Infection Control in Dental Practice

Transcription

1 Infection Control in Dental Practice Dr. Juma Al Khabuli, BDS, MDentSci, MFS RCPS(Glasg), FICD, PhD Asso Prof, Oral Biology Dept RAKCODS RAK Medical and Health Sciences University

2 When should we start to think about infection control?

3 Understanding of Basic Microbiology! Why understanding of BM is important for D. Personnels? To understand mechanism of infection transmission Helps in understanding the need for careful compliance with recommended I.C. protocols Protect yourself, office staff and your patients from illness

4 Groups of Microorganisms Pathogenic microorganisms Potentially pathogenic microorganisms Non pathogenic microorganisms Remember, some infections occur only in immunocompromised individual (( Opportunistic Infections))

5 Cont d Microorganisms: Bacteria Fungi Viruses Protozoa Algae Many diseases can be transmitted during routine dental treatment/care Important to understand the principles behind the infection control recommendations

6 Bacteria Bacteria can live independently Some are harmless, other cause disease Some form capsule (protective wall) Un/ certain conditions some form spore Virulent Resistant Environment to live- O2, nutrients, optimum temperature Goal of an I.C. program is to stop growth of bacteria (bacteriostatic), to kill (bactericidal), sporicidal, virucidal, via use of high temperature (approved method of sterilization)

7 Viruses Viruses cannot live or multiply outside of a host Virus infection can be latent (no symptoms), chronic (long-lasting), or slow. Slow persistent infections- the virus replicating slowlycausing damage- seen only after a number of yrs (Hep C) Latent infections are of particular interest to dental professionals because many patients may not realize that they are infectious.

8 Cont d Examples of oral diseases caused by viruses: Herpes infections Coxsackievirus (H/F/M) disease Oral lesions from measles Blood-borne diseases caused by viruses: Hepatitis B and C Human immunodeficiency virus (HIV/AIDS)

9 Fungi Defined as plants that lack chlorophyll Includes mushrooms, yeasts and molds Oral Candidiasis is the most common yeast infection of the oral cavity caused by Candida albicans Clinically, oral candidiasis may be presented as pseudomembranous C., Ch. Atrophic C., Ac. Atrophic C. Candida is considered an opportunistic infection, in other words, it usually occurs in someone who s immune system is not functioning normally

10 How are diseases transmitted in the dental setting? From the patient to the dental worker From the dental worker to the patient From the dental office to the community Transmission Direct- infected person to another person who is not immune Indirect- contact with contaminated object Droplet- from spray or splatter contact with M. membranes (eye/nose/mouth) Inhalation- airborne microorganisms

11 Example The Infectious Process Chain of Infection Infectious agent Hepatitis B Unvaccinated Susceptible host D W Reservoir The bloodstream Puncture Port of Entry wound Port Bleeding of Exit wound Transmission Via needle stick

12 Cont d Infectious Agent- any potential pathogen- Bacteria, Virus, Fungus, etc Reservoir- where the pathogen lives- a person, on equipment, surfaces Portal of exit- how the infectious agent leaves its reservoir and reach a new host. Transmission- direct, indirect, airborne, droplet Portal of entry- how the infectious agent gets into the new host (bloodstream, mucous membrane, etc.) Susceptible host- someone who is not immune

13 What alters immunity and normal defense mechanisms? What makes an individual a susceptible host? Abnormal Physical Conditions Systemic Diseases (diabetes, HIV infection, etc) Drug Therapy (chemotherapy, steroids, etc.) Stress Prosthesis&Transplants-Joint/organ replacements Poor nutrition

14 What factors influence the development of infection? Number of microorganism- how many? Duration of Exposure- How long? Virulence of organisms- ability to cause disease Immune status of the host (body defenses)

15 Infection Control 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

16 Cont d The main goal of an infection control program to break the chain of infection Pathogen Practicing protocols which would prevent the infectious Susceptible agent from moving from one Source host to another and preventing Host cross-contamination Entry Mode

17 Cont d Cross infection: Defined as the transmission of infectious agents among patients & staff within a clinical environment Principles of infection transmission: Requires- Source of infection- person with infection the index case Vehicle/Mode- by which the infective agent is transmitted; blood, saliva, instruments, etc. Route of transmission: inhalation, ingestion

18 Source of Infection in Clinical Dentistry The source of infection in clinical dentistry is mainly Human being and constitute those: With overt infections- liberates large number of organisms in the environment- e.g. droplets& discharges,ulcers, woumd Prodromal stage of certain infections- during incubation period the microorganism multiply without evidence of infection (pt is highly infectious) Healthy carriers of pathogens-convalescent carriers- the ptatient is recovering from the illness e.g. tonsillitis, Hepatitis B. Asymptomatic carriers- no of history of infection e.g. Hepatitis B

19 Clinical Focus We need to ask ourselves the following questions? How can we break the chain of infection in our dental office today? Are there areas of our daily practice where crosscontamination could be happening? How can we make changes that will prevent crosscontamination in our daily practice?

20 INFECTION CONTROL PRECAUTIONS Generally, there are two levels of infection control precautions: Standard Precautions- which are applied to all patients Additional Precautions- for at risk patient groups Transmission based precautions Protective isolation guidelines

21 Apply to all patients Standard Precautions Universal Precautions Integrate and expand Universal Precautions to include organisms spread by blood: Body fluids, secretions, excretions except sweat Non-intact skin Mucous membranes These guidelines were developed as a response to the understanding that other body fluids besides blood are potentially infectious, and that anyone with patient contact could be at risk.

22 Elements of Standard Precautions Hand washing Use of gloves, masks, eye protection and gowns Patient care equipment Environmental surfaces Injury prevention- sharp injuries Prevention of use of contaminated instruments Instrument cleaning, sterilization and storage Disposal of waste

23 Cont d Personnel Health Elements of an Infection Control Program Education and training Immunizations Exposure prevention & post-exposure management Med condition management & work-related illnesses Health record maintenance

24 Hand Hygiene Why is hand hygiene important? The most common mode for pathogen transmission Prevent health care-associated infections Reduce spread of antimicrobial resistance

25 Cont d When to clean hands? Visible dirt After touching contaminated objects Before and after patient treatment (before glove placement and after glove removal)

26 Cont d What do we mean by hand hygiene? Hand washing- Washing hands with plain soap & water Antiseptic hand wash- Water & soap or detergents containing antiseptic agent Alcohol-based handrub- Rubbing hands with an alcoholcontaining preparation Surgical antiseptic- Handwashing with an antiseptic soap or an alcohol-based handrub before operations by surgical personnel

27 Efficacy of Hand Hygiene Preparations in Reduction of Bacteria Good Better Best Plain Soap Antimicrobial soap Alcohol-based hand rub

28 Cont d Remember: Alcohol- based Preparations limitations Limitations Benefits Cannot Rapid and be used effective if hands are antimicrobial visibly soiled action Store Improved away skin from condition high temperatures More accessible or flames than Hand sinkssofteners and glove powders may build-up

29 Hand care considerations Use a dedicated clean sink for hand-washing in clinic Keep fingernails short & clean, remove Jewelry Obvious cuts must be covered with adhesive dressing Follow good hand-washing technique Use liquid saop and not bar soap Hands must be dried thoroughly using disposable towels Use moisturizing cream to prevent skin dryness

30 Personal Protective Tools Importance: Form major part of the standard Precaution Protocol Protects the skin and mucous membranes from exposure to infectious materials in spray and spatter Must be removed when leaving treatment area

31 Cont d Personal hygiene Refrain from unnecessary touch- eye, nose, mouth, hair, etc Cover cuts/bruises on fingers with dressings, tidy up hair. Barrier protection Routinely wear disposable gloves- 3 types (prote/ster/hdu Wear surgical mask, eye glass/sheild to protect MM of eye Change masks between patients/ when wet Clean reusable face protection between patients Rubber dam isolation

32 Cont d Clinic clothing Wear gown/lab coat/uniform-covers skin& personal clothing Change clothing if become visibly soiled Remove all barriers before leaving the clinic Immunization procedure All staff should have up-to-date imm record Vaccination against Hepatitis B

33 Sterilization and Disinfection Sterilization: is a process that kills or removes all organisms (and their spores) in a material or an object Disinfection: is a process that kills or removes pathogenic organisms in a material or an object (excluding bacterial spores), so that they pose no threat of infection Antisepsis: is the application of a chemical agent externally on a live surface (skin or mucosa) to destroy organisms or to inhibit their growth. All antiseptics could be used as disinfectants, but all disinfectants cannot be used as antiseptics because of toxicity

34 Cont d Ideally, all instruments and appliances used in dentistry should be sterilized, although some items of equipment and certain surfaces (e.g. bracket tables attached to the dental chair) do pose problems. Sterilization is broadly classified into: Critical items Semi-Critical items Non-Critical items

35 Cont d Critical items/instruments: Penetrate M. membranes /contact bone, the bloodstream, or other normally sterile tissues (of the mouth) Use heat sterilized items, use sterile single-use, disposable devices-e.g Surgical Instr, blades, perio scalers, and surgical dental burs Semi-Critical items//instruments: Contact mucous membranes but do not penetrate soft tissue. Heat sterilize or high-level disinfect- Examples, dental mouth mirrors, amalgam condensers and handpieces

36 Cont d Non-Critical Instruments/Device Potential contact with intact skin- Clean and disinfect using a low to intermediate level disinfectant Examples: X-ray heads, facebows, pulse oximeter, blood pressure cuff

37 Cont d Recommendations for instrument processing area: Use a designated processing area Divide processing area into work areas: Preparation and packaging Sterilization area Storage area

38 Cont d Sterilization: There are three types of heat sterilization: Steam under pressure (autoclaving) Dry heat sterilizers are either static air (convection or FDA-approved oven type) or forced air (rapid heattransfer). Unsaturated chemical vapor sterilizers use a proprietary formula of alcohol/formaldehyde.

39 Clinical Contact Surfaces

40 Cont d

41 Further information! Centers for Disease Control and Prevention (CDC) ctioncontrol/guidelines/ppt.htm Organization for Safety and Asepsis Procedures (OSAP)- Group of dental workers, scientists, teachers, and product manufacturers and distributors.

42 Thank you