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OBJECTIVES
Protect one self, staff and patients Use of protective gear and proper sterilization to minimize infection risks Ensuring the patient the highest standard of care Providing a relaxed and non-threatening environment to minimize patients anxiety.
OBJECTIVES
Opportunistic infections occur in those whose immune systems are compromised (eg. Oral Candidiasis: fungi)
MODES OF TRANSMISSION
Direct: person to person Indirect: contact with objects that are contaminated Air-borne: spray or splatter contact with mucous membranes, or contact with aerosols
A high speed handpiece is capable of creating air-borne: Bacteria: from water-spray system Microbial contaminants: from saliva, tissues, blood, plaque and debris from cutting carious teeth These exist in the form of spatter, mists and aerosols.
MODES OF TRANSMISSION
Aerosols (50mm-55mm) may carry agents of respiratory infection, borne by the patient (airborne or blood-borne). Mists (50mm) are likely to transmit active pulmonary/pharyngeal tuberculosis from the cough of a patient. Spatter has a trajectory of 3 ft from the patients mouth. It is a potential route of blood-borne pathogens.
PREVENTION
PRETREATMENT
Hand washing Mouth rinse Rubber dam High-velocity air evacuation
DURING TREATMENT
Gloves Gowns Masks Protective eyewear Adequate air circulation
VIRAL HEPATITIS
A
Source of virus
feces
D
blood/ blood-derived body fluids
E
feces
Route of transmission
Chronic infection Prevention
fecal-oral
percutaneous permucosal
yes
percutaneous permucosal
yes
percutaneous permucosal
yes
fecal-oral
no
no
preexposure immunization
pre/postexposure immunization
blood donor pre/postscreening; exposure risk behavior immunization; modification risk behavior modification
LOW
Feces Sweat
Tears
Moderate
Breast milk
HIV is killed by all methods of sterilization. When used properly, all disinfectants except some quaternary ammonium compounds, are said to inactivate HIV in less than 2 minutes. In dried infected blood, 99% of HIV has been found to be inactive in appx. 90 minutes. However when kept wet, the virus may survive for 2 or more days. Hence caution is required with container of used needles in which the virus may remain wet.
Barriers have proved successful in protecting dental personnel. HIV has been found to mostly be transmitted by blood contaminated fluids that have been heavily spattered or splashed.
CRITICAL ITEMS
Instruments that cut or penetrate through tissues Require thorough cleaning and sterilization
SEMI-CRITICAL ITEMS
Items handled by gloved hands coated with blood and saliva or may touch mucosa.
Air-water syringe tip Suction tip Handpieces Lamp handles
Must be removed to clean and sterilize unless disposable or can be protected using plastic covers.
NON-CRITICAL ITEMS
Items not ordinarily touched during treatment. Environmental surfaces:
Chairs Floor/walls Supporting equipment of dental unit
Contaminated items require cleaning and disinfection. Wear gloves to clean. Uncovered chair arms may become contaminated with spatter.
ASEPTIC TECHNIQUES
Prevents cross-contamination. All items touched with saliva MUST be free of contamination before treating next patient. Contaminated items can be:
Discarded/Removed Protected by disposable covers Cleaned Sterilized
Clinician should NOT directly touch items that he/she does not want to contaminate
DISINFECTANTS
Regarding disinfection, these two principles should be remembered:
1. Disinfection cannot occur until fresh disinfectant is reapplied to a thoroughly cleaned surface. 2. Disinfection does not sterilize.
DISINFECTANTS
MUST be active against:
Mycobacterium species Polioviruses Staphylococcus species Pseudomonas species HIV (within 1-2 mins)
DISINFECTANTS
Major categories of chemical disinfectants:
1. 2. 3. 4. 5. Chlorine compounds Iodophors Combination synthetic phenolics Glutaraldehydes Phenolic/alcohol combinations
These can be used using different methods of disinfection like spraying and immersion techniques.
DISINFECTANTS
DISINFECTANTS
DISINFECTANTS
70-79% ethyl alcohol
MOST effective on cleaned surfaces
Glutaraldehydes (conc.)
Used for instrument disinfection Highly toxic 20 min.s to kill mycobacterium species
Education and training Immunizations Exposure prevention and post-exposure management Medical condition management and workrelated illnesses and restrictions Health record maintenance
HAND WASHING
Hands must be washed when: Visibly dirty After touching contaminated objects with bare hands Before and after patient treatment (before glove placement and after glove removal)
GOOD BETTER BEST
Plain Soap
Anti-microbial Soap
Alcohol-based Soap
http://www.cdc.gov/handhygiene/materials.htm
HAND WASHING
Hand cleansers containing a mild antiseptic such as:
1. 3% parachlorometaxylenol (PCMX) or Chlorhexidine:
Preferred to control transient pathogens Suppress overgrowth of skin bacteria.
Special cleansing (e.g. for surgery gloves leak or clinician experiences injury) Can be hazardous to eyes.
3. Alcohol rubs:
Effective against pathogens Less drying to the hands
ALCOHOL-BASED SOAP
Limitations Benefits
Rapid and effective antimicrobial action Improved skin condition More accessible than sinks Cannot be used if hands are visibly soiled Store away from high temperatures or flames Hand softeners and glove powders may build-up
GLOVES
OSHA regulations specifies that all clinical personnel MUST wear treatment gloves during all treatment procedures and each appointment. Gloves must meet new FDA regulations . Puncture-resistant utility gloves should be worn. If a leak is detected, gloves are removed, hands are washed, and fresh gloves are used on DRY hands.
GLOVES
REMOVAL OF GLOVES
Pinch the palm side of the outer cuff surface with the gloved fingers of the other hand.
EYE WEAR
May consist of goggles or glasses with solid sideshields.
Should be worn with clean hands before gloving and removed with clean hands after gloves are removed.
MASK
Should be worn to protect against aerosols. Edges of the rectangular mask should be pressed close around the bridge of the nose and face. Face Shields are also used for heavy spatter.
HAIR PROTECTION
Hair should be kept back, out of the treatment field, because hair can entrap heavy contamination. Personnel should protect their hair with a surgical cap when encountering heavy spatter (e.g. from an ultrasonic scaling device).
OVER-GARMENT
An over-garment must be protective of clothing and Sleeves with knit cuffs that tuck skin
under gloves are preferred. Simple light-weight garment Must cover the arms and chest up to the neck and the lap when seated, provide more adequate protection. Garments should be changed and skin be washed as soon as possible in case of treatments that produce spatter that wets or penetrates the garment.
OVER-GARMENT
Wear gowns, lab coats, or uniforms that cover skin and personal clothing likely to become soiled with blood, saliva, or infectious material Change if visibly soiled Remove all barriers before leaving the work area
NEEDLE DISPOSAL
Goals for needle disposal are:
Dispose off needles in a hardwalled, leak-proof, and sealable container which has the OSHA biohazard label. Locate the needle-disposal container in the operatory close to where the needle will be used Avoid carrying unsheathed contaminated needles or containers in a manner that could endanger others.
Great care should be used in passing instruments and syringes with unsheathed needles to another individual.
Hanging handpieces upside down in some types of hangers can angle the bur away from the operator.
Submersion of a high-speed handpiece in a high-level disinfectant has not been an option accepted by manufacturers.
MICROWAVE IRRADIATION
Studies have been carried out to disinfect contaminated gypsum casts through microwave irradiation. Unlike impression disinfection, this method can be used to eliminate cross-contamination via the cast, as it can be repeated at every stage as required.
So far it has been observed that microwave irradiation of the casts for 5 minutes at 900W gives high level disinfection of the gypsum casts.
STERILIZATION
Autoclave sterilization of handpieces One of the most rapid methods. Works at 121*C for 20 min and 15 lb pressure. All stainless steel instruments & burs can be autoclaved. Chemical vapor pressure sterilization Recommended for some types of handpieces Works at 131*C for 30 min and at 20lb pressure by using aldehyde vapours. Carbon steel and other corrosion sensitive burs can be sterilized.
SUMMARY
All dental disciplines must be considered with the dangers involved in the spread of certain infectious diseases.
Prosthodontists and their personnel may be exposed to certain diseases such as Hepatitis and Tuberculosis.
Dentists must ensure that they at least follow the basic infection control procedures.
Additional infection control procedures should be observed in the fabrication and handling of dental impressions and prosthesis.
Dental offices and labs should work closely together to coordinate control of potential cross-infections between the two disciplines.