Hand Hygiene
Objective
To raise awareness of the importance of hand hygiene and ensure staff understand the correct technique for effective handwashing.
Further information: Preventing Infection Workbook - Page 59
Why Hand Hygiene Matters
Hands are the main pathway for germ transmission in care homes. They can harbour invisible microorganisms that spread infections between residents, staff, and the wider environment.
Good hand hygiene is the single most effective way to prevent the spread of infection.
6 Handwashing Hot Spots
Most frequently missed areas according to scan data from millions of hands.
These areas are commonly missed during handwashing, listed from more frequently missed to less frequently missed:
More Frequently Missed Areas
1. Under the fingernails - Germs often remain trapped beneath nails.
2. Wrist area - Hands are washed, but wrists are often ignored.
3. In and around jewellery - Rings, bracelets, and watches can block effective handwashing. Remember to follow the "Bare Below the Elbows" policy when working in a social care environment.
4. Webbing of the hands - The skin between fingers is frequently overlooked.
Less frequently missed areas (but still important)
5. Ridges around nail polish - Polish and artificial nails can trap germs.
6. Knuckles, skin ridges, and palm lines - Creases and textured areas can retain bacteria.
When to Perform Hand Hygiene
Follow the "5 Moments for Hand Hygiene at the Point of Care" (Link to Official poster available in the Resources section below):
1. Before Resident Contact
When?
- Clean your hands before touching a resident.
Why?
- To protect the resident against harmful germs carried on your hands.
2. Before a Clean/Aseptic Procedure
When?
- Clean your hands immediately before any clean/aseptic procedure.
Why?
- To protect the resident against harmful germs, including the resident's own, from entering their body.
3. After Body Fluid Exposure Risk
When?
- Clean your hands immediately after an exposure risk to body fluids (and after glove removal).
Why?
- To protect yourself and the healthcare environment from harmful resident germs.
4. After Resident Contact
When?
- Clean your hands after touching a resident and his/her immediate surroundings when leaving the resident's side.
Why?
- To protect yourself and the healthcare environment from harmful resident germs.
5. After Contact with Resident Surroundings
When?
- Clean your hands after touching any object or furniture in the resident's immediate surroundings when leaving - even if the resident has not been touched.
Why?
- To protect yourself and the healthcare environment from harmful resident germs.
Other times to wash your hands include
- When visibly dirty or soiled.
- At the start and end of your shift.
- Before and after breaks.
- After using the toilet.
- After coughing, sneezing, or blowing your nose.
- After handling used laundry.
- After emptying commodes, urine bottles, or catheter bags.
Technique for Effective Handwashing
Care home staff should be "Bare below the elbow":
- Sleeves ending at the elbow.
- No wrist/hand jewellery (one plain band ring is allowed).
- Nails short, clean, and free from varnish, false, or gel nails.
Steps for washing with soap and water (should take at least 20 seconds):
- Wet hands and apply liquid soap.
- Rub palms together.
- Rub back of each hand with opposite palm.
- Interlace fingers and rub between them.
- Rub backs of fingers against opposite palms.
- Rotate and rub each thumb.
- Rub fingertips in opposite palm.
- Rinse thoroughly with water.
- Dry hands well with a clean towel.
- Use elbow to turn off tap.
When using alcohol hand rub
- Ensure hands are visibly clean.
- Apply enough product to cover all hand surfaces.
- Rub for at least 15 seconds until dry.
Alcohol hand gel is NOT effective against Clostridioides Difficile (C. diff) or Norovirus. If residents have Diarrhoea and Vomiting (D&V), hands must be washed with soap and water before using alcohol hand gel.
Supporting Residents
Residents should be encouraged to wash their hands regularly, especially before eating or drinking. Assist those who cannot manage independently.
Skin Care and Safety
- Use a hand moisturiser (personal or pump) to prevent dryness and chapping.
- Report any skin problems to your manager and seek advice from a pharmacist or GP.
- Keep cuts covered; if wounds make hand hygiene difficult, inform your line manager.
Auditing Hand Hygiene
Use the Hand Hygiene Observational Audit Tool:
- Complete during infection incidents and proactively at monthly intervals.
- The Care Home Manager and Infection Control Champion should review findings together and agree corrective actions.
- Keep completed audits for good practice evidence and for inspections by regulators such as Care Inspectorate Wales (CIW).
PPE and Hand Hygiene
Hand hygiene must be performed:
- Before putting on PPE (donning).
- After removing PPE (doffing).
Follow the correct PPE sequence and ensure compliance is regularly monitored using the PPE Donning and Doffing Audit Tool.
Resources
NHS official Donning/Doffing Audit Tool: PPE Audit Tool
Hand Hygiene Poster: publichealthwales.nhs.wales/services-and-teams/healthy-working-wales/workplace-guidance/healthy-work-environments/infection-prevention-and-control/guidance-and-resources/handwashing-poster/
5 Moments for Hand Hygiene at the Point of Care Poster.Your-5-moments-for-hand-hygiene-Care-Home-September-2020.pdf
Infection Prevention Control Hand Hygiene Audit Tool: Hand hygiene Audit Tool
NIPCM Hand Rub Poster: NIPCM Appendix 2: Best Practice - How to handrub step by step images
Infection Prevention Control Basic Hand Hygiene Audit Tool:Hand hygiene Audit Tool
Hand Hygiene Information Leaflet: Hand-hygiene-Leaflet-for-service-users-August-2025.pdf
Further Guidance Links
Handwashing Video Resource: https://www.nhs.uk/live-well/best-way-to-wash-your-hands/
PHW NIPCM Handwashing: Chapter 1 Standard Infection Control Precautions (SICPs) - Public Health Wales
Infection Prevention Control Hand Hygiene:Hand hygiene
