Hand hygiene

Bare below the elbows

About bare below the elbows

Hand hygiene remains one of the most important measures in prevention of healthcare-associated infections. Bare Below the Elbows is an initiative that aims to improve the effectiveness of hand hygiene performed by health care workers. Bare Below the Elbows is achieved when sleeves are above the elbow, hands and forearms are free of jewellery, skin is intact, and nails are natural, short, and unvarnished.

Research suggests that wearing of rings is associated with higher median skin organism counts, contamination with Staphylococcus aureus, gram-negative bacilli, or Candida species. There is also an increased risk of contamination with any transient organism as the number of rings worn by a person increases. The World Health Organization (WHO) recommends that long sleeves be avoided. Long sleeves have been found to be contaminated with pathogens and can hinder effective hand hygiene.

Healthcare workers should perform hand hygiene in accordance with the National Hand Hygiene Initiative.

Bare below the elbows guideline

The Bare below the elbows guideline provides instructions for all Queensland Health employees (permanent, temporary, and casual) and all organisations and individuals acting as its agents (including Visiting Medical Officers and other partners, contractors, consultants, students, and volunteers) and all Queensland licensed private health facilities. The information found in this guideline may also be used by other health and residential care services. Human Rights have been considered in the formation of this guideline.

Clinician quick reference

Clinician Quick Reference Guide for Bare below the elbows

Details
A Bare Below the Elbows approach enables healthcare workers to decontaminate their hands and improves the effectiveness of hand hygiene. All staff having direct contact with patients or a patient’s environment should observe the following Bracelets, wrist watches, and rings should not be worn. A significant ring such as a single flat ring or band, with no stones or ridges may be permitted but should not interfere with effective hand hygiene practice. If working in a high risk setting such as Operating Theatres, wearing of any type of ring is not permitted. Long sleeves are discouraged. If worn, sleeves should be rolled or pushed up above the elbow when giving direct patient care or in the patient environment so as not to interfere with effective hand hygiene. Fingernails should be kept natural, short, and clean, and nail polish or embellishments should not be worn. Artificial nails (acrylic and gel) should not be worn. Any skin integrity breaches (abrasions, cuts, or dermatitis) should be covered with waterproof film dressing. Staff with dermatitis should report for assessment as per local procedures. Remove protruding piercings and body modification jewellery/items positioned from the elbow to the fingertips as they impede effective hand hygiene (including but not limited to piercings or other body modifications, resulting in non-intact skin from the elbow to the fingertips). Guidance from staff line manager or local infection prevention and control service should be sought for any staff with casts or compression garments below the elbows prior to patient contact. Implementation The following resources have been developed to assist with implementing the guideline locally. Bare Below the Elbows - Compliance audit tool Presentation - Bare below the Elbows Posters (available from Queensland Health computers only) - courtesy of Princess Alexandra Hospital, Infection Management Services, Southern Queensland. Information for staff and contractors Having clean hands is one of the most important ways to prevent infections in hospital for both workers and patients. Refer to the Bare Below the Elbows fact sheet for more information. Evidence statement The content on this page is informed by the Guideline document Bare Below the elbows guideline. As such, references are not included for ease of reading. References can be found in the Guideline document Bare Below the elbows guideline Related links Australian Commission on Safety and Quality in Healthcare National Hand Hygiene Initiative Implementation Guide National Health and Medical Research Council Australian Guidelines for the Prevention and Control of Infection in Healthcare World Health Organisation WHO guidelines on hand hygiene in health care

Details

A Bare Below the Elbows approach enables healthcare workers to decontaminate their hands and improves the effectiveness of hand hygiene. All staff having direct contact with patients or a patient’s environment should observe the following

Bracelets, wrist watches, and rings should not be worn.
A significant ring such as a single flat ring or band, with no stones or ridges may be permitted but should not interfere with effective hand hygiene practice. If working in a high risk setting such as Operating Theatres, wearing of any type of ring is not permitted.
Long sleeves are discouraged. If worn, sleeves should be rolled or pushed up above the elbow when giving direct patient care or in the patient environment so as not to interfere with effective hand hygiene.
Fingernails should be kept natural, short, and clean, and nail polish or embellishments should not be worn. Artificial nails (acrylic and gel) should not be worn.
Any skin integrity breaches (abrasions, cuts, or dermatitis) should be covered with waterproof film dressing. Staff with dermatitis should report for assessment as per local procedures.
Remove protruding piercings and body modification jewellery/items positioned from the elbow to the fingertips as they impede effective hand hygiene (including but not limited to piercings or other body modifications, resulting in non-intact skin from the elbow to the fingertips).

Guidance from staff line manager or local infection prevention and control service should be sought for any staff with casts or compression garments below the elbows prior to patient contact.

Implementation

The following resources have been developed to assist with implementing the guideline locally.

Bare Below the Elbows - Compliance audit tool
Presentation - Bare below the Elbows
Posters (available from Queensland Health computers only) - courtesy of Princess Alexandra Hospital, Infection Management Services, Southern Queensland.

Information for staff and contractors

Having clean hands is one of the most important ways to prevent infections in hospital for both workers and patients. Refer to the Bare Below the Elbows fact sheet for more information.

Evidence statement

The content on this page is informed by the Guideline document Bare Below the elbows guideline. As such, references are not included for ease of reading. References can be found in the Guideline document Bare Below the elbows guideline