1. 2003 CDC Guidelines for Dental Healthcare Settings Infection Control, DA116

2. Review: OSHA = ________ CDC = ___________________ ◦ OSHA Bloodborne Pathogens 1991 ◦ CDC Guidelines 1993 ◦ OSHA Needlestick Safety and Prevention Act 2001 ◦ CDC Guidelines for Infection Control in Dental Health-Care Settings — 2003.  Built on previous laws and recommendations

3. OSHA Needlestick Safety and Prevention Act 2001 ___________ must consider using safer needle devices to prevent needle-stick injuries ____________ must be involved in identifying and choosing the new devices for office use

4. CDC 2003 CHANGES 2003 CDC guidelines follow previous CDC guidelines and OSHA Standards but add some details or slight changes to the original documents.

5. Standard Precautions Standard Precautions Apply to ____ patients Integrate and expand Universal Precautions to include organisms spread by _____ and also ◦ Body fluids, secretions, and excretions except sweat, whether or not they contain blood OPIM ◦ Non-intact (broken) skin ◦ Mucous membranes

6. Elements of Standard Precautions Elements of Standard Precautions Handwashing Use of gloves, masks, eye protection, and gowns Injury prevention Patient care equipment Environmental surfaces

7. Personnel Health Elements Vaccinations  HBV  Influenza  Measles, Mumps, Rubella  Varicella ◦ Documentation of vaccination or immunity ◦ Baseline TB test upon employment Post-exposure prophylaxis (PEP) to  HBV, HCV, HIV  Offices should make advance arrangements for testing and treatment with local occupational health physician so no delays in PEP occur Continued Bloodborne Pathogens Standard compliance Written work restriction policies for workers infected with or exposed to major infectious diseases Annual evaluation of safety devices such as dental safety syringes

8. Guidance for selecting and using PPE Protective eyewear ◦ _____side shields Thick _____ gloves ◦ Instrument cleaning and housekeeping _______ surgeons’ gloves for oral surgery Respirator protection ◦ Patients with TB

9. Hand Care When/How to use: ◦ Plain soap ◦ Antimicrobial _____ ◦ Alcohol-based ____________ ◦ Oral surgical antisepsis  Antimicrobial soaps or alcohol rubs with persistent activity NOTE: WASH hands for every 5-10 hand-rubs to keep hands clean ◦ ___________:  Prevent/ease skin dryness  Caution: type of lotion ◦ Irritant and contact dermatitis ◦ Latex (type I) hypersensitivity  Establish latex-safe environment if necessary ◦ ______ fingernails  no artificial nails  no finger jewelry

10. Sterilization and Disinfection More detailed than 1993 guidelines ◦ Sterilizer monitoring ◦ Sterilization of unwrapped items ◦ Storage of sterilized items ◦ Differences between types of disinfecting chemicals ◦ Water quality

11. SPECIAL CONSIDERATIONS CDC 2003 gives specific guidelines for several situations common to the dental office

12. Dental Handpieces and Other Devices Attached to air and waterlines but removable Permanently attached to air and waterlines Clean and heat _______ intraoral devices that can be removed from air and waterlines Follow manufacturer’s instructions for cleaning, lubrication, and sterilization Do ____ use liquid germicides or ethylene oxide Items do not enter patient’s mouth but may become contaminated Use _______ and change between uses Clean and intermediate- level ________ the surface of devices if visibly contaminated

13. Saliva Ejectors Saliva Ejectors Previously suctioned ________ might be retracted into the patient’s mouth when a seal is created Do not advise patients to close their lips tightly around the tip of the saliva ejector

14. Dental Radiology Wear gloves and other appropriate ____ as necessary Use ______ or single-use items when possible _______ sterilize heat-tolerant radiographic accessories Transport and handle exposed radiographs so that they will not become contaminated Avoid contamination of processing equipment or computer equipment if using digital

15. Precautions for Parenteral Medications (medications injected into body) _____ tubings, bags, connections, needles, and syringes are single-use, disposable _________ dose vials ◦ Do not administer to multiple patients even if the needle on the syringe is changed ◦ Do not combine leftover contents for later use

16. Single-Use (Disposable) Devices Intended for use on _____ patient during a single procedure Usually ______ heat-tolerant ________ be reliably cleaned Examples: Syringe needles, prophylaxis cups, and plastic orthodontic brackets

17. Pre-procedural Mouth Rinses ◦ Have a patient use an anti-microbial mouth rinse prior to dental procedure  ________ microorganisms in the mouth, aerosol and spatter  Scientific evidence is inconclusive

18. Precautions for Surgical Procedures Sterile Irrigating Solutions Sterile Surgeon’s Gloves Surgical Scrub

19. Handling Biopsy Specimens Place biopsy in sturdy, _________ container Avoid contaminating the outside of the container ________ with a biohazard symbol

20. Extracted Teeth Considered ________ medical waste ◦ Do not incinerate extracted teeth containing amalgam ◦ Clean and disinfect before sending to _____ for shade comparison Can be given back to patient Educational setting: ◦ Remove visible blood and debris ◦ Maintain hydration ◦ Autoclave (teeth with no amalgam) ◦ Use Standard Precautions

21. Laser/Electrosurgery Plumes and Surgical Smoke Destruction of tissue creates _______ that may contain harmful by-products ◦ Infectious materials (HSV, HPV) may contact mucous membranes of nose ◦ No evidence of HIV/HBV transmission Need further studies ◦ no specific recommendations – ◦ Note: most offices use HVE to contain fumes due to offensive odor

22. Dental Laboratory Dental prostheses, appliances, and items used in their making are potential sources of contamination Handle in a manner that protects patients and DHCP from exposure to microorganisms Clean and disinfect prostheses and impressions Wear appropriate PPE until disinfection has been completed Clean and heat sterilize heat-tolerant items used in the mouth Communicate specific information about disinfection procedures

23. INFECTIOUS DISEASES Bloodborn Pathogens are still a concern but CDC 2003 also refers to TB and prion diseases

24. Transmission of Mycobacterium tuberculosis Spread by __________ nuclei Healthy immune system usually _________ spread Bacteria can remain alive in the lungs for ______ years (latent TB infection) Risk is low in dental setting Baseline TB test recommended at initial hire

25. Preventing Transmission of TB in Dental Settings Assess patients for history of ___ Defer ________ dental treatment If patient must be treated: ◦ DHCP should wear respirator mask ◦ Separate patient from others/mask/tissue ◦ Refer to facility with proper TB infection control precautions

26. Creutzfeldt-Jakob Disease (CJD) and other prion diseases Prion: altered form of a normal cellular protein ◦ Animal and human forms Long incubation period; very rare ◦ Results in a fatal, degenerative CNS disorder  “mad cow” Infection Control for Known CJD or vCJD Dental Patients ◦ Use single-use disposable items and equipment ◦ Consider items difficult to clean (e.g., endodontic files, broaches) as single-use disposable ◦ Keep instruments moist until cleaned ◦ Clean and autoclave at 134°C for 18 minutes ◦ Do not use flash sterilization

27. PROGRAM EVALUATION Periodic observational assessments Checklists to document procedures Routine review of occupational exposures to bloodborne pathogens