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D340. Hand Hygiene: “Below the Elbows”

Policy Statement

This policy applies to all staff in direct contact with people when carrying out personal or nursing care, including providing help with eating and drinking, moving and transferring, taking to the toilet, etc.

The policy applies to non-care and senior staff on occasions when they become involved in direct care activity.

It applies in relation to other infection prevention and control policies, particularly:

  1. Cleanliness and Infection Control (and its section on Effective Handwashing)
  2. Handwashing and Hand Hygiene.

It is written to conform with the Department of Health and Social Care Health and Social Care Act 2008 Code of Practice on Prevention and Control of Infections (July 2015), which recommends that uniform and dress code policies should specifically support good hand hygiene, and NICE guidance (Clinical guideline CG139: Healthcare-associated Infections: Prevention and Control in Primary and Community Care) stating that anyone providing direct care should make sure that their hands can always be properly decontaminated throughout their work.

A “below the elbows” approach will make this possible.


NICE guidance CG139 defines “below the elbows” as “not wearing false nails or nail polish; not wearing a wristwatch or stoned rings; wearing short-sleeved garments or being able to roll or push up sleeves”.

It considers that hand hygiene is improved when:

  1. skin is intact
  2. nails are natural, short and unvarnished
  3. hands and forearms are free of jewellery
  4. sleeves are above the elbow.


To implement this guidance {{org_field_name}} has adopted the following requirements for all staff whenever they are carrying out any direct care task in any role.

Staff should make sure that they do not wear or have attached any item of clothing or accessory “below their elbows” when in direct contact with people and when carrying out hand hygiene procedures. This will be best achieved by:

  1. wearing a short-sleeved garment (recommended as best practice), or making sure that longer-sleeved clothing can be easily rolled up above the elbow when providing direct care and when carrying out hand hygiene procedures
  2. not wearing nail polish at work or false nails
  3. keeping nails short and clean
  4. not wearing a wristwatch or stoned rings (a flat band permanently worn or unable to be removed, eg a wedding ring, is permissible, but should always be included in hand hygiene procedures)
  5. making sure that all breaches of the skin (abrasions, cuts and dermatitis) are covered in waterproof film dressings
  6. avoiding wearing or carefully concealing other potentially contaminated items that can unintentionally come into contact with hands such as ties or long scarves and dangly objects.

A staff member who has difficulty in meeting these requirements on any grounds should discuss the reasons with their supervisor or line manager. Where it is impossible to meet the requirement, a “next best” solution might be found, which does not compromise the good infection control and hand hygiene principles on which the “below the elbows” policy is based.


All new staff are made aware of this policy on appointment and taken through it in their induction as part of their safe working practices training. They can expect the policy to be reinforced in supervision and further training.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next review date: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.

Copyright ©2024 {{org_field_name}}. All rights reserved

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