By Andrew G. Whitehead
You wear gloves, face masks, and protective eyewear to protect yourself when performing procedures in your practice. But what about your exposed surfaces in the operatory? Your countertops, bracket trays, handpieces, syringes, X-ray units, light handles, etc., are also exposed to potential contamination from aerosols and spatter.
Want to know how much? Dr. James Crawford, the father of infection control in dentistry, did know how much. He published a landmark infection control study exploring the premise "if saliva were red." Using red poster paint to simulate saliva, practitioners dipped their fingers into red paint and began normal clinical treatment on patient mannequins. The paint subsequently "contaminated" an array of operatory surfaces, demonstrating the cross-contamination that occurs from a practitioner's saliva-covered fingers.
An expanded study by Glass, Cottone, and Leuke at the University of Texas in San Antonio resurrected the poster-paint concept to mark contamination from spatter during a simulated lower second-molar operative procedure using a high-speed handpiece and water coolant. In addition to contaminating the protective clothing of the dentist and assistant, the high-volume evacuator became laden with intraoral fluids.
In a study by Molinari and York at the University of Detroit Mercy, secretions were transferred from the gloved hands of the clinical staff to the patient charts, the instrument tray, various hand instruments, the air-water syringe and the unit light handle (OSAP Monthly Focus, #4, 1999).
The bottom line is that operatory surfaces must be cleaned and disinfected between patients. Use of a surface spray or wipe is acceptable and effective provided you use the proper method of cleaning - clean/wipe/clean - and carefully follow the instructions for use. Unfortunately, it takes time to clean and disinfect properly. And even then, are you cleaning and disinfecting all exposed surfaces? The answer: probably not.
The alternative is surface barriers. To determine which surfaces need to be covered, consider the system outlined in OSAP's 1997 Infection Control in Dentistry Guidelines:
•Touch surfaces - Usually contacted and contaminated by staff during a dental procedure. Exam-ples of touch surfaces include the X-ray exposure button, dental chair switches, headrest, and the air-water syringe. These surfaces require either between-patient cleaning/disinfection or protection with an impervious, single-use barrier.
•Transfer surfaces - Not touched directly by the dental worker, but usually are contacted by contaminated instruments. Examples of transfer surfaces include instrument trays and bracket tables. For optimal asepsis, these surfaces should be maintained in the same manner as touch surfaces.
•Splash, spatter, and aerosol surfaces - Comprise all surfaces in the operatory not classified as touch or transfer surfaces. Exam-ples include the X-ray view box and any unused countertop areas. Splash and spatter surfaces need not be disinfected, but should be cleaned at least daily.
Select barrier film of high quality and ample thickness. The protection provided by surface barriers is only as effective as the quality of the product and its placement. Choose the product and method of surface disinfection that works best for your practice.
Remember, at the end of the day, it is you, your team, your family, and your practice that you are protecting - you're all worth the extra effort!
Visit the OSAP Web site at www.osap.org to learn more about surface barriers.
Andrew G. Whitehead is a vice president for Crosstex International, manufacturer of infection control and disposable products distributed in 60 countries. He has more than 30 years of experience in the dental industry. He Is a founding member and board member of the Organization for Safety and Asepsis Procedures (OSAP), dentistry's resource for infection control and safety. Whitehead may be reached at (631) 582- 6777, by email at firstname.lastname@example.org, or visit www.crosstex.com.