Hand hygiene is considered one of the most important ways to reduce the transmission of infectious agents that cause healthcare associated infections (HCAIs).

Clinical hand-wash basins (HWBs) must:

• be used for that purpose only and not used for the disposal of other liquids
• have mixer taps, no overflow or plug and be in a good state of repair
• have wall mounted liquid soap and paper towel

Hand hygiene facilities should include instructional posters.

Before performing hand hygiene:

• expose forearms (bare below the elbow)
• remove all hand and wrist jewellery. The wearing of a single, plain metal finger ring, eg a wedding band, is permitted but should be removed (or moved up) during hand hygiene. A religious bangle can be worn but should be moved up the forearm during hand hygiene and secured during patient care activities
• ensure fingernails are clean and short, and do not wear artificial nails or nail products
• cover all cuts or abrasions with a waterproof

To perform hand hygiene:

• Wash hands with non-antimicrobial liquid soap and water if:
• hands are visibly soiled or dirty
• caring for patients with vomiting or diarrhoeal illnesses
• caring for a patient with a suspected or known gastrointestinal infection, eg norovirus or a spore-forming organism such as Clostridioides difficile.

In all other circumstances, use alcohol-based handrubs (ABHRs) for routine hand hygiene during care.

ABHRs must be available for staff as near to the point of care as possible. Where this is not practical, personal ABHR dispensers should be used, eg within the community, domiciliary care, mental health units etc.

Where running water is unavailable, or hand hygiene facilities are lacking, staff may use hand wipes followed by ABHR and should wash their hands at the first opportunity.

Perform hand hygiene:

1. before touching a
2. before clean or aseptic
3. after body fluid exposure
4. after touching a patient; and
5. after touching a patient’s immediate surroundings.

Always perform hand hygiene before putting on and after removing gloves.

For how to wash hands, see the step-by-step guide in appendix 1 of this document. For how to hand rub, see the step-by-step guide in appendix 2 of this document.

Skin care

• dry hands thoroughly after hand washing, using disposable paper towels
• use an emollient hand cream regularly eg during breaks and when off duty
• do not use or provide communal tubs of hand cream in the care setting
• staff with skin problems should seek advice from occupational health or their

Surgical hand antisepsis

Surgical scrubbing/rubbing (this applies to those undertaking surgical and some invasive procedures):

• perform surgical scrubbing/rubbing before donning sterile theatre garments or at other times, eg before inserting central vascular access devices
• remove all hand and wrist jewellery (including wedding band)
• single-use nail brushes must only be used for decontaminating nails. Nail picks can be used if nails are visibly dirty
• use an antimicrobial liquid soap licensed for surgical scrubbing or an ABHR licensed for surgical rubbing (as specified on the product label)
• ABHR can be used between surgical procedures if licensed for this

For surgical scrubbing (not rubbing), follow the step-by-step guide in appendix 3 of this document.

For surgical rubbing (not scrubbing), follow the step-by-step guide in appendix 4 of this document.

For hand hygiene posters/leaflet, refer to the resources section of NIPCM. Further information can be found in the hand hygiene literature reviews:

• Hand washing, hand rubbing and indications for hand hygiene
• Hand hygiene products
• Skin care
• Surgical hand antisepsis in the clinical setting

Download a PDF copy of the National infection prevention and control manual for England