Infection Control in Dentistry

Module 1 Microbiology
Nancy Goodwin, CDA, RDH, MEd. All rights reserved

Questions to think about..

How can you break the chain of infection in your office today? Are there areas of your daily practice where cross-contamination could be happening? How can you make changes that will prevent cross-contamination in your daily practice?

Objectives
After completing this Module, participant will be able to:

Explain why an understanding of basic microbiology is essential for dental professionals. List the major groups of microorganisms. List the various modes of transmission of potential pathogens in the dental setting. List the components of the chain of infection and examples of each. Explain the role of the CDC, OSHA and OSAP as they relate to infection control in dentistry. Explain the difference between Standard Precautions and Universal Precautions. Explain the rationale for Standard Precautions Discuss the difference between bacteriostatic and bacteriocidal. Name the four ways that transmission can occur between persons or groups. Explain the difference between aerosols and spatter. List factors that contribute to a person becoming a susceptible host. List factors that contribute to the likelihood of infection development. Define cross contamination.

Rationale

An understanding of basic microbiology is essential for all dental personnel. This understanding will help you understand the need for careful compliance with recommended infection control protocols. The ultimate objective is to protect yourself, the office staff, and your patients from illness.

Types of Microorganisms

Pathogenic (causing disease)

Potentially Pathogenic
Non-Pathogenic

Some infections only occur in individuals who are immunocompromised because their immune system is unable to fight the potential pathogen. These are called opportunistic infections.

Major Groups of Microorganisms

Bacteria Algae Protozoa Fungi Viruses

Since a number of diseases can be transmitted during routine dental care, it is important to understand the principles behind the infection control recommendations of the CDC and OSAP.

Bacteria

One celled microorganisms Can live independently Classified according to their shape Some are harmless, some are disease-producing (pathogenic) Some types of bacteria form a capsule that protects the cell; Bacteria with this protective coating are particularly virulent, or disease causing.

Bacteria (continued)

Under some conditions, some bacteria (and some fungi) change into spores, which are the most resistant form of life known. Tetanus is an example of a disease caused by a spore-forming bacillus. Different bacteria require different things to grow (oxygen, nutrients, temperature)

Bacteria (continued)

The goal in an infection control program is to use agents and techniques to prevent growth of bacteria (bacteriostatic), and/or to kill bacteria (bacteriocidal), spores (sporicidal), viruses (virucidal). Some products are specific for a specific pathogen (tuberculocidal) The most sure way to kill bacteria or other microorganisms in the shortest amount of time is to expose them to the high temperatures that are found in approved methods of sterilization.

Viruses

Viruses cause many of the diseases in human beings, but can also infect animals and plants. Examples of diseases caused by viruses: Measles Mumps Colds Severe acute respiratory syndrome (SARS)

Viruses (continued)
Examples of oral diseases caused by viruses: Herpes infections Coxsackievirus (hand, foot and mouth disease) Oral lesions from measles Blood-borne diseases caused by viruses Hepatitis B and C Human immunodeficiency virus (HIV/AIDS)

Viruses (Continued)

Viruses cannot live or multiply outside of a host Virus infections can be latent (no symptoms), chronic (long-lasting), or slow. Slow persistent infections occur when the virus replicates slowly, causing damage that is seen only after a number of years. (Hepatitis C is an example of this type) Latent infections are of particular interest to dental professionals because many patients may not realize that they are infectious.

Algae

Range from single-cell to multiple-cell organisms Are found in fresh and salt water habitats Most do not produce human disease

One cell organisms Found in fresh water and salt water habitats and in soil. A small number of protozoa cause intestinal infections Others can infect the blood, lungs, liver, or brain Protozoa are not a substantial concern in the dental setting Pneumocystis Carnii is an opportunistic protozoan infection.

Protozoa

Fungi

Defined as plants that lack chlorophyll Includes mushrooms, yeasts and molds Oral Candidiasis is the most common yeast infection of the oral cavity. Candidiasis is caused by Candida albicans Candida is considered an opportunistic infection, in other words, it usually occurs in someone whos immune system is not functioning normally.

How are diseases transmitted in the dental setting?

From the patient to the dental worker From the dental worker to the patient From one patient to another From the dental office to the community

Transmission can be

Direct- from an infected person to another person who is not immune, Indirect- from contact with objects that are contaminated, like surfaces or instruments, Droplet-from spray or splatter contact with mucous membranes, or contact with aerosols (stay suspended in the air for longer periods of time)

Aerosols

Aerosols may be mists (fine, stay in the air) or spatter (larger and easily seen). They may contain airborne or bloodborne pathogens. The aerosol contents and the concentration of pathogens determines their potential danger.

The Infectious Process Chain of Infection

Infectious agent

Susceptible host

Reservoir

Port of Entry

Port of Exit

Transmission

The Chain of Infection Components

Infectious Agent-any potential pathogen (bacteria, virus, fungi, etc.) Reservoir-where the pathogen lives (a person, on equipment, surfaces, instruments, etc) Portal of exit- how the infectious agent leaves its reservoir and reach a new host. Transmission-direct, indirect, airborne, droplet Portal of entry- how the infectious agent gets into the new host (bloodstream, mucous membrane, etc.) Susceptible host-someone who is not immune

The chain of infection example

Infectious agent Hepatitis B

Susceptible host
Unvaccinated Dental worker

Reservoir
The bloodstream

Port of Entry
Puncture wound

Port of Exit
Bleeding wound

Transmission
Direct via needle stick

What alters normal defenses, making a person a susceptible host?

Abnormal Physical Conditions Systemic Diseases (diabetes, HIV infection, etc) Drug Therapy (chemotherapy, steroids, etc.) Stress Prosthesis and Transplants (joint or organ replacements) Poor nutrition

What factors influence the development of infection?

The number of microorganisms and duration of exposure (how many and for how long?) Virulence of organisms (ability to cause disease; pathogenic properties) Immune status of the host (body defenses)

**Application to Practice**

The goal of an infection control program is to break the chain of infection by consistently practicing protocols which would prevent the infectious agent from moving to one host to another and preventing cross-contamination.

Cross-Contamination

Defined: The spread of microorganisms from one source to another.

http://www.openxsky.deviantart.com/gallery/ Isabel L.

Clinical Focus

How can you break the chain of infection in your office today? Are there areas of your daily practice where cross-contamination could be happening? How can you make changes that will prevent cross-contamination in your daily practice?

To protect health care workers and patients, the CDC has made recommendations which have been continually updated since 1985. Universal Precautions were released first, Standard Precautions were released in 2003.

Universal Precautions

Universal Precautions were recommended to protect exposure from blood and other body fluids Standard Precautions are the latest recommendations, although Universal Precautions are still used regarding the OSHA bloodborne pathogens standard.

Standard Precautions

Apply not only to contact with blood but also to

All

body fluids, secretions and excretions except sweat Non-intact skin Mucous membranes

These guidelines were developed as a response to the understanding that other body fluids besides blood are potentially infectious, and that anyone with patient contact could be at risk.

What is the role of the CDC?

The Centers for Disease Control and Prevention is considered the foremost public health agency in the United States. The CDC tracks disease trends across the country and investigates disease outbreaks. The CDC also reviews current scientific information and makes recommendations based on that information to protect the health of the population

Centers for Disease Control

In 2003, the CDC released the most current recommendations: Guidelines for Infection Control in Dental Health-Care Settings,2003. CDC recommendations not only are intended to protect the dental healthcare worker, but the patients they treat. The CDC does not have the authority to make laws, but does make recommendations from which some laws are made.

Link

Check out this CDC link and review slide 1 through 10 in their PowerPoint as review:

http://www.cdc.gov/OralHealth/infectioncontrol /guidelines/ppt.htm

What is the role of OSAP?

The Organization for Safety and Asepsis Procedures (OSAP) is a group of dental workers, scientists, teachers, and product manufacturers and distributors. They work together to provide infection control and safety information to dental personnel around the world. OSAP is considered the leading resource for infection control and safety information in dentistry.
From Policy to Practice: OSAPs Guide to the Guidelines, 2004, p. i.

Links

Please check out the following links: http://www.osap.org/

http://www.osap.org/displaycommon.cfm?an= 1&subarticlenbr=250

OSAP is dentistrys Leading resource for infection control information. bookmark this link on your computer for quick reference.

Clinical Focus

If you have a question about infection control, which website would you consult? To maintain up to date on all the latest recommendations, consider setting an office computer to OSAPs home page then you will be the first to know about any of the new changes

What is the role of OSHA?

The Occupational Safety and Health Administration (OSHA) is a division of the U.S. Department of Labor. It is a regulatory agency and has the authority to make and enforce laws. Additionally, they can impose fines. OSHAs responsibility is to ensure the safety and health of American workers. Consequently, OSHA makes and enforces protective standards that employers must follow to offer a safe work place for their employees.

OSHA

OSHA developed the Bloodborne Pathogens Standard, which became effective in 1992 It is intended to protect workers from exposure to blood-borne pathogens in the workplace. OSHA requires that a copy of this standard be available in every dental office and clinic.

Bloodborne Pathogens Standard

The standard requires an employer to protect employees from exposure to blood and other potentially infectious materials (OPIM) in the workplace and to provide recommended care if such an exposure does occur. This protection includes the provision of appropriate personal protective equipment, such as mask, eyewear, and gloves. Failure to comply can result in fines and penalties for the employer.

One last link.

The Journal of the American Dental Association provides links to excellent articles and resources in the area of infection control. Read the following article to discover the evolution of our infection control standards. http://jada.highwire.org/cgi/reprint/134/5/569

Congratulations, you are done with Module One!