I find it ironic that a deliberate activity to show strong infection control can lead to patients questioning, well, infection control.
Recently I conducted an unofficial experiment with my non-dental friends where I asked them to watch a video of an assistant opening a pack of instruments ‘in front of them'. Once opened, the assistant briefly arranged the instruments and attached the triplex.
I then asked them for their feedback.
This was a routine dental appointment, not a surgical. Therefore, the instruments were semi-critical.
Here are some of their reactions:
“If those instruments have come out of a sterile packet, why would she touch them with her bare hands?”
“Is the assistant not confident if that’s what she’s doing?”
“I would want to ask for a clean set, I would not be happy for those instruments to be used on me”
“As an uninformed patient, I want to see gloves when my dental tools are handled”
But also, “nothing untoward there, I’m happy”. LOL
However, informed health care workers know that if there is no body fluid exposure risk then gloves are not required, but they do want to see hand hygiene. ‘Ideally, hand hygiene should have been conducted after touching the pouch and before arranging those instruments, that way her hands would have been clean.’ ‘I think it would have been better if she just opened them and then walked away.’ ‘It seems like excessive handling, clean hands or not’.
Handling packs in front of patients with confidence relates to several principles, including aseptic technique, Spaulding classification, hand hygiene, glove use, and zoning of the treatment room.
From a patient's perspective, there is a perception that as soon as that pack is opened, its cleanliness is at risk yet wearing gloves to handle clean items is also not the answer - as gloves do not replace hand hygiene.
So what to do? If opening packs and arranging instruments, you could try this:
1. Have packs ready to open on the bench, not on the tray.
2. Perform hand hygiene.
2. Open the pack onto the tray (your hands are now ‘dirty’).
3. Perform hand hygiene again.
4. Arrange the instruments with clean hands.
5. Leave certain items, like handpieces and triplexes, for the practitioner to handle.
6. Perform hand hygiene again before moving to another task.
There's a lot you can do to advocate for quality throughout the patient experience, beyond opening packs in front of patients.
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