Quality statement 3: Hand decontamination

Quality statement

People receive healthcare from healthcare workers who decontaminate their hands immediately before and after every episode of direct contact or care.

Rationale

Effective hand decontamination, even after wearing gloves, results in significant reductions in the carriage of potential pathogens on the hands and decreases the incidence of preventable healthcare-associated infections, leading in turn to a reduction in morbidity and mortality. Hand decontamination is considered to have a high impact on outcomes that are important to patients. Although hand hygiene has improved over recent years, remaining misconceptions about this standard principle of infection control are reported and good practice is still not universal.

Quality measures

Structure

a) Evidence of local arrangements to ensure the availability of facilities for hand decontamination.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that all healthcare workers receive training in hand decontamination.

Data source: Local data collection.

c) Evidence of local arrangements to ensure that regular local hand hygiene observation audits are undertaken.

Data source: Local data collection.

Outcome

Incidence of healthcare-associated infection.

Data source: 2014/15 NHS Outcomes Framework indicator 5.2.

What the quality statement means for service providers, healthcare workers and commissioners

Service providers ensure that healthcare workers are trained in effective hand decontamination techniques, and that handrub and handwashing facilities are available so that healthcare workers can decontaminate their hands immediately before and after every episode of direct contact or care.

Healthcare workers ensure that they are trained in effective hand decontamination techniques, and that they decontaminate their hands immediately before and after every episode of direct contact or care, even when gloves have been worn.

Commissioners ensure that they commission services in which healthcare workers are trained in effective hand decontamination techniques and decontaminate their hands immediately before and after every episode of direct contact or care, and that hand hygiene observation audits are carried out regularly.

What the quality statement means for patients, service users and carers

People receiving healthcare are looked after by healthcare workers who always clean their hands thoroughly (using handrub or soap and water), both immediately before and immediately after coming into contact with the person or carrying out care.

Source guidance

Definitions of terms used in this quality statement

Hand decontamination

Hand decontamination is the use of handrub or handwashing to reduce the number of bacteria on the hands. The term is often interchangeable with 'hand hygiene'.

An alcohol-based handrub should be used for hand decontamination before and after direct contact or care, except in the following situations when soap and water must be used:

  • when hands are visibly soiled or potentially contaminated with body fluids or

  • when caring for patients with vomiting or diarrhoeal illness, regardless of whether or not gloves have been worn.

[Adapted from NICE clinical guideline 139, recommendation 1.1.2.2, and epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England, recommendation SP7]

Direct contact or care

Direct contact or care refers to 'hands on' or face-to-face contact with patients. This encompasses any physical aspect of the healthcare of a patient, including treatments, self-care and administration of medication. [NICE clinical guideline 139]