chapter 17 infection control systems copyright © 2011, 2006 mosby, inc., an affiliate of elsevier....

Chapter 17

Infection Control Systems

Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved.Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved.


Infection Control

• Disease prevention is the role of everyone in the dental office.

• As an administrative assistant, you must understand both the risks and management of occupational exposures to blood borne pathogens.


The Role of the Administrative Assistant in Infection Control• Responsibilities include

• A thorough understanding of the routes of disease transmission

• Maintaining an adequate inventory of acceptable disinfectants, sterilants, personal protective equipment (PPE), and barrier covers

• Maintaining records verifying compliance with the Occupational Safety and Health Administration (OSHA) requirements


The Role of the Administrative Assistant in Infection Control

• Responsibilities Transmitting spore samples to the appropriate

monitoring agencies for determination of sterilization effectiveness • Attending training sessions• Maintaining records on employees • Verifying employee compliance with OSHA • Scheduling continuing education courses for the

staff


The Role of the Administrative Assistant in Infection Control • Responsibilities

• Verifying quality assurance • Maintaining all Material Safety Data Sheet

(MSDS) forms • Arranging for the disposal of hazardous waste • Providing infection control training for new

employees • Interacting with outside agencies


Organizations Associated with Infection Control The American Dental Association (ADA), the

Organization for Safety and Asepsis Procedures (OSAP), and the Centers for Disease Control and Prevention (CDC) have established infection control and safety procedures for the dental healthcare worker (DHCW).


Guidelines for Infection Control in Dental Health Care Settings• Guidelines from the CDC provide

recommendations on• Educating and protecting dental healthcare

personnel• Preventing the transmission of bloodbourne

pathogens• Hand hygiene• PPE• Contact dermatitis and latex hypersensitivity


Guidelines for Infection Control in Dental Health Care Settings• Guidelines

• Sterilization/disinfection of patient care items• Environmental infection control• Dental unit water lines, biofilm, and water quality• Special considerations (e.g., dental handpieces

and other devices, radiology, parenteral medications, oral surgical procedures, and dental laboratories)


Disease Transmission

• Diseases can be transmitted by various media during dental treatment including blood, saliva, nasal discharge, dust, hands, clothing, and hair.


Types of Infections

• Autogenous infections are infections in which the patient is the source.• When a patient has an infection in one site and

it is transferred to another site• Cross-infections are transferred from one person

to another.• When a person coughs or sneezes, the

caregiver may contract the infection through airborne or droplet transmission.


Routes of Infection Transmission • Transmission in the dental office occurs by three

general routes: • Direct contact with a lesion, organisms, or debris

during intraoral procedures• Indirect contact through contaminated dental

instruments, equipment, or records• Inhalation of aerosols from a patient’s blood or

saliva during the use of high-speed or ultrasonic equipment, such as a high-speed handpiece or an ultrasonic scaler


Breaking the Chain of Disease Transmission

• Because every member of the health care team is responsible for breaking the chain of infection, you must review the cycle of disease transmission.


Cycle of Disease Transmission


Safe Practice Principles

• Practicing safely includes• Obtaining a complete and accurate

patient history• Observing aseptic techniques including

the use of PPE• Adhering to sterilization procedures• Practice proper disinfection and dental

laboratory asepsis procedures


Health Protection Program for the Dental Staff• An office policy must include a health

service program for the staff that covers• Education and training• Immunizations• Exposure prevention and postexposure

management• Employee medical conditions, work-

related illness, and any work restrictions


Health Protection Program for the Dental Staff• Health Protection Program

• Allergies or sensitivities to work-related materials, such as latex

• Records maintenance, data management, and confidentiality

• A medical physician to treat staff members for any emergencies

• Confidential, up-to-date medical records for all workers


Standard Precautions

• OSHA establishes guidelines to protect workers from occupational exposure to bloodborne diseases.

• Regulations require that employees in direct contact with blood or infectious materials and substances use Standard Precautions.


Standard Precautions

• Practicing standard precautions means all patients are treated as if they have a potentially infectious disease.


OSHA Task Categorization

• Category I• Tasks that involve exposure to blood, body

fluids, or tissues; dentists, hygienists, clinical assistants, and laboratory technicians are in this category

• Category II• Tasks that involve no exposure to blood, body

fluids, or tissues but may have unplanned exposure to category I tasks; may include clerical or nonprofessional workers


OSHA Task Categorization

• Category III• Tasks that involve no exposure to blood,

body fluids, or tissues; may include receptionists, bookkeepers, and insurance clerks


Maintaining Regulatory Records• Regulatory records that are kept in an

office include:• Exposure determination form

• Describes the office infection control program and procedures

• Employee training records• Describes HBV vaccination availability,

requirements, and implementation


Sample Exposure Determination Form


Sample Employee Training Record


Maintaining Regulatory Records

• Employee medical records (Figure 17-6)• Informed refusal for hepatitis B vaccination

(Figure 17-7)• Postexposure evaluation and follow-up training• Employee informed refusal of postexposure

medical evaluation (Figure 17-8)• Incident report of exposure to occupational

illness (Figure 17-9)


Sample Employee Medical Record


Sample Refusal of Hepatitis B Vaccination


Sample Informed Refusal of Postexposure Medical Evaluation


Incident Report of Exposure


Hazard Communication Program• OSHA’s hazard communication standards

require all dental professionals to develop and implement a program involving• Employee training• A list of hazardous chemicals• Maintenance of MSDSs• Proper labeling of all chemicals in the

office


Hazard Communication Program• A single coordinator of the program should be

responsible for the following:• Disseminating information about the program• Recognizing the hazardous properties of

chemicals found in the workplace• Keeping up-to-date on procedures for safe

handling of chemicals• Implementing measures for protecting the

office staff from hazardous chemicals


Material Safety Data Sheet (MSDS)• An MSDS is kept for all products with hazardous

potential and includes• The manufacturer’s name and address• The product name• The generic name (if applicable)• Potential routes of entry• The organs affected by the chemical• Means of protecting against or reducing the

effects of chemical exposure (e.g., eyewash)


Labeling of Hazardous Materials• Products purchased from dental supply

companies arrive with permanently affixed information about hazardous chemicals.

• If chemicals are transferred to smaller containers, hazard communication labels must be put on these containers.


Labeling of Hazardous Materials• The label designates the hazard class, the

routes of entry into the body, and the organs affected.


Labeling of Hazardous Materials


Equipment for Hazardous Situations• Equipment that should be available for

preventing or dealing with a hazardous spill include:• Fire extinguisher• Eyewash stations• Amalgam spill kit• Masks • Protective clothing


Equipment for Hazardous Situations• Hazardous spill equipment

• Kitty litter, broom, and dustpan• Protective nitrile gloves and glasses• Bags in which to seal spilled materials and

contaminated objects• Well-ventilated areas for work (able to be

turned off if an accident occurs)• Scavenging system (for use with nitrous

oxide)


Aseptic Technique

• Procedures used to maintain asepsis and prevent cross-contamination include • Use of barrier coverings when appropriate• Disinfection of exposed surface• Use of disposable items if items can not be

disinfected or sterilized • Sterilization of contaminated reusable items


Aseptic Technique

• Aseptic procedures • No touching of eyewear, masks, or hair once

gloves are donned• Use of pretreatment antimicrobial mouth rinse• Disinfection of hands with an antimicrobial soap

or alcohol rub immediately before placement and removal of gloves

• Obtaining a complete and comprehensive health history for every patient


Personal Protection

• Personal protection involves two considerations:1. Immunological protection

(immunization)2. Barrier protection


Immunization

• Dental healthcare workers should receive all appropriate and available vaccines.

• Approved vaccines are available for many infectious diseases. • The hepatitis B vaccine and a yearly

tuberculin Mantoux test to assess exposure to tuberculosis are essential precautions for dental healthcare workers


Barrier Protection

• Physical barriers are a fundamental component of an infection control program.

• Disposable examination gloves, over gloves, and utility gloves should be used.

• During treatment, face masks, and protective clinic attire and eyewear should be worn.


Instrument Sterilization

• The administrative assistant may assume a major role in monitoring the efficiency of the sterilization systems.


Sterilization Testing Strips

• A test strip is placed in the sterilization chamber with instruments.

• The test strip is returned to the manufacturer or a monitoring agency for verification that sterilization has occurred.

• The office receives written documentation that is maintained as a record.


Laboratory Asepsis

• Items received from the laboratory should be disinfected before placement.• All items must be disinfected according to

product directions.• The administrative assistant may prepare

and receive cases from the dental laboratory, so an understanding of the recommended guidelines is essential.


Waste Disposal in the Dental Office• The Environmental Protection Agency (EPA)

is a federal regulatory agency that oversees the handling, tracking, transportation, and disposal of medical waste.


Waste Disposal in the Dental Office

• All infectious waste should be placed in closable, leak-proof containers or bags that are color coded or labeled appropriately.

• All infectious material is disposed of in accordance with federal, state, and local regulations and appropriate forms are maintained.


Waste Disposal in the Dental Office

• Most of the regulated waste in dental offices consists of contaminated sharps and extracted teeth.

• Some offices may also generate a small amount of nonsharp solid medical waste such as 2 × 2s or cotton rolls saturated/caked with blood or saliva.


Educating Patients about Infection Control Programs

• The best course of action is to educate the staff and patients about the importance of safe practice and the use of standard precautions for all patients.

• The two best ways to avoid potential litigation and OSHA inspections are prevention and good documentation.

chapter 17 infection control systems copyright © 2011, 2006 mosby, inc., an affiliate of elsevier....

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