Biosafety and Infection Control Protocol PDF

BIOSAFETY AND INFECTION CONTROL PROTOCOL Dena Mohamed CPHQ, MSc, MFDRCSI, BDS Concept of infection control 01 Principles of infection control 02 Transmission of infection 03 Aim of infection control 04 Infection control basics 05...

BIOSAFETY AND INFECTION CONTROL PROTOCOL Dena Mohamed CPHQ, MSc, MFDRCSI, BDS Concept of infection control 01 Principles of infection control 02 Transmission of infection 03 Aim of infection control 04 Infection control basics 05 OBJECTIVES Components of infection control 06 Use of extracted teeth in dental 07 educational settings Infection control concept It refers to a comprehensive and systemic program that, when applied prevents the transmission of infectious agents among persons who are in direct or indirect contact with the health care environment. Principles of infection control Avoid contact Limit the spread Make objects safe Stay health with blood and of contamination for use body fluids Immunizations; handle sharp Using surface By cleaning and postexposure instruments with barriers, cleaning sterilizing management and care, use safety and disinfecting instruments, medical follow- devices when surfaces; monitoring up; routine hand appropriate, and minimizing sterilization hygiene wear personal splashes to processes; and procedures; protective reduce following equipment contamination, manufacturer’s (PPE) and properly instructions for disposing of use and medical waste. sterilization. Transmission of infection Modes of disease transmission 1. Contact a. Direct contact: contact with microorganisms at the source (human-human) b. Indirect contact: contact with contaminated items (human-subject) 2. Droplet infection a. Splatter of blood, saliva or nasal secretion into broken mucosa or skin b. Airborne by aerosol of microbes  Transmission of infection Routs of entry of microorganisms into the body 1. Inhalation Inhalation of aerosol 2. Ingestion droplets of saliva/blood or particles from 3. Autoinoculation/ percutaneous injury instruments are swallowed a. Touching with contaminated PPE or instruments b. Injury with contaminated sharp injury Aims of infection control Create and maintain a safe clinical environment to eliminate the potential for diseases transmission from dentist to the patient or the patient to the dentist or from patient to patient. https://youtu.be/rsaN-gWBa44 Infection control basics Standard precautions for all patients care Transmission-based precautions used in addition to standard precautions for patients with known or suspected infection Standard precautions Definition of standard Standard precautions apply to precaution contact with: 1. Blood Is a standard of care designed to 2. all body fluids, secretions, and protect HCP and patients from excretions (except sweat), pathogens that can be spread by regardless of whether they blood or any other body fluid, contain blood; excretion, or secretion 3. nonintact skin; 4. mucous membranes. Components of infection control 1. IMMUNIZATION Dental personnel should maintain up-to-date immunization records that include vaccination against: 1. Hepatitis B 5. Influenza 2. Rubella 6. Poliomyelitis 3. Measles 7. Tetanus/diphtheria 4. Mumps 8. COVID-19 Components of infection control 2. PATIENT SCREENING Complete medical history to determine the infectious status and should be updated during the recall visits Components of infection control 3. HAND HYGIENE Is the most important aseptic procedure in the prevention of health care associated infections. WHY? Hands are the most common mode of pathogen transmission Reduce spread of antimicrobial resistance “THE WEARING OF GLOVES DOES NOT REPLACE HANDWASHING” Components of infection control 3. HAND HYGIENE Material used: Components of Good Handwashing Include a) Cleaning nails and skin thoroughly to remove all visible soil b) Rinsing well to remove all visible soap c) Drying thoroughly to reduce risk of skin chapping. Components of infection control 3. HAND HYGIENE The 5 moments for hand hygiene approach defines the key moments when health-care workers should perform hand hygiene. Components of infection control 3. HAND HYGIENE Recommendation to maintain hand hygiene Artificial nails are contraindicated Colored nail polish is contraindicated Nails should be short All hand jewelry should be removed Components of infection control 4. PERSONAL PROTECTIVE EQUIPMENT (PPE) Is designed to protect the skin and the mucous membranes of the eyes, nose, and mouth of the DHCP from exposure to infectious agents Primary PPE used in health care settings includes: gloves, surgical masks, protective eyewear, face shields, and protective clothing Less frequently used PPE includes: shoe and head covers  Components of infection control 4. PERSONAL PROTECTIVW EQUIPMENT (PPE) PROTECTIVE CLOTHING: Must be changed daily (in case of visibly soiled, change immediately) Contaminated clinical wear should be taken home in a plastic bag and laundered using a high temperature cycle (60-70°C) with a normal bleach concentration Use of disposable gowns may be considered when performing surgical procedures and treating known carriers of infectious diseases Following patient care, protective clothing is considered contaminated. IT SHOULD NOT BE WORN OUTSIDE OF THE CLINIC Components of infection control 4. PERSONAL PROTECTIVW EQUIPMENT (PPE) MASK The mask should cover the mouth and nose completely and adjusted firmly on the bridge of the nose Masks should not be worn below the nose or below the chin Once placed, masks should not be touched Mask should be discarded when: visibly soiled become wet When a mask is no longer necessary for patient care using the phone or leaving the clinic Components of infection control 4. PERSONAL PROTECTIVW EQUIPMENT (PPE) PROTECTIVE EYEWEAR OR FACE SHIELD Uses: when performing procedures that can cause aerosols When performing procedures that produce projectiles When it is likely that unprotected eyes will be exposed to any type of physical injury or splashes from corrosive or toxic chemicals (e.g. sodium hypochlorite) All eye protection must be disinfected between patients to avoid possible contamination or infection. Components of infection control 4. PERSONAL PROTECTIVW EQUIPMENT (PPE) GLOVES Gloves reduce hand contamination by 70-80%, prevent cross- contamination and protect patients and HCW from infection. The use of gloves does not eliminate the need for handwashing both prior to placement and following removal of gloves. A new pair of gloves is worn for each patient Once gloves have been placed, nothing else should be touched other than the patient and those instruments, equipment, and supplies that have been prepared solely for the use of that patient Gloves should be removed when leaving the clinic Components of infection control 4. PERSONAL PROTECTIVW EQUIPMENT (PPE) The order of wearing PPE Protective clothing Protective eyewear Place gloves 01 03 05 02 04 Mask Wash hand Components of infection control 4. PERSONAL PROTECTIVW EQUIPMENT (PPE) The order of removing PPE Gloves Protective eyewear Hand wash 01 03 05 02 04 Mask Protective clothing Components of infection control While dealing with high-risk patients: Use double mask and double gloves techniques, Schedule the last appointment for them, Practitioner with any cuts on skin of hands should be prohibited from attending the operative procedures Golden rule All patients should be treated as if they are infectious and routine cross-infection control is necessary dealing with every patient Components of infection control 5. Needle and sharp instrument safety Sharp ends of any instrument or device should be angled away from both the doctor and the coworkers when receiving, handling or passing such instruments. Sharp instruments should not be passed over the patient’s face. Used needles should not be bent or broken prior to disposal. Unsheathed needles are placed directly into the designated, puncture-proof disposal container (safety box) Components of infection control 5. Needle and sharp instrument safety Technique for needle recapping 1. one-handed “scoop” technique 2. mechanical device designed to hold the needle sheath Components of infection control 6. Instrument sterilization and disinfection: Sterilization: Disinfection: A process which will destroy all forms of A process which destroy or inhibit most life applied especially to microorganisms pathogenic agents on an objects by chemical or physical means. Disinfection cannot occur in the presence of organic debris Used for equipment and surfaces that cannot be sterilized Components of infection control 6. Instrument sterilization and disinfection: Sanitization: The process of removing organic debris in order that disinfection can occur Bacteriostatic: An agent that inhibit the increase in the number of bacteria Bactericidal, fungicidal, virucidal: An agent that destroy bacteria, fungi, or viruses respectively Components of infection control 6. Instrument sterilization and disinfection: Dental instruments are classified according to their risk of transmitting infection and the need to sterilize them between use: Critical Semi-critical Non-critical instruments used to penetrate Instruments that contact oral Instruments or medical soft tissue or bones and mucous membrane devices that come in contact contact blood and body fluid with intact skin should be sterilized after each Should be sterilized after Disinfected with use each use, If sterilization is not intermediate-level or low- feasible, high-level level disinfection disinfection. forceps, scalers, burs mirrors, amalgam condenser external component of X ray head Components of infection control 6. Instrument sterilization and disinfection: Step for sterilization procedures: 1. Initial storage: contaminated instruments are immersed in a sink of water or in a pre- soak disinfectant immediately after use 2. Removal of debris: debris are removed either by manual scrubbing, use of ultrasonic cleaner or use of specialized instrument washers 3. Inspection: check the instruments for cleanliness and drying, signs of rust or cracks, and proper opening and closing before packing for sterilization. 4. Wrapping (bagging): cleaned instruments are contaminated, therefore, must be handled with gloves 5. Sterilization Components of infection control 6. Instrument sterilization and disinfection: Sterilization methods: 1. Steam under pressure (autoclave) Items are exposed to direct steam contact at the required temperature and pressure for the specified time Temperature of the steam is 121 – 132 °C (250 – 270 °F) Time required is 3 – 20 minutes (depend on the type of sterilizer and wrapping) Components of infection control 6. Instrument sterilization and disinfection: Sterilization methods: 1. Steam under pressure (autoclave) Advantages Disadvantages Effective against spore-forming Causes rust and corrosion (in organisms unprotected carbon steel instruments) Quick and easy to use Causes damage to the heat sensitive Penetrates fabric and paper wrapping materials Can be monitored Dulls unprotected cutting edges Components of infection control 6. Instrument sterilization and disinfection: Sterilization methods: 2. Dry heat Less efficient than moist heat A higher temperature is required than moist heat Dry heat cycle is 1 hr at 170 °C OR 2 hr at 160 °C Components of infection control 6. Instrument sterilization and disinfection: Sterilization methods: 2. Dry heat Advantages Disadvantages No rust and corrosion Longer processing time Has monitoring capabilities Cause damages to plastics Scorches paper of cloth wrapping Cycle must be uninterrupted Components of infection control 6. Instrument sterilization and disinfection: Sterilization methods: 3. Unsaturated chemical vapor (chemiclave) Use a specific mixture of formaldehyde, alcohols, ketone, acetone and water under pressure at 132 °C (270 °F) Time required 20 – 40 minutes The chemical solution must be used once Components of infection control 6. Instrument sterilization and disinfection: Sterilization methods: 3. Unsaturated chemical vapor (chemiclave) Advantages Disadvantages Relatively quick Produce offensive odor Minimal rust and corrosion Not penetrate fabric wrapping Works with paper packaged articles Damages plastics Has monitoring capabilities High cost of special solutions Components of infection control 6. Instrument sterilization and disinfection: Recommended methods of sterilization of various dental items: Handpieces: High speed handpiece Low speed handpiece must be subjected Surgical handpiece to heat sterilization  Components of infection control 6. Instrument sterilization and disinfection: All instruments and all items that are able to withstand repeated exposure to heat must be heat sterilized between patients. a. All band and orthodontic instruments; b. All burs and bur changers, including contaminated laboratory burs and diamond abrasives; c. All endodontic instruments; d. Air-water syringe tips; e. Metal impression trays f. Surgical instruments; g. Ultrasonic periodontal scalers and tips; h. Electrosurgery tips Components of infection control 6. Instrument sterilization and disinfection: Some items that may be chemically sterilized include, but are not limited to the following: 1. Glass mixing slabs; 2. Metal or plastic spatulas; 3. Mirrors for intraoral photography; 4. Some cheek retractors; 5. Handles for brush tips Components of infection control 6. Instrument sterilization and disinfection: Single Use Items: All single use or disposable items, labeled as such, used in patient treatment must be discarded and not reused. Some of the single use items include: Disposable needles and syringes; local anesthetic carpules; saliva ejectors, high volume evacuator tips and air water syringe tips; polishing disks, cups, points; prophy angles cups, and brushes; fluoride trays; disposable impression trays; gloves, masks, orthodontic wires, bands and brackets, matrix bands Components of infection control 7. Surface disinfection and general operatory asepsis: Contaminated surfaces should be disinfected routinely following each patient visit. Preclean and dry all surfaces prior to disinfection. These include but are not limited to the following: All those areas that were covered with barriers, countertops, mobile air/water syringe handles, suction and saliva ejector couplings, dental chair, operator and assistant stools, soap and towel dispenser areas and X-ray viewer and switch. Utility gloves are used during disinfection to reduce risk to the operator from pathogens as well as the chemical disinfectant. Components of infection control 8. Radiographic asepsis: Gloves must be used when exposing radiograph and handling contaminated film packets. Use heat-tolerant or disposable intraoral devices, clean and sterilize the heat-tolerance device between patients (high level disinfect for semi critical heat sensitive device) For digital radiograph sensors: Clean and heat-sterilize, or high-level disinfect, between patients, barrier protected semi critical items. Components of infection control 9. Laboratory asepsis: Cross-contamination from impression, jaw relation records, casts are possible Should be cleaned and disinfected, then thoroughly rinsed before being sent to the laboratory Impressions, prosthesis, or appliances should be disinfected as soon as possible after removal from patient’s mouth Tips for dental tubes hygiene Internal surfaces of handpiece, ultrasonic scaler may become contaminated with patient material during use, which may be expelled intraorally during subsequent uses. So, handpieces should be run to discharge water and air for a minimum of 20 – 30 seconds after use on each patient The low-volume suction lines should be disinfected between patients. Using a small amount of a waterline cleaner/disinfectant for 2 minutes between patients, and at the beginning of each day. Use of extracted teeth in dental educational settings: Should be collected in a sealed container Avoid contamination of the outside of the container Before extracted teeth are manipulated in dental educational exercises, teeth should be cleaned by scrubbing with detergent and water stored and immersed in a fresh solution of sodium hypochlorite (diluted 1:10 with tap water) persons handle extracted teeth should wear gloves and other PPE after completion of work activities: gloves should be disposed properly hands should be washed work surfaces and equipment should be cleaned and disinfected  THANK YOU ! QUESTIONS