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
HANDWASHING EQUIPMENT AND
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.
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
Before gloving, after degloving, and before
At the end of the day.
Dental staff personnel involved in patient care
must follow a rigid handwashing protocol including
the following practices:
the hands and wrists
Removing all jewelry and other ornaments from
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
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
poor, these problems may occur:
short or technique is
Fingertips, thumbs, and the areas between the
fingers are washed poorly or may be skipped
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.