5 Infection Control: Transmissible Diseases

Not covering the tables on sl. 19, sl. 22, table 5-2 mentioned on sl. 25, 9 major types of herpes on sl. 31,

A standard of care to protect healthcare providers and their patients from pathogens spread by body fluids

Standard Precautions

Who does Standard Precautions apply too?

All patients

You can contract a diease through all expect what?

sweat

Respiratory or mucous membrane contact transmitted through airborne droplets

Droplet precautions

Direct skin or indirect contact

Contact precautions

Droplet nuclei - special air handling and ventilation required

Airborne precautions

Percutaneous sharps injury

Sharps precautions

The oral cavity is sterile when?

in utero

What is the origin of microorganisms in the oral cavity?

• Transmission from family/caretakers

• Continuing Introduction

Where does salivary bacteria come from?

dorsum side of tongue (bottom), mucous membranes, gingival/periodontal tissues

Where are there high counts of microorganisms?

• dental biofilm

• periodontal pocket

What does Clostridium tetani and enteric bacteria fall under?

Dust Borne Organisms

What category does Large airborne particles from coughing, sneezing and talking fall under?

Dust Borne Organisms

• Biologic contaminants

• Solid or Liquid

• Invisible

• Remain suspended for long periods

Aerosols

• Heavier, larger particles

• Suspended for shorter amount of time

• Drop on objects, people. floor. Usually fall 2 feet from origin

• May be visible

• May come in direct contact with membranes of eyes, nose, and mouth

Spatter

How do aerosols and spatter travel?

With air currents

Aerosols and spatteer are produced by what procedures?

All intraoral procedures

Where are aerosols and spatter more concentrated?

Closest to site of instrument

What are the 4 ways to prevent transmission of airborne infection?

• Elimination and limitation of organisms at their source

• Interruption of transmission

• Protection of Potentially susceptible recipient

• Careful monitoring procedures for all patients

How do you remove biofilm?

Antiseptic/antimicrobial mouth rinse, swish for 30 seconds

Purpose of High Volume Evacuation

Interruption of Transmission

Purpose of Aerosol Mitigation System

Interruption of Transmission

Purpose of Air-control methods providing ventilation, filtration, relative humidity

Interruption of Transmission

What is the EPA? (Environmental Protection Agency)

They set the standards for drinking water

What are the standards for drinking water?

<500 CFU/ml of heterotrophic water bacteria

How long are you supposed to flush the waterlines between patients to obtain clean water?

20-30 seconds

What can help treat water to keep it clean

Chemical treatments

What can prevent back-flow it water lines?

Anti-retraction devices

How does one transmit Tuberculosis (Mycobacterium tuberculosis)

Inhalation

• aerosolized droplet nuclei

• Sputum/saliva

• coughing, sneezing, speaking

Are standard precautions sufficient to protect against transmission of Tuberculosis?

No, they may be insufficient

Can we treat those with Tuberculosis?

No, those suspected to have it must be referred for a medical consultation immediately.

What is Drug-resistant TB?

It means the patient is non-compliant and does not have medication

What is Drug-resistant TB

• Non-complience (not taking medication as often as needed)

• Patient doesn’t have medication

What is Multidrug-resistant TB?

Resistance to at least 2 of the first-line drugs

What is Extensively dug-resistant TB?

Resistance to first-line drugs & at least 1 of 3 second-line drugs

Where are people primarily infected when they have TB?

in lungs

If you are infected in the lymphnodes, meninges, kidneys, bones, skin, and oral cavity, what type of TB do you have"?

Extrapulmonary TB

What should you cover about TB with your patient?

Routinely question patients about TB history and symptoms

What happens if patients have symptoms of TB?

They are immediately referred for medical evaluation

When is urgent dental care provided for those with TB?

ONLY in a facility with an airborne isolation room

What is the main symptom/effect of Viral Hepatitis?

Inflammation of liver

How are all the forms of Viral Hepatitis transmitted?

Through infected body fluids entering someone else’s body through bloodstream

What 3 types of Viral Hepatitis are chronic, carrier state, and directly impacts dental hygiene?

HBV, HCV, and HDV

How is Hepatitis B Virus (HBV) transmitted?

Blood & other body fluids, including saliva

Can transmission of HBV occur from inanimate objects?

yes

Term for exposure through the skin, specifically cuts and wounds:

Percutaneous

Term for exposure through the mucous membrane:

Permucosal

What are some common modes of transmission for HBV?

• percutaneous and premucosal exposure

• exchanging contaminated needles, syringes, other intravenous drug paraphernalia

• sexual exposure

• blood transfusion

How can you prevent the transmission of HBV when it comes to Perinatal transmission?

• Screen all pregnant women for HBsAg

• Vaccinate infants born to infected mothers within 12 hours of birth

What can HBV lead to later in life?

acute & chronic hepatitis, cirrhosis, and liver cancer

is the HBV vacine required for DHCP?

yes

How else can you prevent the transmission of HBV?

• Immunization for adolescents and adults at high risk

• Enforce blood bank controls

• Enforce use of disposable needles and syringes

What is a vaccine for?

Acts to stimulate antibodies and convey immunity

How is HCV often transmitted?

• Primarily drug use

• Mucous membranes exposures to blood

• Sexual transmission can occur in HIV infected individuals

Is there significant risk for transmission of HCV in the healthcare setting?

No

Can people get vaccinated for Hepatitis C Virus (HCV)?

No, there is no vaccine available

In what ways can we prevent the transmission of HCV?

• Strict attention to standard infection control procedures

• Education and behavior modification

• Recommended testing

What is Hepatitis D Virus?

It has the delta agent

What’s significant about how this virus causes infections?

It cannot cause infection UNLESS HBV is present: Delta infection is superimposed on HBsAg carriers

How is HDV transmitted?

Through the blood:

• Sharing needles

• accidental needle sticks in healthcare

• blood transfusions

How can you prevent HDV?

Getting vaccinated for HBV

Key points on Human Herpes Virus:

• endemic worldwide

• Highly infectious

• Significant public health problem

• 9 major types

What tendencies does Herpes have when producing diseases?

They’re latent, recurrent, and sometimes have malignant tendencies (ability to worsen)

What patients often have more frequent and severe herpes infections

Those who are immunosuppressed

How does Herpes compare to HIV/AIDS?

One of the most opportunistic organisms

Where does Herpes virus travel in the body?

along sensory nerve pathways to specific ganglia where they become latent

What happens to those who are infected with Herpes virus who’s immune system becomes lowered?

Becomes reactivated to produce recurrent infection

Herpes that travels to trigeminal ganglia is known as:

HSV-1

Herpes that travels to thoracic, lumbar, & sacral dorsal root ganglia is known as:

HSV-2

Travels to sensory ganglia of the vagal, spinal, or cranial nerves

Varicella-Zoster Virus (VZV)