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Dr. Hisham Al-Shorman
Assistant professor of Periodontology
Department of Preventive Dentistry
JUST
Monday 8/7/2013
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INFECTION CONTROL
1.Personal Protective
Equipment:
a.Gowns
b.Gloves
c. Masks
d.Protective eyewear
2.Surfaces
3.Hand hygiene
4.Clinical wastes
5.Blood-BornePathogens
6.Food and drinks
7.Infections
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WHY IS IT IMPORTANT?
Both patients & dental health-care personnel areexposed to pathogens
Nature of profession i.e. contact with blood, oral
and respiratory secretions and contaminatedequipment
Hospital settingreferral institution for medically
compromised patients
Proper procedures can preventtransmission ofinfections
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MODES OF TRANSMISSION
Direct contact with blood or body fluids
Indirect contact with contaminatedinstruments or surfaces
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MODES OF TRANSMISSION
Contact of mucosa of the eyes, nose, ormouth with droplets or spatter
Inhalation of air-borne microorganisms
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Exposure To Blood & Body Fluids
Laceration (wax knife,scalpel, carvers,)
Needle stick (anesthesia,irrigation,)
Puncture with dentalinstruments (burs, ortho
wires,)
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Exposure To Blood & Body Fluids
Splash of blood or saliva to mucousmembranes of (mouth, nose or eyes) and tobroken areas of skin:
Handpieces, scalers,
Sneezing, coughing, gag reflexes,speaking,
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Chain of Infection
Pathogen
Source
ModeEntry
Susceptible Host
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Potential Routes of Transmissionof Blood-borne Pathogens
Patient Operator
Patient
Patient Patient
Operator
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STANDARD PRECAUTIONS
Standard PrecautionsA standard of caredesigned to protect health-care providersand patients from pathogens that canspread by blood and other body fluids
Apply these standard precautions to allpatients
ALL BLOOD AND BODY FLUIDS ARECONSIDERED TO BE INFECTIOUS
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PPE
Consider all patients as infectious
Wear personal protective equipment:
Gowns
GlovesMasks
Protective Eyewear
Should be removed when leaving treatmentareas
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GOWNS / WHITE COATS
Should cover operators clothesand protect them from splashesand aerosols:
High neck
Long sleevesKnee long
Design!!! Reduce folds, pockets
and any other areas thatfacilitates accumulation of soil oraeresoles
Change if visibly soiled
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Minimize the risk of crossinfection:
From patients to operators
From operators to patients
From one patient to another
Are NOT a substitute for handwashing!
GLOVES
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Disposable latex, vinyl, ornitrile gloves:
Non-surgical procedures
Sterile disposable gloves
All surgical procedures
GLOVES
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UTILITY GLOVES
Heavy duty utility glovesafter patient treatment
Must be washed withantimicrobial soap,
rinsed and dried
Stored in plastic bag inlocker
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RECOMMENDATIONS FORGLOVING
Wear gloves when contact with
blood, saliva, and mucous
membranes is possible
Remove gloves after patient care
New gloves for each patient
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If torn, cut or
puncturedreplace
them
Do NOT wash, disinfect
or sterilize gloves for
re-use
RECOMMENDATIONS FORGLOVING
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Masks to protect: Face
Oral and nasal mucosa
Must be changed if theybecome damp
Must be changed for eachnew patient, except for
short exams
If a face shield is worn itmust be worn at the same
time as a surgical mask
MASKS
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PROTECTIVE EYEWEAR
Protect from aerosol and spatter
Regular eyewear must have side shields - free
of vents or openings
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SEQUENCE OF PUTTING ON PPE
1. Hand hygiene - FIRST
2. Gownif sterile (Surgical)
3. Mask
4. Protective eyewear
5. Gloves - LAST
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SEQUENCE OF REMOVING PPE- Reverse
1. GlovesFirst (most contaminated)
2. Hand hygiene
3. Protective eyewear - handle by head band or ear
pieces
4. Gown
5. MaskBy elastics -Front of mask is contaminated
DO NOT TOUCH!
6. Hand hygiene
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SHARPS
Used needles, blades, burs, endo filesand reamers, anesthetic cartridges andall other sharps are to be discarded in:
SHARPS CONTAINERS
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Recap anesthetic needlesby using the needle re-capper
If unavailable, use the onehanded scoop technique
SHARPS
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FOOD AND DRINKS
Eating and drinking are prohibitedin all clinical areas
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Enjoy them outside!
FOOD AND DRINKS
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HAND HYGIENE
Plain soap and water
Antiseptic hand wash -
washing hands with water
and soap or other detergents
containing an antiseptic
agent
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HAND HYGIENE
Alcohol-based hand rub
Surgical scrub
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ALCOHOL-BASED PREPARATIONS
Rapid and effective
antimicrobial action Improved skin
condition
More accessible
than sinks
Cannot be used ifhands are visiblysoiled
Store away from hightemperatures or
flames Hand softeners and
glove powders maybuild-up
Benefits Limitations
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Efficacy of Hand Hygiene Preparations inReduction of Bacteria
Good Better Best
PlainSoap
Antimicrobialsoap
Alcohol-basedhandrub
http://www.cdc.gov/handhygiene/materials.htm
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Long fingernails
Colored nail polish
False fingernails
PROHIBITED!
SPECIAL HAND HYGIENECONSIDERATIONS
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Avoid hand jewelry that may tear gloves
SPECIAL HAND HYGIENECONSIDERATIONS
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HANDS NEED TO BE CLEANED
When visibly dirty
After touching contaminated
objects with bare hands
Before and after patient
treatment (before glove
placement and after glove
removal)
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BEST
Taps with sensors or foot
control to avoid hand contact
TAP DESIGN
AT LEAST
Taps with lever Use arm or back of your hand
to activate it
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TAP DESIGN
AVOID TAPS WITH KNOB
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HAIR
Hair should be short and well-managed
Long hair should be pulled back orcompletely covered with a surgical capto minimize the possibility ofcontamination
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HOUSEKEEPING
Worksite must be maintained in a clean
and sanitary condition
Equipment and work surfaces must becleaned and decontaminated after contact
with blood and other infectious materials
Protective coverings must be used tocover equipment and work surfaces
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CATEGORIES OF ENVIRONMENTALSURFACES
CLINICAL CONTACT SURFACES
High potential for direct contamination
from spray or spatter or by contact withgloved hand
HOUSEKEEPING SURFACES
Do not come into contact with patientsor devices
Limited risk of disease transmission
HOUSEKEEPING SURFACES
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HOUSEKEEPING SURFACES
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CLINICAL CONTACT SURFACES
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CLEANING CLINICAL CONTACTSURFACES
Risk of transmittinginfections greater than forhousekeeping surfaces
Clean and disinfectsurfaces
Apply barriers
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SURFACE COVERS
Handles, handpieces or similar surfacesthat may be contaminated by blood orsaliva - wrap with clear plastic wrap.
Head rest cover
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GENERAL CLEANINGRECOMMENDATIONS
Use barrier precautions (e.g. heavy-dutyutility gloves, masks, protective eyewear)when cleaning and disinfectingenvironmental surfaces
Physical removal of microorganisms bycleaning is as important as the disinfection
process
Do not use sterilant/high-level disinfectantson environmental surfaces
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CLEANING CLINICAL CONTACTSURFACES
Surface barriers can be used and changedbetween patients
OR Clean then disinfect with hospital disinfectant
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CLEANING HOUSEKEEPINGSURFACES
Routinely clean with soap and water orhospital disinfectant
Clean mops and cloths and allow to drythoroughly before re-using
Prepare fresh cleaning and disinfectingsolutions daily and per manufacturerrecommendations
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WASTE DISPOSAL
Regular House Waste
Contaminated Medical Waste
Sharps
Human Tissues
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PREVENTION OF INJURIES
1. Remove burs fromhandpiece immediatelyafter completion ofdental procedure
2. Recap anestheticneedles
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PREVENTION OF INJURIES
3. Restrict use of fingers in tissue retractionor palpation during suturing oradministration of anesthesia
4. Avoid uncontrolled movements of dentalinstruments. THINK BEFORE MOVING ANINSTRUMENT.
h i i k
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Who is at risk?
Everybody!
Elderly pts
Children (lower resistance, Cystic fibrosis,)
Cardiac pts (e.g. valvular disease)
Respiratory disease pts (for air-borne infections)
Impaired healing functions
Immuno-deficient patients (e.g. auto-immune pts)
Other immuno-suppressants (e.g. transplant pts)
Cancer pts
Pts on steroids
Diabetics
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TAKE-HOME MESSAGE
Infection control regulations aremandatory to ALL
Violations of these regulations will
be taken seriouslyIt is better to play safe
Clinical assessment will consider
infection control practiceIf not sure, ASK!
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