Dirty Little Secrets
Is tighter, better?
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.
Q: I have a client who insists that her staff wear gloves that are very tight. She believes tight gloves are safer and promote better dexterity and accuracy. Is this correct? I always thought I should encourage customers to use gloves that fit well – but not too tightly – so they would be comfortable.
A: Great question! I think this is a common belief, probably based on stories and experiences of accidents resulting from gloves getting caught in rotary instruments or lab equipment such as model trimmers. These accidents do happen, and they motivate workers to avoid gloves that fit loosely. Honestly, these stories foster the belief, especially among lab technicians, that gloves cannot be worn in dental labs. Fingers have been lost in grinders, burs have wrapped glove material up and cut fingers, and loose gloves can catch on sharp instruments, injuring hands. From an injury prevention point of view, glove fit can contribute directly to accidents or indirectly over time to ergonomic injuries. Gloves should conform to the contours of the hand without extra material that might catch on sharp objects or get picked up easily by rotary instruments or equipment. On the other hand (pardon the pun), gloves that are too tight can literally squeeze the circulation and feeling out of hands, leading to hand pain, loss of sensation (numbness) and dexterity, as well as long-term cumulative trauma disorders such as carpal tunnel syndrome or neuropathy.
Gloves should be proportioned correctly for each person. Even though gloves stretch, the original shape of the glove should be close to the person’s hand shape. For example, some gloves have long fingers and some have shorter fingers. Getting rid of excess glove material may not be a matter of using a smaller size – it might be a matter of finding a differently proportioned glove. Many people fail to notice that their thumbs are being squeezed in toward their palms, or pulled back, flattening the profile of their hand. Clinicians who experience this should be guided toward better fitting gloves to avoid constriction-related trauma. Left and right fitted gloves accomplish this, but they too must fit properly.
The bottom line: gloves should fit comfortably; not too tight or loose to avoid immediate risk of injury and long-term cumulative trauma. Fit customers’ hand shape AND size, and consider fitted gloves, especially for customers with hand discomfort.
Non-critical cleaning
Q: Is it true that bib chains must be sterilized or disposed of after each use to comply with OSHA rules?
A: No, OSHA does not require that bib chains be disposed of or sterilized. Bib chains and clips are non-critical items that may be wiped off with a surface disinfectant. However, bib chains come in complex shapes that may create hiding places for organisms, preventing effective cleaning and disinfecting using the spray and wipe technique that is recommended for clinical surfaces.
In a recently published clinical study by Dr. John A. Molinari (Dental Advisor Newsletter, Number 29, June, 2010), common skin pathogens remained on bib chains after they were used on about four consecutive patients during dental care. These bib chains were cleaned and disinfected between each patient using a leading brand of EPA registered intermediate level surface disinfectant wipes. The organisms were likely to have come from dental spray, hand contact from workers, or from the patient’s skin. While the risk of disease transmission from bib chains is not widely considered to be the most dangerous risk in dental settings, sterilizable or disposable bib chains avoid this risk.
Bottom line: OSHA does not require that bib chains be sterilized or disposed of after each use, but tests show that either of those options provides a more reliable way to avoid cross-contamination than using surface disinfectants between patients.
Rules of contact
Q: I co-traveled with someone who has eczema. He has open cracks on his hands and rashes on his skin that look "open." Is he at risk for catching something in dental offices?
A: The short answer is yes. If he has areas of non-intact skin, many pathogens can enter his body through the lesions – both in and outside of dental offices. There are serious contact, respiratory, wound and bloodborne infections that are of concern. This rep should cover the open areas, and be careful not to touch contaminated surfaces while he is in a dental office. The important thing to remember is that all surfaces and items may be reservoirs for pathogens, but some are more likely than others to be contaminated. In dental offices, we focus on known areas where contamination is likely: patient treatment areas, the lab and instrument sterilization areas. However, anyone at greater risk of contracting diseases should be aware that doorknobs, counters, faucets, and even shared pens can transmit infectious diseases.
There is another perspective to consider. A rep with open skin lesions may be seen as a source of infection by his customers. His visible lesions can transmit skin, wound and bloodborne diseases to others, and dental professionals are likely to recognize that risk. While they may be polite and not say anything to his face, they may want to avoid contact with him. In fact, if he enters the office and touches surfaces or items, an aware healthcare worker will recognize this potential risk and may even be cleaning and disinfecting the area after he leaves. This is hardly a business builder! If you know him well enough, I suggest you discuss this with him as a friend.
Dental reps with visible skin wounds or lesions should take every precaution to protect the involved skin from exposure and to ensure that they do not spread infection. In sales, actual disease transmission risk is important, and the perception of that risk is also important.
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