Patient Perceptions of Infection Prevention

It has been more than 20 years since the only known clinical transmission of HIV from a dental health-care professional to a patient occurred.

by Mary Govoni, CDA, RDA, RDH, MBA

It has been more than 20 years since the only known clinical transmission of HIV from a dental health-care professional to a patient occurred.

For those of us who were working in dentistry at the time, it wasn’t pretty. It was tragic for Kimberly Bergalis and the other patients who were infected with AIDS by a dentist who practiced in Florida.

It was an extremely uncomfortable time for those who worked in dental settings. Patients questioned everything we did with regard to infection control and prevention. Some even wanted their own instruments and dental handpieces, not trusting that their dentist was appropriately sterilizing those items.

In the middle of this “crisis of confidence” in dentistry, the OSHA Bloodborne Pathogens Standard was finalized. This required dental practices to implement new protocols for preventing transmission of bloodborne pathogens to employees.

The Centers for Disease Control and Prevention (CDC) also published several sets of guidelines for infection prevention in health-care settings, including dentistry. The implementation of these standards and guidelines prompted most dental practices across the U.S. to update their protocols, train and vaccinate employees, and be more proactive with patients about sharing safety information.

Although most patients’ confidence in dentistry has been restored, a recent court case has me wondering how patients perceive our infection prevention procedures. The Supreme Judicial Court of Massachusetts recently upheld a decision by the Massachusetts Board of Registration in Dentistry that suspended the license of a dentist who, according to court documents, could not prove that he was spore-testing his sterilizer on a weekly basis.

The recommendation for weekly monitoring for sterilizers comes from the CDC “Guidelines for Infection Control in Dental Health-Care Settings – 2003.” Although this is not a law or regulation, many dental boards, including Massachusetts, use these guidelines as standards of care for patient safety.

The Massachusetts Board suspended the dentist’s license for six months and placed him on probation for five years. The disciplinary action occurred as a result of complaints from two patients.

The previous CDC guidelines (1993) recommended monthly sterilizer monitoring, which most practices complied with. But some have not increased the frequency since the guidelines have been updated to “at least weekly,” as stated in the 2003 guidelines.

There are many outside services for sterilizer monitoring, including several dental schools. Other services include ConFirm Monitoring Systems, The Dental Advisor, North Bay Bioscience, Sterilizer Monitoring Systems, SPS Medical, and others provided by dental suppliers such as Patterson Dental and Henry Schein Dental.

In-office monitoring systems are also available. These systems include Attest from 3M, ConFirm In-Office, and SporeCheck from Hu-Friedy. Outside monitoring services require that the spore test strips be mailed to the service and a report returned to the facility. In-office monitoring systems require processing of glass vials of spore-containing medium. This is placed in the sterilizer and then into an incubator.

These systems come with a log book for recording results. If a failure of the sterilizer occurs, an outside service immediately alerts the dental facility, then walks team members through a troubleshooting process.

If a failure occurs while using an in-office system, it is incumbent on team members to contact the manufacturer of the monitoring system and/or sterilizer to determine what caused the failure. In-office and outside services meet CDC guidelines for sterilizer monitoring.

It is important to note that each sterilizer used in a facility must be monitored weekly. If a failure occurs, that sterilizer should not be used until the cause of the failure is identified. Keeping good records, whether from an outside service or an in-office monitoring system, is a critical part of risk management and safety documentation.

In the case from Massachusetts, the dentist may have been monitoring the sterilizer, but no records of the spore testing could be produced. If no documentation exists, the assumption is that it is not being done.

The fact that patients made complaints to the dental board suggests to me that they are being observant and are concerned about their safety. In the 20 years since the scrutiny took place, some practices may have become a little complacent about patient perceptions.

Take a look around the clinical areas in your facility. What perceptions might patients have about your infection prevention procedures?

Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Clinical Dynamics, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at mary@marygovoni.com.

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