Infection Control Notes (Page-by-Page)

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Wilkins Ch. 6 Infection Control: Clinical Procedures
PART 1: Preparing the Operatory

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• Reduction of pathogenic microorganisms: Reduce to a level which the body's resistance mechanisms can handle.
• Break the chain of cross contamination.
• Standard precautions.
• Universal precautions.

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• Patient Preparation:
  • Have patient rinse with a preprocedural rinse.
  • Have patient brush.
  • Preprocedural antiseptic options mentioned: Cool Mint LISTERINE ANTISEPTIC.
  • (Note: some garbled text in the Transcript; the intended point is preprocedural rinsing/brush with antiseptic mouthrinses.)

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• Definition: “The spread of microorganisms from one source to another.”
• Modes of spread: person to person; person to object to another person.
• Example: Patient John’s saliva to dental instrument to Hygienist Mary’s hand when she picks up without gloves.

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• Definitions:
  • Disinfect: to destroy pathogenic microorganisms (mo’s).
  • Sterile: free from viable microorganisms.

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• Decontaminate: Use of a physical or chemical means to remove, inactivate or destroy pathogenic microorganisms on a surface or item to the extent that they are no longer capable of transmitting infectious disease; the surface or item is rendered safe for handling, use or disposal.
• Disinfectant: An agent, usually a chemical but may be a physical agent such as X-rays or ultraviolet light, that destroys microorganisms but may not kill bacterial spores.

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• Sterilization: Process by which all forms of life, including bacterial spores, are destroyed by physical or chemical means.

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• Features that make cleansing easier: Easy to clean, smooth uncluttered surfaces.
• Removable hoses; hoses that are not retractable.
• Syringe tips that are autoclavable or disposable.
• Handpieces with anti-retraction valves.
• Handpieces that are autoclavable.
• Use of barriers where possible.

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• Supplies: Sterilized or disposable.
• Treatment Room Features:
  • Barrier covers.
  • Light: Autoclavable handle or barrier cover.
  • Clinician's stool: Foot controls; Easy clean surface; No seams.
  • Sharps disposal.
  • Sink: Stainless steel; Electronic or foot controls; Deep for washing up to elbows.
  • Biohazard waste: Foot control; Sealable liner.
  • Waste: Large opening; Heavy duty liner.
  • Chair: Foot controls; Easy clean surface; No seams.
  • Unit: Removable hoses, straight, not coiled; Easy clean surfaces; Autoclavable handpieces.
  • Floor: Smooth, easy clean, nonabsorbent, no carpeting.

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• Controls foot-operated; if not, need to be covered.
• Surfaces need to be seamless and easily cleaned.

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• Treatment Room Features:
  • 2. Light: Foot activated switches or sensors; if not, barriers.
  • (Note: the transcript includes an unclear term “Prison Cave” which appears to be an error and is not relevant to the official content.)

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• Treatment Room Features:
  • 3. Clinician's Stool: Smooth; Foot operated controls.

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• (No content provided in the transcript for this page.)

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• Foot operated or sensor controlled.
• Wide and deep enough for effective hand washing.
• Separate sink for hand washing and instrument care.

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• Treatment Room Features:
  • 5. Floors: No carpeting.
  • 6. Supplies: All sterilizable or disposable.
  • 7. Waste: Receptacle with large opening; Separate Sharp’s Container; Small biohazardous receptacle.

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• What is wrong with this picture? When polishing a patient's teeth, the splatter zone goes out $6 \text{ feet}$.

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• Cluttered countertops.
• Exposed supplies (gloves, masks).
• Same sink used for sterilization and hand washing.
• Same countertop for clean and dirty instruments.
• Soda in treatment area!

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• Disinfecting Surfaces.

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• Surfaces that come in contact with sprays, splatters, contaminated instruments, and gloved hands:
  • Dental light handles;
  • Chair switches;
  • Dental radiograph equipment;
  • Chairside computer keyboards;
  • Reusable containers of dental materials;
  • Drawer handles;
  • Faucet handles;
  • Countertops;
  • Pens;
  • Telephones;
  • Doorknobs;
  • Contaminated instruments or devices.

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• Categorized by biocidal activity:
  • High level: Inactivates spores and all forms of bacteria, fungi, and viruses; may either be a disinfectant or sterilant depending on time.

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• Intermediate Level: Will not destroy spores; Will inactivate all forms of microorganisms.
• Low Level: Inactivates vegetative bacteria and certain lipid-type viruses; Will not destroy spores, TB bacilli, or nonlipid viruses.

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• Chemical Disinfectants: Uses include environmental surface disinfectant; dental lab impressions and prostheses.
• (Transcript shows garbled text in some lines; the essential point is that chemical disinfectants are used for environmental surfaces and lab impressions/prostheses.)

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• Disinfection depends on contact of solution.
• Items must be cleaned and dried for the agent to work.
• Action of the agent may be altered by foreign matter.

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• EPA approved products.
• Tuberculocidal, bacteriocidal, virucidal and fungicidal.
• Label must state:
  • Shelf life,
  • Use life,
  • Reuse life,
  • Directions for activation,
  • Storage,
  • Directions for use,
  • Disposal instructions,
  • Warnings.

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• Attributes of good disinfectants:
  • Broad spectrum;
  • Fast acting;
  • Not affected by physical factors;
  • Nontoxic;
  • Surface compatibility;
  • Residual effect on treated surfaces;
  • Easy to use;
  • Odorless;
  • Economical.

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• Glutaraldehydes should not be used as a surface disinfectant.
• Other disinfectants listed:
  • 2. Chlorine compounds;
  • 3. Iodophors;
  • 4. Combination phenolics.

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• High level disinfectant: Can be used as a cold disinfectant.
• Limitations:
  • Caustic to the skin;
  • Irritating to eyes;
  • Corrosive to some metals;
  • Items need to be rinsed in sterile water;
  • Toxic fumes; therefore not used as a surface disinfectant.

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• Sodium hypochlorite: Chlorine dioxide.
• Use life of $1 \text{ day}$; must be mixed daily.
• Use distilled water; improves stability.
• Can harm eyes;
• Corrosive;
• Odor;
• Economical.

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• Povidone-iodine (iodophor): Broad spectrum.
• Can discolor.
• Mix $1:213 \text{ parts water}$ (1 part iodophor mixture to 213 parts water).
• Mixture changes color from amber to clear as it loses activity.

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• Combination phenolics: Broad spectrum.
• Lower concentrations used as surface disinfectants.

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• High-level disinfectants inactivate spores and all forms of bacteria, fungi, and viruses. Intermediate-level disinfectants inactivate all forms of microorganisms but do not destroy spores.
• Question: Which statements are correct?
  • A) Statement A is correct and statement B is correct.
  • B) Statement A is correct and statement B is incorrect.
  • C) Statement A is incorrect and statement B is correct.
  • D) Statement A is incorrect and statement B is incorrect.

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• Eyewash station usage: recommended duration is $15 \text{ minutes}$.

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• Disinfection/sterilization note: Used only for items that cannot be sterilized.
• Chemical may disinfect in $10 \text{ to } 30 \text{ minutes}$ but may take $10 \text{ hours}$ to sterilize.

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• Disadvantages of chemical sterilants/disinfection:
  • Cannot verify sterilization;
  • Difficult to store instruments;
  • Time constraints;
  • Chemical sterilant requires the longest time to complete cycle.

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• Objectives:
  • Control disease transmission;
  • Increase working efficiency;
  • Atmosphere of cleanliness and orderliness;
  • Increase patients’ confidence;
  • Maintenance of equipment.

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• Hand contacts:
  • Touch only what you need;
  • Plan ahead;
  • Use paper towel barrier.
• Sterilize items: Critical and semicritical items need to be sterilized.

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• Surface category definitions:
  • Critical: Penetrate soft tissue or bone; Sterilize or dispose of items such as needles, curets, explorers, probes.
  • Semicritical: Touch intact mucous membranes, oral fluids; Does not penetrate; High-level disinfection when sterilization cannot be used. Examples: Radiographic biteblock, ultrasonic headpiece, amalgam condenser, mirror.
  • Noncritical: Do not touch mucous membranes (only intact epithelium); Cleaning & TB intermediate-level disinfection. Examples: Light handles, certain x-ray machine parts, safety eyewear.
  • Environmental: No contact with patient surfaces (or only intact skin); Cleaning & intermediate to low disinfection. Examples: Counter tops, equipment surfaces, housekeeping surfaces.

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• Disposable items: Use whenever possible.
• Cover items that can be covered.
• Chemical disinfection.

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• The effectiveness of the disinfectant procedure is the result of two actions:
  1) The physical rubbing and removal of contaminated material;
  2) The chemical inactivation of the living microorganism.

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• Flushed for $2 \text{ minutes}$ at the beginning of the day.
• Flush for $30 \text{ seconds}$ before and $30 \text{ seconds}$ after each patient appointment.

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• BARRIERS!
• (Note: the transcript lists a standalone number “300” which appears to be out of context; it is included here as part of the slide heading.)

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• Quote/End slide: Only YOU can stop the spread of infection!