1. DENT 1260 Infection Control UNIT 2 PROTECTIVE BARRIERS

2. Unit 2  P P E PERSONAL PROTECTIVE EQUIPMENT  Barriers used in dentistry to protect DHCW

3. Reasons for protective barriers  Contamination of the body with microorganisms must occur before disease can develop.  Better to prevent this exposure or contamination (when possible) than to rely on body’s resistance to fight off disease after contamination.

4. PPE  Gloves  Masks  Protective Eyewear  Protective Clothing  Protective value  Uses  Types  Limitations

5. PPE  GLOVES:  PROTECTIVE VALUE--------  Protect DHCW from direct contact with microbes in patients’ mouth  Protect Patients from microbes on the hands of DHCW

6. Gloves  Protection of the Dental Team Skin is an excellent barrier Cuts or abrasions cause port of entry Protection against contact with chemicals

7. Gloves  Protection of Patients Microorganisms are present on many surfaces Ungloved hands touch contaminated surfaces Ungloved hands contact patient’s mouth Spread of microbes

8. Gloves  Documented case of disease spread:  Ungloved dental hygienist with dermatitis cared for patient with active herpes  Spread of microbes to 20 other patients  Modes: /patient to dental team member/ /dental team member to patient/ /patient to patient

9. Gloves  Patient Care Gloves Also called exam gloves Always disposable Never to be washed Never to be reused

10. Gloves in Dentistry  Patient care: surgical latex exam vinyl exam nitrile exam powderless exam flavored exam  Utility gloves Heavy latex gloves Heavy nitrile gloves Thin copolymer gloves Thin plastic “food handlers” gloves  Other gloves: Heat resistant gloves Dermal (cotton) gloves

11. Sizes of gloves  EXAM gloves:  Extra small, small, medium, large, extra large  Ambidextrous  Surgeon’s gloves:  Provided in half-sizes ranging from 5-9  Made for right hand and left hand

12. Specialty Gloves  Operatory cleanup and instrument processing requires the use of heavy duty utility gloves  Utility gloves when handling contaminated laundry or contaminated waste  Heat-resistant gloves when unloading sterilizers

13. Limitations of gloves  High level of protection against direct contact with infectious agents through touching  Little protection against injuries with sharp objects such as instruments, needles, and scalpel blades

14. Limitations of gloves  Never use gloves that are torn  Handle sharps carefully even when wearing utility gloves  If utility gloves are cracked or punctured, discontinue using

15. Harmful Reactions to Gloves  Some health-care workers and patients have reactions  Reactions can be to the latex proteins in gloves or the other chemicals used in the manufacturing processes (up to 200 different chemicals)

16. Items containing latex  Dental Products Gloves Rubber dams Prophy cups Nitrous oxide masks Bite blocks Mixing bowls Blood pressure cuffs

17. Other Products containing Latex  Stethoscopes  Tourniquets  Electrode pads  Rubber aprons  Catheters & tubing  Syringe stoppers  Carpeting & adhesives  Erasers and rubber bands  Automobile tires  Handlebar grips  Raquet handles  Elastic bands  Condoms & diaphragms  Balloons & rubber toys  Baby bottle nipples  Pacifiers  Hot water bottles

18. Three types of reactions:  Irritant Contact Dermatitis  Allergic Contact Dermatitis  Latex Allergy

19. Latex allergy

20. Irritant Contact Dermatitis  Most reactions are irritants of the skin From non-latex chemicals used in the making of gloves From handwashing soaps Not rinsing the hands Not drying the hands thoroughly

21. Irritant Contact Dermatitis  Consider Changing Glove Brands  Consider Changing Handwashing Agent Brands  When changing glove brands, check the manufacturer. Same glove may be sold under different brands

22. Allergic Contact Dermatitis  Delayed Hypersensitivity or allergy  Most frequently occurring reaction to gloves  Limited to area of contact Itching, redness, sores within 24-48 hours  Type IV allergy  Similar to reaction of poison ivy

23. Latex Allergy  Immediate Hypersensitivity  Person is allergic to the proteins in latex  Symptoms begin within 20 minutes of contact  Hives (urticaria), redness, burning, itching  Respiratory symptoms can develop

24. Managing Latex Allergies  In the dental worker: avoid contact with latex protein Use non-latex gloves Establish “latex-safe” environment Or Reduced presence of latex in office

25. Managing Latex Allergies  In patients: Ask appropriate questions on health history Provide treatment in a specially prepared room Minimize previous contact of items with latex Prevent latex from directly contacting patient Minimize patient exposure to airborne proteins

26. Handwashing  Protective Value: Hands are one of the most important sources of microorganisms in disease spread. Handwashing is a primary disease prevention procedure.

27. Handwashing  Two types of Microbial Flora on hands: 1. Resident skin flora Always there Never be totally removed 2. Transient skin flora Contaminate the hands during the touching of or other exposure to contaminated surfaces “come and go” --

28. Handwashing  Procedures: Mechanical action is important to suspend dirt and microorganisms from the skin surface so they can be rinse away with water Plain soap removes dirt Plain soap removes some transient microflora Antimicrobial soap needed for healthcare

29. Antimicrobial Agents  Common agents in handwashing products:  CHG – chlorhexidine digluconate  PI – povidone iodine  PCMX – para-chlorometaxylenol  TLS – triclosan

30. Handwashing procedures  Frequent use of 10- to 30-second routine handwashing procedures minimizes the number of transient microorganisms on the hands and aids in reducing the number of resident bacteria by means of their bactericidal chemical activity.

31. When to Wash??  Beginning of each day  Before and after patient care  Before placing gloves  After removing gloves  Before and after breaks  End of day  Other: whenever hands become contaminated

32. Handwashing Before Gloving and After Glove Removal  When skin is tightly covered up with gloves, members of resident flora dramatically increase, as great as 4,000-fold per hour  Increased growth of microorganisms in warm, moist environment

33. MASKS  Protective Value:  Protects the patient from microbes from respiratory tract of operator  Protects the wearer from disease agents that might be present in sprays, splashes, or aerosol particles

34. Masks  Uses and types: New one worn for each procedure Covers nose and mouth Worn any time risk of spraying or splashing Masks can be secured with ties, ear loops, or elastic bands

35. Masks  Limitations of masks:  Do not provide a perfect seal around edge  Wet masks must be replaced

36. PROTECTIVE EYEWEAR  Protective value:  Disease agents may cause infection of eyes  Or enter the mucous membranes and cause systemic infections  Protects against physical damage by propelled objects such as tooth fragments

37. Eyewear  All DHCW need to protect eyes  At Chairside  During Clean-up  When working in dental laboratory  Patients should wear protection during treatment

38. Eyewear  Uses and types:  Used whenever potential for harm  Protection from high intensity lights  Decontaminated before reuse  Provide front, top and side protection

39. Eyewear  Limitations:  Goggles may be worn by themselves or over prescription eyeglasses  Fogging can occur  Face shields should be chin-length

40. Protective Clothing  Protective Value:  Outer clothing can protect forearms and chest from contamination  Covering up street clothes provides protection

41. Protective Clothing  Uses and types:  Worn whenever there is chance for contamination of skin or other clothing with spray or splashes of saliva, blood, or OPIM (other potentially infections materials)  Uniforms, clinic jackets, laboratory coats, aprons, and gowns

42. Placing and removing barriers  PUTTING ON: 1. Protective clothing 2. Mask 3. Protective eyewear 4. Gloves

43. Placing and removing barriers  REMOVING: 1. Disposable gown 2. Gloves 3. Protective eyewear 4. Mask

44. Removing barriers  All disposable items are put immediately into the waste receptacle.  Do not touch underlying clothes or skin with the contaminated gloves.  ALWAYS WASH, RINSE AND DRY HANDS AFTER REMOVING GLOVES