Promoting Hand Hygiene in Healthcare: A Critical Measure for Infection Control

Hand hygiene is known to be the single most critical measure for reducing the transmission of organisms (infectious agents) to patients and each other. Performing hand hygiene helps prevent the spread of infection and is one of the most important parts of infection control in healthcare facilities. Hand hygiene includes hand washing with soap and water, antiseptic hand wash, alcohol-based hand rub, and surgical antisepsis. Our focus will be on soap and water handwashing and alcohol-based hand rub for hand hygiene.

In hospitals, improper or total disregard of hand hygiene has resulted in outbreaks of infections. Within hospital settings, studies have shown a less than 40 percent adherence to hand hygiene. Some of the most frequent reasons given for the lack of hand hygiene among healthcare personnel are:

  • Inaccessible products,
  • Products cause skin irritation,
  • Healthcare providers are too busy to perform hand hygiene and it interfered with patient care,
  • Workers were wearing gloves and felt hands were not contaminated,
  • They just didn’t think about it, and
  • They lacked the knowledge of when and how to perform hand hygiene.


Hand washing with soap and water should take place when hands are visibly soiled or dirty, before eating, after going to the restroom, and after providing care for a patient with diarrhea.

The proper sequence to hand washing is shown in the following steps:

  1. Wet hands first with water.
  2. Apply plain or antimicrobial soap to hands and rub hands together to create a lather.
  3. Vigorously rub hands for at least 30-40 seconds, ensuring to cover all surfaces of hands and fingers.
  4. Rinse with water, dry with a disposable towel, turn the faucet (if manual) off with the towel.


Alcohol-based hand sanitizers are preferred if hands are not visibly soiled. Hand sanitizers should have at least 60% alcohol or higher in them. The proper steps for using alcohol-based sanitizer are as follows:

  1. Apply the specified amount of the product from manufacturer. Healthcare personnel should follow the manufacturer’s instructions on the amount of sanitizer to be used.
  2. Rub hands together, covering all surfaces of hands and fingers.
  3. Continue rubbing hands until all surfaces of the hands are dry. This process should take 20-30 seconds.


Each facility should have and consider these elements to be included in a hand hygiene program. The infection control officer should involve staff in the selection and evaluation of hand hygiene products. Lotions should be considered and provided that are compatible with soaps and alcohol-based hand rubs.

Artificial nails and long natural nails should not be worn when providing direct patient care, as they compromise the efficacy of handwashing. Artificial nails have been linked to disease outbreaks in high-risk hospital settings. Bacteria can adhere to artificial nails making it impossible to properly clean. They can also cause gloves to tear and are not recommended for healthcare workers.

Hand hygiene education should be provided at the time of hire and no less than annually thereafter. Compliance with recommended hand hygiene practice should be monitored and findings reported back to staff on a routine basis. Input from staff on the hand hygiene program is an important part of compliance.

We have seen an increase in respiratory illness, flu, RSV, and COVID in the U.S. During respiratory illness season, healthcare workers should ensure and perform hand hygiene regularly throughout each day. Clean hands are an important defense against spreading infections. If you need assistance with ensuring your office is meeting compliance expectations, reach out to TMC today. We have decades of experience and can make sure you and your staff are safe and compliant during this busy season.