I have been struggling with the fear of contracting an infectious disease from a patient if I have a cut, even though wearing gloves. I was wondering if any other hygienists have this fear. I just want to be able to enjoy my career again. Any advice?
Thank you for your question. I understand your concern. Thankfully the CDC Guidelines and current standards of dental hygiene practice, when followed properly, are your best bet for practicing safely. Although very low, the practice of dental hygiene does involve some risks of injury and infection, but following safe practice techniques, utilizing universal/standard precautions, and staying abreast of current infection control guidance will help you avoid injury and infection.
First, safe practice techniques to avoid occupational exposure to blood (ie; percutaneous injuries such as cuts or needlesticks) include using intra-oral fulcrums with hand instruments for stability, using sharp instruments to be effective in removing deposits, using work practice controls defined by CDC guidelines (pg 12-13) as safety behaviors designed to reduce risk (ie; restricting use of fingers to retract tissue vs. using a mouth mirror, or removing a bur from a hand piece prior to dis-assembly), and engineering controls (devices that help you work safely (ie; instrument cassettes to avoid sharps injuries, or a one handed scoop technique to recap needles, or use of recapping devices).
Second, treating all patients as if they are infectious (Universal/standard precautions) is another way to practice safely. You can not tell by looking at someone if they are infectious or not, so utilizing Universal/standard precautions is prudent. Ensuring that you are using the same type of PPE and infection control protocols for every patient, basically doing it the same way every time. Having an efficient system that you are familiar with saves time and protects you. Also making sure you are properly immunized against Influenza annually and Hepatitis B which is by far the most concerning bloodborne disease. Hepatitis is far more likely to be transmitted than HIV as HIV is not as virulent and does not live long outside of the host. You can be vaccinated against Hepatitis B. Other respiratory diseases such as Tuberculosis, and SARS are far less likely to be transmitted to dental workers when correct precautions are taken.
Lastly, make sure to stay informed and educated about the latest CDC Guidance and OSHA standards related to dentistry. OSHA is designed to protect workers. The OSHA Bloodborne Pathogens (BBP) Standard and the OSHA Occupational Hazard Standards were put in place to protect workers and ensure a healthy working environment. Every dental office is required by OSHA to have a copy (either electronic or hard copy) of these standards accessible for all employees who have occupational risks. Your office is also required by OSHA to have an Exposure Control Plan (a set of policies related to the BBP, and guidance for when an occupational exposure incident occurs). Many offices have these combined with their Infection Control Policies. Compliance with these OSHA standards is required by law and are subject to hefty fines and penalties if not in compliance. You should have had a medical evaluation after your exposure incident with follow up counseling about infectious diseases. That usually alleviates the fear and anxiety for most people. Here are some excellent resources to stay abreast of changes and updates related to infection control:
The OSHA BBP website: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051 OSAP (the Organization for Safety Asepsis and Prevention) www.osap.org The ADA http://www.ada.org/en/member-center/oral-health-topics/infection-control-resources CDC Guidelines for Dentistry: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm The American Dental Hygienists' Association: www.adha.org
I hope this alleviates your fear and anxiety. Again, as long as you are practicing safely there is no need to have excessive worry and anxiety. Prudent, cautious, and careful behavior is the key to safe practice.