By Noel Kelsch, RDH, RDHAP, MS
Everyone has days that go nonstop from start to finish. Sometimes I enter the dental environment and it feels like a vortex. Scotty has beamed me up and I'm now on Planet Dental, no turning back. It's very important that I do not make exceptions to the infection prevention steps no matter the situation.
On days when you have no time, those are the days it's most important to take your time. Accidents happen when we're in a hurry. Let's look at a few examples of poor decision-making in infection control, and some simple solutions for managing those times.
Personal Protective Equipment (PPE)
The Myth: Oh, it won't hurt if I wear my PPE to the front this one time to give them this note.
CDC direct quote: Remove barrier protection, including gloves, mask, eyewear, and gown, before departing work area (dental patient care, instrument processing, or laboratory areas).1
Why? Although you are well protected by the PPE barriers, including gloves, mask, and gown, the people you are approaching are not. You might be carrying pathogens on the gown you're wearing to the front of the office, lunch area, restroom, outdoors, etc. You're risking other people's health by not removing PPE when you leave the work area. Mask and gloves are single use.
Solution: Dedicate a hook to hang your PPE. Use single-use PPE one time for one patient, and then dispose of it.
Handpieces
The Myth: This one time I'm in a hurry and there are no heat-sterilized handpieces available. I'll just wipe the handpiece down between patients and put barrier protection on it.
CDC direct quote: Dental handpieces and other devices attached to air and water lines:
Clean and heat-sterilize handpieces and other intraoral instruments that can be removed from the air and water lines of dental units between patients. Follow the manufacturer's instructions for cleaning, lubrication, and sterilization of handpieces and other intraoral instruments that can be removed from the air and water lines of dental units. Do not surface-disinfect; use liquid chemical sterilants or ethylene oxide on handpieces and other intraoral instruments that can be removed from the air and water lines of dental units.2
Why? The CDC states, "Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high-level or surface disinfected. Although these devices are considered semicritical, studies have shown that their internal surfaces can become contaminated with patient materials during use. If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially infectious materials."3
Solution: Buy enough handpieces to serve the number of clients you will see in a day. It's the cost of doing business.
Being in a hurry can impact the effectiveness of your infection control program. Think about the long-term effect of being in a hurry and skipping a step. Your infection control is only as good as the least effective step. Rushing during stressful times is human nature. When you rush, you can cause injury or risk to everyone in the dental setting as well as the community. So what do you need to do?
I'm not leaving Planet Dental any time soon, and I do not make exceptions to the infection prevention steps. Preventing accidents means I have to follow the infection control prevention steps no matter what the situation. RDH
Tips from Planet Dental
Always put infection control first-If the staff does not comply with infection control, you're risking the health of both patients and staff. Think about the long-term effects of not complying with infection control.
There are no shortcuts in infection control-Do not consider skipping steps, such as "clean and disinfecting," a two-step process. Each requirement is there for a reason and will impact the effectiveness of infection control. For example, if you do not clean an item before it is sterilized, the sterilization process may not be effective.
Dress for success-Always wear your PPE and take it off when you leave the work area (lab, operatory, sterilization area). Use the right equipment for each job. For example, always use utility gloves that are chemical- and sharps-resistant when working with chemicals, cleaning and disinfecting rooms, and in sterilization.
Know the risks involved-Read the labels and instructions for the products and chemicals you use, and the instructions for the equipment you use. Follow the directions exactly.
Attitude-When you're stressed, you might take on an attitude that leads to risk. Most importantly, do the safest job you can for patients and staff and not the fastest job. The attitude of responsibility means looking at the long-term effects of skipping steps in infection control. Justifying skipping steps with statements such as "I did this for years without utility gloves and I'm fine," will lead to risky situations.
Plan for challenges-Simply looking at the challenging times and planning for them can help minimize the risks involved. You must prioritize the areas of importance and set aside some tasks until you have time to deal with them. Think ahead of time about what the priorities should be and how other staff members can be trained to pitch in if needed. Finding simple solutions such as instrument management systems can simplify processes and keep everyone safe.
NOEL BRANDON KELSCH, RDH, RDHAP, MS, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists' Association.
References
1. Recommendations from the Guidelines for Infection Control in Dental Health-Care Settings - 2003. p. 7. http://www.cdc.gov/oralhealth/infectioncontrol/pdf/recommendations-excerpt.pdf Accessed Oct. 11, 2016.
2. Recommendations from the Guidelines for Infection Control in Dental Health-Care Settings - 2003. p. 13. http://www.cdc.gov/oralhealth/infectioncontrol/pdf/recommendations-excerpt.pdf Accessed Oct. 11, 2016.
3. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. p. 14. http://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care.pdf accessed October 11, 2016.
