Infection Prevention Starts with Clean Hands

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Both the CDC and the World Health Organization promote hand hygiene as the most important infection prevention tool. Today, we'll be focusing on the need -to-know information for dental professionals on hand hygiene. Our guest is Mary Govoni, an internationally recognized speaker, author, and coach focusing on infection prevention and control, OSHA, HIPAA, and ergonomics. She's a certified dental assistant and registered dental hygienist with 50 plus years of experience in the dental profession. Before we get started, I would like to mention that Mary's webinar titled A Pandemic Year in Review, Where We Are Now with Infection Prevention in Dentistry is now available as an on-demand webinar on vivalearning.com. Simply type in the search field Govoni, G-O-V-O-N-I, and you'll see it. It's an excellent webinar for the entire dental team and very timely. Mary, it's a pleasure to have you on Dental Talk. It's a pleasure to be here. Thank you. So we're talking about hand hygiene. Let me just begin with the first question. Why is hand hygiene so important? And in the scheme of things, especially in the dental operatory, how big an impact does it have on infection prevention and control? There's so many reasons why hand hygiene is so critical. The main one is that not only do we have... resident microorganisms, bacteria primarily on our skin that grow on our hands. But we have transient ones from when we touch surfaces like in a public setting, or we might touch something, a contaminated surface in a dental operatory if we didn't have gloves on and so forth. And then if you do not wash your hands and remove those transient microorganisms, if you touch your face, rub your eyes. especially you can then transmit those microorganisms to the mucous membranes of either your eyes, nose, or mouth. So it's important to make sure that we do not transfer any of those microorganisms to our patients on our hands, but we also need to make sure that we're not doing it even when we're out in public, that we're not picking up any microorganisms on our skin. What options do dental professionals have to clean their hands so that in the most efficient way they could get their hands in a state where they're not passing microorganisms down the pike? Well, the two options they have are soap and water wash or an alcohol-based hand rub. And both are... suitable for use in dentistry, I think you just have to look at what are you trying to accomplish. The alcohol-based hand rubs work very quickly to kill the transient microorganisms on the skin. And if they use them properly, meaning you use about a dime size portion of that product and you rub your hands, you go in between your fingers and so forth. and rub your hands together until all the product has evaporated, then you've got nice dry hands to put your gloves on and it's easier to put your gloves on than if they're wet. Soap and water. Doesn't have to be an antimicrobial soap unless it's a surgical procedure. It can be plain soap, so it's not irritating to your skin. And again, it's about a 20-second procedure where you wash in between your fingers, the juncture between your thumb and your index finger, and just keep lathering your hands and then rinse them. What I typically recommend is using alcohol-based hand rubs before a procedure, disinfect your hands, make it easier to put your gloves on, and then... use a soap and water wash at the end when you take your gloves off because you may have developed some little micro tears or micro pores in your gloves that have allowed some bacteria or some blood or saliva to get actually on your skin and you want to get it off. Alcohol products are not particularly good cleaners, but soap and water is. So there are different types of cleaning agents that you can purchase for the dental office. There's foams. there's lotions and can you go over some of the different, let's use the term formats or is that the right word? Yeah. Yeah. The different kinds of formats that these cleansers come in and anything that you feel through your experience may be more efficient and better for a dental operatory. Well, I think it really depends on what. is the preference of the dental team members. First of all, bar soap should never be used in a clinical setting because it can actually grow microorganisms in it. So we never use that. So you can use a liquid soap. You can use a foam. Foam products are also available in alcohol-based hand sanitizers. The best thing to do is to have a dispenser that can hold enough that you don't have to worry or be inclined to want to top it off because that's one thing you should never do with any kind of a hand care product. You use it until the container is empty, then you clean and disinfect the container before you refill it, but you just don't take some soap or hand sanitizer and keep topping off your container because remember the dispenser, whether it's the pump or underneath. where you might put your hands if it's a hands-free one, your hands are contaminated at that point. And so it's possible if you touch the opening on a hands-free dispenser or when you touch the pump, you can get some contamination on that product. But I really think it's a matter of preference. I find sometimes that the foam products that are alcohol, hand sanitizers, they're actually more of a benzoyl. colonium chloride or a quad based product. Sometimes they seem to leave a little stickiness or debris on the hands, but I think it's really a matter of preference. So we've talked offline about some of the different products that are available. And I know Gojo, which is very popular with Purell, they have a professional line and you mentioned you like their products. What is it about Gojo products that you like? Well, what I like about the product is that it has ethyl alcohol, which is considered to be the most effective. Not all the products that are out there on the market as alcohol hand sanitizers contain ethyl alcohol. And it comes in good size dispensers, but it also has a little bit of emollient in it so that it's not so drying to the skin. That makes a big difference. We don't want... skin to dry and crack, because that's obviously going to make a pathway for things we do not want to happen, which is getting an infection under the skin, a staph infection or so forth, which could then spread to another employee or a patient. So the advantages of using an alcohol-based hand rub in dentistry, sum up what those advantages are. Well, number one, they're very effective. They kill microorganisms on the skin very quickly, within about 10 seconds. Simple to use. And as I said before, if you use it before you glove up, then your hands are dry. As long as you keep rubbing until it's all evaporated, your hands are dry and it's easier to put the gloves on. Less chance that they will tear, less chance you're going to get moisture building up underneath that glove surface. So my... My recommendation to my clients is use that alcohol-based hand rub before you glove up and then wash your hands with soap and water after. But one of the big mistakes I see is that a lot of teams don't do anything. They don't use hand sanitizer. They don't use soap and water after they take their gloves off. They just take their gloves off and then go do whatever they're going to do. Dismiss their patient or... but it's very important to clean your hands after you take your gloves off. And what if an operatory had a dispenser of Gojo foam, alcohol rub based cleanser, and they just use that solely, dispense that on their hands, rubbed it around thoroughly, it evaporated, put their gloves on, took their gloves off after the procedure, went back to that foam dispenser, and they just didn't use soap and water. Is that okay? That is okay. According to the CDC guidelines, that is okay. The only thing that the CDC says, if there is a lot of debris on their hands, and there may not be after they take their gloves off, they can easily use that. Way back in 2002, the CDC introduced their guidelines for hand hygiene in healthcare settings, and that really put the...-based hand rubs on the map, so to speak, for use in healthcare. And they've updated that guidance, I believe, in 2018, and simply reiterating all the research that they've been effective. Absolutely. You could use just that. The one thing I think is interesting is that patients really pay attention to whether or not we wash our hands in dentistry. They don't necessarily in other areas of healthcare, but when people first started using the alcohol hand rubs, routinely patients were questioning, well, I didn't hear the water run. Did you wash your hands? Now I think more people are used to that. And I recommend that we keep some. hand sanitizer right at the front desk. So when patients come in or we allow the patients, we give them some hand sanitizer when we sit them in the chair and let them, you know, clean their hands because we don't know where their hands have been. And we don't want, again, to miss an opportunity to prevent the spread of bacteria and viruses. So we talked offline briefly, Mary, about the tridemic, which is now. in progress. You know, a few months ago, we were confident that the COVID-19 pandemic was waning and we're kind of coming out of it and people aren't wearing masks as much in the grocery store and in the restaurants and whatever, maybe still on the airplane. I don't know what they're doing on planes. I haven't traveled too much lately. What's going on with this tridemic and how much at risk is a dental professional compared to the way they were during the COVID crisis? Great question. Well, the tridemic that... and the World Health Organization are talking about right now, and particularly the CDC and the US is influenza. Influenza rates are already setting records for this early in the flu season. And we've already seen a number of deaths, I think somewhere close to 800 deaths from flu already, including three or four children. And then we have the RSV or respiratory syncytial virus that is just running rampant among children, so much so that the hospitals, the pediatric units and the pediatric hospitals are just overrun with these cases. And there have been some deaths due to RSV. And then we have new variants of COVID, what some of the public health experts now are calling the Scrabble variants, because they start with the letters that are the high value letters in a Scrabble game, which I think is. Funny. But these variants of Omicron are vaccine evasive. They don't make people as sick, which is the good news. So the bad news about COVID is it's continuing to spread. It's probably going to spread more over the holidays, the upcoming Thanksgiving holiday travel season, and then going into the December holidays, along with flu and RSV. And there's the potential for people to be co-infected with. all of the above. So it's a very serious thing. And we need to go back to the basics of, are we washing our hands? Are we cleaning our hands? Not only when we're in the dental office, but when we're out in public and we come home from doing things, but dental team members can certainly be at risk. They should still be screening their patients for respiratory symptoms and asking if they have a fever and not treating patients that have respiratory symptoms, reschedule them. And depending on what the COVID transmission levels are, or the influenza levels are, if they're high in a particular area, then there's no shame in asking your patients to wear a mask when they come in, just like we did during the height of the pandemic. But we need to let the patients know that we're doing it for everyone's safety. And I've seen in my area, In the last couple of weeks, people starting to take this seriously about the flu because more and more people that I see are wearing masks. And I do still see some people wearing a mask on an airplane, which I think is good. I'm not sure I ever want to fly again without wearing a mask on a plane. Hand hygiene, as you said, is very, very important, but it's only one component to infection prevention and control because we have aerosols and we need face masks and all the other things we do in the office, barriers. The bottom line is we have to maintain everything we were doing during the COVID crisis because this is not going away. And although the death rate from COVID has declined dramatically, we still are facing a pandemic to some extent that is something we have to take very seriously. We certainly don't want people to get sick when they come to the dental office. No, absolutely not. And just because we're not hearing so much about COVID on the news all the time, and unfortunately our president declared the pandemic over, it's really not over. And just because people are not getting so seriously ill that they're hospitalized or they're dying from COVID doesn't mean we don't still need to do the things that we know work to help prevent the spread because we don't know. all the potential effects from long COVID at this point. And there seem to be some pretty serious ones. So it may not be a serious case, may not make people really sick, but they still may end up with long COVID. And from a public health standpoint, we have an obligation as healthcare professionals to try to prevent the spread, COVID, influenza, whatever we can. Thank you so much, Mary, for the insight that you continue to bring to Viva Learning. And again, I recommend highly. Mary's webinar, a pandemic year in review where we are now with infection prevention and dentistry. So please take the time to watch that so we can all be on the same page as far as what the CDC is recommending for our dental clinicians in the operatory. Thanks so much, Mary, and have a great and a happy holiday season. Thank you. And you too.