Manal Infection Control
-
Upload
alooooooosh -
Category
Documents
-
view
225 -
download
0
Transcript of Manal Infection Control
-
8/3/2019 Manal Infection Control
1/57
INFECTION CONTROL IN
FIXED PROSTHODONTICS
Prepared & Presented By:
-
8/3/2019 Manal Infection Control
2/57
LAYOUT
-
8/3/2019 Manal Infection Control
3/57
OBJECTIVES
Protect one self, staff and patients Use of protective gear and proper
sterilization to minimize infection risks Ensuring the patient the highest
standard of care
Providing a relaxed and non-threateningenvironment to minimize patientsanxiety.
-
8/3/2019 Manal Infection Control
4/57
OBJECTIVES
To fulfill these objectives, a basic understandingof microbiology is essential.
There are 3 types of microorganisms: Pathogenic Potentially pathogenic Non-pathogenic
Opportunistic infections occur in thosewhose immune systems are compromised(eg. Oral Candidiasis: fungi)
-
8/3/2019 Manal Infection Control
5/57
MODES OFTRANSMISSION
Direct: person to person Indirect: contact with objects that are
contaminated Air-borne: spray or splatter contact
with mucous membranes, or contactwith aerosols
A high speed handpiece is capable ofcreating air-borne:
Bacteria: from water-spray system Microbial contaminants: from saliva,
tissues, blood, plaque and debrisfrom cutting carious teeth
These exist in the form of spatter,
mists and aerosols.
-
8/3/2019 Manal Infection Control
6/57
Aerosols(50mm-55mm) may carry agents ofrespiratory infection, borne by the patient (air-
borne or blood-borne). Mists(50mm) are likely to transmit active
pulmonary/pharyngeal tuberculosis from thecough of a patient.
Spatter has a trajectory of 3 ft from thepatients mouth. It is a potential route ofblood-borne pathogens.
MODES OFTRANSMISSION
-
8/3/2019 Manal Infection Control
7/57
-
8/3/2019 Manal Infection Control
8/57
Hand washing Mouth rinse
Rubber dam High-velocity air
evacuation
Gloves
GownsMasks
Protective eyewearAdequate air circulation
PRE-TREATMENT
DURINGTREATMENT
PREVENTION
-
8/3/2019 Manal Infection Control
9/57
-
8/3/2019 Manal Infection Control
10/57
HBV CONCENTRATION IN BODYFLUIDS
Blood
Serum
WoundExudates
HIGH
Semen
VaginalFluid
Saliva
Moderate
Urine
Feces
Sweat
TearsBreastmilk
LOW
-
8/3/2019 Manal Infection Control
11/57
HIV RISK FOR DENTALPERSONNEL
Precautions must be made to minimize injury byneedles or sharp instruments used to treat HIV infectedpatients.
Patients seriously ill with AIDS may harbor transmissible
respiratory infections such as tuberculosis and CMVinfections.
Personnel without adequate barrier protection shouldavoid exposure to coughing , saliva spatter and heavyaerosol from HIV infected person with signs of
respiratory infections.
Pregnant women should especially be cautious oftransmitting CMV infection to new-bornUSING INFECTION CONTROL MEASURES ,
THE RISK FOR INFECTION TRANSFER IS
VERY LOW.
-
8/3/2019 Manal Infection Control
12/57
HIV INFECTIONCONTROL
HIV is killed by all methods of
sterilization. When used properly, all
disinfectants except somequaternary ammoniumcompounds, are said to
inactivate HIV in less than 2minutes.
In dried infected blood, 99% ofHIV has been found to be
inactive in appx. 90 minutes.However when kept wet, thevirus may survive for 2 or moredays. Hence caution is requiredwith container of used needles
in which the virus may remainwet.
Barriers have provedsuccessful in protecting
dental personnel.HIV has been found tomostly be transmitted byblood contaminated fluidsthat have been heavilyspattered or splashed.
-
8/3/2019 Manal Infection Control
13/57
CRITICAL ITEMS
Instruments that cut or penetrate through tissues
Require thorough cleaning and sterilization
-
8/3/2019 Manal Infection Control
14/57
Items handled by gloved handscoated with blood and saliva ormay touch mucosa.
Air-water syringe tip Suction tip
Handpieces
Lamp handles
Must be removed to clean andsterilize unless disposable orcan be protected using plasticcovers.
SEMI-CRITICALITEMS
-
8/3/2019 Manal Infection Control
15/57
Items not ordinarily touched duringtreatment.
Environmental surfaces: Chairs Floor/walls
Supporting equipment of dental unit
NON-CRITICALITEMS
Contaminated items require cleaning and disinfection. Wear gloves to clean. Uncovered chair arms may become contaminated with
spatter.
-
8/3/2019 Manal Infection Control
16/57
ASEPTICTECHNIQUES
Prevents cross-contamination.
All items touched with saliva MUST be freeof contamination before treating nextpatient.
Contaminated items can be:
Discarded/Removed
Protected by disposable covers
Cleaned
Sterilized
Clinician should NOT directly touch items thathe/she does not want to contaminate
-
8/3/2019 Manal Infection Control
17/57
BETWEEN PATIENTAPPOINTMENTS
Whatever is touched iscontaminated.
Directly touch ONLY what hasto be touched.
-
8/3/2019 Manal Infection Control
18/57
BETWEEN PATIENTAPPOINTMENTS
Use one of the following to control contamination:
a) Clean and sterilize
b) Protect surfaces and equipments, that
are not sterilized, with disposable,single-covers. Discard after every
appointment.
c) Use paper towel/plastic bags over gloves to
handle equipments briefly(cabinets/drawers)
d) Scrub and disinfect noncriticalsurfaces (countertops, door
handles, light switches etc.)
-
8/3/2019 Manal Infection Control
19/57
DISINFECTANTS
Regarding disinfection, these two principlesshould be remembered:
1. Disinfection cannot occur until fresh disinfectant isreapplied to a thoroughly cleaned surface.
2. Disinfection does not sterilize.
-
8/3/2019 Manal Infection Control
20/57
MUST be active against:
Mycobacterium species
Polioviruses
Staphylococcus species
Pseudomonas species
HIV (within 1-2 mins)
Activity is reduced by organicdebris/blood.
Most water-based disinfectantsare effective for removing dried
blood.
DISINFECTANTS
-
8/3/2019 Manal Infection Control
21/57
Major categories of chemicaldisinfectants:
1. Chlorine compounds
2. Iodophors3. Combination synthetic phenolics
4. Glutaraldehydes
5. Phenolic/alcohol combinations
These can be used usingdifferent methods of disinfectionlike spraying and immersiontechniques.
DISINFECTANTS
-
8/3/2019 Manal Infection Control
22/57
Some drawbacks of chemicaldisinfectants:
Not readily compatible withirreversible hydrocolloids
Potentially harmfulto usershealth and environment
May have unpleasant odor
Take time
Expensive
DISINFECTANTS
-
8/3/2019 Manal Infection Control
23/57
Factors influencingdisinfectants effectiveness:
1) Type of micro-organism2) Number of micro-organism
3) Concentration ofdisinfectant
4) Length of exposure time ofdisinfectant
5) Amount of organic matter[bio-burden] remaining
DISINFECTANTS
-
8/3/2019 Manal Infection Control
24/57
70-79% ethyl alcoholMOST effective on cleaned
surfaces
Chlorine and iodine:
React and absorbed by plastic ofdispensing bottles.
Glutaraldehydes (conc.) Used for instrument disinfection
Highly toxic 20 min.s to kill mycobacterium species
DISINFECTANTS
-
8/3/2019 Manal Infection Control
25/57
Education and training
Immunizations Exposure prevention and post-exposure
management
Medical condition management and work-related illnesses and restrictions Health record maintenance
PERSONNEL HEALTHELEMENTS
-
8/3/2019 Manal Infection Control
26/57
-
8/3/2019 Manal Infection Control
27/57
PERSONNEL BARRIER
PROTECTION
Hand washing
GlovesEyewear
Masks
Hair protectionProtective over-garment
-
8/3/2019 Manal Infection Control
28/57
HAND WASHING
Hands must be washed when: Visibly dirty
After touching contaminated objects with barehands
Before and after patient treatment (before gloveplacement and after glove removal)
GOOD BETTER BEST
Plain Soap Anti-microbial Soap Alcohol-based Soap
http://www.cdc.gov/handhygiene/materials.htm
-
8/3/2019 Manal Infection Control
29/57
-
8/3/2019 Manal Infection Control
30/57
-
8/3/2019 Manal Infection Control
31/57
HAND WASHING
Hand cleansers containing a mild antiseptic such as:
1. 3% parachlorometaxylenol (PCMX) orChlorhexidine:
Preferred to control transient pathogens
Suppress overgrowth of skin bacteria.
2. Hand cleansers with 4% chlorhexidine:
Special cleansing (e.g. for surgery gloves leak or clinician
experiences injury) Can be hazardous to eyes.
3. Alcohol rubs:
Effective against pathogens
Less drying to the hands
-
8/3/2019 Manal Infection Control
32/57
ALCOHOL-BASED SOAP
Benefits
Rapid and effectiveantimicrobial action
Improved skin
condition
More accessiblethan sinks
Limitations
Cannot be used ifhands are visibly
soiled
Store away fromhigh temperatures
or flames
Hand softeners andglove powders may
build-up
SPECIAL HAND
-
8/3/2019 Manal Infection Control
33/57
SPECIAL HANDHYGIENE
Keep fingernails short
Avoid artificial nails
Avoid hand jewellery that
may tear gloves Use hand lotions to prevent
skin dryness
Consider compatibility of
hand care products withgloves (e.g., mineral oilsand petroleum bases maycause early glove failure)
-
8/3/2019 Manal Infection Control
34/57
GLOVES
OSHA regulations specifies thatall clinical personnel MUSTwear treatment gloves duringall treatment procedures and
each appointment. Gloves must meet new FDA
regulations .
Puncture-resistant utility glovesshould be worn.
If a leak is detected, gloves areremoved, hands are washed,and fresh gloves are used onDRY hands.
-
8/3/2019 Manal Infection Control
35/57
Gloves must NOT bewashed
Must NOT be used formore than one patient.
Gloves help preventpainful and
transmissible herpeticinfections to fingers(WHITLOW) andhands.
GLOVES
-
8/3/2019 Manal Infection Control
36/57
-
8/3/2019 Manal Infection Control
37/57
Pinch the palm side of the outer cuffsurface with the gloved fingers of the
other hand.
REMOVAL OF GLOVES
Pull off the glove, inverting it.
Remove both gloves simultaneously in thesame manner.
Alternately, after removing one, insert
bare fingers under the cuff to grasp andpull off the remaining glove.
Discard gloves safely.
-
8/3/2019 Manal Infection Control
38/57
May consist ofgoggles or glasseswith solid side-
shields.Should be worn with
clean hands before
gloving and removedwith clean handsafter gloves areremoved.
EYE WEAR
-
8/3/2019 Manal Infection Control
39/57
Should be worn to protect against aerosols.
Edges of the rectangular mask should be pressedclose around the bridge of the nose and face.
Face Shields are also used for heavy spatter.
MASK
HAIR
-
8/3/2019 Manal Infection Control
40/57
Hair should be kept back, outof the treatment field,
because hair can entrapheavy contamination.
Personnel should protect theirhair with a surgical cap when
encountering heavy spatter(e.g. from an ultrasonicscaling device).
HAIRPROTECTION
-
8/3/2019 Manal Infection Control
41/57
OVER-GARMENT
Sleeves with knit cuffs that tuckunder gloves are preferred.
Simple light-weight garment
Must cover the arms and chest upto the neck and the lap whenseated, provide more adequateprotection.
Garments should be changed andskin be washed as soon aspossible in case of treatments thatproduce spatter that wets or
penetrates the garment.
An over-garment must be
protective of clothing andskin
-
8/3/2019 Manal Infection Control
42/57
OVER-GARMENT
Wear gowns, lab coats,or uniforms that cover
skin and personal clothinglikely to become soiledwith blood, saliva, orinfectious material
Change if visibly soiled
Remove all barriersbefore leaving the work
area
DISPOSAL OF CLINICAL
-
8/3/2019 Manal Infection Control
43/57
DISPOSAL OF CLINICALWASTE
Contaminatedmaterials such asblood-soaked orsaliva-soaked
sponges, and cottonrolls must bediscarded safely.
Excised tissuerequire separatedisposal and may notbe discarded into the
trash.
-
8/3/2019 Manal Infection Control
44/57
NEEDLE DISPOSAL
Goals for needle disposal are:
Dispose off needles in a hard-walled, leak-proof, and sealable
container which has the OSHAbiohazard label.
Locate the needle-disposalcontainer in the operatory closeto where the needle will be used
Avoid carrying unsheathedcontaminated needles orcontainers in a manner that couldendanger others.
PRECAUTIONS TO AVOID
-
8/3/2019 Manal Infection Control
45/57
PRECAUTIONS TO AVOIDINJURY
The same principlesthat apply toneedles should be
reasonablytranslated andapplied, however toused burs, wires,
and sharpinstruments fromthe operatory.
Great care should be used
in passing instruments andsyringes with unsheathedneedles to anotherindividual.
PRECAUTIONS TO AVOID
-
8/3/2019 Manal Infection Control
46/57
PRECAUTIONS TO AVOIDINJURY
Sharp and curved ends shouldbe turned away from therecipients hand.
Burs should be removed from
handpieces when finished or ifleft in the handpiece in thehanger, the bur should bepointed away from the handsand body.
Hanging handpieces upsidedown in some types ofhangers can angle the buraway from the operator.
HANDPIECE SURFACE CONTAMINATION
-
8/3/2019 Manal Infection Control
47/57
HANDPIECE SURFACE CONTAMINATIONCONTROL
Blood and saliva contaminate thesurfaces of handpieces duringvarious dental treatments.
Irregular surfaces and especiallycrevices around the bur chuck aredifficult to clean and disinfect,especially by a brief wipe with adisinfectant-soaked sponge.
Submersion of a high-speedhandpiece in a high-leveldisinfectant has not been an optionaccepted by manufacturers.
Only STERILIZATIONcan approach
complete infectioncontrol of handpiece
surfaces.
INSTRUMENT PROCESSING
-
8/3/2019 Manal Infection Control
48/57
INSTRUMENT PROCESSINGAREA
Use a designated processingarea to control quality andensure safety.
To prevent cross-
contamination, the instrumentprocessing area should bephysically or spatially dividedinto regions for:
Receiving, cleaning, anddecontamination
Preparation and packaging
Sterilization
Storage
DISINFECTION OF IMPRESSIONS &
-
8/3/2019 Manal Infection Control
49/57
DISINFECTION OF IMPRESSIONS &PREOSTHESES
All prosthesis removed from themouth should be carefully rinsedunder running water, cleaned ofdebris in an ultra-sonic cleanerwhenever possible, anddisinfected.
All impressions should be rinsedand disinfected before the dentalstone models are fabricated.
Working pumice should be
discarded after use Lathe attachments such as stones,
acrylic burs, and rag wheels,should be removed from the latheafter each use and stored in a
disinfectant.
DISINFECTION OF IMPRESSIONS &
-
8/3/2019 Manal Infection Control
50/57
Lathe shields and air filtrationsshould be used to containcontaminated splashes andairborne contamination.
Care should be exercised to cleanand disinfect touch and splashsurfaces in the laboratory.
Clothing worn during patienttreatment should be covered with adisposable apron, specially whencontaminated impressions andprosthesis are handled.
DISINFECTION OF IMPRESSIONS &PREOSTHESES
DISINFECTION OF IMPRESSIONS &
-
8/3/2019 Manal Infection Control
51/57
Impressions can also be disinfected and sterilized using ultra-violet radiation and gas [ethylene dioxide] in closedchambers.
A cast from a properly disinfected
impression may subsequentlybecome contaminated by atechnician and/or a clinician.
Also the prosthesis will becomecontaminated by patient after try in;
this can re-contaminate the castafter repositioning.
In practice, it is thus, difficult tochemically disinfect thecontaminated gypsum casts.
DISINFECTION OF IMPRESSIONS &PREOSTHESES
MICROWAVE
-
8/3/2019 Manal Infection Control
52/57
MICROWAVEIRRADIATION
Studies have been carried out todisinfect contaminated gypsumcasts through microwaveirradiation.
Unlike impression disinfection,this method can be used toeliminate cross-contamination viathe cast, as it can be repeated atevery stage as required.
So far it has been observed thatmicrowave irradiation of the castsfor 5 minutes at 900W gives highlevel disinfection of the gypsum
casts.
-
8/3/2019 Manal Infection Control
53/57
STERILIZATION
Autoclavesterilizationof handpieces One of the most rapid methods.
Works at 121*C for 20 min and 15 lbpressure.
All stainless steel instruments & burs canbe autoclaved.
Chemical vapor pressure sterilization
Recommended for some types of
handpieces Works at 131*C for 30 min and at 20lb
pressure by using aldehyde vapours.
Carbon steel and other corrosion sensitiveburs can be sterilized.
-
8/3/2019 Manal Infection Control
54/57
SUMMARY
All dental disciplines must be considered with the dangersinvolved in the spread of certain infectious diseases.
Prosthodontists and their personnel may be exposed tocertain diseases such as Hepatitis and Tuberculosis.
Dentists must ensure that they at least follow the basicinfection control procedures.
Additional infection control procedures should be observedin the fabrication and handling of dental impressions andprosthesis.
Dental offices and labs should work closely together to co-ordinate control of potential cross-infections between thetwo disciplines.
-
8/3/2019 Manal Infection Control
55/57
-
8/3/2019 Manal Infection Control
56/57
-
8/3/2019 Manal Infection Control
57/57