Spread your infection control knowledge and slow the spread of COVID-19

We can all agree: 2020 has been a crazy year so far. COVID-19 has flipped some lives upside down, and has introduced tragedy, stress, and financial burden on many. We are all hoping that a “magic” vaccine will provide a solution to our problems. It’s the shining light at the end of the tunnel. But how long is this tunnel? According to the World Health Organization (WHO), over sixty percent of the world’s population are collaborating towards this shared goal of developing and distributing a vaccine through the WHO; ultimately, they project to manufacture billions of vaccines by the end of 2021.¹

Even if we reach this hopeful goal, what will happen between now and then? We all witnessed the rapid spread of COVID-19 throughout the world in a matter of months. What will happen in over a year without a vaccine? How can we stop the detrimental effects COVID-19’s continued spread? Even after the COVID-19 vaccine comes out, what if another epidemic or pandemic hits us in the future? This is where a hygienist’s favorite word comes into play—prevention.

How many of you cringe when you see the public improperly using their personal protective equipment (PPE), without even knowing it? We have all seen it—people scratching their nose with contaminated gloves, removing their mask with their contaminated hands to speak more clearly to the grocery store clerk, using the same pair of gloves to handle both money and food, or wearing a dirty surgical mask that has been clearly reused more than once.

Prevention is the best medicine. Not only are hygienists experts at preventing decay and disease, but we are also highly trained in preventing the spread of pathogens through infection control protocols. Aside from this, dental professionals also interact with the general public more frequently than most other health professionals. Dental hygienists routinely see healthy individuals two to four times per year, whereas most other health professionals see patients less frequently, or only when a particular concern arises.

So, what if we did our part in slowing the spread of COVID-19 through incorporating infection control into patient education? As experts in prevention and infection control, we are qualified to educate the public on proper PPE use, handwashing, and sterilization. By taking advantage of our frequent interactions with the general, healthy public, dental professionals can do their part in fighting COVID-19. Providing the public with this knowledge will not only help with controlling the spread of COVID-19 but will also control the spread of other viruses to come.

So, what exactly can dental professionals do? You can start by catching the patient in the act. When a patient walks into the office with a mask on, notice how they are wearing it, what the mask looks like, and how they remove the mask for the dental cleaning. If you notice the patient’s mask is visibly soiled, torn, or wet, inform them about proper reuse of a mask. One should not wear the same mask for over six hours,² cloth face coverings must be washed in between uses, and masks must be disposed of or washed when wet. When machine washing cloth face masks, inform the patient to use warm water, laundry detergent, and dry at the highest heat setting in dryer. When hand-washing cloth masks, inform the patient to use four teaspoons of bleach per quart of room temperature water, and to lay flat in direct sunlight until completely dry.⁵ Cloth face coverings become a breathing hazard when worn wet, so surgical masks should be worn during activities that produce sweat. If the patient’s mask is dirty or torn, provide them a new one and advise them to inspect the mask before wearing.²

When the patient removes their mask to start the appointment, how do they remove it? Where do they store it during the cleaning? Do they wash their hands first? Advise your patients to perform hand hygiene prior to removing their mask, remove the mask using the ear loops, and to store it either in a breathable bag or hung up in a dry space.² When they perform hand hygiene, did they bring their own hand sanitizer? Is their hand sanitizer at least 60% alcohol? Are they rubbing until dry?³ You both need to perform hand hygiene, so why not do it together an demonstrate how to properly do so?

Is your patient wearing an N95 respirator to your office? Check their medical history. N95 masks are contraindicated with lung conditions, heart conditions, hypertension, and other health conditions.⁴ If a patient with health complications wears an N95 respirator without medical clearance, it could exacerbate their existing condition. Prior to using N95 masks, an individual must have medical clearance, training, an N95 fit test in order to ensure safe and effective use.⁵ An individual must perform a seal check when putting an N95 mask on, and a proper seal cannot be achieved if an individual has facial hair or if the N95 is not the right size.⁴ Without a sufficient seal, the individual may not be protecting themselves from COVID-19 at all. During times of PPE shortage, the general public should be advised to save the N95 respirator masks for the professionals.⁴

Lastly, let’s talk about the patients that wear gloves into the office. Are they wearing the gloves from their car into the treatment room, and throughout their appointment? This is a perfect opportunity to tell them how the treatment room was sterile, but now anything the patient touches in the treatment room with their gloves has now been contaminated. Explain how gloves are supposed to be single use only; otherwise, they just carry the germs around from place to place. Hand hygiene, however, kills the germs in their tracks and is the best method to prevent the spread of pathogens.⁶

Since the outbreak of COVID-19, everyone has become familiar with the term PPE. However, what’s the point of wearing PPE if nobody uses it correctly? As dental professionals, we are trained in the use of PPE, we are educators, and we interact with the general public more frequently than most other health-care providers. If we can spread this knowledge on infection control protocol to the general public, we can do our part in contributing to a cleaner, healthier, and happier future.

References

1. More than 150 countries engaged in COVID-19 vaccine global access facility. World Health Organization. July 15, 2020. Accessed July 17, 2020. https://www.who.int/news-room/detail/15-07-2020-more-than-150-countries-engaged-in-covid-19-vaccine-global-access-facility.

2. Toomey E, Conway Y, Burton C, et al. Extended use or reuse of single use surgical masks and filtering facepiece respirators. The Centre for Evidence-Based Medicine. June 5, 2020. Accessed July 17, 2020. https://www.cebm.net/covid-19/extended-use-or-re-use-of-single-use-surgical-masks-and-filtering-facepiece-respirators-a-rapid-evidence-review/.

3. Handwashing: do’s and don’ts. Mayo Clinic. April 1, 2020. Accessed July 17, 2020. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/hand-washing/art-20046253.

4. N95 respirators, surgical masks, and face masks. US Food and Drug Administration. June 7, 2020. Accessed July 20, 2020. https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-and-face-masks#s1.

5. Respiratory protection. US Department of Labor Occupational Safety and Health Administration. Accessed July 17, 2020. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134.

6. When to wear gloves. Centers for Disease Control and Prevention. Updated July 16, 2020. Accessed July 17, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/gloves.html.

Joy McCarthy, RDH, has been practicing in the state of Massachusetts for over four years. In private practice, she holds the title of OSHA infection control coordinator, where she keeps the office updated on current CDC guidelines and OSHA protocols. She received her bachelor’s degree from the University of New England in Portland, Maine, in 2016, and is currently working towards her master’s degree in health-care education at St. Joseph’s College of Maine. For more information, email her at [email protected].