The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#181 The Often Forgotten "Splash Zones" - a Source of Cross-Contamination in Dentistry
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What is the one area in every dental office that becomes highly contaminated that we don't usually think about? If you say "sinks", you would be right. In this episode, the Divas discuss splash zones and infection prevention and control. It's an eye opener!
Resources:
- CDC Considerations for Reducing Risk: Water in Health Care Facilities https://bit.ly/3YJOJss
- Infection Prevention and Control Resource Hub - Water Management: Sinks and Drains https://bit.ly/4eYXULe
Welcome. I'm Leslie Cannum. I'm Mary Gavoni.
SPEAKER_01I'm Linda Harvey. I'm Olivia Juan. And together we are the Compliance Divas. Welcome to the Compliance Divas Podcast. I'm Leslie Cannum and I'll be your moderator for this podcast where we're going to focus on splash zones. We bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. You can subscribe to the Compliance Divas podcast for your favorite podcast channel, or you can go to our website, thecompliancedevas.com. The resources that we mentioned during our podcast can be found in the show notes of each podcast and on our website, when you click on the episode, it will lead you right to the podcast and the show notes. We always encourage you to submit your questions to support at the compliancedivas.com. Well, we've been talking a lot about water safety in the wake of Milton and Helene, especially for dental practices in areas with oil water advisories. We've also had several compliance divas podcasts on dental unit waterline monitoring. But today I'd like to focus on the various sinks around a dental setting, places where we wash our hands, reprocess instruments, sinks in our treatment rooms, and even the sinks where in some places, some dental practices, they're considered to be a toothbrushing station, like in orthodontic or pediatric practices. Some dental practices actually even have a hand washing station in their sterilization room. And there may be a combination of sinks for hand washing and working on instruments and an eye wash station. In larger facilities, sometimes in hospital settings or in larger clinics, they have clean sinks and they have dirty sinks. We've even spent some time at the complaints divas talking about eye wash stations, where they should be located. And I don't think everyone has really ever considered a splash zone as far as how that could be a source of cross-contamination. So when I think of splash zone, it you know kind of sounds like a water park where you ride down a slide with water splashing through, or a summertime sprinkler toy. But in healthcare settings, a splash zone is activity where the sink or the water that splashes could contaminate patient care items. Mary, can you tell us why we should be concerned about water at the sink and the risk of contamination to patients and dental offices?
SPEAKER_00Absolutely, Leslie. And I have that water park image in my head as well. Or when you see facilities that have these big long sinks where everybody's washing their hands at the same time. The reason we're concerned about this is that municipal water that comes to those sinks and in those hand washing stations and so forth has microbial contamination in it. And so there can be opportunistic pathogens, as they are referred to by the CDC, that get splashed from that sink or from the drain when we're doing things like hand washing or washing instruments. And so the CDC actually has guidance on this for prevention of health care-acquired infections, and they talk about precautions such as avoiding placing patient care or personal items on counters next to the sink. So we sometimes will put plastic cups that can be used for patients to rinse with, or we might put our box of masks and a box of gloves next to the sink. The Centers for Medicare Medicaid Services says that that splash zone that Leslie talked about is about three feet. So that's some space that we need to keep those items away from something that can splash from the sink, the basin itself, the faucet, the faucet handles, and onto that surrounding countertop. So we should be using a cleaner at the end of the day, or maybe several times a day, depending on how much activity is going on around those areas to prevent that splashing of opportunistic pathogens.
SPEAKER_01Well, that certainly gives us something to think about. And I know our diva, who couldn't be here today, Linda, was very concerned about the items that we see in a dental setting. And you know, sometimes there's even patient education materials and literature that is out on the counter. During COVID, a lot of that have been removed from the treatment room. And I hate to see some of those things come back in again where they're difficult to clean and disinfect after patients. And it's eye-opening to think that there's a three-foot radius that is considered a splash zone. Now, one of the things that we might want to consider is if we're building a new practice or if remodeling a practice, to consider sync design when installing or modifying sinks and choosing designs that prevent splashing and have adequate depth. Many times dental offices are designed by the contractors that don't really have a good concept of where a sharps container could go, for example, or where drop-throughs should go, or uh evident like where the hand washing station is with in relationship to other parts of the countertop where things might be stored. There's also some consideration that can be given, according to CDC, if we angle or offset faucets so that they don't pour directly into the sinks. I know that many dental practices will have patients rinse, either pre-procedural rinse in the sink, and so they're rinsing and spitting or after procedures or just to remove gravelly stuff from inside the mouth after a procedure. So it's an area where not just hand washing occurs, but where patients are actually rinsing and spitting out. And so we want to make sure that those that how the sinks are designed is not going to splash back whatever has gone down that drain. You might want to also take consideration of where hand cleaning or hand hygiene products are located and paper towels. And then another point that was brought up by CDC is monitoring and regulating the water pressure that's used in patient care area sinks so that the splashing is minimized when the water flow is used. That I had never thought of before. And you know, I think when I'm using my hose in my garden, when it doesn't have adequate pressure or when it has too much, never considered that in a dental setting at the sink.
SPEAKER_00Well, Leslie, another thing that I wanted to add to the information that you discussed about design, what I've seen in a number of designs over the last few years is that to save money on plumbing and equipment, many designers are not including a sink in a dental operatory. And back in the day, we had usually two sinks, one on the doctor's side, one on the assistant side in the treatment rooms. And again, as a cost-cutting measure, they're eliminating them. And some of the designers I've spoken with have said, well, there's alcohol-based hand rubs, they can just use those. They don't need to do soap and water washing. But the reality is that they do, and especially when they take off their gloves after treatment, because they may actually have some debris on their hands. So another trend that I do like because then it sort of eliminates the splash zone on items on the countertops in the treatment room, is perhaps a sink on the back of maybe a 12 o'clock wall or at the entrance to a treatment room where hands can be washed conveniently and then you go into the treatment room. But we just have to be careful about, you know, again, how deep is the sink? Can it prevent splashing? And getting away from this notion that you don't need a sink for hand washing in a treatment room because you do, we absolutely do. And I agree with our Diva Linda about the concern about cups and things that are left out on the counter. And I think that one of the lessons we learned from COVID was because those aerosols could contaminate items that are left on the counter, then because COVID is still here and other respiratory viruses are still occurring, we really shouldn't have those things out on the countertop. And you think about an open box of gloves, you think about an open box of masks, they can be contaminated by the splash from the plumbing that comes from the sink or by the aerosols that we're creating when we're doing treatment if we're not collecting them adequately. So we have two sort of splash contamination zones, one at chairside and one at the sink.
SPEAKER_01You're absolutely right. And that brings to mind that our diva Olivia, who also is not with us here, wanted us to talk a little bit more about the treatment room and the decor. We love sometimes to make our practices look homey and comforting. And we like to display pictures of our family and maybe some you know artwork kids to provide for us. But the treatment room is a place where things become aerosolized on. And Centers for Medicare and Medicaid Services has actually just defined a splash zone as an area within three feet of a sink or a drain where contamination can occur. We know from other studies that have been conducted that aerosols generated during patient treatment, this the uh fallout is six feet diameter from the patient's mouth. So when you're talking about the size of a treatment room, Mary, that's really not much, very many places where fallout doesn't occur. And in making a treatment room homey, there are probably some better ways to do it than to bring a lot of decoration in. One thought is you know, to put pictures in a picture frame, mount them on the wall, to maybe have if you want to have trinkets or you want to have you know little artsy craftsy statue kind of things, think about a shadow box where they can be displayed, but they're not necessarily out in the open and have to be disinfected after every patient. And so that's you know, important that we don't make a treatment room homey and then sacrifice infection control because surfaces do need to be cleaned and disinfected. And I think our patients appreciate more that we're looking out for their safety as opposed to welcoming them into our, you know, part of our life and part of our personality with these various different things. So that's something that we should all keep in mind. And you know, what Linda had mentioned about the drinking cups and and the then also the sinks being outside of the treatment room, as you mentioned, I see a lot of treatment rooms where the sink is um in between two operatory chairs. So it's well out of the splash zone of direct care for patient care items or for countertops, but it's out of the line of sight of the patient. So for those who have sinks that are not within the line of sight, maybe the sinks are in the hallway, uh, I would wonder if patients think that we didn't wash our hands. So a suggestion would be to make a show of drying your hands, just step around in front of the patient and put that towel in your hands, and so it it looks like you've done the work of washing your hands. And if you do use alcohol hand sanitizer when your hands are not visibly soiled or contaminated, then maybe do the same. Perhaps step in front of the patient and rub that alcohol hand sanitizer all the way in, even if it's already dried in all the way in. At least that gives the impression that you have done what you need to do. What patients can't see could lead them to believe that it was not done, that hand hygiene wasn't performed.
SPEAKER_00And Leslie, I think it's so interesting the discussion about having these items to, you know, decor and making it homey, and people are, you know, putting pictures of their families, and there's nothing wrong with that except that, again, they get contaminated by aerosols and so forth. And and I look at the difference, and it's pretty stark between our treatment rooms and a medical exam or a medical treatment room. You have only the items that are necessary for use in a medical practice because they have to meet accreditation standards. And the accreditation standards say that you can't have all that stuff out there. And although most dental practices are not accredited, so they don't have somebody doing a review or a survey of their practice to make sure they're in compliance on a regular basis, then you know the tchotchkis start coming out, and of course, we're now getting into Halloween and we'll have Thanksgiving and the December holidays to celebrate. That decor is not appropriate in the treatment rooms where it can become contaminated.
SPEAKER_01Mary, that just brings to mind something that I saw, and uh it was several years ago, but I see it again and again. I was in a dental practice just before Halloween, and they had the treatment room with all the that white spider webby stuff everywhere. And I thought to myself, how in the world are they disinfecting the counters? They had it up around the x-ray arm, they had it behind where the towels are, and and we're coming up again, yeah. As we're with this broadcast is in October, so you're you're right. We have Halloween, we have Thanksgiving, we have the Christmas decorations and other holiday decorations, and then the spring and the Valentine's Day. All of those are wonderful in the reception area and at the reception desk, but they really don't have a place in the treatment room when you want to convey a message of a culture of infection prevention and safety.
SPEAKER_00I totally agree with you, Leslie.
SPEAKER_01Well, with that, I think we've put enough information out to give people some food for thoughts surrounding the sinks and what goes on the countertops and the treatment room. I did have one other thought before I close out. I know many times dental offices will offer patients a blanket, and I would recommend that you have purchased multiple, maybe some of the acrylic blankets you can buy very inexpensively and launder them in between patient usage. Don't leave them out in the treatment room. I've seen people take the chair cover, the plastic chair cover, and use that to bury your protective blanket after it's been laundered before it's placed back in the treatment room. And that way, if it is used for a patient, then it's just like anything else that you might have in an autoclave bag. It is not been aerosolized on. And uh again, that's something that I don't think that we think about. We're thinking about the patient's comfort, but yet we're not thinking about infection prevention and cross-contamination and aerosols. So, with that, we at the compliance divas like to bring clarity and simplicity to compliance by navigating the regulatory environment. Please look for those resources from CDC and Centers for Medicaid Care and Medicaid Services for the information that we provided today. And we hope that when you are on our show notes, that you will leave us a little review on how we did and how we're doing for you as the Compliance Divas podcast.