Imagine using your hand to grease a cake pan, then washing your hands with a light splash of soap, and going about your day. The residual grease would divulge the rest of the day’s activities by the dots on surfaces touched. The careless transfer of grease from its origin to hundreds of other places proves a great analogy for the spread of bacteria, too. That’s why dental offices have policies and procedures, termed “infection control”, which eliminate the risk of bacterial and viral transfer when properly executed.
Actually, a federal regulatory agency called the Occupational Safety and Health Administration (OSHA) is responsible for keeping U.S. workers healthy and safe, setting mandatory compliance standards for handling body fluids and hazardous materials. The general premise for the safety of both patients and providers, adopted in 1991, is termed “universal precautions” and is based on guidelines set forth by the Centers for Disease Control. It’s the reason for disposable products, disinfected and barrier-covered surfaces, sterile instruments, and personal protective equipment (PPE). Adequate PPE for a health care worker includes disposable gloves or utility gloves, eye protection, a face mask, and lab coat or scrubs if working with risk of contamination.
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[/media-credit]The biggest obstacle, however, lies in the proper implementation of infection control procedures. We usually can’t see germs on any surfaces, cannot determine whether disinfected and sterilized items are 100% clean, or whether staff might have spread germs to other surfaces while going about their day, much like the grease from the pan. The only real solution to the problem is standardized procedures, thorough training and complete communication among the dental team.
Your observations skills while at the dentist are important.
Here’s what you should look for to ensure effective infection control procedures during your dental treatment. First look at the overall appearance of the entire office. This is crucial because, if the team doesn’t pay attention in presentation of the office, they most likely aren’t either. It doesn’t need to be flashy, but attention to detail is needed. Plants and reading material should appear fresh, burned-out bulbs replaced, corners cleaned, and organized procedures put in place.
The staff should enter the treatment room wearing a lab coat or uniform that is eventually removed when they leave the building. Their hair must be pulled back or off their shoulders so there is no tendency to brush hair away during a procedure, which causes contamination. Staff does not “don” personal protective equipment until after you are seated and draped.
The treatment room should have up-to-date equipment since new technologies have vastly improved the level of care provided. These furnishings should be draped in disposable plastic or paper wrappings with localized plastic barrier protection on handles, light switches, and equipment handles that don’t lend themselves to sterilization. There are usually only a few items on the counter, thus minimizing contamination by aerosol spray or splatter during procedures. These surfaces should be routinely disinfected between patients. Pay particular attention to hand mirrors, the overhead high-intensity light and staff member’s glasses when inspecting your surroundings.
The staff then seeks “informed consent” by reviewing the procedure planned for the appointment, and begins setting up the necessary equipment and supplies. Note that most items, if not disposable, come wrapped in sterile bags or plastic cassette cases with masking-tape that turns striped once properly sterile. Once a procedure begins, staff member’s gloves are considered contaminated so they are unable to reach into drawers and containers to retrieve needed items, or pick up items from the floor. They must replace their gloves. When cleaning up after procedures, they should wear heavy utility gloves and face protection while working with chemicals and sharp objects. Of course, many materials used in dental procedures come in contact with body fluids, either saliva or blood, or contain tissues like bone, teeth, or gums. These items are called “biohazard” because they have the potential to transmit disease. There are laws regulating their proper disposal, often in red containers that are later incinerated by a trained retrieval service. Similarly, most “drill bits” used for removing decay and shaping teeth are considered disposable. If they are re-used, they must undergo rigorous sterilization procedures to maintain a sharp cutting edge yet ensure thorough debridement. The hand-held drill is also removed, flushed out and sterilized between each patient.
Many dental products now come in unit-dose containers that significantly cut down on contamination. However, it isn’t feasible for all items. Pay attention when a staff member takes material from a general – use container, or something that has a lid or cap. This requires a clean glove or some no-touch delivery mechanism.
You would be surprised how many staff members don’t realize the potential for germ growth around fake fingernails and jewelry, areas that stay warm and moist. Even natural, but long fingernails easily puncture gloves, poke tissue, and make it difficult to safely handle materials. Broken cuticles or hand wounds present a risk for germs entering the staff member’s blood stream.
If you notice something while in the dentist offices which makes you have a question about their proper infection control procedures, please ask the dentist or staff member about it, as their concern should be your comfort before, during and after your appointment with them.
