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Medical Forum / General / General / April 2007Any suggestions on how to find a dental office with good infection control?
I have seen what I consider poor and inadequate infection control practices in dental offices. Examples of such include: - dentist not wearing a mask while *talking* and examining the patient - dentist/hygienist touching non-sanitized surfaces after putting gloves on - touching the outer surfaces of gloves with non-sanitized hands before putting them on I am very concerned about the apparent lack of awareness of or attention to infection control issues by medical/dental office personnel. If anyone has suggestions for finding a good dental office with good infection control, I'd love to hear. (On a directory, one dental office looks the same as any other. It's hard to tell if a new dental office will be any better than the previous one before switching.) > I have seen what I consider poor and inadequate infection control > practices in dental offices. Examples of such include: [quoted text clipped - 11 lines] > looks the same as any other. It's hard to tell if a new dental office > will be any better than the previous one before switching.) I'm a dentist....and I have been in many dental office before. I can suggest that you visit as many office as you can, and determine which office you trust. It is all about the dentist who own the office. I set the rules on how I want my staff handle the infection control. Many staff who do not follow my rules is no longer working for me. So you need to observe the dentist carefully. If a dentist don't care about infection control, why will his staff care. P.S: Fee For Service office live on reputation, and they normaal work harder to protect their reputation. > I'm a dentist....and I have been in many dental office before. I can > suggest that you visit as many office as you can, and determine which [quoted text clipped - 5 lines] > P.S: Fee For Service office live on reputation, and they normaal work > harder to protect their reputation. Thanks for the suggestions. Since you are a dentist, maybe you can share with us your insight as an insider. Is it common for dentists to get requests from prospective new patients to visit the facility and discuss the practice's infection control measures before establishing a dentist-patient relationship? How do most dentists take it when they get a request like that? I thought about your idea of observing prospective dentists before but was unsure whether that's something that could be arranged. If I do ask to visit a dentist's office before becoming a patient, how do I find out their infection control measures *as practiced*? > ahuangd...@gmail.com wrote: > [quoted text clipped - 17 lines] > arranged. If I do ask to visit a dentist's office before becoming a > patient, how do I find out their infection control measures *as practiced*? Why not......I have many potential patients came in to visit my two offices and given a tour on how we conduct our infection control and practice philosophy. If we can not do that.....What reason do we give our potential patient why they need to choose us over the other dentist down the road. A dental treatment room is not a hospital OR. What you really want are reasonable safeguards about cross-contamination. (IOW's if there was a guy with AIDS in the room before you, was it disinfected and instruments sterilized/disposed of so that you are not in danger) Truth is that patients rarely caught anything back before gloves, masks, all of the disposables, plastic covers, autoclaving hand pieces, etc. However, a few of the diseases carry serious consequences and *most* offices go a long way to reduce the chances of transmission. Plus you would like to not even catch a cold. One thing to think about though...what about the restaurants, convenience stores, and work places through the rest of your life? If you want a dental treatment room to match the sterility of a hospital OR, you better get a second mortgage on your house before your next visit. ;-) Steve > I have seen what I consider poor and inadequate infection control > practices in dental offices. Examples of such include: [quoted text clipped - 11 lines] > looks the same as any other. It's hard to tell if a new dental office > will be any better than the previous one before switching.) > If you want a dental treatment room to match the sterility of > a hospital OR, you better get a second mortgage on your house > before your next visit. After working in ORs for quite some time, aside from the actual draped operating table, the OR is likely the most unsterile place on the earth, IMO. Think of all that blood and fluid that has dripped and splattered in the OR all over the floor, walls, ceiling, and equipment (much, much more than in the average dental office). For example, an incredible amount of blood is lost during many orthopaedic surgeries that the surgeons often wear rubber boots. I've watched staff clean it up in the OR....no way they get it all. Thats why staff shouldn't wear the same clothes and shoes outside of the hospital. Think about the gurney that brings the patient into the OR.....how often are those handles wiped by staff? Hospitals have huge problems controlling infection spread. While in the OR, the surgical area is kept sterile (which is all that matters), everything else is just like a dental office, and probably worse. John Good point. D >>If you want a dental treatment room to match the sterility of >>a hospital OR, you better get a second mortgage on your house [quoted text clipped - 18 lines] > > John John & Ninetta wrote: >>>If you want a dental treatment room to match the sterility of >>>a hospital OR, you better get a second mortgage on your house [quoted text clipped - 17 lines] >> matters), everything else is just like a dental office, and probably >> worse. Boy, I'd be worried about John's OR too. I hope that was a long, long time ago. If he's correct in his observations (I'm not sure he is), that place ought to be shut down. That's just not the way it's done anymore these days. OR's are terminally cleaned between each case, meaning that the floor is disinfected and all flat surfaces, OR lights and equipment are wiped down and disinfected every single time. Likewise all gurneys and carts. I can't imagine a 21st century operating room that isn't cleaner than the cleanest dentist's office. HMc > Boy, I'd be worried about John's OR too. I hope that was a long, long time > ago. If he's correct in his observations (I'm not sure he is), that place [quoted text clipped - 4 lines] > carts. I can't imagine a 21st century operating room that isn't cleaner > than the cleanest dentist's office. I'm talking 10 years ago. Please understand that the actual operating site and any equipment that is used in the operative site is kept absolutely sterile. This is really what matters. As for the floor around the table.......sure its mopped (only once usually, not twice or three times with fresh disinfectanteach time) with that same pail used for the entire room (how clean is it after wiping down all that blood?). As for the lights, the handles come in each sterile kit so the surgeon can adjust it himself and then its taken off to be resterilized, but as for the rest of the light....I'm not sure how often its gets wiped, and yes, it has to occasionally get splashed with something. But then again, no one is touching that part of the light. Also, realize who is doing the cleaning. Usually a team of 2 or 3 people that not only have to clean up, but also set up for the next patient, all in less than 15 minutes usually. This same team probably takes care of several rooms as well. They also were not in the room during the surgery, so they don't know if anything potentially splashed on that wall that wouldn't normally get wiped each time, for example. Sure they clean the floor and the table, but there are lots of nooks and grooves in those $10,000 tables. Much easier to clean a dental chair. I would like to see a study on the bacterial culture or occult blood swab from all the OR tables in a hospital....it might shock the public, but not me. The nice thing about a dental office (or any smaller medical clinic for that matter) is the buck stops with the dentist who owns the clinic...not some "head of infection control" in a hospital who doesn't even know the names of the people who are doing the cleaning. Much easier to enforce rules when the boss is not so removed as compared to someone only pushing paper. Clearly I'm generalizing as there are dental offices out there that also don't follow the rules. But much more easier to sway from them when there are lots of layers of management. I just don't want you to be misled thinking that the inside of an OR is super sterile. Just not the case in any hospital in North America. John >> Boy, I'd be worried about John's OR too. I hope that was a long, long >> time ago. If he's correct in his observations (I'm not sure he is), that [quoted text clipped - 42 lines] > I just don't want you to be misled thinking that the inside of an OR is > super sterile. Just not the case in any hospital in North America. Sounds like your ORs ran a little substandard in attention to some of these important details. HMc I really do wonder about John's comments on his OR. I have worked in the OR and all our orthopedic cases were nearly bloodless. We used a spiral banage to squeese the blood from the limb and then applied a tourniquet (carefully timed). There was very little blood loss--even with amputations! It was certainly not splashed all over the place. Then all surfaces were thoroughly cleaned. Also we had infection control nurses who regularly took swabs for cultures and watched our protocols and procedures like a hawk. The rubber boots were worn to reduce static electricity, not because of fluids running and dripping down. Please tell me where you worked John so I know to never go there! Hummy. When my wife was having a C-section, there were bloody 'sponges' in a big pile beside the table on the floor. Hardly what I would call 'bloodless'. OTOH, 10-20 extractions under a general anesthesia would gross out the surgery nurses at the local hospital. They would comment that it was 'bloodier than hip surgery'. Both of these examples were quite a few years ago. I don't know if it has changed much or not. D > I really do wonder about John's comments on his OR. I have worked in > the OR and all our orthopedic cases were nearly bloodless. We used a [quoted text clipped - 8 lines] > there! > Hummy. Dear Hummy, I can only tell you what I saw.....lots of orthopaedic cases, many with lots of blood. Tourniquets used sometimes....other times not (not sure why not sometimes while other times it was obvious why it wasn't used, but I was doing the anaesthesia). Lots of times I had to give blood products. By the way, the hospital I did my residency in is now closed due to amalgamation with one nearby and I believe condos are on that site now. It was a teaching hospital, so maybe that had something to do with the blood loss. John >I really do wonder about John's comments on his OR. I have worked in > the OR and all our orthopedic cases were nearly bloodless. We used a [quoted text clipped - 8 lines] > there! > Hummy. Hey John, I am driving up to London on May 4th to attend the implant lecture with Roy. We are planning on sharing dinner after the meeting. Any interest in attending?  Signature/ Amatus / > Dear Hummy, > [quoted text clipped - 22 lines] >> there! >> Hummy. > I am driving up to London on May 4th to attend the implant lecture with > Roy. We are planning on sharing dinner after the meeting. Any interest in > attending? Will email you personally to discuss. John > Dear Hummy, > [quoted text clipped - 9 lines] > > John Was this in England, or in the USA? HMc > A dental treatment room is not a hospital OR. What you really > want are reasonable safeguards about cross-contamination. (IOW's > if there was a guy with AIDS in the room before you, was it > disinfected and instruments sterilized/disposed of so that > you are not in danger) The kind of precautions that I observed as missing is basic, and I do believe that they play a significant role in reducing infections from other patients' body fluids. Procedure masks are inexpensive. Keeping gloved hands from contact with potentially contaminated surfaces (other than those necessarily contaminated with the patient's own body fluids) requires mostly adherence to good work habits and procedures. > Truth is that patients rarely caught anything back before gloves, > masks, all of the disposables, plastic covers, autoclaving > hand pieces, etc. I'm not sure if that's true. Was there systematic surveillance on the prevalence of cross-infections from dental procedures before the days of "gloves, masks, ..."? If there was, were diseases like HIV/AIDS, hepatitis B/C included? These serious diseases have long asymptomatic phases. Between a dental procedure and subsequent manifestation of symptoms, a lot has happened. It would seem very difficult for epidemiologists to attribute elevated risks to having had dental procedures done, given the large number of confounding factors. The lack of common recognition that a problem exists is not in itself very reassuring to me. > However, a few of the diseases carry serious consequences and > *most* offices go a long way to reduce the chances of transmission. > Plus you would like to not even catch a cold. One thing to think > about though...what about the restaurants, convenience stores, and > work places through the rest of your life? I certainly hope workers in dental offices take infection control seriously. From what I understand, the infecting done to a dental station consists (mostly?) of wiping down surfaces with disinfectant. Since small splatters of body fluids may be invisible to the naked eye, such a procedure would seem quite error-prone -- there would be no indication if a spot is missed, nor would we know if enough disinfectant has reached where it should. Some surfaces may be missed altogether because they escaped the attention of the person doing the disinfecting. Even if the standard disinfecting practice is effective, better infection control before and during a procedure can't hurt. There is a difference between a dental office and a restaurant. In a dental office, it's a safe bet that most of the patients from earlier in the day, and the days before, bled and contaminated some surfaces around the dental station during their visits. Plus when you are being worked on in a dental chair, the dentist/hygienist will likely create/open some bleeding sites in your mouth. In other words, in a dental office, the likelihoods of blood-borne pathogens introduced into the environment and them finding entrance into your bloodstream are both higher than in most other everyday settings. > If you want a dental treatment room to match the sterility of > a hospital OR, you better get a second mortgage on your house > before your next visit. I don't know if that's true, but relative to the unsatisfactory (to me) infection control practices I've seen, there are at least several simple improvements that can be made. >> A dental treatment room is not a hospital OR. What you really >> want are reasonable safeguards about cross-contamination. (IOW's [quoted text clipped - 46 lines] > > There is a difference between a dental office and a restaurant. You are correct...there is a difference, but the restaurants are much worse. You will never know what goes on in restaurants and the like (disgruntled employees who spit in the food, or put stuff in the food - employees that use the restrooms (both pee and poop), and don't wash their hands (happens all the time - I've seen it many times in my life, and also reported it). I saw my urologist's male surgical nurse assistant (they have a full surgical suite) take a piss once while I was in one of the hallway public restrooms, and walk right on out without washing his hands. Boy did that piss me off. I was going to report him but god knows what kind of retaliation might take place in the future. Retaliation in life is a very real thing - don't ever forget it (and I am not one to be intimidated). And the surgical stirrups in the OR had other peoples hair from their legs on them. I could go on with other stories - surgical suites and OR's are far from sterile. And you should have seen the gross mishandling of the instrumentation, when I once had a 24 hour ph - it was a joke - and I got one of my worst cases of bronchitis I ever had, immediately after having the probe removed the next day. Of course I can't prove it was because of them, but these are just examples. Try this on for size - gastro's (gastroenterologists) used to (not too many years ago before all the insurance crap started controlling everything) perform EGD's and Colonoscopies right in their office (not a surgical suite), and when you went in for an office visit you could see the different size scopes hanging on the wall gathering dust and any kind of micro stuff that could fall on it. I would certainly hope they were thoroughly cleaned just before using, but I wouldn't bet on it. Anyway that stopped in the mid 90's or so. I believe they are now required to be done in either endoscopy centers or in ambulatory surgery in a hospital. I think you are worrying way too much about the dentist stuff. Like the other person said, the dentist is wearing the mask to protect himself from splattering debris, not to protect you - he shouldn't be coughing in your face anyway - lol . And (last but not least), I seriously doubt most dentists will allow you to inspect their office for sterile procedures before you accept them as your dentist. Good luck on that one, and let us know if it works. Dentists are not near the prima donnas that MD's are, but I doubt very many will let you do that, especially if they have a long established clientele. Pete In a > dental office, it's a safe bet that most of the patients from earlier > in the day, and the days before, bled and contaminated some surfaces [quoted text clipped - 13 lines] > me) infection control practices I've seen, there are at least several > simple improvements that can be made. > >> A dental treatment room is not a hospital OR. What you really > >> want are reasonable safeguards about cross-contamination. (IOW's [quoted text clipped - 116 lines] > > - Show quoted text - http://www.aidsfraudvideo.com Important video relating to HIV and AIDS. rocketscience >> A dental treatment room is not a hospital OR. What you really >> want are reasonable safeguards about cross-contamination. (IOW's [quoted text clipped - 5 lines] >believe that they play a significant role in reducing infections from >other patients' body fluids. Reasonable people can quibble about some of those issues. But back to your basic point... Why not just ask? If you care that a dentist observes a certain precaution, ask your prospective dentist if s/he does. By asking about a couple of specific points, you should be able to tell what you want to know, including their attitude about the broad concern. bob >>> A dental treatment room is not a hospital OR. What you really >>> want are reasonable safeguards about cross-contamination. (IOW's [quoted text clipped - 15 lines] > > bob Bob...how are you going to ask the dentist these questions w/o making an appointment with him or her first. You can try asking the twit that answers the phone, but it is very unlikely that the dentist will call you back (especially if you are not an existing patient) - certainly not in the medical doctor world - have you ever tried getting a medical doctor on the phone these days (I mean your own doctor) - no such thing unless you're out in the hills of West Virginia (ie one of the good old Doctor Welby's that are now non existent) - stopped many years ago. The standard answer from the office manager is, if they talk to you they will be stealing time from another patient - but the real answer is, if they talk over the phone too much, they will lose an office visit charge. I have been to approx. 75 doctors in my life, so I am qualified to talk about this. Now, I will admit that you are more likely to get a dentist on the phone than an MD (as a matter of fact much more likely - they are usually more patient friendly, and you can even call them by their first name). But you will probably have to be a patient first and have some kind of follow up problem. It is extremely unlikely that you will be able to get a new dentist on the phone by telling the receptionist you want to ask him or her about their sterilization procedures. I am out of steam now. Pete :-) > There is a difference between a dental office and a restaurant. In a > dental office, it's a safe bet that most of the patients from earlier in > the day, and the days before, bled and contaminated some surfaces around > the dental station during their visits. Plus when you are being worked > on in a dental chair, the dentist/hygienist will likely create/open some > bleeding sites in your mouth. If you saw the mouths of many of my patients, you would know that there is a very good chance of very bad microbes contaminating plates, cups, glasses, silverware, and tables all over your favorite restaurant, the carts in your grocery store, and every surface that you also touch in the public setting. Disinfection in the dental office has taken great strides over the last 20 years. The argument over whether it has gone far enough, or needs more work (not counting the offices who are not practicing according to 'modern' recommendations) will continue forever. We disinfect for our patients' sake, but also for our own! We are the ones who work in that office every day. Cleanliness and disinfection is certainly needed, but it is impossible and probably not necessary to be totally perfect about it. Too much disinfection and medication can lull your immune system to sleep and not be able to respond when you really need it. Steve > I have seen what I consider poor and inadequate infection control > practices in dental offices. Examples of such include: > > - dentist not wearing a mask while *talking* and examining the patient Strictly speaking this is not poor infection control, for example your doctor will not wear a mask while examining you in his office and you probably won't wear a mask when talking to strangers. Surgical masks MUST be used when surgical procedures are performed (fillings, extractions, scalings, root canals etc) and they are used mostly for the protection of the dentist rather than the patient (since it's the dentist who is in danger of inhaling or being splashed with contaminated bodily fluids). It is essential to maintain good infection control as you said during dental treatment, but establishing a truly aseptic environment is not feasible or even desirable in everyday dental practice, except from certain invasive procedures. Regards, George |
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