How to talk to your patients about infection control breaches

May 3, 2019

Here's what to do when infection control breaches are in the news.

No one in the dental profession likes to turn on the news and see a story about an infection control breach. At best, it can paint dental healthcare professionals as less than professional; at worst, it can make patients nervous, questioning the safety of their own dentist’s practice.

While there's plenty of professional emphasis and resources available for infection control, there seem to be more publicized breaches than ever.

“I am seeing them more and more often,” says Joyce Moore, RDH, an infection control consultant and clinical instructor at Bristol Community College in Fall River, Massachusetts. “There’s been at least one a week that’s popped up, lately.”

“I’ve set my Google Alerts for anything involving dental safety, dental sterilization and dental infection control,” adds infection prevention consultant and speaker Jackie Dorst, RDH, BS. “And it’s almost every week somewhere in the United States, there is a breach of some sort. There’s a notification. There’s an inspection. I’m amazed, I really am. It seems the dental boards are inspecting more dental offices, and there are more Occupational Safety and Health Administration (OSHA) inspections now than there have been in the last 20 years. I think that’s due to an increased awareness from both the dental boards and OSHA there are dental offices not practicing infection prevention to the standard of care.”                                                                     

A teachable moment

The best thing to do is use a well-publicized breach as an opportunity to educate patients on how your practice keeps them safe.

“If you’re looking at a breach that happens at another facility or something you’ve heard about in the media, it’s a good opportunity to have a teachable moment with your patients,” Moore says. “They may question you, but you also have the opportunity to reassure your patients your practice is using the best current infection control practices.”

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For instance, she would show patients exactly what steps her practice took to keep them safe.

“I’d say, ‘This is our sterilization area’, where you could see in through the glass and people could see it was clean and wasn’t hidden away,” Moore says. “It gives you the opportunity to say we follow the Centers for Disease Control and prevention (CDC) guidelines. You can open your instrument pouches in front of the patients and say, ‘This pouch is sterile and I’m opening it for your care.’ So, they see you opening the instruments and see they’re properly packaged and being used appropriately. It gives you the opening to show them you’re using chemical indicators and other things to prove there is sterility.”

But there is no one-size-fits-all answer, and each practice has to adjust its message based on the environment and mitigating circumstances.

“It would depend on the community you’re in,” Dorst says. “If it’s a smaller community, and in a suburban or rural area where more people know each other, then it might be appropriate to address in a Facebook posting, or when patients come to the office. As far as sending out a letter of reassurance or some sort of other communication, I would wait until patients are prompted to ask. If the practice is doing everything on the CDC checklist, and they’re practicing proper protocols for infection prevention and sterilization, safety is going to be visibly evident to patients. Throwing a broad statement out there might even raise concerns from a patient that wasn’t previously concerned.”

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It may seem inappropriate to mention another office’s infection control breach, but the practice can still promote its own safety endeavors without throwing another under the bus.

“If you have the opportunity to promote your office and what you do, hang a sign that says, ‘We are committed to patient safety,’” Moore says. “ The Organization for Safety, Asepsis and Prevention (OSAP) has Dental Infection Control Awareness Month, so they have these items-postings, social media tags, signs-you can print to show in your office. You can put a sign out that says, ‘Ask us what we do to keep you safe. We are serious about safety.’ If people want to ask, they’ll feel the door is open to them. Commonly, in medical, we hear the patient say, ‘I don’t want to tell the doctor I want him to wash his hands’. But if we have a sign saying something like that, it opens the door.”

A consistent message

However, if the subject is to be brought up, Moore recommends everyone in the practice be on the same page so a consistent message is shared.

“If you do want to talk about it, as a team, your management should decide, ‘This is how we are going to present our office,'" Moore says. “And the whole team should have the same message. Everyone needs to be on the same page so that we make sure our messages is being consistent.”

“Educate the team to use the correct terminology when speaking to patients,” Dorst adds. “Often, the front desk may be the first team member to encounter a patient’s questions about sterilization and infection prevention. If the front desk team is knowledgeable about the sterilization protocols and what the team is doing for infection prevention, they can respond with confidence to that patient’s concerns, whether it’s over the telephone or in person. If there’s a concern about dental unit water line contamination, then for that front desk person to be able to say to the concerned patient, ‘Yes, we treat our dental unit water lines with an FDA-approved dental water treatment. We test our waterlines on a regular basis, according to the state dental board and the CDC recommendations to validate our water is safe.’  That reassures the patient the front desk person has accurate information.”

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Social media

Social media sites, like Facebook, Instagram and Twitter-and even the practice’s own website-are tools that can be leveraged for more than just sharing pictures of one’s lunch or inspirational quotes. They can also be used to promote the practice’s clean and safe environment, whether that be overt or subtle.

“On the practice website, I frequently have clients who will put up photos of their sterilization and clinical area of the office,” Dorst says. “Use good judgement. Practices should post photos only if your practice adheres to the CDC and state dental board standards. For instance, you may want to post a photo of the sterilization room, along with the rest of the office photos; the operatory, the reception room, along with a photo of the team. And with our internet world, many new patients now come to the practice after looking at the website for the practice.”

“Personal referrals are still preferred,” she continues. “New patients would much rather have a friend refer them, a colleague, someone they have trust and confidence in. But in our mobile world, very often going to the internet is how we find a new healthcare professional. And so, having those photos on the website, without even having to make a statement, gives visual reassurance to patients. ‘Hey, this office puts a high priority on being clean and safe.’”

A social media presence is also a great way to reach and positively influence patients.

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“Follow website posting with social media,” Dorst continues. “Most dental practices and dental specialty practices now have a Facebook page. One of my offices actually did a Boomerang photo of their water lines with their air water syringes when their water lines passed tests. It was a fun demonstration, but they’re communicating, ‘We passed our water line test.’ The message was put out there with humor, but again, what’s the subtle message to the patients? ‘Hey, this practice is on top of dental unit water line contamination I’ve heard about in the media.

“Several breaches have occurred with handpiece sterilization,” she continues. “So, being able to put a photo on your Facebook page about, ‘We just installed a new handpiece cleaner/lubricator in our office to standardize all of our procedures. We are always looking to be better at our dental practice for safe patient care.’ Using those words, ‘safe patient care’, ‘meeting patient expectations’, ‘practicing to the standard of care’, in any of your social media or website communications, is appropriate language to convey to patients all you do to protect them on each patient visit.”

Damage control

Talking about a well-publicized infection control breach is awkward enough, but what if that well-publicized breach is your own? That doesn’t mean the end for the practice. How the incident is managed is critical to recovery efforts.

“First and foremost, your infection control coordinator and your management need to look closely at what happened and why,” Moore says. “That’s pretty broad, but I think the biggest thing is you really need to be transparent with your patients about what happened, what steps are being taken and how you’re going to prevent this in the future.”

Next, and possibly the most uncomfortable step, is to let patients know a breach occurred.

“Patients will need to be identified and contacted,” Moore says. “You may be contacting them personally. One point person may mail a letter or send an email, and then, of course, it is out of the media. For some patients, that’s when they find out. Having your team ready to address the patients and to know what they’re going to say and advise them about the plan you have to make sure this does not happen again is critical. If testing is needed, make sure the testing in that medical care is appropriate and available.”

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“If the practice has a breach, then with the breach they must notify patients that were treated with non-sterile instruments, with patients that could have been possibly exposed,” Dorst adds. “So, they’re going to have to send letters to those patients and communicate with them. I think it would definitely be a positive for the practice to send a letter to all of their patients of record of what they have done to correct that breach; whatever caused the breach; what corrective measures have been taken in the office; and a review and retraining has been done with the staff. If a consultant has come in to review all existing protocols and to review any lapses that could have occurred, they should convey that as well. I think that would be very reassuring, because mistakes happen. They will happen. It’s part of our busy society, and we are human.”

An infection control breach doesn’t have to mean the end of the practice.

“If you have a good team approach, and that might mean having a social media team helping you through it, it isn’t necessarily a death knell,” Moore says. “It really depends on how you manage it. I do believe transparency and having a consistent message, having proper information, appropriate testing, all of these, can put you in a better light. We do know things like this can impact your practice. It’s a lot worse when people try to sweep it under the rug. Accidents happen. You’re driving your car, you’re walking through the store, you can trip, accidents happen. It’s about making sure people see we’ve looked at why and how not to let this happen again.”