Mary Govoni, CDA, RDA, RDH, MBA
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Dental professionals have a variety of choices when it comes to hand hygiene products and techniques. While these many options are good, it may be difficult at times to decide what product or technique is appropriate for the various situations that dental professionals encounter.
Let’s take a look at what to use and when. The first thing to know is that bar soap is never appropriate for health-care settings. Bars of soap can serve as reservoirs for bacterial growth. Scrub brushes that have been used in the past can also be reservoirs for microbes, and can abrade the skin. They should not be used in health-care settings. For surgical procedures, sponges saturated with antimicrobial soaps are appropriate for hand washing. Orangewood sticks can be used to clean under fingernails prior to surgeries.
According to the Centers for Disease Control and Prevention, antimicrobial soaps are recommended for surgical procedures but no specific recommendation is made for the use of antimicrobial soaps for nonsurgical procedures. Given this recommendation, skin sensitivity may be a factor in the choice of soaps for nonsurgical procedure. A good choice is Hu-Friedy’s Antibacterial Soap, which is clear (dye-free) liquid soap with .5% triclosan, an effective antimicrobial agent that is less irritating to skin.
If a particular soap is drying to the skin, as is the case with many products with a 4% concentration of chlorhexidine, a less-drying product should be used. SaniClenz from Crosstex has a 2% concentration of chlorhexidine and is much less drying to skin. Dry skin easily cracks and can lead to potential skin infections. Most plain soaps are nondrying to the skin and are good choices, especially in cold weather months when skin tends to dry out even more. Some good choices are Hu-Friedy Hand Essentials Lotion Soap, and VioNexus Foaming Soap with Vitamin E from Kerr Total Care.
Sometimes the soap dispenser is as important as the soap. Foam soaps tend to be slightly less messy than liquid dispensers since the foam does not drip on surfaces. Touch-free dispensers such as VioNexus No-Touch dispenser are available, and can reduce the potential for cross-contamination by touching the dispenser with dirty hands.
But it is important to note that liquid soap dispensers should never be “topped off.” The CDC recommends that the dispenser be emptied, disinfected, and then refilled since some cross-contamination may have occurred by touching the dispenser prior to washing hands.
Many dental professionals have incorporated the use of alcohol-based, waterless hand sanitizers into their hand hygiene protocols. While these products have been shown to be effective in controlling the number and regrowth of microbes on the skin, they are not effective at removing debris from the hands. Washing hands with soap and water after completing a procedure and removing gloves is most appropriate since some saliva or blood may have penetrated through small tears or openings in exam gloves. Using an alcohol hand sanitizer prior to donning gloves may be desirable since the alcohol evaporates quickly, and it is easier to put gloves on dry hands than on damp hands that have not been adequately dried after soap and water washing. In some cases, especially surgical settings, soap and water washing is followed by the use of an alcohol hand sanitizer for additional protection.
While alcohol-based products have been shown to be effective, daily use of these products can be drying to the skin. Many of the over-the-counter products have lower alcohol levels to lessen the drying effect. But alcohol levels below 60% isopropanol or ethanol are not proven to be as effective. The CDC recommends alcohol concentration between 60% and 95%. Recent studies have affirmed that the higher the alcohol concentration, the more effective the product.
But it is important to choose a product that also has some moisturizer incorporated into the gel or solution to balance the drying effect. For example, Sterilium Comfort Gel from Hu-Friedy has 85% ethanol for greater effectiveness and several emollients to moisturize and combat dryness of the hands. SaniTyze Waterless Moisturizing Antimicrobial Gel from Crosstex has aloe vera, keratin, and Vitamin E to help keep hands moisturized.
It is always tempting to choose over-the-counter products for hand hygiene in dental facilities since many of these products tend to be less expensive and can be purchased in bulk at discount stores. These products may not be as effective (e.g., lower alcohol concentrations), or may not have specific additives or moisturizers that have been used and studied in health-care settings. Over-the-counter products are developed for normal household use. Hand hygiene products that are developed and distributed specifically for health-care applications are typically more appropriate products for dental professionals. After all, our hands are worth it!
Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Clinical Dynamics, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected].