Hand hygiene is a vital infection control measure that all dental practices need to perform to prevent the spread of microorganisms amongst patients, staff and visitors. When hands are not cleaned properly with hand wash and alcohol-based hand sanitiser, infections can strike and result in health complications such as inflammation or delayed wound healing, or in some cases even death; with 45 fatalities from dental infections occurring in Australia between 2007 and 2016 (ABS, 2017). Therefore, it is important that dental professionals, including dentists, dental assistants, dental hygienists, and practice managers are trained and use best practice in hand hygiene.
Recommended Use of Alcohol Based Hand Rubs
As part of the Hand Hygiene Australia protocol for hand hygiene measures, alcohol-based hand rub (ABHR) is highly recommended for all clinical situations (Australian Dental Association, 2015) in a dental environment.
According to Hand Hygiene Australia (n.d.), alcohol gel plays a critical role in the best practice of hand hygiene. The waterless solution is convenient, gentle on the skin and eliminates any tough bacteria that may have survived after hand washing within a minute.
Dental practitioners must provide TGA approved hand sanitisers in their dental practice to ensure it provides rapid disinfection and hand cleansing. Furthermore, sanitiser dispensers should always be positioned in working areas for patients, staff and visitors. Empty bottles cannot be refilled and must be discarded after use.
5 Moments of Hand Hygiene
Developed by the World Health Organization, there are five significant moments for performing hand hygiene.
As illustrated by the World Health Organisation (2009b), there are five distinct moments for hand hygiene applicable to all dental practices.
Before contact with a patient, e.g. shaking hands at reception
Before inserting an invasive medical device, e.g. oral suctioning
After cleaning any contaminated surface and soiled material, e.g. dentures
After contact with a patient, e.g. shaking hands at reception
After contact with a patient’s surroundings, e.g. dental chair
Hand Hygiene Application for Dental Professionals
Dental practitioners are required to perform hand hygiene on a continual basis to protect their patients, staff and visitors. Applying alcohol gel between patient visits and during disruptions for each appointment, prevents the spread of infectious agents in the dental practice setting (Australian Dental Association, 2015).
It is important for dentists to thoroughly wash hands with soap when visibly soiled, immediately before donning gloves, and immediately after doffing gloves with each patient interaction. The simple act of wearing gloves is not a substitute for hand hygiene.
Hand Hygiene Technique for Dental Professionals
Dental practitioners are primarily responsible for implementing a hand hygiene programme that measures up to the guidelines of Hand Hygiene Australia i.e. endorsing the use of alcohol gel in instances where hands are not visibly soiled (Australian Dental Association, 2015).
Dental professionals are expected to perform the correct technique in all aspects of hand care, including hand wash and sanitiser. When using alcohol gel, apply only to dry hands and rub together until completely dry. This method of hand hygiene is faster, more effective, and better tolerated than hand washing (World Health Organisation, 2009b).
Hand Hygiene Compliance
To improve compliance of hand hygiene in dental environments, practice managers are strongly advised to initiate a long-term plan that provides the infrastructure for hand washing and hand sanitising, continually trains staff in hand hygiene, examines areas of improvement for best practice and empowers positive change for everyone at the clinic. The WHO Multimodal Hand Hygiene Improvement Strategy (World Health Organisation, 2009a) is a five-year plan divided into five phases that rotate on an annual basis:
1. System Change
Separate sinks for strictly hand washing and strictly cleaning dental equipment are highly advised. Both water taps and hand wash dispensers should be automated, to avoid unnecessary contact with hands (Australian Dental Association, 2015). The accessibility and availability of hand hygiene determines its use at all points of care.
2. Education Programme
Both pre-service training and regular training for staff in infection control principles, policies, and procedures is fundamental in facilitating behavioural change at the clinic. Improving hand hygiene practices involves adopting the 5 Moments for Hand Hygiene in a dental setting and educating staff on correct techniques for how to hand wash and use hand sanitiser.
3. Observation and Feedback
To measure the effectiveness of the implementation strategy, direct observation of hand hygiene practices suitable infrastructure is required, in addition to delivering staff performance reviews.
4. Workplace Reminders
Providing visual cues, such as A4 posters, about the importance of hand hygiene, when to perform hygiene, and the correct procedures for hand sanitiser and hand washing, is a great opportunity to keep staff alert and pro-active in their daily work routine.
5. Hand Hygiene Safety Culture
The active support and commitment towards making positive changes for hand hygiene in the dental environment can only be achieved as a team. With all levels of staff and management promoting a culture of hand hygiene safety, the uptake of hand hygiene compliance will rise.
- Australian Bureau of Statistics 2017, Causes of death, Australia, 2016, ‘Table 1.2: Underlying cause of death, All Causes, Australia, 2007-2016’, data cube: Excel spreadsheet, viewed 15 May 2018, cat. no 3303.0 <http://www.abs.gov.au/ausstats/abs@.nsf/DetailsPage/3303.02016?OpenDocument>
- Australian Dental Association 2015, ADA’S Guidelines for Infection Control, Third edition
- Hand Hygiene Australia n.d., Alcohol Based Hand Rubs, viewed 17 May 2018, <https://www.hha.org.au/hand-hygiene/alcohol-based-handrubs>
- NHMRC 2010, Australian Guidelines for the Prevention and Control of Infection in Healthcare, Commonwealth of Australia, viewed 9 May 2018,
- ‘Thousands of dental patients in Sydney urged to undergo hepatitis, HIV testing over clinic hygiene breaches’ 2015, ABC News, 2 July, viewed 15 May 2018, <http://www.abc.net.au/news/2015-07-02/dental-health-hiv-hepatitis-scare-sydney-may-affect-thousands/6588534>
- World Health Organisation 2009a, Guide to implementation of the WHO multimodal hand hygiene improvement strategy, WHO, Geneva, viewed 18 April 2018, <http://apps.who.int/iris/bitstream/handle/10665/70030/WHO_IER_PSP_2009.02_eng.pdf>
- World Health Organisation 2009b, Hand Hygiene: Why, How & When?, WHO, Geneva, viewed 9 May 2018, <http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf>