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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
Minimizing infection risk is vital to you, your patients and your practice.
There are plenty of no-brainers when it comes to infection control. Everyone knows to wear protective gloves and surgical masks; everyone knows to disinfect surfaces. But there are also common precautions and places within the practice that might not seem obvious, and these mistakes have occurred either because of bad habits or trying to take short cuts.
Read on to learn about six commonly overlooked areas in the dental office that can help improve infection control.
For Karen Daw, an infection control consultant and former clinic health and safety director for The Ohio State University College of Dentistry, the practice’s sterilization area is often misused.
“That’s an area where we have the potential to do the greatest amount of harm, and yet we are assigning people, who in some cases have no experience, to be in charge of instrument processing,” she says. “There are several states where dental assistants do not need any formal training before they go into an office and many times they receive on-the-job training, as far as instrument processing. We are not giving them the training and tools to be successful.”
Clinicians must follow cleaning and disinfecting guidelines both from the Centers for Disease Control and Prevention (CDC) and product manufacturers, but the rules are not always cut-and-dried.
“Another challenge is getting clear-cut instructions from some of the manufacturers about proper instrument reprocessing,” Daw says. “You’ll see some IFUs state, ‘Clean this instrument with detergent and water.’ Well, is there a certain type of detergent we need to use? Can this be submerged completely in water?”
Pouches are sometimes mishandled, Doug Braendle, product manager at SciCan, says. Following the proper protocol will ensure safety and compliance.
“Once they are wet, if you put them in a contaminated area, like putting them down in their area where an ultrasonic is running and we don’t have a lid on it, then we run the risk of reinfecting the contents of the package,” Braendle says. “It’s something we call ‘wicking.’ Because if you put a wet pouch down on top of a contaminated surface, the pores on the package are open and it allows the bacteria and the microbes in. It’s like wind through a screen door.
“All the manufacturers will say, in their protocol, that packages must be dry coming out of the sterilizer,” he continues. “But we understand the reality. The reality is that the office is working fast and there’s a lot of stuff being processed. And when you tell an office that is notorious for taking wet stuff out and you say, ‘They have to stay in there until everything is dry,’ the reaction we get, 99 percent of the time, is, ‘Oh, we just don’t have time for that.’ They kind of know, sometimes, that’s the wrong thing to do, but they just do it anyway.”
A major concern for infection control is not only having the right equipment, but using it properly. For example, Braendle says something his staff sees often is the lid not being on the ultrasonic cleaner.
“A good percentage of the time our reps will walk into the sterilization area, the ultrasonic unit is running and there’s no lid on top,” Braendle says. “And then when you ask, almost the universal answer is, ‘I don’t know.’ And the minute you get, ‘I don’t know,’ this is not a one-time offense where somebody forgot to put the lid on. If they don’t know where the lid is, this has been going on for along time. These are instruments that had literally just been taken out of the operatory, they’ve been in people’s mouths, there is blood, there’s all kind of contamination on these instruments.”
Leaving the lid off of the ultrasonic can lead to some pretty disturbing results.
“The thing that happens is what is called ‘aerosolization,’” Braendle explains. “When we have an ultrasonic cleaner trying to do its job, there’s this aerosolization mist that comes out.”
Practice consultant Noel Kelsch studied aerosolization by placing Petri dishes at varying distances from an open-topped ultrasonic.
“She was actually getting growth on the Petri dishes 12 to 15 feet away,” Braendle says. “That tells us that with what we call the ‘dirty soup,’ that stuff is going everywhere.”
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Another bad habit practices can sometimes fall into is using what Braendle dryly calls: “magic towels.”
“There are two magic towels,” Braendle says. “The first is the one where, when you’re taking wet instruments out of a sterilizer, and then they’re basically just dumping them onto this magic towel that, I guess, is supposed to maintain some type of sterility, which it can’t. It never does. And then the other magic towel is the one on the other side of the ultrasonic cleaner when you take your instruments out of the pouch, they end up dumping the instruments on this towel. One of our reps in Michigan calls this little pile the “rattlesnake’s nest.’ When you dump these sharp instruments into a pile, then all these things are kind of sticking out and you have to find your way into this with your hand-hopefully with a utility glove on-to pull out some of the sharp instruments so that you can get to the point where you can put another towel on top, pat them dry, and then assemble them into pouches and continue the sterilization process.
“I don’t know how often these magic towels get cleaned off or get switched over into new towels, but our observation is not so often.”
Clinicians must follow proper technique to achieve appropriate infection control results.
“Where I see a lot of problems is in technique,” Daw says. “Are we cleaning before we disinfect when we need to? Are we following the manufacturer’s instructions for contact time? I’ll have an office that’s using a disinfectant, and they’re wiping down what they’re supposed to, but the label will clearly state, for example, ‘It must remain wet for three minutes to inactivate these organisms,’ but they’re leaving it on for only 30 seconds and they think that they’re done, but they haven’t even given the product enough time to do its job.”
Pay attention to the disinfectant’s contact times. Wiping them off too soon negates their disinfecting qualities, and a common defense that Braendle sees is, “I don’t have enough time.”
“Then, one of two things,” Braendle says. “You’re using the wrong product. I would use a product that would give you a little bit better time. Or the other thing is just read the label-you have to. You just have to adjust your day or adjust your patient flow if that’s the product you’re going to use. Otherwise, why not just use regular water, because you’re certainly not disinfecting it.”
It’s easy to fall into a state of apathy when it comes to infection control, but keeping one’s self-and the practice- informed will help prevent mishaps.
“Ongoing continuing education is so important,” Daw says. “Even in states that do not mandate infection control continuing education, I think it would behoove the practice owner and the team members to take ongoing continuing education in this area. If anything, just to make sure they remain diligent and updated if there are any changes. Also, it’s a nice refresher for some of the concepts they might’ve learned in school, but through bad habits or working in a practice that didn’t do it correctly, they can actually educate those team members.”
Also important, she notes, is having written policies and procedures in place.
“It comes into play when you’re onboarding new people,” Daw says. “You can refer to it, you can use it for coaching and ongoing internal education.”
And there’s no shame in seeking outside help.
“A lot of the OSHA and infection control coordinators in private practice feel like they have to know it all or the doctor is going to be disappointed,” Daw says. “I don’t think that’s the case. It’s okay to become a member of OSAP and to partner with a consultant so that you have a resource to turn to if you have additional questions.”
Minimizing infection risk is vital to you, your practice and your patients. Being mindful of the places where infection control is routinely overlooked will keep everyone happy and safe.