Chris Miller, PHD
While infection control has always had an important role in dentistry, the advent of AIDS led to a new emphasis in this area during the early to mid 1980s. Within the past 15 years or so, dentistry and hygiene have witnessed the expansion of CDC infection control guidelines to more specifically include dentistry.
They also have seen the development of the OSHA bloodborne pathogens standard, which became effective in 1992. In addition, several states have added their own infection control regulations, and many of them have been in place for several years. Although new infection control concerns will continue to develop, the current regulations and recommendations have been around for a while.
So one of the key issues now is to prevent complacency.
Not a routine buzz word
It`s important for infection control to be practiced routinely for all patients as indicated by the concept of universal precautions. The blood and saliva of all patients must be considered to be infectious for HIV and hepatitis viruses. This is not just a "catchy" pair of "buzz words" that will soon go out of existence. Universal precautions form the basis for developing a standard infection-control regimen that will interfere with the spread of microbes during the care of all patients.
When this regimen is practiced routinely, it will not only interfere with microbial spread during those times of obvious potential exposure, but also during those unexpected events that can cause exposure. The OSHA bloodborne pathogens standard states that personal protective barriers are to be worn by employees whenever a potential for exposure to body fluids may be "reasonably anticipated."
Reasonable anticipation would include, for example:
- Anytime when placing hands into a patient`s mouth.
- Generating spatter and aerosols from using handpieces and ultrasonic scalers.
- Touching surfaces contaminated with body fluids.
Examples of unexpected events would include:
- The typically unpredictable cough by the patient, causing blood and saliva to be sprayed at your face.
- The surprising, periodic "squirt" of saliva from the patient`s mouth when you say "open wide."
- Accidentally dropping an instrument cassette into the ultrasonic cleaning solution, splashing contaminated fluids towards your eyes.
Infection control that is routinely practiced can prepare you for the expected as well as for the unexpected. However, when some people continue to do things the same way over and over, they may become bored, lose interest, and perceive a reduced importance of the task. We simply cannot let this happen with infection control. We cannot take infection control for granted. It is as important now as it ever was.
Microbes are still around
A case of hepatitis B spread from dentist to patients in the dental office has not been reported since the early 1980s. We`d like to think this is a result of the increased emphasis on infection control, as well as the development of the first hepatitis B vaccine that occurred about this time. Nevertheless, thousands of new cases of hepatitis B still occur every year nationwide, which tells us that the virus is still around. Also, while you and your health care colleagues may have been vaccinated against hepatitis B, most of your patients have not. Patients are still susceptible.
Thus, we cannot let down our guard, for there are still plenty of bloodborne and respiratory pathogens around as well as the ever-present normal oral microbiota.
Unfortunately, we seldom see the headline, OInfection control prevents the spread of disease agents.O We usually hear about someone suggesting that a breach of procedure may have led to cross-contamination.
We need to Ocreate our own headlinesO in our offices. The reminders will allow us to keep infection control in the forefront of our brains rather than letting it slip back into those little-used nooks and crannies of our gray matter. Here are some suggestions for ways to keep infection control in our thoughts.
- Schedule a 10-minute training/review session during each office staff meeting, concentrating on one infection control procedure at each meeting. The office infection-control coordinator can conduct the reviews, or a different staff person could be assigned for each meeting to review one procedure.
- Host a competition each month among the employees for the best OcatchyO infection control phrase. Then post the phrase in strategic sites in the office as reminders of infection control importance. A phrase to get you started is: OBe sharp ? Handle sharps carefully!O
- Someone in every dental office should join OSAP (Office Sterilization & Asepsis Procedures Research Foundation) to get monthly information and updates on the latest in infection control. The information from monthly mailings and regional and national conferences are then shared with all in the office. This is a not-for-profit professional organization of hygienists, assistants, dentists, researchers, educators, manufacturers, distributors, and others with interests in infection control. It is the premier educational organization in dental infection control. Dental office staff can join for just $35 by calling (800) 298-6727. If in Maryland, call (410) 798-5665.
Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.