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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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  1. All of the following statements regarding hand hygiene in healthcare settings are true except which one?

    • The overall adherence of HCWs to fundamental principles of infection control and aseptic technique (e.g., failure to wear gloves and perform hand hygiene) is low.
    • Poor adherence to hand hygiene practices is a primary contributor to healthcare-associated infection.
    • Hand hygiene is not necessary if gloves are worn.
    • The prevalence of healthcare-associated infections is decreased as adherence to recommended hand hygiene practices is improved.
  2. Intercellular lipids, which form the only continuous domain of the skin essential for a complete barrier function, e.g., to minimize microbial invasion from the environment, are a basic component of the ____________.

    • stratum corneum
    • viable epidermis
    • dermis
    • hypodermis
  3. Hand hygiene products and procedures can decrease the barrier function of skin by ____________.

    • extracting skin lipids
    • chemically inducing irritation
    • physically stripping the stratum corneum
    • All of the above.
  4. Which of the following statements is correct in relation to homeostatic control and the rate of keratinocyte proliferation?

    • Under basal conditions, differentiated keratinocytes require 2 weeks to exit the nucleated compartment and an additional 2 weeks to move through the stratum corneum.
    • When stimulated by injury or infection, keratinocytes have the capacity for increased rates of proliferation and maturation, and 50 to 60% of barrier recovery typically occurs within 6 hours.
    • When stimulated by injury or infection, keratinocytes have the capacity for increased rates of proliferation and maturation, and complete normalization of barrier function occurs in 5 to 6 days.
    • All of the above.
  5. Which of the following statement in relation to the normal skin flora and the acquisition and transmission of healthcare-associated pathogens is incorrect?

    • One of the largest human-associated microbial habitats is the skin.
    • Transient organisms tend to colonize the superficial layers of skin and since they are amenable to removal by washing hands with plain soap and water, they are less likely to cause healthcare-associated infections than resident pathogens.
    • Organisms are transferred in much larger numbers from wet hands than from hands that are thoroughly dried.
    • Resident organisms are attached to deeper layers of skin and they are more resistant to removal than transient pathogens.
  6. Which of the following infections can be potentially transmitted from patients to HCWs if appropriate glove use and hand hygiene are not performed?

    • Herpes simplex virus infections
    • Colonization or infection Staphylococcus aureus
    • Hepatitis B and C virus infection
    • All of the above.
  7. Hand hygiene refers to ____________.

    • handwashing, i.e., washing hands with plain soap and water
    • hand antisepsis, i.e., antiseptic hand wash or antiseptic hand rub
    • surgical hand antisepsis
    • All of the above.
  8. Handwashing is an inappropriate hand hygiene procedure ____________.

    • when the hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids
    • to remove or destroy transient microorganisms and reduce the resident hand flora
    • before eating
    • after using the bathroom
  9. Antimicrobial-impregnated wipes, i.e., towelettes ____________.

    • might be considered as an alternative to washing hands with plain soap and water
    • are as effective as alcohol-based hand rubs
    • are as effective as washing hands with antimicrobial soap and water
    • B and C
  10. Alcohol-based hand rubs have good or excellent antimicrobial activity against which of the following microorganisms?

    • Viruses and fungi
    • Mycobacteria
    • Gram-positive and gram-negative bacteria
    • All of the above.
  11. Each of the following statements regarding alcohol-based hand rubs is true except which one?  Alcohol-based hand rubs ____________.

    • reduce bacterial counts on the hands of HCWs more effectively than plain and antiseptic soap and water
    • kill microorganisms more rapidly than iodophors and other antiseptic containing soaps
    • are only effective if they are applied for ≥60 seconds
    • have been demonstrated to cause less skin irritation and dryness than repeated handwashing (i.e., washing hands with plain soap and water) or antiseptic handwash (i.e., washing hands with antimicrobial soap and water)
  12. If hands are not visibly soiled or visibly contaminated with blood or other proteinaceous material, which of the following regimens is the most effective for reducing the number of pathogenic organisms on the hands of HCWs?

    • Handwashing, i.e., washing hands with plain soap and water.
    • Antiseptic handwash, i.e., washing hands with an antimicrobial soap and water.
    • Hand antisepsis, i.e., applying an appropriate amount of alcohol-based hand rub to the hands and rubbing hands together until they feel dry.
    • Using an antimicrobial impregnated wipe, i.e., towelettes.
  13. All of the following statements regarding surgical hand antisepsis are true except which one?

    • Antimicrobial counts on hands are reduced as effectively with a 5-minute scrub as with a 10-minute scrub.
    • A brush or sponge must be used when applying the antiseptic agent to adequately reduce bacterial counts on hands.
    • The FDA, CDC, and the WHO recommend surgical hand antisepsis using an antimicrobial soap and water or two-stage surgical hand antisepsis.
    • Handwashing with plain soap and water followed by the application of an alcohol-based hand rub is an acceptable method of surgical hand antisepsis.
  14. According to the CDC, which antiseptic agent is least likely to produce irritant contact dermatitis or allergic contact dermatitis?

    • Chlorhexidine
    • Ethanol
    • Triclosan
    • Iodophors
  15. Compliance with hand hygiene guidelines is substantially improved when a multidimensional strategy includes ____________.

    • introduction of alcohol-based hand rub
    • educational and behavioral initiatives
    • institutional verification of compliance and feedback
    • All of the above.

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