What is the first step for performing correct hand hygiene with alcohol-based handrub?

What is hand hygiene? 

Hand hygiene is a way of cleaning one’s hands that substantially reduces potential pathogens (harmful microorganisms) on the hands. Hand hygiene is considered a primary measure for reducing the risk of transmitting infection among patients and health care personnel. Hand hygiene procedures include the use of alcohol-based hand rubs (containing 60%–95% alcohol) and hand washing with soap and water. For surgical procedures, perform a surgical hand scrub before putting on sterile surgeon’s gloves. For routine dental examinations and nonsurgical procedures, use an alcohol-based hand rub or use water and plain or antimicrobial soap specific for health care settings. Unless hands are visibly soiled (e.g., dirt, blood, body fluids), an alcohol-based hand rub is preferred over soap and water in most clinical situations because it:

• Is more effective than soap at killing potentially deadly germs on hands
• Requires less time
• Is more accessible than handwashing sinks
• Produces reduced bacterial counts on hands, and
• Improves skin condition with less irritation and dryness than soap and water

For more information on Hand Hygiene, please visit CDC’s Hand Hygiene in Healthcare Settings.

Always perform hand hygiene in the following situations:

• Before and after treating each patient (e.g., before and after gloving).
• After touching with bare hands instruments, equipment, materials, and other objects that are likely to be contaminated by blood, saliva, or respiratory secretions.
• Before leaving the dental treatment area.
• When hands are visibly soiled.
• Before regloving and after removing gloves that are torn, cut, or punctured.

Using alcohol-based hand rub (follow manufacturer directions):

• Dispense the recommended amount of product
• Apply product to the palm of one hand
• Rub hands together, making sure that all surfaces of hands and fingers are covered until they are dry (no rinsing is required)

Hand washing with soap and water:

• Wet hands first with water (do not use hot water)
• Apply soap to hands
• Rub hands vigorously for at least 15 seconds, covering all surfaces of hands and fingers
• Rinse hands with water and dry thoroughly with a paper towel
• Use a paper towel to turn off the water faucet

Surgical hand hygiene/antisepsis:

• Use either an antimicrobial soap or alcohol-based surgical hand-scrub product with continuous activity
• Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer
• Alcohol-based surgical hand-scrub product: follow manufacturer’s recommendations. Before applying, wash hands and forearms with a non-antimicrobial soap

Store and dispense products according to manufacturer’s instructions. Products such as liquid soaps and lotions can become contaminated with bacteria or other microorganisms. Liquid products should be stored in closed containers and dispensed from either disposable containers or containers that are washed and dried thoroughly before refilling. Soap should not be added to a partially empty dispenser; the practice of “topping off” might lead to bacterial contamination of soap and cancel the beneficial effect of hand cleaning and disinfection.

Yes, certain types of lotions such as those that contain petroleum can weaken latex gloves and increase porousness. If using lotions during the workday, select a water-based product. Lotions that contain petroleum or other oil emollients should only be used at the end of the workday. When choosing a lotion to use in the dental office, get information from the manufacturer about interaction between gloves, lotions, dental materials, and antimicrobial products.

CDC. Guideline for hand hygiene in health care settings: Recommendations of the Health Care Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(No. RR-16). Available at: www.cdc.gov/mmwr/PDF/rr/rr5116.pdf pdf icon[PDF-1.2M]. Accessed June 27, 2015.

CDC. Basic Expectations for Safe Care Training Module 2 – Hand Hygiene. Available at: https://www.cdc.gov/oralhealth/infectioncontrol/safe-care-modules.htm. Accessed May 8, 2018.

CDC. Guidelines for infection control in dental health-care settings – 2003. MMWR 2003; 52(No. RR-17):1–66. Available at: www.cdc.gov/mmwr/PDF/rr/rr5217.pdf pdf icon[PDF-1.5M]. Accessed June 27, 2015.

CDC. Hand Hygiene in Healthcare Settings Educational Material https://www.cdc.gov/handhygiene/

Ellingson K, et. Al. Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. A Compendium of Strategies to Prevent Healthcare-associated Infections in Acute care Hospitals: 2014 Updates.Infect Control and Hospital Epidemiol 2014;35 No. S2: S155-S178.

Momeni, SS, Tomlin N, Ruby JD. Isolation of Raoultella planticola from refillable antimicrobial liquid soap dispensers in a dental setting. J Am Dent Assoc 2015;146:241–245.

Myers R, Larson E, Cheng B, Schwartz A, Da Silva K, Kunzel C. Hand hygiene among general practice dentists a survey of knowledge, attitudes and practices. J Am Dent Assoc 2008;139:948–957.

Recommendations for routine hand hygiene technique vary according to the formulation being used, with major differences between alcohol-based hand rub (ABHR), foam hand rubbing, and soap and water.

Surgical hand hygiene technique is a different technique again, and we will look at this in the next section.

Regardless of which formula is being used the manufacturer’s instructions for use must always be followed, otherwise, you cannot guarantee your hand hygiene will be effective.

Waterless hand hygiene. When waterless hand hygiene solutions are being used it is important that enough solution is applied to cover the entire palm. The number of applications needed to ensure the correct amount varies according to the volume dispensed with each dose and the size of the user’s hand. Once sufficient product has been applied, users should rub their hands together ensuring all surfaces of the hands and fingers are covered. This procedure takes between 20 to 30 seconds to complete. Rubbing should be performed until the hands are dry. (Detailed illustrations of this technique are available in the WHO Guidelines on Hand Hygiene.)

Rub your hands together to cover your entire palms. Don’t forget the sides of your hands, as well. Place your left hand over the back of your right hand and interlace your fingers, and rub clean, trying to clean right between your fingers, and in all the cracks and crevices, and up and down the inside of your fingers. As well, you are aiming to thoroughly clean the back of your hand.

Then, place your right hand over the back of your left hand and repeat this procedure.

Now reverse and do the insides. Place your palms together, interlace your fingers, and clean both your palms and between your fingers from the inside. You’re trying to get right in the cracks and crevices between your fingers as well as ensuring your palms are well cleaned.

Now, lock your hands together using your fingers to ensure your palms are opposite each other. Clean the ends of your fingers and nails really well, making sure the fluid reaches into the crevices.

Now for your thumbs. Grasp your thumb with the forefingers of the opposite hand and clean the thumb you have grabbed really well in a twisting motion, then do the same on the other hand. You need to completely clean all surfaces of your thumb down to and including your wrist.

Once you have done that and you feel as f you are really getting your hands clean, you now need to rub in a circular manner with your clasped fingers, into the palm of your hand. Make sure you do this with both of your hands. Clean fingers are essential for hand hygiene.

When your hands are dry of all alcohol-based hand rub, and you are satisfied you have completed the hand rub correctly, your hands should be safe.

Learn more about hand hygiene here: https://www.ausmed.com.au/cpd/articles/hand-hygiene-101.