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Review
. 2006 Oct;6(10):641-52.
doi: 10.1016/S1473-3099(06)70600-4.

Evidence-based model for hand transmission during patient care and the role of improved practices

Didier Pittet  1 , Benedetta Allegranzi, Hugo Sax, Sasi Dharan, Carmem Lúcia Pessoa-Silva, Liam Donaldson, John M Boyce; WHO Global Patient Safety Challenge, World Alliance for Patient Safety
Affiliations
Review

Evidence-based model for hand transmission during patient care and the role of improved practices

Didier Pittet et al. Lancet Infect Dis. 2006 Oct.

Abstract

Hand cleansing is the primary action to reduce health-care-associated infection and cross-transmission of antimicrobial-resistant pathogens. Patient-to-patient transmission of pathogens via health-care workers' hands requires five sequential steps: (1) organisms are present on the patient's skin or have been shed onto fomites in the patient's immediate environment; (2) organisms must be transferred to health-care workers' hands; (3) organisms must be capable of surviving on health-care workers' hands for at least several minutes; (4) handwashing or hand antisepsis by the health-care worker must be inadequate or omitted entirely, or the agent used for hand hygiene inappropriate; and (5) the caregiver's contaminated hand(s) must come into direct contact with another patient or with a fomite in direct contact with the patient. We review the evidence supporting each of these steps and propose a dynamic model for hand hygiene research and education strategies, together with corresponding indications for hand hygiene during patient care.

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