Alcohol-Based Hand Rub 

Purpose: 

To prevent the spread of bacteria and ensure hand hygiene. 

Procedure: 

1. Application: 

• Apply the alcohol-based hand rub product to the palm of one hand. 

2. Rubbing: 

• Rub hands together, covering all surfaces of the hands and fingers. 

• Continue rubbing until hands are dry. 

3. Situational Use: 

• Alcohol-based hand rubs are not appropriate for use when hands are visibly dirty or contaminated with proteinaceous material (e.g., blood, body fluids). 

• In such cases, use soap and water for handwashing. 

Compliance and Documentation: 

• Ensure adherence to CMS guidelines and Requirements of Participation for Long-Term Care Facilities regarding hand hygiene practices. 

• Regularly educate and train staff on proper hand hygiene techniques, emphasizing the importance of using alcohol-based hand rubs appropriately. 

• Monitor and audit hand hygiene practices to ensure compliance with this policy. 

• Document any instances of non-compliance and the corrective actions taken. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes. 

• Centers for Disease Control and Prevention (CDC) Hand Hygiene Guidelines.