Why Is Following Clinical Etiquette Necessary?
The dentist and the patient in the intraoperative room or dental operatory would be exposed to the aerosols and the oral pathogens during oral surgical or dental treatments, and dental surgeons need to follow the recommended clinical etiquette or guidelines that can prevent this infectious spread between operators and patient. Following the given enlisted clinical operator's etiquette can protect dentists from being carriers of droplet infections or respiratory infections. Ever since the outbreak of COVID-19 infection, it has been mandatory to prevent droplet and respiratory infections from patients to dental operators because of safety concerns as well.
What Are Clinical Etiquette or Instructions to Be Followed?
1. Cough Etiquette: The practice of “cough etiquette” is considered, in fact, one of the most crucial in clinical or hospital setting factors that can be preventive against influenza and other types of respiratory droplet infections or infectious diseases transmitted through droplets that are specifically generated by the acts of coughing or sneezing. Specifically, patients should be instructed in the clinical or hospital setting to follow the cough etiquette, mainly to cover their mouth and nose by using a proper mask before dental treatment and use a paper tissue or handkerchief during dental treatment, or cough or sneeze into the sleeve only before, during and after the course of the dental procedure whenever they may tend to cough or sneeze. Ever since the beginning of the COVID-19 infection, it must be important for both medical and dental personnel to instruct patients, whether in the waiting area or in the clinic area, to practice cough etiquette because even that alone would be such insufficient to prevent viral transmission in between patients or transmission of infection from asymptomatic or pre-symptomatic respiratory infected patients to the operator. As for the dental operator practicing this etiquette, it is ideal, especially during the procedure, to keep the nose covered throughout, with the face or mouth mask firmly attached to the face without leaving any gaps in between.
2. Practicing Appropriate Hand Hygiene: Hand hygiene would be mainly further subdivided into two categories: these are the “hand disinfection” protocols, which can be practiced by the use of alcohol-based hand sanitizers or even by simply “handwashing” with running water from tap and using liquid soap to correctly clean in between the fingers and rub the palms together thoroughly to eliminate any possible bacterial or viral contamination in the clinical setting. It is a known research fact that has been made aware to the general public that even in a nonclinical or non-hospital setting like the home, office, or while one commutes even in ordinary situations, hand hygiene should be practiced for thorough “hand disinfection.”
As the dentist and the patient often have a close approach or contact especially to the skin for supporting or instrumentations and disinfection, with the saliva of the patient further being an unavoidable factor during dental procedures, it is important immediately after the procedure to wash the hands thoroughly using the right-hand washing techniques. Appropriate rubbing-type alcohol-based hand washes or sanitizers are recommended generally by maxillofacial surgeons or the general dentist as normal hand washes or sanitizers as products may only cause ‘dry skin’ with repeated hand washing, which would be because of the emollient effects they contain.
3. Gargling: Individuals who may be very sensitive, such as those easily prone to skin, oral, or dental allergies who may not be able to disinfect correctly with the use of alcohol-based sanitizers, should then opt for thorough gargling of the oral cavity or the mouth. This can be done both preoperatively before the dental or oral surgical procedure or even postoperatively. Patients typically gargle using a mouth rinse, which can aid in cleaning the pharynx and oral cavity by the effective anti-viral or anti-bacterial effects exerted by the liquid or the pre-procedural mouth rinse. In the intraoperative dental setting as well, pre-procedural mouth rinses are an extremely effective way to prevent any kind of possible contamination through the tiny or solid microparticles or the aerosol materials that would be generated due to the dental or medical equipment. In the case of geriatric patients or the elderly and the immunocompromised undergoing treatment in the clinical setting, pre-procedural and post-procedural gargling would often be associated with a high risk of accidental ingestion. Hence, the dentist or surgeon should instruct the same for patients who are not familiar with the gargle procedures or mouth rinsing procedures.
While it is definitely easier to rinse and spit the mouth rinse in the intraoperative setting, gargling would be more risky in general, even though it is more potent as a disinfecting method. Caution should hence be exercised by the patients while gargling, and care should be taken not to contaminate the dental clinic or surrounding environment while one spits.
4. Personal Protection Equipment (PPE): The operator is ideally supposed to wear the N95 respirator along with the face shield or goggles in the scenario of a COVID breakout. However, in the general surgical or dental setting, a surgical cap covering the ears, surgical gloves, and PPE are always beneficial in preventing a possible infection chain.
How Can Operating Room Precautions Prevent the Chain of Infection?
A simple PPE that corresponds specifically to PPE use for surgery in intraoperative conditions would mean increased patient and operator protection, allowing scope for safe dental or oral surgical practice, and also would prevent a chain of infection between the operator and patient.
Operating Room Environment: The dentist or maxillofacial surgeon should handle several settings in the dental clinic or hospital with simple measures to prevent any viral or bacterial breakout by droplet infections by implementing these simple measures:
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Promoting Flow: Promoting laminar flow or ventilation settings in tune or in accordance with the operating room standards so that there is a highly reduced risk of patterns and operators from inhaling droplets and aerosols that would tend to be generated through the operative field.
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The Use of Intraoral Suction: For effective control of wastes, suction devices usually do not allow scope for the re-entry of any exhaust air into the operating room.
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Use of High-Efficiency Particulate Air (Hepa) or Equivalent Filters: These would be needed in multiple dental chair settings for safe disposal of solid, liquid, or fluid waste.The dentist or the maxillofacial surgeon opts to perform a detailed preoperative assessment of the patient, including eliciting their medical history, especially two days prior to the oral and maxillofacial surgery or procedure.
Conclusion
The above enlisted intraoperative guidelines for disinfection and through a detailed preoperative assessment by the maxillofacial surgeon, patients, and the operator as well can hence be less prone to any possible chain of infection, especially through prevention of respiratory droplet infections and hand contamination.
