Attention turns to infection control, cleanliness and safety for patients and staff in dental care facilities as lapses in equipment sterilization protocol discovered in the dental clinic at the John Cochran VA Medical Center in St. Louis, may have exposed more than 1,800 veterans to Hepatitis B, C and HIV, the virus that causes AIDS.
Last week, the VA confirmed two positive tests each for Hep B and Hep C.
Ollie Fisher, DMD is a Saint Louis County dentist in private practice and a captain in the U.S. Navy Reserve. Dr. Fisher said safety and infection control procedures are the same in military and civilian dental facilities.
“In the military it’s called standard operating procedures – we practice those same standards,” he said. Fisher said those standards are reinforced at minimum, annually.
“If we see any problems – any gross violations, we do a stand down – we stop, huddle everybody together and deal with it immediately,” Fisher said. “I’ve seen other treatment facilities do it.”
At Fisher Wellness Center, staff members participate in mandatory infection control procedures, which include health and safety protocols to protect both patients and staff.
“You want the staff to use what we call PPE – personal protective equipment. That means they should always have gloves, they should use masks,” he said.
“Even with our laundry, they have to use gloves and cover themselves even when they do our laundry.”
Treatment clothes are not street clothes, and visa versa.
“They should have outer garments that they only use in the operatory or treatment area – lab coats, so they wouldn’t take that contaminated lab coat, keep it on and take it into the area where they are eating,” Fisher said. “Conversely, they should not come into the treatment area with street clothes on.”
Fisher said scrubs are short-sleeved and outer garments should be worn on top of it.
“They should have to have a garment with long sleeves so they are completely covered and they should wear eye protection as well,” Fisher said. That eye protection goes for the patient as well.
Anything that has been touched also must be disinfected, said Fisher, including the handles, the light fixtures and countertops.
“We wrap everything that we are going to touch,” Fisher said. “If it’s disposable, after use it’s thrown away –not to expose another patient.
“We are challenged all the time. Occasionally we are working on a patient and we need something in the drawer. Always take off the glove, get what you need, disinfect your hands and re-glove (new set of gloves),” Fisher said.
“Otherwise, you contaminate everything in the drawer.”
“That’s why we anticipate what we need or have a person with clean hands who is not working on a procedure get something for you,” he explained.
Fisher said there are two ways sterilization of equipment is handled.
“The gold standard for cleaning instruments is a heat autoclave. That sterilizes the instruments under heat and pressure. The equipment is monitored on at least a monthly basis to make sure it is operating and functioning properly,” Fisher said. “Those instruments are washed with soap and water, rinsed and then sterilized – usually a 20- to 30- minute cycle. There are some machines that can do it faster.”
To monitor his sterilizing equipment, Fisher’s his office runs a sample through the machine. The sample is sent to a lab biweekly, and the lab gives his office a verification that the equipment is operating properly.
Fisher said the sterilization area where all the contaminated instruments go should be a separate room.
There are some instruments that cannot stand the heat and the high temperatures of an autoclave, such as pieces made with plastic or some other material that will melt.
“Those must be thoroughly cleaned with soap and water and placed in an approved disinfectant in cold sterilization,” Fisher explained. “It depends on the manufacturer’s recommendation, but generally its several hours.”
Dr. Fisher offers suggestions on what patients should look for at any dental or medical health setting.
• If you can visibly see dirt, blood splatter or anything that is contaminated, you know it is not being properly cleaned.
• Disposable equipment, protective wear and supplies must be thrown away after one use to avoid exposing another patient to someone else’s germs
• If you see that someone is not doing something right, you should not feel uncomfortable to call them on it, he said. If your doctor makes you comfortable about speaking up – it’s time to find a new dentist.
Fisher, who served eight years on the board of health for the Missouri Department of Health and Senior Services, said lapses in infection control can happen in other places as well. He said people tend to take shortcuts, perhaps because of budgets and they don’t want to throw anything out.
“The bottom line with infection control is constant surveillance and retraining because people tend to become lax over periods of time. You have to continually reinforce these standards,” Dr. Fisher said.
“It’s not just for the patient – it’s just as important for the staff. It only takes one patient to expose the entire office if we don’t keep our standards high. We don’t want to take anything home either.”
More information on infection control is available online. At the American Dental Association site, www.ada.org, go to Public Resources, Oral health Topics, and Infection Control.
At the Centers for Disease Control and Prevention, www.cdc.gov, search Guideline for Disinfection and Sterilization in Healthcare Facilities.
