©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Infection Control Chapter 11

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Rationales of Infection Control Observe universal precautions Practice standard precautions Maintain chain of asepsis

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Regulators of Infection Control ADA Centers for Disease Control (CDC) Occupational Safety and Health Administration (OSHA)

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Regulators of Infection Control Federal Drug Administration (FDA) Environmental Protection Agency (EPA) Organization for Safety and Asepsis Procedures (OSAP)

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. OSHA 1991 Bloodborne Pathogens Standard –Determine exposure risk –Prepare written exposure control plan –Train initially and annually –Provide PPE –Establish standard operating procedure (SOP) –Office hepatitis B vaccinations

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. OSHA Needlestick Safety and Prevention Act –Passed in 2001 –Addresses use of newer, safer medical devices –Maintain sharps injury log

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. OSHA Compliance Dental office will be investigated for compliance if: –Complaint has been filed –Office has eleven or more employees –Invited by office

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check Under what category of occupational exposure risk to bloodborne pathogens does the DA fall? –Category 1 – exposure to blood, body fluids, saliva, and body tissues

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cross-Contamination Pathways From DA to patient From patient to DA Can go on to infect families and friends

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chain of Infection Agent: –Biological Bacteria, virus, fungi, or protozoa –Chemical Pesticides, food additives, or medications –Physical Heat, light, noise, or radiation

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chain of Infection Reservoir: –Colonization –Reproduction Portal of exit: –Body secretions

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chain of Infection Mode of transmission: –Contact –Airborne –Vehicle –Vector-borne

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chain of Infection Portal of entry: –Integumentary system –Respiratory system –Genitourinary tract –Gastrointestinal tract –Circulatory system –Transplacental

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chain of Infection Host: –Age –Concurrent disease –Stress –Immunization –Lifestyle

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chain of Infection Host: –Occupation –Nutritional status –Heredity

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Breaking the Chain of Infection Between agent and reservoir –Cleansing –Disinfecting –Sterilizing

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Breaking the Chain of Infection Between reservoir and portal of exit –Having proper hygiene –Cleaning equipment –Cleaning dressings

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Breaking the Chain of Infection Between portal of exit and mode of transmission –Blocking exits –Cleaning dressing –Wearing gloves

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Breaking the Chain of Infection Between mode of transmission and portal of entry –Having proper hand hygiene –Using barrier protection

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Breaking the Chain of Infection Between portal of entry and host –Maintaining skin integrity –Using sterile technique

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Breaking the Chain of Infection Between host and agent –Having proper nutrition –Exercising –Updating immunizations

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check Handwashing and wearing PPE break the chain of infection between what parts of the chain? –Mode of transmission and portal of entry to the host

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Routes of Transmission in the Dental Office DirectDirect Direct contact with lesion or microorganism Blood or saliva Open lesion InhalationInhalation Microorganism inhaled HandpiecesHandpieces Ultrasonic cleaner IndirectIndirect Through cross- contamination CountertopsCountertops EquipmentEquipment PensPens ChartsCharts

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Infection Control Techniques Immunizations Medical history Handwashing Alcohol-based hand rubs Lotions © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. PPE Eyewear Gloves Masks Protective clothing Barriers © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Disinfection Cleaning –Physical removal of matter Sanitization –Decontaminated, but not free of microbes Disinfection –Destruction of some microorganisms Sterilization –Destruction of all microorganisms

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chemical Disinfectants Chlorine dioxide Glutaraldehyde Sodium hypochlorite Iodophor Phenolics Alcohol

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Disinfection Technique Spray-wipe-spray-wipe 1.Spray 2.Wipe to eliminate surface debris 3.Spray 4.Let sit approximately 10 minutes 5.Wipe

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ultrasonic Cleaning Holding bath 3- to 10-minute cleaning cycles Sound waves used Cavitation process

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dishwasher-Disinfector Device Provides high-level disinfection Has thermal disinfector Washes, cleans, disinfects, and dries

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Sterilization Methods Liquid chemical disinfectant Ethylene oxide Dry heat Chemical vapor Steam under pressure Steam autoclave

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Sterilization Equipment maintenance –Necessary for proper function –Ensure correct solution is used in appropriate machine Handpiece sterilization Packaging and loading sterilizer Instrument storage

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Sterilization Monitoring Biological monitors Process indicators Dosage indicators © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Infection Control Techniques Pre-procedure antiseptic mouth rinses High-volume evacuation Dental dam usage Disposable items

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check Explain why hand hygiene is so important. –It prevents the spread of infection from the DA to the patient and from the patient to the DA

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Clinical Asepsis Asepsis –Environment free of pathogens Housekeeping standards Government guidelines

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment Room Preparation Wash hands Review chart Place new barriers Prepare instrument tray Put on PPE

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Completion of Dental Treatment Move tools back to treatment tray Document information on chart or computer with overgloves on Remove patient napkin and dismiss Remove all barriers with gloves on Remove gloves and wash hands

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Final Cleaning Put on utility gloves Employ spray-wipe-spray-wipe technique Set routine

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Unit Water Lines Small tubes that connect water line to instruments Biofilms –Thin layer of bacteria that lines tubes Flush at start of day and between patients Install retraction devices

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Radiography and Equipment Rom Often missed Preparation similar to treatment room Disinfect once completed

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Laboratory Disinfect in same manner as other rooms Clean and disinfect after working Clean and disinfect appliances created

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check What is the disinfection technique used to prepare the treatment room? –Spray-wipe-spray-wipe