Personal Protection Infection Control, DA116
, and Infection Control • OSHA and CDC both work to enhance Infection Control in the dental office • CDC recommends certain Infection Control steps • To protect everybody • Things we do to prevent cross-contamination • OSHA mandates certain protective actions • To protect employees • Employer is responsible for making sure we comply • Together, both agencies protect employees’ and patients’ health and well-being.
Personal Protective Equipment Mandated by OSHA Employers responsible to provide for employee and to oversee employee compliance Called Personal Protective Equipment because clinical staff uses it… We could also called it Patient Protective Equipment because our use protects the patients also.
Immunization: • Process by which resistance to an infectious disease is induced or augmented. Human body can produce immunity on it’s own to particular diseases or conditions. • When no immunity exists for disease, immunization can occur through vaccination • Example of vaccinations that healthcare workers should have: • Hepatitis B • Measles, mumps, rubella • Chicken pox • Polio • Tetanus • Diphtheria • TB tine tests • Influenza (optional
PERSONAL PROTECTIVE EQUIPMENT “PPE” Gloves Face masks Gowns (aka “lab coats”) Protective eyewear For more sterile environments: Surgical caps Surgical shoe covers
GLOVES • Purpose: to protect from exposure to contamination through cuts and abrasions often unseen on hands. • Skin is a good protection against microorganisms if intact. • Take a minute and look at your hands… • Gloves protect by providing an extra barrier against the entry of microorganisms through breaks in the skin. • Also protect patients from microorganisms on your hands
When to wear gloves: • Wear gloves whenever • you put your hands into any patient’s mouth or • touch contaminated instruments, equipment or surfaces in the operatory or in the lab • Use a new pair for every patient • If visibly soiled or torn during a procedure, change gloves immediately • Note: Hand washing after any possible contact with blood is the best protection
Types of gloves: Disposable examination gloves Sterile disposable gloves General purpose utility gloves Over-gloves Under-gloves
Disposable Examination Gloves • Available in Latex or Nitrile • no difference in effectiveness, • depends on skin tolerance for latex • Also available: vinyl • Not as strong or well-fitting as latex or nitrile • Purchased according to size in an ambidextrous box • Powdered or unpowdered • Scented or unscented • Not Sterile
Sterile Disposable Gloves • Use when sterility is necessary, as in oral surgery • Usually come packaged in pairs; sealed before use • Available in latex, nitrile, and vinyl
General Purpose Utility Gloves • Use when cleaning instruments, equipment, and contaminated surfaces • Can be washed, disinfected, and reused many times • Replace if tears or cracks appear • Polynitrile can be autoclaved and are puncture resistant • Available in sizes small, medium, large, extra-large • Not for use in direct patient care
Over-gloves • Food handlers gloves used over exam gloves • To retrieve forgotten item from drawer • Chart information in the computer • Handle other items within the operatory • Note: if you leave the room, remove your gloves!! • Not to be used in the mouth or when cleaning sharp instruments
Under-gloves • Tight fitting knit fabric glove, used to protect hands from powder, latex, vinyl, sweat or moisture
Managing gloves: • Surgical or Examination gloves • never wash or reuse • washing causes “wicking” which increases flow of liquid through undetected holes in gloves • Utility gloves can be reused if not punctured or torn; can be washed, disinfected and/or autoclaved • If gloves are torn, cut or punctured, remove immediately and dispose of properly. Wash hands thoroughly with soap and water before putting new gloves on • Disposal: • exam gloves to clinical trash; sterile gloves to biohazard waste trash
Facial Protection: • Blood, saliva, and OPIM (Other Potentially Infectious Material) can spatter during dental procedures; it can enter the body through the eyes, nose and mouth • Tiny amounts of blood containing HBV can cause infection if it gets into the eye • When to wear: • Whenever blood or fluids contaminated by blood may be spattered • During patient treatment • While cleaning instruments or contaminated surfaces • Disposing of contaminated fluids
Methods of Facial Protection 1) Mask and protective safety eyewear 2) Chin length face shield that covers eyes, nose and mouth, plus a mask to protect respiratory tract
When to wear face protection: • Whenever blood or fluids contaminated by blood may be spattered • During patient treatment • While cleaning instruments or contaminated surfaces • Disposing of contaminated fluids • With hazardous chemicals which call for masks on MSDS slips or labels • MOUTH AND NOSE MUST BE COVERED; DO NOT WEAR UNDER YOUR CHIN!! • Examples of appropriate times to wear a facial protection device: • Preparing a tooth with a high speed handpiece • Polishing teeth with slow speed handpiece • Polishing a crown • Washing contaminated instruments • Emptying a suction trap • During use of an air/water syringe • Mask must provide at least 95% filtration capacity.
Managing Face Masks • Always handle as contaminated, when wearing or disposing. Contamination on the inside is from you, and outside is from the patient. • When handling a used mask, hold it either by the body while still wearing gloves, or by the ties or elastics with clean hands • Use a new mask for every patient • Replace a wet mask during treatment; a wet mask will collapse against the face, and won’t provide a strong barrier against microorganisms • Discard any gloves which come into contact with the body of the mask
As shown by a black light, a surgical mask’s outer surface can become contaminated with infectious droplets from spray of oral fluids or from touching the mask with contaminated fingers. Wet masks should be changed.
Face shields: Wear when you would wear a mask and protective eyewear Need to wear a mask also to prevent breathing in microorganisms Protects against splashes, keeps entire face clean Can be worn more comfortably with prescription glasses Do not need to dispose of in between patients, but must decontaminate, by disinfecting between patients, use gloves when handling them prior to disinfection, and dry with a paper towel
Safety Glasses or Goggles: Wear with a mask whenever there is spatter or chance of flying debris Glasses should have solid side shields to prevent eye injury Decontaminate between patients by first cleaning with soap and water; then disinfecting with an intermediate disinfecting chemical Grasp the sides when removing them, to avoid contamination with front of glasses
Lab Coat or Gown: Must wear a lab coat with long sleeves and high neck which can be zipped or snapped up the front to protect street clothes from contamination Gloves fit over the cuffs of lab coats Must wear whenever the chance of blood or fluid contaminating blood might contaminate clothing
Managing the Lab Coat or Gown • Should change daily or more often, if visibly soiled • To remove visibly contaminated clothing, fold the soiled area inside, keeping gloves on to protect your hands. Put soiled clothing into specially marked hazardous laundry bag provided by employer (employer responsible for cleaning lab coats!!) • Do not wear lab coat outside the office; remove before going to lunch, on breaks, behind the reception desk or home.
Managing Lab Coat, con’t • Very important to realize that your work clothing can be contaminated and should be changed as soon as you get home or before leaving the office • In some types of offices, it might be appropriate to wear even greater protective clothing: • Surgical caps and or hoods and shoe covers or boots • Aprons • Knee length gowns
Remember: All of these PPE requirements are mandated by OSHA Bloodborne Pathogens Standard which went into effect in 1991. They are not voluntary, and the employer is responsible for seeing that you follow the rules. The employer can be fined for not following these mandates and…..if you don’t comply, YOU may lose your job!!
OSHA The OSHA Hazard Communication Standard: AKA: Employee right to know law BECAUSE OSHA regulations are intended to protect the health and safety of the Employee. State OSHA programs must be at least as strict as the federal OSHA regulations
EPA and CDC EPA (Environmental Protection Agency) has jurisdiction over hazardous waste. CDC (Center for Disease Control) Dental Infection Control Guidelines recommend training of healthcare workers: -On initial employment - Annually as a minimum - When new tasks or procedures affect the employee’s occupational exposure