8.3 Hand Hygiene and PPE Selection

Hand Hygiene: Moments and Methods

Hand hygiene is the single most important infection-control measure. Per CDC, dental healthcare personnel perform hand hygiene at these moments:

• When hands are visibly soiled
• After barehanded touching of contaminated instruments, surfaces, or OPIM
• Before and after treating each patient
• Before donning gloves and immediately after removing gloves (gloves leak microscopically and hands sweat under them)
• After touching the face, nose, or any non-clinical surface during care

Method depends on soil:

The classic trap: alcohol-based hand rub does not work on visibly soiled hands—organic matter inactivates it—so blood or debris always means soap and water. Keep nails short, avoid artificial nails (they harbor pathogens and tear gloves), and remove rings/wrist jewelry that trap microbes and puncture gloves.

Donning and Doffing PPE in Order

PPE is wearable protection—gloves, masks, protective eyewear, face shields, gowns/clinic jackets—worn whenever spray or spatter of blood or saliva is anticipated. Sequence matters because contamination concentrates on gloves and gown fronts.

Donning (clean → on the body, gloves last):

1. Perform hand hygiene
2. Gown/clinic jacket (long sleeves, high collar, fluid-resistant for spatter work)
3. Mask (secure over nose and chin; mold the nosepiece)
4. Protective eyewear or face shield (side shields required)
5. Gloves, pulled over the gown cuffs

Doffing (most-contaminated first, hand hygiene last):

1. Gloves (contaminated outsides; peel inside-out)
2. Hand hygiene
3. Eyewear/face shield (handle by the headband/earpieces, not the front)
4. Gown (roll away from the body, contaminated side in)
5. Mask (touch only the ties/ear loops, not the front)
6. Hand hygiene — always the final step

PPE is changed at minimum between every patient. Replace a mask when it becomes wet (a wet mask wicks fluid and stops filtering), torn, or after an aerosol-heavy procedure. A standard surgical/procedure mask suffices for routine spatter; an N95 respirator (fit-tested) is reserved for airborne precautions such as suspected/active tuberculosis. Gowns are changed when visibly soiled and before leaving the work area.

Matching PPE to Exposure and Glove Discipline

PPE selection follows anticipated exposure:

• Gloves for all contact with blood, saliva, mucous membranes, OPIM, or contaminated items. Exam gloves are single-use, single-patient, single-task—never washed and reused. Utility (heavy) gloves, which are puncture-resistant and can be disinfected, are for operatory cleanup and instrument processing, not patient care.
• Mask + eyewear/face shield whenever procedures generate spray or spatter to the face's mucous membranes—the eyes, nose, and mouth are portals of entry.
• Gown/jacket when clothing or skin could be soiled.
• Nitrile instead of latex for latex-sensitive patients or staff.

Glove discipline is a frequent test point. Treatment gloves must not touch clean charts, the phone, drawer handles, the keyboard, eyeglasses, or personal items—doing so transfers contamination (indirect transmission) and is always the "unsafe" answer in a multiple-choice item. If a clean item must be handled mid-procedure, use an overglove or a clean second person. After any glove removal—routine, torn, or contaminated—hand hygiene is performed before re-gloving. Together, correct timing, the soap-versus-rub rule, ordered donning/doffing, and strict glove discipline answer nearly every Domain 3A PPE question.

Glove Types and Mask/Respirator Distinctions

Know the glove inventory and when each applies:

For face protection, distinguish a surgical/procedure mask—which filters spatter and is changed when wet or between patients—from a fit-tested N95 respirator, which forms a seal and is required only for airborne precautions (e.g., suspected pulmonary tuberculosis). A mask protects against droplets and spatter; only a properly fitted respirator protects against true airborne particles. Protective eyewear must have side shields, and a full face shield is added over a mask for heavy-spray procedures because a shield alone does not seal around the nose and mouth.

Finally, remember the "wet mask" rule and the "reach with a barrier" rule, because both appear repeatedly: a mask that becomes wet has lost filtration and is replaced, and contaminated gloves never open clean drawers—an overglove or clean assistant does. These two micro-decisions, plus ordered donning/doffing and hand hygiene as the final step, are the workhorse answers of Domain 3A PPE items.

A few more nail-down rules: PPE is removed before leaving the treatment area, never worn into break rooms or the front office (it carries contamination out and exposes others). Reusable protective eyewear is cleaned and disinfected between patients rather than discarded. Gowns with long sleeves and a high neckline are chosen for spatter-heavy work and are changed when visibly soiled or torn. And the employer—not the employee—provides, launders, and replaces required PPE at no cost under Cal/OSHA, mirroring the Hepatitis B vaccine rule covered later in this chapter.