PRACTICAL INFECTION CONTROL-1

1. PRACTICAL INFECTION CONTROL-1 Géza T. Terézhalmy, D.D.S.,M.A. Professor and Dean Emeritus School of Dental Medicine Case Western Reserve University Cleveland, Ohio gtt2@case.edu

2. Practical Infection Control Terezhalmy

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8. Practical Infection Control The transmission of pathogenic organisms in the oral healthcare setting is RARE, yet cross-infection does present a POTENTIALHAZARD to OHCWs and patients alike. Terezhalmy

9. Practical Infection Control OHCWs’ primary obligation and ultimate responsibility is the delivery of quality care in the privacy of a comfortable and SAFE ENVIRONMENT Terezhalmy

10. Practical Infection Control To prevent or minimize cross-infection, it is MANDATEDthat oral healthcare facilities develop a written infection control/exposure control protocol. Terezhalmy

11. Practical Infection Control QUALITY OF INFECTION CONROL PRACTICES Protocol should be appropriate for setting ▼ Add quality at the production stage ▼ Factors that affect quality are structure, process, and outcome Terezhalmy

12. Practical Infection Control • 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 Terezhalmy

13. Practical Infection Control • 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 Terezhalmy

14. Practical Infection Control • 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 Terezhalmy

15. Practical Infection Control • Outcome • Impact of infection control/exposure control strategies • Enhanced knowledge • Changed behavior • Improved health of both OHCWs and patients Terezhalmy

16. Practical Infection Control • 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 Terezhalmy

17. Practical Infection Control EDUCATION AND TRAINING Compliance is significantly improved when personnel understand the rationale for 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 Terezhalmy

18. Practical Infection Control • 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) Terezhalmy

19. Practical Infection Control • 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 Terezhalmy

20. Practical Infection Control • 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 Terezhalmy

21. Practical Infection Control • Pathogenic organisms of concern • HBV • Mode of transmission • Contact with blood and OPIM • Major risk of occupational exposure in the oral healthcare setting Terezhalmy

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24. Practical Infection Control • HCV • Mode of transmission • Contact with blood and OPIM • The risk of occupational exposure in the oral healthcare setting is remote Terezhalmy

25. Practical Infection Control • HIV • Mode of transmission • Contact with blood and OPIM • The risk of occupational exposure in the oral healthcare setting is remote Terezhalmy

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27. Practical Infection Control • 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 Terezhalmy

28. Practical Infection Control • 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 Terezhalmy

29. Practical Infection Control • 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 Terezhalmy

30. Practical Infection Control • 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 Terezhalmy

31. Practical Infection Control • 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 Terezhalmy

32. Practical Infection Control • 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 Terezhalmy

33. Practical Infection Control • 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 Terezhalmy

34. Practical Infection Control • Vaccinations • Reduce the risk of vaccine-preventable diseases • Hepatitis B vaccine • Mandated for all healthcare workers • Mandatory Hepatitis B Vaccination Declination Form Terezhalmy

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36. Practical Infection Control • 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 Terezhalmy

37. Practical Infection Control • 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 Terezhalmy

38. Practical Infection Control • 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 Terezhalmy

39. Practical Infection Control • 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 Terezhalmy

40. Practical Infection Control • 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 Terezhalmy

41. Practical Infection Control • 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 Terezhalmy

42. Practical Infection Control • Heavy-duty utility gloves • Worn for all instrument, equipment, and environmental surface cleaning and disinfection Terezhalmy

43. Practical Infection Control • 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) Terezhalmy

44. Practical Infection Control • 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 Terezhalmy

45. Practical Infection Control • 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 Terezhalmy

46. Practical Infection Control • Engineering and work-practice controls • Engineering controls • Take advantage of available technology to eliminate, minimize, or isolate biohazards • Work-practice controls • Promote safer behavior Terezhalmy

47. Practical Infection Control • Hand hygiene • Wearing gloves does not eliminate the need for hand hygiene Terezhalmy

48. Practical Infection Control • 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 Terezhalmy

49. Practical Infection Control • 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 Terezhalmy

50. Practical Infection Control • Routine handwash • Plain soap and water • Removes soil and transient microorganisms • Acceptable method prior to performing • Physical examinations • Nonsurgical procedures Terezhalmy