While flying home from a recent vacation, I observed a couple across the aisle perform a very interesting procedure prior to taking their seats. The man and woman used some type of wipes to clean virtually every surface in and around their seating area. I watched with great interest as they wiped their seats, headrests, armrests, the light and audio control buttons, the overhead reading lights, window shades, and even the outside of the overhead luggage compartment. The wipes they used had a strong odor that reminded me of disinfectants.
While I can only assume the couple’s motives for their behavior, it appeared to me as if they were paranoid about exposure to infection from contact with their surroundings. If my assumption was correct, they were accurate in presuming that the things they touch, such as light and volume controls, might be potential sources of infection, but the seats they were going to sit on were not likely culprits. And they missed the greatest potential threat to their health on the airplane, which was the air. It is well known that the air on planes is recirculated during flights, which means that potential pathogens, such as cold or flu viruses, can be spread from one person to another via this recirculated air. Yet neither the man nor the woman was wearing a face mask, which may have been a more practical thing to do rather than go to such great lengths to clean their seats.
I couldn’t help but think how ironic it was that I should witness such a scene, given my occupation. But even more ironic is the fact that I observe similar behavior in dental practices. Disinfecting procedures are sometimes based on paranoia, rather than focused on the most likely sources of potential disease transmission. Some hygienists tend to be more concerned with drenching their patient chairs with disinfectant solution than in changing their face masks after each patient or washing their hands thoroughly after they remove their gloves.
The observation on the airplane reminded me that we can all use a little review session every now and then. We need to make sure that our information is current and that we are acting on fact and science, rather than what seems to be true and necessary.
How are diseases transmitted in dental health-care settings? Microorganisms that cause disease can be spread through direct transmission, such as person-to-person contact during patient treatment. Direct transmission of microorganisms may also include droplets produced by sneezing or coughing. Colds and flu are commonly transmitted in this manner. Microorganisms can also be spread through spatter, created by dental handpieces and mechanical scalers. Other vehicles for transmission of infectious microorganisms are indirect, by breathing in airborne particles, or from contact with equipment, instruments, or surfaces that have been contaminated by touching or spatter.
Wearing personal protective equipment, such as eye protection and respiratory protection (face masks), can protect us from droplet infection from cold and flu viruses, measles, and chicken pox. Protection from tuberculosis requires specialized respiratory protection. Bloodborne diseases, such as HIV/AIDS and hepatitis, are not known to be transmitted through the air.
Preventing infections from contact with spatter includes the use of barriers to cover equipment and surfaces, as well as decontaminating the surfaces with disinfectants. This is where the paranoia sometimes emerges. Certainly, surfaces such as chair and light switches that have been touched during treatment are potential sources of contamination, but is it likely that the entire dental chair is contaminated?
Like the couple on the plane, many dental professionals will clean and disinfect the entire chair after a procedure. While the patient is seated in the chair, they are covering much of the chair, thus preventing many parts of the chair from becoming contaminated from spatter. When cleaning and disinfecting the chair, be practical about what parts of the chair are most likely to be contaminated by touch or spatter. These typically include the control switches, headrests, and armrests.
Rather than obsess over the patient chair, review your procedures for writing on and handling patient charts in the treatment room. This should never be done with contaminated gloves on. How are items, such as instruments, stored in drawers or cabinets in treatment rooms? Are the items packaged or protected from spatter or touch? If you retrieve an item from a drawer or cabinet during treatment, do you use a clean cotton forceps or instrument pick-up? Leaving the treatment room with contaminated gloves on is a potential source of cross-contamination. Always remove your gloves and wash your hands before leaving the room.
Take a little time to review what you know about infectious diseases, how they are transmitted, and their potential threat to you and your patients. Be practical, safe, and healthy.
Mary Govoni, CDA, RDH, MBA, is the owner of Clinical Dynamics, a consulting company based in Michigan. She is a member of the Organization for Safety and Asepsis Procedures and is a featured speaker on the ADA Seminar Series. She also writes a column for Dental Equipment & Materials magazine. She can be contacted at [email protected].
