The 2003 CDC Guidelines for Infection Control in Dental Health Care Settings recommend that

Standard Precautions be practiced while delivering dental treatment to all patients. These precautions
include practices and procedures that integrate and expand the elements of universal precautions. The
result is a standard ofcare designed to protect health care workers and patients from pathogens that
can be spread by blood or any other body fluids. Saliva has always been considered a potentially
infectious material in dental infection control.
The United States Occupational Safety and Health Administration (OSHA) indicates that
protection of dental health care practitioners (DHCP) can be accomplished by following three basic
employee protection schemes (Table I).4,5 The most effective method is through the
application of engineering and work practice controls. Together, such controls either eliminate or
greatly reduce the chances of occupational exposures and injuries.
Where occupational risk remains after application of engineering and work practice controls, personal
protective equipment (PPE) should be worn. PPE can and does prevent disease spread in dental
environments no matter which mode of spread may be present (Table II).
PPE must be appropriate for the task to be completed and meet the challenges that a given
occupational hazard can present. Correct fit increases effectiveness, wearer safety, and wearer
comfort. The greater the comfort, the greater the compliance by the health care worker.1-3
EYE PROTECTION
There are three types of eye/face protection - safety glasses, face shields and goggles. All are
designed to protect in some manner against occupational hazards, such as projectiles, chemicals,
dust, heat and biohazards.
Safety glasses are intended to protect the wearer's eyes from hazards, especially against impact and
chemicals. Side and top shields offer additional protection against flying objects. Many prescription
glasses include adequate impact resistance. Face shields are designed to protect all or part of the
wearer's face in addition to the eyes. Face shields best protect against spatter. Goggles are designed
to fit the wearer's face immediately surrounding the eyes and form a protective seal.
Because of comfort, appearance and ease ofuse, safety glasses are usually preferred over goggles.13,6
Tips for wearing protective eyewear include:

* Make sure that all eyewear has adequate impact resistance (e.g., meets American National
Standards Institute, ANSI, Standard Z87.1-1989)
* Clean reusable protective eye-wear with soap and water
* If visibly soiled, clean and then disinfect
* Thoroughly rinse clean/disinfected eyewear
SURGICAL MASKS
Surgical masks are composed of multiple layers of synthetic (micro fiber) filter materials designed to
collect and retain microscopic particles. Masks that filter out 95% of small particles that directly
contact the mask are sufficiently protective against aerosols and against large droplet spatter. Masks
must fit well in order to beprotective. Because of fit and composition, most surgical masks used in
dentistry are not to be considered as respirators.1-3,5,6
Masks come in a variety of shapes and sizes. Some masks are preformed domes, while others are
more pliable. Masks are secured to the user by elastic bands, ear loops, or some type of tie. Most
masks are form-fitted over the bridge of the nose and cheeks to reduce fogging by warm, expelled air.
In order to have the proper mask for a given application, several different types and sizes of masks
must be made available. Change masks between patients, or during patient treatment if the mask
becomes wet. Wet masks become less effective. Masks should be removed by touching only the ties,
bands or loops.
Masks must be worn in combination with eye protection devices such as goggles or safety glasses with
side shields or full-length face shields whenever splashes, spray, spatter or droplets of blood or other
potentially infectious materials may be generated and when eye, nose or mouth contamination can be
reasonably anticipated.
Tips for wearing masks include:
* Consider filtration efficiency when selecting a mask; choose masks that are rated above 95%
efficient; many are rated at close to 99%
* Change masks that become wet or loose-fitting
PROTECTIVE APPAREL

Protective apparel is a type of PPE and should be worn to prevent contamination of street clothing and
to protect the skin of DHCP from exposures to blood and body substances.1-3,6
Protective apparel comes in two types - reusable and disposable. Ideally, protective clothing should
have high necks and long sleeves and have some measure of fluid resistance. Protective apparel
should not be worn outside of the facility and should be changed at least daily or when it becomes
visibly soiled or when blood or patient body fluids penetrate through.
Tips for protective apparel include:
* Compare the costs of reusable versus disposable gowns
* Compare the cost of professional laundering versus in-house washing
* Select apparel that has high levels of wearer comfort
* Uniforms, pants, and shirts are not considered PPE unless they are intended to protect the DHCP
against hazard.
GLOVES
Gloves prevent contamination of health care workers' hands when touching patients or instruments
and piecesof equipment contaminated with patient blood and other potentially infectious materials.
Gloves also reduce the likelihood that microorganisms present on health care workers' hands can be
transmitted to patients during surgery or patientcare procedures.1-3,6,8
Medical gloves come in two forms - sterile and nonsterile. Sterile surgeons gloves are to be worn when
performing oral surgery procedures. Nonsterile examination gloves are appropriate for all other
procedures. Nonmedical, heavy-duty utility gloves are proper for cleaning and disinfection and
handling used instruments or chemicals. Nonmedical gloves are never to be used during patient care.
A new pair of medical gloves must be worn for each patient. Never wash medical gloves before or
during use. Gloves are to be removed after use and hands are then washed immediately to avoid
transfer ofmicroorganisms to other patients or the environment. Remove gloves that have become
torn, cut or punctured as soon as feasible and wash hands prior to regloving.
Gloves must be appropriate for the hazard present. For example, heat-resistant gloves are to be used
when removing sterilized instruments from the autoclave, while puncture=/chemical=resistant are

best when handling used instruments prior to cleaning or when performing housekeeping tasks.
Appropriate gloves in the correct sizes must be readily available.
Tips for selecting gloves include:
* Match glove composition with the task at hand
* Select glove characteristics of most importance (e.g., fit, cuff length, color, scent, taste and
presence ofpowder)
* Carefully monitor any adverse skin reactions
The Organization for Safety and Asepsis Procedures, OSAP, is dentistry's resource for infection control
and safety. OSAP has recently published a book on the CDC Guidelines - From Policy to Practice:
OSAP's Guide to the Guidelines. The book is designed to support the efforts of dental practices to
better understand the recommendations and to identify effective and efficient methods for compliance.
Order information is available at either www.osap.org or 410-571-0003.
References
References
1. Centers for Disease Control and Prevention. Guideline for infection control in dental health care
settings, 2003. MMWR. 2003;52 (RR-17): 1-78.
2. Miller, CH and Palenik, CJ. Infection Control and Hazardous Materials Management for the Dental
Team, Third Edition, 2004, St. Louis, MO, C.V. Mosby.
3. Organization for Safety and Asepsis Procedures. From Policy to Practice: OSAP's Guide to the
Guidelines, 2004, Annapolis, MD, OSAP.
4. U.S. Occupational Safety and Health Administration. 29 C.F.R. Part 1910.1030. Occupational
exposure to bloodborne pathogens; Needlestick and other sharps injuries; Final rule. Federal Register
56:64175-182, 2001.
5. Palenik CJ and Govoni M. Selection and use of masks. Dent Today 23 (February):72, 74-75, 2004.
6. Miller CH. Be prepared: a PPE primer, Part I. Dent Prod Report 38 (July):52,54-55, 2004.

7. Centers for Disease Control and Prevention. Respiratory hygiene/etiquette in health care settings.
Available at: www.cdc.gov/flu/professionals/ infectioncontrol/resphygiene.htm. Accessed: September
2004.
8. Palenik CJ. Gloves in the dental office: their use and effectiveness. Dent Today. 23 (July):64-67,
2004.
AuthorAffiliation
By Ginny Jorgensen, CDA, EFDA, EFODA, AAS and Charles John Palenik, MS, PhD, MBA
Ginny Jorgensen, CDA, EFDA, EFODA, AAS, has been employed as an orthodontic assistant, general
chairside assistant, and a trainer for a large group practice. Currently, she is a full-time, clinical
procedures dental assisting instructor at Portland Community College in Portland, Oregon. She is an
approved speaker on Bloodborne Pathogens for the National Association ofDental Laboratories (NADL),
and is a member of The Dental Assisting National Board (DANB), Infection Control Exam (ICE) test
construction committee.
Charles John Palenik, MS, PhD, MBA, has held a number of academic and administrative positions at
Indiana University School of Dentistry, and currently is Director/Infection Control Research & Services.
Dr. Palenik has published hundreds of articles, monographs, books and book chapters, the
majority of which involve infection control and human safety and health. In addition, he has provided
110 continuing education courses.
Copyright American Dental Assistants Association Nov/Dec 2004