Hand Hygiene
Kumi Horii, Infection Control Nurse
Infection Control Office, Deputy Chief Nurse

Contents of Learning
1. Necessity of hand hygiene
2. Timing of hand hygiene
3. Procedure of hand hygiene

Resident Flora
Resident flora of the skin
 Coagulase negative Staphylococcus
 Corynebacterium spp.
 Propionibacterium spp.
 Acinetobacter spp.
Bacterial growth 2 times in 20 minutes
 4 times in 40 minutes
It is difficult to remove, as it attaches to the deep layer of the skin.

Transient Flora
Transient flora
 Escherichia coli
 Pseudomonas aeruginosa
 Candida spp.
 Virus
Bacteria attach while giving care.

They don’t grow or colonize on the hand.
They are likely to cause hospital infection.

Infection Route Via the Hands ofHealthcare Professionals
 Pathogen is present on the patient’s skin as wellas on surrounding environments and goods.
 Pathogens move to the hands of healthcare
professionals through care.
 Pathogens survive for several minutes on thesurface of hands of healthcare professionals
 Inadequate hand hygiene of healthcare
professionals
 Hands contaminated with pathogens directlytouch another patient or touch materials that thepatient directly touches.

Necessity of Hand Hygiene
 To protect oneself against pathogens.
 Prevent the transmission / spread ofpathogens within hospital via hands
Paying enough attention to handhygiene to prevent the transmission
and spread of pathogens protects
not only yourself but also patientsand their families against infection.

The principle of hand hygiene is“Hand hygiene after each treatment”

WHO Guidelines on Hand Hygiene 2009“Guidelines on Hand Hygiene in Health Care”
 As hands of healthcare professionals play animportant role in transmission of pathogens,hand hygiene is an important infection control
measure.

6 Timing When Hand Hygiene is Needed
After touching
patients

Before touching
patients

When going out
from patient’s room,
after temperature
taking /consultation

When entering
patient’s room,
before temperature
taking / consultation
Before aseptic /cleanlinessprocedures

Before drip infusion /blood sampling /
insertion of catheters/ wearing gloves
Move from acontaminated bodypart to another part
Touch an intravenous line after
putting down an urinary bag
Suction after genital wash
Blood sampling after treatmentof wounded part

After nottouching patients
but surroundings
Adjust infusion rate
Cancel alarm
Hold on a bed rail
Improve environment

After exposurerisk to body fluid
After insertion of catheters /changing diapers / removing
gloves for disposing of urine
WHO Guidelines on Hand Hygiene in Health
Care: World Health Organization 2009 (partially modified)
http://www.who.int/gpsc/5may/background/5moments/en/

Types of Hand Hygiene

Hand-washing with soap under running water
・When hands are visibly contaminated (blood, bodyfluid, etc.)
・When microorganisms that have resistance toalcohol (CD, Norovirus, etc.) are expected* Don’t top up
Hand antisepsis with alcohol-based hand-rubs
・Hands are not visibly contaminatedHigh effects of sterilization
・Procedure of protecting skin with humectant is simple

Basic Measure of Infection Control is Hand Hygiene:
Correct Technique of Hand-Washing

Wet hand under
running water

Dispense soap
on the palm

Make a lather
with the soap

Wash well
between fingers

Wash fingers
well

Wash thumbclasped in the palmof other hand

Wash the wrists

Wash off under
running water

Tap with a paper
towel to wipe awaywater

National Center for Global
Health and Medicine

Wash with right palm
over left dorsum andvice versa

Wash fingertips
and nails well

Infection Control Committee

Basic Measure of Infection Control is Hand
Hygiene: Correct Technique of Hand-Washing

Dispense 1 push ofdisinfectants on thepalm

First, rub fingers ofboth hands

Then, rub hands
palm to palm

Rub palm to palm
with fingers
interlaced

Rub thumb clasped
in other palm

Remember to rubwrists until theybecome dry

National Center for Global
Health and Medicine

Rub right palm overleft dorsum andvice versa

Infection Control Committee

Understand the Characteristics of Hand
Disinfection / Hand-Washing
Hand disinfection with alcohol-based handrub is basic:
 Eliminate most microorganisms (including viruses)

 Able to obtain the effect in a short time (20-30 seconds)
 Likely to protect the skin of the hands

However, hand-washing with soap under runningwater is required When hands are visibly dirtyImmediately after touching a patient with vomiting / diarrhea orafter going out of the patient’s room
 When microorganisms with resistance to alcohol-based
disinfectants are expected(Norovirus, Rotavirus, Cereus spp., Clostridium difficile, etc.)

Disinfecting Effects of hand hygiene areconfirmed in various research results.
Disinfecting effects of hand hygiene
Hand hygiene
techniqueSoap + running
water
Alcohol-based
handrub

Disinfecting effectIn case of 15
seconds

In case of 30
seconds

1/4-1/13

1/60-1/600

In case of 30 seconds

1/3,000

Boyce J.M., et al.：MMWR. Recommendations and Reports., 2002, 51（RR-16）, pp. 8-9
Takashi Okubo, Hiroyoshi Kobayashi (supervising translation)“CDC Guideline for Hand Hygiene in Health-Care Settings”,13
2003, Medical Publishing, pp. 31-33
Infection Control Editorial Office “INFECTION CONTROL”, 2009 Spring Special Edition, p. 17 (partially modified)清潔ケア後Aさん
After Cleanliness Care – Ms. A
Before hand- washing

After hand-washing withsoap and running water

After Cleanliness Care – Ms. D
Before handantisepsis

After handantisepsis

Q & A (1)In order to prevent rough skin on the hands, it
was instructed to gently wipe up water with apaper towel and then dry naturally after handwashing. Is this instruction right?

YES

○ NO

For protecting hands against roughening, it isimportant to thoroughly wipe water with a paper
towel and dry hands completely.

Q & A (2)Even after touching the surroundings of a bed
in a patient’s room of a patient for whom noMRSA is detected, hand antisepsis is needed.

○ YES

NO

Regardless of whether or not a patient has aninfectious disease, standard preventive
measures including hand hygiene must be taken
for all patients.

Q & A (3)When hands are visibly dirty, do
hand-washing with soap under
running water.

○ YESNO

When hands are not visibly dirty,
alcohol-based handrubs should
be used.

Q & A (4)Hand hygiene is needed not only
before wearing gloves but also after
removing them.

○ YESNO

Because gloves are not perfect and they may
have a pinhole, hand antisepsis is needed
before wearing and after removing gloves.

Q & A (5)As alcohol-based handrubs contain muchalcohol, they are likely to be less protective
for hands than hand-washing with soap under
running water

YES

○ NO

Alcohol-based handrubs contain skin barriers,
and they are likely to be more protective
compared to hand-washing with soap under
running water.

Reference WHO Guidelines

on Hand Hygiene in Health Care: World HealthOrganization 2009, (modified)
http://www.who.int/gpsc/5may/background/5moments/en/
 Takashi Okubo, Hiroyoshi Kobayashi (supervising translation) “CDC
Guideline for Hand Hygiene in Health-Care Settings”, 2003, Medicus
Shuppan Publishers
 Guidelines for Infection Control in University Hospitals 2nd edition Edited byJapan Infection Prevention and Control Conference for National and Public
University Hospitals, amended version, Jiho Inc., 2015
 Miho Uchida “Actual Practice of Infection Control” Ishiyaku Pub, Inc., 2012
 Educational Tool Ver. 3.2 of the Japanese Society for Infection Preventionand Control (partially modified)