Infection Control PDF

7/27/2019 Infection Control PDF

1/102

Dr Sara Sarraj


2/102

Both patients and dental personnel can be

exposed to pathogens

Contact with blood, oral and respiratory

secretions, and contaminated equipmentoccurs

Proper procedures can prevent transmission

of infections to patients and dental Team.


3/102


4/102

Pathogen:sufficient virulence & adequate

numbers

Source:fertile soil for germ growth

Mode: pathway of transmission from source tohost

Entry: Portal of the pathogen

Susceptible host: Host with deficient immune

system The pathway of disease transmission between

people is referred to as the chain of infection


5/102

Direct transmission primary exposure

Needle-stick and sharps injuries

Injury from an instrument during a procedure

Spray or debris entering the eye

Bacterial aerosol and splatterduring a procedure

Unprotected skin

Indirect transmission secondary exposure

Contaminated instruments

Contaminated surfaces and equipment

Bacterial aerosol


6/102

Invisible particles 5nm-50nm

Suspended in the air and breathed for hours

May carry respiratory infectious agents

No evidence for transmission of blood borneinfection such as HBV,HIV


7/102

Almost 50nm

Become visible in a beam of light

Settled after 5-15 minutes

Mist+aerosol can transmit active tuberclosis


8/102

Particles>50nm,visible splashes,

3feet from patient mouth,therefore can cover face

and garment of attending dental team

Source of blood borne pathogens


9/102

Dentistry as it mayhave been practiced inthe past. Rotaryinstrumentation canexpose personnel to

heavy spatter of morethan 50-mm particlesand mists. Aerosolparticles of less than 5mm remain suspendedand can reach the

alveoli if not stopped bya barrier. Airpurification is agrowing concern.


10/102

Assume all patients are potentially infectious

Infection control policies are determined by

the procedure, not the patient


11/102

Handwashing

Using personal protective equipment

Handling contaminated materials/equipment to

prevent cross contamination Cleaning/disinfecting environmental surfaces

Using engineering/work practice controls

Respiratory hygiene/cough etiquette

Safe injection practices


12/102

Used with standard precautions to interruptthe spread of certain pathogens

Three types

Airborne (TB)

Droplet (>5 microns) (Influenza)

Contact (Herpes)


13/102

Varicella

Measles

Mumps

Rubella Influenza

Hepatitis B


14/102

Policies should encourage personnel to

seek care & report their illnesses


15/102

Standard Precautions

Engineering Controls

Work Practice Controls

Post-exposure Management and Prophylaxis


16/102


17/102

3 dose vaccine

Check for antibodies 1-2 months after third

dose

Revaccinate DT(Dental Team) who do notdevelop adequate antibody response

Booster doses of vaccine and periodic

serologic testing to monitor antibody

concentration after completion of the vaccineseries are not recommended for vaccine

responders


18/102

Safe

Effective

Long lasting


19/102

Controls that isolateor remove thebloodbornepathogens hazardfrom the workplace

Commonly used incombination withwork practicecontrols and Personalprotective equipment(PPE)to preventexposure

Follow local policy


20/102

Handling Syringes

Practices incorporatedinto the everyday work

routine that reduce the

likelihood of exposure

by altering the mannerin which a task is

performed


21/102


22/102

Specify: eye, mouth,other mucousmembrane, non-intactskin or parenteralcontact with

blood/OPIM (includingsaliva in dentalsettings) resulting fromperformance duties

Establish procedure forreporting andevaluating exposureincident


23/102

Mucous membrane contactSplash to the eyes, nose or mouth

Percutaneous inoculationMisuse of sharps (broken glass, needles, scalpels,

dental bur, knife)

Exposure to broken/damaged skinRisk increases if contact involves a large area of

broken/damaged skin or if contact isprolonged

* Risk increases with high titer levels in the source


24/102

Source Risk (%)

HIV 0.3

Hepatitis C 1.8

Hepatitis B 3.0


25/102

Clean wounds with soap and water

Flush mucous membranes with water

No evidence of benefit for:

application of antiseptics or disinfectants

squeezing (milking) puncture sites

Avoid use of bleach and other agents caustic

to skin


26/102

Date and time of exposure

Procedure detailswhat, where, how, with

what device

Exposure details...route, body substanceinvolved, volume/duration of contact

Information about source person

Information about the exposed person

Exposure management details


27/102

Immediate evaluation & follow-up completedby a qualified health-care professional

After each incident review circumstances

surrounding the injury & the post-exposure

plan

Provide training to implement changes as

needed


28/102

Report all needle stick and sharps-relatedinjuries promptly to ensure that you receive

appropriate follow-up care.

Tell your employer about any sharps hazards

you observe.

Participate in training related to infection

prevention.

Get a Hepatitis B vaccination.


29/102

Skin: Do not squeeze(Milk) the wound to bleedit, do not put the pricked finger in mouth.Wash with soap &water, dont scrub, noantiseptics or skin washes (bleach, chlorine,

alcohol, betadine). Eye: wash with water/ normal saline/ dont

remove contact lens immediately if wearing,no soap or disinfectant.

Mouth: spit fluid immediately, repeatedly rinsethe mouth with water and spit / no soap/disinfectant.


30/102

Evaluation must be made rapidly so as to starttreatment as soon as possible-ideally within2hours but certainly within 72 hours ofexposure. However all exposed cases dont

require prophylactic treatment. Factors determining the requirement of( post

exposure prophylactic)PEP-

Nature/Severity of exposure and risk of

transmission HIV status of the source of exposure

HIV status of the exposed individual


31/102

HBV vaccination is recommended for allhealthcare workers (unless they are immune

because of previous exposure). HBV vaccine

has proven to be highly effective in preventing

infection in workers exposed to HBV. However,no vaccine exists to prevent HCV or HIV

infection.


32/102

Eliminate or reduce the use of needles andother sharps

Use devices with safety features to isolate

sharps

Use safer practices to minimize risk for

remaining hazards


33/102


34/102


35/102


36/102


37/102

1.When hands are visibly contaminated 2.Before and after treating each patient (e.g.,

before glove placement and after gloveremoval)

3.After barehanded touching of Lifelessobjects likely to be contaminated by blood orsaliva

4.Before re-gloving ,after removing gloves that

are torn, cut, or punctured 5.Before leaving the dental operatory, dental

laboratory, or instrument processing area


38/102

When hands are visibly dirty, contaminated, orsoiled

non-antimicrobial or antimicrobial soap &

water (rub hands together for a minimum of 15

seconds)

use of liquid soap (vs. bar soap) and hands-

free dispensing controls is preferable


39/102


40/102

If hands are not visibly soiled non-antimicrobial or antimicrobial soap &

water (rub hands together for a minimum of 15

seconds)

or

alcohol-based hand rub (rub hands until dry)


41/102

Before an oral surgicalprocedure: antimicrobial soap and

water; scrub hands andforearms for length oftime recommended by

manufacturer (usually 2-6minutes) or

alcohol-based hand rubwith persistent activity:before applying, pre-washhands & forearms withnon-antimicrobial soap;follow manufacturerrecommendations


42/102

Keep fingernailsshort with smooth,

filed edges to allow

thorough cleaning

and to prevent glove

tears


43/102

Protects the skin &mucous membranes

of the eyes, nose,

and mouth from

exposure to blood

or OPIM

Use of PPE is

dictated by theexposure risk, not

the patient


44/102

Masks and Protective Eyewear

1.Wear a surgical mask

and protective eyewear

with solid side shields to

protect mucousmembranes of the eyes,

nose, & mouth

2.Change masks

between patients, orduring treatment if it

becomes wet


45/102

A face shield may substitute for protectiveeyewear,but not masks

Clean protective eyewear with soap & water or

if visibly soiled, clean & disinfect between

patients


46/102

Other potentionaly infectious

materials (OPIM)Clinical Gowns

Wear long-sleevedreusable or disposablegowns, clinic jackets,or lab coats to protectskin of the forearms

and clothing likely to besoiled with blood,saliva, or OPIM

Change immediately ifvisibly soiled


47/102

1. The following human body fluids:

Cerebrospinal fluid (fluid surrounding the brain and spinal cord)

Synovial fluid (fluid surrounding bone joints) Pleural fluid

Pericardial fluid

Peritoneal fluid

Amniotic fluid

Saliva in dental procedures

Any body fluid that is visibly contaminated with blood All body fluids in situations where it is difficult or impossible to differentiate

between body fluids

2. Any unfixed tissue or organ (other than intact skin) from a human, or non-human primate (living or dead).

3. HIV-containing cell or tissue cultures, organ cultures, and HIV or HBV-containing culture medium or other solutions, and blood, organs or othertissues from experimental animals infected with HIV or HBV.

4. Any pathogenic microorganism

5. Human cell lines


48/102

Long-sleeved protective clothing is indicatedwith

Use of handpieces

Sonic/ultrasonic scaling

Manipulation using sharp cutting instruments

(e.g., perio surgeries, prophies)

Spraying air and water into a patients mouth

Oral surgical procedures Manual instrument cleaning


49/102

Wear when potentialexists for contacting

blood, saliva, OPIM, or

mucous membranes

Gloves DO NOT replacethe need for hand

hygiene

Wash hands before

donning gloves and

upon glove removal


50/102

Vinyl, nitrile, or latex examination gloves mustbe worn when treating nonsurgical patients


51/102


52/102

Do not wash glovesbefore use or for

reuse

Remove gloves that

are cut, torn, or

punctured


53/102

Sterile disposablegloves must be

worn during all

surgical procedures


54/102

PPE/Laundry

Remove all PPE before

leaving the work area

Do not store

contaminated clothing orPPE in lockers or offices

Place contaminated

laundry in an

appropriately labeledcontainer


55/102

Instrument

Processing

Cleaning

minimize exposure

potential

Use carrying containersto transport

contaminated

instruments from the

operatory to theinstrument processing

area

I t t P i


56/102

Instrument Processing

Cleaning

Wear puncture- and chemical-

resistant heavy duty utility

gloves for instrument

cleaning & decontamination

proceduresWear a mask, protective

eyewear, and long-sleeved

protective clothing when

splashing/spraying isexpected during cleaning


57/102

Clean it First

Clean all visible bloodand other

contamination from

dental instruments

and devices before

sterilization

procedures

Ultrasonic Cleaner


58/102

Automatedequipment ispreferable tomanual hand

scrubbing If hand scrubbing is

unavoidable, usework practice

controls (e.g., longhandled brush) &PPE

VS


59/102

Before heatsterilization, inspect

instruments for

cleanlinessWrap or place in

packages to maintain

sterility during

storage


60/102

Use FDA-clearedmedical devices Steam autoclave

Dry Heat

Unsaturated ChemicalVapor

Do not overload thesterilizer

Allow packages todry in the sterilizerbefore handling


61/102

Mecahnical Chemical

Biological


62/102

for monitoring sterilization include assessing the cycle time,

temperature, and

pressure of sterilization equipment by observing

the gauges or displays on the sterilizer.

Some tabletop sterilizers have recording devices

that print out these parameters. Correct readings do

not ensure sterilization, but incorrect readings

could be the first indication that a problem hasoccurred with the sterilization cycle.


63/102

Internal and external, use sensitive chemicals to assess physicalconditions such as temperature during the sterilization process.Chemical indicators such as heat sensitive tape change colorrapidly when a given parameter is reached. An internal chemicalindicatorshould be placed in every sterilization package to ensurethe sterilization agent has penetrated the packaging material andactually reached the instruments inside. An external indicator

should be used when the internal indicator cannot be seen fromoutside the package. Single-parameter internal indicators provideinformation on only one sterilization parameter and are availablefor steam, dry heat, and unsaturated chemical vapor. Multi-parameter internal indicators measure 23 parameters and canprovide a more reliable indication that sterilization conditionshave been met. Multi-parameter internal indicators are only

available for steam sterilizers (i.e., autoclaves). Refer tomanufacturer instructions for proper use and placement ofchemical indicators.


64/102

Indicator test results are shown immediately afterthe sterilization cycle is complete and could

provide an early indication of a problem and where

the problem occurred in the process. If the internal

or external indicator suggests inadequateprocessing, the item that has been processed

should not be used. Because chemical indicators

do not prove sterilization has been achieved, a

biological indicator (i.e., spore test) is required.


65/102

are the most accepted means of monitoring thesterilization process because they directlydetermine whether the most resistantmicroorganisms (e.g., Geobacillus or Bacillusspecies) are present rather than merely determine

whether the physical and chemical conditionsnecessary for sterilization are met. Because sporesused in BIs are more resistant and present ingreater numbers than are the common microbial

contaminants found on patient care equipment, aninactivated BI indicates that other potentialpathogens in the load have also been killed.


66/102

Use an internalchemical indicatorin every package. Ifthe internal

indicator is notvisible from theoutside, then use anexternal indicator

Inspect indicator(s)after sterilization &at time of use


67/102


68/102

Use biological indicators (spore tests) at leastweekly

Autoclave/chemiclaveGeobacillus

stearothermophilus

Dry heat

Bacillus atrophaeus


69/102

Whenever a new type of packaging material ortray is used.

After training new sterilization personnel.

After a sterilizer has been repaired.

After any change in the sterilizer loading

procedures.


70/102

Expiration date

package and its contents

remain sterile until some

event (e.g., the packaging

becomes wet or torn) causesthe item(s) to become

contaminated


71/102

A surfacecontaminated from

patient materials

either by direct spray

or spatter generatedduring dental

procedures or by

contact with DTs

gloved hands


72/102

Use surface barriersto protect clinical

contact surfaces,

especially those

that are difficult toclean

Change barriers

between patients


73/102

Clean and disinfectclinical contact

surfaces that are not

barrier-protected using

an EPA-registered

intermediate level

(tuberculocidal)

disinfectant after each

patient


74/102

Clean housekeepingsurfaces on a

routine basis

depending on

nature of surfaceand contamination

& when visibly

soiled


75/102

Solid waste that is soaked or saturated withblood or saliva (e.g., gauze saturated with

blood following surgery)

Items that are caked with dried blood or OPIM

capable of releasing these materials duringhandling

Extracted teeth

Surgically removed hard & soft tissues

Contaminated sharp items


76/102

Use water thatmeets standards setby the EPA fordrinking water

(fewer than 500CFU/mL ofheterotrophic waterbacteria) for non-

surgical dentaltreatment outputwater


77/102

Benefits Water Bottle

Allows daily draining

and air purging if

indicated

Allows application ofperiodic &/or

continuous chemical

germicides


78/102

Between patients,discharge water andair for a minimum of20-30 seconds fromany dental deviceconnected to thedental water systemthat enters thepatients mouth (e.g.,

handpieces,ultrasonic scalers,air/water syringe)


79/102

In-office testing with self-contained test kits Water laboratory testing using Method 9215

Test each unit quarterly or according to

manufacturer instructions


80/102


81/102

Screen all patients for latex allergy Develop policies & procedures for evaluation,

diagnosis, and management of DT withsuspected or known occupational contact

dermatitis Obtain a definitive diagnosis by a qualified

health-care professional (allergist,dermatologist) for any DT with suspected latexallergy

Have emergency treatment kits with latex-freeproducts available


82/102


83/102

Clean & heat sterilize all

headpieces and other

intraoral instruments that

can be removed from the

air and waterlines of the

dental unit between

patients


84/102

Standard precautions Hand hygiene

Personal protectiveequipment

Clean and intermediate-level disinfect alllaboratory items beforeentering the dental lab

Heat sterilize any items

used intra orally or oncontaminatedappliances


85/102

PROVIDERDENTAL LAB


86/102

StandardPrecautions

Hand hygiene

PPE (gloves at a

minimum) Clean & disinfect

equipment orbarrier-protect

Heat sterilizeaccessories (filmholding devices)


87/102

Transport andhandle exposed

radiographs in an

aseptic manner to

preventcontamination of

developing

equipment


88/102

Equipment difficult, if notimpossible, to clean and

disinfect

Barrier-protect clinical

contact surfaces


89/102

Barriers do notalways protect theitem from potentialcontamination

Presently, these itemsare not heat-tolerant

At a minimum barrierprotect and clean &disinfect with an

intermediate leveldisinfectant afterbarrier removal


90/102

Biopsy Leakproof Container

During transport,place biopsy

specimens in a

sturdy, leakproofcontainer labeled

with the

biohazard symbol


91/102

Regulated medicalwaste (unless

returned to the

patient)

Do not disposeextracted teeth

containing amalgam

in regulated medical

waste intended for

incineration


92/102

Assess all patientsfor history of

tuberculosis

Most common

symptom persistent/

productive cough

Defer elective dental

treatment untilnoninfectious


93/102

If patient must betreated:

Separate from other

patients (have them

wear a mask)

Refer to area/facility

with proper air

handling Staff to wear fit-

tested N-95 mask


94/102

Incision, excision, or reflection of tissuethat exposes normally sterile areas of

the oral cavity

Examples include: biopsy, periodontal

surgery, implant surgery, apical surgery,& surgical extractions of teeth


95/102

Sterile surgeons glovesSterile

irrigating

solutions

Surgical

handantisepsis


96/102

Conventional dental units cannot reliablydeliver sterile water even with an independent

water reservoir

Use a sterile irrigating syringe, sterile single-

use disposable tubing, sterilizable tubing orsterile water delivery systems


97/102

Reduce the level oforal microorganisms

in aerosols & spatter.

and Improves

healing. May be most useful

before procedures

using a prophy cup or

ultrasonic scaler orbefore surgical

procedures


98/102

Use single-usedevices for one

patient only and

dispose of

appropriately Do not clean &

sterilize for reuse


99/102

Effective infection-control strategies aredesigned to prevent disease transmission &

must occur as routine components of practice.

Proper procedures can prevent transmission

of infections to patients and DT.


100/102

Ounce of prevention is better than pounds of cure


101/102

Think prevention


102/102

Exam at 11 am Saturday

10H 3&4

NB66

Documents

Infection Control PDF