1. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 1 Chapter 9 Infection Control

2. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 2 Ways to Maintain Good Health Get plenty of rest Eat a well-balanced diet Include proper exercise routine Keep a positive attitude Get necessary immunizations –Hepatitis B

3. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 3 Ways to Maintain Good Health Asepsis: environment free of pathogens –Pathogens: disease-causing microorganisms –Creating an aseptic environment Housekeeping standards Government guidelines

4. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 4 The Chain of Infection Virulence (strength) Numbers Susceptible host Portal of entry

5. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 5 Infection Control Hepatitis (strong) HIV (weak) Type of pathogen Virulence (strength) High-volume evacuation (HVE) Rubber dam Pretreatment mouth rinse Handwashing Barriers Disinfection of surfaces Sterilization of instruments Methods to reduce pathogens Number of pathogens Have not been vaccinated Extreme stress Malnourished Elderly Disease Lower immune system Susceptible host Sexually transmitted Respiratory tract Eyes and nasal passages Broken skin Portal of entry

6. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 6 Open lesion Blood or saliva Direct contact with lesion or microorganism Direct Charts Pens Equipment Countertops Through cross contamination Indirect Utrasonic cleaner Handpieces Microorganisms inhaled Inhalation Routes of Microbial Transmission

7. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 7 Cross Contamination The spread of disease through contact with contaminated items such as the following: –Faucets, handles, and switches –Food and water –Instruments, handpieces, and supplies –Surfaces and equipment –Cosmetics –Hair –Eyewear –Patient charts –Phone receivers and computer keyboards

8. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 8 Pathways of Cross Contamination

9. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 9 Cross Contamination Outside the Office Shopping cart handles Gas pumps Handshakes Door handles Mail Kitchens Fast-food restaurants

10. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 10 Division of Health Services

11. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 11 Occupational Safety and Health Administration (OSHA) It is a division of the Department of Labor. It regulates and enforces employers to provide a safe work environment.

12. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 12 State OSHA Agencies Many state OSHA agencies have stricter standards than federal OSHA. Office is held to highest standard.

13. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 13 State Dental Societies Source of comprehensive training manuals Specific to state standards Contain training forms and guidelines Yearly training on infection control required

14. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 14 OSHA: Areas of Concern Physical –Ergonomics Chemical –Exposure Infectious hazards –Blood –Other potentially infectious material (OPIM)

15. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 15 When OSHA Inspections Occur After an employee or a patient complaint Randomly if office has 11 or more employees By invitation of office

16. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 16 OSHA-Mandated Training Bloodborne pathogen standard Written exposure control plan Accident incident policy Communication standard Material Safety Data Sheets (MSDS) manual

17. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 17 Consequences of Noncompliance with OSHA Citations and fines issued Office revisited until compliance gained Possibility of office closure

18. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 18 Standard Precautions Designed to protect both the health care provider and the patient Combines the following standards –Universal precautions –Body substance isolation Practiced before, during, and after procedures Ensures aseptic environment

19. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 19 Universal Precautions Treat all patients as if they have an infectious disease Body substance isolation (BSI) Personal protective equipment (PPE)

20. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 20 Bloodborne Pathogen Standard Prepare a written exposure control plan Determine occupational exposure risk –Dental assistants are Category 1 Provide PPE Launder laboratory coats Offer hepatitis vaccine Implement a postexposure plan

21. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 21 Bloodborne Pathogen Standard Applies to any office where employees have the potential to become exposed to infectious body fluids Facilities affected –Funeral homes –Emergency medical services –Hospitals –Medical and dental offices

22. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 22 Employee Training and Documentation Yearly updates When a new employee is hired (within 30 days) When an employee changes job functions Records kept throughout employment plus 30 years When a new product is used

23. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 23 Food and Drug Administration (FDA) Division of U.S. Department of Health and Human Services Regulates manufacturing and labeling of medical devices and solutions –Sterilizers –Chemical and biological indicators –Sterilizing and disinfecting solution –Gloves, masks, and glasses

24. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 24 Environmental Protection Agency (EPA) Involved in the safety and effectiveness of disinfecting and sterilizing solutions Regulates the disposal of hazardous waste

25. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 25 Infection Control in the Dental Office

26. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 26 Handwashing Minimum 30-second handwashing Use antimicrobial soap and warm water Remove jewelry Scrub nails and between fingers Rinse with cold water to close pores

27. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 27 Barriers Placed on areas that are difficult to disinfect –Dental chair –Light handles –Handpieces –High-volume evacuation tubing –Saliva ejector

28. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 28 Other Infection Control Measures Personal Protective Equipment (PPE) Vinyl and latex gloves Utility and Nytrile gloves Overgloves Masks

29. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 29 Acceptable Uniform High collar Cuffed sleeves Ideal length

30. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 30 Criteria for Protective Gowns Disposable Washed at office Washed by commercial laundry service Always removed before leaving the work area

31. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 31 Patient Protection Protective eyewear Patient napkin Rubber dam Pre-rinse with antimicrobial agent

32. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 32 Centers for Disease Control Classification of Instruments Critical –Touches bones or penetrates soft tissue Semicritical –Touches mucous membranes Noncritical –Contacts only intact skin

33. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 33 Sanitization Physical removal of blood, debris, and tissue Area is cleaned and decontaminated Microorganisms have not been destroyed

34. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 34 Ultrasonic Cleaner Cleans instruments 3- to 10-minute cycles Sound waves Bubbles implode

35. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 35 Disinfection The process of killing pathogens by physical or chemical means Spores and resistant viruses are not destroyed

36. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 36 Classifications of Disinfectants High level –Sterilant: Kills spores Intermediate level –Tuberculocidal: Kills resistant groups of microorganisms –Used on countertops and surfaces Low level –Used on noncritical items –Nontuberculocidal

37. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 37 Chemical Disinfectants Glutaraldehydes –High level Sodium hypochlorite –Intermediate Iodophor –Intermediate Phenolics –Intermediate

38. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 38 Sterilization All forms of microorganisms are destroyed, including spores and viruses.

39. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 39 Methods of Sterilization Liquid chemical disinfectant/sterilization Dry heat sterilizer Steam autoclave Chemical vapor sterilizer

40. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 40 Liquid Chemical Disinfectant/Sterilization 6 to10 hours submersion Only for items that cannot endure sterilizer (plastics) Difficult to monitor Requires well-ventilated area

41. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 41 Dry Heat Sterilizer 340° F for 1 hour Dry instruments before placement Disadvantages –Avoid placing plastic and fabric in the unit

42. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 42 Autoclave: Steam Under Pressure Pressure + temperature + time 250° F for 20 minutes Requires distilled water Loose or bagged instruments

43. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 43 Chemical Vapor Sterilizer Does not cause rust on instruments 270° F for 20 minutes Formaldehyde and alcohol gas vapors under pressure –Carcinogen –Requires special ventilation –Hazardous material fees-shipping

44. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 44 Reasons for Sterilization Failures Overloading Incorrect processing time Damaged gasket on the door Incorrect packaging material Door opened during cycle to add or remove contents

45. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 45 Packaging Systems If kept in sealed bag, instruments remain sterile until opened. Sterilization indicator alerts operator of problem.