Infection is recommended only if hands are

Infection Prevention and Control in the Dental OfficebyMohammed Klef BIO4322 Microbiology I Dental Hygiene, Level 01 Professor: Michelle AtkinsonMohammed Klef, Fall of 20171TABLE OF CONTENTSINTRODUCTION 2PATHWAYS OF CROSS-CONTAMINATION 2HAND HYGIENE 2IMMUNIZATION 3PREVENTION OF SHARP INJURIES 4DENTAL OPERATORY SANITIZATION 5NAILS, JEWELLERY AND INFECTION CONTROL 5PERSONAL PROTECTIVE EQUIPMENT 6MEDICAL ATTIRE 7BARRIERS 7GLOVES 7DISINFICTING WIPES 7BIOHAZARDS 7WATERLINES AND SUCTION TUBES 7RECOMMENDATIONS# 7OPTIM WIPES SDS 8NOTES AND RECOMMENDATIONS 11REFERENCES 12Mohammed Klef, Fall of 20172INTRODUCTIONThe risk of bloodborne, or airborne transmitted infections in the dental setting is a major concern for many patients who visit their dentist on a regular basis, and have dental instruments inserted in their oral cavities. To insure the safety of patients and healthcare providers, these guidelines are put together to aid you in your dental office to establish and maintain adequate infection prevention protocols. The goals of this document include:• Protect all patients, and oral care providers from any infectious microbes,• Eliminating cross contamination in your office and,• Proper handling, or even disposal, of instruments that may have been introduced to a source of infection. PATHWAYS OF CROSS-CONTAMINATIONThere are multiple ways, or pathways that a cross-contamination could occur in. These are paths that the microbe could use to transport from a host to infect another vulnerable host. some are observable by the naked eye, and some are not. Such pathways include:• Contact with lesions that could also release agents by breathing if present in the mouth through breathing with an open mouth,• Patient to staff,• Patient to patient and,• Community to dental clinic (Miller, 1998).”When health workers are infected at work, this puts other healthcare workers at risk, but also can be a risk to all other patients, understanding where the breach in these measures is occurring and taking the steps needed to fully implement infection prevention and control measures can put an end to these … infections.” (Fukuda, 2015).HAND HYGIENEThe first step in preventing any infection from transporting through hosts is hand hygiene. Hence, it is considered the main method of limiting the spread of microbes and there are two methods to carry hand hygiene. First is the hand-rub, and this technique is the preferred one since it uses an alcohol based hand rub without the need for water, which is more effective, and saves time. Hand washing is the second method and it is recommended only if hands are visibly not clean since it is more effective in this case.Patient PatientOperator OperatorNext Patient PatientCross-Contamination in Dental SettingsFigure 1: Dental instruments may transport bacterial and viral infections.Mohammed Klef, Fall of 20173Below is a chart on how to perform both methods, obtained from Ontario public health.IMMUNIZATIONAccording to the Canadian Immunization Guide and the Royal College of Dental Surgeons of Ontario, all personnel working in a dental office are required to be immunized against the following diseases due to the exposure they face working on patients with different medical needs:Hepatitis BVaricellaMeaslesDiphtheriaMumpsPertussisRubellaTetanusPolioInfluenzaRecord of Immunization (to be updated semi-annually for each staff member): Vaccine Date Given Next Booster Date Hepatitis B Measles Mumps Rubella Varicella Tdap Polio TB Readings (in mm)Mohammed Klef, Fall of 20174PREVENTION OF SHARP INJURIESSharps should be kept out of the reach of the patients, and disposes of in a labelled puncture resistant container, provided by the employer, if they are a one-time use item. Injuries caused by a sharp instrument (e.g. needles, and scalers) are very dangerous because they may carry bloodborne pathogens. To prevent such exposure, personal protective equipment should be used all the time around patients and contaminated instruments, and a safe handling of sharps is to be used consistently. PPE is to be changed between patients, or every time there is an opening in them. To prevent percutaneous injuries there are some preventative measures to take which may include:• Needles are to be always capped before use on patient. But, never bend, recap or handle used needles with your hands. The one hand scoop method is preferred,• Blades that have been used should be removed using a blade remover,• Removal of burs from handpieces is required following any use and,• Heavy-duty utility gloves are to be used in cleaning contaminated instruments along with a long-handled brush. ALWAYS USE EXTREM CAUTION HANDLING SHARPS.In the case of a percutaneous exposure with contaminated instruments, you are to follow the following steps immediately:• Administer the appropriate first-aid in such cases. Wash hands with soap and water then bandage, and flush eyes, nose, or mouth thoroughly if exposed.• Report the injury to the dentist, and seek immediate advice from healthcare professionals based on the injury.• Seek medical help if needed, and fill an injury form.An injury form should include the following:o Name of the exposed, with their immunization record,o Name, and medical history and current medical health status of the host,o Date, time, and nature of the exposure (include actions taken).• Refer both persons involved to see physicians to perform blood test,• If history of infections is not known for the source, post-exposure prophylaxis should be administered within the first hours after the event.Mohammed Klef, Fall of 20175In the unfortunate event an injury occurs, it is to be logged on the injury log provided below.Sharps Injury LogFacility Name: _________________________________________ Date Report No. Name of exposed worker Instrument or Device Location where injury occurred Brief discerption of incidentDENTAL OPERATORY SANITIZATIONTo maintain asepsis and prevent contamination of surfaces, dental chair, and the operation stools the following steps must be followed bases on the clinical asepsis sheet at Algonquin college dental clinic:• All handles on chairs and bracket table must be covered by barriers if are to be used during dental operations,• Make sure that you wear heavy duty utility gloves to handle the sharps, and the proper PPE• After dismissal of patients, make sure that all contaminatedinstruments are carried to the sanitization room,• All surfaces of the operatory must be sanitized before being reused for the next client, use sanitizing wipes to do so such as the Optim33 wipes,• Make sure your gloves are covered with wipes at all times,• Make sure to sanitize all surfaces (including arms and poles) of: light, bracket table, lines, suction trap and box, water bottle, lines’ holders, cuspidor. Discard wipes and cover gloves with new ones then,• Make sure to sanitize all surfaces (top to bottom, including arm rests adjusting handles and knobs) of: dental chair, operator stool, DA stool. Discard wipes and cover gloves with new ones then,• Make sure to sanitize all surfaces of the walls, backsplash and mounted items, the back shelf, and countertops, drawers, cabinets and handles.• Take off your PPE and wash hands properly to maintain asepsis until leaving the operatory.NAILS, JEWELLERY AND INFECTION CONTROLNails are a part of your hand hygiene, they are to be kept short to allow the hand hygiene performed to reach and clean them and under them, and to not tear gloves in the middle of a dental operation. Many assume that having nail polish is not a source of worry. But according to the Royal College of Dental Surgeons of Ontario (2009), prosthetic nails and nail polish have been shown to cause hospital outbreaks involving fungal and bacterial infections. By leaving it on, the harbored microbes may cause cross-contamination from a staff member to aMohammed Klef, Fall of 20176patient through chipped pieces that may not be easily observed. That could have serious health and legal implications on both the staff and the office itself. Jewellery on hands, neck, or face could also attract airborne microbes traveling away from the patient’s mouth, hence acts as an additional source of contamination.PERSONAL PROTECTIVE EQUIPMENTPPE’s main purpose is to protect healthcare workers is to protect them from any infectious microbes than can be transmitted through patients, instruments, or other staff attending to other patients at the same time. PPE also protects major organs from hazardous material that could irritate eyes (through proper use of protective glasses), respiratory system (by correctly positioning a mask on the face), or damage the skin (by wearing appropriate gloves, and gowns when needed). Specific instructions regarding main items in PPE are listed below:• Masks must cover nose and mouth at all times when procedures are carried to protect the respiratory system from any infectious airborne microbes. They must be changed if they become moist or if worn for an hour. If masks are worn in a highly aerosolized setting then change mask every 20 minutes.• Use N95 masks to prevent leakage around edges and to filter small particles that may not be filtered by regular medical masks.• Eyes must be protected from debris that are present during dental procedures. Doing so requires protective eyewear, must fit tightly if operator has prescription glasses, or a face shield. they should be cleaned after each patient or if soiled.Protective eyewear should be placed before glovesMohammed Klef, Fall of 20177MEDICAL ATTIREAccording to institute of biomaterial and biomedical engineering at the university of Toronto, dedicated sealed bags or containers are to be used to transport coats and scrubs to and from laundry along with the use pf separate bins for dirty and clean attire to avoid cross-contamination. Scrubs should be laundered after every daily use if they become in contact with any patients, and white lab coats should be laundered once a week or sooner if soiled (Bearman et al, 2014).BARRIERSBarriers are used to shield equipment that may be used on different patients throughout the day from contamination from flying debris or operator gloves, but after each patient they should be removed and the covered area must be sanitized as they are not closed to saliva and other particles leaving the gloves or the patient’s mouth.GLOVESExamination gloves should be worn consistently when operating on patients, they should be changed when torn, or if worn for an hour or more. Heavy duty utility gloves are to be worn when disinfecting the operatory, handling sharps, and when performing clinical asepsis. The use of cream and lotion is only permitted between patients, as using them while wearing gloves will degrade the latex and affect the integrity of the gloves and compromise safety of operators. (Safety, 2017)DISINFICTING WIPESWipes such as Optim 33 should be used in sanitizing your office. The presence of debris on surfaces will compromise the disinfection as it will travel along with the wipes to other surfaces, and as a result the change of wipes is recommended before moving to another surface on the operatory. They contain hydrogen peroxide and that may irritate skin if used without gloves. Below a safety data sheet regarding the Optim 33 Wipes will be included.BIOHAZARDSBiohazards in the dental office include blood, saliva, any chemicals used and other microbes. They are to be dispose of in a biohazard container, used needles must go in the sharps marked container, and saliva ejector tips must be thrown away and not used again.WATERLINES AND SUCTION TUBESWaterlines in the dental operatory must be purged thoroughly for 2-3 minutes at the start of the day and for 30 seconds between patients. Suction lines should be cleaned with suction solutions after each use. Never touch the insides of the container carrying the suction solution with your suction lines (clinical asepsis sheet at Algonquin college dental hygiene clinic, 2017). The water bottle should be emptied after each use, and never be touched with contaminated hands. Never touch the tube that pulls water up from the bottle.RECOMMENDATIONSDental offices use many disposable materials, such as disposable tubes and tips, thus they are changed between clients. One recommendation to be more environmentally safe is to try and use material that can be disinfected like the instruments we use, barriers that are made to be disinfected after.Mohammed Klef, Fall of 20178Mohammed Klef, Fall of 20179Mohammed Klef, Fall of 201710Mohammed Klef, Fall of 201711Mohammed Klef, Fall of 201712Note to the readers: we advise every staff member to keep themselves updated on infection control and prevention that relate to the industry. Infection control procedures and guidelines continue to evolve at a fast rate. The Infection Control protocols” of this dental office will be revised and updated every six months or continuously as new research is made available. It is recommended to better educate the staff on the correct handling of water bottles attached to the dental unit.Mohammed Klef, Fall of 201713REFRENCESIncorrect placement of PPE . (n.d.). Retrieved December 19, 2017, from https://www.halyarddental.com/media/12793/didyouknow_app.pngWipes on contaminated chair. (n.d.). Retrieved December 19, 2017, from http://www.dentalnews.com/wp-content/uploads/2017/08/0002121_400.jpegBearman, G. et. al. (2014, February). Expert Guidance: Healthcare Personnel Attire in Non-Operating Room Settings. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820072/Canada, P. H. (2017, April 19). Page 11: Canadian Immunization Guide: Part 3 – Vaccination of Specific Populations. Retrieved from https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-3-vaccination-specific-populations/page-11-immunization-workers.html#p3c10t1CDC. (2017, October 8). Proper sequence of PPE. Retrieved from https://www.cdc.gov/niosh/npptl/images/infographics/PPE-SequencePage1.jpgCDC. (2017, September 28). The National Personal Protective Technology Laboratory (NPPTL). Retrieved December 19, 2017, from https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/respsource3healthcare.htmlCenter for Devices and Radiological Health. (2015, July 22). Safely Using Sharps (Needles and Syringes) at Home, at Work and on Travel – Best Way to Get Rid of Used Needles and Other Sharps. Retrieved from https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/Sharps/ucm263240.htmHeneghan, E. B. (2015, February 23). U.N. experts warn of ‘critical knowledge gaps’ on Saudi MERS virus. Retrieved December 19, 2017, from https://www.reuters.com/article/us-health-saudi-mers/u-n-experts-warn-of-critical-knowledge-gaps-on-saudi-mers-virus-idUSKBN0LR16D20150223Infection Prevention and Control (IPAC). (2017, December). Retrieved from https://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Pages/default.aspxInfection prevention and control in dentistry. (2010, February). Retrieved from http://www.rcdso.org/publicprotection/advisoryservices/infectionpreventionandcontrolLab Coat Procedures | IBBME, University of Toronto. (n.d.). Retrieved December 19, 2017, from http://www.ibbme.utoronto.ca/safety/ehs/lab-coat-procedures/Major Aspects of Infection Control in Dental Environment. (2017, August 14). Retrieved December 19, 2017, from http://www.dentalnews.com/2017/08/10/major-aspects-infection-control-dental-environment/Nails hygiene digital image. (2014, August 07). Retrieved from http://nuvail-rx.com/2014/08/07/nail-biting-is-a-bad-habit/Palenik, C. (2005, March 01). Proper use and selection of masks. Retrieved December 19, 2017, from http://www.dentistryiq.com/articles/dem/print/volume-10/issue-2/focus/proper-use-and-selection-of-masks.htmlSciCan | OPTIM 33TB: One-Step Cleaner & Intermediate Disinfectant. (n.d.). Retrieved December 19, 2017, from https://www.scicancanada.ca/optim-33tb

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