By Mary Govoni, CDA, RDA, RDH, MBA
We survived 2013's firestorm of news stories about infection control issues in dentistry, particularly the events that are still unfolding in Tulsa, Okla. In the hope that we do not see these types of events occur again anytime soon, let's take a look at the top 10 steps that dental practices can take to ensure that dentistry is safer for patients and the team.
1. Sterilizer monitoring is the No. 1 item that was cited in infection control breach reports, and should be No. 1 on the list of every dental practice for review. There are in-office systems from several companies. Attest from 3M, and SporeCheck from Hu-Friedy are two examples. Crosstex, North Bay Bioscience, SPS Medical, and the Dental Advisor all have mail-in, third-party monitoring services. Many dental schools have monitoring services, as well as dental distributors, such as Patterson and Henry Schein.
2. Hand washing is one of the most effective infection prevention tools. Hands should be washed prior to donning gloves and immediately after removing gloves. Hand-washing agents should contain antimicrobial agents for surgical procedures. For nonsurgical procedures, even plain soaps that are gentle on the skin are acceptable, according to the Centers for Disease Control and Prevention. Some examples of soaps for nonsurgical procedures are Derma Scrub from Rosedale Therapeutics, Hand Essentials Lotion Soap from Hu-Friedy, and VioNexus Foaming Soap with Vitamin E from Metrex Research.
3. Facemasks are critical personal protective equipment items to protect dental health-care workers from aerosol and spatter during dental treatment. Classified as single-use, disposable items, facemasks should be changed after every patient, or sooner if they become wet. As I have mentioned previously, Crosstex has a variety of facemasks. A great resource on the company's website called Maskenomics helps in the selection of an appropriate facemask.
4. Utility gloves are probably the most overlooked item in personal protective equipment. The OSHA Hazard Communication Standard requires the use of utility gloves for protection from certain chemicals and some surface disinfectants. The Bloodborne Pathogens Standard requires the use of the gloves for protection from puncture from sharp, contaminated items during cleaning procedures. Team members should be wearing utility gloves when preparing instruments for sterilization. Many of the utility gloves seem bulky and ill-fitting; however, the Hu-Friedy Lilac Utility Gloves come in a variety of sizes (there is a sizing chart on the package), and they are lined for easy donning and removal.
5. Instrument management is a critical part of efficiency and safety in instrument cleaning and sterilization. The OSHA Bloodborne Pathogens Standard requires that contaminated, sharp instruments be transported in covered, puncture-resistant containers. Cassettes or instrument boxes are a great way to achieve compliance and increase safety in this area. Dux Dental, Hu-Friedy, Premier, and Zirc are examples of companies that have instrument cassettes and other organization systems.
6. Water quality from dental units and water-line maintenance are also critical elements of patient safety. The CDC standard for dental unit water quality is ≤500 CFU/ml, which is easily achievable with the many water-line cleaner/disinfectants available. There are a couple of systems worth noting that do not require adding a product each time the water bottle is filled. Examples of these products are the Sterisil Straw from Sterisil and the DentaPure B series from DentaPure. These products slowly release antimicrobial agents into the water and last for several months to one year.
7. Packaging of instruments prior to sterilization is another patient safety protocol that is recommended by the CDC. All instruments, including handpieces, must be packaged. If a practice is using cassettes, the cassettes need to be wrapped or placed in pouches. Packaging protects the sterility of the instruments when they are placed in storage.
8. Surface disinfectants are evolving into more environmentally friendly (safer for the users) as well as shorter (one minute) contact times. They are one-step products. This means that if there is not a high level of contamination, one wipe with the disinfectant is sufficient to achieve disinfection on an environmental surface. Some examples of these products are BioSURF from Micrylium, Monarch Surface Disinfectant from Air Techniques, and Optim 33TB from SciCan.
9. The lab is sometimes overlooked in terms of infection control. Rag wheels on the laboratory lathe should be used for only one patient, then rinsed well and placed in the autoclave. Pumice should be dispensed in single-use amounts. All impressions must be disinfected prior to pouring up in the office lab, or prior to being sent out to a lab. Prostheses (crowns, bridges, partials, and dentures) must also be disinfected prior to being sent out to the lab.
10. Finally, for the well-being of team members and their families, remember that contaminated clothing should not be worn outside of the office or when eating. OSHA states that employers are responsible for laundering contaminated clothing either on-site or via a laundry service.
Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Mary Govoni & Associates, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected] or www.marygovoni.com.
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