Hand Hygiene

1. Hand Hygiene Janet Weber, RDH, MEd

2. Why Is Hand Hygiene Important? • Hands are the most common mode of pathogen transmission

3. Hand washing is an extremelyimportantstep in overall infection control since it removes the bacterial flora on the skin • All humans have bacterial flora on their skin. The bacterial flora on the hands can be divided into two groups: •  Resident flora are found on the surface of the skin and under the superficial layers. They live and multiply on the hands. A common example is Staphylococcus epidermidis. Resident bacterial hand flora are unlikely to cause infections on the skin surface but may be problematic if they enter wounds or body cavities. • Transient bacterial flora are frequently acquired from contact with surfaces, substances or people. An example is Staphylococcus aureus. They may or may not colonise the hands and are more easily removed by handwashing than resident flora. Transient flora may be pathogenic and cause health care-associated infections.

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

5. 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.

6. Hand Hygiene Definition • Hand hygiene is a general term that applies to either hand washing, antiseptic hand wash, alcohol-based hand rub, or surgical hand hygiene/antisepsis.

7. 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)

8. 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

9. Before the procedure • Long sleeves rolled up. • 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

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

11. Hand Hygiene: Frequently Missed Areas Courtesy of SDS Kerr

12. Hand washing Technique • Apply soap or detergent to the palms of the hands and rub palms together vigorously • Place the right palm over top of the left hand and rub. Repeat this with the left hand over the right hand • Place palms together and interlace fingers and rub. Link fingers so that the backs of fingers are against the opposite palm and rub • Place the fingertips in the palm of the opposite hand, rotate and rub. Repeat this for the other hand • Grasp the right thumb with the left hand, rotate and rub. Repeat with the opposite thumb

13. Grasp the left wrist with the right hand. Rotate and rub. Repeat this for the other wrist. • Rinse hands thoroughly, holding them downwards • Turn off taps with elbows or wrists. If this is not possible, use a disposable paper towel to touch the tap while turning it off • Dry hands thoroughly using as many disposable paper towels as necessary. Place used towels in a foot-operated waste bin. • This entire procedure normally takes 15-30 seconds. A longer surgical scrub will require extra soap or detergent. • Be sure not to touch ANYTHING after washing

14. Hand Protection

15. 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!

16. 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 notwash, disinfect or sterilize gloves for reuse

17. Types of Procedural Gloves” Patient Procedure Surgical

18. Glove Fit: • Should be available in a variety of sizes and types • May causes hand fatigue if gloves don’t fit correctly • Glove integrity may be compromised • Injury is more likely to occur do to an ill fitting glove

19. 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.

20. 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.

21. Example of Gloves that are JUST RIGHT!

22. Taking off the first glove: 1. 2. 3.

23. 4. 5.

24. Taking off the second glove: 2. 1.

25. 5. 4. 6.

26. Disposal: