Staying in the infection control zone: Studies verify the importance of environmental surfaces

April 15, 2016
Infection control columnist Noel Kelsch, RDHAP notes two studies that demonstrate the importance of focusing on environmental surfaces.  


Sometimes my daily tasks get me in trouble. I zone out going through the steps that I have done so many times before. Yesterday was no exception. I loaded the washing machine with my whites and later put the clothes in the dryer. When I returned to fold them, I soon found out that the lipstick I had been looking for was no longer lost. All of my white clothes had red spots covering them.

There are times in dentistry that we just go through the motions. Going through the motions without thought can really impact outcomes. One area in dentistry where we need to stay aware and alert is operatory turnover.

Contamination of the dental environment and the risks involved need to be of paramount concern for both the patient and dental health-care provider. We all know that improper cleaning and disinfection of the dental environment can create an environment where transmission of disease may occur.1

How are we doing?

There are two infection control studies in this area that should make us all stop zoning out when it comes to taking care of environmental surfaces in dental infection control.

One study from the British Dental Journal looked closely at the transmission of methicillin-resistant Staphylococcus aureus (MRSA) in the dental setting. It revealed that MRSA contamination could occur via the surfaces in the dental operatory. Testing was done on the environmental surfaces; then revision and training of infection control practices were done, and the areas were retested. In the first test, five MRSA colonies were isolated. In the second test, there was no contamination observed. The outcome of the second study revealed that awareness of adequate infection control guidelines and effective infection control practices can reduce MRSA contamination in the dental setting.2

A study from the Journal of International Oral Health is very concerning. It took 100 samples from the dental environment in relation to nosocomial infections. The areas that had the highest percentage of contamination were dental chair light handles, suction tips, and the pens used by the dental health-care providers (DHCPs), followed by instruments and laboratory equipment. Areas we should all pay attention to that had equal amounts of bacterial contamination included laptops, dental chair units, light handles, mobile phones, sink tap, etc. The study concluded that DHCPs need to be maintaining effective preventive strategies and practicing the infection control guidelines that we all have been given. If we don't, we are risking the transmission of nosocomial infections in the dental environment.3

We all know that it is up to us to change this dynamic. Step back and take a look at what you are doing to keep the environment in which you spend much of your waking hours safe. Are you:

  • Cleaning and disinfecting (two steps) the clinical contact surfaces following label directions for an EPA-approved hospital-grade disinfectant
  • Using single-use disposables whenever possible? Disposing of them after use
  • Using barrier protection for areas that are difficult to clean and disinfect
  • Not allowing cell phones to be used by dental professionals during clinical hours? Asking patients to put cell phones away during treatment because of the high bacterial content
  • Practicing hand hygiene before and after every patient
  • Reviewing the proper use of personal protective equipment, including wearing, removal, and disposal
  • Implementing engineering controls as much as possible, such as hands-free sinks, light systems, and chairs
  • Reviewing modes of transmission and chains of infection
  • Participating in yearly required OSHA training on blood-borne pathogens
  • Paying attention to the task at hand? Focusing on what needs to be done and the steps to accomplishing this task

I spent this afternoon removing lipstick from my whites. This reminder has helped me to not zone out in the laundry room. I hope these studies will help you do the same in the dental setting. RDH

What is MRSA?

MRSA is a type of Staphylococcus aureus. This specific bacteria is resilient and resistant to the normal antibiotics that would be used to treat a bacterial infection, including antistaphylococcal penicillins (methicillin, oxacillin, nafcillin) and cephalosporins. This disease is a major concern in the medical setting, because it can be invasive very quickly and treatment can be complex. Currently, it is estimated that there are 94,360 invasive MRSA infections annually in the United States, which lead to 18,650 deaths each year. Eighty-six percent of all invasive MRSA infections are health-care associated.


1. Merchant VA. Herpes viruses and other microorganisms of concern in dentistry. Dent Clin North Am. 1991;35(2):283-298.
2. Kurita H, Kurashina K, Honda T. Nosocomial transmission of methicillin-resistant Staphylococcus aureus via the surfaces of the dental operatory. British Dental Journal. 2006;201:297-300.
3. Umar D, Basheer B, Husain A, Baroudi K, Ahamed F, Kumar A. Evaluation of bacterial contamination in a clinical environment. J Int Oral Health. 2015;7(1):53-55.

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.

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