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Infectioncontrolinthedentalclinic 140917140103 Phpapp02 PDF
Infectioncontrolinthedentalclinic 140917140103 Phpapp02 PDF
Entry Mode
(of transmission
(portal that the from source to host)
pathogen can
enter the host)
Definitions:
CDC:
Center of Disease Control and Prevention .
ADA:
American Dental Association.
ADAA:
American Dental Assistants Association.
OSHA:
Occupational Safety and Health Administration.
OSAP:
Organization for Safety and Asepsis Procedures.
EPA:
Environmental Protection Agency.
FDA :
Food and Drug Administration.
NIOSH:
National Institute for Occupational Safety and Health.
Why , Who and what
1) Hand washing
2) Gloves
3) Face masks
4) Protective eye wear
5) protective clothing
6) instrument sterilization and disinfection
Diseases Transmission in Dental Office
Diseases Transmission in Dental Office
The dental office should have an infection control program to prevent the
transmission of disease from the following :
Patient to dental team
Dental team to patient
Patient to patient
Dental office to community ( include dental team’s family )
Community to dental office to patient
1. IMMUNIZATION
2. PATIENT SCREENING
3. HAND WASHING
4. BARRIER TECHNIQUES -
• Personal Protective Equipment (PPE)
• Rubber dam, Pre-procedural rinsing
5. NEEDLE & SHARP INSTRUMENT SAFETY
• Occupational Exposure To Blood/Body Fluids
7. SURFACE DISINFECTION
8. radiographic asepsis
9. laboratory asepsis
10. infectious dental waste management & disposal
Modes of Diseases Transmission
Direct contact with blood or body fluids
Indirect contact with a contaminated
instrument or surface
Contact of mucosa of the eyes, nose, or
mouth with droplets or spatter
Inhalation of airborne microorganisms
A) Infection Control during the Pretreatment
Period
• It is the period of protective equipment :
An essential pretreatment procedure is the preparation
of all personnel involved in patient care. This includes
the utilization of personal protective equipment (gown,
eyewear, mask and gloves) and hand hygiene.
Infection Control During the Pretreatment Period
The process of infection control begins during the period of
preparation for clinical treatment. Paying attention to infection
control at this time has several payoffs. In addition to reducing the
risk of transmission of infectious agents during patient care,
thinking ahead will make the treatment session more efficient and
will also make the post treatment infection control process easier
and more effective.
1. Remove unnecessary items from the dental procedure area :
The dental procedure area should be arranged to facilitate a
thorough cleaning following each patient.
2. Preplan the materials needed during treatment.
Set out all instruments, medications, impression materials,
and other items that are needed for a procedure. Thinking
ahead minimizes the need to search for additional items or to
enter cabinets and drawers once gloves have become
contaminated.
3. Utilize disposable items whenever possible :
The use of disposable items saves time during cleanup
and decontamination and solves the problem of proper
reprocessing.
4. Use prearranged tray set-ups for routine or frequently
performed procedures.
Helps to eliminate the need to go into cabinets once you have
started a procedure.
5. Use individualized, sterilized bur blocks for each procedure
. Using individualized bur blocks containing only the burs required
for that procedure helps to eliminate the contamination of other,
unneeded burs and to make clean-up easier.
6. If indicated, have the rubber dam setup on the tray.
When a rubber dam will be used during a clinical procedure, it
also should be included on the tray setup. In addition, include
those items needed for high-velocity evacuation.
7. Identify those items that will become contaminated during
treatment.
While preparing the dental procedure area prior to beginning a
clinical procedure, consider which items will become
contaminated during treatment. Examples of such surfaces include
countertops, light handles, X-ray unit heads, tray tables etc. Decide
whether to use a barrier, e.g., plastic wrap to prevent
contamination of these surfaces and items or to disinfect them
when the procedure is complete.
8. Review patient records before initiating treatment and place
radiographs on the view box.
Do not leave the record on the countertop or handle it after
beginning treatment. Place the record in a drawer or out of the
dental procedure area, so that it doesn’t become contaminated.
Entries into the record should be done before and after the
procedure.
9. Prepare personnel involved in patient care.
An essential pretreatment procedure is the preparation of all
personnel involved in patient care. This includes the utilization of
personal protective equipment (gown, eyewear, mask and gloves)
and hand hygiene.
A .Handwashing and hand care :
According to the U.S. Centers for Disease
Control (CDC) , hand washing is the single most
important procedure for preventing the spread of
infection. So , you must wash your hands each time
before you put on gloves and immediately after you
remove gloves . Handwashing is also required if you
touch contaminated instruments or surfaces during
working .
We should always use liquid soap during handwashing
. Bar soap should never be used because it may
transmit contamination .
Hands Need to be Cleaned When
• Visibly dirty
• After touching
contaminated objects with
bare hands
• Before and after patient
treatment (before glove
placement and after glove
removal)
Personal protective equipment ( PPE )
OSHA requires the employer to provide employees
with appropriate personal protective equipment .
Examples of PPE :
1- Protective clothing
2- Surgical masks
3- Face shields
4- Protective eyewear
5- Disposable patient treatment gloves , and
6- Heavy-duty utility gloves .
These PPE must be used whenever
you :
• Performing tasks that could produce
splash or spatter .
• Any contact with body fluids
• Perform other clinical activities that
require handling contaminated items e.g.
radiographs , impressions , dentures or
contaminated equipment and surfaces .
We will study 4 aspects of each
one of these equipments :
1) Laboratory coats
2) Gown
3) Surgical scrubs
Guidelines for the use of protective clothing
1) It should not be worn out of the office for any reason .
2) Change these work clothes at least daily, or more often
if soiled, especially if they become visibly contaminated
with blood.
3) It must not be worn during eating or in resting rooms .
4) It should be washed and laundered separately .
Protective clothing requirements :
1) Should be made of fluid-resistant material ( cotton ,
cotton/polyester, or disposable jackets or gowns .
2) Clothing should have long sleeves and a high neckline
to minimize the amount of uncovered skin .
3) Must cover dental personnel at least to the knees
when seated
2) Protective masks :
Purpose the mask worn over the nose and mouth to
protect the person from inhaling infectious organisms
spread by the aerosol spray of the handpiece or air-water
syringe .
Types the two most common types of masks are the
dome-shaped and flat types .
Examination gloves
2) Overgloves are made of lightweight , inexpensive ,
clear plastic . Overgloves may be worn over contaminated
treatment gloves ( overgloving ) to prevent
contamination of clean objects ( telephone , pen ,opening
drawers and cabinets ) that may be handled during
treatment . Overgloves are discarded after a single use .
Chair Drapes
Film Dispenser
Some plastic bags are specially designed to the shapes of
the dental chair , air-water syringe , and light handles .
Sticky tape as a plastic barrier is frequently used to
protect smooth surfaces , such as electrical switches on
chairs and x- ray unite
Infection Control During the Post-Treatment
Period
1. Continue to wear personal protective equipment during
clean-up: After patient care is completed, begin the
cleaning and disinfection process by removing
contaminated gloves used during treatment, wash your
hands and use the utility gloves before beginning the
clean up. Continue to wear protective eyewear, mask,
and gown.
2. Remove all disposable barriers : All of the barriers
placed before treatment, including light handle covers
and countertop barriers, should be removed.
3. Clean and disinfect all items not protected by barriers.
Cleaning and disinfection of the dental treatment room
surfaces are important components in an effective
infection control program .
Precleaning
Precleaning means that all contaminated surfaces must be
precleaned before they can be disinfected . Precleaning
reduces the number of microbes and remove blood , saliva
, and other body fluids .
Precleaning techniques are most effective when
used on contaminated surfaces that are smooth and easily
accessible for cleaning .
Materials used for precleaning regular soap and water
always used for precleaning . However , a disinfectants
that can cleans as well as disinfect are present today .
Disinfection
Disinfection is directed to kill disease-causing
microorganisms that remain on the surface after
precleaning .
Sterilization monitoring
Because sterilization failure can occur at any time, it is
critical to determine that dental instruments are properly
sterilized or not because microorganisms can not be seen
by naked eye.
Nowadays, three forms for sterilization monitoring are
used :
Process indicators
This is used externally outside the instruments packages
like autoclave tape and color change marking. Its aim is to
determine if the package is processed or not.
They simply identify instrument packs that have been
exposed to a certain temperature.
They do not measure the duration or the pressure. They
are useful only in distinguishing between packages that
were processed and those that were not processed. This
can prevent accidental use of unprocessed instruments.
Process integrators
Process integrators are placed inside instrument
packages. They respond to a combination of pressure,
temperature, and time. All sterilization factors are
integrated. Examples of process integrators include
strips, tabs, or tubes of colored liquid.
Biologic monitoring
This is the best way to determine if sterilization has
occurred.
Biologic monitoring , or spore testing, is the only way to
determine if sterilization has occurred. The CDC, American
Dental Association recommend at least weekly biologic
monitoring of sterilization equipment .
Biologic indicators (BIs), also known as spore tests, are
vials or strips of paper that contain harmless bacterial
spores (spores are highly resistant to heat).
Method :
Three BIs are used in testing. Two BIs are placed inside
instrument packs, and the sterilizer is operated under
normal conditions.
The third strip is set aside as a control. After the load has
been sterilized, all BIs are cultured. If the spores survive
the sterilization cycle (a positive culture), a sterilization
failure has occurred. If the spores are killed (a negative
culture), the sterilization cycle was successful.
Sterilization in the dental office :
The three most common forms of heat sterilization in the
dental office are :
Steam sterilization,
Chemical vapor sterilization, and
Dry heat sterilization.
1) Steam sterilization : involves heating water to
generate steam, producing a moist heat that
rapidly kills microorganisms. As the steam
completely fills the sterilizing chamber, the
cooler air is pushed out of an escape valve,
which then closes and allows the pressure to
increase which increase the temperature
reaches up to 120 C which is higher than boiling
water . It is the heat, not the pressure that
actually kills the microorganisms.
A disadvantage of steam sterilization is that the moisture
may cause corrosion on some high-carbon steel
instruments. Distilled water should be used in autoclaves
instead of tap water, which often contains minerals and
impurities. Distilled water can minimize corrosion and
pitting.
0peration cycles :
Dental office steam sterilizers usually operate through four
cycles :
1) heat-up cycle 2) sterilizing cycle
3) depressurization cycle 4) drying cycle
Flash Sterilization
involves sterilizing unpackaged instruments using short
exposure times. The instruments are placed in the
chamber unwrapped. The sterility of the instruments is
defeated immediately when the instruments are
removed from the sterilizer.
Flash sterilization should be used only for instruments
that are to be used promptly on removal from the
sterilizer.
Dry-heat Sterilizers
Dry-heat sterilizers operate by heating air and transferring
that heat from the air to the instruments. This form of
sterilization requires higher temperatures than steam or
chemical vapor sterilization . temperature ranges between
(160 C to 190 C) .
The total cycle time :
placing instruments in oven, heating to 170 C, timing for 1
hour, and then cooling it from 2–2.5 hours .
The advantage of dry heat is that the instruments will not
rust if they are thoroughly dry before they are placed in
the sterilizer.
The disadvantage of dry heat is the risk of damaging
plastic and rubber instruments and also it need long time .
Chemical liquid sterilization