Personal protective equipment (PPE) is essential for dental health care personnel (DHCP) to protect them from exposure to or contact with infectious agents. These include gloves, masks, protective goggles, face protectors and protective clothing. PPE can also prevent DHCP from spreading microorganisms to patients. The Occupational Safety and Health Administration (OSHA) Standard for Occupational Exposure to Bloodborne Pathogens requires the practice of “universal precautions” in dentistry when there is a possibility of exposure to blood-borne pathogens in the dental office and laboratory.
Guidelines were published in 1996 on precautions in case of contact with blood and other body fluids, including secretions (except sweat) and excretions. These guidelines include and replace universal precautions and are called standard precautions. Standard precautions require that the same infection control procedures be followed for any dental procedure or task determined for each patient and that all patients and materials be treated as potentially infectious. The use of sterile surgeon gloves is recommended during invasive procedures, such as surgery and periodontal scraping. Overgloves are thin copolymer or plastic gloves for handling food that can be used over non-sterile examination gloves when it is necessary to touch objects that are not in the oral cavity, such as patients' medical records, during patient treatment.
However, it is difficult to put on additional gloves without contaminating the exam gloves. Therefore, in most cases, a better alternative is to remove the examination gloves and then replace them with new gloves when the patient's treatment resumes. The gloves are discarded after use on each patient. Multipurpose gloves are heavy, non-sterile, puncture-resistant gloves that should be used when cleaning and processing contaminated instruments, cleaning and disinfecting contaminated surfaces, and handling chemicals. They should be cleaned and disinfected after each use.
The gloves used for treatment (examination gloves and surgeon's gloves) are available in natural latex and synthetic materials, such as vinyl, nitrile and neoprene. In addition, they can be powdered or dust-free. Both exam gloves and those of the surgeon should be changed for each patient or more frequently if the texture of the glove changes during use. The use of gloves during the treatment of the patient does not prevent hand washing. Before non-surgical dental procedures, hands should be washed for at least 15 seconds, rinsed and dried thoroughly before putting on and after removing gloves.
Do not wash gloves because they can absorb and decompose the composition. The use of an antimicrobial hand soap is preferred, although a milder cleanser can be used if the dental operator experiences skin irritation from the hand cleaning agent. Avoid wearing long nails or rings under treatment gloves as this can contribute to holes or breaks in gloves, and can harbor bacteria due to inadequate hand cleaning during hand washing. Fungal infections can also occur under rings or artificial nails due to moisture retention. In October 2002, the Centers for Disease Control and Prevention added to their hand hygiene recommendations the approval of 60-95% alcohol-based products (ethyl alcohol preferred) for hand cleaning. These products are available in the form of foams, gels or rinses, and are applied to the hands and rubbed for at least 15 seconds until the agent is dry.
However, these products are not appropriate when hands are visibly contaminated or dirty. They should also be used and stored away from high temperatures because they are highly flammable. Semicritical objects include items such as radiographic film holders, shadow guides, and oral accessories that come into contact with, but do not penetrate, the mucous membranes. Sterilization with heat or chemical liquid (high-level disinfectants) is required for these objects. Heat sterilization is preferred, although sterilization with chemical liquids may be necessary for items that can be damaged by heat.
Liquid chemicals for sterilization include glutaraldehyde, hydrogen peroxide, and peracetic acid. The long sterilization time (6 to 10 hours), the possibility of corrosion and the maintenance of sterility during storage are disadvantages of liquid chemical sterilization. In one study, 15% of dental students developed non-allergic irritation or contact dermatitis because of the disposable latex gloves that were commonly used. Remember the methods that can be used to prevent cross-contamination during the distribution of dental supplies. The body should also be protected with a liquid-resistant gown or a waterproof apron in addition to the long-sleeved tunic and pants which are part of the protective equipment commonly used in the dental office during work hours. These items include the dental unit, switches, handles, X-ray tube heads, dental chair, gypsum bowls and spatulas. All dental professionals are dedicated to safety of patients and staff; wearing protective eyewear; periodically reviewing workplace protocols; ensuring staff is properly trained; can reduce or eliminate risks of eye injuries in dental health care environment.
