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Some why questions

Nov. 1, 2010
For over 30 years, I've been answering "why" for some very important people: my children. My first response to them as they can tell you to this day is always, "Glad you asked."
by Noel Kelsch, RDHAP[email protected] For over 30 years, I've been answering "why" for some very important people: my children. My first response to them as they can tell you to this day is always, "Glad you asked." When they were little they were famous for questioning everything. Their inquiries went far beyond "Why is the sky blue?" or "Where do babies come from?" Together we discovered some interesting whys:
  • Newborn babies don't have tears when they cry because their tear ducts are not fully formed at birth and may take a while to develop. Babies are born with a basal tearing that delivers just enough moisture to keep the eyes moist and healthy. Psychic tears appear between two and four months. These are the tears that are triggered by emotion. We found this out by looking it up in an infant development book.
  • A shark can grow new teeth in a week. We discovered this by talking to a marine biologist.
  • A cat has 32 muscles in each ear and three eyelids, information we gathered from a local vet.
  • 70% of living organisms are bacteria, and that information came from a day visiting a microbiologist.
  • The dot of the small letter i is called a tittle, and we found this out from a meeting with a local printer.
  • The tiny thing on your shoestring that helps you thread it is called an aglet, which we learned from a field trip to a cobbler.
  • The roar you hear when you place a seashell next to your ear is not the ocean but the sound of blood surging through the veins in your ear and "echoing" in the shell. We learned this from an ear, nose, and throat doctor.
My life has not changed much over the years. My children still call me with "why" questions, and many of you who read this column contact me with the same questions. Each time we ask "why" we have an opportunity to learn. We need to go to the best available source to find the answers. It is always important to go to the right source and find out why before we practice infection control.

Here are three of the most important "why" questions I received this year:

1. Why can't I make my own wipes by putting cotton 2x2's in a container and covering them with hospital grade disinfectant?

I asked the Organization for Safety and Asepsis this question. They are a great place to take your infection control questions, and they have an entire part of their Web site devoted to your "why" questions!

OSAP's Infection Control In Practice: Managing Environmental Surfaces manual states: In general, cotton fibers contained in gauze may shorten the effectiveness of some disinfecting agents when stored in containers together. Germicides, especially iodophors or chlorines, may be inactivated or absorbed by the gauze. If you use gauze to apply disinfectant to surfaces, saturate the gauze with the disinfecting agent at the time of use.1

I then confirmed this by looking it up in the book "Practical Infection Control in Dentistry." It states that disinfectants should not be stored in containers with gauze because this may shorten the effective life of the disinfectant.2 There is currently no study that tells how long one can soak disinfecting agents in cotton and render it ineffective. It is known that the products used in manufacturing cotton, such as bleach, can inhibit the disinfectant. The material used to make hospital grade disinfectant wipes was developed specifically for that use, and is completely different than cotton.

Making your own wipes is an off-label use, and the manufacturer is only able to state that it is a hospital grade disinfectant if you follow the label use. Keep in mind as you use a product that you are replicating how it was used in science-based testing and approved as a hospital grade disinfectant. Those are the instructions on the label. The disinfectant is tested to be hospital grade under very specific conditions. You must follow the directions to create those conditions. Off-label uses do not guarantee that a product will be effective; in fact, it probably won't be. If you are not following the directions, you may be putting people at risk.

2. Why can't I use food handlers' gloves for patient care?

I found this information in both the CDC Infection Control Guidelines3 and in Food and Drug Administration (FDA) materials. Dental health-care professionals are required to use medical grade gloves while delivering patient care. Food handler gloves are not medical grade and do not have the characteristics of a medical grade glove. Not all gloves are the same. You cannot just buy gloves off the store shelf for medical procedures. They must be medical grade and be considered a medical device.

Medical gloves are regulated by the FDA in harmony with the consensus standards of the International Organization for Standardization (ISO) and the American Society for Medical Testing (ASMT). The FDA makes sure the manufacturers meet performance criteria such as leak resistance, tear resistance, etc.

There was some confusion about food handler gloves a few years ago when it was recommended that they could be used over medical grade gloves in order to write notes. This is a good use for food handler gloves, but once you have finished the notes you must use medical grade gloves for patient care.

3. Why can't I use hand sanitizer instead of washing my hands?

According to the CDC, hand washing is "The simplest and most effective measure for preventing the spread of bacteria, pathogens, and viruses. It is the single most effective way of preventing the spread of disease."5 Hand sanitizer was never meant to take the place of washing your hands because it does not remove debris and cannot penetrate debris or the bacteria and viruses harbored under that debris. The CDC Guidelines for Hand Hygiene in Health Care Settings state you must wash your hands:

  • When hands are visibly soiled
  • After barehanded touching of inanimate objects likely to be contaminated by blood, saliva, respiratory secretions, or other potentially infectious material
  • Before and after treating each patient
  • Before donning gloves
  • Immediately after removing gloves
Hand sanitizers were developed for times when hand washing is not available or the above criteria are not present.

I am glad you all are asking "why" about infection control and hope that you will use all available resources to discover the most effective way to keep patients and yourself safe.

  1. OSAP's Infection Control in Practice: Managing Environmental Surfaces. Vol. 3, No. 3 April 2004.
  2. Practical Infection Control In Dentistry, 3rd. Edition. By Molinari and Harte. Kluwer/Lippincott/Williams & Wilkins Publishers. Copyright 2010. Page188.
  3. Guidelines for Infection Control in Dental Health-Care Settings, 2003. MMWR, December 19, 2003:52(RR-17).
  4. Accessed November 11, 2009.
  5. accessed 8/11/10
Noel Brandon Kelsch, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She is a member of the Organization for Safety and Asepsis Procedures and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamine and drug use. She is immediate past president of the California Dental Hygienists' Association, and is on the board of directors for the Simi Valley Free Clinic.

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