Here we take a look at some of the infection control issues to address in the new year
The new year gives people a chance to leave their bad habits behind and symbolically start fresh. Maybe the resolutioner wants to lose weight. Maybe they want to save more money. Whatever the case may be, the new year seems to be a popular time to get back on track toward doing the things that they should’ve been doing all year. The same seems to be true at the dental practice. The new year seems like a good time to remind themselves of what they should’ve been doing all along, especially as far as infection control is concerned.
In 2022, practices should embrace the things that maybe they didn’t know about or lost steam on over the course of 2021.
In 2022, Infection prevention consultant Katherine Schrubbe, RDH, BS, MEd, PhD, observes that practices without an infection prevention coordinator should add that role to their team.
“In 2021, in a lot of practices I consulted with did not have a designated safety officer,” Dr Schrubbe says. “OSHA requires you to have a safety officer in your practice, and the CDC recommends that you have an infection control coordinator in your practice. And that person is supposed to be a key person, or the team member responsible for coordinating the infection control program.”
The infection prevention coordinator is highly recommended in the dental practice, and can help the team maximize its infection prevention efforts.
“To have that key person in place is really important,” she adds. “I noticed that when I go to many practices and I say, ‘Who’s your safety coordinator?’ ‘Who’s the infection control coordinator?’ And they all look around the room and say, ‘We haven’t assigned anybody.’ That is something I think should be really important as we hit 2022. One person trained in infection prevention should be assigned for that. Many times it’s a hygienist, or it might be a dental assistant. Those individuals will then help to maintain the written protocols.”
One of the challenges faced by dental practices during the pandemic has been a shortage of supplies. As such, practices may have had to change the preferred brand of product that they conventionally use – like a disinfectant. Those new products likely come with their own instructions for use. Now is a good time to review those instructions.
“Things may have changed during the pandemic, either because of shortages of products that they had used prior to the pandemic or supply shortages created by the pandemic were not available,” Jackie Dorst, RDH, BS observes. Dorst is an infection prevention consultant and speaker. “They may have changed to alternative products or changed use protocols with it. It’s time to review the ‘manufacturer’s instructions for use’ for all infection control products and the first thing I would look at is their surface disinfectant. Surface disinfectant is so important. It is used multiple times per day. With the shortages, they may have started using a different brand disinfectant, and maybe there was an oversight in that the manufacturer’s instructions for use did not get thoroughly reviewed. They just started using that new disinfectant in the way that they had been using the previous disinfectant and the wet contact time was different.”
Personal protective equipment
Because of the personal protective equipment (PPE) shortage caused by the pandemic, regulatory bodies loosened some of their rules and allowed products to be used that wouldn’t have met pre-pandemic requirements. But, for many products, crisis supply conditions no longer exist, and practices should ensure that they’re using the appropriate PPE.
“Many of them started using N95 respirators instead of surgical masks, and when they couldn’t get FDA/NIOSH approved N95, they bought the KN95’s,” Dorst says. “And now that the FDA has removed those crisis supply conditions that permitted the use of KN95s. So, all offices should be back to using FDA/NIOSH approved N95 respirators. They should provide employee fit testing for the initial use of that type of N95. And OSHA is now requiring that an annual fit test be done again. We’re out of that PPE crisis shortage period where allowances were made.”
The pandemic caused a shortage of many pieces of PPE, and especially gloves.
“Also under PPE are the exam gloves,” Dorst says. “Shortages have caused an increase in price of over 300 percent. I would urge dental offices to look at their glove usage. Many offices have gotten accustomed to using their exam gloves in the sterilization room for some procedures that they should use utility gloves for safety and to help preserve exam glove inventory for patient care.”
Since SARS-CoV-2 is an airborne virus, how the practice manages air quality and respiratory protection deserves extra attention.
“OSHA has added in respiratory protection,” Dorst says. “And it’s required now for all healthcare facilities that they have a respiratory protection plan. I predict that it will become a future standard that will be added to the other OSHA safety standards - Bloodborne Pathogen , Hazard Communication and General Safety. And now, dental offices will have to have the respiratory protection standard, even into the future.”
In addition to respiratory protection, overall air quality requires attention.
“Another thing that OSHA has put into place is looking at the air quality in the office,” Dorst says. “And that means how efficient is the heating and air conditioning system at filtering the air and what’s the volume of air that it filters, or runs through the system, every hour? At this time, OSHA does state that healthcare facilities should have MERV 13 filters in their heating and air conditioning systems. I would urge dental offices to set a standard of when the filter is changed or when it’s cleaned. If it’s one of the ones that can be cleaned, then maybe it’s every 30 days or every 6 weeks. But, maintenance will depend on how the volume of air filtered, how many hours that heating and air conditioning system is operated, and even the number of people that are in the facility – the larger the facility, the greater the number of people, then the HVAC filter may need to be changed more often.
“Another thing that has been a challenge for dental offices is determining the number of air changes per hour of their heating and air conditioning system,” she adds. “And to determine that you need an ASHRAE HVAC tech technician or an engineer.”
Pre-procedural mouth rinses
Like so many parts of the COVID pandemic, recommendations and requirements are constantly evolving. One, for 2022, could be the more consistent use of a pre-procedural mouth rinse (PPMR).
“There’s a lot of research going on with PPMR regarding COVID and viral activity,” Dr Schrubbe says. “What is the best pre-procedural mouth rinse to reduce COVID activity? It’s very hard to pinpoint any specific thing. A recent study published in the November 2021 issue of JADA studied 4 rinses to evaluate viral load of SARS-CoV-2; saline, one percent hydrogen peroxide, 0.12 percent chlorhexidine, and 0.5 percent povidone-iodine. Participants vigorously rinsed with 7.5 mL of the mouth rinse for 30 seconds, expectorated, and rinsed with the remaining 7.5 mL for a further 30 seconds. All 4 mouth rinses decreased viral load by 61 percent through 89 percent at 15 minutes and by 70 percent through 97 percent at 45 minutes. I don’t have any specific recommendations because I would say we still need to watch the literature, and this is something that the practice’s infection prevention coordinator should keep an eye on in 2022.
“It’s been in the CDC Guidance for Dental Healthcare settings since 2003,” Dr Schrubbe says. “It’s never been a requirement – even pre-COVID, but we know that there are certain mouth rinses and products that will absolutely reduce bacterial load, but bacteria are different from viruses. So, many of the studies done on pre-procedural mouth rinses are done on periodontal disease organisms, and what would help reduce activity of those. There are a lot of pre-procedural rinses that will help reduce bacterial load in the mouth, so, in specialty offices such as perio, you may see that as a pre-treatment standard to help reduce bacterial load of the patient, but it was never a mandated procedure. Following the research on PPMR will be important as COVID continues.”
There’s nothing magic about starting something new when the clock strikes midnight on January 1. But, even embracing the new year as a symbolic starting point at least gets the practice heading in the right direction.