| FAQ - Hand Hygiene - 2014
If using an alcohol-based hand rub would you also recommend a double washing at the beginning of clinic?
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). 1
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 (130). Factors that can influence the effectiveness of the surgical hand antisepsis in addition to the choice of antiseptic agent include duration and technique of scrubbing, as well as condition of the hands, and techniques used for drying and gloving. CDC’s 2002 guideline on hand hygiene in health-care settings provides more complete information (123). 1
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:
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:
2. Hand-hygiene technique
A. When decontaminating hands with an alcohol-based
hand rub, apply product to palm of one hand and
rub hands together, covering all surfaces of hands
and fingers, until hands are dry (IB) (288,410).
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 towel to turn off the faucet
(IB) (90-92,94,411). Avoid using hot water, because
repeated exposure to hot water may increase the risk
of dermatitis (IB) (254,255).
C. Liquid, bar, leaflet or powdered forms of plain soap
are acceptable when washing hands with a nonantimicrobial
soap and water. When bar soap is used,
soap racks that facilitate drainage and small bars of
soap should be used (II) (412-415).
D. Multiple-use cloth towels of the hanging or roll type
are not recommended for use in health-care settings
3. Surgical hand antisepsis
A. Remove rings, watches, and bracelets before
beginning the surgical hand scrub (II) (375,378,416).
B. Remove debris from underneath fingernails using a
nail cleaner under running water (II) (14,417).
C. Surgical hand antisepsis using either an antimicrobial
soap or an alcohol-based hand rub with persistent
activity is recommended before donning sterile gloves
when performing surgical procedures (IB)
D. When performing surgical hand antisepsis using an
antimicrobial soap, scrub hands and forearms for the
length of time recommended by the manufacturer,
usually 2–6 minutes. Long scrub times (e.g., 10
minutes) are not necessary (IB) (117,156,205,
E. When using an alcohol-based surgical hand-scrub
product with persistent activity, follow the
manufacturer’s instructions. Before applying the
alcohol solution, prewash hands and forearms with
a non-antimicrobial soap and dry hands and forearms
completely. After application of the alcohol-based
product as recommended, allow hands and forearms
to dry thoroughly before donning sterile gloves (IB) 2
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 15, 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 15, 2014.