Download 4. Infection control 3

Dr. Abdelmonem Altarhony
Infection control measures II
Objectives
At the end of the course, the students should
have an understanding of:
• Administrative controls
• Engineering controls
Infection Control Program
Infection Control Program is designed to:
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Minimize the risk of infections to patients and staff.
Limit unprotected exposure.
Provide training.
Meet government and Joint Commission regulations and
standards.
The Program includes:
 Identification of Infection Risks
 Infection Prevention Intervention
 Infection Control Intervention
 Infection Surveillance and Reporting
 Patients
 Staff
Exposure Control Plan & Check
lists
• The Organizational Exposure Control Plan lays down procedures,
practices, vaccination requirements, and a appropriate Reporting for
incidents of exposure in a health environment.
• The plan specifies the agents and procedures to be used for disinfection
and sterilization, and where each is to be applied.
• Guidelines and materials arranged in tabular form are easy to follow, and
provide an overview.
 Checklists for individual areas, e.g. for equipment and room disinfection,
assist the personnel responsible for each procedure.
 The hygiene measures should also include guidelines for regulating patient
appointments: treatment of infectious patients should be scheduled at the
end of the day.
An effective Infection Control Program is based
on a hierarchy of infection control measures.
These include:
• Administrative controls
• Engineering controls
• Work place controls
Administrative controls
include:
1. Developing and implementing effective policies and procedures to
en ensure the rapid identification, isolation, evaluation, and
treatment of persons with signs and symptoms of infective disease,
2. Educating healthcare workers about infectious diseases and
teaching clients good infection control practices, e.g. using a tissue
when coughing, washing hands…
3. Maintaining an effective employee screening program, which
includes respiratory protection and education relevant to infectious
diseases control.
Personnel Health Elements of an
Infection Control Program
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Education and training
Immunizations
Exposure prevention and postexposure management
Medical condition management and work-related
illnesses and restrictions
• Health record maintenance
Infection Control Training
• New employees must demonstrate proficiency in Infection
Control and Prevention before having contact with patients or
handling equipment.
• Education of health care providers, clients and
families/visitors/caregivers.
• Annual, documented training and competence testing as
required by OSHA (Occupational Safety and Health
Administration) and other agencies on the following Infection
Control topics:
– Infectious Disease: Prevention and Control
– Bloodborne Pathogen and Bio-Hazardous Waste
– Tuberculosis; Symptoms and Precautions
Infection Monitoring
• Any infectious condition shall be noted to alert staff.
• Delivery and cleaning staff should use standard
precautions and follow the infectious plan
procedures when servicing patients identified with
an infectious condition
Infection Monitoring
Staff should receive education on when to stay home
from work in a health care setting. This includes:
1. Febrile respiratory illness
2. Dermatitis on their hands (consult your physician about
your risk)
3. Cold sores or shingles that can’t be covered
4. The initial days of a respiratory illness
5. Diarrhea
6. Eye infections until treated
Most employers of health care providers will have
policies in this regard.
Infection Reporting
• The Operations Manager is to be notified immediately
whenever an actual or suspected infectious condition exist.
• Any incident involving the patient and/or staff member
contracting an infectious condition traceable to the other shall
be reported immediately.
– To the Operations Manager
– Accident/Incident Report Form
Follow-up for punctures or mucous membrane
exposures to bloodborne pathogens
Ensure you know the procedure at your facility
• First Aid: Rinse, wash and clean involved area after exposure
• Recognize importance of medical follow-up (use of Post-Exposure
Prophylaxis within one to two hours can reduce HIV transmission by 90%)
• Medical follow-up at appropriate agency to be assessed for bloodborne
pathogens: Hepatitis B, Hepatitis C and HIV
• Proper follow-up includes;
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Significance of exposure
Risk factors
Prophylactic medication if indicated
Education and counselling for informed consent and testing if required
Precautions necessary
If testing is required – serial testing should be conducted at time of
exposure, then at three and six months.
Occupational Injuries
Sharps injury/contamination incident includes:
1. Inoculation of blood by a needle or other ‘sharp’
instroments.
2. Contamination of broken skin with blood
3. Blood splashes to mucous membrane e.g.
eyes or mouth
4. Swallowing a person’s blood e.g.
after mouth-to- mouth resuscitation
5. Contamination where clothes have been
soaked by blood
6. Bites.
Factors Influencing Occupational Risk
of Bloodborne Virus Infection
1. Frequency of infection among patients
2. Risk of transmission after a blood exposure
(i.e., type of virus)
3. Type and frequency of blood contact
Characteristics of Percutaneous
Injuries Among DHCP
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Reported frequency among general dentists has declined
Caused by burs, syringe needles, other sharps
Occur outside the patient’s mouth
Involve small amounts of blood
Among oral surgeons, occur more frequently during fracture
reductions and procedures involving wire
Transmission of HVB AND HIV from
Infected Dentists to Patients
• Prevalence of HCV infection among dentists similar
to that of general population (1%-2%)
• No reports of HCV transmission from infected DHCP
to patients or from patient to patient
• Risk of HCV transmission appears very low
• Only one documented case of HIV transmission from
an infected dentist to patients
• No transmissions documented in the investigation of
63 HIV-infected HCP (including 33 dentists or dental
students)
Flu Standard Precautions
• Avoid close contact
• Stay at home or take respiratory precautions when you have
the flu (wear a mask)
• Cover your mouth and nose when you cough or sneeze
• Keep your hands clean and avoid touching your eyes, nose or
mouth
• Healthcare workers must: be medically assessed by their
doctor if they have a persistent cough and practice respiratory
hygiene/ cough etiquette
Recommended vaccination for
Health Care workers
Recommended for the dentist, dental student, and auxiliary.
• (No vaccine against hepatitis C is available.)
• Annual influenza immunization
• Measles, Mumps and Rubella (MMR) – two doses
• Tetanus Diphtheria and Polio (TDP)
• Hepatitis B (full series with follow up blood work to determine conversion)
• For susceptible health care providers, varicella vaccine is recommended
• Tuberculosis
B. Engineering controls
• Engineering controls are built into the design (Rx
room, private bathrooms, private rooms, HVAC
(Heating ventilation and air conditioning) systems) of
a healthcare facility. Infection prevention and
control professionals should be involved in the
design and planning of new facilities.
• An Infection Control Risk assessment should be
done to evaluate and mitigate potential risks for
microorganism transmission by means of air, water
and environmental sources.
Infection Control Engineering
The spatial arrangements in a well-organized
operating room must meet the following
requirements:
1.Clean zone
2.Hygienic zone
3.Sterile Zone
Operating room
1.Clean Zone:
Office environmental, common use rooms
2. Hygienic Zone
The dental or surgical operating room
3.Sterile Zone
The chair side surgical environmental
The environmental/ clinical
room
The room should comply with the following:
• Ceiling and walls should have intact and washable surfaces .
• A suitable covering should be used i.e. tiles or washable emulsion paint.
• Flooring should be intact, impervious, washable and visibly clean (no
carpeted areas).
• Windows should be in good condition and be visibly clean.
• Cupboards and work surfaces must be structurally sound, intact, seamless
and washable
• The dental chair and dental surgeon’s stool material should be intact and
impervious to body fluids.
• There should be a designated hand wash basin with elbow-operated taps,
which is not used for the decontamination of equipment.
• Ideally a dirty utility area/room should be available for the
decontamination of equipment and it should be within easy access of the
procedure room.
• In addition mechanical methods i.e. washer disinfector is recommended
for the cleaning of instruments. In the absence of such facilities, there
should be a designated area, with a designated sink for the pre-cleaning of
contaminated equipment, within the room itself.
• The work load should be managed in such a way to ensure that
decontamination of equipment, including the autoclave working, does
not occur whilst the patient is in the room.
Surgery Design
• The surgery layout should be such that there are areas for the operator and
for the assistant.
• The operator’s area to have access to the turbines, 3 in1 syringe, slow
handpiece, bracket table, operating light and an elbow- or foot-operated
hand washing sink
• The nurse‘s area to contain the suction lines and perhaps the 3 in 1 syringe,
curing light and the cabinetry containing the dental materials. In addition
an elbow- or foot- operated sink
• A designated area for clinical waste
• Within these areas the design should facilitate a workflow from clean to
dirty
• The work surfaces should be seamless, with covered ends that prevent the
accumulation of contaminated material and facilitate cleaning
• The surfaces should remain clutter free
Environmental Controls
• Control source of infection
• Dilute and remove contaminated air
• Control airflow :
– Keep infectious air moving outside
– Keep HCWs ‘upwind’ , infectious patients
‘downwind’
Key Points
• Engineering controls (EC) are the 2nd priority in control
measures AFTER administrative controls, But they are
complementary
• Dilution ventilation is the most important EC
• Negative pressure or directional airflow keeps contaminated
air away from HCWs
• UVGI and filtration devices are adjuncts or back-ups for highrisk areas
– Require maintenance
– Need to consider cost-effectiveness
Natural vs Mechanical
Ventilation
• Good natural ventilation is better than bad
mechanical ventilation.
• Major limitation of natural ventilation is that it
depends upon outdoor weather conditions.
• Can control odour and improve comfort of
occupants , but not if very cold or very hot.
• Usually we do not have a choice and must
work with where we are!
C. Work Practice Controls
Change the manner of performing tasks
Examples include:
• Using instruments instead of fingers to retract
or palpate tissue
• One-handed needle recapping
YES
NO
YES
General Cleaning Recommendations
• Use barrier precautions (e.g., heavy-duty utility gloves, masks,
protective eyewear) when cleaning and disinfecting
environmental surfaces
• Physical removal of microorganisms by cleaning is as
important as the disinfection process
• Follow manufacturer’s instructions for proper use of EPAregistered hospital disinfectants
Surface/Environmental Barriers
The benefits of surface barriers include:
• less time spent performing environmental asepsis,
more reliable asepsis, and visible barriers that
communicate asepsis to patients.
• Aseptic techniques are needed to handle and change
barriers, and uncovered clinical contact surfaces
must still be cleaned and disinfected between
patients.
Other measures that help to
reduce microbial exposure
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Instrument sterilization
Proper disinfectants
Adequate air circulation
Pre-treatment mouth rinse
( reduce 80% of contamination in aerosols)
5. Rubber dam
6. High-velocity air evacuation
( 80% effective in reducing aerosol)
Isolate or remove the hazard
Single-Use (Disposable) Devices:
• Intended for use on one patient during a
single procedure
• Usually not heat-tolerant
• Cannot be reliably cleaned
• Examples: Syringe needles, prophylaxis cups,
and plastic orthodontic brackets
Disposal of clinical waste/Safe
handling of sharps
Contaminated materials must be discarded safely.
• Judgment is essential in bagging medical waste so that injury or
direct contact with liquids does not occur because HIV and HVB
can survive beyond a few days while wet.
• Separating needles and sharp into hard –walled, leak-proof, and
sealable containers and out of soft trash has provided adequate
safety.
Appropriate handling of
laundry
Linen soiled with blood, body substances, secretions,
and excretions must be handled, transported and
processed in a manner that prevents skin and mucous
membrane exposures, contamination of clothing, and
transfer of micro-organisms to healthcare workers,
other patients and associated environments.
Dental Unit Waterlines, Biofilm,
and Water Quality
• Microbial biofilms form in small bore tubing of
dental units
• Primary source of microorganisms is municipal
water supply
• Using water of uncertain quality is
inconsistent with infection control principles
• Untreated dental units cannot reliably
produce water that meets drinking water
standards
Dental Handpieces and Other Devices
Attached to Air and Waterlines
• Clean and heat sterilize intraoral devices that
can be removed from air and waterlines
• Follow manufacturer’s instructions for
cleaning, lubrication, and sterilization
• Do not use liquid germicides or ethylene oxide
Dental Radiology
• The Rx equipment should not be in the operator
room.
• Wear gloves and other appropriate personal
protective equipment as necessary
• Avoid contamination of developing equipment and
cover the Rx tube… Prevent cross infection
Remember
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Hand washing (hand hygiene);
Use of personal protective equipment
Environmental cleaning
Appropriate handling of waste and
Taking care of yourself (e.g. immunization)
Thank you