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Disease Transmission
and Infection Control
Chapter 19
Copyright © 2005 by Elsevier Inc. All rights reserved.
Introduction
As a member of the dental healthcare team, the dental
assistant is at risk of exposure to disease agents through
contact with blood or other potentially infectious materials.
By carefully following infection control and safety
guidelines, you can minimize your risk of disease
transmission in the dental office.
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The Chain of Infection
• The chain of infection consists of four parts:
– Virulence
– Numbers
– Susceptible host
– Portal of entry
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Fig. 19-1 To break the chain of infection,
at least one part must be removed.
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Virulence
• The virulence of an organism refers to the degree of
pathogenicity or strength of that organism in its ability
to produce disease.
• Because we cannot change the virulence of
microorganisms, we must rely on our body defenses
and specific immunizations.
• Avoid coming in contact with microorganisms
by always following the infection control techniques.
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Numbers
• In addition to being virulent, pathogenic microorganisms must
be present in large enough numbers to overwhelm the body’s
defenses.
• The number of pathogens may be directly related to the amount
of bioburden present.
– Bioburden refers to organic materials such as blood
and/or saliva.
• The use of the dental dam and high volume evacuation help
minimize bioburden on surfaces and reduce the number of
microorganisms in the aerosol.
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Susceptible Host
• A susceptible host is a person who is unable to resist
infection by the pathogen.
• An individual who is in poor health, chronically
fatigued, under extreme stress, or has a weakened
immune system is more likely to become infected.
• Staying healthy, washing hands frequently, and
keeping immunizations up-to-date will help members
of the dental team resist infection and stay healthy.
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Portal of Entry
• To cause infection, the pathogens must have a portal
of entry (or means of getting into the body).
• The portals of entry for airborne pathogens are
through the mouth and nose.
• Bloodborne pathogens must have access to the
blood supply as a means of entry into the body.
– This occurs through a break in the skin caused by a
needle stick, a cut, or even a human bite.
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Types of Infections
• Acute infection: Symptoms are often quite severe and
appear soon after the initial infection occurs.
• Chronic infections: Those in which the microorganism
is present for a long period; some may persist for life.
• Latent infection: A persistent infection in which the
symptoms come and go. Cold sores are in this category.
– Oral herpes simplex and genital herpes are latent
viral infections
• Opportunistic infections: Caused by normally
nonpathogenic organisms and occur in individuals
whose resistance is decreased or compromised.
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Methods of Disease Transmission
• Direct transmission: By coming into direct contact with
the infectious lesion or infected body fluids (e.g., blood,
saliva, semen, vaginal secretions).
• Indirect transmission: Transfer of organisms to a
susceptible person can occur by, for example, handling
contaminated instruments or touching contaminated
surfaces and then touching the face, eyes, or mouth.
• Splash or spatter: Diseases transmitted during a dental
procedure by splashing the mucosa (mouth or eyes) or
nonintact skin with blood or blood-contaminated saliva.
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Methods of Disease Transmission-cont’d
• Airborne transmission also known as droplet
infection: Spread of disease through droplets of
moisture containing bacteria or viruses.
• Aerosols containing saliva, blood, and
microorganisms are created by the use of the highspeed handpiece, air-water syringe, and ultrasonic
scaler during dental procedures.
• Mists: Droplet particles larger than those generated by
the aerosol spray.
• Spatter: Large droplet particles contaminated with
blood, saliva, and other debris.
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Methods of Disease Transmission-cont’d
• Parenteral transmission can occur through needlestick injuries,
human bites, cuts, abrasions, or any break in the skin.
• Bloodborne transmission occurs through direct or indirect
contact with blood and other body fluids.
• Food and water transmission occurs by contaminated food that
has not been cooked or refrigerated properly or water that has
been contaminated with human or animal fecal material.
• Fecal/oral transmission: Many pathogens are present in fecal
matter. If proper sanitation procedures, such as handwashing
after use of the toilet, are not followed, these pathogens may be
transmitted by touching another person or by contact with
surfaces or food.
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Fig. 19-2 Pathogens can be transferred from staff to patient, patient to staff,
and patient to patient from contaminated equipment.
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The Immune System
• The human body receives resistance to
communicable diseases from the immune system.
• A communicable disease is one that can be
transmitted from one person to another or by contact
with the body fluids from another person.
• Inherited immunity is present at birth.
• Acquired immunity is developed during a
person’s lifetime.
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Acquired Immunity
• Acquired immunity can occur either naturally or
artificially:
– Natural acquired immunity: Occurs when a person has
contracted and is recovering from a disease.
• Active immunity
• Passive immunity
– Artificially acquired immunity: Antibodies can be
introduced into the body artificially by immunization
or vaccination.
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Fig. 19-3 Acquired immunity can occur either
naturally or artificially.
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Disease Transmission in the Dental Office
• Every dental office should have an infection control
program designed to prevent the transmission of
disease from:
– Patient to dental team
– Dental team to patient
– Patient to patient
– Dental office to community
(includes dental team’s family)
– Community to patient
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Patient to Dental Team
• The most common route is through direct contact
(touching) with the patient’s blood or saliva.
• Droplet infection occurs through mucosal surfaces
of the eyes, nose, and mouth. It can occur when the
dental team member inhales aerosol generated by
the dental handpiece or air-water syringe.
• Indirect contact occurs when the team member
touches a contaminated surface or instrument.
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Disease Transmission
• Ways to prevent disease transmission from the
patient to the dental team member.
– Gloves
– Handwashing
– Masks
– Rubber dams
– Patient mouth rinses
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Patient-to-Patient Disease Transmission
• Patient-to-patient disease transmission has occurred in
the medical field, but no cases of this type of
transmission have yet been documented in dentistry.
• Although this transmission can occur, contamination
from instruments used on one patient would need to be
transferred to another patient.
• Infection control measures that can prevent patient-topatient transmission include (1) instrument sterilization,
(2) surface barriers, (3) handwashing, (4) gloves, and (5)
use of sterile instruments.
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Dental Office to Community
• Microorganisms can leave the dental office and enter the
community in a variety of ways.
– Contaminated impressions sent to the dental laboratory
– Contaminated equipment sent out for repair
– The dental team could, in theory, transport microorganisms
out of the office on their clothing or in their hair.
• The following can prevent this type of disease transmission:
– Handwashing
– Changing clothes before leaving the office
– Disinfecting impressions and contaminated equipment
before such items leave the office.
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Community to Dental Office to Patient
• In this type of disease transmission:
– Microorganisms enter the dental office through the
municipal water that supplies the dental unit.
• Waterborne organisms colonize the inside of the dental
unit waterlines and form biofilm.
• As water flows through the handpiece, air-water syringe,
and ultrasonic scaler, a patient could swallow
contaminated water.
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Roles and Responsibilities of CDC
and OSHA in Infection Control
• The Centers for Disease Control and Prevention (CDC) and the
Occupational Safety and Health Administration (OSHA) are
federal agencies that play very important roles in infection
control for dentistry.
• The CDC is not a regulatory agency. Its role is to issue specific
recommendations based on sound scientific evidence on healthrelated matters.
• CDC’s recommendations are not law, but they do establish a
standard of care for the dental profession.
• OSHA is a regulatory agency. Its role is to issue specific
standards to protect the health of employees in the U.S.
• In 1991, based on the CDC guidelines, OSHA issued the
Bloodborne Pathogens Standard (BBP)
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CDC Guidelines for Infection Control
in Dental Health-Care Settings
• In December of 2003, the CDC released the Guidelines for
Infection Control in Dental Health Care Settings-2003
– The new guidelines have expanded upon the existing OSHA
Bloodborne Pathogens Standard, and have included some
areas that were not already covered.
– The guidelines are based on scientific evidence and are
categorized on the basis of existing scientific data,
theoretical rationale, and applicability.
– The guidelines apply to all paid or unpaid dental health
professionals who might be occupationally exposed to
blood and body fluids by direct contact or through contact
with contaminated environmental surfaces, water, or air.
Copyright © 2005 by Elsevier Inc. All rights reserved.
Fig. 19-4 Guidelines for Infection Control in
Dental Health Care Settings-2003
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OSHA Bloodborne Pathogens Standard
• The bloodborne pathogens standard (BBP) is the most
important infection control law in dentistry
– It is designed to protect employees against occupational
exposure to bloodborne pathogens, such as hepatitis B,
hepatitis C, and human immunodeficiency virus (HIV).
– Employers are required to protect their employees from
exposure to blood and other potentially infectious materials
(OPIM) in the workplace and to provide proper care to the
employee if an exposure should occur.
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OSHA Bloodborne Pathogens Standard-cont’d
• The BBP applies to any type of facility in which
employees might be exposed to blood and/or other
body fluids, which include:
– Dental and medical offices
– Hospitals
– Funeral homes
– Emergency medical services
– Nursing homes
• OSHA requires that a copy of the BBP be present in
every dental office and clinic.
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Requirements of the Standard
• Exposure control plan clearly describes how the office complies with
the standard.
• The term Universal Precautions is referred to in the OSHA Bloodborne
Pathogens Standard.
– Universal precautions is based on the concept that all human blood and body fluids
(including saliva) are to be treated as if known to be infected with the bloodborne
disease, HBV, HCV, or HIV.
– The CDC expanded the concept and changed the term to Standard Precautions.
• Standard Precautions integrate and expand the elements of universal
precautions into a standard of care designed to protect healthcare
providers from pathogens that can be spread by blood or any other body
fluid, excretion, or secretion.
• It is not possible to identify those individuals who are infectious, so
infection precautions are used for all healthcare personnel and their
patients.
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Table 19-1 Occupational Exposure Determination
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Postexposure Management
• Accidents happen!
• Before an accident occurs, the BBP requires the
employer to have a written plan.
• This plan explains exactly what steps the employee
must follow after the exposure incident occurs and
the type of medical follow-up that will be provided to
the employee at no charge.
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Follow-up measures for exposed worker
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Hepatitis B Immunization
• OSHA requires the dentist to offer the hepatitis B virus
(HBV) vaccination series to all employees whose jobs
include category I and II tasks.
• Vaccine must be offered within 10 days of employment.
• The dentist/employer must obtain proof from the
physician who administered the vaccination.
• The employee has the right to refuse the HBV vaccine;
however, the employee must sign an informed refusal
form that is kept on file in the dental office.
• The employee always has the right to change his or her
mind and receive the vaccine at a later date at no charge.
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Hepatitis B Vaccine
• The vaccine is administered in a series of three injections.
The most common vaccination schedule is 0, 1, and 6
months.
• The preferred injection site is in the deltoid muscle (on
the arm)
– The seroconversion rate (development of immunity) is higher than
when the vaccine is administered in the buttocks.
• The Centers for Disease Control and Prevention (CDC)
states that pregnancy should not be considered a
contraindication to the HBV vaccine; however, the
woman’s obstetrician should be consulted.
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Post-vaccine Testing as
Recommended by the CDC
• Between 1 to 2 months after the series has been
completed, a blood test should be performed to
ensure that the individual has developed immunity.
• Individuals who have not developed immunity should
be evaluated by their physician to determine the
need for an additional dose of HBV vaccine.
• Individuals who do not respond to the second 3-dose
series of the vaccine should be counseled regarding
their susceptibility to HBV infection and precautions
to take.
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Need for a Booster
• Routine booster doses of the HBV vaccine are not
recommended by the CDC.
• The CDC does not recommend routine blood testing
(after the initial testing to determine initial immunity)
to monitor the HBV antibody level in individuals who
have already had the vaccine.
• The exception to this recommendation is if an
immunized individual has a documented exposure
incident and the attending physician orders the
administration of a booster dose.
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Employee Medical Records
• The dentist/employer must keep a confidential
medical record for each employee.
• These records are confidential and must be stored
in a locked file.
• The employer must keep these records for 30 years.
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Managing Contaminated Sharps
• Contaminated needles and other disposable sharps, such as
scalpel blades, orthodontic wires, and broken glass, must be
placed into a sharps container.
• The sharps container must be puncture-resistant, closable,
leak-proof, and color-coded or labeled with the biohazard
symbol.
• Sharps containers must be located as close as possible to the
place of immediate disposal.
• Do not cut, bend, or break the needles before disposal.
• Never attempt to remove a needle from a disposable syringe.
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Fig. 19-5 A puncture-resistant sharps disposal container should be located
as close as possible to the area where the disposal of sharps takes place.
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Preventing Needlesticks
as Recommended by the CDC
• Never recap used needles by using both hands or
any other technique that involves directing the point
of a needle toward any part of the body.
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Hand Hygiene
• Wash your hands each time before you put on gloves and
immediately after you remove gloves.
• Wash your hands when you inadvertently touch
contaminated objects or surfaces while barehanded.
• Always use liquid soap during handwashing. Bar soap
should never be used because it may transmit
contamination.
• For most routine dental procedures, such as examinations
and nonsurgical procedures, an antimicrobial soap can be
used.
• For surgical procedures, you should use a germicidal
surgical scrub product.
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Fig. 19-8 Areas of the hand that are not thoroughly washed
because of poor handwashing technique
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Hand Care
• Dry hands well before donning gloves.
• Keep nails short and well manicured, and rings (except
for wedding rings), fingernail polish, and artificial nails
are not to be worn at work.
• Microorganisms thrive around rough cuticles and can
enter the body through any break in the skin.
• Dental personnel with open sores or weeping dermatitis
must avoid activities involving direct patient contact
and handling contaminated instruments or equipment
until the condition on the hands is healed.
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Alcohol-Based Hand Rubs
• Waterless antiseptic agents are alcohol-based products that are
available in gels, foams, or rinses.
• They do not require the use of water. The product is simply applied
to the hands, which are then rubbed together to cover all surfaces.
• These products are more effective at reducing microbial flora than
a plain soap, or even an antimicrobial hand wash.
• Concentrations of 60-95% are the most effective. Higher
concentrations are actually less effective.
• They contain emollients that reduce the incidence of chapping,
irritation, and drying of the skin.
• These products are very “dose sensitive.” This means you must
use the amount that is recommended.
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CDC Recommendations for Hand Care
• For most routine dental procedures, such as
examinations and nonsurgical procedures, wash
your hands with either a nonantimicrobial or
antimicrobial soap and water.
• If your hands are not visibly soiled, you may use an
alcohol-based, waterless handrub.
• For surgical procedures, you should perform a
surgical scrub using either a nonantimicrobial or
antimicrobial soap and water, dry your hands, and
apply an alcohol-based surgical hand rub.
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Fig. 19-22 Hand lotions must be compatible with glove material.
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Personal Protective Equipment (PPE)
• OSHA requires the employer to provide
employees with appropriate personal protective
equipment (PPE) without charge to the employee.
• Examples of PPE include:
– Protective clothing
– Surgical masks
– Face shields
– Protective eyewear
– Disposable patient treatment gloves
– Heavy-duty utility gloves
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Protective Clothing
• Types of protective clothing can include smocks,
slacks, skirts, laboratory coats, surgical scrubs
(hospital operating room clothing), scrub (surgical)
hats, pants, and shoe covers.
• The type of protective clothing you should wear is
based on the degree of anticipated exposure to
infectious materials.
• The BBP prohibits the employee from taking
protective clothing home to be laundered.
• Laundering contaminated protective clothing is the
responsibility of the employer.
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Protective Clothing Requirements
• Protective clothing should be made of fluid-resistant
material.
• To minimize the amount of uncovered skin, clothing should
have long sleeves and a high neckline. Note: The type and
characteristics of protective clothing depend on the degree
of exposure anticipated.
• The design of the sleeve should allow the cuff to be tucked
inside the band of the glove.
• During high-risk procedures, protective clothing must cover
dental personnel at least to the knees when seated.
– Buttons, trim, zippers, and other ornamentation should
be kept to a minimum.
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Fig. 19-14 Appropriate clinical attire consists of
long-sleeved gowns, gloves, and eye wear
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Protective Masks
• A mask is worn over the nose and mouth to protect
you from inhaling possible infectious organisms
spread by the aerosol spray of the handpiece or airwater syringe and accidental splashes.
• A mask with at least 95% filtration efficiency for
particles 3 to 5 mm in diameter should be worn
whenever splash or spatter is likely.
• The two most commonly used types of masks are
the dome-shaped and flat types.
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Guidelines for the Use of Masks
• Masks should be changed for every patient or more often
(CDC Guideline).
• Masks should be handled by touching the side edges only, to
avoid contact with the more heavily contaminated body of the
mask.
• The mask should conform well to the shape of the face.
• Masks should not contact the mouth when being worn because
the moisture generated will decrease the mask filtration
efficiency.
• A damp or wet mask is not an effective mask.
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Protective Eyewear
• Protective eyewear is worn to protect eyes against the danger
of eye damage resulting from aerosolized pathogens.
• Protective eyewear also prevents spattered solutions or caustic
chemicals from injuring the eyes.
• OSHA requires the use of eyewear with both front and side
protection (solid side shields) for use during exposure-prone
procedures.
• If you wear contact lenses, you must wear protective eyewear
with side shields or a face shield.
• After each treatment or patient visit, clean and decontaminate
your protective eyewear according to the manufacturer's
instructions (CDC Guideline).
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Face Shields
• A chin-length plastic face shield may be worn as an
alternative to protective eyewear.
• A shield does not substitute for the use of a face
mask because it does not protect against inhaling
contaminated aerosols.
• When splashing or spattering of blood or other body
fluids is likely during a procedure (such as surgery),
a face shield is often worn in addition to a protective
mask.
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Fig. 19-30 Face shields provide adequate eye protection, but a face mask
is still required when assisting with aerosol-generating procedures.
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Protective Eyewear for Patients
• Patients should be provided with protective eyewear
because they also may be subject to eye damage
during the procedure.
• This may result from:
– Handpiece spatter
– Spilled or splashed dental materials, including
caustic chemical agents
– Airborne bits of acrylic or tooth fragments
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Fig. 19-31 Patients should be provided with protective eyewear.
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Gloves
• Because dental personnel are most likely to contact
blood or contaminated items with their hands, gloves
may be the most critical PPE.
• You must wear a new pair of gloves for each patient,
remove them promptly after use, and wash your hands
immediately to avoid transfer of microorganisms to
other patients or the environment (CDC Guideline).
• Consult with the glove manufacturer regarding the
chemical compatibility of the glove material and dental
materials you use (CDC Guideline).
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Fig. 19-21 Nonsterile exam gloves
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Guidelines for the Use of Gloves
• All gloves used in patient care must be discarded
after a single use.
• These gloves may not be washed, disinfected, or
sterilized; however, they may be rinsed with water
to remove excess powder.
• Latex, vinyl, or other disposable medical-quality
gloves may be used for patient examinations and
dental procedures.
• Torn or damaged gloves must be replaced
immediately.
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Guidelines for the Use of Gloves-cont’d
• Do not wear jewelry under gloves. (Rings harbor
pathogens and may tear the glove.)
• Change gloves frequently. (If the procedure is long,
change gloves about once each hour.)
• Contaminated gloves should be removed before
leaving the chairside during patient care and
replaced with new gloves before returning to patient
care.
• Hands must be washed after glove removal and
before regloving.
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Gloves Damaged During Treatment
• Gloves are effective only when they are intact
(not damaged, torn, ripped, or punctured).
• If gloves are damaged during treatment, they must
be changed immediately. The procedure for regloving
is:
– Excuse yourself and leave the chairside.
– Remove and discard the damaged gloves.
– Wash hands thoroughly.
– Reglove before returning to the dental procedure.
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Overgloves
• Overgloves, which also are known as “food handler”
gloves, are made of lightweight, inexpensive, clear
plastic.
• These may be worn over contaminated treatment
gloves (overgloving) to prevent the contamination of
clean objects handled during treatment.
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Fig. 19-18 To prevent contamination, an
overglove is worn while a chart entry is made.
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Guidelines for the Use of Overgloves
• Overgloves are not acceptable alone as a hand
barrier or for intraoral procedures.
• Overgloves must be worn carefully to avoid
contamination during handling with contaminated
procedure gloves.
• Overgloves are placed before the secondary
procedure is performed and are removed before the
patient treatment that was in progress is resumed.
• Overgloves are discarded after a single use.
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Sterile Surgical Gloves
• Sterile gloves should be worn for invasive procedures
involving the cutting of bone or significant amounts of
blood or saliva, such as oral surgery or periodontal
treatment.
• Sterile gloves are supplied in prepackaged units to
maintain sterility before use.
• They are provided in specific sizes and are fitted to
the left or right hand.
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Utility Gloves
• Utility gloves are not used for direct patient care.
• Utility gloves must be worn:
– when the treatment room is cleaned and disinfected between
patients.
– while contaminated instruments are being cleaned or handled.
– for surface cleaning and disinfecting.
• Utility gloves may be washed, disinfected, or sterilized and
reused.
• Used utility gloves must be considered contaminated and
handled appropriately until they have been properly
disinfected or sterilized.
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Fig. 19-34 Utility gloves are used when preparing
contaminated instruments for sterilization.
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Nonlatex-Containing Gloves
• Health care providers or patients may experience
serious allergic reactions to latex.
• For the person who is sensitive to latex, there are
gloves made from vinyl, nitrile, and other nonlatexcontaining materials.
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Maintaining Infection Control While Gloved
• During a dental procedure, it may be necessary to
touch surfaces or objects such as drawer handles
or material containers.
• If you touch these with a gloved hand, both the
surface and glove become contaminated.
• To minimize the possibility of cross-contamination,
use an overglove when it is necessary to touch a
surface.
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Glove Caution
• Chemicals such as glutaraldehyde and acrylates
readily permeate (pass through) latex gloves and can
irritate the skin
– Note: that irritation can be mistaken for an allergic
reaction to the chemicals in the latex glove.
• This is why latex gloves should never be worn when
handling chemicals.
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Latex Allergies
• The use of natural rubber latex gloves has proved to
be the one of the most effective means of protecting
the dental worker and the patient from the
transmission of disease.
• The number of healthcare workers and patients who
have become hypersensitive to latex has increased
dramatically.
• The CDC Guidelines include recommendations for
contact dermatitis and latex hypersensitivity.
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Latex Allergies
• There are three common types of latex allergic
reactions.
• Two types involve an immune reaction, and one type
involves only surface irritation.
– Irritant dermatitis, a nonimmunologic process (does
not involve the body's immune system), is caused by
contact with a substance that produces a chemical
irritation to the skin.
• The skin becomes reddened, dry, irritated, and, in severe
cases, cracked. Irritant dermatitis can be reversed by
identifying and correcting the cause of the problem.
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Fig. 19-25 Irritant Dermatitis
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Latex Allergies-cont’d
• Type IV Sensitivity
– The most common type of latex allergy, type IV
sensitivity, is a delayed contact reaction, and it
involves the immune system.
• It may take up to 48 or 72 hours for the red, itchy rash
to appear.
• The reactions are limited to the areas of contact and
do not involve the entire body.
• An immune response is produced by the chemicals that
are used to process the latex used in manufacturing the
gloves; it is not caused by the proteins in the latex.
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Latex Allergies-cont’d
• Type I Allergic Reaction
– This is the most dangerous type of latex allergy, and
it can result in death.
• The reaction is in response to the latex protein in the
glove (in contrast to the reaction to chemical additives
in type IV).
• There is a severe immunologic (immune system)
response that usually occurs 2 to 3 minutes after the
latex allergens contact the skin or mucous
membranes.
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Treatment of Latex Allergies
• There is no specific cure for latex allergy.
• The only options are prevention, avoidance of latexcontaining products, and treatment of the symptoms.
• Anyone who suspects he or she may have an allergy
to latex should see a qualified healthcare provider to
have a test to confirm the allergy.
• Once anyone is diagnosed as having a latex allergy,
he or she should practice latex avoidance in all
aspects of his or her personal and professional lives.
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Remember…
• When one employee in the dental office has been
diagnosed as having a latex allergy, all staff
members should use practices to minimize the use of
latex-containing products. These practices include
the wearing of powder-free gloves by all dental staff
members to minimize the risk of airborne latex
particles.
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Latex-Sensitive Patients
• In the healthcare setting, patients with latex allergies
should be treated using alternatives to latex.
• Vinyl gloves and a nonlatex rubber dam should be
available in all dental offices.
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Waste Management in the Dental Office
• Dental practices are subject to a wide variety of
federal, state, and local regulations concerning waste
management issues.
• The Environmental Protection Agency (EPA) and the
majority of state and local regulations do not
categorize saliva or saliva-soaked items as infectious
waste.
• Because of the high probability that blood may be
carried in saliva during dental procedures, CDC
guidelines and OSHA regulations consider saliva in
dentistry to be a potentially infectious body fluid.
Copyright © 2005 by Elsevier Inc. All rights reserved.
Classifications of Waste
• General waste: All nonhazardous, nonregulated waste should
be discarded in covered containers.
– Examples include disposable paper towels, paper mixing
pads, and empty food containers.
• Contaminated waste is waste that has had contact with blood
or other body fluids.
– Examples include used barriers and patient napkins.
• Hazardous waste poses a risk to humans and the
environment. Toxic chemicals and materials are hazardous
waste.
– Examples include scrap amalgam, spent fixer solution,
and lead foil from x-ray film packets.
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Classifications of Waste-cont’d
• Some items, such as extracted teeth with amalgam
restorations, may be both hazardous waste (because
of the amalgam) and infectious waste (because of the
blood).
• Infectious or regulated waste (biohazard) is
contaminated waste that is capable of transmitting
an infectious disease.
– Blood and blood-soaked materials
– Pathologic waste
– Sharps
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Handling Dental Office Waste
• Contaminated waste: Items that may contain the
body fluids of patients, such as gloves and patient
napkins, should be placed in a lined trash receptacle.
• Medical waste is any solid waste that is generated in
the diagnosis, treatment, or immunization of human
beings or animals in research.
• Infectious waste is a subset of medical waste. Only a
small percentage of medical waste is infectious and
needs to be regulated.
– Must be labeled with the universal biohazard symbol.
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CDC Guidelines for Handling
Extracted Teeth
• Dispose of extracted teeth as regulated medical waste
unless returned to the patient. When teeth are returned to
the patient, the provisions of the standard no longer
apply.
• Do not dispose of extracted teeth containing amalgam in
regulated medical waste that will be incinerated.
• Note: Because of the mercury in amalgam fillings, you
should check your state and local authorities for
regulations regarding disposal of teeth containing
amalgam.
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Handling Contaminated Waste
• Contaminated items that may contain the body fluids of
patients, such as gloves and patient napkins, should be
placed in a lined trash receptacle.
• Receptacles for contaminated waste should be covered
with a properly fitted lid that can be opened with a foot
pedal.
• Keeping the lid closed prevents air movement and the
spreading of contaminants.
• Red bags or containers should not be used for
unregulated waste. Check the specific requirements
of your local state or county health department.
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Fig. 19-26 Waste is separated into clearly marked containers.
Unregulated waste is on the left; regulated waste is on the right.
Copyright © 2005 by Elsevier Inc. All rights reserved.
Handling Medical Waste
• Medical waste is any solid waste generated in the diagnosis,
treatment, or immunization of humans or animals in research.
• Infectious waste is a subset of medical waste. Only a small
percentage of medical waste is infectious and needs to be
regulated.
• Infectious waste containers of infectious waste (regulated
waste) must be labeled with the universal biohazard symbol,
identified in compliance with local regulations, or both.
• Containers used for holding contaminated items must be
labeled. Examples of such containers are contaminated sharps
containers, pans or trays used for holding contaminated
instruments, bags of contaminated laundry, specimen
containers, and storage containers.
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Disposal of Medical Waste
• Once contaminated waste leaves the office: it is regulated
by the EPA and by state and local laws.
• Under most regulations, the manner of disposal is
determined by the amount (weight) of infectious materials
for disposal.
• The average dental practice is categorized as a “small
producer” of infectious waste, and disposal is regulated
accordingly.
• The law requires the dentist to maintain records of the final
disposal of this medical waste, including documentation of
how, when, and where it was disposed of.
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Additional Infection Control Practices
• Never eat, drink, smoke, apply cosmetics or lip balm,
or handle contact lenses in any area of the dental
office where there is possible contamination, such as
the dental treatment rooms, dental laboratory,
sterilization area, or the x-ray processing area.
• Never store food or drink in refrigerators that contain
any potentially contaminated items.
• You can minimize the amount of splash and spatter
contamination produced during dental procedures
with the skillful use of a dental dam and high-volume
evacuation.
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CDC Guidelines Special Considerations:
Saliva Ejectors
• Do not advise patients to close their lips tightly around
the tip of the saliva ejector to evacuate oral fluids.
– Rationale: Backflow from low-volume saliva ejectors
occurs when the pressure in the patient’s mouth is
less than that in the evacuator. This backflow can be
a potential source of cross contamination between
patients. Although no adverse health effects
associated with the saliva ejector have been reported,
you should be aware that in certain situations,
backflow could occur when using a saliva ejector.
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CDC Guidelines Special Considerations:
Dental Laboratories
• Use PPE when handling items in the laboratory until they have been
decontaminated.
• Clean, disinfect, and rinse all dental prostheses and prosthodontic materials
(e.g., impressions, bite registrations, occlusal rims, and extracted teeth).
• Consult with manufacturers regarding the stability of specific materials
(e.g., impression materials) relative to disinfection procedures.
• Clean and heat sterilize heat-tolerant items used in the mouth
(e.g., metal impression trays and face-bow forks).
• Follow manufacturers' instructions for cleaning, sterilizing or disinfecting
items that become contaminated but do not normally contact the patient
(e.g., burs, polishing points, rag wheels, articulators, case pans, and lathes.)
If manufacturers' instructions are unavailable, clean and sterilize heat stable
items and disinfect.
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CDC Guidelines Special Considerations:
Preprocedural Mouthrinses
• Preprocedural mouthrinses are intended to reduce the
number of microorganisms released in the form of aerosol or
spatter.
• Preprocedural mouth rinsing can decrease the number of
microorganisms introduced into the patient’s bloodstream
during invasive dental procedures.
• The scientific evidence is inconclusive that preprocedural
mouth rinsing prevents clinical infections among dental
health professionals or patients.
• This is an unresolved issue and no recommendation is made.
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CDC Guidelines Special Considerations:
Creutzfeldt-Jacob Disease and Other Prion Diseases
• Creutzfeldt-Jacob Disease (CJD) belongs to a group of rapidly
progressive, invariably fatal, degenerative neurologic disorders.
• They can affect both humans and animals and are thought to be
caused by infection by a prion.
• Prion diseases have an incubation period of years and are usually
fatal within 1 year of diagnosis.
• Potential infectivity of oral tissues in CJD patients is an unresolved
issue. Scientific data indicate the risk, if any, of sporadic CJD
transmission during dental and oral surgical procedures is low to
nil.
• No recommendation is offered regarding use of special precautions
in addition to standard precautions when treating known CJD
patients (unresolved issue).
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CDC Guidelines Special Considerations:
Laser/Electrosurgery Plumes or Surgical Smoke
• During surgical procedures that use laser or an electrosurgical
unit, a smoke by-product is created by the thermal destruction of
the tissue.
• Laser plumes or surgical smoke creates another potential risk for
dental healthcare professionals.
• One concern is that the aerosolized infectious material in the laser
plume may reach the nasal mucosa of the operator or other
members of the dental team. However, the presence of an
infectious agent in a laser plume might not be enough to cause
disease from airborne exposure.
• The effect of the exposure (e.g., disease transmission or adverse
respiratory effects) on DHCP from the use of lasers in dentistry has
not been adequately evaluated (unresolved issue).
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