Enhanced Verifiable CPD from the
University of Birmingham

Cross Infection Control
Hand washing

The main purpose of hand washing is to reduce the number of pathogenic (disease-causing) micro-organisms on the skin surface.

Warm water should be used when washing hands. Why is this better than cold water?

Each surgery must have at least one dedicated wash-hand basin. The UK NHS recommends that separate dedicated wash-hand basins for use by staff conducting decontamination should be provided. (In addition, two dedicated sinks should be available for decontamination work – including where an automated washer-disinfector is in use. These sinks should not be used for hand-washing.)

Taps should be hands-free. This means they can be turned on with the wrist or elbow, foot-operated, or have electronic sensors. This will prevent cross contamination from the handle.

How should you turn a tap off after washing your hands if it is not hands-free?

Solid soap? No!
Ordinary soap is not antibacterial – in fact, bacteria can grow well on soap. Using ordinary soap will remove obvious dirt, but may actually increase the amount of pathogens on the hands.

Even antibacterial solid soap will be remain contaminated on the surface after it is used.

Liquid or foam detergent hand wash, and dispenser
These are recommended for use in dental practices. The dispenser should ideally be “hands-free” – an infra-red beam detects when a hand is under the dispenser. Most experienced dental staff will have seen how dirty a “push-dispenser” gets after a while.

The detergent should be provided in sealed single-use bags

Antiseptic Hand Rub
Antiseptic Gel or Foam dispensers are commonly seen in hospital wards and corridors. They are sometime called Hand Sanitisers, Hand antiseptics, or Alcohol Rubs. They contain mainly alcohol, with a thickening agent like glycerine. Again, dispensers should be hands-free to prevent cross contamination.

They are used for killing bacteria and viruses on clean hands. They will not remove dirt.

Orange sticks for cleaning dirty nails.
These should be used when hands are initially washed to clean dirt from under the nails. This should be done gently. It is recommended (by HTM01-05) that nail brushes should not be used.

Scrubbing brushes? No
The dental team should not use scrubbing brushes to clean the skin. Why?

After rinsing, the hands should be dried with disposable towels. This is an essential part of removing dirt and bacteria, which are present in the residual water on the hands. Using a towel can decrease the bacteria on the hands by 75%.

Hot air driers, and jet driers, should not be used. This can actually increase the amount of bacteria on the skin, as well as spreading bacteria into the air.

The procedure

• Remove jewellery.
• Cover any skin abrasions with a waterproof plaster.

Washing (should take about 1 minute)
• Wet hands with warm water.
• Apply antiseptic hand wash.
• Wash hands using an approved technique (picture below).
• Use an orange stick, if necessary, to clean nails.
• Rinse hands under running water.
• Dry with a disposable towel.

Disinfecting (about 20 seconds)
• Use an Antiseptic hand rub until it has evaporated.

Sequence for hand washing and/or disinfecting

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Types of hand washing

1) Social Hand-wash

Routine for all patient contact. Use liquid or foam detergent from a dispenser.
This will remove 95% of transient micro-organisms from the hands. more…

2) Disinfection Hand-wash
Prior to undertaking operative procedures. Use liquid/foam detergent as above, then alcohol rub. This combination will remove 99% of transient micro-organisms, and some resident micro-organisms.

3) Surgical Scrub
Prior to undertaking surgical procedures. Use an antiseptic hand wash solution like Hibiscrub, Aquasept, Hydex etc, for two minutes. Include forearms. Effective against both transient and resident mico-organisms.

Alcohol rub technique

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The Hand Hygiene Policy

A practice should have a written policy for hand hygiene. For a printable version you can use in your practice, CLICK HERE

Click the picture below to magnify.

magnify Hand Care Policy

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