Exposure Control:Exposure Control:Barriers for Barriers for

Patient and ClinicianPatient and Clinician

Immunizations and Periodic Immunizations and Periodic TestingTesting

Basic Immunizations:Basic Immunizations: Hepatitis A, BHepatitis A, B DiphtheriaDiphtheria TetanusTetanus PertussisPertussis Influenza type BInfluenza type B Measles, mumps, Measles, mumps,

rubella (MMR)rubella (MMR) VaricellaVaricella MeningococcalMeningococcal

Boosters:Boosters: May occur upon May occur upon

exposureexposure

Adult Recommendations: Tetanus and Tetanus and

diphtheria diphtheria =every 10 years=every 10 years

Annual influenzaAnnual influenza Annual TB skin Annual TB skin

testtest

ReviewReview

Which of the following should be done annually?Which of the following should be done annually?A) Tuberculin skin test (Mantoux)A) Tuberculin skin test (Mantoux)B) Influenza vaccineB) Influenza vaccineC) HBV vaccine boosterC) HBV vaccine boosterD) Tuberculin skin test and influenza vaccineD) Tuberculin skin test and influenza vaccineE) HBV booster, tuberculin skin test, and influenza vaccineE) HBV booster, tuberculin skin test, and influenza vaccine

AnswerAnswer

D) Tuberculin skin test and influenza D) Tuberculin skin test and influenza vaccinevaccine

The tuberculosis skin test needs to be The tuberculosis skin test needs to be done annually as well as the done annually as well as the influenza (flu) vaccine. The HBV influenza (flu) vaccine. The HBV vaccine does not have a specified vaccine does not have a specified booster schedule.booster schedule.

Personal Protective Personal Protective Equipment(PPE)Equipment(PPE)

1.Clinical attire: Gown1.Clinical attire: Gown Hair: Pulled back from field of vision Hair: Pulled back from field of vision 2.Face mask: pulled over nose and chin2.Face mask: pulled over nose and chin 3.Protective eyewear with side-shields3.Protective eyewear with side-shields 4.Gloves: changed often 4.Gloves: changed often OSHA Recommendations: Occupational OSHA Recommendations: Occupational

Safety and Health AdministrationSafety and Health Administration Protects the worker from physical, chemical or Protects the worker from physical, chemical or

infectious hazards in the workplace.infectious hazards in the workplace.

PPE’sPPE’s

When is it appropriate to wear When is it appropriate to wear personal protective gear?personal protective gear?

A. When in contact with aerosols, A. When in contact with aerosols, spatter, or body fluidsspatter, or body fluids

B. When taking radiographsB. When taking radiographs C. Handling denturesC. Handling dentures D. All of the aboveD. All of the above

AnswerAnswer

D. All of the aboveD. All of the above

What is OSHA?What is OSHA?

Occupational Safety and Health Occupational Safety and Health Administration Administration

A government agency in the A government agency in the Department of Labor to maintain a Department of Labor to maintain a safe and healthy work environmentsafe and healthy work environment

Material Safety Data SheetMaterial Safety Data Sheet

MSDS: MSDS: OSHA requires chemical OSHA requires chemical products in the clinic and company products in the clinic and company information be made available to all information be made available to all individuals in the work placeindividuals in the work place

Contains: Contains: hazard chemical inventory hazard chemical inventory of each product, exact name, product of each product, exact name, product number and supplier’s name and number and supplier’s name and addressaddress

Test your KnowledgeTest your Knowledge

What does MSDS mean?What does MSDS mean? Where is it located?Where is it located?

AnswerAnswer

Material Safety Data SheetMaterial Safety Data Sheet Dental clinic/front desk areaDental clinic/front desk area

Facial and Facial and Respiratory ProtectionRespiratory Protection

Use of a face maskUse of a face mask Mask efficiencyMask efficiency

Filtration: Filtration: 95% of particles as small as 3 u95% of particles as small as 3 u Fit : Fit : cover entire nose and chin areacover entire nose and chin area Moisture absorption: Moisture absorption: change after each change after each

patient and wore no longer than 1 hourpatient and wore no longer than 1 hour Comfort: supports complianceComfort: supports compliance

Mask removal: graspMask removal: grasp side string side string

ReviewReview

When should the face mask be changed?When should the face mask be changed?A) Every hourA) Every hourB) When it becomes wetB) When it becomes wetC) For each patientC) For each patientD) For each patient, when it becomes wet, and D) For each patient, when it becomes wet, and

at least every hourat least every hour

AnswerAnswer

D) For each patient, when it becomes wet, and D) For each patient, when it becomes wet, and at least every hourat least every hour

A new face mask should be used with each A new face mask should be used with each patient to prevent cross-contamination. The patient to prevent cross-contamination. The effectiveness of the face mask is effectiveness of the face mask is compromised when wet and after use for an compromised when wet and after use for an hour and should be changed accordingly.hour and should be changed accordingly.

Protective EyewearProtective Eyewear Clinician protection: Clinician protection: prevent injury and prevent injury and

infectioninfection Patient protection: Patient protection: prevent injury, prevent injury,

contact lens protectioncontact lens protection Features: Features: wide lens, side shieldswide lens, side shields Types of eyewear: Types of eyewear: goggles or glasses goggles or glasses

(magnification loupes)(magnification loupes) Eyewash station: Eyewash station: located at each sink in located at each sink in

clinicclinic

Face ShieldFace Shield

Worn over mask and safety glassesWorn over mask and safety glasses Used during polishing and ultrasonic Used during polishing and ultrasonic

scalerscaler

Hand Care Hand Care Hands: means of transmission, Hands: means of transmission,

reservoir, port of entryreservoir, port of entry Hand care: Hand care: avoid breaks in cuticlesavoid breaks in cuticles Fingernails: Fingernails: Short, trimmedShort, trimmed Jewelry wear: Jewelry wear: traps bacteriatraps bacteria CDC 2002 guidelinesCDC 2002 guidelines

http://www.cdc.gov/handhygiene/http://www.cdc.gov/handhygiene/

Handwashing PrinciplesHandwashing Principles Rationale: Rationale: prevent organisms prevent organisms

acquired from patient acquired from patient Purposes: Purposes: Reduce bacteria floraReduce bacteria flora Facilities: Facilities: foot control to avoid cross-foot control to avoid cross-

contaminationcontamination Agents: Agents: antimicrobial soap or alcohol antimicrobial soap or alcohol

rub rub

““Handwashing is considered the most important Handwashing is considered the most important single procedure for prevention of cross-single procedure for prevention of cross-

contamination.”contamination.”

Dr. Esther M. WilkinsDr. Esther M. Wilkins

Indications for HandwashIndications for Handwash

Before gloves placedBefore gloves placed After gloves removedAfter gloves removed Torn, punctured glovesTorn, punctured gloves After bare hands touch inanimate objectAfter bare hands touch inanimate object When visibly soiledWhen visibly soiled Entering and leaving operatoryEntering and leaving operatory

Gloving TechniqueGloving Technique Mask and eyewear placement: Mask and eyewear placement: prior to prior to

handwashing and glovinghandwashing and gloving

Preglove handwash:Preglove handwash:

Glove placement:Glove placement: Glove removal: Glove removal: wash promptly after wash promptly after

removalremoval

Factors Affecting Factors Affecting Glove IntegrityGlove Integrity

Torn, cut, or punctured gloves: Torn, cut, or punctured gloves: replacereplace

Length of time worn: Length of time worn: each new patient, no more than 1 hour, each new patient, no more than 1 hour, when they become stickywhen they become sticky

Size of glove: Size of glove: proper fit important for tactile sensitivityproper fit important for tactile sensitivity

Agents used in care provision: Agents used in care provision: vaseline, antiseptic vaseline, antiseptic handwash, and alcohol breakdown glove integrityhandwash, and alcohol breakdown glove integrity

Hazards from hands, jewelry: Hazards from hands, jewelry: long nails and ringslong nails and rings

Latex SensitivityLatex Sensitivity Clinical manifestations: dermatitis to anaphylaxisClinical manifestations: dermatitis to anaphylaxis

Individuals at riskIndividuals at risk: health care workers, multiple : health care workers, multiple surgeries, food allergiessurgeries, food allergies

Clinical management: patient may ask about our clinic…Clinical management: patient may ask about our clinic…latex free latex free

ReviewReview

Which of the following are at high risk of developing a Which of the following are at high risk of developing a latex allergy?latex allergy?

A) A person with spina bifidaA) A person with spina bifidaB) Healthcare workersB) Healthcare workersC) A person allergic to bananasC) A person allergic to bananasD) A person allergic to bananas, a person with spina D) A person allergic to bananas, a person with spina

bifida, and healthcare workersbifida, and healthcare workers

AnswerAnswer

D) A person allergic to bananas, a person with spina D) A person allergic to bananas, a person with spina bifida, and healthcare workersbifida, and healthcare workers

Individuals at high risk for latex sensitivity have had Individuals at high risk for latex sensitivity have had frequent exposure to latex products; this would frequent exposure to latex products; this would include healthcare workers and persons who have include healthcare workers and persons who have had multiple surgeries. Also, persons with certain had multiple surgeries. Also, persons with certain food allergies such as avocado, banana, kiwi fruit, food allergies such as avocado, banana, kiwi fruit, chestnuts, and papaya are at higher risk for latex chestnuts, and papaya are at higher risk for latex allergies.allergies.

Factors to Teach Factors to Teach the Patientthe Patient

Importance of medical history for Importance of medical history for patient and clinicianpatient and clinician

Necessity for personal protective Necessity for personal protective equipmentequipment

Importance of eye protection during Importance of eye protection during clinical procedures clinical procedures