#81 What NOT to have in a Treatment Room

The holiday season often brings cheers, excitement, and patients bearing yummy goodies. Some dental practices go all out with holiday decorations. While we want our patients to feel “at home” in our office, there are certain things that should not be in the treatment room whether it's the holiday season or not.

• CDC Guidelines for Infection Control in Dentistry - 2003 - https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf
• Motion Picture Licensing Corp. Umbrella License for ADA Member Dentistshttps://www.ada.org/resources/practice/practice-management/risk-management/mplc-umbrella-license-for-ada-dentists

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SPEAKER_01 0:04

Welcome. I'm Leslie Cannon. I'm Mary Gavoni.

SPEAKER_02 0:09

I'm Linda Harvey. I'm Olivia Juan. And together we are the Compliance Divas.

SPEAKER_00 0:20

Welcome to this episode of the Compliance Divas Podcast. We bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. We encourage you to subscribe to the Compliance Divas Podcast for your favorite podcast channel or on our website, thecompliancedeevas.com. And the resources we mentioned during our podcast can be found on our website as well as asking you to submit your questions to support at thecompliancedevas.com. My name is Leslie Canham, and I'm your moderator for this podcast. We thought it would be appropriate to have a podcast as we're nearing the end of the year on things that should not be in a dental treatment room. As the holidays come around, we want to make it cozy and fun in our dental practices, and holiday decorations sometimes go up. And while they may seem cozy, infection control and patient safety may be compromised as a result of what we're doing. So I want to focus this Compliance Divas podcast on things that should not be in a dental treatment room, as well as some other subjects that you may not have thought of when it comes to your treatment room. What I'd like to do is start out with our diva Olivia to give us a little quick uh overview of patient care items on countertops that do need to be there, but are subject to aerosols and fallout. Can you share some information and some light on that and how we can better protect our patients?

SPEAKER_02 1:55

Sure, Leslie. One of the things that concerns me, Leslie, when I go on-site to a dental practice is when I see, for example, hygiene rooms or even doctor rooms with lots of supplies out on the countertops. You know, we've learned over the years that within so many feet of the patient's oral cavity is subjected to contamination with the uh aerosol and overspray from the patient's mouth. So when there are items out on the countertop, whether it's floss dispenser or I see a lot of picture frames with the clinical team members' family photos or items like that, or even educational displays and brochures, there's really no way to clean and decontaminate those items between patients. Matter of fact, Leslie, in one office, I saw a stuffed animal hanging off the light mount. Now, obviously, the effort behind that was to make that child feel you know more at home or cozy. But like you mentioned, you know, we want a cozy atmosphere, but it can't be at the expense of cross-contamination. So one of the things that we might put into place is unit dose concept, only setting out what we will use for that patient's appointment and utilizing the cabinetry to put things away. Now, I think we get into that mode of, well, let's save time and have it at reach, but that is not the best practice. Now, in the dental offices that might be older design and they don't have a lot of cabinetry or drawers to put things away, uh, Leslie, they may want to think about purchasing some inexpensive plastic storage boxes that actually have little drawers so that items can be put away and they're protected from aerosol and cross-contamination. So I think all of the divas have seen this when we go on site, and I'm sure our listeners may even see it in their own office. So the concept is to have everything put away. What's your thought, Leslie?

SPEAKER_00 4:17

I agree 100% because I too have been uh of the school of thought that hey, when uh aerosols are generated, they can fall out as far as six and a half feet away from the patient's mouth. And when you think about it, the countertops are within reach of the dentist and the demo assistant, and it's certainly within that six and a half foot range. So the little cabinets, the little uh tiny plastic drawers that you talked about, a great place to store things like cotton rolls or or other items that you might need frequently, unit dosing, if you can estimate what you're going to need for each patient. And of course, what's left over would not be able to be utilized again because it's been aerosolized on. Mary, can you tell us about some other things that should be covered or protected when we're in a dental treatment room?

SPEAKER_01 5:06

Absolutely, Leslie. And I want to add on to Olivia's excellent suggestion about having the plastic containers with the drawers or a cover that you can flip up. Remember that those are great for protecting from aerosol, but if you go in with contaminated hands to retrieve items out of them, then all bets are off. So I always recommend that in every instrument or every procedure set up, there be two sets of cotton pliers, one that are used on the tray for direct patient care, and the other pair that is for retrieving items either out of containers or drawers, and we don't mix the two. You can open a drawer or you can open a cover on a container very easily with the tips of those cotton force, and then go in to retrieve anything you need. Sometimes instrument pickups that might be used in oral surgery would be appropriate as well. The pet peeve that I have going into practices is the burr block. Um, many practices have one common burr block and it sits out on the counter many times uncovered. Sometimes it does have a cover on it. But the best way, in my opinion, to manage burrs is either you use disposable burrs, one-time use, single-use diamonds as well. And especially if those burrs that you're purchasing don't come with reprocessing instructions according to the FDA, that means they are disposable, one-time use. But if you have burrs or diamonds that are not or that do have some reprocessing instructions, are not designated as disposable, then you can put them in a small burr block that goes in with the instrument setup. It can be sterilized in a pouch. Um, the burr block, many of the burr blocks can actually go through the sterilizer. They'll lock the burrs in place. And for the most part, dental practices have a set of maybe three or four burrs that they use for cavity prep or for crown prep that are standardized. So you can standardize those and then have one resource that is covered, that's stored in a drawer, perhaps, for any extra types of burrs that you might need. Technology is an especially tricky thing to keep clean and to prevent cross-contamination on. Um, we did a podcast not long ago about washable keyboards, and you can get um this the washable keyboards, you can get um barriers that you can place over your keyboard so you're not if you're typing with contaminated hands, you're not contaminating the keys. You can protect your mice, you can get washable mice as well. So those are big issues to think about. And also think about anything else in your treatment room that you could or should use a barrier on. I'm a huge proponent of headrest covers because we see damage to um chairs from um sometimes from people's hair care products. They can stain or or leave residue. Um, you can have issues with head lice that you don't want to have to deal with in your practice that can be left behind. So headrest covers, something that is a plastic, which does make it a little slippery if you have pediatric patients, but maybe plastic-backed paper that isn't so slippery, that is impermeable. Um, there are many practices that will use things like dry cleaner plastic. Um, keep in mind that those are not FDA-approved covers or barriers in a practice. And if there's any printing or any ink on those, it can transfer from the heat of the patient, transfer onto your patient chair. And so then your patient chair becomes a walking advertiser for your local dry cleaner, which is probably not what you want to do.

SPEAKER_00 9:25

I'd like to add on to that is that you know, something that I often see in dental treatment rooms is a blanket. If patients get cold because we keep our treatment rooms cooler, uh, if we have three people in there, a lot of times there's the operator, the patient, and an assistant. And even with the hygiene, do we still have uh the hygienist and the patient and either overhead light and it can get very warm? I mean, you know, we feel warm, so we keep the temperature cool for us who have to be in that treatment room all day long. And the patients many times are cold. So a blanket is not a bad idea. It's warm, it's cozy, but this is something that should be not only laundered after every patient, but if it's going to be in the treatment room for the event that you'll need it, it could be in a barrier as well. And that blanket could be in a dry cleaner bag. And I just remember uh when I first heard about the dry cleaner bag uh transferring the ink, that the warning about suffocation, boy, that's the last thing I think I'd want a patient to see when they sit down on a dental chair. No, Mary, thank you very much for that. Our our compliance, Diva Linda, is not with us today, but she did want to mention some other things that we see in a dental treatment room that could be a point of cross-contamination. And you know, speaking of uh pediatric practices, a lot of times there's a toy chest or a reward box. And that type of uh uh incentive to be good may be in the treatment room, but remember that gets aerosolized on as well. And if uh knowing kids as well as I know kids, they got to look at everything before they make a decision, which means they're gonna touch everything and see what they want. So, my uh what Linda would recommend was that we keep the toy chest out of the treatment room so that it doesn't become a point of cross-contamination, and that we let the child point to what toy they want. And of course, we with clean hands can reach in and grab that toy. And if they decide that's not the one they wanted, then we can go back and put it back and get another one. Uh, Olivia did a nice job of mentioning stuffed animals. And again, uh, even patient education animals, stuffed animals uh can be aerosliced on. If they're going to be in the treatment room, they should be either put in a cupboard or a drawer or barrier protected. And then uh for use, of course, we will want to uh demonstrate with clean gloves or clean hands. I think today a magazine rack really is kind of a thing of the past because when we have to have a patient that needs a little bit of extra time where they're going to be sitting without the uh care being provided, maybe a doctor is gonna um leave the room for a few minutes or or the hygienist is gonna go uh process some films or images. Um, the magazine rack can become aerosolized on as well. And with COVID, we took a lot of our magazines out of the reception area for that reason. I think people are perfectly entertained well with their own cell phones. If you do allow them to look at their email or look at Facebook or look at different things while they're in the dental practice, that they can keep themselves entertained. And again, you know, mindful of the privacy regulations, we certainly don't want someone with a cell phone to be taking pictures or recording anything where others could have their privacy jeopardized. Uh, Linda also wanted to point out that sometimes people will entertain themselves by watching streaming videos. And that's fine if it's on their own cell phone or their own device. But many times dental practices will have a monitor in the treatment room or even in the reception area that plays movies or cartoons. Uh, and I don't know that everyone is aware of this. I think I hear a lot of uh surprised um uh voices when I talk about this to people, but uh you actually have to have a motion picture license in order to display movies or in exam rooms to entertain patients. And uh it's considered a public performance. So that's what the license is for. The U.S. Copyright Act uh was adopted in 1976 to provide guidelines for compliance and maintain creativity. So movie and television programs are originally attended, really intended for personal use and require a license when they're shown in a public area. Failure to comply with the Copyright Act is really infringement, and it can result in some liability damages ranging from $750 to $150,000 for illegal exhibition plus court costs plus attorney's fees. So it's best that we comply. Dennis can easily comply with the copyright uh act by having an umbrella license for unlimited uh programs. And there's actually something that is at the American Demo Association, where members and I believe non-members as well can purchase an umbrella license. So that's something to keep in mind that we want to avoid uh copyright infringement. What I'd like to do is just spend a little time with the divas talking about other items that should not be in the treatment room. Mary, have you got something to contribute there?

SPEAKER_01 14:46

I do. Certainly, any kind of food and beverage does not have a place in the treatment room. And a lot of times people will bring their coffee cup into the treatment room or their water bottle. Should not be in any clinical area, not in the sterilization area, not in the treatment room. Um, we need to make sure that we do not set up ultrasonic cleaning units in the treatment rooms, even if you put those um tanks in there with the cover on, there still is the potential for aerosolizing contaminants in that solution. So, not a good idea. It is not a patient care item, it is an ancillary item, should not be in there. Um, and in terms of um other types of things, no cosmetics, no, we shouldn't keep our lip balm in the treatment room or saline solution or any of those kinds of things, no cosmetics or any of those kinds of things in treatment rooms.

SPEAKER_00 15:47

Olivia, would you like to take a point of other things that should not be in the treatment room?

SPEAKER_02 15:52

I think Mary summarized it really well. I I wanted to share a thought. I was going over this information with a team member about not having, you know, water bottles and coffee cups in the treatment room. And she said to me, Well, what about these animal cracker crackers in my lab coat pocket? And she opened up the pocket of her jacket, and sure enough, there were animal crackers in it, just loose in her jacket coat. So I think there's room for us to improve in this area, and keep in mind it's safety for the employees as well as safety for our patients.

SPEAKER_00 16:32

That's a very good point. And when we're talking about patient safety, I think today, really, unless there absolutely has to be a family member or a caregiver in the operatory, that we shouldn't have other people that are exposed to the aerosols or to the procedures that we're performing. And so again, you know, a lot of times parents have to accompany a child or a caregiver as necessary. But if it can at all be avoided, I believe that's the the best practice, thinking, keeping in mind that we have about six and a half feet that aerosols are going to be generated and land on other people. I think we did a good job of covering cell phones. And, you know, again, during the holidays, I know we like to keep our practices cozy and home-like, but uh candles, live candles, have no place at all in a dental setting. Now they are cozy and warm, but you can use the little LED light candles and you can use other types of fragrance diffusers or other type of uh way of making a dental practice smell more festive or smell better. And uh Mary, you wanted to contribute something here. Why don't you tell us a little bit about your thoughts?

SPEAKER_01 17:41

I did, and and I have um my observation during my dental hygiene, my dental assisting days has always been like in the with pediatric patients, that they tend to behave better many times when the parent isn't in the room. And a disincentive for parents to be in the room would be to ask them to wear a face mask for respiratory protection, since everybody else is and they're exposed to the potential aerosols in the treatment room that we tell them, you know, if you are going to stay, you will need to have a face mask on, just like we wear. And many times that discourages them.

SPEAKER_00 18:20

Boy, that's a good point. You know, I was in a dental practice not long ago where they had um the uh artificial intelligence. So, you know, they would as Lexa or if you have Siri, and uh they suggested that maybe if you're gonna have that for patient comfort, maybe to play music and or do other things, uh, you know, ask the weather, that that you turn off the microphone during patient care because they're always listening. It's artificial intelligence, and so uh conversations that we have in a treatment room are protected health information. I also found uh dental practices that in most of them are using some kind of flooring that is uh easy to clean flooring, but we still have uh offices that prefer carpet to keep the echo down and the noise down in the treatment area. Uh CDC recommends that we veer away from carpeting and cloth furniture upholstery because it is difficult to clean it. And if you think about what it would take to keep that carpeting clean, how often are you going to uh either rent a carpet cleaner or own one and spend that time cleaning the carpeting and cleaning the upholstery to make sure that it's safe? And then I think probably the most unusual thing that I've seen in a treatment room was um a birdcage that had a bird in it. And I thought, well, you know, it wonderful pet type of oriented practice. But uh yeah, I think the only reason I could see for having a bird, a live bird in a birdcage in a treatment room would be to test to see if the air is safe, if the bird is dead. Probably not a safe treatment room. But when I think about that, there may be people who do have allergies to birds. And so that's possible that the bird droppings could create an issue. And um, so again, we want to be uh use common sense with what we bring into a treatment room. And one Halloween I did see the uh the spider web type of netting stretched across the uh where the overhead light was and and around the window dressings. And I think about how much aerosol is generated and how it's caught on that. How do we clean appropriately? What about plants? Are we gonna, I know that they again bring a nice air of greenery and and and look alive. We want all of that to be again like we're in a home, but at the risk of cross-contamination or uh maybe infection control protocols. So, with that, we have wrapping up our podcast on what should not be in a dental treatment room. And we talked a little bit about some laws to follow and patient privacy and infringement. In closing our podcasts, I want to remind our listeners that we like to bring clarity and simplicity to compliance by navigating the regulatory compliance world to keep you on course. Please submit your questions to support at thecompliancedivas.com and share this podcast with your friends on their favorite podcast channel or at thecompliancedivas.com.