Enhanced Verifiable CPD from the
University of Birmingham

Hands and HTM 01-05

The UK Department of Health published guidance on dental cross-infection control in a book called "Decontamination Health Technical Memorandum 01-05: Decontamination in primary care dental practices." (Updated 2013)

UK practices are expected to follow this guidance when decontaminating.

Note: this guidance is for decontamination procedures. It is not about clinical and surgical procedures.

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Hand hygiene

6.1  The term hand hygiene covers not only hand-washing, but also alternative and additional measures such as hand disinfection using antibacterial-based hand-rubs/gels.

6.2 Hand hygiene is crucial in preventing the spread of infection and the recontamination of surgical instruments and devices. Clean hands are an essential counterpart to the use of gloves. Neither measure is a substitute for the other.

6.3 As part of essential quality requirements, training in hand hygiene should be part of staff induction and be provided to all relevant staff within dental practices periodically throughout the year. .

6.4 There are three different levels of hand hygiene (see Appendix 2). The level required depends on the potential for contamination of the hands and the risk factors related to the process to be undertaken. For the decontamination of devices, as described here, good levels of social hand hygiene will be sufficient. Accordingly, the aim is to render the hands physically clean and to remove transient microorganisms encountered in the performance of normal duties.

6.5 Hand hygiene should be practised at the following key stages in the decontamination process so as to minimise the risk of contamination:
• before and after each treatment session;
• before and after the removal of PPE;
• following the washing of dental instruments;
• before contact with instruments that have been steam-sterilized (whether or not these instruments are wrapped);
• after cleaning or maintaining decontamination devices used on dental instruments;
• at the completion of decontamination work.

6.6 Mild soap should be used when washing hands. Bar soap should not be used. Apply the liquid soap to wet hands to reduce the risk of irritation, and perform hand-washing under running water. Ordinarily, the hand-wash rubbing action should be maintained for about 15 seconds. After the exercise, the hands should be visibly clean. Where this is not the case, the hand hygiene procedure should be repeated.

Drying of hands

6.7 Effective drying of hands after washing is important because wet surfaces transfer microorganisms more easily than when they are dry, and inadequately dried hands are prone to skin damage. To prevent recontamination of washed hands, disposable paper towels should be used.

Skin care

6.8 Hand cream, preferably water-based, should be used to avoid chapped or cracking skin. Communal jars of hand cream are not desirable as the contents may become contaminated and subsequently become an infection risk. Ideally, wall-mounted hand-cream dispensers with disposable cartridges should be used. Any staff that develop eczema, dermatitis or any other skin condition should seek advice from their occupational health department or general practitioner (GP) as soon as possible.
6.9 Fingernails should be kept clean, short and smooth. When viewed from the palm side, no nail should be visible beyond the fingertip. Staff undertaking dental procedures should not wear nail varnish and false fingernails.

6.10 Rings, bracelets and wristwatches should not be worn by staff undertaking clinical procedures. Staff should remove rings, bracelets and wristwatches prior to carrying out hand hygiene. A wedding ring is permitted but the skin beneath it should be washed and dried thoroughly, and it is preferable to remove the ring prior to carrying out dental procedures.

Facilities and procedures for hand-washing

6.11 In accordance with the advice above, a separate wash-hand basin should be provided:
• The basin should not have a plug or an overflow and be fitted with a remote running trap (that is, the U-bend is not directly under the plughole).
• It should have a sensor-operated or lever-operated mixer tap.
• Taps should not discharge directly into the drain aperture as this might generate aerosols.

6.12 Wall-mounted liquid hand-wash dispensers with disposable cartridges should be used. It should be ensured that the nozzle is kept clean. Refillable hand-wash containers should not be used as bacteria can multiply within many of these products and are therefore a potential source of contamination.

6.13 Hand hygiene is an essential part of preventing infection in the practice. A cleanable poster depicting a six- or eight-step method should be displayed above every clinical wash-hand basin in the practice (see Section 3).


Hand hygiene

What do you understand by the term "hand hygiene" ?



Hand hygiene is crucial in preventing the spread of infection and the recontamination of surgical instruments and devices. Clean hands are an essential counterpart to the use of gloves. Neither measure is a substitute for the other.

When should staff be trained in hand hygiene?



For the decontamination of devices like dental instruments, what level of hand hygiene is appropriate?



At what stages in the decontamination process should hand hygiene be practised so as to minimise the risk of contamination?



Drying of hands

Why is effective drying of hands after washing important?



Why should disposable towels be used?



Skin care

Hand cream, preferably water-based, should be used to avoid chapped or cracking skin.
Why are communal jars of hand cream not desirable?



What is the ideal type of hand-cream dispenser?



What should staff that develop eczema, dermatitis or any other skin condition do?



Fingernails should be kept clean, short and smooth. When viewed from the palm side, how much nail should be visible?



What are the rules regarding nail varnish and false fingernails?



What are the rules regarding rings, bracelets and wristwatches?



Facilities and procedures for hand-washing

In accordance with the advice above, a separate wash-hand basin should be provided:
• The basin should not have a plug or an overflow and be fitted with a remote running trap (that is, the U-bend is not directly under the plughole).
• It should have a sensor-operated or lever-operated mixer tap.
• Taps should not discharge directly into the drain aperture as this might generate aerosols.

What type of liquid hand-wash dispensers should be provided?



Hand hygiene is an essential part of preventing infection in the practice. A cleanable poster depicting a six- or eight-step method should be displayed above every clinical wash-hand basin in the practice.

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