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Questions and Answers
What is the minimum alcohol concentration recommended in alcohol-based hand rubs for effective disinfection?
Which microorganism is specifically noted to be ineffective against alcohol-based hand rubs?
What types of bacteria are primarily involved in causing nosocomial infections on the hands?
What is the main disadvantage of using alcohol-based hand rubs that users must be aware of?
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What percentage of patients during their hospital stay are likely to acquire a healthcare-associated infection?
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What should be done before applying alcohol-based hand rubs on hands?
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Which characteristic distinguishes resident bacteria from transient bacteria on the hands?
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Which of the following impacts the effectiveness of hand hygiene when wearing rings?
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What is the key reason for the high rate of healthcare-associated infections according to the content?
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What is the primary purpose of surgical hand hygiene?
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Which statement accurately describes the limitations of alcohol-based hand rubs?
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Which one of the following moments for hand hygiene is not mentioned in the provided content?
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During surgical hand hygiene, which scrubbing technique requires maintaining the hand above the elbow?
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What is a critical requirement when washing hands and forearms in surgical scrubs?
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What occurs if any part of the hand touches a non-sterile surface during the scrubbing process?
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Study Notes
Hands are a Source of Infection
- Hands harbor microorganisms that can cause infections
- The entire surface of the human body is colonized by microorganisms
- The skin below the waist, particularly in the perineal and inguinal regions, is a prime area for microbial colonization
- People shed approximately a million skin scales (squames) daily
- Microorganisms attach to shed skin scales
- The skin of the hands harbors two types of bacteria: resident and transient
- Resident bacteria are gram-positive, low virulence, not easily transmitted from hand contact, and resistant to removal by hand hygiene.
- Transient bacteria are gram-negative bacteria, important causes of nosocomial infections, and can be removed by hand hygiene.
- Resident bacteria make up the persistent flora of the hands
- Resident bacteria live on the surface of the skin without causing infection.
- When the skin is breached, resident bacteria can become opportunistic pathogens, causing wound or deep-seated infections.
- Staphylococcus epidermidis is a common resident bacterium
- During activities like shaking hands or touching a patient’s face, hundreds, even thousands of bacteria can be transferred onto the dentist’s hands
- Approximately 5-10% of patients develop a healthcare-associated infection during their hospital stay.
- 2 million patients acquire infections in hospitals annually.
- 80,000 deaths per year are attributed to hospital-acquired infections.
- 600,000 healthcare-associated infections (HCAIs) are due to the failure of healthcare workers to wash their hands after every patient.
When to Clean Hands
- The World Health Organization (WHO) recommends five moments for hand hygiene based on evidence of microbial transmission.
- Five moments for hand hygiene:
- Before touching a patient
- Before clean/aseptic procedures
- After exposure to body fluids, such as saliva or blood
- After touching a patient
- After touching patient surroundings
Choosing the Correct Hand Hygiene Product
- Hand washing is an essential part of hand hygiene.
- Three common types of hand hygiene products are traditional hand washing with soap, antiseptic hand washes, and alcohol-based hand rubs.
- Not all forms of hand hygiene are equally effective.
- The choice of hand hygiene product depends on the reason for cleaning the hands.
Alcohol-Based Hand Rubs
- Alcohol-based hand rubs contain an alcoholic solution ranging from 65% to 70% alcohol, with low or high concentrations of detergents.
- Surfactants, such as biguanides, quaternary ammonium compounds, or peroxides, can be added to alcohol-based hand rubs.
- Ethanol-containing products are diluted with water (10 to 40% by weight) to enhance the denaturation of microbial proteins.
- Ethanol or isopropyl alcohol act rapidly against a wide range of gram-negative and gram-positive species, including MRSA and vancomycin-resistant enterococci.
- The (-OH) group in alcohol forms hydrogen bonds with proteins, leading to protein denaturation and loss of structure and function.
- Alcohol lyses the bacterial cytoplasmic membrane, inactivating the bacteria.
- Vigorous rubbing with alcohol-based hand rubs for 15 seconds has been shown to be effective at preventing the transmission of gram-negative bacteria (GNB).
- Hands should be washed for 30 seconds to allow alcohol to evaporate from the skin.
- Alcohol evaporates completely, leaving no antiseptic residue on the skin, which helps to prevent the development of microbial resistance.
Limitations of Alcohol-Based Hand Rubs
- Alcohol-based hand rubs should only be used on visibly clean hands.
- They are ineffective against Clostridium difficile, a bacteria that forms spores.
- Alcohol evaporates rapidly, making its effect short-lived.
Systemic Effects of Alcohol-Based Hand Rubs
- Prolonged and repeated use of alcohol-based hand rubs can alter thyroid and reproductive systems in neonates and adolescent animals
- Studies conducted on humans revealed detectable levels of alcohol in the blood.
Hand Hygiene Technique
- Remove rings and watches before performing hand hygiene, as these can harbor bacteria.
- Silver rings inhibit bacterial growth, while gold and platinum rings do not.
- Gloves are more likely to tear when rings are worn.
- Artificial nails can also harbor bacteria.
- Standard hand hygiene technique can be used with water and soap or alcohol-based hand rubs
- The first step is to wash your hands, followed by a hand rub.
- The hand hygiene technique targets commonly missed areas of the hands, including fingers, thumbs, cuticles, wrists, and the back of the hands.
Surgical Hand Hygiene
- Surgical hand hygiene requires more extensive disinfection, also known as antisepsis, to reduce resident bacteria to a minimum.
- It is not possible to completely sterilize the skin.
- The basic principle of surgical hand hygiene is to wash from clean to less clean.
- Two common methods are the numbered stroke method and the timed scrub method.
- The numbered stroke method involves scrubbing each finger, palm, back of the hand, and arm using a specific sequence.
- The timed scrub method involves scrubbing for 5 minutes.
- Wash hands, nails and forearms with antimicrobial disinfectant for 2 minutes.
- Cold water prevents soap from lathering which can reduce the effectiveness of washing away dirt and germs.
- Clean subungual areas with a brush.
- Proceed to scrub the arms, keeping the hand higher than the arm at all times using a rotational action for 1 minute.
- Wash the soap from your hands and forearms by holding your arms up with your hands elevated under the tap.
- This prevents bacteria-laden soap and water from contaminating the hands.
- Repeat the procedure on the other hand.
- If either hand touches anything other than the brush, the scrubbing time must be extended by one minute for that area.
- Repeat the procedure three more times, first down to the mid forearm, then to the wrists (1 minute each).
- Keep your arms elevated.
- Dry your hands and forearms with the sterile towels in the gowning pack using a dabbing motion.
- Avoid vigorous scrubbing to prevent abrasions.
- Avoid splashing water onto surgical attire.
- Scrubbing precedes gowning and gloving.
Goals of an Infection Control Program
- The goals of an infection control program are to:
- Reduce the spread of infection
- Protect patients and staff from infection
- Ensure the safety of the dental environment.
Personal Hygiene
- Practice proper personal hygiene to reduce the spread of infection.
- Items such as nail care, jewelry, and personal attire can contribute to microbial transmission.
Respiratory/Cough Etiquette
- Practice respiratory hygiene to prevent the spread of respiratory droplets, which can harbor infectious agents.
- Cover your mouth and nose when coughing or sneezing.
- Dispose of tissues properly.
- Wash your hands after coughing or sneezing.
Protective Attire (PPE)
- PPE is essential to protect you and your patients from infection.
- Appropriate attire includes:
- Gloves
- Masks
- Goggles
- Headwear
- Shoe coverings
- Select PPE based on the specific procedures being performed and the risk of exposure.
- PPE must be worn correctly and disposed of properly.
Barrier Techniques
- Use barrier techniques to minimize the spread of infection.
- Gloves should be worn during all patient care procedures.
- Overgloves can be worn over gloves for an extra layer of protection.
- Masks and face shields protect against airborne and droplet transmission.
- Eyewear protects the eyes from splashes and sprays.
- Headwear should be worn to prevent contamination of hair.
Preparation of the Dental Treatment Room (DTR)
- The DTR must be prepared between patients to ensure hygiene and prevent contamination.
- Use a safe needle system to reduce the risk of needlestick injuries.
- Prepare the DTR by:
- Cleaning and disinfecting all surfaces
- Replacing items that were used in the previous treatment session
- Disposing of contaminated materials properly
- Secure the DTR at the end of the day by:
- Cleaning and disinfecting all surfaces
- Disposing of contaminated materials properly
- Covering instruments and equipment with a protective barrier
Sterilization
- Sterilization is the process of killing all microorganisms and spores.
- Designated work areas should be set up for sterilization.
- Receiving and cleaning are the first steps in the sterilization process.
- Storage of sterile items is important to maintain their sterility.
- Sterilization methods include:
- Autoclaving
- Dry heat sterilization
- Chemical sterilization
- Drying and packaging are the final steps in the sterilization process.
References
- Health Protection Scotland (2015) National Infection Prevention and Control Manual.
- Loveday HP, Wilson JA, Pratta RJ et al.(2014) Epic3: national evidence‐based guidelines for preventing healthcare‐associated infections in NHS hospitals in England.Journal of Hospital Infection, 86(Suppl. 1), S1–S70.
- Pittet D, Hugonnet S, Mourouga P et al.(2000) E ectiveness of a hospital‐wide programme to improve compliance with hand hygiene. Lancet, 356, 1307–12.
- World Health Organization (2009) WHO Guidelines on Hand Hygiene in Healthcare.
Final Course Output
- Submit a laboratory infection control manual that provides instructions and protocols for the:
- Disinfection of the dental environment
- Hand hygiene
- Scrub technique
- Donning and doffing of PPE
- The manual should include detailed information on all aspects of infection control. It should be clear, concise, and accessible to all dental staff.
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Description
This quiz explores the role of hands in harboring microorganisms that can lead to infections. It discusses the types of bacteria found on hands, the significance of resident and transient bacteria, and the importance of hand hygiene in preventing nosocomial infections. Test your knowledge on how hands contribute to microbial colonization and infection risk.
