Ethical Dilemma in Dental Setting

Ethical Dilemma in Dental Setting

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Step 1
In the practices of Karen’s infection control, ethical dilemmas may or may not exist. The first issue Jane has with Karen’s practices, is her unnecessary contact of surfaces with contaminated gloves. Karen thoroughly disinfects the operatory after a patient. However, the chance exists that cross contamination could be possible. Is Karen putting the patient in harm’s way, in her practice of cross-contamination, if she is thoroughly disinfecting the surfaces?
The other issue also may or may not be an ethical dilemma. Karen’s action of putting XCPs in cold sterilization throughout the morning and then removing them during her lunch hour is, by itself, ethically wrong. The ethical dilemma that may be associated is evident when the needs of the patient is taken into consideration. If the XCPs are required to diagnose patients, and insufficient XCPs are available, does the risk of infection outweigh the patients need for radiographs? Although a morally weak argument, the issue still stands to question.
Step 2
According to the American Dental Associations guidelines on infection control, the surfaces Karen touches with contaminated gloves are considered non-critical (American Dental Association, 2009). Items in this category are sufficiently disinfected by cleansing the surface with an intermediate disinfectant, as performed by Karen between patients (American Dental Association, 2009). If Karen is sufficiently wiping down all surfaces she has contacted, there is no violation of infection control standards. But if Karen contacts critical instruments, or does not perform adequate cleansing with disinfectant, she may be putting the patient at risk.
XCPs are considered semi-critical by these same guidelines, for they do not penetrate tissue, but come in contact with mucosa (American Dental Association, 2009). Items in this category require sterilization (American Dental Association, 2009). Assuming the XCPs, are unable to be sterilized in the office’s autoclave, a high level disinfectant may be used. This leads to a grey area in disinfection. The difference between sterilization and disinfection, with this solution, is the amount of time the item is submerged (American Dental Association, 2009). The required time to sterilize using cold sterilization solutions is often around ten hours (American Dental Association, 2009). The amount of time Karen is submerging the XCPs is inadequate to achieve sterilization.
Step 3
There are several options available in reference to Karen’s use of contaminated gloves to access drawers, with varying degrees of ethical soundness. The first is to do nothing. If Karen is properly disinfecting and not contacting critical or semi-critical instruments, there is no reason to believe there is an infection risk to patients.

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If she is not taking the necessary precautions, Jane needs to address the issue. She may talk directly to Karen, express her concern for risk to patient care, and request that Karen modify or change her practices. Depending on Jane’s tact and communication skills, as well as Karen’s attitude, this may lead to a soured relationship with Karen or even with the Dentist. Jane may also talk directly to the Dentist and present a case for the required use of over gloves in the office. Jane may discuss concerns about infection control to the dentist and provide a case for extra measures, without implicating Karen as violating infection control procedures.
Karen’s handling of XCPs ethically requires action to be taken. One course of action is to talk to Karen and explain why the practice is unethical. Jane should explain that she understands that the XCPs are required for optimal patient care, but infection control should not be compromised. If there truly is not enough XCPs to complete a day, perhaps Jane and Karen can talk to the dentist about possible solutions. Suggestions could include purchasing more XCPs (so that they may be adequately rotated) or purchasing XCPs that can be processed in the offices autoclave (reducing time needed to sterilize).
Step 4
Both ethical dilemmas presented in this situation fall under the category of substandard care. With Karen’s handling of contaminated gloves, there exist a question of proper infection control. She could be violating the principle of nonmaleficence because she is causing unneeded risk to the patients’ safety. An ethical dilemma exist because she is practicing professional autonomy in her choice of infection control, but her autonomy may be in conflict with the principle of nonmaleficence. To do nothing would leave this dilemma in ambiguity, but to take action and discuss the issue with her or the dentist could remedy the dilemma and restore nonmaleficence. Asking her to change her habits may violate her autonomy, but she is also bound to uphold nonmaleficence concerning patient care and this should be the first priority.
Karen’s handling of the XCPs blatantly violates the principles of nonmaleficence and has a conflict with the principle of beneficence. The possibility of infecting a patient with a microorganism exist because of improper sterilization time, resulting in a violation of nonmaleficence. The argument can be made that having inadequate XCPs for the afternoon would result in patients not receiving diagnostic radiographs, violating the principle of beneficence. The resolution to this dilemma would be allowing adequate sterilization time by purchasing more XCPs or purchasing XCPs that may be autoclaved. It cannot be certain whether Karen’s decision to give the XCPs adequate sterilization time is from moral weakness or moral uncertainty, but not addressing the issue would not be practicing nonmaleficence.
Step 5
In regards to Karen’s practices concerning contaminated gloves, the best option would be to talk to the doctor about requiring use of over gloves in the office. When presenting the idea to him, many points should be touched on. It would limit the risk, to patient and provider, of coming in contact with infectious agents. The practice could save him from a lawsuit. It could also reduce the need to change glove as often and help cut cost. By presenting this idea as a precaution to keep the patients best interest in mind and not specifically implicating Karen as possibly violating infection control, a conflict may be avoided and the patients’ needs still put first.
The problem of the XCPs sterilization must be handled more delicately. Instead of approaching Karen with a negative attitude, Jane should approach her with a collaborative attitude. Karen is described as respectful and a team player. If Jane appeals to these qualities when addressing the issue, conflict may be minimized. Instead of attacking her, be on her team. Jane should explain the handling of the XCPs concerns her and why. After explain the ethical issue, shift the blame from Karen to a lack of adequate XCPs. Jane should express that she understand Karen is just trying to keep things running smoothly, but perhaps they can discuss a resolution together with the dentist.
Step 6
Both actions should be followed through with in a respectful manner. Part of providing the best patient care possible is having a team that will work well together and keep patients best interest in mind.




References

American Dental Association. (2009, July). Sterilization and Disinfection of Dental Instruments. Retrieved February 7, 2014, from www.ada.org: http://www.ada.org/sections/professionalResources/pdfs/cdc_sterilization.pdf

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