Global Handwashing Day is a day of advocacy focused on handwashing with soap as an easy, effective and inexpensive way to prevent the spread of diseases and save lives. Celebrated each year on October 15, Global Handwashing Day is a campaign by the Global Handwashing Partnership, a coalition of international stakeholders who work to promote handwashing with soap and recognize hygiene as a pillar of international development and public health.
Hand hygiene history
Proper hand hygiene is the most important step dental practices can take in the name of infection control and prevention. While the first Global Handwashing Day was held in 2008, advocacy for handwashing and the use of antiseptic agents to fight infectious disease in healthcare dates to the 19th century.
In 1847, Hungarian physician and scientist Ignaz Semmelweis observed that women whose babies were delivered by doctors who washed their hands upon entering the obstetrical clinic were far less likely to contract puerperal fever, a life-threatening infection of the reproductive tract. Semmelweis then proposed that physicians should wash their hands with chlorinated lime, an antiseptic agent, before treating patients. Meanwhile, in America, Dr. Oliver Wendell Holmes independently reached identical conclusions, urging his peers to take similar precautions. At the time, both men’s viewpoints were deemed highly controversial and the medical community largely ignored their calls to action. However, it’s now clear that these initial discoveries laid the groundwork for modern hygiene standards accepted across all avenues of healthcare – including dentistry.
Today, hand hygiene is recognized as the cornerstone of infection control in the dental practice, with the Centers for Disease Control and Prevention (CDC) calling it “the most important measure to prevent the spread of infections among patients and dental healthcare personnel (DHCP).” Proper handwashing with soap and water not only helps clean the skin of pathogens like SARS-CoV-2, the virus that causes COVID-19, but also breaks down the lipid envelope encasing these microorganisms, limiting their ability to infect the body through the oral and nasal passages. According to the CDC, hand sanitizers that contain at least 60% ethanol and 70% isopropanol, active ingredients in most alcohol-based rubs, also are highly effective at stopping the spread of illnesses.
Challenges to hand hygiene compliance in healthcare settings
Unfortunately, evidence shows that healthcare workers have historically failed to adhere to hand hygiene protocols, with reported rates of compliance as low as 40% to 60%. As a direct result of hand hygiene negligence, healthcare-associated infections persist, putting both patients and practitioners in peril.
Although hand hygiene in dental settings may seem like common knowledge – even common sense – barriers to compliance as well as confusion surrounding proper technique exist. One frequent misstep is the use of gloves in place of hand hygiene. Gloves are an essential piece of personal protective equipment (PPE), and, therefore, of infection control, but they’re not an adequate substitute for handwashing or the use of waterless antiseptics. In fact, the humidity produced during wear can turn gloves into an incubator of sorts for harmful bacteria – such as methicillin-resistant Staphylococcus aureus (MRSA) – that live on skin. This, in turn, creates a cross-transmission hazard if gloves are removed or damaged and skin-to-skin (or skin-to-surface) contact occurs.
In addition, some DHCP forgo hand hygiene because of dermatitis or skin irritation, perceived low risk of cross-transmission (especially in the absence of visible contamination), lack of time as a result of understaffing or inconvenient hygiene station placement, and forgetting – or not even knowing – proper technique.
Hand hygiene: Best practices in the dental setting
To combat these issues, DHCP should look to the experts for guidance on hand hygiene best practices. Both the Occupational Safety and Health Administration (OSHA) and the Organization for Safety, Asepsis, and Prevention (OSAP) defer to the CDC as the primary authority on hand hygiene. CDC resources of particular import are the seminal Guidelines for Infection Control in Dental Health-Care Settings—2003 as well as 2002’s Guideline for Hand Hygiene in Health-Care Settings, which offers a more in-depth exploration of the subject.
In the 2003 publication, the CDC recommends performing hand hygiene “whenever hands are visibly soiled, after barehanded touching of inanimate objects likely to be contaminated by blood, saliva, or respiratory secretions,” and “before and after treating each patient.” It also advises hand hygiene “before donning gloves and immediately after removing gloves.” Both documents provide step-by-step hand hygiene walkthroughs along with special considerations (both are covered in the infographic on page 21).
Hand hygiene products for dental practices
The CDC resources certainly provide you with the knowledge needed to perform hand hygiene safely and effectively. Now, all that’s left is finding the right products for the task at hand. Speak with your Patterson Dental representative for quality gloves, soaps, lotions and waterless cleaners suitable for your dental practice.
Soap and water vs. hand sanitizer
In a busy dental office, it’s easy to see why staff might choose the convenience of a waterless sanitizer over washing with soap and water. But is one option better than the other? As explained in CDC guidelines, several factors determine the preferred method for hand hygiene: the kind of procedure, the level of contamination, and the desired length of antimicrobial action on the skin.
For routine dental examinations and nonsurgical procedures, either handwashing (with plain soap) or hand antisepsis (using antibacterial soap) is adequate. If hands are not visibly soiled, the use of an alcohol-based rub will suffice. Before and after performing surgery, however, the rules are stricter. Clinicians should perform a full surgical scrub before donning surgical gloves and must use soaps and alcohol-based hand rubs with continuous antibacterial activity to prevent transmission of bacteria to or from an operative wound.
Regardless of the product used, team members should always follow manufacturer instructions to ensure efficacy. Below is a step-by-step refresher on hand hygiene along with bonus tips for best practices.
Hand hygiene, the right way
Choosing which hand hygiene method to use depends on the circumstances. Here’s what the CDC suggests:
Alcohol-based hand rubs:
Suitable for routine dental examinations and nonsurgical procedures when hands are not visibly soiled.
- Dispense the recommended amount of product according to the manufacturer’s instructions
- Apply product to the palm of one hand
- Rub hands together until dry, making sure that all surfaces and fingers are covered
Handwashing with soap and water:
Suitable for routine dental examinations and nonsurgical procedures and when hands are visibly soiled.
- Wet hands first with water – do not use hot water
- Apply soap to hands
- Rub hands together vigorously for 15 to 20 seconds, covering all surfaces and fingers
- Rinse hands with water and dry with a disposable paper towel
- Use towel to turn off the faucet and then discard
Antimicrobial soap or alcohol-based surgical hand scrubs with continuous activity:
Suitable for surgical scrubbing.
- For an antimicrobial soap, scrub hands and forearms according to the length of time designated by the manufacturer
- When using an alcohol-based hand scrub, follow all manufacturer directions, but, before applying, be sure to wash hands and forearms with a plain (non-antimicrobial) soap
Hand hygiene: Special considerations
From product choice to technique, there are many considerations when performing hand hygiene. The following are a few frequently overlooked yet important things to remember:
- Jewelry: Before performing hand hygiene, remove all jewelry including watches and rings. This reduces the risk of cross-transmission and prevents jewelry from compromising the fit and integrity of gloves.
- Fingernails: Long, sharp fingernails can create a cross-transmission risk and potentially damage gloves. Avoid wearing artificial fingernails or extenders, and keep nails short with smooth, filed edges.
- Lotions: Moisturizing lotions, creams, and soaps are a great way to counteract the harm done by repeated hand washing and sanitizing. However, when selecting products, be wary of possible interactions petroleum or other oil emollients may have with glove material. Read all manufacturer instructions for both moisturizers and gloves to ensure safe use.
- Storage: Liquid hand-care products should be stored either in disposable closed containers or closed containers that can be washed and dried before refilling. Never top off (add soap or lotion) a partially empty dispenser – this can compromise product efficacy and possibly cause cross-contamination.
Selected references and further reading
Centers for Disease Control and Prevention. Recommendations from the guidelines for infection control in dental health-care settings—2003.
Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings. October 25, 2002.
Centers for Disease Control and Prevention. Hand hygiene. March 1, 2016.
HealthDay. Hand hygiene compliance rates peaked >90 percent in March 2020. April 28, 2021.
Molinari, JA. Effective, sensible, and safe hand hygiene. RDH. October 1, 2017.
Occupational Safety and Health Administration. Standard interpretations: Handwashing requirements. April 9, 1992.
Organization for Safety, Asepsis, and Prevention. FAQ: Hand hygiene.
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