Topic 2.2 Hand Hygiene and Respiratory Hygiene

Hand hygiene is widely recognised as the single most effective measure for preventing the transmission of infectious diseases in healthcare, community and occupational settings. Every day, Occupational Therapists (OTs) come into contact with clients, assistance animals, colleagues, equipment and environmental surfaces, creating numerous opportunities for microorganisms to spread. Appropriate hand hygiene interrupts the chain of infection by removing or destroying microorganisms before they can be transferred to another person, animal or surface.

Respiratory hygiene is equally important in reducing the transmission of respiratory pathogens. Infectious diseases such as influenza, COVID-19, respiratory syncytial virus (RSV) and pertussis spread primarily through respiratory droplets and aerosols generated during coughing, sneezing, talking and even breathing. The widespread public health measures introduced during the COVID-19 pandemic demonstrated that relatively simple interventions—including hand hygiene, respiratory etiquette, improved ventilation and staying home when unwell—can significantly reduce the spread of many respiratory infections.

For Occupational Therapists working with assistance animals, effective hand and respiratory hygiene protects not only clients and practitioners but also assistance animals. While many discussions focus on preventing diseases transmitted from animals to humans, humans may also transmit infectious diseases to assistance animals. Maintaining good hygiene therefore supports the health and welfare of both members of the assistance animal partnership and reflects the principles of One Health.

This topic explores the scientific basis of hand hygiene, the World Health Organization’s recommendations, respiratory hygiene practices, common barriers to compliance, and practical strategies for implementing effective hygiene measures across occupational therapy and assistance animal practice.

The Importance of Hand Hygiene

Hands are one of the most common vehicles for transmitting infectious microorganisms. During routine clinical practice, hands frequently come into contact with:

• clients
• assistance animals
• mobility equipment
• therapy resources
• door handles
• desks and workstations
• wheelchairs
• keyboards
• phones
• shared environmental surfaces.

Microorganisms acquired during these interactions can remain on the hands and be transferred to other people, animals or objects unless appropriate hand hygiene is performed.

Effective hand hygiene interrupts the chain of infection by:

• removing transient microorganisms
• reducing microbial load
• preventing cross-contamination
• protecting vulnerable individuals
• reducing healthcare-associated infections
• protecting assistance animals from reverse zoonotic disease transmission.

Because many infectious diseases are transmitted through contaminated hands, hand hygiene remains one of the simplest, least expensive and most effective infection prevention strategies available.

Resident and Transient Microorganisms

Understanding the difference between resident and transient microorganisms helps explain why hand hygiene is so effective.

Resident Flora

Resident microorganisms naturally live on healthy skin and form part of the body’s normal microbiome.

These organisms:

• provide protection against harmful pathogens
• contribute to skin health
• are generally harmless
• are difficult to remove completely.

Routine hand hygiene reduces resident microorganisms only slightly and should not eliminate them entirely.

Transient Flora

Transient microorganisms are acquired through contact with people, animals, contaminated surfaces or the environment.

Unlike resident flora, transient microorganisms:

• survive on the skin for relatively short periods
• are more easily removed through hand hygiene
• are more likely to include infectious pathogens
• are responsible for most healthcare-associated infections.

The primary purpose of routine hand hygiene is to remove transient microorganisms before they are transmitted to another host.

Methods of Hand Hygiene

Hand hygiene may be performed using either soap and water or alcohol-based hand rubs.

The appropriate method depends upon the circumstances.

Handwashing with Soap and Water

Soap and water physically remove microorganisms, dirt and organic material from the hands.

Handwashing is recommended:

• when hands are visibly dirty
• after contact with blood or body fluids
• after using the toilet
• before eating or preparing food
• after cleaning animal waste
• after removing heavily contaminated gloves
• when caring for individuals with gastroenteritis caused by organisms such as norovirus or Clostridioides difficile, where alcohol-based hand rub alone is less effective.

Proper handwashing should include all surfaces of the hands, fingers, thumbs, fingertips and wrists before thorough rinsing and drying.

Alcohol-Based Hand Rub (ABHR)

Alcohol-based hand rubs are the preferred method of routine hand hygiene in most healthcare settings because they:

• rapidly destroy many microorganisms
• require less time than handwashing
• are easily accessible
• improve compliance
• are less irritating to the skin when formulations contain moisturisers.

Alcohol-based hand rub should contain an appropriate concentration of alcohol (generally between 60% and 80%) to maximise antimicrobial effectiveness.

However, alcohol-based hand rub is not suitable when hands are visibly soiled or contaminated with organic material.

The World Health Organization’s Five Moments for Hand Hygiene

The World Health Organization (WHO) developed the Five Moments for Hand Hygiene to identify the critical points during healthcare where hand hygiene should be performed.

These are:

1. Before touching a client
2. Before a clean or aseptic procedure
3. After exposure to body fluids
4. After touching a client
5. After touching the client’s surroundings

Although originally developed for hospital settings, these principles can be readily adapted to occupational therapy practice across hospitals, community services, schools, workplaces and home visits.

For Occupational Therapists working with assistance animals, additional consideration should be given to performing hand hygiene before and after handling the assistance animal or its equipment where appropriate.

Hand Hygiene in Assistance Animal Practice

Occupational Therapists frequently interact with both clients and assistance animals during therapy.

Examples where hand hygiene should be considered include:

• before greeting an assistance animal
• after handling the animal
• after fitting or adjusting harnesses
• after handling leads or mobility equipment
• after cleaning up animal waste
• after contact with saliva, urine or faeces
• before eating or drinking
• before handling shared therapy resources
• after touching frequently handled environmental surfaces.

Routine hand hygiene protects both human and animal health while maintaining public confidence in assistance animal partnerships.

Respiratory Hygiene and Cough Etiquette

Respiratory hygiene refers to measures that reduce the spread of infectious respiratory droplets and aerosols.

These measures became particularly prominent during the COVID-19 pandemic but remain important for preventing many respiratory illnesses.

Good respiratory hygiene includes:

• covering the mouth and nose when coughing or sneezing
• using disposable tissues
• disposing of tissues immediately after use
• performing hand hygiene after coughing, sneezing or blowing the nose
• wearing a mask where clinically indicated
• maintaining appropriate physical distance when unwell
• avoiding close contact with vulnerable individuals
• staying home when experiencing significant respiratory symptoms where possible.

These practices reduce opportunities for respiratory pathogens to spread within healthcare and community settings.

Ventilation and Air Quality

Respiratory hygiene extends beyond individual behaviour.

Well-ventilated environments reduce the concentration of infectious respiratory particles and contribute significantly to infection prevention.

Strategies include:

• opening windows where appropriate
• increasing fresh air exchange
• using mechanical ventilation systems
• maintaining air-conditioning systems
• using portable HEPA filtration units when indicated
• conducting activities outdoors where clinically appropriate.

Occupational Therapists should consider ventilation during environmental assessments and intervention planning, particularly when working with vulnerable populations.

Skin Care and Hand Health

Frequent hand hygiene may contribute to skin irritation, dryness and dermatitis.

Damaged skin is uncomfortable for practitioners and may increase the risk of microbial colonisation.

Strategies for maintaining healthy skin include:

• using moisturising creams regularly
• selecting skin-friendly hand hygiene products
• thoroughly drying hands after washing
• avoiding excessively hot water
• reporting occupational dermatitis where required
• covering cuts or abrasions with waterproof dressings.

Maintaining healthy skin supports both practitioner wellbeing and effective infection prevention.

Common Barriers to Hand Hygiene Compliance

Despite its importance, hand hygiene compliance is often inconsistent.

Common barriers include:

• time pressures
• workload
• inadequate access to hand hygiene facilities
• skin irritation
• forgetfulness
• competing clinical priorities
• misconceptions regarding infection risk
• inadequate education and training.

Recognising these barriers allows organisations to implement strategies that support sustained compliance.

Promoting Good Hygiene Practices

Occupational Therapists have an important role in modelling and promoting effective hygiene practices.

This may involve:

• educating clients and carers
• teaching children effective handwashing
• supporting people with cognitive impairment
• adapting hygiene routines for people with disabilities
• incorporating hand hygiene into therapy goals
• encouraging routine hygiene after interacting with assistance animals
• promoting accessible hand hygiene facilities within workplaces and community settings.

Education should be person-centred, culturally appropriate and tailored to the individual’s abilities and environment.

The Occupational Therapist’s Role

Occupational Therapists contribute to infection prevention by consistently applying hand and respiratory hygiene principles during all aspects of practice.

Responsibilities include:

• performing hand hygiene at appropriate times
• modelling effective hygiene behaviours
• educating clients, carers and support workers
• adapting hygiene interventions to individual needs
• considering environmental accessibility
• promoting healthy assistance animal partnerships
• protecting both human and animal health through evidence-informed practice.

By integrating hygiene practices into everyday therapy, Occupational Therapists support safe participation without creating unnecessary barriers to inclusion.

Key Practice Principle

Hand hygiene and respiratory hygiene are fundamental components of infection prevention and control. By consistently applying evidence-based hygiene practices, Occupational Therapists can interrupt the chain of infection, reduce the transmission of infectious diseases, protect assistance animals from reverse zoonotic disease transmission, and promote safe, inclusive and person-centred occupational therapy practice across healthcare and community settings.