilled and should be replaced when empty or if outwith manufacturer expiry date 

The World Health Organization’s ‘4 moments for hand hygiene’ should be used to highlight the key indications for hand hygiene:

1. before touching a resident
2. before clean/aseptic procedures. If hand rub cannot be used, then antimicrobial liquid soap should be used
3. after body fluid exposure risk
4. after touching a resident

Some additional examples of hand hygiene moments include, but are not limited to:

• after touching a resident’s immediate surroundings
• before handling medication
• before preparing food
• before donning (putting on) and after doffing (taking off) PPE
• after visiting the toilet
• before putting on and after removing PPE
• between carrying out different care activities on the same resident
• after cleaning and disinfection procedures
• after handling used linen
• after handling waste

It is important that residents are routinely encouraged to perform hand hygiene and given assistance if required.

 

The four moments for hand hygiene poster can be used in your care home to show staff when hand hygiene should be done and the reasons why.

 

Select image for full size version.

 

 

 

 

 

Hands should be washed with liquid soap and water if/when:

• they are visibly soiled or dirty
• they are potentially contaminated with blood, other body fluids or excretions
• caring for a resident with vomiting or diarrhoeal illness
• caring for a resident with a suspected or known gastro-intestinal infection such as norovirus or a spore forming organism such as  Clostridioides difficile 

 

Note:

Hands should be washed with warm/tepid water to mitigate the risk of dermatitis associated with repeated exposures to hot water and to maximise hand washing compliance. Compliance may be compromised where water is too hot or too cold.

Hands should be dried thoroughly following hand washing using a soft, absorbent, disposable paper towel from a dispenser which is located close to the sink but beyond the risk of splash contamination.

The use of antimicrobial hand wipes is only permitted where there is no access to running water. Staff should perform hand hygiene using ABHR immediately after using the hand wipes and perform hand hygiene with soap and water at the first available opportunity.

In all other circumstances use hand rub for routine hand hygiene. 

Skin care

• Hand rubs should contain emollients in their formulation.
• Pat hands dry after hand washing using disposable paper towels. Avoid rubbing which may lead to skin irritation/damage.
• Use an emollient hand cream during breaks and when off duty. These should be applied all over the hands including between the fingers and the back of the hands.
• Staff with skin problems should seek advice from the local occupational health department if available or their GP.
• Barrier creams should not be used in the workplace.

Do not use refillable containers or communal tubs of hand cream in the care home setting.

 

Resources

 

Read the hand hygiene literature reviews to find out more about the evidence base for hand hygiene.

 

To make sure you clean your hands properly with soap and water you should follow the steps in the poster ‘How to hand wash step by step images’. This poster can be printed off and displayed throughout the care home to ensure that all staff and visitors are aware of and practice this hand hygiene method when required in the care home.

 

Select image for full size version

 

 

To make sure you clean your hands properly with hand rub you should follow the steps in the poster ‘How to hand rub step by step images’. This poster can be printed off and displayed throughout the care home to ensure that all staff and visitors are aware of and practice this hand hygiene method when required in the care home.

Select image for full size version