Compliance is really the key

The application of routine infection–control procedures, practices, and protocols has dramatically reduced potential occupational exposures ...

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The application of routine infection–control procedures, practices, and protocols has dramatically reduced potential occupational exposures and infection risks for health–care providers and patients during treatment. Stop and think for a moment about how far your routine infection precautions have come. Examples include adoption of newer hand hygiene products, improved gloves, masks, eyewear, clinic jackets, needle recapping devices, more efficient heat sterilizers, instrument cassettes, automated instrument cleaning units, disinfectant wipes, and dental water treatment systems.

Yet, despite the documented, long–term success of protocols and the development of additional products, I still find a range of opinions among conscientious health professionals concerning either the necessity or the speed of infection–control implementation. As you would expect, there are individuals who say published recommendations are not developed and implemented fast enough. Others counter that many of the published guidelines have not been substantiated by documented scientific data nor are they necessary.

One thing to keep in mind when considering these comments is that — even as we continue to witness the ongoing evolution of a variety of infection–control technologies and products — long–standing, basic infection–control principles have not changed. There certainly is no single “best list” to reference. But in discussions to illustrate the principles, I include a few of the following points:

  • Exposure is not synonymous with infection
  • Cleaning is the fundamental first step in infection–control practices
  • Hand hygiene is the basic and most important infection–control practice
  • Do you know whom or what you are treating?
  • Professional vaccination for health–care providers involves more than receiving the hepatitis vaccine
  • Most hand dermatitis is not an allergic reaction to latex
  • Use respiratory hygiene/cough etiquette
  • Do not disinfect when you sterilize
  • Effective infection control allows for acceptable choices

Although many of you could easily come up with additional areas and wording changes, the point here is to comprehend the “why” and not merely the “what” of recommended precautions. As one develops a better understanding of the rationale for infection prevention practices, increased compliance with specific precautions will logically increase.

Another requirement for improved compliance means considering possible misconceptions and the effect they can have in daily routines. Comments ranging from a belief that infection–control precautions do not guarantee 100% protection, to those who state that much of what we are asked to do is “overkill,” represent two ends of this spectrum.

Unfortunately, a common thread that runs through these types of comments is the misplaced belief that each infection–control procedure or product should provide an absolute safeguard against cross–infection.

I suggest that we view each area of the total program as providing a twofold benefit: 1) each can afford an acceptable level of effectiveness and safety as a stand–alone (i.e., hand hygiene practices and use of work practice and engineering controls to prevent accidental sharps exposures when recapping needles); and 2) each practice also should provide an overlapping margin of protection with and for other protocols that are in place.

The latter is exemplified when you use appropriate personal protective equipment, automated instrument cleaning units, and cassettes when reprocessing contaminated instruments. Each is important to protect personnel from sharps accidents, much like a single–handed scoop recapping technique or self–sheathing device protects against needlesticks.

A lack of compliance with basic principles can have an adverse ripple effect simply by lessening the margin of overlap needed when shortcuts are taken in the performance of routine tasks. It may not appear so, but each infection–control procedure and protocol reinforces the others.

While the potential for occupational risks is not eliminated even when the best infection–control practices are employed, when compliance wanes, the door may be unknowingly opened for increased microbial cross–contamination and cross–infection. You can easily check for this by looking for possible areas of overlap. You probably are accomplishing much of this without realizing it.

Dr. John A. Molinari is director of infection control for THE DENTAL ADVISOR. Previously, he was professor and chairman of the Department of Biomedical Sciences at the University of Detroit Mercy School of Dentistry. Contact him at

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