________________________________________________________ Infection Control for Dental Professionals
When adhering to Standard Precautions, always [5]: • Use good hand hygiene. • Use gloves for contact with blood, bodily fluids, nonintact skin (including rashes), mucous membranes, used equipment, linens, and trash. • Change gloves if they become heavily soiled when working on a patient or if you must go from a potentially more infective area to a lesser one. In addition, never: • Wear artificial fingernails. • Touch a second patient with the same pair of gloves used on the first patient. • Contaminate the environment with dirty gloves. • Wear gloves outside the treatment area unless you can say why you are wearing them. Protective Clothing Gowns are intended to protect the arms and exposed body areas and prevent contamination of clothing with blood, bodily fluids, and OPIM. The type of gown selected is based on the nature of the patient/provider interaction, including the anticipated degree of contact with infectious material and potential for blood and bodily fluid penetration of the barrier. General work clothes (e.g., uniforms, scrubs, laboratory coats, jackets) are not considered PPE. Dental personnel should change protective clothing when it becomes visibly soiled or as soon as possible if penetrated by blood or other possibly infectious fluid [18]. Masks, Protective Eyewear, and Face Shields In general, dental professionals are required to wear surgical masks that cover both the nose and mouth, in combination with either chin-length plastic face shields or protective eyewear when there is potential for splashing or spattering of blood, droplets, chemical, or germicidal agents, or OPIM. After each patient, masks should be changed and disposed of properly. After each patient treatment, face shields and protective eyewear shall be cleaned and disinfected, or disposed [9; 18]. Masks should fit snugly and fully cover the nose and mouth to prevent fluid penetration. For this reason, masks that have a flexible nose piece and can be secured to the head with string ties or elastic are preferable. Surgical masks protect against micro-organisms generated by the wearer and also protect dental personnel from large-particle droplet spatter that might contain bloodborne pathogens or OPIM. If the mask becomes wet or contaminated, it should be changed between patients or even during patient treatment. For employees at increased risk of exposure to ATDs, such as those working in endemic areas (e.g., Southeast Asia) or in areas designated for isolation or quarantine, the employer must provide a respirator at least as effective as an N95 respirator.
• Engaging in direct contact with patients who are colonized or infected with pathogens transmitted by the contact route, such as vancomycin-resistant enterococci or methicillin-resistant Staphylococcus aureus (MRSA) • Handling or touching visibly or potentially contaminated patient care equipment and environmental surfaces Studies have repeatedly shown that vinyl gloves have higher failure rates than latex or nitrile gloves. For this reason, either latex or nitrile gloves are preferable for clinical procedures that require manual dexterity or those involving more than brief patient contact. Heavier, reusable utility gloves should be used for non-patient-care activities, such as handling or cleaning contaminated equipment or surfaces, handling chemicals, or disinfecting contaminated tools [9; 18]. During dental procedures, patient examination gloves com- monly contact multiple types of chemicals and materials, such as disinfectants and antiseptics, composite resins, and bonding agents, and these materials can compromise the integrity of latex, nitrile, and other synthetic glove materials. In addition, latex gloves can interfere with the setting of vinyl polysiloxane impression materials. Given the diverse selection of dental materials on the market, dental practitioners should consult glove manufacturers regarding the chemical compatibility of glove materials [5; 18]. Wearing sterile surgeon’s gloves during surgical procedures has a strong theoretical rationale. Sterile gloves minimize transmis- sion of micro-organisms from the hands of surgical personnel to patients and prevent contamination of the hands of surgical personnel with the patient’s blood and bodily fluids. In addi- tion, sterile surgeon’s gloves are more rigorously regulated by the FDA and may provide an increased level of protection for the provider if exposure to blood is likely [10; 18]. Gloves should be removed and replaced if torn or punctured and discarded between patients to prevent transmission of infectious material. They should never be washed and reused, as micro-organisms cannot be removed reliably from glove surfaces. Glove reuse has been associated with transmission of MRSA and gram-negative bacilli [9; 10]. When gloves are worn in combination with other PPE, they should be put on last. Gloves that fit snugly around the wrist are preferred for use with a gown because they will cover the gown cuff and provide a more reliable continuous barrier for the arms, wrists, and hands. Removing gloves properly also prevents hand contamination. Hand hygiene following glove removal ensures that the hands will not carry poten- tially infectious material that might have penetrated through unrecognized tears or contaminated the hands during glove removal. When processing contaminated sharp instruments, needles, and devices, heavy utility gloves should be used to prevent puncture injuries [10; 18].
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