Skip to Main Content




Hand washing has been shown to reduce nosocomial infection dating back to Semmelweis’ historic research on obstetric infections in the 1800s. Hand washing is now the focus of recommendations and requirements from the Centers for Disease Control and the Joint Commission for Accreditation of Healthcare Organizations. It is also widely felt to be the best measure to prevent the emergence and transmission of drug-resistant nosocomial infections, such as Methicillin Resistant Staphylococcus Aureus (MRSA).


Definitions and Terms


  • ▪  Plain (detergent) soaps: Used for cleansing but lack intrinsic antimicrobial properties.
  • ▪  Antimicrobial soaps Detergent plus an antimicrobial such as alcohol, chlorhexidine, or povidone-iodine.
  • ▪  Alcohol-based hand rub: Contain ethanol or isopropanol and denature proteins when used in water-containing solutions; rapidly active against bacteria, mycobacteria, fungi, and viruses; typically combined with moisturizer to prevent hand chapping.
  • ▪  Chlorhexidine and iodophors: Alternative antiseptic agents with intermediate speed of action and variable activity against infectious agents, chlorhexidine has good persistence (see below).
  • ▪  Visibly soiled hands: Show visible dirt or proteinaceous material, blood, or body fluids.
  • ▪  Persistent (antimicrobial) activity: The property of certain hand-cleansing agents having extended antimicrobial action.




  • ▪  Visibly soiled hands: Wash with soap and water.
  • ▪  Before eating or after using the restroom: Wash with soap and water.
  • ▪  Not visibly soiled hands: Use an alcohol-based hand rub under the following circumstances:
    • —Before direct patient contact
    • —Before donning sterile gloves for a procedure
    • —Before insertion of urinary catheters, intravascular devices, or other invasive devices
    • —After contact with a patient’s skin
    • —After contact with bodily fluids, excretions, or dressings
    • —After contact with inanimate objects in the immediate vicinity of a patient (ie, ventilator, bed rail)
    • —After removing gloves
  • ▪  Remove visible debris from beneath fingernails.
  • ▪  Routine hand washing: Wet hands with water, apply recommended amount of soap, and rub hands together vigorously for at least 15 seconds covering all surfaces of hands and fingers. Dry with disposable paper towel and turn water off with towel.
  • ▪  Decontamination with alcohol-based hand rub: Apply product to palm of one hand and rub hands together covering all surfaces of hands and fingers until hands are dry (Figure 4-1).
  • ▪  Additional recommendations for healthcare workers
    • —Remove rings, watches, and bracelets before hand scrub.
    • —Do not wear artificial fingernails.
    • —Keep natural fingernail length less than 1/4 in long.
    • —Wear gloves when in contact with blood or other infectious agents.
    • —Remove gloves after patient care.
    • —Change gloves when moving from one patient to another.
  • ▪  Recommendations for healthcare institutions
    • —Make improved hand hygiene adherence an institutional priority (Figure 4-2).
    • —Solicit multidisciplinary input in the development of policies pertaining to hand hygiene and product selection.
    • —Ensure ready access to alcohol-based hand rub (Figure 4-3).
    Figure 4-1.Graphic Jump Location

    Hand washing between patient contacts.

    Figure 4-2.Graphic Jump ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.