“Wash your hands!” Most health care providers have heard these simple words over and over again their entire lives—whether from their mother in childhood or at work from infection-control colleagues. Despite the fact that this simple action decreases nosocomial infection and constitutes only a fraction of a provider’s day, compliance with hand hygiene is dismal. Alarmingly the intensive care unit (ICU) is associated with the lowest overall hand-hygiene compliance rates (about 50%) in the hospital, despite the fact that the need for frequent and effective hand hygiene is paramount. The consequences of poor hand hygiene are uniformly injurious and contribute to nosocomial infections that are an important source of morbidity and mortality in patients. On average, infections can complicate 8% to 10% of all hospital admissions; infection rates in the ICU occur at an even increased incidence. Studies have shown that as hand-hygiene rates improve, nosocomial infection rates go down. Reasons associated with poor compliance for proper hand hygiene include higher professional status; reluctance to experience skin irritation; poor access to supplies; “being too busy;” inattention to existing protocols; and the wearing of gloves (which is thought to “negate” the need for hand hygiene).

To briefly review, hand hygiene encompasses both hand washing with soap and water and hand rubbing with waterless alcohol-based solutions. Many health care workers falsely believe that traditional hand washing is both more efficacious and gentle on the skin. However, alcohol-based solutions are microbiologically superior, gentler on skin with less disruption to the skin’s lipid layers, and more likely to be used correctly when compared with soap-and-water washing.

Some common definitions pertaining to hand hygiene are as follows:

The Centers for Disease Control and Prevention (CDC) guidelines for hand hygiene in the health care setting suggest the following: