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Are You Hanging
Pathogens Around Your
Patient’s Neck?
A
s a 15-year-old, Susie was used to the occasional
outbreak of acne, but the bump on her neck
seemed different this time. It started out fairly
small and itchy, but now it was big, red, and sore. After
visiting her physician, her mother was shocked to hear
that the bump was a boil (or furuncle), an infection usu-
ally caused by Staphylococcus bacteria that possibly came
from pathogens on a dental bib clip.
You are probably already thinking, “Give me a break.
I don’t sterilize or wipe down bib clips and have never had
a problem.” Of course, we don’t have the problem, our
patients have the problem. Yet, we might have invited
rashes, itching, eczema, folliculitis, boils, impetigo, acne,
or other bacterial/fungal infections to the patient’s neck
through cross-contamination.
Bib Clips and Pathogens
Bib clips are loaded with a variety of pathogens. Oral
health care professionals often place the nonsanitized bib
clip on the patient before washing hands, donning gloves,
or putting on protective eyewear and masks. Pathogens
come from previous patients, dental aerosols, and from
the care provider. Who would have thought that a simple
bib clip could be so hazardous? The answer, apparently, is
not many because the problems they can cause are not
necessarily connected to simple daily activities. Dental
professionals play an important role in reducing many dif-
ferent types of infection-causing pathogens.
There are more than 30 species of Staphylococcus bac-
Patricia Pine, RDH
Dental Learning
Editorial Advisory Board Member
“U”nique Dental Organizational Services
Fountain Hills, AZ
Email: 1smile4ever@cox.net
Web site: www.uniquedentalservices.com
www.dentallearning.net
teria that can cause a wide variety of illnesses. Staphylo-
coccus aureus can spread through skin-to-skin contact
and can precipitate skin infections like folliculitis, boils,
impetigo, and cellulitis. Though often limited to a small
area, all of these infections can be serious and are espe-
cially hazardous for immuno-compromised patients.
MRSA (Methicillin-resistant Staphylococcus aureus) is a
Staphylococcal infection commonly found in health care
settings including dental offices. MRSA, as the name in-
dicates, is well known for its resistance to antibiotics and
is the cause of profound community concern.
Researchers took a variety of
samples in the university’s clinic after
dental and dental hygiene clinical
sessions and grew the bacteria in
agar. They found dense growth or
increases in colony-forming units
after 18 hours of incubation.
Every instrument must be sterilized to kill unknown
pathogens. Without sterilization, many patients can be-
come infected with diseases such as hepatitis B virus and
human immunodeficiency virus. The question is: “Do we
need to sterilize this small vital tool, the bib chain, that
does not enter the mouth?”
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
involving bib chains and pathogens on their hard-to-reach
surfaces. Researchers took a variety of samples in the uni-
versity’s clinic after dental and dental hygiene clinical ses-
sions and grew the bacteria in agar. They found dense
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
of dental bib chains to justify processing them through ster-
ilization procedures just as we do with dental instruments.
Bib chains need ultrasonic cleaning, rinsing, wrapping,
and processing through an autoclave sterilizer. If going green
is your style, sterilization is your best choice. Bib chains can
be bagged with instrument cassettes or pouches to be
opened in front of the patient. This extra step might increase
costs, but what is a patient’s health worth?
Considering the time and material cost of sterilization,
the practitioner might consider replacing the bib chain with
a single-use, disposable bib holder, such as Bib-Eze from
DUX Dental (Figure 1), or Sani-Tab disposable bibs with
sticky tabs from Crosstex (Figure 2). These products are
more economical for the practice owner and make life eas-
ier for the staff. Weigh the costs compared with the risks.
Disclosure:
Pat Pine is a speaker for DUX Dental.

2 Dental Learning / November 2010 www.dentallearning.net