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Since I began practicing, the discipline that has affected dentistry the most is infection control. We have made significant advancements in technology, but infection control has changed the way that we practice on a fundamental level.
In dental school, we wore gloves only for particularly bloody extractions. Even then, some instructors made fun of those who wore gloves. We washed our hands before and between patients, which was considered proper infection control. Although we used autoclaves for instruments, nearly everything else was simply wiped with a moist alcohol gauze pad.
Certainly, infection control has become much more serious and effective. Everything that goes into the patient’s mouth is autoclaved or disposable. Countertops and surfaces that cannot be sterilized are disinfected. We know we cannot make the dental operatory a completely sterile environment, but we’re certainly doing a better job of controlling it.
UNC School of Dentistry bib chain culture study
Even with current infection control procedures in place, we still miss the obvious. The UNC School of Dentistry in Chapel Hill, N.C., conducted a study of bib clip style chains. The chain can be an actual source of real cross-contamination, and most dental offices have not addressed or even thought about this issue.
Consider that when the patient is first seated, the ungloved assistant takes the bib chain (one that has already been used on many patients) from the chair, fiddles to straighten out the knots, and places it around the patient’s neck. The dental assistant’s hands are now contaminated with saliva, pathogens, blood, hair, and aerosol sprays that have been clinging to the bib chain after exposure to previous patients.
Then, during normal treatment, the bib slides from side to side and gets readjusted with our gloved hands, which are contaminated with the saliva, aerosol, blood, and pathogens found from the current treatment. We all know that bib chains are rarely disinfected and almost no one sterilizes them.
The UNC School of Dentistry bib chain culture study demonstrated that one in five bib chains harbored pseudomonas, E. Coli, or staphylococcus aureus. Considering that the disease-causing bacteria found on these bib chains have been implicated in respiratory infections in the general public, patients with compromised immune systems and breathing disorders may be at even greater risk.
We know that bloodborne viruses can live on operatory surfaces for up to one week when not properly cleaned and disinfected. The Centers for Disease Control and Prevention defines cross-contamination as the act of spreading bacteria and viruses from one surface to another. In short, the bib chain fits every definition of cross-contamination, so it is high time we addressed this in the dental office.
The reason I am making a big deal of this is because it’s important. I have been around dentistry long enough to know that if we don’t start taking care of these matters ourselves, they will become news events. The media can slant information to make the public think that dentists are infecting patients every day.
Ways to avoid the risk of bib chain contamination
- Rinse off any gross debris, immerse the bib chain in an EPA registered disinfectant (for the time needed to properly disinfect), then remove, dry, and store in a clean area.
- Ultrasonically clean the bib chain, place it in a sterilization pouch, then autoclave it (for complete sterilization). This is effective but time consuming and expensive and not an option if there is any rubber on the bib clip.
- Use disposable bib holders (such as Bib-Eze by DUX Dental). These are single-use, disposable bib holders made of a soft elasticized fiber that will stretch to fit any patient. They eliminate cross-contamination and the need to clean a chain. They are a very low-cost item that costs much less than other options in terms of time and effort.
I have to give credit to our fellow dental professionals, specifically dental hygienists and assistants. An article in the January 2010 RDH® magazine highlights this same issue.
We must see and hear what happens around us. Before an investigative reporter sees a bib clip fall off the dental chair, get stepped on and rolled over, then picked up and put into use, we must take action. Let’s make these improvements with no arguing. When such a simple solution exists, let’s just do it. We do not need any more scandals in dentistry.
Dr. Louis Malcmacher is a practicing general dentist and internationally known lecturer, author, and dental consultant known for his comprehensive and entertaining style. An evaluator for CLINICIANS REPORT, Dr. Malcmacher is the President of the American Academy of Facial Esthetics. Contact him at (440) 892-1810 or e-mail [email protected]. His Web site is www.commonsensedentistry.com, where you can sign up for a free monthly e-newsletter.