Infection Control-Ch 19/COMPLETE

Chain of Infection

Infectious agent

Reservoir

Portal of exit

Mode of transmission

Portal of entry

Susceptible host

What is an infectious agent?

It is a pathogen (a microorganism that causes disease), these pathogens can be/are bacteria, virus, fungus, parasite, prion. They must be virulent to cause a serious disease.

what is a reservoir?

a place where the pathogen can live and reproduce. these places can be in a human, animal, food, water, bioburden (the total number of live microorganisms present on or in a product, such as a medical device or pharmaceutical, before it is sterilized), contaminated surfaces.

what is portal of entry?

The route in which how a pathogen enters into a body. ways of entry can be through being airborne, blood-borne, contact with mucous membranes, or breaks in the skin.

What is a susceptible host?

A person who is at risk of infection due to factors such as weakened immune systems, age, underlying health conditions, chronically fatigued, or under extreme stress. Susceptible hosts are more likely to become infected when exposed to pathogens.

What is mode of transmission?

The way in which a pathogen is spread from one host to another. This includes direct contact, droplets, airborne particles, or vectors such as insects.

what is portal of exit?

The route by which a pathogen leaves the host body, such as through respiratory secretions, blood, or other bodily fluids. This exit is essential for the spread of infection to new hosts.

Types of infection

Acute infection: Symptoms are often quite severe and appear soon after the initial infection occurs

Chronic infection: present for a long period

Latent infection: Persistent infection in which symptoms come and go (e.g., cold sores)

Opportunistic infection: Caused by normally nonpathogenic organisms; occurs in individuals whose resistance is decreased or compromised

Modes of disease transmission

Direct transmission: Direct contact with the infectious lesion or infected body fluids (e.g., blood, saliva, semen, vaginal secretions)

Indirect transmission: Transfer of organisms to a susceptible person through, for example, the handling of contaminated instruments or touching of contaminated surfaces and then touching the face, eyes, or mouth

Airborne transmission: Known as droplet infection, involves spread of disease through droplets of moisture containing bacteria or viruses

Aerosols, sprays, and spatter: Contain saliva, blood, and microorganisms and are created with the use of the high-speed handpiece, air-water syringe, and ultrasonic scaler during dental procedures

Mists: Droplet particles larger than those in aerosol spray

Spatter: Large droplet particles contaminated with blood, saliva, and other debris

Happens during a dental procedure when the mucosa (mouth or eyes) or nonintact skin is splashed with blood or blood-contaminated saliva

Other modes of transmission

Parenteral transmission: Needle stick injuries, human bites, cuts, abrasions, or any break in the skin

Blood-borne transmission: Involves direct or indirect contact with blood and other body fluids

Food and water transmission: Contaminated food not cooked or refrigerated properly or water that has been contaminated with human or animal fecal material is consumed

Fecal-oral transmission: NOT handwashing after use of the toilet

The different types of immunity

Communicable disease: is one that can be transmitted from one person to another or by contact with the body fluids from another person

Inherited immunity: is present at birth

Acquired immunity: is developed over a person’s lifetime

Naturally acquired immunity: occurs when a person has contracted and is recovering from a disease

Active immunity: body fighting infection, forms antibodies

Passive immunity: fetus receives antibodies

Artificially acquired immunity: Example: Hep B vaccination, your body will develop antibodies through exposure to a vaccine.

Disease transmission in the dental office

Patient to dental team

Dental team to patient

Patient to patient

Dental office to community (including dental team’s family)

Community to dental office to patient

Disease transmission in the dental office: patient to dental team. Explain how it occurs and what you can do to prevent it.

1. Direct contact: touch of the patient’s blood or saliva

2. Droplet infection occurs through mucosal surfaces of the eyes, nose, and mouth. It can occur when the dental-team member inhales aerosol generated by the dental handpiece or air-water syringe

3. indirect contact: touch a contaminated surface or instrument

Ways to prevent it is by using gloves, handwashing, masks, rubber dams, and patient mouth rinses

Disease transmission in the dental office: dental team to patient. Explain how it occurs and what you can do to prevent it.

1. Very unlikely to happen

2. Can result if the dental team member has lesions on the hands, or if the hands are cut while in the patient’s mouth, permitting the transfer of microorganisms

Infection control measures that help to prevent team-to-patient transmission include:

Masks

Gloves

Handwashing

Immunization

Disease transmission in the dental office: patient to patient. Explain how it occurs and what you can do to prevent it.

1. No cases documented in dentistry

2. Contamination from instruments used on one patient must be transferred to another patient

Infection control measures that can prevent patient-to-patient transmission include:

Instrument sterilization

Surface barriers

Handwashing

Gloves

Use of sterile instruments

Dental office to community, how can contamination be spread to the community?

1. Microorganisms can leave the dental office and enter the community in a variety of ways

• Contaminated impressions sent to the dental lab

• Contaminated equipment sent out for repair

• Transportation of microorganisms out of the office on the dental team’s clothing or hair

  2. The following measures can prevent this type of disease transmission:

• Handwashing

• Changing clothes before leaving the office

• Disinfecting impressions and contaminated equipment before such items leave the office

Community to dental office to patient. how can the contamination be spread?

Microorganisms enter the dental office through the municipal water that supplies the dental unit

• Waterborne organisms colonize the inside of the dental unit waterlines and form biofilm

• As water flows through the handpiece, air-water syringe, and ultrasonic scaler, a patient could swallow contaminated water

The role and responsibility of the CDC and OSHA in infection control

Federal agencies that play important roles in infection control for dentistry:

• The Centers for Disease Control and Prevention (CDC)

• The Occupational Safety and Health Administration (OSHA)

The CDC is not a regulatory agency, it establishes a standard of care for the dental profession

OSHA is a regulatory agency, it protect the health of employees. As a dental assistant, it is imperative to follow all of OSHA’s guidelines and recommendations

CDC ranks of evidence 

Category IA

Category IB

Category IC

Category II

Unresolved issue

OSHA Blood-Borne Pathogens Standard (BBP)

The most important infection control law in dentistry!

Designed to protect employees against occupational exposure to blood-borne pathogens, such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV)

Employers are required to protect their employees from exposure to blood and other potentially infectious materials (OPIM) in the workplace and to provide proper care to the employee if an exposure should occur

The BBP applies to any type of facility in which employees might be exposed to blood and/or other body fluids, which include:

Dental and medical offices

Hospitals

Funeral homes

Emergency medical services

Nursing homes

OSHA requires that a copy of the BBP be present in every dental office and clinic

Standard and Universal Precautions

Universal Precautions are based on the concept that all human blood and body fluids (including saliva) are to be treated as if known to be infected with one of the blood-borne diseases, HBV, HCV, or HIV

The CDC expanded the concept and changed the term to Standard Precautions

Standard Precautions apply to contact with

blood,

all body fluids,

non intact skin

mucous membranes

Hepatitis B Immunization

OSHA requires the dentist to offer the hepatitis B virus (HBV) vaccination series to all employees whose jobs include category I and II tasks

Vaccine must be offered within 10 days of employment

The dentist/employer must obtain proof from the physician who administered the vaccination

Employees have the right to refuse the HBV vaccine; however, they must sign an informed refusal form that is kept on file in the office

The vaccine is administered in a series of three injections

Most common vaccination schedule is 0, 1, and 6 months

The preferred injection site is in the deltoid muscle (on the arm)

Postvaccine Testing

Between 1 to 2 months after the series has been completed, a blood test should be performed to ensure that the individual has developed immunity.

Employee Medical Records

The dentist/employer must keep a confidential medical record for each employee

These records are confidential and must be stored in a locked file

The employer must keep these records for 30 years

Preventing Needle Sticks

Never recap used needles by using both hands or any other technique that involves directing the point of a needle toward any part of the body

Always use the single-handed scoop technique or some type of safety device

Hand Hygiene: Handwashing Guidelines

Wash your hands each time before you put on gloves and immediately after you remove gloves

Wash your hands when you inadvertently touch contaminated objects or surfaces while barehanded

Always use liquid soap during handwashing

Bar soap should never be used because it may transmit contamination

For most routine dental procedures, such as examinations and nonsurgical procedures, an antimicrobial soap can be used

For surgical procedures, you should use a germicidal surgical scrub product

Dry hands well before donning gloves

Personal Protective Equipment (PPE)

OSHA requires the employer to provide employees with the appropriate PPE without charge to the employee

Examples of PPE

Protective clothing

Surgical masks

Face shields

Protective eyewear

Disposable patient-treatment gloves

Heavy-duty utility gloves

Handling Contaminated Laundry

Protective clothing may be laundered in the office

Contaminated linens that are removed from the office for laundering should be placed in a leakproof bag with a biohazard label or an appropriately color-coded label

Guidelines for the Use of Gloves

All gloves used in patient care are a single use

These gloves may not be washed, disinfected, or sterilized; however, they may be rinsed with water to remove excess powder

Latex, vinyl, or other disposable medical-quality gloves may be used for patient examinations and dental procedures

Torn or damaged gloves must be replaced immediately

Do not wear jewelry under gloves

Change gloves frequently

Remove contaminated gloves before leaving the chairside during patient care and replace them with new gloves before returning to patient care

Hands must be washed after glove removal and before regloving

Overgloves

Also known as food handler gloves; are made of lightweight, inexpensive clear plastic

These may be worn over contaminated treatment gloves (overgloving) to prevent the contamination of clean objects handled during treatment

Guidelines for Use of Overgloves

Overgloves are not acceptable alone as a hand barrier or for intraoral procedures

Overgloves must be worn carefully to avoid contamination during handling with contaminated procedure gloves

Overgloves are donned before the secondary procedure is performed and removed before the patient treatment that was in progress is resumed

Overgloves are discarded after a single use

Sterile Surgical Gloves

Sterile gloves should be worn for invasive procedures involving the cutting of bone or significant amounts of blood or saliva, such as oral surgery or periodontal treatment

Provided in Prepackage form

Utility Gloves

Utility gloves are not used for direct patient care

Utility gloves must be worn:

• When the treatment room is being cleaned and disinfected between patients

• While contaminated instruments are being cleaned or handled

• For surface cleaning and disinfection

Utility gloves may be washed, disinfected, or sterilized and reused

Used utility gloves must be considered contaminated and handled appropriately until they have been properly disinfected or sterilized

Are utility gloves used when contaminated instruments are prepared for sterilization

yes

Maintaining Infection Control While Gloved

During a dental procedure, it may be necessary to touch surfaces or objects such as drawer handles and material containers

If you touch these objects with a gloved hand, both the surface and glove become contaminated

To minimize the possibility of cross-contamination, use an overglove when it is necessary to touch a surface

Computer keyboard with a smooth surface allows for effective cleaning and disinfection, yes or no

Yes

are disposable sleeve used for high-tech devices like the ipad or remotes

Yes

what is irritant dermitits?

A skin condition caused by contact with irritants, leading to inflammation, redness, and discomfort. It can occur from exposure to chemicals, soaps, or materials without proper protection.

Type IV (4) Allergic Reaction

The most common type of latex allergy

Is a delayed contact reaction and involves the immune system

• It may take as long as 48 or 72 hours for the red, itchy rash to appear

• Reactions are limited to the areas of contact and do not involve the entire body. Caused by chemicals the permeate the gloves irritating the skin.

• An immune response is produced by the chemicals that are used to process the latex used in manufacturing the gloves, not by the proteins in the latex

Type I Allergic Reaction

Most serious type of latex allergy; can result in death

Anaphylaxis is the most severe form of immediate allergy reaction, death can result from closure of the airway caused by swelling

Waste Management in the Dental Office

Dental practices are subject to a wide variety of federal, state, and local regulations concerning waste management issues

The Environmental Protection Agency (EPA):

1. Do not categorize saliva or saliva soaked items as infectious was.1

2. CDC guidelines and OSHA regulations consider saliva in dentistry a potentially infectious body fluid

Classification of Waste

1. General waste

• All nonhazardous, nonregulated waste should be discarded in covered containers

• Examples include disposable paper towels, paper mixing pads, and empty food container

2. Contaminated waste

• Waste that has had contact with blood or other body fluids

• Examples include used barriers and patient napkins

3. Hazardous waste

• Poses a risk to human beings and the environment

• Toxic chemicals and materials are hazardous waste

• Examples include scrap amalgam, spent fixer solution, and lead foil from x-ray film packets

4. Infectious or regulated waste (biohazard)

• Contaminated waste that is capable of transmitting an infectious disease

• Some items like extracted teeth with amalgam restoration may be both hazardous waste (because of the amalgam) and infectious waste (because of the blood)

Most dental offices are exposed to the following types of infectious waste:

• Blood and blood-soaked materials

• Pathologic waste

• Sharps

Additional Infection Control Practices

OSHA Blood-Borne Pathogens Standard

• Never eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in any area of the dental office where contamination is possible, such as the dental treatment rooms, dental laboratory, sterilization area, or the area for the processing of x-rays

• Never store food or drink in a refrigerator that contains any potentially contaminated items

You can minimize the amount of splash and spatter contamination produced during dental procedures with the skillful use of a dental dam and high-volume evacuation

CDC Guidelines: Special Considerations

Saliva ejectors

Do not advise patients to close their lips tightly around the tip of the saliva ejector to evacuate oral fluids

Many patients have become accustomed to closing their lips around the suction

CDC Guidelines: Preprocedural Mouth Rinses

Intended to reduce the number of microorganisms released in the form of aerosol or spatter

Can decrease the number of microorganisms introduced into the patient’s bloodstream during invasive dental procedures

CDC Guidelines: Mycobacterium tuberculosis (TB)

For patients with known or suspected active TB, the CDC recommends that elective dental treatment be delayed until the patient is noninfectious