Demarco ppt

Dental Hygiene Patient Care Setting

  • Dental hygiene care environment: Setting where clinical care is performed.
    • Includes office space, equipment, and treatment areas.

Stools and Chairs

  • Operator stool:
    • Traditionally for dentists; high.
    • Not ergonomically ideal for hygienists.
  • Saddle stool:
    • Designed to keep spine straight and lower back comfortable.
    • Mimics a horse saddle.
  • Assisting stool:
    • Found in dental clinics.
  • Dental chair:
    • For patients; moves up/down and leans back.

Dental Unit

  • Contains cords, hoses, suction, water, and dental handpieces (drills).
  • Dental lights for visibility.
    • Some modern offices use loops with lights instead of dental unit lights.

Structural Fixtures

  • Storage cabinets, sink, paper towels/dispenser, soap, and hand sanitizer.
  • Hand hygiene:
    • Handwashing vs. hand sanitizer.
    • Both options needed in every operatory.
  • Air compressor room:
    • Powers air-driven equipment (drills) and hydraulic chair lifts.
  • Instrument recirculation area:
    • Sterilization area for processing dental instruments.
  • X-ray equipment:
    • Wall-mounted or handheld X-ray unit.
    • Digital X-ray.
    • Panoramic device for full mouth X-rays.
  • Dental laboratory:
    • Where dental materials are handled (relevant for dental materials course).

Infection Control and Prevention

  • Chapter 10: Covering infection control and prevention.
  • Crucial for dental hygienists.
  • Goal: Protect patients and themselves.

Basic Infection Control Concepts

  • Primary objective:
    • Prevent healthcare-associated infections in patients.
    • Prevent occupational injuries/illnesses in practitioners.

Government Agencies

  • Four main agencies overseeing infection prevention:
    • CDC, OSHA, FDA, EPA.
CDC (Centers for Disease Control and Prevention)
  • Mission: Promote health and quality of life by preventing/controlling disease, injury, and disability.
  • Develop guidelines and recommendations for preventing disease.
  • Under the US Department of Health and Human Services.
  • Not a regulatory agency; provides guidelines, not legally binding rules.
OSHA (Occupational Safety and Health Administration)
  • Purpose: Ensure safe and healthy workplace.
  • Manages workplace health and safety.
  • Enforcer of regulations.
  • Part of the US Department of Labor.
  • Applicable to employees and students.
FDA (Food and Drug Administration)
  • Controls anything ingested (food or drugs).
  • Regulates toothpaste, mouthwash, fluoride treatments, and water quality.
  • Standardizes products and ensures public awareness of safety.
  • Continues to monitor approved products for long-term side effects.
EPA (Environmental Protection Agency)
  • Mission: Protect human health and the environment.
  • Regulates medical and chemical waste and disinfectants.
  • Ensures materials used in dentistry have minimal environmental impact.
  • Regulatory body.

Standard of Care

  • Level of care a reasonably prudent practitioner would exercise.
  • Minimum acceptable care for all aspects of treatment.
  • A decision that a reasonable person would make in treating a patient.

Organism and Disease Transmission

  • Diseases transmitted through bacteria and viruses.
  • Requires:
    • Organism.
    • Transmission method.
    • Portal of entry in a susceptible host.
  • Routes of disease transmission:
    • Direct: Contact with blood, oral fluids, or tissues.
    • Indirect: Contact with contaminated objects.
    • Contact of conjunctiva (eyes), nasal membranes, or oral mucosa with droplets/aerosols.
  • Aerosols:
    • Produced during procedures like ultrasonic scaling.
    • Can hang in the air for up to six hours.

Four Main Principles of Infection Control (CDC)

  • Take action to stay healthy.
  • Avoid contact with blood and other infectious body substances.
  • Make client care items safe to use.
  • Limit the spread of blood and other infectious body substances.
Principle 1: Take Action to Stay Healthy
  • Immunizations.
  • Hand washing.
  • Recommended immunizations for dental health care professionals:
    • Hepatitis B, flu, measles, mumps, rubella, varicella, tetanus, diphtheria, pertussis, meningococcal (and TB and influenza).
Principle 2: Avoiding Contact
  • Personal protective equipment (PPE).
  • Gloves, face masks, etc.
Principle 3: Making Client Items Safe for Use
  • Disinfecting, sterilizing, cleaning.
  • Using disposable items.
Principle 4: Limiting the Spread
  • Using protective barriers.
  • Plastic covers on dental chairs.

Universal Precautions

  • Approach where all human blood/bodily fluids are treated as infectious.
  • Assume infectiousness; protect self/patients.

Standard Precautions

  • Protocols/practices followed regardless of infectious status/health history.
  • Universal is the assumption, standard is the practice.
  • Applies to:
    • Blood.
    • Bodily fluids.
    • Secretions.
    • Excretions (except sweat and tears).
    • Non-intact skin.
    • Mucous membranes
  • Why assume everyone is infectious?
    • Better safe than sorry.
    • Patients may not disclose information accurately or understand the need to disclose.

Engineering Controls

  • Adaptations in the environment to make it safer.

Work Practice Controls

  • Precautionary measures to prevent issues.
  • Performing tasks in a way that minimizes risk of exposure.
  • Example: Recapping needles using countertop instead of holding the cap.

PPE (Personal Protective Equipment)

  • Worn to protect self and patient.
  • Masks, eyewear, gloves, etc.
  • Types of gloves:
    • Medical examination gloves: Clean, not sterile.
    • Surgical gloves: Sterile, individually packaged, left/right-hand specific.
    • Heavy-duty/utility gloves: Thicker, for handling instruments and cleaning rooms.
    • Each student will get their own utility glove
  • Face and eye protection:
    • Standard of care to provide patients with eyewear.
  • Masks:
    • ASTM Level 3 mask prevents most aerosols and droplets from going through.
    • N95 masks used when sick or treating patients with tuberculosis (very communicable disease).
  • Hand hygiene:
    • Single most important way to prevent disease transmission.
    • Remove rings and jewelry first.
    • Keep fingernails short with smooth filed edges (quarter inch max, if you see the fingernail when looking at your palm, it is too long.)

Sterilization

  • Destruction of all living organisms, including bacterial spores (bacteria in a static state that they can come back out of).
  • Terms:
    • Critical, semicritical, noncritical items.
      Noncritical items: Contact only with intact skin.
      Semicritical items: Contact oral fluids but do not penetrate soft tissue/bone.
      Critical instruments: Penetrate soft tissue or bone.

Levels of Clean

  • Sanitation/cleaning:
    • Reducing contaminants to a safe level (e.g., countertops).
  • Disinfection:
    • Using chemicals, UV, or X-rays to destroy microorganisms (but doesn't affect spores).
  • Sterilization:
    • Removing live and spore forms of viruses/bacteria (physical or chemical).

Instrument Cleaning Process

  • Transport in solid container.
  • Presoak to remove material.
  • Melee machine or ultrasonic to preclean before sterilization.

Methods of Sterilization

  • Heat sterilization (heat under pressure).
  • Sterilization pouches.
  • Know specs for different types of heat sterilization (time, pressure, heat).
  • Heat kills live bacteria; pressure kills spores.
  • Dry heat can sterilize but takes longer and wears instruments faster.

Classes of Disinfectants and Sterilants

  • Glutaraldehydes, fluorines, iodophors, and phenolics.
  • Disinfectants should kill broad spectrum antibacterial and antiviral, tuberculosis, hep a, hep b, hep c, HIV.
  • Cold sterilization for plastics:
    • Uses glutaraldehyde mixture for 3-24 hours.

Assuring Sterility

  • Biological indicators.

Biohazard

  • Anything that can transmit a disease (bacteria or virus).
  • Know symbols and appropriate colors (red).
  • Sharps containers for sharp items.