Food in the dental setting

by Noel Kelsch, RDHAP
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I am not a picky eater. I will eat just about anything as long as it does not have a face. Yes, as a matter of fact I am a tofu-eating, vegetable-gravy-ladling, hummus-indulging vegetarian. My choice in cuisine has been the brunt of more than one joke with the columnists and editor of RDH magazine. I do not know how the subject started, but at one point humorous conversations escalated to the point where someone took the initiative to fulfill my worst nightmare – they sent me a box of Spam, Vienna sausages, chipped beef, and many things that I simply chose not to identify.

Somehow this jovial banter turned into a complex conversation about Spam. In light of the kind gesture and conversation, I have gathered gifts during my various travels for Mark Hartley – chili-flavored Spam from Mexico, Panamanian Spam from my adventures in Panama, and others. As we friends and authors discuss our likes and dislikes, I find it very interesting that our choice in food literally reflects our culture, life, and likes and dislikes. Having a safe place to eat and store these foods in the dental setting is a vital part of any infection control program.

Dress for the occasion: The Guidelines for Infection Control in the Dental Setting 2003 remind us that we must remove our personal protective equipment (PPE) before we leave the work area. This includes masks, protective eyewear, face shields, gowns, lab coats, and gloves. None of these should be present in areas that are designated for eating. Remove PPE and then perform hand hygiene tasks before touching or handling food to limit cross-contamination.

Where shall we eat? The Occupational Safety and Health Administration Bloodborne Pathogen Standards have been very specific about just where we are supposed to be eating and drinking. It states: "Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure." Food and drink should never be in the operatory or lab areas. It is vital to have a separate designated area for eating and drinking.

What else do we have to remember? Occupational Safety and Health Administration Bloodborne Pathogen Standards also tell us that "food and drink shall not be kept in refrigerators, freezers, shelves, cabinets, or on countertops or bench tops where blood or other potentially infectious materials are present." Food should not be stored where there is a chance of chemical contamination or food-contaminating dental materials. There should be separate refrigerators for food and dental materials, blood, and other potentially infectious materials. A designated safe area outside the operatory and laboratory for staff to store their food, take breaks, and eat lunch is a vital part of any infection control program.

I am not your mother: When my son was in fifth grade, he forgot to do his science project. He called me at work with his dilemma. As I was leaving the office, I grabbed my lunchbox and found his science project in our office fridge. The leftover moldy lunches that everyone had abandoned were soon converted to an award-winning project. One area of infection control in the dental setting that is often overlooked is the kitchen. Many times in the rush to get back to our patients, we overlook the steps for keeping this area safe.

So who do we charge with the responsibility of what happens in the kitchen in our dental practice? It is important for all staff members to be involved in this process. Address the subject in a staff meeting. Be sure to involve every staff member in the process. Ask one person to review the regulations during the meeting, someone else write down all the challenges of compliance, and then yet another team member write out the solutions. Formulate a plan to keep everyone in the dental kitchen setting safe, including the staff.

Here are some suggestions for solutions:

1. Set aside a designated area for storing food and eating food. Have two separate refrigerators for food and dental materials.
2. Let all office staff members know that the refrigerator is emptied every Friday (or the last day of the week). This will eliminate the risk of spoiled food being in an area that could cross-contaminate other food.
3. Ask everyone to wash their containers after eating so odors do not linger. If they forget to take their containers home, keeping them clean will help reduce the chance that they become a source of contamination or an attraction for bugs.
4. Do not allow anyone to bring PPE into the staff kitchen area. Post a reminder about the CDC guidelines.
5. Involve everyone in the process of keeping the room clean. Assign each person a day of the week that his or her task will be checking the room at the end of the day. This will also help keep out vermin and bugs.
6. Post what is expected when people are using this area. For example, in one office there was a nice laminated checklist. It listed things such as Did you wash and dry the silverware you used and put it back in the drawer?
7. Use the proper cleaners for the room. Remember that food is going to be prepared in this area. You do not want to put chemicals that could be toxic on the surface, because the food could become contaminated. This is not an area where blood-borne pathogens are going to be present. It is vital to have a household cleaner, not a hospital grade disinfectant, for this area.
8. Replace clothes for cleaning and wash frequently (at least daily). If you do not have a place to wash the clothes, use disposables. Sponges, washcloths, and dish towels can be a harbor for bacteria. Use paper towels to clean anything that could cause cross-contamination such as poultry or meat. Do not wash dishes in the lab sink or operatory sink.
9. Have separate chopping boards for food and meat. Clean them after each use.
10. Do not leave things to soak. This is just putting off what needs to be done.

Each of us has foods that we enjoy ... foods that reflect our own individual personality and life. At the end of the day, we should all be able to return home healthy and safe after working in the dental setting. Following the guidelines for eating and drinking in the dental setting will allow all of us to do just that.

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.