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July 20, 2009

Question #1: In your opinion, which is better: a disposable, reusable, or washable gown?

Answer: The OSHA Bloodborne Standard requirement is that clinical apparel be made of material that "does not permit blood or other potentially infectious materials to pass through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used."

For all forms of personal protective equipment (PPE), comfort relates to compliance. The more well fitting, breathable (freer air movement), and stylish a gown, the greater will be its acceptance and use.

For general dentistry, disposable gowns should have barrier protection like reusable gowns do. Disposable gowns are usually more convenient because they do not have to be laundered. Costs may vary. No matter which type you use, gowns must be changed daily or as soon as possible when they become visibly soiled.

Reference ? OSHA Bloodborne Pathogens Standard, Final Rule. Available at www.osha.gov/SLTC/bloodbornepathogens/index.html.

Question #2: What are my chances of getting AIDS from a needlestick accident?

Answer: Prospective hospital-based studies estimate the risk for HIV infection after a percutaneous exposure to HIV-infected blood is approximately 1 in 333 (0.3%). Occupational exposure to HIV has resulted in 57 documented cases of HIV seroconversion among health-care personnel in the United States. The last case occurred almost 10 years ago.

None of the confirmed occupationally acquired cases of HIV occurred in dentistry. Most of the occupationally related cases involved hollow needles, while most sticks in dentistry involved solid needles (e.g., burs and hand instruments).

Reference ? CDC/Centers for Disease Control and Prevention. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Morbid Mortal weekly Rep 2001;50(RR-11). Available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm.

Question #3: How can we check the performance of our office ultrasonic cleaner?

Answer: You can perform what is called an "aluminum foil test." Create a four-inch square of foil and smooth out any wrinkles. Hold the foil straight up in the center of the unit's chamber as best as possible. Operate the unit for 30 seconds. Remove and inspect the foil. If the unit is operating well, the foil's surface should be pebbled and rough. There may even be holes in the foil.

Reference ? CDC/Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health Care Settings ? 2003. MMWR Morbid Mortal weekly Rep 2003;52(RR-17). Available at www.cdc.gov/mmwr/PDF/rr/rr5217.pdf.

Question #4: Are booster shots recommended to protect against hepatitis B?
Answer: Currently, booster doses are not recommended for persons with normal immune status who were vaccinated as infants, children, adolescents, or adults. Of course, proper application of the correct amount of vaccine is necessary, in the deltoid muscle at zero, one, and six months.
Reference ? CDC/Centers for Disease Control and Prevention. A comprehensive strategy to eliminate transmission of hepatitis B virus infection in the United States. MMWR Morbid Mortal weekly Rep 2006;55(RR-16). Available at www.cdc.gov/mmwr/PDF/rr/rr5516.pdf.

Question #5: How often do I need to biological monitor the office sterilizer?

Answer: The CDA and ADA recommend weekly biological monitoring, except if there are implantable items in a load. In these cases, each load must be monitored.

Reference ? CDC/Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health Care Settings ? 2003. MMWR Morbid Mortal weekly Rep 2003;52(RR-17). Available at www.cdc.gov/mmwr/PDF/rr/rr5217.pdf.

Dr. Charles John Palenik is the director of Infection Control Research and Services at the Indiana University School of Dentistry. In 2003, he was chairman of the Executive Board of OSAP, dentistry's resource for infection control and safety. Direct infection control questions to cpalenik@iupui.edu.

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