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SH CP 12
Hand Hygiene Procedure
(Infection Prevention and Control Policy: Appendix 6)
This Hand Hygiene Appendix must be read in conjunction with the
Infection Prevention and Control Policy.
Version: 3
Summary:
This Hand Hygiene Appendix advises staff of the
actions they must take in order to prevent cross
infection via contaminated hands.
Target Audience:
All staff of all disciplines, Non-Executive Directors,
Volunteers, Governors and Contractors
Next Review Date:
October 2018
Approved by:
IP&C & Decontamination
Group
Date issued:
November 2014
Author:
Theresa Lewis
Lead Nurse Infection Prevention and Control
Sponsor:
Della Warren
Executive Director of Nursing and Allied Health
Professions and DIPC
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
Date of meeting:
4th November 2014
1
Version Control
Change Record
Date
05.10.12
04.11.14
Author
Theresa Lewis
(Lead Nurse
Infection
Prevention and
Control)
Theresa Lewis
Version
Page
Reason for Change
2
Throughout
Acquisition of Ridgeway to Southern Health NHS
Foundation Trust.
3
Throughout
Policy review
Reviewers/contributors
Name
Angela Roberts
Jacky Hunt
Louise Piper
IP&C Group Members
IP&C Consultation Group
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
Position
IP&C Team
As above
As above
All Divisions Represented
Version Reviewed &
Date
V3 21.10.14
V3 21.10.14
2
Contents
Page
1.
Introduction
4
2.
Definitions
4
3.
Process
• Hand Care
• Bare Below the Elbows
• Facilities Required
• When to Perform Hand Hygiene
• How to Perform Hand Hygiene
• Choice of Cleansing Agent
5
4.
Training
11
5.
Audit
11
6.
References
11
Appendices
• 6.1 Hand Hygiene Outside of the Healthcare Environment
• 6.2 WHO 5 Moments for Hand Hygiene
• 6.3 Hand Washing Technique
• 6.4 Hand Hygiene Poster’s
• 6.5 Hand Hygiene Technique for Alcohol Gel use
13
14
15
16
18
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
3
Hand Hygiene Procedure
1.
Introduction:
1.1
Hand hygiene is a term that incorporates the decontamination of the hands by methods
including routine hand washing, surgical hand washing and the use of alcohol hand
rubs and gels (Uniform and Workwear Guidance, DH 2010). Contaminated or dirty
hands are closely associated with the transmission of Healthcare Associated
Infections. This contamination can be as a result of an occupational exposure to microorganisms but importantly it should be understood that a significant amount of hand
contamination is from the individual themselves e.g. touching own face or sneezing into
own hand.
1.2
Hand hygiene is the most important measures to protect patients, healthcare workers
and the environment from microbial contamination (WHO 2009). Failure to perform
appropriate hand hygiene is considered the leading cause of healthcare associated
infections (HCAI) and spread of multi-resistant organisms, and has been recognised as
a significant contributor of outbreaks (WHO 2009).
1.3
This Hand Hygiene Appendix advises staff of the actions they must take in order to
prevent cross infection via contaminated hands. This does not cover surgical hand
preparation as this is covered in LNFH Theatre Policy.
2.
Definitions:
Alcohol Gel - A sanitising gel containing approx. 60% isopropanol alcohol and
emollients (skin softeners). Dispensed in a measured dose from a wall mounted /stand
alone dispenser or carried by staff. The alcohol gel disinfects / sanitises physically
clean hands. These agents have disinfectant activity, and destroy most transient microorganisms. If applied for an extended length of time, they will also destroy some
resident flora. Alcohol gel does not contain soap and is therefore ineffective in the
presence of physical soiling. Please note alcohol gel is not suitable for environmental
cleaning.
Bare Below the Elbow – The term used to describe the removal of all jewellery,
(except a plain wedding ring), watches, nail varnish and false nails. Where sleeves are
worn, these must be rolled up when having close contact with service users and
remained rolled up until an appropriate hand washing technique has been performed.
Emollient - A non-perfumed hand cream / skin moisturising agent that must be
compatible with the soap and gel in use. Emollient should be applied when hands are
at rest i.e. during coffee break, lunch break or at the end of the working day.
Hand soap – A non-perfumed gentle liquid soap that does not contain anti-bacterial
agents. Dispensed from a well maintained, wall mounted or stand alone dispenser in a
measured dose.
Handwashing – Washing hands with plain / antimicrobial soap and warm water
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
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Point of Care - The place where the healthcare worker provides care or treatment to
the service user
Resident Flora – Normal flora or ‘commensal organisms’, forming part of the body’s
normal defence mechanisms, and protecting the skin from invasion by more harmful
micro-organisms. They rarely cause disease and are of minor significance in routine
clinical situations. However, during surgery or other invasive procedures, resident flora
may enter deep tissues and establish infections. Removal of these organisms is
essential in these situations, by following the surgical scrub technique (please refer to
the LNFH policy)
Transient Flora - Microorganisms that colonise the superficial layers of the skin.
They are also acquired by touch e.g. from the environment, touching patients, laundry,
equipment etc. Transient flora are readily transmitted to the next thing touched, and
are responsible for the majority of healthcare–associated infections. They are easily
removed by hand decontamination.
Visibly Soiled Hands - Hands on which dirt or body fluids are readily visible.
3.
Process:
3.1
Hand Care:
The frequent use of hand hygiene agents may cause damage to the skin and alter
normal hand flora. Excoriated hands are associated with increased colonisation of
potentially pathogenic microorganisms such as Meticillin-resistant Staphylococcus
Aureus (MRSA), and increase the risk of infection. In order to achieve effective hand
hygiene, it is therefore important to look after the skin and fingernails. Continuing
damage to the skin may result in cracking and weeping, exposing the care worker to
increased infection risk, and can lead to sick leave.
Cover cuts and abrasions with a water-impermeable dressing, prior to contact with
service users. Staff with skin lesions on their hands eg eczema or psoriasis, that
cannot be adequately covered (wearing gloves to protect open lesions on hands is not
acceptable) must not work until they have received advice from the Occupational
Health Department.
Skin damage and dryness often results from frequent use of harsh soap products,
application of soap to dry hands, or inadequate rinsing of soap from the hands. It is
therefore essential that only approved liquid soap products are used, and that staff
carefully follow correct hand hygiene techniques. Emollient creams alone e.g.
Diprobase, are insufficient to provide clinical hand hygiene. Please contact the
Occupational Health Dept if you need further advice.
All care areas should ensure adequate supplies of moisturiser (wall mounted where
appropriate) are available for staff use, as this is more cost-effective than sicknessabsence due to damaged skin. Several controlled trials have shown that regular use of
such products can help prevent and treat irritant contact dermatitis caused by hand
hygiene products (WHO 2009). Moisturiser available from the NHS Supply Chain is
free from perfumes to reduce the risk of reaction with other products. Therefore ideally
only moisturisers purchased via the NHS Supply Chain should be used. Staff should
regularly use moisturiser to maintain skin patency when hands are at rest. Communal
tubs of moisturiser are not recommended
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
5
Natural fingernails harbour micro-organisms (Larson 1995). Fingernails should be kept
short, clean and free from nail varnish.
3.2
Bare Below the Elbows
The Trust has adopted the Department of Health ‘Bare Below the Elbows’ Strategy.
This includes:
•
•
•
•
•
Clothing - Remove long sleeved clothing or roll up long sleeves before undertaking
any direct ‘hands on’ care. Long sleeves prevent thorough hand hygiene
procedures and are more likely to become contaminated during work activities
Nails - Fingernails should be short, clean and free from false nails or nail polish
when having direct contact with services users at work (EPIC 3, 2014). Artificial
nails and nail extensions harbour higher levels of micro-organisms than natural
fingernails, and these micro-organisms are not removed easily during hand hygiene
(DH 2010). Artificial fingernails can also fall off when caring for service users. Long
nails can puncture gloves and are harder to keep clean.
Jewellery - Remove rings (except wedding band), wristwatches, bracelets and all
other wrist and hand jewellery when having any contact with service users (EPIC 3,
2014). Rings, wristwatches and other jewellery worn on the hands and wrists
become contaminated during work activities and in addition skin underneath rings
is more heavily colonised with microorganisms in comparison to other areas where
rings are not worn (WHO 2009). In addition they prevent thorough hand hygiene
procedures
Non-Clinical Roles - Staff who work in certain non-clinical roles e.g. cleaning staff,
catering or food handling staff will need to comply with being Bare Below the
Elbows to facilitate effective hand hygiene
Social Care - In social care settings staff should be bare below the elbows when
undertaking physical care activities
Staff who are unable to comply with the ‘Bare Below the Elbow’ strategy may wear
disposable over sleeves/gauntlets. These are single use items and must be changed
between each different procedure on the same patient and between patients. They are
to be removed after patient contact and before hand hygiene is performed. Disposable
over sleeves should be disposed of as clinical waste and are not to be worn outside of
the care area. Please contact a member of the IP&C team for further advice if
required.
3.3
Facilities Required:
Adequate facilities must be provided to enable staff to wash and dry their hands
regularly and appropriately, to use alcohol hand gel if applicable, to use clinell wipes if
applicable and to protect their skin using moisturiser.
Each inpatient and non-domestic area must have the following equipment near to the
service user, to ensure adequate hand washing:
•
•
•
•
Dedicated hand wash basin*, that is easily accessible (separate to a dedicated sink
for cleaning equipment or body fluid discharge)
Ideally should have elbow operated mixer taps – if elbow taps are not available
disposable paper towels can be used to turn off the taps
Well maintained liquid soap dispenser, with adequate supply of liquid soap
Disposable paper towels
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
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•
•
•
Hand hygiene posters (laminated) indicating correct technique
New builds should include hand washing sinks which conform to national standards
eg they must not have a plug or overflow (HBN 00-10 DH 2013).
Well maintained moisturiser dispenser with adequate supply of emollient – these
are usually placed in staff rest areas
*Requirements for a clinical hand wash basin (HBN 00-09 DH 2012)
• The dimensions of the clinical hand wash basin should be large enough to
contain most splashes and therefore enable the correct hand wash technique to
be performed without excessive splashing of the user
• Clinical hand wash basins should be wall mounted using concealed brackets and
fixings. They should be sealed to a waterproof splash-back to allow effective
cleaning of all surfaces
• They should not have a plug or a recess capable of taking a plug.
• Clinical hand wash basins should not have overflows as these are difficult to
clean and become contaminated
• Clinical hand wash basins should be accessible eg not situated behind curtain
rails
• Taps should be elbow operated or sensor and be fitted with a thermostatic
mixing valve
• Taps should not be aligned to run directly into the drain aperture as
contamination from the waste outlet could be mobilised
• Clinical hand wash basins should not be used for other purposes eg cleaning
patient equipment
Each area must also have (where it is deemed safe to use following Risk Assessment)
easily accessible alcohol hand rub/gels (with emollients). Suggested locations include:
•
•
•
•
•
At every ward/unit entrance in a wall dispenser;
At the entrance to service user bays in a wall dispenser;
On all healthcare record trolleys and drugs trolleys and outside isolation rooms
By every patient’s bed / at the point of care, except in certain areas such as Child
Health and Mental Health
If on risk assessment alcohol gel is deemed unsafe to be located at the point of
care, staff should be provided with pocket sized containers of alcohol gel which is
carried on a short clip or retractable cord
Community Staff: Mobile community staff should be provided with appropriately sized
containers of alcohol hand-gel. When hand washing is required and mobile staff have
no access to soap and water, hand wipes e.g. clinell sanitising wipes can be used.
(order code VJT119 from NHS Supplies*). However these wipes should only be used
as a last resort, when there is no alternative and hands should be washed with soap
and water at the first available opportunity.
*Please note this order code is accurate as at Oct 2014.
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
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Social Care: Staff working within supported living environments, where possible,
should have access to dedicated hand hygiene facilities. Where liquid soap, water and
disposable paper towels are not available, tottle bottles of alcohol gel and disposable
hand wipes should be made available for staff use. It is not appropriate for staff to use
communal bars of soap or to share a communal hand towel.
Moisturising cream should also be freely available to maintain skin integrity. Where
appropriate this should be supplied in wall-mounted dispensers, located in suitable
positions eg staff rest room. Alternatively individual pocket sized containers can be
used.
Please see Appendix 6.1 for further guidance on performing hand hygiene outside of
the healthcare environment.
3.4
When to Perform Hand Hygiene:
Hands must be decontaminated before each episode of direct patient contact or care
including clean or aseptic procedures (EPIC 3 2014).
Both the decision to decontaminate hands and what type of cleaning agent to be used
should be based on a risk assessment. This must include the likelihood that microorganisms have been acquired or may be transmitted, whether the hands are visibly
soiled or not, and what procedure is about to take place.
Hands must be decontaminated:Before and after each episode of patient contact / care – NB hand hygiene is only
required once between each patient contact e.g.:
• Changing dressings
• Handling invasive devices
• Administrating medications or in between administrations (when assisting the
service user) during a drug round.
• Handling food
• Contact with urethral catheters
• Bed making or in between bed making if making multiple beds
• Assisting service users with personal hygiene
Before e.g.:
•
•
•
•
•
•
Direct close contact with a service user
Before performing a clean or aseptic technique
Leaving source isolation
Leaving the care area
Before eating or serving food
Commencing work
After e.g.:
• Direct close contact with a service user
• Close contact with the service user’s environment
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
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•
•
•
•
•
•
Removing personal protective clothing
Sluice room activities
After any exposure to body fluids
After the removal of personal protective equipment e.g. gloves and aprons
Personal contamination e.g. coughing or sneezing
Handling surfaces that are likely to be contaminated e.g. specimen pots, suction
equipment
• After contact with waste
• Using the toilet
• After handling soiled laundry
The World Health Organisation (WHO) 5 moments for hand hygiene is a useful tool
which can be used for guidance as to when hand hygiene could be performed. See
Appendix 6.2
3.5
Choice of Cleansing Agent
The following types of cleansing agent can be used to remove micro-organisms from
hands:
Liquid Soap - Washing the hands with plain liquid soap and tepid water* is adequate
for most routine activities. Hand washing with soap lifts transient micro-organisms from
the surface of the skin and allows them to be rinsed off. An effective hand wash
technique involves three stages; preparation, washing and rinsing, and drying. In
preparation for hand washing, staff must be bare below the elbows see section 3.2.
*Apart from the issue of skin tolerance and level of comfort, water temperature does
not appear to be a critical factor for microbial removal from hands being washed.
However warmer temperatures have been shown to be very significantly associated
with skin irritation and therefore the use of very hot water for hand washing should be
avoided as it increases the likelihood of skin damage. (WHO 2009). The use of cold
water alone may deter some from washing their hands during cold winter conditions
(HSE 2014).
Bars of soap should not be used for hand hygiene.
Technique
Routine hand washing – use liquid soap and tepid water, and follow this procedure:
•
•
•
•
•
•
•
Wet hands under running water
Dispense one dose of liquid soap into the cupped hand
Wash hands vigorously – cover all surfaces as per 6-step hand hygiene poster
Hands must be rubbed together vigorously for a minimum of 15-20 seconds, paying
particular attention to the tips of fingers, the thumbs and areas between the fingers
Rinse hands thoroughly under running water
Turn off taps using elbows (or a paper towel if taps are not elbow operated)
Pat hands dry with a disposable paper towel and discard without touching a dirty
surface e.g. bin lid
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
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Please see appendix 6.3 for Hand Washing Technique Poster and Appendix 6.4 for
generic Hand Hygiene posters
Hand drying
Because wet hands can more readily acquire and spread microorganisms, the proper
drying of hands is an integral part of routine handwashing. Hands must be patted dry
and not rubbed. Care must be taken to avoid recontamination of washed and dried
hands. Reusing or sharing towels should be avoided because of the risk of crossinfection (WHO 2009).
Alcohol hand rub/gels (with emollients). These may be used in place of soap and
water if hands are visibly clean. They are especially useful if hand washing and
drying facilities are inadequate, or where there is a need for rapid or frequent hand
washing. These agents have disinfectant activity, and destroy transient microorganisms. If applied for an extended length of time, they will also destroy some
resident flora.
In some religions, alcohol use is prohibited or considered an offence. As a result the
adoption of alcohol-based formulations for hand hygiene may be unsuitable or
inappropriate for some HCW’s either because of their reluctance to have contact with
alcohol, or because of their concern about alcohol ingestion or absorption via the skin.
WHO (2009) state that in general, those religions with an alcohol prohibition in
everyday life demonstrate a pragmatic vision in the perspective of optimal patient-care
delivery and do not object to the use of alcohol-based products for environmental
cleaning, disinfection or hand hygiene.
When NOT to use alcohol gel:
Visibly clean hands can be decontaminated with alcohol gel for all activities with the
following two exceptions when liquid soap and water must be used instead.
•
•
When hands are visibly soiled or potentially contaminated with body fluids
When caring for a service user with diarrhoea and/or vomiting e.g. norovirus or
clostridium difficile
Technique
• Enough alcohol gel should be dispensed to ensure all surface areas of the skin are
covered.
• Hands must be rubbed together vigorously, paying particular attention to the tips of
the fingers, the thumbs and the areas between the fingers until the solution has
evaporated and the hands are dry.
Please see Appendix 6.5 for poster on Hand Hygiene Technique with alcohol hand
rubs
Sanitising Hand Wipes. If hands are visibly dirty and soap and water is not available,
a clinell sanitising wipe can be used. Care must be taken to ensure the wipe covers all
surfaces of the hands.
Common Examples:
If your hands are visibly soiled or covered with body fluids:
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
10
•
Use soap and water followed by drying with a disposable paper towel. If no access
to soap and water use a clinell sanitising wipe or similar.
If exposure to potential spores e.g. Clostridium difficile and viral diarrhoea &
vomiting in suspected outbreaks of norovirus
•
Use soap and water followed by drying with a disposable paper towel. If
there is no access to soap and water antiviral gel can be used in suspected
outbreaks of viral diarrhoea and vomiting. Antiviral gel differs from the normal
alcohol gel used as this has been proven to be effective against viruses such
as norovirus. Standard alcohol gel is not effective against viruses.
If you are about to, or have had, contact with a servicer user and your hands are
visibly clean:
•
You can use either alcohol hand gel / soap and water followed by drying with a
disposable paper towel. Clinell sanitising wipes can be used as a last resort if no
other method is available.
If you are about to perform an aseptic technique:
•
Use soap and water followed by drying with a disposable paper towel if hands are
visibly dirty
OR
• Use alcohol hand gel if hands are visibly clean.
3.6
Hand Hygiene and Service Users
Service users and relatives should be provided with information about the need for
hand hygiene and how to keep their own hands clean.
Service users should be offered the opportunity to clean their hands before meals,
after using the toilet, commode or bedpan and at other times as appropriate (EPIC 3,
2014).
Products available should be tailored to the needs of the service users and may
include alcohol hand rub, hand wipes and access to handwash basins.
HCW’s should educate service users and carers about their role in maintaining
standards of healthcare workers’ hand decontamination. (NICE 2012).
4
Training
Training in hand hygiene is included as part of IP&C essential training at induction and
as part of ongoing training.
Practical training in hand hygiene using the light box is carried out by our IP&C link
advisors or by a member of the IP&C team if hand hygiene audit scores drop or during
outbreak if this is required.
Refer to TNA in IP&C Policy.
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
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5
Audit
Hand hygiene is audited regularly as part of the IP&C Annual Audit plan. Results from
audits are reported via the IP&C Group and through Divisional Governance systems.
Where appropriate hand hygiene compliance scores are on display in clinical areas.
6
References:
Department of Health (2010) Uniform and Workwear. Guidance on Uniforms and
Workwear Policies for NHS Employees London HMSO
Department of Health (2010) Saving Lives: a delivery programme to reduce
Healthcare Associated Infections including MRSA. London HMSO
Department of Health (2012) Health Building Note 00-09: Infection Control in the built
environment
Department of Health (2013) Health Building Note 00-10 Part C: Sanitary assemblies
Hand Hygiene Task Force (2007) Guideline for hand hygiene in health-care settings.
Recommendations of the Healthcare Infection Control Practices Advisory Committee
and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Morbidity and Mortality
Weekly Report 51(16) 1-48
Health and Safety Executive (2014) A review of the data on efficacy of handcleaning
products in industrial use as alternatives to handwashing
Larson E (1995) APIC guideline for handwashing and hand antisepsis in healthcare
settings. American Journal of Infection Control 23(4), 251-269
Loveday J, Wilson J, Pratt R, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J, &
Wilcox M. (2014) epic 3: National Evidence-Based Guidelines for Preventing
Healthcare-Associated Infections in NHS Hospitals in England Journal of Hospital
Infection 86S1 (S1-S70)
National Patient Safety Agency (2004) Clean Your Hands Campaign. NPSA
National Institute for Health and Clinical Excellence (2012) Prevention and control of
healthcare associated infections in primary and community care NICE 2012
Pittet D., Dharan S., Touveneau S., et al (1999) Bacterial contamination of the hands
of hospital staff during routine patient care. Archives of Internal Medicine 159: 821-826
World Health Organisation (2009) WHO Guidelines on Hand Hygiene in Healthcare –
First Global Patient Safety Challenge Clean Care is Safe Care
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Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
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Appendix 6.1: Hand Hygiene Outside of the Healthcare Environment
In some circumstances employees working in the community will not have access to the
equipment necessary to carry out hand hygiene such as no running warm water, no access
to liquid soap and no equivalent to disposable hand towels.
Prior to visiting a client in their home the clinician should discuss with the patient what is
required to carry out effective hand hygiene.
This would include providing:
Plain liquid soap in a dispenser or pump (not a bar of soap) – this does not have to be for
the clinician’s exclusive use.
Warm running water.
Clean towel for the clinician’s specific use. Disposable paper towels in the form of a roll
of paper if necessary e.g. kitchen roll
HCWs can obtain supplies of liquid soap and paper towels/roll from their usual supply chain.
There will be certain circumstances when this is not achievable and in those situations the
following alternatives can be used:
ALCOHOL HAND GEL
• Before and after providing direct patient care.
• After removal of gloves and before performing further patient care.
• On entering and leaving the patient’s home..
DISINFECTANT WIPES e.g. Clinell (recommended only if soap and water are not
available)
• After several applications of alcohol hand gel if hands have become tacky.
• When hands are soiled with organic material such as dirt or body fluids.
MOISTURISERS
• Dispensers can be located at meeting areas, such as GP surgeries, to allow this part of
the hand hygiene policy to be carried out.
• Individual hand moisturisers when used must be purchased through the routine supply
chain to ensure it is compatible with the alcohol hand gel.
This is not an exhaustive list of circumstances. For further advice contact the IP&CT.
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
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Appendix 6.2: WHO 5 Moments for Hand Hygiene
The World Health Organisation have developed an approach called the 5 moments for hand
hygiene. This supports the national Clean your Hands campaign and helps all health care
professionals to decide when to clean their hands. The Five Moments of hand hygiene is
based around preventing the transfer of micro-organisms between each patient zone e.g. the
zone around a patients bed or chair and lists the important times during our work, where we
should stop to clean our hands. The 5 moments is applicable in all healthcare environments.
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
November 2014.
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Appendix 6.3: Hand Washing Technique
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
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Appendix 6.4: Hand Hygiene Posters
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
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Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
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Appendix 6.5: Hand Hygiene Technique with Alcohol-Based Formulations
Hand Hygiene Procedure.
Author: Theresa Lewis – Lead Nurse IP&C.
Version: 3
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