DENTAL PRACTICE ARTICLES

Infection Prevention and Control
Sandie Baillargeon Posted on July 4th, 2018

    In the Dental Office

  • Course Outline
  • Infection Control
  • Personal Protection Equipment (PPE)
  • Hand Hygiene
  • Daily Sterilization Routine
  • Surface Disinfectant
  • Sharps and Biological Waste
  • Equipment Maintenance
  • Checklists: Reprocessing, Team Training, Team Immunization

    DISCLOSURE

  • This course is not a certification Course but does award CE points to attendees.
  • A link is provided for a Reprocessing Certification course for clinical staff, approved and recommended by Public Health.
  • Why is Infection Control Important in Dentistry?
  • Both patients and dental health care personnel (DHCP) can be exposed to pathogens.
  • Contact with blood, oral and respiratory secretions and contaminated equipment occurs.
  • Proper procedures can prevent transmission of infections among patients and DHCP.
    What we do know….

  • Live blood cells, bacteria and viral cells live in the head of a disinfected handpiece
  • Hand pieces “inject” material into tissue
  • Cross contamination of x-ray film occurs in the processor
  • Patients can easily suck back material from the saliva ejector
  • No disease reporting system exists to detect cross infection
  • Patients lie about their infections
    What we don’t know…

  • exact composition of microbes
  • when our resistance is low
  • when entrance into the body is compromised

    A BEST OFFENCE IS A GOOD DEFENCE

  • CDC Dental Recommendations
  • Infection Control Officer
  • It is the DDS’ responsibility to ensure that the team is trained in infection control procedures.
  • Supplies & equipment must be available, up to date and monitored.
      “Infection Control Officer” (one team member is assigned)

    1. Maintain an IPAC manual
    2. Certification training (renewed every 5 years)
    3. Monitor and review policy and procedure
    4. Provide site specific training and review at least annually

  • Infection Prevention and Control Manual must be created and maintained.
  • Re-processing

Instruments should be processed in a central area designed to facilitate quality control & ensure safety.

Required sections for:

  • Receiving, Cleaning & Decontamination
  • Preparation & Packaging
  • Sterilization
  • Storage
  • Personal Protective Equipment

  • PPE must be worn for cleaning and handling contaminated equipment/devices. Will be removed whenever leaving the treatment room.

  • Scrubbing Gloves: Must be long enough to cover wrists and forearms, of sufficient weight to be highly tear-resistant and allow adequate dexterity of the fingers. Disinfect between use. One pair per user.

  • Treatment Gloves: Never wash and reuse. New gloves for every patient.

  • Masks must be 95% filtration for particles 3-5 microns in diameter. They become ineffective when moist. Dispose each time you leave the treatment room. One mask per patient.

  • Eye-wear – clean and disinfect between patients. Eyewash stations are mandatory.

  • Protective Clothing – long sleeves are preferred when spatter and spray are anticipated (lab coat, gown). Uniforms and scrubs must NOT be worn outside the dental office.

  • Hand Hygiene

  • Handwashing
  • When hands are soiled
  • After removing and placing gloves
  • After contact with contaminated instruments & equipment
  • Following personal hygiene
  • No jewellery
  • No artificial nails or polish
  • Soap and water wash for 15 seconds – Rinse 15 seconds – Dry

Soap and ABHR cannot be refilled

  • Hand Sanitizer
  • 70-90% alcohol based
  • Used when there is no debris on hands or sink is not available
  • Before and after direct contact with individuals
  • After contact with surfaces or equipment in treatment room
  • After contact with lab materials
  • Before eating or drinking.
  • Alcohol Based Hand Rub (ABHR)

ABHR is to be placed:

  • At entrance and exit of Sterilization Area
  • At reception with signage and have tissues and masks available for patient use
  • Have closed automatic garbage for tissue disposal
  • In lunch room
  • Throughout office depending on size

  • DESIGNATED HANDWASHING SINKS
  • Are to be located close to the decontamination and preparation areas.
  • Hands are not to be washed in the sink that is used for scrubbing instruments.
  • ABHR should be available at entrance and exit from contaminated area
  • BARRIERS
  • Are to be used on all surfaces that cannot be cleaned proper with a wipe
  • Are to be changed after every patient
  • Are to be put over chart, keyboard and mouse
  • Cleaning and Disinfection

Read the Instructions for Use
What are you using? (wipes preferred over spray)

When do you use it?

How is it to be used?

What precautions do you need to use it safely?

ALWAYS CHECK INSTRUCTIONS FOR USE

Office needs to create and IFU Binder

  • Pre-Cleaning & Cleaning
  • Receiving, Cleaning and Decontamination
  • Contaminated instruments are to be placed in a locking puncture resistant container at point of use, then transported to processing area
  • Use puncture resistant gloves (that fit properly), & PPE when handling & manually cleaning contaminated instruments
  • Have PPE available in Sterile Bay
  • Ultrasonic Cleaning

If scrubbing at sink do so with a stiff, long handled brush, under fresh non-running water. Scrubbing equipment needs to be disinfected between use.

  • Pre-rinse
  • Immerse in ultrasonic – lid on
  • See Instructions for Use-typically 1.5 mins per instrument
  • Set timer
  • Rinse
  • Dry instruments completely
  • Foil Test weekly
  • Solutions changed at least daily or if water becomes cloudy or if temperature elevates
  • Instrument Washers
  • Automated cleaning equipment does not require presoaking
  • Increases productivity,
  • Improved cleaning effectiveness
  • Decreases worker exposure to blood & body fluids
  • Dries instruments
  • Drying Instruments
  • Use lint-free towels. Towels are to be replaced when visibly soiled and laundered at least daily
  • Inspect instruments at point of drying
  • If using Silicone Drying Mat, disinfect between use
  • Sterilization Monitoring

Sterilization Monitoring is done to identify that the sterilizing process was successful Mechanical Monitoring

  • Autoclaves have print outs, USB or digital displays that show temperature and pressure. The USB information is to be downloaded to the office computer and printed out daily and signed. monthly or stored in binder. This data is to be logged on the Sterilization Log Sheet.
  • Sterilization Monitoring

Chemical Monitoring

  • A chemical indicator (CI) class V is to be placed in sterilizer with each load.
  • Indicators should also be used in every cassette and sterilization bag that does not have an internal indicator already there. Use class IV or V for these.
  • External indicators are Class I. These are on the outside of cassette wrapping (indicator tape) or on the outside of sterilization pouches.
  • Class 1 – Process Indicators
  • Class 2 – Bowie Dick Indicators (for vacuum sterilizers)
  • Class 3 -Temperature Specific Indicators
  • Class 4 – Multi Parameter Indicators
  • Class 5 – Integrating indicators
  • Sterilization Monitoring

  • Biological Indicator (BI) – test ampules or spore laden strips – test 1st load of day and every load containing implants. Refer to ‘Instructions for Use’ (IFU)
  • One BI per sterilizer.
  • One control vial per day.
  • Implantable Instruments in the processed load should not be used until the results of the BI test are available
  • Packaging
  • Instruments that are to be sterilized must be wrapped or packaged.
  • Instruments cannot touch each other that are in bags or cassettes.
  • Wrapping/packaging must allow adequate air removal, steam penetration and evacuation.
  • All pouches need to be labelled with date, cycle #, sterilizer # and user initials.
  • Packaging

Inspect for cleanliness

Packages for Sterilization

  • Wrapped perforated cassettes
  • Peel and View pouches
  • Sterilization packaging is specifically designed to allow penetration of heat, steam or vapor and then to seal the sterilized instruments inside the package for sterile storage
  • Semi-critical instruments that are sterilized in a HLD cold soak, should be used immediately or within a short time. Storage, even temporary, will be in a closed lid container to prevent contamination.
  • Sterilization and Loading

Sterilizer must be registered with Health Canada

  • Do not overlap or stack cassettes or bags on top of each other or touching the inside of the sterilizer chamber
  • Bags are to be placed either paper side down or up(see IFU of sterilizer) or vertical on a rack all facing the same direction (one instrument per bag)
  • Place a Class V indicator in every sterilization load
  • Document information on sterilization log
  • Instruments must stay in sterilizer for the full drying cycle (see IFU of sterilizer)

IMMEDIATE USE STEAM STERILIZATION

  • Immediate-use steam sterilization (IUSS) shall only be used in emergency situations and shall not be used for implantable equipment/devices or on complete sets of instruments.
  • This is only for one-time emergency events for single instruments needed immediately.
  • Record this event with instrument, time, sterilizer #, cycle #, patient name, reason for IUSS and user initials. This information is also recorded in the patient chart and add to daily log sheet.
  • Chemical indicator Class V is to be used.
  • Transport instrument in a sterile covered container.
  • Do not overuse Immediate Use Steam Sterilization. Decide if there is a need for an additional sterilizer or more instruments.
  • Unloading a Sterilizer
  • Perform hand hygiene
  • Stand away from sterilizer door
  • Inspect items for dryness, integrity, internal CI change, external CI change

  • Document all information on sterilization log sheet.
  • Sterile packages are only to be opened when they are ready to be used in treatment room.
  • Storage of Sterile Instruments
  • Storage areas should be dustproof, dry well ventilated and easily accessible for routine dental use.
  • Items should be positioned so that packaged items are not crushed, compressed or punctured.
  • Outside shipping containers and corrugated cartons should not be used.
  • Compromised packaging must be cleaned, packaged and sterilized again.

  • Sterilization of Impressions
  • Don appropriate PPE
  • Wash impression under cold water to remove traces of saliva, blood and any food debris.
  • Spray impression with disinfectant and leave on for appropriate time (see IFU).
  • Rinse with water and place in sealed plastic bag.
  • Label bag with patient name, time and date of disinfection and user initials
  • Eyewash Stations
  • Eyewash Stations are mandatory in dental clinics.
  • To be placed 10 seconds from a likely hazard.
  • One hand action control
  • Thermal regulator to control water temperature
  • Signage for location/s
  • Dental Unit Water Lines (DUWL)
  • Do not heat water for the dental unit
  • Be careful not to contaminate bottles when changing water
  • Purge all waterlines: 2 – 3 minutes at beginning of each day
  • And 20 – 30 seconds between each patient
  • Follow instructions for daily and weekly maintenance of closed delivery systems
  • Water lines need to be disinfected and purged daily
  • Dental Radiography
  • Use gloves when handling film packets
  • Sterilize film holders and positioning devices
  • Clean and disinfect or use barriers on tube heads and control panels
  • Dry film packets with paper towel or gauze to remove blood and saliva & place in a container or disposable cup to transport
  • Film packets should be disinfected before opening to avoid contamination
  • Barriers on film packets are also acceptable
  • Use barriers on Digital Sensors and Intra Oral cameras
  • Always refer to IFU
  • Handling Sharps
    Management of Injuries & Exposure
  • Includes percutaneous injuries from contaminated sharps as well as blood saliva or other body fluids splashed onto non-intact skin, mucosa or eyes.
    • Wash, bandage, report, refer
    • Extreme caution when transferring sharps during 4 handed dentistry
    • Remove all burs before removing handpiece from the dental unit
    • One handed needle technique or recapping device
    • Dispose of sharps at point of use (sharps in every operatory)
    • Yellow Sharps container labeled & removed by biomedical waste carrier
    • Waste Management

    Biomedical Waste

    • Anatomical waste (Human Tissue)
    • Separate and collect in RED lined bag that is labeled with Biohazard symbol, stored in a stand alone refrigeration unit that is marked “Biohazard”
    • Removed by a carrier for disposal

    • Non-anatomical waste (needles, blood soaked material)
    • Separate and collect in Yellow Hazard container
    • If storing biomedical waste for more than 4 days it must be kept at a temperature of less than 4°C and disposed of via an approved waste carrier.
    • Consult RCDSO flow charts for disposal of mercury, lead, silver and chemicals

    • Extracted Teeth
    • May be returned to patient after cleaning off tissue and disinfecting
    • Disposed of as office waste if NO amalgam
    • Disposed of as mercury containing material if amalgam
    • Disinfected if being sent to lab for shade
    • Handpiece Maintenance

    After each use:

    • Clean
    • Lubricate
    • Package
    • Sterilize
    • Flush each line for 20 – 30 seconds
    • NEW AND LOANER EQUIPMENT
    • Have IFU for all new or loaned sterilizing equipment or instruments
    • Document reason for loaner equipment
    • New sterilizer must pass 3 consecutive cycles with a BI, and Air Removal Test (if applicable)placed in empty chamber
    • One load with a full load of instruments
    • Loaner equipment must pass one load with BI and Air removal Test
    • One full load
    • Personnel Health & Responsibility
      Immunization

    All DHCP should be immunized against:

    • Hepatitis B
    • Measles
    • Mumps
    • Rubella
    • Varicella
    • Tetanus
    • Diphtheria
    • Pertussis
    • Influenza

    Thank You And Good Luck!

    Phone: 905-332-2326
    www.dentalofficeconsulting.com

    Sandie Baillargeon
    sandie@dentalofficeconsulting.com

    Beth Ryerse, RDH 

    beth@bethryerse.com

    Author: Sandie Baillargeon

     

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