Comparison of Hand Hygiene Guidelines
Comparison of Hand Hygiene Guidelines
|Centers for Disease Control and Prevention (CDC) |World Health Organization (WHO) |Differences |
| | |Between Guidelines |
|Indications for Handwashing and Hand Antisepsis |
|When hands are visibly dirty or contaminated with|Wash hands with soap and water when visibly dirty or |None. |
|proteinaceous material or are visibly soiled with|contaminated with proteinaceous material, or visibly | |
|blood or other body fluids, wash hands with |soiled with blood or other body fluids, or if | |
|either a non-antimicrobial soap and water or an |exposure to potential spore-forming organisms is | |
|antimicrobial soap and water. |strongly suspected or proven or after using the | |
|Before eating and after using a restroom, wash |restroom. | |
|hands with a non-antimicrobial soap and water or | | |
|with an antimicrobial soap and water. | | |
|If hands are not visibly soiled, use an |Preferably use an alcohol-based handrub for routine |None. |
|alcohol-based hand rub for routinely |hand antisepsis in all other clinical situations | |
|decontaminating hands or alternatively, wash |described in items listed below, if hands are not | |
|hands with an antimicrobial soap and water in all|visibly soiled. Alternatively, wash hands with soap | |
|clinical situations described in described below:|and water. | |
|Decontaminate hands before having direct contact |Perform hand hygiene: | |
|with patients |Before and after having direct contact with patients | |
|Decontaminate hands before donning sterile gloves|After removing gloves | |
|when inserting a central intravascular catheter |Before handling an invasive device for patient care, | |
|Decontaminate hands before inserting indwelling |regardless of whether or not gloves are used | |
|urinary catheters, peripheral vascular catheters,|After contact with body fluids or excretions, mucous | |
|or other invasive devices that do not require a |membranes, non-intact skin, or wound dressings | |
|surgical procedure |If moving from a contaminated body site to a clean | |
|Decontaminate hands after contact with a |body site during patient care | |
|patient’s intact skin (e.g., when taking a pulse |After contact with inanimate objects (including | |
|or blood pressure, and lifting a patient) |medical equipment) in the immediate vicinity of the | |
|Decontaminate hands after contact with body |patient | |
|fluids or excretions, mucous membranes, | | |
|non-intact skin, and wound dressings if hands are|Wash hands with either plain or antimicrobial soap | |
|not visibly soiled |and water or rub hands with an alcohol-based | |
|Decontaminate hands if moving from a |formulation before handling medication or preparing | |
|contaminated-body site to a clean-body site |food. | |
|during patient care | | |
|Decontaminate hands after contact with inanimate |When alcohol-based handrub is already used, do not | |
|objects (including medical equipment) in the |use antimicrobial soap concomitantly. | |
|immediate vicinity of the patient | | |
|Decontaminate hands after removing gloves | | |
| | |The CDC guidelines do not |
| | |mention hand hygiene prior to|
| | |preparing food or handling |
| | |medication. |
| | | |
| | |Concomitant use of |
| | |alcohol-based handrub and |
| | |antimicrobial soap is not |
| | |addressed in the CDC |
| | |recommendations. |
|Antimicrobial-impregnated wipes (i.e., |Alcohol-impregnated towelettes contain only a small |CDC speaks of |
|towelettes) may be considered as an alternative |amount of alcohol and are not much more effective |antimicrobial-impregnated |
|to washing hands with non-antimicrobial soap and |than washing with soap and water. |wipes, which are not |
|water. Because they | |necessarily alcohol based. |
|are not as effective as alcohol-based hand rubs | |However, the concept is the |
|or washing hands with an antimicrobial soap and | |same. |
|water for reducing bacterial counts on the hands | | |
|of HCWs, they are not a substitute for using an | | |
|alcohol-based hand rub or antimicrobial soap. | | |
| | | |
|Wash hands with non-antimicrobial soap and water | | |
|or with antimicrobial soap and water if exposure | | |
|to Bacillus anthracis is suspected or proven. The| | |
|physical action of washing and rinsing hands |A recent study demonstrated that washing hands with |None. |
|under such circumstances is recommended because |either non-antimicrobial soap or antimicrobial soap | |
|alcohols, chlorhexidine, iodophors, and other |and water reduced the amount of Bacillus atrophaeus | |
|antiseptic agents have poor activity against |(a surrogate for B. anthracis) on hands, whereas an | |
|spores. |alcohol-based handrub was not effective. | |
| | | |
|No recommendation can be made regarding the | | |
|routine use of non-alcohol-based hand rubs for | | |
|hand hygiene in health-care settings. Unresolved | | |
|issue. | | |
|Do not add soap to a partially empty soap | | |
|dispenser. This practice of “topping off” | | |
|dispensers can lead to bacterial contamination of| |Non-alcohol-based handrubs |
|soap. | |are not addressed by WHO |
| |Although liquid soaps are generally preferred over |guidelines. |
| |bar soaps for handwash, the risk for either intrinsic| |
| |or extrinsic microbial contamination still exists. |Essentially, no difference. |
|Hand Hygiene Technique |
|When decontaminating hands with an alcohol-based |Apply a palmful of the product and cover all surfaces|CDC refers to the |
|hand rub, apply product to palm of one hand and |of the hands. Rub hands until hands are dry. |manufacturer’s directions. |
|rub hands together, covering all surfaces of | | |
|hands and fingers, until hands are dry. Follow |When washing hands with soap and water, wet hands | |
|the manufacturer’s recommendations regarding the |with water and apply the amount of product necessary | |
|volume of product to use. |to cover all surfaces. | |
| | | |
|When washing hands with soap and water, wet hands| | |
|first with water, apply an amount of product |Vigorously perform rotational handrubbing on both | |
|recommended by the manufacturer to hands, and rub|hand palms and backs, interlace and interlock fingers|CDC guidelines say to rub |
|hands together vigorously for at least 15 |to cover all surfaces. |hands together vigorously for|
|seconds, covering all surfaces of the hands and |Rinse hands with water and dry thoroughly with a |at least 15 seconds; WHO |
|fingers. |single-use towel. Use running and clean water |guidelines state 40-60 |
|Rinse hands with water and dry thoroughly with a |whenever possible. |seconds for the entire |
|disposable towel. |Use towel to turn off tap/faucet. Duration of the |procedure. |
|Use towel to turn off the faucet. |entire procedure: 40 – 60 seconds. | |
| | | |
|Multiple-use cloth towels of the hanging or roll |Make sure hands are dry. Use a method that does not | |
|type are not recommended for use in health-care |re-contaminate hands. Make sure | |
|settings. |towels are not used multiple times or by multiple |None. |
| |people. | |
| | | |
|Avoid using hot water, because repeated exposure |Avoid using hot water, as repeated exposure to hot | |
|to hot water may increase the risk of dermatitis.|water may increase the risk of dermatitis. | |
| | | |
|Liquid, bar, leaflet or powdered forms of plain |Liquid, bar, leaf or powdered forms of plain soap are|None. |
|soap are acceptable when washing hands with a |acceptable when washing hands with a | |
|non-antimicrobial soap and water. |non-antimicrobial soap and water. | |
| | | |
|When bar soap is used, soap racks that facilitate|When bar soap is used, small bars of soap in racks |None. |
|drainage and small bars of soap should be used. |that facilitate drainage should be used. | |
| | | |
| | | |
| | | |
| | |None. |
|Surgical Hand Antisepsis |
|Surgical hand antisepsis using either an |Surgical hand antisepsis should be performed using |None. |
|antimicrobial soap or an alcohol-based hand rub |either an antimicrobial soap or an | |
|with persistent activity is |alcohol-based handrub, preferably with a product | |
|recommended before donning sterile gloves when |ensuring sustained activity, before donning sterile | |
|performing surgical procedures. |gloves | |
| | | |
|Before applying the alcohol solution, pre-wash | | |
|hands and forearms with a non-antimicrobial soap |If hands are visibly soiled, wash hands with plain | |
|and dry hands and forearms completely. |soap before surgical hand preparation. |WHO guidelines recommend |
| | |washing with plain soap if |
|Remove debris from underneath fingernails using a| |hands are visibly soiled. |
|nail cleaner under running water. | | |
| |Remove debris from underneath fingernails using a |None. |
|Remove rings, watches, and bracelets before |nail cleaner, preferably under running water. | |
|beginning the surgical hand scrub. | | |
| |Remove rings, wrist-watch, and bracelets before | |
|When performing surgical hand antisepsis using an|beginning the surgical hand preparation. |None. |
|antimicrobial soap, scrub hands and forearms for | | |
|the length of time recommended by the |When performing surgical hand antisepsis using an | |
|manufacturer, usually 2–6 minutes. Long scrub |antimicrobial soap, scrub hands and | |
|times (e.g., 10 minutes) are not necessary. |forearms for the length of time recommended by the |Essentially none. |
| |manufacturer, 2 to 5 minutes. Long scrub times (e.g. | |
|When using an alcohol-based surgical hand-scrub |10 minutes) are not necessary. | |
|product with persistent activity, follow the | | |
|manufacturer’s instructions.. After application |If quality of water is not assured in the operating | |
|of the alcohol-based product as recommended, |theatre, surgical hand antisepsis using an | |
|allow hands and forearms |alcohol-based handrub is recommended before donning | |
|to dry thoroughly before donning sterile gloves. |sterile gloves when performing surgical procedures. | |
| | | |
| |When using an alcohol-based surgical handrub product | |
| |with sustained activity, follow the manufacturer’s | |
| |instructions. Apply the product on dry hands only. | |
| |Do not combine surgical hand scrub and surgical | |
| |handrub with alcohol-based products sequentially. | |
| | | |
| |When using an alcohol-based product, use sufficient | |
| |product to keep hands and forearms wet with the | |
| |handrub throughout the procedure. | |
| | | |
| |After application of the alcohol-based product as | |
| |recommended, allow hands and forearms to dry | |
| |thoroughly before donning sterile gloves. | |
|Other Aspects of Hand Hygiene |
|Do not wear artificial fingernails or extenders |Do not wear artificial fingernails or extenders when |CDC guidelines speak only |
|when having direct contact with patients at high |having direct contact with patients. |about direct contact with |
|risk (e.g., those in intensive-care units or |Artificial nails are prohibited. |high risk patients; WHO |
|operating rooms). |Keep natural nails short (tips less than 0.5 cm |guidelines prohibit |
|Keep natural nails tips less than 1/4-inch long. |long). |artificial nails for all |
| | |direct patient contact. |
|Wear gloves when contact with blood or other | | |
|potentially infectious materials, mucous |The use of gloves does not replace the need for hand |Essentially no difference. |
|membranes, and non-intact skin could occur. |cleansing by either handrubbing 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 |Remove gloves after caring for a patient. Do not wear| |
|wear the same pair of gloves for the care of more|the same pair of gloves for the care of more than one|None. |
|than one patient, and do not wash gloves between |patient. | |
|uses with different patients. | | |
| |When wearing gloves, change or remove gloves during | |
|Change gloves during patient care if moving from |patient care if moving from a contaminated body site | |
|a contaminated body site to a clean body site. |to a clean body site within the same patient. Change | |
| |or remove gloves after touching a contaminated site | |
| |and before touching a clean site or the environment. | |
| | | |
| |Avoid the reuse of gloves. If gloves are reused, | |
| |implement an adequate reprocessing method to ensure | |
| |glove integrity and microbiological decontamination. | |
| | | |
| | | |
| |Sinks should be designed to reduce the risk of |The WHO addresses methods of |
| |splashes |cleaning and reusing gloves |
| | |in countries where supplies |
| | |are limited. |
| | | |
|No recommendation can be made regarding wearing | |CDC does not address sink |
|rings in health-care settings. Unresolved issue. | |design. |
| | |Neither the CDC nor WHO have |
| | |any recommendations regarding|
| | |rings. The WHO guidelines do|
| | |discuss problems with HCWs |
| | |wearing jewelry in general; |
| | |however, they have not come |
| | |out with any official |
| | |recommendation. |
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