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Dental Gloves in the Practice
Category: Infection Control
Personal protective equipment (PPE) is designed to protect the skin and mucous membranes of the eyes, nose, and mouth of dental healthcare practitioners (DHCP). PPE includes specific clothing or equipment DHCP wear for protection against a hazard. PPE includes but is not limited to gloves, gowns/jackets, surgical masks, face shields, and protective eyewear. Wearing PPE in specific circumstances reduces the risk of occupational exposure to bloodborne pathogens.1,2
Use of rotary dental and surgical instruments, such as handpieces, ultrasonic scalers, and air-water syringes, generates a spray that primarily contains large-particle droplets of water, saliva, blood, microorganisms, and other debris. Spatter, being relatively heavy, travels short distances and settles down quickly. DHCP are exposed to spatter; spray may contain aerosols, which are small (< 10 mm). Aerosols can remain airborne for extended periods and can be inhaled.1,2
In addition to droplet infection, diseases can be spread by direct and indirect contact. Touching soft tissue or teeth in a patient's mouth results in direct contact with microorganisms with immediate spread from the source. This gives microorganisms an opportunity to penetrate the body through small breaks or cuts in the skin and around the fingernails of ungloved hands. A second mode of spread is called indirect contact, which can result from injuries with contaminated sharps (eg, needlesticks) and contact with contaminated instruments, equipment, surfaces, and hands. These items and tissues can carry a variety of pathogens, usually because of the presence of blood, saliva, or other secretions from a previous patient.3,4
Dental Gloves prevent contamination of DHCP hands when touching oral tissues or instruments and pieces of equipment soiled with patient blood and saliva. Gloves also reduce the likelihood that microorganisms present on DHCP hands will be transmitted to patients during surgery or patient-care procedures.
Over the last 20 years, the use of gloves by DHCP has increased markedly. Dental Glove usage is often identified as being "the first line of PPE defence." Increased glove usage began in the mid-1980’s. This behavioural change was initially a response to the emergence of the HIV/AIDS epidemic. During the same time period, a set of blood and body fluids precautions termed "universal precautions" emerged. Under universal precautions, blood and certain body fluids of all patients were to be considered potentially infectious for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens. Universal precautions are intended to prevent parenteral, mucous membrane, and nonintact skin exposures of healthcare workers to bloodborne pathogens. In addition, immunization with HBV vaccine is recommended as an important adjunct to universal precautions for healthcare workers who have exposures to blood.1,5
Soon, the relevance of universal precautions to other aspects of disease transmission was recognized. And in 1996, the Centres for Disease Control and Prevention (CDC) expanded the concept and changed the term to standard precautions. The standard of care was designed to protect DHCP from all pathogens, not just bloodborne pathogens. Standard precautions apply to contact with blood and all body fluids, secretions, and excretions (except sweat), regardless of whether they contain blood and contact nonintact skin or mucous membranes. Saliva has always been considered a potentially infectious material in dental infection control.1
The new CDC infection control guidelines offer advice as to the best use of gloves.1 Concerning general glove use, the CDC indicates the following:
- Wear Dental gloves when a potential exists for contacting blood, saliva, other potential infectious materials (OPIM), or mucous membranes.
- Wear sterile surgeons' gloves when performing oral surgical procedures.
- Wear a new pair of dental gloves for each patient, remove them promptly after use, and wash hands immediately to avoid transfer of microorganisms to other patients or the environment.
- Remove gloves that are torn, cut, or punctured as soon as feasible and wash hands before regloving.
- Do not wash surgeons' or patient examination dental gloves before use or wash, disinfect, or sterilize gloves for reuse.
- Ensure that appropriate gloves in the correct size are readily accessible.
- Use appropriate gloves (eg, puncture- or chemical-resistant utility gloves) when cleaning instruments and performing housekeeping tasks involving contact with blood or OPIM.
- Consult with glove manufacturers regarding the chemical compatibility of glove materials with hand hygiene products as well as the dental materials being used.
The CDC made no recommendation regarding the effectiveness of wearing 2 pairs of gloves to prevent disease transmission during oral surgical procedures. The majority of studies among healthcare personnel and DHCP have demonstrated a lower frequency of inner glove perforation and visible blood on the surgeon's hands when double gloves are worn; however, the effectiveness of wearing 2 pairs of gloves in preventing disease transmission has not been demonstrated.1
Dental Gloves are also an important issue for the Occupational Safety and Health Administration (OSHA). In its Bloodborne Pathogens Standard OSHA mandates that all healthcare workers wear gloves during patient care activities where contact with blood or OPIM may be anticipated.5,6
General recommendations from OSHA indicate that employers shall select and require employees to use appropriate hand protection when employees' hands are exposed to hazards such as those from skin absorption of harmful substances; severe cuts or lacerations; severe abrasions; punctures; chemical burns; thermal burns; and harmful temperature extremes.5
As for selection, OSHA indicates that employers shall base the selection of the appropriate hand protection on an evaluation of the performance characteristics of the hand protection relative to the task(s) to be performed, conditions present, duration of use, and the hazards and potential hazards identified.5
DENTAL GLOVE EFFECTIVENESS
Dental Gloves' effectiveness in preventing contamination of healthcare workers has been repeatedly confirmed.6-9 One study indicated that glove usage reduced the number of bacteria on healthcare workers' hands by more than 80%.10
However, it is essential that all DHCP understand that wearing gloves does not eliminate the need for appropriate hand hygiene. Gloves cannot completely protect hands against microbial contamination. Wearing gloves cannot totally prevent occupational acquisition of serious pathogens through some type of exposure, such as a needlestick. Glove manufacturing guidelines have resulted in higher quality gloves. However, glove defects can and do occur. Also, gloves can be cut, abraded, or punctured. Glove removal is a possible source of hand contamination.1,6-9
Even though gloves have limitations, they do prevent hand contamination during direct patient contact. Gloves also minimize the hazards of handling instruments, equipment, appliance/prostheses, and impressions contaminated with patient body fluids. Gloves reduce the incidence of nosocomial infections. They also inhibit contamination of patient tissues by organisms present on practitioner hands.1,6,11
DENTAL GLOVE MATERIALS
Medical gloves fall into 2 main categories—natural rubber latex (NRL) and synthetic. NRL is a tree product found in tropical areas of the world. NRL gloves are the product of a very complex and multistep process, which involves a significant number of chemicals. These include additives to help vulcanize/cross-link the materials. The result is a glove that has strength and elasticity. However, compounds inherent to NRL, produced during processing or added to the final product can be problematic. Increased glove usage results in greater DHCP exposure.7,8 The problem of latex sensitivity has recently been well reviewed.12
Synthetic (manmade) nonlatex materials, depending upon their polymeric composition, can be dipped, molded, or extruded into a final glove product. Synthetic gloves are desirable because they reduce the risk of latex exposure. There are 4 basic types of synthetic (elastomeric) gloves. These include nitrile, neoprene (polychloroprene), thermoplastic elastomers (polyethylene and polyurethane), and solvent-dipped processed types (polyvinyl chloride-PCP or vinyl, polyvinyl chloride copolymer, and block copolymer).6-8
Many synthetic gloves have enhanced chemical or puncture resistance. Some have stretchability similar to latex. The decision between NRL and synthetic gloves involves a number of factors. Selecting gloves is task-specific—the right type of glove for a given situation. As with all PPE, comfort and fit are very important. Glove quality (lack of defects) comes next. A number of other issues (eg, cost, allergen content, tactile sensation) are also important. The US Food and Drug Administration () regulated gloves because they are considered to be medical devices. Only -cleared gloves may be used for patient treatment.1,6,7
SELECTING DENTAL GLOVES
Surgical gloves were first selected as a form of barrier protection to protect practitioners, not the patient. In 1890 at Johns Hopkins Hospital, William Stewart Halstead began the use of surgical rubber gloves to protect the hands of his scrub nurse, Caroline Hampton. Her skin was negatively affected by the harsh disinfectants used in the surgery. So, this initial use of gloves involved a response to contact dermatitis rather than a way to improve infection control.6-8
Table. Glove Types and Basic Uses.*
Glove Indication Comments
Patient Examination Gloves# Patient care, examinations, and other nonsurgical procedures involving contact with mucous membranes and lab procedures
- Nonsterile and sterile single-use disposable: use for one patient and discard properly
Surgeons' Gloves# Surgical procedures
- Sterile and single-use disposable: use for one patient and discard properly
Nonmedical Gloves Housekeeping procedures (eg, cleaning and disinfection), handling contaminated sharps or chemicals; not for use during patient care
- Commonly referred to as utility, industrial, or general- purpose gloves
- Should be puncture- or chemical-resistant, depending on task
- Latex gloves do not provide adequate chemical protection
- Sanitize after use
* Modified from Reference 1.
# Medical/dental gloves include patient-exam gloves and surgeons' gloves and are .
Only -cleared medical/dental patient-examination and surgical gloves can be used for patient care.
As glove usage increased, a significant decrease in postsurgical infections was quickly noted. Hand barrier protection helped to prevent surgical wound infection. Gloves definitely protected patients and practitioners. They are the standard in all surgical procedures. Gloves are generally task-specific; their selection should be based on the type of procedure to be performed (eg, surgical or patient examination) (Table). Gloves should be selected and worn depending on the task to be performed. Sterile gloves must be worn when performing sterile procedures. Nonsterile (examination) gloves may be worn for other tasks.1-8
Glove selection is dependent upon practitioner needs and wants as well the criteria used by a practice or facility or a selection committee.1-4,13
Practitioners select gloves based on the following:
- the type of procedure planned,
- the anticipated length of the planned procedure,
- the stress and wear-and-tear expected,
- if needed, the possibility of double gloving,
- reaction (sensitivity) of the practitioner and the patient, and
- individual preference.
- acilities or committees often select gloves based on the following:
- physical nature—latex versus synthetic or powdered versus nonpowdered,
- gloves with lower latex protein levels,
- the presence of residual chemical levels,
- the known quality of the manufacturer,
- known chemical resistance, and
- the presence of a wide variety of products (eg, composition and sizes) a manufacturer offers.
Selection may also be influenced by the interaction between a glove and the types of hand hygiene products used. The composition of the gowns worn is also a consideration. Most disposable gowns have special coatings or special fabrics that retard the passage of fluids. This leads to the possibility of gloves sliding down the cuffs of the gowns.1-4,13
Additional information on infection control including the use of gloves is available at the OSAP Web site: osap.org. OSAP has recently published a useful workbook, From Policy to Practice: OSAP's Guide to the Guidelines, concerning the new CDC infection control guidelines. More information is available at the OSAP website.
References
- Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for infection control in dental health care settings — 2003. MMWR Recomm Rep. 2003;52(RR-17):1-68. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm. Accessed June 2004.
- Organization for Safety and Asepsis Procedures. From Policy to Practice: OSAP's Guide to the Guidelines. Annapolis, Md: Organization for Safety and Asepsis Procedures; 2004:29-38.
- Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. 3rd ed. St Louis, Mo: Mosby; 2004:87-93.
- American Dental Association. Infection control recommendations for the dental office and the dental laboratory. J Am Dent Assoc. 1996;127:672-680.
- Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries; final rule. Occupational Safety and Health Administration (OSHA), Department of Labor. Final rule; request for comment on the Information Collection (Paperwork) Requirements. Fed Regist. 2001;66:5318-5325.
- Association for Professionals in Infection Control and Epidemiology. Glove Information for Healthcare Workers. Washington, DC: APIC; 1998:1-2. Available at: www.apic.org/resc/SearchResult.cfm. Accessed June 2004.
- Education Module II — Barrier Protection: Choosing Proper Hand Barriers. Red Bank, NJ: Ansell Healthcare, Ansell Education Services; 2002:1-27. Available at: www.ansellhealthcare.com/america/usa/ceu/pdfs/ceu_4.pdf. Accessed June 2004.
- An Analysis of Gloving Materials, A Self-Study Guide. Red Bank, NJ: Ansell Healthcare, Ansell Education Services; 2003:1-27. Available at: www.ansellhealthcare.com/america/usa/ceu/pdfs/ceu_7.pdf. Accessed June 2004.
- Palenik CJ. Hand hygiene; bring on the alcohol rubs. Dent Today. Dec 2003;22:44-49.
- Olsen RJ, Lynch P, Coyle MB, et al. Examination gloves as barriers to hand contamination in clinical practice. JAMA. 1993;270:350-353.
- Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep. 2002;51(RR-16):1-45.
- Hamann CP, Rodgers PA, Sullivan K. Allergic contact dermatitis in dental professionals: effective diagnosis and treatment. J Am Dent Assoc. 2003;134:185-194.
- Twomey CL. Getting a grasp on the surgical glove market. Infection Control Today. March 2003. Available at: www.infectioncontroltoday.com/articles/331feat1.html. Accessed June 2004.
Dr. Palenik has held over the last 25 years a number of academic and administrative positions at Indiana University School of Dentistry. These include professor of oral microbiology, director of human health and safety, director of central sterilization services, and chairman of the infection control and hazardous materials management committees. Currently he is director of infection control research and services. Dr. Palenik has published 125 articles, more than 290 monographs, 3 books, and 7 book chapters, the majority of which involve infection control and human safety and health. Also, he has provided more than 100 continuing education courses throughout the United States and 8 foreign countries. All questions should be directed to OSAP at office@osap.org.
Infection Control Practices for Dental Radiography
When taking dental radiographs, there is significant potential for cross-contamination of equipment and environmental surfaces with blood and/or saliva if proper aseptic techniques are not practiced. Dental healthcare personnel (DHCP) also can be at risk. Research indicates that oral micro-organisms can remain viable on inert radiographic equipment for up to 48 hours. Similar microbes have been shown to survive in x-ray developer/fixer for periods as long as 2 weeks.1-4
Infection control practices for dental radiography are identical to those used in the operatory. They are grounded in the practice of standard precautions and are directed toward preventing disease transmission from patients to DHCP, from DHCP to patients, from patient to patient, and from the practice to the surrounding locale.1-3
For infection control during radiographic procedures, a variety of procedures and materials are used, including use of (1) disposable and heat-sterilizable x-ray accessories; (2) immersion of heat-sensitive items in liquid chemical sterilants/high-level disinfectants; (3) surface covers and intermediate-level chemical disinfectants for clinical contact surfaces; (4) engineering and work practice controls; (5) personal protective equipment (PPE) and (6) DHCP training.1-3
The central element or greatest risk factor is the handling of exposed radiographic films. Limiting the spread of body fluids present on such films is an essential activity. Film packs used intraorally become contaminated, then they are handled and transported throughout the practice environment. Also important is the covering or decontamination of soiled items. There are many surfaces that could be touched and become contaminated, including tube heads, extension cones, control panels, exposure buttons, chair controls, film processors, surfaces in darkrooms, and any area touched by contaminated film, gloved hands, or equipment used orally.2-4
Infection control procedures for dental radiography can be divided into segments or components. These include activities before taking radiographs, activities performed while taking a radiograph, things to do after radiographs have been taken, and finally, tasks associated with film processing. All suggested activities first discussed apply to the taking of standard intraoral x-rays using film held within barrier protective pouches. Some films come pouched by the manufacturer, or pouches can be purchased separately, and films can then be placed into them.2-4 Advice on using x-ray films without barrier pouches, taking panoramic/cephalometric x-rays, using a daylight loader for processing, and the use of digital radiography sensors will then be provided.
USING INTRAORAL FILMS HELD WITHIN BARRIER POUCHES
Table 1. Prior to taking x-rays (modified from references 2 to 5).
Step Action
1
Acquire all necessary disposable and heat-sterilized intraoral x-ray accessories
2 Place surface covers on selected clinical contact surfaces
3 Unit-dose necessary supplies, equipment, and instruments
4 Provide patient with appropriate shielding apron
5 Wash hands, dry well, and put on examination gloves
6 Place other types of PPE if necessary
Table 2. While taking x-rays (modified from references 1 to 8).
Step Action
7 Wear gloves while taking x-rays and when handling contaminated films
8 Wear other PPE such as masks, protective eyewear, and gowns if spatter is expected
9 Use films held within -cleared barrier pouches
10 Touch as few surfaces as possible
11 After exposure and with gloved hands, dry each film with disposable gauze or paper towel to remove patient fluids
12 Repeat process until all films are exposed
Table 3. After taking x-rays (modified from references 1 to 8).
Step Action
13 Return reusable film-holding devices to the designated area.
14 Carefully remove the film packets from their protective pouches to avoid contamination of the film surfaces. Allow the films to fall from the pouches into clean paper or plastic cups or onto clean paper towels—avoid touching the transport cups
15 Discard all contaminated disposable materials
16 Remove covers (barriers) from the surfaces protected and discard
17 Disinfect uncovered surfaces that were contaminated while wearing gloves
18 Remove gloves and wash hands properly
Preparing to Take Dental Radiographs
It is important to prepare the area prior to seating the patient. Advanced preparation increases the chances of success. Whenever possible, items used in the mouth should either be single-use, disposable, or sterilized by heat (Table 1).
Covers generally involve plastic sheets, tubes, or pieces with adhesive edges. Examples of surfaces best covered include chair headrest and control adjustments, exposure buttons, control panels, and x-ray tube heads and yokes.2-4
Unit-dosing reduces the need to leave the immediate area in search of needed items, and it decreases the chances of DHCP contaminating large boxes or storage containers of materials while searching. Unit-dosing also reduces the chances of cross-contamination of environmental surfaces. Items best taken from a centralized supply area and unit-dosed include paper towels, mouth props, film holders (eg, cups), gloves, surface covers, film packs, and cotton rolls. Such items can be collected, stored, or segregated through the use of small plastic drinking cups.2-4
Film barriers have distinct advantages. First, barriers protect films from direct contamination. Second, barriers reduce the time needed for preparation and processing by eliminating the need for disinfection in the darkroom and the necessity of wearing additional pairs of gloves. Film barriers are the method of choice, especially when using daylight loaders. Their use eliminates almost all potential for equipment contamination.2-4
After the patient has been seated, hands can be washed, dried, and gloves placed. Then, heat-sterilized x-ray holding/positioning devices can be removed from their packages and assembled in view of the patient.2,3
Taking Dental Radiographs
Gloves should always be worn when taking radiographs and handling contaminated film packets. Other PPE should be used when the spattering of patient body fluids is likely. Ideally, only heat-tolerant intraoral x-ray accessories (eg, film holders and positioning devices) should be used. Some items such as mouth props can either be sterilized or be single-use and disposable (Table 2).
After Taking Dental Radiographs
Care must be taken when peeling or pulling open the protective barriers covering the x-ray films. Patient fluids must not reach either the films or the transport cups. Unsoiled films are the desired goal. Handling such items without gloves makes processing much easier in the darkroom and daylight loader1-4 (Table 3).
Developing Dental Radiographs
Once in the developing area, open film packets with clean, ungloved hands. Holding the tab, films can go into clean plastic cups or onto paper towels. Holding films by their edges, insert them into the processor. Just to be safe, it is best either to cover or to clean and disinfect the surfaces of developing equipment regularly1-4 (Table 4).
Table 4. Processing x-rays (modified from references 1 to 8).
Step Action
19 Transport films in disposable containers; gloves are not needed because the outside of the films and the containers is not contaminated
20 Discard all contaminated disposable materials
21 Prepare the processing area by unit-dosing out necessary items such as gloves, paper cups, paper towels, film mounts, and paper envelopes
22 Unwrap films and process; hold films only by their edges
23 Label film mounts or film envelopes
24 Disinfect uncovered surfaces of the developing equipment
Table 5. Processing unprotected x-rays (modified from references 1 to 8).
Step Action
A
Transport films in disposable container cups
B Place cups onto paper towels and prepare processing area
C Put on new gloves, open film packets, and allow film to fall onto clean paper towels
D Dispose of transport cups and empty film packets
E Remove gloves and wash hands
F Process films by holding them by their edges
G Label film mounts and envelopes
H Disinfect uncovered surfaces that were contaminated while wearing gloves
Table 6. Extraoral radiographs (modified from references 1 to 8).
Step Action
A Wash and dry hands—extraoral cassettes can be handled with ungloved hands
B Use sterile reusable or single-use disposable bite guides
C If deemed necessary, barrier protect chin rests, head positioning guides, and handgrips
D After exposure of the film, ask the patient to remove the bite guide and barrier covers
E If patient cannot or will not comply, the DHCP must put on gloves and handle bite guide and surface covers
F Remove gloves and wash hands prior to handling film cassettes
USING INTRAORAL FILMS NOT HELD WITHIN BARRIER POUCHES
It is important when handling and processing films not held in protective barriers that they be well wiped off chairside after removal. It is very important either to cover or clean and disinfect any surface that may become contaminated2,3 (Table 5).
PANORAMIC/ CEPHALOMETRIC X-RAYS
Fewer intraoral pieces of equipment are used when taking extraoral radiographs such as panoramic and cephalometric films. The chances of contamination with patient blood or saliva are greatly reduced. Bite guides should be sterilized or be single-use disposable types. The use of covers over the bite guide is less desirable2,3 (Table 6).
PROCESSING X-RAY FILMS IN A DAYLIGHT LOADER
Daylight loaders commonly have cloth or rubber sleeves, cuffs, or flaps. These are used to allow for the passage of materials in and out of the daylight loader without allowing light to enter. This means that the equipment is difficult or impossible to clean or disinfect. Therefore, it is imperative that an effective yet efficient protocol for aseptic use be established and rigorously maintained. After reviewing the following steps, it should be obvious how useful barrier protected films are2-6 (Table 7).
DIGITAL X-RAYS AND OTHER TECHNOLOGIES
Table 7. Using daylight loaders (modified from references 1 to 8).
Step Action
A Open the lid of the loader and place all necessary items inside: paper towels, plastic cups, and powder-free inexpensive gloves
B Place cups containing contaminated films next to clean plastic cups
C Close the lid and insert arms into the unit
D Put on gloves and select a single-film packet to be processed and open it as aseptically as possible. Repeat until all films have been opened
E Allow film to fall onto a clean paper towel
F Place all disposable materials into a plastic cup
G Remove gloves and place them into a cup
H Feed films into the processor, handling them only by the edges (or process films by hand by immersing them in the appropriate chemical-filled cups while wearing a new pair of gloves)
I Remove ungloved hands from the unit and wash them
J Lift lid and remove processed films—label film mounts or film envelopes
K Aseptically remove and dispose of waste materials
Digital radiographic sensors and other high-technology instruments such as intraoral cameras, electronic periodontal probes, colossal analysers, and lasers come into contact with mucous membranes. Such devices are considered to be semi-critical items. Ideally, they should be cleaned and heat-sterilized or high-level disinfected between patients. However, many cannot be heat-sterilized or undergo high-level disinfection.
Semi-critical items that cannot be reprocessed by heat sterilization or high- level disinfection should at a minimum be barrier-protected by using a -cleared barrier to reduce gross contamination. Covers are not always totally protective. Therefore, after removing the barriers, devices should be cleaned and disinfected using an intermediate level disinfectant (tuberculocidal) after each patient. Manufacturers should be consulted as to sterilization and disinfection processes as well as to the types of covers to be used.1-6
SUMMARY
Infection control for dental radiography employs the same materials, processes, and techniques used in the operatory, yet unless proper procedures are established and followed, there is a definite potential for cross-contamination to clinical area surfaces and DHCP. In general, the aseptic practices used are relatively simple and inexpensive, yet they require complete application in every situation.
References
Kohn WG, Collins AS, Cleveland JL, et al; Centers for Disease Control and Prevention. Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep. 2003;52(RR-17):1-61.
Organization for Safety & Asepsis Procedures. From Policy to Practice: OSAP’s Guide to the Guidelines. Annapolis, Md: Organization for Safety & Asepsis Procedures; 2004:91-97.
USAF Dental Investigation Service. Infection control practices for dental radiology. Available at: http://www.brooks.af.mil/dis/DOWNLOAD/radiologyinfcontrol.pdf. Accessed April 2004.
Organization for Safety & Asepsis Procedures. Infection control and dental radiography. Infection Control In Practice. 2003;2(November):1-8.
Miller CH, Palenik CJ. Sterilization, disinfection, and asepsis in dentistry. In: Block SS, ed. Disinfection, Sterilization, and Preservation. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:1049-1068.
Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. 2nd ed. St Louis, Mo: Mosby; 1998:217-221.
Haring JI, Jansen L. Infection control and the dental radiographer. In: Haring JI, Jansen L. Dental Radiography: Principles and Techniques. 2nd ed. Philadelphia, Pa: WB Saunders; 2000:194-204.
Glass BJ, Terezhalmy GT. Infection control in dental radiology. In: Cottone JA, Terezhalmy GT, Molinari JA, eds. Practical Infection Control in Dentistry. 2nd ed. Baltimore, Md: Williams & Wilkins; 1996:229-238.
Dr. Palenik has held over the last 25 years a number of academic and administrative positions at Indiana University School of Dentistry. These include professor of oral microbiology, director of human health and safety, director of central sterilization services, and chairman of infection control and hazardous materials management committees. Currently he is director of infection control research and services. Dr. Palenik has published 125 articles, more than 290 monographs, 3 books, and 7 book chapters, the majority of which involve infection control and human safety and health. Also, he has provided more than 100 continuing education courses throughout the United States and 8 foreign countries. All questions should be directed to OSAP at office@osap.org.
