Clean hands are one of the most important ways to stop infections spreading. Hands carry germs from person to person all day, so hand hygiene matters even when your hands look clean.
The five moments
The NIPCM uses the World Health Organization (WHO) five moments. Clean your hands:
- before touching a person;
- before a clean or aseptic procedure, such as dressing a wound;
- after a risk of body fluid exposure;
- after touching a person;
- after touching the person's immediate surroundings, such as their bed, chair or table.
Also clean your hands before putting on gloves and after taking them off.
Which method?
- Alcohol-based hand rub (ABHR) is the usual choice for routine hand hygiene when your hands are not visibly dirty. It should be near the point of care. Adult social care guidance says it should contain at least 60% alcohol and meet BS EN 1500:2013.
- Use liquid soap and water when your hands are visibly dirty or soiled, when you care for someone with vomiting or diarrhoea, and when you care for someone with a suspected or known stomach infection such as norovirus or C. difficile. Alcohol does not reliably destroy these germs.
- If there is no running water, use hand wipes, then ABHR, and wash your hands at the first chance.
How long?
WHO gives these times for the whole procedure:
- hand rub: 20 to 30 seconds;
- hand wash: 40 to 60 seconds.
Cover all surfaces: palms, backs of hands, between the fingers, thumbs, fingertips and wrists. Rub until the hands are dry. After washing, dry your hands well with disposable paper towels.
Before you start
- Bare below the elbows. Keep your forearms uncovered during care. Remove wrist watches, bracelets and hand jewellery. One plain metal ring, such as a wedding band, is allowed. Move it or take it off when you clean your hands.
- Keep nails clean and short. Do not wear artificial nails or nail products.
- Cover cuts and grazes with a waterproof dressing.
Looking after your skin
Sore, cracked skin carries more germs and is harder to clean.
- Dry your hands thoroughly.
- Use a hand cream (emollient) often, for example in breaks and at home.
- Do not share a communal tub of cream at work.
- If you have a skin problem, talk to occupational health or your GP.
Common mistakes
- Rubbing for only a few seconds, so the gel dries before it has worked.
- Missing the thumbs, fingertips and wrists.
- Using the same pair of gloves for several tasks or people.
- Touching your face, phone or hair after cleaning your hands, then touching a person.
- Wearing a ring with stones or a watch that traps germs.
Gloves are not a substitute
Gloves do not replace hand hygiene. Germs can reach your hands through tiny holes or when you take gloves off. Never wash or rub alcohol on gloves to use them again.
Sinks and supplies
Clinical hand wash basins should be used for hand washing only. They need liquid soap, paper towels and, in clinical areas, mixer taps. Your employer must supply the products and facilities.
What your employer must still do
This lesson explains the rules. It cannot show that your technique is good. Your employer should train you in the technique in practice and check it. Ask to be shown if you have not been.