Chapter 1: Infection Prevention and Control

1.3 Hand Hygiene and Non-Sterile Gloves

Critical Thinking Exercises: Questions, Answers, and Sources / References

Critical thinking questions are in bold type, and the answers are italicized. Additional resources or references are provided below.

  1. Name four factors that decrease the effectiveness of hand hygiene.
  • Jewellery: Rings and bracelets increase microbial count on hands. Rings also increase the risk of torn or pierced gloves (Longtin, Sax, Allegranzi, Schneider, & Pittet, 2011).
  • Skin integrity: Skin cracks, dermatitis, or cuts can trap bacteria and may place patients at an increased risk (CDC, 2007).
  • Artificial nails and nail extenders: Artificial nails and nail extenders increase the viral load of bacteria up to nine times compared with bacteria found on hands. Extenders or artificial nails are not recommended for healthcare workers (Kennedy, 2013).
  • Nail length: Most microbes on hands come from under the fingernails. Subungual areas (under the fingernails) can harbour higher concentrations of microorganisms (Kennedy, 2013). In addition, long nails are harder to clean and may lead to more frequent glove punctures from the thumb and forefinger (Patrick & Van Wicklin, 2012).
  • Nail polish: Studies have shown that chipped nail polish and polish older than four days can harbour microorganisms (Patrick & Van Wicklin, 2012).
  • Water temperature and products: Warm water removes less protective oils than hot water; whereas, hot water increases the likelihood of skin damage (WHO, 2009).


Centers for Disease Control and Prevention (CDC). (2007). Part III: Precautions to prevent the transmission of infectious agents. In, Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings.

Kennedy, L. (2013). Implementing AORN recommended practices for sterile technique. AORN Journal, 98(1), 14-26.

Longtin, Y., Sax, H., Allegranzi, B., Schneider, F., & Pittet, D. (2011). Hand hygiene. New England Journal of Medicine, 34(13), 24-28.

Patrick, M., & Van Wicklin, S. A. (2012). Implementing AORN recommended practices for hand hygiene. AORN Journal, 9(4), 492-507.

World Health Organization (WHO). (2009). WHO guidelines for hand hygiene in health care: First global patient safety challenge.


2. What are two ways to reduce or prevent skin irritation with hand hygiene or non-sterile (clean) glove use?

  • If contact dermatitis occurs from alcohol-based hand rub (ABHR), use soap and water.
  • Washing hands regularly with soap and water immediately before or after using an alcohol-based product can cause contact dermatitis; therefore, this should be avoided.
  • Use warm water rather than hot when washing hands.


Kampf, G., & Löffler, H. (2003). Dermatological aspects of a successful introduction and continuation of alcohol based hand rubs for hygienic hand disinfection. The Journal of Hospital Infection, 55(1), 1-7.

World Health Organization (WHO). (2009a). Five moments for hand hygiene

World Health Organization (WHO). (2009b). WHO guidelines for hand hygiene in health care: First global patient safety challenge.