The Puzzle of OSHA Compliance and Infection Control in the ...The Puzzle of OSHA Compliance and...

The Puzzle of OSHA Compliance and Infection Control in the Dental Laboratory

•The Bloodborne Pathogen Standard:29 CFR 1910.1030 1991/2001

•The Hazard Communication Standard:29 CFR 1910.1200 1989/1994/1998

•The “Hazard Assessment” Standard(s):29 CFR 1910.132-138

•Infection Control Recommendations

The Puzzle of OSHA Compliance in the Dental Laboratory

Kevin Plummer DDS

OSAP 2014 Symposium 1

Rules vs. Recommendations

•Federal Laws = RulesØOSHA

üProtect Employees

•Infection Control Recommendations = Standards of Care

ØCenters for Disease Control and PreventionØAmerican Dental Association

üProtect Patients/Employees

• Publication Date: 12/06/1991• Publication Type: Final Rules• Fed Register #: 56:64004• Standard Number: 1910.1030• Title: Final Rule on Occupational Exposure to Bloodborne Pathogens

Dental Laboratory Infection Control

• Set the policy• Enforce the policy• Communicate the

policy

• Know the policy• Comply with the policy• Communicate about the

policy

Lab Personnel

Lab Customer

Kevin Plummer DDS



The standard infection controlprocedures in a dental laboratorymust be known to the clientsusing the facility.

Laboratory Policies

Likewise, the laboratory must be aware of the infection control philosophy used by its clients


Dental laboratories should ensure that clientsreceive a written guide on the requirementsfor submitting work to the laboratory.

Communication is essential because, whileinfection control is very important, mostmaterials should be handled and/or disinfectedonly once to prevent damage and possible distortion of prosthodontic materials.

Laboratory Policies

Kevin Plummer DDS


At the same time,infection controlprocedures cannotbecome one of the“Its Not My Job”categories in theoffice or the lab.


• Dental Materials• Equipment in Lab and Operatory

• Sterilization v.s. Disinfection

• Use of Laboratory• Recommendations v.s. Regulations and Laws

Specific Problems

Kevin Plummer DDS



• Prostheses– Repairs– Adjustments

• Impressions• Clinicians and Staff• Dental Laboratory

Sources of Contamination


• Wax• Stone• Acrylic• Metals• Hydrocolloids• Vinyl Polysiloxanes• Polyether

Dental Materials

Kevin Plummer DDS


Dental Laboratory Infection Control• Articulators• Lathe• Water Bath• Facebows• Shade & Mold Guides• Impression Trays• Rag Wheels• Flame Sources

Equipment


Clean Labs - All infection control procedures done in the patient care area or clinic

Dirty Labs - All infection control

procedures done in the laboratory

Dental Laboratories canbe operated as:

Basic Laboratory Operations

Plummer, K.D. and Wakefield C.W. Practical Infection Control in Dental Laboratories. General Dentistry, 1994, Volume 42, #6:545-548.

Kevin Plummer DDS



A case receiving area is designated for infection control procedures.

“Dirty” Laboratory Operation


A case receiving area is designated for infection control procedures.


All materials entering the production area must be properly disinfected prior to using the laboratory’s production facilities.

Kevin Plummer DDS



• Personnel in the case receiving area must use gloves and other proper personal protective equipment (PPE)

• If work is done in the production area on any case that may be “dirty” employees must wear proper PPE



• Receiving areas should be disinfected before using the same area for packing and shipping

• Permanent receiving areas should be cleaned and disinfected daily


Kevin Plummer DDS


Sink

Receiving

UnpackingDecontamination

Distribution

Eyewash


Large commercial laboratories and laboratoriesreceiving work of an unknown contamination

status should usethe “dirty” conceptof Infection Control

?


Kevin Plummer DDS



• All items entering laboratory are cleaned and disinfected before arrival (in the operatory)

• Enforcement - Bare Hands Concept

“Clean” Laboratory Operation


• All items entering laboratory are cleaned and disinfected before arrival

• Enforcement - Bare Hands Concept

“Clean” Laboratory Operation

Kevin Plummer DDS



• STERILIZATION: Destruction of all microbial life forms to include spores

• DISINFECTION: Inhibition or destruction of most microbial pathogens

• CLEANING: Removal of visible contamination

Definitions


• EPA/FDA Registered As:– tuberculocidal*– virucidal**– hospital level***

* kills mycobacterium tuberculosis** kills hydrophilic & lipophilic viruses*** kills staff aureus, salmonellatyphimurium, & pseudomonasaeruginosa

Chemical Disinfectants

Kevin Plummer DDS



• Use according to the manufacturer’s instructions

• Hazard Communication Training

Disinfectants and the Dental Laboratory

• EPA registered/ number on label


• Use according to the manufacturer’s instructions

• Hazard Communication Training

Disinfectants and the Dental Laboratory

• EPA registered/ number on label

Kevin Plummer DDS



• Concentration and nature of the contaminant and microorganism

• Concentration of chemical• Length of exposure time• Amount of bio-burden• Preparation of surface to be disinfected

Disinfectant Effectiveness


The "Ideal" Chemical Disinfectant

Non-ToxicBroad Spectrum = Kills Everything

Rapid and Lethal

Easy to U

se

CheapOdorless

Surface Compatib

ility

Fast

Kevin Plummer DDS



•Chlorines•Phenols•Quats•Other

Disinfectant Choice


•Sodium Hypochlorite

•Chlorine Dioxide

CHLORINES

Kevin Plummer DDS



•Other Iodine Products

IODOPHORS


•Alcohol Based Phenols Water Based

PHENOLS

Kevin Plummer DDS



•New Generation Quats

Dual or Synergized plus alcohol

•Accelerated Hydrogen Peroxide

OTHER CHEMICALS


• Time is critical• Detergent/Camel Hair Brush• Scrub with Stone• Disinfect• Use disinfectant with contact time less than 10 minutes

• Chlorine or Idophor

HydrocolloidImpressions

Tullner JB, Commette JA, Moon PC. Lineardimensional changes in dental impressionsafter immersion in disinfectant solutions. JProsthet Dent 1988;60:725-8.

Goodacre C, etal. Effect of disinfection on irreversible hydrocolloid and alternative impression materials and the resultant gypsum casts. J Prosthet Dent 2012;108:250-8.

Kevin Plummer DDS



Scrub with detergent and stone, spray with appropriate disinfectant*

Hydrocolloid Impressions

Dental Laboratory Infection Control• Time is not so critical:

– Detergent/Camel Hair Brush– Scrub with Stone– Disinfect

• Use disinfectant compatible with material

• Polyether probably should not be immersed

Other ImpressionMaterials

Kevin Plummer DDS



• Detergent and brush• Use disinfectant compatible with material

• Spray and hold or soak* for proper time

• Non-heated ultrasonic cleaner OK (not wax)

*even preferred for acrylics

Restorations and Interim Objects

Chau V, Saunders T, Pimsler M, Elfring D. In-depth disinfection of acrylic resins. J Prosthet Dent 1995;74:309-13.


Paper towel reline This is not custom acrylic tinting

Exceptions to the Rules

Kevin Plummer DDS



Isolated and ready for ultrasonic

Exceptions to the Rules

Soaking after proper cleaning


• Careful handling to avoid surface damage

• Spray with disinfectant, drain, cover

• Soak in clear slurry water with sodium hypochlorite added

• Disinfect impression is the better option

• Barrier protect cast

Dental Casts

Kevin Plummer DDS



• Chemical disinfection before placing in patient’s mouth• Use aseptic technique during chairside adjusting

• Clean and disinfect before using laboratory equipment

• Clean/disinfect before placing back in patient’s mouth

Prosthodontic Restorations


• New v.s. disinfected cases and pumice

• Pumice in general• Polishing machines• Pressure pots• Lab benches• Personal Protective Equipment

But what about?

*Schedule

Kevin Plummer DDS



• Disinfection is not needed before shipping from lab

• Shipping documents should state cleaning and disinfection is required before placing in patient’s mouth

• All items should be wrapped or bagged to prevent contact with shipping materials

Shipping


• First Aid

• Decontaminate Area

• Decontaminate Prosthesis

• Disinfect

• Handle Normally

Accidental Contamination

Kevin Plummer DDS


The Puzzle of OSHA Compliance and Infection Control in the ...The Puzzle of OSHA Compliance and...

Documents

Transcript of The Puzzle of OSHA Compliance and Infection Control in the ...The Puzzle of OSHA Compliance and...