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In the heat of summer, it can be hard to stay cool while still maintaining proper infection control protocols. But there are a variety of ways to beat the heat while still keeping clean.
There is a lot to love about the summer months: The Fourth of July, barbecues, and for those who live in the northern part of the country, a welcome break from the snow and cold. However, that break can be fleeting. No matter where one lives, the temperature can go from warm and pleasant to hot and stifling in no time, and, for those wearing personal protective equipment (PPE), that warm temperature quickly becomes unpleasant. This may lead to some team members becoming lax with their PPE adherence. Obviously, this poses several safety problems. There are ways, however, to beat the heat and still maintain adequate level of safety.
PPE serves to protect dental health care providers and patients from potentially hazardous material. However, for some, that protective gear can become unpleasant.
“You’re going to have team members that are either always hot or always cold with PPE,” infection prevention consultant Dr Katherine Schrubbe, RDH, BS, MEd, PhD., says. “Maybe, if you’re too warm with your scrubs and your heavy clinic gown in the summer, you could go to a disposable gown which meets OSHA criteria, is much lighter, and will serve the same purpose.”
PPE comes in different styles, so it is important to ensure that whatever PPE variation that the practice gets suits its needs and any regulatory requirements. That selection can also include the distinctions necessary for comfort.
“There’s a big difference in different types of PPE,” Dorst says. “Say, for instance, the gown that we wear. OSHA states that the gown should provide protection from the splatters and splashes that we are exposed to and that fluid does not soak through to our clothing underneath. Fortunately, in dentistry, we’re not exposed to the large volume of fluids that we would need a fluid-impervious lining. So, if the office is buying those fluid-impervious gowns, look to the ones that don’t have that plastic backing, so to speak, on them. That will make them much more lightweight and breathable.”
Dorst says that team members who put in the effort may even be able to find equipment that is comfortable, aesthetically pleasing, and long-lasting.
“Over the years, as I’ve purchased different clinic jackets, and I’ve always worn what looks like a surgical gown.” she says. “I have a couple that I purchased almost 20 years ago that are made of a very breathable fabric. The gown is attractive with colorful floss and toothbrushes all over it. Even on the hottest of days, and working in the sterilization room where we’ve got all of those hot autoclaves constantly releasing steam and the warm ultrasonic solution, that type of fabric is much cooler for me.”
Researching different types of PPE is not just helpful for scrubs or gowns. The same is true of masks.
“Looking at different masks, when we go to the higher-level filtration mask, such as the Level Two or Level Three that we’ve been using during the airborne disease pandemic, it’s more difficult to breathe through those,” Dorst says. “If you have the mask securely fitted around your face for maximum protection, then it’s going to get hotter, but there are different mask brands that are more breathable. So, you just have to try several type masks. Get samples, if possible, from your dental distributor, from a sales rep, and find out which ones fit the best and provide you the greatest comfort.”
Team members can supplement their PPE with accessories designed for cooling.
“There are some very interesting, reusable cooling bead necklaces,” Dr Schrubbe observes. “You freeze the beads and they will stay cool for a period of time, and then you can wear them around your neck where they would not be seen through a clinic gown. Interestingly enough, if you’re going the more natural route, peppermint oil can trigger the temperature receptors on your skin. If you place a small amount of peppermint oil on the back of your neck it will trigger a reaction on your skin to provide a cooling sensation. There are also powders that you could use that are wicking and are specifically made to absorb moisture, et cetera. Their primary ingredient is traditionally cornstarch, but they do work quite well.”
“There are even available some vests and scarves that are cooling mechanisms, like you see with athletic equipment,” Dorst adds. “They have fabrics that wick away the moisture from the skin. Well, I’ve even seen these cooling vest that have chill packs that you insert in them if you are working in a really hot environment. I think we’re going to see a lot more innovative adaptations for PPE to give us that comfort zone. We need to be comfortable enough that we can focus on patients’ care and not be so hot that it compromises both our focus and our physical wellbeing as we care for patients.”
Dr Schrubbe looks to the Twice As Nice brand of uniforms that are manufactured with temperature regulating fabric properties.
“They can keep you cool,” she says. “The fabric has a wicking material built right in it. The scrubs are a good quality and keep their shape. They also manufacture PPE clinic gowns and jackets which meet the criteria for what we need, and utilize a patented fabric that’s very temperature sensitive.”
It sounds like advice that anyone’s mother would give, and mothers tend to be right: Stay hydrated.
“One of the things that I’ve recommended to my clients is that they try to set up a hydration station that is close to the clinical area. The staff lounge may be upstairs or downstairs, or quite a long distance away from where the operatories are,” Dorst observes. “CDC and OSHA tell us, for basic infection control and safety, that we should not have any food or drink in the clinical area or in the laboratory. However, what we can do is find somewhere, a distance away from the operatory, or maybe in a side hallway, or maybe even in the supply room, that we can just have a countertop where we can keep closed containers, such as one of the sport water bottles or insulated beverage container. In between patients, a team member could step in there and safely remove their mask and take a drink of water and take a couple of deep breaths of air before they re-mask and see the next patient.”
“We don’t want to have a food or drink in the clinical areas, in the operatories at all,” Dr Schrubbe adds, “but if there’s a staff room or a lunchroom that you can take a little break, every so often, have really cool water ready to go so to stay hydrated and cool at the same time.”
Good hydration not only helps cool the team member, but helps with other physical needs.
“It’s for their wellbeing to stay hydrated, because I’m wearing the N95 respirators,” Dorst says. “Not only do you build up more heat, but it can actually increase the wearer’s blood pressure, and you’re rebreathing more carbon dioxide. So, they do need those breaks for the respiratory system as well as a hydration. Being able to schedule that hydration break and have it in a convenient area that they can quickly get to where they don’t have time, maybe, to go the further distance to the staff lounge is a big help for the clinical team.”
Striking a balance
To keep the clinical team cool, it may result in the air-conditioning system being turned up to the point where front office staff, as well as patients, are freezing, even on the hottest summer days.
“We’ve always had the war-of-the-thermostat in the dental office,” Dorst observes. “The front office team wants it warm and comfortable, and then the clinical team, because of all that PPE and the equipment that they’re running, they want it at least 10 degrees cooler, if not more. I’ve always said that every office designer should design a dental building with two thermostats – one for the clinical team and one for the front office team. I know, as a dental hygienist, that during summer patients arrive for their dental appointment, dressed in lightweight clothing, maybe even kids coming in and shorts and t-shirts. We have the temperature so cold they’re shivering after they sit in the chair for 10 to 15 minutes. We even keep blankets available for the cold patients, but that adds another infection control challenge – laundering the blankets. There are some dental offices that when reminding patients of their appointment, the office includes, ‘Please come with a jacket or a sweater. Our office will be a little colder than you’re accustomed to because of all of the protective equipment that we’re wearing.’ I think that’s a very professional way to communicate chilly information to them.”
There are many valid reasons that cooler temperatures should take precedence in the dental practice.
“Healthcare practices keep the temperature cool, traditionally, to accommodate the clinical team with all their PPE,” Dorst says. “But then there’s another reason for that: The cooler temperatures reduce the potential for microbial growth. If you have a warmer environment, that can encourage bacteria and fungus to grow – not so for viruses, viruses like a cool dry temperature. So, having those lower temperatures is going to reduce microbial growth. Even the humidity is critical for controlling microorganisms. The humidity should be between 40-60%. The reason for that is if it gets lower than 40%, that encourages viruses. Viruses really like a cool, dry environment to multiply in. That’s why winter time is the time of influenza.”
That is not to suggest that there is no room to strike somewhat of a temperature balance between clinical and front office staff.
“One of the biggest things, first, is communication,” Dr Schrubbe says. “Training is key, and this is what we consultants pride ourselves on is educating people, training them, and communicating well with the team. First, get that team together and say, ‘OK we have to come to some decision on the temperature in here, because I’ve heard stories where people actually say, ‘The thermostat is supposed to be set at, XYZ degrees and Sue, who is always warm, is constantly sneaking over and changing the temperature.’ You don’t want to have that happening.”
If the temperature is too cold, there can be performance and safety issues as well.
“Cold air blasting constantly creates issues for muscles and joints,” Dr Schrubbe continues. “At the lower temperatures, muscles lose their heat and that causes them to contract. People can get stiff, and we don’t want that in dentistry, because it could affect our hands, arms and posture which is all vital for the delivery of dental care.”
Summer can be a wonderful time of year, but for team members ensconced in restrictive PPE, the heat can become stifling and overwhelming. However, taking the time to research one’s options can lead to a more productive, comfortable, and efficient summer.