In-a-rush infection control: Skipping a step or two is not an option for dental clinicians

If you are looking for something to do, might I make a suggestion? Stop and step back for a minute. Sometimes I feel like I am in such a rush to get things done in the dental setting that I simply do not have time to even think. Being in a rush can really put people at risk. The Occupational Safety and Health Administration (OSHA) reports that rushing is the number one factor behind accidents.

By not rushing, you can prevent injury and save time. Taking the time to do things properly and preventing an injury that leads to the need for medical care can make a dental office more efficient. Think about the long-term consequences. Are you really saving time by rushing?

So, what do I need to do?

When you are behind in the schedule, or in a rush to get things done, follow some simple concepts:

• Know what is required, and plan for those needs. The Centers for Disease Control and Prevention (CDC) and OSHA develop great regulations when it comes to bloodborne pathogens and other potentially infectious materials. There has to be time in the schedule to continue to educate and implement the those standards. For example, the engineering and work practice controls in relation to sharps are to be reviewed annually, as well as needed, and should be considered when we are in a rush. Look closely at what is being asked in these controls (they do require time and effort and simply cannot be rushed):
  1. Identify, evaluate, and select devices with engineered safety features at least annually and as they become available on the market (for example, safer anesthetic syringes, blunt suture needle, retractable scalpel, or needleless IV systems).
  2. Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers located as close as feasible to the area in which the items are used.
  3. Do not recap used needles by using both hands or any other technique that involves directing the point of a needle toward any part of the body. Do not bend, break, or remove needles before disposal.
  4. Use either a one-handed scoop technique or a mechanical device designed for holding the needle cap when recapping needles (between multiple injections and before removing from a nondisposable aspirating syringe)
• Do not leave the basic concepts behind. When we are in a hurry, we often think we can save time by simply skipping a step. With infection control, you put everyone at risk by skipping any steps in the process of prevention. For example, if you do not sterilize your handpiece between patients to save time, the CDC’s “Summary of Infection Control Practices in the Dental Setting Basic Expectations for Safe Care” states “Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high-level or surface disinfected. Although these devices are considered semicritical, studies have shown that their internal surfaces can become contaminated with patient materials during use.” If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially infectious materials. Steps involving personal protective equipment, cleaning and disinfecting clinical contact surfaces, etc. cannot be skipped or cut.
• Be realistic with the schedule. The schedule can be a major player in the need to rush. It is easy for it to get out of control. We have to look at what time factors are involved. It is important to train all staff on infection control, including those who work at the front desk and manage the schedule. They need to be aware of the processes and time involved. For example, if I am using an EPA-registered disinfectant on clinical contact surfaces to turn a room around and the directions state that there is a 10-minute wait time, a patient could not be seated in that chair until the kill time is over.The scheduler will have to schedule accordingly, giving ample time to clean, disinfect and wait.
• Plan and cross train. When things are backed up, have a plan-ahead time. Who can help get things back on track? What will their assignment be to get things caught up? I was in an office last week where all the staff in the front and back are cross-trained. If things get behind in the back, the front office staff has assignments and immediately go into action. It was great seeing the receptionist don personal protective equipment and process instruments. She shared that, when things are crazy at the front desk, the dental assistant is trained to answer phones and assist with scheduling appointments.

Planning for times when we need to use time manage efficiently is so important in infection control. Skipping steps is never an option. Knowing duties and cross-training for procedures is the key. RDH

Who takes care of me?

The agency that was developed to take care of you is the Occupational Health and Safety Administration (OSH)A. They do not take care of patient issues at all unless the patient is impacting your health and safety. They are there to make sure you go home safe at the end of the day. They were developed to ensure safety in the workplace.

OSHA establishes safety and health standards, and it ensures workplace compliance through inspections. Working in cooperation with the Centers for Disease Control and Prevention (CDC), OSHA implemented the Bloodborne Pathogen Standard in 1991 to protect health-care workers from occupational exposure to pathogens. Something we should all be following. They want you to go home healthy at the end of the day.

NOEL BRANDON KELSCH, RDH, RDHAP, MS, 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.