Table 2: Hand Hygiene Methods and Indications Method Agent
Duration (Minimum)
Purpose
Indication
Routine handwash
Water and nonantimicrobial soap.
Remove soil and transient microorganisms. Remove or destroy transient
15 seconds.
Before and after treating each patient. After barehanded touching of inanimate objects likely to be contaminated by blood or saliva. Before leaving the dental operatory or the dental laboratory. When visibly soiled. Before regloving after removing gloves that are torn, cut, or punctured.
Antiseptic handwash
Water and antimicrobial soap.
15 seconds.
microorganisms and reduce resident flora.
Antiseptic hand run
Alcohol-based hand rub. Remove or
Rub hands until the agent is dry.
destroy transient microorganisms and reduce resident flora. Remove or destroy transient microorganisms and reduce resident flora (persistent effect).
Surgical antisepsis
Water and antimicrobial soap OR water and non- antimicrobial soap, followed by an alcohol-based surgical hand-scrub product with persistent activity.
2-6 minutes. Follow manufacturer instructions for surgical hand- scrub product.
Before donning sterile surgeon’s gloves for surgical procedures.
Note . Adapted from Table 2 in “Guidelines for Infection Control in Dental Health-Care Settings – 2003,” by W. G. Kohn, A. S. Collins, J. L. Cleveland, J. A. Harte, K. J. Eklund, and D. M. Malvitz, MMWR Recommendations and Reports, 52 (RR-17), pp. 1-61. NEEDLES AND SHARPS SAFETY
Injuries with contaminated sharp instruments and needles pose a risk of bloodborne disease transmission to DHCP. In a review of national surveillance data collected between 1995 and 2004, researchers examined occupational exposures among DHCP in healthcare settings, including the types of injuries that occurred, the circumstances surrounding the injuries, and the individuals involved. General practice dentists sustained the greatest number of injuries during that time, followed by oral surgeons (Cleveland, et al., 2007). Attempts to reduce percutaneous or “sharps” injuries in dental settings have included reducing the use of needles, eliminating or isolating injury hazards by using sharps containers, needle-recapping devices, or self-sheathing needles, and instituting workplace controls (e.g., placing sharps containers closer to the point of use, recapping needles with one hand, and not passing unsheathed needles) (Cleveland, et al., 2007). Because the majority of injuries involve needles, reducing or preventing these injuries is an important goal of an infection control program, and protocols for handling contaminated sharps are emphasized. Strict regulations by Cal/OSHA, the Dental Board of California, CDPH, and other agencies address the use, handling, and disposal of sharps. Section 1005 stipulates that “needles shall be recapped only by using the scoop technique or a protective device. Needles shall not be bent or broken for the purpose of disposal” (California Code of Regulations, 2011). And all instruments that have the potential for injury, such as “disposable needles, syringes, scalpel blades, or other sharp items or instruments shall be placed into the sharps containers for disposal as close as possible to the point of use according to all applicable local, state, and federal regulations” (California Code of Regulations, 2011). To avoid puncture wounds to operators, sharps containers must never be filled above the “filled” indicator line (California Dental Association, 2019). In the event that an injury does occur, a plan for managing occupational exposures must be in place and noted in the written protocol (California Code of Regulations, 2011). Figures 1 through 3 outline the current Cal/OSHA Bloodborne Pathogens Standard and CDC protocols for occupational exposure. It should be noted that compressing a puncture wound to encourage bleeding is not recommended. Caustic agents such
as bleach should not be used to cleanse a wound. Washing skin around an injury with soap and water or flushing mucous membranes with water is recommended to cleanse the area or remove debris. Figure 1: Post-Exposure Management, Part 1
Note . Adapted from “Guidelines for Infection Control in Dental Settings – 2003,” by the Centers for Disease Control and Prevention, 2003, MMWR Recommendations and Reports, 52(RR-17), 1-68; and “Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis,” by D. T. Kuhar, D. K. Henderson, K. A. Struble, W. Heneine, V. Thomas, L. W. Cheever, … A. L. Panlilio, 2014, Infection Control and Hospital Epidemiology, 34 (9), 875-892.
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