Handwashing is defined as washing hands with water and plain soap, i.e., a detergent (esterified fatty acids and sodium or potassium hydroxide) that does not contain an antimicrobial agent or contains low concentrations of antimicrobial agents that are effective solely as preservatives. The cleaning activity of plain soap is attributed to its detergent properties, which result in removal of dirt, soil, and various organic substances from the hands.
Handwashing removes loosely adherent transient microorganisms and is indicated when (1) hands are visible soiled with blood, and/or other potentially infectious material, (2) before eating, (3) after using a restroom, (4) after caring for patients colonized with *Clostridium difficile*, (5) following suspected or proven exposure to *Bacillus anthraces*, and (6) as part of two-stage surgical hand antisepsis, i.e., handwashing followed by the application of an alcohol-based hand scrub.2,13
When performing handwashing (Figure 1), wet hands with water. Follow the manufacturer’s recommendations regarding the volume of soap to be used. Bar, liquid, foaming, leaflet, or powdered forms of plain soap are acceptable. When bar soap is used, the soap should be small and stored in a soap rack that facilitates drainage. Occasionally, plain soaps have become contaminated with gram-negative bacilli and have caused outbreaks of nosocomial infections.14
Following handwashing, the hands must be dried thoroughly with a single-use towel. It is of note that organisms are transferred in much larger numbers from wet versus dried hands.6 Multiple-use cloth towels are not recommended for use in healthcare settings. Antimicrobial-impregnated wipes (i.e., towelettes) may be considered as an acceptable alternative to handwashing; however, the use of towelettes is not an acceptable alternative to hand antisepsis or surgical hand antisepsis.
Figure 1. How to Handwash when Hands are Visibly Soiled?