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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