by Mary Govoni, CDA, RDA, RDH, MBA
If the news reports are to be believed, we are headed for a major flu epidemic this winter. Even if you were vaccinated, you may not be protected against this year's most serious flu strain. So what do you do to protect yourself? Something Mom used to tell you all the time — wash your hands. According to infection prevention experts, handwashing is one of the most important tools we can use to stop the spread of many infectious diseases, including cold and flu viruses. Not only is this practical information for life outside of the office, handwashing procedures are an important element in infection control protocols in the office.
On Oct. 25, 2002, the Centers for Disease Control and Prevention issued its Hand Hygiene Guidelines for Health Care Settings, which are intended to improve hand hygiene in all types of healthcare settings. In December 2003, the CDC was scheduled to issue its updated infection-control guidelines for dental health-care settings, which will likely include the recommendations from the Hand Hygiene Guidelines. Information on these guidelines is available on the CDC Web site at www.cdc.gov.
How can such a simple procedure such as washing your hands reduce infection rates? Numerous studies show that handwashing procedures reduce infections by removing and/or reducing the numbers of microorganisms on the hands. Since our hands come in contact with patients, treatment-room surfaces, equipment, and materials, many opportunities exist for transferring potentially infectious microorganisms by touching. But what about gloves? Don't they eliminate the need for handwashing? According to the CDC, the use of gloves does not eliminate the need for hand hygiene. The CDC states that gloves reduce hand contamination by 70 to 80 percent, but what about the other 20 to 30 percent?
Handwashing seems like such a simple task. We do it all day long. We do it, for the most part, without thinking about it. But do we do it properly? And are we using the right products? In the October 2002 Hand Hygiene Guidelines, the CDC defines a number of terms related to hand hygiene (Click Here to download a .pdf of the tables). These terms are important to understand when selecting a handwashing product and to understand what hand hygiene procedures are most appropriate for dental procedures.
For most dental procedures, hand antisepsis is recommended. This means using a handwash (with water) or a hand rub (does not require water) that contains an antimicrobial agent. Although studies show that the antimicrobial agents used in the soaps or hand rubs are effective in achieving this goal, accepted evaluation methods require health-care workers to wash hands or use hand rubs for 30 seconds. The CDC states, however, that the typical healthcare worker uses soaps or hand rubs for only 15 seconds. In light of this information, we may need to be more cognizant of the time we spend — or don't spend — washing our hands.
Prior to a surgical procedure, a longer handwashing procedure is recommended, as the CDC calls "surgical hand antisepsis." Studies have demonstrated that 3- and 5-minute hand-scrub procedures will reduce microbial counts on the hands to acceptable levels to prevent cross-contamination of a surgical site. The CDC recommends the use of antimicrobial agents that have persistent activity, which can be effective for several hours after handwashing. In the past, surgical handwashing procedures included the use of scrub brushes, which are no longer recommended due to the potential to abrade or damage the skin of the health-care worker. The CDC cites a number of studies indicating that the use of a disposable sponge is as effective as using a brush.
So now that we're going to spend a few more seconds washing our hands, what products will we use? The guidelines list the types of handwash or hand-rub preparations that are recommended for use in health-care settings (table 2). Your choice of product will be influenced by the type of procedures you perform, your preference of the type of antimicrobial agent, and, most likely, how your skin reacts to the repeated use of the product. If you want to use an antiseptic handwash product, your choices include the products listed in table 3 (page 56).
Some tips from the Association for Professionals in Infection Control and Epidemiology on handwashing include:
⇒ Use warm, rather than hot water, to reduce drying of the skin and risk of dermatitis.
⇒ Use liquid or powdered soap.
⇒ Use moisturizing skin-care products or barrier creams, but ensure that these products will not compromise gloves.
If you choose to use antiseptic handrubs as a substitute for soap-and-water washing, your choices include the products listed in table 4 (page 56).
Tips from APIC on the use of alcohol handrubs include:
⇒ Choose alcohol handrubs that contain 60-95% isopropyl, ethanol, or n-propanol.
⇒ Alcohol-based handrubs, rinses, or gels containing emollients have been shown to cause less skin irritation and dryness than soaps or antimicrobial soaps.
⇒ It is not necessary or recommended to routinely wash hands after application of alcohol-based handrubs.
Some additional tips from manufacturers of alcohol handrubs include washing hands with soap and water after five to 10 uses of the handrub, and donning powder-free gloves when using alcohol-based handrubs, as the powder may react with the product, resulting in a grainy feel to the skin. In addition, because these products are flammable, placement of dispensers is very important in terms of fire prevention. National fire codes prohibit installation of dispensers in exit hallways, although local or state codes may permit it. Users should be aware of local fire codes. Dispensers should not be installed near electrical outlets and product should not be stored near heat sources. Also, health-care workers using alcohol hand rubs should rub their hands until the product has completely evaporated and their hands are dry.
Whatever you choose for hand hygiene products, keep in mind that your intact skin is an extremely important barrier against an occupationally acquired infection. Be thorough about washing your hands, but change products if you experience skin irritation that you believe is due to your handwash product. If skin irritation persists, see a physician to get a definitive diagnosis of your problem. So listen to Mom and wash your hands. And have a healthy winter.
In the next issue: a complete update on the new CDC dental infection-control guidelines. Stay tuned …
Mary Govoni is a Certified and Registered Dental Assistant and a Registered Dental Hygienist, with over 28 years of experience in the dental profession as a chairside assistant, office administrator, clinical hygienist, educator, consultant, and speaker. She is the owner of Clinical Dynamics, a consulting company dedicated to the enhancement of the clinical and communication skills of dental teams. She can be reached at [email protected].
