Management of Dental Hygiene Care: Clinic

What federal agency enforces workplace safety regulations, including infection control in healthcare settings?

OSHA

What is the main directive of OSHA?

Protection of employees

What is a key document in OSHA that impacts infection prevention & control in dentistry?

Bloodborne Pathogens Standard

What is the federal facility that develops infection-control guidelines for healthcare settings?

CDC (Centers for Diseases Control & Prevention)

What is a key document in CDC that impacts infection prevention & control in dentistry?

CDC Guidelines for Infection Control in Dental Healthcare Settings

What federal agency charged with the approval and oversight of the use and disposal of hazardous materials?

EPA (Environmental Protection Agency)

What does the EPA regulate?

medical and chemical waste

What key document in the EPA impacts prevention and control in dentistry?

Hospital antimicrobial disinfectant registrations

What is an agency in the US Department of Health and Human Services was established to help assure safe and healthful working conditions by providing research, information, education, and training in the field of occupational safety and health?

NIOSH (National Institute for Occupational Safety and Health)

What are the hierarchy of controls?

1. Elimination

2. Substitution

3. Engineering Controls

4. Administrative Controls

5. PPE

What is a dental membership association comprised of individual clinicians, group practices, educators, researchers, consultants, trainers, compliance directors, policymakers, and industry reps who advocate for the safe and infection-free delivery of oral healthcare?

OSAP and NOW CALLED ADS (Association for Dental Safety)

What agency regulates the manufacturing and labeling of medical devices such as: gloves, masks, sterilizers, ultrasonic cleaners, dental instruments, and protective eyewear?

FDA (Food and Drug Administration)

What is regulated waste?

Infectious waste that requires special handling, neutralization, and disposal

*sharps

*tissue and extracted teeth

*blood items

What is nonregulated waste?

waste that is generated, including all disposable items

*gloves

*saliva ejectors

*cups

What are the routes of diseases-organism transmission?

Direct and Indirect contact, droplets, airborne microorganisms (aerosol), fecal-oral transmission

What contact is mode of disease transmission requiring person-to-person body contact with blood, oral fluids, or other patient materials?

Direct contact

What contact is spread of disease agents through fomites (objects or surfaces)

*cuts or punctures with contaminated sharp objects

Indirect contact

What is an example of cuts or punctures with contaminated sharp objects and entrance through nonintact skin as a result of touching contaminated instruments, surfaces, or other items

Indirect objects

What are some conditions for disease-organism transmission?

-a pathogenic organism of sufficient virulence and in adequate numbers to cause disease

-a reservoir or source that allows the pathogen to survive & multiply

-a mode of transmission from the source to the

-host one who is not immune

Standard Precautions

The infection prevention and control practices by which healthcare personnel follow the same protocols for ALL patients, regardless of infectious status or health history

What do Standard Precautions apply to?

Blood

All body fluids, secretions and excretions except sweat & tears

Nonintact skin

Mucous membranes

PPE

Designed to protect the oral health care worker from exposure to bloodbone and other pathogens to the skin, clothing, eyes mouth, and other mucous membranes

what PPE incldues

eye and face protection

masks

protective clothing

gloves

What are level 1 masks?

lowest barrier performance; ideal for procedures where low amounts of fluid, spray, and/or aerosols are produced

What are level 2 masks?

idea for procedures where moderate to light amounts of fluid, spray, and/or aerosols are produced

What are level 3 masks?

highest barrier performance, ideal for procedures where heavy to moderate amounts of fluid, spray and/or aerosols are produced

What is an N95 mask for?

maximum filtration; indicated for use when treating patients with airborne diseases such as TB, Influenza, and COVID

What gloves are used when handling contaminated sharps to reduce risk of accidental puncture injury and provide greater protecting during the handling of disinfectants?

heavy-duty utility gloves

What are most medical examination gloves made of now?

nitrile rubber not latex

Purpose of PPE and Sequence

-minimize exposure to spatter, biological contaminants that are greater than 50 um in diameter may be visible

-minimize exposure to aerosol, invisible biologic contaminants less than 50 um in diameter

reduce direct contact

Sequence for donning

protective clothing, mask, eyewear, and then gloves

how often should you change your gloves

In between patients

medical examination gloves

provide little protection against sharps injuries

*What is the most important behavior in the prevention of disease transmission?*

hand hygiene

For routine dental procedures, wash hands with either plain or antimicrobial soap for how long?

20 seconds

after initial clense with hand washing what is acceptable when no visuble soil appears

alcohol based hand rub

What are agents used to destroy or inhibit the growth of microorganisms?

disinfectants

What are the levels of disinfectants?

-High (destroys all microorganisms, glutaraldehyde)

-Intermediate (destroys vegetative bacteria, most fungi and viruses TUBERCULOCIDAL, iodophors, phenolics)

-Low (destroys vegetative bacteria, NOT tuberculocidal, detergents)

What are some chemical disinfectants for surface disinfection?

-Chlorines

-Iodophors

-Synthetic phenolics

Dual or synergized quaternaries

how often should you change clinical barriers

In between patients

Housekeeping surfaces

floors, walls, and sinks less likely to transmit disease

clinical contact surfaces

Surfaces that become contaminated from spray or droplets of oral fluids or by touching with gloved hands during the procedure.

What are some qualities of an ideal disinfectant?

-broad spectrum

-fast acting

-does NOT have an offensive odor

-provides residual effect (substantivity)

What does the CDC not recommend for compouds as surface disinfectants

alcohol, household bleach, or early generation quaternary ammonium

What is the destruction or removal of all living organisms including highly resistant bacterial spores

sterilization

What ensures destruction of all organisms transferred to an item use on a patient before reuse of item on subdequent patient

sterilization process

What method of sterilization is used on 250 degrees for 15-30 minutes, economical and efficient, and can cause corrosion of non-stainless steel & dulling of instruments?

Steam Autoclave

What method of sterilization is 320 degrees for 1-2 hours, NO corrosion, but has a long exposure time and high heat for both types

Dry Heat

What method of sterilization is 270 degrees for 20 minutes, time efficient & decreased corrosion, and can cause a slight odor, damage to plastic, and must use special solutions?

Chemical Vapor

What are critical instruments?

instruments used to penetrate soft oral tissue or bone

*periodontal probes

*explorers

*scaling and root planning intruments

*surgical intruments

What are semi-critical instruments?

do not penetrate soft tissue or bone, but contact mucous membranes or nonintact skin

*mouth mirrors

*handpieces

*impression trays

*radiographic film holders

*oral photogrphy retractors

What are noncritical intruments?

contact intact skin

*BP cuff

*X-ray head

*light handles

*intrument tays

*countertops

sterilization must be heat sterilized between each use or discarded if disposable

critical

sterilization or high level disinfection (sterilize between each use)

Semi-critical

Low to intermediate level disinfection

Noncritical

What are items containing heat-sensitive chemicals that change color when exposed to certain temperatures to assess conditions during the sterilization process?

chemical indicators (autoclave tape)

what allows operators to determine the presence of certain necessary parameters such as heat or steam

Chemical indicators

*What are the highest level of sterility assurance?*

biologic indicators (BIs)

what are spore tests for verification of sterility

biologic indicators

What are commonly used BIs

Geobacillus stearothermophilus and Bacillus pumilus

Nonsurgical procedures water strandards

use systems that provide output treatment water that meets drinking water strandards

Surgical procedures drinking water standards

only sterile solutions such as coolants and irrigants in sn appropiate delivery device such as a sterile bulb syringe, sterlie tubing that bypasses dental unit waterlines or sterile single use devirs

*__________ CFU/mL of heterotrophic water bacteria* for nonsurgical procedures

Less than or equal to <500

Health history should include

Demographic information, vital signs, physical characteristics, social history, medical history, pharmacological, history, and chief complaint/concern

social history should include

tobacco use, alcohol consumption, and use of recreational drugs

Demographic information

patients name

address

telephone numbers

e-mail address

DOB

sex

Ethnicity

maritial status

occupation

patients current physician info (name, address, number, email info)

BMI Scale

Underweight

Less than 18.5

BMI Scale Normal

18.5-24.9

BMI Scale Overweight

25- 29.9

BMI Scale Obesity

greater than or equal to 30

What is the pulse range?

Tachycardia:

Bradycardia:

60-100 BPM

Tachy: > 100 BPM

Brady: < 60 BPM

What is the normal temperature range?

96.8-100.4 F

Pulse WNL

60-100 bpm

Pulse tachycardia

>100 bpm

Pulse braycardia

<60 bpm

What is blood pressure

Pressure that is exerted on the walls of the blood vessels

What is the top number on blood pressure called

systolic

what is the bottom number on blood pressure called

diastolic

What does systolic pressure measure

This number is measured during the heart's contraction phase, when the heart is pumping blood out into the body

What does diastolic pressure measure?

measures the pressure in your arteries when your heart is at rest between beats.

Normal BP

<120 mm Hg AND < 80 mm Hg

Elevated BP

120-129 mm Hg AND <80 mm Hg

Stage 1 Hypertension

130-139 mm Hg OR 80-89 mm Hg

Stage 2 Hypertension

equal to or greater than 140 OR greater than or equal to 90

Hypertensive urgency

>180 and/or > 120

Hypertensive emergency

>180 + target organ damage and/or >129 + target organ damage

Many of these patients are

noncompliant with antihypertensive therapy and do not have clinical or

laboratory evidence of new or

worsening target organ damage; reinstitute or intensify antihypertensive drug therapy, and treat anxiety as applicable

Hypertensive

Urgency

Admit patient to an intensive care unit for continuous monitoring of BP and

parenteral administration of an

organ damage

appropriate agent in those with new/progressive or worsening target organ damage (see tables 19 and 20 in the 2017 Hypertension Guideline)

Hypertensive

Emergency

Highlights of Nov. 2017 BP Guidelines

No prehypertension (now called elevated BP)

More hypertension patients because the definition of hypertension is lower (130/80)

Many in Stage 1 can be controlled with lifestyle modifications

Emphasis on CVD

BP lowering medication

What is the ASA?

American Society of Anesthesiologists

is Risk assessed even when anesthesia is not part of the planned treatment

Yes

A patient classified as ______ should not receive elective dental treatment

ASA IV or greater

Only palliative care is recommended for a patient with a

ASA V status

A patient classified as ASA ____ or greater should NOT receive elective dental treatment.

Only _________ care is recommended for a patient with an ASA V status.

IV

palliative

TX modifications for ASA 1

No modifications indicated

TX modifications for ASA 2

Medical consultation when indicated, possible sedative techniques, pain control

What ASA is a normal, healthy patient little or no dental anxiety

ASA I

TX modifications for ASA 3

Exercise caution, allow patient to rest, monitor patient closely, sedative techniques, pain control

TX modifications for ASA 4

Postpone elective dental care, treat emergency dental care in hospital setting

TX modifications for ASA 5

Palliative treatment for pain management only