Module 14

Infection Control and Related Health

and Safety in the Dental Office
Part 2
 Infection Control and
Related Health and Safety

Kathy Eklund, RDH, MHP

The Forsyth Institute

Infection Control and Related Health and Safety (Eklund)

 Disease
Transmission

Infection Control and Related Health and Safety (Eklund)

 Host Factors
 General health
 Portal of entry
 Host immune system/immune
status

Infection Control and Related Health and Safety (Eklund)

 Mechanisms of
Transmission
 Mechanisms of escape
Natural –
– Oral activities such as sneezing, coughing, etc..
Artificial
– Hands, instruments, etc.
 Methods of entry
Inhalation, ingestion
Contact with mucous membranes
Penetration of intact skin

Infection Control and Related Health and Safety (Eklund)

 Routes of Transmission
 Direct
Patient - Clinican
Clincian - Patient
Patient - Patient
Autogenous
 Indirect
Fomite
 Aerosol or droplet (spatter)

Infection Control and Related Health and Safety (Eklund)

 The Transmission Equation
 Disease
Virulence of the microorganism
Dose of the microorganism
Host resistance

Infection Control and Related Health and Safety (Eklund)

 Contamination, Infection,
Disease
 Risks
 Prevention
 Management

Infection Control and Related Health and Safety (Eklund)

 Objectives of an Infection
Control Program
 Reduce the available number of
microorganisms
 Interrupt the spread, break the cycle
of cross-contamination
 Treat all clients and clinicians as if
infected
 Protect from exposure, infection and
disease

Infection Control and Related Health and Safety (Eklund)

 Elements of an Effective
Infection Control Program
 Client assessment  Environmental
 Immunizations Asespsis
 Exposure incident  Aseptic techniques
prevention and  Sterilization and
management Management of Patient
 Universal Care Items
Precautions/  Housekeeping practices
Standard Environmental asepsis
Precautions Waste
 Personal
Protective  Hazard communication
Equipment
Infection Control and Related Health and Safety (Eklund)
 Client Assessment

Infection Control and Related Health and Safety (Eklund)

 Universal Precautions/
Standard Precautions
 Procedure-specific,
NOT patient people specific.
 Based-upon the exposure risks
associated with the procedure,
always assuming the patient and
the clinician are infected with a
bloodborne pathogen

Infection Control and Related Health and Safety (Eklund)

 Emerging and Reemerging
Diseases

Infection Control and Related Health and Safety (Eklund)

 Old Diseases Reemerging
New Diseases Emerging

Infection Control and Related Health and Safety (Eklund)

 Emerging Infectious Diseases
 Conditions that Contribute to
Disease Emergence
 Infection Control for Health Care
Personnel
 Immunizations and Immunity
 Antibiotics in Dentistry

Infection Control and Related Health and Safety (Eklund)

 Examples
 Airborne
 Waterborne
 Bloodborne

Infection Control and Related Health and Safety (Eklund)

 The Players
 Common Cold
 Influenza
 Bloodborne Pathogens
Hepatitis B, Hepatitis C, HIV ,
Others???
 Airborne
Tuberculosis
 Waterborne Microorganisms
Legionellosis
Cryptosporidium
Infection Control and Related Health and Safety (Eklund)
 Conditions That May Contribute
to Disease Emergence
 Ecological  Technology
changes
 Changes in
 Microbial
human changes
demographics  Breakdown of
or behaviors
public health
 International
travel and
measures
commerce
Infection Control and Related Health and Safety (Eklund)
 Occupational Risks to
Healthcare Workers
 CDC Estimated Risks following
exposure to infected source patients
HBV – 6-35%
HCV – 3-10%
HIV - .3 %
–99.7% exposures do not lead to infection

Infection Control and Related Health and Safety (Eklund)

 Immunity and
Immunizations
 Childhood immunizations
 Hepatitis B immunization
 Others to consider
Hepatitis A vaccine
Varicella Zoster / Chickenpox vaccine
Tetanus Boosters

Infection Control and Related Health and Safety (Eklund)

 Guideline for Infection Control
in Health Care Personnel, 1998
Bolyard, et.al. AJIC (1998;26:289-354)

Infection Control and Related Health and Safety (Eklund)

 Immunization of Healthcare
Workers- Recommendations of the
Advisory Committee on
Immunization Practices (ACIP)
and the Hospital Infection Control
Practices Advisory Committee
MMWR 1997; 46(No. RR-18) 21-2

Infection Control and Related Health and Safety (Eklund)

 Infection Control and Safety
Developing Policies, Selecting
Products and Implementing
Procedures

Infection Control and Related Health and Safety (Eklund)

 Aseptic Technique
 Concepts
Asepsis
Antisepsis
Disinfection
Sterilization
 Prevent exposure incidents
 Contain and manage exposure
incidents

Infection Control and Related Health and Safety (Eklund)

 Universal Precautions/
Standard Precautions
 Treat every one as if infected
with a pathogenic
microorganism
 Handle every contaminated item
as if carrying a bloodborne
infectious agent
Infection Control and Related Health and Safety (Eklund)
 System of infection control and
related health and safety that is
procedure specific, not based
upon the known or unknown
sero-status of client

Infection Control and Related Health and Safety (Eklund)

 Standard Precautions
 Standard Precautions synthesize the major features of Universal
(Blood and Body Fluid) Precautions (designed to reduce the risk
of transmission of blood-borne pathogens) and Body Substance
Isolation (designed to reduce the risk of transmission of
pathogens from moist body substances) and applies them to all
patients receiving care regardless of their diagnosis or
presumed infection status.
 Standard Precautions apply to (1) blood, (2) all body fluids,
secretions, and excretions except sweat, regardless of whether
they contain visible blood, (3) non-intact skin, and (4) mucous
membranes.
 Standard Precautions are designed to reduce the risk of
transmission of microorganisms from both recognized and
unrecognized sources of infection in hospitals [ Guideline for
isolation precautions in hospitals Part II, Recommendations for
isolation precautions in hospitals]
Infection Control and Related Health and Safety (Eklund)
 Exposure Incident Prevention
and Management
 Preventive  Medical follow-
strategies up
Exposure Designated HCP
prevention Baseline testing
 Management Prophylaxis
Basic first aid Therapy
Reporting Monitoring
Documentation Management

Infection Control and Related Health and Safety (Eklund)

 Prevention: Engineering
Controls and Work Practices
 Prevent Sharps  Prevent Mucous
Injuries Membrane
(Percutaneous) Exposures
 Needles  Protective
 Bladed Barriers
Instruments – Eyewear,
 Scalpel Blades Mask
 Wires in surgery
and orthodonics
Infection Control and Related Health and Safety (Eklund)
 Your Hands: Occupational
Health and Infection Control
 Handcare and occupational risks
 Handwashing
 Gloves and gloving

Infection Control and Related Health and Safety (Eklund)

 Preventing and Managing
 Irritant  Contact
Dermatitis Dermatitis
 Latex Allergy

Infection Control and Related Health and Safety (Eklund)

 Handwashing/ Antisepsis
 Policy
 Procedure
 Products

Infection Control and Related Health and Safety (Eklund)

 Handwashing/Antisepsis
 Wash and dry hands before
donnning and upon removal of
gloves
 Do not use hand creams/lotions that
contain petroleum products when
wearing latex gloves
 Remove all hand jewelry before
washing hands and donning gloves

Infection Control and Related Health and Safety (Eklund)

 Gloves and Gloving
 Choose the correct glove for
the task to be performed
Sterile vs nonsterile gloves
Examination gloves
Latex, synthetic, nitrile
 Use non-powdered gloves

Infection Control and Related Health and Safety (Eklund)

 Gloves con’t
 Overgloves
 To prevent contamination of clean areas
 Overgloves are single patient/client items
 Puncture resistant gloves for handling
contaminated sharps and household tasks
 Nitrile
 Always considered contaminated, because
they are used for “dirty” contaminated
tasks

Infection Control and Related Health and Safety (Eklund)

 Personal Barrier
Protection/PPE
 Eyewear
 Masks
 Face Shield
 Gloves
 Attire
 Resuscitation Devices

Infection Control and Related Health and Safety (Eklund)

 Face Masks
 Mucous Membrane Barrier for
the nose and mouth
 Types of masks
 Filtration quality
 When to change the mask

Infection Control and Related Health and Safety (Eklund)

 Protective Eyewear
 Mucous membrane barrier for
the eyes
 Protect from spatter and splash
exposures
 Protect from projectiles/impact
protection

Infection Control and Related Health and Safety (Eklund)

 Protective Eyewear
 Standards
American National Standards
Institute (ANSI)
– High impact plastic
– Peripheral barrier protection
with solid side shields
Aseptic Management

Infection Control and Related Health and Safety (Eklund)

 Face Shields
 Task Specific
 If they do not meet ANSI
standards for impact protection,
protective eyewear should be
worn under the face shield

Infection Control and Related Health and Safety (Eklund)

 Protective Attire
 Types
 Reusable
 Disposable
 Designed to be a barrier for clothing
and non-intact skin
 Design/style should be based upon
anticipated exposure to body fluids of
patients
 Laundering resuable attire

Infection Control and Related Health and Safety (Eklund)

 Resources
 Recommendations
 Centers for Disease Control and Prevention
(CDC) www.cdc.gov
 National Institutes of Occupational Safety and
Health (NIOSH) www.cdc.niosh.gov
 Professional Recommendations
– OSAP www.osap.org
– ADA www.ada.org
– ADHA www.adha.org
– ADAA www.adaa.org

Infection Control and Related Health and Safety (Eklund)

 Resources
 Regulations/statutes
 Food and Drug Administration
www.fda.gov
 Environmental Protection Agency (EPA)
– www.epa.gov
 Occupational Safety and Health
Administration (OSHA)
– www.osha.gov

Infection Control and Related Health and Safety (Eklund)

 Resources (continued)
 Regulations/statutes
State Boards of Registration
State Departments of Public Health
State /local agencies who regulate waste
Biohazard, chemical, general

Infection Control and Related Health and Safety (Eklund)

 From Policy to Practice
 Site-specific application of
policies
 Standard operating procedures
 Day -to- Day management of
policies and procedures

Infection Control and Related Health and Safety (Eklund)

 Education and Training
 Techniques
 Tools
 Organization for Safety and Asepsis
Procedures (OSAP)
 SOP for each practice setting
 Resources (related guidelines, standards,
regulations and statutes)
 Approaches ( talking vs teaching vs
training)
Infection Control and Related Health and Safety (Eklund)
 Compliance
 Assessment / Evaluation
Feedback and Reflection
 Assuming Responsibility for Health
and Safety of Patients/clients,
Yourself and Other Staff
Ethical
Legal
 Enforcement
Positive Reinforcement
Negative Reinforcement

Infection Control and Related Health and Safety (Eklund)

 Kathy Eklund Motto for Infection
Control and Health and Safety
 Learn the concepts, keep current
with the science and relevant
standards
 Believe that it is critical to
healthcare delivery
 Behave in a manner consistent
with the above

Infection Control and Related Health and Safety (Eklund)