Common Sense Dentistry - Monthly Newsletter

DON'T CROSS-CONTAMINATE ME

Since I began practicing dentistry, now almost 30 years ago, probably the area that has changed the most is the area of infection control in dentistry. Yes we have had many technological advances such as CADCAM and lasers but on a day-to-day, in the office nuts and bolts part of the practice, infection control has changed the way that we practice dentistry and may continue to do so.

I remember in dental school we never wore gloves, except for particularly bloody extractions and even that was unusual. I remember some instructors calling people, who wanted to wear gloves during those kinds of extractions, “sissies”. We would certainly wash our hands very well before each patient and in between patients and that was considered adequate infection control. Before I sound like I am from the dark ages, we did have autoclaves even back then but most everything in the operatory was wiped down with a somewhat damp alcohol gauze. That was considered good enough.

Certainly, in this day and age, infection control has become much more serious and much more effective. Everything that goes into the patients’ mouth is autoclaved. Countertops and other areas that cannot be sterilized are disinfected with excellent products. We know that we cannot make the dental operatory a complete sterile environment, but we have certainly done a much better job controlling this as never before.

With all of our infection control procedures, what is incredible is that sometimes we miss the very obvious. I would like to direct you to a study done at the University of North Carolina Chapel Hill School of Dentistry about bib clip chains. Yes, that is right, the little chains that you clip on the patients bibs can be a real source of cross-contamination and most dental offices have not even thought about or addressed this issue. Think about this scenario – a patient walks in, sits down in the dental chair, the assistant bare-handed then takes the bib that is put on the end of the dental chair which has been used on the last six patients, she picks up this bib chain, fiddles with it to straighten it out because sometimes it gets knotted up, and then puts this around the patient’s neck. The dental assistant’s hand has now been cross-contaminated with saliva, pathogens, hair, blood, and lots of aerosol sprays that have been clinging to this bib chain. The patient is then laid back into the chair and as is very normal, the bib starts to slide off of one side so we fix it for the patient and many times the bib chain brushes against the patient’s face or even their lips or sometimes even into their mouths. You and I both know that bib chains are rarely disinfected and certainly never sterilized.

The bib chain culture studies, carried out at the UNC School of Dentistry, demonstrated that 1 in 5 bib chains harbored pseudomonas, E.Coli, and staphylococcus aureus. These colony-forming units were of sufficient quantity to be considered an actual source of cross contamination. Further, considering that the disease-causing bacteria found on bib chains have also been implicated in respiratory infections within the general public, patients with compromised immune systems and breathing disorders may be even at greater risk.

Certainly, we all know that blood borne viruses can live in operatory surfaces for up to one week especially when these surfaces are not disinfected either the right way or certainly when they are not cleaned or sterilized at all. The Center for Disease Control and Prevention defines cross-contamination as the act of spreading bacteria and viruses from one surface to another. In short, the bib chain fits every definition of cross contamination so it must be addressed in the dental office.

The reason it sounds like I am making a big deal of this is because it is. I have been around too long in dentistry to know that if we don’t start taking care of some of these major or minor concerns ourselves, then they become big expose articles in Reader’s Digest or on CNN Health Watch and the media can make it sound as if dentists are infecting millions of patients every single day with something that is just so easy to take care of.

Here are your choices to avoid the risk of bib chain contamination. With each patient bib change you can:

Ultrasonically clean them, place in a pouch, and autoclave to completely sterilize the bib chain.
Rinse off any gross debris, immerse the bib chain in an EPA Registered disinfectant (for the time needed to properly disinfect), then remove, dry and store in a clean area.
Use a disposable bib holder such as Bib-Eze by DUX Dental www.duxdental.com. These are single use disposable bib holders made of soft elasticized fiber which will eliminate the cross-contamination and you will never have to clean a bib holder again. They are also priced very economically and come out to less than a disinfectant wipe.

By the way, here is one area that I have to give credit to the other dental professionals we work with such as dental hygienists dental assistants. An article just came out in January 2010 in Dental Economic sister magazine, RDH about this issue. Dental hygienists have been bringing this issue to our attention for years and it’s about time we listen to them before some investigative reporter brings a hidden camera into the dental office and watches as a bib clip falls off the dental chair we step on it a few times, roll our other chairs over it and then pick it up and put it on a patient, then lay the patient back with the bib clip in close proximity, if not even in the mouth (especially in little kids who love to chew on everything). I love it when there are simple solutions that present themselves so that I never have to worry about such a small item that could turn into the next “scandal” in dentistry.

Clinician:

Dr. Louis Malcmacher is an internationally known lecturer and author, known for his comprehensive and entertaining style. He works closely with dental manufacturers as a consultant and clinical researcher in developing new products and techniques. Dr. Malcmacher is a contributing editor for Dentistry Today, a monthly columnist for Dental Economics, and an evaluator for Clinical Research Associates. For close to two decades, Dr. Malcmacher has inspired his audiences to truly enjoy doing dentistry by providing the knowledge necessary for excellent clinical and practice management. His group dental practice has maintained a 45% overhead since 1988.

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Dr. Louis Malcmacher is a practicing general dentist and an internationally known lecturer, author, and dental consultant known for his comprehensive and entertaining style. An evaluator for Clinicians Reports, Dr. Malcmacher is a consultant to the Council on Dental Practice of the ADA. You can contact him at 440 892-1810 or email dryowza@mail.com. His website is www.commonsensedentistry.com where you can find information about his lecture schedule, botox and dermal filler hands-on workshops, audio cd’s, download his resource list, and sign up for a free monthly e-newsletter.