CHLORHEXIDINE    GLUCONATE.—This antiseptic   is   usually   marketed   as   4   percent chlorhexidine gluconate with 4 percent isopropyl alcohol in a sudsy base. Chlorhexidine gluconate is an effective antiseptic for reducing transient and resident microbial hand flora, and has a sustained antimicrobial effect. It does not appear to affect the skin adversely. Also, it is approved as a surgical scrub. Waterless Handwashing Agents Waterless handwashing agents contain 70 percent isopropyl alcohol and virtually disinfect the skin in 20 seconds.  They  are  effective  against  tubercle  bacilli, fungi,  and  viruses.  Unfortunately,  they  are  volatile, flammable,  evaporate  quickly,  and  dry  the  skin. Alcohol-based, waterless handwashing agents may be used in areas where handwashing sinks are not readily available. HANDWASHING EQUIPMENT AND SOAP DISPENSERS All  patient  care  areas  should  have  sinks  with electronic or mechanical elbow, foot, or knee action faucet control for asepsis and ease of function. The use of no hand (no touch) actuated soap dispenser  controls  is  preferable.  Maintenance  for refillable handwashing agent dispensers is to empty, disassemble, and clean them weekly. Do not use bar soaps in bathrooms or clinical and common areas. HANDWASHING  GUIDELINES All personnel involved in patient care must wash their hands, wrists, and forearms with a disinfectant soap and water at the following times: At the beginning of each day. Between patients, before and after going to lunch,  after  taking  a  break,  after  using  the bathroom,   or   any   time   they   become contaminated. Before gloving, after degloving, and before regloving. At the end of the day. HANDWASHING  TECHNIQUES Dental staff personnel involved in patient care must  follow  a  rigid  handwashing  protocol  including the following practices: the hands and wrists Removing all jewelry and other ornaments from Trimming the fingernails and cuticles. Nails should be no longer than the finger tips to avoid puncturing gloves. Do not use false fingernails since contamination may occur from fungal growth between the false and natural nails. Also, do not wear nail polish since micro-organisms can hide in small cracks in the finish. Wetting the hands under warm, running water and applying the necessary amount, if antimicrobial soap is required, to work up a lather. Vigorously rub the hands together, fingers entwined. This creates friction and loosens dirt and micro-organisms. Clean under the fingernails using a nail brush. Continue scrubbing the wrists and lower forearms. Visibly soiled hands may require more time. Surgical teams must scrub their hands up to the elbows with an antimicrobial surgical product for the time specified by the manufacturer. After scrubbing, dry with a sterile towel. When washing times are too poor, these problems may occur: short or technique is Fingertips, thumbs, and the areas between the fingers are washed poorly or may be skipped entirely. The dominant hand is generally washed less thoroughly than the nondominant hand. Microbe counts under the fingernails have been found to remain high even after surgical scrubs. Rinse soap off by placing hands under warm running water. If the sides of the sink are touched, you must repeat the handwashing. Dry hands with paper towels. If the sink does not have an electronic elbow, foot, or knee action faucet control, use a dry paper towel when turning off the faucet. 9-14