Mary Govoni, CDA, RDA, RDH, MBA
For more on this topic, go to www.dentaleconomics.com and search using the following key words: infection prevention, personal protective equipment, CDC, training, Mary Govoni.
It may seem irrelevant whether we, as dental professionals, address what we do to protect ourselves and patients as infection control or infection prevention. On the other hand, do we want to just control infectious diseases in our practices, or do we really want to prevent them?
I vote for the latter because it better describes what we do. There have been few incidents of infectious disease transmission in dental health-care settings. The most notable was the HIV transmission in Florida in the early 1990s.
Recently, there have been several well-publicized events involving a dental clinic at a Veterans Administration health center in St. Louis, Mo., and documented cases of hepatitis B transmissions in a free clinic in West Virginia. With these events, I hear in lectures and consulting visits that patients are again questioning infection prevention practices.
In a time when some patients are reluctant to maintain regular dental visits due to economic constraints, we surely do not want to give them another reason - fear of infectious disease - to stay away. So now would be a great time to review protocols, update OSHA-required documentation and annual infection prevention training, and make sure that you are following the appropriate standards of care for preventing disease transmission in your facility. Here are a few highlights.
Training
The OSHA Bloodborne Pathogens Standard requires employees to have initial training in infection prevention and disease transmission, and all employees to participate in an annual training update. This can be accomplished by many different methods: a seminar, webinar, self-study course, in-house program presented by a member of your team or outside facilitator, or available-for-purchase, video-based training programs. A word of caution: watching the same video year after year really does not qualify as an "update."
I recommend that all team members participate in the training updates. Even though business team members may not be involved in clinical procedures daily, they do need to be knowledgeable in order to respond to questions from patients when answering the phones. I also recommend that infection prevention and occupational safety (a.k.a., OSHA compliance) should be included on the agenda for regular team meetings. Making safety a priority keeps it fresh in everyone's minds.
Personal protective equipment
The use of gloves, masks, safety glasses, and protective clothing is perhaps the most notable change in protocols for dental professionals since the Bloodborne Pathogens Standard was finalized nearly 20 years ago. The manufacturers of these protective devices have provided great options for sizing, comfort, and optimal protection.
In other words, there is no excuse not to use them. There is also no excuse to abuse them. A reminder: face masks should be changed after each patient since they are single- use, disposable items. Prescription eyeglasses do not qualify as safety glasses, unless the prescription lenses are in specially designed safety glass frames with side shields. Remember that wearing gloves is not a substitute for hand washing.
Instrument management
The most common exposure-related injury in dental facilities occurs when team members clean and prepare contaminated instruments for sterilization. To prevent these puncture injuries, heavy-duty utility gloves should be worn while cleaning and packaging instruments. In addition, OSHA requires that instruments be transported in covered, puncture-resistant containers. Again, the manufacturers have provided many great options in the form of plastic, resin, and stainless steel cassettes to make handling contaminated instruments safer.
Sterilizer monitoring
The Centers for Disease Control and Prevention (CDC) Guidelines for Infection Control in Dental Health Care Settings - 2003 states that sterilizers should be monitored at least weekly. This can be accomplished through a third-party monitoring service, using an in-office monitoring system or a combination of both. If your facility has multiple sterilizers, each of the sterilizers must be monitored weekly. Since a common cause of sterilizer failure is operator error, it is a good idea to consult the manufacturer's instruction manual to make sure the sterilizer is being loaded and maintained properly.
These are some basic elements of infection prevention in dentistry. More will come next month. Feel free to send me comments, questions, and suggestions for future topics at [email protected]. I would love to hear from you.
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 [email protected].
