When to, how to, (and how not to) use surface barriers in the dental practice.
The best way to avoid a parachuting accident is not to go skydiving, the best way to avoid a speeding ticket is not to speed, and the best way to make sure a surface is clean and disinfected is not to contaminate it in the first place.
While some surfaces are going to get contaminated no matter what you do, there are some surfaces that can avoid contamination using barrier protection. Their use may seem straightforward, but there are best practices for how to use them, when to use them, and when not to use them.
Barriers are simply a tool to help with disinfection – their use isn’t required. That is, while disinfection is necessary, barriers simply provide a way to keep surfaces from becoming contaminated in the first place.
“Barriers are an either/or thing,” Lisa Kane, DMD, of Dental Office Compliance of New England says. “Everything has to be clean and disinfected, so it's up to you whether you use them or not. Being consistent in every operatory is important.”
Barriers are ideal for surfaces that are hard to clean. For instance, objects that have uneven surfaces are ideally suited for barriers.
“Barriers are going to be used in those harder to reach places,” Karen Gregory, RN, Director of Compliance and Education for Total Medical Compliance says. “I think of the tubing that goes to the handpieces or the handpiece cradles, which are areas that will take you a lot longer to clean and disinfect. Consider any areas with a lot of little crevices which are hard to reach. You should begin each day ensuring that the surfaces are cleaned and disinfected.”
“The side of chairs, for example,” Dr Kane adds. “Sometimes on older chairs, there'll be places that are hard to clean, like electrical components. Those are good surfaces to put barriers on. Barriers are great on things like the old-fashioned buttons on the outside of the X-ray machines. I would put barriers on that.”
Barriers can be overused. For instance, there are surfaces where using a barrier is simply overkill.
“I've seen people during the COVID-19 pandemic start putting barriers on doorknobs and things like that,” Dr Kane says. “I think that’s unnecessary. Unless you're changing them out in between every single person that's touching them, they're useless. Barriers are like people that you see walking around wearing gloves and touching everything, thinking that their hands are clean, but everything else that they're touching is dirty, because they've touched so many things. Barriers have to be clean, and they should only be touched with the gloves and stuff that you're using for the appointment. I don't think you need barriers on everything. People put barriers on things like door handles, and those are things that you can easily wipe down. It's all about efficiency, so whatever makes you the most efficient. When you can get the job done and when you're able to disinfect every surface, whatever's easiest for you, I think is the best thing.”
Remember, the use of barriers isn’t mandated. Some practices may be worried about barriers’ effect on the planet.
“Some offices are worried about all the plastics and the waste,” Dr Kane says. “So, people don't like barriers because of that. But I think that if you do that, if you decide that your office is going to go green, I think that making some sort of nice sign in the waiting room saying, ‘Hey, because we're trying to be conscientious of the environment, you're not going to see barriers around, but rest assured everything's disinfected,’ and then make sure that everyone is doing the same thing, so people don't think that the dentist is clean and the hygienist is not or vice versa.”
Some practices use whatever material they can get their hands on, and if it’s protecting the surface, those materials seem to be OK. Ideally, practices will use the right material for the job.
“It’s always best to buy a barrier that has been manufactured for that purpose, as opposed to some other material,” Gregory says. “For instance, sometimes I'll go in and tin foil is wrapped around a light handle. That's impervious, but I'm always going to recommend that you find a product that was created to be used at as a barrier. It's been a challenge in the industry to find barriers specific for different products, but many more products are available now.”
Ultimately, it’s about using the right tool for the job.
Gregory says, “Tin foil can serve a as a barrier, but I wonder what does that look like from a patient's perspective? Why would you have aluminum foil wrapped around a handle in a beautiful, high-tech practice? So, I think we can do barrier better, and there are products that are available for light handles and other hard-to-reach spaces.”
“I would buy something reputable,” adds Dr Kane. “I would buy something from a dental manufacturer. I think we learned with the KN95, for instance, that anyone can make anything and sometimes they're not effective. I would just buy something real and make sure to put barriers on things important to put barriers on like keyboards and mouses.”
It is in equal parts about quality and efficacy. If the material isn’t keeping the surface protected, it’s not worth the effort.
“Sometimes, like on Amazon, you can get a like-brand that you could get from a dental supplier,” Dr Kane says. “I would stick with specific barriers that are directed toward healthcare and related to infection control. I would focus on that. If a barrier isn't working, you're going to have to, obviously, disinfect underneath it. So, what's the point?”
Even though barriers are used to prevent surfaces from becoming contaminated, their proper use is what’s important. Often, practices don’t understand how often those barriers need to be changed.
“The important thing about barriers is that you have to change them in between each patient, whether or not you touch them,” Dr Kane says. “So, you can't just stick a barrier up and say, ‘OK, now I'm good for the day.’ You must change them out in between every patient. I always think of the operatory: Once a patient opens her mouth, the whole room is dirty. So, you can't just say, ‘Oh, I didn't use that, so I'm going to leave that there.’ You must change everything out.
“People just leave them there,” she continues. “There are different kinds of barriers. I see people putting a barrier on the curing light that hangs out in the operatory indefinitely. And then once it's used, they just grab it with the current dirty barrier that's already on there. So, make sure it’s a brand new, clean barrier that hasn't been sitting out.”
The Organization for Safety, Asepsis and Prevention (OSAP) produced a training video called “If Saliva Were Red” in 2003. It shows just how widespread saliva can be in the dental practice, underscoring the need for proper disinfection or barrier use.
“One of the things that I noted was that because the saliva was dyed red, you could see the transfer of bloody saliva outside of the actual area that was covered with a barrier,” Gregory says. “One example was in adjusting the above head light. Part of the hand touched the light handle that had the barrier on it, but the thumb touched the actual light outside of the area that was covered. And so, everyone must be very mindful that if you touch outside of that barrier, then that surface is contaminated and needs to be clean and disinfected, as opposed to just removing a barrier.”
Ultimately, the proper use of barriers can help a practice with their overall speed, efficiency, and safety as far as infection prevention is concerned.
“If you use barriers appropriately and remove them appropriately, they actually can reduce the overall time it takes to prepare that operatory for the next patient,” Gregory says. “If used appropriately, areas that are barrier protected will not need to be cleaned and disinfected, which will save time over the course of the workday.
Speed and efficiency are highly desirable when it comes to turning over an operatory. Faster and safer methods assure that patients can be seen as fast as possible, while still maintaining necessary safety protocols. Even though they’re not required, barriers are a good way to achieve that goal.