The Joint Commission Update for Infection Control

WHO hand hygiene text added to safety goals

Can be used as an alternative to CDC

The Joint Commission has added a new patient safety goal for 2008 that allows hospitals to comply with hand hygiene guidelines by the World Health Organization. Hospitals can either comply with the WHO guidance or the Centers for Disease Control and Prevention (CDC) hand hygiene guidelines, which have been listed as a patient safety goal since 2004.

"The Joint Commission recognizes that alternative guidelines exist for international health care with respect to hand hygiene and that the WHO guideline is contemporary in its approaches," says Peter Angood, MD, vice president and chief patient safety officer at The Joint Commission.

The CDC guidelines are widely considered the gold standard for hand hygiene, but the WHO guidelines are a good alternative, he says. "U.S.-based health care systems occasionally review international guidelines for incorporation into their practices," Angood says. "The Joint Commission has issued this modification to the National Patient Safety Goal in recognition and support of this specific hand hygiene guideline approach."

The other major patient safety goal related to infection control remains intact. It calls for hospitals to "manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care-associated infection."

The WHO guidelines, which use the same ranking system as the CDC, include the following recommendations for health care workers:

A. Wash hands with soap and water when visibly dirty or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids, or if exposure to potential spore-forming organisms is strongly suspected or proven (IB). (Strongly recommended for implementation and supported by some experimental, clinical, or epidemiological studies and a strong theoretical rationale); or after using the restroom (II). (Suggested for implementation and supported by suggestive clinical or epidemiological studies or a theoretical rationale or a consensus by a panel of experts.)

B. Preferably use an alcohol-based hand rub for routine hand antisepsis in all other clinical situations described in item C listed below if hands are not visibly soiled (IA). (Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiological studies.) Alternatively, wash hands with soap and water (IB).

C. Perform hand hygiene:

  • before and after having direct contact with patients (IB);
  • after removing gloves (IB);
  • before handling an invasive device (regardless of whether or not gloves are used) for patient care (IB);
  • after contact with body fluids or excretions, mucous membranes, nonintact skin, or wound dressings (IA);
  • if moving from a contaminated body site to a clean body site during patient care (IB);
  • after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient (IB);
  • wash hands with either plain or antimicrobial soap and water or rub hands with an alcohol-based formulation before handling medication and preparing food (IB);
  • when alcohol-based hand rub is already used, do not use antimicrobial soap concomitantly (II).

(Editor's note: The WHO hand hygiene guidelines are on the web at: