Download Infection Control

Chapter 9
Infection Control
Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED.
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Ways to Maintain Good Health
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Get plenty of rest
Eat a well-balanced diet
Include proper exercise routine
Keep a positive attitude
Get necessary immunizations
– Hepatitis B
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Ways to Maintain Good Health
• Asepsis: environment free of pathogens
– Pathogens: disease-causing microorganisms
– Creating an aseptic environment
• Housekeeping standards
• Government guidelines
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The Chain of Infection
Virulence
(strength)
Numbers
Susceptible host
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Portal of entry
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Infection Control
Virulence
(strength)
Number of pathogens
Susceptible host
Portal of entry
Type of pathogen
Methods to reduce pathogens
Lower immune system
Broken skin
HIV (weak)
Sterilization of instruments
Disease
Eyes and nasal passages
Hepatitis (strong)
Disinfection of surfaces
Elderly
Respiratory tract
Barriers
Malnourished
Sexually transmitted
Handwashing
Extreme stress
Pretreatment mouth rinse
Have not been vaccinated
Rubber dam
High-volume evacuation (HVE)
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Routes of Microbial
Transmission
Direct
Indirect
Inhalation
Direct contact with
lesion or microorganism
Through cross contamination
Microorganisms inhaled
Blood or saliva
Countertops
Handpieces
Open lesion
Equipment
Utrasonic cleaner
Pens
Charts
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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
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Pathways of Cross
Contamination
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Cross Contamination Outside
the Office
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Shopping cart handles
Gas pumps
Handshakes
Door handles
Mail
Kitchens
Fast-food restaurants
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Division of Health Services
United States Department of Health Services
Public Health Services
Center for Disease Control and Prevention
Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED.
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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.
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State OSHA Agencies
• Many state OSHA agencies have stricter
standards than federal OSHA.
• Office is held to highest standard.
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State Dental Societies
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Source of comprehensive training manuals
Specific to state standards
Contain training forms and guidelines
Yearly training on infection control required
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OSHA: Areas of Concern
• Physical
– Ergonomics
• Chemical
– Exposure
• Infectious hazards
– Blood
– Other potentially infectious material (OPIM)
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When OSHA Inspections Occur
• After an employee or a patient complaint
• Randomly if office has 11 or more
employees
• By invitation of office
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OSHA-Mandated Training
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Bloodborne pathogen standard
Written exposure control plan
Accident incident policy
Communication standard
Material Safety Data Sheets (MSDS)
manual
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Consequences of
Noncompliance with OSHA
• Citations and fines issued
• Office revisited until compliance gained
• Possibility of office closure
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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
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Universal Precautions
• Treat all patients as if they have an
infectious disease
• Body substance isolation (BSI)
• Personal protective equipment (PPE)
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Bloodborne Pathogen Standard
• Prepare a written exposure control plan
• Determine occupational exposure risk
– Dental assistants are Category 1
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Provide PPE
Launder laboratory coats
Offer hepatitis vaccine
Implement a postexposure plan
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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
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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
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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
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Environmental Protection
Agency (EPA)
• Involved in the safety and effectiveness of
disinfecting and sterilizing solutions
• Regulates the disposal of hazardous
waste
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Infection Control in the
Dental Office
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Handwashing
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Minimum 30-second handwashing
Use antimicrobial soap and warm water
Remove jewelry
Scrub nails and between fingers
Rinse with cold water to close pores
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Barriers
• Placed on areas that are difficult to
disinfect
– Dental chair
– Light handles
– Handpieces
– High-volume evacuation tubing
– Saliva ejector
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Other Infection Control
Measures
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Personal Protective Equipment (PPE)
Vinyl and latex gloves
Utility and Nytrile gloves
Overgloves
Masks
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Acceptable Uniform
• High collar
• Cuffed sleeves
• Ideal length
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Criteria for Protective Gowns
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Disposable
Washed at office
Washed by commercial laundry service
Always removed before leaving the work
area
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Patient Protection
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Protective eyewear
Patient napkin
Rubber dam
Pre-rinse with antimicrobial agent
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Centers for Disease Control
Classification of Instruments
• Critical
– Touches bones or penetrates soft tissue
• Semicritical
– Touches mucous membranes
• Noncritical
– Contacts only intact skin
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Sanitization
• Physical removal of blood, debris, and
tissue
• Area is cleaned and decontaminated
• Microorganisms have not been destroyed
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Ultrasonic Cleaner
• Cleans instruments
• 3- to 10-minute cycles
• Sound waves
• Bubbles implode
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Disinfection
• The process of killing pathogens by
physical or chemical means
• Spores and resistant viruses are not
destroyed
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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
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Chemical Disinfectants
• Glutaraldehydes
– High level
• Sodium hypochlorite
– Intermediate
• Iodophor
– Intermediate
• Phenolics
– Intermediate
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Sterilization
• All forms of microorganisms are
destroyed, including spores and viruses.
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Methods of Sterilization
• Liquid chemical disinfectant/sterilization
• Dry heat sterilizer
• Steam autoclave
• Chemical vapor sterilizer
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Liquid Chemical
Disinfectant/Sterilization
• 6 to10 hours submersion
• Only for items that cannot endure sterilizer
(plastics)
• Difficult to monitor
• Requires well-ventilated area
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Dry Heat Sterilizer
• 340° F for 1 hour
• Dry instruments before
placement
• Disadvantages
– Avoid placing plastic and
fabric in the unit
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Autoclave:
Steam Under Pressure
• Pressure + temperature + time
• 250° F for 20 minutes
• Requires distilled water
• Loose or bagged instruments
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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
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Reasons for Sterilization
Failures
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Overloading
Incorrect processing time
Damaged gasket on the door
Incorrect packaging material
Door opened during cycle to add or
remove contents
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Packaging Systems
• If kept in sealed bag, instruments remain
sterile until opened.
• Sterilization indicator alerts operator of
problem.
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