INFECTION CONTROL.pptx

INFECTION CONTROL The goal is: To ensure compliance with standard precautions and other methods to minimize infection risks. Air-borne Contamination Air-borne Contamination A high-speed hand-piece is capable of creating air-borne contaminants from:- bacterial residents in the dental unit water spray...

INFECTION CONTROL The goal is: To ensure compliance with standard precautions and other methods to minimize infection risks. Air-borne Contamination Air-borne Contamination A high-speed hand-piece is capable of creating air-borne contaminants from:- bacterial residents in the dental unit water spray system - microbial contaminants from saliva, tissues, blood, plaque. With respect to size, these air-borne contaminants exist in the form of: spatter, mists and aerosols. Aerosls: Aerosols consist of invisible particles ranging from 5 μm to approximately 50 μm that can remain suspended in the air and breathed for hours. Aerosols and larger particles may carry agents of any respiratory infection carried by the patient. Mists Mists that become visible in a beam of light consist of droplets estimated to be around 50 μm. Heavy mists tend to settle gradually from the air after 5–15 min. Spatter Spatter consists of particles generally larger than 50 μm and even visible splashes. Barrier protection of personnel using masks, protective eyewear, gloves and gowns is now a standard requirement for dental procedures. To help reduce exposure to air-borne particles capable of transmitting respiratory infections, adequate air circulation should be maintained. GLOVES Regulations specify that all clinical personnel must wear treatment gloves during all treatment procedures. After each appointment, or whenever a leak is detected, gloves are removed, hands are washed and fresh gloves are used. Gloves must not be used for more than one patient. Inexpensive, disposable, well-fitting treatment gloves are available for chair-side use. Gloves must not be washed. Personal Barrier Protection - At the beginning of a routine treatment period, the clinician should remove his or her wristwatch, jewelry and rings then wash hands with a suitable cleanser. - Eyewear or shields are very important and when removed, they should be cleaned and disinfected. - Hair can trap heavy contamination that, if not washed away, can be rubbed back from a pillow onto the face at night. Hair must be protected with a surgical cap. - A mask should be worn to protect against aerosols. Face shields are appropriate for protection against heavy spatter, but a mask still is required to protect against aerosols that drift behind the shield. The mask should be changed between every patient. - Operatory clothing is heavily spattered with invisible saliva and traces of blood throughout the day. An overgarment must protect clothing as well as skin. Disposal of Clinical Waste Contaminated materials such as used masks, gloves, blood-soaked or salivasoaked sponges and blood-soaked or saliva-soaked cotton rolls must be discarded safely. Separating needles and sharps into hard-walled, leak-proof and sealable containers and out of soft trash has been shown to provide adequate safety avoiding carrying unsheathed contaminated needles or containers in a manner that could endanger others. Great care should be used in passing instruments and syringes with unsheathed needles to another individual. Sharp and curved ends should be turned away from the recipient’s hand. - Burs should be removed from hand-pieces when the procedure is finished; Disinfectants Regarding disinfection, two principles should be remembered: I. Disinfection cannot occur until fresh disinfectant is reapplied to a thoroughly cleaned surface. II. Disinfection does not sterilize. Disinfectants containing 70%–79% ethyl alcohol are considered the most effective disinfectants on cleaned surfaces. Procedures, Materials and Devices for Cleaning Instruments before Sterilization Following are step-by-step standard operating procedures for the preparation of the dental chair, dental unit and instruments between appointments I. Wash hands with antiseptic hand soap, rinse and dry or use an accepted alcohol hand rub. II. Remove (unscrew) the resheathed needle from the anesthetic syringe, and discard it with all other sharp disposable items in a sharps container. III. Spray any used bottles, containers and tubes with disinfectant, and wipe with a paper towel. Spray again, and leave the items damp with disinfectant as they are put away. Spraying in this manner has been found to be effective. VI. Invert, remove and discard the plastic drapes from the control unit remove and discard the protective covers from lamp handles and the surface covering from the side table. These disposables may be placed into the large bag and removed from the control unit. V. For any controls and switches that were not covered, use a disinfectant wipe to wipe the lamp switch and controls that were contaminated. Do not spray control switches. Wipe any contaminated surfaces not previously covered, including the side table, arms of dental chair, contaminated drawer handles, radiographic viewbox switch and paper towel dispenser. Discard the used disinfectant wipe. Sterilization Sterilization is defined as killing all forms of life, including the most heatresistant forms, that is, bacterial spores. Since most instruments contact mucosa or penetrate oral tissues, it is essential that contaminated reusable instruments be cleaned and sterilized thoroughly by using accepted methods that can be tested and monitored routinely. The four accepted methods of sterilization are as follows: I. Steam pressure sterilization (autoclave) II. Chemical vapour pressure sterilization (chemiclave) III. Dry heat sterilization (dryclave) IV. Ethylene oxide (ETOX) sterilization. Steam Pressure Sterilization (Autoclaving) - Sterilization with steam under pressure is performed in a steam autoclave Advantages of Autoclaving Autoclaving is the most rapid and effective method for sterilizing cloth surgical packs and towel packs (other methods are not suitable for processing cloth packs). Automated models are available, although they must be evaluated with a biologic spore test monitoring system. Disadvantages of Autoclaving Items sensitive to the elevated temperature cannot be autoclaved. Autoclaving tends to rust carbon steel instruments and burs. Steam seems to corrode the steel neck and shank portions of some diamond instruments and carbide burs. II. Chemical Vapour Pressure Sterilization (Chemiclaving) They are similar to steam sterilizers but sterilization by chemical vapour (aldehydes) under pressure is performed in a chemiclave. Advantage of Chemiclaving Carbon steel and other corrosion-sensitive burs, instruments and pliers are said to be sterilized without rust or corrosion Disadvantages of Chemiclaving Items sensitive to the elevated temperature are damaged. Instruments must be lightly packaged in bags obtained from the sterilizer manufacturer... Towels and heavy cloth wrappings of surgical instruments may not be penetrated to provide sterilization. Biologic spore test monitoring strips need to be used routinely to confirm heat penetration of heavy packs before using them. Only fluid purchased from the sterilizer manufacturer can be used. III. Dry Heat Sterilization A-Conventional Dry Heat Ovens B-Short-cycle, High-temperature Dry Heat Ovens Short-cycle, High-temperature Dry Heat Oven A rapid high-temperature process that uses a forced-draft sterilization chamber (a mechanical convection sterilization chamber that circulates heated air with a fan or blower) is available. It reduces total sterilization time to 6 min for unwrapped instruments and 12 min for wrapped instruments These short-cycle, high-temperature dry heat sterilizers operate at 375°F (190°C). Advantages of dry heat sterilization Carbon steel instruments and burs do not rust, corrode or lose their temper or cutting edges if they are well dried before processing. Disadvantages of dry heat sterilization High temperatures may damage more heat-sensitive items such as rubber or plastic goods. IV. ETOX Sterilization ETOX (Ethylene oxide) gas is the best way to sterilize rotary handpieces.