To understand different approaches for hand cleansing understanding of normal bacterial skin flora is essential. Normal human skin is colonized with bacteria. Different parts of the bodies have varied bacterial counts. In 1938 bacteria recovered from hands were divided into two categories, Transient and Resident.

Resident – attached to deeper layers of skin, more resistant to removal
Transient – on superficial layers of skin, easier to remove with hand washing.

• It also discussed that automatic hand washers do not show any quality or frequency of hand washing increased when used.
• The main issue that is apparent is that education is required. There is a lack of scientific information to impact or improve hand hygiene. There is a failure to perform appropriate hand hygiene. This is the leading cause of assorted infection in health care settings.
• Poor adherence to recommended practices, a few major issue:
• Males and Physicians less likely to follow practices
• Sinks are inconveniently located/shortage of sinks
• Often too busy
• Wearing gloves/beliefs that with glove use no need for hand hygiene.
• Fingernail and Artificial Nails are a main area of concern. Chipped nail polish may grow and increase the number of organisms on fingernail; again no scientific proof only assumed at this point. Fingernails overall show evidence that pose an infection hazard.
• CDC Glove Policy- states gloves can reduce the transmission of infection and bacteria. However, those who wear gloves are less likely to wash or clean their hands prior to putting on gloves.
• Alcohol based hand rubs may be a better option than traditional hand washing w/ soap and water or antiseptic hand wash. The alcohol rubs require less time, act faster and are less likely to irritate hands less than traditional hand soaps.
• Recommendations are not for food processing. THE CDC guidelines are strongly recommended or suggested for implementation. There are really no clear cut guidelines and no one mandating them.