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Module 14 Infection Control and Related Health and Safety in the Dental Office Part 2 Infection Control and Related Health and Safety in the Dental Office.

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Presentation on theme: "Module 14 Infection Control and Related Health and Safety in the Dental Office Part 2 Infection Control and Related Health and Safety in the Dental Office."— Presentation transcript:

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2 Module 14 Infection Control and Related Health and Safety in the Dental Office Part 2 Infection Control and Related Health and Safety in the Dental Office Part 2

3 Infection Control and Related Health and Safety (Eklund) Infection Control and Related Health and Safety Kathy Eklund, RDH, MHP The Forsyth Institute Kathy Eklund, RDH, MHP The Forsyth Institute

4 Infection Control and Related Health and Safety (Eklund) Disease Transmission

5 Infection Control and Related Health and Safety (Eklund) Host Factors  General health  Portal of entry  Host immune system/immune status  General health  Portal of entry  Host immune system/immune status

6 Infection Control and Related Health and Safety (Eklund) Mechanisms of Transmission  Mechanisms of escape  Natural – –Oral activities such as sneezing, coughing, etc..  Artificial –Hands, instruments, etc.  Methods of entry  Inhalation, ingestion  Contact with mucous membranes  Penetration of intact skin  Mechanisms of escape  Natural – –Oral activities such as sneezing, coughing, etc..  Artificial –Hands, instruments, etc.  Methods of entry  Inhalation, ingestion  Contact with mucous membranes  Penetration of intact skin

7 Infection Control and Related Health and Safety (Eklund) Routes of Transmission  Direct  Patient - Clinican  Clincian - Patient  Patient - Patient  Autogenous  Indirect  Fomite  Aerosol or droplet (spatter)  Direct  Patient - Clinican  Clincian - Patient  Patient - Patient  Autogenous  Indirect  Fomite  Aerosol or droplet (spatter)

8 Infection Control and Related Health and Safety (Eklund) The Transmission Equation  Disease  Virulence of the microorganism  Dose of the microorganism  Host resistance  Disease  Virulence of the microorganism  Dose of the microorganism  Host resistance

9 Infection Control and Related Health and Safety (Eklund) Contamination, Infection, Disease  Risks  Prevention  Management  Risks  Prevention  Management

10 Infection Control and Related Health and Safety (Eklund) Objectives of an Infection Control Program  Reduce the available number of microorganisms  Interrupt the spread, break the cycle of cross-contamination  Treat all clients and clinicians as if infected  Protect from exposure, infection and disease  Reduce the available number of microorganisms  Interrupt the spread, break the cycle of cross-contamination  Treat all clients and clinicians as if infected  Protect from exposure, infection and disease

11 Infection Control and Related Health and Safety (Eklund) Elements of an Effective Infection Control Program  Client assessment  Immunizations  Exposure incident prevention and management  Universal Precautions/ Standard Precautions  Personal Protective Equipment  Client assessment  Immunizations  Exposure incident prevention and management  Universal Precautions/ Standard Precautions  Personal Protective Equipment  Environmental Asespsis  Aseptic techniques  Sterilization and Management of Patient Care Items  Housekeeping practices  Environmental asepsis  Waste  Hazard communication

12 Infection Control and Related Health and Safety (Eklund) Client Assessment

13 Infection Control and Related Health and Safety (Eklund) Universal Precautions/ Standard Precautions  Procedure-specific,  NOT patient people specific.  Based-upon the exposure risks associated with the procedure, always assuming the patient and the clinician are infected with a bloodborne pathogen  Procedure-specific,  NOT patient people specific.  Based-upon the exposure risks associated with the procedure, always assuming the patient and the clinician are infected with a bloodborne pathogen

14 Infection Control and Related Health and Safety (Eklund) Emerging and Reemerging Diseases

15 Infection Control and Related Health and Safety (Eklund) Old Diseases Reemerging New Diseases Emerging

16 Infection Control and Related Health and Safety (Eklund) Emerging Infectious Diseases  Conditions that Contribute to Disease Emergence  Infection Control for Health Care Personnel  Immunizations and Immunity  Antibiotics in Dentistry  Conditions that Contribute to Disease Emergence  Infection Control for Health Care Personnel  Immunizations and Immunity  Antibiotics in Dentistry

17 Infection Control and Related Health and Safety (Eklund) ExamplesExamples  Airborne  Waterborne  Bloodborne  Airborne  Waterborne  Bloodborne

18 Infection Control and Related Health and Safety (Eklund) The Players  Common Cold  Influenza  Bloodborne Pathogens  Hepatitis B, Hepatitis C, HIV,  Others???  Airborne  Tuberculosis  Waterborne Microorganisms  Legionellosis  Cryptosporidium  Common Cold  Influenza  Bloodborne Pathogens  Hepatitis B, Hepatitis C, HIV,  Others???  Airborne  Tuberculosis  Waterborne Microorganisms  Legionellosis  Cryptosporidium

19 Infection Control and Related Health and Safety (Eklund) Conditions That May Contribute to Disease Emergence  Ecological changes  Changes in human demographics or behaviors  International travel and commerce  Ecological changes  Changes in human demographics or behaviors  International travel and commerce  Technology  Microbial changes  Breakdown of public health measures

20 Infection Control and Related Health and Safety (Eklund) Occupational Risks to Healthcare Workers  CDC Estimated Risks following exposure to infected source patients  HBV – 6-35%  HCV – 3-10%  HIV -.3 % –99.7% exposures do not lead to infection  CDC Estimated Risks following exposure to infected source patients  HBV – 6-35%  HCV – 3-10%  HIV -.3 % –99.7% exposures do not lead to infection

21 Infection Control and Related Health and Safety (Eklund) Immunity and Immunizations  Childhood immunizations  Hepatitis B immunization  Others to consider  Hepatitis A vaccine  Varicella Zoster / Chickenpox vaccine  Tetanus Boosters  Childhood immunizations  Hepatitis B immunization  Others to consider  Hepatitis A vaccine  Varicella Zoster / Chickenpox vaccine  Tetanus Boosters

22 Infection Control and Related Health and Safety (Eklund) Guideline for Infection Control in Health Care Personnel, 1998 Bolyard, et.al. AJIC (1998;26: )

23 Infection Control and Related Health and Safety (Eklund) Immunization of Healthcare Workers- Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee MMWR 1997; 46(No. RR-18) 21-2

24 Infection Control and Related Health and Safety (Eklund) Infection Control and Safety Developing Policies, Selecting Products and Implementing Procedures

25 Infection Control and Related Health and Safety (Eklund) Aseptic Technique  Concepts  Asepsis  Antisepsis  Disinfection  Sterilization  Prevent exposure incidents  Contain and manage exposure incidents  Concepts  Asepsis  Antisepsis  Disinfection  Sterilization  Prevent exposure incidents  Contain and manage exposure incidents

26 Infection Control and Related Health and Safety (Eklund) Universal Precautions/ Standard Precautions  Treat every one as if infected with a pathogenic microorganism  Handle every contaminated item as if carrying a bloodborne infectious agent  Treat every one as if infected with a pathogenic microorganism  Handle every contaminated item as if carrying a bloodborne infectious agent

27 Infection Control and Related Health and Safety (Eklund) System of infection control and related health and safety that is procedure specific, not based upon the known or unknown sero-status of client

28 Infection Control and Related Health and Safety (Eklund) Standard Precautions  Standard Precautions synthesize the major features of Universal (Blood and Body Fluid) Precautions (designed to reduce the risk of transmission of blood-borne pathogens) and Body Substance Isolation (designed to reduce the risk of transmission of pathogens from moist body substances) and applies them to all patients receiving care regardless of their diagnosis or presumed infection status.  Standard Precautions apply to (1) blood, (2) all body fluids, secretions, and excretions except sweat, regardless of whether they contain visible blood, (3) non-intact skin, and (4) mucous membranes.  Standard Precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals [ Guideline for isolation precautions in hospitals Part II, Recommendations for isolation precautions in hospitals]  Standard Precautions synthesize the major features of Universal (Blood and Body Fluid) Precautions (designed to reduce the risk of transmission of blood-borne pathogens) and Body Substance Isolation (designed to reduce the risk of transmission of pathogens from moist body substances) and applies them to all patients receiving care regardless of their diagnosis or presumed infection status.  Standard Precautions apply to (1) blood, (2) all body fluids, secretions, and excretions except sweat, regardless of whether they contain visible blood, (3) non-intact skin, and (4) mucous membranes.  Standard Precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals [ Guideline for isolation precautions in hospitals Part II, Recommendations for isolation precautions in hospitals]

29 Infection Control and Related Health and Safety (Eklund) Exposure Incident Prevention and Management  Preventive strategies  Exposure prevention  Management  Basic first aid  Reporting  Documentation  Preventive strategies  Exposure prevention  Management  Basic first aid  Reporting  Documentation  Medical follow- up  Designated HCP  Baseline testing  Prophylaxis  Therapy  Monitoring  Management

30 Infection Control and Related Health and Safety (Eklund) Prevention: Engineering Controls and Work Practices  Prevent Sharps Injuries (Percutaneous)  Needles  Bladed Instruments  Scalpel Blades  Wires in surgery and orthodonics  Prevent Sharps Injuries (Percutaneous)  Needles  Bladed Instruments  Scalpel Blades  Wires in surgery and orthodonics  Prevent Mucous Membrane Exposures  Protective Barriers –Eyewear, Mask

31 Infection Control and Related Health and Safety (Eklund) Your Hands: Occupational Health and Infection Control  Handcare and occupational risks  Handwashing  Gloves and gloving  Handcare and occupational risks  Handwashing  Gloves and gloving

32 Infection Control and Related Health and Safety (Eklund) Preventing and Managing  Irritant Dermatitis  Contact Dermatitis  Latex Allergy

33 Infection Control and Related Health and Safety (Eklund) Handwashing/ Antisepsis  Policy  Procedure  Products  Policy  Procedure  Products

34 Infection Control and Related Health and Safety (Eklund) Handwashing/AntisepsisHandwashing/Antisepsis  Wash and dry hands before donnning and upon removal of gloves  Do not use hand creams/lotions that contain petroleum products when wearing latex gloves  Remove all hand jewelry before washing hands and donning gloves  Wash and dry hands before donnning and upon removal of gloves  Do not use hand creams/lotions that contain petroleum products when wearing latex gloves  Remove all hand jewelry before washing hands and donning gloves

35 Infection Control and Related Health and Safety (Eklund) Gloves and Gloving  Choose the correct glove for the task to be performed  Sterile vs nonsterile gloves  Examination gloves  Latex, synthetic, nitrile  Use non-powdered gloves  Choose the correct glove for the task to be performed  Sterile vs nonsterile gloves  Examination gloves  Latex, synthetic, nitrile  Use non-powdered gloves

36 Infection Control and Related Health and Safety (Eklund) Gloves con’t  Overgloves  To prevent contamination of clean areas  Overgloves are single patient/client items  Puncture resistant gloves for handling contaminated sharps and household tasks  Nitrile  Always considered contaminated, because they are used for “dirty” contaminated tasks  Overgloves  To prevent contamination of clean areas  Overgloves are single patient/client items  Puncture resistant gloves for handling contaminated sharps and household tasks  Nitrile  Always considered contaminated, because they are used for “dirty” contaminated tasks

37 Infection Control and Related Health and Safety (Eklund) Personal Barrier Protection/PPE  Eyewear  Masks  Face Shield  Gloves  Attire  Resuscitation Devices  Eyewear  Masks  Face Shield  Gloves  Attire  Resuscitation Devices

38 Infection Control and Related Health and Safety (Eklund) Face Masks  Mucous Membrane Barrier for the nose and mouth  Types of masks  Filtration quality  When to change the mask  Mucous Membrane Barrier for the nose and mouth  Types of masks  Filtration quality  When to change the mask

39 Infection Control and Related Health and Safety (Eklund) Protective Eyewear  Mucous membrane barrier for the eyes  Protect from spatter and splash exposures  Protect from projectiles/impact protection  Mucous membrane barrier for the eyes  Protect from spatter and splash exposures  Protect from projectiles/impact protection

40 Infection Control and Related Health and Safety (Eklund) Protective Eyewear  Standards  American National Standards Institute (ANSI) –High impact plastic –Peripheral barrier protection with solid side shields  Aseptic Management  Standards  American National Standards Institute (ANSI) –High impact plastic –Peripheral barrier protection with solid side shields  Aseptic Management

41 Infection Control and Related Health and Safety (Eklund) Face Shields  Task Specific  If they do not meet ANSI standards for impact protection, protective eyewear should be worn under the face shield  Task Specific  If they do not meet ANSI standards for impact protection, protective eyewear should be worn under the face shield

42 Infection Control and Related Health and Safety (Eklund) Protective Attire  Types  Reusable  Disposable  Designed to be a barrier for clothing and non-intact skin  Design/style should be based upon anticipated exposure to body fluids of patients  Laundering resuable attire  Types  Reusable  Disposable  Designed to be a barrier for clothing and non-intact skin  Design/style should be based upon anticipated exposure to body fluids of patients  Laundering resuable attire

43 Infection Control and Related Health and Safety (Eklund) ResourcesResources  Recommendations  Centers for Disease Control and Prevention (CDC)  National Institutes of Occupational Safety and Health (NIOSH)  Professional Recommendations –OSAP – ADA – ADHA –ADAA  Recommendations  Centers for Disease Control and Prevention (CDC)  National Institutes of Occupational Safety and Health (NIOSH)  Professional Recommendations –OSAP – ADA – ADHA –ADAA

44 Infection Control and Related Health and Safety (Eklund) ResourcesResources  Regulations/statutes  Food and Drug Administration  Environmental Protection Agency (EPA) –www.epa.gov  Occupational Safety and Health Administration (OSHA) –www.osha.gov  Regulations/statutes  Food and Drug Administration  Environmental Protection Agency (EPA) –www.epa.gov  Occupational Safety and Health Administration (OSHA) –www.osha.gov

45 Infection Control and Related Health and Safety (Eklund) Resources (continued)  Regulations/statutes  State Boards of Registration  State Departments of Public Health  State /local agencies who regulate waste Biohazard, chemical, general  Regulations/statutes  State Boards of Registration  State Departments of Public Health  State /local agencies who regulate waste Biohazard, chemical, general

46 Infection Control and Related Health and Safety (Eklund) From Policy to Practice  Site-specific application of policies  Standard operating procedures  Day -to- Day management of policies and procedures  Site-specific application of policies  Standard operating procedures  Day -to- Day management of policies and procedures

47 Infection Control and Related Health and Safety (Eklund) Education and Training  Techniques  Tools  Organization for Safety and Asepsis Procedures (OSAP)  SOP for each practice setting  Resources (related guidelines, standards, regulations and statutes)  Approaches ( talking vs teaching vs training)  Techniques  Tools  Organization for Safety and Asepsis Procedures (OSAP)  SOP for each practice setting  Resources (related guidelines, standards, regulations and statutes)  Approaches ( talking vs teaching vs training)

48 Infection Control and Related Health and Safety (Eklund) ComplianceCompliance  Assessment / Evaluation  Feedback and Reflection  Assuming Responsibility for Health and Safety of Patients/clients, Yourself and Other Staff  Ethical  Legal  Enforcement  Positive Reinforcement  Negative Reinforcement  Assessment / Evaluation  Feedback and Reflection  Assuming Responsibility for Health and Safety of Patients/clients, Yourself and Other Staff  Ethical  Legal  Enforcement  Positive Reinforcement  Negative Reinforcement

49 Infection Control and Related Health and Safety (Eklund) Kathy Eklund Motto for Infection Control and Health and Safety  Learn the concepts, keep current with the science and relevant standards  Believe that it is critical to healthcare delivery  Behave in a manner consistent with the above  Learn the concepts, keep current with the science and relevant standards  Believe that it is critical to healthcare delivery  Behave in a manner consistent with the above


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