by Patricia Pine, RDH, AAS, and Harriet Ludjin, RDH, MAdEd
The art and science of dentistry has exploded over the last decade or two. Treatment options are custom tailored to the individual as we assist our clients in meeting their needs and wants. In doing so, we educate them on various products and health issues, thus creating informed consumers. This explosion of dental technology enhances the abilities of hygienists and dentists alike, creating an exciting atmosphere for those practitioners just entering the field.
Comparisons of past modalities are often made to current ones. For example, years ago, if a person wanted whiter, brighter teeth, the option was to place crowns, often referred to by Hollywood as “caps.” “Bleaching” was something the dentist did to lighten a tooth after performing a root canal. Tooth whitening treatments vary widely, from the at-home application of strips and gels to in-office laser whitening - “one stop shopping,” so to speak, for those patients requiring instant gratification.
The pressure from the consumer to look “perfect” in a short period of time often causes a practice to accept the time-equals-money theory. The temptation is strong to cut corners, fostering an attitude of “after all, we didn’t use all that infection control stuff years ago and we’re fine.”
Just as the meanings of the words we use have changed, (for example “sweet” meant something we ate, “smokin’” meant smoking a cigarette, and “hot” meant don’t touch it or you will get burned), our attitudes towards infection control need to change. Years ago, the term sterilization meant using an autoclave and “cold sterilization” solution. Now, that term has become only a small part of what is considered infection control practices. Thirty years ago, most people in dentistry were concerned with the “yuck” that was covering the teeth; now, we have a heightened awareness of the debilitating effects of Hepatitis C, tuberculosis, and HIV infection.
The focus is now on keeping our clients and staff members safe from infectious diseases and injuries by minimizing the potential for cross contamination. Infection control has truly become a “team” effort.
A fun way to think about infection control would be to consider your practice as a “reality show.” Imagine Donald Trump (the dentist) rallying the team at a monthly staff meeting. Trump asks for a report from the administration and finance department (business staff), the public relations person (assistant), and the treatment advisor (hygienist). Each department would report on what’s new, MSDSs, potential hazards, and the resultant work practice controls.
An exciting and informative discussion would be followed by role-playing and trouble-shooting, resulting in the elimination of cross-contamination glitches. Taking the time to review and understand current concepts in infection control, the role of the CDC (Centers for Disease Control), and how it all impacts the practice of dentistry will enable each practice to safeguard their clients, themselves, and their money.
Team training is frequently under-utilized; the thinking is that the two to three hours of time is unproductive time. Nothing could be further from the truth. A well-trained staff is a healthy and safe staff. Healthy staff do not miss work due to illness and are more productive because they have high energy levels. It is a staff that is enrolled in the well-being of the practice and not just compliant. The team approach to infection control encourages the staff to think globally - that is, to think about how every action performed impacts another person and how that person impacts others and so forth. A team that is only compliant is not a true team. Once the reason for being compliant is gone, the staff will fall back on old habits.
In other words, they have not enrolled in the belief that infection control is important - they do not value it. A true team values each other’s efforts and strives to support each other. They will offer suggestions to improve the flow of contaminated instruments safely to the sterilization room; they will search out cost-effective methods of ensuring there are no breaks in cross-contamination (for example, comparing various types of barriers), and they will keep current with disinfectant solutions and the effects of such on themselves and the environment.
People come to us with the expectation that their needs and wants will be met in a safe and caring environment. As a team, we must be prepared to meet that challenge. This team approach begins with the first phone call and continues through each and every appointment.
The office/business staff often have first contact with clients. While using established screening protocol, they are able to determine the necessity for pre-medication, allergy concerns, and special needs or recommendations. The clinical staff are then better prepared to meet each person’s preventive and restorative needs with an individualized treatment plan. This, of course, includes blood pressure screenings and in-chair medical profile reviews.
And speaking about chairs ... this is an area that team involvement ranks high. Consider what droplets and aerosols have landed on the uncovered chair, the equipment, the computer, the overhead light, etc. A complete staff meeting could be devoted to trouble shooting ways to prevent cross-contamination, utilizing chair covers, handle barriers, and wipe-wipe-wipe (4x4 with disinfectant).
Sit in a chair sometime and look around. What do you see? Spots of prophy paste on the light cover? Dried blood on the chair? Impression material imbedded in the towel clips? Who is responsible for ensuring everyone’s safety? The team! Each member keeps an eye open for concerns and pitches in to help remove/reduce the problem.
Many practices choose to empower one person to be the infection control officer (ICO). Frequently this role is delegated to the hygienist. In some cases, especially if the hygienist is part time, the responsibility is handed off to the assistant. The ICO ensures that the MSDSs are filed properly, hazardous waste is disposed of correctly, assists staff members in updating their section in the Standard Operating Procedures Handbook, and arranges for professional trainers to conduct the office’s annual update.
One of the most effective ways to cover all aspects of office infection control is to develop a game plan. This plan might include something as basic as acknowledging that the office, in fact, needs a plan. Post a list of goals in a conspicuous place (bulletin board in staff room) along with a deadline for each goal. Individual team members might end up working on the same project together, making the task a friendly one rather than a “have to” one.
As Henry Ford once said, “Nothing is particularly hard if you divide it into small jobs.”
Review this list during the monthly staff meetings and discuss progress made. Request your infection control presenter to assess the practice at the annual update program and to offer the practice a written report.
Just as Donald Trump’s team works together to ensure the company’s success, everyone in the office pools their efforts to take their team to its highest level of achievement. In doing so, they demonstrate their allegiance to the practice, to the dentist, to themselves, and to the team. In working together, the team removes the obstacles that not only impact client health and their health, but also the financial health of the practice.
When the team becomes lax in its efforts, the practice is at risk for financial destruction. This may be in the form of fines assessed during an official inspection, illness of a client or staff member, or perhaps costly repairs to equipment due to poor and inadequate maintenance, thus the saying that optimum infection control practices saves the practice money.
Often, sharing personal and business stories during team meetings can foster a deeper appreciation for what obstacles occur in the practice. Through working together, solutions are discovered and plans initiated according to each one’s abilities. As each team member demonstrates personal accountability and proactively works to move the team forward, the challenge will be keeping things “fresh” and positive.
This approach reflects the viewpoint of the CDC - take a new look at an “old” procedure. An example would be the challenge to evaluate and document findings, as a team, the efficacy of needle/syringe safety systems.
Today’s mobile society not only enhances learning opportunities, it also opens up channels of concern. Emerging infectious diseases such as severe acute respiratory syndrome (SARS), monkey pox and West Nile Virus (WNV) place oral health-care providers at risks that did not exist 30 years ago. As a team, the practice can work together to strengthen its line of defense against both known and unknown entities.
Supporting each others’ efforts to use personal protective equipment (PPE) properly and to think beyond “universal precautions” flames the fans of enthusiasm, validates efforts, and fuses new energy into the practice. By asking challenging questions (When was the last professional office training? How is the MSDS manual implemented? What new research is influencing purchase orders?), the team will ensure the protection of clients, staff, family, and friends. Protection is a given!
Joe Paterno, a legendary college football coach, says, “When a team outgrows individual performance and learns team confidence, excellence becomes a reality.”
Patrica M. Pine, RDH, AAS, is president and owner of “U”nique Dental Organizational Services, which provides individualized infection control consulting and hands-on training programs to dental practices throughout the country. She is an OSHA-authorized provider, maintains membership in OSAP, and is an active in ADHA. She may be reached at (480) 816-1562 or at [email protected]. Harriet Ludjin, RDH, MAdEd, is co-founder and executive director of Professional Directions Conferences. She is a multi-level certified American Red Cross and American Heart Association instructor and an authorized OSHA instructor. She is active in the ADHA, OSAP, and APIC and continues in clinical practice while speaking, writing, and presenting. She may be reached at [email protected].