What does decontamination of the hands mean?

What is hand hygiene? 

Hand hygiene is a way of cleaning one’s hands that substantially reduces potential pathogens (harmful microorganisms) on the hands. Hand hygiene is considered a primary measure for reducing the risk of transmitting infection among patients and health care personnel. Hand hygiene procedures include the use of alcohol-based hand rubs (containing 60%–95% alcohol) and hand washing with soap and water. For surgical procedures, perform a surgical hand scrub before putting on sterile surgeon’s gloves. For routine dental examinations and nonsurgical procedures, use an alcohol-based hand rub or use water and plain or antimicrobial soap specific for health care settings. Unless hands are visibly soiled (e.g., dirt, blood, body fluids), an alcohol-based hand rub is preferred over soap and water in most clinical situations because it:

• Is more effective than soap at killing potentially deadly germs on hands
• Requires less time
• Is more accessible than handwashing sinks
• Produces reduced bacterial counts on hands, and
• Improves skin condition with less irritation and dryness than soap and water

For more information on Hand Hygiene, please visit CDC’s Hand Hygiene in Healthcare Settings.

Always perform hand hygiene in the following situations:

• Before and after treating each patient (e.g., before and after gloving).
• After touching with bare hands instruments, equipment, materials, and other objects that are likely to be contaminated by blood, saliva, or respiratory secretions.
• Before leaving the dental treatment area.
• When hands are visibly soiled.
• Before regloving and after removing gloves that are torn, cut, or punctured.

Using alcohol-based hand rub (follow manufacturer directions):

• Dispense the recommended amount of product
• Apply product to the palm of one hand
• Rub hands together, making sure that all surfaces of hands and fingers are covered until they are dry (no rinsing is required)

Hand washing with soap and water:

• Wet hands first with water (do not use hot water)
• Apply soap to hands
• Rub hands vigorously for at least 15 seconds, covering all surfaces of hands and fingers
• Rinse hands with water and dry thoroughly with a paper towel
• Use a paper towel to turn off the water faucet

Surgical hand hygiene/antisepsis:

• Use either an antimicrobial soap or alcohol-based surgical hand-scrub product with continuous activity
• Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer
• Alcohol-based surgical hand-scrub product: follow manufacturer’s recommendations. Before applying, wash hands and forearms with a non-antimicrobial soap

Store and dispense products according to manufacturer’s instructions. Products such as liquid soaps and lotions can become contaminated with bacteria or other microorganisms. Liquid products should be stored in closed containers and dispensed from either disposable containers or containers that are washed and dried thoroughly before refilling. Soap should not be added to a partially empty dispenser; the practice of “topping off” might lead to bacterial contamination of soap and cancel the beneficial effect of hand cleaning and disinfection.

Yes, certain types of lotions such as those that contain petroleum can weaken latex gloves and increase porousness. If using lotions during the workday, select a water-based product. Lotions that contain petroleum or other oil emollients should only be used at the end of the workday. When choosing a lotion to use in the dental office, get information from the manufacturer about interaction between gloves, lotions, dental materials, and antimicrobial products.

CDC. Guideline for hand hygiene in health care settings: Recommendations of the Health Care Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(No. RR-16). Available at: www.cdc.gov/mmwr/PDF/rr/rr5116.pdf pdf icon[PDF-1.2M]. Accessed June 27, 2015.

CDC. Basic Expectations for Safe Care Training Module 2 – Hand Hygiene. Available at: https://www.cdc.gov/oralhealth/infectioncontrol/safe-care-modules.htm. Accessed May 8, 2018.

CDC. Guidelines for infection control in dental health-care settings – 2003. MMWR 2003; 52(No. RR-17):1–66. Available at: www.cdc.gov/mmwr/PDF/rr/rr5217.pdf pdf icon[PDF-1.5M]. Accessed June 27, 2015.

CDC. Hand Hygiene in Healthcare Settings Educational Material https://www.cdc.gov/handhygiene/

Ellingson K, et. Al. Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. A Compendium of Strategies to Prevent Healthcare-associated Infections in Acute care Hospitals: 2014 Updates.Infect Control and Hospital Epidemiol 2014;35 No. S2: S155-S178.

Momeni, SS, Tomlin N, Ruby JD. Isolation of Raoultella planticola from refillable antimicrobial liquid soap dispensers in a dental setting. J Am Dent Assoc 2015;146:241–245.

Myers R, Larson E, Cheng B, Schwartz A, Da Silva K, Kunzel C. Hand hygiene among general practice dentists a survey of knowledge, attitudes and practices. J Am Dent Assoc 2008;139:948–957.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009.

Alcohol-based (hand) rub

An alcohol-containing preparation (liquid, gel or foam) designed for application to the hands to inactivate microorganisms and/or temporarily suppress their growth. Such preparations may contain one or more types of alcohol, other active ingredients with excipients, and humectants.

Soap (detergent) containing an antiseptic agent at a concentration sufficient to inactivate microorganisms and/or temporarily suppress their growth. The detergent activity of such soaps may also dislodge transient microorganisms or other contaminants from the skin to facilitate their subsequent removal by water.

An antimicrobial substance that inactivates microorganisms or inhibits their growth on living tissues. Examples include alcohols, chlorhexidine gluconate (CHG), chlorine derivatives, iodine, chloroxylenol (PCMX), quaternary ammonium compounds, and triclosan.

A piece of fabric or paper pre-wetted with an antiseptic used for wiping hands to inactivate and/or remove microbial contamination. They may be considered as an alternative to washing hands with non-antimicrobial soap and water but, because they are not as effective at reducing bacterial counts on HCWs’ hands as alcohol-based handrubs or washing hands with an antimicrobial soap and water, they are not a substitute for using an alcohol-based handrub or antimicrobial soap.

Compounds that possess a cleaning action. They are composed of a hydrophilic and a lipophilic part and can be divided into four groups: anionic, cationic, amphoteric, and non-ionic. Although products used for handwashing or antiseptic handwash in health care represent various types of detergents, the term “soap” will be used to refer to such detergents in these guidelines.

Detergents that contain no added antimicrobial agents, or may contain these solely as preservatives.

An antiseptic agent (liquid, gel or foam) that does not require the use of exogenous water. After application, the individual rubs the hands together until the skin feels dry.

Antiseptic handwashing

Washing hands with soap and water, or other detergents containing an antiseptic agent.

Applying an antiseptic handrub to reduce or inhibit the growth of microorganisms without the need for an exogenous source of water and requiring no rinsing or drying with towels or other devices.

Reducing or inhibiting the growth of microorganisms by the application of an antiseptic handrub or by performing an antiseptic handwash.

Actions to reduce the risk of skin damage or irritation.

Washing hands with plain or antimicrobial soap and water.

Action of performing hand hygiene for the purpose of physically or mechanically removing dirt, organic material, and/or microorganisms.

is extensively used as a term in some parts of the world and can refer to antiseptic handwash, antiseptic handrubbing, hand antisepsis/decontamination/degerming, handwashing with an antimicrobial soap and water, hygienic hand antisepsis, or hygienic handrub. Since disinfection refers normally to the decontamination of inanimate surfaces and objects, this term is not used in these Guidelines.

Treatment of hands with either an antiseptic handrub or antiseptic handwash to reduce the transient microbial flora without necessarily affecting the resident skin flora.

Treatment of hands with an antiseptic handrub to reduce the transient flora without necessarily affecting the resident skin flora. These preparations are broad spectrum and fast-acting, and persistent activity is not necessary.

Treatment of hands with an antiseptic handwash and water to reduce the transient flora without necessarily affecting the resident skin flora. It is broad spectrum, but is usually less efficacious and acts more slowly than the hygienic handrub.

Antiseptic handwash or antiseptic handrub performed preoperatively by the surgical team to eliminate transient flora and reduce resident skin flora. Such antiseptics often have persistent antimicrobial activity. Surgical handscrub(bing)/presurgical scrub refer to surgical hand preparation with antimicrobial soap and water. Surgical handrub(bing) refers to surgical hand preparation with a waterless, alcohol-based handrub.

Cumulative effect

Increasing antimicrobial effect with repeated applications of a given antiseptic.

The (possible) effect of the application of a hand hygiene formulation when tested in laboratory or in vivo situations.

The clinical conditions under which a hand hygiene product has been tested for its potential to reduce the spread of pathogens, e.g. field trials.

Inert substance included in a product formulation to serve as a vehicle for the active substance.

Concept related to the “geographical” visualization of key moments for hand hygiene. It contains all surfaces in the health-care setting outside the patient zone of patient X, i.e. other patients and their patient zones and the health-care facility environment.

Ingredient(s) added to hand hygiene products to moisturize the skin.

Disposable gloves used during medical procedures; they include examination (sterile or non-sterile) gloves, surgical gloves, and medical gloves for handling chemotherapy agents (chemotherapy gloves).

Concept related to the “geographical” visualization of key moments for hand hygiene. It contains the patient X and his/her immediate surroundings. This typically includes the intact skin of the patient and all inanimate surfaces that are touched by or in direct physical contact with the patient such as the bed rails, bedside table, bed linen, infusion tubing and other medical equipment. It further contains surfaces frequently touched by HCWs while caring for the patient such as monitors, knobs and buttons, and other “high frequency” touch surfaces.

The prolonged or extended antimicrobial activity that prevents the growth or survival of microorganisms after application of a given antiseptic; also called “residual”, “sustained” or “remnant” activity. Both substantive and non-substantive active ingredients can show a persistent effect significantly inhibiting the growth of microorganisms after application.

The place where three elements come together: the patient, the HCW, and care or treatment involving contact with the patient or his/her surroundings (within the patient zone).1 The concept embraces the need to perform hand hygiene at recommended moments exactly where care delivery takes place. This requires that a hand hygiene product (e.g. alcohol-based handrub, if available) be easily accessible and as close as possible – within arm’s reach of where patient care or treatment is taking place. Point-of-care products should be accessible without having to leave the patient zone.

Microorganisms residing under the superficial cells of the stratum corneum and also found on the surface of the skin.

An attribute of some active ingredients that adhere to the stratum corneum and provide an inhibitory effect on the growth of bacteria by remaining on the skin after rinsing or drying.

A microorganism used to represent a given type or category of nosocomial pathogen when testing the antimicrobial activity of antiseptics. Surrogates are selected for their safety, ease of handling, and relative resistance to antimicrobials.

Microorganisms that colonize the superficial layers of the skin and are more amenable to removal by routine handwashing.

Hands on which dirt or body fluids are readily visible.

Copyright © 2009, World Health Organization.

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