Alcohol-Based Hand Rub (ABHR)

When performing hand hygiene using the alcohol-based hand rub technique, a liquid, gel, or foam alcohol-based solution (e.g., ethanol, isopropanol, or combination) is used. The ABHR is the preferred method to use when your hands are not visibly soiled to reduce the number of most transient microorganisms on your hands, and is more effective than washing hands with soap and water (PIDAC, 2014). 

Benefits of ABHR:

• Kills the majority of microorganisms (including viruses) from hands. 
• Requires less time to use than soap and water (20 to 30 seconds).
• Are easy to use and have high levels of availability at the point of care (e.g., where three elements occur together: the client, the healthcare provider, and care involving the client).
• Provides better skin tolerability and reduces skin irritation because it contains emollients (PIDAC, 2012).

You should perform hand hygiene with an ABHR in front of the client prior to beginning and at the end of the examination. The ABHR should have 70–90% alcohol concentration (PIDAC, 2014). 

Hand Hygiene with ABHR

Steps	Additional Information
1. Inspect hands for cuts and open sores, and cuticles for tears. Open cuts, sores, and abrasions should be covered prior to starting work. Inspect for visible soiling. If present, you need to wash your hands with soap and water.
2. Remove all jewellery on hands and wrists. If a watch is worn, it must be moved high above the wrist or removed to provide access to your wrists to wash.
3. Apply 1 to 2 pumps of product into the palm of dry hands. Product should not be applied to wet hands, as this will dilute the product. Product should not be applied to visibly soiled hands. Enough product should be applied to thoroughly wet hands and fingers for the entire procedure of 20 to 30 seconds before drying. Always follow the manufacturer’s guidelines.
4. Rub hands together, palm to palm. Rubbing hands together ensures palmer surfaces are covered by the product.
5. Rub the back of the hands. Rubbing the back of the hands allows all surfaces of the fingers to be exposed to the product.
6. Rub the alcohol between all the fingers to cover all the fingers. Rubbing between the fingers allows all surfaces of the hands to be exposed to the product.
7. Press fingertips into the palm of the opposing hand and rub back and forth. Pressing the fingertips into opposing palms and rubbing ensures fingertips and nails are exposed to the cleaning product. Nails harbour more bacteria than do hands.
8. Rub each thumb in a circle in the palm of the opposite hand. Rubbing each thumb, from the base of the thumb to the top, provides complete coverage of the product on the thumb.
9. Rub hands together until they are dry. Rubbing hands together provides adequate time for the alcohol to dry. The minimum time required for proper rubbing technique when using ABHR is 20 to 30 seconds, and until your hands are dry. Do not use a paper towel to dry hands (your hands should dry from rubbing action).
10. Hands are now safe to use. Hands must be completely dry prior to providing care, touching a client or their personal items, medical equipment, and environment.
Source: PIDAC, 2012; PIDAC, 2014.

Safety Considerations

• Do not use ABHR in combination with soap and water, as it may increase skin irritation.
• Use ABHR that contains emollients (oils) to help reduce skin irritation and over-drying.
• Allow hands to dry completely before initiating tasks (e.g., touch client or environment) or applying clean or sterile gloves.
• ABHR may be used for all four moments of hand hygiene, as long as hands are not contaminated or visibly soiled.
• DO NOT use ABHR if the client is suspected to have or confirmed with C. difficile, norovirus, or Bacillus anthracis. ABHR will not kill spore-forming pathogens.

Common Errors when Performing an ABHR

• Not letting it air dry (rubbing on your pants to dry it off).
• Shaking out your hands to dry. 
• Applying too much alcohol-based solution.
• Not applying enough alcohol-based solution.
• Not rubbing hands long enough for a minimum of 20 seconds and until hands are dry.
• Skipping steps (e.g., fingernails, wrists, back of the hands, thumbs).

Common Errors	Example
It is important to wash your hands thoroughly before drying.  The most commonly missed areas are circled in the photos which include: the base of your thumbs, fingertips, between your fingers, and the ulnar aspect of your hand.
Remove all jewelry. Check your institution’s policy regarding watches, as institutional policies may differ. Your watch should be pushed above the wrist or removed.
Nails should be short, with no nail polish or acrylic nails.

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Attribution

This page was remixed with our own original content and adapted from: 

Clinical Procedures for Safer Patient Care — Thompson Rivers University Edition by Renée Anderson, Glynda Rees Doyle, and Jodie Anita McCutcheon is used under a CC BY 4.0 Licence. This book is an adaptation of Clinical Procedures of Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, which is under a CC BY 4.0 Licence. A full list of changes and additions made by Renée Anderson can be found in the About the Book section.

Physical Examination Techniques: A Nurse’s Guide by Jennifer Lapum, Michelle Hughes, Oona St-Amant, Wendy Garcia, Margaret Verkuyl, Paul Petrie, Frances Dimaranan, Mahidhar Pemasani, and Nada Savicevic is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.