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SANITIZE
If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating
hands in all other clinical situations.
2
The following two formulations are recommended by
the WORLD HEALTH ORGANIZATION for alcohol-based hand rubs: ethanol 80% (v/v) or
isopropyl alcohol 75% (v/v).
3
The FDA and CDC have recommended alcohol concentrations between 62 and 95% as
far back as 1994.
4
More recent research published in The Lancet recommends a minimum
concentration of 80% v/v ethanol.
5
Research appears to be trending toward higher alcohol
content for greater effi cacy.
Ultimately, adherence to recommended hand-hygiene practices should become part of a
culture of patient safety, where a set of interdependent quality elements interact to achieve
a shared objective.
6
See the Instant Hand Sanitizers section for additional guidance on
when alcohol rubs are appropriate.
CLEANSE
When hands are visibly contaminated or soiled with blood or other body fl uids, wash hands
with plain or antimicrobial soap and water.
1
See the Plain Soaps section for additional
guidance on when soap and water is appropriate.
CARE
Irritant contact dermatitis is the primary reason for [hand hygiene] failure.
7
Based on CDC
guidelines, hand lotions and creams can increase skin hydration and replace altered or
depleted skin lipids that contribute to the barrier function of normal skin. Several controlled
trials have demonstrated that regular use (e.g., twice a day) of such products can help
prevent and treat irritant contact dermatitis caused by hand-hygiene products.
8
1,2,4,8
Boyce J., Pitet D. Guidelines for Hand Hygiene in Health-Care Settings. Atlanta, GA: Centers for Disease Control and Prevention (CDC), US Dept
of Health and Human Services; 2002. Report available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm. Accessed March 10, 2010.
3, 6
World Health Organization. WHO Guidelines on Hand Hygiene in Health Care. Geneva 27, Switzerland: WHO Press, World Health Organization;
2009. Report available online at whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf. Accessed April 21, 2010.
5
Kramer A, Rudolph P, Kampf G, Pittet D. Limited ef cacy of alcohol-based hand gels. Lancet. 2002; 359; 1489-1490.
7
Visscher, M, Davis, J, Wickett R. Effect of topical treatments on irritant hand dermatitis in health care workers. Skin Sciences Institute, Cincinnati
Children’s Hospital; Cincinnati 2010.
from Centers for Disease Control and Prevention and World Health Organization
EVIDENCE-BASED
RECOMMENDATIONS