Keep on doing it!

July 1, 2002
Infection control procedures can be monotonous and even boring.

Infection control procedures can be monotonous and even boring. In some ways, this is a good thing, because it means that it has become a natural part of the office routine. However, we must not become complacent about infection control. Since we don't hear much about the occurrence of some infectious diseases, complacency is a risk. However, when we figure out ways to control an infectious disease, it does not mean we have eradicated the causative microbe. It merely means we have reduced exposures or increased resistance through vaccination.

For example, there are still those who carry Corynebac-terium diphtheriae asymptomatically in the nasopharny-geal area. However, diphtheria is not noteworthy in the United States because most of us have been vaccinated against the microbe.

If we relaxed our vaccination standards and did not give the DPT inoculations (D-diphtheria, P-purtussis, T-tetanus) to our children, we would see a resurgence of diphtheria, whooping cough, and perhaps tetanus. This is exactly what happened when Russia reorganized into independent states that disrupted their vaccination programs in 1992.

All of the "nasty" microbes you've ever heard of - except possibly the smallpox virus - are still around. This group includes the causes of diphtheria (Corynebacterium diphtheriae), scarlet fever (alpha-hemolytic Group A streptococcus), the plague (Yersinia pestis), rabies (Rabies virus), whooping cough (Bordetella purtussis), as well as microbes that cause more common infections such as herpes, influenza, pneumonia, ear infections, strep throat, hepatitis,and many others.

The need for infection control in the dental office is as great as it ever was.

Infection control works! It reduces contact with microbes. Your gloves are protecting you and your patients from each other's microbes. When you wash your hands, you are removing most of the transient microbes that were transferred to your hands from touched surfaces. Washing also helps remove the chemicals from gloves that have contacted your hands and reduces the number of microbes that may have multiplied on your skin beneath the gloves.

Your mask and protective eyeglasses are preventing the patient's oral microbes in spatter from contacting the mucous membranes of your mouth, nose, and eyes. Protective clothing is protecting your underlying clothes and skin from the patient's microbes. When you remove this protective clothing, you reduce the chances for microbes spreading when you leave the work area, go out to lunch, or go home at the end of the day.

The disinfection of appliances and impressions reduces the spread of patient's microbes to lab personnel and lab equipment.

Surface cleaning and disinfection reduces the number of microbes on a surface. So few microbes, if any, will be transferred to the next patient when those surfaces are used again. Even better, covering surfaces that cannot be properly cleaned, disinfected, or sterilized prevents them from becoming contaminated in the first place.

Cleaning, packaging, and sterilizing instruments and equipment keep microbes from being transferred from one patient to the next. The cleaning facilitates sterilization by removing the debris and most of the microbes. Packaging before sterilization keeps the instruments in functional sets and protects them from re-contamination, until they are presented for use on the next patient. Heat sterilization is more reliable than liquid chemical sterilants.

Sterilization can be monitored through spore testing, allowing packaging to maintain sterility. Monitoring the sterilization process with spore tests and chemical indicators helps assure the safety of the instruments for patient care. Monitoring also can serve as a good training tool to confirm that new staff are performing sterilization procedures correctly.

Disposable items such as air/water syringe tips, HVE tips, prophy angles, and fluoride trays clearly prevent the spread of microbes from patient to patient, because the items are discarded after use on one patient. Proper waste management protects you from unnecessary contact with potentially dangerous items, particularly contaminated sharps. Handling sharp instruments carefully and slowly will help prevent sharps injuries. Once contaminated sharps are placed in proper containers, they are safely contained and ready for final disposal.

A device providing good quality water during treatment reduces contamination of patients with the high numbers of extraneous microbes that are present in dental unit water.

In summary, infection control really does reduce exposure to microbes and limits the spread of microbes in the office. Infection control is still important, even though it may seem boring. We all need to be "jolted" from time to time about the importance of routine procedures.

Chris H. Miller, PhD, is professor of oral microbiology and executive associate dean at the Indiana University School of Dentistry.