1. Registered Dental Assistant: Infection Control
By Janice Lewis

2. Abbreviations DHCP-Dental Health Care Personnel
EPA-Environmental Protection Agency
FDA-Food and Drug Administration
HBV-Hepatitis B Virus
IC-Infection Control
ICC/ICRF-Infection Control Committee/Review Function
OPIM-Other Potentially Infectious Materials
PPE- Personal Protective Equipment

3. Rationales of Infection Control
Observe Universal Precautions
Practice Standard Precautions
Maintain a chain of asepsis
To protect yourself and the health of your patients, every patient you encounter should be treated as if he or she is infectious. Prior to, during, and after each procedure, it is important to practice techniques that will prevent the spread of infection such as use of PPE and body substance isolation techniques. Practicing aseptic techniques will prevent cross contamination from one patient to the next and from one health care worker to the next.

4. Regulators of Infection Control
Federal Drug Administration (FDA)
Regulates manufacturing and labeling of medications and medical devices.
Environmental Protection Agency (EPA)
Regulates the safety and effectiveness of disinfecting and sterilizing solutions.
Organization for Safety and Asepsis Procedures (OSAP)
National organization of health care workers from all health industries.
Meets to cover topics of infection control and hazard communication

5. Regulators of Infection Control
Many organizations make protecting you and the patients a priority.
The ADA:
Makes recommendations through various media such as journals, the internet, newsletters, etc.
The CDC describes:
Body substance isolation (BSI)
Personal protective equipment (PPE)
OSHA defines:
Potentially infectious materials
Bloodborne pathogens standards
OSHA is the regulating body to ensure that health care facilities are protecting their employees from exposure to infectious diseases or materials.

6. Occupation Safety Health Administration (OSHA)
Four step process for exposure determination:
Step 1 - Type of employee
Dentist, D.A., Hygienist, Lab Tech
Receptionist, Coordinating assistant
Accountant, Insurance agent
Step 2 – How often at risk
Step 3 – Manual developed
Step 4 – Written policy
Training cannot be solely videos or interactive computer programs alone. Dental practices must make sure employees understand completely through hands-on interaction.

7. OSHA Compliance
A dental office will be investigated for compliance if:
A complaint has been filed
The office has eleven or more employees
Invited by the office
All states are regulated by OSHA standards.
Twenty-four states are regulated also through a state agency and are often more demanding than the federal standards.
The rest of the states are administered through regional branches of the federal Occupational Safety and Health Administration

8. Chain of Infection
The agent is the entity capable of causing disease. The agent can be biological (from a living organism), chemical (substances that interact with the body), or physical (environmental factors that affect the body).

9. Chain of Infection
The reservoir is the place where the agent can survive. It promotes the growth of the agent under proper conditions. Some individuals may be carriers of an infectious agent but may not become ill with infection. These individuals are still able to transmit the infection to others.

10. Chain of Infection
The portal of exit is the manner in which the agent leaves the reservoir to be transferred to a host. This normally occurs through body secretions:
Sputum
Semen
Vaginal secretions
Urine
Saliva
Feces
Blood
Draining wounds

11. Chain of Infection
The mode of transmission bridges the gap between the portal of exit of the infectious agent and the portal of entry to the new host.
Contact transmission occurs through physical transfer of an agent to an infected person. Contact can be indirect as in through exposure to contaminated secretions or direct as in physical contact with an infected person for example sexually transmitted diseases.
Airborne transmission occurs through contact with droplets of dust particles contaminated with an infectious agent.
Vehicle transmission occurs through contact with an inanimate object that carries and infectious agent such as contaminated drinking water.
Vector-borne transmission occurs through contact with an infectious organism such as a mosquito.

12. Chain of Infection
The portal of entry is the route from which the infectious agent enters the host. It can occur through breaks in the skin, inhalation of droplets into the respiratory tract, through contaminated vaginal secretions or semen, ingestion of contaminated food or water, into the blood stream, and from mother to fetus via the placenta.

13. Chain of Infection
The host is the organism affected by an agent. The host is affected due to a weakness in its system. This can be caused by age, other disease processes, stress, lack of vaccinations, lifestyle risk practices, occupational exposure risks, poor nutrition, and genetics.

14. Breaking the Chain of Infection
Between agent and reservoir
The chain of infection can be broken between any of the links. You can eliminate the spread of the agent to the reservoir through proper cleaning, disinfecting, and sterilization of equipment and work areas.

15. Breaking the Chain of Infection
The key to stopping the infection between the portal of exit and the mode of transmission is to block the exit of the infectious agent. This can be done by clean dressing, use of gloves and masks, and encouraging the practices of covering the mouth and nose when sneezing or coughing.

16. Breaking the Chain of Infection
Stopping the infectious process between the mode of transmission and portal of entry is to block the entrance of the agent. This can be accomplished through hand hygiene and use of barrier protections such as gloves, masks, and gowns.

17. Breaking the Chain of Infection
Breaking the chain of infection between the portal of entry and the new host requires blocking the agent from invading the host. This can be done by maintaining the integrity of the skin. If the skins must be punctured or is procedures required are invasive sterile technique must be used.

18. Breaking the Chain of Infection
Breaking the chain of infection between host and agent means stopping the infection before it begins. This is the result of maintaining one’s health through good nutritional practices, exercise, and maintaining updated immunizations.

19. Transmission in the Dental Office
Routes of
Transmission in the Dental Office
Open lesion
Blood or saliva
Direct contact with
lesion or microorganism
Direct
Charts
Pens
Equipment
Countertops
Through cross contamination
Indirect
Ultrasonic cleaner
Handpieces
Microorganisms inhaled
Inhalation

20. 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.

21. Personal Protective Equipment (PPE)
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
Gloves:
Common to see latex allergy
Petroleum-based lotion prior could break down gloves
Change gloves after each patient
Overgloves
Utility gloves
Polynitrile autoclavable gloves

22. Personal Protective Equipment (PPE)
Masks:
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

23. Disinfection Cleaning area: physically remove all debris
Sanitized: microorganisms still exist
Disinfection: some microorganisms destroyed
Sterilization: all microorganisms destroyed

24. Chemical Disinfectants
Iodophor
Phenolics
Alcohol
Chlorine Dioxide
Glutaraldehyde
Sodium hypochlorite
Various disinfectants are used in the dental office. Some provide high level disinfection and some provide low or moderate level disinfection

25. 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.

26. Sterilization Methods
Dry heat
Chemical vapor
Steam under pressure
Steam Autoclave
Liquid chemical disinfectant
Ethylene oxide
Hot glass bead or salt
All forms of microorganisms are destroyed in the process of sterilization. The 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.

27. 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.

28. 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.

29. 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.

30. 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.

31. Completion of Dental Treatment
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.
Move tools back to the treatment tray

32. 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.

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