Registered Dental Assistant: Infection Control Techniques Click the play (arrow) button to advance to the next slide. By Janice Lewis

Routes of Infection Transmission Direct Contact with lesion or microorganism Blood or saliva Open lesion Indirect Cross contamination Countertops, equipment Pens, charts Inhalation Microorganisms inhaled Handpieces Ultrasonic cleaner

Infection Control Techniques The dental assistant must maintain his or her health and should make sure all immunizations are current. This will keep the immune system working to fight infection. At each appointment the dental assistant should discuss the patient’s medical history to be sure the information on the patient is up to date and accurate. This will allow any current problems or risks to be identified and procedures can be put in place to prevent any further spread of infectious agents. Handwashing is the most important method to maintaining infection control and preventing the spread of disease. The hands should be thoroughly washed at the beginning of the day, before and after every patient care, donning and removing gloves, breaks, and at the end of each day.

PPE - Eyewear Personal protective equipment – eyewear Protects mucous membranes from spatter of blood and saliva Hepatitis, Herpes simplex, and pink eye Metals and enamel may injury eye. Over glasses designed to be worn over eyeglasses Side shield may be placed on personal eyewear. Difficult to see in slide. Goggles with side shields

PPE - Gloves Personal protective equipment – gloves Latex allergies are common Petroleum-based lotion prior could break down gloves Change gloves after each patient Polynitrile autoclavable gloves Overgloves Utility gloves

PPE – Masks and Clothing Face shield to be worn in addition to mask Goggles rest on top of side shields Protective Clothing Only to be worn in the dental offices, not to lunch or home Must close tightly at neck and around cuff area During a high-risk procedure, must bbe knee length Must be laundered in office or sent to laundry service

Chemical Disinfectants Physically remove all debris Cleaned: Microorganisms still exist Sanitized Some microorganisms destroyed Disinfected All microorganisms destroyed Sterilized Various disinfectants are used in the dental office. Some provide high level disinfection and some low or moderate level disinfection Chlorine Dioxide Glutaraldehyde Sodium hypochlorite Iodophor Phenolics Alcohol

Ultrasonic Cleaner Holding bath Three to ten minute cleaning cycles Sound waves used Loosens hardened debris from instruments prior to sterilizing by submerging instruments. Cavitation process is where bubbles implode.

Sterilization Methods All forms of microorganisms are destroyed in the process of sterilization. Dental assistant most often is the person who ensures that all items used in intraoral procedures are sterile. Many types of machines and tools used to sterilize. Liquid chemical disinfectant Ethylene oxide Hot glass bead or salt Dry heat Chemical vapor Steam under pressure Steam Autoclave

Sterilization Monitoring Biological monitors are often the most accurate way to assess that sterilization has occurred. Process indicators are normally heat-sensitive tapes or inks printed on packaging materials. Dosage indicators are dyes placed in the sterilization packaging and change color when exposed to dry heat, chemical vapor, or steam. Monitors for liquid disinfectants/sterilizers do not exist; however, by using several strips to test concentration and following EPA directions, this ensures the product is working.

Infection Control Techniques The use of a preprocedure mouth rinse is a recommendation. This reduces the number of microorganisms in the patient’s mouth before treatment. The high volume evacuator will effectively reduce spray coming from handpiece and air-water syringe. This reduces the risk of inhalation exposures and releasing pathogens into the air. The dental dam provides a barrier to the fluids in the oral cavity during procedures. Equipment that can be disposed of after one use eliminates the possibilities of transferring microorganism by cross contamination.

Clinical Asepsis Asepsis Environment free of pathogens Housekeeping standards Government guidelines Creating an environment free of pathogens is key. A dental office should always be not only meeting government standards, but striving to keep things as clean as possible.

Treatment Room Preparation After chart has been reviewed, it can be placed under a plastic envelope barrier or under a surface barrier. New barriers could be placed on dental chair, hoses, counter, light switches and controls, etc. Instrument tray should include packaged sterile instruments with patient’s napkin and protective eyewear. PPE should be last, including eyewear, mask, gloves, and over gloves.

Completion of Dental Treatment Move tools back to the treatment tray Gloves should be kept on until all potentially infected materials have been removed and disposed of correctly. A final washing of the hands is also imperative.

Final Cleaning Put on utility gloves Spray-wipe-spray-wipe technique Set routine By following a routine procedure that meets all regulatory standards as well as each individual office, the dental assistant completes this practice.

References Dental Assisting: A Comprehensive Approach (3rd. Ed.) by Phinney and Halstead. Thomson /Delmar Learning, 2008