Documenti di Didattica
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and Equipment
Module 4
Nancy Goodwin, CDA, RDH, MEd.
All rights reserved
Objectives
Upon completion of this module, participant will be able to:
Define the difference between clinical contact surfaces and
housekeeping surfaces.
Classify the surfaces in the dental setting
Define touch, transfer, and splash/splatter surfaces
Describe the two methods used to control surface contamination
describe the clinical surfaces ordinarily protected by surface
barriers and rationales.
Name the government agency responsible for registering
disinfectants for dentistry.
List EPA-approved intermediate-level disinfectants
Describe and demonstrate the CDC guidelines fordisinfecting
clinical contact surfaces.
Describe and demonstrate the CDC guidelines for disinfecting
housekeeping surfaces.
Demonstrate the process of cleaning and disinfecting a treatment
room.
Discuss the difference between cleaning and disinfection.
Housekeeping Surfaces
do not come in contact with hands or
devices that are used during dental
procedures.
may be cleaned at the end of the day
Examples: floors, walls, sinks
Clinical Application
Think about the operatory or operatories
where you practice..where are the
housekeeping surfaces?
Do you have a schedule for cleaning these
areas on a regular basis?
Are there any areas that you need to add
to the schedule?
Clinical Application
Think about the clinical surfaces in your
practice setting.
Which ones do you regularly touch
during patient care?
Which ones are splash or splatter
surfaces? How about transfer surfaces?
What can you do to limit the surfaces you
touch during patient care?
Examples of Clinical
Contact Surfaces
Light handles/switch (touch)
Bracket table (touch and/or transfer)
Air/water syringe (touch)
Suctions and hoses (touch)
Countertops (splash/splatter)
Shade guides (touch)
X ray equipment/lead apron/exposure
buttons(touch)
ETC!
How do I decide?
Listen to this audio file which help you decide
which method is appropriate for a given
surface.
Remember
The purpose for surface
barriers and surface
disinfection is to
decrease the likelihood
of cross-contamination
from patient to patient.
Surface Barriers
Should be fluid resistant
Are specially made to adapt to many
clinical surfaces.
Prevent contamination of the surface
Save time
Reduce chemical use in the office
Are inexpensive
Barriers are
Available in
All sizes and
shapes
Computer
keyboard/mouse
X ray exposure control
Pens/pencils used to
write during procedures
Etc.
**Remember: if a surface
cannot be easily cleaned
and disinfected, it should
be covered by a barrier.
Precleaning
Defined as the cleaning that must take
place before disinfecting.
Many dental professionals fail to carry
out this step.
Wiping a surface with a disinfecting
towlette or spraying and wiping a surface
once is not disinfection.
Remember
If a surface is not clean, it
cannot be disinfected!
Blood, saliva and other body fluids
(bioburden) must be removed before surface
disinfectants can be effective.
If this step is not performed, bioburden is just
spread around and not removed.
Clinical Application
Next time you break down your operatory
after patient care, take note of how you
disinfect before the next patient is seated.
Do you carefully remove all barriers?
Do you preclean any contaminated areas
before you wipe with disinfectant?
Do you allow for the recommended kill
time for the disinfectant to work before
the next patient is treated?
This photograph provides another good example of the need for precleaning
surfaces prior to disinfection. The cultures in the top portion of this agar plate were
obtained from the clean area of the countertop in the sterilization area.
This type of surface is appropriate for surface disinfection because it is
hard and smooth. Unfortunately, just wiping the
counter with a disinfectant without the precleaning step just spreads the
microbes all around without removing them, or providing disinfection.
Precleaning procedures
Soap and water or a disinfectant that can clean
as well as disinfect may be used (best).
Mask, utility gloves and protective eyewear
should be worn.
Spray paper towel or gauze with product (or
use premoistened disinfecting towlette)
Vigorously wipe the surface (this is the step
that removes the bioburden). The surface is
now ready to be disinfected.
Disinfection
Described as the process which destroys or
inactivates most pathogenic microorganisms.
Must use an EPA-approved product that is a
tuberculocidal, Intermediate level disinfectant.
( the ability to kill mycobacterium tuberculosis
is considered the benchmark for disinfectants)
These products will destroy all
microorganisms, except spores if used as
directed.
Remember
To mix the product according to the
manufacturers directions.
To use all the product or replace it before its
expiration date.
If an item can be heat sterilized, it should be
heat sterilized, not disinfected.
To follow the CDC recommendations for
environmental infection control.
Types of disinfectants
Not recommended
Chlorine bleach-no
longer recommended
because it is not EPA
registered.
Alcohol-not effective;
not recommended by
the ADA, CDC, or
OSAP
Recommended
Quaternary
Ammonium
compounds
Complex phenols
Iodophors
Phenol-alcohol
combination
Other halogens
Link
http://www.osap.org/displaycommon.cfm?
an=1&subarticlenbr=367
from this page, click on the link:
OSAP SURFACE DISINFECTANT
REFERENCE CHART - 2006
Disinfection Procedures
1. Wear utility gloves, eyewear and protective
clothing (latex gloves are not appropriate
because they are compromised by many
disinfectants).
2. Only surfaces that have been previously
cleaned are ready for this step.
3. To disinfect, spray a paper towel or gauze
with the product or use an EPA approved
premoistened disinfectant towlette. Wipe the
surface thoroughly.
Equipment asepsis
The best solution for equipment is to
keep it from becoming contaminated in
the first place.
Computers, for example, should be
protected with a barrier to avoid
contamination since they cannot be
adequately cleaned and disinfected..
Reusable keyboard covers are available.
If used, they must be precleaned and
disinfected. You may also choose an
appropriate disposable barrier.
Remember
Once you have been in a patients
mouth with gloves, they are
contaminated. Do not touch
surfaces (charts, content of
drawers, etc.) which will not be
disposed of, sterilized or
disinfected. This practice is the
difference between asepsis and
cross-contamination.
Aseptic Practices
Make sterile cotton pliers a part of every
tray set up. You may use them if you need
to retrieve something out of a container
or drawer during procedure.
Some products are available in unit
doses for individual patient use. For
example, a hygienists pack might contain
gauze, floss, and prophy angle and paste.
To review.
Classify operatory surfaces first
Choose the most appropriate method for
clinical surfaces: barriers or disinfection
If a surface would be impossible to
thoroughly clean, you must choose
barrier protection
Preclean any contaminated surfaces
before disinfecting.
Congratulation
you are done w
Module 4!