Updated Compendium Provides Practical Tools to Improve Hand Hygiene Among Health Care Personnel


New guidance provides recommendations on infection prevention strategies, performance measures, and how to implement these approaches.

Only 7% of people in health care effectively clean their entire hands, according to the new guidance Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene: 2022 Update, a compendium published in the journal Infection Control & Hospital Epidemiology.

Thumbs and fingertips were cited as the least cleaned parts on the surfaces of hands, and the guideline recommends that health care professionals be consistently trained in handwashing and sanitizer use.

“Hand hygiene is a basic function of healthcare safety,” said lead author Janet Glowicz, PhD, RN, CIC, with the US Centers for Disease Control and Prevention, in a recent press release. “By engaging healthcare personnel and establishing reliable processes described in the compendium, we can achieve effective, consistent hand hygiene.”

In the 2022 updated document (first published in 2008 and updated in 2014), the authors said that alcohol-based hand sanitizers are an important tool for healthy skin and nails. They noted that facilities make wall-mounted hand sanitizer dispensers widely available even when soap and water is the recommended cleaning measure. Wall-mounted dispensers are a better alternative to individual, pocket-sized hand sanitizers, the authors suggest.

Additionally, health care personnel should wear gloves if organisms, including C. difficile and noroviruses, could be present—in most situations, it is not recommended to use double gloves. Upon removing the gloves, health care personnel should follow the structured methods of hand washing and sanitizing.

Nails with nail polish, gel, and shellac are harder to clean than natural nails that have standard or no polish, evidence suggests. However, policies about these embellishments—along with nail extenders—should be left to the discretion of a facility’s infection prevention disease.

This is not the case for health care personnel who scrub for surgery or work in high-risk areas. They are recommended to have short, natural fingernails without any polish or extenders. Surgical personnel are further recommended to avoid brushes in surgery prep, and waterless hand hygiene is a good way to improve compendium compliance.

The guidance suggests that facilities can continue to encourage compliance of its recommendations by making decisions about hand sanitizers, moisturizers, and how effective they are with gloves and antiseptics using the suggestions of the health care personnel who work on-site.

The compendium combines the guidance of more than 100 global experts in a multiyear document. It is a systematic review of recent literature that provides expert consensus on an array of topics, from catheter-associated urinary tract infections and Clostridium difficile infections to methicillin-resistant Staphylococcus aureus infections and surgical site infections.

The guidance is sponsored by the Society for Healthcare Epidemiology, in collaboration with the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission.

“Commitment by healthcare leadership is also necessary to establishing a culture of safety,” Glowicz said in the press release.


Healthcare Epidemiology of America. Hand hygiene is focus of updated advice to prevent healthcare-associated infections. News Release. February 8, 2023. Accessed on February 8, 2023. https://www.eurekalert.org/news-releases/978850

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