Infection prevention and patient records

March 1, 2011
All the experts advise us that documentation is a critical step in dental treatment. Treatment notes, charting of existing teeth and conditions ...

by Mary Govoni, CDA, RDA, RDH, MBA

For more on this topic, go to and search using the following key words: infection prevention, patient records, documentation, dental treatment, Mary Govoni.

All the experts advise us that documentation is a critical step in dental treatment. Treatment notes, charting of existing teeth and conditions, as well as periodontal charting are vital elements of each patient's dental treatment history, as well as legal records of services rendered.

Yet, maintaining proper aseptic technique while fulfilling these requirements can be a challenge. Preventing cross-contamination of paper charts or electronic equipment for digital charting requires thoughtful planning and developing new habits. Let's explore some of these challenges and do some problem solving.

There seems to be about an equal split between those practices that maintain paper recordkeeping systems and those that have switched to electronic systems. For those practices still using paper charts, the charts are exposed to contaminants in the treatment rooms if they sit on a counter or work surface during treatment. The aerosols created by using a handpiece, air/water syringe, or mechanical scaler can contaminate work surfaces and any or all items that are on those surfaces, including patient charts.

This is why the Centers for Disease Control and Prevention (CDC) recommends that the number of items on work surfaces be minimized, in containers, or covered by barriers that can be changed after each patient. Since paper charts cannot be disinfected, placing them in plastic sleeves, available at an office supply store, is a good option if the charts must be out on the counter during treatment.

When the dentist, assistant, or hygienist prepares to write in the chart, gloves must be removed and hands washed to prevent contamination of the chart by touching. Another alternative is to have a team member who has clean hands do the recording. This is especially helpful for hygienists who are doing periodontal charting on patients. It is extremely unlikely that hepatitis or HIV would be transmitted from a contaminated patient chart.

There is, however, the possibility of transmitting cold, influenza, and other viral or bacterial infections when the charts are handled by team members who may have cuts or abrasions on their hands, or who touch the contaminated records and their hands come in contact with the mucous membranes of their eyes, nose, or mouth. The bottom line is that patient records should never be handled or written on with contaminated gloves or hands.

In practices in which charting is electronic, the cross-contamination challenge is with the computers, specifically input devices. The keyboard and mouse should not be touched with contaminated hands unless they are covered with an impervious barrier. This can be difficult with a mouse, and many of the keyboard covers make it difficult to type.

Developing the habit of taking off gloves and washing hands before inputting information is one option. Another option is to use a waterproof keyboard that can be cleaned and disinfected after use. There are several types available.

The type that I have found great success with is a smooth, glass, or acrylic surface – preferably with a glide pad that can be used in place of a mouse. This surface can easily be wiped with a disinfectant wipe as part of the treatment room clean-up procedure.

Monitors should never be touched with contaminated gloves. The surface of the screen is not likely to be compatible with disinfectant solutions. Since some practices use monitors that have touch screen capabilities, or as clinicians may be in the habit of touching the monitor screen to point out areas of concern to patients, it is again critical that gloves be removed and hands washed before touching the monitor screen.

Another option that has not been popular until now is voice recognition technology for recording patient treatment information. Most of the dental practice-management software companies have voice recognition capability. Early adopters of this technology became easily frustrated by the lack of accuracy; however, new software platforms have greatly improved accuracy and ease of use. The availability of digital and wireless headsets/microphones also makes this a more efficient and effective option.

Whatever your patient recordkeeping system – paper or electronic – remember that infection prevention is a very important step in the process.

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].

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