Dr.

Hisham Al-Shorman
Assistant professor of Periodontology Department of Preventive Dentistry JUST
Monday 8/7/2013
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INFECTION CONTROL
1. Personal Protective Equipment: 3. Hand hygiene 4. Clinical wastes 5. Blood-Borne Pathogens 6. Food and drinks

a. Gowns

b. Gloves
c. Masks

d. Protective eyewear
2. Surfaces

7. Infections

WHY IS IT IMPORTANT?

Both patients & dental health-care personnel are exposed to pathogens Nature of profession i.e. contact with blood, oral and respiratory secretions and contaminated equipment Hospital setting referral institution for medically compromised patients Proper procedures can prevent transmission of infections
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MODES OF TRANSMISSION

Direct contact with blood or body fluids

Indirect contact with contaminated instruments or surfaces

MODES OF TRANSMISSION

Contact of mucosa of the eyes, nose, or mouth with droplets or spatter

Inhalation of air-borne microorganisms

Exposure To Blood & Body Fluids

Laceration (wax knife, scalpel, carvers,)

Needle stick (anesthesia, irrigation,)

Puncture with dental instruments (burs, ortho wires,)

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Exposure To Blood & Body Fluids

Splash of blood or saliva to mucous membranes of (mouth, nose or eyes) and to broken areas of skin: Handpieces, scalers,

Sneezing, coughing, gag reflexes, speaking,

Chain of Infection

Pathogen Susceptible Host Source

Entry

Mode

Potential Routes of Transmission of Blood-borne Pathogens

Patient Operator

Operator

Patient

Patient

Patient

STANDARD PRECAUTIONS

Standard Precautions A standard of care designed to protect health-care providers and patients from pathogens that can spread by blood and other body fluids
Apply these standard precautions to all patients ALL BLOOD AND BODY FLUIDS ARE CONSIDERED TO BE INFECTIOUS

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PPE

Consider all patients as infectious

Wear personal protective equipment: Gowns Gloves Masks Protective Eyewear Should be removed when leaving treatment areas

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GOWNS / WHITE COATS

Should cover operators clothes and protect them from splashes and aerosols:
High

neck Long sleeves Knee long

Design!!! Reduce folds, pockets and any other areas that facilitates accumulation of soil or aeresoles

Change if visibly soiled

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GLOVES

Minimize the risk of cross infection: From patients to operators From operators to patients From one patient to another

Are NOT a substitute for hand washing!

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GLOVES

Disposable latex, vinyl, or nitrile gloves:

Non-surgical procedures

Sterile disposable gloves All surgical procedures

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UTILITY GLOVES
Heavy duty utility gloves after patient treatment Must be washed with antimicrobial soap, rinsed and dried

Stored in plastic bag in locker

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RECOMMENDATIONS FOR GLOVING

Wear gloves when contact with blood, saliva, and mucous membranes is possible Remove gloves after patient care New gloves for each patient

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RECOMMENDATIONS FOR GLOVING

If torn, cut or punctured replace them

Do NOT wash, disinfect or sterilize gloves for re-use

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MASKS

Masks to protect: Face Oral and nasal mucosa Must be changed if they become damp Must be changed for each new patient, except for short exams If a face shield is worn it must be worn at the same time as a surgical mask

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PROTECTIVE EYEWEAR

Protect from aerosol and spatter

Regular eyewear must have side shields - free of vents or openings

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SEQUENCE OF PUTTING ON PPE

1. Hand hygiene - FIRST 2. Gown if sterile (Surgical) 3. Mask 4. Protective eyewear 5. Gloves - LAST

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SEQUENCE OF REMOVING PPE - Reverse

1. Gloves First (most contaminated) 2. Hand hygiene 3. Protective eyewear - handle by head band or ear
pieces

4. Gown 5. Mask By elastics -Front of mask is contaminated

DO NOT TOUCH!

6. Hand hygiene

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SHARPS

Used needles, blades, burs, endo files and reamers, anesthetic cartridges and all other sharps are to be discarded in:

SHARPS CONTAINERS
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SHARPS

Recap anesthetic needles by using the needle recapper

If unavailable, use the one handed scoop technique

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FOOD AND DRINKS

Eating and drinking are prohibited in all clinical areas

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FOOD AND DRINKS

Enjoy them outside!

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HAND HYGIENE
Washing hands with plain soap and water or with other indicated material Minimum 15 seconds

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HAND HYGIENE

Plain soap and water

Antiseptic hand wash washing hands with water and soap or other detergents containing an antiseptic agent
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HAND HYGIENE

Alcohol-based hand rub

Surgical scrub

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ALCOHOL-BASED PREPARATIONS

Benefits

Limitations

Rapid and effective antimicrobial action Improved skin condition More accessible than sinks

Cannot be used if hands are visibly soiled Store away from high temperatures or flames Hand softeners and glove powders may build-up
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Efficacy of Hand Hygiene Preparations in Reduction of Bacteria

Good
Better Best

Plain Soap

Antimicrobial soap

Alcohol-based handrub

http://www.cdc.gov/handhygiene/materials.htm

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SPECIAL HAND HYGIENE CONSIDERATIONS

PROHIBITED!
Long fingernails
Colored nail polish False fingernails
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SPECIAL HAND HYGIENE CONSIDERATIONS

Use hand lotions to prevent skin dryness Consider compatibility of hand care products with gloves (e.g., mineral oils and petroleum bases may cause early glove failure)

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SPECIAL HAND HYGIENE CONSIDERATIONS

Avoid hand jewelry that may tear gloves

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HANDS NEED TO BE CLEANED

When visibly dirty

After touching contaminated objects with bare hands Before and after patient treatment (before glove placement and after glove removal)

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TAP DESIGN
BEST Taps with sensors or foot control to avoid hand contact

AT LEAST Taps with lever Use arm or back of your hand to activate it
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TAP DESIGN

AVOID TAPS WITH KNOB

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HAIR

Hair should be short and well-managed

Long hair should be pulled back or completely covered with a surgical cap to minimize the possibility of contamination

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HOUSEKEEPING

Worksite must be maintained in a clean and sanitary condition Equipment and work surfaces must be cleaned and decontaminated after contact with blood and other infectious materials
Protective coverings must be used to cover equipment and work surfaces

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CATEGORIES OF ENVIRONMENTAL SURFACES

CLINICAL CONTACT SURFACES High potential for direct contamination from spray or spatter or by contact with gloved hand HOUSEKEEPING SURFACES Do not come into contact with patients or devices Limited risk of disease transmission
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HOUSEKEEPING SURFACES

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CLINICAL CONTACT SURFACES

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CLEANING CLINICAL CONTACT SURFACES

Risk of transmitting infections greater than for housekeeping surfaces Clean and disinfect surfaces Apply barriers

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SURFACE COVERS

Handles, handpieces or similar surfaces that may be contaminated by blood or saliva - wrap with clear plastic wrap.

Head rest cover

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GENERAL CLEANING RECOMMENDATIONS

Use barrier precautions (e.g. heavy-duty utility gloves, masks, protective eyewear) when cleaning and disinfecting environmental surfaces
Physical removal of microorganisms by cleaning is as important as the disinfection process Do not use sterilant/high-level disinfectants on environmental surfaces
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CLEANING CLINICAL CONTACT SURFACES

Surface barriers can be used and changed between patients OR Clean then disinfect with hospital disinfectant

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CLEANING HOUSEKEEPING SURFACES

Routinely clean with soap and water or hospital disinfectant Clean mops and cloths and allow to dry thoroughly before re-using Prepare fresh cleaning and disinfecting solutions daily and per manufacturer recommendations
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WASTE DISPOSAL

Regular House Waste Contaminated Medical Waste Sharps

Human Tissues

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PREVENTION OF INJURIES
1.

Remove burs from handpiece immediately after completion of dental procedure

2.

Recap anesthetic needles

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PREVENTION OF INJURIES
3.

Restrict use of fingers in tissue retraction or palpation during suturing or administration of anesthesia

4.

Avoid uncontrolled movements of dental instruments. THINK BEFORE MOVING AN INSTRUMENT.

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Who is at risk?

Everybody!

Elderly pts
Children (lower resistance, Cystic fibrosis,) Cardiac pts (e.g. valvular disease) Respiratory disease pts (for air-borne infections) Impaired healing functions

Immuno-deficient patients (e.g. auto-immune pts) Other immuno-suppressants (e.g. transplant pts) Cancer pts Pts on steroids Diabetics
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TAKE-HOME MESSAGE
Infection control regulations are mandatory to ALL Violations of these regulations will be taken seriously It is better to play safe Clinical assessment will consider infection control practice If not sure, ASK!
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Wishing you a happy, safe and joyful clinical life

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