Chapter 7 Body Systems

advertisement
Disease Transmission
and Infection Control
Chapter 19
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 19
Lesson 19.1
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives







Identify the links in the chain of infection.
Describe the differences between a chronic infection
and an acute infection.
Give an example of a latent infection.
Describe the routes of disease transmission in a
dental office.
Describe the types of immunity and give examples of
each.
Describe the roles of the CDC and OSHA in infection
control.
Describe the components of an OSHA exposurecontrol plan.
(Cont’d)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
(Cont’d)






Explain the difference between universal precautions
and standard precautions.
Explain the rationale for standard precautions.
Identify the OSHA categories of risk for occupational
exposure.
Describe the first aid necessary after an exposure
incident.
Discuss the rationale for hepatitis B vaccination for
dental assistants.
Describe the proper handling and disposal methods
for each type of waste generated in dentistry.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Introduction
As a member of the dental healthcare team, the
dental assistant is at risk of exposure to disease
agents through contact with blood and other potentially
infectious materials.
By carefully following infection-control and safety
guidelines, you can minimize your risk of disease
transmission in the dental office.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
The Chain of Infection

The chain of infection consists of four parts:




Virulence
Numbers
Susceptible host
Portal of entry
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-1 At least one part must be removed
to break the chain of infection.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Virulence



The virulence of an organism refers to the
degree of pathogenicity or strength of that
organism in its ability to produce disease.
Because we cannot change the virulence of
microorganisms, we must rely on our body
defenses and specific immunizations.
Avoid contact with microorganisms by always
using infection-control techniques.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Numbers


In addition to being virulent, pathogenic
microorganisms must be present in large enough
numbers to overwhelm the body’s defenses.
The number of pathogens may be directly
related to the amount of bioburden present.


“Bioburden” refers to organic materials such as blood
and saliva.
The use of the dental dam and high-volume
evacuation helps minimize bioburden on
surfaces and reduce the number of
microorganisms in the aerosol.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Susceptible Host



A susceptible host is a person who is unable
to resist infection by the pathogen.
An individual who is in poor health,
chronically fatigued, or under extreme stress
or who has a weakened immune system is
more likely to become infected.
Staying healthy, washing hands frequently,
and keeping immunizations up to date will
help members of the dental team resist
infection and stay healthy.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Portal of Entry



To cause infection, a pathogen must have a
portal of entry (or means of getting into the
body).
The portals of entry for airborne pathogens
the mouth and nose.
Bloodborne pathogens must have access to
the blood supply to gain entry into the body.

This occurs through a break in the skin caused by
a needlestick, a cut, or even a human bite.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Types of Infections



Acute infection: Symptoms are often quite severe and
appear soon after the initial infection occurs.
Chronic infections: In these infections, the
microorganism is present for a long period; some may
persist for life.
Latent infection: A latent infection is a persistent
infection in which the symptoms come and go; cold
sores fall in this category.


Oral herpes simplex and genital herpes are latent viral infections
Opportunistic infections: Caused by normally
nonpathogenic organisms, opportunistic infections occur
in individuals whose resistance is decreased or
compromised.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Routes of Disease Transmission



Direct transmission occurs when someone comes
into direct contact with the infectious lesion or
infected body fluids (e.g., blood, saliva, semen,
vaginal secretions).
Indirect transmission involves the transfer of
organisms to a susceptible person through, for
example, the handling of contaminated instruments
or touching of contaminated surfaces and then
touching the face, eyes, or mouth.
Splash or spatter transmission happens during a
dental procedure when the mucosa (mouth or eyes)
or nonintact skin is splashed with blood or bloodcontaminated saliva.
(Cont’d)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Routes of Disease Transmission
(Cont’d)




Airborne transmission, also known as droplet
infection, involves the spread of disease through
droplets of moisture containing bacteria or viruses.
Aerosols, containing saliva, blood, and
microorganisms, are created with the use of the highspeed handpiece, air-water syringe, and ultrasonic
scaler during dental procedures.
Mists are droplet particles larger than those
generated in aerosol spray.
Spatter is large droplet particles contaminated with
blood, saliva, and other debris.
(Cont’d)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Routes of Disease Transmission
(Cont’d)




Parenteral transmission can take place through needlestick
injuries, human bites, cuts, abrasions, or any break in the skin.
Bloodborne transmission involves direct or indirect contact with
blood and other body fluids.
Food-and-water transmission occurs when contaminated food
that has not been cooked or refrigerated properly or water that
has been contaminated with human or animal fecal material is
consumed.
Fecal/oral transmission occurs when proper sanitation
procedures, such as handwashing after use of the toilet, are not
followed and one of the many pathogens present in fecal matter
is transmitted when the infected person touches another person
or makes contact with surfaces or food.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-2 Pathogens can be transferred from staff to patient, from patient to
staff, and from patient to patient through the use of
contaminated equipment.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
The Immune System




The human body receives resistance to
communicable diseases from the immune
system.
A communicable disease is one that can be
transmitted from one person to another or by
contact with the body fluids from another
person.
Inherited immunity is present at birth.
Acquired immunity is developed over a
person’s lifetime.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Acquired Immunity

Acquired immunity can occur either naturally
or artificially.


Naturally acquired immunity occurs when a person
has contracted and is recovering from a disease.
• Active immunity
• Passive immunity
In artificially acquired immunity, antibodies are
introduced into the body by means of
immunization or vaccination.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-3 Acquired immunity.
(From Applegate EJ: The anatomy and physiology learning system, ed 2, Philadelphia, 2000, Saunders.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Disease Transmission in the Dental
Office

Every dental office should have an infectioncontrol program designed to prevent the
transmission of disease from:





Patient to dental team
Dental team to patient
Patient to patient
Dental office to community
(including the dental team’s families)
Community to patient
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Patient–to–Dental Team
Transmission



The most common route is through direct
contact (touching) of the patient’s blood or
saliva.
Droplet infection occurs through mucosal
surfaces of the eyes, nose, and mouth. It can
occur when the dental-team member inhales
aerosol generated by the dental handpiece or
air-water syringe.
Indirect contact occurs when the team
member touches a contaminated surface or
instrument.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Disease Transmission

Ways to prevent disease transmission from
the patient to the dental team member.





Gloves
Handwashing
Masks
Rubber dams
Patient mouth rinses
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Patient-to-Patient Disease
Transmission



Patient-to-patient disease transmission has occurred
in the medical field, but no cases of this type of
transmission have been documented in dentistry.
Although such transmission is possible,
contamination from instruments used on one patient
must be transferred to another patient for this to
occur.
Infection-control measures that can prevent patientto-patient transmission include (1) instrument
sterilization, (2) surface barriers, (3) handwashing, (4)
gloves, and (5) use of sterile instruments.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Dental Office–to–Community
Transmission

Microorganisms can leave the dental office and enter
the community in a variety of ways.




Contaminated impressions sent to the dental laboratory
Contaminated equipment sent out for repair
In theory, transportation of microorganisms out of the office
on the dental team’s clothing or hair
The following measures can prevent this type of
disease transmission:



Handwashing
Changing clothes before leaving the office
Disinfecting impressions and contaminated equipment
before such items leave the the office
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Community–to–Dental Office–to–
Patient Transmission

Microorganisms enter the dental office
through the municipal water that supplies the
dental unit.


Waterborne organisms colonize the inside of the
dental unit waterlines and form biofilm.
As water flows through the handpiece, air-water
syringe, and ultrasonic scaler, a patient could
swallow contaminated water.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Roles and Responsibilities of CDC
and OSHA in Infection Control





The Centers for Disease Control and Prevention (CDC)
and the Occupational Safety and Health Administration
(OSHA) are federal agencies that play very important
roles in infection control for dentistry.
The CDC is not a regulatory agency. Its role is to issue
specific recommendations based on sound scientific
evidence on health-related matters.
CDC’s recommendations are not law, but they do
establish a standard of care for the dental profession.
OSHA is a regulatory agency. Its role is to issue specific
standards to protect the health of employees in the U.S.
In 1991, based on the CDC guidelines, OSHA issued the
Bloodborne Pathogens Standard (BBP).
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
CDC Guidelines for Infection Control
in Dental Health-Care Settings

In December of 2003, the CDC released the
Guidelines for Infection Control in Dental Health Care
Settings-2003.



The new guidelines have expanded upon the existing OSHA
Bloodborne Pathogens Standard, and have included some
areas that were not already covered.
The guidelines are based on scientific evidence and are
categorized on the basis of existing scientific data,
theoretical rationale, and applicability.
The guidelines apply to all paid or unpaid dental health
professionals who might be occupationally exposed to blood
and body fluids by direct contact or through contact with
contaminated environmental surfaces, water, or air.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
OSHA Bloodborne Pathogens
Standard

The bloodborne pathogens standard (BBP) is
the most important infection control law in
dentistry.


It is designed to protect employees against
occupational exposure to bloodborne pathogens,
such as hepatitis B, hepatitis C, and human
immunodeficiency virus (HIV).
Employers are required to protect their employees
from exposure to blood and other potentially
infectious materials (OPIM) in the workplace and
to provide proper care to the employee if an
exposure should occur.
(Cont’d)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
OSHA Bloodborne Pathogens
Standard
(Cont’d)

The BBP applies to any type of facility in
which employees might be exposed to blood
and/or other body fluids, which include:

Dental and medical offices
 Hospitals
 Funeral homes
 Emergency medical services
 Nursing homes

OSHA requires that a copy of the BBP be
present in every dental office and clinic.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Requirements of the Standard


Exposure control plan clearly describes how the office complies
with the standard.
The term Universal Precautions is referred to in the OSHA
Bloodborne Pathogens Standard.

Universal precautions is based on the concept that all human blood
and body fluids (including saliva) are to be treated as if known to be
infected with the bloodborne disease, HBV, HCV, or HIV.
 The CDC expanded the concept and changed the term to Standard
Precautions.


Standard Precautions integrate and expand the elements of
universal precautions into a standard of care designed to protect
healthcare providers from pathogens that can be spread by
blood or any other body fluid, excretion, or secretion.
It is not possible to identify those individuals who are infectious,
so infection precautions are used for all healthcare personnel
and their patients.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Table 19-1 Occupational Exposure Determination
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Postexposure Management



Accidents happen!
Before an accident occurs, the BBP requires
the employer to have a written plan.
This plan explains exactly what steps the
employee must follow after the exposure
incident occurs and the type of medical
follow-up that will be provided to the
employee at no charge.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Follow-up Measures for
Exposed Worker*
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Hepatitis B Immunization





OSHA requires the dentist to offer the hepatitis B virus
(HBV) vaccination series to all employees whose jobs
include category I and II tasks.
Vaccine must be offered within 10 days of employment.
The dentist/employer must obtain proof from the
physician who administered the vaccination.
The employee has the right to refuse the HBV vaccine;
however, the employee must sign an informed refusal
form that is kept on file in the dental office.
The employee always has the right to change his or her
mind and receive the vaccine at a later date at no
charge.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Hepatitis B Vaccine


The vaccine is administered in a series of three
injections. The most common vaccination schedule is
0, 1, and 6 months.
The preferred injection site is in the deltoid muscle
(on the arm).


The seroconversion rate (development of immunity) is higher
than when the vaccine is administered in the buttocks.
The Centers for Disease Control and Prevention
(CDC) states that pregnancy should not be
considered a contraindication to the HBV vaccine;
however, the woman’s obstetrician should be
consulted.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Post-vaccine Testing as
Recommended by the CDC



Between 1 to 2 months after the series has been
completed, a blood test should be performed to
ensure that the individual has developed immunity.
Individuals who have not developed immunity should
be evaluated by their physician to determine the need
for an additional dose of HBV vaccine.
Individuals who do not respond to the second 3-dose
series of the vaccine should be counseled regarding
their susceptibility to HBV infection and precautions
to take.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Need for a Booster



Routine booster doses of the HBV vaccine
are not recommended by the CDC.
The CDC does not recommend routine blood
testing (after the initial testing to determine
initial immunity) to monitor the HBV antibody
level in individuals who have already had the
vaccine.
The exception to this recommendation is if an
immunized individual has a documented
exposure incident and the attending physician
orders the administration of a booster dose.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Employee Medical Records



The dentist/employer must keep a
confidential medical record for each
employee.
These records are confidential and must be
stored in a locked file.
The employer must keep these records for 30
years.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Managing Contaminated Sharps





Contaminated needles and other disposable sharps,
such as scalpel blades, orthodontic wires, and broken
glass, must be placed into a sharps container.
The sharps container must be puncture-resistant,
closable, leak-proof, and color-coded or labeled with
the biohazard symbol.
Sharps containers must be located as close as
possible to the place of immediate disposal.
Do not cut, bend, or break the needles before
disposal.
Never attempt to remove a needle from a disposable
syringe.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-4 A puncture-resistant sharps disposal container should be located
as close as possible to the area where the disposal of sharps takes place.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Preventing Needlesticks
as Recommended by the CDC

Never recap used needles by using both
hands or any other technique that involves
directing the point of a needle toward any part
of the body.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 19
Lesson 19.2
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives






Explain the importance of hand care for dental
assistants.
Explain proper hand hygiene for dental assistants.
Explain the advantages of alcohol-based hand rubs.
Discuss the types of personal protective equipment
(PPE) needed for dental assistants.
Demonstrate the proper sequence for donning and
removing PPE.
Discuss the various types of gloves used in a dental
office.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Hand Hygiene





Wash your hands each time before you put on gloves
and immediately after you remove gloves.
Wash your hands when you inadvertently touch
contaminated objects or surfaces while barehanded.
Always use liquid soap during handwashing. Bar
soap should never be used because it may transmit
contamination.
For most routine dental procedures, such as
examinations and nonsurgical procedures, an
antimicrobial soap can be used.
For surgical procedures, you should use a germicidal
surgical scrub product.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-7 Areas of the hand not thoroughly washed
because of poor handwashing technique.
(From Samaranayake LP, Essential microbiology for dentistry, ed. 2, New York, 2002, Churchill Livingstone.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Hand Care




Dry hands well before donning gloves.
Keep nails short and well manicured; rings (except
for wedding rings), fingernail polish, and artificial nails
are not to be worn at work.
Microorganisms thrive around rough cuticles and can
enter the body through any break in the skin.
Dental personnel with open sores or weeping
dermatitis must avoid activities involving direct patient
contact and handling contaminated instruments or
equipment until the condition on the hands is healed.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Alcohol-Based Hand Rubs






Waterless antiseptic agents are alcohol-based products
that are available in gels, foams, or rinses.
They do not require the use of water. The product is
simply applied to the hands, which are then rubbed
together to cover all surfaces.
These products are more effective at reducing microbial
flora than a plain soap, or even an antimicrobial hand
wash.
Concentrations of 60% to 95% are the most effective.
Higher concentrations are actually less effective.
They contain emollients that reduce the incidence of
chapping, irritation, and drying of the skin.
These products are very “dose sensitive.” This means that
you must use the amount that is recommended.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
CDC Recommendations for Hand
Care



For most routine dental procedures, such as
examinations and nonsurgical procedures, wash your
hands with either a nonantimicrobial or antimicrobial
soap and water.
If your hands are not visibly soiled, you may use an
waterless alcohol-based hand rub.
For surgical procedures, you should perform a
surgical scrub using either a nonantimicrobial or
antimicrobial soap and water, dry your hands, and
apply an alcohol-based surgical hand rub.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-10 Hand lotions must be compatible with
glove material.
(Courtesy of Crosstex.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Personal Protective Equipment


OSHA requires the employer to provide
employees with the appropriate personal
protective equipment (PPE) without charge to
the employee.
Examples of PPE






Protective clothing
Surgical masks
Face shields
Protective eyewear
Disposable patient-treatment gloves
Heavy-duty utility gloves
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Protective Clothing




Types of protective clothing include smocks,
slacks, skirts, laboratory coats, surgical
scrubs (hospital operating room clothing),
scrub (surgical) hats, pants, and shoe covers.
The type of protective clothing you should
wear is based on the degree of anticipated
exposure to infectious materials.
The BBP prohibits the employee from taking
protective clothing home to be laundered.
Laundering of contaminated protective
clothing is the responsibility of the employer.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Protective Clothing Requirements





Protective clothing should be made of fluid-resistant
material.
As a means of minimizing the amount of uncovered skin,
clothing should have long sleeves and a high neckline.
Note: The type and characteristics of protective clothing
depend on the anticipated degree of exposure.
The design of the sleeve should allow the cuff to be
tucked inside the band of the glove.
During high-risk procedures, protective clothing must
cover dental personnel at least to the knees when seated.
Buttons, trim, zippers, and other ornamentation should be
kept to a minimum.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-11 Appropriate clinical attire consists of
long-sleeved gowns, gloves, and eyewear.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Protective Masks



A mask is worn over the nose and mouth to
protect you from inhaling possible infectious
organisms spread by the aerosol spray of the
handpiece or air-water syringe and accidental
splashes.
A mask with at least 95% filtration efficiency
for particles 3 to 5 mm in diameter should be
worn whenever splash or spatter is likely.
The two most commonly used types of masks
are dome-shaped and flat.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Guidelines for the Use of Masks





Masks should be changed for every patient or
more often (CDC guideline).
To handle a mask, touch the side edges only;
avoid contact with the more heavily
contaminated body of the mask.
The mask should conform well to the face.
The mask should not make contact with the
mouth while being worn because the
moisture that is generated will decrease
filtration efficiency.
A damp or wet mask is not an effective mask.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Protective Eyewear





Eyewear is worn to protect eyes against the danger
of damage caused by aerosolized pathogens.
Protective eyewear also prevents spattered solutions
or caustic chemicals from injuring the eyes.
OSHA requires the use of eyewear with both front
and side protection (solid side shields) during
exposure-prone procedures.
If you wear contact lenses, you must wear protective
eyewear with side shields or a face shield.
After each treatment or patient visit, clean and
decontaminate your protective eyewear in
accordance with the manufacturer's instructions
(CDC guideline).
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Face Shields



A chin-length plastic face shield may be worn
as an alternative to protective eyewear.
A shield cannot be substituted for a face
mask because it does not protect against
inhalation of contaminated aerosols.
When splashing or spattering of blood or
other body fluids is likely during a procedure
(such as surgery), a face shield is often worn
in addition to a protective mask.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-18 Face shields provide adequate eye protection, but a face
mask is still required during assistance with
aerosol-generating procedures.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Protective Eyewear for Patients


Patients should be provided with protective
eyewear because they also may be subject to
eye damage during the procedure.
This may result from:

Handpiece spatter
 Spilled or splashed dental materials, including
caustic chemical agents
 Airborne bits of acrylic or tooth fragments
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-19 Patients should be provided with
protective eyewear.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Gloves



Because dental personnel are most likely to come
into contact blood or contaminated items with their
hands, gloves may be the most critical PPE.
You must wear a new pair of gloves for each patient,
remove them promptly after use, and wash your
hands immediately to avoid the transfer of
microorganisms to other patients or the environment
(CDC guideline).
Consult with the glove manufacturer regarding the
chemical compatibility of the glove material and the
dental materials you use (CDC guideline).
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-21 Nonsterile exam gloves.
(Courtesy of Crosstex.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Guidelines for the Use of Gloves




All gloves used in patient care must be
discarded after a single use.
These gloves may not be washed,
disinfected, or sterilized; however, they may
be rinsed with water
to remove excess powder.
Latex, vinyl, or other disposable medicalquality gloves may be used for patient
examinations and dental procedures.
Torn or damaged gloves must be replaced
immediately.
(Cont’d)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Guidelines for the Use of Gloves
(Cont’d)




Do not wear jewelry under gloves. (Rings
harbor pathogens and may tear gloves.)
Change gloves frequently. (If the procedure is
long, change gloves about once each hour.)
Remove contaminated gloves before leaving
the chairside during patient care and replace
them with new gloves before returning to
patient care.
Hands must be washed after glove removal
and before regloving.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Gloves Damaged During Treatment


Gloves are effective only when they are intact
(not damaged, torn, ripped, or punctured).
If gloves are damaged during treatment, they
must be changed immediately. The procedure
for regloving is:




Excuse yourself and leave the chairside.
Remove and discard the damaged gloves.
Wash hands thoroughly.
Reglove before returning to the dental procedure.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Overgloves


Overgloves, which also are known as “food
handler” gloves, are made of lightweight,
inexpensive clear plastic.
These may be worn over contaminated
treatment gloves (overgloving) to prevent the
contamination of clean objects handled
during treatment.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Guidelines for the Use of Overgloves




Overgloves are not acceptable alone as a
hand barrier or for intraoral procedures.
Overgloves must be worn carefully to avoid
contamination during handling with
contaminated procedure gloves.
Overgloves are donned before the secondary
procedure is performed and removed before
the patient treatment that was in progress is
resumed.
Overgloves are discarded after a single use.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Sterile Surgical Gloves



Sterile gloves should be worn for invasive
procedures involving the cutting of bone or
significant amounts of blood or saliva, such
as oral surgery or periodontal treatment.
Sterile gloves are supplied in prepackaged
units to maintain their sterility before use.
They are provided in specific sizes and are
fitted to the left or right hand.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Utility Gloves


Utility gloves are not used for direct patient care.
Utility gloves must be worn:





When the treatment room is being cleaned and disinfected
between patients.
While contaminated instruments are being cleaned or
handled.
For surface cleaning and disinfection.
Utility gloves may be washed, disinfected, or
sterilized and reused.
Used utility gloves must be considered contaminated
and handled appropriately until they have been
properly disinfected or sterilized.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-22 Utility gloves are used in preparing
instruments for sterilization.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Maintaining Infection Control While
Gloved



During a dental procedure, it may be
necessary to touch surfaces or objects such
as drawer handles
and material containers.
If you touch these objects with a gloved hand,
both the surface and glove become
contaminated.
To minimize the possibility of crosscontamination, use an overglove when it is
necessary to touch a surface.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Non–Latex-Containing Gloves


Healthcare providers or patients may
experience serious allergic reactions to latex.
For the person who is sensitive to latex, there
are gloves made from vinyl, nitrile, and other
nonlatex-containing materials.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Glove Caution

Chemicals such as glutaraldehyde and
acrylates readily permeate (pass through)
latex gloves and can irritate the skin.


Note that irritation can be mistaken for an allergic
reaction to the chemicals in the latex glove.
This is why latex gloves should never be
worn for the handling of chemicals.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 19
Lesson 19.3
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives







Explain the types and symptoms of latex reactions.
Describe the proper handling and disposal methods for each
type of waste generated in dentistry.
Describe the roles of the CDC and OSHA in infection control.
Explain the CDC recommendations regarding the use of a saliva
ejector.
Explain the precautions necessary when treating a patient with
active tuberculosis.
Describe the rationale of CDC recommendations regarding
Creutzfeldt-Jakob disease and other prion-related diseases.
Describe the rationale of CDC recommendations regarding laser
plumes.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Latex Allergies



The use of natural-rubber latex gloves has
proved one of the most effective means of
protecting the dental worker and the patient
from the transmission of disease.
The number of healthcare workers and
patients who have become hypersensitive to
latex has increased dramatically.
The CDC Guidelines include
recommendations for contact dermatitis and
latex hypersensitivity.
(Cont’d)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Latex Allergies
(Cont’d)


There are three common types of allergic
reactions to latex.
Two types involve an immune reaction and
one type involves only surface irritation.

Irritant dermatitis, a nonimmunologic process
(does not involve the body’s immune system), is
caused by contact with a substance that produces
chemical irritation of the skin.
• The skin becomes reddened, dry, irritated, and, in severe
cases, cracked. Irritant dermatitis can be reversed by
identifying and correcting the cause of the problem.
(Cont’d)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-24 Irritant dermatitis.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Latex Allergies
(Cont’d)

Type IV sensitivity

The most common type of latex allergy, type IV
sensitivity, is a delayed contact reaction, and it
involves the immune system.
• It may take as long as 48 or 72 hours for the red, itchy
rash to appear.
• Reactions are limited to the areas of contact and
do not involve the entire body.
• An immune response is produced by the chemicals that
are used to process the latex used in manufacturing the
gloves, not by the proteins in the latex.
(Cont’d)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Latex Allergies
(Cont’d)

Type I allergic reaction

This is the most dangerous type of latex allergy,
and it can result in death.
• The reaction comes in response to the latex protein in
the glove (in contrast to the reaction to chemical
additives in type IV reactions).
• A severe immunologic (immune system) response
usually occurs 2 to 3 minutes after the latex allergens
make contact with the skin or mucous membranes.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Treatment of Latex Allergies




There is no specific cure for latex allergy.
The only options are prevention, avoidance of latexcontaining products, and treatment of the symptoms.
Anyone who suspects that he or she has an allergy to
latex should see a qualified healthcare provider to
have a test to confirm the allergy.
Once a latex allergy has been diagnosed, the
affected person should practice latex avoidance in all
aspects of his or her personal and professional lives.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Remember…

When a latex allergy has been diagnosed in
one employee in the dental office, all staff
members should use practices to minimize
the use of latex-containing products. These
practices include the wearing of powder-free
gloves by all dental staff members to
minimize the risk of airborne latex particles.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Latex-Sensitive Patients


In the healthcare setting, patients with latex
allergies should be treated with the use of
alternatives to latex.
Vinyl gloves and nonlatex rubber dams
should be available in all dental offices.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Waste Management in the Dental
Office



Dental practices are subject to a wide variety of
federal, state, and local regulations concerning waste
management issues.
The Environmental Protection Agency (EPA) and
most state and local regulations do not categorize
saliva or saliva-soaked items as infectious waste.
Because of the high probability that blood may be
carried in saliva during dental procedures, CDC
guidelines and OSHA regulations consider saliva in
dentistry a potentially infectious body fluid.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Classifications of Waste

General waste: All nonhazardous, nonregulated
waste should be discarded in covered containers.


Contaminated waste is waste that has had contact
with blood or other body fluids.


Examples include disposable paper towels, paper mixing
pads, and empty food containers.
Examples include used barriers and patient napkins.
Hazardous waste poses a risk to human beings and
the environment. Toxic chemicals and materials are
hazardous waste.

Examples include scrap amalgam, spent fixer solution,
and lead foil from x-ray film packets.
(Cont’d)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Classifications of Waste
(Cont’d)


Some items, such as extracted teeth with
amalgam restorations, may be both
hazardous waste (because of the amalgam)
and infectious waste (because of the blood).
Infectious or regulated waste (biohazard) is
contaminated waste that is capable of
transmitting an infectious disease.



Blood and blood-soaked materials
Pathologic waste
Sharps
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Handling Dental Office Waste



Contaminated waste: Items that may contain the
body fluids of patients, such as gloves and patient
napkins, should be placed in a lined trash receptacle.
Medical waste is any solid waste that is generated in
the diagnosis, treatment, or immunization of human
beings or animals in research.
Infectious waste is a subset of medical waste. Only a
small percentage of medical waste is infectious and
needs to be regulated.

Must be labeled with the universal biohazard symbol
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
CDC Guidelines for Handling
Extracted Teeth



Dispose of extracted teeth as regulated medical
waste unless they are being returned to the patient.
When teeth are returned to the patient, the provisions
of the standard no longer apply.
Do not dispose of extracted teeth containing
amalgam in regulated medical waste that will be
incinerated.
Note: Because of the mercury in amalgam fillings,
you should check with state and local authorities for
regulations regarding disposal of teeth containing
amalgam.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Handling Contaminated Waste




Contaminated items that may contain the body fluids
of patients, such as gloves and patient napkins,
should be placed in a lined trash receptacle.
A receptacle for contaminated waste should be
covered with a properly fitted lid that can be opened
with a foot pedal.
Keeping the lid closed prevents air movement and
the spreading of contaminants.
Red bags or containers should not be used for
unregulated waste. Check the specific requirements
of your local state or county health department.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 19-25 Waste is separated into clearly marked containers.
Left, unregulated waste. Right, regulated waste.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Handling of Medical Waste




Medical waste is any solid waste generated in the
diagnosis, treatment, or immunization of human beings or
animals in research.
Infectious waste is a subset of medical waste. Only a
small percentage of medical waste is infectious and needs
to be regulated.
Containers of infectious waste (regulated waste) must be
labeled with the universal biohazard symbol, identified in
compliance with local regulations, or both.
Containers used for holding contaminated items must be
labeled. Examples of such containers include
contaminated sharps containers, pans or trays used to
hold contaminated instruments, bags of contaminated
laundry, specimen containers, and storage containers.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Disposal of Medical Waste




Once contaminated waste leaves the office, it is
regulated by the EPA and by state and local laws.
Under most regulations, the manner of disposal is
determined by the amount (weight) of infectious
materials requiring disposal.
The average dental practice is categorized as a
“small producer” of infectious waste, and disposal is
regulated accordingly.
The law requires the dentist to maintain records of
the final disposal of this medical waste, including
documentation of how, when, and where it was
disposed of.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Additional Infection Control Practices



Never eat, drink, smoke, apply cosmetics or lip balm,
or handle contact lenses in any area of the dental
office where contamination is possible, such as the
dental treatment rooms, dental laboratory,
sterilization area, or the area for the processing of xrays.
Never store food or drink in a refrigerator that
contains any potentially contaminated items.
You can minimize the amount of splash and spatter
contamination produced during dental procedures
with the skillful use of a dental dam and high-volume
evacuation.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
CDC Guidelines Special Considerations:
Saliva Ejectors

Do not advise patients to close their lips
tightly around the tip of the saliva ejector to
evacuate oral fluids.

Rationale: Backflow from low-volume saliva
ejectors occurs when the pressure in the patient’s
mouth is less than that in the evacuator. This
backflow can be
a source of cross-contamination between patients.
Although no adverse health effects associated
with the saliva ejector have been reported, you
should be aware that in certain situations backflow
could occur with the use of a saliva ejector.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
CDC Guidelines Special Considerations:
Dental Laboratories





Use PPE when handling items in the laboratory until they have
been decontaminated.
Clean, disinfect, and rinse all dental prostheses and
prosthodontic materials (e.g., impressions, bite registrations,
occlusal rims, and extracted teeth).
Consult with manufacturers regarding the stability of specific
materials (e.g., impression materials) relative to disinfection
procedures.
Clean and heat-sterilize heat-tolerant items used in the mouth
(e.g., metal impression trays and face-bow forks).
Follow manufacturers' instructions for cleaning, sterilizing, or
disinfecting items that become contaminated but do not normally
come into contact with the patient (e.g., burs, polishing points,
rag wheels, articulators, case pans, and lathes.) If manufacturer
instructions are unavailable, clean and sterilize heat-stable
items and disinfect them.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
CDC Guidelines Special Considerations:
Preprocedural Mouth Rinses




Preprocedural mouth rinses are intended to reduce
the number of microorganisms released in the form of
aerosol or spatter.
Preprocedural mouth rinsing can decrease the
number of microorganisms introduced into the
patient’s bloodstream during invasive dental
procedures.
Scientific evidence that preprocedural mouth rinsing
prevents clinical infections among dental health
professionals or patients is inconclusive .
This is an unresolved issue, and no recommendation
has been made.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
CDC Guidelines Special Considerations:
Creutzfeldt-Jakob Disease and Other
Prion Diseases





Creutzfeldt-Jakob Disease (CJD) belongs to a group of rapidly
progressive and invariably fatal degenerative neurologic
disorders.
They affect both human beings and animals and are thought to
be caused by infection with prions.
Prion diseases have an incubation period of years but are
usually fatal within 1 year of diagnosis.
The infectivity of oral tissues in CJD patients is an unresolved
issue. Scientific data indicate that the risk, if any, of sporadic
CJD transmission during dental and oral surgical procedures is
low to nil.
No recommendation is offered regarding the use of special
precautions in addition to standard precautions in the treatment
of patients with known CJD (unresolved issue).
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
CDC Guidelines Special Considerations:
Laser/Electrosurgery Plumes or Surgical
Smoke




In surgical procedures involving the use of a laser or
electrosurgical unit, a smoke byproduct is created during the
thermal destruction of the tissue.
Laser plumes and surgical smoke pose a risk to dental
healthcare professionals.
One concern is that the aerosolized infectious material in the
laser plume may reach the nasal mucosa of the operator or
other members of the dental team. However, airborne exposure
to an infectious agent in a laser plume might not be enough to
cause disease.
The effect of the exposure (e.g., disease transmission or
adverse respiratory effects) on dental healthcare professionals
resulting from the use of lasers in dentistry has not been
adequately evaluated (unresolved issue).
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Download