PRACTICAL INFECTION CONTROL-2

1. PRACTICAL INFECTION CONTROL-2 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 • Preprocedural antimicrobial rinses • Procedures shall be performed in such a manner as to minimize splash, spattering, and aerosols • Patients MAY rinse with chlorhexidine gluconate-, or an essential oil-, or povidone iodine-containing mouthwash Terezhalmy

3. Practical Infection Control 0.12% Chlorhexidine gluconate Terezhalmy

4. Practical Infection Control Terezhalmy

5. Practical Infection Control Terezhalmy

6. Practical Infection Control • Disposition of reusable patient-care items • Critical • Penetrate soft tissue and bone during their intended use • Semi-critical • Touch mucous membranes or non-intact skin during their intended use • Non-critical • Contact only intact skin during their intended use Terezhalmy

7. Practical Infection Control • Critical and semi-critical items • MUST be cleaned and MUST be heat sterilized • Heat-sensitive items MUST be cleaned and MUST be sterilized using • Ethylene oxide OR • FDA-registered sterilants • e.g., glutaraldehyde, glutaraldehyde with phenol, hydrogen peroxide, or hydrogen peroxide with peracetic acid http://www.epa.gov/oppad001/chemregindex.htm Terezhalmy

8. Practical Infection Control • Central instrument processing area • Receiving and cleaning • Clean instruments using an ultrasonic system with a strainer type basket • Visually inspect instruments are for residual debris and damage Terezhalmy

9. Practical Infection Control • Preparation and packaging • Assemble cassettes, tray sets, or packs with hinged instruments unlocked and open • Place an internal or an external chemical indicator in or on each cassette, tray set, or pack • Date all cassettes, tray sets, or wrapped packs Terezhalmy

10. Practical Infection Control • Sterilization • MUST use an FDA cleared sterilizer • Load cassettes, tray sets, or packs according to manufacturer’s recommendations • Set cycle time, temperature, and pressure according to manufacturer’s recommendation • Allow packages to cool and dry before removing from the sterilizer Terezhalmy

11. Practical Infection Control • Storage • MUST be a clean, enclosed, and dry area • Cassettes, tray sets, or packs remain sterile indefinitely • Instruments in compromised cassettes, tray sets, or packs MUST be re-cleaned, re-wrapped, and re-sterilized • Cassettes, tray sets, or packs MUST be delivered to the operatories in a manner that maintains sterility until instruments are used Terezhalmy

12. Practical Infection Control • Monitoring the sterilization process • Mechanical: each load • Assess the cycle time, temperature, and pressure by observing the gauges or displays on the sterilizer • Chemical: each load • Use time- and temperature-sensitive internal or external indicators to assess physical conditions during the sterilization process Terezhalmy

13. Practical Infection Control • Biological: weekly • Place a spore strip or vial inside one of the cassettes, tray sets, or packs • Place the cassette, tray set, or pack in the center of the load • A strip or vial, which is not heat processed, is used as a control • Maintain a record of the weekly results Terezhalmy

14. Practical Infection Control • Quality assurance procedures following mechanical, chemical, or biological failure • Secure sterilizer • Make log entry • Take corrective action • Retest sterilizer using a biological monitor • Suspect loads dating back to the last negative biological test MUST be re-called, re-wrapped, and re-sterilized Terezhalmy

15. Practical Infection Control • Non-critical items • MUST be cleaned • MUST be disinfected • EPA-registered intermediate-level hospital disinfectant with tuberculocidal claim • e.g., chlorine-containing products, quaternary ammonium compounds with alcohol, phenolics, or iodophors http://www.epa.gov/oppad001/chemregindex.htm Terezhalmy

16. Practical Infection Control • Disposition of single-use patient-care items • Disposable sharps • MUST be removed from cassettes, tray sets, or packs in the patient treatment area • MUST be placed in a puncture-resistant, leak-proof, labeled/color-coded container in the patient treatment area Terezhalmy

17. Practical Infection Control • Other contaminated single-use items • Blood- or saliva-soaked cotton rolls, gauze, pellets, tissue coverings (packs) MUST be placed in small biohazard bag • Disposed of into a centralized Regulated Waste Receptacle after each appointment Terezhalmy

18. Practical Infection Control • Handpieces • MUST be sterilized between patients • Clean, sterilize, and maintain each handpiece according to manufacturer’s recommendations Terezhalmy

19. Practical Infection Control • Saliva ejectors • Backflow with low-volume suction • Do not place any portion of the suction tubing holding the tip above the patient’s mouth • Do not use simultaneously with high-volume evacuation • Do not have patient create a seal around the saliva ejector Terezhalmy

20. Practical Infection Control • Dental radiography • Cover clinical contact areas with protective barrier • Hand hygiene and PPE before initiating the radiographic process • Use disposable or heat-sterilized film-holding and positioning devices • Use FDA-cleared film barrier pouches • Remove film packet from pouch and place in a clean container • Remove gloves, wash hands, and transport the exposed films to the dark room Terezhalmy

21. Practical Infection Control • Panoramic radiography • Place disposable plastic cover over bite guide before the patient is positioned in the machine • If no barrier is used, use a sterile bite guard • Digital radiography sensors and other high-technology instruments • Should be cleaned and sterilized according to manufacturer’s recommendations Terezhalmy

22. Practical Infection Control • Oral surgical procedures • Perform surgical hand antisepsis • Don sterile surgeon’s gloves • Use only sterile saline or sterile water as a coolant or irrigant • Laser plumes or surgical smoke may contain aerosolized infectious material • Follow standard precautions Terezhalmy

23. Practical Infection Control • Biopsy • Place specimen in leak-proof, puncture-resistant, closed container with a secure lid for storage and transportation • If container becomes visibly contaminated, clean it, disinfect it, or placed in an impervious bag • Label with the biohazard symbol Terezhalmy

24. Practical Infection Control • Extracted teeth • If sent to the laboratory for shade and size comparison • Clean and disinfect with an EPA-registered, intermediate-level hospital disinfectant claiming tuberculocidal activity, • e.g., chlorine-containing products, quaternary ammonium compounds with alcohol, phenolics, or iodophors • With dental amalgams • Consult state and local regulations regarding disposal of amalgam Terezhalmy

25. Practical Infection Control • Extracted teeth returned to the patient • Clean and disinfect • Extracted teeth in educational settings • Cleaned of visible blood and gross debris and maintained in a hydrated state (e.g., water or saline) in a well constructed closed container • The teeth are heat-sterilized (autoclave cycle for 40 minutes) before clinical exercises or study • Teeth with amalgam restorations are disinfected by immersion in 10% formalin solution for 2 weeks Terezhalmy

26. Practical Infection Control • Laboratory asepsis • Environmental surfaces • Barrier-protected or cleaned and disinfected • Use PPE when handling items in the laboratory until they have been disinfected • Impressions, prostheses, and other devices • Rinsed under running tap water an disinfected with EPA-registered intermediate level disinfectant with tuberculocidal claim Terezhalmy

27. Practical Infection Control • Burs, polishing points, rag wheels, and laboratory knives • Cleaned and then heat-sterilized or disinfected following manufacturer’s recommendations or discarded • Metal impression trays and face bow forks • Cleaned and heat sterilized • Articulators, case pans, and water pans • Cleaned and disinfected according to manufacturer’s recommendations Terezhalmy

28. Practical Infection Control • Dental unit waterlines • Must meet the regulatory standard for safe drinking water • <500 CFU/mL • Self-contained water systems in combination with a chemical germicide • Follow the recommendations for monitoring water quality provided by the manufacturer of the unit or waterline treatment product • Dental devices connected to the water system • Operated for 20-30 seconds after each patient to discharge water and air Terezhalmy

29. Practical Infection Control • Boil-water advisory • Do not deliver water from the public water system • For hand hygiene use an alcohol-based hand rub or bottled water • When the boil-water advisory is lifted disinfect dental waterlines according to manufacturer’s recommendations Terezhalmy

30. Practical Infection Control • Dental records • Charts are notated and radiographs viewed • Before gloving • After the gloves are removed and the hands are washed • While wearing cover gloves Terezhalmy

31. Practical Infection Control Terezhalmy

32. Practical Infection Control Terezhalmy

33. Practical Infection Control • Environmental infection control • Provides for a safer work environment • Environmental surfaces • Clinical contact surfaces • May serve as reservoirs for microbial contamination • Housekeeping surfaces • Do not contribute to significant cross-contamination Terezhalmy

34. Practical Infection Control • Clinical contact surfaces • Cover with materials impervious to moisture • Coverings are removed and discarded between patients • Surfaces are examined for visible soil • Soiled surfaces are cleaned and disinfected with an EPA-registered intermediate-level hospital disinfectant with tuberculocidal claim • General cleaning and disinfection is performed at the end of daily work activities regardless of barrier protection Terezhalmy

35. Practical Infection Control • Housekeeping surfaces • Walls, window drapes, and other vertical surfaces • Unless visibly clean, cleaning is unnecessary • Floors and sinks • Clean regularly with a detergent and water OR • An EPA-registered hospital disinfectant/detergent designed for general housekeeping • Carpeting and cloth furnishing • Cannot be reliably disinfected Terezhalmy

36. Practical Infection Control • Spills and spatter of blood or OPIM • Visible organic material is removed using disposable paper towels • Discard in a leak-proof, biohazard-labeled container • Contaminated surface is cleaned with a detergent and water AND • Disinfected with an EPA-registered intermediate-level hospital disinfectant with tuberculocidal claim Terezhalmy

37. Practical Infection Control • Biohazard communication • Labels • Fluorescent orange or orange red, with lettering or symbols or a contrasting color • Affixed to containers or regulated waste by string, wire, adhesive, or other methods • Red bags or red containers may be substituted for labels • Decontaminated regulated waste is not labeled or color-coded Terezhalmy

38. Practical Infection Control • Post-exposure management and follow-up • Establishes policies and practices to reduce the risk of post-exposure infection Terezhalmy

39. Practical Infection Control • Post-exposure protocol • Immediately after an exposure incident • Wash area of injury with soap and water • Report the exposure incident immediately • Complete the Uniform Needlestick and Sharp Object Injury Report Form Terezhalmy

40. Practical Infection Control • Within 2 hours of an exposure incident • Arrange for a post-exposure evaluation by a physician • A copy of the employee’s medical record • A copy of the Uniform Needlestick and Sharp Object Injury Report • Any information available about the source individual Terezhalmy

41. Practical Infection Control • As soon as feasible after an exposure incident • If the source person can be identified and with his/her consent • The source person’s blood is tested for HBV, HCV, and HIV • Results are made available to the employee • Applicable privacy laws and regulations apply Terezhalmy

42. Practical Infection Control • Post-exposure management and prophylaxis • According to latest CDC recommendations • A written report from the consultant physician is obtained within 15 days of the post-exposure evaluation • Written report becomes part of the OHCW’s medical record Terezhalmy

43. Practical Infection Control • Medical record • Maintained on all personnel • Name and SSN • Documentation of vaccination status • A copy of the Mandatory Hepatitis B Vaccination Declination Form (if applicable) • A copy of all results of examinations, medical tests, and other post-exposure follow-up data Terezhalmy

44. Practical Infection Control • The medical record is confidential • Its content is not disclosed except as required by law • The medical record is made available to the OHCW for examination • A copy is provided upon request • The medical record is maintained for at least the duration of employment plus 30 years Terezhalmy

45. Practical Infection Control • Administrative controls • Establish exclusion policies from work and patient care Terezhalmy

46. Practical Infection Control • Minimize latex-related health problems among OHCWs and patients • Reduce exposure to latex-containing materials • Train and educate OHCWs to recognize signs and symptoms of latex-related adverse effects • Monitor signs and symptoms of latex-related adverse effects among OHCWs and patient Terezhalmy

47. Practical Infection Control • Minimize the exposure of OHCWs with acute or chronic diseases to patients • i.e., to patients who have been diagnosed with a transmissible infectious disease • OHCWs shall consult with their personal physician • Determine if their condition(s) might affect their ability to safely perform their duties Terezhalmy

48. Practical Infection Control • Minimize the exposure of patients to OHCWs • i.e., to OHCWs who have been exposed to or have been diagnosed with an infectious disease • Restrictions based on the mode of transmission and the period of infectivity of the pathogen Terezhalmy

49. The In’s and Out’s of Germ Warfare Terezhalmy

50. The In’s and Out’s of Germ Warfare Terezhalmy