Personal protective equipment (PPE) such as protective clothingand eyewear and disposable gloves are worn as a barrier to preventthe transmission of microorganisms between patients and the dentalteam. The type of protective clothing required will depend upon thepotential risks associated with the planned task. Legally it is thehealth care workers responsibility to assess this risk and decideupon the necessary clothing as appropriate. However, the employermust provide suitable PPE that must be freely and readily availablefor use.
The Role of Gloves : -To provide a barrier to protect the wearer from contamination with patientsblood or salivaTo reduce the risk of transmission of microbes from dentist to patient.Gloves should be worn for all routine dental treatment and discardedbetween patientsGloves do not prevent sharps injuries but the wiping effect of the glovereduces the risk of contamination.Wash hands before donning and after removing gloves.
Safe use of gloves in the dental surgery:Hands must be washed before donning gloves. Never consider gloves to be an alternative tohand washingGloves protect the operators hands from contaminated blood and saliva and the patientsmicrobial flora.Never re-use single use disposable gloves.Changing your gloves between patients prevents cross infection between patients andcontamination of hard surfaces in the surgery. Do not touch patients notes, pens and computerkeyboards, door or drawer handles or your face with gloved hands (see section x on surgeryzoning).
Gloves must only be worn whilst treating the patient and removedat the end of the procedure. Dispose of as hazardous waste.Remember hands are not necessarily clean because gloves havebeen worn. When removing gloves the patients microorganismscan be transmitted from the external surface of the glove to thedentists hands and need to be removed by hand hygiene .Change gloves during very long procedures, as u p to 40% ofgloves develop tears after prolonged use and may leak . Glovesalso become porous during prolonged use due to hydration of thelatex. By changing your gloves you can prevent excess sweatingand this reduces the risk of dermal infections or inflammation.
Choosing a suitable glove for the taskUse non-sterile gloves for routine dentistry.Use sterile surgical gloves for minor oral surgery, periodontal and implantsurgery.Gloves should be powder-free and have the lowest levels possible ofextractable proteins and chemical accelerators .Always hoose a glove that fits you correctly . Gloves that are too smallespecially if worn for prolonged periods of time will produce musclefatigue in fingers and hands. If they are excessively tight over the wrists itcan exacerbate the symptoms of carpal tunnel syndrome.Dont use disposable clinical gloves for scrubbing instruments. Tohelp protect the hands from sharps injuries use heavy duty, linedhousehold gloves for washing instruments and general environmentalcleaning. These gloves are reusable, wash whilst on the hands and dry. Ifexcess sweating under the gloves becomes a problem, cotton glove linerscan be worn. They need to be checked regularly for small tears, anddiscarded accordingly.
If you develop an allergy to NRL glovesAlternative to NRL gloves that have similar physicalproperties, i.e. do not impair dexterity and are notprone to splitting and are impermeable to bloodborne viruses include:-Nitrile (acylonitrile) /polychloroprene (Neoprene)-Tactylon (multipolymer synthetic styrene-ethylene-butadine-styrene)Staff sensitised to natural rubber latex (NRL) glovesmust be supplied with appropriate alternatives.All staff should be trained to recognise the allergysymptoms so that they can avoid the use of latexgloves and devices.
Types of Disposable Medical Gloves Latex gloves are the original medical exam gloves, and also the most common type used by medical professionals today. They are strong, elastic and proven to prevent the transmission of infections. Latex gloves are the thickest and most protective of the different glove types, but are not without drawbacks. Because a small percentage people are allergic to latex, disposable nitrile gloves have been developed as an alternative.Disposable nitrile gloves are made with a synthetic latex and can be used bypeople with latex allergies. They are known for their comfort ; puncture resistanceand their resistance to many chemicals.Vinyl exam gloves, made of Polyvinyl Chloride (PVC), are latex free anda secondary alternative to latex gloves. They are often used due to theirnon-reactive nature. They are also good for protecting the hands duringactivities such cleaning. Their lower cost and versatility make vinyl glovesthe preferred choice for many non-medical applications.
Reactions are classified asDelayed hypersensitivity (type IV) resulting in contact dermatitis,rhinitis, conjunctivitis. This is the most common hypersensitivityreaction to NRL or accelerating agents. Response occurs between6-48 hours after exposure.Immediate hypersensitivity (type I) - asthma, urticaria, laryngealoedema, anaphylactic shock/collapse. Response occurs 15-30minutes after exposure.
Protective eyewearGoggles or visors should be worn during all types of dental treatmentor when manually cleaning instruments prior to sterilisation.Goggles should be decontaminated according to the manufacturersinstructions e.g. alcohol based surface disinfectant or hypochlorite 1000ppm available chlorine followed by thorough rinsing in water.Spectacles do not provide sufficient eye protection, so wear a visor orface shield over spectacles.Visors have the added advantage of discouraging touching of the facewith contaminated gloved hands.Visors are either single use disposable, or if designated re-useable,then follow manufacturers instructions for cleaning the surface withdisinfectant.Use disposable visors if treating patients with a contagious respiratoryillness (e.g. Flu), as re-useable visors and goggles with elastic strapscannot be readily cleaned.
Surgical face masksStandard surgical facemasks are resistant to fluidsand act as a physical barrier helping to protect thewearer from splashes of blood, saliva and otherpotentially infectious substances. The mainpurpose of a mask is to prevent particles(respiratory droplets, skin squames) expelled intothe environment by the wearer contaminating thesurgical site. Most masks produce a poor facialseal and are not designed to filter the air as it isbreathed into the lungs. So do not protect thewearer from aerosol inhalation. Hence, standardsurgical facemasks provide no or only partialprotection of the wearer from respiratory pathogenssuch as Mycobacteria tuberculosis or influenza.
-Masks are recommended for all dental procedures-Masks are single use items. They should be changed after everypatient and not reused.-Try to avoid touching the outer surface of the mask, which may becontaminated.-Remove the mask by breaking, undoing the straps or lifting over theears.-Mask should be disposed of as hazardous clinical waste.-Clean your hands after removing the mask in order to preventcontamination of your face and the surgery environment.
Respirator type masksRespirator type masks offer a higher degree of personal respiratoryprotection compared to a standard facemask. They filter out airborneparticles as the air is breathed in through the mask. However, theyare not intended to filter out gases.Such masks are recommended for dental healthcare workers for usewhilst treating patients with tuberculosis or other infections that arespread via aerosols e.g. influenza.In appearance they resemble moulded surgical facemasks.
-When fitted and worn correctly, they seal firmly to the face thus reducingthe risk of leakage.-Beards and stubble interfere with the fit and seal of the respirator.-Instructions for fitting and the leak tests to be carried out by the wearerdiffer slightly with each product and are supplied by the manufacturer.-Avoid touching the outer surface of the respirator mask once it is fitted.Always wash hands after handling the mask.-Respirators are intended to be single use only. Dispose of as hazardousclinical waste.
Protective equipment should be removed in the following orderFirst - Gloves (then clean hands).Second - Mask (or respirator), or a visor if worn and thenmask.Third - Protective eyewear (goggles).-Followed by hand hygiene.Gloves are removed first as they will be contaminated ontheir outer surface with the patients secretions and thismanoeuvre prevents the dental HCW touching andpotentially infecting their own skin, eyes or mouth whilstremoving the other items of PPE. Removal of glovesimmediately after completing treatment also reducescontamination of the surgery environment.
Tunic/uniforms as a protective barrierSplatter generated during the use of rotaryequipment falls mainly on the operators face, chest,hands and wrists. To protect these areas of skin fromcontamination, high-necked tunics /uniforms thatcover the chest area, with long sleeves and tightfitting cuffs are advised. Gloves should be worn overthe cuff of the sleeve, which protects the wrists fromcontamination and helps to prevent wetting of theuniform sleeve. If short sleeves uniforms are wornthen the wrists and forearms must be cleanedwhenever clinical hand hygiene is performed.
However, tunics and uniforms are not usually made ofmaterials that are impermeable to body fluids. Disposable plastic apronsshould be made available for staff to wear when contamination of clothingor uniform with blood and body fluids could occur e.g. during minor oralsurgery, or periodontal treatment where there is likely to be excessivebleeding or when manually cleaning instruments. Plastic aprons should bediscarded after each procedure and between patients.If there is a high risk of splashing with blood such as during MOS orimplant surgery then disposable, impermeable fluid repellent surgicalgowns are advised.
Preventing tunics and uniforms becoming a source of infectionTunics and uniforms become contaminated withmicroorganisms during clinical treatment. To dateno reported dental studies have demonstratedtransmission of infection by this route but inhospital wards multi-drug resistant bacteria havebeen transmitted via contaminated uniforms.Gentlemans ties have been implicated intransmission of MRSA and ties should not be wornwhen treating patients or should be concealedunder the tunic /uniform.
-Therefore, it is recommended that tunics /uniforms are washed andchanged daily.-Protective clothing should not be worn in designated eating and restareas within the practice. Remove protective clothing when eatingand drinking-Tunics and uniforms and should be removed before leaving thepractice.-When purchasing tunics and other protective clothing choose items thatcan tolerate washing at the higher temperatures that kill bacteria. Washprotective clothing separately from other clothes using a "hot" washingmachine cycle at a setting of 50 o C or above. The heat produced byironing also contributes to destroying bacteria remaining on clothes.