Examinations carried out by the CQC in 2013 revealed that dental practices met the required infection control standards in 93 per cent of inspections. However, the 2012/2013 State of Care Report also demonstrated that where problems were found around 38 per cent had a major or moderate impact on patients.
Nobody is claiming therefore that UK dental practices are out-of-control breeding grounds for infection and disease, quite the opposite in fact as the statistics show (especially when compared to other areas of public health). However where problems do arise, they could present a potentially significant threat. Therefore a practitioner should do all that they can to avoid adding to the disappointing seven per cent that do not meet the CQC standards.
But what more can a dental professional do when they already try to follow every guideline, regulation and recommendation set forth to govern infection control?
In a practice there tends to be two kinds of equipment available for the clinician: single-use disposable tools that are discarded after use to prevent infection, or reusable instruments that require time-consuming disinfection and sterilisation before subsequent use. For the most part the choices a dental professional has to make around which items their practice stocks as single-use and which should be reusable are already made for them. Gloves and syringe-tips for example, as any dentist knows, should be used for one patient and then discarded, whilst the probes and drills and mirrors they use would normally fall into the latter category and require sterilisation.
However there are some tools that a dentist will have to make their own decision on, and it may be these pieces of equipment that make all the difference - and choosing the right ones could even save a practice time.
One such piece of apparatus is the dental bib holder, not regarded as a ‘medical device’ they are often unfortunately neglected. A dentist currently has the option of a reusable metal or plastic clip or a disposable paper one. Recently there have been many studies that have attempted to shed light on the advantages and disadvantages of reusable bib clips as opposed to single-use, and many of these studies looked at the microbial residue after treatment. Some found that they present a very real risk of cross-contamination, as well as a significant “yuck-factor”, in some instances even accumulating previous patients’ hair and sweat.
One study from Tuft University examined the number and type of germs found on patients’ bib holders. Testing both metal and rubber clips, they found bacteria on between 40 per cent and 70 per cent of those analysed, in spite of regular cleaning and disinfection. Although in this study all of the bacteria found were non-pathogenic - the most common to be found were staphylococci and streptococci - it was clear in principle that unwelcomed bacterial transfer could be facilitated through reusable bib holders.
Another report from June 2010 by Dr Molinari again looked into the microbial contamination of bib clips. This investigation sought to examine and evaluate the presence and composition of bacterial contaminants before and after assessment and treatment, it found that both metal and plastic versions were susceptible to retaining bacteria.
Furthermore this study looked into the effectiveness of cleaning procedures on bib holders and established that their thorough cleaning requires substantial time and effort on the part of dental personnel. It also revealed that although the amount of bacteria present was lessened after cleaning with a disinfectant wipe, the microbial levels were still far higher than those seen on an unused bib holder.
Finally, an investigation in 2012 asked: “Do bib clips pose a crosscontamination risk at the dental clinic?” Like the Molinari report this sought to examine whether they retained excessive levels of bacteria after dental procedures, and to evaluate the effectiveness of disinfection after use.
This investigation looked at two different types of dental clinic, an endodontic practice and an orthodontic practice. Although it revealed differing amounts of microbial colonies developing on the bib holders, in both clinics the results showed that some bacterial contaminants persisted in spite of thorough cleaning. It concluded that although effective reduction was achieved by following the disinfection protocol, 20-30 per cent still harboured bacterial contaminants.
Although the figures from each study differ in scale, the results remain the same: using reusable bib clips increase the risk of crosscontamination from patient to patient, and take considerable amounts of time and energy to thoroughly disinfect. Therefore would it not be far safer and simpler to use a disposable bib holder that has none of the associated risks? The clinician can be assured that the bib holder they use does not carry remnants of the bacteria, hair or sweat from a former patient, without it requiring the time-consuming, scrupulous cleaning needed for effective infection control with reusable holders.
Disposable bib holders, like Bib-Eze hygienic bib holders from Dux Dental, would therefore seem the obvious choice for any dental professional looking for ways to increase their standards of infection control. Reusable bib holders are the simple and effective way of reducing the ‘yuck-factor’ and the risks of cross-contamination in your practice whilst encouraging a more efficient workflow.
References available on request.