3
Hand Hygiene
Recommendations
Table 1. Recommendations to Prevent Healthcare-
Associated Infections through Hand Hygiene
Essential Practices: foundational to all HAI prevention programs in acute-care
hospitals
1. Promote the maintenance of healthy hand skin and fingernails. (H)
a. Promote the preferential use of alcohol-based hand sanitizer (ABHS) in most
clinical situations. (H)
b. Perform hand hygiene as indicated by the US Centers for Disease Control and
Prevention (CDC) or the World Health Organization (WHO) Five Moments.
(H)
c. Include fingernail care in facility-specific policies related to hand hygiene. (H)
▶ HCP should maintain short, natural fingernails.
▶ Nails should not extend past the fingertip.
▶ HCP who provide direct or indirect care in high-risk areas (e.g., intensive care
unit [ICU], perioperative) should not wear artificial fingernail extenders.
▶ Prohibitions against fingernail polish (standard or gel shellac) are at the
discretion of the infection prevention program, except among scrubbed
individuals who interact with the sterile field during surgical procedures;
these individuals should not wear fingernail polish or gel shellac.
d. Include measures for primary and secondary prevention of dermatitis.
e. Provide HCP with readily accessible, facility-approved hand moisturizers.
f. Engage all HCP in primary prevention of occupational irritant and allergic
contact dermatitis. (H)
g. Provide cotton glove liners for HCP with hand irritation and educate these
HCP on their use. (M)
2. Select appropriate products. (H)
a. For routine hand hygiene, choose liquid, gel, or foam ABHS with at least 60%
alcohol. (H)
b. Involve HCP in selection of products. (H)
c. Obtain and consider manufacturers' product-specific data if seeking ABHS with
ingredients that may enhance efficacy against organisms anticipated to be less
susceptible to biocides. (M)
d. Confirm that the volume of ABHS dispensed is consistent with the volume
shown to be efficacious. (H)
e. Educate HCP about an appropriate volume of ABHS and the time required to
obtain effectiveness. (H)
f. Provide facility-approved hand moisturizer that is compatible with antiseptics
and gloves. (H)
g. For surgical antisepsis, use an FDA-approved surgical hand scrub or waterless
surgical hand rub. (H)
