Test FAQ's Office Design & Management
|Frequently Asked Questions (FAQs) On Dental Infection Control - Office Design & Management|
|Frequently Asked Questions for Office Design & Management|
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|Q||How can infection control be incorporated into the office design? |
|A|| When designing an office, keep in mind six main considerations for the safety of patients and workers: (1) office flow; (2) cabinetry; (3) laminate, wall, and floor coverings; (4) fixtures, dispensers, and waste drops; (5) support equipment; and (6) ventilation. Office flow should expedite moving from one area to another with minimal cross-contamination. In cabinetry, the number of drawers and their contents should be minimized to ease clean-up and reduce possible cross-contamination. Drawers should also be no less than five (5) inches deep to accommodate support instruments. Laminates, wall, and floor coverings allow cleaning and disinfection of all surfaces. Fixtures, dispensers, and waste drops should require minimal hand contact to maximize the effectiveness of infection control. Support equipment should be positioned strategically with operator ease, comfort, and team safety in mind. Finally, work areas must have positive ventilation to rid area of noxious vapors(*). References:|
(*) Pollock R, Young, J. Infection control considerations in dental office design. Cottone JA, Terezhalmy GT, Molinari JA, eds. Practical Infection Control in Dentistry, 2nd ed. Philadelphia:Williams and Wilkins, 1996:281.
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|Q||Is carpet appropriate for a dental office?|
|A||Compared to non-porous, hard-surface flooring, carpeting is more difficult to keep clean and cannot be reliably disinfected, especially after spills of blood and body substances. Several studies have documented the presence of diverse microbial populations, primarily bacteria and fungi, in carpeting.(1,2) Cloth furnishings pose similar contamination risks in areas of direct patient care and where contaminated materials are managed (e.g., dental operatory, laboratory, instrument processing area). For these reasons, carpeted flooring and upholstered furnishings should be avoided in these areas.References:|
(1) Gerson SL, Parker P, Jacobs MR, Creger R, Lazarus HM. Aspergillosis due to carpet contamination. Infect Control Hosp Epidemiol 1994;15(4 Pt 1):221-3
(2) Suzuki A, Namba Y, Matsuura M, Horisawa A. Bacterial contamination of floors and other surfaces in operating rooms: a five-year survey. J Hyg (Lond) 1984;93(3):559-66
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|Q||Should a specific, well-defined area be designated for instrument processing? |
|A||If possible, instruments should be cleaned and sterilized in an area designated for that purpose. If a lack of space prohibits this scenario, establish a clearly defined location for holding and processing contaminated instruments and devices. Ensure that this area is physically separated from the area where clean instruments are stored. If instruments must be decontaminated in patient treatment areas, don't seat the next patient until all instrument processing has been completed and the area has been cleaned and disinfected.|
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|Q||Does an office need two refrigerators—one for medicine and one for biopsies/cultures?|
|A||If the containers are leakproof and the items are well separated and clearly marked, two refrigerators may not be necessary. Call your state's OSHA office and Department of Public Health for further clarification regarding your state's rules.(1) Food, medications or other consumables should not be stored in the same refrigerator with chemical products or items containing potentially infectious materials such as blood, tissue or saliva.References:|
(1) OSHA. State Occupational Safety and Health Plans. Available at http://www.osha.gov/fso/osp/index.html
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|Q||How can one reduce the amount of aerosols in the office's environment?|
|A||To reduce spatter and aerosol generation during patient treatment, use of a high-volume evacuation when using high-speed handpieces or prophy angles, properly position the patient so aerosols are contained within the oral cavity, use rubber dam to maintain a dry field, and ensure good ventilation in the office. |
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|Q||How do we disinfect laptops in the treatment room? |
|A||Since the use of liquid chemical germicides could prove harmful to laptop computers, the proper management would be to prevent contamination from occurring. Use impervious barriers or plastic shields, or place the computer in a location that is not subject to contamination via touch or splatter. |
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|Q||If an office gets flooded, what should be done with supplies? |
|A||As addressed by Lynne Sehulster, PhD, with the Centers for Disease Control and Prevention's Division of Healthcare Quality Promotion: |
Determine the source of the flooding. If it's a leak (e.g., water pipe develops a leak, roof leaks after a heavy rain), stop the leak and make the repair. If the flooding is from a natural event, remove the water or allow it to recede.
Determine if the potable tap water supply has been compromised. Check with the municipal water utility for more guidance if the problem comes from natural flooding. Comply with "boil water" advisories(1) issued by local authorities. If the flooding comes from a plumbing leak in the building, the plumber should be able to advise you as to whether water quality will be restored after the leak is repaired. Note: The importance of restoring water quality early on is to help with the rest of the operatory clean up.
With regard to operatory equipment, instruments, and supplies, discard any disposable, single-use items that have become wet. Reuseable supplies, packaged or unpackaged, should be cleaned with clean, potable water and reprocessed according to manufaturer recommendations. If water quality cannot be readily restored, use bottled water (such as you would find in the supermarket) for this purpose. Equipment should be cleaned up as much as practical. If electrical equipment is water-damaged, check with the manufacturer to obtain its recommendations for cleaning and restoring safe operation.
Clean hard, non-porous environmental surfaces (e.g., floors) with clean water and a detergent disinfectant. Clean and then disinfect operatory surfaces such as the countertops using a low- or intermediate-level disinfectant.
Dental/medical records should be dried out and copies made if needed. If records are contaminated (e.g., from a major sewage spill) and they can't be copied, then laminate the page or surround it with plastic wrap. Check with local hospitals to see what methods might be available to for record restoration and preservation.
Structural damage to walls, floors, ceilings, etc. from major flooding should be addressed ASAP. To prevent the growth of mold and mildew, wet sheetrock, plasterboard, carpeting, and any other absorbent building material needs to be thoroughly dried out within 72 hours. If this is not feasible, then those wet materials need to be removed to allow the underlying structure to dry. It may help to have an engineer or a health department industrial hygienist come by with a moisture meter to make the determination of "dryness."
Additional OSAP resources on managing flood conditions.References:
(1) CDC. Suggested procedures for dental offices during boil-water advisories. Available at http://www.osap.org/issues/news/index.php?name=969375729
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|Q||What are the benefits of OSAP membership and how can I become a member?|
|A||OSAP invites interested individuals or institutions take part in OSAP by becoming a Member or by being a Subscriber to our publications. Manufacturers and distributors are eligible to join as Corporate Members. Benefits are outlined on our Join OSAP page. |
In addition to tangible benefits like newsletters, the chance to earn continuing education credit, and discounts on programs and materials, being a part of OSAP offers some intangibles as well. As a multidisciplinary group of clinicians, educators, researchers, policymakers, and the dental trade, OSAP provides a cross-disciplinary forum for dialogue, idea exchange, and advice that is hard to find elsewhere. OSAP's most valuable resource is its membership. Consider joining today.OSAP invites you to contact the Central Office with any questions (800-298-6727 / 410-571-0003), or to sign up for your OSAP membership at http://osap.org/pass/register.htm.
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|Q||Are there any regulations that would restrict the duties of healthcare workers or students with oral piercings?|
|A||OSAP is not aware of any specific regulations concerning healthcare workers and/or students with oral/facial piercings. We do not believe that this should hinder the delivery of safe care in the dental or other healthcare setting. |
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|Q||Are there any autoclavable computer keyboard and mouse combinations available? Are there any recommendations concerning sterilization or disinfection of computer keyboard and mouse?|
|A||The computer keyboard/mouse are sources of contamination and must be barrier protected or cleaned and disinfected (we are aware of one type of keyboard/mouse that is autoclavable). |
Dental infection control experts recommend using barrier protection to cover equipment, especially sensitive equipment, such as computer keyboards/monitors/mouse and other difficult-to-clean surfaces. Reminder, barriers must be changed between patients and surfaces only need to be cleaned and disinfected if the barrier has been compromised.
The Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Healthcare Settings (December 2003) states the following:
Barriers include clear plastic wrap, bags, sheets, tubing, and plastic-backed paper or other materials impervious to moisture. Because such coverings can become contaminated, they should be removed and discarded between patients, while DHCP are still gloved. After removing the barrier, examine the surface to make sure it did not become soiled inadvertently. The surface needs to be cleaned and disinfected only if contamination is evident. Otherwise, after removing gloves and performing hand hygiene, DHCP should place clean barriers on these surfaces before the next patient. (1)
Keyboards and mouse not barrier protected should be cleaned and disinfected according to manufacturer instructions. The computer/equipment manufacturer should be consulted prior to cleaning and disinfecting with chemical agents because the equipment warranty may be void if chemicals not approved by the manufacturer are used on their product. There are specially designed computer keyboards for use in healthcare settings that may be disinfected.
Further information about autoclavable computer keyboard and mouse combinations can found at:
The Journal of the American Medical Informatics Association also provides information concerning computer keyboards at:
The North Carolina Statewide Program for Infection Control and Epidemiology (SPICE) provides information on disinfecting computer keyboards in one of their monthly reports. The information may be viewed at:
1) CDC's Infection Control Guidelines for Dental Healthcare Settings (December 2003):http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm
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|Q||When a patient vomits, since this is OPIM, it should be discarded with our infectious waste, correct? Is there any documentation of this?|
|A||Under OSHA's Bloodborne Pathogens Standard 29 CFR 1910.1030 only blood and certain body fluids are considered regulated waste or other potentially infectious materials. It should be noted that under Universal Precautions OSHA does not list vomit as OPIM. However, OSHA states that it is the employer's responsibility to determine the existence of regulated waste. |
Disposal of all regulated waste shall be in accordance with applicable regulations of the United States, States and Territories, and political subdivisions of States and Territories.
The Standard defines the following terms:
Universal Precautions is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens. (1)
Regulated Waste means liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials. (1)
Other Potentially Infectious Materials means (1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. (1)
According to the authors of Infection Control & Management of Hazardous Materials for the Dental Team, the prevailing view is that no epidemiologic evidence suggests that most medical waste is any more infective than residential waste. Also, no epidemiologic evidence indicates that current medical/dental waste handling and disposal procedures have caused disease in the community. Therefore, identifying wastes for which special precautions are necessary is largely a matter of judgment concerning the relative risk of disease transmission. (2)
What now is agreed commonly is that only a limited amount of medical waste needs to be regulated (requiring special handling, storage, and disposal methods). For dentistry, these items include bulk blood or blood products, pathology waste, and sharps. Often the blood and blood products group is expanded to include liquid or semi-liquid blood (and any other potentially infectious materials), contaminated items that release liquid or semi-liquid blood or other potentially infectious materials when compressed items caked with dried blood or other potentially infectious materials that could be released during handling, and pathologic or microbiologic wastes that contain blood or other potentially infectious materials. Usually other body fluids are exempt. However, the CDC considers saliva to be infectious waste because it often is tainted with blood during treatment. Fortunately for dentistry, the generation of infectious waste items is modest. (2)
Based on CDC's Standard Precautions, all blood and body fluids, including secretions and excretions (except sweat), should be considered as potentially infectious in all patients.
With regard to the clean up of vomit, blood, saliva, body fluids, and OPIM (other potential infectious materials), we will refer you directly to the Centers for Disease Control and Prevention's Infection Control Guidelines for Dental Healthcare Settings. Although the guidelines do not specifically address vomit, the following is applicable:
The relevance of universal precautions to other aspects of disease transmission was recognized, and in 1996, CDC expanded the concept and changed the term to standard precautions. Standard precautions integrate and expand the elements of universal precautions into a standard of care designed to protect HCP and patients from pathogens that can be spread by blood or any other body fluid, excretion, or secretion (11). Standard precautions apply to contact with 1) blood; 2) all body fluids, secretions, and excretions (except sweat), regardless of whether they contain blood; 3) nonintact skin; and 4) mucous membranes. Saliva has always been considered a potentially infectious material in dental infection control; thus, no operational difference exists in clinical dental practice between universal precautions and standard precautions. (3)
Cleaning and Disinfection Strategies for Blood Spills
The majority of blood contamination events in dentistry result from spatter during dental procedures using rotary or ultrasonic instrumentation. Although no evidence supports that HBV, HCV, or HIV have been transmitted from a housekeeping surface, prompt removal and surface disinfection of an area contaminated by either blood or OPIM are appropriate infection-control practices and required by OSHA. (3)
Strategies for decontaminating spills of blood and other body fluids differ by setting and volume of the spill. Blood spills on either clinical contact or housekeeping surfaces should be contained and managed as quickly as possible to reduce the risk of contact by patients and DHCP. The person assigned to clean the spill should wear gloves and other PPE as needed. Visible organic material should be removed with absorbent material (e.g., disposable paper towels discarded in a leak-proof, appropriately labeled container). Nonporous surfaces should be cleaned and then decontaminated with either an EPA-registered hospital disinfectant effective against HBV and HIV or an EPA-registered hospital disinfectant with a tuberculocidal claim (i.e., intermediate-level disinfectant). If sodium hypochlorite is chosen, an EPA-registered sodium hypochlorite product is preferred. However, if such products are unavailable, a 1:100 dilution of sodium hypochlorite (e.g., approximately ¼ cup of 5.25% household chlorine bleach to 1 gallon of water) is an inexpensive and effective disinfecting agent. (3)
Carpeting and Cloth Furnishings
Carpeting is more difficult to clean than nonporous hard-surface flooring, and it cannot be reliably disinfected, especially after spills of blood and body substances. Studies have documented the presence of diverse microbial populations, primarily bacteria and fungi, in carpeting. Cloth furnishings pose similar contamination risks in areas of direct patient care and places where contaminated materials are managed (e.g., dental operatory, laboratory, or instrument processing areas). For these reasons, use of carpeted flooring and fabric-upholstered furnishings in these areas should be avoided. (3)
1) OSHA: Bloodborne Pathogens Standard 29 CFR 1910.1030
2) Infection Control & Management of Hazardous Materials for the Dental Team, 3rd. Edition. By
Miller and Palenik. Elsevier/Mosby Publishers. Copyright 2005.
3) Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental
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|Q||Eyewash stations with faucets that turn upward, can they be considered an eyewash station?|
|A||Because dental offices utilize materials deemed hazardous (refer to each chemical/dental materials MSDS) offices must be equipped with emergency eyewash stations for use by all employees including handicapped employees who may be exposed to injurious materials. |
OSAP can provide you with general information concerning eyewash station requirements as they relate to OSHA”s Hazardous Communication Standard (Hazardous Chemicals).
In addition, if the practice is located in a state with a state operated OSHA there may be additional eyewash requirements that OSAP would not be aware of. Therefore, the practice should also contact their state OSHA, if applicable, for specific eyewash station requirements in their state.
States without state operated OSHA plans must adhere to Federal Standards. OSAP would like to refer you directly to the Federal OSHA Standard that applies to emergency eyewash stations.
Based on ANSI requirements, it should be noted that the employee (who may be partly blinded by chemicals in the eyes) should be able to reach and use the eyewash equipment within appproximately10 seconds. If an employee accidentally turned on hot water to the emergency eyewash equipment it could result in further injury to the eyes, therefore, the eyewash should be a style, or installed in a manner, that by-passes the hot water line. The employee should be able to simultaneously flush both eyes. In addition, each eyewash station location should be designated by a sign/poster.
This national consensus standard provides details on emergency eyewash and shower equipment. The basic requirement is to have emergency showers and eyewashes within 10 seconds travel distance of a hazard.
This requires that flushing fluids shall be tepid. make sure that supplied water temps are in the range of 60°-90° F. Personal eyewash equipment ,such as squeeze bottles, do not meet the requirements of plumbed or self-contained eyewash equipment. Make sure units meeting ANSI Z358.1-1998 are within 10 seconds of travel time from hazard time.
ANSI Z358.1-1998 EMERGENCY EQUIPMENT PERFORMANCE SPECIFICATIONS:
Eyewashes:.4 GPM for a minimum of 15 minutes
Nozzles protected from airborne contaminants provide flushing fluid to both eyes simultaneously at a velocity low enough to be non-injurious. Simple operation: "off" to "on" in 1 second or less.
Height from standing surface 33" to 45".
Nozzles located 6" from nearest wall or obstruction
Minimum operating pressure: 30 psi.
Hands-free operation once activated.
A log shall be maintained and posted by eyewash stations indicating testing date and individual.
Because of the wide variety of eyewash equipment, OSAP would not be in a position to determine whether or not an eyewash station meets all of the requirements. However, we can provide you with the following additional information and resources.
Paragraph (c) of OSHA (Occupational Safety & Health Administration) Standard 29 CFR 1910.151. The OSHA requirements for emergency eyewashes and showers, found at 29 CFR 1910.151(c), specify that "where the eyes or body of any person may be exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within the work area for immediate emergency use." As the standard states, an eyewash and/or safety shower would be required where an employee's eyes or body could be exposed to injurious corrosive materials.. OSHA refers to the requirements with respect to highly corrosive chemicals contained in the American Standard for Emergency Eyewash and Shower Equipment ANSI Z358.1-1998. (1)
OSHA Standard 29 CFR 1910.151(c) is available at:
According to OSHA, while not having the force of a regulation under the OSH Act, the current ANSI standard addressing emergency eyewash and shower equipment (ANSI Z358.1-2004) provides for eyewash and shower equipment in appropriate situations when employees are exposed to hazardous materials. ANSI's definition of "hazardous material" would include caustics, as well as additional substances and compounds that have the capability of producing adverse effects on the health and safety of humans. ANSI's standard also provides detail with respect to the location, installation, nature, and maintenance of eyewash and shower equipment. (2)
If OSHA inspects a workplace and finds unsuitable facilities for quick drenching or flushing of the eyes and body, a citation under 29 CFR 1910.151(c) would be issued. When determining whether the eyewash or shower facilities are suitable given the circumstances of a particular worksite, OSHA may refer to the most recent consensus standard regarding eyewash or shower equipment, which would be the 1998 version of ANSI Z358.1, as well as other recognized medical, technical and industrial hygiene sources. (2)
Because OSHA utilizes the ANSI standards for emergency eyewash requirements, OSAP would like to refer you to the standards of the American National Standards Institute (ANSI). These standards are copyrighted, however, you may obtain copies of these standards by contacting ANSI at:
American National Standards Institute, Inc.
11 West 42nd Street
New York, New York 10036
Phone: (212) 642-4900
(1) The Occupational Safety & Health Administration: http://www.osha.gov
The Occupational Safety & Health Administration has posted resources for dentistry at:
(2) The Occupational Safety & Health Administration: Standards Interpretation:
1) OSHA”s Hazardous Communication Standard: http://www.osha.gov/SLTC/hazardcommunications/index.html
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|Q||What exposure management protocols should be used in the darkroom?|
|A||OSAP would like to refer you directly to the Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental Healthcare Settings. In part, the guidelines state the following: |
When taking radiographs, the potential to cross-contaminate equipment and environmental surfaces with blood or saliva is high if aseptic technique is not practiced. Gloves should be worn when taking radiographs and handling contaminated film packets. Other PPE (e.g., mask, protective eyewear, and gowns) should be used if spattering of blood or other body fluids is likely. Heat-tolerant versions of intraoral radiograph accessories are available and these semi-critical items (e.g., film-holding and positioning devices) should be heat-sterilized before patient use. (1)
After exposure of the radiograph and before glove removal, the film should be dried with disposable gauze or a paper towel to remove blood or excess saliva and placed in a container (e.g., disposable cup) for transport to the developing area. Alternatively, if FDA-cleared film barrier pouches are used, the film packets should be carefully removed from the pouch to avoid contamination of the outside film packet and placed in the clean container for transport to the developing area. (1)
Various methods have been recommended for aseptic transport of exposed films to the developing area, and for removing the outer film packet before exposing and developing the film. Other information regarding dental radiography infection control is available. However, care should be taken to avoid contamination of the developing equipment. Protective barriers should be used, or any surfaces that become contaminated should be cleaned and disinfected with an EPA-registered hospital disinfectant of low- (i.e., HIV and HBV claim) to intermediate-level (i.e., tuberculocidal claim) activity. Radiography equipment (e.g., radiograph tubehead and control panel) should be protected with surface barriers that are changed after each patient. If barriers are not used, equipment that has come into contact with DHCP's gloved hands or contaminated film packets should be cleaned and then disinfected after each patient use. (1)
Additionally, OSAP's November 2003 issue of Infection Control In Practice is devoted to infection control and dental radiography. In part, this issue provides the following protocols:
Wear gloves while exposing films in the patient's mouth. Place exposed films in a paper cup. When all films are exposed, remove and discard gloves. Transport to the darkroom, re-glove and carefully open the packs and drop the films on a clean surface. Discard the contaminated wrappers, remove and discard the gloves, and process the films. When using an x-ray processor with a daylight loader, extra precautions are required to avoid contamination of the sleeves, and external and internal components of the processor. X-ray films packaged in fluid impervious barriers are available. A slight modification of the recommended x-ray and darkroom protocol is indicated. After exposing the film, pull on the edges of the barrier pack, allowing the film to drop into a clean paper cup without contaminating the inner film packet. When all films have been exposed and collected in the cup, remove procedure gloves and take films to the darkroom or daylight loader for processing. (2)
Place reusable film-holding devices in the designated area. If film barrier pouches have been used:
? Carefully peel back the barrier and allow each film packet to fall from its pouch into a clean disposable container (such as a plastic cup) for transport to the developing area. Use care to avoid contaminating the outside of the film packet and the cup. (2)
If barrier pouches have not been used (to protect the film):
? Follow instructions below for Handling Film Without Barriers. (2)
Discard all contaminated disposable items.
Carefully remove contaminated barriers.
Remove gloves and wash hands.
Remove the lead apron and dismiss the patient.
Disinfect all uncovered surfaces that were contaminated.
? If barriers are not used, x-ray equipment that has come into contact with gloved hands or contaminated film packets must be cleaned and then disinfected after each patient use. Use protective barriers or clean and disinfect any surfaces that become contaminated by using an EPA-registered low-(with HIV and HBV claim) to intermediate-level (with a tuberculocidal claim) hospital disinfectant. (2)
For developing film:
With clean, ungloved hands, transport the disposable container of exposed film to the processing area. (2)
- paper cup(s)
- paper towel(s)
- film mount or paper envelope. Take care to avoid contaminating the developing equipment.
- Use barriers or clean and disinfect any surfaces that become contaminated.
Handling Film Without Barrier Pouches:
Barrier sleeves for x-ray film packets are commercially available. These barriers are placed over the x-ray film packet before the film is positioned in the patient mouth and removed immediately after the x-ray is taken, providing dental workers with a clean, uncontaminated film packet for processing. The barriers protect film from contamination, reduce preparation time, and simplify processing. Removed in a lighted area with gloved hands, the barrier is simply peeled back and the film packet dropped onto a clean paper towel or into a clean disposable cup. Barrier-protected film packs are especially useful when using a daylight loader. If your practice setting uses film that is not barrier-protected, add these steps to the infection control protocol for dental x-rays. (2)
a. Place paper towel on your work surface
b. Place container with films next to paper towel
c. Secure door and turn out light (if applicable)
d. Put on gloves
e. Remove film from container
f. Open film packet
g. Allow film to drop onto paper towel
h. Dispose of empty packet
i. After all film packets have been opened, discard container
j. Remove gloves and wash hands
k. Process film by edges only
l. Label film mount or envelope
OSAP members and subscribers have access to Infection Control In Practice. Further information may be viewed at: http://www.osap.org
1) Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental
2) OSAP's Infection Control In Practice. Vol. 2, No. 8 November 2003.
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