Hand Hygiene and Infection Control OSCE, WHO 5 Moments and PPE Guide

Why Infection Control Is Tested

Healthcare-associated infections (HCAIs) affect approximately 300,000 patients per year in the UK. Hand hygiene is the single most effective intervention to prevent transmission. Infection control stations appear in early clinical years and are marked rigorously. Examiners look for correct technique, knowledge of when to use each method, and understanding of the principles behind each precaution.

The WHO 5 Moments for Hand Hygiene

The World Health Organisation (WHO) "5 Moments" framework defines the exact points at which hand hygiene is required:

Alcohol Gel vs Soap and Water: When to Use Each

The 6-Step Handwashing Technique

The WHO-approved 6-step technique takes a minimum of 20 seconds with gel, or 40-60 seconds with soap and water:

Step 1: Rub palm to palm

Step 2: Right palm over back of left hand with interlaced fingers; repeat with the other hand

Step 3: Palm to palm with fingers interlaced

Step 4: Backs of fingers to opposing palms with fingers interlocked (knuckles)

Step 5: Rotational rubbing of left thumb clasped in right palm; repeat with the other thumb

Step 6: Rotational rubbing backwards and forwards with clasped fingers of right hand in left palm; repeat with the other hand

Finish by rinsing thoroughly and drying with a single paper towel.

Standard Precautions

Standard precautions apply to all patients at all times, regardless of known infection status:

• Hand hygiene at all 5 moments
• PPE appropriate to anticipated exposure
• Safe handling and disposal of sharps
• Safe waste disposal (clinical waste in yellow bags)
• Respiratory hygiene and cough etiquette
• Environmental cleaning and decontamination
• Safe handling of linen

Transmission-Based Precautions

Use in addition to standard precautions for specific organisms:

PPE: Donning (Putting On) Order

Always don in this order to protect clean areas:

1. 1Apron
2. 2Gloves

For full PPE (airborne precautions):

1. 1Apron or gown
2. 2FFP3 respirator mask (perform a seal check)
3. 3Eye protection / visor
4. 4Gloves (put on last to avoid contamination)

PPE: Doffing (Removing) Order

The most contaminated items come off first:

1. 1Gloves (most contaminated; roll inside out as you remove)
2. 2Apron (roll from inside out, touching only the ties)
3. 3Eye protection (remove from behind, touching only the arms)
4. 4Mask (remove from behind; do not touch the front)
5. 5Hand hygiene after each removal step

Sharps Safety

• Never resheath a needle after use
• Dispose of sharps directly into a yellow sharps bin immediately after use
• Sharps bins must not be overfilled beyond the fill line (usually three-quarters)
• If a needle stick injury occurs: encourage bleeding (do not suck), wash under running water, report immediately and attend occupational health for assessment and post-exposure prophylaxis if needed

Isolation Precautions: Practical OSCE Points

• Patients with suspected or confirmed infection requiring contact precautions should be nursed in a single room where possible
• Alert staff on entering the room
• Remove all PPE before leaving the room (inside the room or in the anteroom)
• Patient equipment should be dedicated to that patient where possible
• Visitors should be instructed on hand hygiene

Frequently Asked Questions

"Why can't you use alcohol gel for C. difficile and what should you use instead?"

Clostridioides difficile (C. diff) produces spores that are resistant to alcohol. The physical structure of the spore coat is impermeable to alcohols, meaning that hand gel, even at 70% concentration, does not kill or remove C. diff spores from the skin. Soap and water removes spores mechanically through the action of washing, friction, and rinsing, physically dislodging spores from the hands. This is why soap and water is mandatory when caring for patients with confirmed or suspected C. diff infection, and after leaving the patient's room or bed space. The same principle applies to norovirus, which is also resistant to alcohol-based hand rubs. In an OSCE, if asked to demonstrate hand hygiene on a C. diff ward, state clearly that you would use soap and water and explain why.

"What is the correct order for donning and doffing PPE, and why does order matter?"

The order of donning PPE ensures that clean items are not contaminated during application. The correct donning order is: apron first, then mask (with seal check if FFP3), then eye protection, then gloves last. Gloves go on last so they cover the cuffs of the gown and are not contaminated during mask and visor application. The correct doffing order removes the most contaminated items first: gloves first (the outer surface has had the greatest contact with the patient), then apron (touching only the inside or ties), then eye protection (handled by the arms only, never the visor front), then mask last (touching only the straps, never the front). Hand hygiene must be performed after removing each item. The purpose of this sequence is to prevent self-contamination: the front of all PPE is considered contaminated.

"What is an FFP3 mask, when is it required, and how does it differ from a surgical mask?"

An FFP3 (Filtering Face Piece 3) mask is a tight-fitting, fit-tested respirator that filters at least 99% of airborne particles when correctly worn. It is required for aerosol-generating procedures (AGPs) such as intubation, bronchoscopy, and non-invasive ventilation, and for caring for patients with airborne-transmitted infections: active pulmonary or laryngeal tuberculosis, measles, varicella zoster, and COVID-19 during AGPs. FFP3 masks must be individually fit-tested for each healthcare worker before use in clinical practice. A surgical mask (Type IIR), by contrast, is a loose-fitting fluid-resistant mask that filters large respiratory droplets but does not provide protection against airborne particles. Surgical masks are appropriate for droplet precautions (influenza, meningococcal disease) and routine clinical contact but not for airborne precautions.

"What should you do if you sustain a needle stick injury?"

The immediate management of a needle stick injury follows a clear sequence. First, encourage the wound to bleed freely by gentle squeezing (do not suck the wound). Wash immediately and thoroughly with running water and soap for at least 5 minutes; do not scrub the wound. Cover with a waterproof dressing. Report immediately to your supervisor and occupational health or the on-call infectious diseases team if out of hours. Document the incident (what needle, what patient, what body substance). The source patient should be tested (with consent) for blood-borne viruses: HIV, hepatitis B, and hepatitis C. If the source patient is HIV positive (or status unknown and high risk), HIV post-exposure prophylaxis (PEP) should be started within 72 hours (ideally within 1 hour). If you are not fully vaccinated against hepatitis B, hepatitis B immunoglobulin and vaccination may be required.