Dear RDH:
Infection control is a series of steps that health-care workers perform with the goal of eliminating as many risks as possible for both clients and staff. Each step helps to limit the pathogens. The series of steps are determined by a group of involved parties, including Occupational Safety and Health Administration (OSHA), Center for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA). Although absolute asepsis cannot be guaranteed, the goal is to work toward it in all that we are doing in the dental operatory environment. All choices in infection control should be working toward that goal.
Each item addressed in Amy Brown’s letter (December 2011 RDH): Barrier protection, gloves, and 2x2 gauze are medical devices that should not be purchased from a manufacturer or distributor that is getting them from an undocumented factory or that has not been approved and cleared by the FDA. Approval and clearance comes after inspection of the facility by FDA employees. A certificate of exportability will only be issued if the facility passes and includes training of the factory employees on environmental considerations and infection control.
The barrier protection you are choosing in dentistry should have FDA approval because it is a medical device. If it does not have approval, there is no way of knowing if it is safe for use or if you are putting your clients at risk. This is why it is vital not to order black market medical devices that do not have approval and may come from an unsafe environment.
Storage and use of the item is as important as the manufacturing environment. Barriers should not be stored in an open package and should be stored in a clean dry place.
In using medical devices such as sterilization pouches, there are processes that have been developed to help limit pathogens. For example, the reason you are opening the bag in the manner described in the “Using a Self-Adhesive Sterilization Pouch” (September 2011 RDH) is because this is the method that has been shown to cause the least amount of cross contamination. Allowing the instruments to drop from the packet eliminates touching and exposure to the outside of the package that may have been contaminated during transportation. Not placing the instruments package on the tray will stop you from contaminating the tray with the bacteria from outside the package. Each of the steps involved limits exposure. Is it perfect? No, but it brings you as close as possible to the desired outcome.
Single-use devices and items (cotton rolls, gauze, and irrigating syringes, for example) for use during oral surgical procedures should be sterile at the time of use, according to CDC Infection Control Guidelines for Dental Healthcare Settings 2003. These can be bought in individual packets that have been sterilized ahead, or you can process your own in individual packages for surgical procedures. Many offices have developed the protocol of sterilizing all disposables that are safe for sterilization (such as tongue depressors, gauze, cotton tip applicators, etc.) as an additional way of reducing exposure to possible pathogens.
The oral environment is not sterile. Reducing the risk involved in exposure includes:
- Having patients brush and perform inter-dental care before treatment.
- Having patients pre-rinse with an antimicrobial mouth rinse has been proven to help reduce the amount of bacteria and viruses (see “Choosing and using procedural mouth rinses,” December 2011 RDH).
- More importantly, do not see patients who have contagious diseases for elective care (see “Don’t Let Me Say, ‘You Make Me Sick’,” June 2008 RDH).
As we each try to implement this series of steps involved in infection control, we are eliminating as many risks as possible for both clients and staff. Absolute asepsis cannot be guaranteed, but, in reducing the pathogens in as many ways as possible, we can get as close to that goal as possible and achieve the safest possible environment for both clients and staff.
Noel Kelsch, RDHAP
Moorpark, California
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