dental team and infection control POHC

Core members of the team include:

Dentist, hygienist, EFDA, assistants, dental lab technician, dental supply salesman, company reps, dental equipment technician

dentist credentialing

Graduate from an accredited program

National Board

State/Regional Board (practical)

Specialists take additional National Board in their specialty.

dental hygienist vs EFDA

RDH is licensed, assistant is certified not licensed

Legislation Governing Dental Practice The State Dental Practice Act: statue of law enacted by state legislatures that defines the practitioners relationship with the public

Provisions: Establishes the State Board of Dentistry

Defines the Powers of the State Board

Established rules governing dental practice

Rules and Regulations: Rules written and adopted by the State Board regulating the profession and defining scope of practice.

**Statute (law) takes precedence over rules and reg's

*only 2 states (Washington and Hawaii) have separate DH Practice Acts and rules and reg's. All other states DH are regulated by the State Board of Dentistry.

direct supervision, general supervision, direct access supervision

Direct Supervision- The dentist has diagnosed and authorized the condition to be treated, remains on the premises while the procedure is performed and approves of the work performed before dismissing the patient.

General Supervision- The dentist has authorized the procedure for a patient of record but need not be present when the procedure is performed

Direct Access Supervision- Hygienist can provide services as she determines appropriate without specific authorization. (public health)

indirect supervision, remote supervision, independant

▪ Indirect Supervision- The dentist must authorize the procedure and be in the office while the procedures are performed

▪ Remote supervision-Supervising dentist is not on site. Communication between oral health care providers is delivered remotely via current technology.

Independent-Dental hygienist can provide services within the scope of dental hygiene practice in any setting and without the authorization of a dentist.

Few states allow a dental hygienist to practice independent of a dentist.

In Pa-20 ceu per biannual renewal period for dental hygienist, 30 ceu for dentist. Child abuse ce is 3 hours at first and 2 hours every 2 every two years aka every license renewal.

Of the 20 hours, 10 may be online

Three must be local anesthesia if holding dental hygienist local anesthesia license. (four in NJ)

Five must be public health if holding public health dental hygiene practitioner license.

Two ceu in child abuse for re-licensure, three at initial licensure

Two ceu of radiation safety for all persons who expose radiographs. This requirement is NOT a State Board of Dentistry requirement. and can not affect your professional license, however, the content may be used toward your 20 ceu.

certification; Certification is non government agency. Licensure is higher level than certification.

process by which a nongovernmental agency or organization grants formal recognition to an individual for completing a specified amount of training or course work or for an acceptable performance on an examination, or graduation from a formal program.

licensure

process by which a government agency certifies that individuals have met pre-determined standards, are minimally qualified, and are permitted to practice in a state

reciprocity

(license by credential): when a state grants a candidate a license based on the individual holding comparable credentials in another state.

American Dental Hygienists' Association (ADHA)-

Tri level structure. National, state, local components.

Main purpose:

to protect profession and give direction

Publishes three publications

Offers members wide range of group benefits.

Principles of Ethics of the ADHA

Provide care using professional knowledge, judgment and skill

Maintain competence

Respect clients and colleagues

Educate the public

Obey the law

Participate in organized Dental Hygiene

National Dental Hygienists' Association (NDHA)

Association of African-American dental hygienists.

Canadian Dental Hygienists' Association (CDHA)

Equivalent of our ADHA

International Federation of Dental Hygienists

Formal international network of DH

Focus is to exchange ideas on issues that affect dental hygiene on worldwide basis.

Members include US, Canada, Japan, Netherlands, Norway, Sweden, UK, Australia, Denmark, and Switzerland

3 classes of microorganisms

• Bacteria-Single celled microorganism identified by their: • Shape (3) • Oxygen requirement-aerobic/anaerobic • Ability to hold gram stain + or -

• Virus - -smallest microorganism ◆ -can only be seen by electron microscope ◆ -have the ability to mutate ◆ -highly resistant to infection control

• Fungal-plant like organism which lacks chlorophyll

micro flora of the oral cavity include

bacteria, yeasts, fungi, protozoa and viruses.

DISEASE PRODUCING CAPABILITY OF PATHOGENS

- Virulence (strength of the organism)

- Concentration (number of pathogens present)

-Host resistance (effectiveness of body's defense mechanisms; their immune system)

modes of transmission

◆ Direct contact with blood or body fluids

◆ Indirect contact with a contaminated instrument or surface ◆ Contact of mucosa of the eyes, nose, or mouth with droplets or spatter

◆ Inhalation of airborne microorganisms

airborne- droplet infection, waterborne (*old tq: Chickenpox can be airborne because of the droplets)

1.Aerosols - invisible liquid or solid particle suspended in air 2.Mists - droplets larger than an aerosol, ex. Coughing (no HIV/HBV)

3.Spatter - larger droplets of aerosols spray, ex. Handpiece or

4.Splatter-large drops of liquid

waterborne- ◆ Transmission of pathogens through contaminated waterlines.

◆ Formation of biofilm

Hepatitis B Vaccine and HCV infection, HIV infection

Test for anti-HBs 1 to 2 months after 3rd dose

Prevalence of HCV infection among dentists similar to that of general population (~ 1%-2%)

HIV transmission rate very low

HSV 1-4

• HSV 1-Herpes Simplex 1 oral/facial lesions

• HSV 2-Herpes Simplex 2 genital lesions

• HSV 3-Varicella chicken pox/shingles

• HSV 4-Epstein Barr mono

4 Diseases caused by Herpes Simplex 1

• Acute gingivostomatitis painful oral vesicular lesions; has to heal 7-10 days before we treat

• Recurrent herpes labialis cold sore/fever blister

• Ocular Keratitis occurs in the eye via splash or fluid from recurring vesicular lesion; untreated leads to blindness

• Herpetic Whitlow infection of finger; virus enters through minor skin abrasion

Recurrent Herpes: HSV 1 & 2 virtually identical

•Both infect mucosal surfaces then become latent in nervous system

•Approx 2/3 have no symptoms or too mild to notice

HSV-1 latent in trigeminal ganglion then goes to lower lip or face ; implicated in oral cancer

HSV-2 latent in sacral ganglion at base of spine then goes to genitals; implicated in cervical cancer

Primary Herpetic Gingivostomatitis

◆ Painful, erythematous, swollen gingiva with multiple tiny vesicles on the perioral skin, vermilion border, oral mucosa

◆ vesicles progress to form ulcers.

◆ Systemic symptoms -fever, malaise, etc.

◆ common occurs children 6mos - 6 yrs.

◆ self-limiting

◆ heal 1 to 2 weeks

Transmission of Mycobacterium tuberculosis

◆ Spread by droplet nuclei

◆ Immune system usually prevents spread

◆ Bacteria can remain alive in the lungs for many years (latent TB infection)

Risk in dental settings is low

◆ Assess patients for history of TB

◆ Defer elective dental treatment

◆ If patient must be treated: • DHCP should wear face mask • Separate patient from others/mask/tissue • Refer to facility with proper TB infection control precautions

Personnel Health Elements of an Infection Control Program

◆ Education and training

◆ Immunizations

◆ Exposure prevention and postexposure management

◆ Medical condition management and work-related illnesses and restrictions

◆ Health record maintenance

Exposure Prevention Strategies

◆ Engineering controls-What you have: Isolate or remove the hazard. Examples: • Sharps container • Medical devices with injury protection features (e.g., self-sheathing needles)

◆ Work practice controls-What you do: Change the manner of performing tasks. Examples include: Using instruments instead of fingers to retract or palpate tissue, One-handed needle recapping

◆ Administrative controls-Policies and procedures: Policies, procedures, and enforcement measures. Placement in the hierarchy varies by the problem being addressed • Placed before engineering controls for airborne precautions

post exposure management program

◆ Clear policies and procedures

◆ Education of dental health care personnel (DHCP)

◆ Rapid access to • Clinical care • Post-exposure prophylaxis (PEP) • Testing of source patients/HCP

◆ Exposure reporting

Hand hygiene is the most important PPE practice and

infection control is the most critical job

protective clothing

• Cover knees when seated

• Long enough to cover all skin (crew length socks)

• No pockets

◆ Hair/head coverings

• Hair up and away from face

• Clinic: washable plastic head band

wear gloves for Medical and dental history including vitals...

◆ Extra-oral exam (E/O)- over gloves required, eyeglasses recommended.

◆ Dispose of E/O over gloves after completing the E/O

◆ Put on glasses, mask then nitrile gloves

◆ Continue with intra-oral exam (I/O)

clean, disinfect, sterile, antiseptic

◆ Cleaning = sanitizing; removing gross debris and some microbes

◆ Disinfection = greatly reduces microbes; may not kill spores (inanimate objects)

◆ Sterilization = kills ALL microbes and spores

◆ Antiseptic = prevents growth or action of microbes on living tissue

critical, semicritical, noncritical

heat sterilize critical instruments.

semi critical is heat sterilized or highly disinfected. mouth mirrors and supraging instruments count as semi critical but may be heat sterilized with a sickel scaler which is critical.

noncritical is Cleaned and disinfected using a low to intermediate level disinfectant theses include X-ray heads, facebows, pulse oximeter, blood pressure cuff

Place instruments in the ultrasonic unit for one full cycle (15 minutes for cassettes, 1 minute for instruments)

◆ Use appropriate basket. Metal should never touch bottom of ultrasonic unit

◆ After cycle complete, remove and inspect, return as needed to ultrasonic

◆ Soak instruments and cassettes in water for 3 minutes, Blot or air dry prior to packaging

◆ Place instruments in a clean autoclave bag, working end first, hinged instruments open and unlocked.

◆ Label the paper side of the bag, or autoclave tape on reusable bag with student's name, clinic session (A or B) and date.

heat based sterilization includes

◆ Steam under pressure (autoclaving)

◆ Dry heat

◆ Unsaturated chemical vapor

The ultrasonic cleanser doesn't disinfect or sterilize. Its just a cleaning solution, it irrigates

steam sterilizer/ autoclave works with steam under pressure

Pressure helps achieve high temp of steam; air displaced by steam

Can corrode or dull instruments

250o @ 15 psi for 15-20 min when time/temp reached

flash sterilizer aka statum uses more pressure.

270o @ 30 psi for 3-8 min

Popular alternative for handpieces

Clinic: 2 pouches max in one load; paper side up

4 uses of dental mirror

difference between angulation and adaptation

retraction, reflection of light, transillumination, indirect vision.

Adaptation is the relationship between tooth and 1/3 tip

Angulation is the relationship between terminal shank and tooth (the terminal shank must be parallel to the tooth). Angulation is the relationship between the cutting edge and the tooth

osha vs. cdc and regs, guidlines, standards and reccomendations

Osha sets rules cdc makes recommendations and issues guidlines.

-Regulations -are governmental orders carrying the force of law

◆ -Standards -indicates an expectation of compliance with a level of requirement

◆ -Guidelines -are policies or rules intended to give practical guidance

◆ -Recommendations -is intended to give advice or counsel

Liquid Chemical Sterilant/Disinfectants

◆ Only for heat-sensitive critical and semi-critical devices

◆ Powerful, toxic chemicals raise safety concerns

◆ Heat tolerant or disposable alternatives are available

◆ Sterile 6-10 hour, disinfect 15-20 min in Glutaraldehyde

Sterilization Monitoring Types of Indicators

◆ Mechanical • Measure time, temperature, pressure

◆ Chemical • Change in color when physical parameter is reached

◆ Biological (spore tests) weekly • Use biological spores to assess the sterilization process directly

barriers and house keeping surfaces

Surface barriers can be used and changed between patients OR Clean then disinfect using an EPAregistered low- (HIV/HBV claim) to intermediate-level (tuberculocidal claim) hospital disinfectant

Cleaning Housekeeping Surfaces Routinely clean with soap and water or an EPAregistered detergent/hospital disinfectant routinely

Medical Waste: Not considered infectious, thus can be discarded in regular trash ◆ Regulated Medical Waste: Poses a potential risk of infection during handling and disposal

Types of regulated waste in dentistry • Sharps contaminated with blood or saliva; discard in sharps container (sharps = anything that could puncture the skin) • Nonsharps saturated (dripping wet or caked) with blood or saliva (discard in biohazard bag) • Tissue (teeth, biopsy specimens) • Liquid blood or saliva

Processes for regulated waste include autoclaving and incineration

dental unit water quality

Colony counts in water from untreated systems can exceed 1,000,000 CFU/mL CFU=colony forming unit

regulatory standards for drinking water are <500 CFU/mL of heterotrophic water bacteria

Dental Handpieces and Other Devices Attached to Air and Waterlines ◆ Clean and heat sterilize intraoral devices that can be removed from air and waterlines

Do not use liquid germicides or ethylene oxide. for the componeneta that are permanately attached to air and water lines Clean and intermediate-level disinfect the surface of devices if visibly contaminated

for saliva ejectors

Previously suctioned fluids might be retracted into the patient's mouth when a seal is created so pt shouldnt close lips around it

antimicrobial mouth rinses

• Reduce number of microorganisms in aerosols/spatter

• Decrease the number of microorganisms introduced into the bloodstream

◆ Unresolved issue-no evidence that infections are prevented

OSHA-Occupational Safety & Health Administration . regulatory

Is a division of the US Department of Labor (Federal)

Passed by Congress to ensure safe and health work environment for all US workers -Original l regulations were for general safety and now covers health care

Occupational Exposure to Blood borne Pathogen Standard

Have authority to investigate, inspect, fine and penalize offices.

CDC ◆ Center for Disease Control. nonregulatory

• Under purview of US Dept of Health

• Studies and monitors the etiology and epidemiology of diseases worldwide.

• Issues guidelines recommending procedures for the control of disease transmission

• Not an enforcement agency (non-regulatory)

EPA ◆ Environmental Protection Agency. regulatory

• Federal agency responsible for regulating the use and disposal of products as waste

• All chemicals used for disinfection/sterilization must be registered with the EPA

• Many states (including PA) the EPA is primary authority for disposal of medical/hazardous wastes

FDA ◆ Food and Drug Administration. regulatory

• Regulates products and equipment that affect living tissue by ingestion ,contact, inhalation or exposure • Includes: chemical products, drugs, food, medical devices, accessories • Reviews all safety and efficacy data submitted by manufacturer

NON Government organization OSAP. "Organization for Safety, Asepsis and Prevention" nonregulatory

• Establishes, implements, maintains valid and reliable standards for infection control

• Consists of practitioners, educators, industry members

describe the 3 steps in surface disinfection procedure

1. Cleaning (removing visible dirt with soap and water)

2. Rinsing (removing soap residue with clean water)

3. Disinfecting (applying a chemical disinfectant to the surface according to manufacturer instructions)