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FAQ - Hand Hygiene - 2014
 FAQ -  Hand Hygiene  -  2014

 

 

I am an assistant professor. I'm reviewing our IC manual for our students and have a question: We have stated in our manual that proper handwashing is a 15 sec wash and then rinse (do this twice at beginning of each clinic and once for subsequent washings). Is this proper protocol?

The 2003 CDC guidelines for infection control in dentistry states as follows:

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 (Table 2). 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 soiled, an alcohol-based hand rub is adequate.  

The purpose of surgical hand antisepsis is to eliminate transient flora and reduce resident flora for the duration of a procedure to prevent 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 (127,128). Thus, an antimicrobial soap or alcohol hand rub with persistent activity should be used before surgical procedures (129–131). Agents used for surgical hand antisepsis should substantially

reduce microorganisms on intact skin, contain a nonirritating antimicrobial preparation, have a broad spectrum of activity, be fast-acting, and have a persistent effect (121,132–135). Persistence (i.e., extended antimicrobial activity that prevents or inhibits survival of microorganisms after the product is applied) is critical because microorganisms can colonize on hands in the moist environment underneath gloves (122). 1

And,

Table 2 from the 2003 CDC guidelines provides more detailed information about hand hygiene methods and indications (page 15) which can be accessed at this link:

http://www.cdc.gov/mmwr/pdf/rr/rr5217.pdf  1

Fifteen seconds is recommended for both routine handwash and antiseptic handwash procedures.

Guideline for Hand Hygiene in Health-Care Settings the Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force references length of time as follows and as accessed at this link:

http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf 

Shortcomings of Traditional Methodologies
Accepted methods of evaluating hand-hygiene products intended for use by HCWs require that test volunteers wash their hands with a plain or antimicrobial soap for 30 seconds or 1 minute, despite the observation in the majority of studies that the average duration of handwashing by hospital personnel is <15 seconds (52,84–89). A limited number of investigators have used 15-second handwashing or hygienic hand-wash protocols (90–94). Therefore, almost no data exist regarding the efficacy of plain or antimicrobial soaps under conditions in which they are actually used by HCWs. Similarly, certain accepted methods for evaluating waterless antiseptic agents for use as antiseptic hand rubs require that 3 mL of alcohol be rubbed into the hands for 30 seconds, followed by a repeat application for the same duration. This type of protocol also does not reflect actual usage patterns among HCWs. Furthermore, volunteers used in evaluations of products are usually surrogates for HCWs, and their hand flora may not reflect flora found on the hands of personnel working in health-care settings. Further studies should be conducted among practicing HCWs using standardized protocols to obtain more realistic views of microbial colonization and risk of bacterial transfer and cross-transmission (51). 2

WHO Guidelines on Hand Hygiene in Health Care can be accessed at this link:

http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf 

The WHO guidelines state:

Hand Hygiene Technique with Soap and Water

Duration of the entire procedure: 40-60 seconds 3

In summary, the 2003 CDC guidelines for infection control in dentistry specifically addresses hand hygiene procedures for dentistry. Several options exist for hand hygiene prior to nonsurgical dental procedures. Selection of the method for hand hygiene varies according to the level of contamination, the desired antimicrobial activity and the type of procedure. 5

Resources

1)     Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(RR-17):1-61. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm    Accessed on July 16, 2014.

2)     US Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-Care Settings the Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf    Accessed on July 17, 2014.

3)     World Health Organization. WHO Guidelines on Hand Hygiene in Health Care. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf   Accessed on July 17, 2014.

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