When to Wash vs. Sanitize

There are two hand hygiene methods — soap and water washing, and alcohol-based hand sanitizer — and knowing which to use when is as important as using either correctly. Choosing the wrong method at the right time provides false protection.

Section 01

The WHO's Five Moments for Hand Hygiene

The World Health Organization defines five critical moments when hand hygiene must occur:

Before touching a patient

Protect the client from organisms you carry from the environment or previous contacts. This is the moment most commonly skipped.

Before a clean/aseptic procedure

Wound care, catheter care, medication preparation — any procedure where introducing organisms would cause direct harm.

After body fluid exposure risk

After any contact with blood, urine, stool, wound drainage, or mucous membranes — regardless of whether gloves were worn.

After touching a patient

Protect yourself and the next surface you touch from organisms on the client's body or in their immediate environment.

After touching patient surroundings

The client's immediate environment — bed rails, bedside table, call button, doorknobs — carries the client's organisms. Treat it as you treat the client.

Section 02

Soap and Water — When It's Required

🚨 Always use soap and water when:

Hands are visibly soiled with blood, body fluids, or organic material
Client has known or suspected C. difficile (Clostridioides difficile) infection — alcohol does not kill spores
Client has known or suspected norovirus infection — alcohol has limited effectiveness
Before eating and after using the restroom — always soap and water
After removing gloves if hands are visibly contaminated

Soap and water mechanically removes organisms — it does not kill them, it removes them from the skin surface. For C. diff and norovirus, mechanical removal is the only reliable method.

Section 03

Alcohol-Based Hand Sanitizer — When It's Appropriate

💡 Sanitizer is appropriate when:

Hands are not visibly soiled
Between patient contacts in routine care
After removing gloves (when hands are not visibly soiled)
Before and after touching a patient when no sink is accessible
Moving between tasks with the same patient

Alcohol sanitizer kills a broad spectrum of bacteria, viruses, and fungi quickly and is more convenient than sink washing — making it the right choice for the majority of hand hygiene moments when hands are not visibly soiled and the client does not have C. diff or norovirus.

Section 04

In the Home — Practical Realities

Carry your own sanitizer: Do not rely on the client's home to have hand hygiene supplies available. A pocket-sized alcohol sanitizer (at least 60% alcohol) should be on your person at every home visit.
Before and after each client: Sanitize before entering the client's home and wash hands with soap and water at the first opportunity after arriving. Sanitize before leaving.
Between tasks: Moving from a wound dressing to food preparation requires hand hygiene between tasks — even if both are "clean" tasks.
Document when soap unavailable: If a client's home has no soap available and you have a soap-required hand hygiene moment, use sanitizer as a temporary measure and document the need for supplies.

Section 05

The Fifth Moment — The Most Forgotten

⚠ After touching patient surroundings

The fifth WHO moment — after touching patient surroundings — is the most consistently missed. The client's environment is as contaminated as the client themselves. When you:

Adjust the bed rails
Hand the client their phone or remote
Touch the doorknob of their room
Rearrange items on their bedside table

...you have had a hand hygiene moment. The organisms on those surfaces are the same organisms that cause infections. Treat the environment as you treat the patient.