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Steering Clear of Infectious Microorganisms in the Dental Office
Placing protective barriers between people and the microorganisms that can harm them
Oral fluids such as blood and saliva, which are encountered regularly during dental procedures, can harbor infectious microorganisms. Between patients, dental team members, and other visitors to the office, the dental office presents numerous opportunities for transmission of these organisms. Potentially infectious microorganisms may be present in the oral fluids of patients, in the body fluids, or on the hands of dental healthcare personnel, and on environmental surfaces.1
For that reason, a wealth of information about these dangers and precautions to minimize them is available on government websites, which offer both recommendations and requirements designed to protect patients and dental healthcare personnel (DHCP). An array of products is available to help protect people, as outlined later in this article.
The Office of Safety and Health Administration (OSHA) mandates that healthcare workers wear gloves, surgical masks, protective eyewear, and protective clothing in specified circumstances to reduce the risk for exposures to bloodborne pathogens. While OSHA offers no specific standards for dentistry, it notes “numerous biological, chemical, environmental, physical, and psychological workplace hazards that may apply to dentistry… hazards [that] include, but are not limited to, the spectrum of bloodborne pathogens, pharmaceuticals and other chemical agents…”2 The Centers for Disease Control and Prevention (CDC), however, offers preventive recommendations directed specifically at dentistry, the most current of which is Guidelines for Infection Control in Dental Health-Care Settings—2003.3
These guidelines can be found in a chart on the Organization for Safety, Asepsis and Prevention website,4 another source of information offered by a nonprofit organization with a stated focus on preventing disease transmission and ensuring the safe delivery of oral healthcare.
Personal Protective Equipment
Personal protective equipment (PPE) is an essential element of infection control in oral healthcare delivery.1
The CDC states that PPE protects the skin and mucous membranes of the eyes, nose, and mouth of dental healthcare personnel from exposure to blood or other potentially infectious material. They include:
Dental healthcare personnel should wear a surgical mask that covers their noses and mouths during procedures and patient-care activities that are likely to generate splashes or sprays of blood or body fluids. A surgical mask protects the patient against microorganisms generated by the wearer and also protects dental healthcare personnel from large-particle droplet spatter that may contain bloodborne pathogens or other infectious microorganisms. When a surgical mask is used, it should be changed between patients or during patient treatment if it becomes wet.
Dental healthcare personnel should wear protective eyewear with solid side shields or a face shield during procedures and patient-care activities likely to generate splashes or sprays of blood or body fluids. Protective eyewear protects the mucous membranes of the eyes from contact with microorganisms. Protective eyewear for patients also can protect their eyes from spatter or debris generated during dental procedures.
Protective clothing such as gowns and jackets prevent contamination of street clothing and protect the skin of personnel from exposure to blood and body fluids. When worn as PPE to guard against potentially infectious material, the sleeves should be long enough to protect the forearms. Protective clothing should be changed daily or sooner if visibly soiled. Personnel should remove protective clothing before leaving the work area.
Dental healthcare personnel wear gloves to prevent contamination of their hands when touching mucous membranes, blood, saliva, or other potentially infectious materials and to reduce the likelihood that microorganisms on their hands will be transmitted to patients during dental patient-care procedures. Gloves are available in various materials, including latex, polyvinyl, nitrile, chloropene, and combinations of synthetic and natural products. Two grades of gloves are available: medical examination and sterile surgical. The type of glove used should be based on the type of procedure to be performed—eg, surgical vs nonsurgical. Sterile surgical gloves must meet standards for sterility assurance established by the US Food and Drug Administration and are less likely than nonsterile examination gloves to harbor pathogens that may contaminate an operative wound. All employees should be aware that they should wash and thoroughly dry their hands immediately before donning gloves and wash hands again after removal. The barrier gloves may be compromised by unapparent defects, punctures, or contamination during removal; and materials may be weakened by exposure to chemicals such as germicides, antiseptics, resins, and bonding agents. Because of the diverse selection of dental materials on the market, glove users should consult manufacturers about the material’s compatibility with various chemicals.
Representing the wide array of option in most categories are these found listed under Infection Control/Personal Protection on the web.
The wide variety of products available includes masks that absorb moisture to prevent eyewear from fogging (Mydent, Cranberry USA, Crosstex), ear loop procedure masks (Henry Schein, Weltex, Crosstex); a mask coated with aloe and vitamins C and E (Cranberry USA); a mask scented with mint (Cranberry USA); and several masks for “sensitive” faces: Cranberry USA’s S3 Tie-On Face Mask, which is dye-free and chemical-free and has a lint-free cellulose inner layer; and Crosstex’s Ultra Sensitive Face Mask for those with sensitive skin or allergies, with a fluid-resistant outer layer and an extra-soft inner layer.
Among those that are powder-free and latex are: JP Solution’s Ecotex said to be premium quality and “eco friendly;” Mydent International’s thin, white, “sensitive” gloves are coated with polymer; Cranberry USA’s two for sensitivity include one “protein-rated, skin-contact-free gloves said to minimize allergen and irritant exposure, and one with Ianolin and Vitamin E. Powder-free and vinyl are Cranberry USA’s low-friction gloves and JP Solutions’ Neuskin gloves said to provide a snugger fit than traditional vinyl. Microflex Corporation’s XCEED™ gloves are said to mimic the fit, feel, and sensitivity of disposable natural rubber latex gloves; AquaSource from Cranberry USA, which are micro-coated with a lanolin and Vitamin E formulation; and Mydent International’s DEFEND® LITE. Rounding out the list are three nitrile gloves—Criterion™ N200 PF Nitrile Gloves from Henry Schein Dental; pH Natural® 5.5 Soft-Nitrile Exam Gloves from Shenwei USA, which is said to optimize the skin’s natural defenses while providing supreme tactile sensitivity and reduced hand fatigue; and Cranberry USA’s Curve Fitted Examination Gloves, natural hand-curve fitted nitrile gloves.
In this category are DEFEND+PLUS Disposable Jackets from Mydent International. According to the company, these fire-retardant, fluid-resistant jackets are made of a soft, breathable three-layer nonwoven SMS fabric and meet OSHA requirements for bloodborne pathogens.
Among disinfecting wipes are Mydent International’s hospital-grade DEFEND+PLUS; OPTIM® 33TB, virtually odorless and biodegrable, distributed by HealthFirst; PDI’s Sani-Cloth® AF, which is quaternary-based, fragrance-free, and alcohol-free; Professional Disposables International’s Sani-Cloth® EPA-Registered Bleach; and Crosstex’s Sanitex Plus Wipes, said to kill MRSA, HBV, and HCV in 2 minutes.
Hand Hygiene Products
Hu-Friedy’s Hand Essentials™ line includes moisturizers and lotion soap; fiteBac SkinCare Germicidal Hand Gel and Germicidal Hand Softening Gel; and SaniTyze® Hand Sanitizer from Crosstex, which also makes a version with emollients and makes hand asepsis compliance
fast and easy.
The Hager Eagles line of frameless wraparound protective eyewear from Hagar Worldwide are said to offer superior coverage and unobstructed peripheral vision and are lightweight, and Sperian Laser Protective Eyewear, which are said to offer “superior protection and comfort,” with an adjustable nose bridge and polycarbonate lens.
According to the company, Crosstex’s iBarrier is a full-coverage, single-use, disposable sleeve/cover for tablet computers.
1. Cuny EJ. Creating a barrier between people and microbes. Inside Dental Assisting Web site. www.dentalaegis.com/ida/2011/06/personal-protective-equipment-creating-a-barrier-between-people-and-microbes. Accessed March 7, 2013.
2. United States Department of Labor: OSHA. Dentistry. http://www.osha.gov/SLTC/dentistry/index.html. Accessed March 7, 2013.
3. Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund JK, Malvitz DM; Centers for Disease Control and Prevention (CDC). Guidelines for Infection Control in Dental Health-Care Settings—2003. MMWR Recomm Rep. 2003;52(RR-17):1-61.
4. OSAP check-up: 2003 CDC Guidelines. Is your infection control program up to date? Infection Control In Practice. 2004;3(1):1-9. http://www.cdc.gov/oralhealth/infectioncontrol/faq/protective_equipment.htm