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the procedure. Allow to dry thoroughly

before donning sterile gloves (IB).

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

9. Fingernails:Do not wear articial ngernails orextenders 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 epidemiologicalstudies.

CATEGORY 1B: Strongly recommended for implementation

and supported by some experimental, clinical,

or epidemiological studies and a st rong

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 consensusby 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 leaet, suggestions shouldbe sent to the Secretariat of the World Alliance for Patient Safety, (EIP/HDS),World Alliance for Patient Safety, World Health Organization, Avenue Appia20, CH-1211 Geneva 27, Switzerlandpatientsafety@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 uids,

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 Usehttp://www.who.int/patientsafety/challenge/en/

8. Surgical HandPreparation:

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 manufacturers

recommendations using enough to keep the

hands and forearms wet with the rub during

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1.Specifc recommendationsor health care acilityadministrators:

Key factors of impor tance for successful strategies:

Access to a safe continuous water supply at all

taps/faucets and the necessary facilities to performhandwashing (IB);

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

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

Hand hygiene adherence as a health care facility

priority that requires appropriate leadership,

administrative support and nancial resources (IB).

IMPLEMENTATION STRATEGY

A multidisciplinary, multifaceted programmeto improve adherence of health-care workersto recommended hand hygiene practices (IB).

2. Education and

motivation o sta :Behaviour change is the keyto improving practice.

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

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

Participate in staff compliance monitoring and feedback(IA).

Encourage patient partnerships to promote handhygiene (II).

3. Choice o Product:

Products should be effectiveand 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 withpatients (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 uids or excretions, mucous

membranes, non-intact skin, or wound dressings (IA);

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

After contact with inanimate objects (includingmedical equipment) in the immediate vicinity ofthe patient (IB).

6. How: Alcohol-based handrub: applya 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 rst and apply enoughsoap 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 set tings

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/)

MULTI

MODAL

STRATEGY