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.

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.

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).

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.

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.

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.

Types of Disposable Medical GlovesLatex 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.

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.

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.

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.

-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.

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.

-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.

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.

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.

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.

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.

-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.