COVID-19Infection Control 2020

01.ABOUT COVID-19This is a new virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

PREVENTION MEASURES

INFECTION CONTROLIs the discipline concerned with preventing nosocomial or healthcare- associated infection

03.

02.

What you need to know to prevent yourself and others

• AS/NZS 4187:2014 Cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment. Maintenance of associated environments in the health care facilities.

• NHMRCInfection Control Guidelines for the prevention of transmission of infection in the healthcare setting 2010.

• Australian Dental Association Guidelines for infection control 3rd Edition 2015.Dental service restrictions in COVID 19

• Infection Control Policies and Procedures: via RHHM Intranet.• Infection Control Presentation for Dental 2018, Wendy Bacalja

Infection Control References

Behind this presentation will improve staff and patient care

COVID-19 is an infectious disease caused by the recently found virus known as SARS-CoV-2 (or coronavirus). Before the outbreak originated in Wuhan, China on December 2019.

COVID-19

Policies and procedures that are put in place to prevent and minimize the risk of spreading infections

What is Infection Control ?

ABOUT CORONAVIRUS

01.

DRY COUGHHIGH FEVER

Irritation and constant coughing without expelling

any mucus

The body feels completely tired and without energy to

perform normal tasks

The body temperature can exceed 37.3 Celsius degrees or 99 Fahrenheit degrees

SYMPTOMS OF COVID-19

TIREDNESS

This disease can spread from person to person through small droplets from the nose or the mouth when the infected person coughs or exhales.

SURFACESThese small droplets land on surfaces, which means any person that touches these surfaces and then their eyes, nose or mouth can become infected.

PEOPLE

Many people infected with COVID-19 show mild symptoms, especially during the first stages of the disease. Thus, you can still catch the disease from an infected person who only has a mere cough and does not feel ill.

ASYMPTOMATIC PEOPLE

HIGH FEVERTIREDNESS

DIFFICULTY BREATHINGDRY COUGH

INFOGRAPHICS

The body temperature can exceed 37.3 Celsius degrees

The body feels completely tired, without energy

Breathing actually feels more difficult

Constant coughing without expelling any mucus

WHAT TO DO IF YOU HAVE SYMPTOMS

You have symptoms or flulike symptoms

STEP 01

Call the designated phone number for your region

STEP 02

You will be given a instructions on what to do

STEP 03

Follow the instructions provided by the doctor

WHAT TO DO IF YOU HAVE SYMPTOMS

Patiently wait for the results of the test

STEP 04

STEP 05

ABOUT 80% OF PEOPLE RECOVER FROM THIS DISEASE WITHOUT NEEDING SPECIAL TREATMENT

04

CURRENT ANTIBIOTICS DO

NOT WORK AGAINST

CORONAVIRUS

PREVENTION MEASURES

02

PROTECTION MEASURES FOR PEOPLE THAT ARE IN OR VISITED INFECTED AREAS

01 02Stay home if you do not feel well, even if you feel mild symptoms such as headaches,

slight fever and a runny nose

If you need to go out make sure to followand maintain a safe distance

03 04If you have difficulty breathing and/or a

high fever, seek medical advice as soon as possible

Call your provider and inform them of any recent travel, especially to countries with

reported cases

Cover your mouth and your nose with your bent elbow or a

tissue when coughing

Seek medical attention if you have difficulty breathing and a

high fever

Follow the directions of your national or local health

authorities

Wash your hands with an alcohol-based sanitizer or with

soap and water

Keep a distance of at least 1 meter between yourself and

anyone who coughs or sneezes

Try your best not to touch your eyes, your nose and your

mouth

PROTECTING YOURSELF AND PREVENTING THE SPREAD OF THE DISEASE

● Before wearing a mask, wash your hands with an alcohol-based disinfectant or with soap and water.

● Cover your mouth and nose with the mask and make sure the mask is firmly pressed against your face.

● Do not touch the mask while you are wearing it; if you do, wash your hands with an alcohol-based disinfectant or with soap and water afterward.

● Replace the mask as soon as it gets wet and do not reuse disposable masks.

● Remove the mask from behind (do not touch its front side); throw it away in a closed container and then wash your hands with an alcohol-based disinfectant or with soap and water.

HOW TO USE A MASK

Level 1-RestrictionsAll dental treatment using standard precautions for people who do not meet epidemiological or clinical risk factors for COVID-19 infection transmission.

Restricted Services Level 1-Defer long services for people who do not meet epidemiological or clinical symptom criteria for COVID-19Urgent dental treatment for people who do meet the symptom criteria for COVID-19 risk or confirmed as COVID-19 case, provided as per ADA Managing COVID-19 Guidelines.

Dental Restrictions During COVID 19

LEVEL 2 RESTRICTIONSProvision of dental treatments that are unlikely to generate

aerosols or where aerosols generated have the presence of

minimal saliva/blood due to the use of rubber dam. This

includes:-

• Examinations• Simple non-invasive fillings without use of high-speed handpieces• Restorative procedures using high speed handpieces only provided with

the use of rubber dam• Non-surgical extractions• Hand scaling (no use of ultrasonic scalers)• Medical management of soft tissue presentations (such as ulcers)• Temporomandibular dysfunction management • Denture procedures• Preventative procedures such as the application of topical remineralising

agents : e.g. Fluoride• Orthodontic treatment

LEVEL 2 RESTRICTIONSRestricted Services, Defer Treatment

• High-speed handpieces without the use of rubber dam• Ultrasonic scalers• Surgical handpieces• All surgical extractions should be referred to specialist oral surgeons/

oral and maxillofacial surgeons who will undertake these procedures using transmission based precautions.

• Elective implant dental treatment should be delayed.

Urgent dental treatment for people who DO meet epidemiological or clinical symptom criteria for COVID-19 risk or confirmed as a COVID-19 case, provided as per Australian Dental Association. Managing COVID-19 Guidelines.

LEVEL 3 RESTRICTIONSOnly dental treatments that do not generate aerosols, or

where treatments generating aerosols is limited to:-

• Management of patients with acute dental pain e.g. endo treatment under rubber dam or extraction

• Management of significantly damaged upper front teeth (e.g. due to trauma, with restorative treatment provided under rubber dam

• Soft tissue pathology e.g. ulcers• Management of complex medically compromised patients with dental

concerns which may compromise their systemic disease.• Management of those at a higher risk of rapid progression of dental

disease due to socioeconomic or cultural factors• Management of patients referred by medical practitioner for medically

necessary dental care.

LEVEL 3 RESTRICTIONSRestricted Services, Defer Treatment

• Extractions of asymptomatic teeth without swelling• Broken or chipped tooth/teeth• Bleeding or sore gums• Loose teeth without aspiration risk• Denture concerns • Crown and bridge• Scale and clean• Clicking/grating in the jaw joint

Urgent dental treatment for people who DO meet epidemiological or clinical symptom criteria for COVID-19 risk or confirmed as a COVID-19 case, provided as per Australian Dental Association. Managing COVID-19 Guidelines.

LEVEL 4 RESTRICTIONSOnly the following dental treatments can be managed:-

• Swelling of the face, neck or mouth• Dental trauma causing change in the position of teeth, soft tissue

damage and/or significant pain• Significant bleeding• Difficulty opening the jaw and/ or swelling • Referral from a specialist medical practitioner for assessment or

management of a patient receiving urgent medical care for medically necessary dental care

• Dental pain causing loss of sleep• Ulcers persisting for 3+ weeks

No routine dental treatment provided. All patients with acute dental pain or concerns to be directed to emergency care centres. (Hospitals)

LEVEL 4 RESTRICTIONS

Defer all dental treatments for patients not fitting the risk

categories identified above.

Urgent dental treatment for people who DO meet epidemiological or clinical symptom criteria for COVID-19 risk or confirmed as a COVID-19 case, provided as per ADA Managing COVID-19 Guidelines.

INFECTION CONTROL

03

What is infection

Policies and procedures that are put into place to help minimise the risk of spreading infections from:

• Patient to patient

• Patient to staff member

• Staff member to family-community

Control?

Personal protective equipment and Infection Control protocol

• Use gown, gloves ( mask and safety glasses if doing a procedure that may generate aerosol)

• Hair must be tied back if below shoulder length

• No jewellery, watches to be worn except a wedding band

• No nail polish or artificial nails

• Suitable enclosed footwear

5 MOMENTS OF HAND HYGIENE

+

Wash your hands:-

• Before touching a patient

• Before clean/aseptic procedures

• After body fluid exposure/risk

• After touching a patient

• After contact with patient surroundings

HAND HYGIENEHand hygiene is the most important step in preventing cross-contamination

germ transfer20-30 second hand wash

PERSONAL PROTECTIVE EQUIPMENTGloves

• Non sterile glovesare used for routine clinical procedures

• Sterile gloves are used for invasive/sterile procedures

• Heavy duty gloves are used for cleaning instruments and environment

PERSONAL PROTECTIVE EQUIPMENTMasks

• Mask must be worn appropriately to cover nose and mouth for all procedures where aerosols or splashing may occur

• Not to be touched by the hand whilst being worn

• Removed as soon as practical after soilingMust not be worn around the neck

• Must be discarded at the end of the procedure

• Not to be worn outside the clinical area

PERSONAL PROTECTIVE EQUIPMENTGowns

• Plastic aprons or single-use disposable gowns are worn for sub-gingival scale and root debridement or a procedure.

• Involving excessive splashing of blood/body fluids.

• All dental aveoli surgery, Endodontics and Periodontal surgery must use sterile gowns.

• Use of appropriate personal protective equipment including gloves, fluid impervious disposable gowns and fit-check P2 respirators must be used for all COVID-19 patients.

PERSONAL PROTECTIVE EQUIPMENTSafety Glasses and Shields

• Must be worn for all procedures where aerosols or splashing may occur

• Must be fitted with side shields

• Must be cleaned between patients

• Prescription glasses should be fitted with clip on shields

Aseptic TechniqueAseptic technique is a framework of aseptic practice.It aims to prevent pathogenic organisms from being introduced to susceptible sites by:

• Hands

• Surfaces

• Equipment

Terminology

• Sterile- Free from microorganisms

• Asepsis- Free from infection or infectious (pathogenic) material

• Clean- Free from dirt, marks or stains

1. Key Part/Site Identification and Protection2. Hand/Hygiene3. Glove Use4. Aseptic Field5. Environment6. Sequencing

6 Core Components

Key Sites/ Parts Identification• Key Site-Open wound, tooth sockets in planned extractions.

• Key Part-Parts of the procedure and equipment that come into direct or indirect contact with key sites or other key parts eg: Instruments, needles, forceps, retractors, scalpels etc.

• Key Site and Key Part-Identification- The best way to protect is not to touch it.Only aseptic key parts can contact other key parts or key sites.

If it is necessary to touch key parts or key sites directly as a critical or surgical / procedure, sterile gloves are used to minimise the risk of contamination.

Otherwise non-sterile gloves are used in line with standard precautions.

Gloves Use

Aseptic Fields

Provide a controlled aseptic working space -

The aseptic field needs to fit the purpose of treatment.

Standard Asepsis or Surgical Asepsis with either

• General Fields

• Critical Fields

• Micro Critical Fields

Aseptic Field- Promotes Asepsis

• Non-sterile gloves.

• Main field is the bracket table and the kimguard, dental bib, or laminar peel.

• Examinations, restorations, scale & clean, endodontics, fixed & removable prosthodontics, orthodontics, periodontics, oral medicine, domiciliary care.

Standard Asepsis

• Large complex procedures• Long duration• Best preformed in dedicated operating theatre• Controlled environment• Sterile gloves and gown• Sterile drapes to cover procedure• Key critical parts are to be placed in the dedicated area on the procedure trolley

to protect against operative contaminates.

Critical Aseptic Field

A small area within general aseptic field to isolate key parts:

• Space on bracket table

• Sterile kidney dish

• Caps and covers

Micro Critical Aseptic Field

Healthcare workers must ensure there are no environment risk factors. The more critical the procedure is, the more important it is to control the environment.Examples:

• Ensure that all fans are off• Ensure Open doors are closed• Surgical procedures are in an enclosed area• Ensure people are not walking around in the area• Aerosols from adjoining rooms cant come in• Surgical trolley is in a safe area• Caps and covers are on correctly

Environment

Use a safe logical and efficient order of events to complete the procedure.

Examples:

1. Cleaning the work surface area2. Hand hygiene before gathering equipment3. Placing on PPE in particular order4. Set equipment before commencing5. Disposal of used equipment appropriately6. Remove sharps when no longer required

Sequencing

Sharps Management

Responsibility

The person who uses the sharp is responsible for its removal and disposal (NHMRC Infection Control Guidelines)

• Never hand sharps to another person

• Never leave sharp sitting on the bracket table

Sharps

What are sharps:

• Needles• Dental Burs• Endo Files• Matrix bands• Scalpel blade• Instruments• Steel Crowns• Ortho bands and wires

Classification

Handling of sharps

• Hand or fingers must not be used for retracting.• Appropriate designated instrument to be used to avoid a sharps injury.

Sharps containers

• Must be located close to point of use.• Must be secure.• Containers must be removed when ¾ full.• Sealed immediately.• Removed from the bay and placed in designated area.

Handling and Containers

After Local Anaesthetic is completed

• Needle must be removed using artery forceps• Must be disposed in a sharps container once the LA is completed• Ensure needle is fully within the sharps container• Used needle must not remain on bracket table• Irrigation syringes must be placed in endo sponges• Needles and syringes used for irrigation are disposed as one unit into

sharps container• Re-sheathing any needle is not permitted

Syringe/Needle Management

• Instruments must be packed carefully ensuring no items are protruding from cassettes

• Cassette hinges must be aligned and latches secured properly• Damaged cassettes and instruments must be tagged and reported to

CSSD• Instruments must be free from blood and debris at all times• Instruments must be placed neatly and spaced apart on the bracket

table ensuring all the items are visual

Instrument Management

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