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Gloves, preferably latex, are worn when there is to be contact with blood and body fluid.

Goggles/masks are worn when there is a danger of splashing or aerosol of blood-contaminated secretions. A plastic apron, or water repellant gown, may be indicated if there is a danger of splashing. Hand washing before and after contact with blood and body fluid, even if gloves are worn. Specimens are treated as biohazard. Refuse and linen are treated as infectious. It is important to establish if the patient is in the acute phase, a carrier, or not. Education of the patient about the disease, is very important, especially in the carrier. by J Pearse

The potentially infectious nature of all blood and body substances necessitates the implementation of infection control practices and policies. In Australia, infection control guidelines have been developed based on the United States Centers for Disease Control and Prevention model, in terms of 'standard precautions' and transmission based precautions. Standard precautions ensure a high level of protection against transmission of bloodborne viruses in the health care setting and the universal application reduces the potential for stigma and discrimination. Standard precautions are the minimum level of infection control required in the treatment and care of all patients to prevent transmission of blood-borne infections including HIV, HBV and HCV. Standard precautions should be implemented universally, regardless of information or assumptions about a patient's infection status. Additional precautions are further measures required to protect against transmission of infections such as tuberculosis. by J Hoy

Risks of Transmission of Blood-borne Pathogens During Dental Procedures Transmission from Patient to Dental Health Care Personnel Generally dental health care personnel are at far greater risk of exposure to blood-borne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), than to transmitting any of these to the patient. The transmission mode for such exposure has been described in the literature as a frequent event and is due primarily to sharps and needle stick injuries. Manipulations without barrier precautions also increase the risk of infection. Adherence to infection control practices and hepatitis B vaccination minimize the risk considerably. One study of a group of 70 dentists in Cairo revealed a seroprevalence of 27.1% for prior exposure to HBV and 7.1% HbsAg positivity; prevalence of anti-HCV was 1.7% for this group.

Transmission from Dental Health Care Personnel to Patient Although the possibility of transmission of blood-borne infections from dental health care personnel to patients is considered to be small, there are several published studies reporting transmission of HBV, HCV, and HIV from dentists to patients mainly due to manipulations without barrier precautions (primarily gloves). Adherence to infection control practices minimizes the risk considerably. Transmission from Patient to Patient. Patient-to-patient transmission of blood-borne pathogens has been reported in several dental settings and is mostly due to poor disinfection and sterilization practices and to lack of disposable instruments. Adherence to infection control practices minimizes the risk considerably.

Hand Hygiene As in any clinical practice setting, hand hygiene plays a central role in the reduction of cross-contamination and in infection control. For most routine dental procedures washing hands with plain, nonantimicrobial soap is sufficient. For more invasive procedures, such as cutting of gum or tissue, hand antisepsis with either an antiseptic solution or alcohol-based handrub is recommended. If available, waterless alcohol handrub/gel could be used in place of handwashing if hands are not visibly soiled.

Indications for hand hygiene

At the beginning of the working day with an antiseptic solution, if available; otherwise, plain non-antimicrobial soap is sufficient. Before donning gloves. Between each patient. After glove removal. After barehanded contact with contaminated equipment or surfaces and before leaving treatment areas. Before and after eating. After using the toilet. At the end of the da

Gloves Properly fitting gloves protect dental health care personnel from exposure through cuts and abrasions often found on the hands. Latex gloves used for patient examinations and procedures are disposable single-use items and must not be used on another patient or washed with detergent. Heavy utility gloves are worn when handling and cleaning contaminated instruments and for surface cleaning and disinfection.

Eyewear Protective eyewear must be worn during procedures that involve splash and spatter of saliva and blood or that have the potential for creating projectiles (e.g., amalgam). Eyewear protects the eyes from damage and from microbes such as hepatitis B virus, which can be transmitted through conjunctiva.

Facemasks Masks serve as barriers in dental procedures to protect the mucous membranes of the nose and mouth from spatter. Dental health care personnel should routinely wear facemasks during dental treatment and should change them when they become wet (i.e., typically between patient treatments). Use a new mask for each patient. Masks should not be worn outside of the dental operatory.

Face shields Face shields serve as barriers to protect the mucous membranes of the eye, nose, and mouth from spatter.

Protective clothing Protective clothing such as reusable or disposable gowns or uniforms should be worn when clothing is likely to be soiled with blood or other body fluids. Clothing typically must have a high neck and long sleeves to protect the arms if splash and spatter occurs. Protective clothing should be changed at least daily and definitely when visibly soiled. Protective clothing must be removed before leaving the workplace. Female dental workers must wear a separate veil for the working area and must change this veil before leaving work. Protective clothing and veils should be washed in the laundry of the health care facility. If there is no laundry present, the attire should be washed separately from other clothing. For additional antimicrobial activity, assuming the fabrics to be washed are not colored or dyed, add bleach (e.g. 0.5%) to the laundry cycle.

Rubber dam Routine use of a rubber dam provides an effective intraoral barrier for both dental health care personnel and patient. Dentistry A rubber dam is primarily used to isolate a tooth or teeth and to keep them dry during a dental procedure. Rubber dams and high volume evacuation also minimize potential spatter during treatment and direct dental health care personnel contact with patients oral mucosa. Rubber dams are effective for reducing microbial contamination at the patients mouth.

Use and Care of Sharp Instruments and Needles Sharp items (e.g., needles, scalpel blades, wires) contaminated with patient blood and saliva should be considered as potentially infective and handled with care to prevent injuries. Used needles should never be recapped or otherwise manipulated utilizing two hands. If needles have to be recapped, a one-handed scoop technique should be employed. Never bend, break, or cut needles before disposal. Used disposable syringes and needles, scalpel blades, and other sharp items should be placed in an appropriate puncture-resistant container located as close as possible to the area in which the items were used.

Cleaning of instruments Before sterilization or high-level disinfection, instruments should be cleaned thoroughly to remove debris. Persons involved in cleaning and reprocessing instruments should wear heavy-duty gloves to lessen the risk of hand injuries. Placing instruments into a container of water or detergent as soon as possible Dentistry after use will prevent drying of patient material and make cleaning easier and more efficient. Cleaning may be accomplished by thorough scrubbing with soap and water or with a detergent solution, or with a mechanical device (e.g., an ultrasonic cleaner). The use of covered ultrasonic cleaners, when possible, is recommended to increase efficiency of cleaning and to reduce handling of sharp instruments. Methods of sterilization No single method of sterilization may be suitable for the range of items used in the dental care. Steam autoclave: Suitable for sterilization of most reusable items and instruments, including dental hand pieces. Dry heat: Dry heat ovens are used in certain clinical settings to sterilize dental instruments, which can become dull and/or corroded when exposed to steam under pressure. The majority of reusable dental instruments are heat stable and can withstand repeated exposures to heat sterilization cycles. Dry heat sterilization is not recommended for most dental hand pieces. Chemical sterilization: There is limited use of chemical sterilization in the dental setting. For heat-sensitive instruments, this procedure may require up to 10 hours of exposure to a liquid chemical agent (e.g., glutaraldehyde). This sterilization process should be followed by aseptic rinsing with sterile water, drying, and, if the instrument is not used immediately, placement in a sterile container.