Effectiveness and efficiency

Jan. 1, 2003
Dental practices stepped up their infection control measures soon after the identification of provider-to-patient transmission of hepatitis B in the late 1970s and the emergence of HIV/AIDS in 1981.

By Charles John Palenik, MS, PhD

Dental practices stepped up their infection control measures soon after the identification of provider-to-patient transmission of hepatitis B in the late 1970s and the emergence of HIV/AIDS in 1981. Concerned about occupational acquisition of bloodborne infections, the Centers for Disease Control (CDC) began to recommend universal precautions (now called standard precautions) in 1987. Under uni-versal/standard precautions, blood and certain body fluids of all patients are considered potentially infectious.

The Occupational Safety and Health Administration (OSHA) followed the CDC with its own mandatory regulations in 1991. Through its Occupational Exposure to Bloodborne Pathogens Standard, OSHA prescribed safeguards to protect workers against bloodborne pathogen hazards.

Infection control compliance has affected dentistry in all areas — time, talent, and treasure. The compliance costs — materials, training, and equipment — have been considerable.The majority of dental practices have made a significant effort to improve health and safety for their patients and employees as well as the surrounding community. Practices have become increasingly sophisticated in the selection of more effective compliance-related materials and processes. They also have begun to seek ways to improve the efficiency of their infection control programs.

How can practices make their infection control decisions more efficient? One way may be to apply a simple set of criteria: determine what is reasonable, necessary, and appropriate.

Let's suppose, for example, that staff members requested heat-resistant gloves to use while removing instruments after sterilization.

Is the request reasonable? Yes. Heat-resistant gloves would increase worker safety and decrease the chances of instruments being dropped.

Is the request necessary? Yes. Worker safety is at issue. Employers are required to provide employees with processes and equipment that help protect them from specific occupational hazards.

Is the request appropriate? Yes. There are many types of heat-resistant gloves. Some investigation may be needed to select the ones that work best.

Applying these three criteria confirms that using heat-resistant gloves while unloading a sterilizer would increase safety and efficiency.

Not all requests will stand up to this three-question evaluation. For example, an employee saw a program about seamless protective suits with attached self-contained breathing devices that orthopedic surgeons wear. The "moon suits" provide total coverage as well as sterile air. Under the demanding and potentially hazardous conditions of orthopedic surgery, the suits are indeed appropriate attire. Their application in dentistry, however, is dubious.

The degree of contamination associated with most dental procedures, the low risk of disease transmission, and the success of standard infection control and safety precautions suggest that a full-coverage, sterile-air protective suit isn't necessary.

However, many infection control decisions are more difficult. Consider the type of protective gown worn in the practice. Can a single type meet the needs of all employees?

The necessity of providing an outer protective gown is not in question, but the issue of which type or form is most appropriate for the practice can be debated. Seek staff input; employees who actively participate in the selection process are more likely to accept the final decision.

As dentistry's resource for infection control and safety information, OSAP provides a wealth of health and safety information for dental practices. For more information, visit www.osap.org or call (800) 298-OSAP.

Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik has authored numerous articles, book chapters and monographs, and is the co-author of the popular Infection Control and Management of Hazardous Materials for the Dental Team. He serves on the Executive Board of OSAP, dentistry's resource for infection control and safety.Questions about this article or any infection control issue may be directed to [email protected].

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