ook of Plastic and Reconstructive Surgery. 2022. ] In contrast, healthcare professionals acquire transient microorganisms through direct contact with patients or contaminated surfaces. These organisms colonize the superficial layers of the skin and are more easily removed with routine hand hygiene. Transient flora are the primary organisms transmitted via healthcare professionals' hands and are most strongly associated with HAIs. [7] [8] [9] [10] [11] Indications The CDC defines hand hygiene as cleansing the hands with soap and water, antiseptic hand washes, alcohol-based hand rubs (eg, sanitizers, foams, or gels), and surgical hand antisepsis. Healthcare professionals should use soap and water for hand hygiene when hands are visibly soiled or contaminated with blood or body fluids, before eating, and after using the restroom. [3] The World Health Organization (WHO) developed the Five Moments for Hand Hygiene  in 2009 to guide clinical practice. Healthcare professionals should perform hand hygiene: Before touching a patient Before performing a clean or aseptic procedure After exposure to body fluids or after glove removal After contact with a patient After contact with the patient’s immediate environment  [3] Healthcare facilities increasingly monitor staff adherence to hand hygiene practices, with increasing compliance as part of ongoing efforts to enhance patient safety and reduce infection risk. When hands are not visibly soiled, healthcare professionals should use alcohol-based hand rubs as the preferred method for hand hygiene. These products are faster and more convenient than soap and water while remaining highly effective. Clinicians should apply alcohol-based hand rubs according to manufacturer recommendations, typically placing 3 to 5 mL in the palm and rubbing all hand surfaces vigorously until dry, which generally takes about 20 seconds. [3]   Healthcare professionals caring for immunocompromised patients must stri