Personal Protective Equipment (PPE) at Dental Clinics PDF

PERSONAL PROTECTIVE EQUIPMENT (PPE) AT DENTAL CLINIC Dr. Inas Karawia  TABLE OF CONTENTS 01 WHAT IS PPE? 02 Gloves 03 Masks 04 Protective Eyewear 05 Protective Clothes 01 WHAT IS PPE?  PERSONAL PROTECTIVE EQUIPMENT Preventing...

PERSONAL PROTECTIVE EQUIPMENT (PPE) AT DENTAL CLINIC Dr. Inas Karawia  TABLE OF CONTENTS 01 WHAT IS PPE? 02 Gloves 03 Masks 04 Protective Eyewear 05 Protective Clothes 01 WHAT IS PPE?  PERSONAL PROTECTIVE EQUIPMENT Preventing exposure means avoiding contact with the microorganisms, and it accomplishes this in 2 ways: 1. To reduce microorganisms from escaping from their source (patient mouth) using: Rubber dam Preprocedure mouth rinsing High volume suction 2. To use barriers to prevent contact with microorganisms (gloves, masks, protective eyewear, protective clothing) 02 Gloves  Gloves- Protection of the dental team Intact skin is an excellent barrier to disease agents. But small cuts and abrasions can serve as routes of entry of microorganisms into the body. Gloves protect against : 1. infectious disease (hepatitis B, … ) 2. chemicals 3. heat-processing instruments.  Gloves- Protection of patients If microorganisms are not removed by hand washing or covered with gloves, they may be transmitted to a patient. A dental patient's blood is retained under the fingernails of a dental team member for several days, even with hand washing, this residue could be a source of infection for subsequent patients. If the dental team member has hepatitis B and working without gloves can spread the virus to the patient.  One documented case An ungloved hygienist with dermatitis on her hands and fingers cared for a patient with active herpes labialis. About one week later, vesicles of herpetic whitlow developed on the hygienist's hands. Before any sign of her infection appeared, she unknowingly spread the virus to at least 20 other patients, who developed intraoral herpes lesions. When the vesicles appeared on the hygienist's hands, she began routinely wear gloves to prevent further spread of the virus to any more patients. Points demonstrated by this case : First: there are 3 modes (pathways) of disease spread in the office : 1. From patient to dental team member. 2. From dental team member to patient. 1. From patient to patient ( indirect ).  Points demonstrated by this case : Second: all these modes of disease spread could have been prevented by routine gloving with every patient. Points demonstrated by this case : Third: dermatitis reduces the effectiveness of hand washing in removing contaminating disease agents. Why? 1. Less vigorous handwashing is performed because of the painful dermatitis. 2. The dermatitis provides additional places on the hands where microorganisms can “hide” from the mechanical action of handwashing.  Uses and types of gloves : Dental professionals should wear nonsterile disposable patient examination gloves during all patient care activities. And when handling items or surfaces contaminated with body fluids. Gloves should not be washed, washing gloves enhance penetration. Remove the gloves and wear a fresh pair (changing gloves) on returning to the chairside. Alternative to changing gloves in these situations is to use inexpensive copolymer or plastic gloves (over gloving ).  Uses and types of gloves : Any surface that is touched with contaminated gloves must have been covered previously or disinfected before care of the next patient. Remove torn or punctured gloves as soon as possible. Nonsterile examination gloves can be used on the right or left hand. They are provided in extra-small, small, medium, and large sizes.  Uses and types of gloves : Sterile surgeon’s gloves are provided in half-sizes ranging from 5 to 9 and provide the best fit because the gloves are made for the right hand and left hand.  Uses and types of gloves : Utility gloves of nitrile or heavy latex when: During cleanup and handling of contaminated instruments. Disinfection of contaminated surfaces. Utility gloves are reusable. They can be washed with an antimicrobial hand- washing agent. Gloves provide a high level of protection against direct contact with infectious agents through touching. They offer little protection against injuries from sharp objects. Thus one still must handle sharps safely, even while wearing gloves. Should not store gloves in direct sunlight or high dust areas.  Uses and types of gloves : Latex gloves give a better fit than vinyl gloves, and more easy to wear. All latex products Deteriorate with petroleum products. Do not use latex gloves and any lotions that contain petroleum products (Vaseline)  Contact Dermatitis and Latex Allergy: Occupationally related contact dermatitis can develop from frequent and repeated use of hand hygiene products, exposure to chemicals, and glove use. Contact dermatitis is classified as either: 1. Irritant contact dermatitis is common, nonallergic, caused by repeated exposure to a substance, and develops as dry, itchy, irritated areas on the skin around the area of contact.  Contact Dermatitis and Latex Allergy: 2. Allergic contact dermatitis (type IV hypersensitivity) can result from exposure to accelerators and other chemicals used in the manufacture of rubber gloves (e.g., natural rubber latex, nitrile, and neoprene), as well as from other chemicals found in the dental practice setting (e.g., methacrylates and glutaraldehyde). Manifests as a rash beginning hours after contact and, similar to irritant dermatitis, is usually confined to the area of contact. Contact Dermatitis and Latex Allergy: Latex allergy (type I hypersensitivity to latex proteins) due to the presence of IgE antibodies to latex proteins It can be a more serious systemic allergic reaction, usually beginning within minutes of exposure but sometimes occurring hours later and producing varied symptoms. More common reactions include runny nose, sneezing, itchy eyes, scratchy throat, and itchy burning skin sensations. More severe symptoms include asthma marked by difficult breathing, coughing spells, and wheezing; cardiovascular and gastrointestinal impairment; and in rare cases, anaphylaxis and death  Contact Dermatitis and Latex Allergy: Natural rubber latex proteins responsible for latex allergy are attached to glove powder. When powdered latex gloves are worn, more latex protein reaches the skin. When powdered latex gloves are removed, latex protein/ powder particles become aerosolized and can be inhaled, contacting mucous membranes. As a result, allergic patients and DHCP can experience cutaneous, respiratory, and conjunctival symptoms related to latex protein exposure. DHCP can become sensitized to latex protein with repeated exposure.  Contact Dermatitis and Latex Allergy: DHCP and dental patients with latex allergy should not have direct contact with latex-containing materials. Dental patients with histories of latex allergy can be at risk from dental products (e.g., prophylaxis cups, rubber dams and orthodontic elastics). Taking histories for both patients and DHCP Certain common predisposing conditions for latex allergy include a previous history of allergies, a history of spina bifida, urogenital anomalies, or allergies to avocados, kiwis, nuts, strawberries or bananas. 03 Masks  Masks Masks were developed originally to reduce postoperative infections from microorganisms in the respiratory tracts In dentistry, masks mainly protect the mucous membranes of the nose and mouth of the dental team from contact with sprays or spatter of oral fluids from the patient. Masks worn by dental team may give some protection to the patients.  Masks Types of masks commonly used in dentistry: Cone shaped Pliable. They may be secured with: Ties Ear loops Elastic band  Masks Limitations: These masks give only partial protection : 1. Can not filter small aerosol particles in airborne infections such as severe acute respiratory syndrome (SARS). In this case, patients should be treated in special facilities. 2. Masks are fitting over the bridge of the nose, but they do not provide a perfect seal around the edges. Thus selection of a mask that fits the face well is important to minimize passage of unfiltered air.  Masks 3. When the mask becomes wet from moist exhaled air, the resistance to airflow through the mask increases, causing more unfiltered air to pass by the edges of the mask. Thus one should replace wet masks, maybe every 20 minutes, to maintain high filterability.  Masks The dental team should wear face masks any time a risk exists of spraying or spattering of fluids that may contain potentially infectious disease agents (high-speed or low-speed handpieces, sonic and ultrasonic scalers, air/water syringes, oral irrigations, grinding, polishing, instrument processing). 04 Protective Eyewear  Protective Eyewear 1. Protecting against infectious disease agents: a variety of disease agents may cause harmful infection of the eyes (e.g., herpes simplex virus, hepatitis B virus which may use the eye as a portal of entry into the body and cause hepatitis B). 2. Protecting against physical damage to the eyes: e.g., tooth fragments, restorative material, calculus, during grinding and polishing). 3. Protecting from chemicals used at the chairside or for cleaning instruments and surfaces.  Protective Eyewear Goggles Give the greatest eye protection against front and side splashes. Glasses have poor side protection, glasses with side shields are recommended. Some glasses have replaceable lenses. Some have antifogging properties. Some are autoclavable. Masks with attached eye protection are also available.  Protective Eyewear Face shields Should be chin length. Provide top protection. And be curved to provide side protection. Wear masks with face shields to reduce inhalation of fluid aerosols and dust particles. 05 Protective Clothes  Protective Clothes Is the outer layer of clothing that protects underlying clothes, or skin. The microorganisms also contaminate different body sites of the dental team, including the forearms and chest area. Unprotected clothing leads to the spread of the contamination from office to home or elsewhere. Covering up microorganisms present on street clothes provide some degree of patient protection.  Protective Clothes Contaminated protective clothing should be changed before providing care for the next patient and removed when leaving clinical areas. Materials with the greatest resistance to fluids provide the greatest protection. Head covers and shoe covers are not mandated for use in dentistry, but head covers are necessary for surgery.  Protective Clothes The best protective clothing involves the use of disposable gowns with long sleeves and a high neck to cover regular work clothes. Reusable protective clothing such as uniforms, and lab coats can be used, but it must be removed before leaving the office and changed when it becomes visibly soiled.