Infection Prevention & Control in Dentistry PDF

Infec&on Preven&on & Control in Den&stry Kelvin Kamupira Aims & Objec&ves The purpose of this session is to provide relevant informa3on rela3ng to principles of infec3on preven3on & control in den3stry 2 Learning Outcomes and O...

Infec&on Preven&on & Control in Den&stry Kelvin Kamupira Aims & Objec&ves The purpose of this session is to provide relevant informa3on rela3ng to principles of infec3on preven3on & control in den3stry 2 Learning Outcomes and Objec&ves By the end of the session you should be able to: Explain the importance of infec&on preven&on & control to the pa3ent, dental team & wider public Iden3fy dangers in the dental surgery Di@eren3ate between decontamina&on, disinfec&on and sterilisa&on techniques Have knowledge of PPE & its correct usage Describe clinician responsibili&es in preven3ng cross infec3on, the need for up-to-date immunisa&on & why proper cleaning is essen3al Understand the zoning technique to ensure environmental infec3on control Explain inocula&on injuries and their avoidance in the dental workplace Recognise the need for proper waste disposal 3  GDC Learning Outcomes 1.1.7 Explain the poten3al routes of transmission of infec3ous agents in dental prac3ce, mechanisms for the preven3on of infec3on, the scien3Lc principles of decontamina3on and disinfec3on and their relevance to health and safety 1.8.2 Implement and perform e@ec3ve decontamina3on and infec3on control procedures according to current guidelines What do you understand by Infec&on Control? Measures in place to prevent spread of infection Quiz Time  Infec&on control It is the methods & measures employed in a workplace (in this case, dental workplace) To prevent everyone from geOng contaminated by or acquire an infec&on from a pa&ent or another member of staQ, or from a dirty instrument. Sta&s&cs 7 in 100 pa3ents, in developed countries and 10 in 100 pa3ents in developing countries will acquire at least one health- care related infec3on. Hep B Hep C It is es3mated that sharps injuries cause about 66,000 HBV, 16,000 HCV and 200- 500 HIV infec3ons among health-care workers each year. Human immunodeficiency virus For health-care workers worldwide this equates to 37%, 39% and 4.4%, respec3vely (WHO 2003) Healthcare associated infections There were an es3mated 834 000 HCAIs in 2016/2017 cos3ng the NHS £2.7 billion, and accoun3ng for 28,500 pa3ent deaths.(BMJ 2019) Who is at Risk? Den3st Hygienist/ Therapist Dental Nurse Families/ commu&ng Technician Pa3ent Why Infec&on Control is Important in Den&stry All members of the dental team have a duty of care to protect their pa3ents, colleagues & themselves coming to harm while in a dental workplace (DH 2013) Importantly prevent gedng contaminated or acquiring an infec3on from a pa3ent or a member of sta@, or a dirty instrument. Bigger picture Ecological changes Unexplained Changes in human emergence behaviour & demographics Breakdown in Interna&onal public health travel and measures commerce Microbial changes Background 12 Background 13 Anyone want to share personal experiences? Regula&on Registra3on for healthcare providers in England is overseen by CQC Compliance with essen3al quality requirements of HTM 01-05 (2013) ensure each workplace meets registra3on requirements of the CQC Compliance with the GDC Standards Health Technical Memorandum (HTM 01-05) gov.uk Need for Infec&on Control in Den&stry Mouth is full of micro- organisms Instruments used in den3stry become contaminated whenever used If no ac3on was taken to clean items afer use – micro- organism contamina3on would pass on via cross-infec/on. 18 Cycle of Infec&on (Aim is to break the cycle) Source: BDJ Dangers in the Surgery Pathogenic micro-organisms of concern to the dental team Herpes Simplex type I USE DISPOSABLE INSTRUMENTS Hepa33s B Hepa33s C Please refer to New-variant Creutzfeldt-Jakob Prions separate lectures disease (vCJD) Human immunodeLciency virus (HIV) COVID-19 & any AGPs How we ensure we are protected before we start delivering clinical care? All dental staQ should receive the following immunisa3ons before working at the chair side Poliomyeli3s Tuberculosis Tetanus MMR (measles, mumps & rubella) Diphtheria Pertussis (whooping cough) Hepa33s B 23 Personal Protec&ve Equipment Worn to protect sta@ from coming into contact with blood and other bodily kuids Legal requirement for dental employers to provide PPE for their sta@ Should be worn correctly as s3pulated in Infec3on Control policy Refer to Infec&on Control Policy Use of Personal protec&ve Equipment (PPE) Uniform UCLH Dress code & Uniform policy requires all pa3ent facing sta@ (including dental) to It is for infec3on control wear a uniform and health & safety purposes Footwear Why? Footwear must be safe, sensible & in good order. Covering all toes with good soles & heels which do not make unnecessary noise in a clinical area Nursingtoes.co.uk  Hair, Jewellery, Piercings etc Long hair must be 3ed both back & up so that it One small earring only per ear does not fall below the shoulders Body piercings must be covered with a No necklaces plaster during work Long fringes must be clipped back or held in place For cultural reasons only, small discreet with a band to avoid `hand-hair` contact nose stud is allowed Plas&c Apron (Single use) To be worn over the uniform during procedures when soiling may occur or while cleaning the clinical area Wearing gloves Come in varying quality Can be latex or non-latex Should be changed in between pa3ents unless torn or heavily soiled Hands frequently become contaminated during removal NB. Wearing gloves is no subs&tute for hand washing. Facemasks 4 Medicalexpress.com Facemasks For AGP procedures you must don the mask you have been Lt- tested on, when trea3ng a pa3ent known or suspected to be su@ering from an infec3ous agent transmined partly or wholly via airborne or droplet route. Medicalexpress.com Protec&ve Eye Wear Addi&onal Reading A visor or face shield should be worn NB Clean eye protec3on with disinfectant wipes in between pa3ents Loupes ON: Apron OFF: Gloves Mask Apron Eyes/Visor Eyes/Visor Gloves Mask Will subs3tute for protec3ve eye wear, but must be worn with a facemask Hand Hygiene Hand Hygiene Covers not only hand washing but addi3onal measures such as hand disinfec3on using an3-bacterial based hand rubs/gels Important in preven3ng the spread of infec3on & the recontamina3on of sterile instruments and devices Clean hands are an essen3al counterpart to the use of gloves Neither measure is a subs3tute for the other When is Hand hygiene important? 1. Before & afer each treatment session 2. Before & afer removal of PPE 3. Afer the washing of dental instruments 4. Before contact with instruments that hav been steam-sterilised 5. Afer the comple3on of decontamina3on work 6. Afer cleaning or maintaining decontamina3on devices used on dental instruments 47 Hand Washing Dedicated hand-washing sinks must be available in the dental workplace Taps should be operated by either elbow or by foot to avoid recontamina3on Nails should be kept short & jewellery removed Mild liquid soap should be used According to WHO, Hand washing should take 40-60 seconds Handwashing Steps using the WHO technique video https://youtu.be/aGJNspLRdrc?feature=shared Improper handwashing technique Alcohol based Hand Rub (not a replacement for handwashing) Alcohol Based Hand Rub BENEFITS LIMITATIONS Rapid & e@ec3ve Cannot be used if hands are visibly an3microbial ac3on soiled Reduced 3me for hand Follow instruc3ons on amount to disinfec3on `gel` More accessible than sinks Highly kammable – implement safety precau3ons Cannot be used repeatedly Skin Care Use approved hand creams or lo3ons Check compa3bility with the manufacturer Some lo3ons may make medicated soap less e@ec3ve Some cause breakdown of latex gloves e.g., petroleum based Lo3ons can become contaminated with bacteria if dispensers are reLlled Cleaning and geOng rid of micro-organisms Social cleaning -clean to a socially acceptable standard but not disinfected nor sterilised Disinfec&on – the killing/destruc3on of bacteria & fungi, but not spores nor some viruses (technique usually involves use of chemicals) Sterilisa&on – the process of killing all micro-organisms to produce asepsis. Involves use of autoclaves Asepsis – the absence of all living pathogenic micro-organisms Cleaning the clinical area The whole of the dental area should be cleaned to a socially acceptable standard (usually carried out by a domes3c cleaner) Standard of cleaning to be achieved in a clinical area is disinfec&on Clinical area should be designated as `clean` and `dirty` so that dirty instruments are not placed where clean items should be placed This is called ZONING Preparing the Dental chair Clinical contact surfaces: Surfaces contaminated from pa3ent materials either by direct spray or spaner generated during dental procedures or by contact with DCP`s gloved hands What needs to be cleaned between pa&ents? Protec&ve Barriers  Clearing and cleaning afer each pa&ent The biggest risk to injury or infec;on occurs during the clean-up & disposal stage  You must wear gloves to reduce 1 cross-infec3on Remove sharps Lrst & dispose of 2 appropriately Ensure all instrument trays are 3 securely closed before placing in the `dirty` zone Disinfect the chair, bracket table, including body 4 of 3 in 1 syringe, slow speed motor and holder, opera3ng light and spinoon Wipe all surfaces with disinfec3on 5 wipes Preven&ng needles&ck injuries An Educational Video - Needle Stick Injuries – YouTube https://www.youtube.com/watch?v=PEI9QmGErWs Needles&ck injuries Injuries from needles used in medical procedures are some3mes called needle-s3ck or sharps injuries Sharps can include other medical supplies, such as syringes, scalpels and lancets, and glass from broken equipment Once someone has used a needle, viruses in their blood, such as hepa33s B, hepa33s C or HIV, may contaminate it. This includes needles used to inject illegal drugs. Blood can also contaminate sharps https://my.uclh.nhs.uk/Interact/Pages/Content/Document.aspx?id=19933 Dental Unit Water Line (DUWL) & Bioglm Collection/growth of bacteria within dental unit water lines What is Bioglm? It is a layer of micro-organisms contained in a matrix (slime layer), which forms on substances in contact with water. British Society of Immunology 63 Risk to StaQ and Pa&ents According to the World Health Organisa3on water should be free from any organism that might pose a health risk to the human popula3on (WHO 2015) Most contaminants are non-pathogenic This is however considered in immuno-suppressed individuals Concern is over opportunis3c respiratory pathogens such as Legionella and non - TB Mycobacterium Type of Bacteria in the DUWL Bacteria is coming from the mains water Less likely oral bacteria DUWL bacteria form very quickly More resistant to treatment with an3microbials, UV & disinfectants Reducing Bioglm TARGET OPTIONS Water lines should be kushed at the Management systems to try beginning of the day and in between and keep acceptable level pa3ents to reduce risk of suck-back Dental units and water lines should be kushed out at the end of each day (kushing reduces bacterial count by 97%) Water lines should be disinfected weekly NB. DUWL are classed as according to instruc3ons medical devices For extended periods of unuse (e.g., bank holidays, Christmas), use Bilpron. It can prevent bioLlm forma3on for up to 3 months Notes for previous page on reducing biofilm Flushing of Dental Units Part of se3ng up the dental bay ac9vity Reducing Bio=lm Sterile bo*led water is Also follow recommended instead of water from surgery tap Prac9ce protocol CQC guidelines Prevent contamina9on of the mains water supply using a physical air gap and of the waterline using point of use ;lters Decontamina9on Decontamina9on – also referred to as `reprocessing`, is the process used to remove contamina9on from reusable items, so that they are safe for further use on pa9ents & sta@ to handle. Involves the following four stages. 1. Cleaning 2. Disinfec9on 3. Inspec9on 4. Sterilisa9on Cleaning of reusable instruments before sterilisa9on Should meet Essen9al quality requirements according to HTM 01- 05. Cleaned instruments should be free of visible contaminants prior to sterilisa9on regardless of method used (Ultrasonic, Washer-disinfector) Cleaning of equipment, instruments and handpeices Three main techniques currently used for cleaning reusable dental equipment. Manual cleaning Decontamina9on & cleaning with Manual cleaning with ultrasonic washer- decontamina9on disinfector Autoclaving (moist heat) sterilisa9on Boiling water alone is INSUFFICIENT to kill spores & viruses E@ec9ve autoclaving 1. Temperature =134ºC 2. Pressure = 32lb/sq (Psi) 3. Cycle 9me = 3.5min Dry heat sterilisa9on NOT ADVISED IN HTM 01-05 - NOT CURRENT STERILISATION METHOD Done in a `Hot Air oven` Suitable for instruments with sharp cuZng edge Please refer to HTM 01-05 Doc 75 Chemical Disinfec9on Suitable for instruments & working surfaces Limita9ons E[cient at certain concentra9on & temperature Object must be thoroughly cleaned Each agent needs a certain minimum exposure 9me Shelf life Certain chemicals may damage some surfaces NB. Alcohol has been shown to bind blood and protein to stainless steel and the use of alcohol with dental instruments should therefore be avoided Sterile Single Use Instruments  Waste Disposal Mandatory Training Clinical waste, is waste that is contaminated with blood, saliva or other body /uids & may prove hazardous to any person coming in to contact with it. It is disposed of in the appropriately labelled bins on clinic (9ger striped) There are other bins on clinic for non–clinical waste such as recycled waste. NEVER touch clinical waste with ungloved hands  Sharps Boxes All used needles, used burs, matrices etc. must be placed in the sharps box ( please do NOT dispose of reusable burs/mandrels etc.) LA cartridges whether par9ally or fully discharged must always be disposed of via sharps container Sharps container should be disposed of when no more than 2/3 full Further Reading  UCLH Sta@ Intranet  Infec5on control policy  Hand hygiene policy  Uniform policy GDC Standards Document  World Health Organisa9on website  www.who.int  Health Technical Memorandum 01-05 (HTM 01-05)  www.gov.uk/doh  CQC Guidelines and Quality Compliance  www.cqc.org.uk