• Hand Hygiene : Washing and Disinfection

    Bacteria and Viruses are commonly transmitted on the hands of health care workers, and hand washing is considered the single most important intervention to prevent such spread.

    During their daily work, health care workers can acquire pathogens from infected patients and transmit them to other patients.

    There are fewer data on the transmission of pathogens in the dental setting; however, given the number of bacteria and viruses found in the mount and the nasopharynx and the potential for aersolization of blood and saliva during dental procedures, it is likely that transmission is common in this setting as well.

  • Compliance with Hand washing Guidelines

    The Canadian Dental Association recommends that hand be washed whit germicidal soap before and immediately after the use of gloves. Using gloves does not obviate the need for hand washing, because the gloves themselves may become contaminated as a result of punctures or the hands may become contaminated after the gloves are removed. A number of factors are associated whit low rates of compliance whit hand washing guidelines: lack of availability of sinks, adverse effects of hand washing on skin condition, high workload and low received risk.

    Compliance also depends on the time required to perform adequate hand washing relative to the time available. Washing hand for 15 seconds achieves a microbial kill of 10 0.6-1.1 and for 30 seconds

  • Hand Disinfection with disinfectant

    Numerous studies have shown that solutions containing 60% to 70% alcohol are effective skin disinfectants. These Preparations are more effective than antimicrobial soaps, reducing bacterial load in the hands by approximately 10 4. For this reason, agents containing alcohol, with or without other antimicrobial compounds, have become increasingly popular as hand disinfectants in Europe. One approach to improving compliance is to find ways of decreasing the time required for hand hygiene, since health care workers often cite lack of time as one of the greatest deterrents to hand washing. Voss and Widmer estimated that the time necessary for hand disinfection whit an liquid disinfectant was inky 25% of the time required for regular hand washing. Also, because disinfectant antiseptic do not require plumbing or a sink, dispensers can be placed in convenient locations, without major expense being incurred. A second deterrent to compliance is irritant contact dermatitis as a result of the damaging effects of soaps and detergents. Rates of dermatitis may exceed 60 % in health care workers who have to wash their hands more than 35 times per shift.

    Concern about the drying effect of alcohol-based products has likely hindered their rapid adoption in North America; however, formulations of alcohol disinfectants containing emollients to prevent drying of the skin are now available. A randomized crossover study comparing soap and liquid disinfectant showed that the disinfectants were associated whit significantly less skin irritation and slyness, as assessed by both subjective and objective measures. Finally, data are beginning o accumulate to show that the introduction of liquid disinfectant antiseptics produces a sustained improvement in companies with hand hygiene whit hand hygiene. Pitted and other showed that, after introduction of an alcohol-based hand disinfectant at a university hospital in Geneva, compliance with hand hygiene increased from 48% to 66%; they also found that this improvement was sustained. 19 Bischoff and others found that providing disinfectant at the bedside improved compliance with hand hygiene guidelines.

    20 few caveats should be considered in the use of alcohol-based products. When the hand have been significantly contaminated by blood or body fluids, regular hand washing should be performed.Conclusion

    Alcohol-based hand disinfectants should be considered an adjunct to hand washing in the health care and dental clinic. These agents have a number of advantages over traditional soaps; they are more effective at disinfectant, they require a shorter contact time, and they are less likely to cause dermatitis. The improvement in compliance with hand hygiene recommendations associated whit the use alcohol-based products will decrease the risk of transmission of infection in the health care dental setting.

    Dr.Jhon is section head, infection control, London Health Sciences Center and St. Joseph’s Health Care, London, Ontario.