Infection control in dental practice

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Information about Infection control in dental practice

Published on January 4, 2017

Author: AbdulwahabAlkholani

Source: slideshare.net

1. ‫هههه‬ ‫ههه‬ ‫هههههه‬ ‫هههههه‬ Professor Abdulwahab Al-kholani

2. Professor Abdulwahab Al-kholani

3. 1. Background 2. Personnel Health Elements 3. Bloodborne Pathogens 4. Hand Hygiene 5. Personal Protective Equipment (PPE) 6. Latex Hypersensitivity/Contact Dermatitis 7. Sterilization and Disinfection 8. Environmental Infection Control 9. Dental Unit Waterlines 10. Sterilization and High-Level Disinfection (summary) 11. Processing of Instruments 12. Sterilization Failure Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

4. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

5. Cross-contamination cycle Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

6. Why Is Infection Control Important in Dentistry? Dr. Abdulwahab Al-kholani  Both patients and dental health care personnel (DHCP) can be exposed to pathogens  Contact with blood, oral and respiratory secretions, and contaminated equipment occurs  Proper procedures can prevent transmission of infections among patients and DHCP Professor Abdulwahab Al-kholani

7. Dr. Abdulwahab Al-kholani Direct contact with blood or body fluids Contact of mucosa of the eyes, nose, or mouth with droplets or spatter Indirect contact with a contaminated instrument or surfaces Inhalation of airborne microorganisms Mode of transmission Professor Abdulwahab Al-kholani

8. Disease Transmission Chain or Cycle: Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

9. Professor Abdulwahab Al-kholani How to Break the Chain of InfectionHow to Break the Chain of Infection

10. Professor Abdulwahab Al-kholani

11. Personnel Health Elements of an Infection Control Program Education and training Immunizations (vaccination) Exposure prevention and postexposure management Medical condition management and work-related illnesses and restrictions Health record maintenance Professor Abdulwahab Al-kholani

12. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

13. Preventing Transmission of Bloodborne Pathogens Are transmissible in health care settings Can produce chronic infection Are often carried by persons unaware of their infection Bloodborne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV): Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

14. Patient DHCP DHCP Patient Patient Patient Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

15. Dr. Abdulwahab Al-kholani Potential Routes of Transmission of Bloodborne Pathogens Professor Abdulwahab Al-kholani

16. Concentration of HBV in Body Fluids High Moderate Low/Not Detectable Blood Semen Urine Serum Vaginal Fluid Feces Wound exudates Saliva Sweat Tears Breast Milk Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

17. Hepatitis B Vaccine  Vaccinate all DHCP who are at risk of exposure to blood  Test for anti-HBs 1 to 2 months after 3rd dose Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

18. Post-exposure Management Wound management Exposure reporting Assessment of infection risk Type and severity of exposure Bloodborne status of source person Susceptibility of exposed person Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

19. Blood borne pathogen Professor Abdulwahab Al-kholani

20. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

21. Why Is Hand Hygiene Important? Hands are the most common mode of pathogen transmission Reduce spread of antimicrobial resistance Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

22. Why Is Hand Hygiene Important? Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

23. 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) Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

24. Hand Hygiene Definitions Handwashing Washing hands with plain soap and water Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based handrub Rubbing hands with an alcohol-containing preparation Surgical antisepsis Handwashing with an antiseptic soap or an alcohol-based handrub before operations Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

25. Hand Hygiene Professor Abdulwahab Al-kholani

26. Good Better Best Plain Soap Antimicrobial soap Alcohol-based handrub Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

27. 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) Keep fingernails short Avoid artificial nails Avoid hand jewelry that may tear gloves Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

28. Special Hand Hygiene Considerations Dr. Abdulwahab Al-kholani Avoid artificial or long nails Avoid hand jewelry that may tear gloves Professor Abdulwahab Al-kholani

29. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

30. A major component of Standard Precautions Protects the skin and mucous membranes from exposure to infectious materials in spray or spatter Should be removed when leaving treatment areas Dr. Abdulwahab Al-kholani Masks, Protective Eyewear, Face Shields Professor Abdulwahab Al-kholani

31. Masks, Protective Eyewear, Face Shields Wear a surgical mask and either eye protection with solid side shields or a face shield to protect mucous membranes of the eyes, nose, and mouth Change masks between patients Clean reusable face protection between patients; if visibly soiled, clean and disinfect Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

32. Protective Clothing Wear gowns, lab coats, or uniforms that cover skin and personal clothing likely to become soiled with blood, saliva, or infectious material Change if visibly soiled Remove all barriers before leaving the work area Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

33. Wearing Personal Protective Equipment Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

34. Removing Personal Protective Equipment Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

35. Gloves Minimize the risk of (HCP) acquiring infections from patients Prevent microbial flora from being transmitted from (HCP) to patients Reduce contamination of the hands of (HCP) by microbial flora that can be transmitted from one patient to another Are not a substitute for hand washing! Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

36. Recommendations for Gloving Wear gloves when contact with blood, saliva, and mucous membranes is essential Remove gloves after patient treatment Wear a new pair of gloves for each patient Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

37. Recommendations for Gloving Remove gloves that are torn, cut or punctured Do not wash, disinfect or sterilize gloves for reuse Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

38. Professor Abdulwahab Al-kholani Personal Protective Equipment (PPE)

39. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

40. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

41. Latex Allergy Type I hypersensitivity to natural rubber latex proteins Reactions may include nose, eye, lips and skin reactions More serious reactions may include respiratory distress–rarely shock or death Vinyl gloves is recommended for hypersensitive dentist or patient Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

42. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

43. Instruments Critical Instruments Semi-Critical Instruments Non-Critical Instruments  Penetrate mucous membranes or contact bone, the bloodstream, or other normally sterile tissues (of the mouth)  Examples: include surgical instruments, scalpel blades, needles periodontal scalers, and surgical dental burs  Autoclaving, heat sterilize between uses or use sterile single- use, disposable devices  Contact mucous membranes but do not penetrate soft tissue  Examples: Dental mouth mirrors, amalgam condensers, and dental handpieces  Heat sterilize or high- level disinfect  Contact intact skin  Examples: X-ray heads, facebows, pulse oximeter, blood pressure cuff  Clean and disinfect using a low to intermediate level disinfectant Professor Abdulwahab Al-kholani

44. Instrument Processing Area Use a designated processing area to control quality and ensure safety Divide processing area into work areas  Receiving, cleaning, and decontamination  Preparation and packaging  Sterilization  Storage Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

45. Instrument Processing Area Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

46. Instrument Processing Area Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

47. Automated Cleaning Ultrasonic cleaner Instrument washer Washer-disinfector Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

48. Manual Cleaning Soak until ready to clean Wear heavy-duty utility gloves, mask, eyewear, and protective clothing Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

49. Preparation and Packaging Critical and semi-critical items that will be stored should be wrapped or placed in containers before heat sterilization Hinged instruments opened and unlocked Place a chemical indicator inside the pack Wear heavy-duty, puncture-resistant utility gloves Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

50. Heat-Based Sterilization Autoclaving (steam under pressure ) Dry heat Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

51. Liquid Chemical Sterilant/Disinfectants Only for heat-sensitive critical and semi-critical devices Powerful, toxic chemicals raise safety concerns Heat tolerant or disposable alternatives are available Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

52. Sterilization Monitoring Types of Indicators Mechanical Measure time, temperature, pressure Chemical Change in color when physical parameter is reached Biological (spore tests) Use biological spores to assess the sterilization process directly Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

53. Storage of Sterile and Clean Items and Supplies Use date- or event-related shelf-life practices Examine wrapped items carefully prior to use When packaging of sterile items is damaged, re- clean, re-wrap, and re-sterilize Store clean items in dry, closed, or covered containment Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

54. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

55. Categories of Environmental Surfaces  Clinical contact surfaces High potential for direct contamination from spray or spatter or by contact with DHCP’s gloved hand Dr. Abdulwahab Al-kholani  Housekeeping surfaces Do not come into contact with patients or devices Limited risk of disease transmission Professor Abdulwahab Al-kholani

56. Dr. Abdulwahab Al-kholani Clinical Contact Surfaces Professor Abdulwahab Al-kholani

57. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

58. 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  Follow manufacturer’s instructions for proper use of disinfectants  Do not use sterilant/high-level disinfectants on environmental surfaces Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

59. Cleaning Clinical Contact Surfaces  Risk of transmitting infections greater than for housekeeping surfaces  Surface barriers can be used and changed between patients Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

60. Cleaning Housekeeping Surfaces  Routinely clean with soap and water or disinfectant routinely  Clean mops and cloths and allow to dry thoroughly before re-using  Prepare fresh cleaning and disinfecting solutions daily and per manufacturer recommendations Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

61. Medical Waste Medical Waste: Not considered infectious, thus can be discarded in regular trash Regulated Medical Waste: Poses a potential risk of infection during handling and disposal Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

62. Regulated Medical Waste Management Properly labeled containment to prevent injuries and leakage Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

63. Preparing the dental operatory Professor Abdulwahab Al-kholani

64. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

65. Dental Unit Waterlines and Biofilm Microbial biofilms form in small bore tubing of dental units Biofilms serve as a microbial reservoir Primary source of microorganisms is municipal water supply Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

66. Dental Unit Water Quality  Using water of uncertain quality is inconsistent with infection control principles  Untreated dental units cannot reliably produce water that meets drinking water standards Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

67. Sterile Irrigating Solutions Use sterile saline or sterile water as a coolant/irrigator when performing surgical procedures Use devices designed for the delivery of sterile irrigating fluids Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

68. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

69. Instruments must be cleaned well before sterilization Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

70. Clean gross deposits of materials or tissues with gauze soaked in holding solution. Soak instruments in holding solution Instruments Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

71. Holding Solution 1. Prevents tissues, fluids, and debris from drying. 2. Reduces the amount of viable micro- organisms during cleaning. Dr. Abdulwahab Al-kholani Instruments Professor Abdulwahab Al-kholani

72. BiB Forte should be prepared fresh daily by diluting 50 ml / 1 litre Holding solution Dr. Abdulwahab Al-kholani Instruments Professor Abdulwahab Al-kholani

73. 1. Alcohol alone not effective for biological debris. 2. Gluteraldehyde effective but toxic. 3. Sodiumhypocloride (Clorox©) corrosive. Holding Solution Dr. Abdulwahab Al-kholani Instruments Professor Abdulwahab Al-kholani

74. Scrub with brush under running water. Washing instruments Washing hands Two sinks Heavy duty gloves to protect from sharp injury Dr. Abdulwahab Al-kholani Instruments & Burs, Barbed Broaches and Files Professor Abdulwahab Al-kholani

75. Ultrasonic cleaners 1. Reduce chances of hand injury. 2. Reduce splatter in environment 3. More effective in cleaning small crevices Dr. Abdulwahab Al-kholani Instruments & Burs, Barbed Broaches and Files Professor Abdulwahab Al-kholani

76. 1- Flush hand-piece into container for 30 seconds 2- Lubricate hand-piece2- Lubricate hand-piece 3- Reattach hand-piece3- Reattach hand-piece and spray excess oiland spray excess oil out by air onlyout by air only 4- Wipe clean4- Wipe clean 5- place in5- place in envelopeenvelope Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani Hand-pieces

77. Hand-pieces Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

78. IMPORTANT To prevent damage to the hand-pieces: Always keep bur inside hand-piece when flushing it. Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

79. DO NOT PLACE HAND-PIECES IN WATER Dr. Abdulwahab Al-kholani Hand-pieces Professor Abdulwahab Al-kholani

80. Heat sealing Auto-sealing Sealing tape Packaging & sealing Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

81. Double fold then tape along the edge Packaging & sealing Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

82. Packaging & sealing Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

83. Chemical indicator Changes color after entering the autoclave Packaging & sealing Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

84. Dr. Abdulwahab Al-kholani Sterilization Failure Improper Cleaning of Instruments Improper Packaging Materials Improper Sterilization Parameters Time Temperature And/or pressure Improper Selection of Sterilization Method Professor Abdulwahab Al-kholani

85. Dr. Abdulwahab Al-kholani Sterilization and High-Level Disinfection: Professor Abdulwahab Al-kholani

86. Professor Abdulwahab Al-kholani Questions?

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