Proper Hand Hygiene in the Age of COVID-19

Hand washing, though it may seem simplistic during a pandemic, can actually be the most e­ffective way of preventing the spread of germs, including those that cause COVID-19. In fact, the U.S. Centers for Disease Control and Prevention (CDC) reports that both alcohol-based rubs and hand washing with basic soap and water can deactivate many types of microbes that can be passed between patients and dental professionals.

As dental practices navigate the recent challenges related to COVID-19 and work to implement strategies to protect patients and staff, a closer look at hand hygiene may prove helpful. Hand hygiene options include washing with plain soap and water, washing with antimicrobial soap and water, and cleaning hands with alcohol-based rubs. In some circumstances, surgical antisepsis may be recommended.

Hand washing with soap and water e­ffectively removes pathogens. In addition, soap also helps to destroy the lipid envelope that the pathogen is encased in, thus weakening the virus. The CDC also reports that sanitizers with at least 60% ethanol and 70% isopropanol, the active ingredients in most alcohol-based rubs, also e­ffectively kill viruses such as COVID-19.

Overall, hand hygiene is a key factor in infection prevention because it helps to stop the transmission of COVID-19 to the mouth, nose and eyes. However, many healthcare providers clean their hands only about half as often as they should.

Hand hygiene: step by step

Dental professionals should wash their hands between every patient anytime they come into contact with respiratory secretions and contaminated objects and materials. Implement these tips to ensure best practices:

  • Remove all jewelry, including watches, before washing hands.
  • Keep fingernails trimmed and neatly filed to about one-quarter inch with no sharp edges.
  • To wash with soap and water, first wet your hands. Then, apply a small amount of liquid soap to your palm.
  • Rub vigorously for at least 20 seconds, scrubbing between fingers, under fingernails, the backs of hands and the palms up to and including wrists.
  • Rinse hands under running water.
  • Dry hands completely with a disposable towel.
  • If the faucet doesn’t have an automatic shut-o­ff, use the towel as a barrier for turning o­ff the water.
  • When using an alcohol-based rub, wet hands entirely for about 20 seconds.
  • If hands are dry after applying the rub, apply more product.

All sinks in the dental practice should be cleaned frequently and provide easy access to adequate soap, water and disposable hand towels. Dental practice COVID-19 training should include reviewing hand hygiene directives and monitoring the cleanliness and availability of e­ffective sanitizing products.

The case for soap and water vs. hand sanitizer

There are benefits to hand washing with soap and water and to using alcohol-based hand sanitizers. Here’s what you should know about how best to navigate hand hygiene during COVID-19.

Use an alcohol-based hand sanitizer:

  • Immediately before touching a patient
  • Before performing an aseptic task or handling invasive medical devices
  • Before moving from work on a soiled body site to a clean body site on the same patient
  • After touching a patient or patient’s immediate environment
  • After contact with blood, body fluids, or contaminated surfaces
  • Immediately after glove removal

Wash with soap and water:

  • When hands are visibly soiled
  • After caring for a person with a known or suspected infectious disease
  • After known or suspected exposure to spores

Hand protection

Dental professionals have always contended with dry, cracked hands that result from frequent washing. In fact, it’s one of the reasons some clinicians give for not performing hand hygiene as often as they should. Follow these four steps to help protect your hands:

  1. Use mild, fragrance-free soap and apply just enough to remove dirt; it shouldn’t create a thick lather.
  2. Wash with warm (not hot) water.
  3. Pat dry; don’t rub.
  4. Apply a moisturizer (preferably cream or ointment rather than lotion) immediately after hands are dry.

Patients and hand hygiene

“Hand hygiene is implicated as one of the biggest contributors to healthcare-acquired infections,” explained Kandis V. Garland, RDH, MS, an associate professor in the Department of Dental Hygiene at Idaho State University in an article in Decisions in Dentistry: The Journal of Multidisciplinary Care. “Routine hand washing helps to get rid of transient bacteria.”

In accordance with CDC guidelines, Garland recommended providing hand sanitizing stations throughout each dental practice, so all team members and patients have access to alcohol-based rubs. The new normal for most dental practices is not only requesting that patients maintain social distancing while wearing masks but also ensuring that they sanitize their hands upon entering the office.

Hand hygiene product interactions and storage

To ensure that best practices are being followed to prevent infections, it’s important to understand the relationship between cleaning products and personal protective equipment (PPE). For example, oil- and petroleum-based products can weaken latex gloves, making them porous and resulting in cross-contamination. Water-based lotions are recommended when latex gloves are used. The CDC recommends seeking information from manufacturers about antimicrobial products and how they interact with PPE.

Dental practices also should consider how hand hygiene products are stored; they can become contaminated if left open or mixed with water or other substances. For example, liquid products are best stored in closed containers that can be dispensed via disposable containers or wall mounts that should be washed and dried before being refilled. The CDC does not recommend “topping o­ff” containers because the practice can lead to bacterial contamination between liquids, which can ultimately render even the best hand hygiene practices ine­ffective.

Recommended products

Hand Sanitizers and Creams

GOJO Industries’ PURELL Hand Sanitizer: The popular liquid sanitizer is available in a range of systems, including wall-mounted stations and bottles, as well as di­fferent forms like gel and foam. The sanitizer is designed to kill 99.99% of the most common germs, including COVID-19.

Patterson Dental Glove’n Care Hand Cream: This cream is designed to alleviate dryness and irritation that can result from wearing gloves and repeated hand washing. The hypoallergenic cream, which is water-based, includes ingredients mined from the Dead Sea.

Patterson Dental Waterless Antimicrobial Gel Hand Sanitizer: Designed to kill 99.99% of bacteria in 15 seconds, this alcohol-based sanitizer is enriched with aloe vera, keratin, and vitamin E to moisturize skin and prevent dryness.

Gloves

Patterson Dental Gloves: Patterson Dental’s glove options fi t many needs. The nitrile gloves are latex- and powder-free, and they provide tactile sensitivity and prevent contamination from blood-borne pathogens. The latex-free chloroprene gloves are designed for extended wear, and the multi-layer latex gloves are powder-free, provide elasticity, and are available in several colors.

Ansell MICROFLEX Gloves: Ultraform nitrile gloves are available in standard and half sizes. They are designed to o­ffer dexterity and protection from contamination. The ERGOFORM Ergonomic Design Technology supports musculoskeletal health for extended wear.  XCEED nitrile gloves are powder-free and help reduce muscle e­ffort. They are 90% stronger than standard latex. Neogard chloroprene gloves are designed to provide both wet and dry grip with tactile sensitivity, and they have a textured fingertip finish. Diamond Grip latex gloves are puncture-resistant and feature textured fingertips for dexterity. They are designed for extended use. NeoPro chloroprene gloves have the feel of latex with a fully textured grip. They provide both manual dexterity and tactile sensitivity.

Selected references

American Dental Association. Hand hygiene for the dental team. Boyce JM, Pittet D.

Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.

MMWR Recomm Rep. 2002;51(No. RR-16):1-45. Brody AV. Want to protect yourself from COVID-19? Step 1: Wash your hands. Decisions in Dentistry. March 13, 2020.

Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): Guidance for dental settings. June 17, 2020.

Centers for Disease Control and Prevention. Hand hygiene in healthcare settings: Show me the science. November 26, 2019. Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM.

Guidelines for infection control in dental health-care settings—2003. MMWR. 2033;52(RR17):1-61. Myers R, Larson E, Cheng B, Schwartz A, Da Silva K, Kunzel C. Hand hygiene among general practice dentists: Survey of knowledge, attitudes and practices. J Am Dent Assoc. 2008;139(7):948-57

Daw K. Hand hygiene: Are dental professionals doing it right? Dentistry IQ. December 11, 2019.

UCLA Health. COVID-19: How to care for dry hands after washing them so much. March 13, 2010.

– – – 

This article originally appeared in OnTarget.