Infection control is more than just extra inventory

Convey the training, time, and expense associated with the infection-control protocols, technique, and regimens you use in your practice.

Convey the training, time, and expense associated with the infection-control protocols, technique, and regimens you use in your practice.

John A. Molinari, PhD

A variety of technological advances have facilitated substantial progress in the evolution of infectious-disease control. Hand-washing procedures and other aseptic-technique applications, safer sharps-management procedures, instrument-reprocessing protocols, heat sterilizers, protective gloves, masks, eyewear, and clinical coats have proven their effectiveness. Most patients routinely expect these infection-control procedures.

These expectations are manifested in different ways. In the most negative scenarios, individuals may be so afraid of "catching something" that they refuse to seek even the most routine care. These people can develop more severe clinical problems and ultimately do not have a choice about subsequent treatment.

Fortunately, dental professionals frequently are beneficiaries of the positive sequelae to patient expectations. You probably are one of them. As an example, many patients often enter treatment areas and unconsciously assess operatory cleanliness, hand-washing procedures, and other visible aspects of the practitioner`s infection-control regimen. Subsequent comments by patients can reflect a positive attitude based on their observations - i,e.,"This practice is always very clean" or "I like seeing those instruments come out of that wrapper; were they sterilized that way?" or "Do you wash your hands as often for all of your patients?"

Have you ever thought about why patients are paying increased attention to infection-control procedures? As you contemplate this question, think about how you respond to unexpected complimentary statements. A first step is to consider what the public thinks of and expects from medical, dental, and other health-care professionals. Positive comments reveal that patients are comparing favorably what they see occurring in your dental practice with experiences they`ve had in other health-care settings.

Expressions of appreciation for protective infection-control practices also reveal a glimpse of an increasingly common public concern. This is the public`s perception of the safety of health care. While the quality of patient care generally is assumed to be excellent, the general population is being continuously exposed to reports of new, untreatable microbial pathogens, disease outbreaks from a variety of common food and water sources, contamination of municipal-water supplies, and emerging microbial resistance to frequently prescribed antibiotics.

Sources of information have expanded in the past 20 years, going far beyond the scope of clinical and scientific journals. The mass media provides information to people via newspapers, news periodicals, the Internet, and a host of other vehicles. Figure 1 provides a representative list of articles from these sources that have been published within the past two years.

It should not come as a surprise, then, that when cities such as Milwaukee, Wis., experience contamination of the municipal-water supply with cryptosporidia, resultant hospitalizations and patient deaths cause the public to become increasingly leery of any water that goes into their mouths. With increased attention focused on the quality and potability of water in the United States, issues and concerns about microbial contamination of dental-unit water became logical targets of re-investigation and questions. The following discussion will attempt to provide suggestions for addressing these and other issues by considering two, non-exclusive questions:

(1) What can be done to answer questions from patients of record and prospective patients?

(2) How can the practice`s infection-control procedures be routinely conveyed and re-enforced to the patient family?

Professional approaches

Despite the conscientious efforts of many physicians, dentists, hygienists, assistants, and managers, public trust in the health professions has come into question. In dentistry, for example, there are phone calls from prospective patients inquiring about practice sterilization procedures, including those for the "dental drill," and how often gloves are changed by employees.

One approach for allaying these concerns is to first make certain that the practice`s receptionist, or other person answering telephone calls, is familiar enough with the practice`s infection-control procedures to provide correct information. This requires including those employees in infection-control discussions at staff meetings, as well as being sure that they understand the rationale and importance of the entire infection-control regimen. This strategy will require you and your staff members to keep current with the latest appropriate, science-based information, such as appropriate recommendations and regulations aimed at protecting personnel and patients, occupational disease risks, vaccine developments and recommendations for health-care workers, and evolving equipment technology.

This may seem like a daunting task when you consider the many responsibilities that already fill a workday. One simple approach is to discuss infection-control procedures during staff meetings. This is especially important when new employees come into the practice.

These individuals may not be familiar with how long you have been performing most infection-control precautions. When did latex gloves became a practice standard for everyone treating patients? When were universal precautions introduced into the practice and how were these precautions applied when the first "high-risk" patients identified themselves? When did you start to biologically monitor the practice heat sterilizer(s)? Share the fact that the practice began paying for hepatitis B vaccinations of employees long before it became an OSHA standard requirement.

When this type of pertinent information is shared, staff members gain a solid understanding of the practice`s infection-control procedures.

Communicate with patients

Equally as important is the communication of pertinent information to the other beneficiaries of your infection-control program - the patients. Patient appointments provide a fine opportunity to talk with patients about what precautions are being taken by practice personnel. This also is often the time when positive comments, such as those mentioned earlier about cleanliness and hand-washing, are heard.

These occasions provide excellent opportunities to re-enforce your efforts in the many areas of infection control that patients cannot readily observe. Use part of the time to discuss components of the office asepsis program, including the rationale for ultrasonic cleaning of instruments, packaging instruments, use of disposable barriers and other items, and sterilization monitoring.

An additional way to communicate this information is to have available a letter or brochure describing office infection-control goals and procedures (Figure 2). This positive message will serve to educate patients about your practice, and also may help them screen and discount erroneous, sensationalistic information that might appear in the mass media.

Summary

Communication of infection-control practices is an overlooked area of practice management. Often, people forget to consider the training, time, and expense associated with the wide variety of protocols, techniques, and regimens. Explore and develop approaches aimed at conveying the infection-control practices you use to other care providers and your patient family. When these are used appropriately, you serve both patients and the community in the capacity for which you were trained - as a health-care professional. It does not get any better than that!

Figure 1

Infectious Disease Articles

(1996-1997)

* "Increased Nosocomial Infections May Be Downside of Downsizing"

* "Less Beef, More Brain"

* "Contaminated Soap Fuels NICU Serratia Outbreak"

* "Germ Warfare - Are Antibiotics Losing Zap?"

* "Deadly Outbreak Traced to Market"

* "Hepatitis G Virus - A True Hepatitis Virus or an Accidental Tourist?"

* "D.C. Showing Alarming Increase in TB"

* "Legionella: The Silent Killer"

* "Has Post-Antibiotic Era Dawned in the Land of the Rising Sun?"

* "Adult Immunizations: How Are We Doing?"

* "Proliferation of Pills - Useless Antibiotics"

* "Cryptosporidiosis: An Emerging, Highly Infectious Threat"

Figure 2: A positive message for patients

Dear Patient:

We thought that in this era of public concern and media coverage about the hazards of infectious diseases, such as hepatitis B and acquired immunodeficiency syndrome (AIDS), you should be informed that we use numerous infection-control procedures to prevent disease transmission in our practice.

We would like to take this opportunity to tell you about these precautions, which we routinely provide for the treatment of all patients. A portion of this commitment has involved our adoption of federal government regulations that were designed to protect the health and safety of the dental office team. These procedures protect you - the patient - as much as us. We are pleased about this, and know you will be, too.

Universal precautions - Before you enter the treatment room, the dental unit and chair are cleaned and disinfected with antimicrobial chemicals approved by the U.S. government. All dental instruments are sterilized or disinfected, as appropriate for the type of material:

* Virtually all instruments can stand high heat. These are first cleaned and then sterilized by one of several proven methods that uses high heat.

* Those few items that cannot be heat-sterilized or disposed of after treatment are cleaned and then disinfected with special, high-level chemical disinfectants.

Both methods are approved by the Centers for Disease Control (CDC) and the American Dental Association (ADA).

Sterilization of handpieces - For years, the ADA has recommended the heat sterilization of handpieces (i.e., dental drills) for equipment that can withstand repeated high-heat cycles. Modern technology now has made it possible to sterilize all reusable handpieces. We are pleased to inform you that all of our dental instruments and handpieces are cleaned, lubricated, and heat-sterilized between each patient use.

Checklist for patients - We care about the health and well-being of all our patients and employees. To prove this for yourself, use the following checklist the next time you visit us and note how we perform each item:

> washing hands and changing gloves

> providing wrapped, sterile instruments for treatment

> appropriate sterilization and disinfection

> properly cleaning and sterilizing handpieces

> keeping the office spotlessly clean

> using disposable items

> wearing protective clothing

> proper disposal of waste

Health-care safety is everyone`s concern - yours and ours. We take the responsibility of treating you and your family very seriously. If you have any questions, please do not hesitate to give us a call before your next appointment, or talk with us during your next office visit. We are very proud of our infection control program and are happy to discuss it with you.

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