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Géza T. Terézhalmy, D.D.S.,M.A. Professor and Dean Emeritus School of Dental Medicine Case Western Reserve University Cleveland, Ohio

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Presentation on theme: "Géza T. Terézhalmy, D.D.S.,M.A. Professor and Dean Emeritus School of Dental Medicine Case Western Reserve University Cleveland, Ohio"— Presentation transcript:

1 Géza T. Terézhalmy, D.D.S.,M.A. Professor and Dean Emeritus School of Dental Medicine Case Western Reserve University Cleveland, Ohio

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8 01/01/2010Terezhalmy8 The transmission of pathogenic organisms in the oral healthcare setting is RARE, yet cross-infection does present a POTENTIAL HAZARD to OHCWs and patients alike.

9 01/01/2010Terezhalmy9 OHCWs’ primary obligation and ultimate responsibility is the delivery of quality care in the privacy of a comfortable and SAFE ENVIRONMENT

10 01/01/2010Terezhalmy10 To prevent or minimize cross-infection, it is MANDATED that oral healthcare facilities develop a written infection control/exposure control protocol.

11 01/01/2010Terezhalmy11 QUALITY OF INFECTION CONROL PRACTICES Protocol should be appropriate for setting ▼ Add quality at the production stage ▼ Factors that affect quality are structure, process, and outcome

12 01/01/2010Terezhalmy12  Structure  Material resources  Example: sterilization area and equipment  Human resources  Example: number and qualification of personnel  Organizational resources  Example: timely availability of post-exposure evaluation and follow-up

13 01/01/2010Terezhalmy13  Process  Criteria, i.e., standards  Based on evidence derived from well-conducted trials or extensive, controlled observations  In the absence of such data, reflect the best- informed or most authoritative opinion available

14 01/01/2010Terezhalmy14  Process (cont’d)  Execution  Development and implementation of activities to meet the criteria  Assessment  Continuous monitoring of compliance and outcome  Response  Activities to resolve issues related to non- compliance and adverse outcome

15 01/01/2010Terezhalmy15  Outcome  Impact of infection control/exposure control strategies  Enhanced knowledge  Changed behavior  Improved health of both OHCWs and patients

16 01/01/2010Terezhalmy16  Office infection-control coordinator  Responsibilities  Development and overall management of the protocol  Provides both access and explanation of its content upon request  Monitors effectiveness of the program on a day-to- day basis, and over time  Ensures that the criteria a relevant, the procedures are efficient, and the practices are successful

17 01/01/2010Terezhalmy17 EDUCATION AND TRAINING Compliance is significantly improved when personnel understand the rationale for infection control policies and practices ▼ Mandatory prior to initial occupational exposure to blood and other potentially infectious material (and annually thereafter) ▼ Training record maintained for the most recent 3-year period

18 01/01/2010Terezhalmy18  The fabric of an educational and training program  Standard precautions  A hierarchy of preventive strategies  Occupational risks in oral healthcare settings  Immunizations  Personal protective equipment (PPE)  Engineering and work-practice controls  Environmental infection control  Post-exposure management  Transmission-based precautions  Administrative controls (policies)

19 01/01/2010Terezhalmy19  Occupational risks in oral healthcare settings  Infection  Invasion and multiplication of microorganisms in body tissues resulting in local cellular injury  Principles of the “chain of infection”  Adequate number of pathogenic organisms  Sufficient virulence of pathogenic organisms  A mode of transmission  A portal of entry  A susceptible host

20 01/01/2010Terezhalmy20  Modes of transmission  Direct contact with blood and other potentially infectious material (OPIM)  Contact with objects contaminated with blood and OPIM  Exposure to splash and spatter containing blood and OPIM  Inhalation of airborne microorganisms suspended in aerosols, i.e., droplets and droplet nuclei

21 01/01/2010Terezhalmy21  Pathogenic organisms of concern  HBV  Mode of transmission  Contact with blood and OPIM  Major risk of occupational exposure in the oral healthcare setting

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24 01/01/2010Terezhalmy24  HCV  Mode of transmission  Contact with blood and OPIM  The risk of occupational exposure in the oral healthcare setting is remote

25 01/01/2010Terezhalmy25  HIV  Mode of transmission  Contact with blood and OPIM  The risk of occupational exposure in the oral healthcare setting is remote

26 01/01/2010Terezhalmy26 Risk of BBP transmission per needlestick SourceRisk HBV (HBsAg +/HBeAg-) 22-31% clinical hepatitis 37-62% serologic evidence HBV (HBsAg +/HBeAg -) 1-6% clinical hepatitis 23-37% serologic evidence HCV1.8% (0-7% range) HIV0.3% ( % range

27 01/01/2010Terezhalmy27  Measles (Rubeola)  Mode of transmission  Inhalation of airborne droplets  Direct contact with nasopharyngeal secretions  Contact with freshly contaminated articles  The risk of occupational exposure in the oral healthcare setting is remote

28 01/01/2010Terezhalmy28  Mumps (Infectious parotitis)  Mode of transmission  Inhalation of airborne droplets  Direct contact with saliva  Contact with freshly contaminated articles  The risk of occupational exposure in the oral healthcare setting is remote

29 01/01/2010Terezhalmy29  Rubella (German measles)  Mode of transmission  Inhalation of airborne droplets  Direct contact with nasopharyngeal secretions  Contact with freshly contaminated articles  The risk of occupational exposure in the oral healthcare setting is remote

30 01/01/2010Terezhalmy30  Herpes simplex  Mode of transmission  Direct contact with vesicular fluid  Direct contact with infected skin and mucous membranes  Contact with freshly contaminated articles  Herpetic whitlow and herpetic keratoconjunctivitis occur commonly in the oral healthcare setting when standard precautions are not followed

31 01/01/2010Terezhalmy31  Varicella (chicken pox) and varicella zoster (shingles)  Mode of transmission  Inhalation of airborne droplets  Direct contact with vesicular fluid  Direct contact with infected skin and mucous membranes  Contact with freshly contaminated articles  The risk of occupational exposure in the oral healthcare setting is remote

32 01/01/2010Terezhalmy32  Influenza and respiratory syncytial viruses  Mode of transmission  Inhalation of airborne droplets  Direct contact with nasopharyngeal secretions  Contact with freshly contaminated articles  Upper respiratory tract infections occur commonly in the oral healthcare setting when standard precautions are not followed

33 01/01/2010Terezhalmy33  Mycobacterium tuberculosis  Mode of Transmission  Inhalation of droplet nuclei  Direct contact with contaminated sputum  Contact with freshly contaminated articles  The risk of occupational exposure in the oral healthcare setting is remote

34  Vaccinations  Reduce the risk of vaccine- preventable diseases  Hepatitis B vaccine  Mandated for all healthcare workers  Mandatory Hepatitis B Vaccination Declination Form 01/01/2010Terezhalmy34

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36  Post-vaccination confirmation of anti-HBs titer  1-2 months after the 1 st series  Anti-HBs titer of >10 mlU/mL is considered adequate  If anti-HBs titer is <10 mlU/mL  A second series is recommended  1-2 months after 2 nd series retest for anti-HBs 01/01/2010Terezhalmy36

37  If no antibody response occurs, test for HBsAg  HBsAg-negative personnel  Shall be counseled about precautions to prevent HBV infection AND  Shall be provided HBIG prophylaxis for any known or probable parenteral exposure to HBsAg-positive blood  HBsAg-positive personnel  Shall obtain appropriate medical consultation AND  Shall be counseled about the prevent of HBV transmission to others 01/01/2010Terezhalmy37

38  Influenza, MMR, varicella, zoster, Td/Tdap, and HPV vaccines  Highly recommended for all healthcare workers  Pneumococcal, hepatitis A, and meningococcal vaccines  Highly recommended for some healthcare workers 01/01/2010Terezhalmy38

39  Personal Protective Equipment  Under normal conditions of use, PPE will not permit blood or OPIM to pass through to and reach  Street clothes  Undergarments  Skin  Mucous membranes  Eyes, nose, and mouth 01/01/2010Terezhalmy39

40  Protective clothing  Gowns or lab coats with long sleeves  Changed at least daily  Anytime it becomes visibly soiled  As soon as possible when penetrated by blood or OPIM  Removed before leaving work area  Dirty clothing is placed in designated areas for disposal or washing 01/01/2010Terezhalmy40

41  Task-specific gloves  Non-surgical and surgical gloves are single-use items  When torn or punctured, change gloves as soon as possible  Gloves may not be washed  Wicking (penetration of liquids through undetectable holes in the gloves)  Double gloving is acceptable for certain extensive surgical procedures 01/01/2010Terezhalmy41

42  Heavy-duty utility gloves  Worn for all instrument, equipment, and environmental surface cleaning and disinfection 01/01/2010Terezhalmy42

43  Surgical masks  Must cover both the nose and the mouth for procedures likely to generate splash, spatter, and aerosols  Those provided for routine use shall have a >95% filtration efficiency (particle >3  m in diameter)  Should be changed, as soon as possible, when they become wet (between patients or even during patient treatment) 01/01/2010Terezhalmy43

44  When treating patients with suspected or confirmed infectious TB disease  National Institute for Occupational Safety and Health (NIOSH)-certified particulate-filter respirator shall be provided  A >95% filtration efficiency when challenged with particle 0.3  m in diameter 01/01/2010Terezhalmy44

45  Protective eyewear  With solid side shields or a face shied shall be worn by all OHCWs  For procedures likely to generate splash, spatter, and aerosols  Protective eyewear with solid side shield is also provided to patients 01/01/2010Terezhalmy45

46  Engineering and work-practice controls  Engineering controls  Take advantage of available technology to eliminate, minimize, or isolate biohazards  Work-practice controls  Promote safer behavior 01/01/2010Terezhalmy46

47  Hand hygiene  Wearing gloves does not eliminate the need for hand hygiene 01/01/2010Terezhalmy47

48  Natural or artificial fingernails shall be kept short to  Facilitates through cleaning  Prevents glove tears  All jewelry and ornaments shall be removed from the hands and wrists  Interfere with glove use  Sinks with electronic, foot, or knee action faucet control  Promote asepsis and ease of function 01/01/2010Terezhalmy48

49  Perform appropriate hand hygiene  At the beginning of each work day  Before gloving, after degloving, and before regloving  Before and after going to lunch, taking a break, using the bathroom  Anytime the hands are contaminated with blood or OPIM 01/01/2010Terezhalmy49

50  Routine handwash  Plain soap and water  Removes soil and transient microorganisms  Acceptable method prior to performing  Physical examinations  Nonsurgical procedures 01/01/2010Terezhalmy50

51  Antiseptic handwash  Antimicrobial soap (i.e., iodophors) and water  Removes or destroys transient microorganisms and reduces resident flora  Acceptable method prior to performing  Physical examinations  Nonsurgical procedures 01/01/2010Terezhalmy51

52  Antiseptic hand rub  Alcohol-based (i.e., 60 to 95% ethanol)  To be used only when no visible soil on hands  Removes or destroys transient microorganisms and reduces resident flora  Acceptable method prior to performing  Physical examinations  Nonsurgical procedures 01/01/2010Terezhalmy52

53  Surgical antisepsis  Antimicrobial soap (i.e., iodophors) and water OR  Plain soap and water followed by antiseptic hand-rub (i.e., 60 to 95% ethanol)  Removes or destroys transient microorganisms and reduces resident flora  Persistent effect  Acceptable method prior to performing  Surgical procedures 01/01/2010Terezhalmy53


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