• Describes decontamination of hands using soap and water, antiseptic wash or alcohol hand rub solution
• Good hand hygiene is the most effective way to prevent spread of infection
• Use this safe method of working at all times to protect staff, patients and others from infection 
• All practitioners are personally accountable for their hand hygiene practice, and for the decontamination of all re-usable equipment that they touch and use in clinical practice

• Hand decontamination must be carried out at the following 5 moments of care regardless of whether or not gloves have been worn
  • before touching a patient
  • before and after aseptic non-touch technique (ANTT)/aseptic procedure
  • after body fluid exposure
  • after touching a patient
  • after touching patient surroundings

Figure 1: Five moments for hand hygiene

• Hands must also be decontaminated
  • on arrival at and before leaving ward/department
  • after visiting the toilet
  • before serving/preparing food or drinks 
  • after any activity or contact that potentially results in hands becoming contaminated 
  • on entering and leaving an isolation cubicle
  • after removing personal protective equipment

• Alcohol hand rub is an effective method of hand decontamination on visibly clean hands but is not recommended when hands are visibly dirty

• Hand washing with liquid soap and water removes dirt, organic matter and transient flora by mechanical action, and is to be used: 
  • when hands are visibly dirty/visibly soiled with body fluids or other organic matter
  • when caring for patients with:
    • suspected or confirmed diarrhoea and/or vomiting 
    • C. difficile/Norovirus and during outbreaks of these organisms on wards/in bays 
  • after several consecutive applications of alcohol hand rub 
  • after visiting the toilet
• Liquid soap alone does not provide sufficient hand disinfection before invasive procedures and surgery

• Bare below elbow for all staff working within clinical areas (e.g. no sleeves below elbow, no wrist watches, wrist jewellery or plaster casts/wrist splints)
• Do not wear false nails, nail extensions, gel nails or nail varnish 
• Keep nails short and clean
• No stoned rings (acceptable to wear a plain wedding band) 
• Long hair tied back or up

Aprons

• <2 metres of child with respiratory tract infection
• Contact with infectious materials or equipment anticipated
• Using hazardous chemicals
• ANTT – see below 

Gloves (non–sterile)

• Contact with respiratory secretions or other infectious material of contaminated surfaces
• ANTT – see below
• Single patient use; new gloves and apron for every procedure
• Take gloves and apron off at point of use and clean hands
• Do not carry gloves in your pocket 
• Do not use alcohol hand rub on gloves

Sterile gloves and gown

• For central venous line (CVL) including peripheral long line (PICC)
• Sterile gloves for ANTT if touching key parts/key sites

Masks

• Surgical face mask 
  • <2 metres of child with respiratory tract infection 
• FFP3 mask (fit-tested) 
  • aerosol generating procedure (e.g. intubation, CPAP, HFNC, suctioning of lower respiratory tract, bag mask ventilation) with respiratory tract infection and when advised by infection prevention team
  • in conjunction with eye protection when increased risk of splashing of body fluids into eyes/nose/mouth

Eye protection

• <2 metres of child with persistent coughing or sneezing
• When increased risk of splashing of body fluids in to eyes
• If increased risk of organism transmitted through conjunctiva (e.g. SARS CoV-2)

• See local ANTT guidelines

Definition

• Essential procedure aimed at protecting patients from infection during invasive procedures
• Achieved by minimising presence of pathogenic micro-organisms as is practically possible
• Specific type of aseptic technique with a unique theory and practice framework, providing core principles for safe aseptic technique and a standardised approach to assessing and applying safe aseptic technique to any invasive clinical procedure
• Do not touch and protect ‘key parts’ or ‘key sites’ e.g. use caps and covers for end of syringes/needles

Preparation phase

• Decontaminate hands 
• Decontaminate tray/trolley using Trust approved disinfectant 
• Clean hands
• PPE (as above)
• Prepare and assemble equipment using a non-touch technique. Protect key parts at all times by not touching
• Remove gloves and decontaminate hands

Patient phase

• Decontaminate hands at point of care
• Apply appropriate PPE. Non-sterile gloves if not touching key parts (e.g. IV drug administration, venepuncture/cannulation), sterile gloves if touching key parts (e.g. urinary catheterisation, central line/PICC insertion) 
• Prepare all equipment using a non-touch technique, protecting key parts at all times by not touching them 
• Decontaminate key parts/key sites using single use chlorhexidine 2% in alcohol 70% (SEPP/FREPP or ChloraPrep® 3 mL) and allow drying for 30 sec
• Perform procedure, ensuring protection of key parts/sites at all times

Decontamination phase

• Dispose of sharps into sharps box immediately at point of use
• Remove PPE at bedside
• Dispose of all equipment as clinical waste in nearest clinical waste bin, return equipment to clinical room ensuring it is cleaned with detergent wipes
• Decontaminate hands