Performative Infection Control: What You Should (and Shouldn’t) Let Patients See

Among their other techniques, magicians use misdirection as a way to pull off their tricks. By sidetracking the audience with a distraction, they conceal their true actions, but the opposite should happen in the dental practice, especially where infection prevention is concerned. It is best for patients to see exactly what team members are doing to keep them out of harm’s way.

Hand hygiene

Magicians and dental team members share something important – what’s going on with their hands. Magicians go to great lengths to conceal what they’re doing, but team members want their patients to see exactly what is going on.

“One thing we’ve always said is that hand-washing is always good,” Shannon Mills, DDS, says. Dr Mills is a private healthcare consultant and Chair of the American Dental Association Standards Committee for Dental Products (SCDP) Subcommittee on Dental Infection Control Products. “Even if you wash your hands right down the hall, you wash your hands for the full 20 seconds before you walk in the door, you should wash your hands again or use and alcohol hand sanitizer, because patients want to know that you’re doing that. They’ve heard over and over and over again how important that is as an element of infection prevention. I think they want to see you [do that].”

Patients should also see the clinician putting on gloves, so that they know they are safe and protected.

“You never want to walk into the operatory with your gloves already on,” infection prevention consultant Katherine Schrubbe, RDH, BS, MEd, PhD. says. “I don’t because the patient has no clue. Even when you do everything appropriately to pre-glove, the patient doesn’t know that, and hand hygiene is still considered the single most important thing for reducing the risk of transmission of organisms from operator-to-patient, patient-to-operator, and patient-to-patient – all of those could be possible routes of transmission from your hands.”

“You don’t want to walk in with a pair of gloves on, because how do they know that you didn’t go to see another patient with those gloves on,” Dr Mills adds. “They want to see you putting on a fresh pair of gloves or know that you’re doing that just for them.”

Hand hygiene may be Infection Control 101, but a refresher is always helpful.

“If you are using soap and water, wash your hands for at least 20 seconds,” Dr Schrubbe says. “Twenty seconds isn’t that long, you can sing happy birthday to yourself twice, then dry your hands and glove. If you’re using an alcohol-based hand sanitizer, then rub your hands together until the product is used up, let the patients see that you are doing your hand hygiene.”

Personal protective equipment

Magicians also rely on their top hats, specially made clothes, and capes as a part of their act. Likewise, the dental team utilizes personal protective equipment (PPE) for safety.

“Wearing your PPE correctly and letting the patients see that can make an excellent impression,” Dr Schrubbe says. “Wearing your mask appropriately--not under your chin--and wearing your eye protection appropriately when you’re taking care of the patients promotes a culture of safety. Because now, especially with COVID-19, patients are very savvy. I just read an article where a Senator in Connecticut literally left the dental office because he didn’t feel as though infection control was a top priority.”

Patients are more knowledgeable now than ever before, and they want to see their dental professionals doing the right things.

“People want to see that you are wearing the right PPE,” Dr Mills says. “They watch TV. They see what people are wearing, and if you’re not, they may wonder why not. In other words, if you’re not wearing eye protection, if you’re not wearing a proper mask and face shield, they want to know, ‘Why is my doctor not doing what people say health care workers are doing now?’ So, just within reason you need to be doing that.”

Tools

Something else that magicians and dentists have in common are their use of tools. Famously, magicians use magic wands, handcuffs, and trick locks. Dentists, on the other hand, use their own specialized tools and equipment, and patients need to know that those instruments are safe.

“Opening instrument packages in front of the patient is vital,” Dr Schrubbe says. “When I do trainings and consulting for practices, I always tell the team that I understand infection control takes dedication to maintaining standards, and commitment to set guidelines and best practices is a lot of work. So, you’ve taken all this time and work to prep those instruments correctly, do the steps for disinfection and sterilization, and now you are in front of the patient. The best thing you can do is crack open that package in front of them and say something – say anything. Say, ‘We take infection control very seriously here. All our instruments are processed and sterilized according to CDC guidelines.’ Let the patient know the work and effort that goes into providing that sterile package to the patient.”

While the best thing to do is open instruments packages in front of the patient, sometimes that may not be possible. If that’s the case, finding a way to convey that message of sterility is important.

“If you open the packages of instruments in front of them, they know that they’ve been sterilized,” Dr Mills says. “But on the other hand, sometimes it’s OK. Sometimes it takes a bit of rigmarole to set that up. I think they should know that that tray, that instrument set, was set up just for them. I don’t think you actually have to open the packages right in front of the patient, because you also have to maintain some level of efficiency and get things set up. On the other hand, you don’t want them walking down the hallway, looking at every operatory and seeing that every empty operatory has the same instrument set up tray set up, already sitting there and who knows how long it’s there?”

What NOT to share

Nobody actually believes that the magician’s assistant gets sawed in half. To convey that illusion, there’s a lot hidden that is going on behind the scenes. Likewise, there still exists some things that patients don’t need to see. For instance, if they want to see what’s going on in the sterilization center, it may not be feasible to bring them back there, especially from a safety standpoint.

“The biggest problem I see is that patients would then have to be in full PPE,” Dr Schrubbe observes. “You can’t just bring somebody into your central sterile area – not that it wouldn’t be great for patients to observe the process and what it takes to get that sterile pack to that operatory – but then they would be required to be in PPE appropriate for reprocessing instruments. And even if they are just observing, there are safety issues to pay attention to because the area has chemicals, and contaminated sharps, which require certain PPE and specialized equipment.”

But, if they do see the sterilization area, make sure that it is presentable.

“As long as their sterilization area looks clean, well-organized and sanitary,” Dr Mills says. “You don’t want them to walk by your instrument processing area and see piles of bloody gauze or dirty instruments sitting on the countertop. They want to see things that are clean and reassuring. So, if your sterilization area, for example, is visible to people, you want to make sure that it’s visible in a way that you would want them to see. And if possible, I don’t think people need to routinely see that.

“I think it’s OK to give the new patient that tour, but make sure the place looks great when you show it to them,” he continues. “The main thing is that you want it to be clean. You want your floors to be clean. You don’t want them to walk in and see that the last patient who had a tooth pulled, or whatever, dribble blood on the floor and you didn’t clean it up. Another example is the waste cans in the treatment room. They should be covered. You don’t want them looking in dirty waste cans.”

Seeing the actual activities of infection control is certainly important but conveying an overall message of safety and professionalism also goes a long way.

“I want to make sure that the patients know that infection control concerns are on everybody’s mind,” Dr Mills says. “We want you to know that we’re fully compliant. You can have a sign up [front] that we fully comply with current CDC guidelines. My family dentist proudly shows her OSAP membership placard in her office. The practice wants people to know that they’re very concerned about your safety, that your safety is their first concern, more than anything else. And then, after that, everything follows. If you don’t take care of people’s safety while being at the dentist, then what else matters?”

Magicians and dentists share many similarities, but where magicians want to hide what they are doing from the audience, dentists should want their patients to see everything that they’re doing, especially because it reinforces their message of safety and professionalism.