In the last article, we looked at the surprisingly high volume of germs on mobile devices and the implications of spreading microbes, especially in clinical environments. Some of the general advice included phone hygiene using several different methods. The most important method to reduce the spread of germs is to have good hand hygiene. Most clinicians and dental staff will assume that their hand washing technique is adequate but it is important to formally train and audit all staff on a regular basis.
In my practice, we carry out hand hygiene audits on an annual basis. It not only identifies training needs but reinforces good practice and is a great team building exercise. Before the audit is carried out it is wise to check that the environment conforms to HTM 01-05 or equivalent requirements. There should be a dedicated hand-washing sink which is devoid of a plug and overflow aperture. The taps should be elbow or foot operated and should not discharge directly into the sinkhole so as to avoid splashback. The 12 step hand washing and 8 step hand rub posters should be displayed adjacent to the sink along with availability of paper towels, alcohol rub and hand moisturiser. The used paper towels should, of course, be disposed of in a domestic waste bin located nearby.
Before the handwashing or hand rub techniques are assessed the following should be checked. Hands and wrists are free from watches and jewellery (non-stoned wedding rings are acceptable). Nails are short and without nail extensions and varnish. Sleeves are bare below the elbows and cuts are covered with a waterproof dressing.
Once the above are confirmed the hand washing technique can be assessed as follows.
- Hands are wet under continuously running water
- Warm Water is used to wash hands
- Liquid soap is applied to wet hands
- Hands are rubbed to create lather
- The lather is rubbed over all surfaces of the hands for 10-15 seconds, including the thumbs, between the fingers, fingertips and the wrist (demonstrating the 12 steps to effective hand hygiene technique)
- Hands are rinsed thoroughly under running water
- Taps are turned off using wrist/elbow levers or using a clean paper towel
- Hands are dried using paper towels
These steps can be audited with ease and feedback with any action points or additional training requirements noted. Records of audits and training should be retained for 2 years and are useful compliance evidence for CQC requirements.