# Hand hygiene in cancer care: staff, patients, families and visitors

Source: https://onco.cc/protocols/hand-hygiene-in-cancer-care/  
OnCo record `hand-hygiene-in-cancer-care` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Clean hands are the single most important way to stop infections spreading to someone whose immunity is low. Staff clean their hands at five set moments around every patient, usually with alcohol rub, and with soap and water when hands are dirty or when there is diarrhoea such as C. difficile. Patients, families and visitors should clean their hands too, and ask staff to if they have not.

## Summary

The WHO 2009 guideline (CDC/HICPAC categories) is the international standard, and NICE CG139 the UK one for community care. Alcohol-based handrub is the preferred means of routine hand antisepsis when hands are not visibly soiled (WHO IA; NICE 'preferably with a handrub'); wash with soap and water when hands are visibly dirty or soiled with body fluids (IB), after the toilet (II), and when spore-forming organisms such as Clostridioides difficile are suspected or proven (IB). WHO's five moments: before touching a patient, before a clean or aseptic procedure (including handling an invasive device such as a central line, whether or not gloves are worn, IB), after body fluid exposure risk (IA), after touching a patient (IB) and after touching the patient's surroundings (IB); also after removing gloves. Gloves do not replace hand hygiene (IB). Handrub takes 20 to 30 seconds and handwashing 40 to 60 seconds (WHO); NICE asks for vigorous rubbing for at least 10 to 15 seconds when washing. Staff do not wear artificial nails with direct patient contact (WHO IA) and are bare below the elbows (NICE). Programmes should be multimodal with monitoring and feedback (IA). For families, the Dutch paediatric oncology guideline makes hand hygiene by patients, carers and staff a strong good practice statement; NICE asks that patients and carers are taught hand decontamination before discharge; the HCT guideline asks all visitors to clean hands before and after visits.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: WHO five moments for hand hygiene; hand washing during chemotherapy; alcohol hand rub; hand decontamination; bare below the elbows; clean hands
- Tags: protocol; hand-hygiene

## Connected records

- protocols: [Central line maintenance bundle: preventing bloodstream infection after insertion](https://onco.cc/protocols/central-line-maintenance-bundle/), [Clostridioides difficile infection in children with cancer or after stem cell transplant](https://onco.cc/protocols/paediatric-clostridioides-difficile/), [Procedural pain and sedation for children with cancer: needles, lumbar punctures and marrow tests](https://onco.cc/protocols/paediatric-procedural-pain-and-sedation/), [Protective measures and daily life during neutropenia: hand hygiene, visitors, pets, plants, school and swimming](https://onco.cc/protocols/neutropenic-precautions-and-daily-life/)
- cancers: [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- institutions: [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/), [World Health Organization Cancer Programme](https://onco.cc/institutions/who/)
- terms: [Central venous access (port, PICC line)](https://onco.cc/terms/central-venous-access/), [Neutropenia](https://onco.cc/terms/neutropenia/)

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