Download - PRACTICAL INFECTION CONTROL-1
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Géza T. Terézhalmy, D.D.S.,M.A.Géza T. Terézhalmy, D.D.S.,M.A.
Professor and Dean EmeritusProfessor and Dean Emeritus
School of Dental MedicineSchool of Dental Medicine
Case Western Reserve UniversityCase Western Reserve University
Cleveland, OhioCleveland, Ohio
[email protected]@case.edu
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The transmission of pathogenic organisms in the oral healthcare
setting is RARE, yet cross-infection does present a POTENTIAL HAZARD
to OHCWs and patients alike.
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OHCWs’ primary obligation and ultimate responsibility is the delivery
of quality care in the privacy of a comfortable and SAFE
ENVIRONMENT
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To prevent or minimize cross-infection, it is MANDATED that oral healthcare facilities develop a written infection control/exposure control protocol.
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QUALITY OF INFECTION CONROL QUALITY OF INFECTION CONROL PRACTICESPRACTICES
Protocol should be appropriate for Protocol should be appropriate for settingsetting
▼▼Add quality at the production stage
▼Factors that affect quality are structure, process,
and outcome
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Structure Material resources
Example: sterilization area and equipment Human resources
Example: number and qualification of personnel
Organizational resources Example: timely availability of post-exposure
evaluation and follow-up
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Process Criteria, i.e., standards
Based on evidence derived from well-conducted trials or extensive, controlled observations
In the absence of such data, reflect the best-informed or most authoritative opinion available
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Process (cont’d) Execution
Development and implementation of activities to meet the criteria
Assessment Continuous monitoring of compliance and
outcome Response
Activities to resolve issues related to non-compliance and adverse outcome
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Outcome Impact of infection control/exposure
control strategies Enhanced knowledge Changed behavior Improved health of both OHCWs and
patients
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Office infection-control coordinator Responsibilities
Development and overall management of the protocol Provides both access and explanation of its content
upon request
Monitors effectiveness of the program on a day-to-day basis, and over time Ensures that the criteria a relevant, the procedures
are efficient, and the practices are successful
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EDUCATION AND TRAININGEDUCATION AND TRAININGCompliance is significantly improved Compliance is significantly improved
when personnel understand the rationale when personnel understand the rationale for infection control policies and practicesfor infection control policies and practices
▼▼Mandatory prior to initial occupational exposure to
blood and other potentially infectious material(and annually thereafter)
▼Training record maintained for the most recent 3-year
period
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The fabric of an educational and training program
Standard precautions A hierarchy of preventive strategies
Occupational risks in oral healthcare settings Immunizations Personal protective equipment (PPE) Engineering and work-practice controls Environmental infection control Post-exposure management Transmission-based precautions Administrative controls (policies)
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Occupational risks in oral healthcare settings Infection
Invasion and multiplication of microorganisms in body tissues resulting in local cellular injury Principles of the “chain of infection”
Adequate number of pathogenic organisms Sufficient virulence of pathogenic organisms A mode of transmission A portal of entry A susceptible host
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Modes of transmission Direct contact with blood and other
potentially infectious material (OPIM) Contact with objects contaminated with
blood and OPIM Exposure to splash and spatter containing
blood and OPIM Inhalation of airborne microorganisms
suspended in aerosols, i.e., droplets and droplet nuclei
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Pathogenic organisms of concern HBV
Mode of transmission Contact with blood and OPIM
Major risk of occupational exposure in the oral healthcare setting
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HCV Mode of transmission
Contact with blood and OPIM The risk of occupational exposure in the oral
healthcare setting is remote
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HIV Mode of transmission
Contact with blood and OPIM The risk of occupational exposure in the oral
healthcare setting is remote
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Measles (Rubeola) Mode of transmission
Inhalation of airborne droplets Direct contact with nasopharyngeal secretions Contact with freshly contaminated articles
The risk of occupational exposure in the oral healthcare setting is remote
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Mumps (Infectious parotitis) Mode of transmission
Inhalation of airborne droplets Direct contact with saliva Contact with freshly contaminated articles
The risk of occupational exposure in the oral healthcare setting is remote
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Rubella (German measles) Mode of transmission
Inhalation of airborne droplets Direct contact with nasopharyngeal secretions Contact with freshly contaminated articles
The risk of occupational exposure in the oral healthcare setting is remote
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Herpes simplex Mode of transmission
Direct contact with vesicular fluid Direct contact with infected skin and mucous
membranes Contact with freshly contaminated articles
Herpetic whitlow and herpetic keratoconjunctivitis occur commonly in the oral healthcare setting when standard precautions are not followed
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Varicella (chicken pox) and varicella zoster (shingles) Mode of transmission
Inhalation of airborne droplets Direct contact with vesicular fluid Direct contact with infected skin and mucous
membranes Contact with freshly contaminated articles
The risk of occupational exposure in the oral healthcare setting is remote
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Influenza and respiratory syncytial viruses Mode of transmission
Inhalation of airborne droplets Direct contact with nasopharyngeal secretions Contact with freshly contaminated articles
Upper respiratory tract infections occur commonly in the oral healthcare setting when standard precautions are not followed
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Mycobacterium tuberculosis Mode of Transmission
Inhalation of droplet nuclei Direct contact with contaminated sputum Contact with freshly contaminated articles
The risk of occupational exposure in the oral healthcare setting is remote
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Vaccinations Reduce the risk
of vaccine-preventable diseases Hepatitis B
vaccine Mandated for all
healthcare workers Mandatory
Hepatitis B Vaccination Declination Form
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Post-vaccination confirmation of anti-HBs titer 1-2 months after the 1st series
Anti-HBs titer of >10 mlU/mL is considered adequate
If anti-HBs titer is <10 mlU/mL A second series is recommended 1-2 months after 2nd series retest for anti-HBs
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If no antibody response occurs, test for HBsAg HBsAg-negative personnel
Shall be counseled about precautions to prevent HBV infection
AND Shall be provided HBIG prophylaxis for any known
or probable parenteral exposure to HBsAg-positive blood
HBsAg-positive personnel Shall obtain appropriate medical consultation
AND Shall be counseled about the prevent of HBV
transmission to others
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Influenza, MMR, varicella, zoster, Td/Tdap, and HPV vaccines Highly
recommended for all healthcare workers
Pneumococcal, hepatitis A, and meningococcal vaccines Highly
recommended for some healthcare workers
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Personal Protective Equipment Under normal conditions of use, PPE will
not permit blood or OPIM to pass through to and reach Street clothes Undergarments Skin Mucous membranes
Eyes, nose, and mouth
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Protective clothing Gowns or lab coats with long sleeves
Changed at least daily Anytime it becomes visibly soiled As soon as possible when penetrated by blood or
OPIM Removed before leaving work area Dirty clothing is placed in designated areas for
disposal or washing
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Task-specific gloves Non-surgical and surgical gloves are single-
use items When torn or punctured, change gloves as soon as
possible Gloves may not be washed
Wicking (penetration of liquids through undetectable holes in the gloves)
Double gloving is acceptable for certain extensive surgical procedures
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Heavy-duty utility gloves Worn for all instrument, equipment, and
environmental surface cleaning and disinfection
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Surgical masks Must cover both the nose and the mouth for
procedures likely to generate splash, spatter, and aerosols
Those provided for routine use shall have a >95% filtration efficiency (particle >3 m in diameter)
Should be changed, as soon as possible, when they become wet (between patients or even during patient treatment)
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When treating patients with suspected or confirmed infectious TB disease National Institute for Occupational Safety and
Health (NIOSH)-certified particulate-filter respirator shall be provided A >95% filtration efficiency when challenged with
particle 0.3 m in diameter
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Protective eyewear With solid side
shields or a face shied shall be worn by all OHCWs For procedures
likely to generate splash, spatter, and aerosols
Protective eyewear with solid side shield is also provided to patients
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Engineering and work-practice controls Engineering controls
Take advantage of available technology to eliminate, minimize, or isolate biohazards
Work-practice controls Promote safer behavior
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Hand hygiene Wearing gloves
does not eliminate the need for hand hygiene
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Natural or artificial fingernails shall be kept short to Facilitates through cleaning Prevents glove tears
All jewelry and ornaments shall be removed from the hands and wrists Interfere with glove use
Sinks with electronic, foot, or knee action faucet control Promote asepsis and ease of function
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Perform appropriate hand hygiene At the beginning of each work day Before gloving, after degloving, and before
regloving Before and after going to lunch, taking a
break, using the bathroom Anytime the hands are contaminated with
blood or OPIM
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Routine handwash Plain soap and
water Removes soil and
transient microorganisms
Acceptable method prior to performing Physical
examinations Nonsurgical
procedures
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Antiseptic handwash Antimicrobial soap
(i.e., iodophors) and water
Removes or destroys transient microorganisms and reduces resident flora
Acceptable method prior to performing Physical
examinations Nonsurgical
procedures
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Antiseptic hand rub Alcohol-based (i.e.,
60 to 95% ethanol) To be used only
when no visible soil on hands
Removes or destroys transient microorganisms and reduces resident flora
Acceptable method prior to performing Physical
examinations Nonsurgical
procedures
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Surgical antisepsis Antimicrobial soap (i.e., iodophors) and water OR Plain soap and water followed by antiseptic hand-
rub (i.e., 60 to 95% ethanol) Removes or destroys transient microorganisms and
reduces resident flora Persistent effect
Acceptable method prior to performing Surgical procedures
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