A Dental Patient's Perspective About Infection Control

BY NOEL BRANDON KELSCH, RDHAP

Kay Perry is not a hygienist, and she never went to dental school. Kay is a consumer. She is aware, bright, and informed. She wrote to ask me a simple favor. She wanted to find an office where the infection control practices kept her out of “harm’s way.” Kay told me what she had seen while sitting in a dental chair — a lack of infection control compliance.

What if Kay is not alone? What if a quarter of your patients are leaving your practice because of their observations of your infection control practices?

In her letter, Kay said, “I want a dentist and hygienist who treat dental work like surgery in terms of infection control. There’s blood involved here, people! I don’t think it’s asking too much to have my procedures done in a hygienic environment where the gloves that go into my mouth have touched only clean hands and sterile surfaces. The last three dentists I’ve been to used gloves that had touched unsanitary surfaces, both before and after going in my mouth.”

Kay was impacted, and her awareness was heightened by campaigns such as “Clean Hands Save Lives.” She shared, “I realize that I have to be my own champion, but it’s not easy. So now I’m watching infection control like a hawk.” You may think Kay is the exception to the rule. I sent out a survey monkey to a random group of nondental working class professionals. Their replies may surprise you.

1. Have you ever left a dental practice because of infection control issues

24% Yes
76% No

• ”I loved the staff but I was afraid to sit in the chair. The entire time the doctor was looking in my mouth I was staring at a light that had crud on it from the patients before me.”
• “There is no nice way to say this; it was gross. I could see the lab when I walked by and it looked like my college dorm room. That is where they were cleaning the stuff they were going to put in my mouth. They kept going into the drawer with gloves on and then into my mouth. It seemed like a great idea to fix my teeth, but I was afraid I would be dead from some disease.”

2. Have you ever been uncomfortable with the infection control procedures you have seen in the dental setting

42% Yes
58% No

• “I took my mom in to the dentist. She is in a wheelchair so I sat with her and held her hand. I’ve had a difficult time going back to the dentist since that day. What I saw those people doing blew me away. They touched a jar with cotton in it after going in my mom’s bloody mouth.”
• “They touched their face and hair, then went into my mouth. They wrote things with a dirty pen, and then went into my mouth. They opened drawers, and reached in their pockets with gloves on that they used in my mouth. I wonder if they think I’m blind.”

Tip: Review your infection control practices from patients’ point of view. Sit in the chair and see what they see. Have a staff meeting where the entire staff goes from the start to the end of the appointment while reviewing what the proper infection control protocols are.

3. Does your dental health-care professional wear a mask

65% Yes
1% No
32% Sometimes
2% I have never noticed

• “During my last visit the hygienist put on a mask that already had blood on it before she touched me. She kept adjusting it and touching it. I finally told her I was sick to my stomach and left. I ask to see the other hygienist now. I have not gone back in two years.”
• “I laugh every time I see my hygienist because she wears the mask below her nose. If she ever sneezes I’m in trouble!”

Tip: The Centers for Disease Control and Infection states that masks are single-use items. Change them when they are soiled, moist, and between every patient. Wear the mask properly. Cover your nose.

4. Does your dental health-care professional wear gloves

66% Yes
1% No
32% Sometimes
.05% I have never noticed

• “She wears gloves but she comes in the room with them on and I really wonder where they’ve been!”
• I’ve noticed in the past that she will put one glove on and does something in my mouth and then touches her other bare hand. Yuck!”

Tip: Do not put your gloves on until you have washed and dried your hands. Put them on in front of the patient.

5. Does your dental health-care professional wash his or her hands

45% Yes
22% No
17% Sometimes
4% I have never noticed

• “I actually asked her when she was going to wash her hands! She turned crimson red and said, ‘I use a hand sanitizer that lasts a long time.’”
• “I will never, ever go back to that practice because the dentist came into the room to do the exam and never washed his hands. I have told all my friends not to go there.”

Tip: Wash your hands before and after each patient or when someone is contaminated. If the sink is not in the room, come into the room while drying with a paper towel so patients know you have washed your hands.

6. Have you ever had to ask your dental health-care professional to improve his or her infection control practice

22% Yes
54% No
30% I am afraid to

• “I told her that the instrument she was holding and was going to put in my mouth touched the chair. She laughed and said, ‘Don’t worry. We clean the chair every morning."
• “I’ve always wanted to say something but I’m really afraid to. I don’t want to change dental offices, but if it happens again I’ll have to. Last time that little envelope thing that holds the instruments was open and I wondered if they had used them on another patient. I’m already scared at the dentist, so I just closed my eyes.”
• “They were really happy to lecture me about flossing, but when I asked about infection control they got really defensive. If there is nothing to hide, why were they so defensive?”

Tip: Be open to patients’ questions, and immediately make any corrections that patients ask for if they are correct. Make patients aware of the strict standards that are upheld in your office.

This survey showed that almost one quarter of patients have left a practice because of infection control issues. Not one area of the survey reflected completely good infection control practice.

Not all patients are going to have Kay’s forthrightness to ask the questions that are keeping them away from your practice. I hope you will make the changes necessary to keep patients safe. We all know what we need to do. RDH

NOEL BRANDON KELSCH, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists’ Association.