Cross contamination can be defined as “the process by which bacteria or other microorganisms are unintentionally transferred from one substance or object to another, with harmful effect”. It is a danger that is present in our everyday lives, our homes and healthcare environments.
In a healthcare environment, ensuring that infection does not spread is critical.
The Royal College of Nursing notes that: “Health and social care settings can provide a challenging environment in which to manage risks associated with the transfer of micro-organisms from patient to patient or between the
environment, equipment, staff and patients...”
When the ‘healthcare environment’ is a dental practice, the Department of
Health’s Health Technical Memorandum 01-05 (HTM01-05) provides valuable
guidance on dealing with controlling infection. The memorandum Decontamination in Primary Care Dental Practices points out that: “Infection control needs to include all aspects of the running of a dental practice: from attention to personal hygiene – hand-washing, masks, protective clothing – to the cleaning and sterilisation of instruments and the maintenance of the equipment.”
Although the memorandum notes that the guidance is primarily focused on medical devices and instruments used in dentistry, it does go on to say: “local policies must be broad-based and consider a comprehensive view of hygiene and cleanliness across all aspects of dental practice and associated
facilities.”
A dental practice infection control policy will contain information including that relating to decontamination, cleaning, waste disposal, disinfectants and so on. The practice must also, of course, register and comply with the CQC requirements of outcome 8 relating to ‘cleanliness and infection control’.
Control of infection and decontamination procedures can also relate to risks of
cross-contamination. Items used in a dental practice can either be reusable, in which case they require appropriate sterilisation or disinfection after each use, or disposable, being discarded after one use, as in the case of disposable gloves and aprons.
However, in the case of reusable bib chains and clips, research published in 2013 showed that while they may be “considered to present relatively low
risks for transmitting infections”, with disinfection proving to be significantly
effective, “some clips retained at least one bacterium on their surfaces after
disinfection.” In the study, while the disinfected clips had bacterial species
that were “typical skin or environmental isolates, some were oral in origin” and the bacterial presence in the study’s setting (hygiene clinic and treatment) was not indicative of an infectious disease problem. It was further noted that “the different bacterial loads on clips suggest that cross-contamination risks may not be the same for all clinics” and the difference may relate to the type of service or treatment carried out.
In another study by Molinari the presence and make-up of bacterial contaminants on bib chains was evaluated, both before and after patient care. The study also investigated how effective cleaning procedures were on reusable bib chains. Using two types of bib chains – metal napkin holders with clips and coiled plastic holders with metal clips - the study found that “microbial contamination was found on both [types] after use during patient care”. Unsurprisingly perhaps, bib chains that were not cleaned between patient use showed the highest concentrations of isolated bacteria. Interestingly however, “although cleaning chains with a disinfectant wipe between patient appointments lessened the microbial load, resultant bacterial
levels were still higher than those noted for new unused patient napkin holders”.
On the basis of the studies referred to above, reusable bib chains may harbour bacteria. However, by using a disposable bib holder, such as Bib-Eze
from Dux Dental, for each patient, any bacteria, along with other substances
such as hair or sweat, which may transfer from the patient to the bib holder, will be disposed of after use. The use of a new bib holder for each patient
may also have a reassuring effect on a patient. Further, for the dental team, the removal of the need to sterilise may offer a saving in time and energy.
Avoiding the risk of crosscontamination is vital for all concerned and disposable bib holders may prove an asset in this important area.
References available on request.