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Clinical Practice Guideline for an Infection Control/Exposure Control Program in the Oral Healthcare Setting
Hand Hygiene

Course Author(s): Géza T. Terézhalmy, DDS, MA

Hand Hygiene

Hand hygiene procedures shall be implemented at the beginning of each work cycle, before gloving, after degloving, and before regloving, and anytime the hands are visibly contaminated with blood or OPIM.

  1. Background

    The transmission of healthcare-associated pathogens most often occurs via the contaminated hands of OHCP. It is axiomatic that wearing gloves during patient care is an essential element of standard precautions, yet gloves do not provide complete protection against hand contamination and the hands are also frequently contaminate after the gloves are removed. It is axiomatic that hand hygiene is one of the most important infection control measures for preventing HAIs.

    The acquisition of various healthcare-associated pathogens is reduced when hand hygiene is performed more frequently and the prevalence of HAIs is decreased as adherence to recommended hand hygiene practices is improved. Oral healthcare facilities are accountable for establishing a system in which OHCP have the knowledge, competence, time, and tools to practice hand hygiene; and OHCP have the duty to perform hand hygiene - perfectly and every time.

    The term hand hygiene is a general term that applies to (1) handwashing (2) hand antisepsis, and (3) surgical hand antisepsis. Products used for hand hygiene in healthcare settings are detergents (surfactants, the term “soaps” is often used). Detergents are compounds that possess cleaning action and are composed of both hydrophilic and lipophilic parts. An antimicrobial soap is a soap that contains an antiseptic agent, a substance that when applied to skin reduces the microbial flora.

  2. Execution/compliance
    1. General considerations
      1. Natural or artificial fingernails are kept short to facilitate thorough cleaning underneath them and to prevent glove tears.
      2. All jewelry and ornaments are removed from the hands and wrists if they interfere with glove use.
      3. Sinks with electronic, foot, or knee action faucet controls are provided for asepsis and ease of function.
      4. The preferred method for hand hygiene depends on the type of procedure to be performed, the degree of contamination, and the desired persistence of antimicrobial action on the skin.
    2. Routine handwash
      1. Removes soil and transient microorganisms
      2. Acceptable method prior to performing physical examinations and nonsurgical procedures
      3. Technique and products
        1. Hands are wetted under warm running water
        2. Nonantimicrobial (i.e., plain) soap is applied
        3. Hands are rubbed together vigorously for 15 seconds to work-up lather
        4. Fingernails are cleaned using the fingernails on the opposite hand
        5. Soap is rinsed off with the hands held under warm running water
        6. Hands are dried with disposable paper towels
    3. Antiseptic handwash
      1. Removes or destroys transient microorganisms and reduces resident flora
      2. Acceptable method prior to performing physical examinations and nonsurgical procedures
      3. Technique and products
        1. Hands are wetted under warm running water
        2. Antimicrobial soap (e.g., chlorhexidine, povidone iodine - 5 to 10% formulations) is applied
        3. Hands are rubbed together vigorously for 15 seconds to work-up lather
        4. Fingernails are cleaned using the fingernails on the opposite hand
        5. Soap is rinsed off with the hands held under warm running water
        6. Hands are dried with disposable paper towels
    4. Antiseptic hand rub (to be used only when there is no visible soil on hands)
      1. Removes or destroys transient microorganisms and reduces resident flora
      2. Acceptable method prior to performing physical examinations and nonsurgical procedures
      3. Technique and products
        1. Hands are rubbed together vigorously with an alcohol-based hand-rub product until dry
          1. Containing 60 to 95 % ethanol or isopropanol alcohol
          2. Alcohol-based preparations containing 0.5% to 1% chlorhexidine gluconate have persistent activity
    5. Surgical antisepsis
      1. Removes or destroys transient microorganisms and reduces resident flora (persistent effect)
      2. Acceptable method prior to performing surgical procedures
      3. Option #1
        1. Technique and products
          1. Hands are wetted under warm running water
          2. Antimicrobial soap (e.g., chlorhexidine, povidone iodine - 5 to 10% formulations povidone iodine - 5 to 10%, formulations) is applied
          3. Hands are rubbed together vigorously for 2 to 6 minutes to work-up lather
          4. Fingernails are cleaned using the fingernails on the opposite hand
          5. Soap is rinsed off with the hands held under warm running water
          6. Hands are dried with disposable paper towels
      4. Option #2
        1. Technique and products
          1. Hands are wetted under warm running water
          2. Nonantimicrobial (i.e., plain) soap is applied
          3. Hands are rubbed together vigorously for 15 seconds to work-up lather
          4. Fingernails are cleaned using the fingernails on the opposite hand
          5. Soap is rinsed off with the hands held under warm running water.
          6. Hands are dried with disposable paper towels.
          7. Hands and forearms are rubbed with an alcohol-based hand-rub product (containing 60 to 95 % ethanol or isopropanol alcohol; alcohol-based preparations containing 0.5% to 1% chlorhexidine gluconate have persistent activity) until the hands and forearms are dry.
    6. Hand hygiene products are stored and dispensed according to manufacturers’ directions.
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