Skill Group: Biosafety and Biosecurity

Hand Hygiene

Dr. Jason Stull; Dr. Amanda Berrian; and Dr. Emily Feyes

Before You Start …

You have previously learned the key concepts of infection control, with deep dives into 2 domains, or tools: correct PPE use and proper disposal of waste and sharps. We will now cover the infection control tool that is often argued to be the most important of them all – hand hygiene.  



Throughout this training, you have seen the term hand hygiene repeatedly used. But what exactly is it?  When do we need to do it? And why should we bother?

Spoiler Alert: correctly performing this simple practice when indicated can have a huge impact on your and your patients’ health.

Learning Outcomes

By the end of this lesson, you should be able to:

  • Define the goals of hand hygiene
  • Recall the who, what, when and how of hand hygiene

Hand hygiene is simply the cleaning of hands using soap and water or an alcohol-based sanitizer (AHS). As discussed earlier, animals and their environment are often contaminated with pathogens. We frequently contaminate our hands with these pathogens through our day-to-day veterinary activities. Once contaminated, these pathogens can live on our hands for days (or even longer depending on the organism), allowing us to further spread the organisms to ourselves, other people, our patients, or the environment. For these reasons, hand hygiene is considered the single most important way to prevent infections in healthcare (including veterinary medicine).


The goal of hand hygiene is to kill or remove microorganisms on the skin while maintaining skin integrity (i.e. prevent skin chapping/cracking).  This is to reduce the number of microorganisms, particularly those that are part of the transient microflora of the skin, as these are easily shed and include the majority of pathogens.


Unfortunately, it is well documented that veterinarians do a poor job of correctly performing hand hygiene, putting themselves and patients at unnecessary infection risk. So how do we do it correctly?  Its simple – you need to know the product to use, when to do it, and the recommended technique (how to do it).


What product (method) to use?

There are two methods of removing/killing microorganisms on hands: washing with soap and running water or using an alcohol-based hand sanitizer (AHS). In most circumstances, either method is effective as long as appropriately performed.

However, there are a few situations, when soap and water is preferred over AHS. These are:

  1. Suspicion of a pathogen that is resistant to AHS – specifically, bacterial spores (e.g., Clostridium spp.), Cryptosporidium spp. and non-enveloped viruses (e.g., parvovirus).
  1. When hands are visibly soiled


In these two circumstances, washing hands with soap and water is encouraged. At all other times, AHS is the preferred method as these products have a superior ability to kill microorganisms on the skin, can quickly be applied, minimize skin damage, and can easily and inexpensively be made readily available.

When to do it?

All veterinary healthcare workers should perform hand hygiene at 5 key times:

  • Immediately before & after contact with a patient or its environment (e.g., cage)
  • After contact with a patient’s body fluids
  • Before putting on gloves and aAfter removing glovesglove removal (such as doffing PPE described earlier)
  • Before eating
  • After using the restroom

How to do it?

What could be so difficult about correctly performing hand hygiene – we all know how to wash our hands, right?  Well, not exactly. When not following correct hand hygiene technique, people tend to miss key areas of their hands (fingertips, between fingers, backs of hands, base of the thumbs).  Because of this, there is a specific hand hygiene technique for people involved in all forms of healthcare.  Follow these steps to ensure you hit the key areas,

  1. Apply product (AHS or soap and water) to hands
  2. Rub product between hands palms-to-palm
  3. Rub back of each hand with palm of other hand with fingers interlaced
  4. Rub palm to palm with fingers interlaced
  5. Rub backs of fingers to opposing palms with fingers interlocked
  6. Rub each thumb clasped in opposite hand
  7. Rub fingertips of each hand in opposite palm
  8. Finish up:
    1. If using soap and water, rinse thoroughly with water, pat dry with paper towel, turn off water using paper towel
    2. Is using AHS, rub hands until dry

 Steps 1-5 should take at least 15 seconds (sing Happy Birthday twice)

Look at this video or poster to help you solidify the process.

To maximize success, be sure to do the following:

  • Use creams or lotions to keep hands from becoming dry or cracked (this is especially important if using soap and water as this strips moisture and oils from the skin). Dry/cracked hands are painful and likely to make pathogens more difficult to remove.
  • Keep nails short (< 0.25 inches), minimize jewelry and do not wear artificial nails or nail enhancements. Long fingernails, artificial nails and hand jewelry are likely to trap pathogens and have been associated with disease outbreaks.

Who needs to do it?

Hand hygiene is the responsibility of all individuals involved in veterinary care. Everyone working around animals (veterinarians, technicians, receptionists) can be involved in spreading pathogens and therefore need to follow hand hygiene recommendations to prevent hospital-associated infections.  

Practice effective hand hygiene in the CVM Skills Lab!

  1. Working with a partner, take turns to watch and record your partner perform hand hygiene. Use the hand hygiene video or poster to guide you.
  2. Video tape yourself performing hand hygiene (verbalizing what you are doing) and review with a peer to self-assess.
  3. Glo-germ for self-assessment. Using the Glo-germ kit, simulate pathogen contamination on your hands. Be sure to follow these steps,
    1. Apply the Glo-germ to your hands;
    2. Ensure you can see the Glo-germ ‘contamination’ using the UV flashlight;
    3. Perform hand hygiene using soap and water (AHS will not remove the Glo-germ product);
    4. Give yourself a careful scan with the UV light to ensure you removed all traces of the Glo-germ.

Wrapping Up

After watching videos of you and your partner performing hand hygiene, write a short reflection on what went well and what you need to improve. What specifically do you need to improve and how can you make these changes?



OSU CVM Veterinary Clinical and Professional Skills Center Handbook Copyright © 2018 by Dr. Jason Stull; Dr. Amanda Berrian; and Dr. Emily Feyes. All Rights Reserved.

Share This Book