INFECTION CONTROL

[Anonymous]

 What is the purpose of personal protective equipment (PPE)?

PPE is designed to protect the skin and the mucous membranes of the eyes, nose, and mouth of dental health-care personnel from exposure to blood or other potentially infectious material. A visible spray is created during the use of rotary dental and surgical instruments (e.g., handpieces, ultrasonic scalers) and air-water syringes. This spray primarily consists of a large-particle spatter of water, saliva, blood, microorganisms, and other debris. Spatter travels only a short distance and settles out quickly, landing either on the floor, nearby equipment and operatory surfaces, dental health-care personnel, or the patient. The spray may also contain some aerosol (i.e., particles of respirable size: 10 microns). Aerosols take considerable energy to generate and are not typically visible to the naked eye. Aerosols can remain airborne for extended periods and can be inhaled. However, they should not be confused with the large-particle spatter that makes up the bulk of the spray from handpieces and ultrasonic scalers. Appropriate work practices such as the use of dental dams and high-velocity air evacuation should minimize droplets, spatter, and aerosols. OSHA mandates that dental health care workers wear gloves, surgical masks, protective eyewear, and protective clothing in specified circumstances to reduce the risk of exposures to bloodborne pathogens.

When should a surgical mask be worn?

Dental health-care personnel should wear a surgical mask that covers both their nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood or body fluids. A surgical mask protects the patient against microorganisms generated by the wearer and also protects dental health care personnel from large-particle droplet spatter that may contain bloodborne pathogens or other infectious microorganisms. When a surgical mask is used, it should be changed between patients or during patient treatment if it becomes wet.

When should protective eyewear be worn?

Dental health care personnel should wear protective eyewear with solid side shields or a face shield during procedures and patient-care activities likely to generate splashes or sprays of blood or body fluids. Protective eyewear protects the mucous membranes of the eyes from contact with microorganisms. Protective eyewear for patients also can protect their eyes from spatter or debris generated during dental procedures. Reusable protective eyewear should be cleaned with soap and water, and when visibly soiled, disinfected between patients.

When should protective clothing be worn?

Various types of protective clothing (e.g., gowns, jackets) are worn to prevent contamination of street clothing and to protect the skin of personnel from exposure to blood and body fluids. When the gown is worn as personal protective equipment (i.e., when spatter and spray of blood, saliva, or other potentially infectious material is anticipated), the sleeves should be long enough to protect the forearms. Protective clothing should be changed daily or sooner if visibly soiled. Personnel should remove protective clothing before leaving the work area.

Why should dental health care personnel wear gloves?

Dental health care personnel wear gloves to prevent contamination of their hands when touching mucous membranes, blood, saliva, or other potentially infectious materials and to reduce the likelihood that microorganisms on their hands will be transmitted to patients during dental patient-care procedures.

Does wearing gloves replace the need for handwashing?

Wearing gloves does not replace the need for handwashing. Personnel should wash their hands immediately before donning gloves. Gloves may have small, unapparent defects or may be torn during use, and hands can become contaminated during removal of gloves. In addition, bacteria can multiply rapidly in moist environments underneath gloves; thus, personnel should dry their hands thoroughly before donning gloves and wash immediately after removing the gloves. If the integrity of a glove is compromised (e.g., if the glove is punctured), the glove should be changed as soon as possible.

Is it safe to wash gloves before use?

Washing of latex gloves with plain soap, chlorhexidine, or alcohol can cause micropunctures. This condition, known as "wicking," may allow liquids to penetrate through undetected holes in the gloves. For that reason, washing of gloves is not recommended.

Are gloves affected by dental materials?

Exposure to glutaraldehyde, hydrogen peroxide, and alcohol preparations may weaken latex, vinyl, nitrile, and other synthetic glove materials. Other chemicals associated with dental materials that may weaken gloves include acrylic monomer, chloroform, orange solvent, eugenol, cavity varnish, acid etch, and dimethacrylates. Because of the diverse selection of dental materials on the market, glove users should consult glove manufacturer about the compatibility of glove material with various chemicals.

Are there different types of gloves?

Yes, there are. The type of glove used should be based upon the type of procedure to be performed (e.g., surgical vs. nonsurgical, housekeeping procedures). Medical-grade nonsterile examination gloves and sterile surgical gloves are medical devices regulated by the U.S. Food and Drug Administration (FDA). General-purpose utility gloves are not regulated by the FDA because they are not promoted for medical use. Sterile surgical gloves must meet standards for sterility assurance established by the FDA and are less likely than nonsterile examination gloves to harbor pathogens that may contaminate an operative wound.

Glove Type Indications Comments Common Glove Materials
Patient examination gloves Examinations and other nonsurgical procedures involving contact with mucous membranes; laboratory procedures Medical device regulated by the FDA.
Nonsterile and sterile, single-use disposable. Use for one patient and discard appropriately.