Lecture 24 Guidelines of Infection Control in Dentistry PDF

Guidelines of Infection Control in Dental Settings Basic Infection Control Measures Dr. Sanabel Barakat Semester 1 / year 3 BDOS., MSc., PhD., JDC. Week 12  ILOs Explore recommended infection control guidelines in order to 1. Learn infection...

Guidelines of Infection Control in Dental Settings Basic Infection Control Measures Dr. Sanabel Barakat Semester 1 / year 3 BDOS., MSc., PhD., JDC. Week 12  ILOs Explore recommended infection control guidelines in order to 1. Learn infection control practices in the dental clinic 2. Discuss role of dentists in infection control 3. Learn infection control measures in dental related areas (Radiography department and the dental lab) 4. Understand role of other members in the dental team 2  Standard precautions Standard Precautions include: 1.Hand hygiene. 2.Use of personal protective equipment (e.g., gloves, masks, eyewear). 3.Respiratory hygiene/cough etiquette. 4.Sharps safety (engineering and work practice controls). 5.Safe injection practices (i.e., aseptic technique for parenteral medications). 6.Sterile instruments and devices. 7.Clean and disinfected environmental surfaces 3  Respiratory hygiene/cough etiquette ✓Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing throughout the visit. ✓Educate DHCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens when examining and caring for patients with signs and symptoms of a respiratory infection. 4  Respiratory hygiene/cough etiquette 1. Post signs at entrances with instructions to patients with symptoms of respiratory infection to (1) cover their mouths/noses when coughing or sneezing; (2) use and dispose of tissues; and (3) perform hand hygiene after hands have been in contact with respiratory secretions. 5  Respiratory hygiene/cough etiquette 2. Provide tissues and no-touch receptacles for disposal of tissues. 3. Provide resources for performing hand hygiene in or near waiting areas. 4. Offer masks to coughing patients and other symptomatic persons when they enter the dental setting. 5. Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible. If available, facilities may wish to place these patients in a separate area while waiting for care. 6  Environmental Infection Control A. General Recommendations 1. Follow the manufacturers’ instructions for correct use of cleaning and the FDA registered hospital disinfecting products 2. Do not use liquid chemical sterilants/high-level disinfectants for disinfection of environmental surfaces (clinical contact ormhousekeeping) 3. Use PPE, as appropriate, when cleaning and disinfecting environmental surfaces, including gloves (e.g., puncture- and chemical- resistant utility), protective clothing (e.g., gown, jacket, laboratory coat), and protective eyewear/face shield and masks 8  Environmental Infection Control Clinical Contact Surfaces 1. Use surface barriers to protect clinical contact surfaces, particularly those that are difficult to clean (e.g., switches on dental chairs) and change surface barriers between patients 2. Clean and disinfect clinical contact surfaces that are not barrier- protected, by using a registered hospital disinfectant with a low- (i.e., human immunodeficiency virus [HIV] and HBV label claims) to intermediate-level (i.e., tuberculocidal claim) activity after each patient. 3. Use an intermediate-level disinfectant if visibly contaminated with blood 9  Environmental Infection Control Housekeeping Surfaces 1. Clean housekeeping surfaces (e.g., floors, walls, sinks) with a detergent and water or a registered hospital disinfectant/detergent on a routine basis, depending on the nature of the surface and the type and degree of contamination, and as appropriate, based upon the location in the facility, and when visibly soiled 2. Clean mops and cloths after use and allow to dry before reuse; or use single-use, disposable mop heads or cloths 10  Environmental Infection Control Housekeeping Surfaces 3. Prepare fresh cleaning registered disinfecting solutions daily and as instructed by the manufacturer 4. Clean walls, blinds, and window curtains in patientcare areas when they are visibly dusty or soiled 11  Environmental Infection Control D. Spills of Blood and Body Substances Clean spills of blood or other potentially infectious materials and decontaminate surface with an a registered hospital disinfectant with low- (i.e., HBV and HIV label claims) to intermediate-level (i.e., tuberculocidal claim) activity depending on size of spill and surface porosity 12  Dental Handpieces and Other Devices Attached to Air and Waterlines 1. Clean and heat-sterilize handpieces and other intraoral instruments that can be removed from the air and waterlines of dental units between patients 2. Follow the manufacturer’s instructions for the cleaning, lubrication, and sterilization of handpieces and other intraoral instruments that can be removed from the air and waterlines of dental units 17  Dental Handpieces and Other Devices Attached to Air and Waterlines 3. Do not surface-disinfect, use liquid chemical sterilants or ethylene oxide on handpieces and other intraoral instruments, that can be removed from the air and waterlines of dental units 4. Do not advise patients to close their lips around the tip of the saliva ejector to evacuate oral fluids 18  Special Considerations Dental Radiology 1. Wear gloves when exposing radiographs and handling contaminated film packets. 2. Use other PPE (e.g., protective eyewear, mask, gown) as appropriate if spattering of blood or other body fluids is likely 3. Use heat-tolerant or disposable intraoral devices whenever possible (e.g., film-holding and positioning devices). 19  Special Considerations Dental Radiology 4. Clean and heat-sterilize heat-tolerant devices between patients. 5. At a minimum, high-level disinfect semicritical heat-sensitive devices, according to manufacturer’s instructions 6. Transport and handle exposed radiographs in an aseptic manner to prevent contamination of developing equipment 20  Special Considerations Dental Radiology The following apply for digital radiography sensors: a. Use FDA-cleared barriers b. Clean and heat-sterilize, or high-level disinfect, between patients, barrier-protected semicritical items (e.g. sensor/film holders). c. If the item cannot tolerate these procedures, then at a minimum protect with an FDA-cleared barrier and clean and disinfect with a registered hospital disinfectant with intermediate level (i.e., tuberculocidal claim) activity, between patients. 21  Special Considerations Dental Radiology Consult with the manufacturer for proper disinfection and sterilization methods of conventional and digital radiology sensors and holders; and for protection of associated computer hardware 22  Special Considerations Aseptic Technique for Parenteral Medications 1. Do not administer medication from a syringe to multiple patients even if the needle on the syringe is changed 2. Use single-dose vials for parenteral medications when possible 3. Do not combine the leftover contents of single-use vials for later use 4. Use fluid infusion and administration sets (i.e., IV bags, tubings, and connections) for one patient only and dispose of appropriately 23  Special Considerations Aseptic Technique for Parenteral Medications The following apply if multidose vials are used: a. Cleanse the access diaphragm with 70% alcohol before inserting a device into the vial b. Use a sterile device to access a multiple-dose vial and avoid touching the access diaphragm. c. Both the needle and syringe used to access the multidose vial should be sterile. 24  Special Considerations Aseptic Technique for Parenteral Medications The following apply if multidose vials are used: d. Do not reuse a syringe even if the needle is changed e. Keep the multidose vials away from the immediate patient treatment area to prevent inadvertent contamination by spray or spatter f. Discard the multidose vial if sterility is compromised 25  Special Considerations Aseptic Technique for Parenteral Medications Safe Injection Practices Added in 2016 1. Prepare injections using aseptic technique in a clean area. 2. Disinfect the rubber septum on a medication vial with alcohol before piercing. 3. Do not reuse needles or syringes to enter a medication vial or solution, even when obtaining additional doses for the patient. 4. Do not use single-dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution for more than one patient. 26  Special Considerations Aseptic Technique for Parenteral Medications Safe Injection Practices Added in 2016 5. Dedicate multidose vials to a single patient whenever possible. 6. If multidose vials are to be used for more than one patient, they are to be kept in a centralized medication area and should not enter the immediate patient treatment area to prevent inadvertent contamination. 27  Special Considerations Aseptic Technique for Parenteral Medications Safe Injection Practices Added in 2016 7. If a multidose vial enters the immediate patient treatment area, it should be dedicated for single-patient use and discarded immediately after use. 8. Date multidose vials when first opened and discard within 28 days unless the manufacturer specifies a shorter or longer date for that vial. 28  Single-Use (Disposable) Devices 1. Use single-use devices for one patient only and dispose of them appropriately 29  Preprocedural Mouth Rinses No recommendation is offered regarding use of preprocedural antimicrobial mouth rinses to prevent clinical infections among DHCP or patients. Although studies have demonstrated that a preprocedural antimicrobial rinse (e.g., chlorhexidine gluconate, essential oils, or povidone-iodine) can reduce the level of oral microorganisms in aerosols and spatter generated during routine dental procedures and can decrease the number of microorganisms in the patient’s bloodstream during invasive dental procedures, the scientific evidence is inconclusive that using these rinses prevents clinical infections among DHCP or patients (Unresolved issue). 30  Oral Surgical Procedures The following apply when performing oral surgical procedures a. Perform surgical and hand antisepsis using an antimicrobial product (e.g., antimicrobial soap and water or soap and water followed by alcohol-based hand scrub with persistent activity) before donning sterile surgeon’s gloves b. Use sterile surgeon’s gloves 31  Oral Surgical Procedures The following apply when performing oral surgical procedures c. Use sterile saline or sterile water as a coolant/ irrigator when performing oral surgical procedures. d. Use devices specifically designed for the delivery of sterile irrigating fluids (e.g., bulb syringes, singleuse disposable products, and sterilizable tubing) 32  Handling of Biopsy Specimens 1. During transport, place biopsy specimens in a sturdy, leakproof container labeled with the biohazard symbol 2. If a biopsy specimen container is visibly contaminated, clean and disinfect the outside of a container, or place it in an impervious bag labeled with the biohazard symbol 33  Handling of Extracted Teeth 1. Dispose of extracted teeth as regulated medical waste unless returned to the patient 2. Do not dispose of extracted teeth containing amalgam in regulated medical waste intended for incineration 3. Clean and place extracted teeth in a leakproof container labeled with a biohazard symbol and maintain hydration for transport to educational institutions or a dental laboratory 4. Heat-sterilize teeth that do not contain amalgam before they are used for educational purposes 34  Dental Laboratory 1- Clean and heat-sterilize heat-tolerant items used in the mouth (e.g., metal impression trays, face-bow forks) 2- Follow the manufacturer’s instructions for cleaning and sterilizing or disinfecting items that become contaminated, but that do not normally contact the patient (e.g., burs, polishing points, rag wheels, articulators case pans, lathes). 36  Dental Laboratory If manufacturer instructions are not available, clean and heat-sterilize heat-tolerant items or clean and disinfect with an EPA-registered hospital disinfectant with low- (HIV, HBV effectiveness claim) to intermediate-level (tuberculocidal claim) activity, depending on the degree of contamination 37  Laser/Electrosurgery Plumes/Surgical Smoke No recommendation is offered regarding practices to reduce DHCP exposure to laser plumes/surgical smoke when using lasers in dental practice. 38  Laser/Electrosurgery Plumes/Surgical Smoke Suggested Practices to reduce HCP exposure to laser plumes/surgical smoke have been suggested, including use of (1) Standard precautions (e.g., high-filtration surgical masks & possibly full face shields) (2) central room suction units with in-line filters to collect particulate matter from minimal plumes (3) dedicated mechanical smoke exhaust systems with a high-efficiency filter to remove substantial amounts of laser-plume particles. 39  Laser/Electrosurgery Plumes/Surgical Smoke The effect of the exposure (e.g., disease transmission or adverse respiratory effects) on DHCP from dental applications of lasers has not been adequately evaluated (Unresolved issue). 40 41