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
 Immunizations
 Exposure incident
prevention and
management
 Universal
Precautions/
Standard
Precautions
 Personal
Protective
Equipment
Infection Control and Related Health and Safety (Eklund)
 Environmental
Asespsis
 Aseptic techniques
 Sterilization and
Management of Patient
Care Items
 Housekeeping practices
Environmental asepsis
Waste
 Hazard communication
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
changes
 Changes in
human
demographics
or behaviors
 International
travel and
commerce
Infection Control and Related Health and Safety (Eklund)
 Technology
 Microbial
changes
 Breakdown of
public health
measures
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
strategies
Exposure
prevention
 Management
Basic first aid
Reporting
Documentation
Infection Control and Related Health and Safety (Eklund)
 Medical followup
Designated HCP
Baseline testing
Prophylaxis
Therapy
Monitoring
Management
Prevention: Engineering
Controls and Work Practices
 Prevent Sharps
Injuries
(Percutaneous)
 Needles
 Bladed
Instruments
 Scalpel Blades
 Wires in surgery
and orthodonics
Infection Control and Related Health and Safety (Eklund)
 Prevent Mucous
Membrane
Exposures
 Protective
Barriers
– Eyewear,
Mask
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
Dermatitis
Infection Control and Related Health and Safety (Eklund)
 Contact
Dermatitis
 Latex Allergy
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)