Dirty Little Secrets
It’s not easy being green
By Nancy Andrews, RDH, BS
Editor’s Note: Are your customers asking tough hygiene questions? Here is your chance to ask someone "In the Know." Nancy Andrews, RDH, BS, will take your questions and tell your tales. Pulling from centuries of experience, endless education, lots of research, and occasional consultation with other experts, Nancy invites your e-mails at Infectioncontrol@mdsi.org. The best question or tale at the end of the year gets $100.
On the safe side of disinfecting
Q: Some of my accounts consider counters clean unless they can see debris or blood on them. Others assume surfaces are contaminated even though they can’t see anything. If surfaces are "clean," they just wipe once, and if the counters are "dirty," they also just wipe once! I’m trying to give them a clear message about the best way to disinfect surfaces between patients, but am not sure what to say. Is it right to only do the cleaning step when you see blood and other contamination on surfaces, or should you always clean before disinfecting?
A: First, pathogens and contamination are not always visible. If surfaces have possibly been exposed to touch, spray or aerosols they should be considered contaminated. Contaminated surfaces must be disinfected. Here is where it gets interesting: as you know (but many clinicians might not know), surface disinfectants are approved for use on "hard non-porous pre-cleaned surfaces." On such surfaces, they can reliably disinfect if applied correctly, for the period of contact time stated on the label. Since contamination on surfaces can interfere with disinfectant efficacy, surfaces must be clean. Back to your question: How do you know if the cleaning step is necessary? Take the high road: if contact, spray or aerosols might have deposited contamination on a surface, clean it off first - even if it looks clean!
The other part of this is that some disinfectants are great cleaners and others are not. Generally, products with high alcohol are poor cleaners and require a separate product to dissolve organic substances (clean the surface) before the disinfectant is applied. Other disinfectants, such as those with no or low alcohol content, are excellent cleaners, so they may be used to both clean and disinfect. And, yes, two steps are needed to do that!
The point: Surface disinfectants are not reliable unless label directions are followed. Pathogens and contaminants may not be visible, so operate with a margin of safety: apply them to surfaces that are clean.
Proper glove protocol
Q: I took my daughter to the dentist (who is also an account of mine) last week and saw the dentist wash his gloves before approaching my daughter. I was stunned. I know this is wrong, but didn’t have any scientific documentation right then to back me up, and I didn’t want to be confrontational. Also, when it is your family, and you are in a "patient/parent" role, it’s intimidating to challenge the doc. I’m ashamed to say I said nothing, but felt very angry. The whole time, I wondered just how much risk my daughter was in, or is it a risk for the doctor mostly?
A: I’m betting this is not the only doctor that does this, and others have suffered this insult - and moment of indecision. We know when things are wrong, but actually confronting an authority in charge of you or your family’s health is more than uncomfortable. Your desire for a scientific reference at that moment shows that you want to be sure you are right in challenging them. (You are!) However, who brings the CDC Guidelines or OSHA regulations with them to personal medical/dental appointments?
Indeed, gloves are single use items, never to be worn for different patients, and should not be washed. Here are the simple reasons: washing gloves may physically or chemically damage the gloves, creating openings or altered texture that may transmit infection between patients, from the healthcare worker to the patient(s), or from the patient(s) to the worker. In short, the gloves may be a source of cross-contamination. If you ever worry about finding the exact citation to back yourself up in a similar situation, I suggest just saying that you feel uncomfortable with it and ask politely that the doctor remove the gloves, perform acceptable hand hygiene, and don new gloves. They should know this is required and correct, and should want you and your daughter to feel comfortable and safe. If they don’t, find a new doctor!
The point: Gloves are single use. Demand safe practices, and ask for what is right.
Get them behind the mask
Q: I noticed that dental assistants in quite a few practices wear masks infrequently, and often position the mask under their noses. You’ve said this is important for their protection, but I can’t get them to take it seriously! I am welcomed in the office and don’t want them to feel I’m judging them or just trying to sell more masks. Any tricks to help them be more safe?
A: Do the doctors or hygienists wear masks? If the whole office is skimping on personal protection, that is a different issue than one non-compliant person on the staff. If the rest of the office is on track, they can help get the non-compliant one in line, because they probably respect the rules and logic behind them. If the whole office needs help, this can be approached with something simple, like bringing in the new ADA Infection Control Poster that was sent out to all ADA members in late 2009. This document clearly directs workers to use masks. Contact the ADA to request their infection control poster (Authored by Dr. John Molinari and me, sponsored by a grant from Septodont). You might "gift" the office with it as a value-added service. Also, emphasizing seasonal and timely risks like the flu season by bringing in OSAP (osap.org) articles or newsletters shows that you are "connected" to important resources. You get the message: back yourself up with the rules, then help them comply - that way you’re "looking out for them."
I have a story for you, from the perspective of the patient. My friend had some restorative work done, and the assistant did not wear a mask. My friend was disgusted when the assistant breathed through her mouth heavily into her open mouth. On top of this, my friend seems to be very susceptible to respiratory infections, and came down with a cold several days later. Of course, (right or wrong) she blamed the assistant for the miserable cold. Even with no proof that the assistant infected her, the damage is done.
The point: wear masks for everyone’s safety and comfort - it’s the standard of care, and patients know it.
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