Quarterly
IPAC Newsletter

Autumn 2020

Welcome to maxill’s IPAC Platinum Quarterly

I retract the word ‘welcome’ in this greeting to modify it for a much more suited word, ‘congratulations’! We have all heard of fantasy sports leagues, well I am creating a fantasy congratulatory celebration for dental professionals. At minimum, the dental profession deserves a parade with a full marching band synchronized by a majorette twirling a fire baton, glorious fireworks sparkling in the background, colourful clowns circling on mini tricycles honking their horns while a lingering smell of popcorn and cotton candy lurks in the air (we can all smell the popcorn and cotton candy as there is no coronavirus and we are not wearing masks in this fantasy parade)! My fantasy parade is to acknowledge YOU!

Dentistry, somehow, is often bumped out of the listing of healthcare providers resulting in a lack of acknowledgement. Every day we impact oral health with an endo, periodontal scaling, tooth replacement and have an educational conversation with our clients about the oral to systemic link, so yah, sure looks like we are healthcare workers! We all know by now that there are no trophies handed out for a job well done in dentistry. Most of us individually celebrate our accomplished goals via vehicle karaoke before arriving home to make dinner, walk the dog and launder another set of scrubs! If we are lucky, we may have had time to squeeze in a staff appreciation pizza lunch to pat each other on the back, but THAT’S IT!!!

More then ever, we must support one another by taking the time to acknowledge our accomplishments. As the pandemic brought us to a halt, we quickly embraced our professional roles of researcher and advocate, deciphering fact from myth on the corona virus and adopting creative solutions to alter our environments to meet the ‘additional precautions’ attached to the standards of practice. We also became our own writers and purchasing departments, updating office polices and scouting out every possible manufacturing source to secure PPE. While the rest of the world was filming tik tok videos and exhausting the flour supply with homemade baking, we in dentistry were battling the when and how we were going to re-open our doors and what that glimpse of change would even resemble. We all know the changes we have made in our practices and it its nothing short of remarkable and phenomenal. It takes courage to get up every morning to face another day greeting clients in the parking lot or enter only via passage of texting or calling and wearing layers of PPE that feel like an unwanted sauna all while smiling our brightest smile explaining over and over to all clients how we are keeping them safe.

In my experience the clients are listening attentively. To what we may think is a broken record and repetition, to them is a moment of relief of fear and anxiety that we have done our homework and indeed have advocated highly for their full safety. The pandemic undoubtedly has had some negative impacts, but I see a silver lining here. It is sometimes difficult to see a silver lining in the moment of the storm but reverse it from the client’s perspective. What are they seeing? Or better yet what are they feeling? Once their fears are reassured, they are feeling the ‘wow’ of the customer experience as their visit, from the moment of their arrival, is personal and focused on them. Whether the screening is in the parking lot or through a phone call on arrival, its not a crowded loud reception area with the client trying to catch the administrative assistant’s attention to announce their arrival. Clients are feeling like #1 from the moment of being personally greeted to the tour of the plastic closed off walls, the HEPA filter in the operatory and the personal hand off at the front desk to book their next appointment. Never have we ‘walked’ the client through so closely. I genuinely believe this is what our clients are taking away from their new normal of a dental appointment. So, in the moment we begin to be frustrated with this new normal, take a moment to remember we are building an even stronger customer rapport and loyalty. The pandemic is not over, and we do not have an ‘end date’ we can add in our i-phone’s calendar reminders. In this pandemic, we can accept the challenge or be defeated. The word defeat is not in dentistry’s vocabulary! Lets’ continue to persevere and march forward with three key words: adaptability, resilience, and determination. As you don your next isolation gown, praying no one changed the air conditioning setting yet again, focus on how absolutely amazing you are and give yourself that mental congratulatory parade, fireworks, marching band, the whole nine yards. YOU deserve it!


—  Michelle Aubé Simmonds RDH

PPE Doffing Cross Contamination Study

Of the many changes with this pandemic scenario, PPE has been in the spotlight. Dental professionals have always been in tune with the purpose and use of PPE in the delivery of dental services. It is not a lack of knowledge in PPE, but rather an expansion to the routine practice of PPE. When ‘additional precautions’ are called upon the PPE line up has no choice but to be expanded. The PPE line up includes the following:

  • Gloves
  • Surgical Masks
  • Respirator Masks
  • Uniforms
  • Shoes
  • Lab Coat
  • Gowns
  • Face Shields
  • Eye Protection (safety rated)

This means there are more layers to be donned and doffed. This means there are more chances for cross contamination in doffing of soiled PPE. In 2015, Dr. Curtis J. Donskey, reviewed a study performed in 4 hospitals in Ohio USA on the ‘Contamination of Health Care Personnel During Removal of Personal Protective Equipment1. The objective of the study was to determine the frequency and sites of contamination on the skin and clothing of personnel during PPE removal and to evaluate the effect of an intervention on the frequency of contamination. The study was over a 6 month period in 2014-2015. The methodology, point-prevalence study and quasi-experimental intervention with 435 glove and gown removal simulations including fluorescent lotion and bacteriophage MS2. Frequency and sites of contamination on skin and clothing of personnel after removal of contaminated gloves or gowns were compared from baseline vs after the intervention. The interventions included simple doffing training on the proper sequence to avoid cross contamination. The following is the data for pre-intervention and post-intervention.

Pre intervention/education:

  • 46% (200/435) contaminated the skin during soiled glove and gown removal simulations
  • 60% combined skin and clothing contamination
  • 52.9% contamination occurred more frequently during removal of contaminated gloves than gowns

Post intervention/education:
Immediate:

  • 18.9% combined skin and clothing contamination (41.1 % improvement!)

1-3 month re-evaluation:

  • 12.0% combined skin and clothing contamination

Two conclusions can be drawn:

  1. Contamination of the skin and clothing of health care personnel occurs frequently during removal of contaminated gloves or gowns.
  2. Educational interventions that include practice with immediate visual feedback on skin and clothing contamination can significantly reduce the risk of contamination during removal of PPE.

How is this study applicable to you and your team? Immediately after reading this study my next step was to work with the maxill team to develop a fluorescent agent that works with the use of black light technology. Many of us have watched the video “If Saliva Were Red” by OSAP (Organization for Safety, Asepsis & Prevention). Although the video offers some comical relief in its staging, it also clearly sets the precedent for how simple it is to cross contaminate. Another great video is one on cross contamination with hand hygiene. The video was made by Seema Marwaha and the CICC at Toronto General Hospital, University Health Network to encourage better hand hygiene and monitor the moments for potential breaks in asepsis.

You can create your own in-office training to monitor proper PPE doffing to ensure the team is not self contaminating by using the maxill Reveal kit and having the team read the article noted in this newsletter as well as the two video links, compliance made easy!


1. JAMA International Medicine. Curtis J. Donskey, MD. JAMA Intern Med. 2015;175(12):1904-1910. doi:10.1001/jamainternmed.2015.4535.
http://archinte.jamanetwork.com/article.aspx?articleid=2457400#Introduction

Cross Contamination Tracking Kit

Reveal Cross Contamination Tracking Cream

In this IPAC Platinum Quarterly maxill product review, it is very fitting to feature the maxill Reveal Kit to support and pursue action goals to be set from the article review discussed in the newsletter.

Dr. Donskey's review proved educational interventions that include practice with immediate visual feedback on skin and clothing contamination can significantly reduce the risk of contamination during removal of PPE. Dental regulatory bodies and public health authorities state the dental office must engage in routine hand hygiene and PPE audits with training to occur at minimum yearly and with each new employee. The training must be logged for proof of compliance in the event of a practice audit. The maxill Cross Contamination Tracking Kit is designed to support offices with their auditing and training by offering a system that supports visual education with the use of the maxill Cross Contamination Tracking Cream and Blue Light.

Kit Includes:

  • Reveal Cross Contamination Tracking cream
  • Reveal Cross Contamination Tracking Blue Light
  • Hardshell Carrying Case
  • Instructions For Use (PPE Simulation, Hand Washing Simulation, Operatory Simulation)
  • Training Log

Safeguarding YOUR Practice with a Quarterly IPAC Review

The time is here again to re-evaluate your practice. IPAC Platinum will remind you quarterly to perform an ongoing inspection, leave the reminder alert to maxill!!! Its our commitment to keep you going in your IPAC journey. Showing proof that your practice is participating regularly in self reflection to ensure compliance and goal setting is crucial for a full circle IPAC program. Remembering the umbrella to an IPAC Program is the concept of risk management, therefore, the quarterly review serves as an IPAC risk assessment to ‘catch’ any issues before they manifest to a real problem.

Be on the look out for your maxill email communication delivering the quarterly IPAC checklist directly to your mailbox. The next step is to download and print the checklist followed by creating an IPAC quarterly review binder. The format can be physical or digital. Most offices prefer to have both. The physical is simple in the event of an audit and the digital is the back up, should something happen to the paper copy. The famous phrase “if it is not written it did not happen”, retain a copy of the completed review of your practice. Organize the binder with tabs for simple retrieval or viewing should an audit ever unfold and an assessor needs to see the ongoing IPAC maintenance of your office. In most geographical areas, compliance records are retained for 10 years. Decide if your binder will support a year or a series of years. Four reviews will be inserted every year.

Do you need assistance with your quarterly review? If you need support, maxill is here to help with either a virtual or live visit from your local sales representative or one of maxill’s IPAC leaders. In keeping with social distancing rules, we can offer a virtual meeting via Zoom. The quarterly review is also an opportunity to inform maxill of any changes to your products or equipment to be updated in your IPAC manual if you are a maxill IPAC 360 customer. Take the time to use the quarterly review to accomplish the following:

  • The review itself using the provided checklist
  • Report new products and confirm the presence of SDS
  • Obtain missing SDS if applicable
  • Report new equipment and confirm the presence of MIFU
  • Obtain missing MIFU from any new equipment
  • Schedule a team IPAC annual training and record the training to place in your IPAC manual
  • Perform an inventory for expired products and remove from practice
  • Confirm team members have up to date CPR training with proof of certification
  • Confirm team members have up to date WHIMS training with proof of completion
  • Confirm potential immunization changes / updates
  • IPAC leader of the office to review IPAC manual for any required updates
  • IPAC leader to complete the manual review log sheet and list any updates if applicable

It cannot be stated enough that maxill is here to help you accomplish the tasks listed above. Don’t forget your access to the maxill IPAC hotline! Connect with a live IPAC agent for your IPAC questions!

Covid Resources

maxill is pleased to keep its customers connected with the latest data on COVID-19. Please navigate to the maxill COVID Resources page for information to assist you in your best practice decisions.

Join maxill’s IPAC leaders in a short video for the navigation and content of the COVID Resource web page titled Re-Entry Into Practice.

Covid Resources   Watch the Video

Upcoming CE Events

As an IPAC Platinum member you will have VIP access to these two quality continuing education webinars. The date and time will be emailed to you for a priority registration.

Dental Equipment Maintenance

Speaker: Nicol Ross CDA

The New AAP Periodontal Classification: Calculating, Staging and Grading; Are You Doing All Three?

Speaker: Michelle Aubé Simmonds RDH



Register with the ODHA for the virtual Reenergize conference, which runs from September 24-25 with access until December 31 2020.

Register  

Two terrific maxill sponsored lectures presented by maxill’s own IPAC guru Michelle Aubé Simmonds:

…and many more CE opportunities.

As an IPAC Platinum member your seat is always reserved for the next continuing education event!

Thumbs Up or Thumbs Down Activity

View the following images and decide if there is an IPAC lapse.
For each image below, select the 'Thumbs Up' if there are no IPAC lapses or the 'Thumbs Down' if there is an IPAC lapse.

Image 1

Correct!

The alginate bowl is not a transportation system for impressions. The alginate bowl is a non-critical item in Spaulding’s Classification. Placing a contaminating impression elevates the risk for the bowl and contaminated it a level higher then its intended use.

Incorrect.

The alginate bowl is not a transportation system for impressions. The alginate bowl is a non-critical item in Spaulding’s Classification. Placing a contaminating impression elevates the risk for the bowl and contaminated it a level higher then its intended use.

Image 2

Correct!

Jewelry is a ‘fomite’. As a source of attracting and holding microbes, jewelry is not to be worn. It was not to be worn pre-pandemic and certainly not now during a pandemic.

Incorrect.

Jewelry is a ‘fomite’. As a source of attracting and holding microbes, jewelry is not to be worn. It was not to be worn pre-pandemic and certainly not now during a pandemic.

Image 3

Correct!

There cannot be two instruments in one bag layered on one another. The corner adhesive section of the bag is not positioned flat. The package is labelled with the date, the load number, initials but missing the sterilizer number. It would be preferred to have the date labelled on the plastic. Best practice would have a label generated from a ‘label gun’ verses using a marker. It does not have a Type V chemical indicator inside the pouch.

Note: The ‘one’ good fact of this image is the hinged instruments are in an open position. The pouch is labelled on the plastic side.

Incorrect.

There cannot be two instruments in one bag layered on one another. The corner adhesive section of the bag is not positioned flat. The package is labelled with the date, the load number, initials but missing the sterilizer number. It would be preferred to have the date labelled on the plastic. Best practice would have a label generated from a ‘label gun’ verses using a marker. It does not have a Type V chemical indicator inside the pouch.

Note: The ‘one’ good fact of this image is the hinged instruments are in an open position. The pouch is labelled on the plastic side.

Test Your IPAC Knowledge

Put your IPAC knowledge to the test with our IPAC Quiz!

True or False

Answer each of the true or false statements below, and click the submit button to find out how you did!

Hint: you will find the answers in this newsletter.

1. An office does not need to perform on going inspections once they have a completed IPAC manual.





2. IPAC training needs to be logged and retained as proof of compliance.





3. Educational interventions that include practice with immediate visual feedback on skin and clothing contamination can significantly reduce the risk of contamination during removal of PPE.





4. The alginate bowl makes an ideal transportation system for impressions to be carried from the operatory to the lab.





5. Hinged instruments must be in an open position to allow proper navigation of steam during sterilization.





6. A fomite is an object that can repel microbes and is often part of an effective IPAC program.





7. A package ready for sterilization will include the following: date, sterilizer #, load # and contents if it is a cassette that is wrapped.





8. Showing proof that your practice is participating regularly in self reflection to ensure compliance and goal setting is crucial for a full circle IPAC program.