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Handwashing
The primary defense against infection and transmission of pathogens is healthy, unbroken skin. Keeping nails short is considered key because the majority of flora on the hands are found under and around the fingernails. Hands are the most common mode of pathogen transmission. Hand hygiene reduces the spread of antimicrobial resistance. Such hygiene is considered the single most critical measure for reducing the risk of transmitting organisms to patients and health care personnel. Dental care workers should wash their hands thoroughly (for a minimum duration of 15 seconds) with an antimicrobial handwash at the beginning of the day and between patients. That is, before and after patient treatment (before glove placement and after glove removal).
Wash after removing gloves and before touching anything. Health care workers shall also wash contaminated or visibly soiled hands with soap and water and put on new gloves before treating each patient. If hands are not visibly soiled or contaminated an alcohol based hand rub may be used as an alternative to soap and water. Alcohol hand rubs are rapidly germicidal when applied to the skin but should include such antiseptics as chlorhexidine, quaternary ammonium compounds, octenidine, or triclosan to achieve persistent activity.
Alcohol-based hand rubs should contain 60%-95% ethanol or isopropanol and should not be used in the presence of visible soiled or organic material. If using an alcohol-based hand rub, apply adequate amount to palm of one hand and rub hands together, covering all surfaces of the hands and fingers, until hands are dry. Follow manufacturer's recommendations regarding the volume of product to use. If hands feel dry after rubbing them together for 10-15 seconds, an insufficient volume of product likely was applied. The drying effect of alcohol can be reduce or eliminated by adding 1%-3% glycerol or other skin-conditioning agents.
Efficacy of Hand Hygiene Preparations in Reduction of Bacteria
Alcohol-based Preparations |
Benefits
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Limitations
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- Rapid and effective antimicrobial action
- Improved skin condition
- More accessible than sinks
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- Cannot be used if hands are visibly soiled
- Store away from high temperatures or flames
- Hand softeners and glove powders may "build-up"
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Spend plenty of time when washing hands. Make sure to work a liquid soap between the webs of the fingers, cleaning the tips of the fingers around fingernails, and rubbing the backs of the hands and the thumbs. Bars of soap can become contaminated so liquid soap in a dispenser is recommended. Do not use scrubbing brushes on hands because they can cause abrasions to the skin. For injuries to the skin, no evidence exists that using antiseptics for wound care or expressing fluid by squeezing the wound further reduces the risk of bloodborne pathogen transmission, however use of antiseptics is not contraindicated. The application of caustic agents like bleach or the injection of antiseptics or disinfectants into the wound is not recommended.
Remember to use disinfectant on the handles of the sink and the pump of the soap container after every patient.
Handwashing products, including plain (non-antimicrobial) soap and antiseptic products, can become contaminated or support the growth of microorganisms. Liquid products should be stored in closed containers and dispensed from either disposable containers or containers that are washed and dried thoroughly before refilling. Soap should not be added to a partially empty dispenser, because this practice of topping off might led to bacterial contamination.
Dampness under gloves can cause irritation. Dry hands thoroughly with disposable paper towels.
Any member of the dental team who has an exudative lesion or weeping dermatitis shall refrain from all direct patient care and from handling patient care equipment until the condition resolves.
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