Infection Control and The Dental Radiographer

What is the primary purpose of infection control procedures?

To prevent the transmission of infectious diseases

pathogen

A microorganism capable of causing disease

common pathogens to be worried about being exposed to in the dental office if infection control procedures were not in place

-Cold and Flu viruses and bacteria

-Cytomegalovirus (CMV)

-Hepatitis B Virus (HBV)

-Hepatitis C Virus (HCV)

-Herpes Simplex Virus (HSV-1, HSV-2)

-Human Immunodeficiency Virus (HIV)

-Mycobacterium tuberculosis

What are the general routes of disease transmission in the dental office?

- Direct contact with pathogens in saliva, blood, respiratory secretions, or lesions

-Indirect contact with contaminated objects or instruments

-Direct contact with airborne contaminants present in spatter or aerosols of oral and respiratory fluids

what three conditions must be present in the dental office for infection to occur?

-A susceptible host

-A pathogen with sufficient infectivity and numbers to cause infection

-A portal through which the pathogen may enter the host

Antiseptic

----- is a substance that inhibits the growth of bacteria ?

What are examples of a antiseptic?

Procedures that prevent infection like handwashing and wound cleaning procedures

Asepsis

------is the absence of pathogens ,or disease causing microorganisms.

aseptic technique

term is often used to describe procedures that prevent infection

Bloodborne pathogens

----Is pathogens present in blood that cause diseases in humans

Disinfect

-----Is a chemical or physical procedure to inhibit or destroy pathogens.

Mycotic (fungal) spores

What are not killed during disinfecting procedures?

Exposure incident

-----Is a specific incident that involves contact with blood or other potentially infectious materials and that results from procedures performed by the dental professional

Infectious wastes

------Is waste that consists of blood, blood products, contaminated sharps or other microbiologic products.

Occupational exposure

-----Contact with blood or other infectious materials that involves the skin, eye, or mucous membranes and that results from procedures preformed by the dental professional

Parenteral exposure

-----Exposure to blood or other infectious materials that results from piercing or puncturing the skin barrier.

Personal Protective Equipment (PPE)

-----is a name for protective attire, gloves, mask, and eyeware.

Sharps

-----Is any objects that can penetrate the skin, including but not limited to, needles and scalpels

Standard precautions

-----Measures that include a standard of care designed to protect the health care personnel and patients from pathogens that can be spread by blood or ant other body fluid, excretion or secretion.

Sterilize

-----Is the use of a physical or chemical procedure to destroy ALL pathogens, including highly resistant bacteria and mycotic spores.

in what year did the CDC release a publication entitled the GUIDELINES FOR INFECTION CONTROL IN DENTAL HEALTH CARE SETTINGS?

In 2003

CDC guidelines must be observed in conjunction with the practices and procedures for worker protection required by the?

Occupational Safety and Health Administration (OSHA)

What recommended infection control practices directly relate to dental radiography?

PPE, Handwashing and care of hands, Sterilization and disinfection of instruments, Cleaning and disinfection of dental unit and environmental surfaces.

When are nonsterile gloves recommended?

For examinations and nonsurgical procedures

When are sterile gloves recommended?

For all surgical procedures

List when one must wash their hands in the dental office?

-Before and after treating each patient

-After removing gloves that are torn, cut or punctured and before putting on new gloves

-After contact of bare hands with inanimate objects likely to be contaminated by blood, saliva or respiratory secretions

-Before leaving the dental operatory

-When hands are visibly contaminated or soiled

List the different types of hand hygiene praticed in dental radiography?

three types:

ROUTINE HAND WASH: Water and nonantimicrobial soap (handsoap) for 15 seconds

ANTISEPTIC HANDWASH: Water and antimicrobial soap (chlorhexidine, iodine and idophers, chloroxylenol, PCMX, tricolsan) for 15 seconds

ANTISEPTIC HAND RUB: Alcohol based product until the hands are dry

all instruments in the dental practice can be classified into one of what categories?

critical, semicritical or noncritical instruments

Critical

Instruments used to penetrate soft tissue or bone are considered?

forceps, scalpels, bone chisels, scalers, and surgical burs

They must be sterilized after each use

-----Are instruments that contact but do not penetrate soft tissue or bone?

Semicritical

sterilized after each used UNLESS the instrument can be damaged by heat then use a high level disinfectant.

Beam alignment devices

-----Are instruments ir devices that do not come in contact with mucous membranes

Noncritical

Because their is little risk of transmitting infection from noncritical devices intermediate or low level infection techniques are required

PID, dental x-ray tubehead, exposure button, x-ray control panel and lead apron

What are acceptable methods of dental sterilization?

Steam under pressure (Autoclave), Dry Heat and Chemical Vapor

How is the proper use of sterilization cycles verified?

By periodic use of a Biologic Indicator (Spore Test)

EPA registered disinfectants are classified as what in the dental field?

High-level disinfectants which can be used to disinfect heat-sensitive semicritical dental instruments

EPA registered chemical germicides labeled as both hospital disinfectants and tuberculocidals are classified as?

Intermediate level disinfectants

Phenolics, Iodophers, Chlorine containing compounds

recommended to clean all contaminated dental unit surfaces

EPA registered chemical germicides labeled as only hospital disinfectants are classified as?

Low level disinfectants

recommended to clean general housekeeping surfaces such as floors and walls

-----Is a standard of care designed to protect health care personnel and patients from pathogens that can be spread by blood or any other body fluid, excretion or secretion.

Standard Precautions

What dental radiography surfaces must be covered and disinfected?

X-ray machine: tubehead, PID, and exposure button must all be covered or disinfected

Dental Chair: headrest and its control as well as chairs controls must be covered or disinfected

Work Area: the area where x-ray supplies (Film sensors) are placed during exposure must be covered or disinfected

Lead Apron: If contaminated the lead apron must be wiped with a disinfectant between patients

how does one clean the sensors/receptors used in digital radiography?

must be wrapped in plastic barrier envelopes to protect from saliva and contamination much like the barriers used for intraoral films MUST COVER BOTH HE SENSOR AND THE WIRE CONNECTION

before radiography exposure what should be covered or disinfected?

x-ray machine

dental chair

work area

lead apron

before radiography exposure what must be prepared before seating the patient?

image receptors

beam alignment devices

cotton rolls

paper towel

disposable container

before radiography exposure what must be prepared before putting on gloves?

adjust chair

adjust headrest

place lead apron on patient

remove metallic objects in the head and neck area of patient

right before radiography exposure what must be prepared?

wash hands

put on gloves

prepare beam alignment devices

During radiography exposure how must films be handled?

dry receptor with paper towel after exposure

place dried receptor in paper towel

During radiography exposure how must devices be handled?

transfer beam alignment device from work area to mouth and back to work area, disassemble over a protected work area, never place on uncovered countertop

after radiography exposure what should be completed before gloves are removed?

dispose of contaminated items

place beam alignment devices in area designed for contaminated instruments

after radiography exposure what should be completed after gloves are removed?

wash hands

remove lead apron

the patients head should be seated with the maxillary arch ----to the floor when seating a person for radiography?

parallel

hands must be washed before putting on gloves in the presence of?

the patient

what is an example of a antiseptic procedure?

handwashing

does antiseptic mean killing?

No!

-----Is the use of a chemical or procedure to destroy pathogens?

Disinfect

does disinfect mean killing?

yes...kills but not all

what is an example of a disinfectant used in radiology?

cavicide for films

----Is the destruction of all pathogens.

sterilize

what must be sterilized in radiology?

adjuncts: XCP, easy grip, beam alignment device, snap a ray

what are types of infection control procedures used in dental radiography?

sterilization, disinfection, and antiseptic techniques

what are the instrument classifications used in radiology?

only semicritical and noncritical not critical for radiology

how must the x-ray machiene be prepared before the patient arrives?

cover control panel with a sticky

tube head with plastic

cover PID

what must be prepared for infection control before the patient arrives?

PREPARE OPERATORY: x-ray machiene, exposure button, dental chair, counter/work area, lead apron

PREPARE SUPPLIES: 2 trays

tray 1: outside of room: x-rays, BWX tabs etc.

tray 2: in operatory: mouth mirror, cotton pliers, cotton swabs, contaminates on here NOT ON COUNTER,

-Name on cup, cavicide dip, paper towel, timer

-new film, barrier films, envelopes or digital sensors

-x-ray arm away from patient and in position

-room neat for patient

how must the exposure button be prepared before the patient arrives?

with a sticky

how must the dental chair be prepared before the patient arrives?

wipe same as in clinic,

cover over headrest and pillow (towels etc.)

chair in position for patient

Where must the tray with the x-rays be placed?

Outside of the room so dosn't get exposed to radiation

where should contaminates be placed while working in radiology?

on the tray inside of the room for reuse with that patient (such as the stick and stabes used) do not place on the countertops!

why is it a good idea to double bag a digital sensor?

for more protection must protect from liquids very expensive dont want to ruin! it cannot be sterilized or get wet

do barrier film itself have to be opened with ungloved hands?

it should be! so the film itself is not contaminated because the barrier not the film packet was only contaminated the point of using them is so that one can do this!

What film procedure is considered to be the most effective method for reducing microbial contamination?

Using barrier film/envelopes!

what must be done when the patient arrives?

-escort patient into operatory

-update medical history

-adjust chair for patient and operator

- position patient so occlusal plain is parallel to floor

-put patient at elbow height

-remove patients partial, glasses, dentures, chewing gum, and piercings when ready to begin (these items will interfer with the procedure)

-drape apron on patient before hands are washed and gloved prior to procedure

-make sure to wash hands in front of patient and let them see you put gloves on

in radiography the arch you are working on needs to be?

parallel to the floor

Dose our clinic require eyeware/gloves while taking x-rays?

Yes! our clinic does! just not a mask because no splash/spatter

----means every patient should be treated in the same manner whether infectious or not. there are no exceptions and therefore no suprises.

Universal precautions

must pre-bagged film-holding devices and instruments be opened in front of the patient?

yes to prove they are clean! so they know something unclean is not going into their mouth!

what must be during the taking of radiographs?

-touch as few surfaces as possible

-film dipped in cavicide must be dried with a paper towel

-paperwork and chart must be place on counter away from sink

-use only sterilizable or disposible film holders

-Dry receptor bag before place receptor back into mouth

-double bag with patients for extra protection

what must be after the taking of radiographs?

-gloves are removed and hands are washed

-make patient comfortable

-return glasses

-reposition chair if needed

-offer bathroom break magazines etc

-remove the lead apron and hang it up (do not fold)

is the lead apron removed with gloved hands?

No it is removed after gloves are removed and hands are washed

the sctcc infection control techniques for processing fits our needs with?

the assigned operators and processors

how does a 2 person removal of film from the contaminated packet work?

one person can open the contaminated packet and the other can remove the film

using daylight loaders for an infection control point of view in dental radiography are not recommended due to?

cross contamination

what film should be used to reduce cross contamination?

barrier film

How do you handle a film packet or stabe that has been dropped on the floor?

kick it to side and leave in on the floor to pick up later