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The Puzzle of OSHA Compliance and Infection Control in the Dental Laboratory
•The Bloodborne Pathogen Standard:29 CFR 1910.1030 1991/2001
•The Hazard Communication Standard:29 CFR 1910.1200 1989/1994/1998
•The “Hazard Assessment” Standard(s):29 CFR 1910.132-138
•Infection Control Recommendations
The Puzzle of OSHA Compliance in the Dental Laboratory
Kevin Plummer DDS
OSAP 2014 Symposium 1
Rules vs. Recommendations
•Federal Laws = RulesØOSHA
üProtect Employees
•Infection Control Recommendations = Standards of Care
ØCenters for Disease Control and PreventionØAmerican Dental Association
üProtect Patients/Employees
• Publication Date: 12/06/1991• Publication Type: Final Rules• Fed Register #: 56:64004• Standard Number: 1910.1030• Title: Final Rule on Occupational Exposure to Bloodborne Pathogens
Dental Laboratory Infection Control
• Set the policy• Enforce the policy• Communicate the
policy
• Know the policy• Comply with the policy• Communicate about the
policy
Lab Personnel
Lab Customer
Kevin Plummer DDS
OSAP 2014 Symposium 2
Dental Laboratory Infection Control
The standard infection controlprocedures in a dental laboratorymust be known to the clientsusing the facility.
Laboratory Policies
Likewise, the laboratory must be aware of the infection control philosophy used by its clients
Dental Laboratory Infection Control
Dental laboratories should ensure that clientsreceive a written guide on the requirementsfor submitting work to the laboratory.
Communication is essential because, whileinfection control is very important, mostmaterials should be handled and/or disinfectedonly once to prevent damage and possible distortion of prosthodontic materials.
Laboratory Policies
Kevin Plummer DDS
OSAP 2014 Symposium 3
At the same time,infection controlprocedures cannotbecome one of the“Its Not My Job”categories in theoffice or the lab.
Dental Laboratory Infection Control
• Dental Materials• Equipment in Lab and Operatory
• Sterilization v.s. Disinfection
• Use of Laboratory• Recommendations v.s. Regulations and Laws
Specific Problems
Kevin Plummer DDS
OSAP 2014 Symposium 4
Dental Laboratory Infection Control
• Prostheses– Repairs– Adjustments
• Impressions• Clinicians and Staff• Dental Laboratory
Sources of Contamination
Dental Laboratory Infection Control
• Wax• Stone• Acrylic• Metals• Hydrocolloids• Vinyl Polysiloxanes• Polyether
Dental Materials
Kevin Plummer DDS
OSAP 2014 Symposium 5
Dental Laboratory Infection Control• Articulators• Lathe• Water Bath• Facebows• Shade & Mold Guides• Impression Trays• Rag Wheels• Flame Sources
Equipment
Dental Laboratory Infection Control
Clean Labs - All infection control procedures done in the patient care area or clinic
Dirty Labs - All infection control
procedures done in the laboratory
Dental Laboratories canbe operated as:
Basic Laboratory Operations
Plummer, K.D. and Wakefield C.W. Practical Infection Control in Dental Laboratories. General Dentistry, 1994, Volume 42, #6:545-548.
Kevin Plummer DDS
OSAP 2014 Symposium 6
Dental Laboratory Infection Control
A case receiving area is designated for infection control procedures.
“Dirty” Laboratory Operation
Dental Laboratory Infection Control
A case receiving area is designated for infection control procedures.
“Dirty” Laboratory Operation
All materials entering the production area must be properly disinfected prior to using the laboratory’s production facilities.
Kevin Plummer DDS
OSAP 2014 Symposium 7
Dental Laboratory Infection Control
• Personnel in the case receiving area must use gloves and other proper personal protective equipment (PPE)
• If work is done in the production area on any case that may be “dirty” employees must wear proper PPE
“Dirty” Laboratory Operation
Dental Laboratory Infection Control
• Receiving areas should be disinfected before using the same area for packing and shipping
• Permanent receiving areas should be cleaned and disinfected daily
“Dirty” Laboratory Operation
Kevin Plummer DDS
OSAP 2014 Symposium 8
Sink
Receiving
UnpackingDecontamination
Distribution
Eyewash
Dental Laboratory Infection Control
Large commercial laboratories and laboratoriesreceiving work of an unknown contamination
status should usethe “dirty” conceptof Infection Control
?
“Dirty” Laboratory Operation
Kevin Plummer DDS
OSAP 2014 Symposium 9
Dental Laboratory Infection Control
• All items entering laboratory are cleaned and disinfected before arrival (in the operatory)
• Enforcement - Bare Hands Concept
“Clean” Laboratory Operation
Dental Laboratory Infection Control
• All items entering laboratory are cleaned and disinfected before arrival
• Enforcement - Bare Hands Concept
“Clean” Laboratory Operation
Kevin Plummer DDS
OSAP 2014 Symposium 10
Dental Laboratory Infection Control
• STERILIZATION: Destruction of all microbial life forms to include spores
• DISINFECTION: Inhibition or destruction of most microbial pathogens
• CLEANING: Removal of visible contamination
Definitions
Dental Laboratory Infection Control
• EPA/FDA Registered As:– tuberculocidal*– virucidal**– hospital level***
* kills mycobacterium tuberculosis** kills hydrophilic & lipophilic viruses*** kills staff aureus, salmonellatyphimurium, & pseudomonasaeruginosa
Chemical Disinfectants
Kevin Plummer DDS
OSAP 2014 Symposium 11
Dental Laboratory Infection Control
• Use according to the manufacturer’s instructions
• Hazard Communication Training
Disinfectants and the Dental Laboratory
• EPA registered/ number on label
Dental Laboratory Infection Control
• Use according to the manufacturer’s instructions
• Hazard Communication Training
Disinfectants and the Dental Laboratory
• EPA registered/ number on label
Kevin Plummer DDS
OSAP 2014 Symposium 12
Dental Laboratory Infection Control
• Concentration and nature of the contaminant and microorganism
• Concentration of chemical• Length of exposure time• Amount of bio-burden• Preparation of surface to be disinfected
Disinfectant Effectiveness
Dental Laboratory Infection Control
The "Ideal" Chemical Disinfectant
Non-ToxicBroad Spectrum = Kills Everything
Rapid and Lethal
Easy to U
se
CheapOdorless
Surface Compatib
ility
Fast
Kevin Plummer DDS
OSAP 2014 Symposium 13
Dental Laboratory Infection Control
•Chlorines•Phenols•Quats•Other
Disinfectant Choice
Dental Laboratory Infection Control
•Sodium Hypochlorite
•Chlorine Dioxide
CHLORINES
Kevin Plummer DDS
OSAP 2014 Symposium 14
Dental Laboratory Infection Control
•Other Iodine Products
IODOPHORS
Dental Laboratory Infection Control
•Alcohol Based Phenols Water Based
PHENOLS
Kevin Plummer DDS
OSAP 2014 Symposium 15
Dental Laboratory Infection Control
•New Generation Quats
Dual or Synergized plus alcohol
•Accelerated Hydrogen Peroxide
OTHER CHEMICALS
Dental Laboratory Infection Control
• Time is critical• Detergent/Camel Hair Brush• Scrub with Stone• Disinfect• Use disinfectant with contact time less than 10 minutes
• Chlorine or Idophor
HydrocolloidImpressions
Tullner JB, Commette JA, Moon PC. Lineardimensional changes in dental impressionsafter immersion in disinfectant solutions. JProsthet Dent 1988;60:725-8.
Goodacre C, etal. Effect of disinfection on irreversible hydrocolloid and alternative impression materials and the resultant gypsum casts. J Prosthet Dent 2012;108:250-8.
Kevin Plummer DDS
OSAP 2014 Symposium 16
Dental Laboratory Infection Control
Scrub with detergent and stone, spray with appropriate disinfectant*
Hydrocolloid Impressions
Dental Laboratory Infection Control• Time is not so critical:
– Detergent/Camel Hair Brush– Scrub with Stone– Disinfect
• Use disinfectant compatible with material
• Polyether probably should not be immersed
Other ImpressionMaterials
Kevin Plummer DDS
OSAP 2014 Symposium 17
Dental Laboratory Infection Control
• Detergent and brush• Use disinfectant compatible with material
• Spray and hold or soak* for proper time
• Non-heated ultrasonic cleaner OK (not wax)
*even preferred for acrylics
Restorations and Interim Objects
Chau V, Saunders T, Pimsler M, Elfring D. In-depth disinfection of acrylic resins. J Prosthet Dent 1995;74:309-13.
Dental Laboratory Infection Control
Paper towel reline This is not custom acrylic tinting
Exceptions to the Rules
Kevin Plummer DDS
OSAP 2014 Symposium 18
Dental Laboratory Infection Control
Isolated and ready for ultrasonic
Exceptions to the Rules
Soaking after proper cleaning
Dental Laboratory Infection Control
• Careful handling to avoid surface damage
• Spray with disinfectant, drain, cover
• Soak in clear slurry water with sodium hypochlorite added
• Disinfect impression is the better option
• Barrier protect cast
Dental Casts
Kevin Plummer DDS
OSAP 2014 Symposium 19
Dental Laboratory Infection Control
• Chemical disinfection before placing in patient’s mouth• Use aseptic technique during chairside adjusting
• Clean and disinfect before using laboratory equipment
• Clean/disinfect before placing back in patient’s mouth
Prosthodontic Restorations
Dental Laboratory Infection Control
• New v.s. disinfected cases and pumice
• Pumice in general• Polishing machines• Pressure pots• Lab benches• Personal Protective Equipment
But what about?
*Schedule
Kevin Plummer DDS
OSAP 2014 Symposium 20
Dental Laboratory Infection Control
• Disinfection is not needed before shipping from lab
• Shipping documents should state cleaning and disinfection is required before placing in patient’s mouth
• All items should be wrapped or bagged to prevent contact with shipping materials
Shipping
Dental Laboratory Infection Control
• First Aid
• Decontaminate Area
• Decontaminate Prosthesis
• Disinfect
• Handle Normally
Accidental Contamination
Kevin Plummer DDS
OSAP 2014 Symposium 21