Quality standard

Quality statement 3: Hand decontamination

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

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

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

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by organisations, for example, from procurement records.

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

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from training records.

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

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, records of hand hygiene observation audits.

Outcome

Incidence of healthcare-associated infection.

Data source: 2020/21 NHS Outcomes Framework indicator 5.2.

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.

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.

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's guideline on healthcare-associated infections, 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's guideline on healthcare-associated infections]