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Hand Hygiene for Nurses

Updated: Aug 17, 2022

Hand hygiene is the single most effective way to prevent the transmission of healthcare-associated infections. And it will most likely be the first task that you’ll learn once you go into your practical placements.

These notes outline the foundations of proper hand hygiene and describe the correct technique to eliminate as many infecting microorganisms as possible.


Hand Hygiene: Introduction

The phrase hand hygiene refers to the technique used to clean our hands with soap and water or with an alcohol-based hand rub. Either way, the technique should leave our hands clean from any resident or transient bacteria that could potentially be transmitted to other individuals. Since we are discussing hand hygiene from a healthcare point of view, our main aim is to decrease the transmission of healthcare-associated infections (HCAIs).

HCAIs are infecting bacteria transferred from a healthcare provider to a patient. These bacteria can then settle on the patient’s skin or invade the patient’s body through wounds, IV cannulas, urinary catheters, drain sites or other invasive devices. Once the bacteria enter the patient’s body, they cause an infection at the entry site. If left untreated, they can continue to spread inside the patient’s body, causing severe life-threatening infections. In addition, some bacteria can be resistant to the regular antibiotic treatment, making it increasingly difficult to stop the infection.

Recent studies have shown that a significant percentage of HCAIs are transmitted through contaminated hands of a healthcare provider. Hence by performing adequate hand hygiene, we’d be tackling the root cause of HCAIs.

Hand Hygiene: How are HCAIs transmitted?

The transmission starts when a nurse comes in contact with an infected patient. The microorganisms travel from the patient onto the nurse’s hands, and if hand hygiene is not performed correctly after the point of patient contact, they remain on the nurse’s hands. The nurse would then move on to another task, and the bacteria travel from the nurse’s hands onto a surface or a vulnerable point of entry such as a wound or invasive device.

Hand Hygiene: When should it be done?

According to the WHO guidelines, nurses need to perform hand hygiene at five vital times:

  1. Before touching a patient

  2. Before performing a clean or aseptic procedure

  3. After being exposed to body fluids

  4. After touching a patient

  5. After touching a patient’s surroundings.

Hand Hygiene: Alcohol-Based Hand Rub

Using an alcohol-based hand rub is very efficient and typically easily accessible. When done right, the nurse’s hands are clean from all transient microorganisms and most of the resident microorganisms. However, alcohol-based hand rub does not affect all species, including norovirus strands and spore-forming microorganisms such as Clostridium difficle. In addition, an alcohol-based hand rub does not remove body fluids, dirt or other organic material from the nurse’s hands.

Hand Hygiene: Soap and water

The second option to perform hand hygiene is by using soap and water. This technique is recommended in cases where the nurse’s hands are visibly soiled or potentially contaminated with body fluids. It’s also recommended that nurses wash their hands with soap and water whenever they care for patients with gastric illnesses, even if they wear gloves.

However, using soap and water is more time consuming than applying an alcohol-based hand rub, and it depends on accessibility. This method is also associated with a higher risk of skin irritation and dryness on the nurse’s hands.

Hand Hygiene: Bare Below the Elbow

As a nurse, you should be following the “bare below the elbow” guideline when on duty. This means that you should not have any clothing, jewellery, or accessories on your forearms, wrists, and hands. This guideline is in place to reduce the risk of microorganisms settling on clothing or accessories. Moreover, you’re expected to keep your nails short and clean; nail polish products and artificial nails harbour an increased amount of bacteria compared to natural nails.

Any cuts or abrasions need to be covered with a waterproof dressing.

Hand Hygiene: The Alcohol-Based Hand Rub Procedure

Start by ensuring that an alcohol-hand rub technique applies to you at that time (meaning that your hands are not visibly soiled, potentially in contact with body fluids or caring for patients with gastric illness and alcohol resistant microorganisms).

With your palm facing up, apply a palmful of hand rub and rub your hands together, covering all areas of both palms. Rub the alcohol over the back of each hand using the palm of the other hand and interlace your fingers. Rub your hands together, interlacing your fingers, and use the palm of your hand to clasp your thumb and rub the alcohol over it in a rotational movement. Press your fingertips on the opposite palm and circularly rub them to clean the tips and your nails. Lastly, rub each wrist with the opposite hand and wait 20-30 seconds until it dries up.

Hand Hygiene: The Soap and Water Procedure

Start by ensuring that the soap and water procedure is the right approach for you at that time. Thoroughly wet your hands under running water, and apply enough soap to cover all of your hands. Repeat the same technique as with an alcohol-based hand rub to get scrub off all areas of your hands. You can start by first rubbing your palms together, rubbing the back of your hands, interlacing your fingers, and rubbing each thumb, the fingertips, and your wrists.

Once you’re done, rinse your hands under the running water to remove all of the soap. Use your elbow to close off the tap, and take a single-use towel to pat your hands dry.

  • Neil Wigglesworth is director, infection prevention and control, Guy’s and St Thomas’ Foundation Trust, London and immediate past president, Infection Prevention Society.

  • Toney-Butler TJ, Gasner A, Carver N. Hand Hygiene. [Updated 2022 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

  • Santy-Tomlinson J. (2020). We need to talk about hand hygiene: A time to reflect on compliance. International journal of orthopaedic and trauma nursing, 39, 100819.

  • Mathur P. (2011). Hand hygiene: back to the basics of infection control. The Indian journal of medical research, 134(5), 611–620.

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