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BACCALAUREATE THESIS

AN INVESTIGATION INTO THE EFFICACY OF PLASTIC SURFACE
BARRIERS USED IN DENTISTRY

Submitted in partial fulfillment of the requirements for the Dental Hygiene Thesis

Megan Myers
Desiree Nelson
Aimee Butler

APRIL 2003

We hereby recommend that the thesis prepared under our supervision by Paula Morse be
accepted as fulfilling partial requirements for the baccalaureate thesis in dental hygiene.

Advisor______________________________________________Date___________

Chair________________________________________________Date___________
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Abstract

The purpose of this study was to re-evaluate the use of plastic surface

barriers and determine their efficacy in the dental practice today. It was

hypothesized that there would be no statistical significance of Colony Formation

Units (CFU’s) found after chemical disinfection between dental operatories that

employed barriers and those that did not. The data was collected from fifty-two

different dental operatories. One group of specimens was collected from dental

units that utilized barriers, and the other group of specimens was collected from

units that did not. The bacterial samples were then inoculated and grown on 5%

sheep blood agar plates. After 48 hours of incubation, the total number of CFU’s

were counted and recorded. The median of each subcategory was calculated

and analyzed using paired t-test and Two-Sample Assuming Equal Variances

testing. No statistical significance was found post-disinfection of a barriered

versus non-barriered unit. The results of this study question the need of plastic

surface barriers in dentistry.
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INTRODUCTION

The main purpose of disinfection protocol in a dental office is to control the

contamination and transmission of disease from patient to patient and from

patient to clinician. Items that are utilized during patient treatment that can not

be sterilized or disposed require chemical disinfection. Barrier utilization started

with minimal use for objects incompatible with chemical disinfectants. Tradition

has a tendency to create a snowball effect with the idea that ―more is better‖;

today barriers are placed on surfaces that are compatible with chemical disinfect.

It’s nearly impossible to remove barriers in a soiled treatment room and

prevent contamination of the surfaces so objects barriered have to be chemically

disinfected too. Consequently, clinician infection control time management is

suffering. The efficacies of chemical disinfection products utilized in dental

offices have proven to prevent the transmission of disease. So why are both

barriers and chemical disinfection being applied when chemical disinfection alone

should be adequate? Many negative effects are created by the overuse of

plastic barriers. The application of barriers increases time of pretreatment set up

and post treatment infection control. This leads to an increase in cost of supplies

and a production of hazardous environmental waste.

The research purpose was to study the efficacy of surface barriers in

dentistry. It was hypothesized that upon post disinfection procedures the

barriered verses non-barriered units will show no statistical difference in

Colonizing Formation Units (CFU’s). The review of literature revealed proper
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universal infection control, microorganism disinfection facts, the hazards of

environmental waste and the use of barriers.

Review of Literature

Proper Universal Infection Control

According to the recommendations of the Center for Disease Control

(CDC, 2003), the dental health care provider (DHCP) should either place barriers

between patients, or use an Environmental Protection Agency (EPA) registered

disinfectant (at least low activity level). Cleaning should be the first step in the

disinfection process, otherwise disinfection can be compromised. Therefore, the

unit should be clean of organic matter, salts, and visible soil prior to disinfection.

Also, the scrubbing action of cleaning removes a lot of microorganisms from

surfaces. After the surfaces have been properly cleaned and disinfected, they

should be covered with barriers (Kohn, et al., 2003).

Barriers can help prevent contamination, especially on hard to clean

areas. But, it’s important to change barriers in between patients because they

can become contaminated. While wearing gloves, the DHCP should remove the

contaminated barriers and then inspect all surfaces that were covered with the

barriers to check for any unintentional soiling/contamination (Boyce & Pittet,

2002). The surface area needs to be cleaned and disinfected ONLY if they are

contaminated. If not contaminated, the DHCP should remove soiled gloves and

perform hand hygiene, and then place new barriers. Hand hygiene is any hand

washing with antiseptic/antimicrobial soap, non-antimicrobial soap, or with

alcohol based/ antiseptic rubs (CDC, 2006).
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If barriers are not being used, the surfaces should be cleaned with an EPA

registered disinfectant that is either a low activity Human Immunodeficiency Virus

(HIV), Hepatitis B Virus (HBV) or an intermediate Tuberculosis (TB) activity

disinfectant level. If the unit has been soiled with blood, the intermediate activity

solution should be used to disinfect. The CDC recommends that the dental unit

be cleaned at the end of every work day, but requires it if the surfaces have been

contaminated since it was cleaned last (Kohn, et al, 2003). Areas of specific

concern are: handles of the suction and air/water syringes should be covered

with barriers. If these handles are contaminated, they should be cleaned,

disinfected (intermediate activity level), and then have new barriers placed

(Kohn, et al).

Contact surfaces that are not protected by barriers should be cleaned and

disinfected with either a low activity level disinfectant (no visible soiling), or an

intermediate activity level disinfectant (blood contamination). All disinfectants

used should be EPA registered hospital disinfectants (Kohn, et al., 2003).

Digital radiography sensors need FDA approved barriers. Some non-FDA

approved barriers have been shown to fail up to 44%. The sensors should be

cleaned with an EPA approved high level activity disinfectant between patients,

and then new barriers placed. If the item can’t tolerate high level disinfectant then

the intermediate level disinfectant can be used (Kohn, et al., 2003).

Microorganism Disinfection Facts

Disinfectant agents do not sterilize a surface. However, disinfection uses

a chemical to inactive and or annihilates pathogenic microorganisms.
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Disinfection destroys the microorganisms to a point that they are unable to

transmit infectious disease (Wilkins, 2005). After an approved disinfectant has

been used according to manufactures instructions the treatment room is

considered safe for treatment of a new patient. Using unapproved chemicals to

treat the patient room may only lead to sanitation. Sanitation is different from

disinfection in that it reduces the number of organisms. An ideal disinfectant for

the use in dentistry should have the following characteristics: EPA approved,

broad spectrum, fast action on bacteria, protozoa, viruses and fungi, activity in

presence of other physical factors, non-toxicity, surface compatibility, leave a

residual effect on treated surfaces, user friendly, odorless and economical

(Andrews, 2006 & Wilkins).

The individual completing disinfection tasks must be aware of facts that

will affect the handling and proper use of the product. These include: shelf life,

use life and reuse life, directions for activation, storage conditions, directions for

use, disposal, and warning (Andrews, 2006 & Wilkins, 2005). The Material

Safety Data Sheets (MSDS) form should be kept for reference (UNC, 2004).

Also, clinicians must be aware of specific directions for disinfection

including: precleaning, temperature and time length required for disinfection

(Wilkens). Many of the disinfections must be kept wet on a surface for a period

of a couple minutes for effective disinfection to occur, so ample product must be

administered (Andrews). Chemicals that have been approved for use in dentistry

include glutaraldehydes, (gluctaraldehyde 2% neutral, gluctaraldehyde 2%

alkaline, gluctaraldehyde 2% alkaline with phenolic buffer, gluctaraldehyde 2%
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acidic) chlorines, (chlorine dioxide, sodium hypochlorite 5.25% household

bleach) phenolics (o-phenylphenyl 9% with o-benzyl-p-chlorophenol 1%).and

iodophors (1% available iodine) (Wilkens).

The Hazards of Environmental Waste

In 2003, U.S. residents, businesses, and institutions produced more than

236 million tons of solid waste. This equals out to about 4.5 pounds of waste per

person per day. Of that number, 11.3% were plastics. Currently in the United

States, 30% of solid waste is recycled or composted, 14% is burned at

combustion facilities, and the remaining majority of 56% is disposed of in landfills

(EPA, 2006).

These landfills can pose health risks to those living nearby. The process

of producing these health risks begins when waste is brought to the landfill, and

over time is decomposed through the action of bacteria. After decomposition,

gases are produced, which are carried through the air to neighboring

communities. Methane and carbon dioxide are the major gases produced by the

bacterial decay of landfill wastes (CDPH, 1997). These two gases are

greenhouse gases, which increase the occurrence of the greenhouse effect,

leading to global warming. Other gases produced by landfill bacteria are termed

reduced sulfur gases or sulfides. These gases mainly contribute to the rotting

smell of most landfills. Other problems with landfills include wind-blown litter,

and attraction of vermin and pollutants such as leachate, which can leach into

and pollute groundwater and rivers (Wikipedia, 2006).
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Hazardous waste is becoming a problem in the environment today.

Methods for controlling wastes are creating serious health risks and methods for

disposal of waste are exhaustive. Hazardous waste exhibits one or more of the

following characteristics: ignitability, corrosivity, reactivity, or toxicity. Most dental

barriers are made of plastics, and these fall under the category of hazardous

waste (Wikipedia, 2006).

The plastics used in dental barriers contribute to the growing problems in

landfills. The production and use of plastics has a range of environmental

impacts. Plastic production involves the use of potentially harmful chemicals,

which are added as stabilizers or colorants. Many of these have not undergone

environmental risk assessment and their impact on human health and the

environment is currently uncertain. The disposal of plastic products also

contributes significantly to their environmental impact. Because most plastics are

non-degradable, they take a long time to break down, possibly up to hundreds of

years when they are land filled. (Waste Online, 2006) With more and more

plastics products being disposed of soon after their purchase, the landfill space

required by plastics waste is a growing concern.
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METHODS

The research design included an experimental and control group and the

research was conducted in two dental clinical settings. The first setting was an

academic dental hygiene clinical facility and the second a private practice dental

hygiene setting. In both settings, the experimental group had plastic surface

barriers on the dental unit during dental hygiene treatment and the control group

did not. Therefore, the independent variable was the use of plastic surface

barriers and the dependent variable was the post-dental hygiene treatment count

of colony formation units (CFUs) that remained on the unit after the removal of

the plastic surface barriers before and after the use of chemical disinfectants.

A comparison of CFU scores between the Pre and Post-disinfection

counts was done to establish that barriers did, in fact reduce the number of CFUs

initially, post-patient care. So, it was expected that the CFU count on post-

treatment barriered units would be lower than that of non-barriered units.

Therefore, it was deemed as noteworthy that on post-disinfection there was a

non-significant result between the barriered and non-barriered CFU count. If the

CFU counts on post-disinfection was non-significant than it can be extrapolated

that the use of barriers, in the end, did not impact asepsis.

It was decided to complete the experimental and control group analysis in

two different clinical settings to see if there was a difference in the use of plastic

surface barriers in each setting and if that concomitantly affected the resultant

CFU count post-disinfection of both groups. It was posited that a higher level of
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CFUs would be present in a private practice setting due a decreased vigilance for

asepsis compared to the academic environment.

Table 1:

Research Design Matrix

Data Collection &
Research Phase Research Design
Analysis
 Pre/post—t test with an
Are Dental Barriers Group 1: T X
alpha value of p = .05
Effective?
Group 2: X
 Observation-qualitative

A total (from both seetings) of 52 operatories were sampled with 5 sites

tested pre-disinfection and 5 sites tested post-disinfection for a total of 520

samples. Microbiological specimens were collected post patient treatment. Each

disinfection study had a sample of five areas swabbed with a sterile cotton swab

moistened with sterile saline solution which included patient chair head rest,

bracket tray, light handle closest to the operator, saliva ejector, and air/water

syringe. A tubercidal/germicidal disinfectant was utilized and the surface was

allowed to dry for ten minutes prior to sampling for post disinfection specimens.

All samples were directly managed to prevent mix-ups and minimize the potential

of contamination. The specimens were inoculated with five percent Sheep Blood

Tryptic Soy Agar (TSA) plates. The CFU total numbers were then counted.

Sample collection occurred in the following manner:

1. All research participants received infection control instructions.

2. Patient treatment was rendered.
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3. Following dismissal of patient a qualitative observation began and

concluded following the post disinfection collection of the sample.

4. The clinician removed their gloves and washed their hands.

5. Clean masks were donned and all other personal protective equipment

was be utilized.

6. An alcohol hand rub was used.

7. New pair of non-sterile gloves were placed.

8. Disposal of plastic barriers were removed and discarded

9. Gloves were removed and disposed.

10. The researcher collected samples then placed a clean mask, washed

their hands and placed a new pair of non-sterile gloves.

11. A sterile cotton swab was moistened with a sterile saline solution and

samples for each of the five areas were be swabbed.

12. Gloves were then removed and discarded.

13. The clinician used an alcohol hand rub and placed on new gloves. All

other personnel protective equipment was worn.

14. The post treatment site was then disinfected by the clinician with an

approved asepsis technique and chemical. The site was allowed to

dry according to the manufacture recommendation.

15. The researcher collecting samples once again utilized all personnel

protective equipment, used an alcohol rub and placed on new gloves.

16. Samples were collected from the five sites utilizing a cotton swab

moistened with a sterile saline solution.
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17. Samples were handled by a microbiology lab after they had received

instructions on minimization of the contamination of samples. A

qualitative observation was performed.

18. The samples were cultured on 5% sheep blood TSA plates.

19. The data was collected using the total number of CFU’s.
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RESULTS

The research purpose was to study the efficacy of surface barriers in

dentistry and to determine the necessity of their use. To reach a valid

conclusion, Colony Formations Units (CFU’s) were examined to determine if

upon post disinfection a barriered versus non barriered unit would result in similar

CFU’s. It was hypothesized that upon post disinfection procedures the barriered

verses non-barriered units would show no statistical difference in CFU’s. The

results will follow with the academic setting first, followed by private practice, and

concluding with post disinfection comparisons. Six t-tests were analyzed which

include:

Academic Setting

Barriered Units: Pre and Post Disinfection Comparison

When comparing pre and post disinfection CFUs of the experimental

group (with barriers) no statistical significance was found, t (59) = 1.328 , p =

0.095 (one tailed). (See Figure 1, Table 2 & 9)
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Academic Setting Barriers

30
Pre-Disinfection
25 Post-Disinfection

0
CFUs

Figure 1: Sum of CFU counts in the academic setting with barriers for pre and

post-disinfection.

Table 2:

t-Test: Paired Two Sample for Means for Barried Units

Pre Post
Mean 0.716666667 0.5
Variance 2.511581921 0.525423729
Observations 60 60
Pearson Correlation 0.627058997
Hypothesized Mean Difference 0
df 59
t Stat 1.328332212
P(T<=t) one-tail 0.094591924
t Critical one-tail 1.671093033
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Non-Barriered Units: Pre and Post Disinfection Comparison

When comparing pre and post disinfection CFUs of the control group

(without barriers) statistical significance was found, t (59) = 2.70, p = 0.005 (one

tailed). (See Figure 2, Table 3 & 9)

Academic Setting Non Barriers

3000

2500

2000
Pre Disinfection
Post Disinfection
1500

1000

500

0
CFU's

Figure 2: Sum of CFU counts in the academic setting with no barriers for pre and

post disinfection.
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Table 3:

t-Test: Paired Two Sample for Means for Non-Barriered Units

Pre Post
Mean 49.8 1.4
Variance 19968.70508 60.2440678
Observations 60 60
Pearson Correlation 0.359142636
Hypothesized Mean Difference 0
df 59
t Stat 2.702749225
P(T<=t) one-tail 0.004483801
t Critical one-tail 1.671093033

Barriered and Non-Barriered Post-Disinfection Scores

When comparing post disinfection procedures for barriered and non

barriered units in the Academic Setting no statistical significance was found,

t (118) = .894, p = 0.186 (one tailed). (See Figure 3, Table 4 & 9)

Academic Setting Barriered & Non Barriered Post Disinfection

60
Barriers
50 Non Barriers

0
1

Figure 3: Sum of CFU counts in the Academic setting with both barriers and

non-barriers comparing post disinfection scores.
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Table 4:

t-Test: Means of Post-Disinfection Scores

Barriered Non-Barriered
Mean 0.5 1.4
Variance 0.525423729 60.2440678
Observations 60 60
Pooled Variance 30.38474576
Hypothesized Mean Difference 0
df 118
t Stat -0.894283738
P(T<=t) one-tail 0.18649526
t Critical one-tail 1.657869523

Private Practice

Barriered Units: Pre and Post Disinfection Comparisons

When comparing pre and post disinfection CFUs of the experimental

group (with barriers) statistical significance was found, t (59) = 3.494, p = 0.001

(one tailed). (See Figure 4, Table 5 & 9)
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Private Practice Barriers

40
Pre Disinfection
Post Disinfection
30

0
CFU's

Figure 4: Sum of CFU counts in the Private Practice setting with barriers for pre

and post disinfection.

Table 5:

t-Test: Paired Two Sample for Means for Barriered Units

Pre Post
Mean 0.883333333 0.283333333
Variance 2.409887006 0.24039548
Observations 60 60
Pearson Correlation 0.57860391
Hypothesized Mean Difference 0
Df 59
t Stat 3.493836938
P(T<=t) one-tail 0.00045484
t Critical one-tail 1.671093033
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Non-Barriered Units: Pre and Post Disinfection Comparison

When comparing pre and post disinfection CFUs of the control group

(without barriers) statistical significance was found, t (59) = 3.06, p = 0.002 (one

tailed). (See Figure 5, Table 6 & 9)

Private Practice Non Barriers

2000

1800

1600

1400

1200 Pre Disinfection
Post Disinfection
1000

800

600

400

200

0
CFU's

Figure 5: Sum of CFU counts in the Private Practice setting with no barriers for

pre and post disinfection.

Table 6:

t-Test: Paired Two Sample for Means for non-barriered units

Pre Post
Mean 31.56666667 0.866666667
Variance 6338.215819 7.066666667
Observations 60 60
Pearson Correlation 0.723380416
Hypothesized Mean Difference 0
df 59
t Stat 3.060046831
P(T<=t) one-tail 0.001663652
t Critical one-tail 1.671093033
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Barriered and Non-Barriered Post Disinfectionn Comparison

When comparing post disinfection procedures for barriered and non

barriered units in the Private Practice setting no statistical significance was

found, t (118) = 1.672, p = 0.049 (one tailed). (See Figure 6, Table 7 & 9)

Private Practice Comparison of Post-Disinfection Scores

Barriered
20 Non-Barriered

0
CFUs

Figure 6: Sum of CFU counts in the Private Practice setting with both barriers

and non barriers comparing post disinfection scores
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Table 7:

t-Test: Comparison of Post-Disinfection Scores for the Private Practice

Barriered Non-Barriered
Mean 0.283333333 0.593220339
Variance 0.24039548 2.62478083
Observations 60 59
Pooled Variance 1.422398474
Hypothesized Mean Difference 0
df 117
t Stat -1.417166498
P(T<=t) one-tail 0.079545831
t Critical one-tail 1.657981659

Environmental Comparisons

Post Disinfection Comparison of Academic & Private Practice

When comparing post disinfection procedures for Academic and Private

Practice settings inclusive of barriered and non barriered units no statistical

significance was found, t (237) = 1.65, p = 0.16 (one tailed). (See Figure 7,

Table 8 & 9)
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Environmental Comparison of Post-Disinfection Scores

120

100

80
Academic
Private Practice
60

0
CFUs

Figure 7: Sum of CFU counts in the Academic and Private Practice comparing

post disinfection scores including barriered and non barriered units

Table 8:

t-Test: Comparison of Post-Disinfection Scores Between Environments

Academic Private Practice
Mean 0.95 0.43697479
Variance 30.33361345 1.434553482
Observations 120 119
Pooled Variance 15.94505194
Hypothesized Mean Difference 0
df 237
t Stat 0.993095219
P(T<=t) one-tail 0.160838194
t Critical one-tail 1.651308392
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Summary of Results

Table 9: Summary of t-test results with p values

Academic Private Practice

Barriered Non-Barriered Barriered Non-Barriered

Pre/Post Pre/Post Pre/Post Pre/Post

p = .09 p = .00 p = .00 p = .00

Comparison of Post Scores Post Scores

p = .18 p = .07

Environmental Comparisons of Post Scores

p = .16
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DISCUSSION

The purpose of this research was to evaluate the efficacy of plastic

surface barriers used in dentistry in conjunction with surface disinfection. It was

hypothesized that there would be no statistical significance when comparing post

disinfection scores of non-barriered and barriered units. Evidence suggests

support for the hypothesis. There was not a statistically significant difference in

CFU’s post treatment, post disinfection between the non-barriered versus

barriered units. As a result, the null hypothesis was rejected.

It needs to be re-emphasized that a comparison of CFU scores between

the Pre and Post-disinfection counts was done to establish that barriers did, in

fact reduce the number of CFUs initially, post-patient care. However, once the

use of an OSHA approved disinfectant was used on both the barriered and non-

barriered units, there was no difference in the CFU count. In the end, post-

treatment asepsis procedures meted the same result, it did not matter whether

barriers were used or not used. This outcome was seen as very significant and

could be extrapolated to mean that the use of barriers did not impact asepsis.

Which in turn leads to the question of whether the continued use of plastic

surface barriers in dentistry should continue to be benchmark practice.

In support of the assertions made in the last paragraph, it was seen as a

positive finding that in both the academic and private practice settings there was

a statistically significant difference in CFU counts between the non-barriered pre

and post-disinfection scores and with the barriered pre and post-disinfection

scores there result was very close to significant for the academic setting and
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significant for the private practice. This was expected because a surface barrier

will reduce CFUs on their own, which would be a great help if all that was being

done for asepsis were the use of barriers. However, since a surface disinfectant

is always used as well, the benefit of the plastic surface barrier is negated.

It needs to be acknowledged that the graphs in the results section can be

visually misleading due to the fact that the left hand grid lines and categories

were different for each graph. This was difficult to homogenize these graphs due

to the fact that in one case the graph depicted a CFU count range of 25 – 50 and

another a range of 500 – 3500. The graphs were left in to show the dramatic

difference in the comparison scores for that graph but could not be realistically

compared to other graphs. With the addition of the quantitative scores for the t-

test analysis, there was little concern that the actual outcomes would be polluted.

Researchers posited that there would be a difference in the CFU post-

disinfection scores between groups between environments. It was interesting

that there was not a significant difference between scores of groups for both

environments. It was theorized that asepsis techniques would be utopian in an

academic setting but that those same skills for disinfection would not be as high

in a private practice environment. These finding add support to the fact that a

high level of asepsis is maintained in private practice as well as academic.

Some recommendations for future researchers include: In the private

practice setting, it would be ideal to allocate more time between patients for

researchers to gather appropriate specimen collection. If a surface disinfection

requires mixing, the researches should be responsible to do so to ensure quality
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control. Possibility may exist for operator error in following proper protocol for

infection control. A future study may indicate a need to check the quality control

of universal standards on precautions. Conducting a double blind study for

quality assurance may be ideal. These recommendations would increase the

validity of future research findings.
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CONCLUSION

The results of this study rejected the null hypothesis and supported the

hypothesis; there was no statistical significance in CFU’s between dental

operatories that utilized barriers and dental operatories that did not.

Disadvantages of using barriers include increased time, money, and negative

effects on the environment. Because of these reasons, it may be beneficial to

dental practices and the environment to reconsider the use of plastic surface

barriers for infection control protocol.
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REFERENCES

Andrews, N. (2006) Office Asepsis: Perception.

http://www.kerrtotalcare.com/learning/publications/wallCharts/pdf/scheni.

Pdf.

Boyce, J. & Pittet, D. (2002). Guideline for hand hygiene in health-care settings

Centers for Disease Control.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm

Connecticut Department of Public Health (CDPH), (1997). What you need to

know about municipal waste landfill gases.

http://www.dph.state.ct.us/Publications/brs/eoha/landfill.pdf.

Environmental Protection Agency (EPA), (2006). Municipal solid waste basic

facts. http://www.epa.gov/epaoswer/non-hw/muncpl/facts.htm.

Kohn, W. et al., (2003). Guidelines for infection control in dental health-care

settings. Centers for Disease Control.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm.
2eption
UNC, (2004) Exposure Control Plan for Bloodborne Pathogens.

http://ehs.unc.edu/biological/bbp/ecpbbp.pdf.

Waste Online, (2006). Plastics recycling information sheet.

http://www.wasteonline.org.uk/resources/InformationSheets/Plastics.htm.

Wikipedia. (2006). Waste management.

http://en.wikipedia.org/wiki/Waste_management.

Wilkens, E., (2005) Clinical Practice of the Dental Hygienist. 9th ed. 65-75.
.S.
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ACKNOWLEDGEMENTS

The researchers greatly thank Professor Kami Hanson, MEd, RDH, for her

countless hours of assistance. We would also like to recognize and thank Lynn

Moyes for his time and effort in the microbiology lab; also Dr. Hincks, who

graciously allowed us to use his practice to obtain samples.
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Appendix A

IRB Approval Letter
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Appendix B

Calibration
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Calibration

A mock specimen collection was presented with all research investigators

present. There was also a discussion involving questions and answers. All

researches read this section prior to data collection to attain a tight calibration.

-No need for any measures until patient is dismissed.

-Once clinician is ready to clean op they are to:

1. Put there instruments in the Ultrasonic and clear disposables

other then plastic barriers. If they have other stuff out have them

clean it up with cavi wipes and put it away before they get you.

Just have them avoid cleaning surfaces of research

2. Alert a research investigator that they are ready

3. If they are utilizing non-barriers, samples are taken

immediately—make sure clinician and researcher use personal

protective equipment (see 4 for additional info)

4. If clinician is utilizing barriers:

-researcher watches them place new gloves (clinician must

wash their hands or use rub while researcher watch, clinician

must also properly place there gloves by touching only the

rim area prior to placing gloves the clinician will done their

mask and will then remove all barriers with as minimal

contact to the underlining barrier surface as possible. The

clinician will then remove their gloves and wash their hands.
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At this time they can be dismissed from the area or remain—

if they are close their masks should stay on. The researcher

must then place gloves, masks, etc as properly directed (if

any questions read Wilkens for proper technique) Pre-

disinfection specimen collection are taken from the areas

with the barriers OFF.

5. Specimen collection:

-This step is the same for pre & post, barriered & non

To yield the most valid/accurate statistics the two most important

aspects are avoiding cross contamination and calibration. Five

areas will be gathered each time you take specimens. A total of 13

pre and 13 post (both barrierd and non barriers) needs to be

assessed. The five sites are: 1, bracket tray (2 inch square area

needs to be swabbed going in vertical strokes followed by

horizontal strokes in the same area. Use the very center portion of

the tray 2, the light handle closest to the operator. Make sure you

know if the clinician is a righty or lefty I will ask the class on

Tuesday and tell you if any one is a lefty (otherwise no worries).

Visually Bisect the light handle in half vertically. Specimen

collection will be in vertical overlapping strokes on the lateral aspect

of the light handle 3, Head rest, utilize a 2 inch square area

directly in the middle of the head rest using, vertical and horizontal

strokes 4, Suction, considering that the saliva ejector (slow
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speed evacuation) is utilized the most the specimen will be

gathered from this site. Visually bisect the metal portion vertically

in half with the side closest to the thumb latch/control being the side

of specimen collection. Use vertical overlapping strokes and finish

by swabbing over the latch/control (make sure you go around the

grooved areas 5, Air water syringe—visually bisect the metal

portion in half in a vertical plane. Sample collection will be on the

half that the air water buttons are on. Use vertical strokes followed

by circular swabs circumferential to the air/water buttons—make

sure you hit all of the grooves very well.

* While you are swabbing the areas minimize any touching to surfaces to avoid

cross contamination. Use a clean swab for each area. As soon as the sample

has been taken swab the petre dish utilize overlapping strokes in three planes at

60 degree angles to each other covering the entire surface. Most of the CFU’s in

the area that is swabbed for pre-disinfection will be removed from the surface.

Because of this make sure the specimen collection is the same size for post

disinfection as it was for pre-disinfection and utilize the sample sites as close as

possible while still ensuring that the same specimen collection site is not used.

(We will go over this in the mock specimen collection to clarify any confusion)

6. Complete a qualitative observation to ensure that asepsis technique is being

completed correctly. The clinician should re-wash/rub hands use new gloves and

where there masks. Make sure all surfaces are disinfected. Allow the surface to
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air dry 5 minutes prior to post-op specimen collection. If possible have the

clinician leave the area until data collection can be assumed.

Make sure the petre dishes are labeled and avoid crossing any samples by

keeping them labeled and organized.
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Appendix C

Data Tables
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Total CFU
Academic Setting

Barriers
Pre Disinfection Post Disinfection
Head Tray Light Air/H20 Suction Head Tray Light Air/H20 Suction
Rest Handle syringe Rest Handle syringe
1. 0 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0
2. 0 2. 0 2. 0 2. 0 2. 0 2. 0 2. 0 2. 0 2. 0 2. 0
3. 0 3. 0 3. 0 3. 0 3. 0 3. 0 3. 0 3. 0 3. 0 3. 0
4. 0 4. 0 4. 0 4. 0 4. 0 4. 0 4. 0 4. 0 4. 0 4. 0
5. 0 5. 0 5. 0 5. 0 5. 0 5. 0 5. 1 5. 0 5. 0 5. 0
6. 0 6. 0 6. 0 6. 0 6. 0 6. 0 6. 1 6. 0 6. 0 6. 0
7. 0 7. 1 7. 0 7. 1 7. 0 7. 0 7. 1 7. 0 7. 0 7. 0
8. 1 8. 1 8. 0 8. 1 8. 0 8. 0 8. 1 8. 0 8. 0 8. 0
9. 1 9. 1 9. 1 9. 1 9. 0 9. 1 9. 1 9. 1 9. 0 9. 1
10. 1 10. 2 10. 1 10. 1 10. 0 10. 1 10. 1 10. 1 10. 1 10. 1
11. 3 11. 2 11. 2 11. 1 11. 1 11. 2 11. 1 11. 2 11. 1 11. 1
12. 3 12. 2 12. 11 12. 3 12. 1 12. 3 12. 2 12. 2 12. 1 12. 2
13. 5 13. 11 13. 8000 13. 5 13. 3 13. 3 13. 2 13. 2 13. 8 13. 2
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Total CFU
Academic Setting

Non Barriers
Pre Disinfection Post Disinfection
Head Tray Light Air/H20 Suction Head Tray Light Air/H20 Suction
Rest Handle syringe Rest Handle syringe
1. 0 1. 0 1. 0 1. 0 1. 1 1. 0 1. 0 1. 0 1. 0 1. 0
2. 1 2. 0 2. 1 2. 0 2. 1 2. 0 2. 0 2. 0 2. 0 2. 0
3. 3 3. 0 3. 1 3. 2 3. 1 3. 0 3. 0 3. 0 3. 0 3. 0
4. 5 4. 0 4. 4 4. 2 4. 2 4. 0 4. 0 4. 0 4. 0 4. 0
5. 6 5. 0 5. 5 5. 3 5. 2 5. 0 5. 0 5. 0 5. 0 5. 0
6. 7 6. 1 6. 5 6. 3 6. 5 6. 1 6. 0 6. 0 6. 0 6. 0
7. 9 7. 3 7. 6 7. 5 7. 9 7. 1 7. 0 7. 0 7. 0 7. 0
8. 10 8. 4 8. 7 8. 7 8. 7 8. 1 8. 0 8. 0 8. 0 8. 0
9. 11 9. 4 9. 7 9. 9 9. 7 9. 1 9. 0 9. 0 9. 1 9. 0
10. 26 10. 5 10. 12 10. 19 10. 12 10. 1 10. 0 10. 0 10. 1 10. 0
11. 300 11. 5 11. 13 11. 180 11. 300 11. 3 11. 1 11. 1 11. 1 11. 1
12. 900 12. 360 12. 150 12. 225 12. 315 12. 7 12. 1 12. 1 12. 1 12. 60
13. 1020 13. 435 13. 300 13. 840 13. 540 13. 90 13. 3 13. 1 13. 2 13. 180
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Total CFU
Private Practice
Barriers
Pre Disinfection Post Disinfection
Head Tray Light Air/H20 Suction Head Tray Light Air/H20 Suction
Rest Handle syringe Rest Handle syringe
1. 0 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0
2. 0 2. 0 2. 0 2. 0 2. 0 2. 0 2. 0 2. 0 2. 0 2. 0
3. 0 3. 0 3. 0 3. 0 3. 0 3. 0 3. 0 3. 0 3. 0 3. 0
4. 0 4. 0 4. 0 4. 0 4. 0 4. 0 4. 0 4. 0 4. 0 4. 0
5. 0 5. 0 5. 0 5. 0 5. 1 5. 0 5. 0 5. 0 5. 0 5. 0
6. 0 6. 0 6. 0 6. 0 6. 1 6. 0 6. 0 6. 0 6. 0 6. 0
7. 0 7. 0 7. 0 7. 0 7. 2 7. 0 7. 0 7. 0 7. 0 7. 0
8. 1 8. 0 8. 0 8. 0 8. 2 8. 0 8. 0 8. 1 8. 0 8. 0
9. 1 9. 1 9. 1 9. 1 9. 2 9. 0 9. 0 9. 1 9. 0 9. 1
10. 2 10. 1 10. 1 10. 1 10. 2 10. 0 10. 1 10. 1 10. 0 10. 1
11. 2 11. 2 11. 2 11. 2 11. 3 11. 1 11. 1 11. 1 11. 1 11. 1
12. 3 12. 3 12. 2 12. 3 12. 10 12. 1 12. 1 12. 2 12. 1 12. 1
13. 150 13. 6 13. 2 13. 5 13. 8100 13. 2 13. 2 13. 2 13. 3 13. 1
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Total CFU
Private Practice

Non Barriers
Pre Disinfection Post Disinfection
Head Tray Light Air/H20 Suction Head Tray Light Air/H20 Suction
Rest Handle syringe Rest Handle syringe
1. 1 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0 1. 0
2. 3 2. 0 2. 0 2. 2 2. 1 2. 0 2. 0 2. 0 2. 0 2. 0
3. 4 3. 1 3. 0 3. 3 3. 1 3. 0 3. 0 3. 0 3. 0 3. 0
4. 6 4. 1 4. 0 4. 3 4. 2 4. 0 4. 0 4. 0 4. 0 4. 0
5. 8 5. 1 5. 1 5. 3 5. 2 5. 0 5. 0 5. 0 5. 0 5. 0
6. 13 6. 1 6. 1 6. 5 6. 4 6. 0 6. 0 6. 0 6. 0 6. 0
7. 20 7. 2 7. 1 7. 5 7. 6 7. 0 7. 0 7. 0 7. 0 7. 0
8. 45 8. 2 8. 1 8. 10 8. 8 8. 0 8. 0 8. 0 8. 0 8. 0
9. 45 9. 2 9. 1 9. 60 9. 30 9. 2 9. 0 9. 0 9. 0 9. 1
10. 90 10. 2 10. 1 10. 45 10. 90 10. 2 10. 0 10. 1 10. 0 10. 1
11. 150 11. 3 11. 1 11. 90 11. 150 11. 10 11. 1 11. 1 11. 1 11. 1
12. 300 12. 5 12. 2 12. 480 12. 180 12. 17 12. 3 12. 2 12. 6 12. 3
13. 390 13. 90 13. 3 13. 1620 13. 1440 13. 4320 13. 8 13. 1080 13. 13 13. 5400
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