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Hand Hygiene: Infection Control/Exposure Control Issues for Oral Healthcare Workers

Géza T. Terézhalmy, DDS, MA; Michaell A. Huber, DDS

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The Institute for Healthcare Improvement in its How-to Guide: Improving Hand Hygiene recommends a multidimensional approach (e.g., introduction of alcohol-based handrub, and educational and behavioral initiatives) to improve compliance with hand hygiene guidelines in healthcare settings.38  The science supporting a multidimensional approach to hand hygiene is sufficiently established to be considered the standard and consist of four components (Table 5).1,3,5,6

Table 5. Multidimensional approach to improve compliance with hand hygiene guidelines.

A novel strategy of video surveillance of hand hygiene coupled with real-time compliance feedback has been reported.39  The study was conducted in a 17-bed intensive care unit.  Cameras were placed with views of every sink and hand sanitizer dispenser to record hand hygiene of HCP.  Sensors in the doorways identified when an individual entered/exited.  Video auditors observed HCP performing hand hygiene upon entering and exiting a room and assigned a pass or fail grade.

Hand hygiene was measured during a 16-week period without feedback and a 91-week period with feedback.  During the 16-week pre-feedback period, hand hygiene rates were less than 10%.  In the first 16-week post-feedback period compliance improved to 81.6%; and, subsequently, was maintained through 75 weeks at 87.9%.  While quality of hand hygiene and HAI-data were not presented, this approach to improve compliance merits consideration.

The Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care published by the CDC in 2016 includes an Infection Prevention Checklist for Dental Settings: Basic Expectations for Safe Care.6  Section I.5 of the checklist relates to institutional hand hygiene policies and practices, while Section II.1 is an evaluation tool to monitor the compliance of oral HCP with hand hygiene practices that fulfill expectations for dental healthcare settings (Box A).

Box A. Hand hygiene compliance: checklist for oral healthcare settings.
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