2.2 Hand Hygiene & Glove Use Standards

2.2 Hand Hygiene & Glove Use Standards

CDC & WHO Hand Hygiene Guidelines

Hand hygiene is universally recognized by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) as the single most effective measure to prevent healthcare-associated infections (HAIs) and halt antimicrobial resistance.

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|                        HAND HYGIENE METHOD SELECTION                    |
+-------------------------------------------------------------------------+
                                     |
                  Are hands visibly soiled with blood/fluids?             |
                  Is patient suspected/confirmed for C. diff?             |
                                     |                                    
                     +---------------+---------------+                    
                     |                               |                    
                   [YES]                            [NO]                  
                     |                               |                    
                     v                               v                    
        +-------------------------+     +-------------------------+       
        | SOAP & WATER WASHING    |     | ALCOHOL-BASED HAND RUB  |       
        | - Warm water & soap     |     | - 60% to 95% alcohol    |       
        | - Minimum 20 seconds    |     | - Rub all surfaces      |       
        | - Friction on all areas |     | - 15 to 20 sec dry time |       
        | - Paper towel turn-off  |     | - Fast, highly effective|       
        +-------------------------+     +-------------------------+       

Alcohol-Based Hand Rub (ABHR)

Alcohol-based formulations containing 60% to 95% ethyl alcohol or isopropanol are the gold standard for routine hand decontamination across clinical settings when hands are not visibly soiled.

• Mechanism of Action: Alcohols rapidly denature proteins, disrupt cell membranes, and dissolve lipid envelopes of vegetative bacteria, mycobacteria, fungi, and enveloped viruses (including HBV, HCV, HIV, and coronaviruses).
• Application Technique:
  1. Apply a manufacturer-recommended palmful of product (typically 1.5 to 3 mL) into a cupped hand.
  2. Rub hands vigorously, ensuring complete coverage of all anatomical surfaces: palm to palm, backs of hands, interlaced fingers, back of fingers to opposing palms, thumbs (rotational rubbing), fingernails/fingertips against palms, and wrists.
  3. Continue rubbing until all surfaces are completely dry, which takes approximately 15 to 20 seconds.
  4. Do not wipe hands on paper towels or clothing while damp, as this removes the active antimicrobial agent before it achieves full efficacy.
• Clinical Advantages: Significantly faster than sink washing, more accessible at the point of care (wall dispensers and mobile carts), causes less dermal irritation and dryness than repeated soap washing due to added emollients, and produces superior bacterial count reductions on clean skin.

Mechanical Soap and Water Washing

Handwashing using plain soap or antimicrobial soap and running water relies on physical friction and surfactant chemistry to lift, emulsify, and rinse away transient flora, debris, and chemical residues.

• Mandatory Indications:
  1. When hands are visibly soiled with blood, body fluids, secretions, excretions, or specimen matter.
  2. After direct contact with or caring for patients with confirmed or suspected spore-forming organisms, particularly Clostridioides difficile (C. diff) and Bacillus anthracis. Bacterial endospores possess a resilient keratinaceous coat that resists denaturation by alcohol; physical mechanical rinsing down the drain is mandatory.
  3. After exposure to non-enveloped enteric viruses such as Norovirus and Rotavirus, which exhibit high tolerance to alcohol rubs.
  4. Before eating, drinking, or handling food.
  5. After using restroom facilities.
  6. When experiencing personal skin irritation or heavy chemical accumulation.
• Standard Procedure (Minimum 20 Seconds):
  1. Turn on water and adjust to a comfortable warm temperature (avoid hot water, which strips natural oils and causes dermatitis).
  2. Wet hands and wrists thoroughly under running water.
  3. Apply an adequate amount of liquid soap (avoid bar soap, which harbors microorganisms).
  4. Lather thoroughly and rub all surfaces vigorously for at least 20 seconds (the duration of singing "Happy Birthday" twice). Include palms, dorsum of hands, interdigital web spaces, knuckles, thumbs, subungual areas (under fingernails), and wrists.
  5. Rinse hands thoroughly under running water with fingers pointed downward, allowing water to flow from the cleanest area (wrists) to the dirtiest area (fingertips) into the basin without touching the sink bowl.
  6. Dry hands completely with clean, single-use paper towels, moving from fingers up to wrists.
  7. Turn off the manual faucet using a fresh, dry paper towel; never touch faucet handles with clean, bare hands, as faucet fixtures are heavily colonized reservoirs.

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The WHO "5 Moments for Hand Hygiene" in Phlebotomy

The World Health Organization defined five distinct clinical moments when hand hygiene must occur during patient care encounters. Phlebotomists must integrate these moments into their standard workflow:

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|                 WHO 5 MOMENTS APPLIED TO PHLEBOTOMY                     |
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| Moment 1 | BEFORE touching a patient (greeting, palpating, positioning) |
| Moment 2 | BEFORE clean/aseptic procedure (disinfecting site, needle)   |
| Moment 3 | AFTER body fluid exposure risk (needle withdrawal, tubes)    |
| Moment 4 | AFTER touching a patient (bandaging, unfastening tourniquet) |
| Moment 5 | AFTER touching patient surroundings (bedrails, chair, tray)  |
+-------------------------------------------------------------------------+

1. Moment 1: Before Touching a Patient
   • Phlebotomy Action: Perform hand hygiene upon entering the patient room or greeting the outpatient before physical contact (e.g., shaking hands, checking wristband, positioning the arm).
   • Purpose: Protects the patient from colonizing microorganisms carried on the phlebotomist's hands.
2. Moment 2: Before a Clean / Aseptic Procedure
   • Phlebotomy Action: Perform hand hygiene immediately before assembling sterile venipuncture equipment, selecting tubes, applying antiseptic to the skin, and donning sterile or clean gloves.
   • Purpose: Prevents harmful microorganisms, including the phlebotomist's transient skin flora, from entering the patient's vascular system.
3. Moment 3: After Body Fluid Exposure Risk
   • Phlebotomy Action: Perform hand hygiene immediately after needle withdrawal, disposing of contaminated sharps, handling filled specimen tubes, and doffing gloves.
   • Purpose: Protects the phlebotomist and prevents cross-contamination of the wider healthcare environment.
4. Moment 4: After Touching a Patient
   • Phlebotomy Action: Perform hand hygiene after completing the draw, applying pressure/bandage, verifying post-draw stability, and concluding patient contact.
   • Purpose: Eliminates patient microflora acquired during the physical interaction before moving to other duties.
5. Moment 5: After Touching Patient Surroundings
   • Phlebotomy Action: Perform hand hygiene after touching inanimate objects in the patient zone (e.g., adjusting bedrails, touching bedside monitors, adjusting the phlebotomy chair, handling bedside tables), even if the patient was not directly touched.
   • Purpose: Prevents indirect transmission of environmental pathogens to subsequent patients or clean laboratory counters.

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Glove-Wearing Principles in Phlebotomy

The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard strictly mandates that healthcare personnel wear non-sterile medical examination gloves during all vascular access procedures, capillary skin punctures, and when handling blood or other potentially infectious materials (OPIM).

Core Rules of Glove Use

• Gloves Do Not Replace Hand Hygiene: Gloves have microscopic porosity and can develop imperceptible micro-tears during use. Additionally, hands become colonized or contaminated during the glove removal process. Hand hygiene must be performed immediately BEFORE donning gloves and immediately AFTER doffing gloves.
• One Patient, One Pair: Never wear the same pair of gloves for more than one patient. A fresh pair of gloves must be donned for every individual patient encounter.
• No Washing or Sanitizing Gloves: Never wash, rinse, or apply alcohol-based hand rub to disposable examination gloves. Alcohol degrades glove polymers (latex, nitrile, vinyl), causing micro-punctures, increased permeability, and barrier failure.
• Proper Sizing and Fit: Gloves should fit snugly without being excessively tight (which causes fatigue and tears) or loose (which impairs fine tactile sensitivity during vein palpation).
• Damaged Gloves: If a glove tears, punctures, or becomes heavily contaminated during a venipuncture procedure, remove the gloves safely, perform hand hygiene immediately, and don a new pair before proceeding.