Preventing Cross-Contamination with Clinical Procedures

BY ROBERT KREYER, CDT

With “Returning-to-Work” presented to us, the primary concern has turned towards the implementation of infection control protocols to prevent cross-contamination. Cross-contamination is two-fold, both between dental health care personnel and between operatory and laboratory personnel. We must understand CDC Universal Precautions in our unique dental settings, along with updated OSHA and CDC COVID-19 guidelines that were established in May of 2020.

The objective of this article is to discuss preventing cross-contamination with clinical procedures, such as impressions and prosthetic procedures between the dental office and laboratory.

Read ahead for helpful links and resources for each topic.

History of Infection Control in Dental Settings
In 1986, the CDC published guidelines in their Morbidity and Mortality Weekly Report (MMWR) for Recommended Infection Control Practices for Dentistry. This weekly report published on April 18, 1986, changed dentistry by creating mandatory Universal Precaution Guidelines for Dental Health Care Personnel (DHCP) within the dental setting. These Infection Control Guidelines have been a part of clinical and technical dental care for the last 34 years. Link to 1986 CDC MMWR:
https://www.cdc.gov/mmwr/preview/mmwrhtml/00033634.htm
 
Updated CDC Guidance in Dental Settings
On May 19, 2020, the CDC provided guidance to prevent cross-contamination in dental settings of suspected COVID-19 patients and how to limit exposure:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
 
Updated OSHA Guidance for COVID-19
The Occupational Safety and Health Administration (OSHA) has updated its guidance for DHCP with a COVID-19 Risk Chart:
https://www.osha.gov/SLTC/covid-19/dentistry.html
 
Tip for Oral Rinse Before Taking Impressions or Working on Prosthetics
The use of a bactericidal mouthwash or rinse can significantly reduce the oral flora and number of microorganisms in dental aerosols. Mouth rinses have been shown to reduce oral flora by 76% to 96% and the number of bacteria in aerosols by 89%. One new mouth rinse formulated for the Coronavirus or COVID-19 using Molecular Iodine is called ioRinse RTU Ready to Use Mouth Rinse:
https://www.iotechinternational.com/products
 
Disinfection Recommendations for Different Impression Materials
Preventing cross-contamination of pathogenic bacteria between dental operatories and laboratories with dental impressions is an essential part of infection control procedures.
Impressions for dental prosthetics should be double-checked during the disinfection procedure for any blood on the surface or around any implant component. If blood is present on the impression, it must be removed then disinfected before pouring, scanning, or sending it to the dental laboratory. To better understand proper disinfection with different impression materials, click on the link:
https://www.dentaleconomics.com/macro-op-ed/article/16393662/impression-disinfection
 
Tip for Pumicing and Polishing Old Dentures and Appliances in the Dental Office
When prosthetic appliances are removed directly from the mouth and pumiced or polished in the dental office without disinfection protocols, pumice can quickly become contaminated. To avoid this–after the denture or appliance is disinfected–use a small amount of fresh pumice for each procedure. Pumice can be set up in advance in the stretch to fit plastic bags that can be fitted around pumice pan. Click on the link for an example of a stretch to fit bags: Elastic Closure Plastic Bag Example.
 
After each use, the pumice must be discarded then replaced with fresh pumice from a plastic fitted bag set-up. The rag wheels and brushes should be disinfected or sterilized after they are used on a denture or appliance that has been in the mouth. The buff wheels and brushes used for pumicing should be stored in a sterilized bag or pouch until needed. After pumicing and polishing the denture or appliance, the prosthesis is then disinfected again before being inserted into the mouth. Any tools used to repair an old denture need to be cleaned and disinfected. Also, if a pressure pot is used, it needs to be disinfected unless the appliance is placed in a sealed bag to isolate it from the pot.
 
Glossary of Infection Control Terms
To improve communication and collaboration with infection control practices, it’s essential that we understand the proper terminology for infection control practices in the dental setting. Link to CDC infection control glossary:
https://www.cdc.gov/oralhealth/infectioncontrol/glossary.htm

As the practice of dentistry enters this new era of infection control, we are prepared with 34 years of experience and knowledge in preventing cross-contamination of pathogenic bacteria. With the updated 2020 guidance from CDC and OSHA, dental offices and laboratories will be providing optimal infection control care for patients seeking prosthetic treatment.