1. Infection control measures l Dr. Abdelmonem Altarhony

2. Objectives At the end of the course, the students should have an understanding of: 1. Standard precaution 2. Personal protective equipments 3. Hand Hygiene

3. STANDARD PRINCIPLES OF INFECTION CONTROL It is not always possible to identify people who may spread infection to others, therefore precautions to prevent the spread of infection must be followed at all times. These routine procedures are called Standard Principles of Infection Control (or Universal Precautions).

5. Standard Principles of Infection Control Precautions include: 1.Hand Hygiene and Skin Care 2.Protective Clothing 3.Safe Handling of Sharps (including Sharps Injury Management) 4.Spillage Management.

6. Standard Precautions It is recommended to protect our self from exposure to blood and all body fluids, secretions, excretions and other potentially infectious materials in the workplace and to provide recommended care if such an exposure does occur.

7. These guidelines were developed as a response to the understanding that other body fluids besides blood are potentially infectious, and that anyone with patient contact could be at risk.  Non-intact skin  Mucous membranes

8. Hand Hygiene One of the most common methods for microbial transmission is through contamination by hands as a result of poor hand hygiene, which has been linked to healthcare-associated infections. ( Nosocomial infections) Appropriate hand hygiene has been found to be the single most critical procedure in the infection control program.

9. Hand Hygiene and Skin Care Hands must be washed: Before and after each work shift or work break. Before and after physical contact with each client. After handling contaminated items such as dressings, impression materials and prosthetic and orthodontic appliances.

10. Before putting on, and after removing, protective clothing including gloves. After using the toilet, blowing your nose or covering a sneeze. Whenever hands become visibly soiled. Before preparing or serving food. Before eating, drinking or handling food and before and after smoking.

11. Hand Hygiene Soaps: Liquid- or foam-dispensed soaps in closed containers offer convenience and a reduced likelihood of contamination. Bar soaps are exposed to microbial contaminants. Foam-dispensed, closed-container soaps offer superior coverage using the minimum amount of product, reducing the potential for skin reactions. No Yes

12. Povidone-iodine is most commonly associated with allergic reactions. Hexachlorophene is contraindicated in children, pregnant women and on denuded skin.

13. Before the handwashing and scrub following preparations are necessary Nails are to be cut & should be free of dirt. Check for skin of the hands & the forearms integrity. Remove all jewelleries

14. Washing Hands

15. Procedure of hand washing Wet the hands and wash with a cleanser. Hands should be leathered at least for 10 seconds, rubbing all surfaces, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers. Hands should be rinsed thoroughly

18. Drying Dry hands thoroughly using good quality paper towels. Disposable paper towels are the method of choice because communal towels are a source of cross contamination.

19. Store paper towels in a wall-mounted dispenser next to the washbasin, and throw them away in a pedal operated domestic waste bin. Do not use your hands to lift the lid or they will become re-contaminate

20. For alcohol-based hand- rubs or solutions: Alcohol has broad spectrum antimicrobial activity against vegetative bacteria, viruses, and fungi but are not sporicidal. Use 60 - 70% concentration with water. Higher concentrations are less effective as the action of denaturing proteins is inhibited without the presence of water. Alcohol-based formulation with chlorhexidine or povidone-iodine are good choices for hand disinfections ( surgery).

21. When decontaminating hands use an alcohol hand rub. (Equivalent to hand washing in recent study Sickbert- Bennett E et all. AJIC 2005 p. 67) Hands should be free from dirt and organic material. The hand rub solution must come into contact with all surfaces of the hand and hands must be rub until the gel evaporates.

22. Easy Message Basic message always the same “Clean you hands before and after every patient touch” Instructions always the same  Squirt / Rub/ Roll

23. Easy Message

24. Surgical scrub Surgical hand washing destroys transient organisms and reduces resident flora before surgical or invasive procedures. Indicated for oral surgical procedures.

25. Surgical scrub How to proceed An aqueous antiseptic detergent solution is applied to moistened hands and forearms for approximately 2 minutes. The nails are scrubbed and a manicure stick can be used to remove dirt from beneath the nail. The disinfection process must be thorough and systematic, covering all aspects of the hands and forearms. The procedure should, take at least, 3 to 5 minutes. Cleaning from the tip of the fingers to the elbows. Use sterile towels for drying.

26. Hand Washing Facilities Facilities should be adequate and conveniently located. Hand washbasins must be placed in areas where needed and where client consultations take place. They should have elbow- or foot-operated mixer taps. Separate sinks should be available for other cleaning and rinsing purposes - such as cleaning and rinsing of instruments:

28. Skin irritation A Limitation to Hand Washing Is an important barrier to compliance Is more frequent with soap and water than with handrubs Is reduced and can be treated by emollient- containing solutions

29. What can we do to help change this Provide easy access to hand hygiene materials Handrub solution Conveniently located: at the patient’s bedside at the patient’s room entrance in convenient / appropriate locations in high traffic public areas Working appropriately Full of product Within use by date

33. Personal protective equipments Selection of protective equipment must be based on an assessment of the risk of transmission of infection between the patient and dental clinical staff.

34. Gloves choice depends on : The need for sterility, Length of the procedure Chemical exposure Fit Latex / manufacturing allergies Alternatives to latex include nitrile and polychloroprene; nitrile provides superior chemical resistance

35. Glove Advantages Reduces bi-directional risk for transfer of organism Cost-effective when used according to directions Much variety in types of gloves, appropriate usage and materials Reduces significantly the amount of blood that penetrates from a puncture

36. Gloves 1. Non Sterile Gloves Should be used when hands may come into contact with body fluids or equipment contaminated with body fluids. 2. Sterile Gloves Should be used when the hand is likely to come into contact with normally sterile areas or during any surgical procedure.

37. 3.Polyurethane/polythene Gloves (Non Sterile and Sterile) Polyurethane/polythene gloves do not act as a barrier to infection. DO NOT USE IT.

38. 4. General-purpose Utility Gloves Rubber household gloves – For cleaning instruments prior to sterilization, or when coming into contact with possible contaminated surfaces or items. The gloves should be washed with general-purpose detergent and hot water, and dried between uses. They should be discarded weekly, or more frequently if the gloves become damaged.

39. Important tips Hand hygiene must be performed immediately before and after removing gloves. Don´t wash gloves (increases the freq. and size of leaks - use paper towel to open drawers or put above other glove and prevent contamination) Single-use gloves are vital elements of infection control programs.

40. Gloves must be changed and discarded as soon as they are torn or punctured or when the integrity has been altered After contact with a patient is complete and before care is provided to another patient When performing separate procedures on the same patient

41. Gloves must be changed and discarded: after completing a task not involving patients but requiring gloves before touching environmental items and surfaces before writing in the medical notes, answering the telephone, using the computer and moving or touching equipment.

42. Eyewear and face shields Protective eyewear should be lightweight, clear, with solid side-shields and distortion-free. Face shield are appropriate for heavy spatter, but a mask still is required to protect against aerosols that drift behind the shield. Protective eyewear and face shields should be washed and disinfected between patients.

43. Recommendations Put eyewear with clean hands before gloving and remove it with clean hands after gloves are removed. Eyewear should be grasped by the temple pieces.

44. Masks Mask or face shield must be worn while performing any procedure where there is a likelihood of splashing or splattering of blood or body substances. Personal respirators are more efficient in infection control of microorganisms inhalation than regular molded and tied-on masks. Checci, 2005.