Infection Control Microbiology Chapters MDA Chapter 18 Microbiology

Infection Control & Microbiology Chapters MDA Chapter 18 – Microbiology Chapter 19 – Disease Transmission & Infection Prevention Chapter 22 – Regulatory Agencies Chapter 23 – Chemical & Waste Management Chapter 24 –Dental Unit Waterlines Chapter 20 – Principles & Techniques of Disinfection Chapter 21 – Principles & Techniques of Instrument Processing & Sterilization

Infection Control DENT 133 MSDS – Now called SDS Safety Data Sheets Prepared and Sent by Manufacturer Ordered by Dr. On file, By Law Hazardous Material Log List of All Potentially Hazardous Materials in Office – Dr. is Responsible

Infection Control DENT 133 Protocol Instructions Specific PPE Steps Must Be Followed – Must be Provided & Cleaned by Dr. Personal Protective Equipment Gloves Masks Glasses Lab Coat

Standard Precautions & BSI Body Substance Isolation Part of Standard Precautions A system requiring personal protective equipment to be worn to protect against contact with all body fluids, whether or not blood is visible.

OPIM Other potentially infectious materials Part of standard precautions

Infection Control DENT 133 Bioburden Visible Organic Debris Bloodborne Pathogens (Pathogen, Pathogenic Microorganisms Present in Blood Capable of Causing Disease

Infection Control DENT 133 Sepsis Asepsis With Infection Free of Infection Aseptic Techniques Avoiding Contamination

Infection Control DENT 133 Antiseptic Against Infection Chemicals Tolerated by Skin, Living Tissue, That Can Kill or Slow Infectious Bacteria 1 Celled Plants, Animals W/ No Chlorophyll

Prion https: //en. wikipedia. org/wiki/Prion

Infection Control DENT 133 Diseases Caused By Bacteria: Syphilis Tuberculosis Typhoid Decay Periodontitis

NOSOCOMIAL Infection commonly acquired in a hospital or medical setting.

Infection Control DENT 133 Bacteriostatic Stops Bacterial Growth, But Doesn’t Kill Bacillus Subtilis/Bacillus Atrophaeus Bacteria Used in Spore Test to Test Effectiveness in Dry Heat & Ethelyne Oxide Sterilizers

Infection Control DENT 133 Bacillus Stearothermophilus Bacteria Used in Spore Test to Check Effectiveness in an Auto/Chemiclave If +, Will Show Up Foggy & Turn From Red to Yellow

Infection Control DENT 133 Virus Microorganisms Smaller Than Bacteria Can’t Live Long Outside Body Can’t Reproduce Outside Living Cells Viruses Cause: Colds, Smallpox, Measles, German Measles, Chickenpox, Herpes, Flu, Polio, Rabies, Infections, Hep B, HIV

Infection Control DENT 133 HBV – Hepatitis B Virus HIV – Human Immunodeficiency Virus Germicides Chemicals Used For Disinfection Kills Germs Some Contain Iodine

Infection Control DENT 133 Sharps Anything That Can Penetrate Skin, Mucosa, Plastic Bag Can Transmit From Contaminated Instruments: Syphilis Thrush Hepatitis

Infection Control DENT 133 Cannot Transmit From Instruments: ANUG Cysts Cancer Tumors

What is Spaulding Classifications? DANB Test Question See next slide

Infection Control DENT 133 Critical Items Instruments and Bone Semi-Critical Used to Penetrate Soft Tissue Items Instruments Not Penetrating Soft Tissue and Bone, But Does Contact Oral Tissues Noncritical Comes Items in Contact With Intact Skin: Must Be Disinfected

Infection Control DENT 133 Federal Agencies: OSHA CDC Occupational Safety & Health Administration Centers for Disease Control/Prevention EPA Environmental Protection Agency

Infection Control DENT 133 State Agency: WISHA Washington Industrial Safety/Health Administration

Infection Control DENT 133 Employee Training Dentist Must Provide (During Work Hours) 1. When a New Employee is Hired, Within 10 Days 2. When a New Hazardous Material is Introduced 3. When Procedures Change/Modify

Infection Control DENT 133 2 Categories of OSHA Guideline Classifications for Bloodborne Pathogens Category 1 Procedures/Tasks Involving Potential For Contact With Blood, Body Fluids, Tissues Saliva Considered Contaminated Follow Universal/Standard Precautions

Infection Control DENT 133 Category II Routines Not Involving Exposure to Blood, Body Fluids, Tissues; But May Be Required As Condition of Employment Appropriate Protective Measures Should Be Readily Available

Infection Control DENT 133 Exposure Incidents Eye, Mouth, Mucous Membrane, Non-Intact Skin, Parenteral Contact With Blood, Infectious Materials Resulting from Specific Tasks 9 Step Protocol For Employee: 1. Stop 2. Report

Infection Control DENT 133 3. Remove Gloves 4. Do NOT Squeeze Blood Out (New) 5. No Toxic Cleaners Like Sodium Hypochlorite 6. Wash With Antimicrobial Soap & Lukewarm H 2 O 7. Dry 8. Bandage 9. Medical Attention – Mandatory & File

Infection Control DENT 133 Protocol For Employer (At His/Her Expense) 1. Document 2. Identify & Document Source Individual 3. If OK, Obtain Results of Blood Test 4. Have Employee’s Blood Tested 5. Rx to Employee, if Nec (Gamma Globulin), Hep B Protease Inhibitors, to Stop HIV Replication

Infection Control DENT 133 6. Counseling & Follow-Up 6 Weeks 12 Weeks 6 Month Intervals Health Dept will follow HEP C for 6 mos Records Must Be Kept for Length of Employment + 30 Years

Important Public Health Needs Incident Report within 7 days Beyond 7 days the Department of Health CANNOT make the source patient test Source patient can only be asked to test ONE time

Infection Control DENT 133 CDC Guidelines Classifications of Instruments, Equipment, Surfaces Handscrub Ok to Use: Bacteriocidal Bacteriostatic Antiseptic Antifungal

Infection Control DENT 133 Chicken Pox Herpetic Whitlow Varicella Zoster Fingers/Toes Herpes Zoster Shingles

Infection Control DANB Review: Clean cabinets/drawers that hold sterile instruments 1 X per week Spina Bifida – cleft in backbone/spine…doesn’t close properly: high incident to latex allergy

Spina bifida POWDER IN GLOVES CARRIES LATEX INTO BLOODSTREAM

Spina bifida ALSO ALLERGIC TO: AVACADOS, KIWI, POTATOES, TOMATOES, BANANAS, PLUMS, PEACHES, CHERRIES, APRICOTS, FIGS, PAPAYAS, CHESTNUTS

Spina bifida SHOULD BE ON HEALTH HISTORIES ANYONE THAT HAS SPINA BIFIDA SHOULD BE CONSIDERED HIGH RISK

Infection Control DENT 133 TB Microorganism Mycobacterium Tuberculosis AG = Antigen + = Active Illness - = No Active Illness

Infection Control DENT 133 AB = Antibody Level + = Built in Resistance (no injections) - = No Resistance (needs injections)

Infection Control DENT 133 Formulas: AG + and AB + = Retest AG+ and AB- = Treat for Illness AG- and AB- = Needs Hep B Vaccines AG- and AB+ = Not Ill, No Need for Vaccines

Infection Control Antigen markers shown by 3 abbreviations: HBs. Ag - surface antigen – sick-highly produced, covers all particle and varion surfaces Presence = active HBV infection-exposure---NOT INFECTIOUS! Present for 6 mos = chronic infection HBe. Ag – if persistent + in blood, development of chronic HBV infection…Infective portion of virus…ability to infect others not for diagnosis, just amt of infectivity & early & active disease HBc. Ag – core antigen…active viral reproduction…found in liver cells All mean antigen + = illness

Hep B Virus

Infection Control DENT 133 If Antibodies Present, Means Immune If Biologic Indicator Strip is +, Means That Sterilization Failed Saliva Greatest Risk = Cross Contamination Can Transfer Colds, TB, Chickenpox, Mumps, Measles, Herpes

Infection Control DENT 133 Gram Danish Man Discovered Staining Bacteria for Visability A. Gram + = Retains Dye, Turns Purple B. Gram - = Colorless

Modes of Disease Transmission Direct Transmission = person to person contact Example: droplets that spread through sneezing or coughing, or even by spatter produced during dental procedure – Unprotected contact with an infectious lesion or infected body fluids such as blood, saliva, semen & other secretions. Diseases such as Hepatitis, herpes, HIV, TB are spread through direct contact.

Indirect Transmission When microorganisms first are transmitted to an object or surface, and then are transferred to another person who touches those objects or surfaces. Example: touching chart or x-rays with dirty gloves and then receptionist handles with bare hands. Saliva on a dental film (from mouth to film to assistant)

Airborne Transmission AKA Droplet Infection Spread of disease through droplets of moisture that contain bacteria or viruses. Example: pathogens carried long distances through the air and ventilation systems (airplanes) Coughing & Sneezing

Blood-Borne Transmissions Direct or Indirect Contact with blood and other body fluids (that may contain blood) Examples: Saliva, needles, instruments, unprotected sex

More examples of transmission Disease Transmission A. Droplet – Moisture, Talking, Sneezing, Coughing, Highspeed Handpiece Droplets Transmit: Colds, Flu, Measles, Chicken Pox, Whooping Cough, TB, Diptheria.

Infection Control DENT 133 C. Indirect Transmission: Dirty Hands, Contaminated Articles (Towels, Instruments, Dust), **needle sticks D. Self-Infection – Bacteria in Mouth, during procedures, oral surgery, flossing, hygiene appointments, etc. Enters Bloodstream, & becomes systemic (potential for Endocarditis)

Infection Control DENT 133 E. Operator – Auxiliary or Dr. Infects Patient, or Vice Versa Through Nose, Mouth, etc. F. Personal Contact – Person to Person (ie. , STD) G. Cross-Contamination – Passing Infection From One Person to Another

Parenteral Transmission Occurs when an infectious agent is spread through breaks in the skin Examples: needle stick, cuts, abrasions, bites, and scrapes Hepatitis & HIV can transmit this way

Food/Water/Oral/Fecal Transmission Examples: Contaminated food, unsanitary conditions, improper handwashing, under-cooked food, human or animal feces, daycare workers, careless food handlers….

Infection Control DENT 133 Carrier Harbors Bacteria Not Sick Passes Illness to Others Infection Control Precautions Cross-Infection Passage of Infectious Microbe From One Person to Another

Infection Control DENT 133 SAFETY PRECAUTIONS Safety Glasses Amalgam Scratches Cornea in Eye Gloves Donned After Handscrub Clean Uniforms – Laundered Daily- Worn Only At Work No Sweaters

Infection Control DENT 133 Long Hair Back – No Hair in Front of Ears Short Nails No Acrylics, Artificial Nails (including Gels or Silks), Nail Polish Protect Eyes, Nose, Mouth, Hands Dental Personnel Has 50% More Respiratory Diseases

Infection Control DENT 133 Most Important Defense Against Infection is Hand Washing Time Needed Before Re-Sterilizing: Paper 1 Month Cloth 3 Months Plastic 6 Months

Infection Control DENT 133 Sterilization All Forms of Life Completely Destroyed Absolute – Sterile is Sterile 4 Major Methods of Sterilization 1. Autoclave (Statim, Midmark) Uses Steamed, Distilled Water Super Heated Steam Under Pressure

Infection Control DENT 133 (Autoclave, con’t) Boiling Point of Water, Under Pressure 121 Degrees Celsius; 15 Pounds Pressure 20 -30 Minutes (or 3 -5) Statim (Unwrapped) Most Economical Disadvantage = Carbon Steel Rusts

Infection Control DENT 133 2. Dry Heat Method of Choice for Rusting Instruments 160 -170 C (320 -340 F) – 120 Minutes 150 C 150 Minutes 121 C Overnight

Infection Control DENT 133 3. Chemical Vapor (Chemiclave) Chemical Sterilization = Heat Under Presssure Using Chemicals, Including Formaldehyde, Not Water 132 C (270 F) & 30 PSI – 20 Minutes Won’t Rust Instruments Like Autoclave

Infection Control DENT 133 4. Chemical Sterilization (Immersion) Glutaraldehyde – Banicide Immersed 6 -10 Hours (Instructions) Only for Instruments That Cannot Be Autoclaved (Which Ones? )

Infection Control DENT 133 3 Other Sterilization Method: 1. Hot Oil/Silicone Fluid Heated to 160 C (320 F) 2. Hot Beads/Salt Beads/Glass Beads For Endo Instruments & Burs Used Chairside for 10 -15 Seconds 450 F

Infection Control DENT 133 3. Ethylene Oxide Gas Hospitals 12 Hours Cloth, Plastic, Rubber, Hoses ok Disadvantages: Expensive, Problems Dispersing Gaseous Exhaust

Infection Control DENT 133 Disinfection Destruction of MOST Infectious Microorganisms Chemicals May Not Kill Spores, TB, Hepatitis, Unless 610 Hours Difficult to Monitor Effectiveness Altered Mostly by Water Dilution

Infection Control DENT 133 Microorganisms Resistant to Disinfectants: Vegetative Easy to Kill All in This Form At Some Time Encapsulated Vegetative With Mucoid (Waxy) Coating More Resistant

Infection Control DENT 133 Spores Most Resistant Viruses Wide Range of Resistance 3 Levels of Disinfection: 1. High Level Strongest Tuberculocidal & MOST Spores

Infection Control DENT 133 2. Intermediate Level 2 nd Strongest Tuberculocidal Will 3. Not Kill Spores Low Level 3 rd Strongest Some Viruses Fungus Most No Bacteria Tuberculosis or Spores

Infection Control DENT 133 10 Properties for Ideal Disinfection: 1. Broad Spectrum 2. Fast Acting 3. Not Affected by Physical Factors 4. Non-Toxic 5. Surface Compatibility 6. Residual Effect on Treatment Surfaces

Infection Control DENT 133 7. Easy to Use 8. Odorless 9. Economic 10. ADA/EPA Approved 7 Factors Affecting Germicidal (Disinfecting) Activity: 1. Dilution 2. Time of Exposure

Infection Control DENT 133 3. Temperature 4. PH (Acid, Alkaline Balance) 5. Objects – the smoother the faster 6. Depends on Manufacturers Instructions 7. Type of Microorganism (debris) Germicidals Will Not Kill Spores

Infection Control DENT 133 4 Tips to Decide What Sterilization Technique to Use: Supply of Instruments – How Many Do You Have? Turn Around Time? Number of Patients Treated Daily Availability & $ of Disposables Compatibility of Materials Sterilized (Melt? )

Infection Control DENT 133 Carbon Steel Instruments Must Be Sterilized By Dry Heat or Ethylene Oxide, Or Will Rust Glutaraldehydes Are Never Used for Surface Disinfection – Toxic Fumes Cold Cure Acrylic Monomers Are Potentially Hazardous

Infection Control DENT 133 To Reduce Mercury Poisoning, Use Pre-Capsulated Amalgam Pericoronitis is NOT Hazardous in the Workplace Need to Screen for HBV Periodically Intact Skin is the Primary Protection Against Disease

Infection Control DENT 133 Change PPE Daily or Must Use Disposables After Each Patient Gloves Masks Minimum 95% bacterial filtration efficiency Change every 20 min. heavy use or 1 hr. normal use SDS Must Be Made Available to Staff Within 5 Days of Product Introduction

MSDS MUST BE MADE AVAILABLE TO STAFF WITHIN 5 DAYS OF PRODUCT INTRODUCTION

Protozoa – simple celled microscopic animal Virus – Bacteria – single cell Fungi -

Waterlines should have no more than amount of bacteria –ALARA - = or less than 500 CFU (colony forming unit)/ml Surgical Scrub – how many minutes? 7 mins plus 7 mins = 14 mins (sterile towel) Ultrasonic not working? Ck with alum foil - pitting

Working Controls Reducing the likelihood of exposure by altering the manner in which a task is performed ie: Wearing PPE

Engineering Controls Isolate or remove a hazard from workplace ie: Sharps container

Infection Control MASKS MUST FILTER BACTERIA AT LEAST 95%

Amalgam Scraps Dispose of in a DRY airtight container Hazardous disposal company will provide container Always wear PPE when opening & closing container!!!!! Vapors We no longer store in a liquid!!! There is no way to dispose of the liquid

Wicking Absorption of a liquid by capillary action along a thread or other material ie: penetration of liquid through an undetected hole in a glove OR See next slide!

Wicking Con’t Handling processed items before they are completely dry! If items are wet it increases the chance of wicking contaminants into the processed sterilization package. Hot packages can act like wicks absorbing moisture and possibly bacteria from hands, therefore cooling is a critical part of sterilization.