[STUDY] Clinical practice guideline for infection control/exposure control program

Oral healthcare personnel

• Delivery of care in comfortable and safe environment

• Must be vaccinated

• Must be screen for tuberculosis (TB) upon hire

Infection prevention program structure

• Must have written infection control protocol to prevent HAIs

• Used to be universal precautions → standard and transmission based precautions

• Infection prevention coordinator (leader)

Standard precautions

• Blood

• All bodily fluids (except sweat)

• OPIM (other potentially infectious materials)

Education and training

• OHCP must be trained at hire and anually

Covers

• Infection risk (HAIs)

• Prevention strategies

• Exposure response

• Safety policies

Why does infection happen?

• Competitive metabolism

  • Steals nutrients

• Toxin production

• Immune mediated reaction

  • Immune system mistaken harmless substance and attacks body

Chain of infection (SSM —DID)

1. Source (pathogen)

2. Susceptible host

3. Mode of transmission

• Direct

• Indirect

• Droplet/ airborne

Mandated hepatitis B vaccination series

• No cost, no history

• If decline — must sign form

• Post vaccination testing (HBsAb) required per series

  • 1—2 months after 3rd shot

If no immunity

• Second vaccine series

• If still non responsive -→ Non—responder. Undergo education & post evaluation

  • HBIG prophylaxis when exposed

NO booster

Other recommended vaccines

• Influenza

• MMR (Measles, mumps, rubella)

• Varicella (chicken pox)

• Pertussis

Personal protective equipment (PPE)

• Must be worn at all times

  • Protect against blood, OPIM, aerosols/ droplets

Types

• Gowns/ lab coat (change if contaminated)

  • Long sleeve — protect forearm

• Gloves (single use, never wash)

  • Punctured — hand contamination

  • Heavy duty utility gloves = cleaning/ disinfecting stuff

• Mask

  • Surgical mask 95% filtration >3 microns

  • Change between patients or during if wet

• Eye protection / face shields

  • Cleaned w/ soap & water

• N95 respirators (airborne disease — TB)

PPE does not replace hand hygiene

General considerations (work practice controls)

• No eating, drinking, smoking, applying cosmetics — where blood/ OPIM present

• Don’t keep food/ drinks in fridge

• Mobile carts — cannot be cluttered

• Safe drinking water <500 CFU/ mL heterotrophic bacteria

2 types of surfaces (Environmental infection control)

Clinical contact surface

• High contamination risk

  • Dental chair controls

  • Light handles

  • Computer keyboards

• Prevention: Barrier protection or disinfection between patients

• EPA— registered disinfectants (tuberculocidal)

Housekeeping surfaces

• Low risk

• Floors/ walls

Treatment precautions

• Prep treatment with PPE

• Give safety glasses

• Use 1 handed scoop technique for recapping

Saliva ejectors

• Patient create seal

• Keep tubing below patient’s mouth

Radiography

• Cover with protective barrier

  • Dental film — aspetic

  • Digital radiography — tuberculocidal

  • Panoramic radiography — sterile bite guard or barrier

Oral surgery

• Laser / plumes — make aerosols

Dental treatment room (DTR)

• Flush water/ air lines for 20—30 secs after each patient

• Small amount of blood/saliva on gowns, gloves, patient bibs — normal trash (not biohazard)

Regulated waste

• Disposable sharps

• Biohazard colored coded — red or orange

Reusable patient care items

Non critical

• Touch intact skin

  • Blood pressure cuff, xray, facebow

  • Disinfect — EPA intermediate level w/ tuberculocidal

Semi critical

• Touch nonintact skin (but not penetrate)

  • Mouth mirrors, instruments

  • Sterilize

Critical items

• Penetrate tissue and bone

  • Scalpel, burs

  • Sterilize

Instrument processing (sterilization cycle)

Clean

• remove debris

Package

• w/ indicators

Sterilize

• autoclave

Monitor

• Mechanical

  • Confirm time, temp, pressure

• Chemical

  • Color change

• Biological

  • Weekly spore test

Store

• Clean, dry, enclosed

Post exposure protocol

• Wash area, report incident, fill exposure form

Then

• Medical evaluation within 2 hrs

• Test source patient (HBV, HCV, HIV)

• Follow CDC prophylaxis guidelines

Track medical records

• Vaccination history

• Test result

• Follow up

Transmission based protocols (TB)

• Screen patients symptoms

• Isolate quickly

• Postpone dental care

• Use N95

• Refer for medical evaluation

• Controlled by CDC