CDC’s draft hand-hygiene recommendations
February 1, 2002 6 minutes read
CDC’s draft hand-hygiene recommendations
These recommendations are designed to improve hand-hygiene practices of health care workers and to reduce transmission of pathogenic microorganisms to patients and personnel in health care settings. As in previous Centers for Disease Control and Prevention’s (CDC) Healthcare Infection Control Practices Advisory Committee (HICPAC) guidelines, each recommendation is categorized on the basis of existing scientific data, theoretical rationale, applicability, and economic impact. The CDC/HICPAC system for categorizing recommendations is as follows:
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.
No recommendation; unresolved issue. Practices for which insufficient evidence or no consensus regarding efficacy exist.
I. Indications for hand washing and hand antisepsis
A. Wash hands with a nonantimicrobial soap and water or an antimicrobial soap and water when hands visibly are dirty or contaminated with proteinaceous material (IA).
B. If hands are not visibly soiled, use an alcohol-based waterless antiseptic agent for routinely decontaminating hands in all other clinical situations described in items I(C) through I(K) listed below (IA).
C. On nursing units where an alcohol-based waterless antiseptic agent is available, provide personnel with a nonantimicrobial soap for use when hands visibly are dirty or contaminated with proteinaceous material. It is not necessary, and may be confusing to personnel, to have both an alcohol-based waterless antiseptic agent and an antimicrobial soap available on the same nursing unit (II).
D. Although waterless antiseptic agents are highly preferable, hand antisepsis using an antimicrobial soap may be considered in settings where time constraints are not an issue and easy access to hand hygiene facilities can be ensured, or in rare instances when a caregiver is intolerant of the waterless antiseptic product used in the Institution (IB).
E. Decontaminate hands after contact with a patient’s intact skin — as in taking a pulse or blood pressure, or lifting a patient (IB).
F. Decontaminate hands after contact with body fluids, excretions, mucous membranes, nonintact skin, or wound dressings, if hands are not visibly soiled (IA).
G. Decontaminate hands if moving from a contaminated body site to a clean body site during patient care (II).
H. Decontaminate hands after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient (II).
I. Decontaminate hands before caring for patients with severe neutropenia or other forms of severe immune suppression (II).
J. Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter (IB).
K. Decontaminate hands before inserting indwelling urinary catheters or other invasive devices that do not require a surgical procedure (IB).
L. Decontaminate hands after removing gloves (IB).
M. To improve hand-hygiene adherence among personnel in units or instances where high workloads and high intensity of patient care are anticipated, make an alcohol-based, waterless antiseptic agent available at the entrance to the patient’s room or at the bedside, in other convenient locations, and in individual pocket-sized containers to be carried by health care workers (IA).
II. Hand-hygiene technique
A. When decontaminating hands with a waterless antiseptic agent such as an 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 (IB). Follow the manufacturer’s recommendations on the volume of product to use. If an adequate volume of an alcohol-based hand rub is used, it should take 15 to 25 seconds for hands to dry.
B. When washing hands with a nonantimicrobial or antimicrobial soap, wet hands first with warm water, apply 3 mL to 5 mL of detergent to hands and rub hands vigorously together for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with warm water and dry thoroughly with a disposable towel. Use towel to turn off the faucet (IB).
III. Surgical hand antisepsis
A. Surgical hand antisepsis, using either an alcohol-based hand rub or an antimicrobial soap, is recommended before donning sterile gloves when performing surgical procedures (IB).
B. To reduce the number of bacteria that may be released from the hands of surgical personnel, while minimizing skin damage related to surgical hand antisepsis, decontaminate hands without using a brush (IB).
IV. Selection of hand hygiene agents
A. Provide personnel with efficacious hand-hygiene products that have low irritancy potential, particularly when used multiple times per shift (IB).
B. To maximize acceptance of hand hygiene products by health personnel, solicit input from caregivers regarding the feel, fragrance, and skin tolerance of any products under consideration. The cost of hand-hygiene products should not be the primary factor influencing product selection (IB).
C. Prior to making purchasing decisions, evaluate dispenser systems of various product manufacturers or distributors to ensure that dispensers function adequately and deliver an appropriate volume of product (II).
D. Do not add soap to a partially empty soap dispenser. This practice of "topping off" dispensers may lead to bacterial contamination of soap (IA).
V. Skin care
A. Provide health care workers with hand lotions or creams in order to minimize the occurrence of irritant contact dermatitis associated with hand antisepsis or hand washing (IA).
B. Solicit information from manufacturers regarding any effects that hand lotions, creams, or alcohol-based hand antiseptics may have on the persistent effects of antimicrobial soaps being used in the institution (IB).
VI. Other aspects of hand hygiene
A. Do not wear artificial fingernails or extenders when providing patient care (IA).
B. Keep natural nails less than a quarter inch long (II).
C. Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, and nonintact skin will occur (IC).
D. Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient, and do not wash gloves between patients (IB).
E. Change gloves during patient care if moving from a contaminated body site to a clean body site (II).
F. No recommendation on wearing rings in health care settings. Unresolved issue.
VII. Health care worker educational and motivational programs
A. As part of an overall program to improve hand-hygiene practices of health care workers, educate personnel regarding the types of patient care activities that can result in hand contamination and the advantages and disadvantages of various methods used to clean their hands (II).
B. Monitor health care workers’ adherence with recommended hand-hygiene practices and provide personnel with information regarding their performance (IA).
C. Encourage patients and their families to remind health care workers to decontaminate their hands (II).
VIII. Administrative measures
A. Make improved hand-hygiene adherence an institutional priority, and provide appropriate administrative support and financial resources (IB).
B. Implement a multidisciplinary program designed to improve adherence of health personnel to recommended hand-hygiene practices (IB).
C. As part of a multidisciplinary program to improve hand-hygiene adherence, provide health care workers with a readily accessible waterless antiseptic agent such as an alcohol-based hand-rub product (IA).
IX. Outcome or process measurements
A. Develop and implement a system for measuring improvements in adherence of health care workers to recommended hand-hygiene practices. Examples are listed below:
1. Monitor and record adherence as the number of hand-hygiene episodes performed by personnel/number of hand-hygiene opportunities, by ward or by service. Provide feedback to personnel regarding performance.
2. Monitor the volume of alcohol-based hand rub (or detergent used for hand washing or hand antisepsis) used per 1,000-patient-days.
3. Monitor adherence to policies dealing with wearing artificial nails.
4. When outbreaks of infection occur, assess the adequacy of health care worker hand hygiene.
Source: Centers for Disease Control and Prevention, Atlanta.
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