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Infection Control

Frequently Asked Questions - Personal Protective Equipment (Masks, Protective Eyewear, Protective Apparel, Gloves)

What is the purpose of personal protective equipment (PPE)?

PPE is designed to protect the skin and the mucous membranes of the eyes, nose, and mouth of dental health-care personnel from exposure to blood or other potentially infectious material. A visible spray is created during the use of rotary dental and surgical instruments (e.g., handpieces, ultrasonic scalers) and air-water syringes. This spray primarily consists of a large-particle spatter of water, saliva, blood, microorganisms, and other debris. Spatter travels only a short distance and settles out quickly, landing either on the floor, nearby equipment and operatory surfaces, dental health-care personnel, or the patient. The spray may also contain some aerosol (i.e., particles of respirable size: 10 microns). Aerosols take considerable energy to generate and are not typically visible to the naked eye. Aerosols can remain airborne for extended periods and can be inhaled. However, they should not be confused with the large-particle spatter that makes up the bulk of the spray from handpieces and ultrasonic scalers. Appropriate work practices such as the use of dental dams and high-velocity air evacuation should minimize droplets, spatter, and aerosols. OSHA mandates that dental health care workers wear gloves, surgical masks, protective eyewear, and protective clothing in specified circumstances to reduce the risk of exposures to bloodborne pathogens.

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When should a surgical mask be worn?

Dental health-care personnel should wear a surgical mask that covers both their nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood or body fluids. A surgical mask protects the patient against microorganisms generated by the wearer and also protects dental health care personnel from large-particle droplet spatter that may contain bloodborne pathogens or other infectious microorganisms. When a surgical mask is used, it should be changed between patients or during patient treatment if it becomes wet.

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When should protective eyewear be worn?

Dental health care personnel should wear protective eyewear with solid side shields or a face shield during procedures and patient-care activities likely to generate splashes or sprays of blood or body fluids. Protective eyewear protects the mucous membranes of the eyes from contact with microorganisms. Protective eyewear for patients also can protect their eyes from spatter or debris generated during dental procedures. Reusable protective eyewear should be cleaned with soap and water, and when visibly soiled, disinfected between patients.

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When should protective clothing be worn?

Various types of protective clothing (e.g., gowns, jackets) are worn to prevent contamination of street clothing and to protect the skin of personnel from exposure to blood and body fluids. When the gown is worn as personal protective equipment (i.e., when spatter and spray of blood, saliva, or other potentially infectious material is anticipated), the sleeves should be long enough to protect the forearms. Protective clothing should be changed daily or sooner if visibly soiled. Personnel should remove protective clothing before leaving the work area.

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Why should dental health care personnel wear gloves?

Dental health care personnel wear gloves to prevent contamination of their hands when touching mucous membranes, blood, saliva, or other potentially infectious materials and to reduce the likelihood that microorganisms on their hands will be transmitted to patients during dental patient-care procedures.

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Does wearing gloves replace the need for handwashing?

Wearing gloves does not replace the need for handwashing. Personnel should wash their hands immediately before donning gloves. Gloves may have small, unapparent defects or may be torn during use, and hands can become contaminated during removal of gloves. In addition, bacteria can multiply rapidly in moist environments underneath gloves; thus, personnel should dry their hands thoroughly before donning gloves and wash immediately after removing the gloves. If the integrity of a glove is compromised (e.g., if the glove is punctured), the glove should be changed as soon as possible.

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Is it safe to wash gloves before use?

Washing of latex gloves with plain soap, chlorhexidine, or alcohol can cause micropunctures. This condition, known as "wicking," may allow liquids to penetrate through undetected holes in the gloves. For that reason, washing of gloves is not recommended.

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Are gloves affected by dental materials?

Exposure to glutaraldehyde, hydrogen peroxide, and alcohol preparations may weaken latex, vinyl, nitrile, and other synthetic glove materials. Other chemicals associated with dental materials that may weaken gloves include acrylic monomer, chloroform, orange solvent, eugenol, cavity varnish, acid etch, and dimethacrylates. Because of the diverse selection of dental materials on the market, glove users should consult glove manufacturer about the compatibility of glove material with various chemicals.

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Are there different types of gloves?

Yes, there are. The type of glove used should be based upon the type of procedure to be performed (e.g., surgical vs. nonsurgical, housekeeping procedures). Medical-grade nonsterile examination gloves and sterile surgical gloves are medical devices regulated by the U.S. Food and Drug Administration (FDA). General-purpose utility gloves are not regulated by the FDA because they are not promoted for medical use. Sterile surgical gloves must meet standards for sterility assurance established by the FDA and are less likely than nonsterile examination gloves to harbor pathogens that may contaminate an operative wound.

Glove Type Indications Comments Common Glove Materials
Patient examination glovesExaminations and other nonsurgical procedures involving contact with mucous membranes; laboratory proceduresMedical device regulated by the FDA.

Nonsterile and sterile, single-use disposable. Use for one patient and discard appropriately.

Natural rubber latex (NRL)

Nitrile

Polyvinyl chloride (vinyl) and other synthetics

Polyethylene (plastic)

Surgeon's glovesSurgical proceduresMedical device regulated by the FDA.

Sterile and single-use disposable. Use for one patient and discard appropriately.

Natural rubber latex (NRL)

Nitrile

Combinations of latex and/or synthetics

Non medical glovesHousekeeping procedures (e.g., cleaning and disinfection)

Handling contaminated sharps or chemicals

Not for use during patient care

Not a medical device regulated by the FDA.

General purpose utility gloves that are puncture or chemical resistant.

Sanitize after use.

NRL and nitrile or chloroprene blends

Neoprene

Nitrile

Butyl Rubber

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Selected References and Additional Resources


Adams D, Bagg J, Limaye M, Parson K, Absi EG. A clinical evaluation of glove washing and re-use in dental practice. J Hosp Infect 1992;20:153–162.

Andersson T, Bruze M, Bjorkner B. In vivo testing of the protection of gloves against acrylates in dentin-bonding systems on patients with known contact allergy to acrylates. Contact Dermatitis 1999;41:254–259.

Baumann MA, Rath B, Fischer JH, Iffland R. The permeability of dental procedure and examination gloves by an alcohol based disinfectant. Dent Mater 2000;16:139–144.

Cappuccio WR, Lees PS, Breysse PN, Margolick JB. Evaluation of integrity of gloves used in a flow cytometry laboratory. Infect Control Hosp Epidemiol 1997;18:423–425.

CDC. Update: Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR 1988;37:377–382, 387-388.

CDC. Recommendations for prevention of HIV transmission in health-care settings. MMWR 1987; 36 (No. 2S):1S–18S.

DeGroot-Kosolcharoen J, Jones JM. Permeability of latex and vinyl gloves to water and blood. Am J Infect Control 1989;17:196–201.

Dodds RD, Guy PJ, Peacock AM, Duffy SR, Barker SG, Thomas MH. Surgical glove perforation. Br J Surg 1988;75:966–968.

Doebbeling BN, Pfaller MA, Houston AK, Wenzel RP. Removal of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing. Ann Intern Med 1988;109:394–398.

Goldmann DA, Platt R, Hopkins C. Control of hospital-acquired infections. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious Diseases. Philadelphia, PA: WB Saunders; 1992:45:378–390.

Goldmann DA. The role of barrier precautions in infection control. J Hosp Infect 1991;18:515–523.

Guidelines for Infection Control in Dental Health-Care Settings, 2003. MMWR, December 19, 2003:52(RR-17);1–61.

Harte JA, Molinari JA. Personal Protective Equipment. In: Molinari JA, Harte JA, eds. Practical Infection Control in Dentistry, 3rd ed. Baltimore: Lippincott Williams & Wilkins, 2010;101–119.

Jordan SLP, Stowers MF, Trawick EG, Theis AB. Glutaraldehyde permeation: choosing the proper glove. Am J Infect Control 1996;24:67–69.

Klein RC, Party E, Gershey EL. Virus penetration of examination gloves. Bio Techniques 1990; 9:196–199.

Korniewicz DM, Laughon BE, Butz A, Larson E. Integrity of vinyl and latex procedure gloves. Nurs Research 1989;38:144–146.

Kotilainen HR, Brinker JP, Avato JL, Gantz NM. Latex and vinyl examination gloves: quality control procedures and implications for health care workers. Arch Intern Med 1989;149:2749–2753.

Larson EL, 1992, 1993, and 1994 Association for Professionals in Infection Control and Epidemiology Guidelines Committee. APIC guideline for hand washing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–269.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, The Hospital Infection Control Practice Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 20;4:247–277.

Martin MV, Dunn HM, Field EA, Field JK, et al. Physical and microbiological evaluation of the re-use of non-sterile gloves. Br Dent J 1988;165:321–324.

Mellstrom GA, Lindberg M, Boman A. Permeation and destructive effects of disinfectants on protective gloves. Contact Dermatitis 1992; 26:163–170.

Miller CH, Palenik CJ. Protective Barriers. In: Miller CH, Palenik DJ, eds. Infection Control and Management of Hazardous Materials for the Dental Team, 4th ed St. Louis: Mosby, 2010:115–134.

Molinari JA, Rosen S, Runnells RR. Personal protective equipment and barrier techniques. In: Cottone JA, Terexhalmy GT, Molinari JA, eds. Practical infection control in dentistry, 2nd ed. Baltimore: Williams & Wilkins, 1996:136–145.

Monticello MV, Gaber DJ. Glove resistance to permeation by a 7.5% hydrogen peroxide sterilizing and disinfecting solution. Am J Infect Control 1999;27:364–366.

Murray CA, Burke FJT, McHugh S. An assessment of the incidence of punctures in latex and non-latex dental examination gloves in routine clinical practice. Br Dent J 2001;190:377–380.

Olsen RJ, Lynch P, Coyle MB, Cummings J, Bokete T, Stamm WE. Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993;270:350–353.

Ready MA, Schuster GS, Wilson JT, Hanes CM. Effects of dental medicaments on examination glove permeability. J Prosthet Dent 1989; 61:499–503.

Richards JM, Sydiskis RJ, Davidson WM, Josell SD, Lavine DS. Permeability of latex gloves after contact with dental materials. Am J Orthod Dentofac Orthop 1993;104:224–229.

US Department of Labor, Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries; final rule. Federal Register 2001;66:5317–5325. Updated from and including 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; final rule. Federal Register 1991;56:64003–64182. Accessed 9/21/09.

US Department of Labor, Occupational Safety and Health Administration. Enforcement procedures for the occupational exposure to bloodborne pathogens. Washington, DC: US Department of Labor, Occupational Safety and Health Administration, 2001; Directive Number. CPL 02–02–069. Accessed 9/21/09.

Whyte W, Hambraeus A, Laurell G, Hoborn J. The relative importance of routes and sources of wound contamination during general surgery. I. Non-airborne. J Hosp Infect 1991;18:93–107.


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