Download Bloodborne Pathogens/Infection Control Tuberculosis Awareness

Bloodborne Pathogens/Infection Control
Tuberculosis Awareness
CDM 3rd years
and Post-docs
June 29th 2016
Biological Safety Officer: Aderemi Dosunmu Ph.D.– [email protected]
Manager, Biological Safety Program: Christopher Aston Ph.D.
[email protected]
Biosafety
www.ehs.columbia.edu
Why is Biosafety Important in Dentistry?

You will come in contact with blood, oral and
respiratory secretions

Contaminated equipment can occur

Both patients and dental health care personnel
(DHCP) can be exposed to pathogens

Proper procedures can prevent transmission of
infections between patients and DHCP
Biosafety
www.ehs.columbia.edu
Agenda
 Infection Control
 Bloodborne Pathogens
 Occupational Exposure
 Sharps Safety
 Regulated Medical Waste
 Environmental Surfaces and Spill Response
 Personal Protective Equipment
 TB Precautions
Biosafety
www.ehs.columbia.edu
Chain of Infection
Pathogen
Susceptible Host
Vaccination
Entry
Disinfection
Source
Mode
Safe sharps
handling
PPE
Biosafety
www.ehs.columbia.edu
Infection Control
 SOPs were created for the protection of the patient and the
and DHCP




Attend training
Wear PPE
Perform safe work practices
Report incidents
 “Institutional safety committees should implement and
maintain surveillance programs to identify & monitor acute
illness. Healthcare providers should routinely inquire about
occupational exposures when evaluating patients.”
 “Any microorganism in the wrong place, in the wrong person,
is capable of causing illness or death”.
Biosafety
www.ehs.columbia.edu
Worse Case
Scenario
First documented report of patient-topatient transmission of hepatitis C
virus associated with a dental setting
in the United States.
Improper sterilization techniques.
Using single vials of medications on
multiple patients.
No written infection control protocol.
Biosafety
www.ehs.columbia.edu
Standard Precautions
Apply to all patients regardless of actual or
perceived risk factors;
treat all blood or Otherwise Potentially Infectious
Material (OPIM) as if infectious.
 Body fluids, secretions e.g., saliva and excretions
(except sweat), whether or not they contain blood
 Non-intact (broken) skin
 Mucous membranes
Biosafety
www.ehs.columbia.edu
Elements of Standard Precautions

Hand washing

Use of gloves, masks, eye
protection, and gowns

Disinfection of patient care
equipment

Disinfection of
environmental surfaces.
Alternatively, cover what
you can

Injury prevention
Biosafety
www.ehs.columbia.edu
Bloodborne Pathogens
HIV
HBV
• Lifetime
infection
• No vaccine,
no cure
• Jaundice
• Symptoms and
• Risk factors: Sharps and
transmission risk
needlesticks
factors similar to
• Chronic infection develops
HBV
~5% of the time,
• Untreated-chronic
increasing risk for
infection and #1
cirrhosis, liver cancer
reason for liver
• Environmental persistence
transplant
on surfaces
• No Vaccine
• Vaccine Available
HCV
Biosafety
www.ehs.columbia.edu
HBV Vaccine
 Vaccine Efficacy >90%
 Currently part of childhood schedule
 OSHA requires employers to offer vaccination
to employees with potential occupational
exposure
Biosafety
www.ehs.columbia.edu
Bloodborne Pathogens
Transmission Probabilities after Needlestick
MATCH THE VIRUS WITH THE RISK
Source
Risk
Up to 30 %
HIV
1.8% (0%-7% range)
HCV
0.3% (0.2%-0.5% range)
HBV~0% when vaccinated
Which one of these probabilities can be
reduced to zero?
Biosafety
www.ehs.columbia.edu
Occupational Bloodborne Pathogen Exposure
Evaluations at Columbia Student Health Services
Historically, what percentage of occupational exposures
reported to Student Health Services consisted of Dental
Students?
A. 0 - 5%
B. 5 - 44%
C. 45 - 66%
D. 67-100%
Biosafety
www.ehs.columbia.edu
Occupational Bloodborne Pathogen Exposure
Evaluations at Columbia Student Health Services
Year
Dental School
(% of total evaluations)
2004-2005
66%
2007-2008
44%
2008-2009
62%
2009-2010
53%
 Historically, about 2/3 of all occupational exposures reported to Student Health
Services consisted of Dental Students.
 Lowest exposure year was 2007-2008.
 Students that sustain an occupational exposure from a known HIV-positive patient
seen at SHS, in excess of 75% of those exposure occur in dental students.
Source: Thomas Mele, MD
Instructor in Clinical Medicine
Biosafety
www.ehs.columbia.edu
Biosafety
www.ehs.columbia.edu
Occupational Exposure
Largest Risk? Needlestick: ‘stick’ from any
contaminated item; mucous membrane, non-intact skin
exposure
 Clean with Betadine and antimicrobial soap
 Rinse eyes/mucous membranes 10 minutes
 Inform Supervisor
 All patients, students or faculty/staff injured in the
clinical facility should file an "Accident Report General Liability". Forms available in the Clinic
Administration Office
Biosafety
www.ehs.columbia.edu
HIV-Post Exposure Evaluation
 First response, seek medical attention
 Prophylactic Medication must be given ASAP “within a
few hours”
– Protease Inhibitors that reduce viral load and inhibit
replication at different step vs. AZT.
 Regimen based on hazard of source material
 Follow-up testing
* For HBV and HCV, post-exposure
anti-viral medication may be given
Biosafety
www.ehs.columbia.edu
Agenda
 Infection Control
 Bloodborne Pathogens
 Occupational Exposure
 Sharps Safety
 Regulated Medical Waste
 Environmental Surfaces and Spill Response
 Personal Protective Equipment
 TB Precautions
Biosafety
www.ehs.columbia.edu
Sharps Safety
Biosafety
www.ehs.columbia.edu
When Do Needle-stick Injuries Occur?
What’s your Guess?
2% Before use
38% During use: passing equipment, collision w/
worker
42% After use/before disposal: activating safety
feature, recapping
18% During and after disposal: improper disposal
Biosafety
www.ehs.columbia.edu
Substitution – ENGINEERED SHARPS
‘Safe
Needles’
mandatory
OSHA
requirement
to use safest
‘sharp’
possible,
engineered-in
safety
features
AVOID
breaking,
bending, or
recapping
needles.
Biosafety
www.ehs.columbia.edu
Sharps Safety – Scoop Method
Biosafety
www.ehs.columbia.edu
Regulated Medical Waste Management



Properly labeled containment to prevent
injuries and leakage
• Red bag waste
• Sharps waste
Medical wastes are “treated” in
accordance with state and local EPA
regulations
Processes for regulated waste include
autoclaving and incineration
Biosafety
www.ehs.columbia.edu
What Goes in the Sharps Container?
Needles
Syringes
Etchants
Sealants
Composite
Glass
Scalpel blades
Orthodontic wires
Endodontic files
Burs
Irrigation syringes
--Anything that would
rip a red bag
--Unused sterile
sharps
--Empty carpules
Biosafety
www.ehs.columbia.edu
What Goes in Red Bags?
or
Biosafety
www.ehs.columbia.edu
Red Bags Are Not Storage Units
Red bag bins are not a
place to store:
• Coats
• Bags
• Dental trays
Please use it for its
intended purpose: an
unobstructed method
to discard RMW
Biosafety
www.ehs.columbia.edu
What Goes Where
No food or drink permitted in the clinic
Iris’ shop
Biosafety
www.ehs.columbia.edu
Extracted Teeth

Teeth are Regulated Medical Waste
• *Extracted teeth must be placed in the
designated, pre-labeled “Extracted
Teeth Containing Amalgam ” regardless
of whether the teeth contain amalgam
or not.
• Disinfect before disposal; containers
•

have a solution of 10% bleach
Do not incinerate extracted teeth
Teeth can be given back to patient
*If it is determined
that histologic
evaluation is not
required
Biosafety
www.ehs.columbia.edu
Environmental Surfaces-2 Types
Clinical contact surfaces
High potential for direct contamination from
spray or spatter or by contact with DHCP’s
gloved hand
Housekeeping surfaces
Do not come into contact with patients or devices
Limited risk of disease transmission
Biosafety
www.ehs.columbia.edu
Clinical Contact Surfaces
High potential for
direct contamination
from spray or spatter
or by contact with
DHCP’s gloved hand
Biosafety
www.ehs.columbia.edu
Housekeeping Surfaces
Generally do not
come into contact with
patients or devices
Limited risk of disease
transmission
Biosafety
www.ehs.columbia.edu
Spills

CODM staff / students can clean small
blood spills on clinical contact surfaces

Cleaning materials and PPE are
available in the clinics
•

Gloves, paper towels, bleach
When to ask for help?
•
Spills on housekeeping surfaces, large
spills, aspiration system failure
Biosafety
www.ehs.columbia.edu
Spills Policy
Biosafety
www.ehs.columbia.edu
Personal Protective Equipment

A major component of Standard Precautions

Protects the skin and mucous membranes from exposure to
infectious materials in spray or spatter

Should be removed when leaving treatment areas
Biosafety
www.ehs.columbia.edu
Personal Protective Equipment
 Disposable gowns should also be
changed daily or when they become
visibly soiled.
• Dispose in normal waste (non-red
bag)
 Gowns are either front or rearopening; NOT reversible.
 Splatter, splash or aerosol-producing
procedures = Surgical masks and
protective eyewear worn at all times
during procedures, whether active or
observing
Biosafety
www.ehs.columbia.edu
Gloves

Minimize the two-way transmission of
microorganisms between patients and providers

Reduce contamination of the hands of health care
personnel by microbial flora that can be transmitted
from one patient to another

Not a substitute for hand washing or sanitizing!
Biosafety
www.ehs.columbia.edu
Hand Hygiene
 When removing gloves,
no glove is 100%
effective
 Change ASAP after
visible contamination
 ‘Purell’ or soap and
water?
 Technique is important
or
?
Biosafety
www.ehs.columbia.edu
Special Hand Hygiene Considerations





Use hand lotions to prevent skin dryness
Be careful of hand care products and gloves
(e.g., mineral oils and petroleum bases may
cause early glove failure)
Keep fingernails short
Avoid artificial nails
Avoid hand jewelry that may tear gloves
Biosafety
www.ehs.columbia.edu
Agenda
 Infection Control
 Bloodborne Pathogens
 Occupational Exposure
 Sharps Safety
 Regulated Medical Waste
 Environmental Surfaces and Spill Response
 Personal Protective Equipment
 TB Precautions
Biosafety
www.ehs.columbia.edu
Risk of Transmission of
Mycobacterium tuberculosis (TB)



M. tuberculosis is spread by droplet nuclei
Immune system usually prevents spread
Latent infection: Bacteria can remain alive in the
lungs for many years (not transmissible)
Biosafety
www.ehs.columbia.edu
Risk of TB Transmission in Dentistry

Risk in dental settings is low

Only one documented case of
transmission

Tuberculin skin test conversions among
DHCP are rare
Biosafety
www.ehs.columbia.edu
Preventing Transmission of TB in
Dental Settings




Baseline medical surveillance of DHCP
(PPD/quantiferon)
Assess patients for history of TB
Defer elective dental treatment
If patient must be treated:
• DHCP should wear a respirator
• Isolation; separate patient from others/mask
• Refer to facility with proper TB infection control
precautions
Biosafety
www.ehs.columbia.edu
Questions?
Biosafety
www.ehs.columbia.edu