Infection Control- Ch 20/COMPLETED

Environmental Infection Control

The Centers for Disease Control and Prevention (CDC) Guidelines for Infection Control in Dental Healthcare Settings—2003 divide environmental surfaces into clinical contact surfaces and housekeeping surfaces

Housekeeping surfaces include floors, walls, and sinks

Clinical Contact Surfaces

Contaminated either by spray or spatter generated during dental procedures or by contact with dental professional’s gloved hands

Infection control guidelines of the Office Safety and Asepsis Procedures Research Foundation (OSAP) recommend clinical surfaces be classified and maintained under three categories

• Touch

• Transfer

• Splash, spatter, and droplet

Touch surfaces are directly touched and contaminated during treatment procedures (Include handles of dental lights, controls of dental units, chair switches, etc)

Transfer surfaces are not directly touched but often are touched with contaminated instruments (Instrument trays and handpiece holders)

Splash, spatter, and droplet surfaces do not actually come into contact with the members of the dental team or the contaminated instruments or supplies (Countertops)

Surface Contamination

There are two methods of dealing with surface contamination

Surface barriers

Precleaning and disinfecting surfaces between patients

Surface Barriers

Wide variety of surface barriers available

Should be resistant to fluids to keep microorganisms in saliva, blood, or other liquids from soaking through to the surface underneath

Some plastic bags are designed in the shape of items such as the dental chair, air-water syringe, hoses, pens, and light handles

Plastic barrier tape is frequently used to protect smooth surfaces (e.g., touch pads on equipment, electrical switches on chairs, and x-ray equipment)

• Aluminum foil can easily be formed around any shape

Single-Use (Disposable) Items

Used only on one patient and then discarded, helps reduce the chance for patient-to-patient contamination

Single-use items are often made of plastic or less expensive metals, and they are not intended to withstand cleaning, disinfection, or sterilization

Never process (clean, disinfect/sterilize) single-use items for use on another patient

Contaminated disposable items that are not sharps and are not soaked or caked with blood may be discarded with the regular office trash

No need to discard these items in a medical waste or biohazard container

State and local regulations may vary, always consult the regulatory agency for your area

Precleaning and Disinfection

OSHA Blood-Borne Pathogens Standard requires that contaminated work surfaces be disinfected between patient visits

Precleaning

Precleaning means to clean before disinfecting

All contaminated surfaces must be precleaned before they can be disinfected

Even if there is no visible blood on a surface, it must be precleaned because even a thin layer of saliva on the surface can decrease the effectiveness of the disinfectant

Precleaning reduces the number of microbes and removes blood and saliva (also called bioburden)

Precleaning is:

Effective when used on contaminated surfaces that are smooth and easily accessible for cleaning

Always wear utility gloves, mask, protective eyewear, and protective clothing when precleaning and disinfecting

Regular soap and water may be used to preclean, but it is more efficient to select a disinfectant that can be used to clean as well as disinfect

Disinfection

Disinfection: Kill disease-producing microorganisms that remain on the surface after precleaning

Spores are not killed during disinfecting procedures

Do not confuse disinfection with sterilization

Sterilization: is a process in which all forms of life are destroyed

Disinfectants

Chemicals that are applied to inanimate surfaces (e.g., countertops and dental equipment)

Antiseptics are antimicrobial agents that are applied to living tissue

Disinfectants and antiseptics should never be used interchangeably because tissue toxicity and damage to equipment can result

Disinfectants are chemicals that destroy or inactivate most species of pathogenic (disease-causing) microorganisms

In dentistry, only those products that are EPA-registered hospital disinfectants with tuberculocidal (kills the tuberculosis bacteria) claims should be used to disinfect dental treatment areas

Mycobacterium tuberculosis is highly resistant to disinfectants, and if a disinfectant will inactivate M. tuberculosis it will inactivate the less resistant microbial families (e.g., bacteria, viruses, and most fungi) on the treated surface

Ideal Surface Disinfectant

An ideal surface disinfectant would:

• Rapidly kill a broad spectrum of bacteria

• Have residual activity and minimal toxicity

• Not damage the surfaces to be treated

• Be odorless and inexpensive

• Work on surfaces with remaining bioburden

• Be simple to use

No single disinfectant product on the market today meets all these criteria

When selecting a surface disinfectant, you must carefully consider the advantages and disadvantages of various products

Disinfectant Precautions

Follow manufacturers’ recommendations for:

• Mixing and diluting

• Application technique

• Shelf life

• Activated use life

• All safety warnings

Iodophors

EPA-registered intermediate-level hospital disinfectants with tuberculocidal action

Because iodophors contain iodine, they may corrode or discolor certain metals and may temporarily cause reddish or yellow stains on clothing and other surfaces

Synthetic Phenol Compounds

EPA-registered intermediate-level hospital disinfectants with broad-spectrum disinfecting action

Phenols can be used on metal, glass, rubber, or plastic

Used as a holding solution for instruments; however, phenols leave a residual film on treated surfaces

Synthetic phenol compound is prepared daily

Sodium Hypochlorite

Sodium hypochlorite (household bleach) is a fast-acting, economical, and broad-spectrum intermediate-level disinfectant (1:100 dilution for surface decontamination)

• Bleach solution is unstable, must be prepared daily, has a strong odor, and is corrosive to some metals, destructive to fabrics, and irritating to the eyes and skin; it may eventually cause plastic chair covers to crack

Alcohol

Alcohols are not effective in the presence of blood and saliva

Evaporate quickly and are damaging to certain materials such as plastics and vinyl

Not recommended as a surface disinfectant by several agencies

Immersion Disinfectants

Some chemicals on the market can be used for sterilization or high-level disinfection

When used as sterilant, they destroy all microbial life, including bacterial endospores

Depending on the type, time for sterilization can range from 6 hours to 30 hours

At weaker dilutions or with shorter contact time, these chemicals provide high-level disinfection, inactivating all microorganisms except endospores

Most of these chemicals are toxic and can irritate the eyes, skin, and lungs

PPE must be worn when these chemicals are used

Glutaraldehyde

Classified as a high-level disinfectant/sterilant; can also be used as a liquid sterilant when immersion time is greatly increased

Useful for plastics and other items that cannot withstand heat sterilization

Very toxic; should be handled carefully to avoid the fumes

Glutaraldehyde-treated instruments should never be used on patients without first being thoroughly rinsed with water

Prolonged contact of certain types of instruments with glutaraldehyde solutions can lead to discoloration and corrosion of the instruments’ surfaces and cutting edges

Chlorine Dioxide

Chlorine dioxide is an effective, rapid-acting environmental surface disinfectant (3 minutes) or chemical sterilant (6 hours)

Chlorine dioxide does not readily penetrate organic debris and must be used with a separate cleaner

Chlorine dioxide must be prepared fresh daily, it must be used with good ventilation, and it is corrosive to aluminum containers

Ortho-Phthalaldehyde

Classified as a high-level disinfectant

OPA is effective in achieving high-level disinfection within 12 minutes at room temperature

More expensive than glutaraldehydes but may be a good alternative for individuals with a sensitivity to glutaraldehydes

It has very little odor and does not require activation or mixing

Ortho-Phthalaldehyde Disadvantages

Costly

Used only half as long as most glutaraldehydes in dentistry

May stain skin and fabrics

Plastics turn a blue-green color where proteins have not been removed

Would require more than 30 hours to secure sterilization

Evacuator System

High-volume evacuation reduces the risk of saliva escaping from patients’ mouths

Regular cleanings help tubes and pipes flow easier

• Clean by flushing with detergent or water

Periodically clean the traps

Housekeeping Surfaces

Floors, walls, and sinks) do not pose a risk for disease transmission in dental healthcare settings

Housekeeping surfaces need to be cleaned only with a detergent and water or an EPA-registered hospital disinfectant/detergent

Make fresh cleaning solution each day; discard any remaining solution and let the container dry to minimize bacterial contamination

Carpeting and Cloth Furnishings

Carpeting is more difficult to clean than is nonporous hard-surface flooring, and it cannot be reliably disinfected, especially after contamination with blood and other body substances

Studies have documented the presence of bacteria and fungi in carpeting

CDC guideline: Avoid using carpeting and cloth-upholstered furnishings in dental operatories, laboratories, and instrument processing areas

Spills of Blood and Body Substances

Most of the blood contamination in dentistry results from spatter and the use of rotary or ultrasonic instruments

No scientific evidence shows that HIV, HBV, or HCV has been transmitted from a housekeeping surface

OSHA requires that blood spills and other body fluids be removed, and the surfaces disinfected

CDC guideline: Clean spills of blood or other potentially infectious materials and decontaminate the surface with an EPA-registered hospital disinfectant with low-level to intermediate activity, depending on the size of the spill and the surface porosity

Greener Infection Control

Protecting the environment has become an important part of our personal lives and in our homes

• That responsibility extends to the provision of dental care

Many of the infection control products and procedures we must use to protect our patients and ourselves have a negative impact on the environment

Use disinfectant wipes instead of spraying disinfectants could reduce the amount of chemicals in the air

Going greener requires thoughtful planning, research, and experimentation

Paper

• Digital patient records could have a significant impact on the amount of paper that is used

Radiology

• Digital radiology is rapidly becoming state-of-the-art

Personal protective attire

• Protective barriers present a challenge in the attempt to go greener

Surface barriers and precleaning/disinfection

• Involves the use of chemicals and PPE