How to share infection control practices with patients

Among healthcare professionals, discussion of infection control policies and procedures can be as formal as mandated annual meetings, or as casual as water cooler chitchat. However, there are sure to be times when patients need to be informed-or may outright ask-about infection control issues.

Communicating those issues requires a certain level of professionalism, finesse, and élan to ensure that the right message is conveyed and that patients are not overwhelmed by too much information.

Why

There are various reasons why infection control information may be shared with patients, not the least of which are patient inquiries.

“There will be some patients that will have concerns, or even apprehension, about infection prevention,” says Jackie Dorst, RDH, BS and “Safe Practices” infection prevention consultant and speaker. “And that usually comes to light in the first minute or two of the patient being seated in the chair. The patient may ask me a question and they might broach it with, ‘I heard on the news,’ or, ‘I read on the Internet,’ and it may be a concern about an infection prevention issue or an accident that has happened in a dental office that has made the news. So, immediately I can detect that this patient has concerns. I’m going to ask some more leading questions to find out, specifically, what are their concerns and then be able to share what we do in the office to provide protection.”

Patient concerns can stem from any subject, including their own personal health concerns.

“Whether patient concern is about dental unit waterline contamination or sterile packaged instruments – any of the infection prevention protocols that provide for safe patient care in the dental practice,” Dorst says. “The other time that infection prevention comes to light is when the patient comes in and they have a health issue or they have a family member who has a health issue that makes them immunocompromised. Maybe they are going through a medical treatment at the hospital, or maybe chemotherapy or radiation treatment after cancer. That patient is much more fragile and susceptible to infections. ‘How safe am I going to be during this dental care?’ Each patient is going to have a unique perspective.”

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When

There is no one, perfect time to field infection prevention queries. That being said, a great time is simply when the subject arises.

“Anytime is a good time to talk to patients about infection control and prevention,” says Karen Daw, “The OSHA Lady” and a speaker and consultant. “I had an office ask me during a video consult how I would have handled the following: ‘The patient asked if we threw away the instruments between appointments. Why would they think we’d toss expensive dental instruments?’” she asked. We discussed the optics of what we do and how patient perception is reality. For example, if we wash our hands outside the room and the patient didn’t see it, did it happen?

“Patients are much more observant about safe practices during their appointments than I think we give them credit for,” she continues. “I wrote an article about how my mom was looking for a new dentist. When calling around, one of the questions she had was, ‘Do you open the instruments once I’m seated or beforehand?’ I was pleasantly surprised my mom would even consider that. She doesn’t even truly know what I present about for a living.”
And if patients aren’t asking the questions, Daw advises opening the discussion, yourself.

“I recommend, during coaching sessions, that if the patients aren’t asking, to invite them to the safety dialogue,” Daw says. “What if we mentioned to Ms. Smith, at her next appointment, ‘We’ve known each other for many years. Have you ever noticed these dots on this pouch your instruments arrive in? They are designed to change colors when they go through the sterilizer. The sterilizer is designed to kill pathogens, like Hepatitis and HIV. So when it turns dark brown, it made it through the sterilizer. Plus we test the sterilizers weekly to make sure they are working properly.’ Many clinicians have expressed how quickly the patient catches on.”
Those conversations can occur anywhere in the practice, and it’s important for staff to be ready when those questions do arise.

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“Education can take place chairside, and even while checking in and waiting,” Daw says. “It’s not uncommon to see televisions in reception areas. Some of them have a constant loop of services provided by the practice. What if, in-between teeth whitening specials, we also include information about proper hand asepsis and sterilization? While at the Ohio State University, I worked with our marketing department to educate patients about DICAM (Dental Infection Control Awareness Month). These looping slides encouraged patients to ask students about infection control behind the scenes. The patients felt more comfortable with the care they received and the students were thrilled that they were being asked.

“I then transferred this to the practices I work with,” she continues. “At an ortho office, we designed a series of infographics, based on literature from www.OSAP.org. The Organization for Safety Asepsis and Prevention is a non-profit group dedicated to patent and employee safety. Their website is chock-full of useful safety information. Also, the Centers for Disease Control and Prevention have an entire oral health division with topics relevant to patients and practices. In other words, there was no shortage of information to choose from.”

Front desk personnel are the practice’s first contact with the patient and should be ready to address questions that may arise. As such, they should be properly trained.

“The front desk should participate in continuing education courses on infection prevention, along with the clinical team, because then they’re hearing the correct terminology, and the front desk is learning all the steps that the clinical team is doing to prevent disease transmission, such as disinfection of the operatory, placing the correct barriers, instrument sterilization, and so forth,” Dorst says. “So, if an infection prevention breach hits the media, and all of a sudden there are questions the next day in the dental office, the front desk does have the correct words and terminology to reply to patient questions. And if more in-depth or technical information is needed, then it would be appropriate to say, ‘Let me get the hygienist to answer that question for you,’ or, ‘Let me have the doctor come in and they’ll provide you with more detailed information.’”

How

How those questions are answered is just as important as when and why they’re answered. Most patients are not healthcare professionals, so some of the concepts and terminology should be suitable for them.

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“Patients will ask a question, and dental professionals tend to have a scientific brain, so we want to share all of the information that we’ve learned in school and in our CE courses,” Dorst observes. “And after the first sentence or two explaining the answer to the question, you might see their eyes glaze over, and that’s when it’s way too much information, way more than the patient wanted to hear. The patient was seeking a reassurance that, yes, these instruments are sterile; yes, the water is safe for their care; and not all of the scientific information about biofilm and the hundreds of microorganisms that are in it; and how we go through the protocol of shocking and treating and testing. That’s way more information then the patient wants to know unless you have that nerdy patient in the chair who does happen to be a scientist or an engineer. And if so, let the patient lead you. They’ll ask more questions.”

A simple, easy conversational discussion will help the message be conveyed as effectively as possible.

“The key, I think, is to work this into the regular workflow and for the conversation to be organic, not forced,” Daw notes. “This way, educating our patients doesn’t add time to the appointment or cause undue stress for the team member. For example, I once asked a patient if she ever noticed that the instruments were wrapped until she was seated, and I did this while washing my hands. Not only did this start a conversation about safety, it drew the patient’s attention to the fact that I had washed my hands. This must have planted a seed, because the next time I ran into her, she shared that she asked to visit the sterilization area just to see what happens behind the scenes. I was ecstatic.”

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Infection prevention discussion is not just the purview of the team. Patients may also, naturally, have questions, and knowing why, when, and how to share that information ensures that patients are properly informed about what’s being done to keep them safe.

CDC app

Dorst recommends that practices use the CDC DentalCheck Mobile App to help track and record their infection prevention efforts. This can be especially helpful if patients have questions. The app can be used to show, specifically, what measures the practice has taken to keep them safe.

“And on the mobile device, that’s where they can validate every step of infection prevention,” Dorst says. “It covers everything from PPE to hand hygiene to disinfection barriers to instrument sterilization. They can record this during facility IC walkabout, who’s the person that did the direct observations and note each element of infection prevention, the date, and save the completed checklist. The completed checklist then becomes their written infection prevention plan. This has given us a tool to improve and validate that we are doing correct infection prevention for patients.”