Minimizing the Risk of Cross Contamination in Dental Practice





By Rebecca Stone July 1, 2019

According to the US Centers for Disease Control and Prevention (CDC), while disease transmission among patients and dental health care personnel is rare, if proper infection control and preventive protocols are not followed, any dental practice can become ground zero for a number of contagious viruses.1

The CDC counts unsafe injection practices, failure to heat sterilize handpieces between patients, and failure to monitor autoclaves among the more egregious breaches.But as important as sound infection control practices in these areas are, decontamination of operatory surfaces is also critical.

Importance of Surface Decontamination

Bacteria and viruses can linger on surfaces for long periods of time. For instance, some pathogens, such as hepatitis B, can exist on inanimate surfaces for 7 days — or longer, as in the case of hepatitis A, which reportedly can remain viable outside the human body for months.1,3–5

This means that cleaning (physically removing debris) and disinfecting (killing the majority of remaining organisms) of all environmental clinical surfaces, including countertops, faucet handles, light switches, radiography equipment, chairside computers, writing implements, and drawer or door knobs, are critical in preventing microbial transfer via hands.1,3–5

Housekeeping surfaces such as floors, walls and sinks also require regular cleaning and decontamination though to a lesser degree than clinical surfaces, due to a lower risk of disease transmission. Of course, visible contamination or spills should be cleaned up immediately.1

Barriers — or Not

Many surfaces, from operatory equipment to furniture, can be protected with barrier sleeves or sheets. Because intact barrier-protected surfaces reportedly do not need cleaning and disinfection, unless visibly soiled,5cleaning and disinfecting time between patients is reduced.6Barriers should, however, be changed between patients.5

If barriers are not used, cleaning and disinfection of surfaces entails wiping or spraying and wiping down counters and operatory equipment between patients. Agents used include Environmental Protection Agency-registered low- or intermediate-level hospital disinfectants, though manufacturer recommendations should always be consulted.5

Even laptops, which are not designed for liquid germicidal treatments, can be protected, if not by barriers, then by placing them in a location not vulnerable to contamination. And, innocuous as they may seem, pens, pencils and patient charts can also become sources of inadvertent contamination, and should, therefore, be stored outside the treatment area.5

Operatory furnishings are increasingly being designed with seamless, easily cleaned upholstery that can withstand application of disinfectants. Adjustments that can be made via foot controls limits the possibility of transferring pathogens on hands — and into mouths.

In the case of systems such as Isolite, several infection control strategies are at play, starting with the single-use mouthpiece. Though the control head of the Isolite isolation systemmay be protected with a proprietary barrier sleeve, the manufacturer states that it may also be sterilized at the user’s discretion. In addition, intermediate-level surface disinfection is recommended for the control base, LED Smart Stick and Power Hose. But cleaning and sterilization of the vacuum pipe are recommended between patients.

For more information, see: https://www.zyris.com/support/cleaning-maintenance/

Training

Training continues to be the first line of defense in infection prevention and control in dental settings. Further, the CDC and other entities recommend designating one person as the infection prevention coordinator. Trained in infection prevention, that person can develop protocols, and verify that all equipment and supplies are available and up to date.1

And for the digitally oriented, a new DentalCheck app, based on the CDC’s “Infection Prevention Checklist for Dental Settings,” is available to help clinicians ensure that their practices are CDC-compliant.

When it comes to 21stcentury infection control, the savvier your staff is and the more tools in your toolbelt the better.

 

REFERENCES

  1. US Centers for Disease Control. Guidelines for infection control in dental health-care settings. 2003. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtmL/rr5217a1.htm. Accessed March 14, 2019.
  2. US Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Dental Care. 2016. Available at: https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care2.pdf. Accessed March 14, 2019.
  3. World Health Organization. Hepatitis B: key facts. July 18, 2018. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. Accessed March 14, 2019.
  4. Daniel C. How Long Can Hepatitis Virus Live Outside the Body? Available at: https://www.verywellhealth.com/how-long-can-hepatitis-virus-live-outside-the-body-1760067. Accessed March 14, 2019.
  5. OSAP. Frequently Asked Questions on Dental Infection Control. Available at: https://www.osap.org/page/FAQ_Instrum_Disinf1/Disinfection.htm#howdowe. Accessed March 14, 2019.
  6. American Dental Hygienists Association. Keeping surfaces safe in the dental setting: a practice guide to barrier protection. Available at: http://www.adha.org/resources-docs/Tear_Save_Kerr_Total_Care.pdf. Accessed March 14, 2019.