Dirty Little Secrets
Q&A winner announced for 2009
By Nancy Andrews, RDH, BS
Editor’s Note: Are your customers asking tough hygiene questions? Here is your chance to ask someone "In the Know." Nancy Andrews, RDH, BS, will take your questions and tell your tales. Pulling from centuries of experience, endless education, lots of research, and occasional consultation with other experts, Nancy invites your e-mails at Infectioncontrol@mdsi.org. The best question or tale at the end of the year gets $100.
This year reps sent in great questions and stories. We’ve discussed putting Drano down suction lines, using over-the counter soaps and cleaners, bars of soap versus liquid – and the subject of refilling soap containers, the impact of moisture on masks, latex allergies and glove powder, sticky and clumsy surface barriers, the risk of getting stuck with the part of a used needle that goes into the anesthetic cartridge, and how you disinfect dentures and cases going to dental labs. We’ve had some fun and shared secrets about the nitty gritty of dental reality. It was hard to pick the best question, but we settled on the following from Brian Evans of Goetze Dental, because it reveals a practice that probably goes on far too often. Sometimes the motivation to discard waste illegally or shortcut recommended formalities is laziness – sometimes it’s a desire to save money: but it always disregards the health and safety of others. In a world of increasing consciousness of the environment, we in dentistry have an even greater responsibility to do what is right. I admire the rep who respectfully and creatively tries to facilitate the solution to problems like these, and who has obviously built rapport and trust with clients. Thanks, Brian!
$100 Q&A Winner: A story with a point!
Q: I have a good relationship with an office manager and recently asked her what they were doing with their Sharps disposals. At first, she just smiled. After a little prodding, she informed me that the dentist has the staff throw their sharps containers in dumpsters. She knows this isn’t the right thing to do, but she does her job and doesn’t question the boss. She also said the staff probably doesn’t know any better because they have been doing it for years. This is how they train their employees. I’m in shock.
A: I’m afraid it may not be as rare as we hope. They are lucky to have you helping them BEFORE the health department, EPA, the State Dental Board or OSHA get involved. Worse yet would be the personal tragedy and possible legal issues of an accidental exposure. Waste disposal laws are plainly written in OSHA’s Bloodborne Pathogen standard, and each office should have a written Injury and Illness Manual that directs the legal and safe disposal of sharps and other hazardous waste. If the office is not attending annual OSHA training and other infection control continuing education courses, I’d strongly encourage them to do so. I trust you to hook this office up with a compliance program and all the supplies they need to put it into place.
The flip side
Q: I noticed that a customer hadn’t ordered gloves on the usual schedule, and asked how their glove supply was, and if they were happy with the gloves I’d been supplying. Understand, with the economy slow, I suspected a reduction of patients. The answer I got kind of threw me though, because they had decided to economize on supplies, and felt that they were wasting too many gloves when they had to interrupt one task and go to another, then return to the first task or patient. The doctor had everyone take their gloves off to leave the patient, then put them on again when they returned rather than get new a pair. The assistant asked, "Is it OK to take gloves off after being used on a patient, keeping the outside out, laying them down on the tray and re-using them again on the same patient?" I said I was sure it was not recommended, but exactly how do I explain the problems with this? Or, is it a logical and OK thing to do, at least during hard times?
A: You are right, gloves should not be removed and re-used, even on the same patient. This practice is not recommended because it’s almost impossible to perform without cross-contaminating and/or damaging gloves. Gloves are categorized as single use disposables, and the "single use" refers to a single procedure – not a single patient over time, with interruptions where the gloves are removed and re-donned. The process of taking gloves off aseptically involves inverting the gloves inside-out as they are removed, then discarding. If gloves are taken off while keeping the outside out, workers are likely to contaminate themselves, and also the inside of the gloves. The pulling and stretching necessary to remove gloves may also damage the gloves, creating pin-holes or thin spots that can fail during use and allow contamination to pass through.
I once saw a doctor remove, invert and then blow into his gloves to get them right-side-out. I saw a dental assistant use the air-water syringe to accomplish this. While that is better than using her mouth, it still manipulates gloves in a way that is likely to cross-contaminate and may damage the glove so the glove is a source of contamination and no longer a reliable barrier. Infection control should never be compromised to cut costs, the possible risks associated with these shortcuts are too serious. Hopefully you can find alternate economic solutions for this account.
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