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This document deals with the performance of hand hygiene in health care settings across the continuum of care (see below) including, but not limited to, acute care, complex continuing care, rehabilitation facilities, long-term care, chronic care, pre-hospital care and home health care. This document provides infection prevention and control practices for:
The best practices in this document reflect the best evidence and expert opinion available at the time of writing. As new information becomes available, this document will be reviewed and updated. Refer to Appendix A, “Ranking System for Recommendations,” for the grading system used for recommendations.
The best practices for hand hygiene set out in this document must be practiced in all settings where care is provided, across the continuum of health care. This includes settings where emergency (including pre-hospital) care is provided, hospitals, complex continuing care facilities, rehabilitation facilities, long-term care homes, outpatient clinics, community health centres and clinics, physician offices, dental offices, offices of health professionals, public health and home health care. This document should be used in conjunction with the Ministry of Health and Long-Term Care (MOHLTC)'s “Just Clean Your Hands” program.
The best practices in this document are based on the assumption that basic infection prevention and control systems are in place in health care settings in Ontario. Collaboration with organizations that have infection prevention and control expertise, such as academic health science centres, regional infection control networks, public health units that have professional staff certified in infection prevention and control and local infection prevention and control associations (e.g. Community and Hospital Infection Control Association – Canada chapters), may be necessary to develop evidence-based programs. In addition to the general assumption (above) about basic infection prevention and control, these best practices are based on the following additional assumptions and principles:
Health care facilities are required to comply with applicable provisions of the Occupational Health and Safety Act (OHSA) and its Regulations. Employers, supervisors and workers have rights, duties and obligations under the OHSA. The OHSA places duties on many different categories of individuals associated with workplaces, such as employers, constructors, supervisors, owners, suppliers, licensees, officers of a corporation and workers. Here is a guide to the requirements of the OHSA. In addition, the OHSA section 25(2)(h) requires an employer to take every precaution reasonable in the circumstances for the protection of a worker. Specific requirements for certain health care and residential facilities may be found in the Regulation for Health Care and Residential Facilities. There is a general duty for an employer to establish written measures and procedures for the health and safety of workers, in consultation with the joint health and safety committee or health and safety representative, if any. Such measures and procedures may include, but are not limited to, the following:
At least once per year the measures and procedures for the health and safety of workers shall be reviewed and revised in the light of current knowledge and practice. The employer, in consultation with the joint health and safety committee or health and safety representative, if any, shall develop, establish and provide training and educational programs in health and safety measures and procedures for workers that are relevant to the workers’ work. A worker who is required by his or her employer or by the Regulation for Health Care and Residential Facilities to wear or use any protective clothing, equipment or device shall be instructed and trained in its care, use and limitations before wearing or using it for the first time and at regular intervals thereafter and the worker shall participate in such instruction and training. The employer is reminded of the need to be able to demonstrate training, and is therefore encouraged to document the workers trained, the dates training was conducted, and materials covered during training. Under the Occupational Health and Safety Act, a worker must work in compliance with the Act and its regulations, and use or wear any equipment, protective devices or clothing required by the employer. For more information, contact your local Ministry of Labour office. A list of local Ministry of Labour offices in Ontario may be found online at: http://www.labour.gov.on.ca/.
Click below to download Best Practices For Hand Hygiene (58 pages, PDF, 590 Kb). English
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