FOR THE CALIFORNIA DENTAL PROFESSIONALCalifornia Dental Provider # 4301

Course # 06-4301-07006

The Institute for Advanced Therapeutics, Inc.P.O. Box 848152

Pembroke Pines, Florida 33084

1-954-441-9553

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INFECTION CONTROLFOR THE CALIFORNIA DENTAL PROFESSIONAL

Consultant and Editor

Mark Blum, D.D.S.

Research and Development:

Charles Edwin Cook, L.M. T., C.R. T.

By:

Renee J. Demmery, C.R.T.

©2006 Renee J. DemmeryAll Rights Reserved

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INFECTION CONTROLFOR THE CALIFORNIA DENTAL PROFESSIONAL

Published By:

The Institute for Advanced Therapeutics, Inc.P.O. Box 848152

Pembroke Pines, Florida 330841-954-441-9553 tel1-954-432-1824 fax

This course was developed to help expand the knowledge and skills of dental professionals with respect to the subject of Infection Control for the California Dental Professional.

It is the responsibility of the dental professional to determine which principles and theories contained herein are appropriate with respect to his/her personal limitations and scope of practice.

The information in this course has been carefully researched and is generally accepted as factual at the time of publication. The Institute for Advanced Therapeutics, Inc. disclaims responsibility for any contradictory data prior to the publication of the next revision of this course.

The images used herein were obtained from IMSI's MasterClips® and MasterPhotos Premium Image Collection, 1895 Francisco Blvd. East, San Rafael, CA 94901-5506, USA.

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TABLE OF CONTENTS COURSE DIRECTIONSMAILING INSTRUCTIONSCOURSE OBJECTIVESINTRODUCTION

COMPONENTS OF AN INFECTION CONTROL PROGRAM

STAFF EDUCATION AND TRAINING STAFF IMMUNIZATION EXPOSURE PREVENTION DISPOSABLE PATIENT CARE ITEMS BIOPSY SPECIMEN HANDLING BIOHAZARDOUS WASTE DISPOSAL WORK RESTRICTIONS POSTEXPOSURE PROPHYLAXIS STAFF RECORD MANAGEMENT

HAND HYGIENE

HAND WASHING USE OF LOTIONS FINGERNAILS JEWELRY PROTECTIVE BARRIERS

GLOVES SURGICAL MASKS, EYEWEAR, AND FACE SHIELDS PROTECTIVE GARMENTS

DISINFECTION AND STERILIZATION CATEGORIES OF PATIENT CARE ITEMS LEVELS OF DISINFECTION ENVIRONMENTAL DISINFECTION STERILIZATION PROCEDURES

NEEDLES AND SHARPS

INSTRUCTIONS FOR COMPLETING THE TEST

INFECTION CONTROL FOR THE CALIFORNIA DENTAL PROFESSIONAL TEST

TEST ANSWER CARD/COURSE EVALUATION

GLOSSARYREFERENCES

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COURSE DIRECTIONS

HOW TO BEST PROCEED WITH THIS COURSE

Each chapter should be approached systematically in a careful and objective manner. It is important to master each chapter before going on to the next. Relax, take your time, and go at your own pace. As 6 credits of continuing education are rewarded after successfully completing this course, the reading of this manual and completion of the test questions should not take less than 6 hours. Only after you have successfully mastered all the material in the course should you proceed to the test questions.

COMPLETING THE TEST

Before beginning, please clearly write your name, address, zip code, and license number on your test answer card. Read each question carefully before answering. Please use a ballpoint pen to fill-in your answers on the answer card by completely shading your choice. Keep in mind that each question has only one correct answer. The test consists of 40 questions. For a passing grade, you must correctly answer 32 questions. We encourage your input and would welcome any suggestions to improve our course or test questions. Please feel free to note your suggestions or comments on the course evaluation found at the bottom of the test answer card.

INFORMATION FOR CERTIFICATION

In order to receive your 6 hours of continuing education credit, you must be a registered purchaser of this course. Please notify us of any address or name changes as we keep permanent records for certification and licensure.

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MAILING INSTRUCTIONS

Please send your completed test answer card and course evaluation to:

The Institute for Advanced Therapeutics, Inc.P.O. Box 848152

Pembroke Pines, Florida 33084

If you have any questions regarding this course, please contact our Customer Service Department at 1-954-441-9553 or fax us at 1-954- 432-1824.

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COURSE OBJECTIVES

Upon completion of this course, you will be able to:

1. List the conditions that must be met in order for infection to be transmitted.

2. Identify ways to reduce sharps injuries.

3. Describe prophylactic measures that can be taken following accidental exposure to hepatitis B and HIV.

4. Discuss methods of disinfection and sterilization.

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INTRODUCTION

The reason for infection control in dentistry is to prevent transmission of disease from patient to dental health care worker, from dental health care worker to patient, and from patient to patient during dental treatment.

Adhering strictly to guidelines developed in collaboration with the California Division of Occupational Safety and Health, Centers for Disease Control, other public agencies, academia, and private and professional organizations, patients and dental professionals can be protected from most pathogenic microorganisms in the dental setting. These bacteria or viruses can be transmitted through the following:

direct or indirect contact with blood or bodily fluids indirect contact with contaminated surfaces contact with droplets containing microorganisms

through an infected person sneezing, coughing, or talking reaching the oral mucosa, nasal membranes, or conjunctivae

contact with microorganisms suspended in the air for long periods through inhalation

The following conditions must be met in order for infection to be transmitted.

a means of access through which the pathogenic microorganism can enter the host

a host that is not immune to the pathogenic microorganism

a method of transmission a source that allows the pathogenic

microorganism to survive and reproduce a pathogenic microorganism hardy enough and in

sufficient quantities to cause disease

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An effective infection control program aims at preventing transmission of disease by breaking the chain of cross-infection above.

Some of the diseases that present the greatest risk for dental professionals include the following.

hepatitis B virus hepatitis C virus cytomegalovirus herpes simplex viruses 1 and 2 HIV Staphylococci Mycobacterium tuberculosis Streptococci

In 1996, the Centers for Disease Control and Prevention developed a standard of care designed to prevent transmission of pathogens that can be spread by blood or body fluids, excretion, or secretion called Standard Precautions.

NOTES

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COMPONENTS OF ANINFECTION CONTROL PROGRAM

STAFF EDUCATION AND TRAINING

All dental practices should develop a written plan to prevent or reduce the risk of transmission of infectious diseases. This program should include ways to implement procedures to identify and help prevent work-related cross-contamination among staff and patients and work-related injuries. This written protocol should include information on instrument processing, operatory cleanliness, and management of injuries. A person to coordinate the infection control program and provide instruction to staff regarding these procedures should be assigned. A copy of this protocol should be posted conspicuously in each dental office. Staff at risk for occupational exposure to pathogens should be educated in infection control measures upon initial employment and periodically throughout the employment history.

STAFF IMMUNIZATION

An essential component of a dental practice’s infection control program should be a staff immunization policy. Dental professionals are considered high risk for acquiring vaccine-preventable diseases such as:

hepatitis B influenza rubella varicella measles mumps

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Vaccinations against these diseases can provide immunity and break the chain of infection by eliminating a susceptible host. Dental employees identified to be at risk for exposure should be offered immunization upon initial employment. Administrative staff can be offered vaccinations as well.

Immunization schedules should take into consideration state and federal regulations and U.S. Public Health Service recommendations.

The Advisory Committee on Immunization Practices (ACIP) has issued national guidelines for health care professionals regarding immunization including dental professionals. These guidelines can be utilized to create a staff immunization policy.

EXPOSURE PREVENTION

As dental health professionals, there are precautions that can be taken to reduce the risk of infection. First, treat every patient as if they have an infectious disease. Many persons with infectious diseases do not exhibit obvious symptoms and may appear to be healthy. Precautions should be taken with patients who deny having an infectious disease as they may not realize they have an infectious disease or they may be concealing their disease for fear of discrimination or being denied treatment.

Exposure to infection can occur through percutaneous injury such as when a contaminated needle or sharp dental instrument punctures the skin or through nonintact skin such as chapped hands. Infection can also occur when infected blood, tissues, or bodily fluids come in contact with the mucous membranes of the eyes, nose, and mouth.

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Proper handling and disposing of sharp instruments is an important strategy in preventing transmission of infectious diseases to dental health care workers. Needles and sharp dental instruments should be handled with care. Needles should never be recapped using both hands or intentionally bent or broken by hand before disposal. The following techniques are acceptable for recapping.

a one-handed scoop specially designed needles with resheathing

mechanisms a device used to hold the cap while using the one-

handed scoop technique

Although the risk of occupational exposure to infection can never be completely eliminated, the following strategies can help prevent exposure and should be part of a dental practice’s infection control policy.

Avoid coming in contact with blood, bodily fluids, or tissues.

Consistently adhere to use of protective barriers during dental procedures.

Comply with the dental practice’s infection control policy.

Consider a product’s ability to reduce accidental percutaneous injury when choosing dental equipment, devices, and instruments to buy.

Vaccinate all eligible employees. Facilitate prompt reporting and management of

exposure incidents. Employ a strict policy of work restrictions. Train staff in infection control measures.

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Use appropriate sterilization and disinfection methods.

Wash hands frequently and thoroughly. Cover your mouth and nose with a tissue when

coughing or sneezing. Do not touch your eyes, nose, or mouth unless

your hands have just been washed or disinfected with an alcohol-based hand rub.

DISPOSABLE PATIENT CARE ITEMS

Disposable single-use patient care items should not be cleaned, disinfected, or sterilized for reuse at a later time. Such items should be used only once then discarded. Some examples include:

saliva ejectors air/water syringes prophylaxis cups prophylaxis brushes prophylaxis angles high-speed air evacuator tips

BIOPSY SPECIMEN HANDLING

Proper handling and transport of biopsy specimens is crucial to prevent infection. All specimens should be placed in a strong container with leak-proof lid for safe transport. The specimen should not be allowed to come in contact with the outside of the container during the collection process. If it does, the outside of the container should be cleaned and disinfected appropriately.

BIOHAZARDOUS WASTE DISPOSAL

Liquid waste materials such as blood and suctioned oral fluids should be disposed of by draining into a sanitary sewer system. Disposable sharps should be placed in puncture-resistant appropriately-labeled sharps containers after single-use.

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Solid biohazardous waste materials should be sealed in impermeable appropriately-labeled bags and handled according to local, state, or federal requirements for disposal of biohazardous waste materials.

WORK RESTRICTIONS

Dental health employees with certain contagious illnesses pose a risk to patients as well as other staff members while they are infectious. These employees should not be allowed to be in the workplace until they are asymptomatic and/or a medical physician deems them non-contagious.

POSTEXPOSURE PROPHYLAXIS

All dental practices where dental health care personnel might experience exposures should have a written policy for management of exposures. The policy should be based on the U.S. Public Health Service guidelines. It should be reviewed periodically to ensure that it is consistent with Public Health Service recommendations.

Procedures should be in place to promptly report, medically evaluate, and record all cases of accidental occupational exposure.

Percutaneous injuries should be washed with soap and water. If the exposure was to the eyes, nose, or mouth, the mucous membranes should be flushed with copious amounts of water.

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A qualified health care professional should be assigned to perform a medical evaluation and provide first aid and counseling if necessary.

The medical evaluator should include in the chart:

the date and time of the exposure details of where and how the exposure occurred the type, brand, and size of the dental instrument

or device involved in the exposure the amount of contaminant involved and what

type of injury details regarding the depth of the wound and

whether any potentially-infectious fluid was injected into the body

an estimate of the amount of potentially-infectious fluid involved

how long the potentially-infectious material remained on the skin or mucous membranes before washing or flushing of the area

the infectious medical history of the patient from which the exposure occurred

the vaccination history of the exposed dental health care professional

details of any counseling, treatment, or prophylaxis performed

For diseases such as hepatitis B and HIV, there are prophylactic measures that can be taken following accidental exposure. In certain cases, anti-retroviral agents can be administered prophylactically. Guidelines published by the U.S. Public Health Service outline management of occupational exposures.

Recommendations for hepatitis B virus postexposure management include initiation of the hepatitis B vaccine series to any susceptible, unvaccinated person who sustains an occupational blood or body fluid exposure.

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Postexposure prophylaxis with hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine series should be considered for occupational exposures after evaluation of the hepatitis B surface antigen status of the source and the vaccination and vaccine-response status of the exposed person. Guidance is provided to clinicians and exposed health-care personnel for selecting the appropriate hepatitis B virus postexposure prophylaxis.

Immune globulin and antiviral agents (e.g., interferon with or without ribavirin) are not recommended for postexposure prophylaxis of hepatitis C. For hepatitis C virus postexposure management, the hepatitis C virus status of the source and the exposed person should be determined, and for health care personnel exposed to a hepatitis C virus positive source, follow-up hepatitis C virus testing should be performed to determine if infection develops.

Recommendations for HIV postexposure prophylaxis include a basic 4-week regimen of two drugs (zidovudine [ZDV] and lamivudine [3TC]; 3TC and stavudine [d4T]; or didanosine [ddI] and d4T) for most HIV exposures and an expanded regimen that includes the addition of a third drug for HIV exposures that pose an increased risk for transmission.

When the source person's virus is known or suspected to be resistant to one or more of the drugs considered for the postexposure prophylaxis regimen, the selection of drugs to which the source person's virus is unlikely to be resistant is recommended.

STAFF RECORD MANAGEMENT

The health status of each dental health worker should be recorded in a medical chart and properly maintained according to state and federal laws regarding confidentiality and duration of maintenance.

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This medical chart should contain information relating to:

immunizations work-related medical examinations initial screening tests exposure incident reports postexposure management work restrictions

NOTES

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HAND HYGIENE

HAND WASHING

Strict adherence to hand hygiene has been demonstrated to both terminate outbreaks and reduce overall infection rates. There are three methods of improving hand hygiene in the dental office – traditional hand washing, hand asepsis, and surgical hand asepsis. The desired method of hand washing should depend on the level of contamination of the hands as well as the type of procedure being performed. Dental health professionals should refrain from all direct patient care and handling of patient care equipment if they have exudative lesions or weeping dermatitis until the condition resolves.

Traditional hand washing involves the use of plain soap and water. Hand asepsis involves the use of an antimicrobial soap and water or alcohol-based hand rub. Surgical hand asepsis involves the use of an antimicrobial soap that has a broad-spectrum of activity and long-lasting antimicrobial effect.

Dental practices should take into consideration a couple of factors when choosing which antiseptic agent to use in their facility:

the efficacy of the product against the pathogens likely to be encountered in the workplace

the persistence of antiseptic activity the speed at which the product takes effect the likelihood of acceptance and compliance by

employees.

A pleasing color, smell, and moisturizing properties all can positively influence acceptance.

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Dental health professionals should be expected to wash their hands:

Just before putting on gloves at the beginning of the workday

If the gloves are noted to have a tear or defect If the hands come in contact with saliva or blood Before a patient is seen and gloves are put on After a patient is seen and gloves are taken off Anytime gloves are removed If the hands are visibly soiled Before exiting the operatory or laboratory Before leaving the office for the day

The three methods of improving hand hygiene are outlined below.

1. Traditional Hand Washing – Purpose is to remove dirt, organic material, and most transient microorganisms. Wet hands with running water and apply soap or detergent. Rub hands together vigorously for at least 10 to 15 seconds. Rinse hands thoroughly and dry.

2. Hand Asepsis – The purpose is to remove or destroy transient microorganisms. Wet hands with running water and apply antimicrobial soap or detergent that contains an antiseptic. Rub hands together vigorously for at least 10 to 15 seconds. Rinse hands thoroughly and dry. An alternative when the hands are not soiled with dirt or organic material is to use an alcohol-based antiseptic hand rub to achieve hand antisepsis. Apply a sufficient amount of the product to the palm of one hand to completely cover the surfaces of both hands and fingers when the hands are rubbed together. Continue to rub the hands together until dry. No rinsing or towel drying is required.

3. Surgical Hand Asepsis – The purpose is to remove or destroy transient microorganisms and reduce resident flora when surgery is to be performed in the event of glove tears. Wet hands and forearms with running water and apply antimicrobial soap or detergent that contains an antiseptic. Rub hands and forearms vigorously for at least 120 seconds including using a brush to clean the fingertips and under the nails.

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USE OF LOTIONS

Frequent hand washing and use of antiseptic products can lead to dry, chapped hands which can provide easy entry for pathogens. Moisturizing lotion to the hands can ease dryness associated with frequent hand washing. However, it is important to avoid petroleum or oil-based lotion since it can break down latex gloves and increase permeability.

FINGERNAILS

Fingernail length should be kept short since most of the bacterial flora on the hands is found under and around the fingernails. Having shorter fingernails can reduce infection rates by:

allowing easier cleaning underneath the nails. decreasing the likelihood of glove punctures.

The use of artificial fingernails is discouraged because of the increased incidence of fungal and bacterial infections associated with their use. Chipped nail polish can also harbor bacteria.

JEWELRY

Although it is not known whether wearing rings while working in a dental setting increases the risk of acquiring an infection, it may make hand washing more difficult to perform and may increase the likelihood of glove tears.

NOTES

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PROTECTIVE BARRIERS

Today, health care professionals have a wide variety of physical barrier devices available. These devices are designed to reduce or prevent contact with blood and/or body fluids of patients who may be infected with HIV or other communicable diseases. Some examples of protective gear include:

1. Latex gloves.2. Protective face shields or safety glasses.3. Face masks.4. Protective garments.

GLOVES

Wearing gloves prevents contamination of the hands during dental procedures and prevents potentially infectious microorganisms on the hands from transmitting to patients. They should be worn whenever contact with mucous membranes, blood, or other potentially infectious materials is possible. Gloves should be used only once on a single patient then discarded. Contamination of the hands is reduced by 70-80% by using gloves.

Washing gloves can cause micropunctures invisible to the naked eye which can compromise the integrity of the gloves. This can allow contaminated fluids to pass through the gloves.

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Hands should be washed thoroughly before putting on each pair of gloves and washed again once gloves are removed. If using an alcohol-based hand rub, hands must be completely dry before putting on gloves since alcohol-based liquid on gloved hands can increase the risk of glove perforation.

The medical glove industry is regulated by the FDA which regulates the following types of gloves:

sterile surgeon’s gloves sterile patient examination gloves non-sterile patient examination gloves

Much higher standards of quality are applied to sterile surgeon’s gloves than to patient examination gloves. Wearing sterile surgeon’s gloves offer an increased level of protection from patient’s blood and body fluids and reduces the risk of transmitting microorganisms from the dental health care professional’s hands to the patient’s oral cavity.

To optimize glove performance and reduce infection rates:

Wear gloves in the appropriate size. Apply gloves to completely dry hands after using

alcohol-based hand rubs. Follow standard precautions when dealing with

sharps. Keep fingernails short. Do not wear hand jewelry. Replace visibly torn or damaged gloves

immediately.

There are two forms of contact dermatitis common among dental health care professionals:

Irritant contact dermatitis - characterized by an itchy, dry skin rash around the area of contact that is generally a result of frequent hand washing with soaps and antiseptic products.

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Allergic contact dermatitis - characterized by a hypersensitivity reaction due to chemicals used in the manufacturing of gloves. The allergic rash usually becomes apparent a few hours after contact.

Contact dermatitis can increase the risk of infection and transmission of pathogens because any damage to the skin can result in more frequent colonization by certain types of bacteria.

Some dental health care professionals develop a hypersensitivity to the natural rubber proteins in latex. This condition is characterized by a systemic hypersensitivity reaction and is far more serious than irritant or allergic contact dermatitis. Symptoms range in severity and include:

itchy burning skin itchy eyes scratchy throat sneezing runny nose hives difficulty breathing wheezing coughing gastrointestinal tract irregularities heart irregularities anaphylaxis or death (rarely)

Latex protein attaches to the powder in gloves and can reach the skin or be inhaled. When this happens, patients who are allergic can develop adverse symptoms.

To reduce the risk of allergy to latex while using latex gloves, reduced protein/powder-free gloves can be worn.

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SURGICAL MASKS, EYEWEAR, AND FACE SHIELDS

Surgical masks that cover both the nose and mouth should be used during all dental procedures in conjunction with either chin length plastic face shields or protective eyewear where spatter of blood, body fluids, or tissues is expected. Surgical masks are used in conjunction with protective eyewear such as glasses with solid sides to protect from side spatter. If a surgical mask becomes visibly soiled or wet during a patient treatment, it should be replaced immediately.

Protective face shields or eyewear prevent blood, body fluids, or tissues during dental procedures from getting into the eyes, nose, or mouth which are potential gateways for infection. This gear should be worn whenever there is a potential for spatter. After each patient, if contaminated, they should be cleaned and disinfected.

PROTECTIVE GARMENTS

Gowns, aprons, or lab coats should be worn when splashes of blood or bodily fluids are likely to be encountered. They protect the skin and street clothes from contamination with blood, bodily fluids, or tissues. For maximum protection, the sleeves should be long enough to completely cover the forearms. Garments must be changed when there is visible soiling or spatter. All protective garments must be removed before leaving the workplace. Reusable garments must be laundered in accordance with Cal-DOSH Bloodborne Pathogens Standards.

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DISINFECTION AND STERILIZATION

CATEGORIES OF PATIENT CARE ITEMS

There are three categories of patient care items (dental devices, instruments, and equipment) depending on their potential risk for transmitting infection.

critical semi-critical non-critical

Critical patient care items are considered at highest risk for transmitting infection because they are used to penetrate soft tissue and bone. These items must be sterilized by autoclaving, dry heat, or chemical vapor if they are heat-tolerant. FDA-approved chemical sterilants and disinfectants should be used for sterilization of critical items that are heat-sensitive.

Semi-critical patient care items are considered lower risk for transmitting infection as they come in contact with only mucous membranes and non-intact skin. If these items are heat-tolerant, they should also be sterilized by autoclaving, dry heat, or chemical vapor. If they are not heat-tolerant, they should be processed by high-level, FDA-approved chemical sterilants/disinfectants.

Non-critical patient care items are considered low risk for transmitting infection because they come in contact with only intact skin. These items can be covered with a disposable barrier or cleaned with soap and water or an intermediate-level disinfectant if visibly soiled with blood.

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Items that should be heat-sterilized between patients include:

1. High-speed dental hand pieces.2. Low-speed hand piece components used intraorally.3. Other dental attachments such as reusable air/water syringe

tips and ultrasonic scaler tips.

Items that should be used for one patient only and then discarded include:

1. Disposable prophylaxis angles, cups and brushes.2. Disposable tips for high-speed evacuators.3. Disposable saliva ejectors.4. Disposable air/water syringe tips.

If a critical or semi-critical instrument is not going to be used immediately after being sterilized by a heat or vapor method, it should be packaged or wrapped before sterilization and remained sealed unless the instruments within them are placed onto a setup tray and covered with a moisture-proof barrier on the day the instruments will be used and stored in a manner so as to prevent contamination.

The sterilization cycle must be tested weekly for proper functioning through the use of a biological indicator. The results of these tests must be maintained for 12 months.

Sterile coolants/irrigants should be used for surgical procedures involving bone or soft tissue. Sterile coolants/irrigants must be delivered using a sterile delivery system.

LEVELS OF DISINFECTION

There are three levels of disinfection for patient care items that do not need to be sterilized.

high intermediate low

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The level of disinfection required depends on the item’s intended use.

There are two levels of disinfection for environmental surfaces.

intermediate low

ENVIRONMENTAL DISINFECTION

Surfaces or equipment in the dental office or operatory that do not touch patients directly are known as environmental surfaces. The surfaces of items such as knobs, switches, and handles can become contaminated with microorganisms. For the purposes of disinfection, there are two categories of environmental surfaces:

clinical contact – (ex. countertops, switches, door knobs).

housekeeping – (ex. walls, floors).

Clinical contact surfaces should be disinfected with more rigorous methods than housekeeping surfaces because they are touched more frequently. If items or surfaces are difficult to clean and disinfect and are likely to become contaminated, they should be protected with disposable impervious barriers.

Following treatment of each patient and at the end of the work day, environmental surfaces that are not protected by impervious barriers should be cleaned with a Cal-EPA registered, hospital grade low to intermediate level disinfectant after each patient. Low-level disinfectants should be labeled as effective against hepatitis B virus and HIV and used in accordance with the manufacturers instructions.

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Environmental surfaces that may have been contaminated with patient debris such as floors, walls and sinks should be cleaned with a detergent and water or a Cal-EPA registered, hospital grade disinfectant.

Dental unit water lines should be anti-retractive. Before each workday, the dental unit lines should be purged with air or flushed with water for at least two minutes before attaching handpieces, scalers, or other devices. The dental unit lines should be flushed for a minimum of twenty seconds between each patient.

Intraoral items should be cleaned and disinfected with an intermediate-level disinfectant before manipulation in the laboratory or placement in the patient’s mouth. Before placement in the patient’s mouth, the items should be thoroughly rinsed.

Splash shields and equipment guards shall be used on dental laboratory lathes. Fresh pumice and a sterilized, disinfected or new ragwheel should be used for each patient. Any device used to polish, trim, or adjust contaminated intraoral devices should be properly disinfected or sterilized.

Contaminated solid waste should be disposed of according to local, state and federal environmental standards.

STERILIZATION PROCEDURES

Sterilization is performed to kill bacteria, viruses, fungi/mold and spores on reusable dental instruments that might otherwise transmit infection. There are several steps to sterilization.

1. Transport – All items for sterilization must be gathered in the operatory and placed in a puncture-resistant sharps container or cassette and wheeled on a mobile cart to the sterilization area.

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2. Cleaning – Before sterilization, all dental instruments must be cleaned to remove excess debris. Cleaning can be achieved by ultrasound or hand scrubbing. Ultrasound cleaning is preferred over hand scrubbing because it reduces the risk of cross-contamination and percutaneous injury.

3. Packaging of instruments – Dental instruments should be drained prior to packaging. Packaging materials should be intended for the method of sterilization used and suitable for the items being sterilized.

4. Sterilization – The three main methods of sterilization are steam autoclave, unsaturated chemical vapor, and dry heat. The time and temperature required for effective sterilization should be in the manufacturer’s instruction manual.

5. Storage – Sterilized items should not be stored loose in drawers or cabinets and should not be stored under a sink where they could get wet.

6. Sterilizer monitoring – Sterilizers have monitoring indicators to ensure items are being sterilized. A biological monitor is the only type of monitor that provides positive proof of sterilization. It should be tested at least weekly to ensure proper functioning of sterilization cycles.

NOTES

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NEEDLES AND SHARPSDisposable instruments that should be placed into a sharps container for disposal according to all applicable regulations include:

1. Syringes.2. Needles.3. Scalpel blades.4. Other sharp items and instruments.

Recapping of non-disposable needles should only be performed using the scoop technique or a protective device. Do not bend or break needles for the purpose of disposal.

NOTES

END OF COURSE

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GLOSSARY

Alcohol-based hand rub: an alcohol-containing preparation designed for application to the hands for reducing the number of viable microorganisms on the hands.

Allergic contact dermatitis: a type IV or delayed-hypersensitivity reaction resulting from contact with a chemical allergen (e.g. certain components of patient care gloves), generally localized to the contact area. Reactions occur slowly over 12-48 hours.

Anaphylaxis (immediate anaphylactic hypersensitivity): a severe and sometimes fatal Type 1 reaction in a susceptible person after a second exposure to a specific antigen (e.g., food, pollen, proteins in latex gloves, or penicillin) after previous sensitization. Anaphylaxis is characterized commonly by respiratory symptoms, itching, hives, and rarely by shock and death (anaphylactic shock).

Antimicrobial soap: a detergent containing an antiseptic agent.

Antiseptic: a germicide that is used on skin or living tissue for the purpose of inhibiting or destroying microorganisms.

Antiseptic handwash: washing hands with water and soap or detergents containing an antiseptic agent. Antiseptic hand rub. The process of applying an antiseptic hand-rub product to all surfaces of the hands to reduce the number of microorganisms present.

Asepsis: prevention from contamination with microorganisms. Includes sterile conditions on tissues, on materials, and in rooms, as obtained by excluding, removing, or killing organisms.

Asymptomatic: Without symptoms.

Biological indicator: a device to monitor the sterilization process that consists of a standardized population bacterial spores known to be resistant to the mode of sterilization being monitored. Biological indicators indicate that all the parameters necessary for sterilization were present.

Cleaning: the removal of visible soil, organic and inorganic contamination from a device or surface, using either the physical action of scrubbing with a surfactant or detergent and water or an energy-based process (e.g., ultrasonic cleaners) with appropriate chemical agents.

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Contaminated: state of having been in contact with microorganisms. As used in health care, it generally refers to microorganisms capable of producing disease or infection.

Critical: the category of medical devices or instruments that are introduced directly into the human body, either into or in contact with the bloodstream or normally sterile areas of the body.

Disinfectant: a chemical agent used on inanimate objects to destroy virtually all recognized pathogenic microorganisms, but not necessarily all microbial forms.

Disinfection: the destruction of pathogenic and other kinds of microorganisms by physical or chemical means. Disinfection is less lethal than sterilization, because it destroys most recognized pathogenic microorganisms, but not necessarily all microbial forms, such as bacterial spores. Disinfection does not ensure the margin of safety associated with sterilization processes.

Hand hygiene: a general term that applies to handwashing, antiseptic handwash, antiseptic hand rub, and surgical hand antisepsis.

High-level disinfection: a disinfection process that inactivates vegetative bacteria, mycobacteria, fungi, and viruses but not necessarily high numbers of bacterial spores. The FDA further defines a high-level disinfectant as a sterilant used under the same contact conditions except for a shorter contact time.

Hypersensitivity: an immune reaction (allergy) in which the body has an exaggerated response to a specific antigen (e.g., food, pet dander, wasp venom). See allergic contact dermatitis, anaphylxis, latex allergy.

Immunization: The process by which a person becomes immune, or protected, against a disease. This term is often used interchangeably with vaccination or inoculation. However, the term “vaccination” is defined as the injection of a killed or weakened infectious organism in order to prevent the disease. Thus, vaccination, by inoculation with a vaccine, does not always result in immunity.

Intermediate-level disinfectant: a liquid chemical germicide registered by the EPA as hospital disinfectant and with a label claim of potency as a tuberculocidal.

Irritant contact dermatitis: the development of dry, itchy, irritated areas on the skin, which can result from frequent handwashing and gloving as well as exposure to chemicals. This condition is not an allergic reaction.

Latex: a milky white fluid extracted from the rubber tree Hevea brasiliensis that contains the rubber material cis-1,4 polyisoprene.

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Low-level disinfectant: a liquid chemical germicide registered by the EPA as a hospital disinfectant. OSHA requires low-level disinfectants also to have a label claim for potency against HIV and HBV if used for disinfecting clinical contact surfaces.

Non-critical: the category of medical items or surfaces that carry the least risk of disease transmission. This category has been expanded to include not only noncritical medical devices but also environmental surfaces. Noncritical medical devices touch only unbroken (nonintact) skin (e.g., blood pressure cuff). Noncritical environmental surfaces can be further divided into clinical contact surfaces (e.g., light handle) and housekeeping surfaces (e.g., floors, countertops).

Percutaneous injury: an injury that penetrates the skin.

Postexposure prophylaxis: the administration of medications following an occupational exposure in an attempt to prevent infection.

Semi-critical: the category of medical devices or instruments that come into contact with mucous membranes and do not ordinarily penetrate body surfaces.

Sterilization: the use of a physical or chemical procedure to destroy all microorganisms including large numbers of resistant bacterial spores.

Ultrasonic cleaner: a device that uses waves of acoustic energy to loosen and break up debris on instruments.

Vaccine: a product that produces immunity therefore protecting the body from the disease. Vaccines are administered through needle injections, by mouth and by aerosol.

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REFERENCES

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CDC. National Institutes of Occupational Safety and Health (NIOSH). Latex Allergy: A Prevention Guide. Questions and Answers about identifying and preventing latex allergy. Cincinnati, OH: US Department of Health and Human Services, Public Health Service, CDC, National Institute for Occupational Safety and Health DHHS NIOSH Publication No. 98-113. Available at http://www.cdc.gov/niosh/98-113.html. Accessed February 2005.

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