I used to work with a very talented oral and maxillofacial surgeon who did not accept just any nurse to be his assistant. The reason for this was that he wanted absolute aseptic environment for the implant surgeries he was performing. In his words

“One either has an aseptic consciousness or doesn’t. It cannot be taught.”

At that time I thought he was exaggerating but I have learned since that he was actually right.

Simplified, the aseptic conscious is an ability to know when surface, instrument, hand is contaminated by bacteria and how and in which order you start to fix it to make it asepsis. It is an ability to know where you can touch without contaminating the gloves when you are treating a patient. It is the key for effective cross infection control in dental practices.

We learn asepsis at dental schools. But there are things you cannot learn by just reading from the book. Sometimes even practice won’t teach us. In my experience aseptic conscious is as hard to learn as singing. If you do not have the gift you will not become a successful singer (the one’s singing in the shower do not count in this comparison!).

Failing in Basics

A dentist puts her face mask on, washes her hands and puts the gloves on. She gets closer to the patient, adjusts her face mask and uses her little finger to move her hanging fringe to the side of her head…

Err, what went wrong? Pretty much everything after putting the gloves on.

Not understanding what contaminates the clean areas/instruments/hands is a major problem in dentistry. It applies to all the dental professionals – not only the dentists. Even bigger problem is that it is also a subject amongst dental professionals that is hard to bring up if you see a colleague doing something that compromises the cross infection control.

But we must speak about it! How else would they learn asepsis?

Clean Hands

Washing hands needs to be done correctly for it to be effective. But washing hands can be replaced by the use of disinfection gel if the hands are not visibly contaminated. But this needs a correct technique too.

All the professional’s should watch this video about washing hands and using the disinfection gel. I bet many of us fail in the technique.

I must point out that in this video they apply far to little of disinfection gel – if you have an automatic dispenser like the ones the hospitals have, trust the amount the dispenser gives you even if it feels too much.

Also in this video they begin the use of disinfection gel in wrong order. The correct technique goes like this:

1. Take the gel to the palm of your left hand (or the right, it doesn’t matter from which hand you start)
2. Dip the finger tips of your right hand in the gel on your balm
3. Pour the gel to the palm of the right hand
4. Dip the left hand’s finger tips in the gel
5. Only then start to spread the gel as advised in the video

Important to remember: Never try to speed up the evaporation of the disinfection gel by waving your hands in the air. This will only contaminate your hands with airborne pathogens.

Revelations

Too many of us professionals fail in either disinfecting the hands or keeping them uncontaminated during the treatments. To prove my point I will tell you my observations.

I have seen

• dentist removing temporarily his face mask during the treatment to speak to the patient and placing it back again (the same mask and the same gloves) before continuing the treatment
• dentist using the mirror handle’s tip to press computer keyboard key’s in the middle of the treatment
• dentist touching the water tap (especially when adjusting dentures/bite block to rinse the apparatus) with the gloves he’s entering patient’s mouth
• dentists, hygienists and nurses to reach instruments/materials inside the surgery cupboard with gloves that are contaminated by patient’s saliva
• dentists removing their glove from one hand in the middle of the treatment to do something “aseptically” and then placing the same glove back again
• dentists removing both of their gloves in the middle of the treatment to do something “aseptically” and then placing the same gloves back again
• dentists using disinfection gel for the gloves
• nurses having long and polished nails – I mean reeeally long
• dentists, hygienists, nurses wearing watches and bracelets

Thank god dental surgeries are pretty much paperless nowadays. The dentists used to check the dental records in the middle of the treatment with the same gloves as they were treating the patient.

Conclusion

A Dentist, hygienist or nurse with pathogen-free hands is every patient’s right to have.

So do pay attention how you get ready for the treatment with each patient. Sometimes we are behind schedule and we cut corners but with this matter you simply cannot.

I will end this post by an information on how all the dental professionals should get ready for the patient (in every day dentistry) and hope you will follow this advise already today.

Before the treatment:

1. disinfection gel (or hand wash if visibly contaminated hands)
2. face mask and eye protection
3. disinfection gel
4. gloves

After the treatment:

1. Remove the gloves
2. disinfection gel
3. remove the face mask and eye protection
4. disinfection gel