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HA . HYGEIE Excerpt from Draft Revised Interpretive Guidance at F 441 Infection Control Hand hygiene.continues to be the primary means of preventing the transmission of infection. Hand washing with soap and water must be done if hands are visibly soiled, before eating or handling food, after using the toilet, and any time needed for personal hygiene. Antimicrobial agents such as alcohol-based hand rubs are also appropriate for cleaning hands and can be used in direct care areas. The following is a list of some situations that require hand hygiene. • When Coming on duty; • When hands are soiled; • Before and after any client contact; • Before and after any invasive procedure; • Before and after•entering isolation precaution settings; • When coming in contact with and after contact with a clients intactskin; • After personal use of toilet; • After blowing or wiping nose; • After contact with a clients mucous membranes, body fluids or excretions; • After handling linens,dressings, PMU equipment; • Before and after removing gloves or apron; and • After completing duty. Recommended techniques for washing hands with soap and water include wetting hands first with water, applying the amount of product recommended by the manufacturer to hands, and rubbing hands together vigorously for at least 15 seconds covering all surfaces of the hands and fingers; then rinsing hands with water and drying thoroughly with a disposable towel. Recommended techniques for performing hand hygiene with an alcohol based hand rub include applying product to the palm of one hand and rubbing hands together, covering all surfaces of hands and fingers, until the hands are dry. ABHR may not be used as a substitute for soap and water when hands are visibly soiled. In addition, gloves or the use of baby wipes are not a substitute for hand hygiene. NOTE: Health & Safety Code (HSC), Section 1279.7, effective January 1, 2009, requires all SNt=s to implement a facility-wide hand hygiene program.