Gloves, Handrubs and HAIs in the Dental Setting

staphylococcus aureus in the dental setting

Health care associated infections, or HAIs, can be acquired anywhere health care is delivered, including the dental office.  As a dental clinician or dentist, you know that proper hand hygiene and gloving is essential to your patient’s safety as well as your own.

But how prevalent are infectious agents such as bacteria, fungi and viruses in the dental setting?  And is your current hand hygiene routine enough to prevent HAIs?

Dental Staph

A recent study conducted by the Department of Public Health and Infectious Diseases at Sapienza University, in Rome, Italy, investigated staphylococci contamination on disposable gloves and clinical surfaces in the dental setting.

Environmental samples were collected from the tray and gloved dominant hand soon after dental therapy of the second or third patient at 136 general dental practitioners’ offices.  Staphylococci were detected in 41% of the trays and 57% of the gloves.  Specifically, S. aureus was found in 5% of both tray and glove samples, and MRSA was detected on 1.5% of the glove and tray samples.

The study concluded that contact surfaces and gloves in the dental setting are “frequently contaminated.”

Studies like this underscore the importance of proper hand hygiene and proper donning and doffing of exam gloves.  But even if you are using the manufacturer’s recommended amount of alcohol-based handrub, another recent study warns that it may not be enough.

Pump Up the Volume

The Bode Science Center in Hamburg, Germany evaluated the effectiveness of different volumes of alcohol-based handrubs.  They used the manufacturer recommended product volumes of 1.1 mL, 2 mL, and 2.4 mL, as well as 1 and 2 pump dispenser pushes for foams and gels.

They discovered that 70% ethanol (v/v) handrubs at the recommended volume of 1.1 mL per application “did not ensure complete coverage of both hands and do not achieve current ASTM efficacy standards.”  Whereas an application of 2 mL of 85% w/w ethanol rub reduces contamination sufficiently to fulfill the US FDA efficacy requirement.

Proper Gloving and Handrub Guidelines

To provide the safest environment possible for yourself and your patients, diligently follow proper gloving and hand hygiene guidelines to reduce HAIs.  This includes handwashing or handrubbing before donning gloves, and immediately after careful removal of gloves.  And when using an alcohol-based handrub, use enough to completely cover all surfaces of your hands.

Share Your Experience – How is your office’s hand hygiene compliance?  What have you done to improve it?  Post your comments below.

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Medical Gloves, Hand Hygiene Help Halt Deadly CRE

Gloves and Hand Hygiene Help Halt CRE

Hospital staffs across the country are doubling down on their efforts to stop the spread of hospital acquired infections (HAIs.)  While progress has been made in understanding and reducing the spread of MRSA, C. diff and other germs, there is a growing and far more deadly threat – carbapenem-resistant Enterobacteriaceae, or CRE.

CRE germs are resistant to antibiotics of last resort, killing one of every two patients who get bloodstream infections from them.  But it could be worse.  CRE can transfer their antibiotic resistance to other bacteria such as E. coli, making the most common cause of urinary tract infections extremely difficult to treat.  Ultimately, CRE could get out into our communities, leading to a public health crisis.

For these reasons, CDC has sounded the alarm.  In the March Vital Signs report, CDC published some alarming facts.  CRE has increased from 1% to 4% in the past decade, and one type of CRE has increased from 2% to 10%.  CRE is more common in the Northeast, but has been reported in 42 states.  About 18% of long-term care hospitals have reported at least one CRE infection during the first half of 2012.

The report also provides detailed information on what state governments, communities, health care CEOs, health care providers and patients can do to help stop the spread of CRE.

There are eight core measures for acute and long-term care facilities to implement, and at the top of the list are hand hygiene and the proper use of contact precautions.  This includes the proper use of medical gloves.

  • Hand hygiene should be performed before donning a gown and gloves.
  • Gown and gloves should be donned before entering the affected patient’s room.
  • Gown and gloves should be removed and hand hygiene performed, prior to exiting the patient’s room.

In the 2012 CRE Toolkit, the CDC states, “It is not enough to have policies that require hand hygiene; hand hygiene adherence should be monitored and adherence rates should be fed directly back to front line staff.  Immediate feedback should be provided to staff who miss opportunities for hand hygiene.”

By following CDC guidelines for CRE, several states have decreased their CRE infection rates.  Colorado is one of six states that currently require hospitals to report CRE to the Department of Public Health and Environment.  Because they are detecting and tracking the bacteria, an outbreak of CRE at the University of Colorado Hospital last August was halted.

In Florida, a year-long CRE outbreak was finally brought to an end when the facility improved its use of CDC recommendations, including the proper use of medical gloves and gowns.  This underlines the importance of proper gloving and hand hygiene, as routine as it may seem.

There is no longer any room for complacency.  This is a critical time here in the U.S.  CRE infections can be controlled if everyone involved in patient care does their part and puts forth consistent effort to follow infection control recommendations with every patient.

What do you think?  Can more be done to stop the spread of CRE?  Post your comments below.

Proper Medical Glove Use and Hand Hygiene Reduces HAIs and Saves Lives

Proper Glove Use and Hand Hygiene Reduces HAIs and Saves Lives

[dropcap]W[/dropcap]hile medical facilities appear to have gained some ground against Hospital Acquired Infections (HAIs,) the problem is still a great and very real daily threat to human life.   Bacteria that cause HAIs, such as C. diff, MRSA, E. coli, and S. aureus result in an astounding 2 million infections a year and an estimated $6.7 billion in hospital costs.  The most sobering statistic is that these deadly infections kill 100,000 people each year – that’s more than all of the deaths from car accidents, AIDS and breast cancer in the U.S. combined.

According to the World Health Organization (WHO,) “hand hygiene is the single most important measure to protect patients, HCWs and the environment from microbial contamination.”  Unfortunately, compliance with this practice is dismally low.  According to the New England Journal of Medicine, less than 40% of Health Care Workers (HCWs) practice proper hand hygiene.

Several studies have shown that wearing medical gloves reduces hand hygiene compliance.  For instance, in one study HCWs were less likely to perform hand hygiene after removing gloves upon leaving a patients room.  In contrast, other studies have shown that glove use increased overall compliance, but these studies did not investigate glove misuse.  For these reasons the impact of wearing medical gloves on hand hygiene policies has not been determined.  One thing we know for certain, though, is that proper use of gloves combined with proper hand hygiene is critical to reducing infections.

WHO Guidelines for the appropriate and safe use of medical gloves includes the following:

Medical glove use does not obviate the need to comply with hand hygiene.  When hand hygiene is indicated, handwashing or handrubbing should be performed before donning gloves.

Careful attention should be paid to glove removal.  Gloves should be removed to perform handwashing or handrubbing to protect a body site from the flora from another body site previously touched on the same patient.  WHO states that “HCWs often fail to remove gloves between patients or between contact with various sites on a single patient, thus facilitating the spread of microorganisms.”

Perform hand hygiene after glove removal.  Hand hygiene must be performed immediately after glove removal to prevent HCW contamination and spread of microorganisms.

Clear direction about medical glove use should be provided.  HCWs should be able to clearly identify situations requiring gloves, situations that do not require gloves, and how to correctly select a glove.  This requires that medical facilities have clear glove use procedures to help HCWs reason and adjust their behavior to comply with proper hand hygiene and glove use.  This includes a clear understanding of when glove use should start and end.

Medical gloves should always be stored in their original boxes.   Tucking gloves away in pockets and carrying them about is not safe.   Gloves should remain in their original box until donned to ensure the gloves do not become contaminated.  This requires that glove boxes should always be available at point of care.

Appropriate use of medical gloves, combined with proper hand hygiene, is an evidence-based measure to protect HCWs, patients and the environment from HAIs.  HCWs that fail to remove gloves or perform proper hand hygiene between patients risk spreading deadly infections.

Fortunately, the medical community is working hard to increase compliance.  New education campaigns, surveillance programs and other tools are helping ensure more HCWs do their part to reduce the cost of HAIs  – in lives lost and the billions spent to treat them.

What do you think?  Can we do more to reduce HAIs with improved hand hygiene and glove use?

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