May 1, 2003
by Oral Health
In October 2002, the Centers for Disease Control and Prevention (CDC) published its updated “Guideline for Hand Hygiene in Health-Care Settings.” Based mainly on hospital-derived data, the document provides workers in all healthcare settings with a scientific review, specific recommendations for reducing the potential for disease transmission through appropriate hand hygiene, and guidance on related issues like surgical hand antiseptics and skin care.
Hand hygiene products for healthcare personnel are the regulatory jurisdiction of the U.S. Food and Drug Administration (FDA). FDA currently uses three classifications to identify these products: patient preoperative skin preparations, antiseptic handwashes, and surgical hand scrubs. Antimicrobials deemed “safe and effective for use in antiseptic handwashes” include ethanol and povidone iodine.
Since the CDC’s last hand hygiene recommendations (published in 1985), a newer category of antiseptic products has been making its way into healthcare settings. Waterless antiseptic agents are alcohol-based gets, foams, or rinses that don’t require the use of water. The preparations are simply applied to the hands, which then are rubbed together to coat all surfaces. The agents have found acceptance in some hospitals, where healthcare worker compliance with handwashing recommendations traditionally has been less than ideal.
According to studies summarized in the new CDC guideline, the waterless, alcohol-based products are more effective at reducing microbial flora on healthcare worker hands than a plain soap or antimicrobial handwash. They even have helped improve hand hygiene and reduce disease transmission in hospitals, where access and time to use handwashing stations may be severely limited. Concentrations of 60-95% alcohol are most effective; higher concentrations are actually less potent. Formulations containing emollients also are reported to reduce the incidence of skin chapping and irritation.
On the downside, alcohols are not appropriate for use when hands are visibly soiled or contaminated with organic material. Furthermore, their efficacy is affected by a number of factors, including the type and concentration of alcohol in the formula, contact time, and whether the hands are wet when the alcohol is applied. Volume also is a factor: Applying a small amount of alcohol to the hand is no more effective than washing with plain soap and water.
IN THE DENTAL SETTING
Although waterless antiseptics appear to have been successful in the hospital setting, what do they mean for dentistry, where the majority of procedures are performed with gloved hands, patients generally are not in acute medical distress and highly susceptible to infection, and handwashing before and after gloving is routine for the dental team? Individual dental practices may have to answer that question on their own.
CDC recommendations allow for routine handwashing to continue. Some experts feel that since the techniques are familiar and compliance is high among dental workers, there is no need for a change. Others suggest that adding alcohol-based hand rubs may help combat dry skin from frequent handwashing, or may speed hand hygiene in institutions and large dental clinics, where team members quickly move from one patient to the next. To find what’s best for your practice:
1. Carefully evaluate your current hand hygiene practices and compliance;
2. Solicit input from the staff regarding the feel, fragrance, and skin tolerance of any products under consideration (for soaps, ease of lathering may also be a factor);
3. Get information from manufacturers on known interactions between hand hygiene products, skin care products, and glove materials (e.g., some petroleum-based creams degrade glove materials); and
4. Evaluate dispensers to ensure adequate function and delivery of the product.
Desirable characteristics for both traditional and no-rinse hand hygiene products include low irritancy potential, broad-spectrum antimicrobial activity, and staff acceptance.
While cost must always be considered, it should not be the primary factor. Ineffective products or products that staff fail to use are never a wise purchasing choice.
Because they should not be used on visibly soiled hands, alcohol rubs cannot ever fully replace the need for sinks or other hand hygiene in any healthcare setting. Nonetheless, they may be highly useful when water facilities are unavailable, or during ‘boil water’ advisories. For dentistry, the antiseptic hand rub simply offers a new option for applying an old tenet: Keeping your hands clean helps keep you and your patients safe and healthy.