General Practice Hygiene – An Immaculate System

Gloves – Vital for Your Personal Safety

Wearing gloves when in contact with infectious materials has proven to be a highly effective protective measure against infection. Gloves protect both the dental team as well as the patients from nosocomial infections. They also shield irritated or injured skin of the hands. Germs are prevented from penetrating the body through these irritations and lesions. At the same time, gloves prevent germs from leaving these hand wounds contaminating the environment.

Unsterile gloves should be used for non-invasive treatments, whereas sterile gloves are required for all invasive operations and procedures. Gloves should always be changed between patients and be disinfected after they are put on. Wearing gloves does not make hand disinfection redundant. Gloves must be elastic, tear-proof, sturdy, and impervious to all fluids and chemicals. The choice of the right glove size is of utmost importance; gloves that are too large will slide on the skin or negatively affect the tactility, whereas gloves that are too small are uncomfortable and restrict the movement. 

Make sure you use gloves that meet the EN 455 norm. This standard regulates the requirements for the biocompatibility and the quantity of soluble proteins and allergens of disposable medical gloves. Various materials (latex, vinyl, and nitrile) fulfill these criteria. In dental clinics, latex gloves are primarily used, as they have optimal characteristics and are very safe. The disadvantage of latex gloves is their relatively high allergenic potential. Many latex protein particles end up on the skin and in the airways. A latex allergy is an immediate-type allergy, i.e., symptoms such as itching or “sniffles” first appear within 5 to 30 minutes after contact with the skin. Should no such symptoms arise within this time period, the gloves can be worn without any further concern.

Which Material is Good for Me? 

According to the TRGS 540 (Technical Rules for Hazardous Substances), latex gloves may no longer be powdered. The powder dust serves as a transport vehicle for the latex proteins, allowing them to spread through the air. 

While disposable gloves are used during the treatment of patients, rubber household gloves are used in the instrument reprocessing room. They are used for the disinfection and cleaning of instruments and thus must be solid, impenetrable, and low in allergens. As these gloves are to be used repeatedly, they must be disinfected after wearing.

Further Protective Measures

The face masks serve to protect the dental team from the inhalation of germ-contaminated aerosol; it also protects the patients and staff from cross-contamination.

The effectiveness of the mask lies in its filtration performance, which is only possible when the edges of the mask fit snuggly against the face. Multilayer dental masks are especially safe, as they can be fitted and adjusted by means of a flexible bar in the nose area. The mask must be replaced when there is a likely contamination or after becoming moist. Dentists and their teams often lower their mask between two treatments in order to have a more personal  conversation with patients. Doing so increases the risk of germ transmission to the face when readjusting the mask.

Safety goggles and visors help protect the eyes from blood particles, pieces of tissue, and other infectious materials. It is important that the goggles cover the sides. Goggles need  to provide distortion-free and nonrestrictive peripheral vision. Visors are suited especially for wearers of glasses. Even when visors cover the entire face, masks must be worn. Safety goggles and visors should be cleaned with a surface disinfectant after every treatment.

Practice shoes should be disinfected weekly with a surface disinfectant. If disposable shoe covers are used, they should be changed after every treatment.

During invasive surgery that puts the patient at an increased risk, all medical staff should wear head caps. Choose the correct size and position the cap properly.

Gowns and drapes serve to protect the patient. If they are not made of disposable materials, they must be changed and washed after every treatment.

Disposable Instruments, Waste and X-ray Chemicals

 The disposal of waste of a dental clinic depends on the type and the origin of the waste. 

Contaminated waste from patient near areas should be collected and sealed in thick and stable containers or bags and disposed of as household waste. The disposal of this waste in the practice should occur as frequently as possible; if storage becomes necessary, the waste should be kept in the red zone. 

• Contaminated disposable instruments, defective instruments, and other pointed, sharp, or fragile objects should be placed in sealed, impenetrable containers and disposed of as hazardous waste. There are special impenetrable containers available specifically for this purpose. When disposing of cannulas, they must never be recapped, as this action raises the risk of a needle stick injury. A cannula should be inserted into the collection container with one hand; while keeping the other away.
• Microbiological cultures, such as saliva tests, are also to be safely sealed and disposed of as household waste.
• Used disinfectant solutions should be drained as waste water. The product will not pollute the environment thanks to the biodegradability and further dilution of the disinfectant. Nevertheless, the manufacturer’s instructions regarding disposal should still be read and followed.
• X-ray chemicals (e.g., film developing chemicals, fixing solutions, as well as X-ray packaging) must be disposed of as hazardous waste and given to a proper disposal company. The disposal must be documented.
• All waste containing mercury (e.g., amalgam waste, extracted teeth with amalgam fillings, empty amalgam capsules, as well as amalgam-containing disposable articles such as cotton rolls or wedges) must be sealed in airtight containers and given to a disposal company. The process must be documented. 

Suction Technique and Dental Dams

Proper suction techniques and the use of dental dams help protect against infection right at the source.

The correct suction technique considerably reduces the number of germs in the aerosol by drawing the saliva out of the patient’s mouth. However, to be effective the suction must be systematically employed right from the start of the treatment. Regardless of treatment area, the opening of the saliva ejector must lie where saliva and cold water are converging. The saliva ejector and the hose should be positioned so that the saliva cannot back up into the patient’s mouth.

The dental dam serves to shield one or more teeth from the rest of the oral cavity. It is made of a flexible material (usually latex) and is fixed in the mouth with clamps and dental dam forceps. The goals of the dental dam include the following: 

To avoid the swallowing of foreign particles such as amalgam or crown pieces as well as pathogens 

• To create a clear and dry work environment 
• To send gentle, aerosol breathable air through the nose
• To provide an opportunity for the disinfection of the work area
• To protect both patients and dentists from infection

The development of a new generation of dental dams has greatly raised the level of comfort for patients and allows for a quick and simple installation. Powder and latex-free dental dams and dental dam napkins further reduce the risk of allergic reactions.

Diseases of Dental Staff

There is always the risk of a cross-infection between team members and patients. Yearly medical examinations and health checks are used to monitor the health of the entire dental staff.

Transmission of minor infections can be avoided by wearing a mask and proper hand disinfection. Any team member suffering from a temporary illness such as flu should remain at home. A doctor’s note determines the duration of the absence from the job. Work related skin diseases may result  in a temporary inability to work. If the disease takes a serious course, it could become a recognized occupational matter. The cause of this dermatological problem could be skin contact with chemical or allergenic materials, which could possibly turn into eczematous changes on the entire skin of the body. At that point, disinfection of the hands is not only painful but also impossible. The healing of the skin is a mandatory requirement for being allowed to return to the dental clinic.

Well Protected with the Recommended Vaccinations

Vaccinations are one of the most important preventative health measures. They are normally well tolerated and protect the vaccinee for a long period of time. Furthermore, a vaccination prevents the vaccinee from spreading the infection to others. Were the entire human population to be vaccinated, many diseases would be effectively eliminated. This was successful, for example, for smallpox, which appeared for the last time in 1977 in Somalia.

However, in recent years, these efforts have been undermined by parents who chose not to vaccinate their children. Without a legal requirement for vaccination, every person may decide which vaccinations to receive. Sometimes people ignore the fact that vaccinations represent an opportunity to protect people from diseases rather than an outdated obligation.

Recommendations for Vaccinations:

Swiss Vaccination Plan created by the Federal Commission on Vaccinations of the Federal Ministry of Health 

• Standing Commission on Vaccinations of the Robert Koch Institute (STIKO) 
• The German Committee for Hygiene in Dentistry (DAHZ)

Recommended Vaccinations for Employees of a Dental Clinic 

Proper vaccinations can be found in the Recommended Vaccinations for Children and Adults as well as the publication regarding Vaccinations for People with a Raised Risk of Exposure. The following vaccinations are recommended for medical personnel working in a dental clinic: tetanus, diphtheria, influenza, measles, mumps, polio, rubella, pertussis, hepatitis A, hepatitis B, and chickenpox.

Post Exposure Prophylaxis

Post exposure prophylaxis (PEP) has the goal of avoiding the outbreak of a disease by taking quick measures after the body has already been exposed to pathogens. The measures consist of a topical and/or systemic treatment.

 Measures for Cut or Needlestick Injuries and Contamination of the Skin, Eyes, or Oral Cavity in a Patient Near Practice Area