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Quicker, Easier, and Safer Infection Control Products for the Dental Assistant
The implementation of infection control in the dental setting requires a team approach. Although the ultimate responsibility of an effective infection control program resides with the dentist, all team members play integral and critical roles. Dental assistants and hygienists are the team members who provide the daily operation of most infection control protocols for the dentist. These personnel clean and disinfect operatories, maintain dental unit waterlines to an acceptable quality, and process instruments such that they are packaged and sterile and ready for use in subsequent dental procedures. Each of these activities requires time, care, and attention to detail. The practice of infection control does not create revenue for the dental practice, nor is it a glamorous component of modern dentistry. Effective infection control may be comparable to the cleaning of a home: Nobody may notice or mention when these tasks are accomplished; however, if not adequately performed they become immediately evident. Unlike the cleaning of a home—the effects of an improperly executed infection control program may put the safety of clinical staff and patients at risk.
During the daily operation of dentistry, personnel involved with infection control protocols are typically very busy. The first priority in any dental setting involves patient care. Performing high-quality dentistry in an environment that is comfortable for the patient is paramount in the success of any dental practice. Once the patient is dismissed, however, there is typically no break for the dental assistant. She “snaps into action” and begins the cleaning and infection control phase of her practice. Dental assistants routinely work with diligence, efficiency, and speed—while complying with infection control regulations.
As the stage is set for dental auxiliaries who implement infection control programs, one can see the importance of supplies and procedures designed to make their work easier, safer, and faster. Fortunately, manufacturers have recognized this need and have responded with technologically advanced products designed to enhance infection control compliance, efficiency, and safety. Following is a list of 10 such products.
Enzymatic Pre-cleaning Solutions
If contaminated instruments cannot be immediately cleaned, they may be soaked or sprayed with an enzymatic cleaner to prevent organic debris from drying on instrument tips. These pre-cleaning solutions may contain dual enzymes to begin the breakdown of both blood and saliva, as well as other patient materials. (These enzymes cannot break down dental materials such as cements and composites—these materials must be removed manually). Enzymatic pre-cleaning solutions make subsequent cleaning easier, less time-consuming and more convenient.1 Although this step in instrument processing is optional, it may be most beneficial in high-volume dental practices where expectations require rapid operatory turnover.
Disposable Air/Water Syringe Tips
Studies have shown that 10% metal air/water syringe tips contain microbial contamination after sterilization.2 Although cross-infection has not been documented with contaminated air/water syringe tips, strong support for the routine use of single-use products exists. A variety of disposable products are available; some require special adapters for the air/water syringe, and others do not. Whether or not an adapter is required, disposable syringe tips are inserted and removed from the air/water unit in the same fashion as metal tips. These disposable products are manufactured as single-use items and must be discarded after use.
Hand Lotions and Skin Repair Creams
The primary defense against infection transmission is healthy, unbroken skin. However, repeated hand hygiene may result in dryness and irritant contact dermatitis.3 These areas of cracked and scaly skin provide ideal hiding spots for microorganisms (because hand hygiene agents cannot reach these hidden pathogens), which makes hand hygiene less effective. Hand lotions may be considered as “feel good, smell good, and luxurious” products, yet they do improve the effectiveness of hand hygiene. Advancements in the area of hand lotions are hand repair creams that actually heal damaged microcracks and scales within the epidermis and enhance epithelial integrity. When considering any hand lotion product, it is important to consider the compatibility with glove use and it is recommended to use products manufactured for healthcare personnel.
Automatic Handpiece Maintenance Systems
Handpieces must be cleaned, lubricated, and have excess lubricant expelled prior to sterilization.4 Although the manual method of handpiece maintenance is acceptable, an automatic system allows handpieces to be properly cleaned and lubricated in a consistent manner each and every time. These devices have the potential to save time and provide consistency to the overall maintenance process. Because of the numerous small, moving parts, this practice will significantly enhance the longevity of handpieces, and some manufacturers will extend handpiece warranty if an automated system is used. Note that the manufacturer’s instructions must be followed for specific brands of handpieces before using any maintenance system.
Single-Use Disposable Endodontic Files and Burs
The purchase and use of these products as single-use disposable items has several advantages. First, burs and endodontic files can be difficult to clean. Before sterilization, instruments must be cleaned and free of debris. If not adequately cleaned, the sterilant may not reach all surfaces of the instrument and sterility may be compromised.5 Second, burs and endodontic files may become contaminated with blood, saliva, and pulpal tissues. These contaminated instruments may be a source of cross-contamination with Prion diseases—neurodegenerative diseases that are rapidly progressive and are always fatal and spread through contaminated neural tissues.6 Unfortunately, sterilization does not kill Prions. Fortunately, these diseases are extremely rare and single-use items will eliminate this risk.6 Third, surface deposits and microcracks are sometimes found on endodontic files after cleaning and sterilization. And, the most common failure of endodontic files is due to fatigue.7 For all of these reasons, some companies now manufacture burs and endodontic files that are prepackaged sterile and are meant to be used only once. These items must be discarded after use. Single-use disposable burs and endodontic files would eliminate inadequate cleaning, the risk of cross-contamination of certain diseases, and minimize instrument fatigue and failure during subsequent use.
One-Step Environmental Surface Disinfectants
New environmental surface disinfectants have been recently introduced to the dental industry that simplify and streamline the cleaning and disinfection process. These products are Environmental Protection Agency (EPA)-registered, intermediate-level surface disinfectants capable of both cleaning and disinfection—in one step. It is important to note, however, that if a surface is visibly soiled it must be cleaned before disinfection—thus a two-step process may be required even though the product is promoted as a one-step disinfectant. Whichever surface disinfectant dental personnel may select, it is imperative to follow the manufacturer’s instructions. In addition to toxicity and personal protective equipment requirements, clinic personnel must know if the product used is intended to clean and/or disinfect, and the contact time required to kill the benchmark microorganisms.
Ecofriendly Environmental Surface Disinfectants
A common active ingredient in environmentally friendly surface disinfectant is accelerated hydrogen peroxide. These products are EPA-registered as intermediate-level surface disinfectants and are compatible with most surface materials. Accelerated hydrogen peroxide (AHP) can easily clean and quickly disinfect—also in one step. AHP breaks down into water and oxygen so there are no toxic chemicals; thus the EPA considers it to be “generally regarded as safe.” As such, AHP is considered to be safer for clinical personnel who clean and disinfect operatories while reducing environmental impact.
Traditional masks used in dentistry were once considered “one size fits all” and provided minimal protection against microbes and particles. Newer masks provide improved filtration capabilities and fluid resistance, as well as improved breathability, comfort, and reduced fogging. Some manufacturers provide masks for specific clinical personnel—those with petite faces and those with sensitive skin. The wide variety of masks available should allow clinical personnel to choose a mask that fits comfortably and tightly around the periphery of the nose and under the chin while providing adequate protection. Mask selection should be based on the risk of the procedures being performed and the anticipated amount of aerosols to be produced. Note that masks should be changed if they become wet and no less than between every patient.
Solutions to Disinfect Impressions
The Centers for Disease Control and Prevention (CDC) state that dental impressions should be disinfected as quickly as possible after removal from the mouth to prevent the drying of blood and other microbes. This practice should be maintained whether the impression is being sent to a laboratory or if models are being poured in-office. Historically, not all disinfectants have been compatible with all impression materials because they may impact impression integrity and, thus, the future model.8 Spray disinfectants are potentially less effective because they may not reach all microbes in the small recesses, grooves, and undercuts.9 Newer disinfectant solutions for immersion are available that are compatible with most impression materials, such as alginate, polyether, and silicone. These solutions allow all surfaces to be thoroughly and quickly exposed to the disinfectant. As with any disinfectant, the manufacturer’s instructions must be followed. Never use a high-level disinfectant (glutaraldehyde) for this purpose.
Saliva Ejectors with One-Way Valves
The CDC guidelines state, “Do not advise patients to close their lips tightly around the tip of the saliva ejector to evacuate oral fluids” yet many clinical personnel do not follow this regulation. Allowing a patient to seal their lips around the saliva ejector may be more effective at suctioning fluids from the patient’s mouth; however, it may cause a backflow of microorganisms from the suction tubing into the oral cavity.10 A technological advancement in saliva ejectors incorporates a one-way valve that allows fluids to flow from the mouth into the suction unit, yet prevents backflow. These devices may be clinically beneficial for children, special needs patients, or any other patient who insists on sealing their lips around the saliva ejector during dental procedures.
While dental assistants are busily engaged in infection control, updated materials and supplies are valued to improve their practice. Technologically advanced products have increased safety and have simplified and streamlined tasks. The dental industry has graciously collaborated with clinical personnel to improve and enhance infection control compliance. It is through this team approach that all involved with clinical care may make the dental operatory safer—for both staff and patients.
1. Centers for Disease Control and Prevention. Guidelines for infection control in dental health-care settings—2003. MMWR Morb Mortal Wkly Rep. 2003;52(No. RR-17):1-61.
2. Molinari JA, Nelson P. Reusable versus disposable air/water syringe tips. The Dental Advisor. Number 13, June 2012. http://www.dentaladvisor.com/images/pdfs/reusable-versus-disposable-air-water-syringe-tips.pdf. Accessed August 4, 2014.
3. Centers for Disease Control and Prevention. Guidelines for hand hygiene in health-care settings—2002. MMWR Morb Mortal Wkly Rep. 2002;51(No. RR-16).
4. Molinari JA, Harte JA. Cottone’s Practical Infection Control in Dentistry. 3rd ed. 2009;158.
5. Walker JT, Dickinson J, Sutton JM, et al. Cleanability of dental instruments-implications of residual protein and risks from Creutzfeldt-Jakob disease. Br Dent J. 2007;203:395-401.
6. Brown SA, Merrit K, Woods TO, Busick DN. Effects on instruments of the World Health Organization—recommended protocols for decontamination after possible exposure to transmissible spongiform encephalopathy-contaminated tissue. J Biomed Mater Res B Appl Biomater. 2005;72(1):186-190.
7. Shen, Y, Coil JM, McLean AGR, et al. Defects in nickel-titanium instruments after clinical use. Part 5: Single use from endodontic specialty practices. J Endod. 2009;35:1363-1367.
8. Merchant VA. Infection control in the dental laboratory equipment. In: Cottone JA, Terezhalamy GT, Molinari JA, eds. Cottone’s Practical Infection Control in Dentistry. 2nd ed. Chapter 16. Baltimore, MD: Williams & Wilkins, 1996:239-254.
9. Molinari JA, Harte JA. Cottone’s Practical Infection Control in Dentistry. 3rd ed. 2009;253.
10. Mann GL, Campbell TL, Crawford JJ. Backflow in low-volume suction lines: the impact of pressure changes. J Am Dent Assoc. 1996;127:611-615.
About the Authors
Marie T. Fluent, DDS
The Dental Advisor
Ann Arbor, Michigan
William C. Sloan, BS
Ann Arbor, Michigan