The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#223 The Dirty Truth: What Handwashing Misses
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Join the Divas as we explore the science behind hand hygiene, nail contamination, and the surprising resilience of pathogens. Are you ready for a deep dive into the bacterial biofilms hiding beneath your fingertips—and why they matter in healthcare.
Resources:
- CDC Guidelines for Hand Hygiene in Healthcare Settings https://www.cdc.gov/infection-control/hcp/hand-hygiene/index.html
- Isolation and diagnosis of bacteria from under long nails (natural and artificial) in young females https://www.biosciencejournal.net/archives/2024/vol6issue1/PartA/6-1-24-401.pdf
- CDC - Clinical Safety: Hand Hygiene for Healthcare Workers https://www.cdc.gov/clean-hands/hcp/clinical-safety/index.html
Welcome! I'm Leslie Cannon. I'm Mary Gavoni. I'm Linda Harvey.
SPEAKER_02I'm Olivia Juan. And together we are the Compliance Divas. Welcome to the Compliance Divas Podcast. This is Linda Harvey, and I will be your moderator for this episode titled The Dirty Truth: What Hand Washing Misses. So lean in for this episode as the divas explore the science behind hand hygiene, nail contamination, and the surprising resilience of the pathogens that might be living under your fingernails. To get us started today, I'd like to ask Diva Mary about an interesting study that she read from last year on fingernails.
SPEAKER_01Mary. Thanks, Linda. This study is very interesting. It's from the University of Kerkuk in Iraq. And we will put this in the show notes so that you can read this entire study. And it talks about fingernails as microbial hotspots. I've done some demonstrations with some teams using Glow germ, which we've talked about before. And especially for the team members who have long fingernails, whether they're natural or maybe acrylic or gel fingernails, always without fail, after they've washed their hands, there is still material underneath their fingernails and around where those fingernails may be lifted. But back to the study, there were 110 samples, and out of those samples of women's fingernails in this study, they showed 86% of them had bacterial growth, and E. coli was the most common at 41% approximately, and staph epidermis or staph that lives on the skin at about 21%. So these bacteria are associated, and I know it sounds a little gross, but are associated with fecal contamination and skin infections. So if hands aren't adequately cleaned after using the bathroom, unfortunately, some of that fecal matter and microbes can be positioned or lodged underneath those fingernails. And I doubt whether many team members actually take some kind of a brush and clean underneath those long fingernails after they've used the restroom. So that's kind of a little scary thought from this study. The study also showed that underneath those nails, we get biofilm formation, just like in the mouth, just like in our water lines. And in the biofilm formation, they found Staph aureus, Pseudomonas serugenosa, which can cause respiratory infections, and different Candida species, meaning some kind of a yeast infection underneath those fingernails. So we need to make sure that we are number one complying with CDC guidance, and Leslie's going to talk about that, and not wearing that's essentially the conclusion of this study is that because of the microorganisms that accumulate under those long fingernails, that we shouldn't be wearing long fingernails if we are working clinically in dentistry. And I see so many of my clients, hygienist assistants and doctors, having long fingernails and beautiful, you know, now the all the different artwork and the beautiful polish effects and all those things, but they're not appropriate in dentistry for infection control.
SPEAKER_02Mary, you couldn't have said it more beautifully. And thank you so much for sharing that study. I think it's very interesting. And the good news is to our listeners, it's not a very long study. I think it's like six or eight pages, maybe at the most. So it's something you could easily download and take to a team meeting and read at your leisure if you like. Well, Mary, you you talked about the CDC guidelines a little bit. So let's hop over to Leslie. And Leslie, could you refresh our memory? Because we know the CDC guidelines are s or what we live by, and so many states have the CDC guidelines written into their Dental Practice Act. So therefore, not practicing the recommended hand hygiene and fingernail hygiene from the CDC is actually a violation of your Dental Practice Act.
SPEAKER_00Yeah, you know, you're right. And Linda, there's been some pretty important information that's been available for, well, since 2002 when the original CDC guidelines for hand hygiene were first published. And the information surrounding fingernails and artificial nails, the studies have demonstrated that areas harbor high concentrations of bacteria underneath fingernails. And when there's artificial nails or even freshly applied nail polish, they still find that they've recovered bacteria. If you think about nail polish, chip nail polish, for example, that creates like a little hole or grand canyon in microorganism wards where these organisms can hang out. And as nails grow, nail polish grows out with it, or artificial nails grow out. And then you have a gap between the nail bed and where the nails start. Again, this is like another Grand Canyon of places for organisms to hide. And organisms that are found underneath fingernails create a substantial risk factor to healthcare workers. So the best policy, of course, is to have plain nails, node polished and nicely groomed and trimmed without very big areas of cuticle hang nadals, I guess you could call it, and short fingernails.
SPEAKER_02Thank you, Leslie. And I particularly liked your analogy of the microscopic Grand Canyon because we can't see it with our naked eye. Maybe we can see with our loops on, but we certainly can see it under the microscope. And so it's very important now because we know in dentistry it's what we can't see that can hurt us or our patients as far as disease transmission. So that reminds me then. So, Mary, there are some other organizations besides the CDC and even the World Health Organization who publish evidence-based guidelines that could impact dental professionals.
SPEAKER_01Could you share with that with us a little bit, please? Absolutely, Linda. There are two organizations, as you said, that we look at for guidelines. And this is especially important for any dental practice that is accredited through the Joint Commission or maybe through the ambulatory care accreditation triple AHC. And they are the AORN, which used to be the Association of Operative Registered Nurses, and now is the Association for Perioperative Registered Nurses, and APIC, which some people in dentistry may be familiar with, the Association for Practitioners in Infection Control. And these are more hospital-based or outpatient facility-based, not necessarily in dentistry organizations, but they have great impact. And especially since more practices now are doing surgical procedures in their offices, meaning implant procedures, it is very important to look at these guidelines. And the AORN published an article in June of this year called Avoiding the Use of Artificial Nails in the Perioperative Setting. And three key points, which we've sort of touched on already, one is artificial and chip nails will harbor pathogens that can lead to health care associated infections. And it's been a common practice in dentistry to prevent healthcare-associated infections to prescribe antibiotics. And we are now in this era of antibiotic stewardship and not wanting to prescribe as many antibiotics for these patients. So hand hygiene and this issue of fingernails hybriding micro microorganisms is critical. In this article, they talk about studies that show that up to 87% of healthcare workers with artificial nails carry pathogenic microorganisms even after they've scrubbed their hands. And those microorganisms not only could be a threat to patients, but think about what you may be taking home with you that you might be sharing with your family if you go home and start preparing meals and handling food. So that's just a crazy statistic, 87%. And the studies also show that natural nails have significantly lower colonization rates. And I would suspect that has a lot to do with the fact that the natural nails are smooth. There's no areas where acrylic or gel or some material has lifted, creating, as Leslie said, that Grand Canyon place for colonization. So we need to look at these and take these seriously as much, and especially with holidays coming up, as much as we want to have pretty fingernails, it's just a big risk in dentistry and not appropriate for clinical team members because of the infection prevention issue.
SPEAKER_02Well, thank you, Mary. And I hope our listeners have not tuned us out because I know many of them do wear acrylic nails and have longer nails, but we really are coming from the perspective of what's safer for you, what's safer for your patients, and what's safer for your family, as well as compliance. And I'd like to add to a couple of things that you mentioned, Mary, regarding ARN and APIC, is that if we have any listeners that see surgical cases in a hospital or ambulatory surgery setting, because there are a growing number of dental ambulatory surgery centers for dentists who provide want to do their surgical procedures, whether it's a pediatric dentist or oral surgeon or whoever, and not do their case in the hospital, they may choose to do their cases in an ambulatory surgery setting. So if any of our listeners see cases in those areas, you may have to comply with the guidelines that they have set up so that would impact nail hygiene as well. And then, Mary and Leslie, we may have some listeners who work in a hospital-based setting, you know, hygienistor assistants that work in different areas that aren't clinical dental hygiene, maybe, or maybe not clinical dental assisting, but they're working in those areas. So it's very important to be mindful of all those different ways that these medical guidelines and best practices that are evidence-based can impact what we need to follow. Leslie, I'd like to come back to you and circle back to the CDC for a moment because we know the CDC is just a wealth of information. And I know there's some information in the CDC about when we should be washing our hands. Can you remind us about that, please?
SPEAKER_00Absolutely. Linda, you know, the hygiene tips first to start off with is to keep nails short and clean. That's number one, and to use a nail brush when washing your hands. So I wanted to go over some of the mechanics, avoiding the artificial nails and nail gels and nail polish and clinical settings, as you mentioned, and to wash thoroughly with soap, especially after using the restroom or, you know, touching contaminated surfaces or items or instruments. And another point I wanted to make before I go into when and what is to remind folks about not topping off soap dispensers, that sometimes we can harbor a bacterial colonization by refilling our soaps containers from, let's say, a gallon jug. And sometimes we're trapping those colonies of bacteria underneath that. There's some pretty good science on that. And I've seen some great pictures from Donnie Byrd from her dental assisting textbook. And it's just an amazing thing to think about that you could be contaminated, have using contaminated soap. But going on to knowing when to clean your hands, of course, immediately before touching a patient and before gloving and before performing aseptic tasks, such as placement of any kind of surgical type of procedures or devices, and consider using an alcohol-based hand scrub and surgical hand, uh, surgical gloves in those circumstances. We want to make sure that we are always washing our hands after touching a patient or their patient care items, as well as after removing gloves. And anytime there's contact with blood, body, fluid, or contaminated surfaces. And another point I want to bring up is what to use, when to use alcohol-based hand sanitizers, and when to use soap and water. Now, according to some dental boards, like for example, in California, we're mandated to use soap and water at the beginning of our clinical day and at the end of our clinical day. But we're free to use alcohol-based hand sanitizers unless hands are visibly soiled. And alcohol hand-based hand sanitizer is actually preferred over soap and water in most clinical situations. But we have to have visibly clean hands before alcohol hand sanitizer can do its job. It's very similar to disinfecting surfaces. You've got to clean that debris off surfaces before that disinfectant will actually touch the surface, the same as instruments. We've got to clean the debris off instruments before the steam, heat, or chemical vapor can actually sterilize those instruments. So we have to keep that same theory in mind with our hands. Now, alcohol hand sanitizer is more effective at killing terms on hands than soap. It's a lot easier to use when providing care because we're quickly able to sanitize our hands either in between glove removals or after glove removal before going on to another patient. And it also sometimes can result in even improved skin condition because sometimes our washing, the repeated frequent hand washing that we do all day long, can irritate and dry out our hands and really can cause a direct cytotoxic reaction that abrades dermal cells. So alcohol hand sanitizers designed for healthcare settings are designed with emollients and moisturizers like aloe and keratin and other ingredients that put back in what we have washed out all day long. So alcohol-based hand sanitizers can actually improve hand hygiene and improve hand hygiene adherence. If you're required to do that, like as in California requires before clinical, the first clinical part of your day. And alcohol hand sanitizers are actually less irritating when they're used more frequently than soap and water in clinical settings. But not to forget that the CDC guidelines for hand hygiene also recommend that we use lotions or creams to prevent and decrease skin dry risk that comes from washing our hands so frequently. But I also want to caution there that the lotions and hand creams that we have, if we use them during the clinical day, they must be compatible with our gloves. So, like petroleum products and other products that may compromise glove integrity should not be used during the clinical day. And of course, in the evenings at home or on weekends when you're just sitting and watching TV, I want to remind our listeners that's a great time to take care of putting something on your hands, lotions or creams that'll help you to regenerate that healthy skin condition. And that's really there's a lot more in that CDC guidelines for hand hygiene. I would encourage our listeners to read through that to get a little bit better information and share that information with their teams on appropriate hand hygiene and skin health.
SPEAKER_02Well, thank you, Leslie, and Mary as well, because those are some very important details that really matter in our field of dentistry. And to supplement a couple of your points, Leslie, which were very good, just reminding everyone the times that we should be practicing hand hygiene and the fact that it's important to practice hand hygiene before we glove and after we take off our gloves. And those are the times that we see dental professionals miss the most. They may have already washed their hands with soap and water as they were setting up, they simply walk to the front, maybe touch a doorknob, you know, bring the patient to the back and put on a bib, and they're not really, they don't feel like they've touched anything, and they start a conversation with the patients, and they don't realize that they haven't practiced hand hygiene right before they put on their gloves, and that's the perfect time to use the hand sanitizer. And as you mentioned, Leslie, it's so very important that they use healthcare grade products. That's only not just because they are compatible with our gloves, that's a huge reason, but also because we can't bring in dyes and fragrancies that may cause allergens and dermatitis in the dental setting. So those are fine in the patient restroom and they're fine at home, but we want to have professional brands in the office. So, Davis, do you have any other thoughts or suggestions to share?
SPEAKER_01Linda, I have a couple of things, and I'm so glad you mentioned about washing after removal of gloves, because that's the biggest issue that I see is people assume that gloves are a substitute for hand washing and they will finish a patient, take their gloves off, walk out, and start touching things, and not necessarily knowing whether or not they had any leakage on their gloves and any kind of contamination on their hands. The other thing I wanted to mention too, and Leslie is exactly right, we should be using some type of a brush to clean under fingernails, but it needs to be very gentle, not a real stiff brush so that we don't abrade the skin. And you don't want to use the scrub brushes on your hands because they can abrade the skin just underneath your fingernails.
SPEAKER_02Perfect, Mary. Thank you so much. Leslie?
SPEAKER_00You know, I want to go back to the 70s and early 80s before we were wearing gloves. And, you know, during those days, short nails and trim cuticles and and uh clean under your fingernails was just so important. My father is a dentist, and I remember, you know, one of the things he was really a stickler about was that my fingernails were always clean when I went to work with him. And uh he had a special trick that he used. It's sort of, I think, maybe common in the beauty world where the manicure is on a man's manicure would not use nail polish, but they would use a chamois buffer and sometimes some buffing agent. And he used to buff his nails after he would trim up the cuticles and and and he would get such a shine from that chamois. It would bring the oil from the nail bed up to the surface and it would actually seal his nails beds. And so when he would wash his hands, of course, there's nothing to hang on to. There's no rock wall, so to speak, as a pun to describe how nails can actually be very rough. And they always look like they had nail polish on it. So I want to uh encourage our listeners who are really used to wearing nail polish, even clear nail polish, to try doing something like that. And I think they'll be very pleased with the result.
SPEAKER_02What great tips, Leslie! And you just reminded me that, you know, the same thing in those days that we had a nail brush by the sink. And I think maybe this year there'd be a lot of nail brushes popping up and dental stockings. I don't know, but that certainly would be a clever idea. Well, thank you for joining the Compliance Divas podcast today. Hope you've enjoyed our exploration of the science behind hand hygiene, nail contamination, and the resilience of those pathogens living under your fingernails. As the Compliance Divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on track. All the resources that we mentioned today will be in the show notes. And we invite you to scroll down at the end of this podcast and leave us a review or comment. We'd love to hear your tips on hand hygiene. If you have any questions, you're also welcome to submit them to support at the compliancedevas.com, and we look forward to seeing you next time.