System for Categorizing Recommendations

Category IA. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.

Category IB. Strongly recommended for implementation and supported by certain experimental, clinical, or epidemiologic studies and a strong theoretical rationale.

Category IC. Required for implementation, as mandated by federal or state regulation or standard.

Category II. Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale.

No recommendation. Unresolved issue. Practices for which insufficient evidence or no consensus regarding efficacy exist.


Surgical Hand Antisepsis

A. Remove rings, watches, and bracelets before beginning the surgical hand scrub. (II)

B. Remove debris from underneath fingernails using a nail cleaner under running water. (II)

C. Surgical hand antisepsis using an antimicrobial soap or an alcohol-based hand rub with persistent activity is recommended before donning sterile gloves when performing surgical procedures. (IB)

D. When performing surgical hand antisepsis using an antimicrobial soap, scrub hands and forearms for the length of time recommended by the manufacturer, usually 2-6 minutes. Long scrub times (e.g., 10 minutes) are not necessary. (IB)

E. When using an alcohol-based surgical hand-scrub product with persistent activity, follow the manufacturer’s instructions. Before applying the alcohol solution, prewash hands and forearms with a nonantimicrobial soap and dry hands and forearms completely. After application of the alcohol-based product as recommended, allow hands and forearms to dry thoroughly before donning sterile gloves. (IB)

Other Aspects of Hand Hygiene

A. Do not wear artificial fingernails or extenders when having direct contact with patients at high risk (e.g., those in operating rooms). (IA)

B. Keep natural nails tips less than ¼-inch long. (II)

C. Wear gloves when contact with blood or other potentially infectious materials, mucous membranes, and nonintact skin could occur. (IC)

D. Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient, and do not wash gloves between uses with different patients. (IB)

E. Change gloves during patient care if moving from a contaminated body site to a clean body site. (II)

F. No recommendation can be made regarding wearing rings in health care settings. Unresolved issue.

Administrative Measures

A. Make improved hand-hygiene adherence an institutional priority and provide appropriate administrative support and financial resources. (IB)

B. Implement a multidisciplinary program designed to improve adherence of health personnel to recommended hand-hygiene practices. (IB)

C. As part of a multidisciplinary program to improve hand-hygiene adherence, provide health are workers with a readily accessible alcohol-based hand-rub product. (IA)

D. To improve hand-hygiene adherence among personnel who work in areas in which high workloads and high intensity of patient care are anticipated, make an alcohol-based hand rub available at the entrance to the patient’s room or at the bedside, in other convenient locations, and in individual pocket-sized containers to be carried by health care workers. (IA)

E. Store supplies of alcohol-based hand rubs in cabinets or areas approved for flammable materials. (IC)

Source: Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002; 51(RR16):1-44.