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13-Feb-2013 | 462-EN

A close look at hygiene in dental practices

What dentists should observe when processing work clothing

BÖNNIGHEIM (ag-dh/ri) Many patients only ever get to see their dentist's eye area. And there is a good reason for that: According to paragraph 36 of the German Infection Protection Act (IfSG), dentists are obliged to equip themselves and their employees with mouth and nose protection, protective goggles and gloves as well as with the traditional professional clothing (tunics). All this is part of the standard hygienic measures in a dental practice. While gloves and masks have to be disposed of after every patient, clothing is not washed until the end of the day in many practices, and then only in a normal household washing machine. But what types of germs are lurking on those tunics after a day's work and how can these be reliably returned to a hygienically sound condition? The experts at the Hohenstein Institute in Bönnigheim have studied this question in depth.

The small amounts of laundry make it difficult for many dental practices to find a commercial laundry operation with monitored washing procedures. In the end, dentists are specialists for teeth and not experts for washing and hygiene. That is why many practices find it hard to implement the recommendation by the Robert Koch Institute ‘Infection prevention in dentistry – hygiene requirements’ (journal of the German Federal Health Office 4/2006) in the sense of hygiene protection. Among the germs feared by dentists are viruses (HIV, hepatitis B and C, herpes) as well as bacteria such as tuberculosis pathogens or staphylococci.

Fungi are often underestimated, even though they are a much more common problem: Over 70 % of all people wearing dentures carry a fungal infection with the oral thrush organism Candida albicans which causes uncomfortable inflammations in the mouth and throat area. As these yeast fungi adhere particularly well to the dentures, they settle there very easily and the pathogens can spread to the employees' clothing through small drops transferred during dental treatments, e.g. when drilling or rinsing.

A study by the Hohenstein Institute has now examined the hygienic performance of different household washing procedures. For this, the scientists used special germ carrying cloths, so-called bioindicators. The result: Yeast fungi such as Candida albicans as well as most bacteria can already be destroyed with low temperature cycles. Skin fungi, viruses and more resistant bacteria can usually only be removed at washing temperatures of at least 60°C using an all-purpose washing powder with bleach and an additional hygiene conditioner. From a hygiene point of view there are consequently no objections to washing the work clothes in a household machine. This sometimes results in recontamination on the washed items, though, caused by old (pathogen) residue in the machine.

What should dentists take into account for washing then? It is especially important to actually reach water temperatures of at least 60 °C and to check this regularly, particularly with older machines. In addition, suitable washing additives (all-purpose washing detergent and hygiene conditioner) have to be used in sufficient quantities.

Dental practices and patients are on the safe side if they additionally check the efficiency of the washing procedure at regular intervals. The experts from the Hohenstein Institute have developed special germ carrying cloths for this purpose. These bioindicators loaded with bacteria or fungi are added to the laundry at regular intervals. The microbiological laboratory of the Hohenstein Institute subsequently determines whether the test pathogens were reliably destroyed. This method has already proven successful in monitoring hygiene in commercial laundries for many years. The successful self-tests can for example be enclosed with the required hygiene plan and displayed in the practice to demonstrate the efficiency of the hygiene measures towards authorities and patients.

More information about this service from the Hohenstein Institute can be found at:

Dr. Anja Gerhardts
Tel. 07143-271 434

Hygiene in dental practices
Requirements for hygiene protection in dental practices are contained particularly in paragraph 36 of the German Infection Protection Act (IfSG) and in the recommendation by the Robert Koch Institute ‘Infection prevention in dentistry – hygiene requirements’ (journal of the German Federal Health Office 4/2006). According to the German Accident Prevention Guideline BGV C8, dentists are furthermore obliged to stipulate measures for disinfection, cleaning and sterilisation as well as for disposal according to the infection risk in a written hygiene plan and to monitor the implementation continuously. The governing state bodies have been carrying out an increasing number of inspections of dental practices in recent years to verify compliance with the appropriate regulations.
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