Chris Miller, PHD
Most physical tasks we perform produce visible re-sults immediately, and re-sults can give us immediate feedback of how well the task was performed. When you perform a prophy, for example, the patient`s clean teeth are immediately visible. When you complete a patient`s chart, the written remarks are immediately visible. When you set up the operatory, the arrangement of the instruments and other items are immediately visible. When you adjust the dental unit light, the clear view inside of the patient`s mouth becomes immediately visible.
Unfortunately, getting immediate feedback after performing infection control is usually not possible. In other words, you usually can`t tell if an infection control procedure actually worked. These procedures involve the killing, removing, trapping, or preventing contact with microbes, and direct proof of success would be determined by actually measuring the presence or absence of those microbes after every procedure.
Obviously, this is not practical to do on a routine basis in the office. If microbes were the size of tennis balls, and they bounced around when they were alive, we would be able to see if our infection control procedures worked. Unfortunately, microbes are invisible and you can`t tell if they`ve all been killed on heat-processed instruments, removed from cleaned and disinfected surfaces, trapped in the face mask, retained on those surface covers, or removed by handwashing.
Even worse yet, you can`t tell if some infection control procedures have even been performed. For example, you can`t always tell if unmarked packages or trays of instruments have actually been processed through the sterilizer or if they`ve just been cleaned but not yet heat-processed. You usually can`t tell if an instrument has been sterilized just by looking at it. You can`t always just look at a surface and tell if it`s been cleaned and disinfected. You can`t always tell if a disposable item (surface cover, air-water syringe, HVE tip, saliva ejector tip, etc.) has been changed after use on the previous patient. You can`t tell if a glutaraldehyde sterilant in an un-marked container is past its expiration date or if the solution is still active.
Infection control assurance
How can you best assure that a given infection control procedure is actually working or has been performed? By practicing infection control assurance (always perform a task correctly and monitor performance whenever possible). In other words, always take the steps necessary to best achieve the desired results. Infection control assurance is probably already being accomplished for most infection control procedures being performed in your office. Thus, establishing this assurance will not create much more work. Infection control assurance can be approached in four steps:
Step 1: Establish and confirm the correct way to perform a procedure. Identifying the correct procedures may involve:
- Reviewing recommendations and regulations made by agencies (CDC, OSHA, state dental boards) and professional organizations (ADA, OSAP).
- Attending CE programs on infection control.
- Reviewing current literature and textbooks.
It is also very important to determine the proper products and or equipment to use for a given procedure, as well as correctly using them according to the manufacturer`s directions and other related recommendations.
Step 2: Prepare a written step-by-step description of the correct procedure. It is important to go through the thought process of determining exactly how to perform the task. Once the steps are written down, perform the task as written to assure that the description is accurate. The written procedures should be placed in the office?s procedures manual or in the required written exposure control plan.
Step 3: Incorporate the procedure into the office training program. The written description and a demonstration of exactly how to perform the task is to become a part of the office training program. Also, emphasize the importance of performing the task the same way every time so that the same result can be expected every time.
This training will ensure that new employees learn the correct way to perform the task routinely. A periodic review of procedures (such as reviewing two specific procedures at each staff meeting) will help prevent current employees from becoming complacent about these routine tasks.
Step 4: Establish an infection control monitoring program. The infection control coordinator for the office should monitor infection control on a schedule that is approved by everyone in the office, and everyone in the office should know that the coordinator has the responsibility of telling other staff when they are doing something incorrectly.
This monitoring should periodically determine that procedures are being performed correctly and at the proper times, and, whenever possible, the procedures are achieving the desired result.
All employees should be periodically observed to determine if any reinforcement is needed. Some offices have decided to actually keep records on this type of subjective monitoring to help document their infection control assurance efforts.
In summary, performing these four steps will help ensure proper infection control. Being able to state that your office practices infection control assurance enhances the credibility of your infection control program.
Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.