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Chapter 9 Infection Control Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 1 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 2 Ways to Maintain Good Health • Asepsis: environment free of pathogens – Pathogens: disease-causing microorganisms – Creating an aseptic environment • Housekeeping standards • Government guidelines Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 3 The Chain of Infection Virulence (strength) Numbers Susceptible host Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. Portal of entry 4 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) Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 5 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 6 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 7 Pathways of Cross Contamination Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 8 Cross Contamination Outside the Office • • • • • • • Shopping cart handles Gas pumps Handshakes Door handles Mail Kitchens Fast-food restaurants Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 9 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. 10 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. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 11 State OSHA Agencies • Many state OSHA agencies have stricter standards than federal OSHA. • Office is held to highest standard. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 12 State Dental Societies • • • • Source of comprehensive training manuals Specific to state standards Contain training forms and guidelines Yearly training on infection control required Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 13 OSHA: Areas of Concern • Physical – Ergonomics • Chemical – Exposure • Infectious hazards – Blood – Other potentially infectious material (OPIM) Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 14 When OSHA Inspections Occur • After an employee or a patient complaint • Randomly if office has 11 or more employees • By invitation of office Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 15 OSHA-Mandated Training • • • • • Bloodborne pathogen standard Written exposure control plan Accident incident policy Communication standard Material Safety Data Sheets (MSDS) manual Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 16 Consequences of Noncompliance with OSHA • Citations and fines issued • Office revisited until compliance gained • Possibility of office closure Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 17 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 18 Universal Precautions • Treat all patients as if they have an infectious disease • Body substance isolation (BSI) • Personal protective equipment (PPE) Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 19 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 20 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 21 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 22 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 23 Environmental Protection Agency (EPA) • Involved in the safety and effectiveness of disinfecting and sterilizing solutions • Regulates the disposal of hazardous waste Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 24 Infection Control in the Dental Office Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 25 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 26 Barriers • Placed on areas that are difficult to disinfect – Dental chair – Light handles – Handpieces – High-volume evacuation tubing – Saliva ejector Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 27 Other Infection Control Measures • • • • • Personal Protective Equipment (PPE) Vinyl and latex gloves Utility and Nytrile gloves Overgloves Masks Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 28 Acceptable Uniform • High collar • Cuffed sleeves • Ideal length Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 29 Criteria for Protective Gowns • • • • Disposable Washed at office Washed by commercial laundry service Always removed before leaving the work area Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 30 Patient Protection • • • • Protective eyewear Patient napkin Rubber dam Pre-rinse with antimicrobial agent Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 31 Centers for Disease Control Classification of Instruments • Critical – Touches bones or penetrates soft tissue • Semicritical – Touches mucous membranes • Noncritical – Contacts only intact skin Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 32 Sanitization • Physical removal of blood, debris, and tissue • Area is cleaned and decontaminated • Microorganisms have not been destroyed Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 33 Ultrasonic Cleaner • Cleans instruments • 3- to 10-minute cycles • Sound waves • Bubbles implode Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 34 Disinfection • The process of killing pathogens by physical or chemical means • Spores and resistant viruses are not destroyed Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 35 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 36 Chemical Disinfectants • Glutaraldehydes – High level • Sodium hypochlorite – Intermediate • Iodophor – Intermediate • Phenolics – Intermediate Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 37 Sterilization • All forms of microorganisms are destroyed, including spores and viruses. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 38 Methods of Sterilization • Liquid chemical disinfectant/sterilization • Dry heat sterilizer • Steam autoclave • Chemical vapor sterilizer Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 39 Liquid Chemical Disinfectant/Sterilization • 6 to10 hours submersion • Only for items that cannot endure sterilizer (plastics) • Difficult to monitor • Requires well-ventilated area Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 40 Dry Heat Sterilizer • 340° F for 1 hour • Dry instruments before placement • Disadvantages – Avoid placing plastic and fabric in the unit Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 41 Autoclave: Steam Under Pressure • Pressure + temperature + time • 250° F for 20 minutes • Requires distilled water • Loose or bagged instruments Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 42 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 43 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 Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 44 Packaging Systems • If kept in sealed bag, instruments remain sterile until opened. • Sterilization indicator alerts operator of problem. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 45