by By Dr. John Molinari and Peri Nelson
Editor’s note: In Best Practices in Infection Control, with THE DENTAL ADVISOR, Dr. John Molinari and Peri Nelson will address common concerns related to infection control in dental practices. Questions can be submitted at dentaladvisor.com, under the Ask The Editors tab
Q: Our practice has a large number of clinical staff, and unfortunately, we are having a problem concerning what type of eyewear to use when treating patients. Some of the doctors, hygienists and assistants use their own personnel prescription glasses while others prefer glasses purchased as professional eyewear. Does it matter which ones we use?
A: When OSHA was developing and soliciting input on their comprehensive Bloodborne Pathogens Standard, one risk area considered was worker eye protection. Many dental and medical procedures generate substantial concentrations of airborne spatter and splash particles. There is also a well-documented history of occupational eye infections in healthcare workers who were exposed to concentrations of airborne bacteria and viruses during provision of patient care (i.e. staphylococcal and herpetic viral conjunctivitis).
To protect healthcare workers’ eyes, the final 1991 published Standard required PPE including eyewear with solid side shields to protect against airborne infectious materials. More recent CDC recommendations reinforced this with the following recommendation: “Wear surgical mask and eye protection with solid side shields or a face shield to protect the mucous membranes of the eyes, nose, mouth during procedures likely to generate splashing or spattering of blood or other body fluids” (CDC, 2003)
While any form of eyewear will provide some level of protection against splash/spray of blood or other body fluids, the style of many of today’s frames are quite small and do not afford appropriate ocular protection. Disposable side shields, which are designed to fit all types of frames, also provide a certain degree of additional protection. Unfortunately, if they are not placed correctly on the arm of the prescription glasses or they are not flush against the sides of the lenses, the opportunity increases for splash/spray to reach the eye.
The best way is to look at the standards of the American National Standards Institute (ANSI). These standards describe protective eyewear as impact-resistant, with coverage from above eyebrows down to the cheek and solid side shields to provide peripheral protection. The eyewear should protect not only from fluids, but also from flying debris that might be generated during a dental procedure. Some models are designed to fit over regular correctives lens. Therefore, specifically designed protective eyewear with side shields, or a face shield worn in conjunction with prescription glasses, will provide an effective barrier against aerosols and macroscopic debris.
Q: Questions have come up in our practice concerning scrubs. Do they have to be long-sleeved and do they also have to be washed in the office?
A: Scrubs do not have to be long-sleeved. However, OSHA requires protective clothing, such as reusable or disposable gowns, laboratory coats, clinic jackets, and uniforms, should be worn when clothing or exposed skin is likely to be soiled with blood or other body fluids. The requirement is for the outer garment to be long-sleeved, fluid-resistant, and that covers and protects forearms and unprotected skin (i.e. neck) from spatter of body fluids during treatment. The garment does not have to be fluid-impervious to meet OSHA standards, but must prevent contamination of skin and underlying clothing. Also, the protective outerwear does not have to be changed after each patient, but should be changed if visibly soiled. Employees may not launder these garments at home, as the employer is responsible for laundering or having them commercially laundered.
