There have been a number of waterless, alcohol-based hand antiseptics marketed in recent years; does this mean that hand washing is no longer considered effective or acceptable?

You have several acceptable choices for accomplishing effective hand hygiene in your practice.

Either plain soap or an antimicrobial soap and water can be used for non-surgical dental procedures, such as examinations, preventive procedures, restorative dentistry, orthodontics, and endodontic procedures. If hands are not visibly soiled or contaminated with blood or other potentially infectious material (OPIM) [i.e. saliva, bloody saliva], use of a waterless, alcohol-based hand rub is also acceptable. It is important to note the specific wording of the recommendation: “If hands are not visibly soiled, an alcohol-based hand rub can also be used.”

While the use of an antiseptic agent provides effective antimicrobial activity against overgrowth of normal, commensal and transient microflora, the basic tenet of hand washing is to clean hands. Several factors must considered when deciding what approach will be used. These factors include the type of procedures performed in the clinical facility, degree of anticipated contamination during patient treatment, and whether or not residual or persistent antimicrobial activity is needed after hand hygiene procedures. Thus, you can choose to routinely use a liquid soap or antimicrobial antiseptic and water. Use of plain soap is appropriate for removing skin debris and microbial contamination. Since intact skin is a primary barrier, any non-antimicrobial soap considered should contain ingredients to prevent skin irritation and dryness to help preserve epithelial integrity. Optimal properties for use of an antimicrobial antiseptic with water should include broad antimicrobial spectrum of activity, fast acting, and a residual, persistent effectiveness.

The key for use of whatever hand hygiene agent you decide upon is compliance. Several clinical reports published in the medical literature have indicated that the incidence of healthcare-associated infections decreased as health care workers (HCW) demonstrated improved hand hygiene practices. Other studies have also shown that compliance increased with use of alcohol-based hand rubs.