Table 1.

Indications for Hand Hygiene During Patient Care^*

Wash hands with soap and water when hands are visibly dirty or contaminated with proteinaceous material, blood, or other body fluids (IA) and if exposure to Bacillus anthracis is suspected or proven (II) In all other clinical situations described below when hands are not visibly soiled, an alcohol-based hand rub should be used routinely for decontaminating hands (IA) Before having direct contact with patients (IB) Before donning sterile gloves when inserting a central intravascular catheter (IB) Before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure (IB) After contact with a patient's intact skin (eg, when taking a pulse or blood pressure or lifting a patient) (IB) After contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled (IA) If moving from a contaminated body site to a clean body site during patient care (II) After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient (II) After removing gloves (IB)

^*Classified according to the level of scientific evidence and based on Centers for Disease Control and Prevention hand-hygiene guidelines. ⁷ Category IA = strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiological studies; category IB = strongly recommended for implementation and supported by certain experimental, clinical, or epidemiological 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 epidemiological studies or a theoretical rationale.