INFECTION CONTROL IN PRACTICE

Continuing Education

HU-FRIEDY PROGRAMS

STANDARD PRECAUTIONS TO PREVENT DISEASE TRANSMISSION INCLUDE:

• Handwashing

• UseofPersonalProtectiveEquipment(PPE)

• CleaninganddecontaminationwithPPE

• Cleaninganddisinfectionofenvironmentalsurfaces

• Injuryprevention

TRANSPORTATION CONSIDERATIONS: STERILIZATION CASSETTES

• Organizeinstrumentsandaccessoriesperprocedure

BENEFITS

• Increaseschair-sideefficiency

• Improvesofficeflow

• Fasterinstrumentprocessingandset-up/teardown (nosortinginstruments,preppingtray)

• Improvessafety

› Lessinjurypotentialduetoreducedhandlingof contaminatedinstruments

• Reducescosts

› Lesspotentialtoloseordamageinstrumentsdueto beingsecuredtightlyincassettes

› Lesscounterspacerequired

• Makesstafftrainingeasy

DESCRIPTION Thisseminarintroducesinfectioncontrolprincipalsandbestpracticespertainingtosterilizationanddisinfectionofpatientcareitemsaswellasdentalunitwaterlines,inaccordancewiththeCDCguidelines.

OBJECTIVES Youwilllearnstrategiestoassistyouinmaximizingsafetyandefficiencyofinstrumentprocessing. Inaddition,youwilllearnhowtooptimizethequalityofwaterthatyoudelivertoyourpatients.

WHAT ARE THE CDC GUIDELINES?

• Consolidatedrecommendationsforpreventingandcontrollinginfectiousdiseases

• Strategiesdesignedtoprotectpatients andhealthcareworkers

• Guidelinesonly,notgovernmentregulations

To access guidelines visit: CDC.Gov/mmwr/preview/mmwrhtml/rr5217a1.htm

CONTINUING EDUCATION:INFECTIONCONTROLINPRACTICE

“Minimize handling of loose

contaminated instruments

during transport to the

instrument processing area.

Use work practice controls

(e.g., carry instruments

in a covered container) to

minimize exposure potential.”

— CDC MMWR 2003; 52 (No.RR-17), VI, C1

STEP 1: TRANSPORTATION

12

34

5

MODULE 1: 5STEPSOF INSTRUMENTPROCESSING

“Designate a central processing area. Divide the instrument processing

area, physically or, at a minimum, spatially, into distinct areas for:

1. Receiving, Cleaning and Decontamination

2. Preparation and Packaging

3. Sterilization

4. Storage

Do not store instruments in an area where contaminated instruments are

held or cleaned.”

— CDC MMWR 2003; 52 (No.RR-17), VI, B1

“Use automated cleaning

equipment (e.g., ultrasonic

cleaner or washer-

disinfector) to remove

debris to improve cleaning

effectiveness and decrease

worker exposure to blood.”

— CDC MMWR 2003; 52 (No.RR-17), VI, C2

REQUIRED PRACTICES IN INSTRUMENT PROCESSING AREA

• WearappropriatePPE(utilitygloves,mask,glasses,gown)

• Useautomatedcleaningequipment

• Followprocessingguidelinesofequipmentmanufacturers

PROPER USE OF AN ULTRASONIC

• Useonlycorrectsolution;changedailyormoreoften

• Neveroverload;followweightlimits

• Submergeallinstrumentsandkeeplidonduringuse

• Conductmonthlyfoiltesttodeterminecleaningeffectiveness

ENZYMATIC ULTRASONIC CLEANING SOLUTION

• Includeproteolyticenzymeswhichbreakupbioburdenanddebrismorerapidlythannon-enzymaticsolutions

› Showntoreducetheneed,ifany,forhandscrubbing

• Dualenzymecleanersincludemultipleenzymesforbettercleaning

› Protease—proteinenzymethatbreaksdownblood

› Amylase—enzymethatbreaksdownplaqueandstarches

DENTAL INSTRUMENT WASHERS*

• Moreeffective,efficient,streamlinedinfectioncontrolprocessthanmanualcleaning

• Lessexposuretobloodandbodyfluids,exposuretosharps

• Mustbeusedaccordingtomanufacturer’sinstructions–nomixing ofmetals.

STEP 2: RECEIVING,CLEANING&DECONTAMINATION

12

34

5

*Dental Instrument Washers are not the same as Dishwashers. Dishwashers are not FDA approved for cleaning dental instruments.

INTERNAL CHEMICAL INDICATOR

• Placeintoeverypackage

EXTERNAL CHEMICAL INDICATOR

• Usewheninternalindicatorcannotbeseenfromoutside

HINGED INSTRUMENTS

• Processopenandunlocked

CHOOSE AN EFFECTIVE POST-CLEANING PACKAGING MATERIAL*

• Allowspenetrationofthesterilizingagent

• Maintainssterilityaftersterilization

• Providesanadequatebarriertomicroorganisms

• Punctureandtear-resistant

• Lowlinting,freeoftoxicelementsanddyes

• Costeffective

HEAT STERILIZATION OF CRITICAL AND SEMI-CRITICAL ITEMS

• Critical:Anythingthattouchessofttissueorbone

• Semi-Critical:Anythingthattouchessofttissueornon-intactskin

TYPES OF HEAT-BASED STERILIZATION

• Steamunderpressure(Autoclaving)

• Dryheat

• Unsaturatedchemicalvapor

STERILIZATION CYCLE COMPONENTS

• Heat-upperiod—mustreachsterilizingtemperature

• Exposureinterval—timerequiredforsterilizationofload

• Cool-downperiod—allowforsufficientcoolingpriortohandling

› Removeexcessmoisture—importantforhandpiecesterilizationandfunction

› DoNOTremovepacksearly

STEP 3:PREPARATION&PACKAGING

STEP 4:STERILIZATION&MONITORING

“Instruments are to be

inspected for cleanliness;

then wrapped or placed

in containers designed to

maintain sterility during

storage.”

— CDC MMWR 2003; 52 (No. RR-17), VI D2

12

34

5

12

34

5

*Practical Infection Control in Dentistry, Third Edition, John A. Molinari, Jennifer A Harte, page 226, Table 16-3

STEP 5:STORAGE

“The ability of equipment to

attain physical parameters

required to achieve sterilization

should be monitored by

mechanical, chemical, and

biological indicators.”

— CDC MMWR 2003; 52 (No.RR-17), Sterilization

12

34

5

CONSIDERATIONS FOR STERILIZERS*

• UseonlyFDAclearedmedicaldevices

• Allowtodryinthesterilizerbeforehandlingtoavoidcontamination

• Arrangetopermitfreecirculationofthesterilizingagent

› Followmanufacturer’sinstructions

› DoNOToverload

› Observeweightlimits

STERILIZATION MONITORING

1.MechanicalIndicators(eachload)

• Observethegaugesordisplaysonthesterilizertoassesstime,temperatureandpressure

2.ChemicalIndicators(eachload)

• Changeincoloruponreachingphysicalparameter

3.BiologicalIndicators/SporeTests(Atleastweekly.Refertostateandlocalguidelines.)

• Whensterilizinganimplantabledevice,itneedstobecompletedwitheachload.

• Assessesthesterilizationprocessdirectly

› Usesthemostheatresistantmicroorganisms

› Indicatesotherpotentialpathogenshavebeendestroyed

• Ifthereisafailure,removesterilizerfromservice.Ensuresterilizationprocesswasfollowedinordertoruleout“operator”error.Correctanyproceduralerrors,re-testthesterilizerusingbiological,mechanical,andchemicalindicators.

› Ifrepeatsporetestsarenegative,returnsterilizertoservice

STORAGE**

• Use“event”or“date”relatedshelflifepractices

› Foreventrelated,placedateofsterilizationonoutsideofpackagingmaterial.Notewhichsterilizerwasused.

• Examinewrappeditemscarefullypriortouse

• Ifthepackagingofsterileitemsisdamaged:

› Re-clean,re-wrap,re-sterilize

• Storesterileitemsinclosedorcoveredcabinets(alsodryarea)

PATIENT PERCEPTION

• Keepinstrumentswrappeduntilpatienttreatment

• Thepayoff:Patientsnotesterilepackages(perceptionandreality)

*CDC MMWR 2003; 52 (No.RR-17) Sterilization, **CDC MMWR 2003; 52 (No.RR-17), Storage

BIOFILM

BIOFILM LIFECYCLE

BIOFILM: Acoatingorcoveringonthesurfaceofalivingornonlivingsubstratecomposedofmicroorganismssuchasbacteria,protozoa, andalgae(i.e.,plaque).

• Highlycomplexmicrobialstructuralentity

• Existsinallenvironments,includingwaterandsolids

COLONIZATION SEQUENCE

• Organismsattachtosurfaceofwalls

• Theygrow,thickenandreproduce

• Createsgreaterresistancetochemicalpenetration

DUWL & BIOFILM

• Microorganismsformoninternalwaterlinesurfaces

• Astherushingwatercomesintocontactwiththeestablishedbiofilm,piecesbreakoff

• Contaminatespatienttreatment

RAPID GROWTH OF MICROORGANISMS IS CAUSED BY:

• Smalldiametersofwaterlinesandslowwaterflow

• Lowvolumeofwaterused

• Waterwarmstoroomtemperature

• Lowusage

BOTTLES DO NOT SOLVE THE PROBLEM

• Canmakemicrobialgrowthworseunlessregularlymaintained

RECOMMENDATIONS

• CDC—Dentaltreatmentoutputwatershouldmeetregulatorystandardsfordrinkingwater(<500CFU/mlofheterotrophicwaterbacteria)*

• ADArecommends<200CFU/mlofheterotrophicwaterbateria**

SOURCES OF BACTERIA AND CONTAMINATION INCLUDE:

• Treatmentplant,exposedtubing,quickdisconnect,handpiececonnectors,etc.

• Incomingmunicipalwater

› Issanitized,butcanhaveupto500cfu/ml

› Biofilmwilldevelopifnotproperlycleanedandmaintained

• Patient’smouth

› Negativepressurecancausefluidfromthepatientsmouthtobe“retracted”backintotheline

› Anti-retractionvalvesareinstalledonmoderndentalequipmenttohelppreventthissituation–butcanfail

*CDC MMWR 2003; 52 (No.RR-17), Dental Unit Waterlines, **ADA Statement on Dental Unit Waterlines, 1995

CELL CLUSTERBULK FLUID

CHANNEL

BIOFILM FORMATION

MODULE 2: DENTALWATERLINEUNITS

BIOFILM

DENTAL UNIT WATER QUALITY*

• Municipalwatersupplyisprimarysourceofmicroorganisms

• Researchshowsmicrobialcountscanbe<200,000cfu/mlwithin5daysof newDUWinstallation.

• Usingwaterofuncertainqualityisinconsistentwithinfectioncontrolprinciples.

• Untreateddentalunitscannotreliablyproducewaterthatmeetsdrinking

• Itisunacceptabletousehighlycolonizedwaterforanykindofdentaltreatment

Complete dental unit waterline systems include use of an antimicrobial cleaner and a maintenance product

• Overtime,bacteriacanoverwhelmthewaterlineenvironment

• Cleaningwithregisteredantimicrobialiskeytoremovingmicrobialdeposits

• Usingapropermaintenanceproductisalsonecessarytokeeptubingsurfacescleanbetweenantimicrobialtreatments

› Preventswaterborneorganismsfromattaching,colonizing,proliferatingintubing

TREATING DENTAL UNIT WATERLINES

TREATING DENTAL UNIT WATER

*CDC MMWR 2003; 52 (No.RR-17), Dental Unit Waterlines, **CDC MMWR 2003; 52 (No.RR-17), Dental Unit Waterlines

Use of an EPA registered antimicrobial cleaner is recommended. Product Example: HU-FRIEDY'S VISTA TAB ANTIMICROBIAL CLEANER

• Cleanslinesofmicrobialcontaminants(periodic)

• Non-corrosivesolution7xmoreeffectivethanbleach

• Environmentallyfriendly–noheavymetals

• Easytouse—requiresonly5minutesamonth

• Non-corrosive;noharmfulbyproducts

VISTACLEAN – DAILY MAINTENANCE PRODUCT

• Dissolveswaterlinecontaminants

• Maintainslinesdaily

• Derivedfromorganic,citrusbotanicals—safeforuseonpatients

• Environmentallyfriendly

• Easytouse

• Noeffectonbondstrength

MONITORING OPTIONS**

• Watertestingusingaprofessionallaboratory

• In-officetestingwithself-containedkits

• Followrecommendationsprovidedbythemanufacturerforuseofthedentalunitorwaterlinetreatmentproduct

Hu-Friedy Mfg. Co., LLC:3232N.RockwellSt.|Chicago,IL60618|USA Telephone:1-800-Hu-Friedy(1-773-975-6100)|Website:Hu-Friedy.com

Hu-Friedy Mfg. Co., LLC:ZweigniederlassungDeutschland Ziegeleiweg1|D-78532Tuttlingen-Möhringen©2013 Hu-Friedy Mfg. Co., LLC. All rights reserved. IMS-511/0713