Let’s face it, staying on top of the latest OSHA and CDC recommendations on infection control is not the most engaging topic; however, even more important now post Covid-19 pandemic. We are not quite sure how our practice of infection control will change in the near future but let’s start with the basics.
Go back in time to when you were a dental hygiene student. Do you remember the day when you were given a list of clinical competencies you had to complete in order to graduate? Now recall the very first competency on INFECTION CONTROL. I can admit that I was totally nervous, doubting myself if I was completing the process correctly as the professor observed my every move and checked off the steps on the competency sheet. Did I wait the right amount of time after the second spray? Did I clean and take the utility gloves off properly? And of course, the biggest question was, did I Saran wrap all the required surfaces? 😉
As practicing dental hygienists, I hope that we all are checking off the steps on the competency sheet for Infection control to protect ourselves and our patients every day no matter the time allotted per patient.
So, let’s take a look at these 5 measures that can prevent spread of infection.
MEASURES TO PREVENT SPREAD OF INFECTION
CDC guidelines for Infection Control in Dental Health Care Settings states that “hand hygiene…is considered the single most critical measure for reducing the risk of transmitting organisms to patients and health care personnel.” Proper hand washing can reduce up to 98% of bacterial transient flora, which colonize the superficial layers of the skin. For routine dental exams and non-surgical procedures, use alcohol-based hand rub (hand sanitizer) or water and plain or antimicrobial soap. Unless hands are visibly soiled, hand sanitizers are a top choice for hand hygiene. Hand sanitizers require less time, more accessible, reduces more bacterial count, and does not irritate or dry the skin as soap and water would.
So, when is a good time to perform hand hygiene?
1. When hands are visibly soiled.
2. Before and after treating each patient
3. Prior to putting on gloves and again immediately after removing gloves.
4. After touching contaminated instruments, equipment, material with bare hands.
5. Before leaving the treatment area
You probably already guessed it… there is a proper way to washing/sanitizing your hands.
To wash with soap and water you would wet your hands first and then apply soap. Rub hands together for at least 15 seconds covering all surfaces of hands and fingers. Rinse and thoroughly dry hands with a paper towel then use the paper towel to turn off the water faucet.
If you are using hand sanitizer, apply and rub for at least 15 seconds and air dry.
When considering lotions to recondition the skin, use water-based products. Petroleum based lotions weaken latex gloves and increases porousness.
Another point to consider about hand hygiene is jewelry: rings and decorative nail jewelry.
It is unknown at this time if wearing rings increases transmission of pathogens. However, as health care providers, wearing rings or decorative nail jewelry should not interfere with glove integrity or proper size.
Personal Protective Equipment (PPE)
Personal protective equipment is the first layer of protection designed to protect the skin and mucous membranes from being exposed to infectious materials and aerosols.
It consists of gloves, eyewear, face shield, masks, and protective clothing.
Remember to always have your PPE when in contact with spray or spatter and remove it when leaving the dental treatment area.
Let’s review the standards of care for each PPE.
STANDARD OF CARE
It is recommended to change masks between patients and definitely once it becomes wet during patient treatment. During airborne infection isolation precautions, such as Covid-19 pandemic, N95 masks are highly recommended for your protection against occupational respiratory infections. In the absence of these masks, ASTM level 3 masks are appropriate as long as you wear a face shield with it.
- Eye protection and face shields:
Clean reusable eye and face protection between patients with soap and water. If visible soil is present perform clean and disinfect steps discussed earlier. Make sure that eye protection has solid side shields.
- Protective clothing:
Lab coats or gowns should be worn to protect the exposed skin and personal clothing that is likely to become soiled with blood, saliva, or infections material. Always change if visibly soiled and remove prior to leaving dental treatment area.
Always wear gloves when in contact with blood, saliva, mucous membrane, contaminated equipment or have non-intact skin. Make sure that gloves are appropriately fit and not compromised in its integrity. Change gloves after every patient and do not wash it. Gloves are not reusable. Remember to wash hands immediately after removing gloves. Moreover, always consider personal and patient allergies when choosing types of gloves.
Cleaning & Disinfecting
How do we ensure that there will be no cross contamination between patients throughout the day? Success of the disinfection process of the environmental surfaces lies in the disinfection technique and the time allowed for the disinfectant to work.
Environmental surfaces can become contaminated during patient care. These are clinical contact surfaces (light handles, switches, radiographic equipment and etc) and housekeeping surfaces (floors, walls, sinks).
The first step is to CLEAN the visible soil (blood) by a physical action of scrubbing with detergents and rinsing with water. This crucial step removes a considerable number of microorganisms and prepares you for your next step in disinfection: “spray-wipe-spray” or “wipe-discard-wipe”. With liquid disinfectant, you would spray the surface with the disinfectant and wipe it using a disposable towel to clean the surface (“spray-wipe”), followed by another “spray” to disinfect the surface. When using disposable disinfectant wipes, you would use one wipe to clean the surface, discards the wipe, and then use a second wipe to disinfect the surface.
Remember to always protect yourself from exposure to infectious agents or chemicals with protective personal equipment (PPE). This includes gloves, masks, gowns and eye protection. CDC further recommends the use of chemical and puncture resistant utility gloves during the cleaning and disinfection process.
Finally, surfaces that cannot be cleaned effectively, should always be protected with barriers and discarded after every patient.
Sterilization completely eliminates all forms of microbial life including bacterial spores when performed correctly. Critical patient care items such as those that penetrate soft tissue or bone (periodontal scalers, surgical instruments) have the highest risk of transmitting infection. Therefore, these items should always be sterilized by heat. Remember to always place contaminated instruments in the ultrasonic cleaner to prevent debris and bioburden from drying on them prior to packaging instruments for autoclave sterilization. Furthermore, it is crucial to avoid overloading the sterilizer which could lead to cycle failure. Lastly, re-bag punctured sterilization bags to assure proper sterilization of instruments.
Dental Unit Waterlines
Studies have shown that dental unit waterlines can become colonized with microorganisms, such as bacteria, protozoa and fungi. Managing your waterlines according to CDC guidelines is crucial to prevent spread of infection to your patients, especially for immunocompromised, elderly, and young children.
These 5 simple steps can prevent spread of infection through water:
1. Start every day by flushing waterlines for two minutes.
2. Run water through dental devices that are connected to the water system after every patient for 20-30 seconds…ie. Ultrasonic, air/water syringes, handpieces.
3. Shock waterlines every 2-3months
4. Use chemical germicides to remove or inactivate biofilms from dental waterlines
5. Consult with the dental unit manufacturer for appropriate water maintenance methods and recommendations for monitoring dental water quality
As practicing clinicians, we get very busy throughout our day. I encourage you to be mindful about the importance of practicing proper infection control procedures without skipping steps. Remember, we take these steps to protect our families, ourselves and our patients!
1. Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings — 2003. MMWR 2003;52(No. RR-17):[1-30]. http://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf
2. Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(No. RR- 16):[1-45]. https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf