Infection Control practices for Dental Radiography .pdf

INFECTION CONTROL PRACTICES FOR DENTAL RADIOGRAPHY  Abbreviations  DHCP - Dental Health-Care Personnel  IC - Infection Control  OPIM - Other Potentially Infectious Materials  PPE - Personal Protective Equipment  Dental Radiography Infection Control Practices Identical to those...

INFECTION CONTROL PRACTICES FOR DENTAL RADIOGRAPHY  Abbreviations  DHCP - Dental Health-Care Personnel  IC - Infection Control  OPIM - Other Potentially Infectious Materials  PPE - Personal Protective Equipment  Dental Radiography Infection Control Practices Identical to those used in the dental operatory  Standard Precautions  Apply to all patients UUSSAAFFDDeennttaalEEvvaaluuaattioonn&&CCoonnssuulttaattioonnSSeerrvviccee  Potential Routes of Transmission of Blood borne Pathogens Patient DHCP DHCP Patient Patient Patient  Goal is to Break the Chain of Infection Pathogen Susceptible Host Source Entry Mode USAF Dental Evaluation & Consultation Service  Potential Sources of Cross-Contamination  Film packet(s)  Exposure button  Film-holding  Environmental devices surfaces  DHCP gloved  Chair/ head rest hands controls  Tube head  Darkroom  Extension cone  Processor and  Control panel solutions  Research  Oral microorganisms  Remain viable on radiographic equipment for at least 48 hours  Can survive in used developer/fixer for up to 2 weeks White SC & Glaze S. J Am Dent Assoc 1978; Bachman CE et al. Oral Surg Oral Med Oral Pathol 1990; Katz JO et al. Dentomaxillofac Radiol 1988; Stanczyk DA et al. Oral Surg Oral Med Oral Pathol 1993. USAF Dental Evaluation & Consultation Service  Prevention  Hand hygiene  Personal protective equipment (PPE)  Environmental IC  Surface barriers  Cleaning and disinfection  Cleaning/disinfection/sterilization of instruments/items  Hand Hygiene  Important means of  preventing disease transmission  Before and after patient treatment  Before gloving/after removing gloves  After touching any contaminated item/surface when ungloved  Gloves are not a substitute for hand hygiene !  Hand Hygiene Alcohol-based hand rubs may be useful in dental radiography  Multiple patients are seen in short period of time  Effective, fast acting, requires less time than handwashing, and potentially causes less dermatitis  DO NOT use if hands are visibly contaminated with blood or OPIM  PPE – Gloves  Gloves must be worn when taking intraoral radiographs and handling contaminated film packets, equipment, or instruments  Single-use  Change between patients USAF Dental Evaluation & Consultation Service  PPE – Gloves  Powder can affect emulsion layer causing image artifacts Powdered  Consider using Gloves powder-free gloves USAF Dental Evaluation & Consultation Service  Additional PPE  Wear a surgical mask, protective eyewear, long- sleeved gown if spattering of blood or OPIM is likely  May be indicated when treating patients with gagging problems or respiratory infections (e.g., common cold) USAF Dental Evaluation & Consultation Service Service  Environmental IC General Principles  Potential to cross-contaminate equipment and environmental surfaces is high if aseptic technique is not practiced.  Use surface barriers or clean and disinfect contaminated surfaces and equipment between patients USAF Dental Evaluation & Consultation Service  Environmental IC General Principles  To minimize contamination, touch as few surfaces as possible  Once gloves are put on and exposure of radiographic films begins, DHCP should only touch barrier-protected surfaces UUSSAAFFDDeennttaalEEvvaaluuaattioonn&&CCoonnssuulttaattioonnSSeerrvviccee  Environmental IC Surface Barriers Advantages  Effective  Simple to use  Minimizes use of disinfectants USAF Dental Evaluation & Consultation Service  Environmental IC Surface Barriers  Cover surfaces/objects that may be touched with contaminated gloved hands or film packets, especially difficult to clean and disinfect surfaces USAF Dental Evaluation & Consultation Service  Environmental IC Surface Barriers  Use disposable, impervious materials (e.g., plastic wrap &/or bags)  Change between patients  Gloves should be worn when removing and discarding barriers USAF Dental Evaluation & Consultation Service  Cleaning and Disinfection If contaminated during procedure clean and disinfect Follow manufacturer’s EPA-Registered instructions Disinfectant  Dilution, use, Material compatibility  Wear PPE until cleaning/disinfection is completed USAF Dental Evaluation & Consultation Service Cleaning and Sterilization  Many items are single-use disposable  Use once and discard appropriately USAF Dental Evaluation & Consultation Service  Cleaning and Sterilization  Most reusable items (e.g., film holding and positioning devices) are heat tolerant  Clean, package, and heat sterilize between patients Cleaning and High-Level Disinfection  If heat-tolerant instruments or single- use disposable alternatives are not available, at a minimum clean and immerse in a liquid chemical germicide labeled as a high -level disinfectant or chemical sterilant.  Always follow the manufacturer’s instructions  Use of heat-tolerant or single-use disposable items is preferable USAF Dental Evaluation & Consultation Service Infection Control Practices Before film exposure   During film exposure  After film exposure  Processing USAF Dental Evaluation & Consultation Service  Before Film Exposure  Prepare the area aseptically before seating the patient  Unit dose supplies, equipment, and instruments  Place surface barriers USAF Dental Evaluation & Consultation Service Examples of Radiography Supplies to Unit Dose  Paper towels/cups  Surface barriers  Powder-free gloves  Radiographic film(s)  Sterile or disposable film holders  Over gloves  Leaded apron with thyroid collar  Cotton rolls  Before Film Exposure Unit Dosing Advantages  Minimizes cross- contamination  Reduces chairside time  Reduces DHCP contact with environmental surfaces Examples of Surfaces to Barrier Protect  Tubehead X-ray cone  Control panel  Exposure button  Headrest  Headrest & chair adjustment controls  Work areas/countertops USAF Dental Evaluation & Consultation Service  Before Film Exposure Radiographic Film Aseptically dispense from central supply area Place in a disposable container USAF Dental Evaluation & Consultation Service  Before Film Exposure Other Considerations  Dispense cotton rolls and paper towels to  Stabilize film placement  Remove excess saliva from film  Protect work surfaces  Seat patient  Adjust headrest, chair  Place leaded apron with thyroid collar  Have patient remove eyeglasses/dentures USAF Dental Evaluation & Consultation Service  Before Film Exposure Other Considerations  Wash hands, don gloves  Remove film holding/ positioning devices from sterile package with gloved hands and assemble in presence of patient USAF Dental Evaluation & Consultation Service  During Film Exposure  Touch as few surfaces as possible  Ideally, surfaces should be barrier-protected  After film exposure and before glove removal  Dry film with paper towel or disposable gauze to remove excess saliva or blood  Place in disposable container for transport to the developing area  Do not touch disposable container with contaminated gloves  Film-holding devices should be transferred to a covered work surface after use  During Film Exposure Managing Interruptions  After Film Exposure  Place reusable film-holding devices in designated area  Discard all disposable contaminated Items  Carefully unwrap all barrier-protected surfaces  Remove gloves, wash hands  Remove leaded apron, dismiss patient  Clean and disinfect all contaminated non - barrier- protected surfaces UUUSSSAAAFFFDDDeeennntaaalEEEvvvaaaluuuaaatiooonnn&&&CCCooonnnsssuuultaaatiooonnn SSSeeerrrvvviccceee  Processing Transport exposed films in a disposable container Unit dose supplies for processing  Gloves  Paper towel(s)  Paper cup(s) Film mount/paper envelope  Radiographic Film Barriers Simple method for maintaining IC measures by protecting the film packets from contamination and reduces preparation and processing time.  Commercially available  Film Barrier – Advantages  Protects films from contamination  Reduces preparation and processing time  Open in lighted area with gloved hands  Drop film packet onto paper towel or into paper cup  Film can then be opened with ungloved hands in the darkroom  Simplest method when using daylight loader  Processing Handling Film with Barriers  Place paper towel on the work surface  Place container with films next to paper towel  Don gloves  Remove film, open barrier carefully avoiding contact with the film packet  Allow film packet to drop onto paper towel or in a disposable cup USAF Dental USAF Dental Evaluation Evaluation & & Consultation Consultation Service Service  Processing Handling Film with Barriers  Dispose of barrier  After all barriers are removed, dispose of container  Remove gloves, wash hands  Unwrap and process films, handling them by their film edges  Label film mount or envelope USAF Dental Evaluation & Consultation Service  Processing andling Film without Barriers  Place paper towel on the work surface  Place container with films next to paper towel  Secure door, turn out darkroom lights (if applicable)  Don gloves From left to right: film packet,  Remove one sheet of lead foil, black light-proof contaminated film paper, radiographic film from container  Open film packet Dispose of contents  Processing Handling Film without Barriers  Allow film to drop onto paper towel  Discard container after all film packets are opened  Remove gloves, wash hands  Process films by edges only  Label film mount or envelope  Clean and disinfect contaminated surfaces  Processing Daylight Loader Procedures  Additional infection control Challenge Have cloth or rubber sleeves, cuffs or flaps to allow access to chamber while minimizing light exposure USAF Dental Evaluation & Consultation Service  Processing Daylight Loader Procedures  Place paper towel, paper cup, powder- free gloves inside loader compartment  Place container with contaminated films next to paper cup  Close the lid and place hands through sleeves USAF Dental Evaluation & Consultation Service  Processing Daylight Loader Procedures  Don gloves  Dispose of film  Remove one film packet contents in from container empty paper cup  Open film packet as previously  After opening all described film packets,  Allow film to drop remove gloves and onto paper towel or processor film place in cup feed slot  Processing Daylight Loader Procedures  Feed all films, handling by edges  Remove hands through sleeves  Wash hands  Lift lid, remove all contents  Label film mount or envelope USAF Dental Evaluation & Consultation Service  Extraoral Radiograhic Procedures  Infection control practices are simplified when taking extraoral radiographs (e.g., panoramic or cephalometric films  Minimal potential for contamination from blood or Saliva  Handwashing  Extraoral cassettes can be handled with ungloved hands © Eastman Kodak Company USAF Dental Evaluation & Consultation Service  Extraoral Radiographic Procedures  Bite guide  Single-Use Disposable  Barrier protect  Sterilize between each patient use  For hygienic purposes consider barriers for chin rest, head positioning guides, handgrips USAF Dental Evaluation & Consultation Service  Extraoral Radiograhic Procedures  After exposure  Patient can aseptically remove the contaminated barrier from the bite guide and discard, OR  DHCP should don gloves before removing the contaminated barrier.  Gloves should be removed and hands washed prior to handling the film cassette. USAF Dental Evaluation & Consultation Service  Digital Imaging General Considerations  Equipment difficult, if not impossible, to clean and disinfect  Preventing contamination is key  Digital Imaging General Considerations  Keyboard  Reusable vinyl/plastic  form-fitted covers – clean & disinfect between patients  Barrier protect with plastic wrap – change between patients  New technologies – keyboards that can withstand cleaning and disinfecting procedures, keyless keyboards, flat- panel touch screens  Digital Imaging General Considerations  Mouse  Use a head rest cover as an over glove  The mouse is outside the head rest cover and is not covered.  New technologies – washable/liquid- proof mice USAF Dental Evaluation & Consultation Service  Digital Radiography Sensors/Imaging Plates  Intraoral sensors/plates come into contact  with mucous membranes  Clean and heat sterilize or high- level disinfect at a Minimum  Presently, sensors/plates CANNOT withstand heat sterilization or complete immersion in a high- level disinfectant USAF Dental Evaluation & Consultation Service  Digital Radiography Sensors/Plates  Barriers do not always protect the item from potential contamination.  44% failure of a commercially available Barrier  6% when latex finger cover used in conjunction with the barrier  Digital Radiography Sensors/Plates  Use FDA-cleared barriers  Clean & heat sterilize or high-level disinfect barrier protected semi-critical items between patients.  If the item cannot tolerate these procedures then, at a minimum clean & disinfect with an EPA- registered product with intermediate level activity. CDC. Guidelines USAFfor infection Dental control&in Evaluation dental health-care Consultation Service settings –2003. MMWR 2003; 52(No. RR-17):1–66.  Digital Radiography Sensors/Plates  Consult the manufacturer regarding compatibility of barrier and disinfection/ sterilization procedures USAF Dental Evaluation & Consultation Service  Digital Radiography Summary  Avoid contamination of computer equipment in the dental operatory  Keyboards/mice should be not used with gloved or contaminated hands  Use surface barriers  Barrier-protect the digital radiography sensor/plate  Clean and disinfect the sensor/plate after removing the barrier  Summary  Dental radiography infection control practices are identical to those used in the operatory.  Potential for cross-contamination in dental radiography is high if aseptic technique is not practiced.  Recommended infection control practices can significantly reduce cross- contamination—protecting patients and staff members. 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