Dental Infection Control

Infection Control

• Infection control refers to methods used to control and reduce the transmission of infectious microorganisms.
• These controls need to be consistently applied.
• Records related to infection control must be kept for the duration of employment plus 30 years.
• Asepsis, necessary for a pathogen-free environment, utilizes aseptic methods to achieve this.
• Pathogens are disease-causing microorganisms.

Rationales and Regulations

• Universal and standard precautions are crucial.
• Precautions must be taken before, during, and after each procedure in a dental office.
• These precautions ensure chain of asepsis remains unbroken and prevent contamination.
• All patients are treated as if they are infectious.
• Government agencies set regulations for infection control in dental offices.
• Organizations involved include the American Dental Association (ADA) and the Centers for Disease Control and Prevention.
• Universal precautions and BSI techniques are synthesized by the CDC.
• BSI mandates the use of PPE to protect against all bodily fluids.
• The National Institute of Health conducts and supports research on various aspects of human health and diseases.
• Research from NIH includes the causes, diagnosis, prevention, and cure of human diseases, processes of human growth and development. It also covers the biological effects of environmental contaminants and the understanding of mental, addictive, and physical disorders. Lastly it handles information exchange in medicine and health including medical libraries.
• The National Institute of Occupational Safety and Health (NIOSH) provides research and prevention programs to eliminate occupational diseases, injuries, and fatalities.
• The Occupational Safety and Health Administration (OSHA), a part of the U.S. Department of Labor, aims to protect workers from physical, chemical, and infectious hazards.
• OSHA includes those from exposure to bloodborne pathogens (BBPs).

Bloodborne Pathogens Standard and Compliance

• The Bloodborne Pathogens Standard, implemented in 1992, applies to workplaces where employees could be exposed to body fluids.
• Workplaces covered include hospitals, funeral homes, and medical offices.
• OSHA inspectors conduct compliance monitoring, with non-compliance resulting in fines and increasing penalties for repeated violations.
• Dental offices are advised to stay updated through resources like OSHA Solutions and CDC’s Morbidity and Mortality Weekly Report (MMWR).
• Compliance investigations can occur after complaints, randomly for offices with 11+ employees, or by invitation.
• OSHA Bloodborne Pathogens Standard has key requirements.
• An Exposure Control Plan including protocols for protection and training must be created, and updated when new safer devices are introduced.
• Training & PPE: All employees must be trained initially, after job changes, and annually. PPE must be provided.
• Standard Operating Procedures (SOPs): These include procedures for infection control, sharps injury logs, hepatitis B vaccination offers, post-exposure plans, and communication of biohazards.
• Recordkeeping: Maintain records of training, vaccinations, and exposure incidents.
• Occupational exposure is any reasonably anticipated eye, mucosa, or parenteral exposure or contact with blood or saliva.
• There are 3 exposure categories. Category 1 is tasks involving exposure to blood, saliva, or body tissues. Category 2 are tasks with occasional exposure to Category 1 tasks. Category 3 has no exposure to blood or body fluids.
• Exposure Plan: Identify tasks, categorize employees based on exposure, schedule for implementing OSHA provisions, write procedures for PPE and develop a policy for addressing exposure incidents, ensuring sharps injury log maintenance.
• The Food and Drug Administration (FDA) regulates manufacturing and labeling of medical devices and solutions. -Division of US department of health and Human services

Regulations and Recommendations

• Regulations must require devices/solutions to meet performance standards prior to public use and use the necessary controls.
• Devices that are regulated are sterilizers, chemical / biological indicators, cleaning and sterilizing solutions, and PPE.
• The Environmental Protection Agency (EPA) regulates safety and effectiveness of disinfecting/sterilizing solutions.
• EPA also regulates disposal of hazardous waste and the use of EPA-approved containers.
• The Organization for Safety and Asepsis Procedures (OSAP)'s overview is to promote safety and infection control in the dental field.
• OSAP Includes dental healthcare workers, distributors of dental equipment / materials, healthcare instructors, dentists, and dental professionals
• OSHA guidelines say dental offices must train dental team members in categories 1 or 2 freely

Training & Contamination

• Training on pathogens must be given before placement in position of risk
• Training is required for all new and reclassifying employees.
• Must be taught in person by a knowledgeable individual, supplemented with in-office instruction
• Training cannot be videos alone
• Training must be accessible to all employees
• If there is a language barrier, the employer must offer an interpreter
• Training session details and qualifications from the trainer and employees present should be maintained
• The following information must be available to all dental employees
  • A copy of the Bloodborne Pathogens Standard and specific information regarding the meaning of the standard
  • Information about bloodborne pathogens, both the epidemiology and symptoms of the diseases
  • Information about the cross-contamination pathways of bloodborne pathogens
  • A written copy of the employer's/office's written exposure control plan
  • Information on the tasks, category placement of employee classifications
  • Information regarding the hepatitis B vaccine
  • Exposure reduction and work practices including standard precautions
  • How to select, use, remove, disinfect, sterilize, and dispose of PPE
  • What to do, and whom to contact, in an emergency involving blood or OPIM
  • How to report incident and what medical follow-up type is available for blood exposure
  • About the post exposure evaluation and follow-up that the employer provides
  • A copy of the OSHA Hazard Communication Standard
  • Safety Data Sheets (SDS) (formerly MSDA)
  • An opportunity for employees to ask questions to the individual giving the information
• Cross-Contamination Pathways are formed when pathogens travel from patients to dentists, dental assistants, dental hygienists, dental laboratory technicians, and other patients
• Pathogens can also travel from dental personnel to patients then to families

Chain of Infection

• Describes necessary elements that affect infectious processes
• Interactive process involving agent, host, and environment
• Without transmission of microorganisms, infectious process cannot occur
• Six essential links within the chain of infection
  • Infectious agent
  • Reservoir
  • Portal of Exit
  • Mode of Transmission
  • Portal of entry
  • Host
• Infectious agents are entities capable of causing disease
• Include biological and chemical agents
• Reservoir is where agent can survive
• Colonization and reproduction can happen there
• Agent can leave the reservoir through body secretions
• Most infectious agents have a usual mode of transmission
• Contact, Airborne, Vehicle, Vector-Borne are all modes of transmission
• Portal of entry has a route by which infectious agent enters the host
• Host can be simple / complex organisms that can be affected by an agent
• Break the chain of infection to prevent spread and apply proper infection control practices

Breaking the Chain of Infection

Apply proper infection control practices that interfere with the spread of microorganisms Six links to break to prevent spread:

• Between Agent and Reservoir:
  • Cleansing, disinfection, sterilization prevents the formation of reservoirs. Isolate individuals and provide treatment.
• Between Reservoir and Portal of Exit:
  • Practice proper hygiene Maintain clean dental operatories and equipment.
• Between Portal of Exit and Mode of Transmission:
  • Block the exit of the patient, encourage mouth covering, wear gloves.
• Between Mode of Transmission and Portal of Entry:
  • Wash hands and use barrier protection, such as gloves, masks, gowns, etc.
• Between Portal of Entry and Host:
  • Maintain skin integrity, sterile techniques, prevents transmission to uninfected
• Between Host and Agent:
  • Eliminate infections, and practice nutrition, exercise, and immunization.

Routes of microbial transmission

• Three primary routes are responsible for microbial transmission.
  • Direct contact
  • Indirect contact
  • Inhalation (aerosol)
• PPE along with proper disinfection and sterilization is important to ensure a cross-contamination free zone.

Infection Control in the Dental Office

• DA should have proper immunizations in case of pathogens along with employer provided information.
• Review of patient history and updated appointments can help prevent the spread of disease.
• Standard precautions, universal precautions, and infection control standards should be incorporated with each patient.
• Proper hand washing is important to prevent the transfer of microorganisms. This should be done by the dental team for at least 15 seconds. Alcohol Based Hand Rubs and Lotions help assist in cleaning and are great against reducing bacteria.
• Personal Protection Equipment helps protect staff/ppl from coming in contact with harmful germs
• OSHA regulates special protective clothing worn only in a dental office
• When Removing Protective Clothing it is helpful to remove one arm then slowly remove the lab coat.
• There are multiple types of allergies associated with latex and products to aide with this. Proper Glove Usage Protocols should be followed with disinfectant and cleanup procedures.

Glove Donning/Removal, PPE and Sterilization in Dental Setting

• GLOVE DONNING AND REMOVAL
• Should be done after washing of hands
• DONNING PPE
• Place protective clothing over your uniform, scrubs, or street clothes
• REMOVING PPE and discard:
• Take the following steps identified
• In dental setting, there are surfaces that need to have barriers. Clinical contact surfaces, touch surface, light handles, unit controls and transfer surfaces.
• Areas that don't lend themselves to the use of barriers need to be disinfected.
• Cleaning, disinfection, and finally sterilization (EPA approval)
• Sterilzation kills when ALL microorganisms have been destroyed
• Disinfection kills SOME microorganisms
• Levels of disinfecting range from High, Intermediate and Low
• Sterilant has varying levels which kills all microorganisms
• Use when instruments are placed into chemical solution. After use, they are rinsed with water
• Disinfectant comparisons
• Chlorine Dioxide or Glutaradehyde is commonly used

Equipment Sterilization and More

• Washer/disinfecter devices have been developed for dental use that wash, disinfect and dries instrument, readying It for sterilization.
• Thermal disinfection, detergents and liquid chemical disinfectants are used
• There are multiple ways to sterilize dental equipment. From dry heat sterilization to steam under pressure sterilizers
• When using steam autoclave sterilization, water is used and safety features included.
• For equipment maintenance, all water jets should be clean and distilled to help prevent the machine from rusting up.
• Follow manufacturer’s instruction in relation to instruments. Make sure to clean them as well!
• Clinical and Asepsis Protocol is important during sterilization
• Staff meetings are important ensure training
• Sterilization requires a room of its own for disinfecting process
• Use of disinfectants is important
• Techniques like wiping, spraying, and sonic cleaners are good to disinfect machines
• PPE is important and should be used daily to sterilize equipment and treatment rooms

Testing Dental Waterlines Before and After Treatment

• DENTAL RADIO and LAB follows infection codes

  1. Treat equipment and supplies so equipment is sterilized properly (if used ). All instruments and tray need to be sprayed, wiped and left with solution.

• TESTING Dental waterlines BEFORE and After:

  1. Flush the lines:
  2. Use a disinfectant or antibacterial to help prevent biofilm build up

Preparing the Dental Treatment room and completing Dental treatment: 1. Supplies and proper protocols for each steps must be followed