Transcript DH 300 Ch17-nbJM

Chapter 17
Infection Control Systems
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Infection Control
• Disease prevention is the role of everyone
in the dental office.
• As an administrative assistant, you must
understand both the risks and management
of occupational exposures to blood borne
pathogens.
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The Role of the Administrative
Assistant in Infection Control
• Responsibilities include
• A thorough understanding of the routes
of disease transmission
• Maintaining an adequate inventory of
acceptable disinfectants, sterilants,
personal protective equipment (PPE), and
barrier covers
• Maintaining records verifying compliance
with the Occupational Safety and Health
Administration (OSHA) requirements
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The Role of the Administrative
Assistant in Infection Control
• Responsibilities
Transmitting spore samples to the appropriate
monitoring agencies for determination of
sterilization effectiveness
• Attending training sessions
• Maintaining records on employees
• Verifying employee compliance with OSHA
• Scheduling continuing education courses for the
staff
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The Role of the Administrative
Assistant in Infection Control
• Responsibilities
• Verifying quality assurance
• Maintaining all Material Safety Data Sheet
(MSDS) forms
• Arranging for the disposal of hazardous waste
• Providing infection control training for new
employees
• Interacting with outside agencies
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Organizations Associated
with Infection Control

The American Dental Association (ADA), the
Organization for Safety and Asepsis
Procedures (OSAP), and the Centers for
Disease Control and Prevention (CDC) have
established infection control and safety
procedures for the dental healthcare
worker (DHCW).
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Guidelines for Infection Control
in Dental Health Care Settings
• Guidelines from the CDC provide
recommendations on
• Educating and protecting dental healthcare
personnel
• Preventing the transmission of bloodbourne
pathogens
• Hand hygiene
• PPE
• Contact dermatitis and latex hypersensitivity
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Guidelines for Infection Control
in Dental Health Care Settings
• Guidelines
• Sterilization/disinfection of patient care items
• Environmental infection control
• Dental unit water lines, biofilm, and water
quality
• Special considerations (e.g., dental handpieces
and other devices, radiology, parenteral
medications, oral surgical procedures, and
dental laboratories)
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Disease Transmission
• Diseases can be transmitted by various
media during dental treatment including
blood, saliva, nasal discharge, dust, hands,
clothing, and hair.
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Types of Infections
• Autogenous infections are infections in which the
patient is the source.
• When a patient has an infection in one site and
it is transferred to another site
• Cross-infections are transferred from one person
to another.
• When a person coughs or sneezes, the caregiver
may contract the infection through airborne or
droplet transmission.
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Routes of Infection
Transmission
• Transmission in the dental office occurs by three
general routes:
• Direct contact with a lesion, organisms, or debris
during intraoral procedures
• Indirect contact through contaminated dental
instruments, equipment, or records
• Inhalation of aerosols from a patient’s blood or
saliva during the use of high-speed or ultrasonic
equipment, such as a high-speed handpiece or an
ultrasonic scaler
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Breaking the Chain
of Disease Transmission
• Because every member of the health care
team is responsible for breaking the chain
of infection, you must review the cycle of
disease transmission.
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Cycle of Disease Transmission
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Safe Practice Principles
• Practicing safely includes
• Obtaining a complete and accurate
patient history
• Observing aseptic techniques including
the use of PPE
• Adhering to sterilization procedures
• Practice proper disinfection and dental
laboratory asepsis procedures
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Health Protection Program
for the Dental Staff
• An office policy must include a health
service program for the staff that covers
• Education and training
• Immunizations
• Exposure prevention and postexposure
management
• Employee medical conditions, workrelated illness, and any work restrictions
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Health Protection Program
for the Dental Staff
• Health Protection Program
• Allergies or sensitivities to work-related
materials, such as latex
• Records maintenance, data management,
and confidentiality
• A medical physician to treat staff
members for any emergencies
• Confidential, up-to-date medical records
for all workers
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Standard Precautions
• OSHA establishes guidelines to protect
workers from occupational exposure to
bloodborne diseases.
• Regulations require that employees in
direct contact with blood or infectious
materials and substances use Standard
Precautions.
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Standard Precautions
• Practicing standard precautions means all
patients are treated as if they have a
potentially infectious disease.
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OSHA Task Categorization
• Category I
• Tasks that involve exposure to blood, body
fluids, or tissues; dentists, hygienists, clinical
assistants, and laboratory technicians are in this
category
• Category II
• Tasks that involve no exposure to blood, body
fluids, or tissues but may have unplanned
exposure to category I tasks; may include
clerical or nonprofessional workers
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OSHA Task Categorization
• Category III
• Tasks that involve no exposure to blood,
body fluids, or tissues; may include
receptionists, bookkeepers, and insurance
clerks
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Maintaining Regulatory
Records
• Regulatory records that are kept in an office
include:
• Exposure determination form
• Describes the office infection control
program and procedures
• Employee training records
• Describes HBV vaccination availability,
requirements, and implementation
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Sample Exposure
Determination Form
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Sample Employee Training
Record
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Maintaining Regulatory
Records
• Employee medical records (Figure 17-6)
• Informed refusal for hepatitis B vaccination
(Figure 17-7)
• Postexposure evaluation and follow-up training
• Employee informed refusal of postexposure
medical evaluation (Figure 17-8)
• Incident report of exposure to occupational
illness (Figure 17-9)
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Sample Employee Medical
Record
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Sample Refusal of Hepatitis B
Vaccination
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Sample Informed Refusal of
Postexposure Medical Evaluation
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Incident Report of Exposure
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Hazard Communication
Program
• OSHA’s hazard communication standards
require all dental professionals to develop
and implement a program involving
• Employee training
• A list of hazardous chemicals
• Maintenance of MSDSs
• Proper labeling of all chemicals in the
office
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Hazard Communication
Program
• A single coordinator of the program should be
responsible for the following:
• Disseminating information about the program
• Recognizing the hazardous properties of
chemicals found in the workplace
• Keeping up-to-date on procedures for safe
handling of chemicals
• Implementing measures for protecting the
office staff from hazardous chemicals
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Material Safety Data Sheet
(MSDS)
• An MSDS is kept for all products with hazardous
potential and includes
• The manufacturer’s name and address
• The product name
• The generic name (if applicable)
• Potential routes of entry
• The organs affected by the chemical
• Means of protecting against or reducing the
effects of chemical exposure (e.g., eyewash)
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Labeling of Hazardous
Materials
• Products purchased from dental supply
companies arrive with permanently affixed
information about hazardous chemicals.
• If chemicals are transferred to smaller
containers, hazard communication labels
must be put on these containers.
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Labeling of Hazardous
Materials
• The label designates the hazard class, the
routes of entry into the body, and the
organs affected.
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Labeling of Hazardous
Materials
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Equipment for Hazardous
Situations
• Equipment that should be available for
preventing or dealing with a hazardous spill
include:
• Fire extinguisher
• Eyewash stations
• Amalgam spill kit
• Masks
• Protective clothing
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Equipment for Hazardous
Situations
• Hazardous spill equipment
• Kitty litter, broom, and dustpan
• Protective nitrile gloves and glasses
• Bags in which to seal spilled materials and
contaminated objects
• Well-ventilated areas for work (able to be
turned off if an accident occurs)
• Scavenging system (for use with nitrous
oxide)
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Aseptic Technique
• Procedures used to maintain asepsis and
prevent cross-contamination include
• Use of barrier coverings when
appropriate
• Disinfection of exposed surface
• Use of disposable items if items can not
be disinfected or sterilized
• Sterilization of contaminated reusable
items
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Aseptic Technique
• Aseptic procedures
• No touching of eyewear, masks, or hair once
gloves are donned
• Use of pretreatment antimicrobial mouth rinse
• Disinfection of hands with an antimicrobial soap
or alcohol rub immediately before placement
and removal of gloves
• Obtaining a complete and comprehensive
health history for every patient
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Personal Protection
• Personal protection involves two
considerations:
1. Immunological protection
(immunization)
2. Barrier protection
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Immunization
• Dental healthcare workers should receive
all appropriate and available vaccines.
• Approved vaccines are available for many
infectious diseases.
• The hepatitis B vaccine and a yearly
tuberculin Mantoux test to assess
exposure to tuberculosis are essential
precautions for dental healthcare workers
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Barrier Protection
• Physical barriers are a fundamental
component of an infection control program.
• Disposable examination gloves, over gloves,
and utility gloves should be used.
• During treatment, face masks, and
protective clinic attire and eyewear should
be worn.
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Instrument Sterilization
• The administrative assistant may assume a
major role in monitoring the efficiency of
the sterilization systems.
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Sterilization Testing Strips
• A test strip is placed in the sterilization
chamber with instruments.
• The test strip is returned to the
manufacturer or a monitoring agency for
verification that sterilization has occurred.
• The office receives written documentation
that is maintained as a record.
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Laboratory Asepsis
• Items received from the laboratory should
be disinfected before placement.
• All items must be disinfected according to
product directions.
• The administrative assistant may prepare
and receive cases from the dental
laboratory, so an understanding of the
recommended guidelines is essential.
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Waste Disposal in the Dental
Office
• The Environmental Protection Agency (EPA)
is a federal regulatory agency that oversees
the handling, tracking, transportation, and
disposal of medical waste.
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Waste Disposal
in the Dental Office
• All infectious waste should be placed in
closable, leak-proof containers or bags that
are color coded or labeled appropriately.
• All infectious material is disposed of in
accordance with federal, state, and local
regulations and appropriate forms are
maintained.
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Waste Disposal
in the Dental Office
• Most of the regulated waste in dental
offices consists of contaminated sharps and
extracted teeth.
• Some offices may also generate a small
amount of nonsharp solid medical waste
such as 2 × 2s or cotton rolls
saturated/caked with blood or saliva.
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Educating Patients
about Infection Control
Programs
• The best course of action is to educate the
staff and patients about the importance of
safe practice and the use of standard
precautions for all patients.
• The two best ways to avoid potential
litigation and OSHA inspections are
prevention and good documentation.
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