​Jenny Nixon explains why hand hygiene remains one of the easiest but most important ways to control the spread of infections.

Hand hygiene is the leading measure for preventing the transmission of healthcare – associated infections (HAIs) and is essential for the provision of safe healthcare. HAIs can affect the quality of health care services, pose a serious risk to patients, staff and business owners and incur significant costs for the NHS.

The importance of hand hygiene came under intense spotlight during the covid pandemic, with governments and healthcare organisations worldwide promoting handwashing as one of the best ways to prevent the spread of pathogens.

In 2020, a research study from UCL found moderate frequency handwashing (six to ten times a day) was associated with a significantly reduced overall risk of contracting coronavirus (36 per cent reduction compared to those who washed their hands zero to five times daily).

At the same time, supermarkets were forced to place restrictions on items such as anti-bacterial wipes and hand soap in a bid to prevent shoppers from stockpiling amid coronavirus fears.

Consumer handwashing

The Food Standards Agency (FSA) has a vested interest in hand hygiene behaviours as poor hygiene can contribute to foodborne diseases, such as E. coli and norovirus, whilst good hand hygiene can reduce the risks of cross-contamination.

Results from an FSA handwashing tracker survey indicated that some handwashing behaviours established during the pandemic have declined. Between April 2020 and January 2022, participants who reported handwashing with soap and warm water ‘always’ or ‘most of the time’ declined from 79 per cent to 68 per cent.

There was also a significant decrease in participants who reported ‘always’ washing their hands before cooking or preparing food, before eating, after handling rubbish and when arriving home or after a trip out.

Participants who reported carrying and using hand sanitising gel as a hand-washing alternative peaked in October 2020, but this proportion of participants has significantly decreased over time.

Stopping the spread

Acute respiratory infections (ARIs) are common, particularly during the winter months, and include the common cold, flu and respiratory syncytial virus (RSV), while covid and its variants remain at large.

ARI-causing pathogens can be transmitted via airborne, surface or person-to-person contact routes. According to a review in The Lancet, “handwashing with soap can prevent many ARIs by mechanically removing pathogens from hands, and by rupturing many bacteria and viruses” and concluded that, “promoting handwashing with soap more broadly could reduce the large endemic burden of respiratory disease”.

In dental practice, because so many infections are spread through respiratory droplets that can be breathed in by others or settle on surfaces, proper surface disinfection is essential, particularly routinely touched surfaces such as door handles, light switches, reception desks and surgical equipment.

Hand care best practices

A dental practice has a duty of care to ensure it is managed in accordance with current regulations and guidelines regarding hand hygiene. There are key stages when hand hygiene procedures must be performed:

  • Before and after each treatment session.
  • Before and after removal of PPE.
  • Following manual cleaning of dental instruments.
  • Before contact with instruments that have been autoclaved
  • After cleaning or maintaining decontamination devices used for dental instruments.
  • After completion of decontamination work.

Although gloves are routinely worn for all clinical and decontamination processes, they are not a substitute for hand hygiene as microorganisms can flourish under gloves. Gloves can also be pierced, torn or become porous over time and a study has shown a perforation rate of 10.3 per cent. Hand hygiene must be carried out before putting gloves on and after taking them off.

Skincare for staff

Hand care products specifically formulated for healthcare settings are designed to target the pathogens that can cause illness. These products are generally perfume-free, have fewer allergenic components and are designed for repeated use throughout the working day. They should also contain emollients and skin conditioners to help counteract any dryness and cracking of the skin.

HTM 01-05, SDCEP and other local regulations recommend the use of wall-mounted touchless dispensers with disposable cartridges for dispensing hand wash, creams and gels. These allow the liquid to be dispensed in a measured dose, which is cost-effective, avoids human contact, and significantly reduces the chance of contamination.

In some instances, it is recommended to use an alcohol hand rub as a supplement or alternative to hand washing with soap and water. However, while alcohol is an effective disinfectant for clean hands, visibly soiled hands must be washed with liquid soap first.

As we all found out during the pandemic, frequent handwashing can lead to dryness and alcohol rubs can be painful when used on cracked or dry skin. The use of a water-based moisturising cream or lotion can help to mitigate the risk of skin irritation.

Communal tubs or jars of hand cream are not desirable as the contents can easily become contaminated and subsequently become an infection risk. In the same way, practices should avoid using alcohol gels or sanitising foams from supermarkets as these domestic options are not tested for efficacy within healthcare environments, as professional products are.

Stop the spread

Hand hygiene is one of the simplest but most important measures to prevent the spread of health care-associated infections. Following correct hand hygiene procedures and selecting appropriate hand hygiene products are all important elements of a practice’s infection control policy.

All staff should be provided with and encouraged to use compliant, high-quality hand hygiene products that reach British and European industry standards to provide both patients and staff with the best possible protection from potential infection risk.

References available on request.

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