Coronavirus and dentists: hand hygiene as the first form of defence

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The health emergency caused by the SARS-CoV-2 virus that continues to afflict the whole world, including Italy, has forced us to change our habits and consider safety from a different standpoint both at work and in our everyday life. In these circumstances, dental appointments have therefore become a source of doubts and concerns, despite the fact that dentistry is one of the sectors with the greatest guarantees in terms of hygiene, due first and foremost to the stringent disinfection protocols applied.

Despite limiting visits to the dentist, and therefore avoiding going to the dental practice for frequent hygiene and check-up appointments, a dentist’s intervention may be necessary in order to solve problems associated with caries, tooth damage and oral cavity infections. As a trip to the dentist is in many cases unavoidable, it is necessary to provide patients with greater reassurance regarding protection against pathogens such as bacteria and viruses, including SARS-CoV-2, which causes COVID-19.

Hands, the main means of transmission

Many studies [1] have demonstrated that hand-eye contact is one of the main sources of infection with a number of pathogens, including the novel Coronavirus. It is no coincidence that health institutions and authorities recommend thorough hand washing and sanitising with alcohol rubs when washing is not possible. However, these solutions may not be adequate for hand hygiene in dental practice, as in any other healthcare environment frequented by a large number of people.

In order to protect all those present in a dental practice, including staff, from dentists to hygienists, hand washing must not only be frequent, but also performed thoroughly and accurately in accordance with specific protocols, in order to avoid the opportunities for transmission that are potentially most common in dental practices.

Before and after contact with patients

As dental practices have a high patient turnover, practice staff should wash their hands thoroughly before and after contact with patients, both when they arrive and immediately after intervention, avoiding any unnecessary contact.

During patient preparation

Hand washing and hygiene are fundamental for preventing the dentist, hygienist or assistant from transmitting pathogens while examining or preparing the patient’s oral cavity for even the simplest procedure.

After intraoral intervention

Working inside patients’ mouths, regardless of whether for straightforward hygiene or for more invasive procedures, exposes dental staff to contamination through the blood or saliva of infected patients. Consequently, hand washing and hygiene become fundamental also at the end of intervention inside the oral cavity, in addition to the protection provided by personal protective equipment such as face-masks, face shields, gloves and protection goggles, which are to be used throughout the procedure.

On surfaces with which the patient has come into contact

In dental practices, frequent use is made of high-pressure jets of water, aspirators, irrigators and turbines that generate within the environment an aerosol consisting of blood and saliva combined with steam that settles on objects and surfaces, thereby increasing the risk of infection. Appropriate hand hygiene, together with thorough disinfection using specific disinfectants, guarantees the greatest possible protection even in the event of accidental contact with areas where contaminated aerosol has settled.

How do dental staff wash their hands?

There are a number of hand hygiene practices and variations, from the washing phases through to specific sanitisers. We will focus on the most common techniques for professional hand hygiene.

Hygienic washing

Removes visible dirt and most pathogens using water and hand-wash, to be performed before and after each operation entailing a risk of contamination, such as contact with organic material, use of toilets and contact with medical instruments or devices. It is essential that washing lasts for at least 40-60 seconds, that it is performed in accordance with a specific protocol with which the practitioner must be familiar and that it covers all the pertinent areas.

Antiseptic washing

A variation of hygienic washing involving the use of  water and specific antiseptic products such as chlorhexidine gluconate, iodophors and triclosan, which again must last for at least 40-60 seconds.

Alcohol rub

When washing with water is not possible or is not practical, the only feasible solution is to rub the hands with a 60-80% alcohol sanitiser gel, liquid or foam, for at least 30 seconds. As these products evaporate after use, they do not require water or drying. They must not be used with antiseptic soaps.

Gloves are no substitute for hand washing.

Correct hand hygiene can be guaranteed only with washing or sanitising procedures, regardless of whether latex or silicone gloves are used. Gloves are used to increase the protection of previously sanitised hands. As gloves can also be a vehicle for contamination, it is necessary to discard them after each use and to wash the hands again, in the interests of both practitioner and patient safety.

A plethora of specific products are available for hygiene in dentistry, such as Zhermack’s Zeta Hygiene range of products certified in accordance with the most stringent standards and intended for the disinfection of instruments and surfaces as well as hand hygiene and the disinfection of dental impressions and suction units.

[1] World Health Organization, WHO Guidelines on Hand Hygiene in Health Care, 2009; 24