While visiting and working in many different practices, I have seen varying approaches to managing metal bib clips. Metal bib clips are common for fastening napkins onto patients. Years ago, hygienist Noel Kelsch wrote about bib clips being an infection control issue, yet their usage continues.1
Why are we still using metal bib clips when we know they pose an infection control risk? Are there better alternatives to prevent cross-contamination and keep our patients safe? Unequivocally, yes, there are.
A source of cross-contamination
Although bibs or napkins are single-use disposable items, the clips are for multiple patients. The Centers for Disease Control and Prevention (CDC) recommends they be wiped down with intermediate, EPA-registered hospital disinfectant with a tuberculocidal claim before reuse on the next patient to reduce the risk of transmission.2
One study showed that metal bib chains may still harbor bacteria and remain a source of cross-contamination even after following proper disinfection procedures.3 One study showed that using an intermediate disinfectant lowered the microbial load but did not eradicate it, meaning that the risk of infection remains.
Another study by Kelsch found increased levels of microbial contamination in the nooks and crannies of bib holders, including the area beneath the smooth tubing.1 Bacterial concentrations were comparable to those seen in airport toilets. It is worth noting that these samples were cleaned with hospital-grade disinfectant before testing.
In line with Kelsch’s findings, research by the University of North Carolina found that one in every five disinfected bib clips tested contained considerable bacterial levels.4 Notably, the source of contamination was due to the accumulation of plaque and saliva, in which high concentrations of Escherichia coli and Staphylococcus aureus were identified. Although research has yet to document actual transmission, some bacteria can become opportunistic pathogens in the right physical conditions, putting susceptible patients or clinicians at serious risk.
Indentations and crevices where bacteria can thrive
Given the proximity of bib holders to the source of infectious aerosol and spatter during dental procedures, it is no surprise that they hold a heavy load of pathogens. Considering the shape and design of metal bib chains, with their many crevices and indentations, it becomes even more apparent how and where bacteria can thrive despite wiping them down between every patient.
It can be difficult to ensure complete decontamination, whether you’re using the traditional chain made of small cylindrical metal balls with clips at the end or the newer designs with smooth tubing.
Corrosion of metal clips after disinfection
I recently went into an office where they sterilized the bib clips between each patient, which was exciting. (Don’t judge—these are things that make me happy when walking into new dental clinics!) However, my excitement was short-lived because the sterilization process was causing the metal clips to rust, making it a less than optimal and reliable solution. Using rusty equipment poses another health hazard: the clips then can’t be sufficiently cleaned and sterilized.
Alternatives to metal bib clips
The revelation that infectious pathogens flourish on metal bib clips even after disinfection is cause for concern. We know that it is possible to lower the bacterial load by thoroughly sterilizing the clips between patients, but the chances of the metal rusting are too high and dangerous to ignore.
The type of clip used is an important consideration. In general, the smoother the surface, the less chance of inaccessible areas harboring microorganisms. The sensible option is to only buy clips that can withstand sterilization and avoid ones prone to rusting. And best of luck finding those. Explore bib holder options with no chains, embossing, or any cavities where bacteria can remain.
Smooth surfaces are also much easier to clean and disinfect. However, although bib holders with rubber tubing have smoother surfaces, their hollow inner area is inaccessible for cleaning or sanitizing, giving bacteria a chance to thrive.
The solution: single-use, disposable bib holders
One method that can truly remove any source of contamination and is easy to implement is utilizing single-use, disposable bib holders. Cost-wise, it will not make much of a difference. Disposable bib holders also save time because there’s no need for cleaning or sanitizing after each use. Most important, they eliminate any possibility of cross-contamination.
By switching to single-use, disposable bib holders exclusively, it is possible to eradicate any potential for infection from this aspect of treatment. Although using metal bib clips has long been the norm, it is high time to make some changes to protect patients and employees better while upholding high safety standards in your office.
References
1. Kelsch N. Don't clip that crud on me. Accessed May 24, 2022. http://www.noelkelsch.com/wp-content/uploads/2011/06/Bib-Clips-Dont-Clip-That-Crud-on-Me.pdf
2. Disinfection and sterilization guidelines. Centers for Disease Control and Prevention (CDC). Accessed May 24, 2022. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/index.html
3. Molinari J. Microbial contamination of patient napkin holders. Dental Advisor Microbiology Research Report. Accessed July 8, 2022. https://www.dentaladvisor.com/pdf-download/?pdf_url=wp-content/uploads/2021/03/RR29_Microbial-Contamination-of-Patient-Napkin-Holders_Research-Report.pdf
4. Dental bib clips can harbor oral and skin bacteria even after disinfection, study finds. Forsyth Institute. Accessed May 24, 2022. https://www.sciencedaily.com/releases/2013/04/130402091651.htm
