The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#135 Cross-Contamination via the Hands of Dental Workers
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Have you ever thought about the non-patient care items you may touch during a procedure or even the possibility of contaminating yourself when removing contaminated PPE? You may unknowingly be spreading contamination throughout the office. Check out this episode for key reminders, tip, and resources for the entire team.
Resources:
- CDC Guideline for Hand Hygiene in Health-Care Settings - 2008, updated 2019 https://www.cdc.gov/mmwr/pdf/rr/rr5116.pdf
- CDC Poster on Donning/Doffing PPE: https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf
- Guidelines for Infection Control in Dental Health-care Settings—2003 https://www.cdc.gov/mmwr/pdf/rr/rr5217.pdf
- If Saliva Were Red Video https://www.osap.org/if-saliva-were-red
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_02I'm Linda Harvey. I'm Olivia Wan. And together we are the Compliance Divas.
SPEAKER_00Welcome to the Compliance Divas Podcast. We bring clarity and simplicity to compliance by navigating the regulatory compliance environment to keep you on course. We ask you to subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, thecompliancedevas.com. And the resources that we mentioned during this podcast can be found on our website, thecompliancedivas.com. If you have questions, send them to support at thecompliancedivas.com. My name is Leslie Canneman. I'm your moderator for this particular podcast where we talk about cross-contamination from the hands of dental workers. In our episode number 35, we talked all about hand hygiene. And I think one of the areas that I observe as an infection control consultant is that sometimes we don't realize that cross-contamination can occur from our hands to our patients, to patient care items, to ourselves. And of course, that creates quite a jeopardy for the practice when we put ourselves and our patients at risk for cross-contamination. So today, what I'd like to do with the divas is just cover some of the things that we should be wary of. First, our diva, Mary, is going to give us some of the information we need to know about what happens when we contaminate ourselves. Mary, can you take it from here?
SPEAKER_01Absolutely, Leslie. One of the things that we are told consistently by infection control experts and by the CDC is that our intact skin on our hands is one of the best barriers against infection. So anyone who is experiencing cuts or scratches or some type of dermatitis on their hands, even if you're wearing gloves, is still at risk for some type of an infection because there's a portal now into the body through the skin. And one of the things that we tend to overlook a lot are our cuticles. And especially now as the weather is turning a little colder, your skin gets dried out a little more, you may have hangnails or just some cracks in your cuticles. So hand care, making sure that you have in-tech skin and in-tech cuticles is critical. Make sure that you use a hand cream frequently that is compatible with the type of gloves that you use in the practice. And you can purchase cuticle oils or um like a bomb, um almost like a petroleum jelly type of product, and even petroleum jelly works to massage into your cuticles. I wouldn't do that during the workday because that might not be compatible with your gloves, but certainly at night, um, the best thing to do before you go to bed is to massage that oil or that ointment into your cuticles and put some good hand cream on to keep your skin intact. So there are a number of diseases, including ringworm, that have been contracted by dental professionals from non-intact skin or wearing jewelry where there's moisture that collects underneath their jewelry when they have their gloves on. So all of those things make a big difference.
SPEAKER_00Linda, can you tell us about how we might uh consider the donning and doffing of PPE in protecting ourselves from cross-contamination?
SPEAKER_03Leslie, when considering doffing or removing PPE, we must be mindful whether we're cross-contaminating ourselves during this process. I think we would all acknowledge we've experienced many sudden and dramatic changes in our PPE and infection control processes during the peak of the pandemic. And now that we are accustomed to having COVID-19 in our environment, similar, say, to a cold or flu, I see many offices going back to their old habits pre-COVID. I'll give you several examples in just a minute. First, I'd like to remind our listeners to maintain self-awareness about what you're touching during patient care as well as what you're touching when it comes to DOffing your PPE. Stop and think for a moment. How many times a day are you removing contaminated PPE as part of your everyday workflow? When it comes to removing PPE, it's best to go back to basics and look at the CDC poster for donning and doffing PPE. The CDC has a very informative two-page poster on the sequence of DOffing and donning PPE, both in English and in Spanish. We'll make sure a link to that chart is in today's show notes. The important thing that I want to point out here, Leslie, is that it's almost impossible to remove contaminated PPE without contaminating your hands. So this lends itself to the awareness and the importance of practicing hand hygiene after removing all of our PPE and maybe even in between removing different items of contaminated PPE when necessary. Remember that the outside of the gloves is contaminated, so be careful. There are several techniques to properly remove your gloves where the gloves end up inside out in lieu of and in lieu of trying to explain that sequence. Next is removing the face shield or your goggles. If you're wearing a face shield, you can certainly reach behind the back of your head to remove it where it's a little less contaminated, say than the front of the face shield. And when removing your goggles, consider reaching up by your ears where it may be just a little bit less contaminated than say touching the front of your goggles. Here's where I see a bad habit rearing its head. That's with our doctors and hygienists who wear loops. When the loops with contamination are removed and they're worn around the neck while performing other duties or even when leaving the clinical area, I see this happening more and more. And Leslie, I even see it in office pictures where the doctor or the hygienist is being a picture is being taken. It's not a patient care picture, but they're wearing a jacket and the loops are hanging around their neck. You have to wonder are those contaminated items? Well, on the CC poster, removing the gown is next. And when it's a disposable gown, you can untie the strings at the back of the neck and bringing the gown down inside out, you know, roll it up into a bundle so you can discard it. If you're unsnapping a scrub jacket, likewise, this this may be one tip for you. You may have another strategy, but try to grasp the jacket from near the inside, near the bottom, on the inside of the jacket, and go kind of underneath, and then unsnap it from the bottom up. Next, the CDC guidelines say that we should remove our mask or respirator. Here's where I see a second bad habit rearing its head again. I'm seeing teens and doctors remove the gloves first and then with that bare hand pull down that contaminated mask under their chin to speak to a patient. And I think we all feel the same thing. The mask feels like a hindrance or an obstacle to effective patient communication. And I certainly understand that. Consider instead, though, removing your mask by grabbing it with your pinky, perhaps under your earloop, and then remove the mask carefully so that you're not contaminating yourself. By all means, don't place the mask in your pocket or think you're going to use it for another day or another patient. Mask or single-use items. Divas, as I kind of close up my thoughts on this, I'd like I think we would all agree. Our clients and audiences work hard to create the professional demeanor and brand for their practice. And nothing tarnishes it any faster than sloppy habits such as wearing masks under your chin. I would love to see our wonderful listeners share this podcast at a team meeting and encourage everyone to review their sequence for donning and doffing BPE. Back to you, Leslie.
SPEAKER_00That's right, Linda. And I think the important thing to think about when it comes to patient protection, it is not fair to the patient if we don our PPE in a manner as so to contaminate it before we handle their patient care items or we work in their mouth. And it's also, again, not fair really to ourselves in trying to protect ourselves if we are donning our PPE in the wrong order and contaminating our hands or contaminating surfaces. So the order that is on the CDC poster, which we will have on our website, we'll make a little note uh as well. We'll have it on the show notes as well, that that donning the or doffing the eyewear should be number one and not the gloves. And not to be um afraid to wash your hands multiple times. If you if you've taken off your gloves and then you take off your clinical jacket and you think your hands may have been contaminated again in that process, you can perform hand hygiene as many times as you want. We just don't want to not do it enough and we don't want to doff it in the wrong order. One of the other things that I see frequently when I visit dental practices is cross-contamination that is inadvertent. And one of the things that seems to come up most frequently is when somebody or a team is treating a patient and they have to get a needed item that is not readily available on their treatment tray. So it means either opening a drawer or getting up and going into another room and coming back with the item. Olivia, can you give us some suggestions on how we could simplify retrieving a needed item when we're working on a patient?
SPEAKER_02Sure, Leslie. One of the things that I wanted to start out with is to mention, having been a dental assistant before, is that we really have to refine our skills in anticipating what the doctor will need during the procedure so that we are not having to jump up and down multiple times, multiple patients for the same things. So we really have to learn the individual dentist style and instruments they prefer and try to anticipate ahead of time to minimize that. Now, obviously, that's going to happen. There's something that's missing that we need that was unanticipated, and we want to avoid cross-contamination. And think about, you know, when you have your gloves on, those gloved hands are coming in contact with multiple surfaces. Matter of fact, Leslie, I remember visiting an office where I was doing a mock inspection, and when I was looking at the bagged pouches that were so-called sterile, there was blood on the outside of the pouch in the sterilization area in the drawer where they kept sterile packs, meaning someone popped up during surgery, needed something out of the pouch, and they grabbed it and contaminated multiple pouches. So the key issue is they're if they're having to leave that treatment room, gloves come off, and we have to practice good hand hygiene. Now, if there's something within the mobile cart that we need to retrieve, we always left an extra cotton plier and dressing pliers out so that we were not touching and contaminating the handle of the mobile cart. I know some others might even prefer an overglove or even making sure we have barriers and barriers that get replaced in between uh patients. And I think it's a sobering reminder to watch the if saliva were red video, which OSAP re did. And it is an amazing educational tool to remind our assistants and hygienists that there are so many surfaces that are contaminated, and if only we could see it, if it was colorized. So I would guess I would say, Leslie, in summary, is to be sure we're using those cotton pliers, anticipate what needs to be in the setup, using barriers. And another thing that might work, you know, sometimes people hate to look at voluminous SOPs. And I get that, but how about creating some short videos of the setups, like maybe two-minute videos, that we could start building a library of how to set up for certain procedures? And the goal is to minimize those interruptions and avoid cross-contamination because the risk of infection from environmental surfaces is very high. So we have to take this seriously. So though those are just a couple ideas I had.
SPEAKER_00Olivia, those are excellent ideas. The videos can be really helpful for training, especially as we have new people entering the workforce in dentistry that may not have had the experience of going to a dental assisting program or being chained on the job. This would be amazing. And I think about myself, sometimes when I'm uh tackling a new task, I'm very focused on things like have I got the right instruments, have I got the right materials, am I going to get it in the right room the right way? And I think that it would be easy to forget the cross-contamination issues. So having your praise set up unit dosed for what you think you're going to need, and then having a way to be able to retrieve items if you've forgotten something, and keeping hand hygiene, clean hands, not cross-contaminating with dirty gloves to other surfaces, top of mind as you're thinking of all these other things you need to think about in dentistry when you're working with patients. Now, one of the other areas of cross-contamination that I see occurs in the sterilization room when sometimes we have dirty gloves touching things. A good example, and one that I like to share with my clients and my audiences, is when we are processing our instruments, we clean them, we package them in sterilization pouches or in uh cassettes and wrap them, and then they're ready to go into the sterilizer. But have we thought of the hand that opens up the sterilizer door? If it's got the same glove that we used, and hopefully a utility glove, uh, if it has the same dirty glove we use to prepare all those instruments for sterilization, then we're going to contaminate the sterilizer door. So I remind my audiences to decide whether their sterilizer door is going to be clean or whether it's going to be dirty. And then everyone sticks to that protocol. Maybe even put a sign on the sterilizer door. Don't touch with dirty gloves. Or if you are going to make that sterilizer door be dirty, then don't open the door with clean hands or clean gloves. And one trick that I've come up with to simplify things, I always wear utility gloves when I process sharp contaminated instruments. And as I package and wrap them, the same thing. I'm being very careful. But what I will do when it's time to load the sterilizer is I'll remove my utility glove and I have a clean exam glove underneath. I'll use that clean glove to open up the door. I'll use my other hand with the utility glove to load all of those pouches and cassettes into the sterilizer. And then I'll use my clean glove to close the door and start the system. And I might just wipe it off with a little disinfectant wipe as an extra precaution to make sure that there's no contaminants on it. This way I know when someone comes in to open that sterilizer door, they're going to touch a handle that's clean. Now, if I didn't take that time to change or to have a clean glove or to remove my contaminated utility glove, when someone comes in and opens that sterilizer door, they may touch it with a bare hand or with a clean glove. And when they go to retrieve the instruments, they're going to cause cost contamination. So that's something we may want to watch in our offices to see how are we doing with that? Are team members all using the same protocol, the same operating procedures, or are some of us touching that door with a dirty glove when we close it and start it, and then others uh retrieving with clean gloves? Another thing that I had brought to my attention, and it's actually uh in the if saliva were red video, but it happens in real life. A dentist shared with me that her newest dental assistant had touched her clinical jacket multiple times with her gloved hand. She would either uh straighten it out like you'd straighten out your skirt if you're a woman, and then uh she would uh touch it again later after she removed her gloves, kind of the same habit. In If saliva were red, there's a scene where the dentist removes her gloves and uh she touches her clinical jacket where there's some blood, well, saliva. If saliva were red, it could be blood or saliva, and she's touching that same contaminated area with her bare hands on her clinical jacket. So it reminds me that we don't always think about cross-contamination. And it needs to be top of mind because sometimes that muscle memory isn't quite following the cross-contamination rules. I'd like to call on our fellow, my fellow divas here on some other talking points on how they might help drive the principles of cross-contamination home to our listeners. Mary.
SPEAKER_01Thanks, Leslie. I'm so glad that you and Olivia mentioned if saliva were read, I think every dental practice, every dental team member needs to watch that video as a reminder of where the cross-contamination is, and it's pretty much everywhere. Something that I see frequently are um team members failing to take off their outermost garment, their scrub jacket or their lab coat when they go in to eat lunch or they go into the break room, or they wear at home, which they shouldn't be um doing. So that's a big concern, especially if there's contamination on it, which there is from spatter and splatter and aerosol, and touching it and then maybe eating your lunch or having a snack. So something to be considered. Um, the other thing, and I believe we've talked about this a little bit before, is doing some in-service training in a practice that you can easily do yourselves with a product called Glow Germ. And it's a lotion that you can put on your hands and as simulated debris on your hands, and then you do your hand hygiene procedures, you clean your hands, and then you um use a black light to examine where you may have missed. And this is where a lot of people really um to the realization how bad a shape their cuticles are in, which again could be a great place to trap um microbes, but it's also a good illustration of the contamination that resides underneath fingernails. The CDC guidelines say we should have natural nails and that acrylic or artificial nails shouldn't be worn in clinical settings. And if you do have long nails, number one, they can puncture your gloves, but you'll be amazed at how much um debris can collect underneath those and then be visible under that black light.
SPEAKER_00That glow germ is so amazing, not only the lotion part, but also the powder part that can be used to help us see where we might be cross-contaminating. Uh, one of our speakers at the OSAF meeting last summer had uh put some of that glow germ powder on a clinical jacket and then had the person remove the clinical jacket in the order of doffing equipment. And then with the black light, you could see where that glow germ powder ended up getting back on the person from the jacket. Linda, you had something you wanted to contribute.
SPEAKER_03Let's see. I'd like to add on to Mary's comments with the OSAPS updated CD um saliva where red. I'd like to just remind everybody that that's only a five-minute video. It's not the same version as before. It's brand new. And if we didn't already say, Divas, that we would put it in our today's show notes, let's be sure that we put that link in the show notes. I think that's great. And also, Mary, you had a perfect point about where are we wearing those scrub jackets for crying out loud. I've used the word parade them, your germs around the office when you escort the patient up front or go to the restroom and heaven forbid, eat. But the reason that I wanted to also focus on why you cannot take that jacket home just to take it, you know, one level deeper, is that's an OSHA violation. So it's the employer's responsibility under the blood-borne pathogen standard to clean and launder those so they cannot go home with the employees. So we want to remind everybody about that quick point. And finally, Leslie, I just wanted to share a quick story. I was in an office recently and I was watching the hygienist just on the side. Uh, she didn't know that I was kind of casually observing. And she had she put on her gloves last and the patient was already reclined, but then she proceeded to shift the chair to a better position because her operatory is a little small. And of course, there she was with her hands all over the chair, which I know should have been decontaminated, but nevertheless, um, you know, that's not something that should have happened. So I would advise our listeners, Leslie, to think about the steps in some of their processes and identify where they may find some opportunities for improvement for themselves.
SPEAKER_00That's excellent information, Linda. And we can probably put together a whole podcast on cross-contamination uh items, issues, actions that we've seen that sometimes occur where it inadvertently cross-contaminating. We don't uh we don't want that to happen. So it's nice when we can bring these stories up and talk about it. Um, I have just another comment to make about besides OSHA having a problem with uh personal protective equipment, going home or being used outside of the work area or areas where you eat, uh, is also uh dental boards, certain dental boards like in California, you're not to re uh take your PPE outside of either the treatment area or areas of patient care activities or laboratory area. So it would be in violation for someone to leave the treatment room or the lab area or the sterilization room wearing gloves. They're wearing their PPE. So dotting and doffing where you do it is important and take a look at your state board regulations, see if you have any specific regulations surrounding when that PPE should be removed. Well, this wraps up our podcast on cross-contamination today. We bring clarity and simplicity to compliance by navigating the regulatory compliance environment to keep you on course. Please submit your questions to support at the compliancedevas.com. And we also will have resources on our show notes where you can access some of the information and charts that we mentioned today. We would especially like it if you would provide us with a review on Apple Podcasts or Spotify. We found that many times we are lecturing and people will come up to us and tell us how much they appreciate the compliance divas podcast and how helpful it is for their practices. And we would just love to hear from you as well. With that, we end another podcast of the compliance divas.