Hand washing is the process of cleaning the hands with soap (or handwash) and water to remove dirt, bacteria, viruses, and other potentially harmful substances. It is a fundamental hygiene practice that helps prevent the spread of infectious diseases, especially in healthcare and pediatric settings.
The World Health Organization (WHO) and CDC emphasize that effective hand washing involves scrubbing all hand surfaces—including between fingers and under nails—for at least 20 seconds, followed by thorough rinsing and drying.
Healthcare providers are not the only ones required to do hand washing. Even the patients and family members are encouraged to learn proper handwashing techniques. Microorganisms may linger on the hands if not washed properly.
There are two preparations for handwashing techniques: (1) soap and water and (2) alcohol. Both are effective methods and are immensely influenced by sufficient rubbing friction and thoroughness of surfaces covered. Medical asepsis through the handwashing technique is done by lowering both hands below the elbow level. Distal body parts like the hands are considered the dirtiest or most contaminated.
Hand washing is done by running hands through water, soap, and friction, which lasts for 15 to 30 seconds. By doing this technique, dirt and other microorganisms are removed from the surfaces of the hands. Additionally, it is best to include cleaning the hidden parts, such as under the fingernails, to cover all aspects. It is ideal to use a clean paper towel to close the faucet after using it instead of bare hands.
Steps of Hand Washing Technique
Hand hygiene is the single most effective way to break the chain of infection removing pathogens by mechanical friction and rinsing with water or alcohol rubs for at least 20–60 seconds.
Hand Hygiene Using Soap and Water
Follow these steps for a thorough soap-and-water wash:
- Wet hands under running water.
- Apply enough liquid soap to cover all hand surfaces.
- Rub palms together (palm-to-palm).
- Right palm over left dorsum with fingers interlaced, then vice versa.
- Palm-to-palm with fingers interlaced.
- Backs of fingers to opposing palms with fingers interlocked.
- Rotational rubbing of each thumb clasped in opposite palm.
- Rotational rubbing of fingertips and nails in opposite palm.
- Rinse hands thoroughly under running water.
- Dry hands completely with a single-use towel.
- Use the towel to turn off the faucet and discard it—your hands are now safe.
When soap and water aren’t available, use a ≥60% alcohol-based handrub, covering all surfaces and rubbing until dry (≈20 seconds).
Hand Hygiene Using Alcohol Based Hand Rub
Follow these steps for a complete alcohol-based handrub—covering all hand surfaces and ensuring a minimum 20-second application time:
- Apply a palmful of product and rub palms together to distribute it evenly.
- Right palm over left dorsum with interlaced fingers, then left palm over right dorsum.
- Palm to palm with fingers interlaced—spreading the rub between fingers.
- Backs of fingers to opposing palms with fingers interlocked (knuckles rubbing).
- Rotational rubbing of each thumb: clasp left thumb in right palm and vice versa.
- Rotational rubbing of fingertips and nails in opposite palms (circling fingertips).
- Rotational rubbing of wrists: clasp wrist in opposite palm and rub.
- Continue rubbing all surfaces — until hands feel dry, at least 20–30 seconds total.
Hands are safe when completely dry—no towel or rinsing needed.
For healthcare settings, perform hand hygiene at the WHO’s “Five Moments”:
- Before patient contact
- Before aseptic tasks
- After body-fluid exposure risk
- After patient contact
- After contact with patient surroundings
The Five Moments for Hand Hygiene
The World Health Organization devised an approach to prevent the spread of infection through hand washing. According to WHO, there are five significant instances where the nurse or healthcare provider should strictly do hand washing techniques.
Here are the WHO’s “Five Moments for Hand Hygiene”, designed to minimize pathogen transmission in healthcare settings:
| Moment | When | Why |
|---|---|---|
| 1. Before Patient Contact | Immediately before touching the patient or their surroundings. | Protect the patient from harmful microorganisms carried on HCW’s hands. |
| 2. Before Aseptic Task | Before performing any clean/aseptic procedure (e.g., IV insertion, wound dressing). | Prevent pathogens from entering sterile body sites. |
| 3. After Body Fluid Exposure Risk | After exposure (or risk) to blood, bodily fluids, secretions, excretions (even gloves). | Protect HCW and environment from contamination. |
| 4. After Patient Contact | Immediately after touching the patient or their immediate surroundings. | Prevent transmission of microorganisms to HCWs and the environment. |
| 5. After Contact with Patient Surroundings | After touching any object or furniture near the patient, even without touching the patient. | Avoid transferring pathogens from patient environment to HCWs or other areas. |
Key Reminders
- Scrub for at least 20 seconds (hum the “Happy Birthday” song twice).
- Use alcohol-based hand rub (60–95% alcohol) if soap and water are unavailable and hands are not visibly soiled.
- Always wash hands before and after patient contact, after using the toilet, before eating, and after coughing or sneezing.
Reference:
- Allergy & Asthma Network. Eczema and Washing Hands Frequently https://allergyasthmanetwork.org/news/eczema-and-washing-hands-frequently/.
- American Academy of Pediatrics. Hand Washing: A Powerful Antidote to Illness (https://www.healthychildren.org/English/health-issues/conditions/prevention/Pages/Hand-Washing-A-Powerful-Antidote-to-Illness.aspx). Last updated 2/7/2022.
- Canadian Centre for Occupational Health and Safety. Hand Washing: Reducing the Risk of Common Infections (https://www.ccohs.ca/oshanswers/diseases/washing_hands.html). Fact sheet last revised 2/17/2021.
- Centers for Disease Control and Prevention (U.S.). Multiple pages on handwashing (https://www.cdc.gov/handwashing/index.html). Last reviewed 5/4/2023.
- National Health Service (U.K.). How to wash your hands (https://www.nhs.uk/live-well/best-way-to-wash-your-hands/). Last reviewed 1/27/2023.
- U.S. Department of Agriculture. Study Shows Most People Are Spreading Dangerous Bacteria Around the Kitchen and Don’t Even Realize It (https://www.usda.gov/media/press-releases/2018/06/28/study-shows-most-people-are-spreading-dangerous-bacteria-around). Press release 6/28/2018.
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