Veterinary Infection Control Initiative

Clean Hands
Save Animals

Healthcare-associated infections in veterinary settings cause real harm — to patients, owners, and public health. Evidence-based hand hygiene guidelines and resources for veterinary teams worldwide.

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80%of vets use CHX against WHO guidelines
67%of surgical gloves get perforated
1.5 minAHR prep vs 5 min scrub
Clean Hands Save Animals
www.veterinaryhandhygiene.eu
About the Project

Why Hand Hygiene in Veterinary Care?

The HAI Burden

Healthcare Associated Infections drive up treatment costs, antibiotic use, and hospital stays — and can be fatal. In veterinary settings they add emotional and financial strain for animal owners, with serious consequences for animal welfare.

The Zoonotic Risk

Many veterinary infections are zoonotic — transmissible from animals to humans. This elevates hand hygiene in veterinary facilities from an animal welfare issue to a direct public health concern.

The WHO Standard

Hand hygiene is the single most validated infection-control intervention in human medicine. The WHO's "Clean Hands Save Lives" campaigns have transformed hospitals — yet equivalent attention in veterinary care remains largely absent.

This Project

"Clean Hands Save Animals" delivers practical guidelines, protocols, and educational resources to veterinary facilities. This initiative is supported by various veterinary and human surgical and infection control specialists from academia and private practice under the guidance of Dr Denis Verwilghen Dipl ECVS Dipl EVDCeq – University of Sydney.

Clinician applying alcohol hand rub
In Practice
Correct technique
makes the difference
UV light box hand hygiene assessment
Research Tool
UV assessment reveals
missed zones

The Evidence Gap

Despite WHO guidelines recommending alcohol-based hand rubs, a survey of 480 board-certified veterinary surgeons found 80% still use chlorhexidine scrubs as their primary method. Only 2.9% use alcohol rub alone. This gap between evidence and practice is precisely why this project exists.

80%use CHX scrubs against WHO guidance
2.9%use alcohol rub only
67%glove perforation rate in surgery
480board-certified surgeons surveyed
WHO Campaign
"Clean Hands Save Lives"
The veterinary counterpart: Clean Hands Save Animals
Protocols

Hand Asepsis Protocols

Hands are the most frequent vector of contamination in veterinary surgery. These protocols apply to all team members across the perioperative pathway.

Preoperative

Surgical Hand Asepsis

01
Clinical Objective: Reduce transient and resident microbial flora on the hands and forearms of all surgical personnel before donning sterile attire and at every transition that exposes hands to potential contamination. Why it matters: Glove perforation occurs in up to 67% of surgical interventions, most commonly at the index finger of the non-dominant hand — making hand preparation before gloving critical, not optional.
Critical Control Points
  • Surgical hand asepsis performed before initial gowning
  • Hand hygiene re-performed at any contamination event
  • Alcohol-based hand rub applied to fully dry hands
Staff  Step-by-Step Protocol
  1. 1Before any patient contact: apply alcohol-based hand rub using the WHO 6-step technique for 20–30 seconds.
  2. 2Before handling IV catheters, infusion lines, or medications: perform hand rub or soap-and-water wash.
  3. 3Before administering sedation or any induction agent: perform hand rub.
  4. 4After removing gloves: perform hand rub immediately. Gloves do not replace hand hygiene.
  5. 5After patient or surface contact, or handling contaminated material: hand rub.
  6. 6Before leaving and on re-entry to the OR: perform hand rub at the door.
Surgeon  Step-by-Step Protocol
  1. 1Perform full surgical hand asepsis before gowning for every procedure.
  2. 2Use alcohol-based hand rub or neutral soap scrub per facility protocol.
  3. 3Ensure hands and forearms are fully dry before donning sterile gloves.
  4. 4Re-apply ABHR after any sterility breach during the procedure.
  5. 5Perform hand rub on re-entry to the OR between cases.
Key Pitfalls to Avoid
  • Wearing gloves instead of performing hand hygiene — gloves are a barrier, not a substitute.
  • Using alcohol rub on visibly soiled hands — wash with soap and water first.
  • Not performing hand hygiene after removing contaminated gloves from patient prep.
  • Skipping re-hygiene when moving between tasks.
If you cannot remember when you last performed hand hygiene during the case, do it now.
All Phases

The 5 Moments for Hand Hygiene

02
Clinical Objective: Ensure every team member performs hand hygiene at each of the five critical moments representing the highest risk of pathogen transmission in the veterinary clinical setting.
The 5 Moments
  1. 1
    Before touching a patient — prevent transmission of organisms from hands to patient.
  2. 2
    Before a clean / aseptic procedure — prevent transmission from hands and environment to patient.
  3. 3
    After body fluid exposure risk — prevent transmission from patient to hands and environment.
  4. 4
    After touching a patient — prevent transmission from patient to hands and environment.
  5. 5
    After touching patient surroundings — prevent transmission from patient environment via hands.
Application in Veterinary Settings
  • Apply the 5 moments across all species, including exotics and small mammals.
  • Patient "surroundings" includes cages, transport carriers, leads, and equipment.
  • Exotic species may carry zoonotic pathogens — moments 3 and 5 are especially critical.
  • Educate support staff and animal owners on hand hygiene when appropriate.
The 5 Moments framework is adapted from the WHO "My 5 Moments for Hand Hygiene" campaign for veterinary clinical environments.
Technique

Alcohol Rub vs. Soap & Water

03
Clinical Objective: Ensure correct agent selection based on hand contamination status, procedure type, and pathogen risk — maximising efficacy while protecting hand skin health.
✓ Use Alcohol-Based Hand Rub (ABHR) WHO Recommended
  • Hands are not visibly soiled or contaminated
  • Before and after patient contact in most clinical situations
  • Surgical hand asepsis when hands are visually clean
  • Application time: 1.5 minutes — versus 5 minutes for medicated scrubs
  • Significantly better sustained efficacy than CHX after 3 hours of surgery (Verwilghen et al., 2011)
✓ Use Soap & Water When Note CHX Risks
  • Hands are visibly soiled or contaminated with blood or body fluids
  • After known or suspected exposure to spore-forming organisms
  • After using the toilet — minimum 40–60 seconds, dry thoroughly before ABHR
  • CHX caution: Linked to MRSA resistance concerns, contact dermatitis risk, and corneal toxicity
  • Scrubbing can increase bacterial transfer by exposing deeper skin flora — limit to nails and fingertips only
Skin Health
  • Use moisturiser regularly — damaged skin harbours more pathogens
  • Cover cuts and abrasions with waterproof dressings
  • Report persistent skin conditions that compromise hygiene compliance
Modern ABHR formulations are less damaging to skin than repeated soap-and-water washing. Skin health and compliance are directly linked.
Perioperative

Role-Specific Responsibilities

04
Clinical Objective: Define hand hygiene responsibilities for each perioperative role to prevent gaps, ambiguity, or assumption of coverage by another team member.
Surgeon
  • Full surgical hand asepsis before gowning for every procedure
  • Re-apply ABHR after any sterility breach
  • Hand rub on re-entry to OR between cases
Anaesthetist / Anaesthesia Technician
  • Hand hygiene before IV access, drug preparation, and airway management
  • After every patient contact moment, including monitoring adjustments
  • Gloves are not a substitute — perform ABHR after glove removal
Prep Technician / Scrub Nurse
  • Hand hygiene before and after clipping, skin prep, and instrument handling
  • Do not touch non-sterile surfaces after performing surgical scrub
  • Re-perform hand hygiene if sterility is questioned
Hand hygiene responsibility cannot be delegated. Each team member is accountable for their own compliance at every moment.
Resources

Educational Posters

Download and display evidence-based hand hygiene posters in your veterinary facility.

Surgical Hand Preparation Posters
Surgical Hand Preparation — English
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English version

Surgical Hand Preparation

Evidence-based poster for display in surgical prep areas. Covers WHO-recommended alcohol-based hand rub technique for pre-operative asepsis.

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5 Moments of Hand Hygiene Posters
Small Animal
Small Animal 5 Moments — Long version
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English version

Small Animal — Long Version

Full-detail 5 Moments poster for central display in small animal hospital corridors and waiting areas.

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Small Animal 5 Moments — Short version
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English version

Small Animal — Short Version

Compact 5 Moments reminder poster — for display at every hand hygiene point in small animal clinics.

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Equine
Equine 5 Moments — Long version
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English version

Equine — Long Version

Full-detail 5 Moments poster for central display in equine hospital corridors and consultation areas.

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Equine 5 Moments — Short version
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English version

Equine — Short Version

Compact 5 Moments reminder poster — designed to be placed at every hand hygiene point in equine facilities.

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Exotics
Exotics 5 Moments — Long version
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English version

Exotics — Long Version

Full-detail 5 Moments poster for exotic animal practice — for display in central hospital locations.

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Exotics 5 Moments — Short version
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English version

Exotics — Short Version

Compact 5 Moments reminder poster for exotic animal practice — for display at every hand hygiene point.

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Farm / Ruminant
Farm / Ruminant 5 Moments — Long version
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English version

Farm / Ruminant — Long Version

Full-detail 5 Moments poster for farm and ruminant animal practice — for display in central locations.

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Your language missing? →
Farm / Ruminant 5 Moments — Short version
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English version

Farm / Ruminant — Short Version

Compact 5 Moments reminder poster for farm and ruminant practice — for display at every hand hygiene point.

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More languages coming soon
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Your language is missing?

We are actively working to expand the poster library. If you would like to contribute a translation or request a specific language, please get in touch.

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Research

Publications

Peer-reviewed research underpinning the hand hygiene guidelines and educational materials on this site.

Veterinary Surgery2011
Pre-Surgical Hand Asepsis: Concepts and Current Habits of Veterinary Surgeons
Verwilghen D., Grulke S., Kampf G.
Key Findings
Survey of 480 board-certified surgeons found 80% still use CHX scrubs contrary to WHO guidelines. Only 2.9% use alcohol rub alone. Glove perforation occurs in up to 67% of surgical interventions, underscoring the critical importance of presurgical hand asepsis.
View on PubMed
Veterinary Journal2011
Surgical Hand Asepsis in Veterinary Practice: Evaluation of Soap Scrubs and Alcohol-Based Rub Techniques
Verwilghen D., Mainil J., Mastrocicco E., Hamaide A., Detilleux J., Van Galen G., Serteyn D., Grulke S.
Key Findings
First in-use veterinary surgical study comparing AHR, CHX, and PVP-iodine. AHR and CHX had comparable immediate efficacy, but AHR showed significantly better sustained efficacy after 3 hours of surgery. Following the study, AHR was adopted without complaints about dermal tolerance.
View on PubMed
Equine Veterinary Education2018
The WHO's "Clean Hands Save Lives": A Concept Applicable to Equine Medicine as "Clean Hands Save Horses"
Verwilghen D. et al.
Key Findings
Applies the WHO "Clean Hands Save Lives" framework directly to equine medicine. Provides a practical roadmap for improving hand asepsis culture in equine hospitals and argues the same evidence base can be translated to veterinary surgical settings.
View Article
PLOS ONE2020
Surgical Hand Preparation in an Equine Hospital: Comparison of General Practice with a Standardised Protocol and Characterisation of MRSA Recovered
Rocktäschel T., Renner-Martin K., Cuny C., Brehm W., Truyen U., Speck S.
Key Findings
Basic knowledge of presurgical hand asepsis was low even among specialised veterinary surgeons. A standardised Sterillium protocol significantly reduced bacterial counts versus individual habits. MRSA was recovered from participants, highlighting antimicrobial resistance risks.
View on PubMed
BMC Veterinary Research2014
Video Observation of Hand Hygiene Practices During Routine Companion Animal Appointments and the Effect of a Poster Intervention
Anderson M.E.C., Sargeant J.M., Weese J.S.
Key Findings
Overall hand hygiene compliance in veterinary clinics was only 14%, with before-patient-contact compliance as low as 3%. Soap and water dominated despite its disadvantages. Poster campaigns alone had limited effect — multimodal interventions are needed.
View on PubMed
Canadian Veterinary Journal2006
Pilot Study to Evaluate 3 Hygiene Protocols on the Reduction of Bacterial Load on the Hands of Veterinary Staff Performing Routine Equine Physical Examinations
Traub-Dargatz J.L., Weese J.S., Rousseau J.D., Dunowska M., Morley P.S., Dargatz D.A.
Key Findings
Alcohol gel and chlorhexidine-alcohol protocols were equivalent or superior to soap washing for reducing bacterial load after routine equine examinations. Established an early evidence base for AHR in veterinary practice.
View on PubMed
Veterinary Surgery2017
Antibacterial Efficacy of Several Surgical Hand Preparation Products Used by Veterinary Students
Chou P.Y., Doyle A.J., Arai S., Burke P.J., Bailey T.R.
Key Findings
Ethanol-chlorhexidine hand rubs and CHX scrubs outperformed propanol and isopropanol solutions in veterinary students. 1.5-minute applications performed comparably to longer durations, supporting shorter application times in practice.
View on PubMed
Vet Clinics North America2004
Guidelines for Reducing Pathogens in Veterinary Hospitals: Disinfectant Selection, Cleaning Protocols, and Hand Hygiene
Weese J.S.
Key Findings
Outlines the "nosocomial prevention triad" — antibiotic stewardship, staff hygiene, and hospital disinfection — as the foundational framework for preventing hospital-acquired infections in small animal veterinary settings.
View on PubMed
Academic Partners
The University of Sydney University of Copenhagen University of Copenhagen Faculty of Medicine
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