5 simple observation tools to improve clinical safety in 5 minutes or less

Nov. 17, 2011
Leslie Canham, CDA, RDA, gives you five tools you can use to assess clinical safety in your dental office in five minutes or less.

By Leslie Canham, CDA, RDA

Here are five observation tools that you can use to assess clinical safety in five minutes or less.

1. Observe proper use of Personal Protective Attire (PPA).

Does each clinical team member wear a clinical jacket/gown that covers the forearms and chest? Is the jacket buttoned or closed in the front to protect clothing and skin? Do clinical team members wear the jacket during all procedures where aerosols or splashes of blood, body fluid, or other potentially infectious materials are generated? Are contaminated jackets removed before team members enter “clean” areas such as the lunchroom or business area? Are clinical jackets removed before leaving the office at the end of the day?

2. Make sure appropriate surgical face masks are worn.

Does each clinical team member wear a surgical facemask that meets the American Society for Testing and Materials (ASTM) performance standards? Choosing a mask depends on the type of procedure and level of contamination anticipated. When performing procedures that generate high levels of aerosolized moisture, such as use of high-speed handpieces, air-water syringes, and ultrasonic scalers, an ASTM “high barrier” category mask should be used. For procedures with low levels of aerosolized moisture or particles, ASTM “moderate barrier” masks can be used. For procedures with no aerosolized moisture or particles, such as oral exams or taking X-rays, ASTM “low or primary barrier” masks can be used. Non-ASTM masks do not meet the ASTM performance standards. These nonrated masks provide only a paper barrier as protection. Check the box to see what level of protection your masks offer.

3. Observe that appropriate protective eyewear is used.

Does each clinical team member wear appropriate protective eyewear? The OSHA Bloodborne Pathogen Standard states, “Eye protection devices, such as goggles or glasses with solid side shields, or chin-length face shields, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated, and eye, nose, or mouth contamination can be reasonably anticipated.”1

The best type of protective eyewear is made of impact resistant plastic. The eyewear should include side shields and a brow guard. Look for eyewear that complies with ANSI Z87.1-2003, the American National Standard for Occupational and Educational Eye and Face Protection. Protective eyewear that meets the ANSI standard meets OSHA requirements. Prescription glasses worn alone are not considered appropriate protective eyewear and may not protect eyes from flying debris, tooth particles, amalgam shrapnel, pumice, chemicals, blood, or other potentially infectious materials. For those who wear prescription glasses, a chin-length plastic face shield offers a larger area of protection, covering the forehead, cheeks, and chin area.

4. Observe proper hand hygiene protocols.

Hand washing should be performed before donning gloves and every time gloves are removed. Effective hand washing is achieved by vigorously rubbing together all surfaces of lathered hands for at least 20 seconds, followed by rinsing under a stream of water. The preferred method for hand hygiene depends on the type of procedure, the degree of contamination, and the desired persistence of antimicrobial action on the skin. For routine dental exams and nonsurgical procedures, hand washing and hand antisepsis is achieved by using either plain or antimicrobial soap and water. If the hands are not visibly soiled, hand antisepsis can also be achieved through use of an alcohol-based hand rub.

5. Observe that appropriate gloves are worn.

Because gloves are task-specific, their selection should be based on the type of procedure to be performed (e.g., surgery or patient examination). Chemical resistant/puncture resistant gloves should be worn when working with chemicals and when processing contaminated instruments. Gloves used in dentistry are usually made of natural rubber latex and synthetic nonlatex materials (e.g., vinyl, nitrile, and neoprene). In addition to different types of glove materials, there are two different types of glove fit. “Ambidextrous” gloves fit either hand, and “fitted” gloves are hand specific (right hand glove and left hand glove). Hand-specific gloves may be more comfortable as they allow the hands to rest in a more relaxed position than ambidextrous gloves. All gloves should fit well as gloves that are too small may cause hand discomfort, and gloves that are too large may interfere with task performance.

In five minutes or less you can assess office safety for your clinical team by using these five simple observation tools.

Author bio
Leslie Canham is a dental speaker and consultant specializing in infection control and OSHA compliance. She has more than 36 years of experience in dentistry. Canham is the founder of Leslie Canham Seminars, providing in-office training, mock inspections, consulting, and online seminars and webinars to help the dental team navigate state and federal regulations. Reach Canham at (888) 853-7543 or Leslie Canham.


1. U. S. Dept of Labor, Regulations Standards 29 CFR. OSHA Bloodborne Pathogens. 1910-1030 http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051