Poor Hand Hygiene Leads to New Guidelines

Infection control experts at the Centers for Disease Control and Prevention are wringing their hands over health care workers’ inability to keep their hands clean, so the CDC will soon be issuing new recommendations to address this basic tenet of proper infection control.

The guideline -- intended to replace the hand hygiene recommendations in Guideline for Handwashing and Hospital Environmental Control, 1985 -- will be published in its final form in 2002.

According to the CDC document, adherence to existing handwashing recommendations by health care personnel is poor. Thus, the objectives of developing a new hand hygiene guideline are to establish and promote new strategies for improving hand hygiene practices in health care and to reduce health care-acquired infections.

In preparing the guidelines, Medline searches of articles and scientific meeting abstracts published from 1966 through early 2001 were conducted. Among the search criteria were hand antisepsis, washing, hygiene agents, and practices.

The Hand Hygiene Task Force and the Healthcare Infection Control Practices Advisory Committee did not include anyone with DDS or DMD after their names; however, among the 354 references cited in the draft guideline, a handful of dental journals were included. Since the recommendations are based on the medical literature, the guidelines are clearly aimed at medical workers.

This does not mean hand cleanliness is of no concern in the dental office, cautioned Eve Cuny, RDA, MS, director of Environmental Health and Safety at the University of the Pacific School of Dentistry in San Francisco. "It means the studies required to support guidelines with evidence of infectious transmission in dental settings are not available."

Cuny, also an assistant professor in the Department of Pathology and Medicine at UOP, explained that little evidence is available regarding the role of hand hygiene in transmission of infectious organisms in dental settings because the relevant studies have focused almost exclusively on inpatient health care settings, such as hospitals.

A discussion of the pathogens found on and transmitted by hands of health care workers is provided in the new guideline. The common preparations used for hand hygiene are reviewed, from chlorhexidine and triclosan to surgical scrubs and plain soap. The factors affecting hand hygiene agent use are provided, including proximity to access agent, allergy, time required, and health care workers’ hand hygiene practices. Even the debate of real vs. artificial fingernails is touched on. In citing a few studies, the guideline’s reviewers went as far as to point out that "chipped nail polish may support the growth of a larger number of organisms on fingernails" compared with freshly applied nail polish.

Also of interest to dental personnel may be a study cited within the guideline that led the reviewers to state: "It might not be prudent to wash and reuse gloves between patient contact," and "hand washing or disinfection should be strongly encouraged after glove removal" as organisms may be found on the hands after contaminated gloves are removed.

It is reaffirmed that hand antisepsis can reduce transmission of health care-acquired microorganisms; thus, improving adherence to recommended hand hygiene practices can reduce health care-acquired infections.

Although the guideline cites poor adherence to handwashing protocols in hospital worker studies, Cuny said, "It is not a dramatic stretch of the imagination to assume the same poor adherence is likely present among dental health care workers."

The CDC guideline’s main conclusion is that "alcohol-based hand rubs reduce bacterial counts on the hands of personnel more effectively than plain or antimicrobial soaps, can be made more accessible than sinks and other handwashing facilities, and require less time to use and cause less skin irritation and dryness than washing hands with soap and water."

Cuny’s caveats are that numerous factors (e.g., concentration, soil present on hands, etc.) can affect the efficacy of alcohol as an antiseptic hand hygiene agent.

Among the guideline’s recommendations that are strongly supported by well-designed studies:

* Wash hands with a non-antimicrobial soap and water or an antimicrobial soap and water when hands are visibly dirty or contaminated.

* If hands are not visibly soiled, use an alcohol-based waterless antiseptic agent for routinely decontaminating hands in all other clinical situations.

* Decontaminate hands after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings, as long as hands are not visibly soiled.

* Do not add soap to a partially empty soap dispenser. The practice of "topping off" dispensers may lead to bacterial contamination of soap.

* Provide health care workers with hand lotions or creams in order to minimize the occurrence of irritant contact dermatitis associated with hand antisepsis or handwashing.

* Do not wear artificial fingernails or extenders when providing patient care.

* As part of a multidisciplinary program to improve hand hygiene adherence, provide health care workers with a readily accessible waterless antiseptic agent such as an alcohol-based handrub product.

* Monitor healthcare workers’ adherence with recommended hand hygiene practices.

* The full draft of the guideline can be downloaded from "www.cdc.gov/ncidod/hip/hhguide.htm."

Home Equity Loans May Help Increase Wealth

By Marios Gregoriou

Home equity loans extend credit to consumers based on the amount of equity they currently have in their homes. In most cases, this equity equals the current value of the home minus the current balance remaining on the mortgage. For many homeowners, a home equity loan is an important source of additional funding that can be used for purposes such as debt consolidation and meeting major life expenses. Some homeowners, however, have taken home equity borrowing one step further by using it not only to meet specific expenses, but also to help create and preserve their personal wealth.

Traditional Home Equity Lending

Second mortgage loans were among the first home equity loan products to be developed. Most second mortgage loans are fully amortized, have a fixed rate of interest, are disbursed in lump sum payments, and are repaid in equal monthly installments. Borrowers applying for second mortgage loans usually do so in order to meet specific financial needs. And, once the loan is paid in full, that particular borrower-lender relationship comes to an end.

Home Equity Lines of Credit

Once federal income tax deductions for interest paid on nonmortgage consumer debt were phased out, demand arose for more flexible forms of consumer borrowing than traditional second mortgage loans. To meet this demand, financial institutions began introducing home equity lines of credit, which allow borrowers to meet their purchase or credit obligations and avoid the high rates of interest imposed by some other lenders, such as credit card companies.

One benefit of a home equity line of credit is that it establishes an ongoing financial relationship between the homeowner and the lender. As a result, it need not be renegotiated whenever future financial needs arise. With the increasing availability of these lines of credit, consumers began to use them for a variety of major life expenses -- such as funding a child’s higher education, paying for vacations or buying a new car or other large-ticket item.

Home Equity Borrowing Today

Although the decision to take out a home equity loan has traditionally been driven by a specific financial need, that is beginning to change. In many cases, home equity loans are now being driven by a desire to add to or preserve personal wealth.

One relatively new approach to wealth creation combines home equity lines of credit with total balance sheet management -- the active management of liabilities in order to help increase or preserve financial assets. Rather than view all debt as negative, Total balance sheet management investors believe that certain kinds of debt can help improve their overall financial health. Such an investment strategy commonly include:

* Consolidating high-interest debt into lower-interest alternatives.

* Maximizing tax deductions and minimizing capital gains events.

* Using credit cards only when necessary.

The total balance sheet management approach to home equity lending has helped change the borrowing patterns of many Americans. For some investors, a home equity line of credit allows for debt consolidation that can free up additional funds for the purchase of stocks and bonds. For others, buying a new car through a home equity line of credit offers allows for tax deductible interest payments that are not available with traditional auto loans.

Home equity borrowing has never been more popular. A borrower may even be offered access to a home equity line of credit when applying for a mortgage -- even if he or she doesn’t intend to access it in the near future.

Marios Gregoriou is an associate vice president, financial adviser, with Morgan Stanley in Sacramento.

This article does not constitute tax or legal advice. One should consult his or her tax or legal adviser before making any tax- or legally related investment decisions. This article is published for general informational purposes only and is not an offer or solicitation to sell or buy any securities or commodities. Any particular investment should be analyzed based on its terms and risks as they relate to one’s individual circumstances and objectives.

Top 10 Considerations for the New Dentist

Dental school is not where future dentists learn the finer points of running a business, according to Dr. Barbara Mousel in an article in the September 2001 Illinois Dental News.

"In four years, there isn’t time to focus on much outside the clinical aspects of dentistry," she said.

Mousel offered new dentists some recommendations for facing the tough issues and decision of starting a practice.

1. Stay current on student loan payments.

2. Buy insurance coverage.

3. Choose a lender who understands service businesses.

4. Borrow enough for working capital.

5. Be cautious about signing on with PPOs and HMOs.

6. Carefully select equipment and delivery systems.

7. Get your name out there.

8. Smile and talk to your patients.

9. Use the services of quality consultants.

10. Join dental organizations.

In dental school, Mousel said, opportunities are slim for learning how to manage schedules, people, or finances, let alone considering such things as office design and overhead control.

"New dentists are starting cold, and it’s easy to quickly become overwhelmed by all of the issues that you know nothing about," she wrote.

Sex Differences Extend Beyond Reproduction

A recently published study of the Institute of Medicine shows there are numerous sex differences in nonreproductive tissues, according to an article in the September 2001 Bulletin of Dental Education.

The 288-page report, "Exploring the Biological Contributions to Human Health: Does Sex Matter?" is the result of a 16-month effort to consider biology at the cellular, developmental, organ, organismal, and behavioral levels.

Institute of Medicine researchers noted that the most obvious and best-studied differences between the sexes are in the reproductive systems. Much less work has been done on sex differences in the nonreproductive areas of biology.

One of the most compelling reasons for looking at what is known about the biology of sex differences is that there are striking differences in human disease that are not explained at this time, according to the institute.

Some major findings and recommendations of the study:

* There are multiple, ubiquitous differences in the basic cellular biochemistries of males and females that can affect an individual’s health. Many of these differences do not necessarily arise as a result of differences in the hormonal regime to which males and females are exposed but are a direct result of the genetic differences between the sexes.

* Sex differences of importance to health and human disease occur throughout the life span, although their specific expression varies at difference stages of life. The Institute of Medicine study recommends that researchers and those who fund research focus on the inclusion of sex as a variable in basic research designs.

* Basic genetic and physiological differences, in combination with environmental factors, result in behavioral and cognitive differences between males and females.

* Males and females have different patterns of illness and different life spans, raising questions about the relative roles of biology and environment in these disparities.

The researchers noted that, historically, studies on race, ethnicity, age, nationality, religion, and sex have sometimes led to discriminatory practices. They expressed the belief that these historical practices should be taken into consideration so that they will not be repeated.

* The full text of the Institute of Medicine publication "Exploring the Biological Contributions to Human Health: Does Sex Matter?" is available at www.nap.edu/catalog/10028.html.

Table Salt Useless for Gag Reflex

The use of table salt did not reduce the time to triggering the gag reflex, according to a comparative pilot study whose results were published in the July/August 2001 issue of the International Journal of Prosthodontics.

Researchers at the Lebanese University School of Dentistry in Beirut compared two methods for reducing gagging induced by stimulation of the soft palate: table salt and nitrous oxide inhalation sedation.

They noted that a method using table salt spread for five seconds on the tip of the tongue supposedly eliminated the gag reflex. The idea seemed interesting and easy, but no clinical trial had been published to support the theory, they noted. The aim of their pilot study was to compare the efficiency of table salt with a method using inhalation sedation with nitrous oxide.

The study used 15 healthy volunteers, eight men and seven women with a mean age of 20.6 years. The volunteers were subjected to a gagging event three times, using a large tablespoon to stimulate the soft palate. The first event used the spoon alone; event two used the spoon and table salt on the tip of the tongue, with a 30-minute break between events one and two. Event three used the spoon and nitrous oxide sedation on another day. Time in seconds was measured from the moment the spoon touched the soft palate until gagging was felt.

The researchers found that nitrous oxide inhalation sedation significantly reduced the gagging/retching reaction, but there was no significant time difference in gagging reaction between stimulation with the spoon alone or when table salt was added.

New $19 million Program Targets Access

The Robert Wood Johnson Foundation has announced a new six-year effort to increase access to dental care for low-income and medically disadvantaged populations.

Funding through the $19 million Pipeline, Profession and Practice: Community-Based Dental Education initiative will be available for up to 10 dental schools to develop programs to increase access to dental care for underserved populations by encouraging community education programs and by recruiting more underrepresented minority and low-income students into dentistry. A total of $15 million will be made available to selected schools, and $4 million will be used to support the overall program.

"While the nation’s overall dental health has improved greatly in the last half-century, disadvantaged populations -- low-income, medically disabled, and geographically isolated -- continue to suffer from poor oral health and inadequate access to care," said Judith Stavinsky, senior program officer at the Robert Wood Johnson Foundation. "Pipeline, Profession, and Practice focuses on the dental schools’ ability to reduce those gaps in care through community-based education programs that expand patient care to underserved populations."

Dental schools funded through the Pipeline program will forge partnerships that enable their students, residents, and faculty to work with private practitioners, health agencies, hospitals, schools, clinics, and other community organizations to provide services to populations with poor oral health and limited access to dental care. Schools will also develop strategies to recruit more low-income students and more African American, Latino, Native American and other underrepresented minorities into dentistry.

* More detailed information about the application process is available in the call for proposals, available on the foundation Web site at www.rwjf.org/index.jsp and the program Web site, dentalpipeline.columbia.edu/

Honors

Wai M. Chan, DDS, has been inducted as a fellow of the American College of Dentists and the Academy of Dentistry International at their annual meeting October in Kansas City, Mo.

The American College of Dentists also honored Arthur A. Dugoni, DDS, dean of the University of the Pacific School of Dentistry, with the William John Gies Award on Oct. 12 in Kansas City, Mo. Established in memory of Gies, a pioneer in the advancement of dental education and research, this award recognizes Dugoni’s leadership and meritorious services to the profession.

The Pacific Coast Society of Orthodontists also honored Dr. Dugoni, with their 2001 Award of Merit. The award recognizes Dugoni’s outstanding contributions to the society and the profession of orthodontics.

The American Dental Association Health Foundation has given Guy C. Lichty, II, DDS, its 2001 Community Preventive Dentistry Meritorious Award for his work with the Anderson Center for Dental Care’s Project Adopt-A-Home.

Upcoming Meetings

2002

Jan. 24-26 Annual Scientific Session and Exhibition of the Hawaii Dental Association, Honolulu, (800) 359-6725, hda@hawaiidentalassociation.net

Jan. 31-Feb. 3 Yankee Dental Congress, Boston, (508) 480-9797, www.yankeedental.com

March 13-16 Academy of Laser Dentistry Annual Conference & Exhibition, San Diego, (954) 346-3776, www.laserdentistry.org

April 4-7 CDA Scientific Session, Anaheim, (916) 443-3382, Ext. 4470

April 12-14 International Dental Exhibition and Meeting, Singapore, 212 -974-8835, www.idem2002.com

May 7-12 American Academy of Cosmetic Dentistry Annual Session, Honolulu, (800) 543-9220, www.aacdhawaii.com

May 16-19 Organization for Safety and Asepsis Procedures Symposium, Nashville, (800) 298-OSAP, www.osap.org

Sept. 27-29 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470.

Oct. 11-13 National Association of Filipino Dentists in America Annual Meeting, San Francisco, (818) 988-3910.

Oct. 19-23 ADA Annual Session, New Orleans, (312) 440-2500.

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.