The hands are the conduits for almost every transfer of potential pathogens from one patient to another, from a contaminated object to the patient, or from a staff member to the patient. Because of this, hand hygiene is the single most important procedure in preventing infection.¹,²,³,⁴ To protect patients from health care–associated infections, hand hygiene must be performed routinely and thoroughly. In effect, clean and healthy hands with intact skin, short fingernails, and no rings minimize the risk of contamination. Artificial nails may serve as a reservoir for microorganisms, and microorganisms are more difficult to remove from rough or chapped hands.¹,²,³,⁴

Hand hygiene is a general term that’s used by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to refer to hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand asepsis.

Washing with soap and water is appropriate when hands are visibly soiled or contaminated with blood or other body fluids, when exposure to potential spore-forming pathogens (Clostridium difficile, Bacillus anthracis) is strongly suspected or proven, and after using the restroom. Using an alcohol-based hand rub is appropriate for decontaminating the hands before direct patient contact; after removing gloves; before inserting an invasive device; after contact with the patient; when moving from a contaminated-body site to a clean-body site during patient care; after contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings (if hands aren’t visibly soiled); after removing gloves; and after contact with inanimate objects in the patient’s environment.¹,²,⁴ (See Your 5 moments for hand hygiene, page 326.)

The CDC recommends performing hand hygiene with soap and water before eating;¹ the WHO recommends using either an alcohol-based hand rub or washing with soap and water before preparing food or handling medication.²