Quick Tips Across the 8 Points of Dental Patient Care

Transcription

1 Quick Tips Across the 8 Points of Dental Patient Care This presentation is supported by Kerr Total Care through an unrestricted educational grant. Presented by: Noel Kelsch, RDH, RDHAP, BS n.kelsch@sbcglobal.net Recognition and Credits PennWell is an ADA CERP recognized provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at PennWell designates this activity for 1 Continuing Education Credit. Dental Board of California: Provider 4527, course registration number This course meets the Dental Board of California s requirements for 1 unit of continuing education. The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2011) to (10/31/2015) Provider ID# Disclosure Declarations Presenter Disclosure: Noel Kelsch, RDH, RDHAP, BS is a Key Organization Leader for American Eagle, Philips Sonicare, Sunstar Americas, Dux Dental and Kerr Total Care. Commercial Support: This course was developed with commercial support by Kerr Total Care. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity, No manufacturer or third party has had any input into the development of course content. CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with any commercial supporter, or with products or services discussed in this educational activity. Heather can be reached at hhodges@pennwell.com. Image Authenticity: No images in this educational activity have been modified or altered. Scientific Basis: All content has been derived from references listed and the author s clinical experience. Research references are provided in the bibliography and/or supplemental materials. Educational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise. 1

2 Objectives Identify the 8 points of Dental Patient Care Recognize the infection control protocols in the Dental Setting Delineate strategies for efficient and effective compliance in infection control 8 Points of Dental Patient Care Simplify 2

3 1. Room Prep Room Prep/Turnover Start of the day Between patients End of the day Weekly Monthly Quarterly Annually In General Check Off List Check Off List Involve the dental team in creating the list. Give them ownership. Include accountability 3

4 Making Kits Saving time and supplies 2. Health Screen: Preventive Do not allow sick people to sit in the chair unless there is an emergency, treat emergency and reschedule for definitive treatment Do not allow staff to come into work sick MMWR 1998 guidelines page 8 and 9 Health History Start before the next visit Always ask on the phone Always ask in the lobby Always ask when the patient is in the chair 4

5 Confirming- Unlocking Mysteries Train the staff so that when they answer the phone they ask the questions that will help eliminate the need to reschedule people that are sitting in your chair. Anything change with your health? Any recent surgeries, hospitalization, medical conditions or medications? Anything you think we should know about your health? 3. Extra Oral/Intra Oral/ Radiographs; Preventive Barrier Protection The barriers can become contaminated so they should be removed and discarded between patients while the dental health-care professional (DHCP) is gloved. These are single-use items and can only be used for a single patient. Large bags can be removed by turning them inside out as you remove them. This limits the chances of touching surfaces with the contaminated material. Carefully remove the barrier so that you do not contaminate the surface you are protecting. After removing the barrier, examine the surface to make sure it did not inadvertently become soiled. 5

6 Barriers Continued The surface should be cleaned and disinfected only if contamination is evident. Otherwise, after removing gloves and performing hand hygiene, DHCP should place clean barriers before the next patient. It is not necessary to clean and disinfect if the area is not contaminated. The barrier protection is a barrier between the patient and the pathogen. At the end of the day, clean and disinfect all clinical contact surfaces in the operatory. Some tips The large chair cover: You can recycle this item by using it as your trash container for cleaning up the room after each patient. After you have turned it inside out with the clean side out, put all the other barrier protection items, disposables such as 2x2's, cotton rolls, etc. in it. Because all the contamination is on the inside, this makes a great tool for room cleanup without getting the trash can out. Extra long chair covers that have an extra two feet of plastic at the bottom make great dental unit covers and can cover the foot peddle at the same time. Barrier tips Prepare barrier protection kits ahead of time, and include a cover for hoses, chair, etc., on each tray to save time and aid in efficiency of setup. Fold back the edge of adhesive products in one area so there is an area where the adhesive does not touch itself. This can help with easy removal after use. 6

7 4. Probing and Perio Charting: Preventive Have staff assist with charting Develop protocol for charting including assigning staff to limit cross contamination Have staff chart outside the room with a clip board if they do not have personal protective equipment on Get a head phone for communication with the front staff or a system that is voice activated on the computer 5. Cleaning and Polishing: Preventive Patient Safety Clinician Safety Splatter and the CDC What is the risk of bloodborne pathogens (e.g., hepatitis B virus (HBV) and HIV) being transmitted through aerosols generated during dental procedures? A visible spray is created during the use of rotary dental and surgical instruments (e.g., handpieces, ultrasonic scalers) and air-water syringes. This spray contains primarily a large-particle spatter of water, saliva, blood, microorganisms, and other debris. This spatter travels only a short distance and settles out quickly, landing either on the floor, nearby operatory surfaces, the dental health care personnel providing care, or the patient. 7

8 And did you know? This spatter can commonly be seen on face shields, protective eyewear, and other surfaces immediately after the dental procedure, but after a short time it may dry clear and not be easily detected. The spray may also contain some aerosol. Aerosols take considerable energy to generate, consist of particles less than 10 microns in diameter, and are not typically visible to the naked eye. Aerosols can remain airborne for extended periods of time and may be inhaled. Aerosols should not be confused with the large-particle spatter that makes up the bulk of the spray from handpieces and ultrasonic scalers. So you need to: To prevent contact with splashes and spatter, dental health care personnel should position patients properly and make appropriate use of barriers (e.g., faceshields, surgical masks, gowns), rubber dams, and high-volume evacuators, bonnets, gloves, utility gloves, task designated Change masks when soiled, moist and between every Patient! Stop! No More Excuses For Your Patients, For You! 8

9 A Series of Errors The Imperfect Storm Inexpensive, Easy to Use, Autoclavable 9

10 Impact Resistant compliance with ANSI (American National Standards Institute) z Suited for specific application in practice Side protection Safety glasses Full face shield Protecting Your Eyes OSHA/CDC: Must wear protective eyewear that covers the eyes during dental procedures whenever splashes, sprays or spatter of blood, saliva, other body fluids, or water contaminated with blood, saliva or other body fluids may be produced. Choosing Face Protection Size and fitting: fit face well, light seal over face and nose. Filtration: 95% Change often Moisture Change between Patients 10

11 What s The Point? Choosing Protective Apparel Long sleeved, knee length Change when becomes soiled Change with blood or body fluid Remove when leave care areas or the lab 11

12 Have Operatory Hangers for PPE PPE Tips Have Utility Gloves That are Marked for Clinicians in Each Room 6. Patient Planning/Treatment: Preventive Develop awellness plan. What do we need to do to keep this patient well? (Varnish, etc.) 12

13 7. Room Disinfection: Operatory Clean Up Divide and conquer Give each other breaks, I will clean your room at 10 you clean mine at 11 Take it step by step Using Instrument Cassettes Why Cassettes? Instrument cassettes are a simple, cost-effective solution. They are designed to hold instruments securely during cleaning, sterilization, and storage, thereby minimizing the dulling, breaking, and warping of instruments. The cassettes eliminate the need to search for that lost instrument, and they save hours of time, production, and frustration. They can help simplify organization and setup for specific procedures. Cassettes also help stop overloading the sterilizers with contaminated instruments, which can affect the sterilization efficacy. Save time. 13

14 Benefits: Engineers and Work Practice Controls An instrument cassette limits exposure to pathogens by restricting the handling of the instruments. Scrubbing instruments by hand creates possible exposure to sharps injuries, aerosols, and pathogens. Scrubbing should be replaced by using the ultrasonic bath with instruments securely divided in cassettes. A 10-year study conducted by the New York University College of Dentistry revealed that 41% of sharps injuries occurred during instrument cleanup. A cassette can limit the exposure to both sharps and aerosols. Color for Each Set Up FDA Approved Medical Device Do Not Fold to Fit Item 14

15 Tips: Do Not Create a Gap in Folding: Fold with Ruler Fold at the perforation line Tip If you are not going to be able to process the instruments right away make a plan! Putting them in a holding solution or spraying with a product will make them much easier to process later and help eliminate the possibility of difficult to remove protein build up Use an enzymatic presoak or cleaner Do not use a sterilant or high level disinfectant. Many can cause binding of debris. 15

16 8. Instrument Reprocessing: Operatory Clean Up Tip: Never leave the operatory without separating! Give the all clear! Remove all sharps and Blood Borne Pathogen risks Put instruments in cassettes Removal all trash from tray Take any item out of service that is not functioning Tips for Clean Up Barrier protection, flip inside out, clean side out as trash bag Put all items that are to be sterilized in the cassette Dispose of all sharps as soon as point of contact is over 16

17 Small things matter a lot Develop a sign that clarifies if the room is clean or dirty Disinfectant Tips Disinfectants are specifically designed to be used on hard, inanimate surfaces and objects. They either destroy or irreversibly inactivate infectious viruses, fungi, and bacteria. They do not necessarily take care of spores. Label Directions Science behind the product Cannot be deviated from 17

18 EPA Evaluates: Ingredients of an antimicrobial pesticide Where it will be used (medical setting, in the home, or on food) Amount, frequency, and timing of its use How it will be discarded or stored Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings MMWR 2003;52 (No.RR-17) EPA Registration Number Verifies that they have been approved. If they do not have this number on them, you should not use them for disinfection. The number will appear as EPA Reg#. The first set of numbers identifies the registrant. The second set identifies the product number. The third set of numbers identifies the distributor. More Information Needed? pesticides/f?p=ppls:1. One example TWA (Time Weight Average) 18

19 Practical? Time: How quickly does it kill TB? Does the contact time match the amount of time available between patients? Scope and Testing: What are the scope and efficacy claims? Bactericidal Fungicidal Virucidal Tuberculocidal Is the product EPA registered? Clean and Disinfect: Does the product have good/excellent cleaning capabilities? (product will both clean and disinfect) If not: is there a compatible pre-cleaner? High Alcohol products are not effective at cleaning. Single Use Items Why do we need disposable tips? Metal air-water syringe tips are made of chrome-plated brass Oxidation occurs on the internal surface Corrosion Roughness and retention of bacterial and organic matter (bio-film build up) Repeated sterilization of metal tips Corrosion Reducing the flow Costly replacement of the tips Biofilm build-up in the air-water syringe tip and waterline tubing after a week * Journal of The California Dental Association Oct

20 Why do we need disposable tips? Cross-contamination is a major issue. A clinician often does not know if a patient is infected. Suck-back CDC Guidelines state all items must be cleaned before autoclaving. Cannot clean narrow lumens. Therefore, cannot sterilize narrow lumens. The Need for Disposable Air/Water Syringes Disposable AWS can eliminate an important source of cross-contamination. No need to clean, package, and sterilize the syringes. Time (and cost!) saving. No bio-film build-up. No corrosion, reduced flow and replacement. No need to clean the lumens 20

21 Thank You For Making a Difference Contact Information: n.kelsch@sbcglobal.net This presentation is supported by Kerr Total Care through an unrestricted educational grant. To claim CE credit for your participation in this activity you must complete the program post-exam. Instructions for completing the post-exam and receiving your Letter of Credit are provided on the following slide. Continuing Education Credits To receive CE credit for participating in this program you must complete the online post-exam and evaluation. To complete the online post-exam click the Claim CE Credit button. On the returning page click the Take Exam link displayed directly across from the course title. Complete the online exam and submit it. An immediate grade report will be provided (for credit you must score 70% or higher). Click Continue and complete the online program evaluation. Once submitted your Letter of Credit can be accessed by selecting the Print/View Certificate link displayed from within the MyCE Archives. Letters of Credit are immediately available from within the MyCE Archives page for viewing and/or printing at ANYTIME in the future. Future access to your CE records may be obtained by signing back in to this CE event website. Claim CE Credit 21