SARS CoV-2 PDF

Prevención y control
de infecciones (PCI)
causadas por el
nuevo coronavirus
(COVID-19)
Módulo 1: Preparación, disposición operativa y PCI
Unidad Técnica y Clínica de la OMS para la PCI

Principios de la gestión de emergencias
Estrategias que ayudan a un
Evaluar los esfuerzos de prevención,
mitigación, preparación y respuesta; Prevención y establecimiento a prevenir y
los establecimientos buscan regresar mitigación disminuir las repercusiones de
una emergencia (por ejemplo,
a la “normalidad” o ser construidos
suministrar al personal la
mejor
vacunación contra enfermedades)
Preparación y
Recuperación disposición
operativa
Medidas que tienen lugar

Actividades en reacción a antes de una emergencia
un evento conocido o
Respuesta
presunto
Fuente: Curless,M., Gerland,M.A., Maragakis,L.,L. 2018 Infection Prevention and Control. Module 11: Infection Prevention and Control Program Management. Reference Manual for
Health Care Facilities with Limited Resources. John Hopkins Medicine. Jhpiego. p.p. 37-52. http://reprolineplus.org/system/files/resources/IPC_M11_Programs.pdf
¿En qué consiste la preparación en la
atención de salud?
• Son los conocimientos, las capacidades y los

sistemas organizativos creados por los
gobiernos, las organizaciones de respuesta y
recuperación, las comunidades y las personas,
con el fin de prever, responder y recuperarse con
eficacia de las repercusiones de emergencias
probables, inminentes, emergentes o actuales.
• Son las medidas que tienen lugar antes de una emergencia y

aumentan la capacidad de un establecimiento para responder cuando
ocurre una emergencia.
• Todos los niveles: nacional, regional y de los establecimientos.
¿Por qué?
• Porque la preparación forma parte integrante

del fortalecimiento de los sistemas de
salud y es fundamental para la gestión de
riesgos de los desastres y las emergencias
de salud.
• Las medidas inadecuadas de PCI pueden dar

lugar a que haya transmisión a los pacientes,
el personal, los visitantes y en la comunidad.
¿Qué es la disposición operativa?
Son las capacidades y los sistemas que deben estar funcionando con
el fin de permitir una respuesta rápida y eficaz ante las emergencias de
salud en caso de desastre (en la situación actual: la importación de
casos de COVID-19) y estar preparados para contener “enérgicamente”
el evento (brote) antes de que se siga propagando.
https://www.who.int/publications-detail/risk-communication-and-community-engagement-readiness-and-initial-response-for-novel-coronaviruses-(-ncov)
¿Qué es la disposición operativa?
Ocho pilares de la respuesta de salud pública:
• Coordinación, planificación y seguimiento a nivel de país.
• Comunicación de riesgos y participación de las comunidades.
• Vigilancia, investigación epidemiológica, respuesta rápida e
investigación de casos.
• Puntos de entrada.
• Laboratorios nacionales.
• Prevención y control de infecciones.
• Gestión de casos.
• Apoyo a las operaciones y los aspectos de logística, incluidos los
planes de contingencia y el mecanismo de financiamiento.
https://www.who.int/publications-detail/risk-communication-and-community-engagement-readiness-and-initial-response-for-novel-coronaviruses-(-ncov)
Disposición operativa
Pilar 1: Coordinación, planificación y seguimiento a nivel de país
Paso Medidas que deben adoptarse

ü Activar mecanismos de coordinación multisectoriales con asociados múltiples, a fin
de brindar apoyo a la preparación y la respuesta.
ü Colaborar con las autoridades nacionales y los asociados clave en la elaboración
de un plan operativo propio del país, con estimación de los recursos necesarios
para la preparación y la respuesta frente a la COVID-19 o, preferiblemente, adaptar
1 un plan existente de preparación para una pandemia de gripe, donde esté
disponible.
ü Hacer una evaluación inicial de la capacidad y un análisis de riesgos, con un mapa
de los grupos vulnerables.
ü Comenzar a establecer métodos de medición y sistemas de seguimiento y
evaluación para determinar la eficacia y el impacto de las medidas planificadas.
Disposición

ü Establecer un equipo de gestión de incidentes, con el despliegue rápido de
personal designado de las organizaciones nacionales y asociadas, en el marco de
un centro de operaciones de emergencias de salud pública o un centro equivalente,
de haberlo.
ü Seleccionar, capacitar y designar voceros.
ü Colaborar con donantes y programas locales existentes con el fin de movilizar y
2
asignar recursos y capacidad para ejecutar el plan operativo.
ü Examinar los requisitos regulatorios y los fundamentos jurídicos de todas las
medidas eventuales de salud pública.
ü Dar seguimiento a la ejecución del SCOP sobre la base de los indicadores clave de
desempeño del plan estratégico de preparación y respuesta, y elaborar informes
Disposición

ü Realizar estudios operacionales regulares para evaluar la eficacia de la ejecución y
la situación epidemiológica, y ajustar los planes operativos según sea necesario.
ü Realizar exámenes posteriores a la acción de conformidad con el RSI (2005),
3 según sea necesario.
ü Aprovechar el brote de COVID-19 para poner a prueba los planes y sistemas
existentes, aprender de ellos y extraer enseñanzas que sirvan de base para
actividades futuras de preparación y respuesta.
PCI: Un requisito básico de la preparación
para un brote epidémico y elemento
fundamental de la disposición operativa
La prevención y el control de infecciones (PCI)

debería ser una actividad permanente, emprendida y respaldada
por el programa nacional y por el punto focal, el equipo y el
comité de PCI, los funcionarios del equipo directivo del
establecimiento de atención de salud y
todo el personal al nivel del establecimiento.
¿Qué es la prevención y el control de
infecciones?
La prevención y el control de infecciones es:
• un enfoque científico con
• soluciones prácticas diseñadas con el fin de prevenir el
daño causado por las infecciones a los pacientes y los
trabajadores de salud;
• se basa en los principios de las enfermedades infecciosas,
la epidemiología, las ciencias sociales y el fortalecimiento
de los sistemas de salud; y
• tiene su fundamento en la seguridad del paciente y la
calidad del servicio de salud.
Fuente: páginas de la OMS sobre PCI; https://www.who.int/gpsc/ipc/en

¿Quién corre el riesgo de infección?
Todos
Ventajas de la PCI
Protegerse a uno
mismo
Proteger a los
pacientes
Proteger a la
familia y la
comunidad
WHO2015 Safe & Quality Health Services Package
Metas de la PCI en la preparación para un
brote
1. Disminuir la transmisión de infecciones

relacionadas con la atención de salud.
2. Fortalecer la seguridad del personal, los
pacientes y los visitantes.
3. Reforzar la capacidad de la organización
o el establecimiento de salud para
responder ante un brote.
4. Disminuir o reducir el riesgo de que el
propio hospital (o establecimiento de
salud) amplifique el brote.
Componentes básicos (CB) de los
programas de PCI eficaces en todos
los contextos
PROGRAMAS DE PCI
• Los programas eficaces de PCI
y vínculos con todos los
programas pertinentes tienen que basarse en la
ejecución de todos los
componentes básicos.
DIRECTRICES EDUCACIÓN Y VIGILANCIA SEGUIMIENTO,
CAPACITACIÓN AUDITORÍA Y
RETROALIMENTACIÓN • Si no se cuenta con
conocimientos, un sistema, una
ENTORNO PROPICIO organización y recursos en
VOLUMEN DE TRABAJO, DOTACIÓN DE
PERSONAL Y OCUPACIÓN DE CAMAS materia de PCI, es poco
ENTORNO CONSTRUIDO, MATERIALES Y
EQUIPOS probable que un país o un
establecimiento pueda
ESTRATEGIAS
responder eficazmente ante un
MULTIMODALES
https://www.who.int/infection-prevention/publications/core-components/en/
brote.
Es necesario disponer por lo menos de los
requisitos mínimos de PCI
Así, los requisitos mínimos representan el punto de
REQUISITOS MÍNIMOS partida para emprender la ruta de la construcción de
programas sólidos y eficaces de PCI al nivel nacional
para los programas de prevención y control y de los establecimientos de atención (figura 2) y
de infecciones
DEBEN ser funcionales en todos los países y los
establecimientos de salud, a fin de respaldar el
progreso hacia la ejecución completa de todos los
componentes básicos.
Los requisitos mínimos se definen de la siguiente

manera:
Las normas de PCI que deberían haberse

implementado al nivel nacional y de los
establecimientos con el fin de prestar un mínimo de
protección y seguridad a los pacientes, los
profesionales de salud y los visitantes, a partir de los
Punto de partida de la ejecución de los componentes componentes básicos de la OMS para los programas
básicos de los programas de prevención y control de
infecciones de la Organización Mundial de la Salud, al nivel de PCI.
nacional y de los establecimientos de salud
https://www.who.int/infection-prevention/publications/core-components/en/
Requisitos mínimos de la PCI
NIVEL NACIONAL NIVEL DE LOS ESTABLECIMIENTOS
CB1: • Atención primaria: Persona de enlace de PCI capacitada.
Programa funcional de PCI • Atención secundaria: Un punto focal de PCI capacitado
que cuente como mínimo con por cada 250 camas, con dedicación exclusiva y
un punto focal de PCI presupuesto específico.
capacitado, con dedicación • Atención terciaria: Un punto focal de PCI capacitado por
exclusiva y un presupuesto cada 250 camas, con dedicación exclusiva y presupuesto
específico asignado a la PCI. específico + un comité multidisciplinario de PCI + acceso al
laboratorio de microbiología.
CB2: • Atención primaria: Procedimientos normalizados de
Directrices nacionales de PCI trabajo (PNT) como mínimo sobre las precauciones
basadas en la evidencia y habituales y los fundamentos de las precauciones basadas
adaptadas al contexto local. en el modo de transmisión.
• Atención secundaria y terciaria: Otros PNT sobre cirugía,
prevención de las infecciones endémicas relacionadas con
la atención de salud y la salud ocupacional.
CB3: • Todos los niveles de atención: Capacitación sobre
Educación y capacitación: PCI dirigida a todo el personal clínico y de limpieza
Política nacional que de primera línea en el momento de la contratación
garantice que todo el (pero también anualmente en los establecimientos de
personal de salud está atención terciaria) + capacitación específica sobre PCI
capacitado en PCI + para los puntos focales de PCI.
programas nacionales de
estudios en PCI +
seguimiento de la eficacia
de la capacitación en PCI.
CB4: • Atención primaria y secundaria: La vigilancia de las
Grupo técnico nacional infecciones relacionadas con la atención de salud no
que elabora planes de es un requisito mínimo, pero debe responder a los
vigilancia de las planes nacionales.
infecciones relacionadas • Atención terciaria: La vigilancia activa de las
con la atención de salud y infecciones relacionadas con la atención de salud, la
el seguimiento de la PCI. resistencia a los antimicrobianos y la retroalimentación
deben constituir una actividad básica del programa de
PCI.

CB5: • Atención primaria: Estrategias multimodales de
Se deben introducir mejoramiento para aplicar las medidas prioritarias de
estrategias multimodales PCI (higiene de las manos, seguridad de las inyecciones,
para mejorar las descontaminación de los equipos médicos, limpieza
intervenciones de PCI. ambiental).
• Atención secundaria: Estrategias multimodales de
mejoramiento para aplicar todas las precauciones habituales
y las precauciones basadas en el modo de transmisión, al
igual que en el triaje.
• Atención terciaria: Igual que en la atención secundaria +
estrategias multimodales de mejoramiento para tipos
específicos de infecciones relacionadas con la atención de
salud (por ejemplo, infecciones del torrente circulatorio
relacionadas con una vía central), en función de los riesgos y
las características epidemiológicas locales.

CB6: • Atención primaria: Seguimiento de los indicadores
Grupo técnico nacional de PCI basados en las prioridades de la PCI (véase
que elabore planes de CB5).
seguimiento de la PCI + • Atención secundaria y terciaria: Una persona con
recomendaciones sobre dedicación exclusiva encargada del seguimiento de la
los indicadores + PCI y la retroalimentación oportuna + la higiene de las
sistemas + capacitación manos como un indicador prioritario.
en PCI.
CB7: • Atención primaria: Sistemas para el flujo de pacientes +
Volumen de trabajo, dotación el triaje + la gestión de consultas.
de personal y nivel de • Con el fin de optimizar la dotación de personal, los
ocupación de camas establecimientos tienen que emprender una evaluación
de la dotación de personal apropiada para ese
centro.
• Atención secundaria y terciaria: Sistema de gestión del
uso del espacio + definir la capacidad hospitalaria
corriente del establecimiento + no más de un paciente por
cama + al menos 1 metro entre los bordes de las camas.
• Con el fin de optimizar la dotación de personal, los
establecimientos tienen que emprender una evaluación
de la plantilla de personal que es apropiada para ese
centro.
CB8: • Atención primaria: Las actividades de atención a los
Entorno construido, pacientes deben aplicarse en un entorno limpio e
materiales y equipo para la higiénico, los establecimientos deben contar con
PCI. zonas separadas para las actividades de
saneamiento, descontaminación y reprocesamiento
de los equipos médicos, y tener suministros
suficientes de PCI y equipos para aplicar las medidas
de PCI.
• Atención secundaria y terciaria: Los
establecimientos deben contar con salas de
aislamiento individual suficientes o tener la capacidad
de crear cohortes, si fuese apropiado.
en el contexto del brote de COVID-19
Evaluar la capacidad de PCI en todos los niveles del sistema de atención de salud, incluidos los consultorios y las farmacias, sean públicos, privados o
tradicionales. Los requisitos mínimos son un sistema funcional de triaje, salas de aislamiento, personal capacitado (en la detección temprana y los
principios habituales de PCI); y suficientes materiales de PCI como equipos de protección personal y servicios de agua, saneamiento e higiene (WASH),
así como estaciones para la higiene de las manos.
Evaluar la capacidad de PCI en los lugares públicos y los espacios comunitarios donde se considere que el riesgo de transmisión es alto.
Examinar y actualizar la orientación nacional de PCI: la orientación nacional debe incluir vías definidas para la derivación de pacientes, incluido un punto
focal para la PCI, en colaboración con los encargados del manejo de casos. La orientación a la comunidad debe incluir recomendaciones específicas
sobre las medidas de PCI y los sistemas de derivación destinados a los lugares públicos como las escuelas, los mercados y el transporte público, así
como para la comunidad, el hogar y los consultorios familiares.
Elaborar y ejecutar un plan de seguimiento del personal de salud expuesto a casos confirmados de COVID-19 para las enfermedades respiratorias.
Elaborar un plan nacional de gestión de los suministros de PCI (reservas y distribución) y definir la capacidad necesaria para hacer frente a un gran
aumento de la demanda (número y competencias).
Designar personal capacitado, con autoridad y conocimientos técnicos especializados, para que lleva a cabo actividades de PCI, y asigne prioridades
según la evaluación de riesgos y las modalidades locales de búsqueda de atención de salud.
Registrar, notificar e investigar todos los casos de infecciones relacionadas con la atención de salud.
Proporcionar la orientación sobre PCI a los prestadores de atención domiciliaria y en las comunidades.
Implementar el triaje, la detección temprana , el control de las fuentes infecciosas, los controles administrativos y técnicos, y alertas visuales (material
educativo en el idioma apropiado) para familiares y pacientes a fin de que sepan informar al personal de triaje sobre sus síntomas respiratorios y tomen
medidas al estornudar y toser.
Facilitar el acceso a los servicios de agua y saneamiento para la salud en los lugares públicos y los espacios comunitarios que presenten más riesgo.
Dar seguimiento a la aplicación de las medidas de PCI y WASH en los establecimientos de salud y lugares públicos seleccionados mediante el marco de
evaluación de la prevención y el control de infecciones, el marco de autoevaluación de la higiene de las manos, los instrumentos de observación del
cumplimiento de la higiene de las manos y el instrumento de mejoramiento de WASH en los establecimientos.
Brindar apoyo adaptado y prioritario a los establecimientos de salud en función de la evaluación de riesgos y de las modalidades locales de búsqueda de
atención, incluidos los suministros, los recursos humanos y la capacitación.
https://www.who.int/docs/default-
source/coronaviruse/covid-19-sprp-unct-
Llevar a cabo actividades de capacitación para abordar las lagunas en las aptitudes o el desempeño.
guidelines.pdf
¿Cuál es la función del punto focal,
el equipo o el comité de PCI?
Punto focal de PCI individual
• Conocimientos: comprender las estrategias de PCI necesarias en caso de
brotes, epidemias, etc.
Establecimientos de salud
• Infraestructura
• Elaboración de políticas y PNT
• Evaluación, preparación y disposición operativa
Comité de PCI
• Participar en la respuesta y la recuperación
• Participar en la vigilancia y el seguimiento
• Gestión de los pacientes
• Educación
de infecciones (IPC)
causadas por el
nuevo coronavirus
(COVID-19)
Módulo 2: Nuevo coronavirus (COVID-19)
Características epidemiológicas, factores de riesgo, definiciones
y sintomatología

¿Qué es un nuevo coronavirus?
• Los coronavirus (CoV) son una gran familia
de virus que causan una amplia gama de
enfermedades desde el resfriado común
hasta enfermedades más graves
• es decir, el síndrome respiratorio de Oriente
Medio [MERS] y el síndrome respiratorio agudo
grave [SARS].
• Un nuevo coronavirus (SARS-CoV-2) es

una cepa nueva que no se había detectado
antes en los seres humanos.
¿Qué es un nuevo coronavirus?
Los coronavirus son zoonóticos, es decir que se transmiten entre
los animales y las personas (por ejemplo, el SARS = gatos de
algalia y el MERS = camellos).
Un nuevo coronavirus (nCoV) es una cepa nueva que no se había

detectado antes en los seres humanos.
• Varios coronavirus conocidos circulan entre los animales, pero todavía no han
infectado a los seres humanos.
El 31 de diciembre del 2019, la oficina de la OMS en China recibió la

notificación de casos de una neumonía de causa desconocida en la
ciudad de Wuhan, provincia de Hubei en la China. Se aisló un nuevo
coronavirus (SARS-CoV-2) y las autoridades chinas lo identificaron como
el virus causal el 7 de enero.
Países afectados
(hasta el 23-02-2020)
Figura 1. Países, territorios o zonas que han informado casos confirmados de COVID-19, al 23 de febrero del
2020
Distribución de los casos de COVID-19 hasta el 23 de febrero del 2020
Número de
casos
confirmados*
*“Los “casos confirmados” comunicados entre el 13 y el 19 de febrero del

2020 incluyen tanto casos confirmados por el laboratorio como casos con
diagnóstico clínico (solo se aplica a la provincia de Hubei); para las
demás fechas, solo se presentan los casos confirmados por el
laboratorio.
País, zona o territorio +Se detectaron 634 casos en un crucero que

con casos+ se encuentra en aguas territoriales del Japón.
Los límites y los nombres utilizados y las denominaciones empleadas en este mapa no implican,
por parte de la Organización Mundial de la Salud, juicio alguno sobre la condición jurídica de
Fuente de los datos: Organización Mundial de la Salud, Comisión países, territorios, ciudades o zonas, o de sus autoridades, ni respecto del trazado de sus fronteras
Nacional de la Salud de la República Popular China. No procede o límites. Las líneas discontinuas en los mapas representan de manera aproximada fronteras
Mapa elaborado por: Programa de Emergencias Sanitarias de la OMS. respecto de las cuales puede que no haya pleno acuerdo.
*El informe de la situación incluye la información suministrada por las autoridades nacionales hasta las 10 horas (horario de Europa central)
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
Lo que sabemos acerca de la COVID-19
• Período de incubación: las estimaciones actuales del período de incubación
del virus oscilan entre 1 y 12,5 días (mediana entre 5 y 6 días).
• Las estimaciones serán más precisas a medida que se cuente con más
datos.
Se necesita más información con el fin de determinar si puede ocurrir
transmisión a partir de las personas asintomáticas o durante el período de
incubación.
• Modos de transmisión: las gotículas expulsadas por las personas afectadas,
el contacto con las secreciones respiratorias de pacientes, las superficies y
los equipos contaminados.
• Transmisión a partir de los animales y de persona a persona.
• En la actualidad no se cuenta con tratamiento ni vacunación, solo con
medidas de apoyo.
Signos y síntomas de la COVID-19
Cefalea
Estornudos
Tos
Disnea
Dificultad respiratoria
La enfermedad parece Insuficiencia renal

comenzar con fiebre,
seguida de tos seca y luego,
una semana después, se Fiebre
presenta la disnea y algunos
pacientes necesitan
tratamiento en medio
hospitalario
Síntomas de la COVID-19
Etapa temprana: Etapa avanzada:

Fiebre (>38°C) Todos los síntomas anteriores más
y • Neumonía
Síntomas respiratorios: • Bronquitis
• Tos
• Disnea
• Rinorrea
• Debilidad
• Malestar general
• Náuseas y vómito
• Diarrea
• Cefalea
Definiciones de caso (al 04 de febrero del 2020)
se debe investigar y realizar la prueba diagnóstica
Infección respiratoria aguda grave:
A. Antecedentes de fiebre, tos y necesidad de hospitalización,
(sin ninguna otra causa que explique plenamente el cuadro clínico)
Y
antecedentes de viaje o residencia en la China en los 14 días
anteriores a la aparición de los síntomas
O
B. Paciente con alguna enfermedad respiratoria aguda Y al menos uno
de los siguientes criterios durante los 14 días anteriores al comienzo
de los síntomas:
contacto con un caso confirmado o presunto de COVID-19
O
trabajó o acudió a un establecimiento de atención de salud donde
recibían tratamiento pacientes con la enfermedad respiratoria
aguda, COVID-19, confirmada o probable.
de infecciones (PCI)
causadas por el
nuevo coronavirus
(COVID-19)
Módulo 3: PCI en el contexto de la COVID-19
Precauciones habituales, precauciones basadas en el modo
de transmisión y recomendaciones específicas para
la COVID-19
Prevención y control de infecciones durante la atención de salud en
caso de presunción clínica de infección por el nuevo coronavirus
(nCoV)
https://www.who.int/publications-detail/infection-prevention-and-control-during-
health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125
Atención en el domicilio de pacientes con presunta infección por el

nuevo coronavirus (nCoV) que tengan síntomas leves y gestión de
los contactos
https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-
coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-
contacts
Orientación sobre el uso de mascarillas en la comunidad, durante la
atención en el domicilio y en los entornos de atención de salud en el
contexto del brote por el nuevo coronavirus (2019-nCoV)
https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-
during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-
(2019-ncov)-outbreak
Recomendaciones generales de la OMS
sobre la COVID-19
• Evitar el contacto directo con las personas que tienen una infección
respiratoria aguda.
• Higienizarse frecuentemente las manos, sobre todo después de
estar en contacto directo con personas enfermas o su entorno.
• Las personas con síntomas de infección respiratoria aguda deben
adoptar medidas de higiene respiratoria, usar una mascarilla
quirúrgica y buscar atención médica en caso de dificultad
respiratoria.
Recomendaciones de la OMS
con respecto a los viajes
• La OMS no recomienda ninguna medida específica de salud para los
viajeros.
• En caso de presentar algún síntoma de enfermedad respiratoria
aguda, ya sea durante o después del viaje, se recomienda a los
viajeros que busquen atención médica y comuniquen sus
antecedentes de viajes al prestador de atención de salud.
¿Qué estrategias de
PCI recomienda la OMS
para la COVID-19?
Estrategias de PCI que recomienda la OMS
con fines de prevención o limitación de la
propagación de la COVID-19
Las estrategias de PCI con miras a prevenir o limitar la transmisión en los
entornos de atención de salud incluyen las siguientes:
1. aplicar las precauciones habituales a todos los pacientes;
2. asegurar el triaje, el reconocimiento temprano y el control de las
fuentes de infección;
3. aplicar precauciones complementarias empíricas en los casos con
presunción de COVID-19;
4. ejecutar las medidas de control administrativo; y
5. aplicar controles ambientales y de ingeniería.
Recomendación 1.
Aplicar las precauciones
habituales con todos los pacientes
Precauciones habituales
Nivel básico de las precauciones de PCI que deben adoptarse con
TODOS los pacientes en TODO momento:
• las medidas preventivas mínimas que son aplicables en todo
momento durante toda la atención al paciente,
independientemente del estado de presunción o confirmación del
paciente.
La evaluación de riesgos es fundamental para todas las
actividades, esto es, evaluar cada actividad de atención de salud y
determinar el equipo de protección personal (EPP) necesario para
lograr una protección adecuada.
Elementos de las precauciones habituales
1. Higiene de las manos.
2. Higiene respiratoria (reglas de comportamiento).
3. EPP en función del riesgo.
4. Prácticas de seguridad de las inyecciones, gestión de objetos
punzocortantes y prevención de lesiones.
5. Seguridad de la manipulación, la limpieza y la desinfección del
equipo de atención al paciente.
6. Limpieza del entorno.
7. Manipulación y limpieza seguras de la ropa sucia.
8. Gestión de desechos.
Cadena de transmisión
Agente
infeccioso
Hospedero Reservorio
susceptible
Cadena de
infección
Puerta de Puerta de
entrada Modo de salida
transmisión
• Para que una infección se propague todos los eslabones deben estar conectados.
• ¡Al romper cualquier eslabón se interrumpirá la transmisión de la enfermedad!
Higiene de las manos
• Es la mejor manera de evitar la propagación de microbios en el
entorno de atención de salud y la comunidad.
• Nuestras manos son nuestra principal herramienta de trabajo como
profesionales de salud y representan el eslabón central en la
cadena de transmisión.
Asas de las puertas Instrumentos
Medicación Apretón de manos
Teléfonos Cuidadores
celulares
Higiene de las manos: Los 5 momentos de la
OMS
2 ANTES DE REALIZAR UN PROCEDIMIENTO LIMPIO O ASÉPTICO
1 ANTES DE TOCAR UN PACIENTE 4 DESPUÉS DE TOCAR UN PACIENTE
5 DESPUÉS DEL CONTACTO

CON EL ENTORNO DEL
PACIENTE
3 DESPUÉS DE UN RIESGO
DE EXPOSICIÓN A LÍQUIDOS CORPORALES
https://www.who.int/infection-prevention/tools/hand-hygiene/en/
Higiene de las manos: ¿CÓMO?
Use el producto y la técnica adecuados.
Cuando no estén visiblemente sucias, es
preferible utilizar un producto desinfectante a
base de alcohol para las manos.
• ¡Frótese las manos durante 20 a 30
segundos!
Cuando las manos estén visiblemente sucias
o contaminadas con material proteínico, utilice
jabón, agua corriente y una toalla de uso
único.
¡Lávese las manos durante 40 a 60 segundos!
¿Cómo higienizarse las manos
con un desinfectante a base de alcohol? ¿Cómo lavarse las manos?
¡Para la higiene de las manos, frótelas con un desinfectante a
base de alcohol! ¡Lávese las manos cuando estén visiblemente sucias! Si no,
Lávese las manos cuando estén visiblemente sucias utilice un desinfectante a base de alcohol
Duración del procedimiento completo: de 20 a 30 Duración del procedimiento completo: de 40 a 60 segundos

segundos
Aplique una cantidad

Mójese las manos Frótese las palmas de las
suficiente de jabón para cubrir
con agua. manos entre sí.
todas las superficies de las
Deposite en la palma de la mano una Frótese las palmas entre sí. manos.
dosis de producto, suficiente para cubrir
todas las superficies.
Frótese la palma de la
mano derecha contra el
Frótese las palmas de las Frótese el dorso de los dedos de
dorso de la mano izquierda
manos entre sí, con los una mano con la palma de la mano
entrelazando los dedos y
dedos entrelazados. opuesta, enganchando los dedos.
viceversa.
Frótese la palma de la mano Frótese el dorso de los

Frótese las palmas
derecha contra el dorso de la dedos de una mano con la
entre sí con los dedos
mano izquierda entrelazando palma de la mano opuesta,
entrelazados. Frótese con un movimiento Frótese la punta de los dedos
los dedos y viceversa. con los dedos enganchados.
circular el pulgar izquierdo de la mano derecha contra la Enjuáguese las manos con
atrapándolo con la palma de la palma de la mano izquierda, agua.
mano derecha y viceversa. con un movimiento circular
en ambas direcciones y
viceversa.
Frótese la punta de los

Frótese con un dedos de la mano derecha
movimiento circular el contra la palma de la Una vez secas, sus
pulgar izquierdo mano izquierda con un manos son seguras.
Séquese cuidadosamente Ahora sus manos son
atrapándolo con la palma movimiento circular en Utilice la toalla para
las manos con una toalla cerrar el grifo. seguras.
de la mano derecha y ambas direcciones y de uso único.
viceversa. viceversa.
¿Por qué es importante la higiene
respiratoria?
La buena higiene respiratoria y el comportamiento
respiratorio correcto al toser pueden reducir la propagación
de los microorganismos (gérmenes) que causan las
infecciones respiratorias (resfriados, gripe).
Fuente de la imagen: https://www.who.int/es/emergencies/diseases/novel-coronavirus-2019/advice-for-public

Procedimientos de higiene y reglas de
comportamiento respiratorios
• Gire la cabeza alejándola de los demás
cuando tose o estornuda.
• Cúbrase la nariz y la boca con un
pañuelo.
• Si utiliza pañuelos descartables, tírelos
de inmediato a la basura.
• Tosa o estornude sobre su manga con el
brazo flexionado si no tiene un pañuelo
al alcance.
• Lávese las manos con agua y jabón o
con productos a base de alcohol.
Promover la higiene respiratoria
• Fomente el lavado de las manos para los pacientes con
síntomas respiratorios.
• Suministre mascarillas a los pacientes con síntomas
respiratorios.
• Los pacientes con fiebre más tos o estornudos deben
mantenerse como mínimo a una distancia de un metro de otros
pacientes.
• Coloque carteles que recuerden a los pacientes y los visitantes
con síntomas respiratorios que se deben cubrir al toser.
• Considere la posibilidad de tener mascarillas y pañuelos
descartables disponibles para los pacientes en todas las zonas.
Ejemplos de EPP contra la COVID-19 para
uso en los entornos de atención de salud
Gafas
Mascarilla facial Mascarilla Careta protectora protectoras
N95
Nariz + boca Nariz + boca Ojos + nariz + Ojos

boca
Bata Delantal Guantes Gorros
Cabeza +
Cuerpo Manos
Cuerpo pelo
Evaluación de riesgos y precauciones
habituales
Evaluación de riesgos: riesgo de exposición y grado de contacto
previsto con la sangre, los líquidos corporales, las gotículas respiratorias
y la piel lesionada.
• Escoja los elementos del EPP que va a utilizar en función de esta
evaluación.
• Practique la higiene de las manos según los “5 momentos” de la
OMS.
• Esta evaluación se debe hacer con cada paciente, en cada
ocasión.
¡Conviértalo en una rutina!
Reducir al mínimo la exposición directa sin
protección a la sangre y los líquidos corporales
Evaluación de riesgos para
GAFAS MASCARILLA BATA GUANTES HIGIENE DE SITUACIÓN
uso apropiado de EPP
QUIRÚRGICA LAS MANOS
Siempre antes y después del

contacto con pacientes y
x
después del contacto con un
entorno contaminado.
En caso de contacto directo
con sangre, líquidos
x x corporales, secreciones,
excreciones, mucosas y piel
lesionada.
Si existe un riesgo de
x x x salpicaduras sobre el cuerpo
del profesional de salud.
Si existe un riesgo de
x x x x x salpicaduras sobre el cuerpo y
la cara.
Principios de utilización del EPP (1)
Lávese siempre las manos antes y después de usar el EPP.
El EPP debe estar disponible donde y cuando está indicado:
• en la talla correcta y
• escogido en función del riesgo o las precauciones basadas en el modo de
transmisión.
Siempre póngase el EPP antes del contacto con el paciente.
Siempre quítese de inmediato el EPP después de haber completado el
procedimiento o al abandonar la zona de atención al paciente.
NUNCA reutilice un EPP desechable.
Limpie y desinfecte el EPP reutilizable entre cada uso.
Principios de utilización del EPP (2)
Cambie de inmediato el EPP cuando se contamine o se dañe.

El EPP no debe ajustarse ni tocarse durante la atención al paciente,
en concreto:
• nunca se toque la cara mientras utiliza el EPP;
• cuando no se cumplen estas prácticas o hay dudas al respecto,
salga de la zona de atención al paciente en un momento seguro,
quítese el EPP y cámbielo por otro de la manera correcta.
• Siempre, quítese con cuidado el EPP a fin de evitar la
autocontaminación (de las partes más sucias hacia las más limpias).
Las siete etapas para la seguridad
de las inyecciones
1 Espacio de trabajo limpio
7
2 Higiene de las manos
3 Jeringuilla estéril con mecanismo de seguridad
4 Viales estériles para la medicación y los diluyentes
5 Limpieza y antisepsia de la piel
6 Recogida adecuada de los objetos punzocortantes
7 Gestión adecuada de los desechos

https://www.who.int/infection-prevention/tools/injections/training-education/en/
¿Qué es la descontaminación?
Descontaminación:
elimina la suciedad y los microorganismos
patógenos de los objetos, de manera que sea
segura su manipulación, su procesamiento ulterior,
su uso o su eliminación.
Limpieza Desinfección Esterilización
Fuente: Organización Mundial de la Salud. 2016. Decontamination and reprocessing of medical devices for health-care facilities.
Tomado de: https://www.who.int/infection-prevention/publications/decontamination/en/
¿Qué es la descontaminación?
Primer paso necesario para eliminar
físicamente la contaminación por materiales
extraños, por ejemplo, polvo o tierra. También
eliminará el material orgánico como sangre,
Limpieza secreciones, excreciones y microorganismos,
con el fin de preparar un dispositivo médico
para la desinfección o la esterilización.
Procedimiento que disminuye el número de

microorganismos viables a un grado menos
Desinfección
perjudicial. Es posible que este proceso no
inactive las esporas bacterianas, los priones y
algunos virus.
Esterilización Un procedimiento validado que se utiliza para

dejar un objeto sin microorganismos viables,
incluidos los virus y las esporas bacterianas,
pero no los priones.
Principios de la limpieza (1)
Definición de limpieza: Remoción física del material extraño (por ejemplo, polvo
o tierra) y el material orgánico (por ejemplo, sangre, secreciones, excreciones o
microorganismos). La limpieza extrae físicamente los microorganismos en lugar
de destruirlos. La limpieza logra con agua, detergentes y acción mecánica.
Los principios básicos de la limpieza y la desinfección se aplican a todas las
zonas de atención al paciente.
• Asegúrese siempre de limpiar el equipo de atención entre cada utilización con
un paciente.
• Donde sea posible, utilice suministros de limpieza dedicados a las zonas de
riesgo mayor (por ejemplo, las salas de aislamiento, de partos y los quirófanos).
• Los suministros de limpieza para el aislamiento deben mantenerse en la zona o
el espacio de aislamiento y ser utilizados solo allí.
Fuente: CDC y CAN. Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings. Atlanta, GA: US Department of Health and Human Services, CDC; Ciudad del Cabo, Sudáfrica: Infection Control Africa Network; 2019. https://www.cdc.gov/hai/pdfs/resource-
limited/environmental-cleaning-508.pdf
Principios de la limpieza (2)
• Siempre, comience de la zona más limpia hacia la zona más sucia:
• limpie desde las zonas altas hacia las zonas bajas, del exterior
hacia el interior;
• limpie por último las zonas de aislamiento.
• Se recomienda limpiar y trapear con medios húmedos a fin de
reducir al mínimo el polvo.
• Use un sistema de tres baldes para la limpieza y la desinfección.
• El agua para la limpieza debe ser agua limpia.
• No se recomienda aplicar desinfectantes en aerosol.
Fuente: CDC y ICAN. Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings. Atlanta, GA: US Department of Health and Human Services, CDC; Ciudad del Cabo, Sudáfrica: Infection Control Africa Network; 2019. https://www.cdc.gov/hai/pdfs/resource-
limited/environmental-cleaning-508.pdf
Limpieza del entorno en las habitaciones y
las zonas de aislamiento
• Aumente la frecuencia de la limpieza por parte del personal de
mantenimiento en las zonas de atención a los pacientes.
• Las zonas de aislamiento deben contar con sus propios suministros de
limpieza, que se conservan separados de las zonas limpias de atención
a los pacientes.
• Todos los desechos de la zona de aislamiento se consideran
contaminados y deben eliminarse siguiendo los protocolos del
establecimiento para los desechos contaminados.
• Es necesario asegurarse de que el personal de limpieza y de
mantenimiento utiliza el EPP apropiado al limpiar una habitación o una
zona de aislamiento.
• Los suministros de limpieza para el aislamiento deben mantenerse en la
zona o la habitación de aislamiento y ser utilizados solo allí.
Procedimientos de limpieza y frecuencia
recomendados
Zona de internación general
Categoría general o zona específica Descripción de la zona Frecuencia Persona o personal Productos Técnica Orientación complementaria
responsable o descripción de la limpieza
(determinado por el
establecimiento, la
división de tareas
exige protocolos
detallados)
Zona de hospitalización Enfermedad no aguda y sin Diario y según Personal de limpieza De limpieza Superficies altas y Las superficies bajas también
Limpieza corriente inmunodepresión sea necesario (detergente pisos; operar en se limpian de manera
(procedimiento médico neutro y dirección de la zona planificada (por ejemplo
corriente) agua) del paciente semanal)
Zona de hospitalización Enfermedad no aguda y sin Tras el alta Personal de limpieza De limpieza Superficies altas y Incluye:
Limpieza terminal inmunodepresión hospitalaria o y bajas y pisos; (véase 1. Remoción de los
(procedimiento médico el traslado del desinfecció la descripción elementos de atención al
corriente) paciente n complementaria) paciente sucios o usados,
para reprocesamiento o
eliminación.
2. Reprocesamiento de todo
equipo reutilizable (no
primordial) de atención
del paciente.
3. Limpieza de todas las
superficies, incluidas las
que no son accesibles
cuando la habitación o la
zona está ocupada (por
ejemplo, la cama o el
colchón del paciente).
Fuente: CDC y ICAN. Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings. Atlanta, GA: US Department of Health and Human Services,
CDC; Ciudad del Cabo, Sudáfrica: Infection Control Africa Network; 2019. https://www.cdc.gov/hai/pdfs/resource-limited/environmental-cleaning-508.pdf
Etapas de la limpieza
Limpieza corriente
Evaluación Suministros Higiene de las manos Zona del paciente
Eliminación Higiene de las manos
Limpieza corriente: Limpieza ordinaria (y desinfección, cuando esté indicada) cuando la

habitación está ocupada con el fin de retirar el material orgánico, reducir al mínimo la
contaminación microbiana y proporcionar un ambiente visualmente limpio, haciendo hincapié
en las superficies dentro de la zona del paciente.
Etapas de la limpieza terminal
Limpieza terminal
Evaluación Suministros Higiene de las manos Zona del paciente
Baño del paciente Pisos Eliminación Higiene de las manos
Limpieza terminal: Limpieza y desinfección después de que el paciente es dado de alta o se

traslada. Incluye la remoción del material orgánico y una importante reducción y eliminación de la
contaminación microbiana, con el fin de garantizar que no se transfiera ningún microorganismo al
siguiente paciente.
Entorno: cómo ocuparse de la ropa usada
en las salas
• Use el EPP en función del riesgo cuando manipula la ropa usada o
sucia.
• Manipule la ropa sucia con un mínimo de agitación a fin de evitar la
contaminación.
• Coloque la ropa sucia en bolsas o recipientes en el lugar de la
atención.
• Cuando la ropa está excesivamente sucia:
• retire la suciedad prominente (por ejemplo, heces, vómito) con una mano
enguantada y un objeto plano y firme;
• elimine el material sólido en el inodoro y deseche la toalla en la basura; y
• coloque la ropa sucia en un recipiente hermético, claramente rotulado (por
ejemplo, una bolsa y un contenedor cerrado) en la zona de atención al
paciente.
Entorno: cómo ocuparse de la ropa usada
en las salas
• La ropa limpia se debe escoger y transportar de manera que
se evite la contaminación (es decir, en contenedores
cerrados).
• La ropa de las salas de atención al paciente debe
almacenarse en un espacio designado (es decir, un armario o
una habitación) o en recipientes cerrados, lejos del acceso al
público.
Procedimiento de gestión de desechos
Reducirlos al mínimo Aislarlos Recogerlos Transportarlos
Almacenarlos Tratarlos Eliminarlos
El tratamiento seguro de los desechos generados durante las actividades de atención

es la responsabilidad de todo el personal.
Aspectos complementarios de las
precauciones habituales
• Es importante cerciorarse de que los procedimientos de limpieza y

desinfección del entorno se siguen de manera sistemática y correcta.
• La limpieza meticulosa de las superficies del entorno con agua y
detergente, aplicando desinfectantes de grado hospitalario de uso
común (como hipoclorito de sodio al 0,5% o etanol al 70%) son
procedimientos eficaces y suficientes.
• Los dispositivos médicos, los equipos, la lavandería, los utensilios del
servicio de alimentación y los desechos médicos se deben manejar en
conformidad con procedimientos corrientes seguros.
Recomendación 2.
Garantizar el triaje, el
reconocimiento temprano y el
control de las fuentes de infección
Atención de los pacientes enfermos que
solicitan atención
Realizar el Realice el triaje clínico en

triaje y el Internar a los
control de pacientes en
los establecimientos de
infecciones una zona atención de salud con el
de manera exclusiva
eficaz y fin de reconocer de
oportuna manera temprana a los
Transportar y Casos pacientes con infección
dar de alta específicos y
hacia el protocolos de respiratoria aguda (IRA) y
domicilio de atención evitar la transmisión de los
manera médica
segura agentes patógenos a los
profesionales de salud y
otros pacientes.
Triaje (1)
• Evite el hacinamiento.
• Realice un triaje rápido.
• Disponga a los pacientes con IRA en zonas de
Realizar el triaje espera específicas, con ventilación adecuada.
Hospitalizar a
y el control de
infecciones de
los pacientes • Además de las precauciones habituales,
en una zona adopte las precauciones antigotículas y las
manera eficaz y
exclusiva
oportuna precauciones de contacto (en caso de
contacto directo con el paciente o con equipos,
Transportar y Casos
dar de alta específicos y superficies o materiales contaminados).
hacia el protocolos de • Solicite a los pacientes con síntomas
domicilio de atención respiratorios que practiquen la higiene de las
manera médica
segura manos, usen una mascarilla y adopten la
higiene respiratoria.
• Garantice una distancia mínima de un metro
entre los pacientes.
Triaje (2)
En la zona de triaje o tamizaje se requiere el equipo siguiente:
• Cuestionario de tamizaje.
• Algoritmo de triaje.
• Documentación.
• EPP.
• Equipos y carteles sobre la higiene de las manos.
• Termómetro infrarrojo.
• Cubos de basura y acceso a la limpieza y la desinfección.
• Carteles de señalización en las zonas públicas, con preguntas del
tamizaje sindrómico a fin de dar instrucciones a los pacientes para que
alerten al personal de salud.
Triaje (3)
Organización de la zona durante el triaje:
1. Garantizar un espacio suficiente para el triaje (mantener como mínimo una distancia de
un metro entre el personal que realiza el tamizaje y la entrada de los pacientes y el
personal).
2. Tener a disposición productos de higiene de las manos a base de alcohol y mascarillas

(también guantes médicos, protección ocular y batas para usarlos en función de la
evaluación de riesgos).
3. Las sillas para los pacientes en la sala de espera deben estar a una distancia de un
metro.
4. Mantener un flujo unidireccional de los pacientes y el personal.
5. Señalizar claramente los síntomas y las direcciones.
6. Los familiares deben esperar fuera de la zona de triaje con el fin de evitar el hacinamiento
en esta zona.
TAMIZAJE DE VIGILANCIA SINDRÓMICA DE
LA INFECCIÓN RESPIRATORIA AGUDA
PREGUNTAS DEL TAMIZAJE EN CASO AFIRMATIVO:
FIEBRE Haga que el paciente:

- ¿Ha observado la aparición reciente de fiebre 1. Se lave las manos.
>38 grados en los últimos 14 días? 2. Mantenga un distanciamiento
social: conservar una distancia
mínima de un metro.
TOS 3. Use una mascarilla si tiene
- ¿Ha observado la aparición reciente de tos o síntomas.
disnea en los 14 últimos días? 4. SIGA EL AISLAMIENTO DE
CONTACTO Y
VIAJE y CONTACTO GOTÍCULAS.
- ¿Ha viajado a un país con alta transmisión de • Esté separado en una habitación
COVID-19 o ha tenido contacto con alguien con individual.
diagnóstico positivo o presunción de COVID-19?
Hospitalización
• Evite hospitalizar a los pacientes con bajo riesgo que
presenten signos y síntomas respiratorios de infección
sin complicaciones y que no tengan ninguna
Hospitalizar a
Realizar el triaje enfermedad subyacente.
los pacientes
y el control de en una zona
infecciones de • Forme cohortes de pacientes con el mismo
exclusiva
manera eficaz y diagnóstico en una zona.
oportuna
• No disponga a los pacientes con presunción clínica en
Transportar y Casos la misma zona de los pacientes con diagnóstico
dar de alta específicos y confirmado.
hacia el protocolos
domicilio de de atención • Disponga a los pacientes con IRA, cuya situación
manera segura médica pueda ser preocupante, en una habitación individual
bien ventilada, siempre que sea posible.
• Designe profesionales de salud con experiencia en
PCI y brotes epidémicos.
Recomendación 3.
Aplicar precauciones
complementarias empíricas a los
casos presuntos de COVID-19
Precauciones complementarias
• dirigidas a los pacientes sintomáticos y con presunción clínica o a
quienes tienen una infección confirmada por un agente patógeno
sumamente transmisible,
• cuando el agente patógeno se considera importante desde un punto
de vista epidemiológico,
• cuando las intervenciones médicas aumentan el riesgo de
transmisión de un agente infeccioso específico, y
• cuando la situación clínica impide la aplicación sistemática de las
precauciones habituales.
¿Qué incluyen las precauciones adicionales?
Precauciones habituales
+
Alojamiento especial o aislamiento (es decir, habitación individual,
espacio entre las camas, inodoro separado, etc.)
+
Señalización
+
EPP
+
Equipo dedicado y limpieza adicional
+
Limitación del transporte
+
Comunicación
Adaptado de: Organismo para la Promoción y la Protección de la Salud de Ontario. Comité Consultivo Provincial sobre Enfermedades Infecciosas. Prácticas corrientes y precauciones adicionales en
todos los entornos de atención de salud. 3.a edición. Toronto, EN: Reina Printer para Ontario; noviembre del 2012.
Las precauciones complementarias se
basan en el modo de transmisión:
modos directos
Contacto directo
El contacto directo ocurre cuando se toca algo; una
persona puede transmitir los microorganismos a las
demás por el contacto de piel a piel o el contacto con las
superficies, el suelo o la vegetación.
Propagación por gotículas
La propagación por gotículas se refiere a la diseminación
de aerosoles relativamente grandes de corto alcance,
que se produce al estornudar o toser.
Modos indirectos
Contacto indirecto:
La transmisión indirecta se refiere a la transferencia de un
agente infeccioso de un reservorio a un hospedero.
La transmisión por el aire ocurre cuando los agentes
infecciosos son transportados por el polvo o los núcleos
goticulares suspendidos en el aire.
Los vehículos pueden transmitir indirectamente un
agente infeccioso.
Los vectores pueden transmitir un agente infeccioso o
pueden favorecer el crecimiento o los cambios en el
agente.
Pacientes con presunción clínica o
confirmación de COVID-19 (1)
• Precauciones de contacto y antigotículas dirigidas a todos los pacientes con
presunción clínica o confirmación de COVID-19.
• Las precauciones referentes a la transmisión por el aire se recomiendan solo en los
procedimientos que generan aerosoles (es decir, la aspiración abierta de las vías
respiratorias, la intubación, la broncoscopia o la reanimación cardiopulmonar).
• Todos los pacientes con enfermedad respiratoria deben estar en una habitación
individual o como mínimo a una distancia de un metro de otros pacientes
mientras esperan una habitación.
• Un equipo de profesionales de salud debe dedicarse exclusivamente a la atención
de los pacientes con presunción clínica de COVID-19.
• Los profesionales de salud deben utilizar el EPP: una mascarilla quirúrgica, gafas
o careta protectoras, bata y guantes.
• La higiene de las manos debe realizarse en toda ocasión cuando se aplican los
“5 momentos” de la OMS y antes de ponerse el EPP y después de quitárselo.
Pacientes con presunción clínica o
confirmación de COVID-19 (2)
• El equipo debe ser de uso único siempre que sea posible, dedicado al paciente y
desinfectado entre cada uso.
• Evite transportar los casos presuntos o confirmados y, de ser necesario, haga que
los pacientes usen mascarillas. El personal de salud debe usar el EPP apropiado.
• La limpieza corriente del entorno es primordial.
• Limite el número de profesionales de salud, visitantes y familiares que entran en

contacto con el paciente. De ser necesaria su presencia, todos tienen que usar el
EPP.
• Se debe llevar un registro de todas las personas que entran a la habitación del
paciente (incluidos los visitantes) (con fines de localización de contactos).
• Las precauciones deben mantenerse hasta que el paciente esté asintomático.

Precauciones de
contacto
• Habitación individual
• El paciente debe permanecer en la habitación.
• Higiene de las manos según los “5 momentos”,
sobre todo antes y después del contacto con el
paciente y después de quitarse el EPP.
• Evitar tocarse los ojos, la nariz o la boca con
las manos contaminadas, enguantadas o
desnudas.
• El personal debe usar el EPP apropiado: bata +
guantes.
• Limpieza de los equipos, desinfección y
esterilización apropiadas.
• Limpieza del entorno reforzada
• Evitar la contaminación de las superficies que
no se usan en la atención directa al paciente
(por ejemplo, los pomos de puertas, los
interruptores o los teléfonos móviles).
Precauciones antigotículas
• Habitación individual
• si no hay habitaciones individuales disponibles,
mantenga una separación de por lo menos un metro
entre los pacientes.
• Los profesionales de salud deben usar el EPP apropiado:
• mascarilla quirúrgica,
• protección ocular (gafas o careta protectoras),
• bata.
• El paciente debe permanecer en la habitación (movimiento
limitado).
• Cuando es necesario el transporte o el movimiento, haga
que el paciente use una mascarilla quirúrgica y utilice
rutas de transporte predeterminadas, a fin de reducir al
mínimo la exposición del personal, otros pacientes y los
visitantes.
Precauciones referentes a la transmisión por el aire
(en el contexto de la COVID-19)
Las precauciones referentes la transmisión por el aire se
recomiendan SOLO durante los procedimientos que generan
aerosoles como:
- la broncoscopia,
- la intubación traqueal,
- la presión torácica durante la reanimación cardiopulmonar,
que puede inducir la producción de aerosoles.
Se deben adoptar las siguientes medidas:
• Habitación individual con ventilación adecuada:
ventilación natural con un flujo de aire de al menos 160 l/s por paciente o
habitaciones con presión negativa y al menos 12 cambios de aire por hora y
dirección controlada del flujo de aire cuando se usa la ventilación mecánica.
• EPP: contacto + gotículas
• Reemplazar en la habitación la mascarilla quirúrgica por una mascarilla de
alta filtración (N-95, FFP2 o dispositivos equivalentes).
Adaptación de las mascarillas filtrantes N95
¡Verifique el sellado antes de entrar a la
habitación!
5B Verificación negativa del

5A Verificación positiva del
sellado
sellado
- Inhale profundamente. Si hay
- Exhale súbitamente. Una presión
fuga, la presión negativa hará
positiva al interior de la
que la mascarilla se pegue a
mascarilla = no hay fuga. En
su cara.
caso de fuga, ajuste la posición y
- En caso de fuga se perderá la
la tensión de las bandas
presión negativa en la
elásticas.
mascarilla debido al paso de
Verifique de nuevo el sellado.
aire por las brechas en el
- Repita los pasos hasta que logre
sellado.
un sellado perfecto de la
mascarilla.
Atención ambulatoria
Los principios básicos de la PCI y las precauciones
habituales deben aplicarse en todos los establecimientos de
atención de salud, incluso en la atención ambulatoria y la
atención primaria.
En el caso de la infección COVID-19 se deben adoptar las

siguientes medidas:
• Triaje y reconocimiento temprano;
• tamizaje sindrómico realizado en los consultorios; e
• hincapié en la higiene de las manos, la higiene
respiratoria y el uso de mascarillas quirúrgicas por
parte de los pacientes con síntomas respiratorios
(considere la posibilidad desplegar carteles).
Atención ambulatoria
En el caso de la infección COVID-19 se deben adoptar las siguientes
medidas (continuación):
• de ser posible, disponga a los pacientes en habitaciones separadas
o alejados de otros pacientes en las salas de espera y use
mascarillas, guantes y bata al atenderlos en el consultorio si es
posible (adopte tantas precauciones de contacto y antigotículas
como sea posible);
• cuando los pacientes sintomáticos tienen que esperar, asegúrese de
que tengan una sala de espera separada (distancia de un metro);
• asigne la prioridad de atención a los pacientes sintomáticos;
• eduque a los pacientes y las familias acerca del reconocimiento
temprano de los síntomas, las precauciones básicas que deben
adoptarse y a cuál establecimiento de atención de salud deben
acudir.
ATENCIÓN
EN EL DOMICILIO
¿Qué estrategias de
PCI recomienda la OMS
en caso de COVID-19?
https://www.who.int/publications-detail/home-care-for-patients-with-suspected-
novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-
management-of-contacts
Atención en el domicilio, orientación
para los trabajadores de salud
Es probable que los pacientes con enfermedad
respiratoria leve necesiten atención en el hogar.
La OMS recomienda que el paciente mantenga una

comunicación constante con un prestador de
atención de salud o un agente de salud pública
durante todo el período de atención domiciliaria,
hasta la desaparición de los síntomas.
Atención en el domicilio, orientación para
los trabajadores de salud
Los profesionales de salud deben:
• Usar una mascarilla e higienizarse las manos de
manera apropiada al dispensar atención.
• Educar el paciente sobre la forma de limitar la
exposición al resto de su familia. Asimismo,
enseñarles las normas de higiene respiratoria y la
higiene de las manos (cubrirse la boca y la nariz
cuando tosen o estornudan).
• Educar a los cuidadores sobre la forma apropiada
de atender al miembro enfermo de la familia con la
mayor seguridad posible; y proporcionar al paciente
y la familia apoyo, educación y seguimiento
contantes.
Atención en el domicilio, orientación para
los trabajadores de salud
Los cuidadores y los familiares deben (de ser posible):
• Estar informados sobre el tipo de cuidados que deben dispensar y
el uso de las protecciones disponibles para cubrirse la nariz y la
boca.
• Cuando no prestan cuidados, cerciórese de que existe una
separación física de las demás personas en el hogar (que
permanezcan en otra habitación o al menos a un metro de
distancia).
• Recordar al paciente que use una mascarilla cuando está en
presencia de otros familiares (de ser posible).
Recursos sobre la COVID-19
Página inicial de la OMS sobre el coronavirus

https://www.who.int/es/emergencies/diseases/novel-coronavirus-2019
Todas las orientaciones técnicas sobre el nuevo coronavirus
(2019nCoV)
https://www.who.int/es/emergencies/diseases/novel-coronavirus-
2019/technical-guidance
Documentos sobre la PCI
https://www.who.int/emergencies/diseases/novel-coronavirus-
2019/technical-guidance/infection-prevention-and-control
https://www.who.int/infection-prevention/publications/en/
Preguntas y respuestas
https://www.who.int/es/emergencies/diseases/novel-coronavirus-
2019/advice-for-public/q-a-coronaviruses
Colaboradores
• Benedetta Allegranzi, sede de la OMS
• April Baller, sede de la OMS
• Alice Simniceanu, sede de la OMS
• Anthony Twyman, sede de la OMS
• Vicky Willet, sede de la OMS
• Christine Francis, sede de la OMS
• María Clara Fonseca Barbosa Padoveze, sede de
la OMS
• María Van Kerkhove, sede de la OMS
• Gertrude Avortri, AFRO
• Pierre Claver Kariyo, AFRO ¡GRACIAS!
• Kevin Ousman, AFRO
• Ana Paula Coutinho, EURO
• Joao Toledo, OPS
• Takeshi Nishijima, WPRO
Novel Coronavirus (COVID-19)—Fighting Productsi
The American Chemistry Council's (ACC) Center for Biocide Chemistries (CBC) has compiled a list of products that have been pre-approved by the U.S. Environmental Protection Agency
(EPA) for use against emerging enveloped viral pathogens and can be used during the 2019 novel coronavirus (COVID-19) outbreak. This product list is not exhaustive but can be used by
business owners, health professionals, and the public to identify products suitable for use during the COVID-19 situation.
The information in this document is being provided as a public service. All efforts have been made to ensure the information is accurate, but ACC and CBC make no representations or
warranties as to the completeness or accuracy of the information. ACC, CBC, and the product manufacturers listed in this document reserve the right to change, delete, or otherwise
modify the information without any prior notice. Persons receiving this information must make their own determination as to a product's suitability prior to use based on the product
labeling. ACC and CBC do not guarantee or warrant the standard of any product referenced or imply approval of the product to the exclusion of others that may be available. All
products listed are registered for labeled uses in accordance with federal laws and regulations as of the date this document is being made available. State regulations may vary. In no
event will ACC or CBC be responsible for damages of any nature whatsoever resulting from the use of or reliance upon products to which the information refers.
Note: The CBC cannot make a determination of the effectiveness of a product in fighting pathogens like COVID-19. For questions related to the effectiveness of any product not listed
below, please contact the manufacturer directly.
For use of the product, please contact the company/distributor to confirm use directions, or consult the EPA approved label at https://www.epa.gov/pesticide-
labels/pesticide-product-label-system-ppls-more-information.
Tier I Products - Products that are in compliance with EPA's Emerging Viral Pathogen Guidance for Antimicrobial
Pesticides
Ready to Use Products
Commercially Available Product Name Company/Distributor EPA REG No.

4STATE PRAIRIEKLEAN SPRAY & WIPE DISINFECTANT Four State Maintenance Supply Inc. 1893-83-55760
Accel Tb Virox Technologies, Inc. 74559-1
Advantage Wechem, Inc. 1839-83-34370
AERO TB FRESH AERO CHEMICAL CO 1839-83-13103
Af Ultra Acid Free Total Bathroom Cleaner Ultra Chem 1839-83-57839
AFFEX QCNA TB NON ACID DISINFECTANT CLEANER AFFLINK HQ 1839-83-88891
Airx 75 Antibacterial Heavy Duty Cleaner & Odor Counteractant The Bullen Companies 1839-83-44089
Airx Spray N Go Disinfectant Cleaner & Odor Counteractant Airx Laboratories 1839-220-44089
All Purpose Virex Diversey, Inc. 1839-83-70627
Apter Disinfecting Cleaner Apter Industries Inc. 1839-220-12017
Aviation RTU Cleaner Zep 6836-152-1270
Avistat-D RTU Spray Disinfectant Cleaner National Chemical Laboratories, Inc. 1839-83-2296
BAC-CIDE Hill Manufacturing Company, Inc 1839-83-402
BioCide 100 BioCide Labs 1839-83-86117
Bioesque Solutions Botanical Disinfectant Solution 12/1 qt Bioesque Solutions/Natureal, LLC 87742-1-92595
Bioesque Solutions Botanical Disinfectant Solution 4/1 gal Bioesque Solutions/Natureal, LLC 87742-1-92595
Bioesque Solutions Botanical Disinfectant Solution 5 gal Bioesque Solutions/Natureal, LLC 87742-1-92595
Bioesque Solutions Botanical Disinfectant Solution 55 gal Bioesque Solutions/Natureal, LLC 87742-1-92595
BioSentry 904 Disinfectant Hacco, Inc. 6836-78-61282
BLEACH DISINFECTANT CLEANER Ecolab Inc 1677-235
BRIGHT N' FRESH TB PRO LINK 1839-83-62512
Bright Solutions Lemon Zip Disinfectant RTU Bright Solutions 1839-83-75473
Bright Solutions RTU Bathroom Cleaner Non-Acid Bowl and Restroom Disinfectant Bright Solutions 1839-83-75473
BS & H NATIONAL AMERICAN SALES CORP. 1839-83-50718
Byotrol Bathroom Disinfectant Cleaner Byotrol, Inc. 83614-1
Byotrol Disinfectant Cleaner Byotrol, Inc. 83614-1
CAM PRO FB-2 RTU DISINFECTANT SPRAY CLEANER Kandel and Son 1839-83-40976
CA-MRSA DISINFECTANT SPRAY OPI Correctional Industries 1839-83-56349
Castle Complete 360 Castle Products, Inc. 1839-220-64174
CaviCide Bleach Metrex 46781-15
CaviCide1 Metrex 46781-12
Citrus II Hospital Germicidal Deodorizing Cleaner Beaumont Products, Inc. 1839-83-68939
Clear Gear Sports Spray On Track Enterprises, Inc d/b/a Clear Gear 6836-152-89301
Clorox 4 In One Disinfecting Spray Clorox Professional Products Company 67619-29
Clorox Clean Up Cleaner + Bleach The Clorox Company 5813-21
Clorox Commercial Solutions® Clorox® 4-in-One Disinfectant & Sanitizer Clorox Professional Products Company 67619-29
Clorox Commercial Solutions® Clorox® Disinfecting Bathroom Cleaner Clorox Professional Products Company 5813-40-67619
Clorox Commercial Solutions® Clorox® Disinfecting Biostain & Odor Remover Clorox Professional Products Company 67619-33
Clorox Commercial Solutions® Clorox® Disinfecting Spray Clorox Professional Products Company 67619-21
Clorox Commercial Solutions® Hydrogen Peroxide Cleaner Disinfectant Clorox Professional Products Company 67619-24
Clorox Commercial Solutions® Tilex Soap Scum Remover Clorox Professional Products Company 5813-40-67619
Clorox Commercial Solutions® Toilet Bowl Cleaner with Bleach1 Clorox Professional Products Company 67619-16
2
Clorox Commericial Solutions® Clorox® Clean-Up Disinfectant Cleaner with Bleach1 Clorox Professional Products Company 67619-17
Clorox Disinfecting Bathroom Cleaner The Clorox Company 5813-40
Clorox Healthcare® Bleach Germicidal Cleaner Spray Clorox Professional Products Company 56392-7
Clorox Healthcare® Fuzion® Cleaner Disinfectant Clorox Professional Products Company 67619-30
Clorox Healthcare® Hydrogen Peroxide Cleaner Disinfectant Clorox Professional Products Company 67619-24
Clorox Multi Surface Cleaner + Bleach The Clorox Company 5813-105
Clorox Pet Solutions Advanced Formula Disinfecting Stain & Odor Remover The Clorox Company 5813-110
Clorox Scentiva Bathroom Disinfectant Foamer The Clorox Company 5813-40
Clorox Scentiva Bathroom Disinfecting Foam Cleaner The Clorox Company 5813-115
Clorox Toilet Bowl Cleaner Clinging Bleach Gel The Clorox Company 5813-89
Clorox Toilet Bowl Cleaner with Bleach The Clorox Company 5813-89
CloroxPro™ Clorox Total 360® Disinfecting Cleaner1 Clorox Professional Products Company 67619-38
Clubz Hospital Quat Cleaner Superior Mfg. 1839-83-85984
Coil Doctor State Industrial Products 44446-23-70799
COOL BREEZE TB READY TO USE DETERGENT & DISINFECTANT SIMPLEX PRODUCTS 1839-83-39419
COOL BREEZE TB RTU DETERGENT & DISINFECTANT JCL SOLUTIONS 1839-83-92191
Coverage Spray TB (shows up in PPLS but not EPA subregistration database) SC JOHNSON PROFESSIONAL USA INC. 1839-83-93115
CSI Disinfectant Central Solutions, Inc. 1839-83-211
DC PLUS 2 DETERGENT DISINFECTANT RTU TRIPLE S 1839-83-12120
DETERGENT DISINFECTANT PUMP SPRAY Stepan Company 1839-83
D-Germ TB Wechem, Inc. 1839-83-34370
DIC-1 Spray Disinfectant The Deirdre Imus Environmental Health Center® 1839-220-83908
DISASEPTIC XRQ READY TO USE DETERGENT DISINFECTANT PUMP SPRAY PALMERO HEALTH CARE 1839-83-10492
DISINFECTANT DISINFECTS CLEANS GOOD CLEAN FUN 1839-83-83969
Disinfectant Spray Cleaner RTU Victoria Bay Victoria Bay 1839-83-68168
Don-O-Mite Edward Don & Company 6836-152-14462
Dutch®Plus Ready-To-Use Disinfectant Spray Franklin Cleaning Technology 1839-83-1124
ES15 Spray & Wipe Disinfectant Cleaner Charlotte Products Ltd. 1839-220-64900
FIBERLOCK I A Q 2500 Fiberlock Technologies, a division of ICP 1839-83-73884
Construction Inc.
Fight Bac RTU Betco Corporation 1839-83-4170
Formula 442 Ready to Use Acid Free Disinfectant Bathroom & Kitchen Cleaner Arrow Chemical Products, Inc 1839-83-5747
Foster First Defense HB Fuller Construction Products Inc. 6836-152-63836
Fresh Breeze TB MISCO PRODUCTS 1839-83-8325
FRESH BREEZE TB CANI INC 1839-83-72174
FRESH BREEZE TB DISINFECTANT J & R PRODUCTS 1839-83-69459
FRESH-ETTE LEMON Griffin Bros. Inc. 1839-83-1770
GERM BANDIT TB ENVIROCHEMICAL INC 1839-83-66061
GERM CRUSHER RTU DETERGENT & DISINFECTANT GMS INDUSTRIAL SUPPLY 1839-83-84842
Germ Swipe CHEMCO PRODUCTS COMPANY 1839-83-10693
Germicidal Giant Neutron Industries 44446-23-42666
Germi-Kleen Non-Acid Bowl & Bathroom Disinfectant National Chemical Laboratories, Inc. 1839-83-2296
Germ-Kleen Germicidal Foaming Cleaner Maintenance Supplies and Marketing, Inc. 1839-83-54865
HAMMER DISINFECTANT CLEANER HOLT PAPER & CHEMICAL CO 1839-83-23747
Hang Time Ready to Use Foaming Disinfectant Cleaner Arrow Chemical Products, Inc 1839-83-5747
HI-TIDE RTU DISINFECTANT MID-AMERICAN RESEARCH CHEMICAL CORP. 1839-83-12204
Hospital Disinfectant Spray Sani-care Salon Products, Inc. 1839-83-75562
Husky 814 Tuberculocidal Disinfectant Canberra Corporation 1839-83-8155
INTERvention Farm Animal Care Disinfectant Cleaner & Deodorizer Ready to Use Virox Technologies, Inc. 74559-9
KLERCIDE 70/30 IPA Ecolab Inc 1677-249
LASAR CHEMICALS K.O. GERMICIDAL RTU DETERGENT AND DISINFECTANT Lasar Chemicals LLC 1839-83-82125
LAV FRESH TB BORTEK INDUSTRIES 1839-83-62541
LAVFRESH TB Bortek Industries 1839-83-62541
Lemon Disinfectant American Chemical Systems 6836-152-86408
LX-0307 RTU QUAT CLEANER DISINFECTANT ABC COMPOUNDING CO., INC 1839-83-3862
LYSOL BRAND BLEACH MULTI-PURPOSE CLEANER RB 777-83
LYSOL BRAND BLEACH MOLD AND MILDEW REMOVER
LYSOL BRAND CLING & FRESH TOILET BOWL CLEANER RB 777-70
LYSOL BRAND POWER PLUS TOILET BOWL CLEANER RB 777-132
LYSOL BRAND POWER TOILET BOWL CLEANER RB 777-81
LYSOL BRAND LIME & RUST TOILET BOWL CLEANER
LYSOL® DISINEFCTANT MAX COVER MIST RB 777-127
LYSOL® DISINFECTANT SPRAY RB 777-99
PROFESSIONAL LYSOL® DISINFECTANT SPRAY
MADACIDE-1 HOSPITAL DISINFECTANT / DECONTAMINANT CLEANER DETERGENT / MADA Medical Products, Inc. 1839-83-11703
DISINFECTANT READY TO USE
MAPS- 1 RTU SynBionic Evolution, LLC. 6836-289-92677
Maxim GSC Germicidal Spray Cleaner Midlab 1839-83-45745
Maxim No Acid Non-Acid Bowl & Restroom Disinfectant Cleaner RB 352 Brite Midlab 1839-83-45745
McKesson Pro-Tech RTU Disinfectant Cleaner McKesson Medical-Surgical, Inc. 1839-83-80366
Medline Micro-Kill R2 Medline Industries, Inc 1839-220-37549
3
Micro-Kill Bleach Germicidal Bleach Solution Medline Industries, Inc 37549-2

Micro-Kill Bleach Germicidal Bleach Wipes Medline Industries, Inc 37549-1
Miracle Disinfectant Spray and Wipe Cleaner Swish Maintenance Limited 1839-83-67205
MORTIMER FRESH BREEZE TB HOOPER LEE GROUP 1839-83-87244
MULTI-GUARD Continental Research 1839-83-9838
NAD NON-ACID BATHROOM CLEANER RTU DISINFECTANT & DETERGENT SOUTHERN MAINTENANCE SUPPLY 1839-83-46167
Nemesis Cleaner & Disinfectant Charlotte Products Ltd. 1839-83-64900
Neutron Power Tabs Neutron Industries 71847-6-42666
Non Acid Bowl Cleaner Swish Maintenance Limited 1839-83-67205
Non-Acid Bathroom Cleaner Victoria Bay Victoria Bay 1839-83-68168
Non-Acid Disinfectant Brady Industries, Inc. 1839-83-33737
Nyco TB Disinfectant RTU Nyco Products Company 1839-83-8370
One-Step Disinfectant Cleaner Schultz Supply Company 6836-152-46493
Optim 1 SciCan Ltd. 74559-9-83259
Optim 33 TB SciCan Ltd. 74559-1-83259
Oracle 1 Share Corporation 88494-3-11547
OXIVIR 1 Diversey, Inc. 70627-74
OXIVIR Tb Diversey, Inc. 70627-56
PARVO SCRUB RTU VETERINARY DISINFECTANT CLEANER JANI SOURCE INC 1839-83-83937
Performex RTU Brulin & Company, Inc. 1839-220-106
PERIMO RTU SURFACE DISINFECT CERTUS MEDICAL INC 1839-83-88205
PEROXIDE DISINFECTANT AND GLASS CLEANER RTU Ecolab Inc/Kay Chemical Co. 1677-251
PEROXIDE MULTI SURFACE CLEANER AND DISINFECTANT RTU Ecolab Inc/Kay Chemical Co. 1677-251
Peroxigard Ready to Use One-Step Disinfectant Cleaner and Deodorizer for Use in Virox Technologies, Inc. 74559-9
Life Sciences
POWER-CIDAL R-T-U MID-AMERICAN RESEARCH CHEMICAL CORP. 1839-83-12204
PREempt RTU Virox Technologies, Inc. 74559-1
PROPOWER ORIGINALS BOWL-CLEAN NON-ACID BOWL CLEANER READY-TO-USE Independent Marketing Alliance 1839-83-75686
Protection that Lives on Microban 24 Hour Keeps Killing 99.9% of Bacteria for Up to The Procter & Gamble Company 4091-22-3573
24 Hours Bathroom Cleaner (Microban 24 hour Bathroom Cleaner)
Protection that Lives on Microban 24 Hour Keeps Killing 99.9% of Bacteria for Up to The Procter & Gamble Company 4091-21-3573
24 Hours Multipurpose Cleaner” (Microban 24 Hour Multi-Purpose Cleaner)
PURACLEEN DISINFECTANT SPRAY QBASED SOLUTIONS, INC. 1839-83-83894
PURELL Food Processing Surface Sanitizer GOJO Industries, Inc. 84368-1-84150
PURELL Foodservice Surface Sanitizer GOJO Industries, Inc. 84368-1-84150
PURELL Healthcare Surface Disinfectant GOJO Industries, Inc. 84368-1-84150
PURELL Multi Surface Disinfectant GOJO Industries, Inc. 84368-1-84150
PURELL Professional Surface Disinfectant GOJO Industries, Inc. 84368-1-84150
QT-TB Hillyard Industries, Inc. 1839-83-1658
QT-TB Hillyard Hillyard Inc./Central Sanitary Supply 1839-83-1658
Quat Plus TB Rochester Midland Corporation 1839-83-527
Quatricide TB Pharmacal Research Labs., Inc. 1839-83-8714
Quick Defense Disinfectant Tabs State Industrial Products 71847-6-70799
READY-SET-GO! MOMAR, Inc. 1839-83-1553
Rejuvenate Ready to Use One Step Disinfectant Cleaner For Use in Spas, Salons & Virox Technologies, Inc. 74559-1
Clinics
REScue Ready to Use One Step Disinfectant Cleaner & Deodorizer Virox Technologies, Inc. 74559-9
RestorOx Virox Technologies, Inc. 74559-9
RTP Ready to Perform Disinfecting Cleaner PDQ Manufacturing, Inc. 6836-152-58880
RTU Disinfectant Cleaner U S Chemical 70627-2-7546
SANI A/C CHEMTRON 1839-83-68921
SANI CLEAN DISINFECTANT DETERGENT Havard Chemical, LLC. 1839-83-61524
Sani-24 Germicidal Spray Professional Disposables International, Inc. 42182-9-9480
Sanicare TBX Buckeye International, Inc. 1839-83-559
Sani-HyPerCide Germicidal Spray Professional Disposables International, Inc. 9480-14
Sani-Prime Germicidal Spray Professional Disposables International, Inc. 9480-10
Sani-Spritz Spray Nyco Products Company 6836-152-8370
Sanizide Plus Germicidal Solution Safetec of America 1839-83-67161
SaniZide Pro 1 Spray Safetec of America, Inc. 88494-3-67161
SaniZide Pro 1 Wipes Safetec of America, Inc. 88494-4-67161
SC-RTU DISINFECTANT CLEANER Stepan Company 1839-220
SC-RTU-360 DISINFECTANT Spectral Chemical Co Inc 1839-220-33466
SELECT ACID FREE BROOKMEADE HARDWARE & SUPPLY COMPANY 1839-83-58336
Simoniz Antimicrobial All-Purpose Disinfectant Cleaner Simoniz USA, Inc. 1839-83-18305

Simple Green Clean Finish Sunshine Makers, Inc 1839-220-56782
Solucide Hard Surface Disinfectant Spray Medical Chemical Corporation 1839-83-15136
Spray 77 Emulso 1839-83-19
SPRITZ CARE LABS, INC 1839-83-56669
Spritz Care Labs, Inc. 1839-83-56669
SUPER Q SELECT SPECIALTY PRODUCTS 1839-83-50735
4
SURFACE KLEEN TB GENERAL PRODUCTS & SUPPLY INC. 1839-83-41316

SUV Ultra 5 Disinfectant & Cleaner OSHA Review, Inc. 6836-366-70809
T.B. QUAT PRO CHEM, INC. 1839-83-11861
TB Cide Quat Spartan Chemical Company, Inc. 1839-83-5741
TB DISINFECTANT CLEANER READY-TO-USE Ecolab Inc/Kay Chemical Co. 1839-83-1677
TB Quat Gordon Food Service 70627-2-45133
TB QUAT AERO CHEMICAL CO 1839-83-13103
TB Quat Disinfectant Warsaw Chemical Holdings LLC 1839-83-2230
TB-Cide Quat® Spartan Chemical Company, Inc. 1839-83-5741
TB-Quat Alco-Chem, Inc. 1839-83-34714
Triple Quick Fresh and Clean Disinfecting Cleaner State Industrial Products 1839-83-70799
Triple Quick Lavender Meadow Disinfecting Cleaner State Industrial Products 1839-83-70799
Turbo Kill Maintex Inc 1839-83-6885
UNITED 282 United Laboratories, Inc. 1839-83-9250
VIRASEPT Ecolab Inc 1677-226
Viro-Stat RTU Share Corporation 6836-152-11547
VIRU SCRUB RTU DISINFECTANT CLEANER JANI SOURCE INC 1839-83-83937
Wet & Forget Indoor Mold+Mildew Disinfectant Cleaner Wet & Forget USA 6836-152-85342
WIPE OUT SPRAY & WIPE LIMPIADOR, DESINFECTANTE, DESODORANTE PRECISE CHEMICAL & EQUIPMENT 1839-83-11824
Xpress Detergent Disinfectant Auto-Chlor System 1839-83-6243
Xpress Detergent Disinfectant Auto-Chlor System 1839-83-6243
X-Ray Apron Cleaner Disinfectant BioXco LLC / MediRedi LLC 6836-289-93240
Zani One-Step Crestek Cleaning Center, Inc. 1839-83-69410
Zep Antibacterial Disinfectant & Cleaner Zep 1839-83-40849
Zep Quick Clean Disinfectant Zep 1839-220-40849
Zep Spirit II Zep 1839-83-1270
5
Tier I Products - Products that are in compliance with EPA's Emerging Viral Pathogen Guidance for
Antimicrobial Pesticides
Dilutable Products

128 Disinfectant Dalco Enterprises, Inc 6836-365-87580
128 E-Fecticide Multi-Clean Inc. 6836-365-5449
14 PLUS ANTIBACTERIAL ALL PURPOSE CLEANER Ecolab Inc 6836-349-1677
20 NEUTRAL DISINFECTANT CLEANER Ecolab Inc 47371-129-1677
256 Century Q Multi-Clean Inc. 47371-129-5449
3M™ Disinfectant Cleaner RCT Concentrate 3M 6836-349-10350
3M™ MBS Disinfectant Cleaner Concentrate 3M 6836-361-10350
3M™ MBS Disinfectant Cleaner Fresh Scent Concentrate 3M 6836-361-10350
3M™ Neutral Quat Disinfectant Cleaner Concentrate 3M 47371-129-10350
3M™ Quat Disinfectant Cleaner Concentrate 3M 6836-78-10350
A-456 II DISINFECTANT CLEANER Ecolab Inc 6836-78-1677
Accel Concentrate Virox Technologies, Inc. 74559-4
ACS Tornado 1 - One Step Disinfectant American Chemical Systems 6836-75-86408
AQ+ Ultra Disinfectant Sanitizer and Deodorizer Franklin Cleaning Technology 6836-70-1124
Array Non-Acid Restroom Cleaner & Disinfectant P Gordon Food Service 6836-75-45133
Aseptrol S10 Tab BASF Corporation 70060-19
Avert Sporicidal Disinfectant Cleaner Diversey, Inc. 70627-72
BNC-15 Spartan Chemical Company 6836-348-5741
BOOST 3200 Ecolab Inc 63761-8-1677
BOOST 3200 CIP Ecolab Inc 63761 -8-1677
BOOST SURFACE TREATMENT Ecolab Inc 63761-10-1677
Brighton Professional Hepastat 256 Staples Contract & Commercial LLC 6836-78-86226
Broad-Cide Plus OSCEOLA SUPPLY, INC. 6836-365-62865
Buckey Sanicare Mint Quat Buckeye International, Inc. 47371-131-559
Buckeye Eco Neutral Disinfectant Buckeye International, Inc. 47371-129-559
Buckeye Eco One-Step Disinfectant-Deodorizer-Cleaner Buckeye International, Inc. 6836-78-559
Buckeye Sanicare Lemon Quat Buckeye International, Inc. 47371-131-559
Buckeye Sanicare Pine Quat Buckeye International, Inc. 47371-131-559
Buckeye Sanicare Quat 128 Buckeye International, Inc. 47371-130-559
Buckeye Sanicare Quat 256 Buckeye International, Inc. 47371-129-559
Buckeye Sani-Q2 Buckeye International, Inc. 6836-266-559
Buckeye Terminator Buckeye International, Inc. 6836-75-559
Cdiff DISINFECTANT TABLETS Total Solutions 71847-6-68562
CEN-KLEEN IV ARJO HUNTLEIGH, INC. D/B/A ARJOHUNTLEIGH 6836-75-45556
Centraz San Sol 10 Centraz Industries, Inc. 6836-266-9194
Cents-Able Disinfectant-Cleaner-Fungicide-Virucide Archer Manufacturing 6836-77-69886
Classic Whirlpool Disinfectant and Cleaner Central Solutions, Inc. 6836-75-211
Clean Quick Broad Range Quaternary Sanitizer The Procter & Gamble Company 6836-278-3573
CLICKSAN DISINFECTANT/SANITIZER Ecolab Inc/Kay Chemical Co. 6836-305-5389
Clorox Disinfecting Bleach2 The Clorox Company 5813-111
Clorox Germicidal Bleach3 The Clorox Company 5813-114
Clorox Performance Bleach1 The Clorox Company 5813-114
CloroxPro™ Clorox® Germicidal Bleach Clorox Professional Products Company 67619-32
Coastwide Professional Hepastat 256 Staples Contract & Commercial LLC 6836-78-86226
CONFIDENCE PLUS 2 WALTER G LEGGE CO/MINE SAFETY APPLIANCES 47371-130-4204
COMPANY
COSA OXONIA ACTIVE Ecolab Inc 1677-129
Dakil S Davis Manufacturing and Packaging, Inc. 47371-129-50591
Enviro Care Neutral Disinfectant Rochester Midland Corporation 47371-131-527
ES364 Neutral Disinfectanat Charlotte Products Ltd. 6836-366-64900
Extra Spearmint Germicidal Detergent and Deodorant U S Chemical 47371-131-7546
FOOD CONTACT QUAT SANITIZER Ecolab Inc 6836-70-541
Formula 17750 Wintermint Chemsafe International 47371-131-55731
Formula 17822 Deo-Clean Multi Chemsafe International 47371-131-55731
Fox Quat Fox Manufacturing, Inc. 6836-70-89911
G-5 Sanitizer Diversey, Inc. 6836-266-70627
GASCO Quaternary Sanitizer GASCO INDUSTRIAL Corp. 6836-266-81974
Germ-A-Cide 64 Detco Industries, Inc. 47371-131-58111
Germicidal Cleaner and Disinfectant Gordon Food Service 47371-131-45133
Husky 892 Arena Plus Canberra Corporation 6836-365-8155
Husky 824 Quick Care Disinfectant Canberra Corporation 6836-348-8155
6
INTERvention Farm Animal Care Disinfectant Cleaner & Deodorizer Virox Technologies, Inc. 74559-4
KAY SURFACE SANITIZER Ecolab Inc/Kay Chemical Co. 6836-70-5389
KAYQUAT II Ecolab Inc/Kay Chemical Co. 6836-266-5389
Lemon All 1 American Formula 47371-131-72114
Lemon Cleaner U S Chemical 47371-131-7546
LYSOL BRAND CLEAN & FRESH MULTI-SURFACE CLEANER RB 777-89
Magic Germicide Osceola Supply 6836-70-62865
MB-10 Tablets Quip Laboratories, Inc. 70060-19-46269
Medline Micro-Kill NQ5 Medline Industries, Inc 6836-364-37549
Micronex Zep 47371-129-1270
Mint Disinfectant Plus Gurtler Industries, Inc. 6836-75-47567
MixMate Germcidal Cleaner U S Chemical 47371-131-7546
MixMate Microtech Non-Acid Restroom Cleaner & Disinfectant U S Chemical 6836-75-7546
MixMate Non-Acid Restroom Cleaner & Disinfectant U S Chemical 6836-75-7546
MULTI-PURPOSE NEUTRAL PH GERMICIDAL DETERGENT Ecolab Inc 47371-131-1677
multi-quat mega-1 Intercon Chemical Company 6836-77-48211
NEUTRAL DISINFECTANT CLEANER Ecolab Inc 47371-129-1677
Neutral Disinfectant Cleaner Gordon Food Service 47371-131-45133
Neutra-Tec 64 Surtec, Inc. 47371-131-40714
OASIS 499 HBV DISINFECTANT Ecolab Inc 6836-78-1677
OPI SpaComplete OPI Products, Inc. 6836-77-70397
OXONIA ACTIVE Ecolab Inc 1677-129
OXYCIDE DAILY DISINFECTANT CLEANER Ecolab Inc 1677-237
OXY-TEAM™ DISINFECTANT CLEAENER Diversey, Inc. 70627-58
PC-30F M-KYL 128 FOAMER Pioneer Chemical Co. 6836-136-151
Performex Brulin & Co., Inc. 6836-364-106
PEROXIDE MULTI SURFACE CLEANER AND DISINFECTANT Ecolab Inc/Kay Chemical Co. 1677-238
Peroxigard Concentrate One-Step Disinfectant Cleaner and Deodorizer for Virox Technologies, Inc. 74559-4
pH7Q Betco Corporation 47371-131-4170
Pillage Disinfectant Tablets Share Corporation 71847-6-11547
Pine Cleaner Disinfectant U S Chemical 47371-131-7546
Pine Quat Betco Corporation 47371-192-4170
PREempt Concentrate Virox Technologies, Inc. 74559-4
PROFESSIONAL LYSOL® HEAVY DUTY BATHROOM CLEANER CONCENTRATE RB 675-54
PUR:ONE EarthSafe Chemical Alterantives, LLC 71847-7-91524

PURTABS EarthSafe Chemical Alterantives, LLC 71847-6-91524
Q.T. 3 Hillyard Industries, Inc 6836-349-1658
QT-3 Hillyard Hillyard Inc./Central Sanitary Supply 6836-349-1658
Q.T.Plus Hillyard Industries, Inc 6836-77-1658
QT-Plus Hillyard Hillyard Inc./Central Sanitary Supply 6836-77-1658
Q-128® One-Step Germicidal Detergent And Deodorant Franklin Cleaning Technology 47371-130-1124
Q-Rinse PDQ Manufacturing, Inc. 6836-70-58880
Q-Rinse 20/20 Chemical 6836-70-73501
Quat-7 International Market Brands, Inc. 6836-70-67395
Quat Stat 5 Betco Corporation 6836-361-4170
QUATERNARY DISINFECTANT CLEANER Ecolab Inc 6836-78-1677
Quaternary Disinfectant Cleaner SC Johnson Professional 6836-78-89900
Quato 78 Plus Germicidal Detergent & Deoderant Swish Maintenance Limited 47371-130-67205
Rejuvenate Concentrate One Step Disinfectant Cleaner For Use in Spas, Virox Technologies, Inc. 74559-4
Salons & Clinics
REScue Concentrate One Step Disinfectant Cleaner & Deodorizer Virox Technologies, Inc. 74559-4
Sani-Blue Crystal Chemical Company, Inc.. 6836-70-67440
SANI QUAD FOOD SERVICE SANITIZER Ecolab Inc/Kay Chemical Co. 6836-70-1677
Sanifect Plus 1 U S Chemical 47371-131-7546
Sanifect Plus 2 Fresh N Clean U S Chemical 47371-131-7546
SANITIZER / COMMERCIAL SANITIZER Ecolab Inc 6836-302-1677
SD Disinfecting Cleaner Native Green 6836-77-85898
Simple Green d Pro 5 Sunshine Makers, Inc. 6836-140-56782
Stepan Spray Disinfectant Concentrate Stepan Company 1839-248
SUPER 60 PYM 64 FOAMER Pioneer Chemical Co. 47371-131-151
SUPER SAN FOOD SERVICE SANITIZER Ecolab Inc/Kay Chemical Co. 6836-305-1677
Symplicity Sanibet Multi-Range Sanitizer Betco Corporation 6836-266-4170
Synergex Ecolab Inc 1677-250
TEC-QUAT 128 Getinge USA Sales, LLC 6836-77-10648
Triforce Betco Corporation 6836-349-4170
TRIPLE PLAY Ecolab Inc/Kay Chemical Co. 47371-131-541
Triple Two Health Technology Professional Products, Inc 6836-75-69146
7
Triton Zep 6836-78-1270

Trumix® DC2 Q-128® One-Step Germicidal Detergent And Deodorant Franklin Cleaning Technology 47371-130-1124
Trumix® DC2 Q-256® One-Step Germicidal Detergent And Deodorant Franklin Cleaning Technology 47371-129-1124
TruShot Disinfectant Cleaner For Hospitals SC Johnson Professional 6836-348-89900
TruShot Disinfectant Cleaner Restroom Cleaner & Disinfectant SC Johnson Professional 6836-348-89900
United 255 DISINFECT PLUS UNITED LABORATORIES INC 47371-131-9250
Vanquish Total Solutions 6836-140-68562
Vimoba Tablets Quip Laboratories, Inc. 70060-19-46269
Virex Plus Diversey, Inc. 6836-349-70627
VIREX™ II / 256 Diversey, Inc. 70627-24
Viro-Stat Share Corporation 6836-140-11547
Whizzer Mueller Sports Medicine 6836-77-10118
Wide Range II Non-Acid Disinfectant Washroom Cleaner Concentrate Diversey, Inc. 6836-75-70627
8
Tier I Products - Products that are in compliance with EPA's Emerging Viral Pathogen Guidance for
Antimicrobial Pesticides
Wipe products

Accel Tb Wipes Virox Technologies, Inc. 74559-3
BROAD SPECTRUM GERMICIDAL DISINFECTANT HEALTH CARE WIPES Kandel & Son Inc 6836-340-40976
Buckeye Sanicare Disinfecting Wipes Buckeye International, Inc. 6836-313-559
CaviWipes Bleach Metrex 46781-14
CaviWipes1 Metrex 46781-13
CLAIRE BROAD SPECTRUM GERMICIDAL & DISINFECTANT WIPE Claire Manufacturing Company 6836-340-706
Clorox Commercial Solutions® Clorox® Disinfecting Wipes Clorox Professional Products Company 67619-31
Clorox Commerical Solutions® Hydrogen Peroxide Cleaner Disinfectant Wipes Clorox Professional Products Company 67619-25
Clorox Disinfecting Wipes The Clorox Company 5813-79
Clorox Healthcare® Bleach Germicidal Wipes Clorox Professional Products Company 67619-12
Clorox Healthcare® Hydrogen Peroxide Cleaner Disinfectant Wipes Clorox Professional Products Company 67619-25
Clorox Healthcare® VersaSure® Wipes Clorox Professional Products Company 67619-37
Dispatch Clorox Healthcare 56392-8
Fabuloso Complete Disinfecting Wipes Colgate-Palmolive Company 6836-336-4582
Germ Freak Bissell Homecare, Inc. 74559-3-6297
Handyclean™ Steridol Wipes Diamond Wipes International, Inc. 6836-340-74058
I7 DISINFECTANT WIPES Ecolab Inc/Kay Chemical Co. 6836-340-1677
INTERvention Farm Animal Care Disinfectant Cleaner & Deodorizer Ready to Use Wipes Virox Technologies, Inc. 74559-10
LCP BROAD SPECTRUM GERMICIDAL & DISINFECTANT WIPES LOR Cleaner Products 6836-340-88324
Lysol® Disinfecting Wipes (All Scents) RB 777-114
Monk Disinfectant Wipes Dreumex USA, Inc. 6836-313-91910
MULTI PURPOSE DISINFECTING WIPES Ecolab Inc 6836-340-1677
NASSCO PRO SERIES 88 BROAD SPECTRUM GERMICIDAL & DISINFECTANT WIPES NASSCO Inc 6836-340-18166
NCLwipes Disinfectant Wipes Lemon Fresh National Chemical Laboratories, Inc. 6836-340-2296
NCLwipes Disinfectant Wipes Waterfall Fresh National Chemical Laboratories, Inc. 6836-340-2296
Optim 1 Wipes SciCan Ltd. 74559-10-83259
Optim 33 Tb Wipes SciCan Ltd. 74559-3-83259
Oxivir 1 Wipes Diversey, Inc. 70627-77
OXIVIR™ WIPES Diversey, Inc. 70627-60
Pathos II Disinfectant Wipes Share Corporation 6836-340-11547
Peroxigard Wipes One-Step Disinfectant Cleaner and Deodorizer for Use in Life Sciences Virox Technologies, Inc. 74559-10
PREempt Wipes Virox Technologies, Inc. 74559-3
PURELL Foodservice Surface Sanitizing Wipes GOJO Industries, Inc. 84150-1
PURELL Professional Surface Disinfectant Wipes GOJO Industries, Inc. 85150-1
Rejuvenate Ready To Use Wipes One Step Disinfectant Cleaner for Use in Spas, Salons & Clinics Virox Technologies, Inc. 74559-3
REScue Wipes One Step Disinfectant Cleaner & Deodorizer Virox Technologies, Inc. 74559-10
Sani-Cloth Prime Germicidal Disposable Wipe Professional Disposables International, 9480-12
Inc.
SCRUBS® MEDAPHENE® Plus Disinfecting Wipes ITW Pro Brands 6836-340-11694
SONO Disinfecting Wipes Advanced Ultrasound Solutions, Inc. 6836- 340-89018
SONO Ultrasound Wipes Advanced Ultrasound Solutions, Inc. 6836- 340-89018
Spec4 Disinfectant Wipes Total Solutions 6836-340-68562
SSS TRIPLE S DISINFECTANT WIPES Triple S 6836-340-12120
Touch Point Plus Disinfectant Wipes Innocore Sales & Marketing 6836-340-92977
Wipes Plus Disinfecting Wipes 1 Progressive Products, LLC. 6836-340-75399
9
Tier II - Products that Disinfect Against Human Coronavirus
As of March 13, EPA is supporting the use of products that have demonstrated efficacy against another human coronavirus similar to SARS-CoV-2 on its List
N, Disinfectants for Use Against SARS-CoV-2. In other words, the product has not proven that it can kill harder to kill viruses than SARS-CoV-2, which would
be a Tier I product, but it can kill viruses like SARS-CoV-2. CBC therefore has amended its list to include a Tier II listing of products that state that they can
disinfect human coronavirus.
EPA recommendation is that only if a product with an emerging viral pathogen claim is not available, use a product that will disinfect against human
coronavirus.
Tier II - Products that Disinfect Against Human Coronavirus
Formulation
Type
Array Comprehensive Clean Germicidal Bleach & Disinfectant Gordon Food Service, Inc 70271-13-45133 Dilutable
BOARDWALK GERMICIDAL ULTRA BLEACH United Stationers Supply Company 70271-13-84728 Dilutable
Champ Wechem, Inc. 1839-169-34370 RTU
Ecolution Disinfectant State Industrial Products 61178-1-70799 RTU
Enviro-Solutions 24+ Charlotte Products Ltd. 1839-79-68138 Dilutable
Enviro-Solutions 25+ Charlotte Products Ltd. 1839-95-68138 Dilutable
Enviro-Solutions 512 Sanitizer Charlotte Products Ltd. 1839-86-68138 Dilutable
Enviro-Solutions 64H Neutral Disinfectant Cleaner Charlotte Products Ltd. 1839-169-68138 Dilutable
FIRST MARK GERMICIDAL ULTRA BLEACH Performance Food Group 70271-13-73835 Dilutable
Formula 236 Terg-o-cide State Industrial Products 10324-154-70799 RTU
Formula 362 No Rinse State Industrial Products 61178-1-70799 RTU
FROSTY ACRES RESTAURANT'S PRIDE ADVANTAGE GERMICIDAL ULTRA FAB Inc 70271-13-55020 Dilutable
BLEACH
Lysol Neutra Air® 2 in 1 RB 777-136 RTU
Lysol® Brand All Purpose Cleaner – (All Scents) RB 777-66 RTU
Lysol® Kitchen Pro Antibacterial Cleaner RB 777-91 RTU
Lysol® Laundry Sanitizer (disinfection in pre-soak using UDM method) RB 777-128 Dilutable
Micro Q64 Cleaner & Disinfectant Charlotte Products Ltd. 1839-169-64900 Dilutable
MONOGRAM CLEANING DISPOSABLES DISINFECTANT BLEACH U.S.Foods, Inc 70271-13-87442 Dilutable
NDC Morning Fresh Neutral Disinfectant Products State Industrial Products 1839-169-70799 RTU
NI-712 Disinfecting Cleaning Concentrate Neutron Industries 1839-169-42666 RTU
Nisus DSV Nisus Corporation 10324-80-64405 Dilutable
PRIME SOURCE GERMICIDAL ULTRA BLEACH Prime Source LLC 70271-13-68613 Dilutable
Pro-Line Wechem, Inc. 1839-168-34370 RTU
PROPOWER ORIGINALS GERMICIDAL ULTRA BLEACH Independent Marketing Alliance 70271-13-75686 Dilutable
Protection that Lives on Microban 24 Hour Keeps Killing 99.9% of The Procter & Gamble Company 4091-20-3573 RTU
Bacteria for Up to 24 Hours Sanitizing Spray (Microban 24 Hour
Sanitizing Spray)
PURE BRIGHT GERMICIDAL ULTRA BLEACH KIK International LLC 70271-13 Dilutable
PURELL Foodservice Surface Sanitizer, No Rinse Required GOJO Industries, Inc 84150-3 RTU
PURELL Healthcare Surface Disinfectant GOJO Industries, Inc 84150-4 RTU
PURELL Professional Surface Disinfectant GOJO Industries, Inc 84150-3 RTU
Qaut X Wechem, Inc. 1839-167-34370 RTU
Quatricide PV Second Generation Pharmacal Research Labs., Inc. 10324-154-8714 RTU
Quatricide PV-15 Second Generation Pharmacal Research Labs., Inc. 10324-141-8714 RTU
Quick Defense NDC State Industrial Products 1839-236-70799 RTU
Quick Defense Wipes State Industrial Products 6836-372-70799 RTU
Saniguard Wechem, Inc. 1839-86-34370 RTU
ServClean Sanitize Charlotte Products Ltd. 10324-81-68138 RTU
State Po2wer DC State Industrial Products 10324-214-70799 RTU
Surface Defense Disinfecting Wipes Neutron Industries 6836-372-42666 RTU
SUV Ultra Disinfecting Wipes OSHA Review, Inc. 6836-372-70809 Wipe
Swish Food Service 1000 Swish Maintenance Limited 1839-79-67205 Dilutable
Swish Food Service 2000 Swish Maintenance Limited 1839-86-67205 Dilutable
SYSCO CLASSIC GERMICIDAL ULTRA BLEACH Sysco Corporation 70271-13-29055 Dilutable
VICTORIA BAY GERMICIDAL ULTRA BLEACH Dade Paper and Bag Company 70271-13-82294 Dilutable
Victoria Bay Quality Products for Everyday Needs Germicidal Ultra Victoria Bay Products 70271-13-82294 Dilutable
Bleach1
Waxie Germicidal Ultra Bleach Waxie's Enetrprises Inc 70271-13-14994 Dilutable
As a public service, CBC is maintaining this list of antimicrobials that have proven to be effective against stronger pathogens, such as norovirus or ebola. By
publishing and maintaining this open list, CBC relieves federal, state, and local health officials’ resources in order to focus on other aspects of the important
effort to limit spread of this new disease. Listing is voluntary and compliance with EPA’s “emerging viral pathogen” guidance for antimicrobial products is
verified by CBC. CBC will be working with federal and state officials to disseminate the list and make it accessible to all those who need to be in the know.
i To include a product on CBC’s list of Coronavirus-Fighting Products, registrants of the products should please contact Ms. Komal K. Jain at
komal_jain@americanchemistry.com. Please also refer to CBC's Frequently Asked Questions guidance at https://
biocides.americanchemistry.com/CBCs-List-of-COVID-19-Fighting-Products-FAQs.html
Updated 3/18/2020
WHO Guidelines
on Hand Hygiene in Health Care: a Summary
First Global Patient Safety Challenge

Clean Care is Safer Care
a
WHO Guidelines
on Hand Hygiene in Health Care:
a Summary
© World Health Organization 2009
WHO/IER/PSP/2009.07
All rights reserved. Publications of the World Health

Organization can be obtained from WHO Press, World
Health Organization, 20 Avenue Appia, 1211 Geneva 27,
Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857;
e-mail: bookorders@who.int). Requests for permission to
reproduce or translate WHO publications – whether for sale or
for noncommercial distribution – should be addressed to WHO
Press, at the above address (fax: +41 22 791 4806; e-mail:
permissions@who.int).
The designations employed and the presentation of the

material in this publication do not imply the expression of
any opinion whatsoever on the part of the World Health
Organization concerning the legal status of any country,
territory, city or area or of its authorities, or concerning the
delimitation of its frontiers or boundaries. Dotted lines on maps
represent approximate border lines for which there may not yet
be full agreement.
The mention of specific companies or of certain manufacturers’

products does not imply that they are endorsed or
recommended by the World Health Organization in preference
to others of a similar nature that are not mentioned. Errors and
omissions excepted, the names of proprietary products are
distinguished by initial capital letters.
All reasonable precautions have been taken by the World

Health Organization to verify the information contained in
this publication. However, the published material is being
distributed without warranty of any kind, either expressed or
implied. The responsibility for the interpretation and use of the
material lies with the reader. In no event shall the World Health
Organization be liable for damages arising from its use.
WHO Guidelines
First Global Patient Safety Challenge

Clean Care is Safer Care
WHO PATIENT SAFETY
WHO Guidelines
Foreword
Health care-associated infections affect hundreds of millions of patients worldwide every year. Infections lead to more
serious illness, prolong hospital stays, induce long-term disabilities, add high costs to patients and their families,
contribute to a massive, additional financial burden on the health-care system and, critically, often result in tragic loss
of life.
By their very nature, infections are caused by many different sustainability of all actions for the long term benefit of everyone.
factors related to systems and processes of care provision as While system change is a requirement in most places,
well as to human behaviour that is conditioned by education, sustained change in human behaviour is even more important
political and economic constraints on systems and countries, and relies on essential peer and political support.
and often on societal norms and beliefs. Most infections,
however, are preventable. “Clean Care is Safer Care” is not a choice but a basic right.
Clean hands prevent patient suffering and save lives. Thank
Hand hygiene is the primary measure to reduce infections. you for committing to the Challenge and thereby contributing
A simple action, perhaps, but the lack of compliance among to safer patient care.
health-care providers is problematic worldwide. On the basis of
research into the aspects influencing hand hygiene compliance
and best promotional strategies, new approaches have proven Professor Didier Pittet,
effective. A range of strategies for hand hygiene promotion Director, Infection Control Programme
and improvement have been proposed, and the WHO First University of Geneva Hospitals and Faculty of Medicine,
Global Patient Safety Challenge, “Clean Care is Safer Care”, Switzerland
is focusing part of its attention on improving hand hygiene Lead, First Global Patient Safety Challenge, WHO Patient
standards and practices in health care along with implementing Safety
successful interventions.
New global Guidelines on Hand Hygiene in Health Care,

developed with assistance from more than 100 renowned
international experts, have been tested and given trials in
different parts of the world and were launched in 2009. Testing
sites ranged from modern, high-technology hospitals in
developed countries to remote dispensaries in poor-resource
villages.
Encouraging hospitals and health-care facilities to adopt

these Guidelines, including the “My 5 Moments for Hand
Hygiene” approach, will contribute to a greater awareness and
understanding of the importance of hand hygiene. Our vision
for the next decade is to encourage this awareness and to
advocate the need for improved compliance and sustainability
in all countries of the world.
Countries are invited to adopt the Challenge in their own

health-care systems to involve and engage patients and
service users as well as health-care providers in improvement
strategies. Together we can work towards ensuring the
WHO PATIENT SAFETY
CONTENTS
INTRODUCTION V
PART I. HEALTH CARE-ASSOCIATED INFECTION AND EVIDENCE OF THE IMPORTANCE OF HAND HYGIENE 1
1. The problem: health care-associated infection is a major cause of death and disability worldwide 2
1.1 Magnitude of health care-associated infection burden
1.2 Health care-associated infection in developed countries
1.3 Health care-associated infection in developing countries
1.4 Health care-associated infection among health-care workers
2. The role of hand hygiene to reduce the burden of health care-associated infection 5
2.1 Transmission of health care-associated pathogens through hands
2.2 Hand hygiene compliance among health-care workers
2.3 Strategies to improve hand hygiene compliance
2.4 Impact of hand hygiene promotion on health care-associated infection
2.5 Cost-effectiveness of hand hygiene promotion
PART II. CONSENSUS RECOMMENDATIONS 11
Consensus recommendations and ranking system
1. Indications for hand hygiene 12

2. Hand hygiene technique 15
3. Recommendations for surgical hand preparation 15
4. Selection and handling of hand hygiene agents 16
5. Skin care 16
6. Use of gloves 17
7. Other aspects of hand hygiene 17
8. Educational and motivational programmes for health-care workers 17
9. Governmental and institutional responsibilities 18
9.1 For health-care administrators
9.2 For national governments
PART III. GUIDELINE IMPLEMENTATION 25
1. Implementation strategy and tools 26

2. Infrastructures required for optimal hand hygiene 28
3. Other issues related to hand hygiene, in particular the use of an alcohol-based handrub 28
3.1 Methods and selection of products for performing hand hygiene
3.2 Skin reactions related to hand hygiene
3.3 Adverse events related to the use of alcohol-based handrubs
3.4 Alcohol-based handrubs and C. difficile and other non-susceptible pathogens
REFERENCES 32
APPENDICES 43
1. Definition of terms 44
2. Table of contents of the WHO Guidelines on Hand Hygiene in Health Care 2009 46
3. Hand Hygiene Implementation Toolkit 49
ACKNOWLEDGEMENTS 50
WHO PATIENT SAFETY
INTRODUCTION
Confronted with the important issue of patient safety, in 2002 the Fifty-fifth World Health Assembly adopted a
resolution urging countries to pay the closest possible attention to the problem and to strengthen safety and
monitoring systems. In May 2004, the Fifty-seventh World Health Assembly approved the creation of an international
alliance as a global initiative to improve patient safety. The World Alliance for Patient Safety was launched in October
2004 and currently has its place in the WHO Patient Safety programme included in the Information, Evidence and
Research Cluster.
WHO Patient Safety aims to create an environment that reducing the transmission of pathogenic microorganisms
ensures the safety of patient care globally by bringing together to patients and HCWs. They have been developed with a
experts, heads of agencies, policy-makers and patient groups global perspective, not addressing developed nor developing
and matching experiences, expertise and evidence on various countries but rather all countries, while encouraging adaptation
aspects of patient safety. The goal of this effort is to catalyse to the local situation according to the resources available.
discussion and action and to formulate recommendations and
facilitate their implementation. The WHO Guidelines on Hand Hygiene in Health Care 2009
(http://whqlibdoc.who.int/publications/2009/9789241597906_
WHO Patient Safety has developed multiple streams of work eng.pdf) are the result of the update and finalization of
and focused actions on the various problem areas (http://www. the Advanced Draft, issued in April 2006 according to a
who.int/patientsafety/en/). One specific approach has been to literature review up to June 2008 and to data and lessons
focus on specific themes (challenges) that deserve priority in learned from pilot testing. The 1st GPSC team was supported
the field of patient safety. by a Core Group of experts in coordinating the process
of reviewing the available scientific evidence, writing the
“Clean Care is Safer Care” was launched in October 2005 as document and fostering discussion among authors. More
the first Global Patient Safety Challenge (1st GPSC), aimed at than 100 international experts, technical contributors, external
reducing health care-associated infection (HCAI) worldwide. reviewers and professionals offered their input in preparing
These infections occur both in developed and in transitional the document. Task forces were also established to examine
and developing countries and are among the major causes of different aspects in depth and to provide recommendations
death and increased morbidity for hospitalized patients. in specific areas. In addition to systematic literature search
for evidence, other international and national infection control
A key action within “Clean Care is Safer Care” is to promote guidelines and textbooks were consulted. Recommendations
hand hygiene globally and at all levels of health care. Hand were formulated based on evidence and expert consensus and
hygiene, a very simple action, is well accepted to be one of were graded using the system developed by the Healthcare
the primary modes of reducing HCAI and of enhancing patient Infection Control Practices Advisory Committee (HICPAC)
safety. of the Centers for Disease Control and Prevention (CDC) in
Atlanta, Georgia, USA.
Throughout four years of activity the technical work of
the 1st GPSC has been focused on the development of In parallel with the Advanced Draft, an implementation
recommendations and implementation strategies to improve strategy (WHO Multimodal Hand Hygiene Improvement
hand hygiene practices in any situation in which health care is Strategy) was developed together with a wide range of tools
delivered and in all settings where health care is permanently (at that time called the “Pilot Implementation Pack”) to help
or occasionally performed, such as home care by birth health-care settings translate the guidelines into practice
attendants. This process led to the preparation of the WHO at the bedside. According to the WHO recommendations
Guidelines on Hand Hygiene in Health Care. for guideline preparation, a testing phase was undertaken
to provide local data on the resources required to carry out
The aim of these Guidelines is to provide health-care workers the recommendations; to generate information on feasibility,
(HCWs), hospital administrators and health authorities with a validity, reliability, and cost–effectiveness of the interventions;
thorough review of evidence on hand hygiene in health care and to adapt and refine proposed implementation strategies.
and specific recommendations for improving practices and Analysis of data and evaluation of the lessons learned from
I
WHO GUIDELINES ON HAND HYGIENE IN HEALTH CARE SUMMARY
pilot sites were of the utmost importance in order to finalize In contrast to the Guidelines, presently available only in
the Guidelines, the implementation strategy and the tools English, this Summary has been translated into all WHO official
currently included in the Implementation Toolkit (see Appendix languages.
3; available at http://www.who.int/gpsc/5may/tools/en/index.
html). It is anticipated that the recommendations (Part II) will remain
valid until at least 2011. WHO Patient Safety is committed to
The final Guidelines are based on updated evidence, data ensuring that the WHO Guidelines on Hand Hygiene in Health
from field testing and experiences during the past few years Care are updated every two-to-three years.
of global promotion of hand hygiene. Special attention has
been paid to documenting all these experiences, including
various barriers to implementation faced in different settings
and suggestions for overcoming them. For example, there is
a subsection on lessons learnt from local production of the
WHO-recommended hand rub formulations in different settings
worldwide (see Part I.12 of the Guidelines).
As compared to the Advanced Draft, in the final Guidelines (see

Table of Contents in Appendix 2) there are no major changes in
the existing consensus recommendations but nonetheless the
evidence grades for some recommendations are different. A
few additional recommendations were added and some others
were reordered or reworded.
Several new chapters on key innovative topics were added to

the final Guidelines, for example the burden of HCAI worldwide;
a national approach to hand hygiene improvement; patient
involvement in hand hygiene promotion; and comparison of
hand hygiene national and sub-national guidelines.
Successful dissemination and implementation strategies are

required in order to achieve the objectives of these Guidelines
and this forms the basis of another new chapter related to the
WHO Multimodal Hand Hygiene Improvement Strategy. Key
messages from this chapter are also summarized in Part III of
this document.
For rational decision making it is necessary to have reliable

information on costs and consequences. The chapter on
assessing the economic impact of hand hygiene promotion
has been extensively revised, with a considerable amount of
new information added to facilitate better assessments of these
aspects, both in low- and high-income settings.
All other chapters and appendices have also undergone

revision and additions based on evolving concepts. The WHO
Guidelines on Hand Hygiene in Health Care 2009 table of
contents is included in Appendix 2.
The present Summary focuses on the most relevant parts

of the Guidelines and refers to the Guide to Implementation
and some tools particularly important for their translation into
practice. It provides a synthesis of the key concepts in order to
facilitate the understanding of the scientific evidence on which
hand hygiene promotion is founded and the implementation of
the Guidelines’ core recommendations.
II
WHO PATIENT SAFETY
PART I.
HEALTH CARE-ASSOCIATED INFECTION

AND EVIDENCE OF THE IMPORTANCE
OF HAND HYGIENE
1
1.
The problem: health care-associated infection (HCAI)
is a major cause of death and disability worldwide
1.1 Magnitude of HCAI burden the difficulty of gathering reliable diagnostic data. This is mainly
due to the complexity and lack of uniformity of criteria used in
HCAI is a major problem for patient safety and its prevention diagnosing HCAI and to the fact that surveillance systems for
must be a first priority for settings and institutions committed to HCAI are virtually nonexistent in most countries.
making health care safer.
Therefore, HCAI remains a hidden, cross-cutting concern that
The impact of HCAI implies prolonged hospital stay, long- no institution or country can claim to have solved as yet.
term disability, increased resistance of microorganisms to
antimicrobials, massive additional financial burdens, an excess
of deaths, high costs for the health systems and emotional 1.2 HCAI in developed countries
stress for patients and their families. Risk of acquiring HCAI
depends on factors related to the infectious agent (e.g. In developed countries, HCAI concerns 5–15% of hospitalized
virulence, capacity to survive in the environment, antimicrobial patients and can affect 9–37% of those admitted to intensive
resistance), the host (e.g. advanced age, low birth weight, care units (ICUs).1, 2
underlying diseases, state of debilitation, immunosuppression,
malnutrition) and the environment (e.g. ICU admission, Recent studies conducted in Europe reported hospital-
prolonged hospitalization, invasive devices and procedures, wide prevalence rates of patients affected by HCAI that
antimicrobial therapy). Although the risk of acquiring HCAI is ranged from 4.6% to 9.3% (Figure I.1).3-9 An estimated five
universal and pervades every health-care facility and system million HCAI at least occur in acute care hospitals in Europe
around the world, the global burden is unknown because of annually, contributing to 135 000 deaths per year and
Figure I.1
Prevalence of HCAI in developed countries*
Norway: 5.1%
Scotland: 9.5% Slovenia: 4.6%

Canada: 10.5%
Switzerland: 10.1%
UK & Ireland: 7.6%
Greece: 8.6%
USA**: 4.5% France: 6.7%
Italy: 4.6%
* References can be found in Part I.3 of the WHO Guidelines on Hand Hygiene in Health Care 2009
**Incidence
2
PART I. HEALTH CARE-ASSOCIATED INFECTION (HCAI) AND EVIDENCE OF THE IMPORTANCE OF HAND HYGIENE
representing around 25 million extra days of hospital stay and 1.3 HCAI in developing countries
a corresponding economic burden of €13–24 billion (http://
helics.univ-lyon1.fr/helicshome.htm). The estimated HCAI To the usual difficulties of diagnosing HCAI, in developing
incidence rate in the United States of America (USA) was 4.5% countries the paucity and unreliability of laboratory data, limited
in 2002, corresponding to 9.3 infections per 1000 patient- access to diagnostic facilities like radiology and poor medical
days and 1.7 million affected patients and an annual economic record keeping must be added as obstacles to reliable HCAI
impact of US$ 6.5 billion in 2004,10.Approximately 99 000 burden estimates. Therefore, limited data on HCAI from these
deaths were attributed to HCAI. 11 settings are available from the literature.
Prevalence rates of infection acquired in ICUs vary from 9 to In addition, basic infection control measures are virtually
37% when assessed in Europe12 and the USA, with crude non-existent in most settings as a result of a combination of
mortality rates ranging from 12% to 80%.2 numerous unfavourable factors such as understaffing, poor
hygiene and sanitation, lack or shortage of basic equipment,
In ICU settings particularly, the use of various invasive devices inadequate structures and overcrowding, almost all of which
(e.g. central venous catheter, mechanical ventilation or can be attributed to limited financial resources. Furthermore,
urinary catheter) is one of the most important risk factors for populations largely affected by malnutrition and a variety of
acquiring HCAI. Device-associated infection rates per 1000 diseases increase the risk of HCAI in developing countries.
device-days detected through the National Healthcare Safety
Network (NHSN) in the USA are summarized in Table I.1.13 Under these circumstances, numerous viral and bacterial
Device-associated infections have a great economic impact; HCAI are transmitted and the burden due to such infections
for example catheter-related bloodstream infection caused by seems likely to be several times higher than what is observed
methicillin-resistant Staphylococcus aureus (MRSA) may cost in developed countries.
as much as US$ 38 000 per episode.14
For example, in one-day prevalence surveys recently carried
out in single hospitals in Albania, Morocco, Tunisia and the
United Republic of Tanzania, HCAI prevalence rates varied
between 19.1% and 14.8% (Figure I.2).15-18
Figure I.2
Prevalence of HCAI in developing countries*
Latvia: 5.7%
Lithuania: 9.2%
Turkey: 13.4%
Albania: 19.1%
Lebanon: 6.8%
Morocco: 17.8%
Tunisia: 17.8%
Thailand: 7.3%
Mali: 18.7%
Malaysia: 13.9%
Brazil: 14.0 %
Tanzania: 14.8%
* References can be found in Part I.3 of the WHO Guidelines on Hand Hygiene in Health Care 2009
3
The risk for patients to develop surgical site infection (SSI), the In some settings (Brazil and Indonesia), more than half the
most frequently surveyed type of HCAI in developing countries, neonates admitted to neonatal units acquire a HCAI, with
is significantly higher than in developed countries (e.g. 30.9% reported fatality rates between 12% and 52%.23 The costs of
in a paediatric hospital in Nigeria, 23% in general surgery in managing HCAI are likely to represent a higher percentage of
a hospital in the United Republic of Tanzania and 19% in a the health or hospital budget in low income countries as well.
maternity unit in Kenya).15, 19, 20
These concepts are discussed more extensively in Part I.3 of
Device-associated infection rates reported from multicentre the WHO Guidelines on Hand Hygiene in Health Care 2009.
studies conducted in adult and paediatric ICUs are also several
times higher in developing countries as compared to the NHSN
system (USA) rates (Table I.1).13, 21, 22 Neonatal infections are
reported to be 3–20 times higher among hospital-born babies
in developing as compared to developed countries.23
Table I.1.
Device-associated infection rates in ICUs in developing countries compared with NHSN rates
Surveillance network, Setting No. of patients CLA-BSI* VAP* CR-UTI*

study period, country
INICC, 2002–2007, PICU 1,808 6.9 7.8 4.0

18 developing countries†21
NHSN, 2006–2007, USA13 PICU — 2.9 2.1 5.0
INICC, 2002–2007, Adult 26,155 8.9 20.0 6.6

18 developing countries†21 ICU#
NHSN, 2006–2007, USA13 Adult — 1.5 2.3 3.1

ICU#
* Overall (pooled mean) infection rates/1000 device-days

INICC = International Nosocomial Infection Control Consortium; NHSN = National Healthcare Safety Network; PICU = paediatric intensive care unit;
CLA-BSI = central line-associated bloodstream infection; VAP = ventilator-associated pneumonia; CR-UTI = catheter-related urinary tract infection.
† Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, El Salvador, India, Kosovo, Lebanon, Macedonia, Mexico, Morocco, Nigeria, Peru, Philippines,
Turkey, Uruguay
#Medical/surgical ICUs
1.4 HCAI among HCWs
HCWs can also become infected during patient care. Transmission occurs mostly via large droplets, direct contact
During the Marburg viral hemorrhagic fever event in Angola, with infectious material or through contact with inanimate
transmission within health care settings played a major role objects contaminated by infectious material. Performance of
on the amplification of the outbreak (WHO unpublished data). high-risk patient care procedures and inadequate infection
Nosocomial clustering, with transmission to HCWs, was control practices contribute to the risk. Transmission of other
a prominent feature of severe acute respiratory syndrome viral (e.g. human immunodeficiency virus (HIV), hepatitis B) and
(SARS).24, 25 Similarly, HCWs were infected during the influenza bacterial illnesses including tuberculosis to HCWs is also well
pandemics.26 known.27
4
2.
The role of hand hygiene to reduce the burden
of health care-associated infection
2.1 Transmission of health care-associated 2.2 Hand hygiene compliance among HCWs
pathogens through hands
Hand hygiene is the primary measure proven to be effective
Transmission of health care-associated pathogens takes in preventing HCAI and the spread of antimicrobial resistance.
place through direct and indirect contact, droplets, air and a However, it has been shown that HCWs encounter difficulties
common vehicle. Transmission through contaminated HCWs’ in complying with hand hygiene indications at different levels.
hands is the most common pattern in most settings and
require five sequential steps: (i) organisms are present on Insufficient or very low compliance rates have been reported
the patient’s skin, or have been shed onto inanimate objects from both developed and developing countries. Adherence of
immediately surrounding the patient; (ii) organisms must be HCWs to recommended hand hygiene procedures has been
transferred to the hands of HCWs; (iii) organisms must be reported as variable, with mean baseline rates ranging from
capable of surviving for at least several minutes on HCWs’ 5% to 89% and an overall average of 38.7%. Hand hygiene
hands; (iv) handwashing or hand antisepsis by the HCWs must performance varies according to work intensity and several
be inadequate or omitted entirely, or the agent used for hand other factors; in observational studies conducted in hospitals,
hygiene inappropriate; and (v) the contaminated hand or hands HCWs cleaned their hands on average from 5 to as many as
of the caregiver must come into direct contact with another 42 times per shift and 1.7–15.2 times per hour. In addition,
patient or with an inanimate object that will come into direct the duration of hand cleansing episodes ranged on average
contact with the patient.28 from as short as 6.6 seconds to 30 seconds. The main factors
that may determine poor hand hygiene include risk factors for
Health care-associated pathogens can be recovered not only non-adherence observed in epidemiological studies as well as
from infected or draining wounds but also from frequently reasons given by HCWs themselves for lack of adherence to
colonized areas of normal, intact patient skin.29-43 Because hand hygiene recommendations (Table I.2.1).
nearly 106 skin squames containing viable microorganisms are
shed daily from normal skin,44 it is not surprising that patient These concepts are discussed more extensively in Part I.16 of
gowns, bed linen, bedside furniture and other objects in the the WHO Guidelines on Hand Hygiene in Health Care 2009.
immediate environment of the patient become contaminated
with patient flora.40-43, 45-51
Many studies have documented that HCWs can contaminate

their hands or gloves with pathogens such as Gram-negative
bacilli, S. aureus, enterococci or C. difficile by performing
“clean procedures” or touching intact areas of skin of
hospitalized patients.35, 36, 42, 47, 48, 52-55
Following contact with patients and/or a contaminated

environment, microorganisms can survive on hands for
differing lengths of time (2–60 minutes). HCWs’ hands become
progressively colonized with commensal flora as well as with
potential pathogens during patient care.52, 53 In the absence of
hand hygiene action, the longer the duration of care, the higher
the degree of hand contamination.
Defective hand cleansing (e.g. use of an insufficient amount of

product and/or an insufficient duration of hand hygiene action)
leads to poor hand decontamination. Obviously, when HCWs
fail to clean their hands during the sequence of care of a single
patient and/or between patients’ contact, microbial transfer
is likely to occur. Contaminated HCWs’ hands have been
associated with endemic HCAIs56, 57 and also with several HCAI
outbreaks.58-60
These concepts are discussed more extensively in Parts I.5-7

of the WHO Guidelines on Hand Hygiene in Health Care 2009.
5
Table I.2.1
Factors influencing adherence to recommended hand hygiene practices
A. Observed risk factors for poor adherence to recommended hand hygiene practices
Doctor status (rather than a nurse)

Nursing assistant status (rather than a nurse)
Physiotherapist
Technician
Male gender
Working in intensive care
Working in surgical care unit
Working in emergency care
Working in anaesthesiology
Working during the week (vs. week-end)
Wearing gowns/gloves
Before contact with patient environment
After contact with patient environment e.g. equipment
Caring for patients aged less than 65 years old
Caring for patients recovering from clean/clean-contaminated surgery in post-anaesthesia care unit
Patient care in non-isolation room
Duration of contact with patient (< or equal to 2 minutes)
Interruption in patient-care activities
Automated sink
Activities with high risk of cross-transmission
Understaffing/overcrowding
High number of opportunities for hand hygiene per hour of patient care
B. Self-reported factors for poor adherence with hand hygiene
Handwashing agents cause irritations and dryness

Sinks are inconveniently located/shortage of sinks
Lack of soap, paper, towel
Often too busy/insufficient time
Patient needs take priority
Hand hygiene interferes with HCW-patient relation
Low risk of acquiring infection from patients
Wearing of gloves/beliefs that glove use obviates the need for hand hygiene
Lack of knowledge of guidelines/protocols
Lack of knowledge, experience and education
Lack of rewards/encouragement
Lack of role model from colleagues or superiors
Not thinking about it/forgetfulness
Scepticism about the value of hand hygiene
Disagreement with the recommendations
Lack of scientific information of definitive impact of improved hand hygiene on HCAI
C. Additional perceived barriers to appropriate hand hygiene
Lack of active participation in hand hygiene promotion at individual or institutional level

Lack of institutional priority for hand hygiene
Lack of administrative sanction of non-compliers/rewarding of compliers
Lack of institutional safety climate/culture of personal accountability of HCWs to perform hand hygiene
6
2.3 Strategies to improve hand hygiene compliance
Over the last 20 years, many studies have demonstrated

that effective interventions exist to improve hand hygiene
compliance among HCWs (Table I.2.2) although measurement
of hand hygiene compliance has varied in terms of the
definition of a hand hygiene opportunity and the assessment of
hand hygiene by means of direct observation or consumption
of hand hygiene products, making comparisons difficult.
Despite different methodologies, most studies used multimodal

strategies, which included: HCWs’ education, audits of hand
hygiene practices and performance feedback, reminders,
improvement of water and soap availability, use of automated
sinks, and/or introduction of an alcohol-based handrub as
well as improvement of the institutional safety climate with
participation at the institutional, HCW and patient levels.
These concepts are discussed more extensively in Part I.20 of

the WHO Guidelines on Hand Hygiene in Health Care 2009.
Table I.2.2
Hand hygiene adherence by HCWs before and after hand hygiene improvement interventions
Reference Setting Adherence Adherence after Intervention

baseline intervention
(%) (%)
Preston, Larson & Stamm78 ICU 16 30 More convenient sink locations
Mayer et al.79 ICU 63 92 Performance feedback

80
Donowitz PICU 31 30 Wearing overgown
Conly et al.81 MICU 14/28 * 73/81 Feedback, policy reviews, memo, posters
Graham82 ICU 32 45 Alcohol-based handrub introduced
Dubbert et al.83 ICU 81 92 In-service first, then group feedback
Lohr et al.84 Pedi OPDs 49 49 Signs, feedback, verbal reminders to doctors

85
Raju & Kobler Nursery & NICU 28 63 Feedback, dissemination of literature, results
of environmental cultures
Wurtz, Moye & Jovanovic86 SICU 22 38 Automated handwashing machines available
Pelke et al.87 NICU 62 60 No gowning required
Berg, Hershow & Ramirez88 ICU 5 63 Lectures, feedback, demonstrations

89
Tibballs PICU 12/11 13/65 Overt observation, followed by feedback
Slaughter et al.90 MICU 41 58 Routine wearing of gowns and gloves
Dorsey, Cydulka Emerman91 Emerg Dept 54 64 Signs/distributed review paper
Larson et al.92 ICU 56 83 Lectures based on previous questionnaire

on HCWs’ beliefs, feedback, administrative
support, automated handwashing machines
Avila-Aguero et al.93 Paediatric wards 52/49 74/69 Feedback, films, posters, brochures
ICU = intensive care unit; SICU = surgical ICU; MICU = medical ICU; MSICU = medical/surgical ICU;
PICU = paediatric ICU; NICU = neonatal ICU; Emerg = emergency; Oncol = oncology; CTICU = cardiothoracic ICU; PACU = post-anaesthesia care unit:
OPD = outpatient department; NS = not stated.
* Percentage compliance before/after patient contact
7
Table I.2.2
Hand hygiene adherence by health-care workers before and after hand hygiene improvement interventions (Cont.)
Reference Setting Adherence Adherence Intervention

baseline after
(%) intervention
(%)
Pittet et al.75 All wards 48 67 Posters, feedback, administrative support,

alcohol handrub made available
Maury et al.94 MICU 42 61 Alcohol handrub made available
Bischoff et al.95 MICU 10/22 23/48 Education, feedback, alcohol gel made
CTICU 4/13 7/14 available
Muto, Sistrom & Farr 96 Medical wards 60 52 Education, reminders, alcohol gel made
available
Girard, Amazian & Fabry 97 All wards 62 67 Education, alcohol gel made available
Hugonnet, Perneger & Pittet98 MICU/ SICU 38 55 Posters, feedback, administrative support,
NICU alcohol rub made available
Harbarth et al.99 PICU / NICU 33 37 Posters, feedback, alcohol rub made available
Rosenthal et al.100 All wards 17 58 Education, reminders, more sinks made

3 hospitals available
Brown et al.62 NICU 44 48 Education, feedback, alcohol gel made

available
Ng et al.101 NICU 40 53 Education, reminders
Maury et al.102 MICU 47.1 55.2 Announcement of observations (compared to

covert observation at baseline)
das Neves et al.103 NICU 62.2 61.2 Posters, musical parodies on radio, slogans
104
Hayden et al. MICU 29 43 Wall dispensers, education, brochures,
buttons, posters
Berhe, Edmond & Bearman105 MICU, SICU 31.8/50 39 / 50.3 Performance feedback
Eckmanns et al.106 ICU 29 45 Announcement of observations

(compared to covert observation at baseline)
Santana et al.107 MSICU 18.3 20.8 Introduction of alcohol-based handrub

dispensers, posters, stickers, education
Swoboda et al.108 IMCU 19.1 25.6 Voice prompts if failure to handrub
Trick et al.64 3 study 23/30/35/ 32 46/50/43/31 Increase in handrub availability, education,

hospitals, poster
one control,
hospital-wide
Raskind et al.109 NICU 89 100 Education
Traore et al.110 MICU 32.1 41.2 Gel versus liquid handrub formulation
Pessoa-Silva et al.111 NICU 42 55 Posters, focus groups, education,

questionnaires, review of care protocols
Rupp et al.112 ICU 38/37 69/68 Introduction of alcohol-based handrub gel
Ebnother et al.113 All wards 59 79 Multimodal intervention
Haas & Larson114 Emerg 43 62 Introduction of wearable personal handrub

department dispensers
Venkatesh et al.115 Hematology unit 36.3 70.1 Voice prompts if failure to handrub
Duggan et al.116 Hospital-wide 84.5 89.4 Announced visit by auditor
ICU = intensive care unit; SICU = surgical ICU; MICU = medical ICU; MSICU = medical/surgical ICU; PICU = paediatric ICU; NICU = neonatal ICU; Emerg
= emergency; Oncol = oncology; CTICU = cardiothoracic ICU; PACU = post-anaesthesia care unit: OPD = outpatient department; NS = not stated.
* Percentage compliance before/after patient contact
8
2.4 Impact of hand hygiene promotion on HCAI At least 20 hospital-based studies of the impact of hand
hygiene on the risk of HCAI have been published between
Failure to perform appropriate hand hygiene is considered 1977 and June 2008 (Table I.2.3). Despite study limitations,
to be the leading cause of HCAI and the spread of multi- most reports showed a temporal relation between improved
resistant organisms, and has been recognized as a significant hand hygiene practices and reduced infection and cross-
contributor to outbreaks. transmission rates.
There is convincing evidence that improved hand hygiene

through multimodal implementation strategies can reduce
HCAI rates.61 In addition, although not reporting infection rates
several studies showed a sustained decrease of the incidence
of multidrug-resistant bacterial isolates and patient colonization
following the implementation of hand hygiene improvement
strategies.62-65
Table I.2.3
Association between improved adherence with hand hygiene practice and health care-associated infection rates (1975– June 2008)
Year Authors Hospital Major results Duration of

setting follow-up
1977 Casewell & Adult ICU Significant reduction in the percentage of patients colonized or infected 2 years
Phillips66 by Klebsiella spp.
1989 Conly et al.81 Adult ICU Significant reduction in HCAI rates immediately after hand hygiene 6 years
promotion (from 33% to 12% and from 33% to 10%, after two
intervention periods 4 years apart, respectively)
1990 Simmons et al.117 Adult ICU No impact on HCAI rates (no statistically significant improvement of 11 months
hand hygiene adherence)
1992 Doebbeling et Adult ICUs Significant difference between rates of HCAI using two different hand 8 months
al.118 hygiene agents
1994 Webster et al.74 NICU Elimination of MRSA when combined with multiple other infection 9 months
control measures. Reduction of vancomycin use. Significant reduction
of nosocomial bacteremia (from 2.6% to 1.1%) using triclosan
compared to chlorhexidine for handwashing
1995 Zafar et al.67 Newborn Control of a MRSA outbreak using a triclosan preparation for 3.5 years
nursery handwashing, in addition to other infection control measures
2000 Larson et al.119 MICU/NICU Significant (85%) relative reduction of the vancomycin-resistant 8 months
enterococci (VRE) rate in the intervention hospital; statistically
insignificant (44%) relative reduction in control hospital; no significant
change in MRSA
2000 Pittet et al.75,120 Hospital-wide Significant reduction in the annual overall prevalence of HCAI (42%) 8 years
and MRSA cross-transmission rates (87%). Active surveillance cultures
and contact precautions were implemented during same time period.
A follow-up study showed continuous increase in handrub use, stable
HCAI rates and cost savings derived from the strategy.
2003 Hilburn et al.121 Orthopaedic 36% decrease of urinary tract infection and SSI rates 10 months
surgical unit (from 8.2% to 5.3%)
2004 MacDonald et Hospital-wide Significant reduction in hospital-acquired MRSA cases 1 year

al.77 (from 1.9% to 0.9%)
2004 Swoboda et al.122 Adult Reduction in HCAI rates (not statistically significant) 2.5 months
intermediate
care unit
2004 Lam et al.123 NICU Reduction (not statistically significant) in HCAI rates (from 11.3/1000 6 months
patient-days to 6.2/1000 patient-days)
2004 Won et al.124 NICU Significant reduction in HCAI rates (from 15.1/1000 patient-days to 2 years
10.7/1000 patient-days), in particular of respiratory infections
9
Table I.2.3
Association between improved adherence with hand hygiene practice and health care-associated infection rates (1975– June 2008) (Cont.)
Year Authors Hospital Major results Duration of

setting follow-up
2005 Zerr et al.125 Hospital-wide Significant reduction in hospital-associated rotavirus infections 4 years
2005 Rosenthal et Adult ICUs Significant reduction in HCAI rates (from 47.5/1000 patient-days to 21 months
al.126 27.9/1000 patient-days)
2005 Johnson et al.127 Hospital-wide Significant reduction (57%) in MRSA bacteraemia 36 months
2007 Thi Anh Thu et Neurosurgery Reduction (54%, NS) of overall incidence of SSI. Significant reduction 2 years
al.128 (100%) of superficial SSI; significantly lower SSI incidence in
intervention ward compared with control ward
2007 Pessoa-Silva et Neonatal unit Reduction of overall HCAI rates (from 11 to 8.2 infections per 1000 27 months
al.111 patient-days) and 60% decrease of risk of HCAI in very low birth weight
neonates (from 15.5 to 8.8 episodes/1000 patient-days)
2008 Rupp et al.112 ICU No impact on device-associated infection and infections due to 2 years
multidrug-resistant pathogens
2008 Grayson et al.129 1) 6 pilot 1) Significant reduction of MRSA bacteraemia (from 0.05/100 patient- 1) 2 years
hospitals discharges to 0.02/100 patient-discharges per month) and of clinical
MRSA isolates
2) all public 2) Significant reduction of MRSA bacteraemia (from 0.03/100 patient- 2) 1 year
hospitals discharges to 0.01/100 patient-discharges per month) and of clinical
in Victoria MRSA isolates
(Australia)
In addition, reinforcement of hand hygiene practices helps In a study conducted in a Russian neonatal ICU, the authors
control epidemics in health-care facilities.66, 67 Outbreak estimated that the added cost of one health care-associated
investigations have suggested an association between infection BSI (US$ 1100) would cover 3265 patient-days of hand
and understaffing or overcrowding that was consistently linked antiseptic use (US$ 0.34 per patient-day).62 In another study
with poor adherence to hand hygiene.68-70 it was estimated that cost savings achieved by reducing
the incidence of C. difficile-associated disease and MRSA
The beneficial effects of hand hygiene promotion on the risk infections far exceeded the additional cost of using an alcohol-
of cross-transmission have been shown also in schools, day based handrub.76 Similarly, MacDonald and colleagues
care centres and in the community setting.71-73 Hand hygiene reported that the use of an alcohol-based hand gel combined
promotion improves child health and reduces upper respiratory with education sessions and HCWs performance feedback
pulmonary infection, diarrhoea and impetigo among children in reduced the incidence of MRSA infections and expenditures
the developing world. for teicoplanin (used to treat such infections).77 For every
UK£1 spent on alcohol-based gel, UK£9–20 were saved on
These concepts are discussed more extensively in Part I.22 of teicoplanin expenditure.
Pittet and colleagues75 estimated direct and indirect costs
associated with a hand hygiene programme to be less than
2.5 Cost-effectiveness of hand hygiene promotion US$ 57 000 per year for a 2600-bed hospital, an average of
US$ 1.42 per patient admitted. The authors concluded that
The costs of hand hygiene promotion programmes include the hand hygiene programme was cost-saving if less than
the costs of hand hygiene installations and products plus the 1% of the reduction in HCAIs observed was attributable to
costs associated with HCW time and the educational and improved hand hygiene practices. An economic analysis of
promotional materials required by the programme. the “cleanyourhands” hand hygiene promotional campaign
conducted in England and Wales concluded that the
To assess the cost savings of hand hygiene promotion programme would be cost beneficial if HCAI rates were
programmes it is necessary to consider the potential savings decreased by as little as 0.1%.
that can be achieved by reducing the incidence of HCAIs.
Several studies provided some quantitative estimates of the These concepts are discussed more extensively in Part III.3 of
cost savings from hand hygiene promotion programmes.74,75 the WHO Guidelines on Hand Hygiene in Health Care 2009.
10
WHO PATIENT SAFETY
PART II.
CONSENSUS RECOMMENDATIONS
11
Consensus recommendations and ranking system
Recommendations were formulated based on evidence described in the various sections of the Guidelines and
expert consensus. Evidence and recommendations were graded using a system adapted from the one developed
by the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and
Prevention (CDC), Atlanta, Georgia, USA (Table II.1).
Table II.1
Ranking system used to grade the Guidelines’ recommendations
Category Criteria
IA Strongly recommended for implementation and strongly supported by well-designed experimental, clinical or epidemiological
studies
IB Strongly recommended for implementation and supported by some experimental, clinical or epidemiological studies and a strong
theoretical rationale
IC Required for implementation as mandated by federal and/or state regulation or standard
II Suggested for implementation and supported by suggestive clinical or epidemiological studies or a theoretical rationale or the
consensus of a panel of experts
1.
Indications for hand hygiene
A. Wash hands with soap and water when visibly dirty or visibly d) if moving from a contaminated body site to another body
soiled with blood or other body fluids (IB) or after using the site during care of the same patient (IB);35, 53-55, 156
toilet (II).130-140 e) after contact with inanimate surfaces and objects
(including medical equipment) in the immediate vicinity of
B. If exposure to potential spore-forming pathogens is strongly the patient (IB);48, 49, 51, 53-55, 156-158
suspected or proven, including outbreaks of C. difficile, f) after removing sterile (II) or non-sterile gloves (IB).53, 159-162
hand washing with soap and water is the preferred means
(IB).141-144 E. Before handling medication or preparing food perform hand
hygiene using an alcohol-based handrub or wash hands
C. Use an alcohol-based handrub as the preferred means with either plain or antimicrobial soap and water (IB).133-136
for routine hand antisepsis in all other clinical situations
described in items D(a) to D(f) listed below if hands are not F. Soap and alcohol-based handrub should not be used
visibly soiled (IA).75, 82, 94, 95, 145-149 If alcohol-based handrub is concomitantly (II).163, 164
not obtainable, wash hands with soap and water (IB).75, 150, 151
D. Perform hand hygiene:

a) before and after touching the patient (IB); 35, 47, 51, 53-55, 66,
152-154
b) before handling an invasive device for patient care,

regardless of whether or not gloves are used (IB); 155
c) after contact with body fluids or excretions, mucous
membranes, non-intact skin, or wound dressings (IA); 54,
130, 153, 156
12
PART II. CONSENSUS RECOMMENDATIONS
Figure II.1
How to handrub
Hand Hygiene Technique with Alcohol-Based Formulation
Duration of the entire procedure: 20-30 seconds
1a 1b 2
Apply a palmful of the product in a cupped hand, covering all surfaces; Rub hands palm to palm;
3 4 5
Right palm over left dorsum with Palm to palm with fingers interlaced; Backs of fingers to opposing palms
interlaced fingers and vice versa; with fingers interlocked;
6 7 8
Rotational rubbing of left thumb Rotational rubbing, backwards and Once dry, your hands are safe.
clasped in right palm and vice versa; forwards with clasped fingers of right
hand in left palm and vice versa;
13
Figure II.2
How to handwash
Hand Hygiene Technique with Soap and Water
Duration of the entire procedure: 40-60 seconds
0 1 2
Wet hands with water; Apply enough soap to cover Rub hands palm to palm;
all hand surfaces;
3 4 5
Right palm over left dorsum with Palm to palm with fingers interlaced; Backs of fingers to opposing palms
interlaced fingers and vice versa; with fingers interlocked;
6 7 8
Rotational rubbing of left thumb Rotational rubbing, backwards and Rinse hands with water;
clasped in right palm and vice versa; forwards with clasped fingers of right
hand in left palm and vice versa;
9 10 11
Dry hands thoroughly Use towel to turn off faucet; Your hands are now safe.
with a single use towel;
14
2.
Hand hygiene technique
A. Apply a palmful of alcohol-based handrub and cover all a towel to turn off tap/faucet (IB).170-174 Dry hands thoroughly
surfaces of the hands. Rub hands until dry (IB).165, 166 The using a method that does not recontaminate hands. Make
technique for handrubbing is illustrated in Figure II.1. sure towels are not used multiple times or by multiple people
(IB).175-178 The technique for handwashing is illustrated in
B. When washing hands with soap and water, wet hands with Figure II.2.
water and apply the amount of product necessary to cover
all surfaces. Rinse hands with water and dry thoroughly C. Liquid, bar, leaf or powdered forms of soap are acceptable.
with a single-use towel. Use clean, running water whenever When bar soap is used, small bars of soap in racks that
possible. Avoid using hot water, as repeated exposure to facilitate drainage should be used to allow the bars to dry
hot water may increase the risk of dermatitis (IB).167-169 Use (II).179-185
3.
Recommendations for surgical hand preparation
A. Remove rings, wrist-watch, and bracelets before beginning G. When performing surgical hand antisepsis using an
surgical hand preparation (II).186-190 Artificial nails are antimicrobial soap, scrub hands and forearms for the
prohibited (IB).191-195 length of time recommended by the manufacturer, typically
2–5 minutes. Long scrub times (e.g. 10 minutes) are not
B. Sinks should be designed to reduce the risk of splashes necessary (IB).200, 211, 213-219
(II).196, 197
H. When using an alcohol-based surgical handrub product
C. If hands are visibly soiled, wash hands with plain soap with sustained activity, follow the manufacturer’s instructions
before surgical hand preparation (II). Remove debris from for application times. Apply the product to dry hands only
underneath fingernails using a nail cleaner, preferably under (IB).220, 221 Do not combine surgical hand scrub and surgical
running water (II).198 handrub with alcohol-based products sequentially (II).163
D. Brushes are not recommended for surgical hand I. When using an alcohol-based handrub, use sufficient
preparation (IB).199-205 product to keep hands and forearms wet with the handrub
throughout the surgical hand preparation procedure (IB).222-
224
E. Surgical hand antisepsis should be performed using either The technique for surgical hand preparation using
a suitable antimicrobial soap or suitable alcohol-based alcohol-based handrubs is illustrated in Figure II.3.
handrub, preferably with a product ensuring sustained
activity, before donning sterile gloves (IB).58, 204, 206-211 J. After application of the alcohol-based handrub as
recommended, allow hands and forearms to dry thoroughly
F. If quality of water is not assured in the operating theatre, before donning sterile gloves (IB).204, 208
surgical hand antisepsis using an alcohol-based handrub
is recommended before donning sterile gloves when
performing surgical procedures (II).204, 206, 208, 212
15
4.
Selection and handling of hand hygiene agents
A. Provide HCWs with efficacious hand hygiene products that d. ensure that dispensers function adequately and reliably
have low irritancy potential (IB).146, 171, 225-231 and deliver an appropriate volume of the product (II);75, 243
e. ensure that the dispenser system for alcohol-based
B. To maximize acceptance of hand hygiene products by handrubs is approved for flammable materials (IC);
HCWs, solicit their input regarding the skin tolerance, feel, f. solicit and evaluate information from manufacturers
and fragrance of any products under consideration (IB).79, 145, regarding any effect that hand lotions, creams or alcohol-
146, 228, 232-236
Comparative evaluations may greatly help in this based handrubs may have on the effects of antimicrobial
process.227, 232, 233, 237 soaps being used in the institution (IB);238, 244, 245
g. cost comparisons should only be made for products
C. When selecting hand hygiene products: that meet requirements for efficacy, skin tolerance, and
a. determine any known interaction between products used acceptability (II).236, 246
to clean hands, skin care products and the types of glove
used in the institution (II);238, 239 D. Do not add soap (IA) or alcohol-based formulations (II) to
b. solicit information from manufacturers about the risk of a partially empty soap dispenser. If soap dispensers are
product contamination (IB); 57, 240, 241 reused, follow recommended procedures for cleansing.247, 248
c. ensure that dispensers are accessible at the point of care
(IB); 95, 242
5.
Skin care
A. Include information regarding hand-care practices designed D. When alcohol-based handrub is available in the health-care
to reduce the risk of irritant contact dermatitis and other skin facility for hygienic hand antisepsis, the use of antimicrobial
damage in education programmes for HCWs (IB).249, 250 soap is not recommended (II).
B. Provide alternative hand hygiene products for HCWs E. Soap and alcohol-based handrub should not be used
with confirmed allergies or adverse reactions to standard concomitantly (II).163
products used in the health-care setting (II).
C. Provide HCWs with hand lotions or creams to minimize the

occurrence of irritant contact dermatitis associated with
hand antisepsis or handwashing (IA).228, 229, 250-253
16
6.
Use of gloves
A. The use of gloves does not replace the need for hand D. When wearing gloves, change or remove gloves during
hygiene by either handrubbing or handwashing (IB).53, 159-161, patient care if moving from a contaminated body site to
254-256
either another body site (including non-intact skin, mucous
membrane or medical device) within the same patient or the
B. Wear gloves when it can be reasonably anticipated that environment (II).52, 159, 160
contact with blood or other potentially infectious materials,
mucous membranes or non-intact skin will occur (IC).257-259 E. The reuse of gloves is not recommended (IB).262 In the case
of glove reuse, implement the safest reprocessing method
C. Remove gloves after caring for a patient. Do not wear the (II).263
same pair of gloves for the care of more than one patient
(IB).51, 53, 159-161, 260, 261 The techniques for donning and removing non-sterile and
sterile gloves are illustrated in Figures II.4 and II.5
7.
Other aspects of hand hygiene
A. Do not wear artificial fingernails or extenders when having B. Keep natural nails short (tips less than 0.5 cm long or
direct contact with patients (IA).56, 191, 195, 264-266 approximately ¼ inch) (II).264
8.
Educational and motivational programmes
for HCWs
A. In hand hygiene promotion programmes for HCWs, focus C. Monitor HCWs’ adherence to recommended hand hygiene
specifically on factors currently found to have a significant practices and provide them with performance feedback
influence on behaviour and not solely on the type of hand (IA).62, 75, 79, 81, 83, 85, 89, 99, 100, 111, 125, 276
hygiene products. The strategy should be multifaceted and
multimodal and include education and senior executive D. Encourage partnerships between patients, their families
support for implementation (IA).64, 75, 89, 100, 111, 113, 119, 166, 267-277 and HCWs to promote hand hygiene in health-care settings
(II).279-281
B. Educate HCWs about the type of patient-care activities that
can result in hand contamination and about the advantages
and disadvantages of various methods used to clean their
hands (II).75, 81, 83, 85, 111, 125, 126, 166, 276-278
17
9.
Governmental and institutional responsibilities
9.1 For health-care administrators 9.2 For national governments
A. It is essential that administrators ensure that conditions are A. Make improved hand hygiene adherence a national
conducive to the promotion of a multifaceted, multimodal priority and consider provision of a funded, coordinated
hand hygiene strategy and an approach that promotes a implementation programme while ensuring monitoring and
patient safety culture by implementation of points B–I below. long-term sustainability (II).292-295
B. Provide HCWs with access to a safe, continuous water B. Support strengthening of infection control capacities within
supply at all outlets and access to the necessary facilities to health-care settings (II).290, 296, 297
perform handwashing (IB).276, 282, 283
C. Promote hand hygiene at the community level to strengthen
C. Provide HCWs with a readily accessible alcohol-based both self-protection and the protection of others (II).71, 138-140,
handrub at the point of patient care (IA).75, 82, 94, 95, 284-288 298-300
D. Encourage health-care settings to use hand hygiene as a

D. Make improved hand hygiene adherence (compliance) an quality indicator (Australia, Belgium, France, Scotland, USA)
institutional priority and provide appropriate leadership, (II).278, 301
administrative support, financial resources and support for
hand hygiene and other infection prevention and control
activities (IB).75, 111, 113, 119, 289
E. Ensure that HCWs have dedicated time for infection control

training, including sessions on hand hygiene (II).270, 290
F. Implement a multidisciplinary, multifaceted and multimodal

programme designed to improve adherence of HCWs to
recommended hand hygiene practices (IB).75, 119, 129
G. With regard to hand hygiene, ensure that the water supply is

physically separated from drainage and sewerage within the
health-care setting and provide routine system monitoring
and management (IB).291
H. Provide strong leadership and support for hand hygiene and

other infection prevention and control activities (II).119
I. Alcohol-based handrub production and storage must

adhere to the national safety guidelines and local legal
requirements (II).
18
Figure II.3
Surgical hand preparation technique with an alcohol-based hand rub formulation
19
Figure II.3
Surgical hand preparation technique with an alcohol-based hand rub formulation (Cont.)
20
Figure II.4
How to don and remove non-sterile gloves
21
Figure II.5
How to don and remove sterile gloves
22
Figure II.5
How to don and remove sterile gloves (Cont.)
23
WHO PATIENT SAFETY
PART III.
GUIDELINE IMPLEMENTATION
25
1.
WHO Implementation strategy and tools
The WHO Multimodal Hand Hygiene Improvement Strategy active participation at both the institutional and
and a wide range of tools were developed in parallel to the individual levels;
Guidelines to translate recommendations into practice at the awareness of individual and institutional capacity to
bedside (see Part I.21.1 of the Guidelines). change and improve (self-efficacy); and
partnership with patients and patient organizations
The implementation strategy was informed by the literature (depending on cultural issues and the resources
on implementation science, behavioural change, spread available; see Part V of the Guidelines).
methodology, diffusion of innovation and impact evaluation.
Together with the Guidelines, the strategy and tools were Central to the recommendations’ implementation at the point
tested in eight pilot sites in the six WHO regions in and many of care is the innovative approach of the “My five moments for
other settings worldwide (see Part I.21.5 of the Guidelines). hand hygiene” (see Part 21.4 of the Guidelines and Part II.1 of
The multimodal strategy consists of five components to be the Hand Hygiene Technical Reference Manual http://www.
implemented in parallel; the implementation strategy itself is who.int/gpsc/5may/tools/training_education/en/index.html) 302
designed to be adaptable without jeopardizing its fidelity and is (Figure III.1). Considering the scientific evidence, this concept
intended therefore for use not only in sites where hand hygiene merges the hand hygiene indications recommended by the
promotion has to be initiated but also within facilities where WHO Guidelines on Hand Hygiene in Health Care (see Part
there is existing action on hand hygiene. II of the Guidelines) into five moments when hand hygiene is
required. This approach proposes a unified vision for HCWs,
The five essential elements are (see Part II of the Guide to trainers and observers to minimize inter-individual variation
Implementation (http://www.who.int/gpsc/5may/Guide_to_ and enable a global increase in adherence to effective hand
Implementation.pdf): hygiene practices.
1. System Change: ensuring that the necessary According to this concept, HCWs are requested to clean their
infrastructure is in place to allow HCWs to practice hand hands (1) before touching a patient, (2) before clean/aseptic
hygiene. This includes two essential elements: procedures, (3) after body fluid exposure/risk, (4) after touching
access to a safe, continuous water supply as well as a patient and (5) after touching patient surroundings.
to soap and towels;
readily-accessible alcohol-based handrub at the This concept has been integrated into the various WHO tools
point of care. to educate, monitor, summarize, feedback, and promote hand
2. Training / Education: providing regular training on the hygiene in health-care settings.
importance of hand hygiene, based on the “My five
moments for hand hygiene” approach and on the correct Data and lessons learned from testing have been of paramount
procedures for handrubbing and handwashing to all importance in revising the content of the Guidelines Advanced
HCWs. Draft. A significant increase in hand hygiene compliance was
3. Evaluation and feedback: monitoring hand hygiene observed across all pilot sites.
practices and infrastructure, along with related
perceptions and knowledge among HCWs, while In addition, an improvement was observed in HCWs’
providing performance and results feedback to the staff. perception of the importance of HCAI and its prevention,
4. Reminders in the workplace: prompting and reminding as well as their knowledge about hand transmission and
HCWs about the importance of hand hygiene and hand hygiene practices. Furthermore, a substantial system
about the appropriate indications and procedures for change was achieved with an improvement in the facilities
performing it. and equipment available for hand hygiene, including the
5. Institutional safety climate: creating an environment and local production of the WHO-recommended alcohol-based
the perceptions that facilitate awareness-raising about formulations in settings where these products were not
patient safety issues while guaranteeing consideration of available commercially (see Part I.12.5 and I.21.5 of the
hand hygiene improvement as a high priority at all levels, Guidelines). According to the main results of testing, the
including: strategy and its core components were confirmed as a
26
PART III. GUIDELINE IMPLEMENTATION
very successful model, key to hand hygiene improvement resources necessary to implementation, provides a template
in different settings and suitable to be used also for other action plan, and proposes a step-wise approach for practical
infection control interventions. The validity of the Guidelines implementation at the health-care setting level.
recommendations was also fully confirmed. Furthermore,
when appropriate, comments from users and lessons Especially in a facility where a hand hygiene improvement
learned enabled modification and improvement of the suite of programme has to be initiated from scratch, the following are
implementation tools. essential steps (see Part III of the Guide to Implementation):
The final version of the WHO Multimodal Hand Hygiene Step 1: Facility preparedness – readiness for action
Improvement Strategy and the Implementation Toolkit are now Step 2: Baseline evaluation – establishing the current situation
available at http://www.who.int/gpsc/5may/tools/en/index. Step 3: Implementation – introducing the improvement
html. activities
Step 4: Follow-up evaluation – evaluating the implementation
The Toolkit includes a range of tools corresponding to each impact
strategy component, to facilitate its practical implementation Step 5: Action planning and review cycle – developing a plan
(see Appendix 3). A Guide to Implementation (http://www.who. for the next 5 years (minimum)
int/gpsc/5may/Guide_to_Implementation.pdf) was developed
to assist health-care facilities to implement improvements The WHO Multimodal Hand Hygiene Improvement Strategy,
in hand hygiene in accordance with the WHO Guidelines on the “My five moments for hand hygiene” and the five-step
Hand Hygiene in Health Care. In its Part II the Guide illustrates approaches are depicted in Figure III.1.
the strategy components into details and describes the
objectives and utility of each tool; in Part III it indicates the These concepts are discussed more extensively in Part I.21 of
Figure III.1
The five components of the WHO Multimodal

The five moments for hand hygiene in health care
Hand Hygiene Improvement Strategy
1a. System change –

E
alcohol-based handrub at point of care OR ASEP
EF EAN/ T IC
B
L OCEDURE
C R
P
2
1b. System change – access to safe,

continuous water supply, soap and towels
4
AFTER
1
BEFORE
TOUCHING TOUCHING
A PATIENT A PATIENT
2. Training and education
3. Evaluation and feedback
3
Y
D
E
AF
T E R BO U
R
FLU OS
4. Reminders in the workplace RIS I D E X P
K
5
AFTER
TOUCHING PATIENT
5. Institutional safety climate SURROUNDINGS
The step-wise approach
Facility Baseline Follow-up Review

Implementation
preparedness evaluation evaluation and planning
27
2.
Infrastructures required for optimal hand hygiene
An important cause of poor compliance may be the lack to be located at every sink in patient and examination rooms
of user-friendly hand hygiene equipment as well as poor when affordable. Wall-mounted handrub dispensers should
logistics leading to limited procurement and replenishment of be positioned in locations that facilitate hand hygiene at the
consumables. point of care. Dispersion of the handrub should be possible in
a “non-touch” fashion to avoid any touching of the dispenser
While not all settings have a continuous water supply, tap water with contaminated hands, e.g. “elbow-dispensers” or pumps
(ideally drinkable), is preferable for handwashing (see Part I.11.1 that can be used with the wrist.304 In general, the design and
of the Guidelines). In settings where this is not possible, water function of the dispensers that will ultimately be installed in
“flowing” from a pre-filled container with a tap is preferable to a health-care setting should be evaluated, because some
still-standing water in a basin. Where running water is available, systems were shown to malfunction continuously despite
the possibility of accessing it without the need to touch the tap efforts to rectify the problem.243 A variation of wall-mounted
with soiled hands is preferable. Sensor-activated manual or dispensers are holders and frames that allow placement
elbow- or foot-activated taps could be considered the optimal of a container that is equipped with a pump. The pump is
standard within health-care settings. Their availability is not screwed onto the container in place of the lid. It is likely that
considered among the highest priorities, however, particularly this dispensing system is associated with the lowest cost.
in settings with limited resources. It should be noted that Containers with a pump can also be placed easily on any
recommendations for their use are not based on evidence. horizontal surface, e.g. cart/trolley or night stand/bedside
table.
Sinks should be located the closest possible to the point of
care and, according to the WHO minimum requirements, the Individual, portable dispensers (e.g. pocket bottles) are ideal, if
overall sink-to-patient bed ratio should be of 1:10.303 combined with wall-mounted dispensing systems, to increase
point-of-care access and enable use in units where wall-
Placement of hand hygiene products (soap and handrubs) mounted dispensers should be avoided or cannot be installed.
should be aligned with promoting hand hygiene in accordance
with the concept of the “My five moments for hand hygiene”. Because many of these systems are used as disposables,
environmental considerations should also be taken into
In many settings the different forms of dispensers, such as account.
wall-mounted and those for use at the point of care, should
be used in combination to achieve maximum compliance. These concepts are discussed more extensively in Part I.23.5
Wall-mounted soap dispensing systems are recommended of the WHO Guidelines on Hand Hygiene in Health Care 2009.
3.
Other issues related to hand hygiene, in particular
the use of an alcohol-based handrub
3.1 Methods and selection of products to perform – no need for any particular infrastructure (clean water supply
hand hygiene network, washbasin, soap, hand towel).
According to recommendation IB, when an alcohol-based Hands need to be washed with soap and water when they
handrub is available it should be used as the preferred means are visibly dirty or soiled with blood or other body fluids,
for routine hand hygiene in health care. when exposure to potential spore-forming organisms is
strongly suspected or proven or after using the lavatory.
Alcohol-based handrubs have the following immediate (recommendations 1A and 1B)
advantages (see Part I.11.3 of the Guidelines):
To comply with routine hand hygiene recommendations,
– elimination of the majority of germs (including viruses); HCWs should ideally perform hand hygiene where and when
– the short time required for action (20 to 30 seconds); care is provided, which means at the point of care and at the
– availability of the product at the point of care; moments indicated (see Part III.1 of this Summary and Figure
– better skin tolerability (see Part I.14 of the Guidelines); III.1), and following the recommended technique and time.
28
Table III.1
Antimicrobial activity and summary of properties of antiseptics used in hand hygiene
Antiseptics Gram- Gram- Viruses Viruses Myco- Fungi Spores

positive negative enveloped non- bacteria
bacteria bacteria enveloped
Alcohols +++ +++ +++ ++ +++ +++ -
Chloroxylenol +++ + + ± + + -
Chlorhexidine +++ ++ ++ + + + -
a
Hexachlorophene +++ + ? ? + + -
Iodophors +++ +++ ++ ++ ++ ++ ±b
Triclosand +++ ++ ? ? ± ±e -
Quaternary ++ + + ? ± ± -
ammonium
compoundsc
Antiseptics Typical conc. in % Speed of action Residual activity Use
Alcohols 60-80 % Fast No HR
Chloroxylenol 0.5-4 % Slow Contradictory HW
Chlorhexidine 0.5-4% Intermediate Yes HR,HW

a
Hexachlorophene 3% Slow Yes HW, but not recommended
Iodophors 0.5-10 %) Intermediate Contradictory HW
Triclosand (0.1-2%) Intermediate Yes HW; seldom
Quaternary Slow No HR,HW;

ammonium Seldom;
compoundsc +alcohols
Good = +++, moderate = ++, poor = +, variable = ±, none = –

HR: handrubbing; HW: handwashing
*Activity varies with concentration.
a
Bacteriostatic.
b
In concentrations used in antiseptics, iodophors are not sporicidal.
c
Bacteriostatic, fungistatic, microbicidal at high concentrations.
d
Mostly bacteriostatic.
e
Activity against Candida spp., but little activity against filementous fungi.
Source: adapted with permission from Pittet, Allegranzi & Sax, 2007. 362
This often calls for the use of an alcohol-based product. the spread of microorganisms and reducing childhood
gastrointestinal and upper respiratory tract infections or
Hand hygiene can be performed by using either plain soap impetigo.72, 139, 305 In health-care settings where alcohol-based
or products including antiseptic agents. The latter have the handrubs are available, plain soap should be provided to
property of inactivating microorganisms or inhibiting their perform hand washing when indicated.
growth with different action spectra; examples include
alcohols, chlorhexidine gluconate, chlorine derivatives, iodine, Alcohol solutions containing 60–80% alcohol are usually
chloroxylenol, quaternary ammonium compounds, and considered to have efficacious microbicidal activity, with
triclosan (Table III.1). concentrations higher than 90% being less potent.305,306
Although comparing the results of laboratory studies dealing Alcohol-based handrubs with optimal antimicrobial efficacy
with the in vivo efficacy of plain soap, antimicrobial soaps, usually contain 75 to 85% ethanol, isopropanol, or n-propanol,
and alcohol-based handrubs may be problematic for various or a combination of these products. The WHO-recommended
reasons, it has been shown that alcohol-based rubs are more formulations contain either 75% v/v isopropanol, or 80% v/v
efficacious than antiseptic detergents and that the latter are ethanol.
usually more efficacious than plain soap. However, various
studies conducted in the community setting indicate that These were identified, tested and validated for local production
medicated and plain soaps are roughly equal in preventing at facility level. According to the available data, local production
29
is feasible and the products are effective for hand antisepsis, However, numerous reports confirm that alcohol-based
have good skin tolerability along with HCW acceptance, and formulations are well-tolerated and associated with better
are low in cost (see Part I.12 of the Guidelines and the Guide to acceptability and tolerance than other hand hygiene
Local Production: WHO-recommended Handrub Formulations products.149, 230, 237, 308-313
http://www.who.int/gpsc/5may/tools/system_change/en/
index.html). Allergic reactions to antiseptic agents including quaternary
ammonium compounds, iodine or iodophors, chlorhexidine,
The selection of hand hygiene products available from the triclosan, chloroxylenol and alcohols132, 314-323 have been
market should be based on the following criteria (see Part reported, as well as possible toxicity in relation to dermal
I.15.2 of the Guidelines and the Alcohol-based Handrub: absorption of products.233, 324 Allergic contact dermatitis
Planning and Costing Tool http://www.who.int/gpsc/5may/ attributable to alcohol-based handrubs is very uncommon.
tools/system_change/en/index.html):
Damaged, irritated skin is undesirable, not only because it
% relative efficacy of antiseptic agents (see Part I.10 of the causes discomfort and even lost workdays for the professional
Guidelines) according to ASTM and EN standards and but also because hands with damaged skin may in fact
consideration for selection of products for hygienic hand increase the risk of transmission of infections to patients.
antisepsis and surgical hand preparation;
% dermal tolerance and skin reactions; The selection products that are both efficacious and as safe as
% time for drying (consider that different products are possible for the skin is of the utmost importance.
associated with different drying times; products that require
longer drying times may affect hand hygiene best practice); For example, concern about the drying effects of alcohol was a
% cost issues; major cause of poor acceptance of alcohol-based handrubs in
% aesthetic preferences of HCWs and patients such as hospitals.325, 326 Although many hospitals have provided HCWs
fragrance, colour, texture, “stickiness”, and ease of use; with plain soaps in the hope of minimizing dermatitis, frequent
% practical considerations such as availability, convenience use of such products has been associated with even greater
and functioning of dispenser, and ability to prevent skin damage, dryness and irritation than some antiseptic
contamination; preparations.171, 226, 231 One strategy for reducing exposure of
% freedom of choice by HCWs at an institutional level after HCWs to irritating soaps and detergents is to promote the use
consideration of the above-mentioned factors. of alcohol-based handrubs containing humectants. Several
studies have demonstrated that such products are tolerated
Hand hygiene actions are more effective when hand skin is free better by HCWs and are associated with a better skin condition
of cuts, nails are natural, short and unvarnished, and hands when compared with either plain or antimicrobial soap.75, 95, 97,
146, 226, 231, 327-329
and forearms are free of jewellery and left uncovered (see Parts With rubs, the shorter time required for hand
I.23.3-4 of the Guidelines and Part IV of the Hand Hygiene antisepsis may increase acceptability and compliance.285
Technical Reference Manual http://www.who.int/gpsc/5may/
tools/training_education/en/index.html). Ways to minimize the possible adverse effects of hand
hygiene include selecting less irritating products, using skin
moisturizers, and modifying certain hand hygiene behaviours
3.2 Skin reactions related to hand hygiene such as unnecessary washing (see recommendations 5A-E
and Part IV of the Hand Hygiene Technical Reference Manual
Skin reactions may appear on HCWs’ hands because of http://www.who.int/gpsc/5may/tools/training_education/en/
the necessity for frequent hand hygiene during patient care index.html).
(see Part I.14 of the Guidelines). There are two major types
of skin reactions associated with hand hygiene. The first and Certain practices can increase the risk of skin irritation and
most common type is irritant contact dermatitis and includes should be avoided. For example, washing hands regularly
symptoms such as dryness, irritation, itching and in some with soap and water immediately before or after using an
cases even cracking and bleeding. The second type of skin alcohol-based product is not only unnecessary but may lead to
reaction, allergic contact dermatitis, is rare and represents dermatitis.163 The use of very hot water for handwashing should
an allergy to some ingredient in a hand hygiene product. be avoided as it increases the likelihood of skin damage. When
Symptoms of allergic contact dermatitis can also range from clean or disposable towels are used, it is important to pat the
mild and localized to severe and generalized. In its most skin rather than rub it to avoid cracking. Additionally, donning
serious form, allergic contact dermatitis may be associated gloves while hands are still wet from either washing or applying
with respiratory distress and other symptoms of anaphylaxis. alcohol increases the risk of skin irritation.
HCWs with skin reactions or complaints related to hand
hygiene should have access to an appropriate referral service.
3.3 Safety issues related to the use of alcohol-
In general, irritant contact dermatitis is more commonly based handrubs
reported with iodophors.171 Other antiseptic agents that
may cause irritant contact dermatitis, in order of decreasing Alcohols are flammable; therefore, alcohol-based handrubs
frequency, include chlorhexidine, chloroxylenol, triclosan and should be stored away from high temperatures or flames in
alcohol-based products (see Part I.11 of the Guidelines). accordance with national and local regulations (see Part B of
30
the Guide to Local Production: WHO-recommended Handrub 3.4 Alcohol-based handrubs and C. difficile and
Formulations http://www.who.int/gpsc/5may/tools/system_ other non-susceptible pathogens
change/en/index.html).
Alcohols have excellent in vitro germicidal activity against
Although alcohol-based handrubs are flammable, the risk of Gram-positive and Gram-negative vegetative bacteria (including
fires associated with such products is very low. multidrug-resistant pathogens such as MRSA and VRE),
Mycobacterium tuberculosis, and a variety of fungi.131, 306, 307, 340-345
For example, none of 798 health-care facilities surveyed in On the contrary, they have virtually no activity against bacterial
the USA reported a fire related to an alcohol-based handrub spores or protozoan oocysts, and reduced activity against some
dispenser. A total of 766 facilities had accrued an estimated non-enveloped (non-lipophilic) viruses. However alcohols, when
1430 hospital-years of alcohol-based handrub use without a used in concentrations present in some alcohol-based handrubs
fire attributed to a handrub dispenser.330 (70–80% v/v), also have in vivo activity against a number of
non-enveloped viruses (e.g. rotavirus, adenovirus, rhinovirus,
In Europe, where alcohol-based handrubs have been used hepatitis A and enteroviruses). 177, 346, 347 Various 70% alcohol
extensively for many years, the incidence of fires related to solutions (ethanol, n-propanol, isopropanol) were tested against
such products has been extremely low.147 A recent study331 a surrogate of norovirus and ethanol with 30-second exposure
conducted in German hospitals found that handrub usage and demonstrated virucidal activity superior to the others.348 In a
represented an estimated total of 25 038 hospital-years, with recent experimental study, ethyl alcohol-based products showed
an overall usage of 35 million litres for all hospitals. A total significant reductions of the tested surrogate for a non-enveloped
of seven non-severe fire incidents was reported (0.9% of human virus; however, activity was not superior to non-
hospitals). This is equal to an annual incidence per hospital of antimicrobial or tap/faucet water controls.349 In general, ethanol
0.0000475%. No reports of fire caused by static electricity or has shown greater activity against viruses than isopropanol.350
other factors were received, nor were any related to storage
areas. Indeed, most reported incidents were associated with Following the widespread use of alcohol-based handrubs as
deliberate exposure to a naked flame, e.g. lighting a cigarette. the gold standard for hand hygiene in health care, concern
has been raised about their lack of efficacy against spore-
In the summary of incidents related to the use of alcohol forming pathogens, in particular C. difficile. The widespread
handrubs from the start of the “cleanyourhands” campaign use of alcohol-based handrubs in healthcare settings has been
until July 2008 (http://www.npsa.nhs.uk/patientsafety/patient- blamed by some.351, 352
safetyincident-data/quarterly-data-reports/), only two fire events
out of 692 incidents were reported in England and Wales. Although alcohol-based handrubs may not be effective against
C. difficile, it has not been shown that they trigger a rise in C.
Accidental and intentional ingestion of alcohol-based difficile-associated disease.63, 76, 353, 354
preparations used for hand hygiene have been reported
and may lead to acute, and in some cases severe, alcohol C. difficile-associated disease rates began to rise in the USA
intoxication.332-335 In the “cleanyourhands” campaign incidents long before the widespread use of alcohol-based handrubs.355,
356
summary, 189 cases of ingestion were recorded in health- One outbreak of the epidemic strain REA-group B1 (
care settings. However, the vast majority was graded as no ribotype 027) was successfully managed while introducing
or low harm, 12 as moderate, two as severe, and one death alcohol-based handrub for all patients other than those with
was reported (but the patient had been admitted already the C. difficile-associated disease.354
previous day for severe alcohol intoxication). It is clear that,
especially in pediatric and psychiatric wards, security measures In addition, several studies recently demonstrated a lack of
are needed. These may involve: placing the preparation in association between the consumption of alcohol-based handrubs
secure wall dispensers; labelling dispensers to make the and the incidence of clinical isolates of C. difficile.353, 357, 358
alcohol content less clear at a casual glance and adding a
warning against consumption; and the inclusion of an additive in Contact precautions are highly recommended during C. difficile-
the product formula to reduce its palatability. In the meantime, associated outbreaks, in particular glove use (as part of contact
medical and nursing staff should be aware of this potential risk. precautions) and handwashing with a plain or antimicrobial
soap and water following glove removal after caring for patients
Alcohols can be absorbed by inhalation and through intact with diarrhoea.359, 360 Alcohol-based handrubs can then be
skin, although the latter route (dermal uptake) is very low. Many used exceptionally after handwashing in these instances, after
studies evaluated alcohol dermal absorption and inhalation making sure that hands are perfectly dry. Moreover, alcohol-
following its application or spraying on skin.324, 336-339 In all based handrubs, now considered the gold standard to protect
cases either no or very low (much less than the levels achieved patients from the multitude of harmful resistant and non-resistant
with mild intoxication, i.e. 50 mg/dl) blood concentrations of organisms transmitted by HCWs’ hands, should be continued to
alcohols were detected and no symptoms were noticed. be used in all other instances at the same facility.
Indeed, while there are no data showing that the use of Abandoning alcohol-based handrub for patients other than those
alcohol-based handrub may be harmful because of alcohol with C. difficile-associated disease would do more harm than
absorption, it is well-established that reduced compliance with good, considering the dramatic impact on overall infection rates
hand hygiene will lead to preventable HCAIs. observed through the recourse to handrubs at the point of care.361
31
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42
WHO PATIENT SAFETY
APPENDICES
43
1.
Definition of terms
Hand hygiene. A general term referring to any action of hand Hand hygiene practices
cleansing (see below, “Hand hygiene practices”).
Antiseptic handwashing. Washing hands with soap and
water or with other detergents containing an antiseptic agent.
Hand hygiene products
Antiseptic handrubbing (or handrubbing). Applying
Alcohol-based (hand) rub. An alcohol-containing preparation an antiseptic handrub to reduce or inhibit the growth of
(liquid, gel or foam) designed for application to the hands microorganisms without the need for an exogenous source of
to inactivate microorganisms and/or temporarily suppress water and requiring no rinsing or drying with towels or other
their growth. Such preparations may contain one or more devices.
types of alcohol, other active ingredients with excipients and
humectants. Hand antisepsis/decontamination/degerming. Reducing or
inhibiting the growth of microorganisms by the application of an
Antimicrobial (medicated) soap. Soap (detergent) containing antiseptic handrub or by performing an antiseptic handwash.
an antiseptic agent at a concentration sufficient to inactivate
microorganisms and/or temporarily suppress their growth. The Hand care. Actions to reduce the risk of skin damage or
detergent activity of such soaps may also dislodge transient irritation.
microorganisms or other contaminants from the skin to
facilitate their subsequent removal by water. Handwashing. Washing hands with plain or antimicrobial soap
and water.
Antiseptic agent. An antimicrobial substance that inactivates
microorganisms or inhibits their growth on living tissues. Hand cleansing. Action of performing hand hygiene for the
Examples include alcohols, chlorhexidine gluconate (CHG), purpose of physically or mechanically removing dirt, organic
chlorine derivatives, iodine, chloroxylenol (PCMX), quaternary material and/or microorganisms.
ammonium compounds and triclosan.
Hand disinfection is extensively used as a term in some parts
Detergent (surfactant). Compounds that possess a cleaning of the world and can refer to antiseptic handwash, antiseptic
action. They are composed of a hydrophilic and a lipophilic handrubbing, hand antisepsis/decontamination/degerming,
part and can be divided into four groups: anionic, cationic, handwashing with an antimicrobial soap and water, hygienic
amphoteric and non-ionic. Although products used for hand antisepsis, or hygienic handrub. Since disinfection refers
handwashing or antiseptic handwash in health care represent normally to the decontamination of inanimate surfaces and
various types of detergents, the term “soap” will be used to objects, this term is not used in these Guidelines.
refer to such detergents in these guidelines.
Hygienic hand antisepsis. Treatment of hands with either
Plain soap. Detergents that contain no added antimicrobial an antiseptic handrub or antiseptic handwash to reduce the
agents or may contain these solely as preservatives. transient microbial flora without necessarily affecting the
resident skin flora.
Hygienic handrub. Treatment of hands with an antiseptic

handrub to reduce the transient flora without necessarily
affecting the resident skin flora. These preparations are
broad spectrum and fast-acting, and persistent activity is not
necessary.
44
APPENDICES
Hygienic handwash. Treatment of hands with an antiseptic Point of care. The place where three elements come together:
handwash and water to reduce the transient flora without the patient, the HCW, and care or treatment involving contact
necessarily affecting the resident skin flora. It is broad with the patient or his/her surroundings (within the patient
spectrum, but is usually less efficacious and acts more slowly zone).302 The concept embraces the need to perform hand
than the hygienic handrub. hygiene at recommended moments exactly where care delivery
takes place. This requires that a hand hygiene product (e.g.
Surgical hand antisepsis/surgical hand preparation/ alcohol-based handrub, if available) be easily accessible and
presurgical hand preparation. Antiseptic handwash or as close as possible – within arm’s reach of where patient care
antiseptic handrub performed preoperatively by the surgical or treatment is taking place. Point-of-care products should be
team to eliminate transient flora and reduce resident skin flora. accessible without HCWs having to leave the patient zone.
Such antiseptics often have persistent antimicrobial activity.
Surgical handscrub(bing)/presurgical scrub refer to surgical Resident flora (resident microbiota). Microorganisms
hand preparation with antimicrobial soap and water. Surgical residing under the superficial cells of the stratum corneum and
handrub(bing) refers to surgical hand preparation with a also found on the surface of the skin.
waterless, alcohol-based handrub.
Surrogate microorganism. A microorganism used to
represent a given type or category of nosocomial pathogen
Associated terms when testing the antimicrobial activity of antiseptics.
Surrogates are selected for their safety, ease of handling and
Efficacy/efficacious. The (possible) effect of the application of relative resistance to antimicrobials.
a hand hygiene formulation when tested in laboratory or in vivo
situations. Transient flora (transient microbiota). Microorganisms
that colonize the superficial layers of the skin and are more
Effectiveness/effective. The clinical conditions under which amenable to removal by routine handwashing.
a hand hygiene product has been tested for its potential to
reduce the spread of pathogens, e.g. field trials. Visibly soiled hands. Hands on which dirt or body fluids are
readily visible.
Health-care area. Concept related to the “geographical”
visualization of key moments for hand hygiene. It contains all
surfaces in the health-care setting outside the patient zone of
patient X, i.e. other patients and their patient zones and the
health-care facility environment.
Humectant. Ingredient(s) added to hand hygiene products to

moisturize the skin.
Patient zone. Concept related to the “geographical”

visualization of key moments for hand hygiene. It contains the
patient X and his/her immediate surroundings. This typically
includes the intact skin of the patient and all inanimate surfaces
that are touched by or in direct physical contact with the
patient such as the bed rails, bedside table, bed linen, infusion
tubing and other medical equipment. It further contains
surfaces frequently touched by HCWs while caring for the
patient such as monitors, knobs and buttons as well as other
“high frequency” touch surfaces.
Persistent activity. The prolonged or extended antimicrobial

activity that prevents the growth or survival of microorganisms
after application of a given antiseptic; also called “residual”,
“sustained” or “remnant” activity. Both substantive and non-
substantive active ingredients can show a persistent effect
significantly inhibiting the growth of microorganisms after
application.
45
2.
Table of contents of the WHO Guidelines on Hand
Hygiene in Health Care 2009
INTRODUCTION 10. Methods to evaluate the antimicrobial efficacy of

handrub and handwash agents and formulations for
surgical hand preparation
PART I. 10.1 Current methods
REVIEW OF SCIENTIFIC DATA RELATED TO HAND 10.2 Shortcomings of traditional test methods
HYGIENE 10.3 The need for better methods
1. Definition of terms 11. Review of preparations used for hand hygiene

11.1 Water
2. Guideline preparation process 11.2 Plain (non-antimicrobial) soap
2.1 Preparation of the Advanced Draft 11.3 Alcohols
2.2 Pilot testing the Advanced Draft 11.4 Chlorhexidine
2.3 Finalization of the WHO Guidelines on Hand 11.5 Chloroxylenol
Hygiene in Health Care 11.6 Hexachlorophene
11.7 Iodine and iodophors
3. The burden of health care-associated infection 11.8 Quaternary ammonium compounds
3.1 Health care-associated infection in developed 11.9 Triclosan
countries 11.10 Other agents
3.2 Burden of health care-associated infection in 11.11 Activity of antiseptic agents against spore-forming
developing countries bacteria
11.12 Reduced susceptibility of microorganisms to
4. Historical perspective on hand hygiene in health care antiseptics
11.13 Relative efficacy of plain soap, antiseptic soaps and
5. Normal bacterial flora on hands detergents, and alcohols
6. Physiology of normal skin 12. WHO-recommended handrub formulation

12.1 General remarks
7. Transmission of pathogens by hands 12.2 Lessons learnt from local production of the WHO-
7.1 Organisms present on patient skin or in the recommended handrub formulations in different
inanimate environment settings worldwide
7.2 Organism transfer to health-care workers’ hands
7.3 Organism survival on hands 13. Surgical hand preparation: state-of-the-art
7.4 Defective hand cleansing, resulting in hands 13.1 Evidence for surgical hand preparation
remaining contaminated 13.2 Objective of surgical hand preparation
7.5 Cross-transmission of organisms by contaminated 13.3 Selection of products for surgical hand preparation
hands 13.4 Surgical hand antisepsis using medicated soap
13.5 Surgical hand preparation with alcohol-based
8. Models of hand transmission handrubs
8.1 Experimental models 13.6 Surgical hand scrub with medicated soap or
8.2 Mathematical models surgical hand preparation with alcohol-based
formulations
9. Relationship between hand hygiene and the acquisition
of health care-associated pathogens 14. Skin reactions related to hand hygiene
14.1 Frequency and pathophysiology of irritant contact
dermatitis
14.2 Allergic contact dermatitis related to hand hygiene
products
14.3 Methods to reduce adverse effects of agents
46
APPENDICES
15. Factors to consider when selecting hand hygiene 23. Practical issues and potential barriers to optimal hand
products hygiene practices
15.1 Pilot testing 23.1 Glove policies
15.2 Selection factors 23.2 Importance of hand hygiene for safe blood and
blood products
16. Hand hygiene practices among health-care workers 23.3 Jewellery
and adherence to recommendations 23.4 Fingernails and artificial nails
16.1 Hand hygiene practices among health-care workers 23.5 Infrastructure required for optimal hand hygiene
16.2 Observed adherence to hand cleansing 23.6 Safety issues related to alcohol-based preparations
16.3 Factors affecting adherence
24. Hand hygiene research agenda
17. Religious and cultural aspects of hand hygiene
17.1 Importance of hand hygiene in different religions
17.2 Hand gestures in different religions and cultures PART II.
17.3 The concept of “visibly dirty”hands CONSENSUS RECOMMENDATIONS
17.4 Use of alcohol-based handrubs and alcohol
prohibition by some religions 1. Ranking system for evidence
17.5 Possible solutions 2. Indications for hand hygiene
3. Hand hygiene technique
18. Behavioural considerations 4. Recommendations for surgical hand preparation
18.1 Social sciences and health behaviour 5. Selection and handling of hand hygiene agents
18.2 Behavioural aspects of hand hygiene 6. Skin care
7. Use of gloves
19. Organizing an educational programme to promote 8. Other aspects of hand hygiene
hand hygiene 9. Educational and motivational programmes for health-
19.1 Process for developing an educational programme care workers
when implementing guidelines 10. Governmental and institutional responsibilities
19.2 Organization of a training programme 11. For health-care administrators
19.3 The infection control link health-care worker 12. For national governments
20. Formulating strategies for hand hygiene promotion

20.1 Elements of promotion strategies PART III.
20.2 Developing a strategy for guideline implementation PROCESS AND OUTCOME MEASUREMENT
20.3 Marketing technology for hand hygiene promotion
1. Hand hygiene as a performance indicator
21. The WHO Multimodal Hand Hygiene Improvement 1.1 Monitoring hand hygiene by direct methods
Strategy 1.2 The WHO-recommended method for direct
21.1 Key elements for a successful strategy observation
21.2 Essential steps for implementation at heath-care 1.3 Indirect monitoring of hand hygiene performance
setting level 1.4 Automated monitoring of hand hygiene
21.3 WHO tools for implementation
21.4 “My five moments for hand hygiene” 2. Hand hygiene as a quality indicator for patient safety
21.5 Lessons learnt from the testing of the WHO
Hand Hygiene Improvement Strategy in pilot and 3. Assessing the economic impact of hand hygiene
complementary sites promotion
3.1 Need for economic evaluation
22. Impact of improved hand hygiene 3.2 Cost–benefit and cost–effectiveness analyses
III 3.3 Review of the economic literature
3.4 Capturing the costs of hand hygiene at the
institutional level
3.5 Typical cost-savings from hand hygiene promotion
programmes
3.6 Financial strategies to support national programmes
47
PART IV. PART VI.

TOWARDS A GENERAL MODEL OF CAMPAIGNING FOR COMPARISON OF NATIONAL AND SUB-NATIONAL
BETTER HAND HYGIENE – A NATIONAL APPROACH TO GUIDELINES FOR HAND HYGIENE
HAND HYGIENE IMPROVEMENT
1. Introduction REFERENCES
2. Objectives
APPENDICES
3. Historical perspective
1. Definitions of health-care settings and other related
4. Public campaigning, WHO and the mass media terms
4.1 National campaigns within health care 2. Guide to appropriate hand hygiene in connection with
Clostridium difficile spread
5. Benefits and barriers in national programmes 3. Hand and skin self-assessment tool
4. Monitoring hand hygiene by direct methods
6. Limitations of national programmes IV 5. Example of a spreadsheet to estimate costs
6. WHO global survey of patient experiences in hand
7. The relevance of social marketing and social movement hygiene improvement
theories
7.1 Hand hygiene improvement campaigns outside of
health care
8. Nationally driven hand hygiene improvement in health
care
9. Towards a blueprint for developing, implementing

and evaluating a national hand hygiene improvement
programme within health care
10. Conclusion
PART V.
PATIENT INVOLVEMENT IN HAND HYGIENE PROMOTION
1. Overview and terminology
2. Patient empowerment and health care
3. Components of the empowerment process

3.1 Patient participation
3.2 Patient knowledge
3.3 Patient skills
3.4 Creation of a facilitating environment and positive
deviance
4. Hand hygiene compliance and empowerment

4.1 Patient and health-care workers empowerment
5. Programmes and models of hand hygiene

promotion, including patient and health-care workers
empowerment
5.1 Evidence
5.2 Programmes
6. WHO global survey of patient experiences
7. Strategy and resources for developing, implementing

and evaluating a patient/health-care workers
empowerment programme in a health-care facility or
community
48
APPENDICES
3.
Hand Hygiene Implementation Toolkit
Guide to Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy
Template Action Plan
Tools for System Change Tools for Training / Tools for Evaluation Tools for Reminders Tools for Institutional
Education and Feedback in the Workplace Safety Climate
Template Letter to
Slides for the Hand Hand Hygiene Technical Your 5 Moments for Hand
Ward Infrastructure Survey Advocate Hand Hygiene
Hygiene Co-ordinator Reference Manual Hygiene Poster
to Managers
Slides for Education Observation Tools: Template Letter to
Alcohol-based
Sessions for Trainers, Observation Form How to Handrub Communicate Hand
Handrub Planning
Observers and and Compliance Poster Hygiene Initiatives to
and Costing Tool
Health-Care Workers Calculation Form Managers
Guidance on Engaging
Guide to Local Production:
Hand Hygiene Ward Infrastructure How to Handwash Patients and Patient
WHO-recommended
Training Films Survey Poster Organizations in Hand
Handrub Formulations
Hygiene Initiatives
Sustaining Improvement
Soap / Handrub Slides Accompanying Soap / Handrub Hand Hygiene: When and – Additional Activities for
Consumption Survey the Training Films Consumption Survey How Leaflet Consideration by Health-
Care Facilities
Protocol for Evaluation
of Tolerability and
SAVE LIVES: SAVE LIVES:
Acceptability of Hand Hygiene Technical Perception Survey
Clean Your Hands Clean Your Hands
Alcohol-based Handrub Reference Manual for Health-Care Workers
Screensaver Promotional DVD
in Use or Planned to be
Introduced: Method 1
Protocol for Evaluation and
Comparison of Tolerability
Perception Survey
and Acceptability of Observation Form
for Senior Managers
Different Alcohol-based
Handrubs: Method 2
Hand Hygiene Hand Hygiene Knowledge
Why, How and Questionnaire for Health-
When Brochure Care Workers
Protocol for Evaluation
of Tolerability and
Glove use Information Acceptability of Alcohol-
Leaflet based Handrub in Use or
Planned to be Introduced:
Method 1
Protocol for Evaluation and
Comparison of Tolerability
Your 5 Moments
and Acceptability of
for Hand Hygiene Poster
Different Alcohol-based
Handrubs: Method 2
Frequently Asked Data Entry
Questions Analysis Tool
Key Scientific Instruction for Data Entry
Publications Analysis
Sustaining Improvement
– Additional Activities for Data Summary
Consideration by Health- Report Framework
Care Facilities
49
Acknowledgements
Developed by the Clean Care is Safer Care Team (WHO Patient Safety, Information, Evidence and Research Cluster):
Benedetta Allegranzi, Sepideh Bagheri Nejad, Marie-Noelle Chraiti, Cyrus Engineer, Gabriela Garcia Castillejos, Wilco
Graafmans, Claire Kilpatrick, Elizabeth Mathai, Didier Pittet, Lucile Resal, Hervé Richet, Rosemary Sudan.
Critical contribution to content from: Elaine Larson Manfred Rotter

John Boyce Columbia University School of Nursing Klinishche Institut für Hygiene und
Saint Raphael Hospital, New Haven, CT; and Joseph Mailman School of Public Medizinische Mikrobiologie der
United States of America Health, New York, NY; United States of Medizinischen Universität, Vienna;
America Austria
Yves Chartier
World Health Organization, Geneva; Yves Longtin Denis Salomon
Switzerland University of Geneva Hospitals, Geneva; University of Geneva Hospitals
Switzerland and Faculty of Medicine, Geneva;
Marie-Noelle Chraïti Switzerland
University of Geneva Hospitals, Geneva: Marianne McGuckin
Switzerland McGuckin Methods International Inc., Syed Sattar
and Department of Health Policy, Centre for Research on Environmental
Barry Cookson Jefferson Medical College, Philadelphia, Microbiology, Faculty of Medicine,
Health Protection Agency, London; PA; United States of America University of Ottowa, Ottawa; Canada
United Kingdom
Mary-Louise McLaws Hugo Sax
Nizam Damani Faculty of Medicine, University of New University of Geneva Hospitals, Geneva;
Craigavon Area Hospital, Portadown, South Wales, Sidney; Australia Switzerland
Northern Ireland; United Kingdom
Geeta Mehta Wing Hong Seto
Sasi Dharan Lady Hardinge Medical College, New Queen Mary Hospital, Hong Kong
University of Geneva Hospitals, Geneva; Delhi; India Special Administrative Region of China
Switzerland
Ziad Memish Andreas Voss
Neelam Dhingra-Kumar King Fahad National Guard Hospital, Canisius-Wilhelmina Hospital,
Essential Health Technologies, Riyadh; Kingdom of Saudi Arabia Nijmegen;The Netherlands
World Health Organization, Geneva;
Switzerland Peter Nthumba Michael Whitby
Kijabe Hospital, Kijabe; Kenya Princess Alexandra Hospital, Brisbane;
Raphaelle Girard Australia
Centre Hospitalier Lyon Sud, Lyon; Michele Pearson Andreas F Widmer
France Centers for Disease Control and Innere Medizin und Infektiologie,
Prevention, Atlanta, GA; United States of Kantonsspital Basel und
Don Goldmann America Universitätskliniken Basel, Basel;
Institute for Healthcare Improvement, Switzerland
Cambridge, MA: United States of Carmem Lúcia Pessoa-Silva
America Epidemic and Pandemic Alert and Walter Zingg
Response, World Health Organization, University of Geneva Hospitals, Geneva;
Lindsay Grayson Geneva; Switzerland Switzerland
Austin & Repatriation Medical Centre,
Heidelberg; Australia Didier Pittet
University of Geneva Hospitals
and Faculty of Medicine, Geneva;
Switzerland
50
ACKNOWLEDGEMENTS
Technical contributions from: Jann Lubbe Special technical contribution from:

Vivienne Allan University of Geneva Hospitals; Geneva; Benedetta Allegranzi
National Patient Safety Agency, London; Switzerland Clean Care is Safer Care Team,
United Kingdom WHO Patient Safety
Peter Mansell
Charanjit Ajit Singh National Patient Safety Agency, London; Peer review from:
International Interfaith Centre, Oxford; United Kingdom Nordiah Awang Jalil
United Kingdom Hospital Universiti Kebangsaan
Anant Murthy Malaysia, Kuala Lumpur; Malaysia
Jacques Arpin Johns Hopkins Bloomberg School of
Geneva; Switzerland Public Health, Baltimore, MD; United Victoria J. Fraser
States of America Washington University School of
Pascal Bonnabry Medicine, St Louis, MO; United States
University of Geneva Hospitals, Geneva; Nana Kobina Nketsia of America
Switzerland Traditional Area Amangyina, Sekondi;
Ghana William R Jarvis
Izhak Dayan Jason & Jarvis Associates, Port Orford,
Communauté Israélite de Genève, Florian Pittet OR; United States of America
Geneva; Switzerland Geneva; Switzerland
Carol O’Boyle
Cesare Falletti Anantanand Rambachan University of Minnesota School of
Monastero Dominus Tecum, Pra’d Mill; Saint Olaf College, Northfield, MN; Nursing, Minneapolis, MN; United States
Italy United States of America of America
Tesfamicael Ghebrehiwet Ravin Ramdass M Sigfrido Rangel-Frausto

International Council of Nurses; South African Medical Association; Instituto Mexicano del Seguro Social,
Switzerland South Africa Mexico, DF; Mexico
William Griffiths Beth Scott Victor D Rosenthal

University of Geneva Hospitals, Geneva; London School of Hygiene and Tropical Medical College of Buenos Aires,
Switzerland Medicine, London; United Kingdom Buenos Aires; Argentina
Martin J. Hatlie Susan Sheridan Barbara Soule

Partnership for Patient Safety; United Consumers Advancing Patient Safety; Joint Commission Resources, Inc., Oak
States of America United States of America Brook, IL; United States of America
Pascale Herrault Parichart Suwanbubbha Robert C Spencer

University of Geneva Hospitals, Geneva; Mahidol University, Bangkok; Thailand Bristol Royal Infirmary, Bristol; United
Switzerland Kingdom
Gail Thomson
Annette Jeanes North Manchester General Hospital, Paul Ananth Tambyah
Lewisham Hospital, Lewisham; United Manchester; United Kingdom National University Hospital, Singapore;
Kingdom Singapore
Hans Ucko
Axel Kramer World Council of Churches, Geneva; Peterhans J van den Broek
Ernst-Moritz-Arndt Universität Switzerland Leiden Medical University, Leiden; The
Greifswald, Greifswald; Germany Netherlands
Michael Kundi Editorial contribution from: Editorial supervision from:

University of Vienna, Vienna, Austria Rosemary Sudan Didier Pittet
University of Geneva Hospitals, Geneva; University of Geneva Hospitals
Anna-Leena Lohiniva Switzerland and Faculty of Medicine, Geneva;
US Naval Medical Research Unit, Cairo; Switzerland
Egypt
51
Patient Safety Programme, WHO Patient safety award: WHO Collaborating Departments:
(All teams and members listed in Benjamin Ellis, Edward Kelley, Agnès WHO Lyon Office for National Epidemic
alphabetical order) Leotsakos Preparedness and Response, Epidemic
and Pandemic Alert and Response,
African Partnerships for Patient Patients for Patient Safety: Health Security and Environment Cluster
Safety: Joanna Groves , Martin Hatlie, Edward
Sepideh Bagheri Nejad, Rachel Heath, Kelley, Anna Lee, Pat Martin, Margaret Blood Transfusion Safety, Essential
Joyce Hightower, Edward Kelley, Yvette Murphy, Susan Sheridan, Garance Health Technologies, Health Systems
Piebo, Didier Pittet, Paul Rutter, Julie Upham and Services Cluster
Storr, Shams Syed
Pulse oximetry: Clinical Procedures, Essential Health
Blood Stream Infections: William Berry, Gerald Dziekan, Angela Technologies, Health Systems and
Katthyana Aparicio, Sebastiana Gianci, Enright, Peter Evans, Luke Funk, Atul Services Cluster
Chris Goeschel, Maite Diez Navarlaz, Gawande, Alan Merry, Isabeau Walker,
Edward Kelley, Itziar Larizgoitia, Peter Iain Wilson Making Pregnancy Safer, Reproductive
Pronovost Health and Research, Family and
Reporting & Learning: Community Health Cluster
Central Support & Administration: Gabriela Garcia Castillejos, Martin
Armorel Duncan, Sooyeon Hwang, John Fletcher, Sebastiana Gianci, Christine Policy, Access and Rational Use,
Shumbusho Goeschel, Edward Kelley Medicines Policy and Standards,
Health Systems and Services Cluster
H1N1 Checklist: Research and Knowledge
Carmen Audera-Lopez, Gerald Dziekan, Management: Vaccine Assessment and Monitoring,
Atul Gawande, Angela Lashoher, Pat Katthyana Aparicio, Carmen Audera- Immunization, Vaccines and Biologicals,
Martin, Paul Rutter Lopez, Sorin Banica, David Bates, Family and Community Health Cluster
Mobasher Butt, Mai Fujii, Wilco
Patient Checklist: Graafmans, Itziar Larizgoitia, Nittita Water, Sanitation and Health, Protection
Benjamin Ellis, Pat Martin, Susan Prasopa-Plaizier of the Human Environment, Health
Sheridan Security and Environment Cluster
Safe Surgery Saves Lives:
Safe Childbirth Checklist: William Berry, Priya Desai, Gerald
Priya Agraval, Gerald Dziekan, Atul Dziekan, Lizabeth Edmondson, Atul WHO acknowledges the Hôpitaux
Gawande, Angela Lashoher, Claire Gawande, Alex Haynes, Sooyeon Universitaires de Genève (HUG), in
Lemer, Jonathan Spector Hwang, Agnès Leotsakos, Pat Martin, particular the members of the Infection
Elizabeth Morse, Paul Rutter, Laura Control Programme, for their active
Trauma Checklist: Schoenherr, Tom Weiser, Iain Yardley participation in developing this material.
Gerald Dziekan, Angela Lashoher,
Charles Mock, James Turner Solutions & High 5s:
Laura Caisley, Edward Kelley, Agnès
Communications: Leotsakos, Karen Timmons
Vivienne Allan, Margaret Kahuthia, Laura
Pearson, Kristine Stave Tackling Antimicrobial Resistance:
Armorel Duncan, Gerald Dziekan, Felix
Education: Greaves, David Heymann, Sooyeon
Esther Adeyemi, Bruce Barraclough, Hwang, Ian Kennedy, Didier Pittet, Vivian
Benjamin Ellis, Itziar Larizgoitia, Agnés Tang
Leotsakos, Rona Patey, Samantha Van
Staalduinen, Merrilyn Walton Technology:
Rajesh Aggarwal, Ara Darzi, Rachel
International Classification for Patient Davies, Edward Kelley, Oliver Mytton,
Safety: Charles Vincent, Guang-Zhong Yang
Martin Fletcher, Edward Kelley, Itziar
Larizgoitia, Pierre Lewalle
52
World Health Organization Email
20 Avenue Appia patientsafety@who.int
CH – 1211 Geneva 27 Please visit us at:
Switzerland www.who.int/patientsafety/en/
Tel: +41 (0) 22 791 50 60 www.who.int/gpsc/en

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Prevención y control

Unidad Técnica y Clínica de la OMS para la PCI

Medidas que tienen lugar

• Son los conocimientos, las capacidades y los

• Son las medidas que tienen lugar antes de una emergencia y

• Porque la preparación forma parte integrante

• Las medidas inadecuadas de PCI pueden dar

Paso Medidas que deben adoptarse

Paso Medidas que deben adoptarse

Paso Medidas que deben adoptarse

La prevención y el control de infecciones (PCI)

Fuente: páginas de la OMS sobre PCI; https://www.who.int/gpsc/ipc/en

1. Disminuir la transmisión de infecciones

Los requisitos mínimos se definen de la siguiente

Las normas de PCI que deberían haberse

NIVEL NACIONAL NIVEL DE LOS ESTABLECIMIENTOS

NIVEL NACIONAL NIVEL DE LOS ESTABLECIMIENTOS

Unidad Técnica y Clínica de la OMS para la PCI

• Un nuevo coronavirus (SARS-CoV-2) es

Un nuevo coronavirus (nCoV) es una cepa nueva que no se había

El 31 de diciembre del 2019, la oficina de la OMS en China recibió la

*“Los “casos confirmados” comunicados entre el 13 y el 19 de febrero del

País, zona o territorio +Se detectaron 634 casos en un crucero que

La enfermedad parece Insuficiencia renal

Etapa temprana: Etapa avanzada:

Atención en el domicilio de pacientes con presunta infección por el

Asas de las puertas Instrumentos

Medicación Apretón de manos

1 ANTES DE TOCAR UN PACIENTE 4 DESPUÉS DE TOCAR UN PACIENTE

5 DESPUÉS DEL CONTACTO

Duración del procedimiento completo: de 20 a 30 Duración del procedimiento completo: de 40 a 60 segundos

Aplique una cantidad

Frótese la palma de la mano Frótese el dorso de los

Frótese la punta de los

Fuente de la imagen: https://www.who.int/es/emergencies/diseases/novel-coronavirus-2019/advice-for-public

Nariz + boca Nariz + boca Ojos + nariz + Ojos

Siempre antes y después del

Cambie de inmediato el EPP cuando se contamine o se dañe.

3 Jeringuilla estéril con mecanismo de seguridad

4 Viales estériles para la medicación y los diluyentes

5 Limpieza y antisepsia de la piel

6 Recogida adecuada de los objetos punzocortantes

7 Gestión adecuada de los desechos

Limpieza Desinfección Esterilización

Procedimiento que disminuye el número de

Esterilización Un procedimiento validado que se utiliza para

Eliminación Higiene de las manos

Limpieza corriente: Limpieza ordinaria (y desinfección, cuando esté indicada) cuando la

Baño del paciente Pisos Eliminación Higiene de las manos

Limpieza terminal: Limpieza y desinfección después de que el paciente es dado de alta o se

Reducirlos al mínimo Aislarlos Recogerlos Transportarlos

Almacenarlos Tratarlos Eliminarlos

El tratamiento seguro de los desechos generados durante las actividades de atención

• Es importante cerciorarse de que los procedimientos de limpieza y

Realizar el Realice el triaje clínico en

2. Tener a disposición productos de higiene de las manos a base de alcohol y mascarillas

4. Mantener un flujo unidireccional de los pacientes y el personal.

5. Señalizar claramente los síntomas y las direcciones.

PREGUNTAS DEL TAMIZAJE EN CASO AFIRMATIVO:

FIEBRE Haga que el paciente:

• Limite el número de profesionales de salud, visitantes y familiares que entran en

• Las precauciones deben mantenerse hasta que el paciente esté asintomático.

5B Verificación negativa del