should be advised not to close their lips tightly around the tip of the saliva ejector. ● Single-use or disposable devices . This provides greater infection-control advantages than reusable clinical products. Single-use devices are meant for one patient only and then discarded. They should never be reprocessed for use on another patient as they generally are not heat-tolerant and cannot be cleaned reliably. Examples of single-use products include saliva ejectors, prophylaxis cups and brushes, exam gloves, face masks, patient napkins, and sterilization wraps and pouches. Certain items, such as prophylaxis angles and air-water syringe tips, are now available in disposable as well as reusable forms and it is important to be able to recognize the difference between disposable and reusable versions. ● Regulated medical waste . This comprises a minimum of the total waste generated from a dental office. Examples of regulated medical waste include solid waste soaked or caked with blood, extracted teeth (without amalgam restorations), surgically removed hard and soft tissues, and contaminated sharp items. Extracted teeth with amalgam restorations should not be incinerated because of hazardous mercury vapors released during the incineration process, which are extremely harmful when inhaled. Regulated waste must be contained in closable bags or containers that are colored red or labeled appropriately. A single, leak-resistant biohazard bag can be used for containment of non-sharp regulated medical waste. Sharp items, such as scalpel blades, needles, syringes, and unused sterile sharps should be placed in a puncture resistant, color-coded, and leakproof container that is kept closed to prevent spillage. All regulated medical waste should be disposed of according to federal, state, and local regulations. 2. What could the busy dental hygienist do to prevent the crusting of debris on these periodontal instruments if they are not able to process them immediately? Discussion 1. If debris is not removed, it will interfere with microbial inactivation and can compromise the disinfection or sterilization process. Thus, the sterility of the instrument could not be guaranteed. Cleaning is the first step in any disinfection or sterilization process and all visible debris must be removed prior to sterilization. 2. If instruments cannot be cleaned immediately, the instruments may be soaked in a container or sprayed with a detergent or an enzymatic cleaner to make subsequent cleaning easier and less time consuming. The quick and simple step of spraying or soaking will keep instruments moist until clinical personnel can properly process them. Points to consider 1. Are patients required to wear protective eyewear? Unfortunately, guidance and standards for patient eye protection is minimal at best. CDC guidelines state that “protective eyewear for patients shields their eyes from spatter or debris generated during dental procedures,” but the wording does not provide recommendations on what should be worn and when. And OSHA does not provide standards for PPE for patients as its mission is to provide a safe work environment for employees. Yet, eye protection is considered a best practice (American Dental Association, 2020).
worn when spattering of blood or body fluids is anticipated. For radiograph placement, use heat-tolerant or disposable intraoral devices. If the lead apron is contaminated with blood or saliva during radiograph exposure, it should be cleaned and disinfected with an intermediate-level surface disinfectant. Consult manufacturers of digital radiography sensors and computer components about appropriate barriers and recommendations for disinfection and sterilization of these items. At a minimum, digital radiography sensors should be covered with FDA-cleared barriers, followed by cleaning and disinfecting with an intermediate-level, EPA-registered hospital disinfectant with intermediate level (tuberculocidal) activity after each patient. It is important to note that manufacturers of all medical devices must provide instructions for reprocessing. Other special considerations Several special considerations pertain to the dental hygienist in the dental office, including: ● Cleaning, lubricating, and sterilization of devices that can be removed from air and waterlines. Ultrasonic and sonic scaling tips, dental handpieces, and associated attachments including low-speed motors and reusable prophylaxis angles should always be heat sterilized between patients. If these devices are not cleaned and sterilized properly, the next patient may be exposed to potentially infectious materials (CDC, 2018a). ● Backflow from low-volume saliva ejectors . This can occur when the pressure in the patient’s mouth is less than that in the evacuator. Studies have reported that backflow in the low-volume suction lines can occur, and microorganisms present in the lines can be retracted into the patient’s mouth when a seal around the saliva ejector is created (CDC, 2016). This backflow can be a potential source of cross-contamination. Thus, dental patients Case study 1 Dr. Smiley’s office was extremely busy on a Tuesday after a long holiday weekend. In addition to a full schedule, three emergency patients needed to be seen that day. There seemed to be no time to immediately process instruments so personnel took contaminated instruments to the instrument processing area and left them on the countertop until clinical personnel could attend to them. Several hours later, Jessica, the hygienist, had some time to dedicate to instrument processing. She noted dried and crusted organic debris on her periodontal scaling instruments, and dried blood on her mouth mirrors. Questions 1. If instruments will ultimately be sterilized in the autoclave, does it matter if dried and crusted debris remains on the instruments? Case study 2 Cecilia, age 5, was scheduled for a routine dental prophylaxis and was accompanied by her mother into the dental hygiene operatory. Before beginning the procedure, Emily, the hygienist, offered Cecilia a pair of sunglasses to wear. Emily noted that the glare from the operatory light might be too bright and wearing sunglasses would make the procedure more comfortable. During the appointment, Cecilia mentioned that the glasses were uncomfortable, and she proceeded to take them off. Emily looked to the mother for guidance. Cecilia’s mother agreed that if Cecilia were more comfortable without the glasses, it was okay with her to remove them.
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