Public Health Agency

Hand hygiene


Hand hygiene is the single most important way to prevent the spread/transmission of infection.

Hand hygiene can be performed with warm water and liquid soap (for cleaning soiled hands), warm water and antiseptic solution (prior to invasive procedures or after contact with patients or infective materials) or by using a hand sanitiser (for hands that are socially clean i.e. not visibly soiled).

There are some situations where hand sanitisers are ineffective.  They should not be used when the hands are visibly dirty or soiled. In this case, running water and liquid soap should be used. Also, most hand sanitisers are not effective against viral infections (e.g. vomiting and diarrhoea caused by Norovirus). They are also not effective against Clostridium difficile (CDI) and are not to be relied on with infectious diarrhoea. In both cases running water and liquid soap should be used.

Any building work or other development (including changes in the use of existing wards, units and clinical areas), must consider how adequate hand hygiene facilities are to be provided. Consultation with the Infection Prevention and Control Team is essential.

Click to download our Hand Hygiene Leaflet

Responsibilities of All Health Care Workers regarding Hand Hygiene


·       Familiarise themselves with the recommended hand hygiene technique

·       Incorporate the guidelines into their practice

·       Report defects in hand hygiene facilities to their manager


·       Assess hand hygiene facilities in their clinical areas

·       Ensure that there are an adequate number of dedicated clinical hand wash sinks with hands free or elbow controlled taps. Sinks should not have an overflow or plug and should be regularly cleaned as per local cleaning guidelines

·       Ensure that there is ready access to liquid soap and disposable hand towels at each clinical hand washing sink; these should in wall mounted dispensers

·       Report problems with providing hand hygiene facilities to their line-manager

·       Ensure that Hand Hygiene posters are placed at each clinical hand washing sink

Hand Hygiene procedure


To facilitate effective hand hygiene:

·       Wear sleeves above the elbows. If wearing long sleeves, these should be “rolled up” to above the elbows

·       REMOVE any hand or wrist jewellery with the exception of one plain band ring

·       Keep nails short and do not wear false nails, nail extensions, gel nails or nail varnish

·       Do not use bar soap or nail brushes


When to preform Hand Hygiene: The Five Moments for Hand Hygiene

The ‘Five Moments for Hand Hygiene from the World Health Organisation (WHO) guideline on Hand Hygiene,  define the key moments for hand hygiene. Not only do the Five Moments align with the evidence base concerning the spread of Healthcare Associated Infections (HCAI’s) but they are interwoven with the natural workflow of care and designed to be easy to learn, logical and applicable in a wide range of settings. These are the key times when healthcare workers must clean their hands to protect their patients from HCAI’s:

For further information on The Five Moments go to:                                                                                                                                                                               

How to Wash your Hands:  The Seven Step Technique

The same basic technique is applied for cleaning the hands whether using a liquid soap or a hand sanitiser.

Skin Care

Hand cream: Hands should be moisturised regularly. It is advisable to carry a personal tube of approved hand cream.  Where individual tubes are not available, multi-dose containers must be pump operated and should only be filled with a sealed cartridge from the manufacturing company.

Skin lesions: If any member of staff has a skin lesion, a chronic skin condition (e.g. eczema) or experiences skin problems associated with hand hygiene, they should consult the Occupational Health Department or seek medical advice. Staff with eczema have a higher risk of skin colonisation with micro-organisms and must pay close attention to skin care.

Cuts and abrasions on the hands must be covered with an impermeable dressing when in the clinical environment and when performing clinical procedures.

Hand Hygiene in the Community setting

Staff visiting a patient in their home should carry out hand hygiene on entering and on leaving. In most instances it will be appropriate to use the facilities within the home. Sometimes it may be necessary to complement or replace this with the use of a hand sanitiser.

How patients and visitors can help prevent the spread of infection

Patients: Hands should be washed after using the bathroom or toilet facilities, before eating food, after coughing or sneezing into the hands, after direct contact with pets/animals or when hands are visibly dirty. Hand wipes may also be used.

Visitors: Should protect themselves and patients by washing their hands when entering and leaving the ward/care home or by using liquid or foam hand sanitisers.


1. World Health Organisation guidance on Hand Hygiene (Available at

2. Five Moments for Hand Hygiene (Available at