the procedure. Allow to dry thoroughly before donning sterile gloves (IB).

Do not combine surgical hand scrub and surgical hand rub with alcohol-based products sequentially (II)

9. Fingernails:Do not wear artificial fingernails or extenders for direct patient contact (IA).

Keep natural nails short (0.5 cm long) (II).

Ranking for evidence:

CATEGORY 1A: Strongly recommended for implementation and strongly supported by well-designed experimental, clinical or epidemiological studies.

CATEGORY 1B: Strongly recommended for implementation and supported by some experimental, clinical, or epidemiological 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 epidemiological studies or a theoretical rationale or a consensus by a panel of experts.

To view the full Guidelines and an Executive Summary: http://www.who.int/patientsafety/challenge/en/

August 2006, version 1.

WHO welcomes comments and feedback on this leaflet, suggestions should be sent to the Secretariat of the World Alliance for Patient Safety, (EIP/HDS), World Alliance for Patient Safety, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland patientsafety@who.int

7. Gloves:Gloves do not replace the need for hand cleansing with rubs or soap and water (IB).

Gloves protect staff from blood and body fluids, non-intact skin and mucous membranes (IC).

Remove gloves after caring for a patient. Do not use the same pair of gloves for more than one patient (IB).

Change or remove gloves if moving from a contaminated body site to a clean site on the same patient (II).

Avoid the reuse of gloves (IB) See Information Sheet 6; Glove Use http://www.who.int/patientsafety/challenge/en/

8. Surgical Hand Preparation:If hands are visibly soiled, wash with soap and water (II).

Remove jewellery (IB).

Use either an antimicrobial soap or alcohol-based handrub before donning sterile gloves (IB).

Where water quality is not assured, use an alcohol-based handrub before donning sterile gloves (II).

When using soap, scrub for 2-5 minutes as recommended by the manufacturer (IB).

When using alcohol rub, follow the manufacturer’s recommendations using enough to keep the hands and forearms wet with the rub during

1. Specific recommendations for health care facility administrators:

Key factors of importance for successful strategies:

Access to a safe continuous water supply at all taps/faucets and the necessary facilities to perform handwashing (IB);

A readily accessible alcohol-based hand rub at the point of patient care (IA);

Alternative products for staff with allergies or adverse reactions and hand creams/lotions for skin care.

Hand hygiene adherence as a health care facility priority that requires appropriate leadership, administrative support and financial resources (IB).

IMPLEMENTATION STRATEGYA multidisciplinary, multifaceted programme to improve adherence of health-care workers to recommended hand hygiene practices (IB).

2. Education and motivation of staf f :

Behaviour change is the key to improving practice.

Multifaceted strategies are the most effective approach to increase hand hygiene. Actively participate in the strategies implemented by your institution.

Be aware of the ease and speed of hand contamination following care activities (II).

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Participate in staff compliance monitoring and feedback (IA).

Encourage patient partnerships to promote hand hygiene (II).

3. Choice of Product:Products should be effective and have a low likelihood of causing irritation (IB).

Staff should be included in choosing products taking account of feel, fragrance and skin tolerance (IB).

Handrub dispensers should be available at the point of patient care (IB).

Handrub dispensers should function adequately.

4. Skin Care:Hand lotions and creams should be used to minimize irritant contact dermatitis (IA).

Staff with allergies or adverse reactions should use alternative products (II).

5. When:Wash with soap and water when hands look soiled or if exposure to potential spore-forming microbes is suspected (1A) or after using the restroom (1B).

Use an alcohol-based handrub for all other clinical situations, particularly before and after direct contact with patients (1A).

Perform hand hygiene:Before and after having direct contact with patients (IB);

After removing gloves (IB);

Before handling an invasive device for patient care, regardless of whether or not gloves are used (IB);

After contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings (IA);

If moving from a contaminated body site to a clean body site during patient care (IB);

After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient (IB).

6. How:Alcohol-based handrub: apply a palm-full of the rub and cover all surfaces of the hand; rub together until the hands are dry (The WHO ”HOW” posters illustrate the correct technique).

Soap and water: wet the hands first and apply enough soap to cover all surfaces of the hands (The WHO ”HOW” posters illustrate the correct technique).

Make sure the hands are dry and towels are not used repeatedly or by multiple people (IB).

Water: health settings are encouraged to ensure that water is available for hand hygiene, BUT in settings without easy access to water, efforts should be made to make available alcohol- based hand rubs as a priority. Alcohol rubs can be made in-house using the WHO formulation (see Information Sheet 5 http://www.who.int/patientsafety/challenge/en/ )

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