Hand Hygiene Janet Weber, RDH, MEd

Why Is Hand Hygiene Important?  Hands are the most common mode of pathogen transmission

 Hand washing is an extremely important step in overall infection control  Hand washing significantly removes the bacterial flora on the skin  Hand washing protects you and your patient from the bacterial flora (from each other) from becoming skin residents

 HAND WASHING BEFORE AND AFTER CONTACT WITH EACH PATIENT IS THE SINGLE MOST IMPORTANT MEANS OF PREVENTING THE SPREAD OF INFECTION

 Hands should be washed with hand soap OR  Alcohol base rubs may be used if hands are not visibly soiled. Studies show that using an alcohol rub for a minimum of 10 seconds can be more effective in removing the bacterial flora on the hands than hand washing.  Antibacterial hand soaps are not necessarily recommended due the drying effect it has on the skin when used frequently. Cracking (open surface) can lead to surface infections on the hands.

Hand Hygiene Definitions: Hand washing Washing hands with plain soap and water  Antiseptic hand wash Washing hands with water and soap or other detergents containing an antiseptic agent  Alcohol-based hand rub Rubbing hands with an alcohol-containing preparation (used after hand washing)  Surgical antisepsis Hand washing with antiseptic soap or alcohol-based handrub before operations by surgical personnel (Antiseptic preparations for surgical hand hygiene should have persistent (long-lasting) antimicrobial activity)

When to Wash:  Visibly dirty  After touching contaminated objects with bare hands  Before and after patient treatment (before glove placement and after glove removal)  Optional use of alcohol based hand rub is acceptable if hands are not visibly soiled  Visibly dirty  After touching contaminated objects with bare hands  Before and after patient treatment (before glove placement and after glove removal)  Optional use of alcohol based hand rub is acceptable if hands are not visibly soiled Hand washing before and after contact with each patient is the single most important hygiene measure for reducing or preventing the spread of infection

 Hand jewelry should not be worn as it may tear gloves and harbor bacteria  Studies have demonstrated that skin underneath rings is more heavily colonized than comparable areas of skin on fingers without rings the more rings worn, the greater concentration of organisms  Hand jewelry should not be worn as it may tear gloves and harbor bacteria  Studies have demonstrated that skin underneath rings is more heavily colonized than comparable areas of skin on fingers without rings the more rings worn, the greater concentration of organisms Rings and Jewelry

Studies have demonstrated that skin underneath rings is more heavily colonized than comparable areas of skin on fingers without rings. The more rings worn, the greater concentration of organisms

 Can affect the integrity of gloves  Can also harbor bacteria  Keep fingernails SHORT!  Avoid artificial nails  Avoid chipped nail polish  Can affect the integrity of gloves  Can also harbor bacteria  Keep fingernails SHORT!  Avoid artificial nails  Avoid chipped nail polish Fingernails

Hand Hygiene: Frequently Missed Areas Courtesy of SDS Kerr

Technique  Initial scrub- 30 seconds  Interlace fingers during scrub  Create friction while washing

Hand washing  Initially (when first preparing for the clinic session)- hands must be washed with antiseptic hand wash for a minimum of 30 seconds.  It is extremely important at this time to focus on technique! Interlace fingers Clean under nails and around cuticles

Hand Hygiene Technique Routine Dental Procedures  Hand washing  Wet hands with cool or lukewarm water, apply soap, rub hands together for at least 15 seconds  Rinse and dry with disposable towel  Use towel to turn off faucet  Hand rubs  Apply to palm of one hand, rub hands together covering all surfaces until dry  Volume: Based on manufacturer’s instructions  Hand washing  Wet hands with cool or lukewarm water, apply soap, rub hands together for at least 15 seconds  Rinse and dry with disposable towel  Use towel to turn off faucet  Hand rubs  Apply to palm of one hand, rub hands together covering all surfaces until dry  Volume: Based on manufacturer’s instructions Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

Technique (continued)  Be sure not to touch ANYTHING after washing  Watch, when rinsing, that rinse water does not touch non clean areas and then contaminate the clean area  Dry hands thoroughly to prevent drying and cracking

. Wash hands (or use and alcohol based rub) before glove placement and after glove removal.

Now, take a moment to watch the: Hand Washing Video

Hand Protection

Gloves  Minimize the risk of acquiring infections from patients  Prevent microbial flora from being transmitted from dental health care providers to patients  Reduce contamination of the hands of dental health providers by microbial flora that can be transmitted from patient to patient  Are not a substitute for hand washing!

Latex Hypersensitivity  Mild to Moderate  Contact Dermatitis – Localized Rash Non Allergic type – Skin Dry & Itchy Allergic Type IV: Delayed reaction- appears over time hrs  Moderate to Severe Hypersensitivity  Allergic Type I Immediate hypersensitivity – may include runny nose, itchy eyes, hives, ‘burning’ skin Severe reactions effect respiratory system  Mild to Moderate  Contact Dermatitis – Localized Rash Non Allergic type – Skin Dry & Itchy Allergic Type IV: Delayed reaction- appears over time hrs  Moderate to Severe Hypersensitivity  Allergic Type I Immediate hypersensitivity – may include runny nose, itchy eyes, hives, ‘burning’ skin Severe reactions effect respiratory system

Irritant Contact Dermatitis: Irritant Contact Dermatitis: Most common reaction to latex products. Dry, itchy, irritated areas on the skin, usually the hands. Not a true allergy.

Allergic Contact Dermatitis: Results from exposure to chemicals added to latex during harvesting, processing or manufacturing. Rash usually begins hours after contact and may progress to oozing skin blisters. Latex allergy can be acquired over time.

Latex Allergy (Type 1 or immediate): The most serious of the reactions that usually begins within minutes of exposure to latex, can occur hours later with a variety of symptoms.

Incidence of latex reaction

In Summary:  Hand washing  Wet hands with cool or lukewarm water, apply soap, rub hands together for at least 15 seconds  Rinse and dry with disposable towel  Use towel to turn off faucet  Hand rubs  Apply to palm of one hand, rub hands together covering all surfaces until dry  Volume: Based on manufacturer’s instructions

 Wear gloves when contacting blood, saliva, and mucous membranes  Remove gloves immediately torn, cut or punctured  Remove gloves after patient care  Do not wash, disinfect or sterilize gloves for reuse

 Wear gloves when contact with blood, saliva, and mucous membranes is possible  Remove gloves immediately that are torn, cut or punctured  Remove gloves after patient care  Do not wash, disinfect or sterilize gloves for reuse  Wear gloves when contact with blood, saliva, and mucous membranes is possible  Remove gloves immediately that are torn, cut or punctured  Remove gloves after patient care  Do not wash, disinfect or sterilize gloves for reuse Recommendations for Gloving:

Types of Procedural Gloves” Patient Procedure Surgical Housekeeping

Look closely at the gloves you choose! Vinyl gloves used to clean the operatory look very similar to the latex gloves. It is hard to tell the difference between them. (Vinyl is thicker to the feel). Housekeeping Gloves

Types of Patient Procedure Gloves: Nitril Latex

NITRIL LATEX More natural oils and chemicals that cause allergies Less puncture resistance Best stretch factor, more comfortable to wear Cheaper to purchase Greater resistance to punctures Integrity of material is stronger Less pliability, therefore, less comfortable to wear A Balancing Act: Which to choose?

Glove Fit:  Should be available in a variety of sizes and types  May causes hand fatigue if gloves don’t fit correctly  Glove integrity may be compromised  Injury is more likely to occur do to an ill fitting glove

Example of Gloves that are too TIGHT Pulls too tightly across the palm. Will cause fatigue at thumb joint. Will cause fatigue as fingers try to flex

Example of Gloves that are too LOOSE Gloves that are too large pose a danger as excess glove material can catch on something and tear. Tactile sensitivity during procedures is greatly reduced as well.

Example of Gloves that are JUST RIGHT!

Taking off the first glove:

4. 5.

Taking off the second glove: 1. 2.

Disposal: