Infection Prevention and Recent Breaches Presented by: Mary Govoni, CDA, RDA, RDH, MBA and Jessica Wilson Sponsored by Hu Friedy

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1 Infection Prevention and Recent Breaches Presented by: Mary Govoni, CDA, RDA, RDH, MBA and Jessica Wilson Sponsored by Hu Friedy Improper disinfection/sterilization of instruments Surgical instruments placed in bleach Failure to follow standard precautions Using a set of instruments reserved for high risk patients Use of rusted/corroded instruments for patient care HIV Use of contaminated needles in multi dose drug vials Failure to spore test the sterilizer 1

2 Failure to spore test the sterilizer 7000 patients to test (6 years) One patient tested positive for HCV precipitated the inspection One patient suing for unspecified infection Rhode Island Dentists: Lincoln and Cranston offices closed by the RI Dept. of Health Instruments not properly sterilized No monitoring of sterilizer Biohazardous waste not properly stored or disposed No utility gloves for processing instruments Arkansas Dentist: Was known to be a drug abuser Potentially contaminated medication vials used for sedation ~100 patients contacted for testing for HIV, hepatitis b and c and syphillis What is the Fallout? Reluctant fearful patients Fearful dentists and team members Inspections Citations/fines Decreased revenue 2

3 Sterilization Guidelines Classification of patient care items critical semi critical noncritical Heat sterilization of critical and semicritical items OSHA Regulations Transporting of contaminated items OSHA BBP standard says in a covered, punctureresistant container Prevents injury during transport Cassettes ideal to meet this requirement Sterilization Guidelines Cleaning instruments prior to packaging for sterilization Use of enzymatic detergents Ultrasonic cleaners and instrument washers NO DISHWASHERS! Regular Visual Inspection Rust Pitting Discoloration Missing parts (Broken tips, hinges, etc.) Handles (cracked resin) Scratched mirrors Routine Maintenance Sharpening First sign of dullness Scaler (not removing calculus) Lubrication of hinged instruments Recommended weekly Rust removal Sharpening First sign of dullness Annual Sharpening protocol daily sterilization cycles Scaler (not removing calculus) Is your scaler grabbing test stick? End of blade appears shiny Increased pressure to perform procedure Ortho Plier mail in 6 9 mos Surgical (elevators, scissors) 3

4 Replace instruments as necessary Remove broken instruments from circulation What is the shelf life of instrument? Are instruments compatible with sterilization protocols? Proper Handling Mixing of metals Carbon Steel & Stainless Steel Burs, Orthodontic instruments Exposure to chemicals Stain & Tarter Remover, Phenols, Bleach? Excess contact with other instruments Scratching? Nicking? Sterilization Guidelines Keep contaminated and clean/sterile items separated in the processing area Sterilization Guidelines Package/wrap instruments/cassettes prior to sterilization Dating packages necessary or not? Use process integrators in each load/pack Process Indicators and Integrators Not a substitute for biological indicators/spore tests A quality control measure, recommended by the CDC Validates that all instrument packs or cassettes in each load have been exposed to the necessary parameters for sterilization Process Indicators and Integrators Available types of indicators single or dual parameter autoclave tape single printed on sterilization pouches usually dual (inside and outside pouch) indicator strips placed in pouches or cassettes Steam sterilization integrators multi parameter ( time temp steam penetration) Class 5 equivalent to BI (again not a substitute for) 4

5 Sterilization Guidelines Monitor sterilizer at least weekly with a biological indicator Sterilization Guidelines Use high level immersion disinfectant/sterilant for heat sensitive items Cannot be monitored for effectiveness like spore testing a sterilizer Follow standard precautions Treat each patient as if they were potentially infectious No extra measures for infectious patients Double gloving Not cleaning instruments in the ultrasonic Sterilizing instruments twice Follow principles of aseptic technique Remove gloves and wash hands before leaving the treatment room Remove gloves or use instrument pick ups to open drawers and retrieve items Change face mask after each patient Or before if it becomes wet Follow principles of aseptic technique Washing hands before donning gloves and immediately after removal Use sterile gloves for surgical procedures Follow principles of aseptic technique Dispose of or clean/sterilize lab items after each use: rag wheels, burs pumice Segregate and dispose of sharps and other contaminated items according to state/local regulations 5

6 Water quality from the dental units <500 cfu/ml purging lines at the beginning of the day not sufficient to control biofilm water quality should be monitored periodically outside testing service Filtration Point of use Point of entry Use of FDA cleared waterline cleaners Decreases level of contamination Continuous use products more efficient Shock treatment at 4 6 week intervals Removes build up not controlled by daily maintenance Personal Protective Equipment Eye protection Respiratory protection masks Protective apparel Personal Protective Equipment Gloves Procedure gloves Utility gloves Infectious Disease Update 6

7 HBV vaccine Influenza (seasonal with H1N1) Tetanus (TDaP) MMR Shingles (Zostavax) HIV/AIDS >1 million in US living with HIV/AIDS 21% unaware of their disease New drug approved for prevention Ongoing vaccine research Home test approved Hepatitis C Update Most common chronic bloodborne infection Risk factors Received blood transfusion or solid organ transplant before 7/92 Received clotting factor concentrates before 1987 Long term dialysis Needlestick, tattoo, body piercing Injectable drug use Drug treatment for chronic hepatitis C Antivirals (Ribivirin & Interferon) Protease inhibitors (Incivek & Victrelis) Hepatitis C Update CDC advisory on one time hepatitis C testing For baby boomers born btw % of U.S. population 73% of new cases of hep C come from this age group Exposure may have been >20 years ago Norovirus Most common cause of gastroenteritis in the U.S. Very contagious Spread from infected person or contaminated food/water Symptoms: Diarrhea, vomiting, nausea, stomach pain, fever, headache, body aches Contagious when sick and 3 days after Outbreaks at highest levels since 1996 Cases in 23 states Including outbreak in July in Indiana No deaths, but 40% were hospitalized Risk of pneumonia and encephalitis 7

8 Tuberculosis Standard precautions not sufficient to prevent transmission TB prevention program Community risk assessment Screening patients for hx of TB or symptoms Defer elective tx for active TB patients Provide only emergency tx with N 95 respirator TST for DHCP s with symptoms Whooping cough Cases on the rise Michigan and California Primarily in infants Health Care Professionals TDaP vaccine for all adults MARY GOVONI CDA, RDA, RDH, MBA JESSICA WILSON, B.A. Deadly infection now an epidemic in U.S. Severe diarrhea from toxins released by bacteria HAI hospital acquired infection Elderly, and patients on antibiotics most vulnerable Use caution when prescribing antibiotics mary@marygovoni.com Jwilson@Hu Jessica Wilson 8