Since the beginning of the Coronavirus emergency, thousands of people in all affected countries have postponed a great many health appointments. Likewise, dental appointments have also often been postponed, for fear of being infected with COVID-19 at the dental practice.
It is important to point out that these patient fears are largely unfounded, given the stringent disinfection protocols applied in this field. It should also be added that, in many cases, postponing dental treatment is quite simply impossible, or at least extremely dangerous, as in cases of oral cavity infections, painful cavities and other similar circumstances.
Consequently, in this situation, it is also the dentist’s duty to guarantee patients added safety, first and foremost by providing protection against pathogens. As has been highlighted repeatedly since the beginning of 2020, one of the main causes of infection is hand-face contact, which can carry the virus to the eyes or airways. Dental practice safety therefore starts with frequent and correct hand hygiene.
Correct hand hygiene practices
Before focusing on the frequency of staff hand washing, it is interesting to stress that there are three different options for carrying out hand hygiene in dental practice, namely:
Hygienic washing: dental staff can wash their hands simply using running water and liquid hand-wash. Hands must be washed for at least 40-60 seconds, following a protocol known to the practitioner and that makes it possible to remove almost all pathogens from the parts of the body involved.
Antiseptic washing: this is a variation on the method described above that involves using running water and, instead of normal hand-wash, a specific antiseptic product, such as chlorhexidine gluconate, iodophors and triclosan.
Sanitising with alcohol rub: the third method is intended for use in circumstances when washing with water is not possible. It involves rubbing the hands with a 60-80% alcohol solution. This method should be avoided in the case of parallel use of antiseptic soaps.
These specific measures are necessary as gloves alone are unable to prevent infection. This applies for both latex gloves and silicone gloves, which must be worn over sanitised hands and discarded after each use, since they are possible vehicles for contamination. It is important to remember that once the gloves have been removed, it is necessary to sanitise the hands again, to protect both the dentist and patients.
Hand washing and sanitising in the dental practice
The measures used to mitigate the risk of infection in other situations are not sufficient for health settings, including use in dental practices. Clear and strict hand washing protocols must be adopted to protect both patients and practitioners against the most common means of transmission of the virus. Hand washing should therefore be performed at three particular time-points:
Before and after contact with patients: dentists, dental hygienists and assistants working in a dental practice meet many different patients in any given day. It is essential for all staff to wash their hands thoroughly before and after contact with patients: this should be considered as the essential basis for safety during the current health emergency, together with the use of personal protective equipment such as face-masks, face shields, gloves and protection goggles.
During the inspection of the patient’s oral cavity: hand washing and sanitising must also be repeated during patient preparation and during the examination of the oral cavity, remembering at all times that pathogens can be transmitted through the mucosae.
At the end of the procedure: even simple hygiene procedures can expose dental staff to a risk of contamination. At the end of the intraoral procedure it is therefore necessary to sanitise hands immediately.
It goes without saying that it is not sufficient to merely wash the hands; it is necessary to perform thorough disinfection using specific cleaning agents on all the surfaces with which the patient may have direct or indirect contact, caused by the aerosol consisting of saliva, blood, residues and steam generated by the use of pressurised jets of water, turbines, irrigators and aspirators.
For the health and safety of both staff and patients, especially in this delicate period, it is therefore advisable to opt for disinfectants and sanitisers that are certified in accordance with the most stringent standards, and developed specifically for the disinfection of instruments and surfaces, and for hand hygiene.