Why is hand hygiene important in healthcare

A number of infectious diseases can be spread from one person to another by contaminated hands.

These diseases include gastrointestinal infections, such as salmonellosis, and respiratory infections, such as influenza, colds and coronavirus (COVID-19) .

Washing your hands properly with soap and water can help prevent the spread of the germs (like bacteria and viruses) that cause these diseases.

Some forms of gastrointestinal and respiratory infections can cause serious complications, especially for young children, the elderly, or those with a weakened immune system.

When to wash your hands

You should wash your hands thoroughly:

• after using the toilet
• after changing nappies
• before, during and after preparing food
• between handling raw and cooked or ready-to-eat food
• before eating
• after blowing your nose, coughing or sneezing
• after using a tissue or handkerchief
• before and after attending to sick children or other family members
• after smoking
• after handling rubbish or working in the garden
• after handling animals
• when you get home, arrive at other people’s homes, at venues or at work.

Avoid touching your eyes, nose, and mouth with unwashed hands.

If you feel a cough or sneeze is coming on, make sure to cough or sneeze into a tissue and then throw it away and wash your hands.

If you do not have a tissue, cough or sneeze into your elbow. It’s a part of your body less likely to touch other surfaces and will help stop the spread of nasty germs.

How to wash your hands properly

To wash hands properly:

• Wet your hands with clean, running water, turn off the tap.
• Apply soap and lather well for 20 seconds (or longer if the dirt is ingrained).
• Rub hands together rapidly across all surfaces of your hands and wrists.
• Don’t forget the backs of your hands, your wrists, between your fingers and under your fingernails.
• If possible, remove rings and watches before you wash your hands, or ensure you move the rings to wash under them, as microorganisms can exist.
• Rinse well under running water and make sure all traces of soap are removed.
• Dry your hands using a clean towel or air dry them.
• It is best to use paper towels (or single-use cloth towel).
• Dry under any rings, as they can be a source of future contamination if they remain moist.
• Hot air driers can be used.

At home, give each family member their own towel and wash the towels often.

Use running water

Use running water instead of a basin of standing water that could become contaminated through use.

Warm water may be better than cold for handwashing as soap lathers (soaps up) better with warm water. However, cold water and soap are still suitable.

Hot water can damage the skin’s natural oils. Over time, this can cause dermatitis.

Soap is important

Washing hands with soap and water will remove substantially more disease-causing organisms than washing hands with water alone.

For people who find that soap causes skin irritation, it is useful to note that soaps can have a different pH – they may be neutral, slightly alkaline or slightly acidic, and perfumes in soap may also cause irritation. Changing soap may help some people.

Liquid soap is best

Generally, it is better to use liquid soap than bar soap, particularly at work. However, bar soap is better than no soap.

No advantage to using antibacterial soap

When following the handwashing steps outlined above, all soaps are equally effective at removing disease causing germs. Antibacterial soap is unnecessary and does not offer an advantage over regular soap.

Soap and water is better than hand sanitiser

Alcohol-based hand sanitisers are effective against some viruses (such as coronavirus), however they are not effective against gastroenteritis.

Washing hands with soap and water is the best way to prevent gastroenteritis infection.

It is best to wash hands with soap and water. If unavailable, use alcohol-based hand sanitiser containing at least 60% alcohol.

Take care of your hands

Handwashing is only one part of hand hygiene. Looking after your skin generally is important, as your skin is your most effective barrier against infection.

After your hands have been dried thoroughly, you can help to look after your hands if you:

• Apply a water-based absorbent hand cream 3 to 4 times a day, or more frequently if your hands are constantly in water.
• Use gloves when washing dishes to protect your hands.
• Use gloves when gardening to prevent a build-up of ingrained soil or scratches.
• Consult a doctor if a skin irritation develops or continues.

Teach hand hygiene to children

The creation of healthy habits during childhood is important to ensure lifelong healthy decisions and actions.

Get kids involved with ‘Soapy Hero’ training to help keep their classmates, family and friends healthy and stop the spread of dangerous infectious diseases with hand hygiene.

Watch this video about hand hygiene.

Where to get help

• Your GP (doctor)
• Your local council’s health department
• Dermatologist

Improving hand hygiene among healthcare workers is a key strategy to minimise the spread of antibiotic-resistant organisms within hospitals and has been prioritised by the Australian Commission on Safety and Quality in Health Care (ACSQHC). Poor hand hygiene compliance among healthcare workers is strongly associated with healthcare associated infection (HAI) transmission and is a major factor in the spread of antibiotic-resistant organisms within hospitals. Improving hand hygiene among healthcare workers will help minimise the spread of antibiotic-resistant organisms within hospitals and has been prioritised by the Australian Commission on Safety and Quality in Health Care (ACSQHC).

The ACSQHC has engaged Hand Hygiene Australia to implement the National Hand Hygiene Initiative. The National Hand Hygiene Initiative aims to improve hand hygiene compliance of healthcare workers in acute care settings.

Read more about the initiative and find Hand Hygiene Australia's resources:

Improving hand hygiene compliance in healthcare workers is reliant on a number of factors including, human behaviour, organisational culture and leadership. A multifaceted approach is required in order to achieve improved hand hygiene compliance.

Risks associated with poor hand hygiene

Healthcare associated infections (HAIs) pose a serious threat to people admitted to hospital and contribute to the economic burden of healthcare.

• Micro-organisms are readily transmitted on health care workers' hands
• It is estimated that there are around 200,000 HAIs in Australian hospitals each year1.
• It is possible to reduce HAIs by using effective infection prevention practices, such as improving hand hygiene compliance.1
• Research has shown that improving hand hygiene compliance is about human behaviour, organisational culture and leadership and requires a multifaceted approach to achieve improved hand hygiene compliance.

Hand Hygiene Compliance Application

The Hand Hygiene Compliance Application (HHCApp) has been developed for use by Australian hospitals to conveniently report their Hand Hygiene Compliance rates as part of the National Hand Hygiene Initiative. The HHCApp can be accessed from a mobile web browser, allowing the use of mobile devices to gather data.

For further information or to login please go to the HHCApp page at Hand Hygiene Australia.

Compliance

There are many reasons for suboptimal hand hygiene compliance among healthcare workers, including:

• Environment - location and/or availability of hand washing sinks
• Organisational - availability of high profile clinical role models
• Psychological - a perceived lack of time for hand hygiene
• Education - for example, misconceptions about when hand hygiene should be performed
• Physical factors - for example skin irritation and dryness

Research has shown that behavioural change requires a multi-level, multidisciplinary, multi-modal program. Hand hygiene compliance programs should consider:

• Education programs
• Feedback and positive reinforcement
• Administrative mandate (and sometimes organisational culture and system change)
• Leadership and motivation

Hand Hygiene Australia (HHA) provides resources and guidance for all Australian healthcare facilities.

Last updated: 13 November 2019