Safe Hands – Chris Wahlers

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  Posted by: The Probe      6th January 2018

Effective infection control is at the heart of every dental practice, as procedures are carried out in an environment that exposes personnel and patients to significant risk. Hand hygiene is one of the main areas for prevention – getting this right can help stop cross-contamination and infection.

Every year, over 4 million individuals in Europe acquire a healthcare-associated infection. The number of deaths occurring as a direct consequence is estimated to be at least 37,000, with an additional 110,000 fatalities each year believed to be related to these infections.[i] The exact data for the spread of viruses or bacteria in the dental practice is relatively scarce. However, the dental setting provides a unique environment where transfer of infectious microorganisms can easily occur.[ii]

The mouth alone contains a wide range of microorganisms such as fungi, bacteria and viruses, as well as saliva and blood, which are recognised vectors of infection. It is well-known that all saliva-contaminated devices have the potential to transfer infectious diseases to dental personnel who handle them, including hepatitis B, tuberculosis, herpes and Acquired Immunodeficiency Syndrome (AIDS).[iii] Furthermore, many procedures in the dental practice are invasive and open, which increases the chance of exposure to microorganisms that can pose a threat for cross-contamination and may even cause systemic infections.[iv]

 

Pathways of contamination can be bidirectional, and it is important to consider that an infectious microorganism may be transferred from a patient to a member of the dental team, but also vice versa. For example, if one of the team is suffering from an acute respiratory infection with a persistent cough or purulent skin infection, patients and colleagues alike could become infected, therefore advice should be obtained from their GP on their fitness to work.

Another concern is that pathogens can be transferred from patient to patient through a surface located in the dental practice.[v],[vi] Modern technology in the workplace, including digital and mobile devices can provide ideal places for bacteria to develop. Without realising, frequent touching may heavily contaminate these devices with pathogens, which can then lead to the cross-contamination between the patient’s oral cavity and the appliance.[vii]

Direct contact is the most easily appreciated mode of infection. However, in order to become established and cause infection, microorganisms must attach to or penetrate the surfaces of the body.[viii] While the body is fairly well protected from microbial invasion by intact skin, openings such as the mouth, nose and eyes provide potential entry sites for infection. These sites are protected by secretions such as saliva and tears, and by cellular and antibody immunological defence mechanisms. However, both mucosal surfaces and damaged skin remain a potential weak link in our defences, which is why protective clothing is essential.

Hand hygiene is universally recommended as the most effective line of defence against infections. It has been defined as the use of mild liquid soap and running water, as well as alcohol gel or hand rubs in order to reduce micro-organisms on the hands.[ix] There are two classes of flora that live on hands: resident and transient. Resident microorganisms reside deep within the epidermis and are part of our normal flora. Their role is to keep skin healthy and they are not normally responsible for causing infection. However, these are usually removed during surgical scrubbing, which often involves up to two minutes of washing in harsh chemicals, such as chlorhexidine gluconate. The daily use of this product was stopped some time ago and the move was made to milder soap, as hands were frequently stripped of their essential fatty acids, resulting in contact dermatitis. Transient microorganisms, in contrast, live on the surface of the skin and are transmitted by direct contact from person to person.9

Gloving is recommended as a barrier protection for dental professionals. When used properly, gloves can help reduce cross-transmission of microorganisms from hands. However, when gloves are not removed after each contact, they become a ‘second skin’ and expose patients to cross-contamination of microorganisms. Selecting safe and effective gloves is equally important. Unigloves is a market-leading manufacturer of high quality, single use gloves. The Vitality Range from Unigloves are of premium quality, specifically designed for the dental sector to provide unrivalled barrier protection, strength and comfort.

Infection control remains one of the most important considerations in the practice. Pathways of contamination can be bidirectional, and it is important that dental practitioners are fully conversant with the latest legislation on infection control. It has long been recognised that the single most effective means of preventing the spread of disease is proper hand hygiene measures which includes the use of protective gloves.[x]

 

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[i] European Centre for Disease Prevention and Control: Healthcare-associated infections. Available online: http://ecdc.europa.eu/en/healthtopics/Healthcare-associated_infections/Pages/index.aspx [Accessed 30th May 2017].

[ii] Laheij, A. M., et al. (2012). Healthcare-associated viral and bacterial infections in dentistry. Journal of Oral Microbiology, 4.

[iii] Khaledi, A., et al. (2015). Dimensional stability of color-changing irreversible hydrocolloids after disinfection. Journal of Dental Biomaterials, 2 (1), 29-32.

[iv] Palenik, C. J. (2012). The effect of long-term disinfection on clinical contact surfaces. The Journal of the American Dental Association, 143 (5), 472-477.

[v] Russell, J. (2016). The importance of hand hygiene. Dental Nursing, 12 (1).

[vi] Oosthuysen, J., et al. (2014). Compliance with infection prevention and control in oral health-care facilities: a global perspective. International Dental Journal, 64 (6), 297-311.

[vii] Oosthuysen, J., et al. (2014). Compliance with infection prevention and control in oral health-care facilities: a global perspective. International Dental Journal, 64 (6), 297-311.

[viii] Pankhurst, C. L., & Coulter, W. A. (2017). Basic guide to infection prevention and control in dentistry. John Wiley & Sons.

[ix] Russell, J. (2016). The importance of hand hygiene. Dental Nursing, 12 (1).

[x] Grant, K. L., et al. (2015). Evaluating utility gloves as a potential reservoir for pathogenic bacteria. The Journal of Dental Hygiene, 89, 258-263.


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