by Noel Kelsch, RDHAP
[email protected]
One of my favorite things to bake is homemade rolls. There is nothing like the feel of dough in my hands, or the aroma that fills my house when I have a batch baking in the oven.
Recently, I sent my husband to the store for some flour so that I could grant him his single wish of a tray filled with "Slap Your Mama" rolls. When he returned, I realized he had not heard a word I said. He came home with the cheapest flour on the shelf, not the "better for bread" flour I had requested. The choice he made would directly affect what I was trying to accomplish. This flour did not contain the amount of protein that science has proven is needed to create the gluten air-filled sacks that make bread light and airy.
Choosing and using a surface disinfectant in dentistry is much like shopping for and using flour.
In 2003, the Guidelines for Infection Control in Dental Health-Care Settings gave us all science-based information that told us we should clean and disinfect clinical contact surfaces that are not barrier-protected by using an EPA registered hospital grade disinfectant with low- (such as HIV and HBV label claims) to intermediate-level (such as tuberculocidal claim) activity after each patient. Use an intermediate-level disinfectant if visibly contaminated with blood.
- Clinical contact surfaces: Surfaces that are touched by contaminated hands, instruments, devices, gloves, etc. They include light handles, switches, radiograph equipment, dental chairside computers, reusable containers of dental materials, drawer handles, faucet handles, countertops, pens, telephones, and doorknobs.1
- Cleaning: Removing visible contamination from a device or surface.
- Disinfection: Destruction of pathogenic and other kinds of microorganisms by physical or chemical means.2
The preceding directives give us great information. Other points to remember include:
❐ We have to clean and then disinfect. This is a two-step process. We must first clean off the debris and then disinfect the surface. Those are two separate steps. For example, in following label directions for using disposable towels that are premoistened, you would use one to clean the contact surface and then throw it away. You would get a fresh towel and use it to disinfect the contact surface. Following directions on the package ensure compliance with the science-based experiment that was conducted in developing use of this product.
❐ EPA-registered, hospital grade disinfectant is not just something you pick up off the shelf at a local store. It must have an EPA registration number and state that it is a hospital grade disinfectant.
❐ Barrier protection is a very effective method of preventing cross-contamination. If the area is difficult to clean, barrier protection should be utilized. If barrier protected surfaces are contaminated during treatment or when removing barrier protection, they should be cleaned and disinfected.
❐ You must use an intermediate-level disinfectant if the area is visibly contaminated with blood.
In choosing and using a surface disinfectant, you need to keep several things in mind:
► Is it safe for the surface I am going to use it on? An office recently shared with me that they had switched to a product and suddenly the threads on their chairs were falling apart. They read the label and soon discovered this hospital grade disinfectant was not intended for use on cloth and had destroyed the thread quickly. Manufacturers of dental devices and equipment should provide information regarding materials compatibility with liquid chemical germicides, whether equipment can be safely immersed for cleaning, and how it should be decontaminated if servicing is required.1
► What personal protective equipment do I need to wear in order to use this product? Both the direction label and the material safety data sheet (MSDS) will tell what you need to wear while using this product. Because of the risks involved with working with chemicals and contaminated surfaces, gowns, masks, eye protection, and chemical- and puncture-resistant utility gloves are a must. Many products can break down latex based gloves exposing clinicians to chemicals that are toxic. Chemical and puncture resistant utility gloves should be utilized during this task.
► How safe is it for me to work with? It is important to note if any staff members are allergic to ingredients or if any of the ingredients have side effects in the method with which it will be used.
► How long can I be exposed to this product? The MSDS will give you the time-weighted average (TWA) for the product and any cautions for length of time of use. It is important that all office members who are using a product are trained in the TWA and MSDS. All tasks need to be delegated so no one is over-exposed.
► What is the shelf life of this product? If the product has a short shelf life, it is important that you are tracking it and replacing it when necessary. Short shelf lives may mean wasted products. Many products require special handling for disposal.
► Do I have to mix this myself? Sometimes just having the time to mix and formulate a product can be very confusing and time consuming. Keeping products simple and easy to use can eliminate the chances for mistakes being made.
► Am I using this for intermediate or low level? Low level targets HIV and HBV label claims, and intermediate level targets tuberculocidal claims. Remember, if there is visible blood, you must use intermediate level.
► How easy is it for me to work with? Some products both clean and disinfect, saving you the time of switching back and forth from one product to another. Some are premixed and ready to use. Check to see if the product is is complex or simple to use, if instructions are included, and if the intended use can be accomplished in your setting.
► Is the wait time realistic? Not very many of us have 15 minutes between patients. Yet there are disinfectants that require that amount of time. Time yourself and see how much time you have between patients and match the product to that time.
The Organization for Safety, Asepsis and Prevention (OSAP) is a nonprofit organization. OSAP is a unique group of dental educators, consultants, researchers, clinicians, industry representatives, and others with a collective mission to be the world's leading advocate for the safe and infection-free delivery of oral care. OSAP supports this commitment to dental workers and the public through quality education and information dissemination.
Your membership in this organization will assure you access to the most current and valuable information you will need in your daily clinical practice to keep you and your patients safe. Membership is an inexpensive investment that includes all compliance issues being addressed in one place!
Check out their website at www.osap.org. I love the "Ask OSAP" section; it has all of the questions you are facing in clinical practice with the science-based answers! The association also maintains a list of EPA-registered, hospital grade disinfectants at www.osap.org/page/SurfDisinfec2010.
Choosing and using a surface disinfectant in dentistry is much like shopping for and using flour. My husband finally got his "Slap Your Mama" rolls after a second trip to the store to get the product that was developed for this purpose. As you make choices with surface disinfectants, I hope that you will use your clinical reasoning skills and science-based information to keep patients and yourself safe.
Noel Brandon Kelsch, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists' Association.
References
- Guidelines for Infection Control in Dental Health-Care Settings 2003
- From Policy to Practice, OSAP's Guide to the Guidelines, 2003
Slap Ya Mama Relaxing Rolls
After a trip to New Orleans, I was starved for those incredible flavors that come from Cajun seasonings. I came up with this flavorful, gorgeous, flaky roll that surprises everyone with its contrasting sweet butter flavor and sharp Cajun bite surrounded by onion.
The rolls:
2 1/2 C warm water
3/4 C sugar
2 T. yeast
2 eggs beaten well
1 1/2 t. salt
3/4 C melted butter
8 C better for bread flour
Topping:
1/2 C melted butter
1/2 C dried minced onion
1 T Slap Ya Mama seasoning or Cajun seasoning
1 C better for bread flour
Place sugar, warm water, and yeast in a large bowl. Sit down until it bubbles (about five minutes – if it does not bubble, your yeast is dead).
Add eggs, salt, butter, and mix well.
Add flour two cups at a time and mix well. Pour out onto floured surface and knead to get all your frustration out for five minutes.
Set in a bowl in a warm spot and let rise; go recline for an hour or so. Get out some more frustration by punching the dough and allowing it to rise again for an hour or so, until double in size.
Pull off golf ball size pieces and roll in the remaining butter. Mix topping; roll the rolls in topping. Place on large baking sheet. Lie down, and allow rolls to rise until double in size. Bake in preheated 400-degree oven for 20 minutes (while you rest).
