Infection Control in Dental Settings

Infection Control in Dental Settings

• Guidelines cover infection control practices in dental clinics, dental related areas (radiography, labs), and the role of various dental team members.
• Learning objectives include understanding infection control practices in the dental clinic, the roles of dentists in infection control, infection control measures within dental areas (radiography, labs), and the part played by other dental team members.

Standard Precautions

• Standard Precautions encompass several critical measures:
  • Hand hygiene is essential.
  • Personal protective equipment (PPE), such as gloves, masks, and eyewear, must be used.
  • Respiratory hygiene/cough etiquette involves covering coughs and sneezes, using and disposing of tissues, and performing hand hygiene.
  • Sharps safety, including engineering controls and work practice controls, is crucial.
  • Safe injection practices, including aseptic techniques for parenteral medications, are mandatory.
  • Sterile instruments and devices must be used.
  • Environmental surfaces should be cleaned and disinfected regularly.

Respiratory Hygiene/Cough Etiquette

• Measures to control respiratory secretions are essential, beginning at the point of entry to the facility.

• Dental healthcare providers (DHCP) receive education on the importance of infection prevention measures, particularly regarding respiratory secretions and the spread of respiratory pathogens.

• Signs at facility entrances guide patients on proper respiratory hygiene like covering mouths/noses, using and disposing of tissues, and performing hand hygiene.

Environmental Infection Control

• General recommendations for cleaning and disinfecting include following manufacturer's instructions for using FDA-registered hospital disinfecting products.
  • Avoid using liquid chemical sterilants for environmental surfaces in clinical settings.
• Appropriate PPE should be worn when cleaning and disinfecting surfaces. This includes gloves, protective clothing (e.g., gowns, jackets, laboratory coats), and protective eyewear/face shield.

Clinical Contact Surfaces

• Surface barriers protect clinical contact surfaces, mainly those hard-to-clean areas.
  • Clinical contact surfaces, including those that are not barrier-protected, must be cleaned and disinfected using registered hospital disinfectants with specified activity.
• Visibly contaminated surfaces should be disinfected with an intermediate-level disinfectant.

Housekeeping Surfaces

• Housekeeping surfaces should be cleaned on a routine basis, considering the type and degree of contamination.
• Mops and cloths should be cleaned, and single-use disposable options are preferable.
• Fresh cleaning solutions must be prepared daily as instructed by the manufacturer.
• Walls, blinds, and window curtains in patient areas should be cleaned when visibly soiled.

Spills of Blood and Body Substances

• Spilled blood and body substances should be cleaned and disinfected with a low to intermediate-level registered hospital disinfectant.

Dental Handpieces and Other Devices Attached to Air and Waterlines

• Handpieces and intraoral instruments must be cleaned and heat-sterilized between patients.

• Manufacturers' instructions for cleaning, and sterilizing should be strictly followed, including the steps related to lubrication.

• Intraoral instruments that can be detached should be cleaned/sterilized/sanitized, following the manufacturer's instructions.

• Patients should not be instructed to close their lips around the tip of a saliva ejector.

• Do not surface-disinfect handheld instruments – use liquid chemical sterilants or ethylene oxide.

Special Considerations for Dental Radiology

• Wear gloves when handling contaminated film packets.
  • Use additional PPE (e.g. eyewear, masks, gowns) if blood or body fluids spatter is likely.
• Heat-tolerant or disposable intraoral devices are preferable.
• Devices must be heat-sterilized or high-level disinfected after each patient.
• Exposures should be handled in a proper aseptic manner to avoid contaminating developing equipment.
• Follow the manufacturer's instructions to maintain proper cleaning and sterilization of dental radiology devices and sensors, including associated computer hardware.
• Use FDA-cleared barriers to protect digital radiography sensors and, if necessary, clean/heat-sterilize/disinfect barrier-protected semicritical items.
• Disinfect with appropriate method if item cannot tolerate procedures stated.

Aseptic Technique for Parenteral Medications

• Do not administer medications from one syringe to multiple patients, even if the needle changes.

• Use single-dose vials when possible.

• Do not combine leftover contents of single-use vials.

• Single-use infusion/administration sets (e.g., IV bags, tubing) are required for each patient.

• Discard these materials immediately.

• If multidose vials are used, treat appropriately.

• Maintain multidose vials in a separate location to avoid cross-contamination.

• Immediately after using, dispose of the multidose vial.

• Clean multidose vials' access diaphragms before use.

• Use sterile devices to access vials, avoiding contact with the diaphragm.

• Sterilize needles and syringes.

• Do not reuse syringes, even if the needle is changed.

• Keep multidose vials away from patient treatment areas.

• Discard multidose vials if their sterility might be compromised. Use aseptic technique to prepare injections in a clean area.

• Disinfect the vial septum (rubber covering) before piercing with a needle.

• Only use needles and syringes once, don't reuse – even after changing the needle.

• Don't re-use single use vials, ampules, or IV bags & bottles.

• Dispose of after use.

• Date the opened multidose vials.

• Discard them within 28 days (or manufacturer's guideline).

Single-Use (Disposable) Devices

• Single-use devices such as disposable devices, are used only once per patient.

Preprocedural Mouth Rinses

• There's no specific recommendation for employing preprocedural antimicrobial rinses (like chlorhexidine) as a preventative measure for clinical infections among dental healthcare personnel (DHCP) or patients.

Oral Surgical Procedures

• Surgical and hand antisepsis with antimicrobial products, such as antimicrobial soap and water or alcohol-based hand scrubs, is mandatory before donning sterile surgeon's gloves during surgical procedures.
• Use sterile saline or sterile water as a coolant/irrigator.

Handling of Biopsy Specimens

• Transport biopsy specimens in a sturdy, leakproof container labeled with the biohazard symbol.
• If the container is visibly contaminated, clean/disinfect it before handling or place it in a dedicated, labelled, impervious bag.

Handling of Extracted Teeth

• Dispose of extracted teeth as regulated medical waste unless returned to the patient.
• Do not throw away amalgam teeth with other dental waste.
• Ensure teeth are hydrated & properly contained for transport to educational institutions & labs.

Dental Laboratory

• Heat-sterilize or clean/disinfect heat-tolerant items.
• Follow Manufacturers' instructions to clean/disinfect devices that do not directly contact the patient.
• Clean/disinfect with EPA-registered hospital disinfectant if manufacturer's instructions unknown. Choose the option (heat-tolerance or disinfection) that best meets the item's characteristics. Apply disinfection or sterilization based on contamination level.

Laser/Electrosurgery Plumes/Surgical Smoke

• There's no current recommendation for practices to reduce DHCP exposure to laser plumes/surgical smoke from dental lasers.

• However, suggested practices to minimize exposure include employing standard precautions, central room suction units with in-line filters, and dedicated mechanical smoke exhaust systems using high-efficiency filters.

• The effect of laser exposure on DHCP, such as disease transmission and adverse respiratory effects, remains incompletely understood.

Test your knowledge on infection control practices in dental settings with this quiz. Questions cover standard precautions, respiratory hygiene, and proper cleaning procedures to ensure patient safety. Perfect for dental professionals and students alike.