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Hand Hygiene Recommendations and the Use of ABHR by Agency

ABHR - Alcohol Base Hand Rub 

Washing Hands Agency: WHO

Is hand hygiene important?

Hand hygiene is essential and should be performed:
  • before donning gloves and wearing PPE on entry to the isolation room/area;
  • before any clean or aseptic procedures is being performed on a patient;
  • after any exposure risk or actual exposure with a patient’s blood or body fluids;
  • after touching (even potentially) contaminated surfaces, items, or equipment in thepatient’s surroundings; and
  • after removal of PPE, upon leaving the isolation area.

It is important to note that neglecting to perform hand hygiene after removing PPE will reduce or negate any benefits of the PPE.

Either an alcohol-based hand rub or soap and running water can be used for hand hygiene, applying the correct technique recommended by WHO. It is important to always perform hand hygiene with soap and running water when hands are visibly soiled. Alcohol-based hand rubs should be made available at every point o f care (at the entrance and within the isolation rooms and areas); running water, soap , and single use towels should also be always available.
Agency: CDC

Infection Prevention and Control Recommendations for Hospitalized Patients with Knownor Suspected Ebola Hemorrhagic Fever in U.S. Hospitals
Key Components of Standard, Contact, and Droplet Precautions Recommended for Prevention of EHF Transmission in U.S. Hospitals

Hand Hygiene
  • HCP should perform hand hygiene frequently, including before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves.
  • Healthcare facilities should ensure that supplies for performing hand hygiene are available:
  • Hand hygiene in healthcare settings can be performed by washing with soap and water or using alcohol-based hand rubs. If hands are visibly soiled, use soap and water, not alcohol-based hand rubs.


Viral hemorrhagic fevers (VHFs)
Interim Guidance for Humanitarian Workers
Recommendations for Humanitarian Workers
If you travel to an area affected by a VHF outbreak, the following guidelines are recommended:
Before you leave
  • Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer, household disinfectant, alcohol-based hand rubs for hand hygiene. In addition, you should include a supply of surgical masks and disposable gloves if your agency does not provide them and you may be in situations where you have close contact with persons suspected of having a VHF infection

Infection Control Guidelines for Cabin Crew Members on Commercial Aircraft


  • Treat any body fluid as though it is infectious
  • Hand hygiene is the single most important infectioncontrol measure
    • Wash hands with soap and water for at least 20 seconds after assisting ill travelers or coming in contact with body fluids or surfaces that may be contaminated.
    • An alcohol-based hand cleaner is an alternative to hand-washing but will not be effective if hands are visibly soiled.
    • Avoid touching your mouth, eyes, and nose with unwashed or gloved hand

Agency: Public Health Agency of Canada

Environmental Sanitation Practices to Control the Spread of Communicable Disease in Passenger Conveyances and Terminals - June 23, 2014

This guidance is based on current available scientific evidence and is subject to review and change as new information becomes available. Personal Hygiene:

 Wash Your Hands Regularly and whenever they become soiled.

  • Washing hands with soap and running warm water is best, because of the removal action of soap and water on transient microorganisms.
  • Hands should be washed using soap and warm waterfor at least 20 seconds.
  • If soap and water are not available, an alcohol-based hand rub (ABHR) can be used. Alcohols are the most rapidly active of all agents used in hand disinfection. However alcohol may not be effective when there is organic material on your hands (e.g. after using the toilet). For this reason, ABHR alone should not be used on visibly soiled hands. Use wipes to remove soil, followed by an ABHR.
Practice proper cough and sneeze etiquette. Cover your mouth and nose with your arm to reduce the spread of germs. If you use a tissue, dispose of it as soon as possible. Wash your hands afterwards.
Agency: Media – CNN interview 

This was a segment from August 4th CNN interviewing Dr. Mark Gendreau from Boston, a physician at the Lahey Hospital and Medical Center.  Below is the transcript. See the specific reference to alcohol based hand sanitizers:
WHITFIELD : That case of Ebola came into the U.S. in a very controlled, careful environment. But could someone with Ebola get on a commercial plane and fly into the U.S.? And how can you protect yourself from any infectious diseases when you do travel? I'm joined now by Dr. Mark Gendreau from Boston, a physician at the Lahey Hospital and Medical Center. He focuses on staying healthy when you travel, especially by plane. He's also going to give us some tips in just a minute. But, first, Dr. Gendreau, I want to ask you, how likely is it that Ebola could get into the United States in a non-controlled environment?

DR. MARK GENDREAU : You know,there is some risk there, but the risk is very, very low. I mean, there have been cases of viral hemorrhagic fever infections that are similar to Ebola who have come to the United States. We had a case in, I believe, 2009 of a passenger who was flying from London to JFK in New Jersey and checked himself into a hospital. And he ended up having Lassa fever which is similar to Ebola. The CDC did track 18 people who they believed were close contacts with this passenger during the flight and everybody did well and -- there was not any problems. So the risk is very, very low.

WHITFIELD : So you have, still, a list for us, of tips that you say can help people fly healthy. A few of them are keep yourself well hydrated, bring an alcohol-based hand sanitizer, wipe down the tray aboard the planes, buses and trains. Why are these things so important to you?

GENDREAU : Well, the biggest thing that you can do is to sanitize your hands. Most infectious diseases that are going to be -- that we come in contact with, we introduce to ourselves through our hands by touching inanimate objects, such as the trays, seat, a kiosk or whatnot. So it's very, very important to sanitize your hands. It needs to be ethyl alcohol based product that has at least 60 percent ethyl alcohol in it. This particular Ebola virus is an enveloped virus. And enveloped viruses do -- are -- ethyl alcohol is effective with enveloped viruses. So I do think that the key here is to make sure that your hands are well sanitized. We touch our eyes, nose and mouth about 200 times a day, which gives ample opportunity for introduction of infectious diseases.

WHITFIELD : All right, Dr. Gendreau. Thank you so much for your time and great tips. Appreciate it.
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