10 questions you need to ask about infection control

January 20, 2017

Poor infection control practices can lead to major problems for your patients, so it's critical to ensure you're doing everything to prevent dental infections.

Having work done at the dentist can be tough enough on patients. Between the anxiety and potential pain, no one suspects it could get worse. But an infection because of sloppy control procedures can be an unexpected and unwelcome surprise.

By asking yourself these ten questions, you can help prevent dental infections.

1. When is the annual infection control training held for the office?

“An interdepartmental meeting is mandated each year where the team member in charge of infection controls reviews the office protocol, written exposure control plan, reviews hand washing and proper PPE protocol,” Dr. Erinne Kennedy, DMD and GPR resident at the VA hospital in Baltimore says. “As a new employee, this question has sparked a great conversation about how frequently they review the protocol, and all of the manuals. If they know when the annual training is held and have a system in place, it’s a great start.”

2. Where are the MSDS sheets?

“As of August 1, 2016, OSHA penalties have increased making it even more pertinent that we are in compliance as health care facilities,” Dr. Kennedy says. “One tip on compliance that we use at my office is keeping the MSDS sheets for all chemicals, products, disinfectants, materials, acids, cleaners and impression materials scanned and labeled in a folder on the share drive. That way you have a back up copy of all paper MSDS sheets and you don’t have to scramble to find the binder or all of the sheets during an inspection. Every time you order a new product, assign the assistant responsible for ordering to scan and upload the new sheets.”

3. Am I following standard precautions?

The Centers for Disease Control (CDC) recommends a basic set of standards for lessening the chances of infection. According to their website:

“Standard Precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients.” Standard Precautions include:

Hand hygiene.

Use of personal protective equipment (e.g., gloves, masks, eyewear).

Respiratory hygiene/cough etiquette.

Sharps safety (engineering and work practice controls).

Safe injection practices (i.e., aseptic technique for parenteral medications).

Sterile instruments and devices.

Clean and disinfected environmental surfaces.

4. Do you use Glo-Germ?

“Glo-germ is a great training tool for offices to help ensure that the surfaces are being cleaned properly,” Dr. Kennedy says. “Germs glow under a black light after you apply the solution. You can see how effective you are at cleaning surfaces that are hard to reach, like handles, cabinets and even parts of your hand after hand washing. Incorporating this into your practice is a great way to ramp up your infection control.”

5. Is my office monitoring sterilization (mechanical, biological and chemical monitors) and how often is the autoclave checked?

“Sterilizing instruments is a key component to patient safety and is part of the standard of care for all dentists,” Dr. Kristopher Mendoza, DDS, a dental anesthesiology resident at UCLA, says. “Sterilization, while routine, is often overlooked by an office leading to serious complications and will compromise patient safety.

“Sterilization can fail for a number of different reasons, including procedural errors (overloading) and mechanical errors,” he continues. “Procedural errors and equipment malfunctions can be detected by mechanical and chemical monitoring, and should be used to supplement biological monitoring performed on a weekly (or more frequent) basis.”

He advises monitoring a number of factors:

Mechanical monitoring: Measure cycle time, temperature and pressure

Chemical monitoring: Use indicator tapes, which change color with each cycle, as long as the autoclave has reached the proper sterilization levels. Remember that indicator tapes are specific for the type of sterilization (chemical vapor vs. steam sterilizer, etc)

Biological monitoring: CDC recommends weekly monitoring using spore monitor strips that can be done in-office or by mail-in.

Continue to page two for more tips...

6. Does my office have a protocol to clean and test the waterlines?

“Dental unit waterlines: tubing that connects the water supply to dental instruments (hand piece, scaler, water syringe, etc), if left untreated,” Dr. Mendoza says, “may contain a higher level of microorganisms than is accepted for drinking water.”

Remediation is not as simple as flushing water through the lines.

“Flushing the waterlines does not clean out biofilm and is an inadequate method of cleaning,” Dr. Mendoza says. “According to the ADA and CDC, the available methods to improve waterline quality include: independent water reservoirs, chemical treatment, source water treatment systems, daily draining and air purging and point-of-use filters. There should be a schedule to monitor waterline quality with one of many in-office testing kits or mail-in testing services.”

He recommends this website for more in-depth information on waterline cleaning.

7. Do I have the proper protective covers on my instruments and equipment?

“Just as dentists are expected to wear proper personal protective equipment, many instruments and surfaces should have their own coverings,” Dr. Mendoza says. “Some of these instruments (such as digital radiograph sensors) should be covered with an approved plastic barrier and then sterilized or disinfected between patients. Some instruments cannot be sterilized, therefore placing a protective covering on them is even more essential.

“Consider placing an FDA approved barrier on noncritical items as well to help prevent or reduce cross contamination,” he continues. “Surfaces under clinical contact should be covered or disinfected between patients. Surface barrier or covers are even more important for surfaces difficult to clean.”

8. Have I washed my hands before and after each patient?

“According to the CDC, hand hygiene is the most important tactic to prevent the spread of infections amongst patients,” Dr. Mendoza says.

For optimal results, the CDC recommends washing hands:

When hands are visibly soiled

After barehanded touching of any instrument or surface likely to be contaminated

Before and after each patient

Before and after putting on gloves

“Use soap and water when hands are visibly soiled, but one can otherwise use an alcohol hand rub,” Dr. Mendoza recommends.

9. Does my office have an infection control coordinator in charge of office policies and protocols?

Having a point person for infection control helps coordinate and centralize the office’s knowledge and efforts.

According to the CDC’s website, “At least one individual with training in infection prevention – the infection prevention coordinator – should be responsible for developing written infection prevention policies and procedures based on evidence-based guidelines, regulations or standards. Policies and procedures should be tailored to the dental setting and reassessed on a regular basis (e.g., annually) or according to state or federal requirements. Development should take into consideration the types of services provided by dental health care personnel and the patient population served, extending beyond the Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard to address patient safety. The infection prevention coordinator should ensure that equipment and supplies (e.g., hand hygiene products, safer devices to reduce percutaneous injuries, and personal protective equipment) are available and should maintain communication with all staff members to address specific issues or concerns related to infection prevention.”

10. Have I reviewed the latest guidelines by the CDC?

Staying on top of the current CDC guidelines is invaluable. You can find more information by clicking here.