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Are You Hanging
Pathogens Around Your
Patient’s Neck?
s a 15-year-old, Susie was used to the occasional teria that can cause a wide variety of illnesses. Staphylo-
outbreak of acne, but the bump on her neck coccus aureus can spread through skin-to-skin contact
seemed different this time. It started out fairly and can precipitate skin infections like folliculitis, boils,
small and itchy, but now it was big, red, and sore. After impetigo, and cellulitis. Though often limited to a small
visiting her physician, her mother was shocked to hear area, all of these infections can be serious and are espe-
that the bump was a boil (or furuncle), an infection usu- cially hazardous for immuno-compromised patients.
ally caused by Staphylococcus bacteria that possibly came MRSA (Methicillin-resistant Staphylococcus aureus) is a
from pathogens on a dental bib clip. Staphylococcal infection commonly found in health care
You are probably already thinking, “Give me a break. settings including dental offices. MRSA, as the name in-
I don’t sterilize or wipe down bib clips and have never had dicates, is well known for its resistance to antibiotics and
a problem.” Of course, we don’t have the problem, our is the cause of profound community concern.
patients have the problem. Yet, we might have invited
rashes, itching, eczema, folliculitis, boils, impetigo, acne, Researchers took a variety of
or other bacterial/fungal infections to the patient’s neck
through cross-contamination.
samples in the university’s clinic after
dental and dental hygiene clinical
Bib Clips and Pathogens sessions and grew the bacteria in
Bib clips are loaded with a variety of pathogens. Oral
health care professionals often place the nonsanitized bib
agar. They found dense growth or
clip on the patient before washing hands, donning gloves, increases in colony-forming units
or putting on protective eyewear and masks. Pathogens after 18 hours of incubation.
come from previous patients, dental aerosols, and from
the care provider. Who would have thought that a simple Every instrument must be sterilized to kill unknown
bib clip could be so hazardous? The answer, apparently, is pathogens. Without sterilization, many patients can be-
not many because the problems they can cause are not come infected with diseases such as hepatitis B virus and
necessarily connected to simple daily activities. Dental human immunodeficiency virus. The question is: “Do we
professionals play an important role in reducing many dif- need to sterilize this small vital tool, the bib chain, that
ferent types of infection-causing pathogens. does not enter the mouth?”
There are more than 30 species of Staphylococcus bac- Bib chains have been tested to determine the presence
of pathogens. The University of North Carolina School of
Dentistry Oral Health Institute recently completed a study
Patricia Pine, RDH
Dental Learning involving bib chains and pathogens on their hard-to-reach
Editorial Advisory Board Member surfaces. Researchers took a variety of samples in the uni-
“U”nique Dental Organizational Services versity’s clinic after dental and dental hygiene clinical ses-
Fountain Hills, AZ
Email: sions and grew the bacteria in agar. They found dense
Web site: growth or increases in colony-forming units after 18 hours Dental Learning / November 2010 1
Figure 1— Bib-Eze
(DUX Dental) dispos-
able bib holders sim-
plify handling while
eliminating any need
to sterilize.

of incubation. The results demonstrated that pathogens Figure 2—
from saliva, dental plaque, skin, and water lines reached Sani-Tab (Crosstex)
is the only chain-free
significant contamination levels on chain surfaces. patient towel with
S. aureus, Escherichia coli, and other virulent bacterial patented adhesive
species normally found only in the oral cavity were present tabs eliminating the
need for bib chains
on one-third of the sampled chains. These particular bacte- and/or straps.
ria are often related to food-borne infections. We must be
aware of cross-contamination between patients with a sim-
ple bib chain. It is our responsibility to keep our patients safe.

Sterilization Processes Disposable Bib Holders and Tabs
Oral contamination was found in a significant quantity Considering the time and material cost of sterilization,
of dental bib chains to justify processing them through ster- the practitioner might consider replacing the bib chain with
ilization procedures just as we do with dental instruments. a single-use, disposable bib holder, such as Bib-Eze from
Bib chains need ultrasonic cleaning, rinsing, wrapping, DUX Dental (Figure 1), or Sani-Tab disposable bibs with
and processing through an autoclave sterilizer. If going green sticky tabs from Crosstex (Figure 2). These products are
is your style, sterilization is your best choice. Bib chains can more economical for the practice owner and make life eas-
be bagged with instrument cassettes or pouches to be ier for the staff. Weigh the costs compared with the risks.
opened in front of the patient. This extra step might increase Disclosure:
costs, but what is a patient’s health worth? Pat Pine is a speaker for DUX Dental.

2 Dental Learning / November 2010