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. 2018 Feb 9:1146–1160.e4. doi: 10.1016/B978-0-323-42974-0.00050-1

TABLE 50.10.

Indications for Hand Hygiene

  • 1.

    Wash hands with soap and water when visibly dirty or visibly soiled with blood or other body fluids (IB) or after using the toilet (II).

  • 2.

    If exposure to potencial spore-forming pathogens is strongly suspected or proven, including outbreaks of Clostridium difficile, hand washing with soap and water is the preferred means (IB).

  • 3.

    Use an alcohol-based handrub as the preferred means for routine hand antisepsis in all other clinical situations described in terms 4(a) to 4(f) listed below, if hands are not visibly soiled (IA). IF alcohol-based handrub is not obtainable, wash hands with soap and water (IB).

  • 4.
    Perform hand hygiene:
    • a.
      before and after touching the patient (IB);
    • b.
      before handling an invasive device for patient care regardless of whether or not gloves are used (IB);
    • c.
      after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings (IA);
    • d.
      if moving from a contaminated body site to another body site during care of the same patient (IB);
    • e.
      after contact with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient (IB);
    • f.
      after removing sterile (II) or nonsterile gloves (IB).
  • 5.

    Before handling medication or preparing food, perform hand hygiene using an alcohol-based handrub or wash hands with either plain or antimicrobial soap and water (IB).

  • 6.

    Soap and alcohol-based handrub should not be used concomitantly (II).

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 some experimental, clinical, or epidemiologic studies and a strong theoretical rationale.

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

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

Adapted from WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009.