Hand Hygiene

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Hand Hygiene




Janet Weber, RDH, MEd


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Why Is Hand Hygiene Important?

• Hands are the most common mode of pathogen
  transmission

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• 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

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

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• 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.

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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)

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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

Hand washing before and after contact with each
patient is the single most important hygiene
measure for reducing or preventing the spread of
infection

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Rings and Jewelry

• 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

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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
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Fingernails

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

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Hand Hygiene Frequently Missed Areas
Courtesy of SDS Kerr
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Technique

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

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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

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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 manufacturers instructions

Guideline for Hand Hygiene in Health-care
Settings. MMWR 2002 vol. 51, no. RR-16.
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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

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Wash hands (or use and alcohol based rub) before
glove placement and after glove removal.
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• Now, take a moment to
• watch the
• Hand Washing Video

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Hand Protection
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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!

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Latex Hypersensitivity

• Mild to Moderate
• Contact Dermatitis Localized Rash
• Non Allergic type Skin Dry Itchy
• Allergic Type IV Delayed reaction-
• appears over time 12-48 hrs
• Moderate to Severe Hypersensitivity
• Allergic Type I
• Immediate hypersensitivity may include runny
  nose, itchy eyes, hives, burning skin
• Severe reactions effect respiratory system

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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.
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Allergic Contact Dermatitis

• Results from exposure to chemicals added to latex
  during harvesting, processing or manufacturing.
  Rash usually begins 24- 48 hours after contact
  and may progress to oozing skin blisters.
• Latex allergy can be acquired over time.

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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.

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Incidence of latex reaction
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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 manufacturers instructions

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• 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

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Recommendations for Gloving

• 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

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Types of Procedural Gloves
Patient Procedure
Surgical
Housekeeping
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Housekeeping Gloves
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).
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Types of Patient Procedure Gloves
Nitril
Latex
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A Balancing Act Which to choose?
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Glove Fit

• Should be available in a variety of sizes and
  types
• May causes hand fatigue if gloves dont fit
  correctly
• Glove integrity may be compromised
• Injury is more likely to occur do to an ill
  fitting glove

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Example of Gloves that are too TIGHT
Will cause fatigue as fingers try to flex
Pulls too tightly across the palm. Will cause
fatigue at thumb joint.
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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.
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Example of Gloves that are JUST RIGHT!
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Taking off the first glove
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2.
3.
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4.
5.
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Taking off the second glove
2.
1.
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5.
4.
6.
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Disposal