24: Dental PPE and Hand Hygiene: Avoiding the Most Common Infection Control Breaches

24: Dental PPE and Hand Hygiene: Avoiding the Most Common Infection Control Breaches

Welcome Back to The Clean Bite! In May 2026, I had the honor of presenting an infection control class for just shy of 900 participants at the California Dental Association’s Art & Science Annual Meeting in Anaheim. I’m not going to lie, my biggest class ever. And the good news? I didn’t fall off the stage or throw up. So as far as this writer is concerned… huge success 😊 If you’ve ever had to “teach the experienced,” you know it can feel a little intimidating. But here’s the best part: I had a line of people waiting afterward and nearly 50 questions submitted through my Google form. That’s always my sign that it landed well: People felt comfortable, engaged, and curious enough to ask. Let’s Talk About the Real Issues During the conference, my friend and fellow infection control enthusiast, Lori Serna-Pate, RDH, MEd, CDIPC, CEO and founder of Dental Training Solutions, and I sat down to discuss the most common infection control breaches we’re seeing. (You can catch the full conversation in the video!) Not surprisingly, personal protective equipment (PPE) usage rose right to the top, second only to hand hygiene. Let that sink in for a second. We’re either: * Not using PPE at all Using PPE as a uniform * Or not removing it properly (like wearing clinical barriers outside treatment areas) And here’s the kicker: This isn’t isolated. It’s happening across the country in every type of dental setting. In Maryland and DC, where Lori works as a dental board inspector, the top 3 violations are: * Lack of hand hygiene * Improper PPE usage and disposal of PPE * Failure to use utility gloves when handling sharps in the sterilization area Sound familiar? “When We Are at Risk” Lori made a statement that really stuck with me: “PPE is to be used when we are at risk, when we face occupational risk in our work setting.” Quick reality check: We are at risk in dentistry. Every single day. Even something as routine as treating a small cavity creates aerosols. That high-speed handpiece (aka…the “drill”) spins at incredible speeds, aerosolizing water and debris. Ultrasonic scalers do the same thing during hygiene visits. And those aerosols? They can travel up to 6 feet in any direction in the operatory. So yes, we suit up differently than our medical colleagues. PPE is chosen based on the risks faced in the work setting or during the activity to be performed. It’s essentially PPE-on-repeat all day long: * Barriers (jackets or gowns) that cover the wrist, neck, and lap * Exam gloves * Masks * Eye protection (safety glasses or face shields) Where We’re Falling Short Here’s the truth: We’re pretty good about using gloves during patient care, but we struggle with: * Hand hygiene before and after gloves * Removing clinical barriers when leaving treatment areas Occupational Safety and Health Administration (OSHA) regulations and CDC guidelines are crystal clear: Hand hygiene must happen before donning and after doffing gloves. But what do we often do? Glove-to-glove transitions. No hand hygiene in between. Yes, this is a big deal. Offices have been fined $10,000 to $15,000 for a single violation. They are not playing around with this one. Now let’s talk about dental barriers (jackets/gowns). I’ll be honest; I used to wear mine everywhere: * Front desk * Bathroom * Breakroom And I still see it all the time. Not because people don’t care, but because we’re busy and it’s easy to forget, or we just don’t know. The Overlooked Risk: Utility Gloves Another big miss? Not using utility gloves when handling sharps and chemicals in the central sterilization area. Here’s something that may surprise you: About 90% of sharps injuries happen during instrument processing—not chairside. That’s exactly why OSHA mandates utility gloves. But here’s the reality in most offices: * One size * Shared by everyone (can you say gross here?) * Poor fit for almost everyone Employer supplying dishwashing gloves instead of puncture and chemical resistant gloves. And when gloves don’t fit? They make instrument handling harder, not safer—especially when you’re dealing with burs, files, blades, cassette wraps, or pouch tape. A Simple Strategy That Works Lori and I also talked about workflow solutions, and one concept I absolutely love: Habit Stacking This means pairing a new habit with something you already do. For example: * Perform hand hygiene while explaining the procedure to your patient * Sanitize while asking, “Do you have any questions before we begin?” It’s simple, but incredibly effective. The Bottom Line Here’s what I want you to walk away with: * Perform hand hygiene before and after glove use * Remove jackets or gowns when leaving clinical areas * Use properly fitting utility gloves when handling sharps and chemicals Make It Easy to Do the Right Thing A few quick wins for your practice: * Create a team pact to remind each other about clinical barriers (jackets and gowns) * Install hooks by operatory doors for easy removal and storage during the busy day * Invest in multiple sizes of utility gloves, or better yet, assign personal pairs Small changes. Big impact. I’ve included the link to our full conversation above (and here again!) so you can dive deeper into the discussion. Because at the end of the day, staying on top of these fundamentals protects you, your team, and your patients and allows you to continue delivering the world-class care you’re known for. Until next time, my friends— Stay informed. Stay clean. Stay safe. 🦷✨ — Sherrie, The Clean Bite

23: Hantavirus: A Podcast with Matthew Pullen, MD, an Infectious Disease Doctor

A rare hantavirus outbreak linked to an expedition cruise ship near South America has drawn international attention and renewed concerns about emerging infectious diseases. While experts emphasize that the risk of a widespread outbreak remains extremely low, the appearance of Andes virus-associated hantavirus pulmonary syndrome on a cruise ship has raised questions about global preparedness, travel-related transmission, and public understanding of infectious disease threats. A rare hantavirus outbreak linked to an expedition cruise ship near South America has drawn international attention and renewed concerns about emerging infectious diseases. While experts emphasize that the risk of a widespread outbreak remains extremely low, the appearance of Andes virus-associated hantavirus pulmonary syndrome on a cruise ship has raised questions about global preparedness, travel-related transmission, and public understanding of infectious disease threats. Matthew Pullen, MD, an infectious disease physician and member of the Infection Control Today® Editorial Advisory Board, said much of the concern stems from confusion about the virus itself. “Hantavirus is actually a very large family of viruses,” Pullen explained. “The ones we’re hearing about most right now are the Sin Nombre virus and Andes virus.” According to Pullen, Sin Nombre virus is the hantavirus most commonly found in the United States and is transmitted through infected deer mice. Andes virus, first identified in Argentina and Chile, has generated greater concern because of limited evidence suggesting possible human-to-human transmission. “There are a few cases where they’re pretty confident there was human-to-human transmission,” Pullen said. “But there’s still academic debate about whether some of those outbreaks represented true transmission or simply shared exposure.” Both viruses can cause hantavirus pulmonary syndrome, a severe disease with a case fatality rate approaching 40%. “It starts like a flu-like illness,” Pullen said. “Body aches, headaches, fever, nausea, vomiting. Then the severe cardiopulmonary phase develops, and that’s what kills people.” Despite the seriousness of the illness, Pullen stressed that fears of a COVID-19-like pandemic are unsupported by current evidence. “I would say the likelihood is very, very, very low,” he said. One reason is the virus's limited transmissibility. “It doesn’t spread like COVID[-19] does. It doesn’t spread like the flu does,” Pullen said. “The last estimate I saw had an R-naught of about 1.2, meaning not every case even propagates to another case.” Pullen also questioned whether current monitoring measures surrounding the cruise ship outbreak are sufficient. “While balancing public health with patient autonomy is important, there are still seemingly unanswered questions about the transmission and exposure events in this outbreak,” Pullen told Infection Control Today®. “This raises concerns about the current monitoring strategy, especially as compared to other nations that have repatriated citizens from the ship and are following tighter monitoring plans.” More than the virus itself, however, Pullen worries about the social environment surrounding emerging disease events. “What worries me most actually isn’t the virus itself,” Pullen said. “It’s the social conditions around the virus.” He pointed to rapidly changing narratives on social media. “One morning, people on social media were saying this was going to be the next pandemic that would kill us all,” he said. “By that afternoon, those same people were posting that hantavirus was nothing to worry about and that the government was lying.” Pullen also warned about individuals attempting to profit from public fear. “There was even a physician online promoting ivermectin as a cure for hantavirus,” Pullen said. “Then conveniently mentioning they also sell ivermectin.” For clinicians, awareness remains important despite the rarity of the disease. “If someone comes in with severe pulmonary syndrome after traveling through Argentina or Chile, that should absolutely bubble up in your mind,” he said. Pullen believes most US hospitals already have the infection prevention infrastructure necessary to manage suspected cases. “Every hospital should be equipped to do respiratory isolation and airborne precautions,” he said. “The key is recognizing the syndrome early and escalating appropriately.” Still, he expressed concern about broader public health capacity. “The people working at CDC are phenomenal,” he said. “But they’re being hamstrung by funding limitations and policy decisions.” Ultimately, Pullen said the outbreak serves as another reminder that emerging zoonotic diseases will remain a global challenge. “Viruses don’t respect borders,” he said. “And the more interconnected the world becomes, the more important preparedness, communication, and public trust become.”

22: Contagious Conversations: How SPD Voices Are Shaping Patient Safety

At the SoCal Sterile Processing Association (SPA) Chapter meeting [https://www.socalspd.com/] on March 21, 2026, in Newport Beach, California, one message came through clearly: Leadership in sterile processing does not begin with a title. It begins with a voice. In this special edition of Contagious Conversations, hosts Jill Holdsworth, MS, CIC, FAPIC, NREMT, CRCST, CHL, AL-CIP; and Brenna Doran, PhD, MA, ACC, CIC, AL-CIP, turned the microphone toward Tori Whitacre Martonicz, MA, lead editor of Infection Control Today®, following her presentation, “Leadership Beyond the Sterile Processing Department: Expanding Professional Influence and Patient Safety Impact.” The conversation reflected broader themes echoed throughout the event, where leaders across sterile processing, infection prevention, and industry highlighted mentorship, communication, and systems thinking as essential to advancing patient safety. The event featured a diverse lineup of speakers, including Shahbaz Salehi, MD, MPH, MSHIA; Randalyn Harreld, CRCST, CIS, CER, CHL, CSPDT, CASSPT, CLS, AAS, FHSPA; Sharon Lashley, MS, MBA; Brian North; and Sarah B. Cruz, AS, CSPDT, CRCST, CHL, CIS, each addressing critical gaps in education, workflow, and system integration across sterile processing. “The March conference was highly successful, with over 100 attendees from Greater Los Angeles to San Diego coming together for a full day of impactful learning, collaboration, and advancement of the sterile processing profession,” said Jaime Amaya, CRCST, president of the SoCal SPA Chapter, and the sterile processing manager, Hoag Memorial Hospital Presbyterian, Newport Beach & Irvine. To highlight their excellence, the chapter also recently won the Healthcare Sterile Processing Association (HSPA) Large Chapter of the Year award for 2026.   Leadership Starts Before the Title For Whitacre Martonicz, the foundation of her presentation came from personal experience and observation. “Leadership is not a title,” she said. “It is a choice about whether you'll use your voice to make a difference.”  She described how her understanding of infection prevention and sterile processing did not come from job titles or hierarchy, but from individuals willing to share their knowledge publicly. “The people that I was learning from were not necessarily the people with all the titles,” she explained. “It was always the person who had gone out beyond their comfort zone and given that information out.”  That insight shaped the core message of her talk: that writing, speaking, and sharing experiences are powerful tools for influence across health care systems. Why Speaking Up Matters in SPD Throughout the discussion, both hosts reinforced the need for leadership development within sterile processing. Holdsworth emphasized the growing demand for these skills within the field. “They are probably one of the professions most hungry for leadership knowledge, and leadership training, and leadership discussions,” she said.  Whitacre Martonicz agreed, noting that many professionals hesitate not because they lack expertise, but because they lack confidence. “I've gotten messages… ‘I'd love to write an article… but I don't know how,’ or ‘I'd love to give a speech… but I don't know how to speak,’” she said. “All you have to do is try.”  Her advice was practical and accessible. Start small, build confidence locally, and expand outward. “Start in your own facility,” she said. “Even if it's just standing in front of your colleagues… or write a post… anything to get that conversation started.”  The Power of Everyday Expertise A recurring theme throughout the panel was the value of everyday problem-solving in sterile processing. Whitacre Martonicz highlighted how even simple observations can lead to broader improvements. “If you have that problem, I guarantee you that there's somebody else… [who's] having the same problem,” she said.  This perspective aligns closely with broader discussions at the event. Harreld’s session on fatigue and interruptions, Lashley’s focus on navigating IFUs, and North’s emphasis on technology and audits all reinforced the idea that small, consistent improvements drive system-level change. Cruz, the president-elect of the national HSPA, echoed similar principles in her focus on quality systems, while Salehi’s presentation on mentorship underscored the importance of guidance and professional growth across career stages. Overcoming Fear and Finding Your Voice One of the most candid moments in the discussion centered on fear, particularly around writing and public speaking. “I was surprised how many people were so terrified of writing,” Whitacre Martonicz said.  She encouraged attendees to reframe the process and lower the barrier to entry. “If you can't think of what to write… write that,” she said. “‘I don't know what to write, but I still have to write, so I will just write that I can’t think of what to write’ and so on… and then suddenly it's coming. It's kind of like the cork out of a bottle.”  Doran added another perspective on building confidence through intentional reflection. “What do I want them to walk away with? If I know the ending… I can back design it,” she said.  Together, these insights offered a practical roadmap for professionals looking to move from silent expertise to active leadership. Writing as a Patient Safety Tool Beyond professional development, Whitacre Martonicz framed communication as a direct pathway to improving patient outcomes. “If you don't have any words down… then I can't help you… and therefore [it cannot be] read by other people… and you saved the life of someone you never met,” she said.  That statement resonated as one of the most powerful takeaways of her session. Writing, presenting, and sharing knowledge are not just career-building activities. They are mechanisms for spreading best practices across facilities and improving care at scale. Building a Culture of Contribution The discussion closed with a call to action for sterile processing professionals to engage more actively in the broader infection prevention community. “I want to know what's going on in your facility,” Whitacre Martonicz said. “What works? What doesn't work?”  She encouraged submissions across a wide range of topics, emphasizing that every question, observation, or improvement has value. “Send it in… we'll get that information,” she added.  Looking Ahead The SoCal SPA will continue this momentum with two additional events in 2026: the Summer Symposium and Vendor Show on August 15 at Long Beach Memorial Medical Center, and the Late Summer Seminar and Vendor Show on September 26 in Riverside, California. If the March conference is any indication, those events will continue to elevate the voices of sterile processing professionals who are ready to lead, not by title, but by action. These are the speakers and topics for this conference: Shahbaz Salehi, MD, MPH, MSHIA, the director of infection prevention and control at Foothill Regional Medical Center, Instructor at UCLA Extension. Topic: “The Power of a Mentor: My Journey From SPD to Medicine.” Tori Whitacre Martonicz, MA, lead editor of Infection Control Today®. Topic: “Leadership beyond the Sterile Processing Department: Expanding Professional Influence and Patient Safety Impact.” Randalyn Harreld: Clinical Education Manager (US), SteelcoBelmed. Topic: “Common Breakdowns caused by Fatigue, Interruptions, and Assumptions” Sharon Lashley, Clinical Education for STERIS. Topic: “Lost in the IFU wilderness? Find your way today!” Brian North, platform specialist—Ascendco Health. Topic: “Modernizing SPD: How Technology, Staffing, and Audits Must Evolve Together” Sarah B. Cruz, Sterile Processing Program Instructor. Topic: “Clean, Sterile, and Streamlined: Quality Systems for Sterile Processing.”

21: What Is Surgical Smoke, and Why Is it So Dangerous? An Expert Explains

Surgical smoke has been part of operating room culture for decades, generated routinely by lasers, electrosurgical devices, and ultrasonic tools. Yet despite its constant presence, it remains one of the least understood and least consistently addressed risks in perioperative care. In a recent interview with Infection Control Today® (ICT®), Vangie Dennis, MSN, RN, CNOR, CMLSO, FAORN, FAAN, a former president of AORN and current member of the ICT’s Editorial Advisory Board, made it clear that this normalization has contributed to a dangerous blind spot in health care. “It is a hazard that sometimes we’ve been doing it for so many years… it is just part of the culture,” Dennis, who is also a health care consultant with Perioperative Consulting, LLC, said, describing how familiarity has dulled concern across the field.  A Risk That Extends Beyond the Surgical Field Dennis, who is also a perioperative nurse executive and speaker [https://www.vangiedennis.com/], stressed that one of the biggest misconceptions about surgical smoke is who it affects. While many clinicians associate exposure primarily with surgeons, the reality is far broader. She pointed to overlooked patient risks, particularly in vulnerable scenarios such as cesarean deliveries or procedures under monitored anesthesia. “The patients are affected by the surgical smoke,” she said. “What about the baby’s first breath on a C-section… the nurse who’s pregnant… that unborn baby is exposed to surgical smoke.”  This framing expands the conversation from occupational safety alone to a shared exposure risk across the entire perioperative team and patient population. “It really affects everybody in that perioperative platform when we generate smoke,” Dennis added, emphasizing that no one in the room is truly isolated from exposure.  Understanding the Science Behind the Smoke Dennis explained that the source of the smoke matters less than many clinicians believe. Whether generated by lasers, electrosurgery, or other heat-producing devices, the resulting plume contains harmful components. “Any heat-generating device will create a surgical plume or smoke… it’s all bad for you,” she said, underscoring that differentiation between technologies does not equate to differences in safety.  She reinforced this point with a lesson from early in her career, recalling a physician who distilled the issue bluntly. “He said, there’s no such thing as safe smoke,” Dennis noted.  To make the risk more tangible, she cited common comparisons used in education and research. “One gram of tissue vaporized by a laser is equivalent to 3 unfiltered cigarettes… by an electrosurgical device, 6 unfiltered cigarettes,” she said.  However, Dennis emphasized that even this comparison may underestimate the danger, given the biological and chemical complexity of surgical smoke, which includes human tissue, blood particles, and toxic gases such as benzene and formaldehyde. Health Effects That Accumulate Over Time Dennis described both the immediate and long-term health consequences associated with repeated exposure. Early in her career, she experienced symptoms that many perioperative staff still report today. “You had headaches… your eyes are burning… nausea, fatigue,” she said, recalling the physical effects of prolonged exposure during smoke-heavy procedures.  While these symptoms may seem transient, Dennis emphasized that chronic exposure could lead to more serious outcomes. “I know several of my friends… one has adult-onset asthma, and the other has stage 2 [chronic obstructive pulmonary disease],” she said, highlighting the potential progression from irritation to long-term respiratory disease.  She also pointed to the presence of mutagenic and carcinogenic compounds in surgical smoke. “We’re being exposed to toxic gases and volatile organic compounds… these are all mutagenic and carcinogenic chemicals,” she explained, reinforcing that the risks are not hypothetical.  In addition to respiratory concerns, Dennis discussed infection risks, noting that viable viral particles have been identified in surgical smoke. “There has been documented, proven risk,” she said, referencing studies involving pathogens such as [human papillomavirus (HPV)].  The Persistent Awareness Gap Despite decades of research and guidance, Dennis believes the greatest barrier to progress remains a lack of awareness. “It is the unknown,” she said. “If you don’t see it, smell it, touch it, it’s not real, but it is real.”  This gap extends beyond clinicians. Dennis highlighted that many ancillary staff, including environmental services personnel, are rarely educated about surgical smoke exposure. “If I walked up to anybody with [environmental services], I bet they would have no idea,” she said, pointing to missed opportunities for broader organizational engagement.  For infection prevention professionals, this underscores the need to expand education beyond traditional clinical roles and create a more unified approach to risk communication. Why PPE Alone Is Not Enough Dennis also addressed a common misconception regarding personal protective equipment (PPE), particularly surgical masks. “The surgical mask is designed to protect the patient from you… not you from the patient,” she said, clarifying its intended purpose.  She explained that standard masks are not capable of filtering the fine particulate matter found in surgical smoke. “They will not protect you,” she added, emphasizing that reliance on masks alone is insufficient.  Engineering Controls and Practical Solutions Instead, Dennis pointed to engineering controls as the most effective intervention. “The first line of defense… is local exhaust ventilation, smoke evacuation systems,” she said.  However, she stressed that proper use is just as important as availability. Smoke must be captured close to its source to be effective. “Within inches of the source… about 2 inches,” she explained, noting that even small deviations can allow contaminants to disperse widely in the room.  Moving Toward System-Level Change Dennis has been actively involved in legislative efforts to mandate smoke evacuation practices. While some states have adopted regulations, others continue to lag behind. “We have to go state by state by state,” she said, describing the slow and uneven pace of change.  At the organizational level, she emphasized the importance of aligning safety initiatives with measurable outcomes and leadership priorities. “You can’t manage what you can’t make measurable,” she said, highlighting the need to connect exposure risks with operational and financial data.  She also pointed to workforce implications, noting that safety investments can influence recruitment and retention. “They want to know you care,” Dennis said, reinforcing that culture and leadership play a critical role in sustaining change.  The Bottom Line for Infection Prevention Ultimately, Dennis believes the path forward requires a coordinated effort across education, policy, and practice. “Compliance and culture change is the biggest barrier,” she said, acknowledging that awareness alone is not enough.  She urged health care organizations to act proactively rather than reactively. “Let’s not wait till we have hurt ourselves… before we make this compliance and culture change,” Dennis concluded.  For infection prevention and control personnel, the message is clear. Surgical smoke is not a minor nuisance. It is a persistent and preventable exposure risk that demands attention, advocacy, and action across the entire health care system.

20: The Invisible Heroes: Why Dental Assistant Recognition Week Matters

Every time you sit in a dental chair, you witness a carefully choreographed performance. The dentist guides the instrument. The hygienist checks your bite. Behind the scenes stands the dental assistant, orchestrating the invisible work that keeps you safe. "Dental assistants do more than just assist the doctor," says Sherrie Busby, EDDA, CDSO, CDIPC, dental assistant speaker and trainer, with 42 years of experience, and a member of the Infection Control Today® (ICT®) editorial advisory board. "We're responsible for setting up rooms, breaking down rooms, following the entire chain of infection control from start to finish." Most states require dental hygienists to earn degrees and complete specialized schooling. Dental assistants? In most states, you can work in infection control without any formal training. Many learn on the job, sometimes absorbing bad habits along with good ones. Yet dental assistants manage staggering responsibilities: sterilizing instruments, documenting visits, managing lab cases, maintaining infection control protocols, and providing patient education. In hospitals, these tasks are divided among specialized roles. In dental offices, one person does it all. The compensation doesn't match the responsibility. The median wage hovers around $20 per hour, with some states paying just $16 to 17. "It's sad that the person with the most duties in the practice is the lowest paid," Busby notes. The infection control stakes are particularly high. Dental settings involve constant exposure to aerosols and instruments. Proper PPE use, meticulous cleaning, and sterilization are non-negotiable. C. difficile bacteria can survive on surfaces for up to 5 months. Failure in any step compromises patient safety. The COVID-19 pandemic exposed this vulnerability. Dental professionals faced harm's way, yet compensation didn't reflect that risk or the essential work they perform. The Dental Assistant National Board is pushing for standardized credentialing and education requirements across states, a long-overdue shift ensuring consistency in infection control practices and knowledge. This Dental Assistant Appreciation Week, it's time to acknowledge what's been invisible too long. Dental assistants aren't just assistants. They're infection control specialists, patient educators, and safety guardians. They deserve recognition, fair wages, and professional standards reflecting the critical work they do every day. The magic you see in the dental chair? Behind every moment is a dental assistant making it happen.