Personal protective equipment such as gloves, protective clothing, eyewear and masks act as barriers to prevent the transmission of microorganisms between patients and dental staff. Gloves should be worn for all dental treatment and changed between patients. Eyewear protects the eyes from splashes and masks prevent the spread of droplets. Protective clothing covers the body and different types of gloves, masks and eyewear are chosen based on the potential risks of the planned dental procedure.

2. Personal protective equipment (PPE) such as protective clothing
and eyewear and disposable gloves are worn as a barrier to prevent
the transmission of microorganisms between patients and the dental
team. The type of protective clothing required will depend upon the
potential risks associated with the planned task. Legally it is the
health care worker's responsibility to assess this risk and decide
upon the necessary clothing as appropriate. However, the employer
must provide suitable PPE that must be freely and readily available
for use.

3. The Role of Gloves : -
To provide a barrier to protect the wearer from contamination with patient's
blood or saliva
To reduce the risk of transmission of microbes from dentist to patient.
Gloves should be worn for all routine dental treatment and discarded
between patients
Gloves do not prevent sharps injuries but the wiping effect of the glove
reduces the risk of contamination.
Wash hands before donning and after removing gloves.

4. Safe use of gloves in the dental surgery:
Hands must be washed before donning gloves. Never consider gloves to be an alternative to
hand washing
Gloves protect the operator's hands from contaminated blood and saliva and the patient's
microbial flora.
Never re-use single use disposable gloves.
Changing your gloves between patients prevents cross infection between patients and
contamination of hard surfaces in the surgery. Do not touch patient's notes, pens and computer
keyboards, door or drawer handles or your face with gloved hands (see section x on surgery
zoning).

5. Gloves must only be worn whilst treating the patient and removed
at the end of the procedure. Dispose of as hazardous waste.
Remember hands are not necessarily clean because gloves have
been worn. When removing gloves the patient's microorganisms
can be transmitted from the external surface of the glove to the
dentist's hands and need to be removed by hand hygiene .
Change gloves during very long procedures, as u p to 40% of
gloves develop tears after prolonged use and may leak . Gloves
also become porous during prolonged use due to hydration of the
latex. By changing your gloves you can prevent excess sweating
and this reduces the risk of dermal infections or inflammation.

6. Choosing a suitable glove for the task
Use non-sterile gloves for routine dentistry.
Use sterile surgical gloves for minor oral surgery, periodontal and implant
surgery.
Gloves should be powder-free and have the lowest levels possible of
extractable proteins and chemical accelerators .
Always hoose a glove that fits you correctly . Gloves that are too small
especially if worn for prolonged periods of time will produce muscle
fatigue in fingers and hands. If they are excessively tight over the wrists it
can exacerbate the symptoms of carpal tunnel syndrome.
Don't use disposable clinical gloves for scrubbing instruments. To
help protect the hands from sharps injuries use heavy duty, lined
household gloves for washing instruments and general environmental
cleaning. These gloves are reusable, wash whilst on the hands and dry. If
excess sweating under the gloves becomes a problem, cotton glove liners
can be worn. They need to be checked regularly for small tears, and
discarded accordingly.

7. If you develop an allergy to NRL gloves
Alternative to NRL gloves that have similar physical
properties, i.e. do not impair dexterity and are not
prone to splitting and are impermeable to blood
borne viruses include:
-Nitrile (acylonitrile) /polychloroprene (Neoprene)
-Tactylon (multipolymer synthetic styrene-ethylene-
butadine-styrene)
Staff sensitised to natural rubber latex (NRL) gloves
must be supplied with appropriate alternatives.
All staff should be trained to recognise the allergy
symptoms so that they can avoid the use of latex
gloves and devices.

8. Types of Disposable Medical Gloves
Latex gloves are the original medical exam gloves, and also the most common
type used by medical professionals today. They are strong, elastic and proven to
prevent the transmission of infections. Latex gloves are the thickest and most
protective of the different glove types, but are not without drawbacks. Because a
small percentage people are allergic to latex, disposable nitrile gloves have been
developed as an alternative.
Disposable nitrile gloves are made with a synthetic latex and can be used by
people with latex allergies. They are known for their comfort ; puncture resistance
and their resistance to many chemicals.
Vinyl exam gloves, made of Polyvinyl Chloride (PVC), are latex free and
a secondary alternative to latex gloves. They are often used due to their
non-reactive nature. They are also good for protecting the hands during
activities such cleaning. Their lower cost and versatility make vinyl gloves
the preferred choice for many non-medical applications.

9. Reactions are classified as
Delayed hypersensitivity (type IV) resulting in contact dermatitis,
rhinitis, conjunctivitis. This is the most common hypersensitivity
reaction to NRL or accelerating agents. Response occurs between
6-48 hours after exposure.
Immediate hypersensitivity (type I) - asthma, urticaria, laryngeal
oedema, anaphylactic shock/collapse. Response occurs 15-30
minutes after exposure.

10. Protective eyewear
Goggles or visors should be worn during all types of dental treatment
or when manually cleaning instruments prior to sterilisation.
Goggles should be decontaminated according to the manufacturer's
instructions e.g. alcohol based surface disinfectant or hypochlorite 1000
ppm available chlorine followed by thorough rinsing in water.
Spectacles do not provide sufficient eye protection, so wear a visor or
face shield over spectacles.
Visors have the added advantage of discouraging touching of the face
with contaminated gloved hands.
Visors are either single use disposable, or if designated re-useable,
then follow manufacturer's instructions for cleaning the surface with
disinfectant.
Use disposable visors if treating patients with a contagious respiratory
illness (e.g. Flu), as re-useable visors and goggles with elastic straps
cannot be readily cleaned.

11. Surgical face masks
Standard surgical facemasks are resistant to fluids
and act as a physical barrier helping to protect the
wearer from splashes of blood, saliva and other
potentially infectious substances. The main
purpose of a mask is to prevent particles
(respiratory droplets, skin squames) expelled into
the environment by the wearer contaminating the
surgical site. Most masks produce a poor facial
seal and are not designed to filter the air as it is
breathed into the lungs. So do not protect the
wearer from aerosol inhalation. Hence, standard
surgical facemasks provide no or only partial
protection of the wearer from respiratory pathogens
such as Mycobacteria tuberculosis or influenza.

12. -Masks are recommended for all dental procedures
-Masks are single use items. They should be changed after every
patient and not reused.
-Try to avoid touching the outer surface of the mask, which may be
contaminated.
-Remove the mask by breaking, undoing the straps or lifting over the
ears.
-Mask should be disposed of as hazardous clinical waste.
-Clean your hands after removing the mask in order to prevent
contamination of your face and the surgery environment.

13. Respirator type masks
Respirator type masks offer a higher degree of personal respiratory
protection compared to a standard facemask. They filter out airborne
particles as the air is breathed in through the mask. However, they
are not intended to filter out gases.
Such masks are recommended for dental healthcare workers for use
whilst treating patients with tuberculosis or other infections that are
spread via aerosols e.g. influenza.
In appearance they resemble moulded surgical facemasks.

14. -When fitted and worn correctly, they seal firmly to the face thus reducing
the risk of leakage.
-Beards and stubble interfere with the fit and seal of the respirator.
-Instructions for fitting and the leak tests to be carried out by the wearer
differ slightly with each product and are supplied by the manufacturer.
-Avoid touching the outer surface of the respirator mask once it is fitted.
Always wash hands after handling the mask.
-Respirators are intended to be single use only. Dispose of as hazardous
clinical waste.

15. Protective equipment should be removed in the following order
First - Gloves (then clean hands).
Second - Mask (or respirator), or a visor if worn and then
mask.
Third - Protective eyewear (goggles).
-Followed by hand hygiene.
Gloves are removed first as they will be contaminated on
their outer surface with the patient's secretions and this
manoeuvre prevents the dental HCW touching and
potentially infecting their own skin, eyes or mouth whilst
removing the other items of PPE. Removal of gloves
immediately after completing treatment also reduces
contamination of the surgery environment.

16. Tunic/uniforms as a protective barrier
Splatter generated during the use of rotary
equipment falls mainly on the operator's face, chest,
hands and wrists. To protect these areas of skin from
contamination, high-necked tunics /uniforms that
cover the chest area, with long sleeves and tight
fitting cuffs are advised. Gloves should be worn over
the cuff of the sleeve, which protects the wrists from
contamination and helps to prevent wetting of the
uniform sleeve. If short sleeves uniforms are worn
then the wrists and forearms must be cleaned
whenever clinical hand hygiene is performed.

17. However, tunics and uniforms are not usually made of
materials that are impermeable to body fluids. Disposable plastic aprons
should be made available for staff to wear when contamination of clothing
or uniform with blood and body fluids could occur e.g. during minor oral
surgery, or periodontal treatment where there is likely to be excessive
bleeding or when manually cleaning instruments. Plastic aprons should be
discarded after each procedure and between patients.
If there is a high risk of splashing with blood such as during MOS or
implant surgery then disposable, impermeable fluid repellent surgical
gowns are advised.

18. Preventing tunics and uniforms becoming a source of infection
Tunics and uniforms become contaminated with
microorganisms during clinical treatment. To date
no reported dental studies have demonstrated
transmission of infection by this route but in
hospital wards multi-drug resistant bacteria have
been transmitted via contaminated uniforms.
Gentleman's ties have been implicated in
transmission of MRSA and ties should not be worn
when treating patients or should be concealed
under the tunic /uniform.

19. -Therefore, it is recommended that tunics /uniforms are washed and
changed daily.
-Protective clothing should not be worn in designated eating and rest
areas within the practice. Remove protective clothing when eating
and drinking
-Tunics and uniforms and should be removed before leaving the
practice.
-When purchasing tunics and other protective clothing choose items that
can tolerate washing at the higher temperatures that kill bacteria. Wash
protective clothing separately from other clothes using a "hot" washing
machine cycle at a setting of 50 o C or above. The heat produced by
ironing also contributes to destroying bacteria remaining on clothes.