Hand Hygiene Recommendations from ICP Expert, Dr. Marie Fluent

You're listening to The Dr. Phil Klein Dental Podcast Welcome to Dental Talk. I'm Dr. Phil Klein. One of the simplest action items for the dental team is practicing proper hand hygiene, yet it still remains one of the most misunderstood methods to prevent the spread of microbes. Today we'll talk about hand hygiene focusing on product considerations and how to improve dental team compliance. Our guest is Dr. Marie Fluent, who has an extensive dental career spanning 35 years as a dental infection control clinical instructor, educator, speaker, author, and consultant. Dr. Fluent is passionate and deeply committed to improving dental infection control and patient safety. Through her writing, webinars, and invited lectures, she has educated thousands of dental professionals and students nationally and internationally. titled Hand Hygiene in the Era of a Global Pandemic and Beyond, is now available as an on-demand webinar on VivaLearning.com. Simply type in the search field Fluent, F-L-U-E-N-T, and you'll see it. It's an excellent webinar for the entire dental team, and an important one. Dr. Fluent, it's a pleasure to have you on Dental Talk. Well, thank you. Thank you, Phil, for the opportunity and to follow up for my webinar. We're certainly very happy to have you on the show. So let's begin with an all-encompassing question. Why is hand hygiene so important in healthcare and dentistry? Well, hand hygiene is the most important thing that we can do to prevent disease transmission in any healthcare setting, including dentistry. It seems common sense. It seems very simple. It is known to be very effective, but unfortunately, our compliance rate is pretty... i'm going to say pretty fair to low i hope that's improved a little bit with covet 19 but historically our compliance rate is uh about 50 so in dentistry we need to really up our game and uh do a better job so to speak and there's lots of things that we can do to make our to make it our hand hygiene much more effective and to prevent disease transmission under our watch and make every uh dental visit a safe dental visit how out of curiosity do you measure compliance so you mentioned 50 how does that number come about Well, those numbers come to us mostly from inpatient settings. And as you know, Phil, we are an outpatient setting. In inpatient settings such as hospitals, they have many more ways of collecting data and measuring compliance, like electronic monitoring systems. But we don't really have those in dentistry, so we really rely on our own integrity and ethics and other compliance measures to make sure we're doing what we need. supposed to be doing. And that's one reason why I want to stress the importance of hand hygiene and dentistry over other health care settings is because we're basically relying on ourselves rather than anybody else or any institutional settings to push us in the right direction. So everyone knows they're supposed to use alcohol-based hand rub or wash their hands. So why do we need policies and protocols? Well, as I already mentioned, our compliance rate is relatively low in all healthcare settings, not just dentistry. I'm not just pointing the finger at dentistry. Keep that in mind. But with our compliance rate being low, like at the 50% mark, that means you could actually flip a coin to determine whether or not your healthcare provider performed adequate hand hygiene, and that's pretty pathetic. So like I said, in dentistry, it's hard to measure compliance in dentistry. So we are relying on ourselves. And the important thing to remember when it comes to ethics and integrity is what are you doing when nobody is watching, especially with hand hygiene? And because we're relying on that, we have to have policies and protocols in place and motivational means of compliance, as I mentioned. And some of the things that we can rely on in dentistry include like having a buddy system where you watch. each other perform hand hygiene and give an encouraging nudge or a pat on the back for a job well done. Training and education is important. Leadership support and leadership demonstration of adequate hand hygiene is important. Sometimes we can create reminders and screen savers, if you will. And overall, we want to create a culture of safety where everybody feels free to speak up and say something if something seems awry a quick little for instance I took my father to an emergency room for an infection on his leg not a dental setting but a medical setting and the health care provider did not perform hand hygiene and I sat there considering do I speak up or don't I speak up and this was pre COVID-19 I think one thing COVID has done for us is given us the okay to be a little infection prevention aware and speak up when something seems awry. But to get back to your question that because of all of these reasons of lack of compliance and um our own accountability it's important to have policies and protocols in place a written hand hygiene program that everybody has read understands and knows that they are required to follow in the dental facility yeah and practices could purchase these guidelines from companies that specialize in training but also they can go directly to the cdc right and also osha Between the CDC guidelines and OSHA standards, it would require a little bit of work to sift through all that and simplify it for the dental team. Or I guess you can just purchase those booklets from a company that specializes in that. Well, better yet, those are available free of charge. And some of the resources I wanted to share with you were our own CDC guidelines. The original blueprint document is Guidelines for Infection Prevention in Dental Healthcare Settings 2003. And then CDC came out with a summary of these guidelines in 2016. And both of these are available free of charge from the CDC website, and they can be downloaded and looked at at any time you want. In addition to that, there's another hand hygiene-specific document called Guidelines. for Hand Hygiene in Healthcare Settings that was published in 2002. Keep in mind that this document has much more in-depth information than the dental-specific guidelines have. But if you wanted to get into the nitty-gritty, the science and understanding, the formulations, hand hygiene for surgical hand antisepsis, et cetera, all of the nitty-gritty details would be included in this 2002 guideline for hand hygiene. and health care settings. Now, one reference and resource that I do want to share with you is that CDC came out with a new app that you can download from your on your cell phone whether it be an iphone device or an android device it's called cdc dental check cdc dental check once again available free of charge and if you download it it will give you access to each of the documents i just shared with you and you will have them readily available at your fingertips so i would like to share all of those resources for dental team members and encourage everybody to have access to the CDC Dental Check app. And thus, you would have quick and easy access to the other documents that I just shared as well. Yeah, thank you for sharing that. Can you tell us which products should and shouldn't be used for hand hygiene in healthcare? And can you also address whether these products can be simply purchased over the counter? Well, it seems like you should be able to purchase them over the counter, but... That's a bad idea, Phil. We should only be using medical grade products. That is products that are intended to be used in health care settings, including dental settings as well, not over-the-counter at-home products. And there's different reasons for that. In dentistry and health care, we're performing hand hygiene numerous times a day. I know when I was practicing clinically, I would wash my hands or perform hand hygiene 50 or 60 times during a rotation or a clinical shift, if you will. are in an orthodontic practice even more than that maybe double that amount so medical grade products actually have skin conditioning agents or emollients in them that are meant to protect the epidermis of our hands and keep our the integrity of our skin intact they're actually easier and more gentle on our skin because the manufacturers know that the integrity of our skin is our first line of defense against any microorganisms that might come in our pathway. So not only do we need products that are effective, but we need products that are gentle as well. So in addition to that, we want to make sure that our products are compatible with the gloves that we use and the other hand hygiene products that we are using as well. We want a product that is effective, that has a pleasing fragrance and a minimal fragrance. or allergenic to our team members or our patients when it comes to lotions it's important to have a lotion that doesn't have a greasy feel to it once again if you have a residue on your hands or a greasy feel it's going to impact how easy you it is to put on your gloves and remove your gloves so we need something that dries quickly and is not not greasy or leaves residue. And then finally, we want something that's acceptable to all of our team members. And that's a very important point because if a team member likes the product, they're more likely to use the product. On the other hand, if they don't like the product or it's offensive to them in some way, shape or form, they're less likely to use it and be less compliant. of those points that I mentioned are very important when it comes to product selection. And in general, all of the medical grade products check each of these boxes and would be acceptable for use in a clinical setting, including dentistry. That's great information. And thank you for that, Dr. Fluent. Gojo Industries makes a product called Purell, which can be purchased over the counter. Is there also a professional line that they offer the dentists that have? all the attributes you just discussed absolutely absolutely and in general the gojo products are fantastic and they are available in the infection control section of your product catalogs and they make a complete lineup of hand hygiene products that are available to be used in any health care setting including dentistry and those professional products they are different than consumer products i assume These products are designed to be used over and over again. Like you mentioned, you wash your hands sometimes 60 times in a day, and that's way more than someone at home would wash their hands. Absolutely. During my days at home, I'll wash my hands three or four times, morning or afternoon, whereas in a clinical setting, many, many more than that. One other factor to keep in mind with medical-grade products is efficacy, that the FDA approves these products, and the degree of efficacy is much more stringent for healthcare settings than it is for over-the -counter products. For instance, If you purchase an over-the-counter product and it says kills most germs upon impact or whatever, does it do that? We don't really know. But a health-grade product, if it says kills X number of microorganisms in X amount of time, the FDA jurisdiction of that is much more stringent and will have efficacy against those microorganisms in that period of time. So that's another large factor as well. Dr. Fluent, thank you very much for your information and your insight into hand hygiene. It was very, very informative. I would like to thank Gojo Industries for sponsoring this podcast and also the webinar that Dr. Fluent did previously. And we really appreciate their focus on professional development, especially in the areas of infection control and prevention. Hope to see you on a future podcast soon. Thank you so much. And thank you for your hospitality. And I look forward to our paths crossing again.