Hand Hygiene and Personal Protective Equipment

Principles and Techniques of Clinical Hand Hygiene

Hand hygiene is the single most effective way to prevent the spread of infections in outpatient clinical settings. In the daily routine of rooming patients, recording vital signs, collecting specimens, administering delegated injections, and performing point-of-care testing under provider supervision, medical assistants encounter numerous opportunities for microbial transmission. Hand hygiene must be performed before and after direct patient contact, regardless of whether gloves were worn during the encounter. In addition, hand hygiene must be performed immediately after contact with blood, body fluids, secretions, or contaminated environmental surfaces.

Alcohol-based hand rub is the preferred method for routine hand hygiene when hands are not visibly soiled. To effectively kill pathogens, alcohol-based hand rubs must contain at least 60% alcohol. To use this product correctly, apply the manufacturer-recommended volume to the palm of one hand and rub the solution over all hand surfaces until completely dry. Allowing the alcohol-based hand rub to dry completely on the skin typically requires about 20 seconds, and hands must not be wiped dry with towels or waved in the air.

Handwashing with soap and running water is required whenever hands are visibly soiled with dirt, blood, or body fluids. Furthermore, alcohol-based hand rub does not reliably remove or inactivate Clostridioides difficile spores, making handwashing with soap and water mandatory after caring for patients with suspected or confirmed Clostridioides difficile infections. Alcohol-based hand rubs are also less effective than handwashing with soap and water against non-enveloped viruses such as norovirus. For instance, when cleaning up after a delegated specimen collection from a patient experiencing acute gastrointestinal symptoms suspected of norovirus or Clostridioides difficile, soap and water must be used.

Proper handwashing technique relies on mechanical action and appropriate supplies. Running water should be comfortably warm or cool, because hot water can irritate the skin. During routine handwashing, avoid touching the sink and rinse thoroughly under running water; hands do not need to be kept below the elbows. Frictional rubbing is necessary to mechanically loosen and remove transient microorganisms across all hand surfaces, including the palms, backs of hands, between fingers, and the wrists. The CDC recommends scrubbing hands with soap and water for a minimum of 20 seconds. The subungual area beneath fingernails harbors high concentrations of microbes and requires focused cleaning. Dry hands thoroughly with a clean paper towel; routine handwashing does not require drying toward the forearms. Finally, a clean, dry paper towel must be used to turn off manual faucets to prevent recontaminating clean hands.

Maintaining natural skin barriers and fingernail hygiene supports effective hand decontamination. Natural fingernails should be kept clean and trimmed short, typically less than one-quarter inch beyond the fingertip. Medical assistants must follow facility policy regarding artificial nails and nail enhancements, avoiding them during direct patient care and especially when caring for patients at high risk of infection. To protect skin integrity, use facility-approved hand lotions that are compatible with hand-hygiene products and clinical gloves, keeping in mind that petroleum-based lotions can weaken latex gloves.