Chapter 6 Infection Control: Clinical Procedures

1. Chapter 6Infection Control: Clinical Procedures

2. Overview • Objectives • Basic considerations for safe practice

3. Dental unit Dental chair Light Clinician’s chair Floor Sink Supplies Waste Treatment Room Features

5. Instrument Processing Center • For instrument: • Care & cleaning • Packaging • Sterilizing • Storing • Located apart from treatment rooms

7. Cleaning Procedures • Instrument washer/thermal disinfector • Ultrasonic processing • Manual cleaning

8. Packaging Step • Purposes • Instrument arrangement • Preparation

10. Sterilization • Approved methods • Selection of method • Tests for sterilization • External chemical indicator • Internal chemical indicator • Biologic monitor

11. Moist Heat: Steam Under Pressure • Autoclave types • Gravity displacement • High-speed prevacuum • Use • Principles of action • Evaluation

12. Review Which of the following is an autoclave? A) It is a chemical vapor sterilizer B) It is sterilization achieved by steam under pressure C) It is a dry heat sterilizer D) It is an ethylene oxide sterilizer

13. Answer B) It is sterilization achieved by steam under pressure is the correct answer. By definition, an autoclave is a sterilizer that sterilizes using steam under pressure. The other sterilizers do sterilize, but by other methods and chemicals.

14. Dry Heat • Use • Principles of action • Operation • Evaluation

15. Chemical Vapor Sterilizer • Use • Principles of action • Operation • Care of sterilizer • Evaluation

16. Care of Sterile Instruments • Storage • Shelf life

17. Chemical Disinfectants • Categories • Uses • Principles of action • Criteria for agent selection

18. Review A. High-level disinfectants inactivate spores and all forms of bacteria, fungi, and viruses. B. Intermediate-level disinfectants inactivate all forms of microorganisms but do not destroy spores. A) Statement A is correct and statement B is correct B) Statement A is correct and statement B is incorrect C) Statement A is incorrect and statement B is correct D) Statement A is incorrect and statement B is incorrect

19. Answer A) Statement A is correct and statement B is correct. High-level disinfectants inactivate spores and all forms of bacteria, fungi, and viruses. Intermediate-level disinfectants inactivate all forms of microorganisms but do not destroy spores.

20. Preparation of the Treatment Room • Objectives • Preliminary planning • Hand contacts • Sterilizable items • Disposable items • Items that may be covered • Items that require chemical disinfection

21. Preparation of the Treatment Room (cont’d) • Clean and disinfect environmental surfaces • Agent • Procedure • Unit water lines • Procedure for clinical use

22. Patient Preparation • Preprocedural oral hygiene measures • Toothbrushing • Rinsing • Application of surface antiseptic • Before injection of anesthetic • Before scaling and other dental hygiene instrumentation

23. Review A. Preprocedural rinsing and other oral hygiene measures help to prevent the spread of communicable diseases. B. Preprocedural rinsing and other oral hygiene measures decrease the number of microorganisms in the oral cavity. A) Statement A is correct and statement B is correct B) Statement A is correct and statement B is incorrect C) Statement A is incorrect and statement B is correct D) Statement A is incorrect and statement B is incorrect

24. Answer A) Statement A is correct and statement B is correct. The use of preprocedural rinsing and toothbrushing has been shown to lower the numbers of oral bacteria and, therefore, to lower the numbers of infected aerosols created during instrumentation.

25. Summary of Standard Procedures • Patient factors • Clinic preparation • Factors for the dental team • Treatment factors • Posttreatment

26. Patient Factors • Comprehensive patient history • Assessment of history • Medical consultation or referral • Preprocedural mouthrinse • Protective eyewear • Patient with communicable condition

27. Clinic Preparation • Waterline cleaning • Environmental surface disinfection • Instrument sterilization

28. Factors for the Dental Team • DHCP medical status • PPE use • Meticulous hand hygiene • Aseptic technique • http://www.osha.gov/

29. Treatment Factors • Hypodermic needles • Removable oral prostheses

30. Posttreatment • Use heavy, puncture-resistant gloves to handle instruments • Disinfect, clean, & prepare instruments • Secure contaminated waste in bags • Disinfect safety eyewear

31. Occupational Post-Exposure Management • Significant exposures • Procedure following exposure • First aid procedures • Documentation • Follow-up • http://www.cdc.gov/

32. Disposal of Waste • Regulations • Guidelines

34. Supplemental Recommendations • Cleaning the face • Smoking and eating • Reception area • Sterilization monitoring • Office policy manual

35. Documentation: Needlestick • Patient name, record #, address, phone #, email • Medical history of HBV, HCV, HIV • For HIV+ source patient: • Current medications & effectiveness • Viral load & current CD4, if known

36. Factors to Teach the Patient • Standard precautions • Medical, dental, and social histories • Sterilization and biologic monitoring • Normal oral flora and disease etiology • Personal oral infection control methods