Infection Control in the Laboratory
Who is responsible for infection control, the dental laboratory or the dentist? This seems like a simple question, right? Well, you might be surprised to learn that doctors and dental laboratories may answer this question very differently.
Many doctors think that the laboratory is responsible for disinfecting the prosthesis prior to delivering it to the dental office. That is not always the case. Only the State of Texas requires dental laboratories to disinfect cases before they are delivered to the dental office. So, although the National Association of Dental Laboratories recommends that the laboratory establish an infection control procedure for both incoming and outbound cases, the responsibility lays with you, the doctor.
“Communication between the dentist and the dental laboratory is critical not only for the safety of the patient, but for the quality of the product created by the dental laboratory. Neither the dentist nor the dental laboratory should presume what the other is doing on this point,” says Mary Borg, president and co-founder of SafeLink, Inc., which specializes in occupational safety and health management services for the dental industry. She adds, “Under the Occupational Safety and Health Administration’s Bloodborne Pathogen Standard, it is not required that the finished case be disinfected by the laboratory prior to shipment to the dental office. However, I believe that it is important that the dental laboratory and the dentist be informed of the other’s infection control procedures as they relate to the appliance or item to be shipped. This is a very important part of patient safety and one that is commonly overlooked.”
In addition, although many laboratories do disinfect cases before they are shipped, the laboratories may not be utilizing a disinfectant of the appropriate strength. According to Borg, laboratories that use non-EPA-registered disinfectants may be using a low-level disinfectant. She suggests that, if a laboratory uses a non-EPA-registered disinfectant, they should place a notice in each case indicating that the finished case has been cleaned by a low-level product. “In my opinion even if the dental laboratory does disinfect the case and package it so it’s tamper-evident, the dental staff should disinfect and rinse it prior to insertion in the patient’s mouth,” says Borg.
Dental offices and laboratories also often have differing ideas of their infection control responsibilities related to the delivery of initial impressions to the laboratory. According to Borg, all items that are removed from the patient’s mouth should be rinsed to remove blood and bioburden and properly disinfected utilizing an EPA-registered, hospital-grade disinfectant that is compatible with the impression material. “Even though some doctors want blood, cotton rolls, and bloody retraction cords to remain for technical reasons, the dental staff should make every attempt to remove these materials before disinfecting the impression and shipping it to the laboratory,” says Borg. Although you may be aware of the hazards of leaving this in the impression, your staff may need additional instruction or training. Remember, when it comes to infection control, open communication and proper training are essential to ensure patient safety, as well as the safety of your office staff and the laboratory staff.