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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?

    • Outbreaks of HBV and HCV infections, primarily in medical settings outside of acute care hospitals, indicate a failure of healthcare personnel (HCP) to perform hand hygiene and wear gloves.
    • While the hand hygiene guideline applies to oral healthcare settings, evidence suggests low compliance with recommended hand hygiene practices by oral HCP.
    • Ongoing education and competency-based training are critical for ensuring that infection prevention policies and procedures are understood and followed.
    • Hand hygiene-related competency following each training cycle does not need to be documented.
  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 normal 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. All of the following statement in relation to the normal skin flora and the acquisition and transmission of healthcare-associated pathogens are correct EXCEPT which one?

    • One of the largest human-associated microbial ecosystems is the skin.
    • Transient organisms tend to colonize the superficial layers of skin, they are amenable to removal by handwashing with plain soap and water, and they are more likely to cause HAIs than resident pathogens.
    • Resident organisms are attached to deeper layers of the skin and while they are more resistant to removal, they are less likely to be associated with HAIs.
    • Organisms are transferred in much larger numbers from dry hands than from hands that are wet.
  6. All of the following statements are correct with respect to the wearing of gloves in healthcare settings EXCEPT which one?

    • To prevent or reduce the risk of occupational exposure, the standard of care mandates that HCP wear gloves.
    • Bacterial flora colonizing patients have been recovered from the hands of HCP who wore gloves during patient contact.
    • The acquisition of hepatitis B, hepatitis C, and herpes simplex viruses (HSV-1) by HCP wearing gloves has been documented.
    • 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 handrub
    • surgical hand antisepsis
    • All of the above.
  8. All of the following statements are correct with respect to detergents EXCEPT which one?

    • Detergents contain esterified fatty acids and sodium or potassium hydroxide and are often referred to as “soaps.”
    • Detergent formulations used in healthcare settings should have a broad antibacterial spectrum, be fast acting, and should have persistent or residual activity.
    • Plain soap does not contain an antimicrobial agent or contains low concentrations of an antimicrobial agent that is effective solely as a preservative.
    • The cleaning activity of plain soap results in the removal of dirt, soil, and various organic substances from the hands.
  9. All of the following statements about handwashing are correct EXCEPT which one?

    • Handwashing, which removes loosely adherent transient microorganisms, is defined as washing hands with plain soap and water.
    • It is indicated when (1) hands are visible soiled with blood and OPIM, and (2) as part of two-stage surgical hand antisepsis.
    • The CDC and the WHO recommend handwashing for routine hand hygiene in clinical situations when the hands are not visibly soiled.
    • The frequent use of plain soap and hot water can cause considerable skin irritation and dryness.
  10. All of the following statements about antiseptic handwash are correct EXCEPT which one?

    • Antiseptic handwash is defined as washing hands with a soap containing an antiseptic agent and water.
    • The FDA classifies povidone iodine (5 to 10%) as a Category I antiseptic agent.
    • The use of antimicrobial-impregnated wipes (i.e., towelettes) is an acceptable alternative to antiseptic handwash.
    • Antiseptic handwash with povidone iodine removes or destroys transient microorganisms and reduces the resident hand flora.
  11. All of the following statements about antiseptic handrub are correct EXCEPT which one?

    • Antiseptic handrub is defined as applying a waterless antiseptic agent (i.e., an antiseptic agent that does not require the use of exogenous water) to the hands.
    • The FDA classifies ethanol (60 to 95%) as a Category II antiseptic agent.
    • Antiseptic handrub removes or destroys transient microorganisms and reduce the resident flora.
    • The CDC and the WHO have concluded that antiseptic handrub is more effective than handwashing or an antiseptic handwash and it is the preferred method for routine hand hygiene in clinical situations when the hands are not visibly soiled.
  12. All of the following statements regarding surgical hand antisepsis are correct 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 performing surgical hand antisepsis to adequately reduce bacterial counts on hands.
    • Surgical hand antisepsis is defined as performing either (1 surgical hand antisepsis using an antimicrobial soap and water or (2) 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.
  13. Before making purchasing decisions related to hand hygiene products _______________.

    • evaluate the dispenser system to make sure that it functions reliably
    • confirm that the dispenser delivers an appropriate volume of the product
    • confirm that the dispenser for alcohol-based formulations is approved for flammable materials
    • All of the above.
  14. All of the following statements are correct with respect to selecting and/or handling plain (non-antimicrobial) or antimicrobial soaps, or an alcohol-based handrub EXCEPT which one?

    • Solicit information from manufacturers regarding any known interactions between hand hygiene products; skin care products; the type of gloves used in the healthcare setting.
    • Hand care products should be stored in disposable or reusable closed containers.
    • To minimize the risk of product contamination, always “top off” partially empty soap dispensers at the end of each day.
    • To maximize acceptance of hand hygiene products solicit input from HCP regarding fragrance (smell), consistency (“feel”), skin tolerance, and color.
  15. All of the following statements are correct with respect to irritant contact dermatitis (ICD) EXCEPT which one?

    • The most common reaction associated with the frequent and repeated use of hand-hygiene products is ICD.
    • ICD is an immunologically mediated dermatitis.
    • ICD is characterized by dryness, itchiness, or burning; the skin may feel “rough;” and appear erythematous, scaly, or fissured.
    • Skin damage can lead to colonization by staphylococci and gram-negative bacilli and also increases the potential for ACD.
  16. All of the following statements related to ICD are correct EXCEPT which one?

    • Factors that contribute to ICD include using hot water, the quality of paper towels used, and physically stripping the stratum corneum while scrubbing.
    • ICD may be caused by the antimicrobial agent or by other ingredients in the product.
    • To minimize the likelihood of ICD, washing hands with soap and water after each use of alcohol-based handrub is highly recommended.
    • Skin damage can lead to colonization by staphylococci and gram-negative bacilli and also increases the potential for ACD.
  17. All Allergic contact dermatitis (ACD) _______________.

    • is a T cell-mediated delayed hypersensitivity reaction (Gell and Coombs Type IV)
    • is characterized by a rash, redness, and itching, which usually begins 24 to 48 hours after contact with offending products
    • associated with alcohol-based handrub or various additives present in certain formulations is quite common
    • may represent true allergy to alcohol, allergy to an impurity or aldehyde metabolites, or allergy to another constituent of the product
  18. Compliance with hand hygiene guidelines is substantially improved when a multidimensional strategy includes _______________.

    • introduction of alcohol-based handrub
    • educational and behavioral initiatives
    • institutional verification of compliance and feedback
    • All of the above.
  19. Which of the following statements are correct with respect to the Infection Prevention Checklist for Dental Settings: Basic Expectations for Safe Care published by the CDC in 2016?

    • Section I.5 of the checklist relates to institutional hand hygiene policies and practices.
    • 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.
    • The checklist provides a mechanism to document the competence of oral HCP to perform hand hygiene following each training cycle.
    • All of the above.
  20. Oral healthcare facilities are accountable for establishing a system in which oral HCP have the knowledge, competence, time, and tools to practice hand hygiene; and oral HCP have the duty to perform hand hygiene - perfectly and every time.

    • True
    • False

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