1 2 Recognition and management of an outbreak of infection

General / clinical / social hand wash

Infection Prevention Solutions

This involves the use of liquid soap products, warm running water and disposable paper towels. This activity mechanically removes transient micro-organisms from the hands and is perfectly acceptable for the vast majority of healthcare interventions.

Alcohol-based general / clinical / social hand decontamination

Alternatively, an alcohol-based product can be used for general hand decontamination in the place of a hand-wash but only if hands are visibly clean and not soiled – see below.

Surgical / antiseptic scrub

This is an extended hand decontamination procedure which is undertaken e.g. prior to surgical procedures and specific high risk invasive procedures using hand wash products containing certain antiseptic skin cleansers e.g. chlorhexidine or povidoneiodine. Alternatively, alcohol-based products can also be used. (see appendix and

additional paragraph at end)

The time taken for surgical hand scrubbing will vary depending on product used and if the hands and arms are grossly soiled, the scrub time should be lengthened. However, it is difficult to find concrete agreement amongst the experts regarding the recommended time for surgical hand asepsis, or about a longer initial scrub and subsequent scrub durations. Therefore as most of the literature recommends timings of between 2-5 minutes, clinical teams should agree locally on an acceptable timing, but the recognised extended Ayliffe 6 step technique should be adopted.

Types of hand decontamination products

Liquid soap products

These products are used for the vast majority of hand decontamination interventions that require the removal of transient micro-organisms. Products should be purchased from an approved supplier of medical products e.g. NHS Supply Chain as these products have been independently evaluated and economies of scale will be achieved with regards to cost. Bar soap must not be used for hand decontamination by staff as it can harbour micro-organisms. Bar soap is acceptable for service user use but should be allocated to each individual rather than being shared.

Soap impregnated wipes are also widely available for hand decontamination and can be useful in certain situations e.g. for service users who cannot easily access a hand wash basin after using a commode or prior to meals. Wipes should not be routinely used by health care workers who require a more thorough hand decontamination that is best provided by the use of soap and running water.