Hand washing.

Hand washing is the single, most critical measure for reducing the risk of transmitting organisms to patients and health care providers. The need for proper hand hygiene procedures is critical. Below are some tips in considering when, how and what to use when hand washing.

According to the 2003 Centers for Disease Control (CDC) Guidelines for Infection Control in Dentistry, there are specific instances when hand hygiene should take place. "Indications for hand hygiene include:

* "when hands are visibly soiled

* "after barehanded touching of inanimate objects likely to be contaminated by blood, saliva, or respiratory secretions

* "immediately after removing gloves

* "before and after treating each patient

* "before donning gloves."

Hand washing is performed often throughout the day, and knowing what to use is also important. The CDC guidelines state, "Perform hand hygiene with either a non-antimicrobial soap or antimicrobial soap and water when hands are visibly dirty or contaminated with blood or other potentially infectious material. If hands are not visibly soiled, an alcohol-based hand rub can also be used."

Antimicrobial soaps are known to kill germs better than non-antimicrobial soaps. Therefore, it is better to use antimicrobial soaps where there is patient contact with blood or saliva.

Alcohol-based hand rubs help reduce the time needed to decontaminate hands, particularly when a sink is not readily available. They have also been shown to improve hand hygiene compliance. However, if hands are visibly soiled or in contact with potentially infectious material, then a wash with soap and water is required. Most alcohol-based hand rubs contain emollients to prevent the alcohol from drying the skin. Multiple uses will create a buildup of emollients that should be washed off with soap and water.

The correct procedure for hand washing with soap and water is as follows:

1. Moisten hands with warm water.

2. Apply lotion or liquid soap.

3. Thoroughly wash all surfaces of hands and wrists for 10-15 seconds, using friction and vigorous action and paying special attention between the fingers and around the nails (see illustrations).

4. Rinse hands well, allow water to continue running.

5. Take two paper towels and thoroughly dry hands.

6. Use paper towels to turn off the faucets, discard towels in plastic-lined trash cans.

Step 6 may seem like overkill, but this step helps minimize the risk of immediately recontaminating hands. Bacteria and germs will multiply in moist areas and can multiply on faucets, doorknobs, etc. This reinforces the importance of using no-touch soap and towel dispensers when possible.

Practicing good hand hygiene is a critical step in reducing the risk of cross-contamination in any health care environment.

Our thanks and appreciation to Sullivan-Schein Dental for providing this information and City College of San Francisco for the photographs.