Disease Transmission and Infection Prevention Chapter 19 Copyright
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Disease Transmission and Infection Prevention Chapter 19 Copyright © 2018, Elsevier Inc. All Rights Reserved. 1
Learning Objectives Lesson 19. 1: Infection and Immunity 1. 2. 3. 4. 5. 6. Pronounce, define, and spell the key terms. Name the links in the chain of infection. Describe the four types of infections. Describe the modes of disease transmission. Describe the types of immunity, and give examples of each. Describe the five ways disease can be transmitted in a dental office. Copyright © 2018, Elsevier Inc. All Rights Reserved. 2
Introduction The dental assistant is at risk of exposure to disease agents through contact with blood and other potentially infectious materials By carefully following infection control and safety guidelines, you can minimize your risk of disease transmission in the dental office Copyright © 2018, Elsevier Inc. All Rights Reserved. 3
The Chain of Infection Consists of six links: Ø Ø Ø Infectious agent Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host Copyright © 2018, Elsevier Inc. All Rights Reserved. 4
Breaking the Chain of Infection From Potter PA, Perry AG, Stockert P, et al: Mosby’s basic nursing, ed 7, St Louis, 2013, Mosby. Copyright © 2018, Elsevier Inc. All Rights Reserved. 5
Infectious Agent A pathogen must be present (e. g. , bacterium, virus, fungus, parasite, prion) Organism must also be virulent Ø Virulence: The degree of pathogenicity, or the strength of the organism in its ability to cause disease Copyright © 2018, Elsevier Inc. All Rights Reserved. 6
Reservoir A place where microorganisms normally live and reproduce Examples: Humans, animals, food, water, bioburden, contaminated surfaces Maintaining excellent hand hygiene and thorough cleaning and disinfection of contaminated surfaces will minimize reservoirs for microorganisms Copyright © 2018, Elsevier Inc. All Rights Reserved. 7
Portal of Entry To cause infection, a pathogen must have a portal of entry (or means of getting into the body) The portals of entry for airborne pathogens are the mouth and nose Blood-borne pathogens must have access to the blood supply to gain entry into the body Ø Ø This occurs through a break in the skin caused by a needle stick, a cut, or even a human bite Can also occur through mucous membranes of nose and oral cavity Copyright © 2018, Elsevier Inc. All Rights Reserved. 8
Susceptible Host A person who is unable to resist infection by the pathogen An individual who is in poor health, chronically fatigued, under extreme stress, or who has a weakened immune system is more likely to become infected Staying healthy, washing hands frequently, and keeping immunizations up-to-date will help members of the dental team resist infection and stay healthy Copyright © 2018, Elsevier Inc. All Rights Reserved. 9
Types of Infections Acute infection: Symptoms are often quite severe and appear soon after the initial infection occurs Chronic infection: The microorganism is present for a long period; sometimes for life Latent infection: Persistent infection in which symptoms come and go (e. g. , cold sores) Ø Oral herpes simplex and genital herpes are latent viral infections Opportunistic infection: Caused by normally nonpathogenic organisms; occurs in individuals whose resistance is decreased or compromised Copyright © 2018, Elsevier Inc. All Rights Reserved. 10
Modes of Disease Transmission Direct transmission Ø Occurs when someone comes into direct contact with the infectious lesion or infected body fluids (e. g. , blood, saliva, semen, vaginal secretions) Indirect transmission Ø Involves the transfer of organisms to a susceptible person through, for example, the handling of contaminated instruments or touching of contaminated surfaces and then touching the face, eyes, or mouth Copyright © 2018, Elsevier Inc. All Rights Reserved. 11
Pathogen Transfer Copyright © 2018, Elsevier Inc. All Rights Reserved. 12
Modes of Disease Transmission (Cont. ) Airborne transmission Ø Also known as droplet infection, involves spread of disease through droplets of moisture containing bacteria or viruses Aerosols, sprays, and spatter Ø Ø Contain saliva, blood, and microorganisms and are created with the use of the high-speed handpiece, air-water syringe, and ultrasonic scaler during dental procedures Mists are droplet particles larger than those generated in aerosol spray Spatter is large droplet particles contaminated with blood, saliva, and other debris Happens during a dental procedure when the mucosa (mouth or eyes) or nonintact skin is splashed with blood or blood-contaminated saliva Copyright © 2018, Elsevier Inc. All Rights Reserved. 13
Other Modes of Transmission Parenteral transmission Ø Blood-borne transmission Ø Involves direct or indirect contact with blood and other body fluids Food and water transmission Ø Can take place through needle stick injuries, human bites, cuts, abrasions, or any break in the skin Occurs when contaminated food that has not been cooked or refrigerated properly or water that has been contaminated with human or animal fecal material is consumed Fecal-oral transmission Ø Occurs when proper sanitation procedures, such as handwashing after use of the toilet, are not followed and one of the many pathogens present in fecal matter is transmitted when the infected person touches another person or makes contact with surfaces or food Copyright © 2018, Elsevier Inc. All Rights Reserved. 14
The Immune System The human body receives resistance to communicable diseases from the immune system A communicable disease is one that can be transmitted from one person to another or by contact with the body fluids from another person Inherited immunity is present at birth Acquired immunity is developed over a person’s lifetime Copyright © 2018, Elsevier Inc. All Rights Reserved. 15
Acquired Immunity From Applegate EJ: The anatomy and physiology learning system , ed 4, St Louis, 2011, Saunders. Copyright © 2018, Elsevier Inc. All Rights Reserved. 16
The Immune System (Cont. ) Naturally acquired immunity occurs when a person has contracted and is recovering from a disease Ø Ø Active immunity Passive immunity Artificially acquired immunity Ø Antibodies are introduced into the body by means of immunization or vaccination Copyright © 2018, Elsevier Inc. All Rights Reserved. 17
Disease Transmission in the Dental Office Every dental office should have an infection control program designed to prevent the transmission of disease from: Ø Ø Ø Patient to dental team Dental team to patient Patient to patient Dental office to community (including dental team’s family) Community to dental office to patient Copyright © 2018, Elsevier Inc. All Rights Reserved. 18
Patient to Dental Team Most common route is through direct contact (touching) of the patient’s blood or saliva Droplet infection occurs through mucosal surfaces of the eyes, nose, and mouth Ø Can occur when the dental-team member inhales aerosol generated by the dental handpiece or airwater syringe Indirect contact occurs when the team member touches a contaminated surface or instrument Copyright © 2018, Elsevier Inc. All Rights Reserved. 19
Patient to Dental Team (Cont. ) Ways to prevent disease transmission from the patient to the dental team member: Ø Ø Ø Gloves Handwashing Masks Rubber dams Patient mouth rinses Copyright © 2018, Elsevier Inc. All Rights Reserved. 20
Dental Team to Patient Very unlikely to happen Can result if the dental team member has lesions on the hands, or if the hands are cut while in the patient’s mouth, permitting the transfer of microorganisms Infection control measures that help to prevent team-to-patient transmission include: Ø Ø Masks Gloves Handwashing Immunization Copyright © 2018, Elsevier Inc. All Rights Reserved. 21
Patient to Patient Has occurred in the medical field, but no cases have been documented in dentistry Although such transmission is possible, contamination from instruments used on one patient must be transferred to another patient for this to occur Infection control measures that can prevent patientto-patient transmission include: Ø Ø Ø Instrument sterilization Surface barriers Handwashing Gloves Use of sterile instruments Copyright © 2018, Elsevier Inc. All Rights Reserved. 22
Dental Office to Community Microorganisms can leave the dental office and enter the community in a variety of ways: Ø Ø Ø Contaminated impressions sent to the dental lab Contaminated equipment sent out for repair In theory, transportation of microorganisms out of the office on the dental team’s clothing or hair The following measures can prevent this type of disease transmission: Ø Ø Ø Handwashing Changing clothes before leaving the office Disinfecting impressions and contaminated equipment before such items leave the office Copyright © 2018, Elsevier Inc. All Rights Reserved. 23
Community to Dental Office to Patient Transmission Microorganisms enter the dental office through the municipal water that supplies the dental unit Ø Ø Waterborne organisms colonize the inside of the dental unit waterlines and form biofilm As water flows through the handpiece, air-water syringe, and ultrasonic scaler, a patient could swallow contaminated water Copyright © 2018, Elsevier Inc. All Rights Reserved. 24
Learning Objectives Lesson 19. 2: CDC and OSHA Regulations 7. Describe the roles of the CDC and OSHA in infection control, including the following: • • • Describe the importance of the OSHA Blood-Borne Pathogens Standard. Describe the components of an OSHA exposure control plan. Explain the difference between Standard Precautions and Universal Precautions. Identify the OSHA categories of risk for occupational exposure. Describe the first aid necessary after an exposure incident. Discuss the rationale for hepatitis B vaccination for dental assistants. Describe the employer’s responsibility regarding employee medical records. Identify the objects that must be placed in the sharps container. Describe ways to prevent needle stick injuries. Copyright © 2018, Elsevier Inc. All Rights Reserved. 25
Roles and Responsibilities of the CDC and OSHA in Infection Control Federal agencies that play important roles in infection control for dentistry: Ø Ø The Centers for Disease Control and Prevention (CDC) The Occupational Safety and Health Administration (OSHA) The CDC is not a regulatory agency Ø Ø Issues specific recommendations based on sound scientific evidence on health-related matters Establishes a standard of care for the dental profession Copyright © 2018, Elsevier Inc. All Rights Reserved. 26
Roles and Responsibilities of the CDC and OSHA in Infection Control (Cont. ) OSHA is a regulatory agency Ø Ø Ø Issues specific standards to protect the health of employees in the United States In 1991, based on the CDC guidelines, OSHA issued the Blood-Borne Pathogens Standard (BBP) As a dental assistant, it is imperative to follow all of OSHA’s guidelines and recommendations Copyright © 2018, Elsevier Inc. All Rights Reserved. 27
CDC Guidelines for Infection Control in Dental Healthcare Settings Released in December of 2003 by the CDC Ø Ø Ø Guidelines expanded upon the existing OSHA Blood-Borne Pathogens Standard and have included some areas that were not already covered Guidelines are based on scientific evidence and are categorized on the basis of existing scientific data, theoretical rationale, and applicability Guidelines apply to all paid or unpaid dental health professionals who might be occupationally exposed to blood and body fluids by direct contact or through contact with contaminated environmental surfaces, water, or air Copyright © 2018, Elsevier Inc. All Rights Reserved. 28
CDC Guidelines for Infection Control in Dental Healthcare Settings (Cont. ) 2016 CDC Dental Infection Prevention Summary Ø In March 2016, CDC issued the 2016 CDC Dental Infection Prevention Summary • • An easy-to-understand/read summary of the 2003 guidelines Includes additional topics and information relevant to dental infection prevention and control since 2003, including the following: Infection prevention program administrative measures Infection prevention education and training Respiratory hygiene and cough etiquette Updated safe infection practices Administrative measures for instrument processing Copyright © 2018, Elsevier Inc. All Rights Reserved. 29
CDC Guidelines for Infection Control in Dental Healthcare Settings (Cont. ) CDC Rankings of Evidence Ø Ø Ø Category IA Category IB Category IC Category II Unresolved issue Copyright © 2018, Elsevier Inc. All Rights Reserved. 30
OSHA Blood-Borne Pathogens Standard (BBP) The most important infection control law in dentistry Ø Ø Designed to protect employees against occupational exposure to blood-borne pathogens, such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) Employers are required to protect their employees from exposure to blood and other potentially infectious materials (OPIM) in the workplace and to provide proper care to the employee if an exposure should occur Copyright © 2018, Elsevier Inc. All Rights Reserved. 31
OSHA Blood-Borne Pathogens Standard (BBP) (Cont. ) The BBP applies to any type of facility in which employees might be exposed to blood and/or other body fluids, which include: Ø Ø Ø Dental and medical offices Hospitals Funeral homes Emergency medical services Nursing homes OSHA requires that a copy of the BBP be present in every dental office and clinic Copyright © 2018, Elsevier Inc. All Rights Reserved. 32
Exposure Control Plan Clearly describes how the office complies with the standard Universal Precautions is referred to in the OSHA Blood-Borne Pathogens Standard Copyright © 2018, Elsevier Inc. All Rights Reserved. 33
Standard and Universal Precautions are based on the concept that all human blood and body fluids (including saliva) are to be treated as if known to be infected with one of the blood-borne diseases, HBV, HCV, or HIV The CDC expanded the concept and changed the term to Standard Precautions Ø Ø Standard Precautions integrate and expand the elements of Universal Precautions into a standard of care designed to protect healthcare providers from pathogens that can be spread by blood or any other body fluid, excretion, or secretion It is not possible to identify those individuals who are infectious, so infection precautions are used for all healthcare personnel and their patients Copyright © 2018, Elsevier Inc. All Rights Reserved. 34
Categories of Employees The OSHA BBP Standard requires employers to categorize tasks and procedures during which an employee might experience occupational exposure BBP defines an occupational exposure as “any reasonably anticipated skin, eye, mucous membrane contact, or percutaneous injury with blood or any other potentially infectious materials” Copyright © 2018, Elsevier Inc. All Rights Reserved. 35
Occupational Exposure Determination Copyright © 2018, Elsevier Inc. All Rights Reserved. 36
Postexposure Management Accidents happen! Before an accident occurs, the BBP requires the employer to have a written plan This plan explains exactly what steps the employee must follow after the exposure incident occurs and the type of medical follow -up that will be provided to the employee at no charge Copyright © 2018, Elsevier Inc. All Rights Reserved. 37
Exposed Worker Copyright © 2018, Elsevier Inc. All Rights Reserved. 38
Employee Training The BBP Standard requires the dentist/ employer to provide training in infection control procedures and safety issues to all personnel who may come in contact with blood, saliva, or contaminated instruments or surfaces Employer must keep records of all training sessions The record must include the date of the session, the name of the presenter, the topic, and the names of all employees who attended Copyright © 2018, Elsevier Inc. All Rights Reserved. 39
Hepatitis B Immunization OSHA requires the dentist to offer the hepatitis B virus (HBV) vaccination series to all employees whose jobs include category I and II tasks Vaccine must be offered within 10 days of employment The dentist/employer must obtain proof from the physician who administered the vaccination Employees have the right to refuse the HBV vaccine; however, they must sign an informed refusal form that is kept on file in the office Copyright © 2018, Elsevier Inc. All Rights Reserved. 40
Hepatitis B Immunization (Cont. ) The vaccine is administered in a series of three injections Ø Most common vaccination schedule is 0, 1, and 6 months The preferred injection site is in the deltoid muscle (on the arm) Ø The seroconversion rate (development of immunity) is higher than when the vaccine is administered in the buttocks Copyright © 2018, Elsevier Inc. All Rights Reserved. 41
Postvaccine Testing Between 1 to 2 months after the series has been completed, a blood test should be performed to ensure that the individual has developed immunity A physician should evaluate individuals who have not developed immunity to determine the need for an additional dose of HBV vaccine Individuals who do not respond to the second 3 dose series of the vaccine should be counseled regarding their susceptibility to HBV infection and precautions to take Copyright © 2018, Elsevier Inc. All Rights Reserved. 42
Need for a Booster Routine booster doses of the HBV vaccine are not recommended by the CDC The CDC does not recommend routine blood testing (after the initial testing to determine initial immunity) to monitor the HBV antibody level in individuals who have already had the vaccine Ø The exception to this recommendation is if an immunized individual has a documented exposure incident and the attending physician orders the administration of a booster dose Copyright © 2018, Elsevier Inc. All Rights Reserved. 43
Employee Medical Records The dentist/employer must keep a confidential medical record for each employee These records are confidential and must be stored in a locked file The employer must keep these records for 30 years Copyright © 2018, Elsevier Inc. All Rights Reserved. 44
Managing Contaminated Sharps Contaminated needles and other disposable sharps (e. g. , scalpel blades, orthodontic wires, and broken glass) must be placed into a sharps container The sharps container must be puncture-resistant, closable, leak-proof, and color-coded or labeled with the biohazard symbol Sharps containers must be located as close as possible to the place of immediate disposal Do not cut, bend, or break the needles before disposal Never attempt to remove a needle from a disposable syringe Copyright © 2018, Elsevier Inc. All Rights Reserved. 45
Sharps Disposal Container Copyright © 2018, Elsevier Inc. All Rights Reserved. 46
Preventing Needle Sticks Never recap used needles by using both hands or any other technique that involves directing the point of a needle toward any part of the body Always use the single-handed scoop technique or some type of safety device Copyright © 2018, Elsevier Inc. All Rights Reserved. 47
Learning Objectives Lesson 19. 3: Infection Control in the Dental Office 8. Explain the importance of infection control practices for dental assistants, including the following: • • 9. Explain proper hand hygiene for dental assistants. Explain the advantages of alcohol-based hand rubs. Discuss the types of PPE needed for dental assistants and demonstrate the proper sequence for donning and removing personal protective equipment. Identify the various types of masks, eyewear, and gloves used in a dental office. Give examples of the infection control considerations needed to protect high-tech equipment in the dental office. Copyright © 2018, Elsevier Inc. All Rights Reserved. 48
Hand Hygiene: Handwashing Guidelines Wash your hands each time before you put on gloves and immediately after you remove gloves Wash your hands when you inadvertently touch contaminated objects or surfaces while barehanded Always use liquid soap during handwashing Bar soap should never be used because it may transmit contamination Copyright © 2018, Elsevier Inc. All Rights Reserved. 49
Hand Hygiene: Handwashing Guidelines (Cont. ) For most routine dental procedures, such as examinations and nonsurgical procedures, an antimicrobial soap can be used For surgical procedures, you should use a germicidal surgical scrub product Dry hands well before donning gloves Copyright © 2018, Elsevier Inc. All Rights Reserved. 50
Commonly Missed Areas During Handwashing From Samaranayake LP: Essential microbiology for dentistry, ed 4, New York, 2014, Churchill Livingstone. Copyright © 2018, Elsevier Inc. All Rights Reserved. 51
Additional Handwashing Guidelines Keep nails short and well-manicured Rings (except for wedding rings), fingernail polish, and artificial nails are not to be worn at work Dental personnel with open sores or weeping dermatitis must avoid activities involving direct patient contact and handling contaminated instruments or equipment until the condition on the hands is healed Copyright © 2018, Elsevier Inc. All Rights Reserved. 52
Alcohol-Based Hand Rubs Waterless antiseptic agents are alcohol-based products available in gels, foams, or rinses The product is applied to the hands, which are then rubbed together to cover all surfaces These products are more effective at reducing microbial flora than is plain soap Concentrations of 60% to 95% are the most effective They contain emollients that reduce the incidence of chapping, irritation, and drying of the skin These products are very “dose sensitive” Copyright © 2018, Elsevier Inc. All Rights Reserved. 53
Hand Care Recommendations For most routine dental procedures, such as examinations and nonsurgical procedures, wash your hands with either a nonantimicrobial or antimicrobial soap and water If your hands are not visibly soiled, you may use a waterless alcohol-based hand rub For surgical procedures, you should perform a surgical scrub using either a nonantimicrobial or antimicrobial soap and water, dry your hands, and apply an alcohol-based surgical hand rub Copyright © 2018, Elsevier Inc. All Rights Reserved. 54
Water-Based Hand Products © 2017 Crosstex International, Inc. Copyright © 2018, Elsevier Inc. All Rights Reserved. 55
Personal Protective Equipment OSHA requires the employer to provide employees with the appropriate personal protective equipment (PPE) without charge to the employee Examples of PPE: Ø Ø Ø Protective clothing Surgical masks Face shields Protective eyewear Disposable patient-treatment gloves Heavy-duty utility gloves Copyright © 2018, Elsevier Inc. All Rights Reserved. 56
Protective Clothing Protects the skin and underclothing from exposure to saliva, blood, aerosol, and other contaminated materials Types of protective clothing include: Ø Smocks, slacks, skirts, laboratory coats, surgical scrubs (hospital operating room clothing), scrub (surgical) hats, pants, and shoe covers The type of protective clothing you should wear is based on the degree of anticipated exposure to infectious materials The BBP prohibits the employee from taking protective clothing home to be laundered Copyright © 2018, Elsevier Inc. All Rights Reserved. 57
Protective Clothing Requirements Protective clothing should be made of fluidresistant material As a means of minimizing the amount of uncovered skin, clothing should have long sleeves and a high neckline The design of the sleeve should allow the cuff to be tucked inside the band of the glove During high-risk procedures, protective clothing must cover dental personnel at least to the knees when seated Buttons, trim, zippers, and other ornamentation should be kept to a minimum Copyright © 2018, Elsevier Inc. All Rights Reserved. 58
Appropriate Clinical Attire Copyright © 2018, Elsevier Inc. All Rights Reserved. 59
Handling Contaminated Laundry The BBP Standard: Protective clothing may not be taken home and washed by employees It may be laundered in the office if the equipment is available and if Standard Precautions are followed for handling and laundering the contaminated clothing Contaminated linens that are removed from the office for laundering should be placed in a leakproof bag with a biohazard label or an appropriately color-coded label Disposable gowns must be discarded daily and more often if visibly soiled Copyright © 2018, Elsevier Inc. All Rights Reserved. 60
Protective Masks Worn over the nose and mouth to protect you from inhaling possible infectious organisms spread by the aerosol spray of the handpiece or air-water syringe and accidental splashes A mask with at least 95% filtration efficiency for particles 3 mm to 5 mm in diameter should be worn whenever splash or spatter is likely The two most commonly used types of masks are dome-shaped and flat Copyright © 2018, Elsevier Inc. All Rights Reserved. 61
Guidelines for the Use of Masks should be changed for every patient or more often (CDC guideline) To handle a mask, touch the side edges only; avoid contact with the more heavily contaminated body of the mask The mask should conform well to the face The mask should not make contact with the mouth while being worn because the moisture that is generated will decrease filtration efficiency A damp or wet mask is not an effective mask Copyright © 2018, Elsevier Inc. All Rights Reserved. 62
Protective Eyewear Worn to protect eyes against the danger of damage caused by aerosolized pathogens Also prevents spattered solutions or caustic chemicals from injuring the eyes OSHA requires the use of eyewear with both front and side protection (solid side shields) during exposure-prone procedures If you wear contact lenses, you must wear protective eyewear with side shields or a face shield After each treatment or patient visit, clean and decontaminate protective eyewear in accordance with manufacturer’s instructions (CDC guideline) Copyright © 2018, Elsevier Inc. All Rights Reserved. 63
Face Shields A chin-length plastic face shield may be worn as an alternative to protective eyewear A shield cannot be substituted for a face mask because it does not protect against inhalation of contaminated aerosols When splashing or spattering of blood or other body fluids is likely during a procedure (such as surgery), a face shield is often worn in addition to a protective mask Copyright © 2018, Elsevier Inc. All Rights Reserved. 64
Face Shield and Face Mask Copyright © 2018, Elsevier Inc. All Rights Reserved. 65
Patient Eyewear Patients should be provided with protective eyewear because they also may be subject to eye damage during the procedure This may result from: Ø Ø Ø Handpiece spatter Spilled or splashed dental materials, including caustic chemical agents Airborne bits of acrylic or tooth fragments Copyright © 2018, Elsevier Inc. All Rights Reserved. 66
Patient Eyewear (Cont. ) Copyright © 2018, Elsevier Inc. All Rights Reserved. 67
Gloves Because dental personnel are most likely to come into contact with blood or contaminated items with their hands, gloves may be the most critical PPE You must wear a new pair of gloves for each patient, remove them promptly after use, and wash your hands immediately to avoid the transfer of microorganisms to other patients or the environment (CDC guideline) Consult with the glove manufacturer regarding the chemical compatibility of the glove material and the dental materials you use (CDC guideline) Copyright © 2018, Elsevier Inc. All Rights Reserved. 68
Nonsterile Examination Gloves Courtesy Crosstex, Hauppauge, NY. Copyright © 2018, Elsevier Inc. All Rights Reserved. 69
Guidelines for the Use of Examination Gloves All gloves used in patient care must be discarded after a single use These gloves may not be washed, disinfected, or sterilized; however, they may be rinsed with water to remove excess powder Latex, vinyl, or other disposable medical-quality gloves may be used for patient examinations and dental procedures Torn or damaged gloves must be replaced immediately Copyright © 2018, Elsevier Inc. All Rights Reserved. 70
Guidelines for the Use of Examination Gloves (Cont. ) Do not wear jewelry under gloves Change gloves frequently Remove contaminated gloves before leaving the chairside during patient care and replace them with new gloves before returning to patient care Hands must be washed after glove removal and before regloving Copyright © 2018, Elsevier Inc. All Rights Reserved. 71
Gloves Damaged During Treatment Gloves are effective only when they are intact (not damaged, torn, ripped, or punctured) If gloves are damaged during treatment, they must be changed immediately The procedure for regloving is: Ø Ø Excuse yourself and leave the chairside Remove and discard the damaged gloves Wash hands thoroughly Reglove before returning to the dental procedure Copyright © 2018, Elsevier Inc. All Rights Reserved. 72
Gloves Damaged by Dental Materials The chemicals you come in contact with on a daily basis may damage your gloves Because so many dental materials are available on the market, you should consult the glove manufacturer about the compatibility of the glove material with various chemicals Copyright © 2018, Elsevier Inc. All Rights Reserved. 73
Examination Gloves Usually made of latex or vinyl Referred to as exam gloves or procedure gloves These are worn by dental professionals during patient care Available in sizes S to XL Copyright © 2018, Elsevier Inc. All Rights Reserved. 74
Overgloves Also are known as food handler gloves; are made of lightweight, inexpensive clear plastic These may be worn over contaminated treatment gloves (overgloving) to prevent the contamination of clean objects handled during treatment Copyright © 2018, Elsevier Inc. All Rights Reserved. 75
Guidelines for Use of Overgloves are not acceptable alone as a hand barrier or for intraoral procedures Overgloves must be worn carefully to avoid contamination during handling with contaminated procedure gloves Overgloves are donned before the secondary procedure is performed and removed before the patient treatment that was in progress is resumed Overgloves are discarded after a single use Copyright © 2018, Elsevier Inc. All Rights Reserved. 76
Sterile Surgical Gloves Sterile gloves should be worn for invasive procedures involving the cutting of bone or significant amounts of blood or saliva, such as oral surgery or periodontal treatment Sterile gloves are supplied in prepackaged units to maintain their sterility before use They are provided in specific sizes and are fitted to the left or right hand Copyright © 2018, Elsevier Inc. All Rights Reserved. 77
Utility Gloves Utility gloves are not used for direct patient care Utility gloves must be worn: Ø Ø Ø When the treatment room is being cleaned and disinfected between patients While contaminated instruments are being cleaned or handled For surface cleaning and disinfection Utility gloves may be washed, disinfected, or sterilized and reused Used utility gloves must be considered contaminated and handled appropriately until they have been properly disinfected or sterilized Copyright © 2018, Elsevier Inc. All Rights Reserved. 78
Utility Gloves (Cont. ) Copyright © 2018, Elsevier Inc. All Rights Reserved. 79
Non–Latex-Containing Gloves Healthcare providers or patients may experience serious allergic reactions to latex For the person who is sensitive to latex, there are gloves made from vinyl, nitrile, and other non–latex-containing materials Copyright © 2018, Elsevier Inc. All Rights Reserved. 80
Maintaining Infection Control While Gloved During a dental procedure, it may be necessary to touch surfaces or objects such as drawer handles and material containers If you touch these objects with a gloved hand, both the surface and glove become contaminated To minimize the possibility of crosscontamination, use an overglove when it is necessary to touch a surface Copyright © 2018, Elsevier Inc. All Rights Reserved. 81
Maintaining Infection Control While Gloved (Cont. ) Opening drawers and cabinets Ø Opening containers Ø Set up instruments, medications, and impression materials ahead of time and use disposable and unit-dose items whenever possible When opening a container, use overgloves, a paper towel, or a sterile gauze sponge to remove the lid or cap Use sterile cotton pliers to remove an item from the container Copyright © 2018, Elsevier Inc. All Rights Reserved. 82
High-Tech Equipment Every aspect of dentistry is entering the arena of high-technology equipment and devices You must carefully consider what infection control procedures are needed to make each piece of equipment safe to use Always follow the manufacturer’s infection control recommendations for every device and piece of equipment Copyright © 2018, Elsevier Inc. All Rights Reserved. 83
Learning Objectives Lesson 19. 4: Latex Reactions, Waste Management, and Additional Infection Control 10. 11. Explain the types and symptoms of latex reactions. Describe waste management in the dental office, including the proper handling and disposal methods for contaminated waste, biohazard waste, and extracted teeth. Copyright © 2018, Elsevier Inc. All Rights Reserved. 84
Learning Objectives Lesson 19. 4: Latex Reactions, Waste Management, and Additional Infection Control (Cont. ) 12. Discuss additional infection control practices in the dental office, including the following: • • • Explain the CDC recommendations regarding the use of a saliva ejector. Describe procedures to prevent cross-contamination in the dental laboratory. Explain the precautions necessary when a patient with active tuberculosis is treated. Explain the use of preprocedural mouth rinses. Describe the rationale of CDC recommendations regarding Creutzfeldt-Jakob disease and other prion-related diseases. Describe the rationale of CDC recommendations regarding laser plumes. Copyright © 2018, Elsevier Inc. All Rights Reserved. 85
Latex Allergies The use of natural-rubber latex gloves has proved to be one of the most effective means of protecting the dental worker and the patient from the transmission of disease The number of healthcare workers and patients who have become hypersensitive to latex has increased dramatically The CDC guidelines include recommendations for contact dermatitis and latex hypersensitivity Copyright © 2018, Elsevier Inc. All Rights Reserved. 86
Latex Allergies (Cont. ) There are three common types of allergic reactions to latex: Ø Ø Ø Irritant dermatitis Type IV allergic reaction Type I allergic reaction Two types involve an immune reaction and one type involves only surface irritation Copyright © 2018, Elsevier Inc. All Rights Reserved. 87
Irritant Dermatitis A nonimmunologic process (does not involve the body’s immune system) Caused by contact with a substance that produces chemical irritation of the skin The skin becomes reddened, dry, irritated, and, in severe cases, cracked Irritant dermatitis can be reversed by identifying and correcting the cause of the problem Copyright © 2018, Elsevier Inc. All Rights Reserved. 88
Irritant Dermatitis (Cont. ) Copyright © 2018, Elsevier Inc. All Rights Reserved. 89
Type IV Allergic Reaction The most common type of latex allergy Is a delayed contact reaction and involves the immune system Ø Ø Ø It may take as long as 48 or 72 hours for the red, itchy rash to appear Reactions are limited to the areas of contact and do not involve the entire body An immune response is produced by the chemicals that are used to process the latex used in manufacturing the gloves, not by the proteins in the latex Copyright © 2018, Elsevier Inc. All Rights Reserved. 90
Type I Allergic Reaction This is the most dangerous type of latex allergy; it can result in death The reaction comes in response to the latex protein in the glove (in contrast to the reaction to chemical additives in type IV reactions) A severe immunologic (immune system) response usually occurs 2 to 3 minutes after the latex allergens make contact with the skin or mucous membrane Copyright © 2018, Elsevier Inc. All Rights Reserved. 91
Treatment of Latex Allergies There is no specific cure for latex allergy The only options are prevention, avoidance of latex-containing products, and treatment of the symptoms Anyone who suspects an allergy to latex should see a qualified healthcare provider to have a test to confirm the allergy Once a latex allergy has been diagnosed, the affected person should practice latex avoidance in all aspects of his or her personal and professional life Copyright © 2018, Elsevier Inc. All Rights Reserved. 92
Treatment of Latex Allergies (Cont. ) Remember: Ø Ø When a latex allergy has been diagnosed in one employee in the dental office, all staff members should use practices to minimize the use of latexcontaining products These practices include the wearing of powderfree gloves by all dental staff members to minimize the risk of airborne latex particles Copyright © 2018, Elsevier Inc. All Rights Reserved. 93
Waste Management in the Dental Office Dental practices are subject to a wide variety of federal, state, and local regulations concerning waste management issues The Environmental Protection Agency (EPA) and most state and local regulations do not categorize saliva or saliva-soaked items as infectious waste Because of the high probability that blood may be carried in saliva during dental procedures, CDC guidelines and OSHA regulations consider saliva in dentistry a potentially infectious body fluid Copyright © 2018, Elsevier Inc. All Rights Reserved. 94
Classification of Waste General waste Ø Ø All nonhazardous, nonregulated waste should be discarded in covered containers Examples include disposable paper towels, paper mixing pads, and empty food containers Contaminated waste Ø Ø Waste that has had contact with blood or other body fluids Examples include used barriers and patient napkins Copyright © 2018, Elsevier Inc. All Rights Reserved. 95
Classification of Waste (Cont. ) Hazardous waste Ø Ø Ø Poses a risk to human beings and the environment Toxic chemicals and materials are hazardous waste Examples include scrap amalgam, spent fixer solution, and lead foil from x-ray film packets Copyright © 2018, Elsevier Inc. All Rights Reserved. 96
Classification of Waste (Cont. ) Infectious or regulated waste (biohazard) Ø Ø Contaminated waste that is capable of transmitting an infectious disease Some items, such as extracted teeth with amalgam restorations, may be both hazardous waste (because of the amalgam) and infectious waste (because of the blood) Most dental offices are exposed to the following types of infectious waste: Ø Ø Ø Blood and blood-soaked materials Pathologic waste Sharps Copyright © 2018, Elsevier Inc. All Rights Reserved. 97
Handling Extracted Teeth Dispose of extracted teeth as regulated medical waste unless being returned to the patient When teeth are returned to the patient, the provisions of the standard no longer apply Do not dispose of extracted teeth containing amalgam in regulated medical waste that will be incinerated Note: Because of the mercury in amalgam fillings, you should check with state and local authorities for regulations regarding disposal of teeth containing amalgam Copyright © 2018, Elsevier Inc. All Rights Reserved. 98
Handling Contaminated Waste Contaminated items that may contain body fluids, such as gloves and patient napkins, should be placed in a lined trash receptacle A receptacle for contaminated waste should be covered with a properly fitted lid, opened by a foot pedal Keep the lid closed to prevent air movement and the spreading of contaminants Red bags or containers should not be used for unregulated waste Check the specific requirements of your local state or county health department Copyright © 2018, Elsevier Inc. All Rights Reserved. 99
Handling Medical Waste Medical waste is any solid waste generated in the diagnosis, treatment, or immunization of human beings or animals in research Infectious waste Ø Ø Ø A subset of medical waste Containers of infectious waste (regulated waste) must be labeled with the universal biohazard symbol, identified in compliance with local regulations, or both Containers used for holding contaminated items must be labeled Copyright © 2018, Elsevier Inc. All Rights Reserved. 100
Marked Waste Containers Copyright © 2018, Elsevier Inc. All Rights Reserved. 101
Disposal of Medical Waste Once contaminated waste leaves the office, it is regulated by the EPA and by state and local laws Under most regulations, the manner of disposal is determined by the amount (weight) of infectious materials requiring disposal The average dental practice is categorized as a “small producer” of infectious waste, and disposal is regulated accordingly The law requires the dentist to maintain records of the final disposal of this medical waste, including documentation of how, when, and where it was disposed Copyright © 2018, Elsevier Inc. All Rights Reserved. 102
Additional Infection Control Practices OSHA Blood-Borne Pathogens Standard Ø Ø Never eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in any area of the dental office where contamination is possible, such as the dental treatment rooms, dental laboratory, sterilization area, or the area for the processing of x-rays Never store food or drink in a refrigerator that contains any potentially contaminated items You can minimize the amount of splash and spatter contamination produced during dental procedures with the skillful use of a dental dam and high-volume evacuation Copyright © 2018, Elsevier Inc. All Rights Reserved. 103
CDC Guidelines: Special Considerations Saliva ejectors Ø Ø Do not advise patients to close their lips tightly around the tip of the saliva ejector to evacuate oral fluids Many patients have become accustomed to closing their lips around the suction Copyright © 2018, Elsevier Inc. All Rights Reserved. 104
CDC Guidelines: Dental Laboratory Use PPE when handling items in the laboratory until they have been decontaminated Clean, disinfect, and rinse all dental prostheses and prosthodontic materials (e. g. , impressions, bite registrations, occlusal rims, and extracted teeth) Consult with manufacturers regarding the stability of specific materials (e. g. , impression materials) relative to disinfection procedures Clean/heat-sterilize heat-tolerant items used in mouth Follow manufacturers’ instructions for cleaning, sterilizing, or disinfecting items that become contaminated but do not normally come into contact with the patient Copyright © 2018, Elsevier Inc. All Rights Reserved. 105
CDC Guidelines: Preprocedural Mouth Rinses Intended to reduce the number of microorganisms released in the form of aerosol or spatter Can decrease the number of microorganisms introduced into the patient’s bloodstream during invasive dental procedures Scientific evidence that preprocedural mouth rinsing prevents clinical infections among dental health professionals or patients is inconclusive This is an unresolved issue, and no recommendation has been made Copyright © 2018, Elsevier Inc. All Rights Reserved. 106
CDC Guidelines: Mycobacterium tuberculosis For patients with known or suspected active TB, the CDC recommends that elective dental treatment be delayed until the patient is noninfectious For patients who require urgent dental care, the CDC recommends referring the patient to a facility with TB engineering controls and a respiratory protection program Copyright © 2018, Elsevier Inc. All Rights Reserved. 107
CDC Guidelines: Creutzfeldt-Jakob Disease and Other Prion Diseases Creutzfeldt-Jakob Disease (CJD) belongs to a group of rapidly progressive and invariably fatal degenerative neurologic disorders Affects both human beings and animals and is thought to be caused by infection with prions Prion diseases have an incubation period of years but are usually fatal within 1 year of diagnosis The infectivity of oral tissues in CJD patients is an unresolved issue No recommendation is offered regarding the use of special precautions in addition to Standard Precautions in the treatment of patients with known CJD (unresolved issue) Copyright © 2018, Elsevier Inc. All Rights Reserved. 108
CDC Guidelines: Laser/Electrosurgery Plumes or Surgical Smoke In surgical procedures involving the use of a laser or electrosurgical unit, a smoke by-product is created during thermal destruction of the tissue Laser plumes and surgical smoke pose a risk to dental healthcare professionals The effect of the exposure (e. g. , disease transmission or adverse respiratory effects) on dental healthcare professionals resulting from the use of lasers in dentistry has not been adequately evaluated (unresolved issue) Copyright © 2018, Elsevier Inc. All Rights Reserved. 109
Questions? Copyright © 2018, Elsevier Inc. All Rights Reserved. 110
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