Infection Control In Dentistry PDF

INFECTION CONTROL IN DENTISTRY DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE COLLEGE OF DENTISTRY DAVID PABLO S. FERNANDEZ JR.,DMD  Why do we need to sterilize? Dentists and other dental team members are exposed to a variety...

INFECTION CONTROL IN DENTISTRY DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE COLLEGE OF DENTISTRY DAVID PABLO S. FERNANDEZ JR.,DMD  Why do we need to sterilize? Dentists and other dental team members are exposed to a variety of potentially infectious microorganisms The transmission of infectious agents from person to person or from inanimate objects Cross infection  Why do we need to sterilize? The goal is to reduce the possibility or risk of cross infection occurring in the dental clinic Producing a safe environment For both patient and sta f  Reducing risks associated with cross infection We do not deal with absolutes Infection control procedures are directed towards reducing, to an acceptable level, The probability that infection will be transmitted  Risks in a state or condition marked by a high level of risk or susceptibility  Risk assessment and management Risk control in dentistry is dependent on a single tier approach In which all patients are treated without discrimination As though they were all potentially infectious  Standard infection control precautions Treats all body uids and secretions With the exception of sweat as source of infection Employ personal barriers and safe behaviors to prevent 2 way exchange of blood, saliva and respiratory secretions fl  Risk assessment in dental practice 1. Identify the hazard 2. Decide who might be harmed and how Evaluate the risks arising from the hazards and decide whether existing precautions are adequate Record your ndings Review assessments periodically and revise if necessary fi  Infections Microorganisms must attach to or penetrate the surfaces of the body in order to establish themselves Damage skin remain a potential weak link in or defenses Vast majority of microbes do not necessarily cause infection  Infections Commensal (resident) Present in the skin, gut and mouth Ex: ________________ They cause infections when the immune system is compromised  Breaking the chain of infection A microorganism causing disease must have a means of transmission from host to host Otherwise it will eventually disappear The dental clinic is an environment where there are inherent infection risks  Breaking the chain of infection A susceptible host, virulence factors to survive the host’s immune system Means of entering and exiting the body Links in the chain can be broken Halting the transmission of disease What are some measures Vaccination Drug therapy Infection control and prevention measures These can all block the route of transmission Routes of transmission 1. Transmission by direct or indirect contact (touching a contaminated surface 2. Percutaneous or _________ such as sharp injuries 3. Airborne, aerosols generated by high speed handpieces and respiratory secretions 4. Common vehicle spread (dental waterlines and plumbing)  Direct contact The most easily appreciated mode of infection spread caused by dental professionals HSV, VZV and EBV HBV - causing common colds  Direct contact Small abrasions on the ngers of the dentist fi  Direct contact S aureus - the most relevant in oral surgery MRSA Resistant to most types of penicillin and cephalosporins Main mode is the hands of the HCW  Direct contact Prevention is by hand washing and wearing gloves Disposable aprons Dental instruments must be decontaminated between patients Dental chair units must be cleaned and disinfected between patients  Infection by uids Prevention is done by disinfectants and detergents Physical barriers fl Percutaneous transmission Blood borne viruses (BBV) HIV and Hepatitis B and Hepatitis C  Hepatitis B virus STD Member of Hepadnaviridae DNA family Causes in ammation of the liver Transmission is parenteral Fatigue, fever, loss of appetite, nausea. Vomiting, abdominal discomfort, and jaundice fl  Hepatitis C Caused by both acute and chronic infections of the liver First proven case of transmission is IV sedation  HIV transmission Modes of transmission are oral and penetrative sexual intercourse Sharing of needles and syringes when injecting drugs The risk of infection with HIV is 100 times less than HBV for a similar exposure  HIV transmission Routine screening If a person remains undetected it is highly unlikely to infect others Because the viral load is reduced  Air borne infections Aerosol, saliva and respiratory secretions Generated using handpiece and ultrasonic scalers MT, rhinoviruses ,VZV, EBV  Tuberculosis Ranks alongside HIV and AIDS as leading cause of death worldwide Dentist to patient is rare Patient to dentist is the reason there are recommendations  Tuberculosis Assess personal or familial history of TB BCG should be o ered to HCW regardless of age Previously unvaccinated individuals Contact with patients or clinical materials Are Mantoux skin test negative ff  Air borne infections Application of standard precautions Well ventilated environment High volume suctions Wearing of surgical or respirator masks  In uenza In uenza virus causes respiratory illness with symptoms of headache, fever, coryza, cough, sore throat Aching muscles and joints In uenza A and B (severe one) Generated by sneezing and coughing fl fl fl  In uenza Transmission is by direct contact Indirect contact by large respiratory droplets Easily deactivated by washing hands with soap and water Alcohol based sanitizers fl  In uenza Annual vaccination of susceptible groups Prophylaxis with antivirals Hand hygiene and respiratory etiquette fl Emerging and re-emerging infections  Emerging infections 1. These challenge our current infection control and prevention protocols 2. These can shake the con dence of the public fi  Emerging infections Rapid globalization Climate change and global warming Agricultural practices Antibiotic selection Health status of the population 1ST QUIZ  Quiz 1. Give 2 reasons for the resurgence of infections 2. 3. What is the causative agent for tuberculosis 4. Bacteria that causes infection when the immune system is compromised 5. The severe form of in uenza fl  Quiz 6. What is the mode of transmission of HIV in dental settings? 7. Give one scenario that BCG vaccine should be o ered 8. The transmission of infectious agents from person to person or from inanimate objects is known as? 9. The most relevant and most commonly observed bacteria in the dental setting 10. Epstein bar virus causes what type of infection? ff Bonus points  Occupational health Members of the dental team are exposed to a variety of hazardous substances Microbial pathogens The rst step is to identify where major infection- associated hazards may lie fi  Occupational health Sharps injuries (exposure to bbv) Respiratory infections from aerosols Eye and skin infections Hypersensitivity reactions (latex gloves) Mercury toxicity  Culture of safety One of the strategies for combating transmission of infection Safe working practices Compliance with infection control policies Reporting injuries E ective management ff  Culture of safety Immunization Incorporating safety devices PPE Postexposure prophylaxis All contribute to defenses  Safety culture How factors come together Commitment of the whole dental team All members of the dental team participating in safety planning and infection control development Routing occupational immunization, PErP, PPE, training Induction training and socialization process for new personnel Immunization requirements In the UK, all clinical and non clinic workers and students are up to date with routine vaccinations Tetanus, diphtheria, MMR BCG (exposed only) Varicella vaccine (exposed and non exposed)  MMR Mumps, measles and rubella During the 21st century there was distrust of the MMR vaccine This led to poor uptake of it Resurgence of mumps and measles  Rubella Toga virus Spread by droplet transmission May begin with a prodromal illness involving low grade fever, malaise, midl conjunctivitis Erythematous rubella rash on the on ears, face and neck can easily be missed as it is transitory  Rubella Incubation period is 14-21 days Person is infectious from one week before symptoms appear to four days after the onset of the rash Infection in pregnancy may cause fetal or congenital rubella syndrome Microcephaly, cataracts, deafness, cardiac problems, in ammatory lesions of the brain, liver and lungs fl  Varicella Chicken pox Varice zoster virus Can occur at any age but more common in children Disease in adults tends to be severe Primary infection presents with blisters on the skin that later scab and cause scarring  Varicella Virus eventually becomes latent in the sensory ganglion (gasserian ganglion) of _________________ Can be reactivated later in life as Shingles (herpes zoster) Results to a painful, vesicular (blistering) skin rash Vesicles contain virus and are infectious  Varicella Varicella is transmitted directly by personal contact or droplet spread Students or sta with no previous history of chickenpox or shingles should have a blood test for immunity If there is history = _________ ff  Syphilis Treponema pallidum Majority of cases are in men who have sex with men Smaller cases of heterosexual women Can cross the placenta and infect the the fetus Oral sex was identi ed as the route of infection approx 40% of cases (UK data) fi  Syphilis Dentists should refer any patients with suspicious lesions suggestive of primary syphilis Primary chancre Secondary syphilis (mucosal lesions/ ulcerations) Most infectious during the primary and secondary stages of the disease Syphilis  Syphilis Dental worker can be infected thru an abrasion or cut in the skin that came into contact with a syphilitic lesion Surgical gloves provide an e ective barrier to transmission Needle stick? The amount of T. Pallidum in blood is very small Transmission is rare ff  Hepatitis B vaccine Contains hebatitis B surface antigen Prepared from yeast cells using recombinant DNA technology Vaccine contains inactivated virus Very safe and incapable of causing hepatitis  Hepatitis B vaccine Standard of 3 immunizations that stimulate the production of speci c antibodies 10-15 percent of individuals respond poorly Age of over 40 years, obesity, smoking, immunosuppression Ine ective in patients with acute hepatitis ff fi  Hepatitis B vaccine Antibody response is measured 1-4 months after completing the course of immunization Max antibody titres are usually found one month after completing the course with a rapid decline of 12 months Immunological memory ensures that protection against infections is sustained even antibodies decline with time Single booster  Bcg vaccine Tuberculosis Most common form is pulmonary TB Fever, fatigue, weight loss, night sweats, persistent cough for more than 3 weeks Hemoptysis Enlarged lymph nodes  Bcg vaccine Respiratory route Vaccine protection may wane but is considered e ective in 10-15 years HCW are more likely than the general population to come into contact with someone with TB Recommendation is for all dental workers and students Mantoux negative ff