Ch. 3 Exposure Control: Barriers for Patient and Clinican
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| Exposure control refers to all procedures during | clinical care necessary to provide top-level protection from exposure to infectious agents for members of the dental team and their patients.
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| Dental healthcare personnel (DHCP) have a professional obligation to serve | all patients with comprehensive oral care, including patients with known or unknown communicable diseases.
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| A written exposure control plan | is prepared to serve as a guide for the entire team.1 The written plan can be the basis for training new personnel
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| Personal Protection of the Dental Team | include immunizations and periodic tests; clothing; barriers to infectious microorganisms, such as face mask and protective eyewear; personal hygiene; handwashing; gloves; and other related habits.
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| Immunization for infant and children. | For infants & children includes protection against hepatitis B(at birth), diphtheria, tetanus, pertussis, haemophilus influenzae type b, poliomyelitis, measles, mumps, rubella, varicella, me-ningococcus, pneumococcus, influenza, & hepatitis A.
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| Imunization for children and adolescents. | For children either at school entry (5-6 y/o or 11-12 y/o) if not immunized previously.For adolescents aged 11-21 years, planned to vaccinate those who have not previously been vaccinated, provide booster shots, & promote preventive health services
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| Booster and Reimmunization | Each agent requires booster or reimmunization on a specific plan, which may range from 1 to 10 years, or reimmunization only upon intimate contact or exposure.
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| For tetanus boosters | intervals of 10 years are indicated. If an injury occurs, however, a booster is required on the day of the injury
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| All immunizations are recommended for all dental healthcare personnel. | Tetanus & Diphtheria (Td): Primary series for adults is 3 doses; 1 dose booster every 10 yearsInfluenza: 1 dose annuallyPneumococcal (polysaccharide): 1 doseHepatitis B: 3 doses (0, 1-2, 4-6 months)Hepatitis A: 2 doses (0, 6-12 months)
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| All immunizations are recommended for all dental healthcare personnel. (cont) | Meningococcal (polysaccharide): 1 doseMeasles, Mumps, Rubella (MMR): (1 dose if MMR vaccination history is unreliable; 2 doses for persons with occupational or other indications); catch-up on childhood vaccinations
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| All immunizations are recommended for all dental healthcare personnel. (cont) | Varicella (chicken pox): 2 doses (0, 4-8 weeks) for persons who are susceptible; catch-up on childhood vaccinations
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| Adult Immunizations | The ACIP revises the schedule for adults annually in keeping with new research findings and the release of new vaccines and toxoids.
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| Immunizations and Periodic Tests | At the time of employment, it is reasonable for a dentist-employer to request of employees a record of current immunizations and their most recent updating, as well as specific tests, such as for tuberculosis.
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| What should be done annually? (test/vaccine) | Tuberculin skin test and influenza vaccine
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| Personal Protective Equipment (PPE) | Clinical attireHairFace maskProtective eyewearGloves
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| Clinical Attire | Gowns or uniforms are clean and maintained free from contamination. The garment is closed at the neck & tied in back, preferably.Long garment to cover knees.Long sleeves with fitted cuffs.
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| Laundering | Commercial laundry services are preferred.When laundered at home, the items from a dental office or clinic need to be kept separate and treated with household bleach for disinfection.
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| Outside Wear | Clinic uniforms and shoes are not to be worn outside the clinic practice setting. When clinical clothing is worn outside, contamination can be carried from, and brought into, the treatment area.
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| Hair and Head covering | Hair is worn off the shoulders & fastened back away from the face.When longer, it needs to be held within a head cover.An appropriate head cover is advised when using handpieces & ultrasonic or air-powder polishing instruments.
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| Use of Face Mask: Respiratory Protection | The use of the face mask is described first because it should be positioned first when preparing for clinical care procedures.
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| Mask Efficiency: Criteria Essential Characteristics | Filtration= Masks with a filter efficiency greater than 95%.Fit= Proper fit over face Moisture Absorption:Lining needs to be impervious. Comfort:Degree of comfort encourages compliance in wearing.
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| Characteristics of an Ideal Mask | No contact with the wearer's nostrils or lips.Has a high bacterial filtration efficiency rate.Fits snugly around the entire edges of the mask.No fogging of eyewear.
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| Characteristics of an Ideal Mask. (cont) | Convenient to put on and remove.Made of material that does not irritate skin or induce allergic reaction.Does not collapse during wear or when wet.
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| Materials | Various materials have been used for masks, including gauze and other cloth, plastic foam, fiberglass, synthetic fiber mat, and paper.*glass fiber and synthetic fiber mat the most effective.
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| Use of A Mask | Place mask and eyewear on before a handwash. Use a fresh mask for each patient.Change mask each hour or more frequently when it becomes wet.Keep the mask on after completing a procedure while still in the presence of aerosols.
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| Use of Protective Eyewear | Eye protection for the dental team members and patients is necessary to prevent physical injuries and infections of the eyes.The most effective defense is the use of protective eyewear by all involved, dental team members and patients.
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| Indications for Use of Protective Eyewear: Dental Team Members | Protective eyewear is worn for all procedures.For dental personnel who do not require a corrective lens for vision, protective eyewear with a clear lens can be a routine part of clinical dress.
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| Indications for Use of Protective Eyewear: Patients | Patients with their own prescription lenses may prefer to wear them, but for the safety of the patient's glasses, the use of the protective eyewear provided in the office or clinic may be advisable.
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| Protective Eyewear:General Features of Acceptable Eyewear | Wide coverage: with side shieldsShatterproof made of strong, sturdy plastic.Lightweight.Flexible & w/ rounded smooth edges to prevent discomfort. Easily disinfected.A clear or lightly tinted lens.Protection against glare.
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| Types of Eyewear:Many styles, including regular eyeglass shapes and those described as follows, have been used. | Goggles: Shielding on all sides of the glasses.Eyewear With Side Shields. Eyewear With Curved Frames.Postmydriatic Spectacles Used by Ophthalmologist. Disposable glasses are available that are made of flexible plastic.Child-Sized.
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| Face Shield | Clinician needs to wear a face shield over a regular mask when aerosol-producing handpiece, power scaler, or power polishing equipment is used.
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| Care of Protective Eyewear | Run eyewear under water stream to remove abrasive particles.Clean with detergent and rinse thoroughly. Air dry.Check periodically for scratches on the lens, and replace appropriately.
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| Eye Wash Station | Do not connect the eye wash station equipment to a sink used by clinicians for patient preparation.It must not be connected to the regular faucets unless the hot water source is turned off permanently.
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| Bacteriology of The SkinResident Bacteria | Many relatively stable bacteria inhabit the surface epithelium or deeper areas in the ducts of skin glands or depths of hair follicles; they are ultimately shed w/ the exfoliated surface cells, or w/ excretions of the skin glands.
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| Bacteriology of The SkinResident Bacteria- cont | The flora may be altered by newly introduced pathogens or reduced by washing.Resident bacteria tend to be less susceptible to destruction by disinfection procedures.
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| Bacteriology of The SkinTransient Bacteria | Transient bacteria reflect continuous contamination by routine contacts; some bacteria are pathogens and may act temporarily as residents.
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| Bacteriology of The SkinTransient Bacteria- cont | They may be washed away or, in the event that a skin break exists, may cause an autogenous infection.Most transients can be removed with soap and water by washing thoroughly.
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| Hand Care:Fingernails | Maintain clean, smoothly trimmed, short fingernails with well-cared-for cuticles to prevent breaks where microorganisms can enter.
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| Effects of short nails. | Make handwashing more effective because of fewer microorganisms harbored under the nails.Prevent cuts in disposable gloves.Permit selection of a closer fit of glove.Decrease chance of patient discomfort.
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| Hand Care: Wristwatch and Jewelry | Remove hand and wrist jewelry at the beginning of the day.Microorganisms can become lodged in crevices of rings, watchbands, and watches, where cleaning is impossible.
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| Hand Care: Gloves | After handwashing, don gloves. Never expose open skin lesions or abrasions to a patient's oral tissues and fluids.After glove removal, wash hands to remove microorganisms.
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| Handwashing Principles: Rationale | Effective & frequent handwashing can reduce the overall bacterial flora of the skin & prevent the organisms acquired from a patient from becoming skin residents.
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| Handwashing Principles: Purposes | The objective of all handwashing is to reduce the bacterial flora of the hands to an absolute minimum. Remove surface dirt and transient bacteria.Dissolve the normal greasy film on the skin.Rinse and remove all loosened debris and microorganisms.
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| Handwashing Principles: Facilities | SinkSoapScrub BrushesTowel
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| Handwashing PrinciplesFacilities: Sink | Large sink w/ goose-neck faucet. For regular sink, turn on water at the beginning and leave on through the entire procedure. Turn faucets off with the towel after drying hands.
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| Handwashing PrinciplesFacilities: Soap | Use a liquid surgical scrub containing an antimicrobial agent. Povidone-iodine (iodophore) has a broad spectrum of action.
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| Handwashing PrinciplesFacilities: Scrub Brushes | Avoid overvigorous use of a brush to minimize skin abrasion. Skin irritation & abrasion can leave openings for additional cross-contamination.Disposable sponges are available commercially and may be preferred when a scrub brush is traumatic to the skin.
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| Handwashing PrinciplesFacilities: Towel | Obtain disposable towel from a dispenser that requires no contact except with the towel itself, which hangs down.Cloth towels are not recommended.
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| Methods of Handwashing: Indications | Before and after treating each patient.Before regloving after removing gloves that are torn, cut, or punctured.After barehanded touching inanimate objects that may be contaminated with blood or saliva.Before leaving the treatment room.
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| Definitions: Routine Handwash | Water and nonantimicrobial soap (plain soap).To remove soil and transient microorganisms.
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| Definitions: Antiseptic Handwash | Water and antimicrobial liquid soap (e.g., chlorhexidine, iodine and iodophors, chloroxylenol [PCMX], triclosan).To remove or destroy transient microorganisms and reduce resident flora.
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| Definitions: Antiseptic Hand Rub | Alcohol-based hand rub (contains 60-95% ethanol or isopropanol).To remove or destroy transient microorganisms and reduce resident flora.
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| Definitions: Surgical Antisepsis (also called Surgical Scrub) | Water and antimicrobial liquid soap.To remove or destroy transient microorganisms and reduce resident flora with a persistent or prolonged effect that inhibits proliferation or survival of microorganisms.
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| Routine Handwash | Wet hands, apply soap.Rub hands together for at least 15 seconds; cover all surfaces of fingers, hands, & wrists.Interlace fingers and rub to cover all sides.Rinse under running water; dry thoroughly with disposable towels.
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| Antiseptic Handwash: Preliminary Steps | Remove watch and jewelry from hands.Fasten hair back securely.Don protective eyewear and mask before handwashing to prevent contamination of washed hands ready for gloving.Use cool water.
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| Antiseptic Handwash: Handwashing Procedure | Lather hands, wrists, & forearms quickly w/ liquid antimicrobial soap.Rub all surfaces; interlace fingers & rub back & forth w/ pressure.Rinse thoroughly, keep water running.Repeat 2 more times.Use paper towels for drying(dry hands then elbows).
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| Antiseptic Hand Rub | Wash away visible dirt prior to use.Decontaminate hands with an alcohol-based hand rub.Apply the product to the palm of one hand, and rub hands together.Rub hands vigorously, covering all surfaces of fingers and hands, until the hands are dry.
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| Surgical Antisepsis: Preliminary Steps | Remove watch & jewelry. Place hair coverings on. Don protective eyewear & mask.Open sterile brush package to have ready.Wash hands & arms, using surgical liquid antimicrobial soap to remove gross surface dirt before using the scrub brush.
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| Surgical Antisepsis: Preliminary Steps(cont) | Lather vigorously w/ strong rubbing motions, 10 on each side of hands, wrists, & arms. Interlace the fingers and thumbs to clean the proximal surfaces.
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| Surgical Antisepsis: Preliminary Steps(cont) | Rinse thoroughly from fingertips across hands and wrists. Hold hands higher than elbows throughout the procedure. Leave water running.Use orangewood stick from the sterile package to clean nails. Rinse.
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| Surgical Antiseptic: Handwashing Procedure-First Hand | Lather the hands & arms & leave the lather on to increase the exposure time to the antimicrobial ingredient.Apply surgical liquid antimicrobial soap, and begin the brush procedure. Scrub in an orderly sequence W/O returning to areas previously scrubbed.
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| Surgical Antiseptic: Handwashing Procedure- First Hand(cont) | Brush back & forth across nails & fingertips, passing the brush under the nails.Use small circular strokes on all sides of the thumb & each finger, overlapping strokes for complete coverage.When arm is completed, leave lather on.
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| Surgical Antiseptic: Handwashing Procedure-Second Hand | Repeat on other arm. Some systems require the use of a second sterile brush for the second hand. When this is so, discard the first brush into the proper container and obtain the second brush.
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| Surgical Antiseptic: Handwashing Procedure- Second Hand(cont) | At one-half of scrub time, rinse hands and arms thoroughly, first one and then the other, starting at the fingertips and letting water pass down over the arm.Lather and repeat.
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| Surgical Antiseptic: Handwashing Procedure- Second Hand(cont) | At end of time (or counts), rinse thoroughly, each arm separately, from fingertips. Apply towel from fingertips to elbow without reapplying to hand area.Hold hands up and clasped together. Proceed to dressing area for gowning and gloving.
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| Criteria for Selection of Treatment/Examination Gloves: Safety Factors-Infection Control | barrier; evidence from manufacturer of quality control standards.Impermeable to patient's saliva, blood, and bacteria.
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| Criteria for Selection of Treatment/Examination Gloves: Safety Factors- Infection Control(cont) | Strength & durability to resist tears & punctures.Nonirritating or harmful to skin; use nonlatex gloves when patient or clinician is allergic.Length: glove cuff extends to provide coverage over cuff of long sleeve.
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| Criteria for Selection of Treatment/Examination Gloves: Ergonomic Choice Factors | Fit hand well; no interference with motion.Tactile sense not decreased.No tight pull over palm or between thumb and index finger.
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| Types of Gloves: Material | Latex.Nonlatex: neoprene, block copolymer, vinyl, N-nitrile.
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| Types of Gloves: For Patient Care | Nonsterile Single-Use Examination/Treatment. Latex, nonlatex.Presterilized Single-Use Surgical. Latex, nonlatex.
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| Types of Gloves: Utility Gloves | Nonsterile Single-Use Examination/Treatment. Latex, nonlatex.Heavy Duty. Latex, nonlatex (puncture resistant for clinic cleanup).Plastic. Food handler's glove to wear as overglove.
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| Procedures For use of Gloves: Mask and Eyewear Placement | Place mask and protective eyewear prior to handwashing and gloving.Prevent the need for manipulating the mask around the face and hair after washing the hands.
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| Procedures For use of Gloves: Pregloving Handwash | Use an antiseptic handwash prior to gloving.Hands must be dried thoroughly to control moisture inside glove and thus discourage growth of bacteria.
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| Procedures For use of Gloves: Glove Placement | Always glove & deglove in front of the patient; a patient may need assurance that gloves are new & used only for that appointment.
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| Procedures For use of Gloves: Avoiding Contamination | Keep gloved hands away from face, hair, clothing (pockets), telephone, patient records, clinician's stool, and all parts of the dental equipment that have not been predisinfected and covered with a barrier material.
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| Procedures For use of Gloves: Torn, Cut, or Punctured Glove | Remove immediately, wash hands thoroughly, and don new gloves
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| Procedures For use of Gloves: Removal of Gloves | Develop a procedure whereby gloves can be removed without contaminating the hands from the exposed external surfaces of the gloves.Wash hands promptly after glove removal.
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| Factors Affecting Glove Integrity | Length of Time Worn.Complexity of the Procedure.Packaging of the Gloves.Pressure of Time. Storage of Gloves. Agents Used.Hazard to hands.
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| Latex Hypersensitivity | Patients and clinicians may have or may develop a sensitivity to natural rubber latex. Symptoms of a hypersensitive reaction range from a dermatitis to a life-threatening anaphylactic shock.
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