should be worn during patient care, instrument processing, disinfection of environmental surfaces, and when harmful or toxic substances are handled. Protective gowns may be disposable or reusable and should be changed when they become visibly soiled and at the end of the workday. Soiled apparel should be placed into a designated container for contaminated laundry. Gloves Medical examination gloves should be worn whenever there is potential for contact with blood, bodily fluids, mucous membranes, nonintact skin, or contaminated equipment and gloves should never be used for the care of more than one patient. Gloves can be made of latex, nitrile, vinyl, or other synthetic materials, and nonlatex options should be provided for dental workers or patients with latex allergies. Sterile surgeon’s gloves must meet standards for sterility assurance established by the FDA. Ambidextrous and hand- specific medical gloves are available. Ambidextrous gloves are generally less expensive, but they may contribute to hand and wrist fatigue. Hand-specific gloves may be more expensive, but they offer better fit, greater comfort, and less hand and wrist strain. Utility gloves have increased puncture and chemical resistance and should be worn when handling contaminated instruments and during environmental surface disinfection. Utility gloves should be routinely checked for punctures, tears, or any other signs of deterioration. If such signs are evident, the gloves should be discarded. Utility gloves may be disinfected with intermediate-level surface disinfectants and some utility gloves may also be autoclaved per manufacturer’s instructions. Irritation contact dermatitis and latex allergies are often associated with glove use and are very common among dental personnel. Although some symptoms of irritation contact dermatitis and allergic contact dermatitis may seem insignificant, any condition that compromises healthy skin increases the risk of exposure to blood and other body fluids. Thus, policies should be in place for the proper diagnosis, treatment, and management of these conditions (CDC, 2016e). Self-Assessment Quiz Question #1 When caring for a patient, a dental hygienist notices a small tear on their glove. They should: a. Continue with care until the procedure is completed. b. Apply alcohol-based hand rub to the affected glove and resume care. c. Stop the procedure, change gloves, and resume care. d. Stop the procedure, remove gloves, perform hand hygiene, don fresh gloves, and resume care. posting signs for patients to cover mouth/nose when coughing or sneezing, recommending the use and disposal of tissues, and performing hand hygiene after hands have been in contact with secretions. 2. Provide tissues and no-touch receptacles for disposal. 3. Provide resources for performing hand hygiene. 4. Offer masks to coughing patients and visitors. 5. Provide space for symptomatic patients to sit as far away from others as possible. 6. Educate dental personnel on the importance of infection prevention measures to prevent the spread of respiratory pathogens.
do not provide adequate coverage and do not have side shields, so they cannot be considered PPE. Chin-length full-face shields may be more comfortable and are more effective against spatter and debris. Eye protection is required for all dental hygiene patient care procedures and for nonclinical tasks such as instrument precleaning and cleaning, disinfecting environmental surfaces. Protective eyewear for patient use is also recommended to protect the patient’s eyes from spatter or debris generated during dental procedures. Reusable eye protection should be decontaminated between patients by washing with soap and water. However, if eyewear is contaminated with blood, intermediate-level disinfectants should be used. Surgical masks Surgical masks protect the mucous membranes of the nose and mouth during dental procedures that are likely to generate splashes or spattering of blood or other body fluids. Masks must fit the face and create a light seal over the nose and mouth to minimize eyewear fogging. Masks should also be worn while cleaning and disinfecting environmental surfaces and while performing other functions that may generate splashes and spatter such as instrument reprocessing. Masks should be changed between patients, and when they become damp from external contamination or from condensation of moist exhaled air. N-95 respirators Surgical N-95 respirators are available for maximum filtration and should be used with patients who have suspected respiratory infections. Surgical masks have historically been used in dentistry to protect from droplet spatter, but they do not provide complete protection against inhalation of aerosolized infectious materials (NPPTL, 2022; CDC, n.d.a). Thus, perhaps for the first time during the COVID-19 global pandemic, dental practices were required to implement wearing of N95 respirators in the context of a comprehensive OSHA-compliant respiratory protection program under the respiratory protection standard. Since the COVID-19 pandemic, dental facilities must have a respiratory program that is comprehensive, written, incorporates initial and annual fit testing, training, medical exam and ensures a seal test is performed when the respirator is donned. Even though the COVID-19 public health emergency has passed, OSHA standards for COVID-19 remain in effect (OSHA, n.d.b; OSHA, n.d.c; OSHA, n.d.d). Protective apparel Protective apparel or gowns are required to shield all clinical personnel from infectious or harmful substances while in the dental office. Protective gowns should cover all personal clothing and skin that is likely to be soiled with blood, saliva, or other potentially infectious material. These garments Respiratory hygiene/cough etiquette Respiratory hygiene and cough etiquette measures are designed to limit the transmission of respiratory pathogens spread by droplet or airborne routes. These measures may apply to the dental patient and/or individuals who accompany patients to the facility—who may have an undiagnosed transmissible respiratory infection (CDC, 2016f). Signs of respiratory illness include cough, congestion, and runny nose. Key recommendations for respiratory hygiene/cough etiquette include: 1. Implement measures to contain respiratory secretions of any individuals who have signs and symptoms of respiratory infection from point of entry to the dental facility, throughout the visit. These measures include
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