Handwashing
October - 2002
Guideline for Hand Hygiene in Health-Care Settings as publish by the Centers for Disease Control and Prevention
25.oct.02
Centers for Disease Control and Prevention
http://www.cdc.gov/MMWR/preview/mmwrhtml/rr5116a1.htm
On October 25, 2002, The Centers for Disease Control (CDC) published their updated hand hygiene guidelines, developed by CDC's Health Care Infection Control Practices Advisory Committee (HICPAC), in collaboration with the Society for Healthcare Epidemiology of America (SHEA), the Association of Professionals in Infection Control and Epidemiology (APIC), and the Infectious Disease Society of America (IDSA). This report, Guideline for Hand Hygiene in Health Care Settings, is part of an overall CDC strategy to promote patient safety by reducing infections.
The most important changes concern recommendations for use of hand sanitizers. In 1961, the US Public Health Service produced a training film that demonstrated hand washing techniques recommended for use by health care workers (HCWs). At the time, recommendations directed that personnel wash their hands with soap and water for 1--2 minutes before and after patient contact. Rinsing hands with an antiseptic agent was believed to be less effective than hand washing and was recommended only in emergencies or in areas where sinks were unavailable.
In 1975 and 1985, formal written guidelines on hand washing practices in hospitals were published by CDC. These guidelines recommended hand washing with nonantimicrobial soap between the majority of patient contacts and washing with antimicrobial soap before and after performing invasive procedures or caring for patients at high risk. Use of waterless antiseptic agents (eg, alcohol-based solutions) was recommended only in situations where sinks were not availableIn 1988 and 1995, guidelines for hand washing and hand antisepsis were published by the Association for Professionals in Infection Control (APIC) Recommended indications for hand washing were similar to those listed in the CDC guidelines. The 1995 APIC guideline
included more detailed discussion of alcohol-based hand rubs and supported their use in more clinical settings than had been recommended in earlier guidelines. In 1995 and 1996, the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommended that either antimicrobial soap or a waterless antiseptic agent be used for cleaning hands upon leaving the rooms of patients with multidrug-resistant pathogens (eg, vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus. These guidelines also provided recommendations for hand washing and hand antisepsis in other clinical settings, including routine patient care. The following recommendations were prepared by a task force comprising representatives from HICPAC, the Society for Healthcare
Epidemiology of America (SHEA), APIC, and the Infectious Diseases
Society of America (IDSA).
These recommendations are designed to improve hand hygiene practices of HCWs and to reduce transmission of pathogenic microorganisms to patients and personnel in health care settings. This guideline and its recommendations are not intended for use in food processing or food service establishments, and are not meant to replace guidance provided by FDA's Model Food Code. As in previous CDC/HICPAC guidelines, each recommendation is categorized on the basis of existing scientific data, theoretical rationale, applicability, and economic impact.
The full CDC report of October 2002 is available at the following Web
site: www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm
Under these guidelines they still should be providing soap: 
1. When hands are visibly dirty or contaminated with proteinaceous
material or are visibly soiled with blood or other body fluids, wash
hands with either a nonantimicrobial soap and water or an
antimicrobial soap and water (IA).
2. If hands are not visibly soiled, use an alcohol-based hand rub for
routinely decontaminating hands in the following clinical situations
(IA):
(An alternative is to wash hands with an antimicrobial soap and water
[IB])
a. Before direct contact with patients (IB)
b. Before donning sterile gloves when inserting a central
intravascular catheter (IB)
c. Before inserting indwelling urinary catheters, peripheral vascular
catheters, or other invasive devices that do not require a surgical
procedure (IB)
d. After contact with a patient's intact skin (eg, when taking a
pulse or blood pressure, or when lifting a patient) (IB).
e. After contact with body fluids or excretions, mucous membranes,
nonintact skin, and wound dressings if hands are not visibly soiled
(IA).
f. If moving from a contaminated-body site to a clean-body site
during patient care (II).
g. After contact with inanimate objects (including medical equipment)
in the immediate vicinity of the patient (II).
h. After removing gloves (IB).
3. Before eating and after using a restroom, wash hands with a
nonantimicrobial soap and water or with an antimicrobial soap and
water (IB).
4. Antimicrobial-impregnated wipes (ie, towelettes) may be considered
as an alternative to washing hands with nonantimicrobial soap and
water but should not be substituted for washing hands with an
antimicrobial soap and water or using an alcohol-based hand rub.
These towelettes are not as effective for reducing bacterial counts
on the hands (IB).
5. Wash hands with nonantimicrobial soap and water or with
antimicrobial soap and water if exposure to Bacillus anthracis is
suspected or proven. The physical action of washing and rinsing hands
under such circumstances is recommended because alcohols,
chlorhexidine, iodophors, and other antiseptic agents have poor
activity against spores (II).
Unresolved issue: the use of nonalcohol-based hand rubs for hand
hygiene in health care settings (No recommendation)