We`ve been discussing pathways for the spread of microbes in the office, of which there are five:
- Patient to dental team
- Dental team to patient
- Patient to patient
- Office to patient
- Community to office
In this article, we`ll look at how the dental office interacts with the community and highlight some routes of microbe spread that may be involved in these interactions.
One of the key aspects of infection control is to attempt to control microbes at their original source whenever possible. There are three ways to achieve this type of control:
(1) contain microbes at the source;
(2) kill microbes at the source; and/or
(3) manage the exit of microbes from the source in ways that limit their subsequent spread.
As we consider the pathway of office-to-community spread, the office is considered as the source and the community is defined as anywhere and anyone outside the office (e.g., our homes and loved-ones, laundry pick-up services, dental laboratories, dental-equipment repair services, waste haulers and disposal sites, or lunch-time restaurants). Thus, we need to contain, kill, or properly manage microbes that are present in the office so they do not put the community at risk.
There is little scientific evidence that microbes from dental offices have caused disease in the community. However, dental laboratory technicians have been occupationally infected with hepatitis B, The likely source of the virus was an impression or appliance from a dental office.
We sometimes hear anecdotal stories such as "Oh, she brought it home from the office." The "it" refers to a cold, the flu, etc. This type of spread usually is impossible to track, but we all pretty much agree that it can happen.
OSHA feels spread of bloodborne agents from the workplace to the community must be addressed with appropriate procedures. Below is a list of these standards quoted from the OSHA Bloodborne Pathogens Standard, along with recommended procedures for compliance.
q "Specimens of blood or other potentially infectious materials shall be placed in a container which prevents leakage during collection, handling, processing, storage, transport, or shipping. The container for storage, transport, or shipping shall be labeled or color-coded...(in accordance with the standard)."
Compliance involves shipping of tissue, blood, or saliva specimens in appropriately labeled containers. Impressions or appliances should be rinsed and disinfected before being shipped to the commercial laboratory, or they must be shipped in an appropriate biohazard container. Communicate with the laboratory so they`ll know how the items have been treated.
"Equipment that may become contaminated with blood or other potentially infectious materials shall be examined prior to servicing or shipping and shall be decontaminated as necessary, unless the employer can demonstrate that decontamination of such equipment or portions of such equipment is not feasible. A readily observable label shall be attached to the equipment stating which portions remain contaminated."
Contaminated equipment shipped to manufacturers for repair (e.g., dental handpieces) is to be disinfected or sterilized before being shipped, and it should be labeled as to what parts were not able to be decontaminated.
"All personal protective equipment shall be removed before leaving the work area."
Not wearing protective clothing away from the work area reduces the potential spread of microbes from the contaminated clothing. This would include not wearing such clothing into the lunchroom at work, outside of the office during the lunch break, or at any other time. Also, employees are not to take contaminated protective clothing home to be laundered. Laundering is the responsibility of the employer by use of laundering facilities in the office or contracting with a laundry service.
"Regulated waste shall be placed in containers which are closable; constructed to contain all contents and prevent leakage of fluids during handling, storage, transport, or shipping; labeled or color-coded...(in accordance with the standard); closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping."
Regulated waste should be properly placed in leak-proof, closable containers that also are puncture-resistant if used for sharps. These consist of "biohazard bags" for non-sharp waste and "sharps boxes" for sharps. The waste should be placed in these containers immediately after use. The containers are to be closed before they are moved. In some states, these containers of waste can be decontaminated prior to disposal in the regular waste stream, but elsewhere they are to be transported to an outside facility for treatment and final disposal.
"When a facility ships contaminated laundry off-site to a second facility which does not use universal precautions in the handling of all laundry, the facility generating the contaminated laundry must place such laundry in bags or containers which are labeled or color-coded (in accordance with the standard)."
Compliance first requires information from the laundry service as to its use of universal precautions and then appropriate action can be taken.
In summary, prevention of microbe spread from the dental office to the community involves proper management of regulated waste and the proper handling of potentially infectious materials. Also, contaminated laundry and protective clothing are to be handled in ways that prevent microbes spread.
Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.