By Noel Kelsch, RDH, RDHAP, MS
I substituted in an office recently. I had a hard time finding the hygienists' instruments. I looked in the cupboards, drawers, and sterilization area. Nowhere to be found. I asked the assistant, and she said, "Look under the sink." I looked under the sink and, sure enough, in a bucket in that dark, dirty, moist place there was a pile of instruments.
I know the hygienist and talked to her about it. She said they are easy to get to, and there is nothing wrong with it. No one ever told her in school that she had to put them in a drawer. She was very irritated. Is there anything that I can share with her?
Thank you for being willing to help someone understand the concepts of infection control. Many times, people will substitute and leave the office without sharing infection control insights with the staff. They will publicly go online and share their findings, but have not figured out how to present those same thoughts to the office. Someone new to an environment can often see things that other people do not see. This gives you the opportunity to make a difference in many lives.
You did the right thing by taking the person aside and sharing your concern. Talking one-on-one eliminates some of the reactions that talking in a group may have elicited.
In the future, may I suggest that you have a documented solution before you approach the person? Collect a few articles or facts on the topic. You can often search for those right on your cell phone. Both the Centers for Disease Control and Prevention (cdc.gov) and OSAP.org have a "frequently asked questions" section that can aid in getting answers for many infection control questions.
Of course, for issues that could lead to patient or staff harm and need to be immediately addressed, you would have to address those promptly (examples include sharps safety, malfunctioning sterilizer, protocol that is unsafe, etc.).
But how do we put this into place? For example, let's imagine a conversation with the doctor on this subject. I would say, "Doctor, I know that keeping patients safe is your utmost concern. I also want to support you in that goal. I have a couple of ideas for the office and wanted to share them directly with you." I would then share an article, state practice act, CDC guidelines, etc., on storing instruments. I would close by saying, "Thank you for caring about patients and staff. I am so glad we have the same goals."
A great example of the material that you could borrow for this topic is on page 17 of the "Recommendations From the Guidelines for Infection Control in Dental Health-Care Settings- 2003" published in 2016. It states:
• Implement practices on the basis of date- or event-related shelf-life for storage of wrapped, sterilized instruments and devices.
• Even for event-related packaging, at a minimum, place the date of sterilization, and if multiple sterilizers are used in the facility, the sterilizer used, on the outside of the packaging material to facilitate the retrieval of processed items in the event of a sterilization failure.
• Examine wrapped packages of sterilized instruments before opening them to ensure the barrier wrap has not been compromised during storage.
• Reclean, repack, and resterilize any instrument package that has been compromised.
• Store sterile items and dental supplies in covered or closed cabinets, if possible.
The next statement that could tie it all together is from CDC's "Frequently Asked Questions."
"Sterile items and disposable (single-use) items should be stored in an enclosed storage area (e.g., cabinet or drawer). Dental supplies and instruments should not be stored under sinks or in other locations where they might become wet. Sterilized items should remain wrapped until they are needed for use. Unwrapped items are susceptible to contamination. Avoid storing items loose in drawers or cabinets because unwrapped items cannot be kept sterile. Items stored in this manner are subject to contamination from dust, aerosols generated during treatment, and the hands of personnel who must handle them."
If you feel unsafe or uncomfortable delivering the message, please go to the proper authority and share your concerns. For employee safety, that would be the OSHA; for patient and employee safety needing immediate evaluation, contact the health department, governing board, etc.
As health-care providers, we have responsibilities that go beyond the chair. Your addressing those concerns may be the difference between a healthy, safe dental visit and an unhealthy, unsafe dental visit. RDH
NOEL BRANDON KELSCH, RDH, RDHAP, MS, 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.