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Are hair barriers standard of care?

Ask the Expert ForumCategory: Infection ControlAre hair barriers standard of care?
Shelly Costley asked 7 months ago
Hair barriers were used more widely during the pandemic in dental settings. Is there any research supporting the use of hair covers in the dental setting?
1 Answers
Kristen Pratt Machado Staff answered 6 months ago
From Kandis Garland, RDH, MS:   The Occupational Health and Safety Administration (OSHA) develops evidence-based standards that employers must follow to ensure worker safety.1 Several OSHA standards for dentistry exist, including the Bloodborne Pathogens (BBP) Standard, Respiratory Standard, and Hazard Communication Standard.2 Personal protective equipment (PPE) falls within the BBP Standard.3 The use of PPE—including masks, face shields, gloves, eyewear, and gowns/lab coats—is required by OSHA to protect workers from infectious pathogens.3 Intact skin and mucous membranes of the mouth, nose, and eyes are at high risk for occupational exposure to infectious pathogens, which why PPE is so vital. Infectious pathogens from aerosol-generating procedures (AGP)—such as air polishing, ultrasonic scaling, and use of high-speed handpieces—became a concern during the early part of the pandemic. Infection control guidance during that time recommended avoiding AGP altogether.4 Revised infection control guidance regarding AGP includes using rubber dams, implementing four-handed dentistry, donning additional PPE (N-95 respirators, goggles, and full-face shields), and using high-volume evacuation (HVE).5 Ultrasonic scalers produce large volumes of aerosols, splash, and spray. The use of HVE and proper PPE, such as high-filtration masks and face shields, significantly reduce aerosol contamination by up to 95%.6 Visual fluorescent photographs depicting aerosol spatter from ultrasonics demonstrate that it is generally focused on the center of the operator’s face, with less contamination of the forehead area. Therefore, it is vital to wear PPE that protects the eyes, nose, and mouth, such as masks and face shields. The hair and scalp are not exposed to as much aerosol contamination nor are they mucous membranes, thus, they are not at risk for disease transmission from infectious pathogens. Protection of the hair or the scalp is not addressed in any current dental infection control guidance, therefore is not required or considered the standard of care in nonsurgical settings.3,5,7 However, best practices generally exceed minimum recommendations, thus oral health professionals are free to implement if desired. Head coverings, such as scrub caps, surgical caps, or bonnets, are required in medical surgical settings in order to provide a sterile environment for patients.8 Human hair contains bacteria that could contaminate a sterile surgical site if not covered. So, the PPE in this case is to primarily protect the patient’s surgical site, and only secondarily to protect the worker. Oral health professionals should wear head coverings during surgical procedures such as oral surgery or periodontal surgery. However, for routine nonsurgical dental procedures, head coverings are not required.

References

  1. Occupational Safety and Health Administration. About OSHA. Available at: osha.g/​v/​aboutosha. Accessed October 11, 2022.
  2. Occupational Safety and Health Administration. Dentistry. Available at: osha.gov/​dentistry. Accessed October 11, 2022.
  3. Occupational Safety and Health Administration. Bloodborne Pathogens Standard 1910.1030. Available at: osha.gov/​laws-regs/​regulations/​standardnumber/딦/딦.1030. Accessed October 11, 2022.
  4. American Dental Association. Postponement Recommendations. Available at: ada.org/​about/​press-releases/떔-archives/​ada-calls-upon-dentists-to-postpone-elective-procedures#:~:text=The%20ADA%20is%20deeply%20concerned,for%20the%20next%20three%20weeks. Accessed October 11, 2022.
  5. Kohn WG, Harte JA, Malvitz DM, et al. Guidelines for infection control in dental health care settings—2003. MMWR Recomm Rep. 2003;52(RR-17):1-61.
  6. Harrel SK, Molinari J. Aerosols and splatter in dentistry. A brief review of the literature and infection control implications. J Am Dent Assoc. 2004;135:429–437.
  7. United States Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings. Available at: cdc.gov/​oralhealth/​infectioncontrol/​pdf/​safe-care2.pdf. Accessed October 11, 2022.
  8. United States National Library of Medicine. Personal Protective Equipment. Available at: medlineplus.gov/​ency/​patientinstructions/�.htm. Accessed October 11, 2022.

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