Hand Hygiene
Hand hygiene is the single most effective measure to prevent the spread of infections in health and social care settings (WHO). Get it right and you protect your residents, your colleagues, and yourself.
The evidence is clear:The World Health Organization (WHO) and the Department of Health & Social Care both identify hand hygiene as the most important measure in preventing healthcare-associated infections. CQC inspectors observe hand hygiene compliance as part of the “Safe” key question assessment.
The WHO 5 Moments of Hand Hygiene
The World Health Organization defines five critical moments when hand hygiene must be performed in health and social care settings. These apply to every care interaction in a care home.
Before Touching a Resident
Wash or sanitise your hands before touching a resident or having any contact with their skin, clothing, or personal items.
Why: Protects the resident from organisms on your hands, including your own flora and organisms picked up from the environment or other residents.
Before Clean / Aseptic Procedure
Wash or sanitise your hands immediately before any clean or aseptic procedure, such as wound care, catheter care, or preparing food.
Why: Protects the resident from organisms entering their body during procedures that bypass natural defence barriers.
After Body Fluid Exposure Risk
Wash your hands immediately after any task that involves exposure to body fluids, including after glove removal.
Why: Protects you and the care environment from organisms that may have transferred to your hands during the procedure or from body fluid contact.
After Touching a Resident
Wash or sanitise your hands after touching a resident or having any contact with their skin, clothing, or personal items.
Why: Protects you and the care environment from organisms that may have transferred to your hands from the resident.
After Touching Resident Surroundings
Wash or sanitise your hands after touching any object, surface, or furniture in the resident's immediate environment — even if the resident was not directly touched.
Why: Protects you and the care environment from organisms that can survive on surfaces and equipment in the resident's surroundings.
Handwashing Technique
When hands are visibly soiled or after using the toilet, hands must be washed with soap and water. The WHO recommends the following technique, which should take approximately 40–60 seconds from wet hands to dry hands.
Wet hands with water
Apply enough soap to cover all hand surfaces
Rub hands palm to palm
5 seconds
Right palm over left dorsum with interlaced fingers and vice versa
5 seconds
Palm to palm with fingers interlaced
5 seconds
Backs of fingers to opposing palms with fingers interlocked
5 seconds
Rotational rubbing of left thumb clasped in right palm and vice versa
5 seconds
Rotational rubbing, backwards and forwards, with clasped fingers of right hand in left palm and vice versa
5 seconds
Rinse hands with water
Dry hands thoroughly with a single-use towel
Use the towel to turn off the tap
Alcohol-Based Hand Rub
Alcohol-based hand rub (ABHR) is the preferred method for routine hand decontamination when hands are not visibly soiled. It is faster, more effective, and better tolerated by skin than soap and water.
When to Use ABHR
- Before touching a resident (Moment 1)
- Before a clean/aseptic procedure (Moment 2)
- After touching a resident (Moment 4)
- After touching resident surroundings (Moment 5)
- When hands are NOT visibly soiled
When NOT to Use ABHR
- When hands are visibly soiled
- After using the toilet (use soap and water)
- After body fluid exposure (Moment 3 — use soap and water)
- When caring for a resident with Clostridioides difficile (spores are alcohol-resistant)
- When caring for a resident with norovirus (use soap and water)
Bare Below the Elbows
The “bare below the elbows” (BBE) policy requires clinical staff to have bare forearms when delivering direct care. This ensures effective hand hygiene and reduces the risk of contamination from clothing, watches, and jewellery.
- •Short sleeves — no long sleeves when delivering care
- •No wristwatches or jewellery (a plain wedding band is usually acceptable)
- •No nail polish or artificial nails — these harbour bacteria
- •Nails should be kept short and clean
Further Reading
Important Notice
Care Handbook is a guidance resource only. It does not replace your organisation's policies, formal training, or current CQC standards. Always follow your employer's specific procedures and consult your line manager or the relevant professional body if you are unsure.