Watermark: CDC unveils new age of hand hygiene

(Editor’s note: The following are selected key recommendations from the Atlanta-based Centers for Disease Control and Prevention’s draft hand-hygiene guideline. The complete text and recommendations are available at your subscriber web site at www.hiconline.com. Look under "Guidelines and Regulations.")

I. Handwashing and hand antisepsis

A. Wash hands with a nonantimicrobial soap and water or an antimicrobial soap and water when hands are visibly dirty or contaminated with proteinaceous material. (Category IA: Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.)

B. If hands are not visibly soiled, use an alcohol-based waterless antiseptic agent for routinely decontaminating hands in all other clinical situations described in items I.C. through I.K. listed below. (IA)

C. On nursing units where an alcohol-based waterless antiseptic agent is available, provide personnel with a nonantimicrobial soap for use when hands are visibly dirty or contaminated with proteinaceous material. It is not necessary, and may be confusing to personnel, to have both an alcohol-based waterless antiseptic agent and an antimicrobial soap available on the same nursing unit. (Category II: Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale.)

D. Although waterless antiseptic agents are highly preferable, hand antisepsis using an antimicrobial soap may be considered in settings where time constraints are not an issue and easy access to hand-hygiene facilities can be ensured, or in rare instances when a care giver is intolerant of the waterless antiseptic product used in the institution. (Category IB: Strongly recommended for implementation and supported by some experimental, Clinical, or epidemiologic studies and a strong theoretical rationale.)

E. Decontaminate hands after contact with a patient’s intact skin (as in taking a pulse or blood pressure, or lifting a patient). (IB)

F. Decontaminate hands after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings, as long as hands are not visibly soiled. (IA)

G. Decontaminate hands if moving from a contaminated body site to a clean body site during patient care. (II)

H. Decontaminate hands after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient. (II)

I. Decontaminate hands before caring for patients with severe neutropenia or other forms of severe immune suppression. (II)

J. Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter. (IB)

K. Decontaminate hands before inserting indwelling urinary catheters or other invasive devices that do not require a surgical procedure. (IB)

L. Decontaminate hands after removing gloves. (IB)

M. To improve hand-hygiene adherence among personnel in units or instances where high workloads and high intensity of patient care are anticipated, make an alcohol-based waterless antiseptic agent available at the entrance to the patient’s room or at the bedside, in other convenient locations, and in individual pocket-size containers to be carried by health care workers. (IA)

II. Hand-hygiene technique

A. When decontaminating hands with a waterless antiseptic agent such as an alcohol-based handrub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. (IB) Follow the manufacturer’s recommendations on the volume of product to use. If an adequate volume of an alcohol-based handrub is used, it should take 15 to 25 seconds for hands to dry.

B. When washing hands with a nonantimicrobial or antimicrobial soap, wet hands first with warm water, apply 3 ml to 5 ml of detergent to hands and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with warm water and dry thoroughly with a disposable towel. Use towel to turn off the faucet. (IB)