CDC tries to clean up hand-washing guidelines

Waterless washing under review

The most significant change in the hand hygiene guidelines currently under review by the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control (CDC) in Atlanta is the recommended use of waterless, alcohol-based gels or rinses for health care personnel.

"There is now enough scientific data to show that waterless, alcohol-based products can be effective in decontaminating hands," says Lynn Steele, MS, CIC, an epidemiologist at the CDC. The comments received on the draft guidelines are currently being reviewed by HICPAC, and Steele expects the final guidelines to be published within the next six months.

In addition to the scientific data that supports the use of waterless products, vendors also have developed products that address staff members’ greatest concern that the alcohol-based rinses are harsh on the hands, says Lynn Yadach-Blakey, RN, MSN, clinical manager of Henry Ford Home Health Care in Detroit.

"Extra emollients in the products mean that the skin doesn’t dry out with repeated uses," she says.

Although the guidelines have not been finalized, Yadach-Blakey’s agency revised their hand-washing policy in October 2001 to reflect the recommended use of waterless products. "Giving employees an option to use a waterless product makes sense when they are with a patient who needs care that requires multiple glove changes," she says.

For example, when a patient needs Foley catheter care and a wound dressing change, the staff member must remove gloves and wash hands before putting on fresh gloves to change the dressing, Yadach-Blakey adds. "It is much safer to sit by the patient and clean your hands with a waterless product," she says. "You can be sure that patient doesn’t contaminate anything, and you don’t have to worry that the patient will fall out of bed."

Yadach-Blakey’s staff members have been testing products and say that they like the convenience. "They do point out that after five or more hand washings with the waterless product, they feel the need to wash with soap and water to remove the sticky feeling left from the buildup of emollients," she says.

The hand-washing policy at Athens (GA) Regional Home Health does allow staff to use waterless products if there is no running water available, says Marta L. Guizar, director of professional services for the agency.

"We provide our clinicians with an antimicrobial soap that they are to use if there is running water. They use the waterless gel if there is no water, then wash with soap and water as soon as possible," she says.

"We limited the use of waterless products after a surveyor discouraged us," says Kathy Stockton, RN, BSN, supervisor officer for performance improvement at Mercy Home Health and Hospital in Nampa, ID. "We will take a look at the new CDC guidelines when they are finalized and evaluate what changes we need to make," she says.

Before changing policies to reflect recommendations in any one guideline, you do need to check requirements of any regulatory or accreditation agency with which you work, Yadach-Blakey says. Because most regulatory and accreditation agencies base their standards on federal guidelines, she expects that all standards will eventually reflect the CDC guidelines that are finalized.

A good hand-washing policy does include instructions on how to use hand-washing products as well as when to use them, says Yadach-Blakey. (For sample hand-washing policy, see Hospital Home Health, June 2001, p. 66.)

"We’ve monitored hand-washing compliance among our staff for about nine years. We routinely report 95% to 98% compliance," she adds.

The less than 100% rate primarily is due to protocol requirements that are complicated and not always feasible, Yadach-Blakey says. For example, when using running water, staff members are to use one paper towel on the counter as a clean field on which to place two other paper towels and the soap. Physical constraints within the patient’s home such as little open counter space may make this protocol difficult to follow, she explains.

"When evaluating your hand-washing policy, be sure your requirements are clear but reasonable," she says.

Another suggestion is to require alcohol-based waterless products that contain at least 60% alcohol, Yadach-Blakey says. "We also insist on fragrance-free products."

Her agency provides staff with the proper products, she says. "We don’t want our staff members picking up products at the local pharmacy or a nearby candle and scents store. There would be no way to guarantee the effectiveness of those products."

[For more information, contact:

  • Lynn Yadach-Blakey, RN, BSN, Clinical Manager, Henry Ford Home Health Care, One Ford Place, 4C, Detroit, MI 48202. Telephone: (313) 874-6500. E-mail:
  • Kathy Stockton, RN, BSN, Supervisor Officer/ Performance Improvement, Mercy Home Health and Hospital, 1512 12th Ave., Nampa, ID 83686. Telephone: (208) 463-5220.
  • Marta L. Guizar, Director of Professional Services, Athens Regional Home Health, 1199 Prince Ave., Athens, GA 30606-2793. Telephone: (706) 475-5500. E-mail:

Additional Resources

For additional info on HICPAC activities and updates on the guidelines, visit:

  • This is the web site for the Centers for Disease Control’s Division of Healthcare Quality Promotion. News updates and information on where to find information on final hand-washing guidelines will be available on this site.
  • This web site contains information on the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) with a description of the committee’s activities and a list of members. Updates on committee meetings and actions can also be found here.