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Infection Control In The Oral Healthcare Setting Back to Course Index

 

INFECTION CONTROL 
In The Oral Healthcare Setting

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Oral healthcare facilities, like all healthcare facilities, are mandated to develop a written infection control/exposure control protocol predicated on a hierarchy of preventive strategies.

Historically, strategies to eliminate or reduce the risk of healthcare-associated infections (HAIs) were based on Universal Precautions, i.e., the concept that patients with bloodborne pathogens can be asymptomatic (unaware that they are infectious) and, therefore, all blood and body fluids contaminated with blood were treated as infectious. Today, Standard Precautions (periodically expanded with new evidence-based elements) and Transmission-based Precautions provide the fabric for a hierarchy of preventive strategies to protect both oral healthcare personnel and patients and apply to contact with blood and all other potentially infectious material.

Infection control/exposure control strategies should be appropriate for the oral healthcare setting.  

Interesting Facts About Infections

A disease is infectious if it can be spread by contact with infected people, animals, food, water or objects.  If a disease can be spread by contact with an infected person, it is considered contagious.  So, don’t infectious and contagious mean the same thing?  No.  Consider this example:  Rabies is infectious because you can catch it from an infected animal.  But, rabies is not contagious because you can’t catch it from an infected person.

  • Before the discovery of penicillin in 1928, infectious diseases were the main cause of death in America.  Today, infectious diseases still cause many severe illnesses and deaths.
  • Every year, at least two million people catch an infection during their stay in a health care facility.  88,000 of them don’t survive the infection.
  • Nearly 200 million doses of antibiotics are given to hospital patients every day in America.
  • There are over 150 different antibiotics and some germs are resistant to all of them!
  • Health care workers use over 22 million pairs of gloves every year!
  • Fresh flowers can pose a risk to your clients especially if they have wounds.  Bacteria build up in the water inside the flower vase.  These bacteria can cause serious wound infections.
  • In the last ten years, over 700 antibacterial products have been developed for people to use in their homes.  These products include antibacterial cleaners, plastic bags, underwear, and bedding.  Most scientists believe that all these products are making the drug resistance problem worse.
  • One case of drug-resistant tuberculosis can cost up to $1 million to treat.
  • Around the world, one person dies of TB every ten seconds.
  • People are not protected against the flu until about two weeks after they’ve had a flu shot.
  • Around the world, five young people (ages 15 to 24) become infected with HIV every minute.
  • Worldwide, over 80% of all adults with HIV became infected with the virus through heterosexual intercourse.
  • The first AIDS case was diagnosed in 1982 in Los Angeles.  Since that time, nearly 22 million people have died from AIDS.
  •  In the year 2000 alone, HIV caused the death of approximately three million people worldwide, including half a million children.

 

 

The Facts About Hand Washing 

Hand hygiene procedures should be implemented at the beginning of each work cycle, before gloving, after de-gloving, and before re-gloving, and anytime the hands are visibly contaminated with blood or bodily fluids.

 

Basic Information About Hand Washing:

 

  • The purpose of handwashing is to get rid of dirt and transient germs.  (There are many tiny bugs that live on our hands all the time.  But, transient germs contaminate our hands and may cause disease.)
  • Scientists have known for over 100 years that handwashing helps prevent infection.  Yet, people continue to get sick because hands are not washed often enough. 
  • The handwashing procedure at your workplace probably calls for you to wash your hands for 30 to 60 seconds.  Yet, studies have shown that most health care workers spend less than 15 seconds washing their hands.

 

Remember!

 

  • Follow your workplace policy for washing your hands or for using a waterless hand cleaner.

  • Don’t make the mistake of thinking that wearing gloves takes the place of washing your hands!

  • Most of the germs on your hands hide under and around your fingernails.  Be sure to clean under your nails when you wash your hands.

 

Vaccinations

Oral healthcare providers should be vaccinated against vaccine-preventable infections in accordance with current state and federal regulations, as well as recommendations made by relevant professional organizations.

Immunization programs have markedly reduced the incidence of vaccine-preventable diseases. Today, a substantial percentage of morbidity and mortality from several vaccine-preventable diseases occurs in adults who escaped natural infection or immunization and who now are at increased risk of these diseases because of lifestyle, advancing age, the presence of certain chronic diseases, or occupation (e.g., healthcare workers).

Personal Protect Equipment 6

 

To prevent or reduce the risk of disease transmission, personal protective equipment should be worn by all oral healthcare providers when performing procedures that are likely to result in exposure to blood and bodily fluids.

Pathogenic organisms in blood and bodily fluids may come in contact with skin; conjunctival and oral mucosal tissues; and respiratory epithelium by inhalation of airborne microorganisms, i.e., droplets or droplet nuclei suspended in the air. Personal protective equipment (PPE) is designed to protect the skin and mucous membranes (eyes, nose, and mouth) and respiratory epithelium of healthcare providers from exposure to a source or reservoir of pathogenic organisms by contact transmission, i.e., direct or indirect contact transmission; and respiratory transmission, i.e., inhalation of droplets or droplet nuclei (airborne transmission).

 

Compliance

Personal protective equipment, which does not permit blood or OPIM to pass through to or reach street clothes, undergarments, skin, or mucous membranes under normal conditions of use and for the duration of time that the protective equipment is used should be provided and should be worn for by all oral healthcare providers.

  • Protective clothing
    Gowns or lab coats with long sleeves are worn to protect the forearms when splash, spatter, or spray of blood or bodily fluids to the forearms is anticipated.
    Protective clothing is changed daily, whenever it becomes visibly soiled, and as soon as possible if penetrated by blood or bodily fluids.
    Protective clothing is removed before leaving the work area.
    Dirty protective clothing is placed in designated areas for disposal or washing.

  • Task-specific gloves
    Non-surgical, surgical, or heavy-duty utility gloves are worn by all healthcare providers to prevent or reduce the risk of contaminating the hands with blood or bodily fluids and to prevent or reduce the risk of cross-infecting in the clinical process.
    To reduce the risk of latex-related allergies, only powder-free, low-allergen latex gloves; and non-latex, nitrile or vinyl gloves should be available.
    Non-surgical and surgical gloves are single-use items, which are used for only one patient and are then discarded.
    When torn or punctured, gloves are changed as soon as possible.
    Gloves may not be washed because it can lead to wicking (penetration of liquids through undetectable holes in the gloves) and subsequent hand contamination.
    Double gloving is acceptable for extensive oral surgical procedures.
    Heavy-duty utility gloves are worn for all instrument, equipment, and environmental surface cleaning and disinfection.
    Wearing gloves does not eliminate the need for hand hygiene.

  • Surgical masks 
    Surgical masks provided for routine use have a filtration efficiency of 95% for microorganisms greater than 3 microns.
    When a mask becomes wet from exhaled air or contaminated with infectious droplets, spray, or from touching the mask with contaminated fingers it is changed as soon as possible (between patients or even during patient treatment)
    Particulate filter respirators
    When airborne infection isolation precautions are necessary (g., transmission-based precautions for patients with TB), a National Institute for Occupational Safety and Health (NIOSH)-certified particulate-filter respirator (N95, N99, or N100) is used, which have the ability to filter. 3 µm particles with a filtering efficiency of 95, 99, and 99.7% respectively.

  • Protective eyewear
    Protective eyewear with solid side shields or a face shield is worn by OHCP during the clinical process likely to generate splash, splatter, and aerosols.
    Protective eyewear with solid side shields is also provided for the patients to protect their eyes from spatter and debris generated during the clinical process.
    Protective eyewear is cleaned with soap and water between patients.

  • Ventilation devices
    Mouthpieces, pocket masks, and resuscitation bags are used when CPR is administered.

Basic Information About Standard Precautions:

Standard precautions are basic infection control guidelines for you to follow as you perform your daily work.  These guidelines help prevent the spread of bloodborne diseases like AIDS and hepatitis C.

 

–Additional precautions are guidelines for protecting yourself and/or clients who need more than just basic infection control.  These extra precautions are divided into categories according to how a disease is spread:

 

  *Airborne:  These germs travel long distance in the air and cause diseases such as TB, measles, and chickenpox.

 

  *Droplet:  These germs travel long distances in the air and cause diseases such as influenza, strep throat, and the mumps.

 

  *Contact:  These germs are spread by touch and cause diseases such as scabies, cellulitis and hepatitis A.

 

 

–Standard precautions also cover the proper way to handle client care equipment and to dispose of hazardous waste.  Be sure to follow your workplace procedures for these tasks.

 

 

The Latest Information About Standard Precautions

 

Some people experience allergic reactions to latex gloves.  Doctors are also seeing an increase in work-related asthma due to powder inside some gloves.  Be sure to let your supervisor know if you have any sensitivity to the gloves at your workplace.

 

Gowns, masks, and gloves are all types of personal protective equipment.  These items are used to protect you from infectious diseases.  However, you must also keep your client’s welfare in mind.  For example, if you don’t change your gown in between clients or you rinse off dirty gloves instead of using new ones, you run the risk of spreading germs from one client to another.  Be sure to follow your workplace procedure for the proper use (and disposal) of personal protective equipment.

 

Oral Workplace Controls

Work-practice controls should be implemented to prevent or reduce the risk of exposure.

The unique nature of oral healthcare settings, dental procedures, and instrumentation require specific strategies to prevent the transmission of infection. Work-practice controls are intended to eliminate or isolate hazards and promote safer behavior in the workplace. These take advantage of available technology to eliminate or isolate biohazards (blood or OPIM). When engineering controls are not available or are not practical, work-practice controls are implemented.

The direct patient care setting is central to the delivery of oral healthcare, but there are other environments within oral healthcare settings that support the delivery of clinical services, i.e., dental radiography and dental laboratory facilities. While the following recommendations primarily relate to non-surgical dental specialty areas, they are sufficiently flexible to serve as a template for developing and implementing practice-specific infection control strategies.

General considerations:

  • Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses should be prohibited in work areas.  
  • All items used in patient care should be stored in closed cabinets or drawers. Mobile carts used for patient care should not be cluttered with excess materials.
  • Bulk items should be covered to prevent contamination and caution should be exercised when retrieving such items to ensure that the remaining items are not contaminated.
  • Have appropriate instrument packs and supplies ready to begin treatment. This includes all necessary PPE (gloves, masks, eye protection, etc.) for the provider, assistant and the patient.
  • Check all sterilized instrument packs and packages to ensure they are intact and the external chemical indicator has changed to the appropriate color.
  • Do not open packs in advance of the patient’s arrival.
  • If additional material is needed during treatment use aseptic technique to retrieve needed items (e.g., sterile cotton forceps or pliers, an over-glove barrier, or remove gloves and perform hand hygiene).
  • Complete charting and computer entries after removing gloves and performing hand hygiene.
  • Place all disposable sharps in designated sharps container.
  • Place instruments in cassette tray (or properly labeled and approved container) for transport to the central sterilization room.

 

Postexposure Evaluation and Followup

Following exposure to blood or bodily fluids, healthcare providers should immediately undergo a confidential medical evaluation and subsequent follow-up by a qualified health-care professional in accordance with current recommendations of the U.S. Public Health Service.

Exposure to blood or bodily fluids, including saliva (even when blood is not visible), must be considered potentially infectious. Consequently, post-exposure evaluation and follow-up is a critical element of a comprehensive infection control/ exposure control protocol.

  • Immediately after an exposure incident:
    Wash injuries with soap and water and apply an antiseptic agent (if available).
    Report the exposure incident immediately to the Office Infection-control Officer or other designated person

 

Transmission-based Precautions

To prevent the transmission of Mycobacterium tuberculosis (MBT), transmission-based precautions based on a three-level hierarchy of administrative, environmental, and respiratory-protection controls are to be implemented.

The primary risk of exposure to Mycobacterium tuberculosis (MBT) in the oral healthcare setting is in contact with patients with undiagnosed or unsuspected infectious tuberculous (TB) disease. A high index of suspicion and rapid implementation of precautions are essential to prevent and interrupt the transmission of MBT.

When reviewing the medical histories (initial and periodic), including a review of organ systems, all patients are routinely asked about a history of exposure to TB, latent TB infection, TB disease, medical conditions that increase the risk of TB, signs, and symptoms of TB.

 

 

Summary

Standard Precautions in combination with Transmission-based Precautions and Respiratory Hygiene/Cough Etiquette provide a hierarchy of preventive strategies to eliminate or minimize HAI’s. This guideline is designed to provide practical information for an effective infection control program in oral healthcare settings.