What are the recommended steps for proper hand hygiene?

Proper hand washing technique (CDC guidelines): (1) Wet hands with clean, running water (warm preferred for comfort and better lather); (2) Apply enough soap to cover all hand surfaces; (3) Scrub all surfaces for at least 20 seconds — palms, backs of hands, between fingers, under nails, including wrists; the 20 seconds typically equals 'Happy Birthday' sung twice; (4) Rinse thoroughly under running water; (5) Dry hands with a clean paper towel or air dryer; (6) Use the paper towel to turn off the faucet (avoiding recontamination); (7) Use the paper towel to open the bathroom door if applicable. Alcohol-based hand sanitizer (60%+ alcohol) is acceptable when soap and water are unavailable, BUT NOT effective for: visibly soiled hands; certain pathogens (C. difficile, Cryptosporidium, norovirus to lesser extent); after bathroom use (soap and water preferred). When to use alcohol sanitizer: apply enough to cover all surfaces; rub until dry (typically 20 seconds). Reasons hand hygiene fails: (1) Too brief — most people wash <10 seconds; (2) Inadequate technique — missing thumbs, fingertips, wrists; (3) Recontamination — touching faucet, dispenser, door without paper towel; (4) Not done at the right times. Healthcare workers should perform hand hygiene at minimum 5 'moments' (WHO): before patient contact, before aseptic task, after body fluid exposure risk, after patient contact, after contact with patient surroundings.