Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 6 Infection Control: Clinical Procedures

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Overview Objectives Basic considerations for safe practice

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment Room Features Dental unit Dental chair Light Clinician ’ s chair Floor Sink Supplies Waste

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Instrument Processing Center For instrument: –Care & cleaning –Packaging –Sterilizing –Storing Located apart from treatment rooms

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Cleaning Procedures Instrument washer/thermal disinfector Ultrasonic processing Manual cleaning

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Packaging Step Purposes Instrument arrangement Preparation

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Sterilization Approved methods Selection of method Tests for sterilization –External chemical indicator –Internal chemical indicator –Biologic monitor

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Moist Heat: Steam Under Pressure Autoclave types –Gravity displacement –High-speed prevacuum Use Principles of action Evaluation

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Review Which of the following is an autoclave? A) It is a chemical vapor sterilizer B) It is sterilization achieved by steam under pressure C) It is a dry heat sterilizer D) It is an ethylene oxide sterilizer

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B) It is sterilization achieved by steam under pressure is the correct answer. By definition, an autoclave is a sterilizer that sterilizes using steam under pressure. The other sterilizers do sterilize, but by other methods and chemicals.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Dry Heat Use Principles of action Operation Evaluation

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chemical Vapor Sterilizer Use Principles of action Operation Care of sterilizer Evaluation

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of Sterile Instruments Storage Shelf life

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chemical Disinfectants Categories Uses Principles of action Criteria for agent selection

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Review A. High-level disinfectants inactivate spores and all forms of bacteria, fungi, and viruses. B. Intermediate-level disinfectants inactivate all forms of microorganisms but do not destroy spores. A) Statement A is correct and statement B is correct B) Statement A is correct and statement B is incorrect C) Statement A is incorrect and statement B is correct D) Statement A is incorrect and statement B is incorrect

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A) Statement A is correct and statement B is correct. High-level disinfectants inactivate spores and all forms of bacteria, fungi, and viruses. Intermediate-level disinfectants inactivate all forms of microorganisms but do not destroy spores.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Preparation of the Treatment Room Objectives Preliminary planning –Hand contacts –Sterilizable items –Disposable items –Items that may be covered –Items that require chemical disinfection

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Preparation of the Treatment Room (cont’d) Clean and disinfect environmental surfaces –Agent –Procedure Unit water lines –Procedure for clinical use

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Preparation Preprocedural oral hygiene measures –Toothbrushing –Rinsing Application of surface antiseptic –Before injection of anesthetic –Before scaling and other dental hygiene instrumentation

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Review A. Preprocedural rinsing and other oral hygiene measures help to prevent the spread of communicable diseases. B. Preprocedural rinsing and other oral hygiene measures decrease the number of microorganisms in the oral cavity. A) Statement A is correct and statement B is correct B) Statement A is correct and statement B is incorrect C) Statement A is incorrect and statement B is correct D) Statement A is incorrect and statement B is incorrect

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A) Statement A is correct and statement B is correct. The use of preprocedural rinsing and toothbrushing has been shown to lower the numbers of oral bacteria and, therefore, to lower the numbers of infected aerosols created during instrumentation.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Summary of Standard Procedures Patient factors Clinic preparation Factors for the dental team Treatment factors Posttreatment

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Factors Comprehensive patient history –Assessment of history –Medical consultation or referral Preprocedural mouthrinse Protective eyewear Patient with communicable condition

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinic Preparation Waterline cleaning Environmental surface disinfection Instrument sterilization

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors for the Dental Team DHCP medical status PPE use Meticulous hand hygiene Aseptic technique

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment Factors Hypodermic needles Removable oral prostheses

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Posttreatment Use heavy, puncture-resistant gloves to handle instruments Disinfect, clean, & prepare instruments Secure contaminated waste in bags Disinfect safety eyewear

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Occupational Post-Exposure Management Significant exposures Procedure following exposure –First aid procedures –Documentation Follow-up

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Disposal of Waste Regulations Guidelines

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Supplemental Recommendations Cleaning the face Smoking and eating Reception area Sterilization monitoring Office policy manual

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Documentation: Needlestick Patient name, record #, address, phone #, Medical history of HBV, HCV, HIV For HIV+ source patient: –Current medications & effectiveness –Viral load & current CD4, if known

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors to Teach the Patient Standard precautions Medical, dental, and social histories Sterilization and biologic monitoring Normal oral flora and disease etiology Personal oral infection control methods