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Infection control by a
health care provider whether an internist, a dermatologist or a dentist is
something most patients presume, and give no further thought. In the
dentist’s office, the sterilization of instruments as well as the disinfections
of the environment in which the patient is treated has changed dramatically
in recent years. For instance, dental schools did not even require that
their students wear gloves for clinical training until 1984. Prior to 1984,
most dentists did not wear gloves except when performing an oral surgery
procedure. It is no small coincidence that awareness of infection control
became heightened after 1983 when AIDS was first classified as a disease.
At this time, a new approach to infection control was introduced known as “universal
precautions.” Universal precautions is an approach to restricting the
transmission of disease in which all human blood and body fluids are
treated as though they are known to be infectious for blood borne pathogens
such as HIV. In this respect, it requires the application of the same disinfections
and sterilization regiment regardless of whether the patient has a cold,
hepatitis or no known illness. The purpose of this update letter is to
share with our patients the manner in which our office follows universal
precautions as a means of infection control.
It is a basic
principle of infection control that sterilized instruments or previously
never used disposables are employed for each patient case. Sterilized
instruments include those located chair side which are used intra-orally
when treating a patient, as well as instruments which are used to take
x-rays. The instrument infection control process commences immediately upon
completion of a dental procedure. After each patient, the instruments are
placed in an ultrasonic machine that removes debris such as loosely
adhesive salvia, blood and tissue. In doing so, the ultrasonic enhances the
efficiency of the sterilization procedure. Next, all instruments are
rinsed, packaged and sterilized. Our office uses a method of sterilization
that consists of intense heat and steam under pressure which is known as
autoclave sterilization. The sterility of the instruments is verified
before use in the operatory by the instrument package itself. Each package
contains a process indicator that changes appearance to verify the
package’s exposure to sterilization conditions.
The sterilization
procedure described above is in full compliance with the guidelines for
infection control recommended by the American Dental Association and the
federal Centers for Disease Control in Atlanta, Georgia. Both endorse the
use of autoclave sterilization for all instruments that penetrate soft
tissue or bone such as burs used for drilling, as well as instruments that
contact oral tissue like mirrors.
The environment in
which patients are treated is kept disinfected. After a patient is treated in
an operatory, all instruments are removed and all disposables are thrown
away. All papers, plastic wraps and barrier wraps or what is commonly known
as the blue tape are also removed and thrown away. The room is then sprayed
with a hospital grade disinfectant that kills viruses such as tuberculosis,
HIV, hepatitis and influenza. All surfaces that have come into contact with
contaminated instruments or waste during the course of treatment, and as a
result have become contaminated, are wiped down and re sprayed. Such
surface areas include the countertops, draw handles and chairs. Next,
surfaces and equipment are covered in barrier wrap to prevent
contamination. For example, by putting barrier tape on the light handle we
prevent the light handle itself from becoming contaminated during the
procedure, and thus eliminate any transfer of contaminants to the next
patient. After the treatment is concluded, the barrier wrap is removed and
the contamination is eliminated. Lastly, new paper is placed in the trays and
the air water syringe handles are covered in plastic. The use of paper in
trays and plastic over syringe handles protects against contamination in
the same manner as barrier tape.
The end result of
following universal precautions is to eliminate risk to our patients from
the transmission of infectious diseases. Providing a safe environment for
patients is not an extraordinary measure. It is the very least any doctor
should do for his or her patients. My staff and myself believe it is
important that our patients know how seriously we take our obligation as
health care professionals to keep abreast of infection control and provide
our patients not only with the best dental care, but the safest.
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