Hand Hygiene

Hand contact is one of the main routes of transmission of the multi-drug resistant bacteria MRSA and herpes viruses, which cause cold sores and shingles.

Hands as a Source of Cross Infection

Shaking hands, touching a patient’s face with hands or typing on a computer keyboard will all result in picking up bacteria and viruses.

Hand contact is one of the main routes of transmission of the multi-drug resistant bacteria MRSA and herpes viruses, which cause cold sores and shingles.

These transient microbes, many of which are pathogenic, do not become part of your resident bacterial hand flora. They can persist for many hours and, in the case of bacteria, replicate unless they are removed by hand hygiene.

The skin’s resident bacterial flora lives in harmony with their human host, forming part of the body’s natural defences against pathogens. Resident bacteria are deep seated in the skin, and are more difficult to remove. Some resident species can cause opportunistic infections during invasive procedures such as oral surgery. 

Prevention of Cross Infection

The key to Best Practice in infection prevention and control is hand hygiene.

Scientific studies have confirmed that hand hygiene is one of the most effective measure for preventing the spread of infection.

Hand hygiene is the physical removal of dirt, blood, body fluids and transient microorganisms from the hands. Prior to performing surgery, such as implant surgery, periodontal surgery and MOS, a more extensive disinfection of the hands is required to reduce the number of resident bacteria as well as remove transient bacteria. This is referred to as surgical hand hygiene or hand antisepsis.

Waterless Dental Hand Hygiene Products

A plain liquid soap acts as a detergent to remove dirt and transient microorganisms.

Alcohol gels and rubs are used as a “waterless” skin disinfectant to clean the hands and wrist. It is a highly effective disinfectant in reducing the microbial load on the hands. Alcohol gels and rubs lack any detergent effect so do not remove dirt. They are intended for use on visibly clean hands.

Visibly dirty hands should be washed with soap prior to using alcohol gels and rubs.

Alcohol gels and rubs do not kill bacterial spores causing diarrhoeal illnesses such as Clostridium. difficile or some enteroviruses.  They are less irritant to hands as many products incorporate a moisturiser.

Alternatives to alcohol containing products are “waterless” alcohol- free hand gels and rubs that contain disinfectants such as a quaternary ammonium or triclosan.

Anti-Bacterial Skin Cleansers

Anti-bacterial skin cleansers, such as chlorhexidine, iodophors, or triclosan, are used with running water.

A major advantage of some of these hand hygiene products is that they have a residual effect as they bind to the outer layer of the skin and remain effective for up to 6 hours after application.

Chlorhexidine and triclosan have the advantage over alcohol hand gels and rubs in that they are not inhibited by the presence of organic material. They can be used as an alternative to soap to clean visibly soiled hands.

Hypersensitivity and allergic reactions are reported with these products. They are used mainly for surgical hand hygiene.

How and When to Clean Hands in the Dental Surgery

To download your copy of the Isopharm Efficient Hand Washing poster click here >

  • Hands must be cleaned immediately before each and every episode of dental patient care, after contact with saliva, blood or other bodily fluid and before donning gloves. This prevents contamination of the patient’s mouth and face with organisms carried on the dental team’s hands.
  • Hands must be cleaned immediately after every episode of patient care and following removal of gloves to minimise contamination of the dental surgery environment and oneself.

Working bare below the elbow encourages effective hand hygiene. Removal of rings and avoidance of nail polish reduces the carriage of pathogens on the hands.

A standardised hand hygiene technique should be used to ensure that all surfaces of the hands and wrists are exposed to the soap or disinfectant and are thoroughly cleaned in a systematic manner.

Employ vigorous rubbing to create friction which physically removes microbes. Duration of hand hygiene is also important. 15 to 30 seconds is recommended to clean hands and wrists when using plain & antibacterial soaps and waterless products. Performing surgical hand hygiene to clean hands, wrists and forearms requires 2 to 3 minutes. 

When using soaps and water, dry hands thoroughly afterwards as bacteria can proliferate on damp hands. Drying hands also helps to maintain skin integrity and prevent skin damage. Microbes grow faster and are shed in greater numbers from damaged skin.

Use a moisturiser regularly to protect the skin from dehydration and damage.

HCAI Code of Practice and HTM 01-05 specifies training in hand hygiene as an essential quality requirement for all existing staff and new staff during induction.

Motivation and compliance can be encouraged by following the example set by senior members of the dental team, the use of posters and regular hand hygiene audits with feedback.

CQC Guidance

Practices are not required under the CQC to have signs to instruct people to wash their hands.

CQC does not require laminated hand washing signs at all hand basins. In addition, there is no national guidance that states hand washing signs should be in place above hand basins.

What the CQC look for in relation to hand hygiene during an inspection is:

  • there is adequate hand washing facilities available and easily accessible to all staff
  • practice staff should notify the practice manager of any lack of hand hygiene products (like hand gels, soap or hand towels) or obstruction to ensure that they remain available at all times (and are not obstructed by bins or other equipment)
  • all clinical staff are trained in hand washing techniques
  • the practice has thought about risks of inadequate hand hygiene and processes are in place to prevent poor hand hygiene