Infection Control Questions for Patients to Ask
Noel Kelsch RDH, RDHAP, BS
My dear friend is the ultimate mother. Her mothering skills are amazing and her attention to details astounds me. She told me she does not feel safe at the dentist any more because she has read national articles about “the dirty little secret in dentistry”.
Oral health impacts over all health to the extent that oral health can be a matter of life and death. Going to the dentist and hygienist is vital but everyone should be aware of the standards of care in infection control that are necessary to keep you safe at the dental office. All patients should be able to expect and receive the highest standards in infection control in the dental setting and feel free to discuss any area of concern with their dental professional.
The stories in the national news are disturbing and have included the devastating breach in infection control in Oklahoma that led to the need to test over 7,000 patients and the suspected transmission of HIV, Hepatitis and other diseases. As a hygienist, infection control instructor and researcher I wanted to reassure her that most offices are very safe. What I realized in talking with her is that I needed to equip her with the questions she needs to ask before sitting in the dental chair.
Open communication with your Dental Health Care Professionals (DHCP) about your concerns in infection control can make all the difference. Just as important as the DHCP helping you understand sealants and filling materials it is vital for them to share the infection control process in their office. If they are hesitant to discuss infection control you may need to find another practice that is willing to share their standards with you.
Questions to ask:
Whether you are deciding on a new dental office or want to have a discussion with the office you are going to there are several questions you need to be prepared to ask.
1. Does your office sterilize all your instruments?
If you notice open instruments on your tray or instrument being pulled from a drawer that are not enclosed in a pouch this is a hazard. The instruments should be processed in a sealed single use pouch and not be opened until you sit in the chair. The internal and external indicators changes color, if they do not change colors to validate that the instruments were sterilized they should not be used. Equally important to note if there are any rusty instruments, they can harbor debris, bacteria, and virus and cannot be processed properly and should not be used.
2. Do you sterilize all your hand-pieces? All hand-pieces that are used in dentistry including the hand-piece for polishing your teeth must be heat sterilized. Studies have shown debris can get in the gears of the hand piece and come out during procedures. The only way assure there is no chance of spreading disease is to heat sterilize the hand-piece. When you enter the room if the hand piece is on the unit ask for a new one that is in a pouch.
3. Are you disposing of single use items? Single Use Items are just that- manufactured to be used on one patient! Some offices reprocess items and put you at risk for cross contamination (possible spreading of disease). For example carpules (containers that hold medication to numb you) are not intended to be reprocessed. Sometimes the clinicians will put too many on a tray and after treating a patient take the unused carpules and clean and disinfect them. They have a semi permeable membrane on the top of the glass vial. Bacteria and disinfectants can go through that membrane. If that was injected into someone it could cause paraesethesia (leaving you numb) and/or spread diseases. If the number 2 with a slash in on a product box it cannot be reused.
4. Can you please wash your hands? Washing hands cannot be overstressed! The current compliance statistics for washing hands in all medical settings are very poor according to the Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health-Care Settings. Studies indicate the rate of compliance overall is about 40%. The World Health Organization (WHO) states that hand hygiene is, “the single most effect way to prevent disease in the medical setting”. Insist that your health care professional in dentistry, at the doctors, at the lab that draws your blood wash their hands before they touch you. Gloves were never intended to take the place of washing your hands!
5. Are you cleaning and disinfecting the room between patients with a hospital grade disinfectant?
After every patient, the room, equipment and clinical contact surfaces have to been cleaned and disinfected. It is a 2-step process. If you see patients coming in and out of the room very quickly that is a concern. Most disinfectants take 3-5 minutes to be effective. Over the counter products that you buy at the grocery store are not developed to treat blood-borne pathogens and target viruses and bacteria that are possibly present is the dental environment. Dental offices should be using hospital grade disinfectants. Counters should be free from clutter and treatment items should be kept in drawers and cupboards to prevent contamination during treatment that creates overspray.
6. Can I have a disposable bib chain? Reusable bib chains have been studied by five universities and have been found to be a source of bacteria and viruses that could be spread in the dental office. The studies found even if you wipe them with a disinfectant they can harbor bacteria. Most offices do not sterilize them. They use them on a patient, wipe them and clip them on the back of a chair. Ask your provider for a disposable holder if they are not processing and sterilizing the chain.
7. Does your office have yearly OSHA training? Occupational Safety and Health Administration in every state requires that offices receive yearly training on blood-borne pathogens and procedures surrounding the concept. Most state dental boards and hygiene boards also require additional training. It is vital that your office stay up to date in this area.
8. Is that a fresh mask? If you see your provider take a mask out of their pocket, have it hanging around their neck or take it off the counter there is no way to guarantee that mask has not been used on another patient. Masks are single use and should be stored in the box it came in or a closed container. Used masks can have debris, viruses, bacteria and blood from previous patients. A new mask is needed for EVERY patient. Masks are to be worn snug on the face and over the nose and mouth to keep both the patient and the DHCP safe.
9. Are those unused gloves? Gloves should not be donned until the DHCP is ready to enter your mouth. They should wash their hands and limit touching the glove with their hands. The gloves should come directly from the box and not be laying on a counter or in a pocket. Using gloves to open unsanitary drawers, cabinets, jars, etc. before going into your mouth can spread disease. Gloves are designed for direct patient care not for touching unprotected surfaces.
10. Are you using barrier protection? Those pieces of plastic they place over items such as the curing light and the light handle are there for a few reasons. They are Food and Drug Administration approved barrier protection that protects you from the chemicals that are on an item that has been cleaned and disinfected and protect you from any bacteria that may be on an item. The CDC recommends that DHCP use barrier protection on items that are difficult to clean and disinfect.
I am happy to report that my friend did have a conversation with the dentist. There was no secret. The dentist was open and reassuring. She not only answered my friend’s questions but also took her on a “tour” of the infection control process in the office. All of us deserve the highest standard of care in infection control.
What do I do if I am afraid to ask my DHCP these questions? My suggestion for you is that you send your dentist an anonymous letter with your concern. You can send them this article and although you do not get a person response they will be aware that patients are wondering. When you return to the office observe your surrounds and evaluate the success.
What if an office is not complying with infection control? What should I do? First talk to the Dentist and share your concerns. If those concerns are not addressed you should report the office to the governing board that oversees them in your state (http://www.dentalboards.org/states/index.htm) as well as your local health department. The life you are saving could be your own.