What do patients think?

Nov. 1, 2005
It has been nearly 15 years since dentistry and infection control were linked in the news media on a daily basis.

It has been nearly 15 years since dentistry and infection control were linked in the news media on a daily basis. For those of you who were not active in the profession back then, those were the days of Kimberly Bergalis, a 20-something patient in Florida, who was allegedly infected with HIV/AIDS during dental treatment. Both Ms. Bergalis and her dentist, Dr. David Acer, died from AIDS. The possibility that Ms. Bergalis, and other patients from the same practice, could have been infected during dental treatment drew a dark cloud over the profession for several years. Patients were fearful and suspicious. They delayed treatment or canceled appointments. If patients did come to the office for treatment, they asked dozens of questions, inquired about purchasing their own instruments and handpieces, and asked to see the sterilizers.

In the wake of this scrutiny, many dental practices became much more proactive about educating patients regarding their infection prevention procedures. It became a common practice to give patients a tour of the sterilization/instrument-processing area. Several companies designed sterilization centers specifically for high patient visibility.

When it became apparent that the Florida case was an isolated incident, much of the media frenzy and the public distrust subsided. To this date, it is the only known case of HIV transmission from a dental health-care professional to a patient.

Around the same time as the Florida incident, most dental practices were coming into compliance with the OSHA Bloodborne Pathogens Standard and updated and/or improved their infection prevention protocols. Although it seemed strange at first to assume that all patients were potential infectious disease carriers, following what was then called “universal” - now called “standard” - precautions became second nature.

After a few years, the questions from the patients seemed to decrease, leading some professionals to assume that patients were no longer concerned about infection control or prevention. But I believe that, although the patients may not verbalize their concerns as often as 15 years ago, they still have them. When I was in a client’s practice a few weeks ago, I overheard a patient ask if the hygienist changed her gloves between patients. This made me wonder about the patients’ perception of how this practice (and others) protect against disease transmissions.

And remember that perception is reality. So, perhaps, when you and your team members participate in your OSHA-required annual infection control training update, you should look at your protocols from the patient’s perspective.

This may be especially important in light of the many recent news reports of a number of hospital-related infections. When patients read statistics about deaths associated with hospital-related infections, it is just possible that they may begin to question us again.

Take a look around your office or practice setting. Keep in mind that clutter and general lack of housekeeping may translate into an unclean and unsafe environment in your patients’ minds. Are there items stored on countertops in treatment rooms that are not essential to patient procedures? By this, I mean items that are used for most (if not all) patients every day, such as boxes of gloves and facemasks, disinfecting solutions, ultrasonic scalers, fluoride, and patient education models. In many cases, some of these items may be able to be stored in cabinets or drawers.

A clutter-free environment is usually perceived as more positive or clean than one that is full of “stuff” that sits on the counters. This goes for all areas of the office, not just the treatment rooms. For example, what is the first thing that patients see when they walk in the door? The reception area, right? Is this room neat and orderly? Is the carpet clean and in good repair? Or is it stained and perhaps torn? As silly as it seems, this first impression may form an image in the minds of your patients about your infection control practices, as good as they may be. Isn’t it better to put our best foot forward from the very beginning?

In several practices in which I worked, we had a rule that we all would sit in various locations around the office to see what the patient would see while sitting in the reception area, in each of the treatment rooms, and in the consultation room. We looked for dust (bunnies) and cobwebs, stains on floors and walls, burned-out light bulbs, dead leaves on the plants, and generally anything that might look to the patients as if we didn’t care about our work environment. The implication to the patients could be that we also didn’t care about them. Is it time for your office to have just such an inspection? Your patients will appreciate it, even though they may not say so.

In addition to the physical environment, which is very important, I believe that we also need to be sensitive to what patients see us do and hear us say about infection control. Do patients see you and all members of your team washing your hands before putting on gloves, and again after gloves are removed? Because we see so many patients in a day, there is a tendency to skip hand washing at times and just put on clean gloves. Remember that for your protection, gloves are not meant to be a substitute for hand washing. Washing hands immediately after removing gloves is meant to remove any potential contamination that may have reached the skin through micro tears or openings in the gloves.

From the patients’ perspective, gloves are about protecting them, and they tend to be very observant about hand-washing procedures before the gloves go on. Since there are many stories in the news about hand washing as one of the most important infection prevention tools, should we not be very proactive about showing patients that we do wash our hands whenever appropriate, and that we do it for them?

I have seen many practices send newsletters and brochures to their patients, including information about infection control and even showing photos of the sterilizers and instruments being processed. This type of information can also be posted on the practice Web site for existing or prospective patients to view.

In the last several years, there have been feature stories on the national network news programs about water contamination in dental units. What is your office doing to improve the quality of water that is delivered from your units during dental treatment? If your patients asked you tomorrow how clean your water is, what would you tell them?

If you’re not sure what to do, the Centers for Disease Control and Prevention (CDC) has guidelines for water quality in dentistry. Those guidelines can be accessed at www.cdc.gov. The Organization for Safety and Asepsis Procedures (OSAP) also has information to help you make decisions about what to do for your dental units, if you have not already done something. OSAP can be contacted at www.osap.org. If you are currently treating your dental unit water, make sure that your patients know what you do to protect them and enhance the quality of their care.

It is important to remember that even though patients may not ask you direct questions about infection control, it doesn’t mean that they don’t have concerns. The events of the past certainly raised suspicion and distrust in the minds of many of them. Let’s be proactive and put the patients at ease and answer the concern before it arises.

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].