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NEW ENGLAND BAPTIST HOSPITAL
INFECTION CONTROL POLICY
Subject:
Hand Hygiene Program
Effective Date:
September, 2007
Approved By:
Infection Control Committee
Approved By:
Medical Executive Committee
Author(s):
Maureen Spencer, M.Ed., CIC, R.N.
Infection Control Manager
Supersedes: April, 2006
PURPOSE:
Effective hand hygiene practices reduce transmission of pathogenic microorganisms to
patients and personnel.
RESPONSIBILITY:
Effective hand hygiene is an institutional priority and is part of the hospital’s overall
Infection Control and Safety plan. All hospital personnel are responsible for adhering to
the hand hygiene program.
This policy applies to providers of direct patient care, those who would touch patients
in the course of providing care and to providers of indirect patient care, those who
would touch critical items that would come in contact with the patient (critical items
include but are not limited to medications, IV solutions, blood products,
instruments/equipment for sterilization and disinfection, food trays, and environmental
disinfection).
DEFINITIONS:
Artificial nails are substances or devices applied to natural nails to augment or enhance nails.
They include but are not limited to bonding, tips, wrappings, tapes and inlays. Anything
applied to natural nails other than polish is considered artificial. Everything but a natural
fingernail is considered artificial.
Hand hygiene: A general term that applies to either hand-washing, waterless alcohol-base
hand sanitizer (liquid, foam or alcohol hand cloths), or surgical hand antisepsis.
Hand-washing: Washing hands with plain soap and water
Alcohol-based hand sanitizer: An antiseptic agent that does not require use of water; After
applying, the hands are rubbed together until the agent dries.
Surgical hand antisepsis: Antiseptic hand-wash or antiseptic hand sanitizer performed
preoperatively by surgical personnel to eliminate transient and reduce resident flora.
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POLICY:
A. Restrictions for fingernails:
1. Long natural fingernails and artificial fingernails nails are not to be worn.
2. Natural fingernails should be of reasonable length (1/8”) beyond fingertip and well
manicured.
3. Fingernail polish may be worn only if completely intact. Chipped fingernail
polish must be removed.
B. Traditional Hand-washing - wash hands with plain soap and water:
1. When hands are visibly soiled with blood or body fluids or visibly dirty.
2. Before eating and after using the restroom
3. The physical action of washing and rinsing hands under circumstances where
contact with microorganisms containing spores may have occurred is
recommended because alcohols and other antiseptic agents have poor activity
against spores.
C. Use an alcohol-based hand sanitizer for routinely decontaminating hands:
1. If hands are not visibly soiled.
2. Before donning gloves, especially prior to insertion of invasive devices, e.g.
intravenous catheters.
3. Before and After direct patient contact
4. After contact with inanimate objects
5. Before and After removing gloves
PROCEDURES:
A.
Proper hand-washing technique includes:
1. Wet hands with soap and water
2. Apply soap to hands and rub together for at least 10 seconds covering all surfaces
of the hands and fingers.
3. Rinse hands with water and dry thoroughly with a disposable towel.
4. Use towel to turn off faucet.
B.
Proper technique for use of waterless alcohol-based hand sanitizer includes:
1. Apply product to palm of one hand and rub hands together, covering all surfaces of
hands and fingers until hands are dry.
C.
Surgical Hand Antisepsis
Refer to Operating Room/ Infection Control Policy “Basic Principles of Surgical
Asepsis”.
D.
Lotions:
1. Lotions may be used to prevent skin dryness associated with hand-washing.
2. Compatibility between lotion and hand hygiene product is considered at the time of
product selection.
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E.
Hand Hygiene Agents
1. Products used for hand hygiene are approved by the Infection Control Committee
on a periodic basis.
Storage and Dispensing of Hand Hygiene Products
2. Liquid products are stored in closed containers.
3. Disposable containers are used.
4. The Environmental Services Department routinely inspects all areas where there
are hand-washing facilities to ensure that hand hygiene products and paper towels
dispensers function properly and are adequately supplied.
5. Alcohol hand sanitizer dispensers will be located in and outside all patient rooms,
operating rooms, radiology procedure rooms, laboratories, pharmacy, ambulatory
care, physician dictation rooms, nurse stations and other designated areas.
F.
Education and Enforcement/Monitoring
1. Departmental directors, managers and supervisors are responsible for monitoring
and enforcing compliance. Human Resources will assist with non-compliance
issues.
2. Efforts to improve hand hygiene practice include education and feedback to staff on
compliance and infection surveillance data. Weekly observational studies by
Infection Control Liaisons, monthly observational studies during patient tracers and
volume use data are analyzed to determine the effectiveness of the hand hygiene
program. Collated data is presented to the Clinical Operations Council and Patient
Care Assessment Committee.
3. Patients are given a hand hygiene brochure in the prescreening process and asked
to bring in a small supply of hand sanitizer when hospitalized. They are also given
a packet of hand wipes on admission.
4. Patients, visitors and families are encouraged to remind health care workers to
practice hand hygiene. This empowers the patient and family to assure safe
practice while hospitalized.
References:
Centers for Disease Control and Prevention Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Healthcare Settings 2007
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References:
(http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf)
“Guideline for Hand Hygiene in Health Care Settings”, Centers for Disease Control and Prevention,
October, 2002
Foca M et al. Endemic Pseudomonas aeruginosa in a neonatal intensive care unit. N Engl J Med
2000: 343(10);695-700
 Investigation of endemic P aeruginosa infections in a neonatal ICU demonstrated that 17 (35%) of
infected or colonized infants and the hands of one HCW who had onychomycosis (infection of the
nail) harbored the same strain of P aeruginosa. Risk factors for HCW carriage of P aeruginosa
included increasing age of the HCW and a history of wearing artificial fingernails or nail wraps.
Gupta, A et al. Outbreak of Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae
iin a Neonatal Intensive Care Unit Linked to Artificial Nails. Infect Control Hosp Epidemiol 2004;
25(3):210-215
Hedderwick SA et al. Pathogenic organisms associated with artificial fingernails worn by healthcare
workers. Infect Control Hosp Epidemiol 2000; 21(8):505-9
 Investigators compared the microflora of hands of HCWs who wore artificial nails to the hands of
HCWs who did not. Those with artificial nails were more likely to harbor pathogens, including P
aeruginosa and other gram-negative organisms.
Pottinger J, Burns S, Manske C. Bacterial carriage by artificial versus natural nails. Am J Infec
Control 1989;17:340-4
 Investigators cultured the fingertips of nurses with artificial and natural fingernails before and after
hand washing. After hand washing there were higher numbers of gram negative rods cultured
from the fingertips of nurses with artificial nails than from the nurses with natural nails. Gram
negative rods are frequent pathogens in nosocomial infections.
Mcginley KJ, Larson EL, Leyden JJ. Composition and density of microflora in the subungual space of
the hand. J Clin Microbiol 1988;26(5):950-3
 Investigators found significant differences in the composition and density of microflora in different
areas of the hands. Substantial numbers of bacteria were found under fingernails an area known
to be difficult to clean.
Saiman L et al. Banning artificial nails from health care settings. Am J Infec Control 2002; 30:252-4
 Article was a template to facilitate policy implementation.
Moolenaar RL et al. A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care
unit: Did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol 2000;
21(2):80-5
 Investigation of an outbreak in a neonatal ICU suggested that long or artificial nails contributed to
colonization of HCWs' hands with the outbreak strain of P aeruginosa. Of 439 neonates admitted
during the study period, 46 (10%) acquired P aeruginosa and 16 (35%) of those died. Infection
was associated with exposure to two nurses; both had hand cultures that yielded strains of P
aeruginosa that were identical by molecular subtyping to strains isolated from cases. One nurse
had natural long nails and one had artificial nails.
Parry MF, Grant B, Yukna, M et al. Candida osteomyelitis and diskitis after spinal surgery: An
outbreak that implicates artificial nail use. Clinical Infectious Diseases 2001;32:352-7
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
Three cases of postoperative Candida osteomyelitis and diskitis following laminectomy were
epidemiologically linked to an operating technician who wore artificial nails at the time of the
procedures.
McNeil SA, Foster CL, Hedderwick S, et al. Effect of hand cleansing with antimicrobial soap or
alcohol-based gel on microbial colonization of artificial fingernails worn by health care workers.
Clinical Infectious Diseases 2001;32(3):367-72
 Investigators studied the effect of hand cleansing with antimicrobial soap or alcohol-based gel
among HCWs with artificial nails compared with a control group. They found that significantly
more HCWs with artificial nails than controls had pathogens remaining after hand cleansing with
soap or gel, suggesting that HCWs with artificial nails may serve as reservoirs for transmission of
pathogens in the healthcare setting.
Reviewed May, 2003
Revised April 21, 2004
Revised April 10, 2006
Reviewed September 2007
hand hygiene policy07.doc
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