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Action Figure 8b Areas most commonly missed following handwashing.

Reproduced by kind permission of the Nursing Times where this first appeared in 1978.

Procedure guideline 3.2 Hand decontamination using alcohol handrub

Essential equipment

Alcohol-based handrub

Procedure

Action Rationale

1 Dispense the amount of handrub indicated in the manufacturer’s instructions into the palm of one hand. Too much handrub will take longer to dry and may consequently cause delays; too little will not decontaminate hands adequately. E

2 Rub the alcohol handrub into all areas of the hands, until the hands are dry, using the illustrated actions in Action Figure 2. To ensure all areas of the hands are cleaned. Alcohol is a rapid-acting disinfectant, with the added advantage that it evaporates, leaving the hands dry. This prevents contamination of equipment, whilst facilitating the application of gloves (WHO 2009, C, E).

Action Figure 2 Alcohol handrub hand hygiene technique – for visibly clean hands. Adapted from WHO (2009).

© Crown copyright.

Reproduced under the terms of the Click-use Licence.

Procedure guideline 3.3 Putting on and removing non-sterile gloves

Essential equipment

Non-sterile gloves

Preprocedure

Action Rationale

1 Clean hands before putting on gloves. Hands must be cleansed before and after every patient contact or contact with patient’s equipment (Pratt et al. 2007, C).

Procedure

2 Remove gloves from the box singly (see Action Figure 2), to prevent contamination of the gloves lower down. If it is likely that more than two gloves will be required (i.e. if the procedure requires gloves to be changed part-way through), consider removing all the gloves needed before starting the procedure. To prevent cross-contamination. E

3 Holding the cuff of the glove, pull it into position, taking care not to contaminate the glove from the wearer’s skin (see Action Figure 3). This is particularly important when the second glove is being put on, as the gloved hand of the first glove can touch the skin of the ungloved second hand if care is not taken. To prevent cross-contamination. E

4 During the procedure or when undertaking two procedures with the same patient, it may be necessary to change gloves. Gloves are single-use items and must not be cleansed and reused. Disposable gloves are single-use items. They cannot be cleaned and reused for the same or another patient (MHRA 2006, C).

5 If gloves become damaged during use they must be replaced. Damaged gloves are not an effective barrier. E

6 Remove the gloves when the procedure is completed, taking care not to contaminate the hands or the environment from the outside of the gloves. The outside of the glove may be contaminated. E

7 Remove the first glove by firmly holding the outside of the glove wrist and pulling off the glove in such a way as to turn it inside out (see Action Figure 7). Whilst removing the first glove, the second gloved hand continues to be protected. By turning the glove inside out during removal, any contamination is contained inside the glove. E

8 Remove the second glove by slipping the fingers of the ungloved hand inside the wrist of the glove and pulling it off whilst at the same time turning it inside out (see Action Figure 8). By putting the fingers inside the glove, they will not be in contact with the potentially contaminated outer surface of the glove. E

Postprocedure

9 Dispose of used gloves as ‘hazardous infectious waste’ (see Action Figure 9), that is, into an orange waste bag, unless instructed otherwise by the infection prevention and control team. All waste contaminated with blood, body fluids, excretions, secretions and infectious agents thought to pose a particular risk should be disposed of as hazardous infectious waste. Orange is the recognized colour for hazardous infectious waste that does not require incineration and may be made safe by alternative treatment (DH 2006a, C).

10 After removing the gloves, decontaminate your hands. Hands may have become contaminated