Guidelines for Practice Success | Managing Regulatory | Centers for Disease Control and Prevention Show
Proper hand hygiene is an effective way to help prevent the spread of infection between patients and dental health care workers during both routine procedures and more invasive oral surgeries. The best way to help ensure that your team knows, and follows, proper hand hygiene practices is to provide education and training. Within the dental setting, proper hand hygiene involves having team members wash hands with water and soap or an alcohol-based hand sanitizer when performing routine exams and nonsurgical procedures. When performing surgical procedures, the recommended protocol calls for team members to perform a surgical hand scrub and don surgical gloves. Soap and water should be used anytime hands are visibly dirty or soiled by body fluids; when hands are not visibly soiled, an alcohol based hand sanitizer is the preferred method of decontamination. Dental health care workers should wash their hands:
Effective handwashing practices include:
Thoroughly rubbing hands with an alcohol-based sanitizer is sufficient at other times. It’s important that each manufacturers’ instructions for use (IFU) be reviewed and followed for all products used when performing hand hygiene. Two helpful resources for guidance on proper hand hygiene are the Centers for Disease Control and Prevention’s (CDC) Guideline for Hand Hygiene in Health-Care Settings and its Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, which was issued in 2016. Some of the topics covered in those resources include:
The Occupational Safety and Health Administration (OSHA) also provides guidelines and regulations on adequate hand washing and hand hygiene products. Those guidelines call for dental healthcare personnel to wash hands with either regular soap and water or an antimicrobial soap and water anytime hands are visibly dirty or contaminated with blood or other body fluids. When decontaminating hands with an alcohol-based hand rub, CDC recommends applying the product and then massaging through the fingers until the product dries. More information is available in this FAQ on Hand Hygiene available through the CDC Division of Oral Health. Resources:
Hand hygiene and infection controlHand hygiene is a crucial action recommended for preventing and controlling the transmission of pathogens within healthcare settings to ensure that patients remain safe and that their risks of acquiring infection are minimized. Hand hygiene is an essential practice for all health-care workers (physicians/doctors, midwives, nurses, pharmacists, dentists, and other care providers including community health workers and family members) in order to protect the patients and themselves. The method employed in ensuring that hand hygiene is effective falls into one of two categories:
Correct method at the correct momentUnderstanding and employing the correct method and technique at the correct moment is highly likely to result in optimum compliance with hand hygiene and maximum safety of patients and staff. The advantages and disadvantages of both alcohol-based handrubs and handwashing with soap and water can be found throughout the WHO Guidelines on Hand Hygiene in Health Care. The following information is intended to support healthcare workers and others in understanding and explaining the challenges presented by patients with C. difficile infection, particularly in relation to hand hygiene. Specific challenges posed by patients with diarrhoeal illnessesPreventing and controlling the spread of all diarrhoea-related bacteria, viruses, and parasites is always important. One of the main actions in this regard is to ensure that hands are washed thoroughly with soap and water when they are: –visibly dirty or visibly soiled with blood or other body fluids; –after using the toilet; –when exposure to potential spore-forming pathogens is strongly suspected or proven, including during outbreaks of C. difficile. What is Clostridium difficile?Background information on C. difficile is available from a range of scientific and patient support documents. The following information is an overview of what C. difficile is and the problems it can cause. C. difficile is a bacterium (germ) that is present naturally in the bowel of some individuals. It can spread by touching faecally contaminated surfaces and then touching your mouth, e.g. when eating. It can also spread following contact with the faeces of people who have the infection, if the bacterium is ingested through your mouth. If someone is taking antibiotics to treat an infection, they can kill the good bacteria living in the bowel as well as the bad; when this happens C. difficile can grow quickly in the bowel and produce toxins that lead to disease. C. difficile is passed out in the faeces of people who are infected, including in the form of spores (a hardy form of the bacterium), which can survive for a long time in patient surroundings on any surface, e.g. toilet areas, clothing, sheets, and furniture, if these items are not regularly and appropriately cleansed. It is possible for anyone to spread the infection (to themselves or others) because they have not performed hand hygiene properly or kept patient surroundings clean. Elderly people and patients with comorbidities or who have had certain medical procedures to the bowel are especially at risk of getting C. difficile infection. Why have there been increasing numbers of cases in certain countries recently?This is not entirely clear, though it is known that a number of factors may be responsible, including natural changes to the way in which bacteria act in relation to their circumstances; for example, C. difficile becoming more resistant to antibiotics in response to their increased and more widespread use. The growing numbers of elderly, sick patients receiving care, the pressures on health-care workers to deliver care, and the way in which services such as cleaning are provided to health-care settings may all have had an impact. New strains of C. difficile have evolved in recent years that appear to spread more readily and may cause more severe cases of illness. It is also possible that the recommended practices for preventing and controlling C. difficile are not always applied for a number of reasons and may, as a result, be contributing to the current problem. Finally, in some countries where there has been no surveillance of C. difficile until now, reports of rising numbers may be explained because they are now looking for it. Can appropriate infection control practices help prevent and control Clostridium difficile?Yes, they can. It is recommended that gloves be worn (together with gown and application of other contact precautions) and hands washed appropriately if exposure to potential sporeforming pathogens is strongly suspected or proven, including C. difficile outbreaks. The method of hand hygiene to be employed must be handwashing using soap and water. Even when gloves have been worn, handwashing is essential. Of note, it is important that the correct technique for handwashing is applied. In all other health-care situations, alcohol-based handrubs remain the preferred method for hand hygiene and the most reliable method to ensure maximum compliance and efficacy to reduce health care-associated infections and cross-transmission of pathogens. What is the concern about health-care workers using alcohol-based handrubs at the point of care when patients have Clostridium difficile?There is concern because alcohol-based handrubs are known to be less effective on soiled hands generally and, specifically, when there is C. difficile infection. This is because of the handrubs’ inability to kill the C. difficile spores that at times can be present. Conveying simple messages to health-care workers, through routine training and updates, and reinforcing these during times of outbreaks will help to ensure that the correct methods for hand hygiene are applied at the correct moments. To sum up, these messages are repeated in the diagram. Should we remove alcohol-based handrubs from areas where there is Clostridium difficile infection?No. Alcohol-based handrubs are required at the point of care for a number of reasons:
Thus, alcohol-based handrubs should NOT be removed from health-care settings; to remove them would be likely to result in greater risk to patients from health care-associated infections. Are visibly clean (not soiled) hands still at risk for cross-transmission?It is very unlikely. Because handwashing with soap and water is recommended when exposure to potential spore-forming pathogens is strongly suspected or proven (this includes outbreaks of C. difficile), it is very unlikely that using alcohol-based handrubs on visibly clean hands will put patients at risk of cross-infection. In fact alcohol-based handrubs are effective in killing the non-spore form of C. difficile that can also be present. Therefore, appopriate glove use and adopting either means of performing hand hygiene on non-soiled hands will ensure clean, safe hands. The bottom line is to remember the message that hands should be washed thoroughly with soap and water when they are visibly dirty or visibly soiled with blood or other body fluids. How often will the spores be present when patients have Clostridium difficile infection?When patients with C .difficile have severe diarrhoea, large amounts of spores can be present. This is the basis of all the recommendations featured here. This is also true of specific strains of C. difficile, including those that are epidemic in certain countries. Effective hand hygiene at the point of care, together with other well-accepted control measures (in particular, glove use and gowning as part of contact precautions, and individual rooms), helps to manage the problem. Clostridium difficile figures are very high is some countries, and seem to have become worse. Is this because of alcohol-based handrubs?There is published evidence that the extensive use of alcohol-based handrubs in hospitals has not led to an increase in C. difficile. Does the promotion of alcohol-based handrubs imply the “downgrading” of sinks and handwashing?No. Guidance usually highlights the fact that handwashing is essential in specific situations (as described above). Although washing hands with soap and water remains an accepted method for routine hand antisepsis, alcohol-based handrubs should be promoted as the gold standard for hand hygiene considering, in particular, their dramatic impact on improving compliance with hand hygiene and ensuring clean, safe hands. What other key measures should be taken to prevent and control Clostridium difficile?There are several measures, including performing hand hygiene, that should be applied to prevent and control C. difficile infection, and these have been published widely. The following is a brief description of these key steps, which should be in place when C. difficile infection is present.
Washing of clothing (including staff uniforms), bed linen, etc. – both in health-care settings using industrial processes and in the home – is also important when someone has C. difficile infection. Careful handling of contaminated clothing is essential in order to prevent the spread of any of the bacteria or its spores to hands or other items. Key points to consider for laundering include:
Organizational steps are also important in aiding prevention and control. An adequate health-care infrastructure should be in place, including:
There are also other specific measures that are recommended during outbreaks of C. difficile (http://www.cdc.gov/ncidod/dhqp/id_Cdiff.html)1 SummaryPreventing and controlling the spread of all diarrhoeal diseases is important. The main message is that hands should be washed thoroughly with soap and water when they are: visibly dirty or visibly soiled with blood or other body fluids; after using the toilet; or when exposure to potential spore-forming pathogens is strongly suspected or proven, including during outbreaks of C. difficile. Performing hand hygiene using an alcohol-based handrub is the recommended and most effective method to clean hands in most patient-care situations. According to recent evidence, alcohol-based handrubs have been a major factor in the reduction of serious infections such as MRSA, for example in the United Kingdom. It is important that the correct technique for hand hygiene is always applied. 1 Vonberg RP, et al. Infection control measures to limit the spread of Clostridium difficile. Clinical Microbiology and Infection. 2008;14(Suppl. 5):2–20. [PubMed: 18412710] What does the CDC recommend for routine decontamination of hands?Alcohol-based hand sanitizers are the preferred method for cleaning your hands in most clinical situations. Wash your hands with soap and water whenever they are visibly dirty, before eating, and after using the restroom.
What type of hand washing is recommended by the CDC?Wash hands with soap and water for at least 20 seconds. Use the cleanest water possible, for example from an improved source. *If soap and water are not available use an alcohol-based hand rub that contains at least 60% alcohol.
What must hands be decontaminated with?An alcohol-based handrub should be used for hand decontamination before and after direct contact or care, except in the following situations when soap and water must be used: when hands are visibly soiled or potentially contaminated with body fluids or.
Which is the correct method to clean your hands after you provide care to a patient with C difficile a washing your hands B using an alcoholdifficile outbreaks. The method of hand hygiene to be employed must be handwashing using soap and water. Even when gloves have been worn, handwashing is essential.
|