![]() Handwashing, hand antisepsis, and surgical hand antisepsis substantially reduces potential pathogens on the hands and is considered the single most critical measure for reducing the risk of transmitting organisms to patients and Health Care Providers (HCP). The U.S. Centers for Disease Control and Prevention’s Hand Hygiene Guidelines Fact Sheet notes that using gloves reduces hand contamination by 70 to 80 percent, prevents cross-contamination and protects patients and healthcare personnel from infection. However wearing gloves is not enough to prevent the transmission of pathogens in the healthcare setting and does not eliminate the need for good hand hygiene. Hospital-based studies have demonstrated that noncompliance with hand hygiene practices is associated with health-care–associated infections and the spread of multi-resistant organisms. Noncompliance also has been a major contributor to outbreaks. The preferred method for hand hygiene depends on the type of procedure, the degree of contamination, and the desired persistence of antimicrobial action on the skin. For routine dental examinations and nonsurgical procedures, handwashing and hand antisepsis is achieved by using either a plain or antimicrobial soap and water. If the hands are not visibly dirty, an alcohol-based hand rub is sufficient. The purpose of surgical hand antisepsis is to eliminate transient flora and reduce resident flora for the duration of a procedure to prevent the introduction of organisms in the operative wound if gloves become punctured or torn. Skin bacteria can rapidly multiply under surgical gloves if hands are washed with soap that is not antimicrobial. Thus, an antimicrobial soap or alcohol hand rub with persistent activity should be used before surgical procedures Persistence in pursuit of cleanliness is critical because microorganisms can colonize on hands in the moist environment underneath gloves. 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 and reliable optimum results. Procedures and Tips Basic Hand-hygiene Technique A. When decontaminating hands with an alcohol-based hand rub, apply the product to the palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Follow the manufacturer's recommendations regarding the volume of product to use. B. When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use a towel to turn off the faucet. Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis. C. Liquid, bar, leaflet or powdered forms of plain soap are acceptable when washing hands with a non-antimicrobial soap and water. When bar soap is used, soap racks that facilitate drainage and small bars of soap should be used. D. Multiple-use cloth towels of the hanging or roll type are not recommended for use in health-care settings. Pro-Tips for Optimum Hand Hygiene A. Do not wear artificial fingernails or extenders when having direct contact with patients at high risk (e.g., those in intensive-care units or operating rooms). B. Keep natural nails tips less than 1/4-inch long. C. Wear gloves when contact with blood or other potentially infectious materials, mucous membranes, and nonintact skin could occur. D. Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient, and do not wash gloves between uses with different patients. E. Change gloves during patient care if moving from a contaminated body site to a clean body site. F. Do not wear rings on the fingers. Studies show that skin underneath rings is more heavily colonized than comparable areas of skin. Furthermore, rings can cause gloves to tear more readily. Author: Charles Ladbrooke J.D. LL.M., Compliance Specialist at Aegis Lion LLC References: American Dental Association Centers for Disease Control and Prevention
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March 2016
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