Infection Control in Dental Health-Care Settings Terri L. Deal
Infection Control • Center for Disease Control updated in 2003 • Previously released in 1986, 1993 • Consolidates recommendations for : • Preventing infectious diseases • Managing personnel health and safety • Updates previous CDC recommendations • Incorporates relevant infection control measures • Discusses concerns not previously mentioned
Infection Control • General recommendations • Develop a written program • Policies • Procedures • Education and training guidelines • Immunizations
Infection Control • Exposure prevention • Post-exposure management • Medical conditions • Work restrictions • Contact dermatitis, latex sensitivity • Maintenance of records, data management and confidentiality • Establish referral arrangements
Infection Control • Education and training • Provide to new employees • When new tasks or procedures affect employees exposure • Provided annually re: exposure to potentially infectious agents and infection control procedures • Provide educational information appropriate in content, vocabulary for the health care provider
Infection Control • Immunization • List of all required and recommended immunizations • Refer employee to prearranged health care provider or their own health care provider • Exposure Prevention and Post-exposure Management • Develop post-exposure management and medical follow up program
Infection Control • Medical conditions, work-related illness, and work restrictions • Develop written policies re: work restriction and exclusion and who can implement • Policies for preventive and curative care and reporting illnesses. Don’t penalize with loss of wages, benefits or job status • Policies for evaluation, diagnosis and management of occupational contact dermatitis • Definitive diagnosis of suspected latex allergy, work restrictions and accommodations
Infection Control • Records Maintenance, data management and confidentiality • Establish and maintain confidential medical records for all dental health care providers • Ensure compliance of federal, state and local laws re: medical recordkeeping and confidentiality
Infection Control • Occupational exposure: • “reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties”
Infection Control • Occupational exposure occurs when your .. • Skin • Eyes • Mucous membrane • Blood
Infection Control • Come into contact with… • Blood or saliva from a patient • Contaminated instruments • Equipment of laundry contaminated by blood or saliva from a patient
Infection Control • Who is potentially infectious?
Universal Precautions: • “…all human blood and certain human body fluids are treated as if known to be infectious…”
Universal Precautions • Transmission of infectious diseases from patient to health care workers usually involves patients who do not know they have an infectious disease.
Occupational Exposure Determination • Category I – Routinely exposed to blood, saliva or both Examples: Dentist, Hygienist, Assistant, Infection Control/Sterilization Assistant, Lab Technician • Category II – May on occasion be exposed to blood, saliva or both
Disease Transmission in the Dental Office • Every dental office should have an infection control program designed to prevent the transmission of disease from: • Patient to dental team • Dental team to patient • Patient to patient • Dental office to community (includes dental team’s family) • Community to patient
Therefore… • Health care workers must… • Consider blood and saliva from all patients as potentially infectious • Take precautions to protect themselves from exposure
Hepatitis B Vaccine • Employer must educate employees. • Employer must offer the vaccine within 10 working days and pay for the vaccine. • Employee can decline, but must sign declination statement.
Post-Exposure Evaluation and Follow-up • Employer must: • Document exposure and circumstances • Document source individual • Source individual’s blood tested • If source is known to be infected, blood test is not necessary.
Post-Exposure Evaluation and Follow-up • Employee’s blood is tested. • If employee refuses HIV testing, then blood is stored at least 90 days. • Confidential medical evaluation • When indicated use post-exposure prophylaxis which will prevent HIV infection
Medical Waste • Blood or saliva mixed with blood
Medical Waste: • Items that release blood or saliva-blood if compressed or during handling
Medical Waste: • Pathological waste • Teeth • Tissue • Contaminated sharps
Disposal of regulated Waste: • Landfills • Private pick-up services • Hospitals • On-site
Remember: • Items that do not release blood and/or saliva when compressed or handled do NOT need special disposal.
Requirements for Transmission of Infection • A reservoir of pathogen • A pathogen of sufficient infectivity and number • A mode of escape from the host • A mode of spread to the new host • A portal of entry • A susceptible host
Infection Control • Preventing Transmission of Blood borne Pathogens • HBV vaccination • Preventing exposure to Blood and OPIM (other potentially infectious material) • Use standard precautions for all patients
Infection Control • Consider sharp items contaminated with blood and saliva as potentially infective • Implement written program to minimize exposures
Sterilization • Destruction of all microorganisms including bacterial spores • Should be used for all instruments which come in contact with blood or saliva
Disinfection • Destroys most microorganisms but not bacterial spores • Used for surfaces and impressions
Disinfectants Versus Antiseptics • Disinfectants are chemicals that are applied to inanimate surfaces (such as countertops and dental equipment). • Antiseptics are antimicrobial agents that are applied to living tissue. • Disinfectants and antiseptics should never be used interchangeably because tissue toxicity and damage to equipment can result.
Disinfectants Versus Antiseptics • If there were an ideal surface disinfectant, it would have a rapid kill of a broad spectrum of bacteria, have residual activity, minimal toxicity, and would not damage surfaces to be treated. In addition, it would be odorless, inexpensive, work on surfaces with remaining bio-burden, and be simple to use.
The “Perfect Disinfectant?” • Unfortunately, no single disinfectant product on the market today meets all these criteria.
The “Perfect Disinfectant?” • When selecting a surface disinfectant, you must carefully consider the advantages and disadvantages of various products. • Often the manufacturers of dental equipment will recommend the type of surface disinfectant that is most appropriate for their dental chairs and units.
Types of Chemical Disinfectants • Iodophors are EPA-registered intermediate-level hospital disinfectants with tuberculocidal action.Because iodophors contain iodine, they may corrode or discolor certain metals and may temporarily cause reddish or yellow stains on clothing and other surfaces.
Types of Chemical Disinfectants • Synthetic phenol compounds are EPA-registered intermediate-level hospital disinfectants with broad-spectrum disinfecting action. Phenols can be used on metal, glass, rubber, or plastic. They also may be used as a holding solution for instruments; however, phenols leave a residual film on treated surfaces. Synthetic phenol compound is prepared daily.
Types of Chemical Disinfectants- cont’d • Sodium hypochlorite (household bleach) is a fast-acting, economic, and broad-spectrum intermediate-level disinfectant (1:100 dilution for surface decontamination). • Disadvantages: It is unstable and must be prepared daily, has a strong odor and is corrosive to some metals. It is also destructive to fabrics and irritating to the eyes and skin; it may eventually cause plastic chair covers to crack.
Types of Chemical Disinfectants- cont’d • Alcohols are not effective in the presence of blood and saliva. They evaporate quickly and are damaging to certain materials such as plastics and vinyl. • The American Dental Association (ADA), CDC, and the Office of Safety and Asepsis Procedures Research Foundation (OSAP) do not recommend alcohol as an environmental surface disinfectant.
Classification of Instruments and Equipment • Instruments and equipment are divided into three classifications: • Critical • Semi-critical • Non-critical • The classifications are used to determine the minimal type of post-treatment processing.
PPEs • Utility gloves • Protective eyewear and mask or face shield • Protective gown
Surface Disinfection • Use PPE for preparation and use of disinfectants • Use an EPA-registered, ADA-accepted disinfectant for cleaning and disinfecting • Follow manufacturer’s directions on the disinfectant label • Use water if dilution is required
Surface Disinfection • Spray, Wipe, Spray……………Wipe • Spray and wipe to clean surface • Spray again and leave disinfectant on surface long enough to be tuberculocidal (usually 10 min.) • Do not pre-saturate gauze squares with disinfectant
Surface Barriers • Surfaces that are difficult to disinfect may be wrapped with water-impervious material that is changed between patients.
Types of Surface Barriers • There is a wide variety of surface barriers available on the market today. • All should be resistant to fluids to keep microorganisms in saliva, blood or other liquids from soaking through to contact the surface underneath.
Types of Surface Barriers • Some plastic bags are designed especially to the shape of items such as the dental chair, air-water syringe, hoses, pens, light handles, etc.
Plastic-barrier sticky tape is frequently used to protect smooth surfaces such as touch pads on equipment, electrical switches on chairs, or x-ray equipment. Aluminum foil can also be used because it is easily formed around any shape.
Cross-Contamination • Something is contaminated if: • You touch it with your bare skin • You touch it after you touch the patient • You touch it after you touch a contaminated item
To avoid cross-contamination • Use over-gloves • Use clean towel or paper towel
Infection Control • Hand hygiene • Wash hands: • When visibly soiled • After barehanded touching likely contaminated objects (by blood, saliva or respiratory secretions) BEFORE and AFTER treating each patient • Before putting on gloves • Immediately after removing gloves • Liquid hand care products stored in containers that can be washed and dried. Don’t top off
Infection Control • Special hand considerations • Use hand lotions to prevent skin dryness • Avoid lotions with petroleum or other oil emollients • Fingernails short