Hand hygiene: the single highest-impact MRSA prevention policy

MRSA rarely travels through the air over any distance. It moves on hands, gloves, cuffs and the surfaces hands have just touched. Break that chain and most transmission stops.

Effective hand hygiene means either soap and water for at least 20 seconds, covering palms, backs, between fingers, thumbs, fingertips and wrists, or an alcohol-based hand rub of 60–95% alcohol worked over the same surfaces until dry.

Alcohol rub is faster and kills staphylococci well, so it is the default in healthcare. Soap and water is preferred when hands are visibly soiled, after using the toilet, and when Clostridioides difficile or norovirus may be involved, because alcohol does not kill spores.

• In healthcare: clean hands before touching a patient, before a clean or aseptic procedure, after body-fluid exposure risk, after touching a patient, and after touching the patient's surroundings.
• Gloves are not a substitute. Clean hands before putting gloves on and immediately after taking them off — contamination happens during removal.
• Keep nails short, avoid artificial nails and gel extensions, and go bare below the elbow so wrists and cuffs cannot carry organisms between patients.
• At home: wash before dressing a wound, after touching a dressing, after handling laundry from an infected person and before preparing food.
• Carry alcohol gel to the gym and to sports fixtures, where sinks are often unavailable at the moment they are needed.

The WHO multimodal hand hygiene improvement strategy — access to rub at the point of care, training, reminders, observation with feedback and visible leadership — repeatedly produced sustained reductions in MRSA acquisition and bacteraemia when all five parts were implemented together.

In England, mandatory MRSA bacteraemia reporting alongside the national 'cleanyourhands' campaign coincided with an approximate 80% fall in reported MRSA bloodstream infections over the following decade.

Compliance measured by direct observation is typically far lower than staff self-report, which is why audit with feedback is part of the policy rather than an optional extra.

• Using alcohol rub on visibly dirty hands, where organic soil blocks the alcohol.
• Rubbing for a few seconds only — the product must stay wet on the skin for the full 20–30 seconds.
• Missing thumbs and fingertips, the two most frequently under-covered areas.
• Wearing the same gloves for several tasks or several patients.