By Noel Kelsch, RDH
One of the most important links in the chain of infection is YOU! The chain of infection has many parts that the dental health care professional has little control over. But the susceptible host and portal of entry are two areas that all dental health care professionals have a lot of control over.
Skin is the single greatest barrier to infection the human body has. The skin has many functions — it’s far more than a mere decoration for the body. Some functions are so important that a person will die if most of the skin surface is not working efficiently. The skin is a wall between us and the outside world. Second- or third-degree burns are extremely serious injuries. When the skin is destroyed over a large area, there is no way to control the rate at which the body loses water to the outside environment, of regulating the temperature of the body, or of controlling infection. Someone who has lost over half of his or her skin is unlikely to survive.
The skin is the largest organ of the human body, making up 12% to 15% of the body’s weight. The skin has two layers for protection from the outside world — the dermis and the epidermis. Your skin is a barrier that protects you from bacteria, viruses, and pathogens. Compromising your skin health increases the likelihood of exposure to these pathogens, changing a scenario from a harmless one to one in which a health care professional can become ill.
The epidermis is the external layer of dead skin cells that functions as a mechanical barrier to the outside environment. It is the first line of defense to keep out dirt, bacteria, viruses, water, insects, and other noxious substances. As a barrier it helps retain fluid within the body to prevent the entire organism from evaporation or even death.
The Chain of Infection
- Pathogen: In sufficient numbers to cause infection
- Source: A place for pathogen to reside and multiply
- Mode: A way for the pathogen to leave its reservoir and reach a new host
- Entry: A proper portal of entry into a new host
- Susceptible host: A person who is not immune to the pathogen and cannot fight it off
The dermis is the living part of the skin. It functions as a barrier to modulate water and heat in the body, and secretes substances to control viral, bacteria, and fungal growth. In addition, the dermis is a critical component of the vitamin D synthesis system. The dermis regulates heat and cold using evaporative cooling of sweat, piloerection of hairs, increased or decreased blood flow to the surface of the skin, and more. These two layers must be healthy and fully functioning to perform the many responsibilities they have.1
Your skin not only serves as a physical barrier against infection, but skin cells themselves can mount an immune response to kill invading microbes by producing antimicrobial polypeptides (AMPs). An overt infection in the skin is a rare event. Researchers have theorized that AMPs play a role in preventing infection from developing in the first place.2
The relationship between normal microbiota (normal flora of the skin) and host cells assists in preventing the overgrowth of pathogens, and thus may be considered a component of the nonspecific defense. For example, in microbial antagonism the normal microbiota prevent pathogens from colonizing the host by competing with them for nutrients and altering conditions that affect the survival of the pathogens (such as pH and oxygen availability).3
An interview with someone who knows
In understanding how you can help keep your skin healthy, it is important to understand who has the most in-depth information and can treat symptoms more effectively. A dermatologist specializes in skin care. This doctor has extensive training in treating skin problems and helping to keep skin healthy. After earning a medical degree and completing an internship, a dermatologist undertakes three more years of specialty training to become the expert who dedicated to skin, hair, and nails.
Dr. David Rahimi, one of the most revered dermatologists in the field, explained his passion. “This is such an amazing profession. I see patients from every walk of life — newborns, kids, teens, pregnant women, and the elderly. I diagnose and identify such a host of diseases. The skin is the window to the body. Infections, cancer, neurological diseases, systemic diseases can all be seen first in the skin, hair, and nails. Just recently I saw a woman with a brown streak under her fingernail. The biopsy that I performed literally saved her life. She had melanoma under her fingernail.”4 See his tips for dental hygienists in the related article.
Skin is the single greatest barrier to infection that the human body has. Health care professionals need to not think of it as a mere decoration but, a barrier to the outside world. Keeping it healthy is one of the most important things a dental hygienist can do to prevent the chain of infection.
About the Author
Noel Brandon Kelsch, RDH, is a freelance cartoonist, writer, and speaker. Noel’s cartoons can be seen in RDH magazine and her articles have been published in both dental and nursing trade magazines, as well as books. She has received many national awards including Colgate Bright Smiles Bright Futures, RDH/Sunstar Butler Award of Distinction, USA magazine Make a Difference Day award, President’s Service award, Foster Parent of the Year, and is a five-time winner of the Castroville (Calif.) Artichoke cook-off! Her family lives in Moorpark, Calif. She can be contacted at [email protected].
- Essentials of Human Anatomy and Physiology, Elaine N. Marieb; Format: Hardcover Publisher: Benjamin-Cummings Pub Co Edition: 8 ISBN-13: 9780805373288 Publication Year: 2005
- EGF receptor activation prevents microbes from going more than skin deep, Journal of Clinical Investigation; Neill, Ushma, June 2006,
- Microbiology: an Introduction (8th Edition), 2003 by Gerard J. Tortora, Berdell R. Funke, Christine L. Case Pearson
- Personal Interview with Dr. David Rahimi, July 6, 2008
Dr. David Rahimi:Ten skin care tips for hygienists
- Washing your hands repeatedly with harsh soaps can break down the skin and create a portal of entry, making you more prone to disease. Every time you wash your hands, dry them gently, then gently rub in a moisturizer.
- Use mild cleansing products such as Cetaphil. Consider using an alcohol-free hand sanitizer such as Neutrogena between washings when there is no debris present.
- If you do develop skin lesions from hand cleansing, keep the lesions covered and apply triple antibiotic ointment. If it does not heal in seven to 10 days, see your health-care provider.
- Moisturizing the skin is vital. Moisturizers do not have to be expensive to meet the need. Aquafore, Nuetrogena, Aveeno and several other brands are inexpensive and do a great job.
- Remember that everything in excess is bad. Do not get products with added perfumes. Look for oil-free, petroleum-free, sensitive formulas, and use time tested brands.
- A balanced diet is very important. It is the building block of the skin. If you are not on a balanced diet you are open to a host of chronic diseases. If you are on a balanced diet, it is not necessary to use supplements.
- Stress makes everything worse as it directly affects the immune system. Skin does not heal as quickly. Try to minimize stress. During times of stress it is very important to stay hydrated and use moisturizers.
- Do not have direct skin contact with chemicals. Formaldahydes and other chemicals used in disinfecting and dental treatment adversely affect the skin.
- To help the integrity of the skin, stay out of the sun. Use at least a 30 SPF sun screen daily and apply frequently throughout the day.
- Aveeno with oatmeal is a great soothing and healing product. Also, vitamin E capsules can be taken systemically or broken open and rubbed directly into the skin.