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Recommended Infection Control Practices. The OSU College of Dentistry August 2003. Infection Control Practices. Exposure to variety of microorganisms via blood or oral or respiratory secretions + peri-oral skin

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recommended infection control practices

Recommended Infection Control Practices

The OSU

College of Dentistry

August 2003

infection control practices
Infection Control Practices
  • Exposure to variety of microorganisms via blood or oral or respiratory secretions + peri-oral skin
  • May include CMV, HBV, HIV, HCV, Herpes 1 and 2, TB, Staph, Strep, and other viruses or bacteria
recommended infection control practices1
Recommended Infection Control Practices
  • Routes of Transmission
    • Direct Contact with blood, oral fluid, secretions
    • Indirect Contact with contaminated instruments, operatory equipment, or surfaces
    • Contact with airborne contaminants in droplet spatter or aerosols of oral or respiratory fluids.
infection control practices1
Infection Control Practices

Susceptible

host

CHAIN OF

INFECTION

Portal

Pathogen

IC strategies break one or more of these "links" - infection prevented

infection control practices2
Infection Control Practices
  • Confirmed transmission of HBV and HIV
  • Reports published from 1970-1987
    • Nine cluster where patients were infected with HBV associated with dental treatment
    • Six patients contracted HIV from dentist
    • HBV transmission from dentist to patient has not been reported since 1987
infection control practices3
Infection Control Practices
  • Vaccines for DHCW
    • Hepatitis B - series of 3 shots, antibody verification needed
    • Measles, Mumps, Rubella
    • Tetanus
    • Influenza
    • TB
infection control practices4

Infection Control Practices

Protective Attire and Barrier Techniques & Dental Techniques

& PPE’s

infection control practices5
Infection Control Practices

Personal Protective Equipment (PPE)

  • Gloves
  • Mask/Facial Shield
  • Eye protection/Glasses
  • Gown/Hat
slide10

MRSA & Infection Control for Restorative Dental Treatment in Nursing Homes

David L. Hall, DDS

Section of Primary Care - Dr. Mead Van Putten - Chairperson

The Ohio State University Geriatrics Program - Dr. Abdel Mohammad - Director

Introduction

Conclusions

Results

The combined prevalence of occasional Methicillin-Resistant Staphylococcus Aureus (MRSA) infections and numerous asymptomatic mostly unidentified MRSA carriers in nursing homes now averages 20-35% of residents or more. One of the most common sites for positive MRSA colonization is the nares and mouth (saliva). Routine restorative dental care is performed onsite in local nursing homes by all Ohio State University (OSU) dental students using portable equipment including handpieces that can generate aerosols. This study was initiated after the author encountered three MRSA+ patients in three different nursing homes during consecutive visits involving approximately 30 patients seen by the OSU College of Dentistry Geriatrics Program. Using a series of cultured test swabs and plates, this cross-over study confirmed that the universal barrier precautions (gloves, gowns, masks, hats, facial shields, glasses), and surface disinfectants combined with infection control oriented techniques (rubber dam, hand excavation & bonding, and electric "high" speed handpiece), plus pre op 0.12% chlorhexidene mouth rinses, high volume evacuation, and perioral skin scrubs provide protection for both dental health care personnel and patients in long-term care facilities.

This investigation did not reveal any evidence of large oral concentrations of MRSA in the carriers studied nor any special tendency or ability of MRSA to aerosolize. The value of two 60-second Peridex® oral pre-rinses with 15-25 minute waiting periods (p<0.05), perioral facial skin scrubs with both 4% chlorhexidine and 62% ethyl alcohol gel, Birex® counter top surface disinfection (p<0.001), and rubber dams was statistically verified. Lacrosse® alcohol gel showed superior CFU reductions vs. 4% chlorhexidine (p<0.02). The use of hand excavation and bonding; electric, high torque handpiece with water spray; and full high-speed air turbine handpiece with water spray dental restorative techniques were compared. Hand excavation and bonding generated the least aerosol CFUs, high-speed air turbine handpieces by far the most CFUs, and BienAir® electric handpieces (p<0.04) produced intermediate CFU values as measured on facial shields.

Methods

Locations Served

Services Provided

Figure 1: MRSA Research Study Set Up

CFUs = Colony Forming Units

Sponsors

OMNII PHARMACEUTICALS (Peridex®)

BIOTROL (Birex®)

APLICARE (Lacrosse®)

BIEN AIR (Bien Air®)

STERILIZATION MONITORING SERVICE, DR. JOEN HARING, DIRECTOR

DR. JOHN SHERIDAN

ORAL BIOLOGY SECTION

Bien Air CE-0120

electric handpiece

Star 430-SWL

air turbine

Full Manuscript will appear in July/August Issue of Special Care in Dentistry

slide11

Infection Control Practices

Gloves

  • Purpose - protect patient & HCW
  • Wear for contact with blood, saliva, sputum, mucous membranes, non-intact skin
  • Non latex gloves
  • Non sterile/sterile
slide12

Infection Control Practices

Soiled Gloves

  • Remove when treatment is completed
  • If torn, cut, or punctured remove as soon as patient safety permits
  • Before leaving dental operatory area
  • Do not touch environment
  • Do not touch face, mask
slide13

Infection Control Practices

Face Protection

  • Prevent mucous membrane contact with spatter & debris
  • Chin-length plastic face shield, surgical mask and protective eyewear
  • Change mask between patient or during patient treatment if it becomes wet or moist
  • Remove when leaving treatment area
slide14

Infection Control Practices

Gowns

  • To prevent clothing contamination
  • Clean gown daily
  • Change if obviously soiled
  • Wear only in clinic area.
infection control practices6
Infection Control Practices
  • Handwashing
  • Handling of sharps
  • Environment Dental Techniques:
  • CHX Pre-rinses (2)
  • High Vac Suction
  • Rubber Dam
  • Elect”HS”<AirHS<USonic
slide16

Infection Control Practices

Handwashing

  • Before and after treating each patient
  • Before and after glove placement or removal
  • After barehanded touching of inanimate objects likely to be contaminated

Handwashing with plain soap is okay

slide17

Infection Control Practices

Handwashing

  • Wet hands
  • Apply soap
  • Wash thoroughly (palms, webs, knuckles, thumbs, fingertips)
  • Sing Happy Birthday
  • Rinse
  • Dry well
  • Turn faucet off with paper towel
infection control practices7
Infection Control Practices

Sharp Instruments and Needles

  • Handle carefully
  • Do not recap with 2 hands
  • Unsheathed multiple injections needles should be placed to prevent contamination and injury
  • Discard or disinfect\sterilize properly
  • Report injuries
slide19

Infection Control Practices

Blood and Body Fluid Exposures

  • Percutaneous injury from contaminated sharps
    • needle stick
    • contaminated sharp
    • bite
  • Contact of mucous membranes or nonintact skin
  • Prolonged skin exposure
infection control practices8
Wash wounds with soap & water

Flush mucous membranes with water

Apply antiseptic

Sterile bandage

Complete dental care

Take pt & chart to OMS

Report ASAP to clinical instructor or manager

Complete necessary incident report form

Infection Control Practices

Exposure Management

infection control practices9
Infection Control Practices

Source Patient Management

  • Request consent for blood draw
    • HBsAg
    • HCAB
    • HIV
  • Take to UHC lab
infection control practices10
Infection Control Practices

Risk of Infection After Exposure to HIV*

  • 0.3% - percutaneous exposure
  • 0.09% - mucous membrane exposure
  • < 0.1% - skin contact
  • Higher risk if
    • exposure to larger quantity of blood, e.g.,
      • device visibly contaminated
      • needle placed directly in vein/artery
      • deep injury *Vs: HBV 10-100X Higher Risks
infection control practices11
Infection Control Practices

Exposed Individual

  • Report to clinical instructor or manager
  • Followed by SHC
  • Baseline blood tests
  • Prophylactic Rx may be recommended
  • Advised of patient test results
infection control practices12

Infection Control Practices

Tuberculosis (TB) Information

infection control practices13
Infection Control Practices

Site of Disease

  • Lungs (85% of all cases)
  • Pleura
  • Central Nervous System
  • Lymphatic System
  • Genitourinary System
  • Bones and Joints
  • Disseminated (miliary)
slide29

Infection Control Practices

Signs and Symptoms

Pulmonary

  • Productive, prolonged cough
  • Chest pain
  • Hemoptysis

Systemic

  • Fever
  • Chills
  • Night sweats
  • Easy fatigability
  • Loss of appetite
  • Weight Loss
conditions that increase risk
Conditions That Increase Risk
  • HIV infection
  • Substance abuse (esp. drug injection)
  • Recent infection with M. tuberculosis
  • CXR suggestive of previous TB (in a person inadequately treated)
  • Diabetes mellitus
  • Silicosis
  • Low body weight (>10% below ideal)
  • Cancer of the head and neck
  • Hematological & reticuloendothelial diseases
  • End-stage renal disease
  • Intestinal bypass or gastrectomy
  • Chronic malabsorption syndromes
  • Prolonged corticosteroid therapy
  • Other immunosuppressive therapy
slide31

Infection Control Practices

High Risk Factors

  • Close contacts of active TB
  • Foreign-born from endemic areas
  • Medically underserved, low-income
  • Elderly
  • Residents of long-term care facilities
  • Injecting drug users
  • Local high-prevalence groups
  • Occupational exposure
slide32

Infection Control Practices

Evaluation for TB

Medical history

  • History of TB exposure, infection or disease
  • Symptoms of TB disease
  • Risk factors for TB

Physical examination

Mantoux tuberculin skin test (PPD)

Chest radiograph

Bacteriologic exam (smear and culture)

infection control practices14
Infection Control Practices

TB Skin Test

  • Intradermal Mantoux test with 0.1 ml of TU PPD tuberculin
  • Read reaction 48-72 hours after injection
  • Measure only induration
  • Record results in millimeters
  • Annual requirement
infection control practices15
Infection Control Practices
  • > 15 mm in all persons
  • > 10 mm
    • certain medical conditions
    • injecting drug users (HIV neg.)
    • Foreign born from endemic areas
    • medically underserved, low income groups
    • residents of long-term care facilities
    • children < 4 yr. of age
    • locally identified high-prevalence groups
  • > 5 mm
    • known or suspected HIV infection
    • close contacts with infectious TB
    • CXR suggestive of previous TB
    • injecting drug users (HIV status unknown)

Positive Skin Test

infection control practices16
Infection Control Practices

Management of Infected Patient

  • Segregate
  • Mask
  • Refer for medical evaluation
  • No elective treatments until not infectious
  • Urgent dental care done in neg. air flow facility
infection control practices17
Preventive Therapy Recommended for PPD +

Known or suspected of having HIV

Close contacts of a person with active TB

CXR suggestive of previous TB and received inadequate treatment

Injecting drug users

Certain medical conditions

Recent tuberculin skin test converters

Rx of Active Disease

Four drugs in initial regimen: INH, RIF, PZA + EMB or SM x 2 mo.

3 drugs may be adequate if drug resistance very unlikely

Adjusted when susceptibilities are known

If susceptibility to INH and RIF, continue INH and RIF x 4 mo.

Adults - 6 mo. total

Longer therapy for children (9 mo.) and HIV-infected persons (12 mo.)

Infection Control Practices

Therapy

infection control practices18

Infection Control Practices

Latex Safe

Powder Free

slide38
American College of Allergy, Asthma and Immunology: 8% - 17% of HCWs exposed to latex are at risk for a latex reaction.
exposure to latex can result in three distinct reactions

Exposure To Latex Can Result in Three Distinct Reactions

Irritant Contact Dermatitis

Allergic Contact Dermatitis

Immediate Allergic Reaction

non allergic reactions to latex
Non Allergic Reactions to Latex
  • Irritant Contact Dermatitis - reaction caused by sweating or rubbing under the gloves
  • Allergic Contact Dermatitis - reaction to chemical additives to latex.
what is latex allergy
What Is Latex Allergy
  • Allergy to the proteins originating from the rubber tree and still present in products made from natural rubber
  • S/S of allergy: rash, hay fever type reactions such as itchy swollen eyes, runny nose, and sneezing
  • Asthma type symptoms chest tightness, wheezing, coughing and SOB.
why powder free
Why Powder Free
  • Latex proteins adhere to the inside of the gloves. When the gloves are removed, the powder becomes airborne and pulls the latex powder with it, exposing the allergen to the skin, eyes and airways of workers and patients.

.