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The facility’s hand hygiene policy should reflect recommendations made by the Centers for Disease Control and Prevention (CDC) (Boyce & Pittet, 2002) or the World Health Organization (WHO, 2009), if a facility desires to be accredited by TJC (2016). ABHR use has been shown to be superior for decontaminating hands without visible soiling and for preserving the integrity of the skin on the hands. Healthcare personnel who have demonstrated sensitivity to hand hygiene products selected for routine use in the facility should be evaluated by occupational health specialists, and accommodation with alternate products should be considered. Some extreme cases may need to transition to work that does not require frequent hand hygiene. Certain recommendations for hand cleaning, however, cannot be abridged. Monitoring hand hygiene compliance with just-in-time coaching has become recognized as an effective means of feedback to healthcare personnel. Monitoring should be accomplished by personnel internal and external to the PACU and should include peer feedback. Results of hand hygiene compliance audits should be reported to the organization.

  • Use ABHR for routine hand cleaning when hands are not visibly soiled. Use sufficient quantity to remain wet on all aspects of the hands and fingers for a minimum of 15 seconds.
  • Use ABHR or antimicrobial soap for handwashing before an invasive procedure such as IV insertion, bronchoscopy, or urinary-catheter insertion.
  • Use soap and water hand washing for visibly soiled hands.
  • Use soap and water hand washing after contact with patients with suspected or confirmed Norovirus or Clostridium difficile associated disease (CDAD) or their environments.
  • Use a surgical hand preparation before performing surgery.
  • Clean hands at the following times:
    • At the beginning of work
    • Upon entering and exiting the patient environment
    • Before and after patient contact, including dry skin contact
    • After removing gloves
    • Before performing invasive procedures
    • Before and after contact with wounds
    • After contact with patients’ bodily substances
    • After handling equipment, supplies, or linen contaminated with bodily substances
    • Before handling sterile or clean supplies
    • After using the restroom
    • After touching or blowing your nose
    • Before leaving the unit
  • Use hand lotion to prevent skin dryness and damage. However, limitations include:
    • Lotion may promote the growth of bacteria. Do not refill containers.
    • Petroleum and mineral oil-based lotions degrade latex (including latex-containing gloves).
    • Petrolatum-based lotions negate the persistent antimicrobial effect of chlorhexidine gluconate (CHG).
    • To maintain hand-skin integrity, use lotion at least four times per day when it can remain on clean hands for 30 minutes before the next washing. Suggested times include upon rising, at meal break(s), at the end of the work shift, and upon retiring.