Standard Precautions in Prevention of Cross-infection:

Policies in Placed

INTRODUCTION GENERAL POLICY STATEMENT PREVENTION OF JAPANESE ENCEPHALITIS PREVENTION OF TUBERCULOSIS PREVENTION OF HIV PREVENTION OF SARS PREVENTION OF H1N1

OUTLINE

The invasion, adhesion, and multiplication of a microorganism in the host.

Infection of a host can occur exogenously (from outside) or endogenously (from inside)

Infection

the transmission of infectious agents between

patients and staff within a clinical environment

either directly or indirectly via instruments,

appliances and surfaces

Cross Infection

Cross infection..

Next patientpatient

TECHNICIAN

Operator

There is always the potential for contamination and

transmission in dentistry.

Saliva is a potentially infectious fluid and has

transmitted Hepatitis B, Herpes and many other infections.

The most serious infections in dentistry are transmitted by

blood to blood contact through accidental sharps injuries.

Risk of Cross infection in Dentistry?

Dentistry always has the potential to transmit

infection and hence 

Standard Precautions 

must always be observed.

1. Direct contact eg. blood or body fluids

2. Indirect contact eg. with a contaminated instrument or

surface

3. Contact of mucosa of the eyes, nose, or mouth with

droplets or spatter

4. Inhalation of airborne microorganisms

Mode of transmission

Chain of InfectionPathog

en

Source

ModeEntry

Susceptible host

General policy statement

Infection control is the concept of standard precautions

to reduce the risk of bloodborne pathogen transmission

The primary principle - medical history and examination

cannot reliably identify all patients infected with blood-

borne pathogens.

All patients, therefore, must be regarded as potentially

infectious.

Policy Statement on Bloodborne Pathogens,Infection Control and the Practice of Dentistry(1999:977, 983; 2004:300; 2008:453)-ADA (1998)

Based on the concept that all blood and body fluids,

secretions and excretions should be treated as infectious

when it comes into contact with non intact skin/mucous

membranes: universal precautions concept expanded by

CDC, USA:1996

Apply to all patients

Standard precaution

Hand Hygiene and Skin Care

Protective Clothing

Safe Handling of Sharps

(including Sharps Injury Management)

Spillage Management.

All blood and body fluids are potentially

infectious and precautions are necessary to

prevent exposure to them.

Everyone involved in providing care in dental

practice should know and apply the standard

principles of hand decontamination

STANDARD PRINCIPLE OF INFECTION CONTROL

Transmission

JE virus is transmitted by the bite of an infected mosquito,

mainly Culex tritaeniorhynchus and C. vishnui complex,

night-time biters that breed in stagnant water such as rice

paddy fields.(1;3)

Humans can also become infected coincidentally through

proximity to JE virus-infected animals and birds.

Japanese Encephalitis

JE virus, rarely, may also be transmitted person-to-person through blood transfusion, organ ,transplantation, intrauterine transmission and possibly breast milk.

(Alberta Health and Wellness Public Health Disease

Under Surveillance Management Guidelines

Japanese Encephalitis,March 2011 )

Single Case/Household Cluster

Determine history of recent living in, immigration from or travel to Asia

and northern Australia including:

geographic location,

season,

duration of exposure, and

occupational and recreational activities (while travelling).

Determine history of mosquito bites.

Determine immunization history (i.e., recent receipt of JE vaccine).

Key Investigation

Temperature:

Destroyed by heating for 30 minutes above 56

;Termal Inactivation Point(TIP) is 40 .℃ ℃

pH:

Inactivated in acid environment of pH 1-3(stable in

alkaline environment ofpH7-9)

Resistance to physical and chemical action

Chemicals/Disinfectants:

Inactivated by organic and lipid solvents,common

detergents,iodine,phenol iodophor 70%thanol,glutaraldehyde

3-8%,formaldegyde 1%,sodium hypochlorite.

Survival:

Sensitive to uv light ad gamma radiation.

PREVENTION AND CONTROL

Sanitary prophylaxis

Housing animals in-doors in screened stabling can provide protection

from mosquitoes

Especially during active JE outbreaks and during peak vector activity

(usually dawn to dusk)

Insecticides, repellents and fans also provide protection

Vector control reduces transmission

Immunisation of swine as they are JE virus amplifier

If practical, swine should not be raised near horses

Medical prophylaxis

Vaccine is available for both horses and swine; also for humans

Two types of vaccine:

modified live (produced in hamster or swine kidney tissue

culture or hamster lung (HmLu) cell line) or

inactivated (prepared in mouse brain, chick embryo

or cell lines, e.g. Vero cells)

(Chapter 2.1.7 Japanese encephalitis in the latest

edition of the OIE Manual of Diagnostic

Tests and

Vaccines for Terrestrial Animals)

TB Infection TB Disease (also called Active TB)

It’s important to recognize the difference!

There are two forms of Tuberculosis..

People with a positive TB skin test have been exposed to the TB germ.

They…◦ Have a TB Infection◦ Do not look or feel sick◦ Cannot infect others◦ May or may not develop TB Disease (Active TB)◦ May take medication to prevent TB Disease from

developing

TB Infection

May have these symptoms… A cough for more than two weeks Coughing up blood Night sweats Fever Loss of appetite Weight loss

TB Disease (Active TB)

Most important to remember:A person with

TB Disease (Active TB)can infect others!

Ask history of TB disease and symptoms suggestive of TB

Promptly referred to a physician Positive history and symptoms of active TB Evaluation for possible infectiousness

Elective dental treatment should be postponed until a physician confirms, using recognized diagnostic

evaluations, that the patient does not have active tuberculosis.

Policy for Treatment of Dental Patients with Active or Suspected Infection with Tuberculosis-CDC:1994

In urgent dental care TB isolation practices Treatment limited to relieve the patient's immediate pain.

DHCWs with persistent cough and other symptoms suggestive of active TB evaluated promptly for TB should not return to work until a diagnosis of TB has been

excluded or on therapy and determination has been made that the worker is not infectious.

Cont..

Blood, saliva, and gingival fluid from all dental patients should be considered infective.

All dental workers should wear surgical masks and protective eyewear or chin-length plastic face shields during dental procedures

Minimize generation of droplets and spatterRubber dams, high-speed evacuation and proper patient

positioning

Universal Precautions for Prevention of Transmission of HIV and other Bloodborne Infections-CDC:1996

Handpieces, ultrasonic scalers should be sterilized after use with each patient.

Cont..

Blood and saliva should be thoroughly and carefully cleaned from material that has been used in the mouth

Contaminated materials, impressions, and intra-oral devices should be cleaned and disinfected

Dental equipment and surfaces that are difficult to disinfect (e.g., light handles or X-ray-unit heads)should be wrapped with impervious-backed paper,

aluminum foil, or clear plastic wrap

Cont..

1. Transmission of H1N1 influenza: droplet exposure of mucosal surfaces indirect contact –by hands and respiratory

secretions from infectious patient/contaminated surface

inhalation of small particle aerosols

Prevention of H1N1 Influenza Transmission in Dental Health Care Settings-CDC:2009

1) Elimination of potential exposures e.g. deferral of ill patients

2) Engineering controls reduce or eliminate exposure at the source without placing

primary responsibility of implementation on individual employees.

3) Administrative controls sick-leave policies and vaccination

4) Personal protective equipment (PPE) exposures that cannot otherwise be eliminated or controlled.

Hierarchy of control measures of H1N1

Should avoid treatment of individuals who have symptoms consistent with SARSwhen these symptoms have started within 10 days of

departing from a SARS affected area. Dentists should ensure that the symptomatic

individuals consult their GP for medical assessment. Dentists should avoid treating probable or confirmed

cases of SARS and contacts of SARS cases whileThey are symptomatic During the period following symptoms when the case is

advised to limit their contact with others

Prevention of SARS –Health Protection Agency (DEC:2003)

ADA Guidelines for infection control 2nd Edition, 2012 Infection Control, Standard Precautions & Tuberculosis.

Washington County Health Sysytem (Effective Date: May 1, 2006)

References

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