Dr.

Hisham Al Shorman, PhD

INFECTION CONTROL
1. Personal Protective Equipment a. Gowns b. Gloves c. Masks d. Protective eyewear 3. Radiography 4. Hand hygiene 5. Clinical wastes 6. HBV Immunization 7. Water lines 8. Food and drinks

2. Surfaces

9. Injury and accident reporting

WHY IS IT IMPORTANT?

Both patients and dental health-care personnel are exposed to pathogens

Contact with blood, oral and respiratory secretions and contaminated equipment Hospital setting referral institution for medically compromised patients
Proper procedures can prevent transmission of infections
3

MODES OF TRANSMISSION

Direct contact with blood or body fluids Indirect contact with a contaminated instrument or surface

Contact of mucosa of the eyes, nose, or mouth with droplets or spatter Inhalation of airborne microorganisms
4

Exposure To Blood and Body Fluids

Laceration (Wax knife, scalpel, carvers,) Needle stick (Anesthesia, irrigation,) Puncture with dental instruments (Burs, ortho wires,) Splash of blood or saliva to mucous membranes of (mouth, nose or eyes) and to broken areas of skin Headpieces, scalers, Sneezing, coughing, gag reflexes, speaking,

Chain of Infection
Pathogen Susceptible Host Source

Entry

Mode

Potential Routes of Transmission of Blood-borne Pathogens

Patient

Operator

Operator

Patient

Patient

Patient
7

STANDARD PRECAUTIONS

Standard Precautions A standard of care designed to protect health-care providers and patients from pathogens that can spread by blood and other body fluids ALL BLOOD AND BODY FLUIDS ARE CONSIDERED TO BE INFECTIOUS

Apply these standard precautions to all patients

Integrate and expand these precautions to include organisms spread by blood and also: Body fluids, secretions, and excretions whether or not they contain blood Non-intact (broken) skin Mucous membranes
9

10

PPE

Consider all patients as infectious Wear personal protective equipment Gowns Gloves Masks Protective Eyewear

Should be removed when leaving treatment areas

11

GOWNS

Gowns/ white coats should cover operators clothes and protect them from splashes and aerosols
High

neck Long sleeves Knee long

Design!!! Reduce folds, pockets and any other areas that facilitates accumulation of soil or areoles. Change if visibly soiled
12

GLOVES

Minimize the risk of operators acquiring infections from patients Prevent microbial flora from being transmitted from operators to patients

Reduce contamination of OUR hands by microbial flora that can be transmitted from one patient to another
Are not a substitute for hand washing!
13

GLOVES

Disposable latex, vinyl, or nitrile gloves should be used in non-surgical procedures

Sterile disposable gloves should be used in all surgical procedures

14

UTILITY GLOVES

Heavy-duty utility gloves after patient treatment

Must

be washed with antimicrobial soap, rinsed and dried in plastic bag in

15

Stored

locker

RECOMMENDATIONS FOR GLOVING

Wear gloves when contact with blood, saliva, and mucous membranes is possible
Remove gloves after patient care Wear a new pair of gloves for each patient

16

RECOMMENDATIONS FOR GLOVING

Remove gloves that are torn, cut or punctured

Do not wash, disinfect or sterilize gloves for reuse

17

MASKS
Masks to protect: Face Oral and nasal mucosa Must be changed if they become damp Must be changed for each new patient, except for short exams If a face shield is worn it must be worn at the same time as a surgical mask.

18

PROTECTIVE EYEWEAR

Must be worn to protect from aerosol and spatter Regular eyewear must have side shields

Side shields must be securely attached to the eyewear frame abutting the lenses and free of vents or openings
19

SHARPS

Used needles, blades, burs, endo files and reamers, anesthetic cartridges and all other sharps are to be discarded in sharps containers

20

SHARPS

Recap anesthetic needles by using the needle recapper Use the one handed scoop technique to recap if a recapper is not available

21

FOOD AND DRINKS

Eating

and drinking prohibited in all clinical areas

22

Injury and accident reporting

Institution regulations!

23

HEPATITIS B VACCINATION

All health care workers must have vaccination Any one here who is not immunized?

24

HAND HYGIENE: DEFINITIONS

Washing hands with plain soap and water Antiseptic hand-wash - Washing hands with water and soap or other detergents containing an antiseptic agent

Alcohol-based hand-rub Rubbing hands with an alcohol-containing preparation

Surgical antisepsis Hand-washing with an antiseptic soap or an alcohol-based hand-rub before operations by surgical personnel

25

Efficacy of Hand Hygiene Preparations in Reduction of Bacteria

Good Better

Best

Plain Soap

Antimicrobial soap

Alcohol-based handrub

http://www.cdc.gov/handhygiene/materials.htm

26

WHY IS HAND HYGIENE IMPORTANT?

Hands are the most common mode of pathogen transmission Reduce spread of antimicrobial resistance Prevent health care-associated infections

27

SPECIAL HAND HYGIENE CONSIDERATIONS

Fingernails must be short in order to prevent collections of microbes and tears in gloves. Colored nail polish is prohibited it may obscure soil under the nails. False fingernails are prohibited.

28

SPECIAL HAND HYGIENE CONSIDERATIONS

Use hand lotions to prevent skin dryness Consider compatibility of hand care products with gloves (e.g., mineral oils and petroleum bases may cause early glove failure) Avoid hand jewelry that may tear gloves

29

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)
30

HAND HYGIENE

Taps with sensors or foot control to avoid hand contact

31

ALCOHOL-BASED PREPARATIONS Benefits

Rapid and effective antimicrobial action Improved skin condition More accessible than sinks

Limitations
Cannot be used if hands are visibly soiled Store away from high temperatures or flames Hand softeners and glove powders may build-up
32

HAIR

Hair should be short and well-managed.

Long hair should be pulled back or completely covered with a surgical cap to minimize the possibility of contamination.

33

HOUSEKEEPING
Worksite

must be maintained in a clean and sanitary condition and work surfaces must be cleaned and decontaminated after contact with blood and other infectious materials

Equipment

Protective

coverings must be used to cover equipment and work surfaces

34

HOUSEKEEPING SURFACES

35

CLEANING CLINICAL CONTACT SURFACES

Risk of transmitting infections greater than for housekeeping surfaces Clean and disinfect surfaces Apply barriers

36

CLINICAL CONTACT SURFACES

37

SURFACE COVERS

Handles, handpieces or similar surfaces that may be contaminated by blood or saliva - wrap with clear plastic wrap. Head rest cover

38

CATEGORIES OF ENVIRONMENTAL SURFACES

Clinical contact surfaces High potential for direct contamination from spray or spatter or by contact with gloved hand Housekeeping surfaces Do not come into contact with patients or devices Limited risk of disease transmission
39

GENERAL CLEANING RECOMMENDATIONS

Use barrier precautions (e.g. heavy-duty utility gloves, masks, protective eyewear) when cleaning and disinfecting environmental surfaces

Physical removal of microorganisms by cleaning is as important as the disinfection process

Do not use sterilant/high-level disinfectants on environmental surfaces

40

Cleaning Clinical Contact Surfaces

Risk of transmitting infections greater than for housekeeping surfaces Surface barriers can be used and changed between patients OR Clean then disinfect with hospital disinfectant

41

Cleaning Housekeeping Surfaces

Routinely clean with soap and water or hospital disinfectant routinely Clean mops and cloths and allow to dry thoroughly before re-using Prepare fresh cleaning and disinfecting solutions daily and per manufacturer recommendations
42

WASTE DISPOSAL

Regular house waste Contaminated medical waste

Sharps
Human tissues
43

44

PREVENTION OF INJURIES

Remove burs from handpiece immediately after completion of dental procedure Recap anesthetic needles

45

PREVENTION OF INJURIES

Restrict use of fingers in tissue retraction or palpation during suturing or administration of anesthesia

Avoid uncontrolled movements of dental instruments. THINK BEFORE MOVING AN INSTRUMENT.

46

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
47

Blood-borne Pathogens

48

Preventing Transmission of Bloodborne Pathogens

Blood-borne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) Are transmissible in health-care settings

Can produce chronic infection

Are often carried by persons unaware of their infection
49

Factors Influencing Occupational Risk of Blood-borne Infection

Frequency of infection among patients

Risk of transmission after a blood exposure (i.e., type of virus)

Type and frequency of blood contact

50

Risk of Blood-borne Virus Transmission after Needle-stick

Source HBV
HBsAg+ and HBeAg+

Risk
22.0%-31.0% clinical hepatitis; 37%-62% serological evidence of HBV infection

HBsAg+ and HBeAg-

1.0%-6.0% clinical hepatitis; 23%-37% serological evidence of HBV infection

HCV HIV

1.8% (0%-7% range)

0.3% (0.2%-0.5% range)

51

Concentration of HBV in Body Fluids

High
Moderate
Low/Undetectable

Blood Serum Wound exudates

Semen Vaginal Fluid Saliva

Urine Feces Sweat Tears Breast Milk

52

Hepatitis B Vaccine
Vaccinate all DHCP who are at risk of exposure to blood Provide access to qualified health care professionals for administration and follow-up testing Test for anti-HBs 1 to 2 months after 3rd dose
53

Transmission of HIV from Infected Dentists to Patients

Only one documented case of HIV transmission from an infected dentist to patients No transmissions documented in the investigation of 63 HIV-infected HCP (including 33 dentists or dental students)

54

Infectious diseases
Viral Bacterial

Parasitic

55

Viral infections
HIV (AIDS) Hepatitis Viruses Papilloma viruses (HPV) Measles, Rubella, Mumps

56

 Hepatitis A, B, C, E, G, H Only vaccination against HBv is available!!

Protect Yourself!

57

 Herpes viruses Herpes simplex (HS type 1 & 2)

Varicella & zoster (human HV 3)

Epstein-Barr virus (human HV 4)

Infectious mononucleosis
Cytomegalovirus CMV (human HV 5)

58

AIDS

59

Bacterial Infections
Tuberculosis (TB) Legionnaires disease

Infected aerosols!
60

Tuberculosis
The bacteria are carried in airborne infective droplets
Generated when persons with pulmonary TB sneeze, cough, speak or sing Infective particles can stay suspended in the air for hours
61

Assessing Patient Risk for Tuberculosis

Routinely ask all patients whether they have a history of TB disease whether they have symptoms suggestive of TB
62

Symptoms of Tuberculosis
Cough

Chest pain
Coughing up blood

Weakness
Fever and/or night sweats Weight loss
63

Patients With History or Symptoms of Undiagnosed TB

Should be referred promptly for medical evaluation of possible infection Should not remain in the dental facility any longer than required to arrange a referral Should wear surgical mask while in the dental facility
64

Patients With History of or Symptoms of Undiagnosed TB

Should have elective dental treatment deferred until a physician confirms that the patient does not have infectious TB If diagnosed as having active TB, elective dental treatment should be deferred until no longer infectious. Should have urgent dental care provided in areas that can provide TB isolation.

65

Transmission of Mycobacterium tuberculosis

Spread by droplet nuclei Immune system usually prevents spread Bacteria can remain alive in the lungs for many years (latent TB infection)

66

Risk of TB Transmission in Dentistry

Risk in dental settings is low Only one documented case of transmission Tuberculin skin test conversions among DHP are rare

67

Preventing Transmission of TB in Dental Settings

Assess patients for history of TB

Defer elective dental treatment

If patient must be treated: DHCP should wear face mask Separate patient from others/ mask/ tissue

Refer to facility with proper TB infection control precautions

68

69