The cornerstone of infection prevention is the use of Standard Precautions, which considers all body fluids (except sweat), from each and every patient to be potentially infectious. Use infection prevention precautions to protect workers from exposure to blood, all other body fluids (except sweat and including saliva) and other potentially infectious materials (OPIM). Standard Precautions also prevent indirect transmission from patient to patient. Finally, follow the precautions to prevent transmission from healthcare workers to patients.
Careful hand hygiene, use of personal barriers (personal protective equipment), and safe handling and disposal of sharps can protect each member of the team and the patients.
Hand hygiene. Hand hygiene is the single most important infection prevention activity in healthcare. Team members must always wash their hands before gloving and after gloves are removed. Where the local water quality is questionable, one should use an alcohol-based hand sanitizer on hands that are not visibly soiled. Although these products are excellent antimicrobials, they are very poor cleaners and are only effective on hands that are free of debris.2,4,5 If hands are visibly soiled, clean them first with previously boiled water or a pre-moistened towelette that contains a cleaning agent. All team members should keep a supply of alcohol-based hand sanitizers for clinical and personal use.
Personal barriers. During dental procedures, use personal protective equipment – surgical masks and eye protection, gloves, and clinical gowns - to protect workers’ skin, clothing, and mucous membranes from contact with patients’ oral fluids and other potentially infectious materials. Determine the degree of barrier protection needed by assessing the types of procedures that each team member performs.
Gloves. Wear single-use disposable gloves throughout patient treatment. If oral surgery is to be performed, use single-use disposable sterile surgeon’s gloves. When decontaminating instruments, always use heavy-duty puncture-resistant gloves to help avoid puncture injuries when handling contaminated sharp instruments. Change gloves between patients and if punctured/torn. Hands are the primary point of contact from worker to patient, so the risk of cross-contamination is considered high.
Gowns. Wear gowns when performing procedures that may produce spray or droplets from the patient’s mouth. Regular clothes are not an appropriate barrier for clinical care. Instead, wear scrubs or other easily laundered clothing.
Select personal protective equipment garments that protect workers’ skin and street clothes. A variety of gown and jacket styles are available. In hotter climates and locations where laundry facilities are not readily available, consider using lightweight paper disposable gowns. Gowns have not been implicated in disease transmission, so it is appropriate to use one gown for multiple patient contacts. Discard the gown when it becomes soiled or overtly contaminated.
Masks and protective eyewear. Wear masks and eye protection to protect the mucous membranes of the eyes, nose, and mouth during procedures that may generate spray or droplet contamination from the patient’s oral fluids. The risk of bloodborne disease transmission from a mucous membrane exposure to infected body fluids is lower than the risk from percutaneous exposures, but mucous membrane exposures have resulted in transmission of HIV, HBV, and hepatitis C virus (HCV) to healthcare workers.2
Select eye protection based on the type of procedures and devices being used. If spray or spatter is anticipated (such as through the use of air-driven handpieces), wear eyewear with side shields for the best protection.
Avoid touching masks and eyewear during dental procedures, and ideally, masks should be changed between patients.