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Infection Control Regulation
OSHA-The U.S. Occupational Safety and Health Administration
OSAP-Organization for Safety, Asepsis, and Prevention
CDC-The U.S Centers for Disease Control and Prevention
Employees in healthcare must have annual OSHA training
OSHA
The U.S. Occupational Safety and Health Administration
OSAP
Organization for Safety, Asepsis, and Prevention
CDC
The U.S Centers for Disease Control and Prevention
Chain of Infection
Mode of Transmission → Chain of Transmission → Exposures/Risk of Infection → Definitions
Mode of Transmission
Direct contact- contact with infected person’s blood/fluid
Indirect contact- contact with contaminated objects, droplets in air, or insects
Bloodborne-contact with infected blood/body fluids
Airborne- inhaled pathogenic droplets in air
Vector -insect bite from insect carrying pathogen
Direct contact
contact with infected person’s blood/fluid
Indirect contact
contact with contaminated objects, droplets in air, or insects
Bloodborne
contact with infected blood/body fluids
Airborne
inhaled pathogenic droplets in air
Vector
insect bite from insect carrying pathogen
Chain of transmission
Reservoir (infected person, animal, food, plant, soil, water, or dust)
Infectious pathogen exits reservoir
Transmission of pathogen through one of the above modes of transmission
Susceptible Host (entry portal through open wounds or mucous membranes)
Chain of transmission #1
Reservoir (infected person, animal, food, plant, soil, water, or dust)
Chain of transmission #2
Infectious pathogen exits reservoir
Chain of transmission #3
Transmission of pathogen through one of the above modes of transmission
Chain of transmission #4
Susceptible Host (entry portal through open wounds or mucous membranes)
Exposures/Risk of infection
Dependent on host (age, immunization status, immune status)
Dependent on # of pathogens present
Dependent on type of exposure/injury
Nosocomial infection- infection acquired in hospital setting
Definitions: Universal precautions
Safety guidelines in which ALL blood and OPIMs (other potentially infectious material) are handled as if they are infected with disease
Definitions: Standard of care
level of care that is competent in treatment of ALL patients at ALL times whether they have disease or not
Definitions: continued
Assume that every bodily fluid is infected with bloodborne pathogens
Bloodbourne pathogens
bacteria, virus, fungus, or parasites transmitted through blood or OPIMs
Hepatitis B,C, and HIV/AIDS
Hepatitis B
Inflammation of the liver caused by hepatitis B virus
Transmitted through blood, sexual activity, or perinatal
Can lead to liver damage, liver cirrhosis, & liver cancer
Vaccination available
How is hepatitis B transmitted?
Transmitted through blood, sexual activity, or perinatal
What can hepatitis B lead to?
Can lead to liver damage, liver cirrhosis, & liver cancer
Is there a vaccine available for hepatitis B?
Yes
Hepatitis C
Inflammation of the liver caused by hepatitis C virus
Transmitted through contaminated needles
Can lead to liver damage, liver cirrhosis, & liver failure
NO vaccine available
How is hepatitis C transmitted?
Transmitted through contaminated needles
What can hepatitis C lead to?
Can lead to liver damage, liver cirrhosis, & liver failure
Is there a vaccine available for hepatitis C?
NO vaccine available
HIV/AIDS
HIV- Human Immunodeficiency Virus
AIDS- Acquired Immunodeficiency Syndrome
Fatal disease where cells that are essential for immune function are damaged
Transmitted through blood, sexual activity, and perinatal
No vaccine, no cure, but there are treatments and prevention meds available
HIV
Human Immunodeficiency Virus
AIDS
Acquired Immunodeficiency Syndrome
How is HIV/AIDS transmitted?
Transmitted through blood, sexual activity, and perinatal
What can HIV/AIDS lead to?
Fatal disease where cells that are essential for immune function are damaged
Is there a vaccine available for HIV/AIDS?
No vaccine, no cure, but there are treatments and prevention meds available
Airborne pathogens
Bacteria, virus, or fungus transmitted through air droplets
Tuberculosis, influenza, and COVID-19
Tuberculosis
Disease that primarily affects the lungs
Caused by mycobacterium tuberculosis
Spreads through air droplets from infected person coughing, sneezing, etc.
Can live up to 1.5 hours outside body
5-10% of people infected develop the disease
Infection vs. disease
Infection-latent & not contagious; no symptoms
Disease- active disease & very contagious; symptoms present
TB test- fluid is injected under skin & is rechecked in 2-3 days to reveal if a person is infected
Positive TB tests cannot determine if person has latent infection or developed disease; patient must have a chest x-ray to confirm
What causes tuberculosis and how is it spread?
Caused by mycobacterium tuberculosis
Spreads through air droplets from infected person coughing, sneezing, etc.
How long can tuberculosis live outside the body?
1.5 hours outside the body
Infection
latent & not contagious; no symptoms
Disease
active disease & very contagious; symptoms present
TB test
Fluid is injected under skin & is rechecked in 2-3 days to reveal if a person is infected
Positive TB tests
cannot determine if person has latent infection or developed disease; patient must have a chest x-ray to confirm
Influenza and COVID-19
Viral infection that affects the respiratory tract
Infection control includes
Hand hygiene
Decontamination
Sterilization
Environmental Infection control
Engineering controls
Dental unit water lines
Dental handpieces
Pre-procedural rinsing
Waste handling and disposal
Handling needles/Needlestick protocol
Work-area restrictions
PPE (Personal Protective equipment)
Hand Hygiene
The most important way to reduce risk of disease transmission
Handwashing should be performed when hands are visibly contaminated, before/after patient contact, before/after glove use, and after using restroom
Decontamination
Removes, inactivates or destroys bloodborne pathogens on surfaces
Sterilization
Destroys ALL microbial life on items that are placed in the patient’s mouth
Environmental infection control
Intermediate level disinfectants should be used on surfaces directly contaminated
Intermediate level disinfectants are tuberculocidal and have HIV/HBV kill claims
Low level disinfectants only have HIV/HBV kill claims
Engineering control
Sharps waste, biohazardous labels, handwashing/eye stations, needle shields
Dental unit water lines
Biofilm lives in water lines; safe level is less than 500 CFU/mL
Flush lines 2 min at beginning of day and after each patient 20-30 seconds
Clean suction lines each day
Dental handpieces
Can retract oral fluids into internal compartments
Must run water lines & air for 2 min at beginning of each day & 20-30 seconds between patients
Must be disinfected/sterilized after each patient
Pre-procedural rinsing
Have the patient rinse with a solution prior to treatment
Reduces risk of disease transmission & # of microorganisms in the oral cavity
Waste handling and disposal
Must be marked with universal biohazard symbol
Dispose in biohazardous waste if:
Items with blood or OPIMs that can release liquid if squeezed (saturated gauze for example)
Items with dried blood
Contaminated sharps
Handling needles/needlestick protocal
Sharps container must be easily accessible
Needles must be recapped after use or properly disposed
Needlesticks are the #1 accident/exposure incidents in dental offices
If needlestick occurs, Wash area with soap and water and report immediately
Do not squeeze wound to express blood; can cause more damage/infection
Work area restrictions
No food or drink
Countertops clear
Avoid touching contact lenses
What is the correct order of putting on PPE (Personal Protective Equipment)?
Gown, mask, eyewear, gloves
Gloves
Caution latex allergies
Do not use petroleum-based lotion or lip moisturizer for patients; this can cause gloves to disintegrate
Do not cross contaminate; gloves should only come in contact with patient, dental instruments or surfaces with barriers
Protective Eyewear
Both patients and clinicians should wear eyewear
Faceshields
Must be worn during aerosol-producing procedures
Masks
Should be changed every patient, every hour, after wet/soiled
Gowns, socks, and caps
Covers skin/protects body from blood and OPIMS & prevents spread
Emergency Procedures: Allergic Reactions
Irritant contact dermatitis (not an allergy, example hands irritated from sanitizer)
Allergic contact dermatitis/delayed type IV hypersensitivity (allergic reaction)
Immediate type I hypersensitivity (can lead to an emergency due to anaphylaxis reaction; example latex allergy)
Irritant contact dermatitis
not an allergy, example hands irritated from sanitizer
Allergic contact dermatitis/delayed type IV hypersensitivity
allergic reaction
Immediate type I hypersensitivity
can lead to an emergency due to anaphylaxis reaction; example latex allergy
Emergency Procedures: Exposures
If blood or OPIMs splashes eyes, flush area with water for 20 min
Wash area with soap & water, report to employer asap, & seek medical care
Employers are required to inform you of how to make incident reports
If exposed/injured, the employer must:
document the name of person exposed/injured
document name of source of blood or OPIM
obtain consent to test source’s blood and consent to receive results and arrange testing
inform exposed/injured person of results
arrange to have exposed/injured person tested and receive medical care as needed
maintain confidentiality of incident
CPR Review
Verify scene safety
Check patient response
Tap patient and say “are you ok?”
Check pulse (check carotid for adults and children; check brachial for infants)
Listen and look for breaths/chest rises
Activate emergency response- call 911 and get the AED
Begin chest compressions
100-120 chest compressions per minute
30:2 compressions & breaths
15:2 compressions and breaths for children & infants with 2 person CPR
Compress at 2 inch chest depth for adults and children; 1.5 inch chest depth for infants
Allow heart to adequately refill between each compression
Giving Breaths
Do not overventilate; give effective breaths over 1-second each
Head tilt-chin lift
Follow AED prompts & compress until EMS arrives or patient regains responsiveness
CPR #1
Verify scene safety
CPR #2
Check patient reponse
Tap patient and say “are you ok?”
Check pulse (check carotid for adults and children; check brachial for infants)
Listen and look for breaths/chest rises
CPR #3
Activate emergency response- call 911 and get the AED
CPR #4
Begin chest compressions
100-120 chest compressions per minute
30:2 compressions & breaths
15:2 compressions and breaths for children & infants with 2 person CPR
Compress at 2 inch chest depth for adults and children; 1.5 inch chest depth for infants
Allow heart to adequately refill between each compression
CPR #5
Giving Breaths
Do not overventilate; give effective breaths over 1-second each
Head tilt-chin lift
CPR #6
Follow AED prompts & compress until EMS arrives or patient regains responsiveness