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Infection Control and Its Importance

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Infection control is important in dental hygiene to protect the health and safety of patients and dental personnel. It is the responsibility of the dental hygienist to follow proper infection control standards to prevent direct or indirect cross-contamination. According to the Clayton State dental hygiene program manual, infection control standards include using effective handwashing, using personal protective equipment (mask, gown, gloves and eyewear), maintaining aseptic technique by using sterilized equipment, and disinfecting the cubicle before and after every patient. (Clayton State University Dental Hygiene Faculty, 2019-2020, p.189).

For my observation, I was assigned to a senior dental hygiene student who had to treat a new patient. Throughout the appointment, I evaluated the appropriateness of the senior student’s infection control. I observed everything the senior did during the pre-treatment phase, the treatment phase, and the post-treatment phase. I also made note of any errors made by the senior student as well as the other seniors and faculty in the clinic.

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My senior observation was scheduled for the afternoon of October 4th, 2019. As soon as I arrived in the clinic, I checked in with Mrs. Hogans. I put on all my personal protective equipment and Mrs. Hogans introduced me to the senior I would be observing that afternoon. The first thing I did when I entered the clinic is check my surroundings. Before the appointment even began, I immediately noticed that the seniors were breaking quite a few infection control protocols in regard to their Personal Protective Equipment (PPEs). A few of the critical errors I noted include placing face mask under chin, bonnet not fully covering hair, holes in student gowns, and leaving cubicle with exam gloves on. The Food and Drug Administration (FDA) states that “when used properly, PPEs act as a barrier between infectious materials such as viral and bacterial contaminants and your skin, mouth, nose, or eyes (mucous membranes).” (Food and Drug Administration, 2018). The seniors were not utilizing their PPEs properly, so they were not protected against contaminants such as spatter and aerosols.

Before treatment phase began, the senior student I was observing made sure to set up her dental unit. She placed all the required supplies such as the wrapped cassette and the metal tray in the correct places. She placed the appropriate barriers on the keypads, light handles, dental light switch, bracket table handles, headrest of patient chair, and cavitron. Although the senior I was observing had correctly placed all of the barriers required, I noticed that the senior student who was in the cubicle beside us had forgotten to use saran wrap to barrier the bracket table handles. This is a critical error because barriers are an essential part of infection control. Failing to use all the required barriers increases the possibility for cross-contamination to occur in the clinic. From my didactic knowledge and the information I learned in lecture and clinic, I know that following proper infection control standards are what allow us to prevent cross-contamination.

Once the senior finished preparing her cubicle, she began creating a patient chart for her new patient. When she received the medical history form the patient completed, she immediately began highlighting all negative “yes” questions along with their corresponding questions. When the patient chart was completed, the student got prepared to bring in her patient. I noticed that although everything was almost perfect, the senior forgot to move the dental light out of the way. This can cause a problem for the patient because it presents an opportunity for them to hit their heads. Luckily that didn’t happen this time because her patient bent his head. After the senior greeted her patient, she established rapport and made the patient feel comfortable. Once the patient was seated, the senior gave him the safety glasses and placed the patient napkin. She explained to the patient that she will prepare for the treatment. She took the patient’s vitals and reviewed their medical history. She asked the appropriate questions to get further information from the patient and asked the patient to sign once she was done transferring the information into Eagle Soft. Afterward she informed her patient that she was preparing for the instructor check. She removed the paper from the sterilized cassette and placed it on the bracket tray in front of the patient. I observed as she donned all her PPEs and she correctly washed and rinsed her hands 3 times for 10 seconds each. She put on her nitrile gloves after carefully drying her hands and she proceeded to give her patient the pre-procedural rinse along with the saliva ejector.

Once the instructor check was done, the senior performed extraoral and intraoral examinations on her patient. She properly positioned her patient in the upright position for the extraoral examination and the supine position for the intraoral examination. The senior asked another senior student to help her record all findings on patient exam forms. Following the extraoral and intraoral exams, the senior did the patient’s periodontal evaluation and dental examination and recorded all the information on Eagle Soft.

Throughout the examinations, I noticed that the senior kept leaning into the patient, her feet were not flat on the floor, and her shoulders were not in neutral position. According to the junior protocol we learned in lecture and clinic, the operator should be in neutral position with feet flat on the floor. The operator must maintain an eye level at 15 to 20 inches from the working area and must refrain from unbalanced leaning. Ester Wilkins explained in her book that “without practicing the principles of neutral position on a regular daily basis, a clinician can experience discomfort, pain, and work-related stress. The long result can be shortened or compromised career longevity with changes in daily life activities.” (Ester Wilkins, 2017, p.103).

After the senior was done with the treatment, she removed her exam gloves and once again washed and rinsed her hands 3 times for 10 seconds each. I observed as she came back and took of her PPEs, but she did not wash her hands after. The Clayton State dental hygiene program manual states that “hands are to be washed immediately or as soon as feasible after removal of gloves or other personal protective equipment” (Clayton State University Dental Hygiene Faculty, 2019-2020, p.64). The senior then escorted her patient to the reception area, stayed with her patient until everything was completed, and thanked him for coming.

As soon as her patient was gone, the senior began the post-treatment phase. She donned her PPEs and put on her utility gloves after washing her hands properly. She put the instruments in the cassette, placed it on the metal tray, and discarded all disposable items in the appropriate locations. She removed all the barriers and used DisCide wipes to disinfect the dental unit. She used paper towels and soapy water to wipe the walls and screen panel. Although the senior did almost everything correctly for the post-treatment, she did not flush the waterlines at all. Flushing the lines for two minutes in the beginning and end of clinic session and 30 seconds between patients is an important part of infection control because it allows us to keep the water lines clean. Once the senior cleaned her cubicle, she proceeded to wash and dry her utility gloves and then she wiped them with disinfectant wipes. She washed her hands and properly threw away all her PPEs.

In conclusion, infection control is an essential part of dental hygiene. The most important point to remember about infection control is that proper standards need to be followed without fail. Even though the senior I was observing did many things right during the appointment, she missed some crucial steps that could lead to a critical incident occurring. Following proper infection control protocols allows us to maintain the health of everyone in the clinic. 

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