CHLORHEXIDINE GLUCONATE. - This antiseptic is usually marketed as 4 percent chlorhexidine gluconate with 4 percent isopropyl alcohol in a sudsy base. Chlorhexidine gluconate is an effective antiseptic for reducing transient and resident microbial hand flora, and has a sustained antimicrobial effect. It does not appear to affect the skin adversely. Also, it is approved as a surgical scrub.

Waterless Handwashing Agents

Waterless handwashing agents contain 70 percent isopropyl alcohol and virtually disinfect the skin in 20 seconds. They are effective against tubercle bacilli, fungi, and viruses. Unfortunately, they are volatile, flammable, evaporate quickly, and dry the skin. Alcohol-based, waterless handwashing agents may be used in areas where handwashing sinks are not readily available.

HANDWASHING EQUIPMENT AND SOAP DISPENSERS

All patient care areas should have sinks with electronic or mechanical elbow, foot, or knee action faucet control for asepsis and ease of function.

The use of no hand (no touch) actuated soap dispenser controls is preferable. Maintenance for refillable handwashing agent dispensers is to empty, disassemble, and clean them weekly. Do not use bar soaps in bathrooms or clinical and common areas.

HANDWASHING GUIDELINES

All personnel involved in patient care must wash their hands, wrists, and forearms with a disinfectant soap and water at the following times:

At the beginning of each day.

Between patients, before and after going to lunch, after taking a break, after using the bathroom, or any time they become contaminated.

Before gloving, after degloving, and before regloving.

At the end of the day.

HANDWASHING TECHNIQUES

Dental staff personnel involved in patient care must follow a rigid handwashing protocol including the following practices:

Removing all jewelry and other ornaments from the hands and wrists

Trimming the fingernails and cuticles. Nails should be no longer than the finger tips to avoid puncturing gloves. Do not use false fingernails since contamination may occur from fungal growth between the false and natural nails. Also, do not wear nail polish since micro-organisms can hide in small cracks in the finish.

Wetting the hands under warm, running water and applying the necessary amount, if antimicrobial soap is required, to work up a lather. Vigorously rub the hands together, fingers entwined. This creates friction and loosens dirt and micro-organisms. Clean under the fingernails using a nail brush. Continue scrubbing the wrists and lower forearms. Visibly soiled hands may require more time.

Surgical teams must scrub their hands up to the elbows with an antimicrobial surgical product for the time specified by the manufacturer. After scrubbing, dry with a sterile towel.

When washing times are too short or technique is poor, these problems may occur:

Fingertips, thumbs, and the areas between the fingers are washed poorly or may be skipped entirely.

The dominant hand is generally washed less thoroughly than the nondominant hand.

Microbe counts under the fingernails have been found to remain high even after surgical scrubs.

Rinse soap off by placing hands under warm running water.

If the sides of the sink are touched, you must repeat the handwashing.

Dry hands with paper towels. If the sink does not have an electronic elbow, foot, or knee action faucet control, use a dry paper towel when turning off the faucet. 9-14