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2003 CDC Guidelines for Dental Healthcare SettingsInfection Control, DA116
Review:OSHA = ________CDC = ___________________
◦OSHA Bloodborne Pathogens 1991◦CDC Guidelines 1993◦OSHA Needlestick Safety and
Prevention Act 2001◦CDC Guidelines for Infection Control in
Dental Health-Care Settings — 2003. Built on previous laws and recommendations
OSHA Needlestick Safety and Prevention Act 2001
___________ must consider using safer needle devices to prevent needle-stick injuries
____________ must be involved in identifying and choosing the new devices for office use
CDC 2003 CHANGES
2003 CDC guidelines follow previous CDC guidelines and OSHA Standards but add some details or slight changes to the original documents.
Standard Precautions
Apply to ____ patients Integrate and expand Universal
Precautions to include organisms spread by _____ and also ◦Body fluids, secretions, and excretions
except sweat, whether or not they contain blood OPIM
◦Non-intact (broken) skin◦Mucous membranes
Elements of Standard Precautions
Handwashing Use of gloves, masks, eye
protection, and gowns Injury prevention
Patient care equipment Environmental surfaces
Personnel Health ElementsVaccinations
HBV Influenza Measles, Mumps, Rubella Varicella
◦ Documentation of vaccination or immunity
◦ Baseline TB test upon employment
Post-exposure prophylaxis (PEP) to
HBV, HCV, HIV Offices should make advance
arrangements for testing and treatment with local occupational health physician so no delays in PEP occur
Continued Bloodborne Pathogens Standard compliance
Written work restriction policies for workers infected with or exposed to major infectious diseases
Annual evaluation of safety devices such as dental safety syringes
Guidance for selecting and using PPEProtective
eyewear◦ _____side shields
Thick _____ gloves◦ Instrument
cleaning and housekeeping
_______ surgeons’ gloves for oral surgery
Respirator protection◦ Patients with TB
Hand CareWhen/How to use:
◦ Plain soap◦ Antimicrobial _____◦ Alcohol-based
____________◦ Oral surgical
antisepsis Antimicrobial soaps
or alcohol rubs with persistent activity
NOTE: WASH hands for every 5-10 hand-rubs to keep hands clean
◦ ___________: Prevent/ease skin dryness Caution: type of lotion
◦ Irritant and contact dermatitis
◦ Latex (type I) hypersensitivity Establish latex-safe
environment if necessary
◦ ______ fingernails no artificial nails no finger jewelry
Sterilization and DisinfectionMore detailed than 1993
guidelines◦Sterilizer monitoring◦Sterilization of unwrapped items◦Storage of sterilized items◦Differences between types of
disinfecting chemicals◦Water quality
SPECIAL CONSIDERATIONS
CDC 2003 gives specific guidelines for several situations common to the dental office
Dental Handpieces and Other Devices
Attached to air and waterlines but removable
Permanently attached to air and waterlines
Clean and heat _______ intraoral devices that can be removed from air and waterlines
Follow manufacturer’s instructions for cleaning, lubrication, and sterilization
Do ____ use liquid germicides or ethylene oxide
Items do not enter patient’s mouth but may become contaminated
Use _______ and change between uses
Clean and intermediate-level ________ the surface of devices if visibly contaminated
Saliva Ejectors
Previously suctioned ________ might be retracted into the patient’s mouth when a seal is created
Do not advise patients to close their lips tightly around the tip of the saliva ejector
Dental Radiology
Wear gloves and other appropriate ____ as necessary
Use ______ or single-use items when possible_______ sterilize heat-tolerant radiographic
accessories Transport and handle exposed radiographs so
that they will not become contaminatedAvoid contamination of processing equipment
or computer equipment if using digital
Precautions for Parenteral Medications (medications injected into body)
_____ tubings, bags, connections, needles, and syringes are single-use, disposable
_________ dose vials◦Do not administer to
multiple patients even if the needle on the syringe is changed
◦Do not combine leftover contents for later use
Single-Use (Disposable) DevicesIntended for use on _____ patient
during a single procedureUsually ______ heat-tolerant________ be reliably cleanedExamples: Syringe needles,
prophylaxis cups, and plastic orthodontic brackets
Pre-procedural Mouth Rinses◦Have a patient use an anti-microbial
mouth rinse prior to dental procedure
________ microorganisms in the mouth, aerosol and spatter
Scientific evidence is inconclusive
Precautions for Surgical Procedures
Sterile Irrigating Solutions
Sterile Surgeon’s Gloves
Surgical Scrub
Handling Biopsy Specimens
Place biopsy in sturdy, _________ container
Avoid contaminating the outside of the container
________ with a biohazard symbol
Extracted TeethConsidered
________ medical waste◦Do not incinerate
extracted teeth containing amalgam
◦Clean and disinfect before sending to _____ for shade comparison
Can be given back to patient
Educational setting:◦ Remove visible
blood and debris ◦ Maintain
hydration◦ Autoclave (teeth
with no amalgam)◦ Use Standard
Precautions
Laser/Electrosurgery Plumes and Surgical Smoke
Destruction of tissue creates _______ that may contain harmful by-products◦ Infectious materials (HSV, HPV) may
contact mucous membranes of nose◦ No evidence of HIV/HBV transmission
Need further studies◦no specific recommendations – ◦Note: most offices use HVE to contain
fumes due to offensive odor
Dental Laboratory Dental prostheses,
appliances, and items used in their making are potential sources of contamination
Handle in a manner that protects patients and DHCP from exposure to microorganisms
Clean and disinfect prostheses and impressions
Wear appropriate PPE until disinfection has been completed
Clean and heat sterilize heat-tolerant items used in the mouth
Communicate specific information about disinfection procedures
INFECTIOUS DISEASES
Bloodborn Pathogens are still a concern but CDC 2003 also refers to TB and prion diseases
Transmission of Mycobacterium tuberculosis
Spread by __________ nuclei Healthy immune system usually _________ spread Bacteria can remain alive in the lungs for ______ years
(latent TB infection)
Risk is low in dental setting Baseline TB test recommended at initial hire
Preventing Transmission of TB in Dental Settings
Assess patients for history of ___Defer ________ dental treatmentIf patient must be treated:
◦DHCP should wear respirator mask◦Separate patient from
others/mask/tissue◦Refer to facility with proper TB
infection control precautions
Creutzfeldt-Jakob Disease (CJD) and other prion diseases
Prion: altered form of a normal cellular protein◦ Animal and
human formsLong incubation
period; very rare◦ Results in a fatal,
degenerative CNS disorder “mad cow”
Infection Control for Known CJD or vCJD Dental Patients
◦ Use single-use disposable items and equipment
◦ Consider items difficult to clean (e.g., endodontic files, broaches) as single-use disposable
◦ Keep instruments moist until cleaned
◦ Clean and autoclave at 134°C for 18 minutes
◦ Do not use flash sterilization
PROGRAM EVALUATION
• Periodic observational assessments
• Checklists to document procedures
• Routine review of occupational exposures to bloodborne pathogens