Check out these miscellaneous infection-control procedures. This is the last in a series of checklists for reviewing your office infection control. The series started in the November 1999 RDH and has covered office recordkeeping, infection-control training, hepatitis B vaccination, post-exposure medical evaluations, barrier protection, aseptic techniques, instrument processing, surface asepsis, and waste management. In this issue, we include a variety of remaining procedures on handwashing, reducing microbe spread, laundering, and safety procedures.
Chris Miller, PhD
* Wash hands at the beginning of the day, just before gloving, after removing gloves, before touching clean patient-care supplies, before applying clean barriers to operatory surfaces, before leaving the restroom, before eating, before applying cosmetics or contact lenses, before leaving the office, whenever hands may have become contaminated with patient fluids.
* Clean fingernails gently to avoid enhancing breaks in the skin. Remove hand jewelry and use a liquid antimicrobial handwashing agent when preparing for patient-care activities. For routine handwashing, vigorously lather the hands for about 20 seconds and thoroughly rinse with cool to warm water for about 10 seconds. Repeat the lathering and rinsing and dry hands, then forearms, with clean paper towels, and use the towels to turn off hand-controlled sink faucets.
* Consider foot-operated or other hands-free sink faucets and liquid detergent-dispensing controls. Avoid using bar soap for it may harbor microbes from the hand of a previous user.
* Avoid washing gloves with detergents for this may enhance wicking of materials through any defects that may be present in the glove. Rinsing examination gloves under the faucet (with water only) to remove excess powder (cornstarch) and patting the gloves dry with clean paper towels is acceptable, if desired, before routine non-surgical dental procedures.
Reducing microbe spread
* Minimize spraying or spattering of patient`s oral fluids by using the high-volume evacuation system and a rubber dam (which are seldom or never used during prophylactic care).
* Consider the preprocedure use of an antimicrobial mouthrinse for patients to temporarily reduce the levels of oral microbes.
* Consider the use of disposable items (e.g., HVE tips, 3-way syringe tips, prophy angles) and dispose of these items after use on a single patient.
* Consider dispensing sterilized cotton forceps with each patient set-up to aseptically retrieve items at chairside during patient-treatment sessions. Avoid reaching into bulk-supply containers or drawers of supplies while wearing contaminated gloves.
* Sterilize or disinfect equipment or other items (e.g., handpieces) before they are repaired or sent out for repair or replacement. If a part of a contaminated item cannot be decontaminated before repair, identify and label that part so precautions can be taken by anyone who must contact that part.
* Use closed, leak-proof, biohazard-labeled containers to store, transport, or ship items contaminated with patients materials (e.g., tissue, teeth, impressions, or other items that have not been decontaminated).
* Handle contaminated laundry (e.g., linens, gowns, clinic jackets, other protective clothing) as little as possible with minimum agitation and only while wearing gloves, protective clothing, and, when needed, eyeglasses and masks.
* Place contaminated laundry in a bag or other container that is red or marked with a biohazard symbol. If all laundry in the office is handled under universal precautions (e.g., while wearing personal protective barriers), the laundry containers need not be red or have a biohazard symbol affixed, but all employees must be trained to recognize the containers of contaminated laundry. If contaminated laundry is wet, the containers must prevent leakage and soak-through.
* Launder reusable items on site or send to a commercial laundry. If the commercial laundry uses universal precautions in handling all laundry, the office laundry containers need not be biohazard-labeled.
* Contaminated reusable sharp instruments are placed in containers that are puncture-resistant, leakproof, colored red, or marked with a biohazard symbol until the instruments are decontaminated (e.g., cleaned and readied for sterilization).
* Contaminated reusable sharp instruments are not stored or processed in a fashion that would require one to blindly reach by hand into the container, risking injury while retrieving the instruments.
* Eating, drinking, smoking, applying cosmetics, and handling contact lenses do not occur in the treatment rooms or instrument-reprocessing area or in other sites where patient blood or saliva may be present in the environment.
* Food and drink are not stored in areas (e.g., refrigerators, cabinets, shelves, and countertops) where surfaces or items contaminated with patients` blood or saliva may be present.
In summary, the checklists provided in the last five RDH issues have offered a fairly comprehensive mechanism for you to review your office infection control. I hope they have been helpful.
Chris Miller, PhD, is professor of oral microbiology and associate dean at the Indiana University School of Dentistry.