New Approaches to Infection Control

By Robert Elsenpeter

Bob Dylan was 100 percent right – The Times They Are a-Chaingin’, and dentists must be able to change with those times.

The COVID-19 pandemic forced dental practices to re-think the ways in which they approach infection control. While traditional methods were, certainly, effective means of controlling infection transmission, when the doors do finally reopen on a regular basis, practices are likely going to want new, more effective, ways to keep themselves, and patients, safe. If anything positive can be taken from the pandemic, it’s that new approaches to infection control are receiving closer attention.

Surfaces

Aquaox offers a unique product for surface disinfection. Their solutions utilize electrolysis-treated salt brine to create two types of solutions. The main component of the first is hypochlorous acid.

“That’s a chemical in our bodies that we generate to ward off any types of infections when we get cut,” Mark Nagano, Aquaox Vice President Operations says. “It’s generated by white blood cells, and they use hypochlorous acid to fight any pathogen trying to invade into our body. Hypochlorous acid is the main ingredient in bleach that does all the killing, but ours is up to 300 times stronger than bleach.”

Their other solution is a high-alkaline water that emulsifies grease and oil very quickly.

“It does have antimicrobial properties, but both solutions are considered all-natural,” Nagano says. “Our solutions are non-toxic, non-corrosive. As you can imagine, because we only use salt and water to make these solutions, we are actually considered organic.”

Aquaox’s solutions are registered with the EPA as a hospital-grade, broad spectrum disinfectant. They recently were approved in Canada to treat COVID-19. They are waiting for a similar US approval.

“We’re just waiting for the paperwork to go through,” Nagano says, “but we know we’re going to get it.”

Rather than just spraying the solutions on specific surfaces, Aquaox utilizes electrostatic spraying to treat an entire room. Nagano compares electrostatic spring to rubbing a balloon on someone’s hair and then hair standing up.

“Electrostatic spraying puts a charge on to the product coming out,” Nagano says. “That charge is 70 times greater than gravity. When it comes out, that droplet won’t just fall to the ground. That droplet has a positive charge on it and everything, inherently, has a negative charge, so it adheres to everything – the ceiling, the wall, the table top, under the table, the legs. We are getting total room coverage with our disinfectant.”

It is also non-corrosive.

“You can spray the whole room and walk away,” Nagano says. “With regular disinfectants, like bleach, you can’t do that. If you did that for a week, everything in that room would start being corroded, not to mention you can’t breathe it. Using our products, dentists can extend the life of their equipment and their furniture.”

Air

In addition to new technologies, now’s a good time to revisit the efficacy of some existing practices, like air treatment.

“Doctors always use high volume evacuation, because they have an assistant to manage that for them,” infection prevention speaker, author, and consultant Mary Govoni says. “The hygienists, on the other hand, especially when they’re using an ultrasonic scaler, don’t necessarily have someone or some way to manage that, so they use low-volume suction or the saliva ejector. There are lots of devices now that are available that don’t require the hygienist to hold onto them while they’re using their ultrasonic scaler. They can be placed in the mouth and secured. There are a number of them on the market, and as long as they work with the high-volume suction, then that alleviates again about 90 percent of that aerosol. And then, of course, there’s the old tried-and-true dental dam. But they are not very popular, because it’s a little time consuming to apply it. It doesn’t work with every procedure, but nonetheless, it’s a great way to control air assault.”

Best practices

Given the tumultuous times, doctors may be hesitant to invest in any new technologies – at least not yet.

“The difficulty that I see right now for dentists is that we don’t have any firm guidance either from the CDC or from OSHA that says what is going to be required, going forward,” Govoni says. “What we have in place is interim guidance. That is geared toward treating emergency patients only. The American Dental Association has really been pushing CDC to update their interim guidance. I’m guessing they’ve done the same thing with, with OSHA, but that’s the struggle.”

Another concern is to what extent, and for how long, stepped-up efforts will be necessary.

“We may not have to do extra things forever,” Govoni observes. “Once the pandemic has died down, maybe we will see that we won’t see that there’s such a great threat. Maybe we don’t have to wear N95 masks all the time, or maybe we don’t have to worry the aerosols, but I think there are better ways. I think mitigating the aerosol production in the first place so that we don’t have the contaminants in the air.”

Are we just worried about COVID-19 or is there another bogeyman hiding under the bed for whom we have to prepare?

“We know that, in laboratory settings, aerosols can stay in the environment for up to three hours,” Govoni says. “So, it’s not just about COVID, it’s about colds, flu possible tuberculosis infections. And what about when we’re removing amalgam restorations and the potential for mercury to be separated out from that amalgam and potentially aerosolized? So, I think what COVID has done is really shined a very bright light on the issue of aerosols in dentistry, in general. As we keep hearing from some of the public health officials, there will be another Coronavirus out there or a pandemic influenza out there. If we start looking at what we can use long-term, in terms of containing or mitigating the aerosols, then we’re going to make a healthier environment in this era and planning for the future. It’s not just about COVID, it’s about what comes next, which is a scary thought.”

Dentists would be wise to heed Bob Dylan’s advice and to be able to change with these times, maybe even embracing new technologies.