Association for Professionals in Infection Control and Epidemiology (APIC) recommends the following procedure for thorough handwashing:
- Wet hands with warm running water.
- Apply handwashing agent (soap) and thoroughly distribute over hands.
- Vigorously rub hands together for 10 to 15 seconds, generating friction on all surfaces of the hands and fingers, including thumbs, backs of fingers, backs of the hands, and beneath the fingernails.
- Rinse hands thoroughly to remove residual soap then dry using paper towels dispensed from holders that require the user to remove them one at a time.
- If the sink does not have foot controls or an automatic shutoff, a paper towel may be used to shut off the faucet to avoid recontaminating the hands.
While there is little evidence to recommend a specific ideal water temperature for effective handwashing, it seems logical to use warm water. Excessively hot water is harder on the skin, dries the skin, and is too uncomfortable to wash for the recommended amount of time. In addition, cold water inhibits the proper lathering of soap.
When using an alcohol-based antimicrobial cleaner, APIC recommends that a vigorous, one-minute rubbing with enough alcohol (3-5ml is generally recommended) to wet the hands completely is the most effective method for hand antisepsis. Failure to cover all surfaces of the hands because of poor technique or use of insufficient amounts of alcohol handrub solution can leave surfaces contaminated. Also, keep in mind that these alcohol handrubs are not designed to remove physical dirt, and therefore should be used with another cleaning agent in the presence of physical dirt.
According to the US Centers for Disease Control and Prevention (CDC), "handwashing is the single most important procedure for preventing the spread of infection."