Gloves, masks, eyewear, and garments provide a physical barrier between the body and the source of contamination.
Transmission of infection requires a series of factors: a source or reservoir for the pathogen, a pathogen of sufficient infectivity and number, a mode of escape from the host, a mode of spread to the new host, a susceptible host, and a portal of entry. Infection-control techniques seek to eliminate one or more links in the chain of infection. Barrier products, including personal protective equipment, provide a physical barrier between the body and the source of contamination.
Experts agree that the single greatest contributor to infection-control effectiveness in dentistry has been adoption of routine gloving. Gloving protects both patients and staff by preventing viral and bacterial organisms in blood or saliva from penetrating the skin through small cuts or abrasions. Left unprotected, these breaks in the skin can serve as an efficient portal for microbes.
The Occupational Safety and Health Administration (OSHA) requires that appropriate gloves be worn when the possibility of contacting blood, blood-contaminated saliva, or other potentially infectious materials can be reasonably anticipated. Disposable gloves, therefore, must be worn during all patient-care activities involving direct hand contact with oral fluids, mucous membranes, or non-intact skin. Gloving also is required when handling items contaminated with body fluids or other potentially infectious materials.
Types of patient-care gloves
Patient-care gloves are disposable items that are not intended for use on more than one patient. Gloves are selected by the type of procedure to be performed. Suitable for exams and other nonsurgical purposes, nonsterile latex or vinyl gloves are inexpensive, usually ambidextrous, and are offered in a range of sizes. For surgical procedures, sterile surgical latex or vinyl gloves are required. They are supplied right- and left-fitted for optimal tactility, comfort, and dexterity.
Before beginning patient treatment, dental health-care workers should wash their hands thoroughly with soap and water, dry completely using paper towels, and don gloves. If called away from chairside during patient treatment, remove gloves and wash hands before leaving the operatory. Hands should be washed after removal of gloves. Upon returning to chairside, wash hands again before donning a new pair of gloves. As an alternative to repeated glove changes, some practices find plastic or copolymer overgloves useful. These thin, loose-fitting gloves are placed over the treatment gloves to contain contamination. They should be removed and discarded upon return to chairside.
It is important to note that while the protective properties of patient-treatment gloves are impressive, they are not infallible. Gloves provide little protection against sharps injuries or chemicals.
To minimize exposure to potentially infectious materials, remove torn, cut, or punctured gloves as soon as patient care permits. Immediately wash and dry the hands, and reglove before completing the dental procedure.
In addition to the role they play in direct patient care, gloves are an essential component of instrument reprocessing and operatory cleanup. Cleaning, drying, and packaging orally soiled, sharp instruments places personnel in close contact with large volumes of highly contaminated items. Also, caustic chemical agents are routinely used to disinfect the operatory. To guard against sharps injuries as well as chemical toxicity, puncture-resistant utility gloves made of nitrile, neoprene, or heavy latex are required.
Most heavy-duty, reusable gloves are able to withstand cleaning and disinfection or, at minimum, a thorough scrubbing with antimicrobial handsoap. Utility gloves should be discarded immediately when there is evidence of cracking, discoloration, etc.
Masks are viewed as a means of protecting both patients and health-care workers from pathogens in potentially infectious sprays, splash, and spatter. Masks must be worn when risk of spray or splash of fluids can be anticipated.
The FDA recommends that surgical masks have a 95 percent or greater bacterial filtration efficiency. OSAP guidelines recommend that dental providers wear surgical masks with at least 95 percent filtration efficiency.
Masks should be changed at least with every patient and more often if heavy spatter is generated during treatment.
Protective eyewear safeguards the eyes from disease agents, such as herpes simplex viruses. It protects against contact with caustic chemicals used at chairside and in operatory asepsis procedures, radiograph development, and dental laboratory work. It protects the eyes against damage from projectiles and ultraviolet irradiation.
OSHA requires use of eyewear with both front and side protection for exposure-prone procedures. Eyewear must be thoroughly washed with soap and water and rinsed well between patients. Eyewear may be decontaminated and disinfected using a spray-wipe-spray technique before reuse.
Protective garments must be worn whenever contact with spray or splashes of blood or other body fluids can be reasonably anticipated. These garments - worn over the clinic uniform, street clothes, or undergarments - prevent organisms on nonclinic attire from shedding into ambient air over patients with open tissues. The garments are to be worn only in treatment areas.
For optimal protection, clinic outerwear should be long-sleeved and high-necked. For routine dental procedures, disposable gowns can be worn and discarded daily, although visibly soiled garments should be changed immediately.
Practices utilizing reusable garments cannot allow employees to launder their own clinic wear. Instead, laundry can be done on-site or through a commercial laundering service, provided universal precautions are applied and personal protective equipment is in place.
This resource was reprinted with the permission of OSAP. OSAP is a nonprofit organization providing information and education on dental infection control and office safety. For more information, please call (800) 298-6727.