1.2 Hand Hygiene

Image of hand for practise good hand hygieneHand hygiene is considered an important practice in reducing the transmission of infectious agents which cause infections.

Hand washing sinks must only be used for hand hygiene and must not be used for the disposal of other liquids. (See Appendix 3 of Pseudomonas Guidance)

Before performing hand hygiene:

Hand washing should be extended to the forearms if there has been exposure of forearms to blood and/or body fluids.

 *For health and safety reasons, Scottish Ambulance Service Special Operations Response Teams (SORT) in high-risk situations require to wear a wristwatch.

To perform hand hygiene

Alcohol Based Hand Rubs (ABHRs) must be available for staff as near to point of care as possible. Where this is not practical, personal ABHR dispensers should be used.

Application of sufficient volume of ABHR to cover all surfaces of the hands is important to ensure effective hand hygiene. Manufacturer’s instruction should be followed for the volume of ABHR required to provide adequate coverage for the hands. In the absence of manufacturers instructions, volumes of approximately 3ml are recommended to ensure full coverage.

The World Health Organization’s ‘5 moments for hand hygiene’ should be used to highlight the key indications for hand hygiene.

poster showing who 5 moments for hand hygiene

  1. before touching a patient
  2. before clean/aseptic procedures. If ABHR cannot be used, then antimicrobial liquid soap should be used
  3. after body fluid exposure risk
  4. after touching a patient
  5. after touching a patient’s immediate surroundings

Some additional examples of hand hygiene moments include but are not limited to: 

Download and print the 5 moments of hand hygiene poster.

Wash hands with non-antimicrobial liquid soap and water if:

Hands should be washed with warm/tepid water to mitigate the risk of dermatitis associated with repeated exposures to hot water and to maximise hand washing compliance. Compliance may be compromised where water is too hot or too cold. Hands should be dried thoroughly following hand washing using a soft, absorbent, disposable paper towel from a dispenser which is located close to the sink but beyond the risk of splash contamination.

In all other circumstances use ABHRs for routine hand hygiene during care.

Staff working in the community should carry a supply of ABHRs to enable them to perform hand hygiene at the appropriate times. 

Where staff are required to wash their hands in the service user’s own home they should do so for at least 20 seconds using any hand soap available. 

Staff should carry a supply of disposable paper towels for hand drying rather than using hand towels in the individual’s own home.  Once hands have been thoroughly dried, ABHR should be used.

The use of antimicrobial hand wipes is only permitted where there is no access to running water.  Staff must perform hand hygiene using ABHR immediately after using the hand wipes and perform hand hygiene with soap and water at the first available opportunity.


(The video above demonstrating Hand Washing and Drying Technique was produced by NHS Ayrshire and Arran)

For how to:

Hand Hygiene posters/leaflets can be found at Wash Your Hands of Them Resources.

NSS supported WHO World Hand Hygiene Day 2023 'Accelerate action together'.

Skin care

Surgical hand antisepsis

Surgical scrubbing/rubbing applies to persons undertaking surgical and some invasive procedures.

Perform surgical scrubbing/rubbing before donning sterile theatre garments or at other times, for example prior to insertion of central vascular access devices.

Surgical scrubbing using an antimicrobial surgical scrub product should be used for the first surgical hand antisepsis of the day. Or perform hand hygiene using water and a non-antimicrobial liquid soap prior to the first surgical antisepsis of the day, this can be carried out in an adjacent clinical area.

For surgical scrubbing



Further information can be found in the Hand Hygiene literature reviews: