Ch. 19 - Disease Transmission

Disease Transmission Disease Transmission and Infection Controland Infection Control

Chapter 19Chapter 19

Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.


Lesson 19.1Lesson 19.1


Learning ObjectivesLearning Objectives

Identify the links in the chain of infection.Identify the links in the chain of infection. Describe the differences between a chronic infection and Describe the differences between a chronic infection and

an acute infection. an acute infection. Give an example of a latent infection.Give an example of a latent infection. Describe the routes of disease transmission in a dental Describe the routes of disease transmission in a dental

office.office. Describe the types of immunity and give examples of each.Describe the types of immunity and give examples of each. Describe the roles of the CDC and OSHA in infection Describe the roles of the CDC and OSHA in infection

control.control. Describe the components of an OSHA exposure-control Describe the components of an OSHA exposure-control

plan.plan.(Cont’d)(Cont’d)



(Cont’d)(Cont’d)

Explain the difference between universal precautions and Explain the difference between universal precautions and standard precautions.standard precautions.

Explain the rationale for standard precautions.Explain the rationale for standard precautions. Identify the OSHA categories of risk for occupational Identify the OSHA categories of risk for occupational

exposure.exposure. Describe the first aid necessary after an exposure incident.Describe the first aid necessary after an exposure incident. Discuss the rationale for hepatitis B vaccination for dental Discuss the rationale for hepatitis B vaccination for dental

assistants.assistants. Describe the proper handling and disposal methods for Describe the proper handling and disposal methods for

each type of waste generated in dentistry.each type of waste generated in dentistry.


IntroductionIntroduction

As a member of the dental healthcare team, the As a member of the dental healthcare team, the dental assistant is at risk of exposure to disease dental assistant is at risk of exposure to disease

agents through contact with blood and other potentially agents through contact with blood and other potentially infectious materials.infectious materials.

By carefully following infection-control and safety By carefully following infection-control and safety guidelines, you can minimize your risk of disease guidelines, you can minimize your risk of disease

transmission in the dental office.transmission in the dental office.


The Chain of InfectionThe Chain of Infection

The chain of infection consists of four parts: The chain of infection consists of four parts: VirulenceVirulence Numbers Numbers Susceptible host Susceptible host Portal of entryPortal of entry


Fig. 19-1 At least one part must be removed Fig. 19-1 At least one part must be removed to break the chain of infection.to break the chain of infection.


VirulenceVirulence

The virulence of an organism refers to the The virulence of an organism refers to the degree of pathogenicity or strength of that degree of pathogenicity or strength of that organism in its ability to produce disease.organism in its ability to produce disease.

Because we cannot change the virulence of Because we cannot change the virulence of microorganisms, we must rely on our body microorganisms, we must rely on our body defenses and specific immunizations.defenses and specific immunizations.

Avoid contact with microorganisms by always Avoid contact with microorganisms by always using infection-control techniques.using infection-control techniques.


NumbersNumbers

In addition to being virulent, pathogenic In addition to being virulent, pathogenic microorganisms must be present in large enough microorganisms must be present in large enough numbers to overwhelm the body’s defenses.numbers to overwhelm the body’s defenses.

The number of pathogens may be directly related to The number of pathogens may be directly related to the amount of bioburden present. the amount of bioburden present. ““Bioburden” refers to organic materials such as blood and Bioburden” refers to organic materials such as blood and

saliva. saliva. The use of the dental dam and high-volume The use of the dental dam and high-volume

evacuation helps minimize bioburden on surfaces evacuation helps minimize bioburden on surfaces and reduce the number of microorganisms in the and reduce the number of microorganisms in the aerosol.aerosol.


Susceptible HostSusceptible Host

A susceptible host is a person who is unable A susceptible host is a person who is unable to resist infection by the pathogen.to resist infection by the pathogen.

An individual who is in poor health, An individual who is in poor health, chronically fatigued, or under extreme stress chronically fatigued, or under extreme stress or who has a weakened immune system is or who has a weakened immune system is more likely to become infected. more likely to become infected.

Staying healthy, washing hands frequently, Staying healthy, washing hands frequently, and keeping immunizations up to date will and keeping immunizations up to date will help members of the dental team resist help members of the dental team resist infection and stay healthy.infection and stay healthy.


Portal of EntryPortal of Entry

To cause infection, a pathogen must have a To cause infection, a pathogen must have a portal of entry (or means of getting into the portal of entry (or means of getting into the body). body).

The portals of entry for airborne pathogens The portals of entry for airborne pathogens the mouth and nose. the mouth and nose.

Bloodborne pathogens must have access to Bloodborne pathogens must have access to the blood supply to gain entry into the body. the blood supply to gain entry into the body. This occurs through a break in the skin caused by This occurs through a break in the skin caused by

a needlestick, a cut, or even a human bite.a needlestick, a cut, or even a human bite.


Types of InfectionsTypes of Infections

Acute infection: Symptoms are often quite severe and Acute infection: Symptoms are often quite severe and appear soon after the initial infection occurs. appear soon after the initial infection occurs.

Chronic infections: In these infections, the microorganism Chronic infections: In these infections, the microorganism is present for a long period; some may persist for life.is present for a long period; some may persist for life.

Latent infection: A latent infection is a persistent infection Latent infection: A latent infection is a persistent infection in which the symptoms come and go; cold sores fall in in which the symptoms come and go; cold sores fall in this category.this category. Oral herpes simplex and genital herpes are latent viral infectionsOral herpes simplex and genital herpes are latent viral infections

Opportunistic infections: Caused by normally Opportunistic infections: Caused by normally nonpathogenic organisms, opportunistic infections occur nonpathogenic organisms, opportunistic infections occur in individuals whose resistance is decreased or in individuals whose resistance is decreased or compromised.compromised.


Routes of Disease TransmissionRoutes of Disease Transmission

Direct transmission occurs when someone comes into Direct transmission occurs when someone comes into direct contact with the infectious lesion or infected body direct contact with the infectious lesion or infected body fluids (e.g., blood, saliva, semen, vaginal secretions).fluids (e.g., blood, saliva, semen, vaginal secretions).

Indirect transmission involves the transfer of organisms to Indirect transmission involves the transfer of organisms to a susceptible person through, for example, the handling of a susceptible person through, for example, the handling of contaminated instruments or touching of contaminated contaminated instruments or touching of contaminated surfaces and then touching the face, eyes, or mouth. surfaces and then touching the face, eyes, or mouth.

Splash or spatter transmission happens during a dental Splash or spatter transmission happens during a dental procedure when the mucosa (mouth or eyes) or nonintact procedure when the mucosa (mouth or eyes) or nonintact skin is splashed with blood or blood-contaminated saliva.skin is splashed with blood or blood-contaminated saliva.





Airborne transmission, also known as droplet infection, Airborne transmission, also known as droplet infection, involves the spread of disease through droplets of involves the spread of disease through droplets of moisture containing bacteria or viruses.moisture containing bacteria or viruses.

Aerosols, containing saliva, blood, and microorganisms, Aerosols, containing saliva, blood, and microorganisms, are created with the use of the high-speed handpiece, air-are created with the use of the high-speed handpiece, air-water syringe, and ultrasonic scaler during dental water syringe, and ultrasonic scaler during dental procedures.procedures.

Mists are droplet particles larger than those generated in Mists are droplet particles larger than those generated in aerosol spray.aerosol spray.

Spatter is large droplet particles contaminated with blood, Spatter is large droplet particles contaminated with blood, saliva, and other debris.saliva, and other debris.





Parenteral transmission can take place through needlestick Parenteral transmission can take place through needlestick injuries, human bites, cuts, abrasions, or any break in the skin.injuries, human bites, cuts, abrasions, or any break in the skin.

Bloodborne transmission involves direct or indirect contact with Bloodborne transmission involves direct or indirect contact with blood and other body fluids.blood and other body fluids.

Food-and-water transmission occurs when contaminated food Food-and-water transmission occurs when contaminated food that has not been cooked or refrigerated properly or water that that has not been cooked or refrigerated properly or water that has been contaminated with human or animal fecal material is has been contaminated with human or animal fecal material is consumed. consumed.

Fecal/oral transmission occurs when proper sanitation Fecal/oral transmission occurs when proper sanitation procedures, such as handwashing after use of the toilet, are not procedures, such as handwashing after use of the toilet, are not followed and one of the many pathogens present in fecal matter followed and one of the many pathogens present in fecal matter is transmitted when the infected person touches another person is transmitted when the infected person touches another person or makes contact with surfaces or food.or makes contact with surfaces or food.


Fig. 19-2 Pathogens can be transferred from staff to patient, from patient to Fig. 19-2 Pathogens can be transferred from staff to patient, from patient to staff, and from patient to patient through the use of staff, and from patient to patient through the use of

contaminated equipment.contaminated equipment.


The Immune SystemThe Immune System

The human body receives resistance to The human body receives resistance to communicable diseases from the immune communicable diseases from the immune system.system.

A communicable disease is one that can be A communicable disease is one that can be transmitted from one person to another or by transmitted from one person to another or by contact with the body fluids from another contact with the body fluids from another person.person.

Inherited immunity is present at birth.Inherited immunity is present at birth. Acquired immunity is developed over a Acquired immunity is developed over a

person’s lifetime.person’s lifetime.


Acquired ImmunityAcquired Immunity

Acquired immunity can occur either naturally Acquired immunity can occur either naturally or artificially.or artificially. Naturally acquired immunity occurs when a person Naturally acquired immunity occurs when a person

has contracted and is recovering from a disease.has contracted and is recovering from a disease.• Active immunityActive immunity

• Passive immunityPassive immunity

In artificially acquired immunity, antibodies are In artificially acquired immunity, antibodies are introduced into the body by means of introduced into the body by means of immunization or vaccination.immunization or vaccination.


Fig. 19-3 Acquired immunity.Fig. 19-3 Acquired immunity.(From Applegate EJ: The anatomy and physiology learning system, ed 2, Philadelphia, 2000, Saunders.(From Applegate EJ: The anatomy and physiology learning system, ed 2, Philadelphia, 2000, Saunders.


Disease Transmission in the Dental Disease Transmission in the Dental OfficeOffice

Every dental office should have an infection-Every dental office should have an infection-control program designed to prevent the control program designed to prevent the transmission of disease from: transmission of disease from: Patient to dental teamPatient to dental team Dental team to patientDental team to patient Patient to patientPatient to patient Dental office to community Dental office to community

(including the dental team’s families)(including the dental team’s families) Community to patientCommunity to patient


Patient–to–Dental Team Patient–to–Dental Team TransmissionTransmission

The most common route is through direct The most common route is through direct contact (touching) of the patient’s blood or contact (touching) of the patient’s blood or saliva.saliva.

Droplet infection occurs through mucosal Droplet infection occurs through mucosal surfaces of the eyes, nose, and mouth. It can surfaces of the eyes, nose, and mouth. It can occur when the dental-team member inhales occur when the dental-team member inhales aerosol generated by the dental handpiece or aerosol generated by the dental handpiece or air-water syringe.air-water syringe.

Indirect contact occurs when the team member Indirect contact occurs when the team member touches a contaminated surface or instrument.touches a contaminated surface or instrument.


Disease TransmissionDisease Transmission Ways to prevent disease transmission from Ways to prevent disease transmission from

the patient to the dental team member.the patient to the dental team member. GlovesGloves HandwashingHandwashing MasksMasks Rubber damsRubber dams Patient mouth rinsesPatient mouth rinses


Patient-to-Patient Disease Patient-to-Patient Disease TransmissionTransmission

Patient-to-patient disease transmission has occurred Patient-to-patient disease transmission has occurred in the medical field, but no cases of this type of in the medical field, but no cases of this type of transmission have been documented in dentistry.transmission have been documented in dentistry.

Although such transmission is possible, Although such transmission is possible, contamination from instruments used on one patient contamination from instruments used on one patient must be transferred to another patient for this to must be transferred to another patient for this to occur.occur.

Infection-control measures that can prevent patient-Infection-control measures that can prevent patient-to-patient transmission include (1) instrument to-patient transmission include (1) instrument sterilization, (2) surface barriers, (3) handwashing, (4) sterilization, (2) surface barriers, (3) handwashing, (4) gloves, and (5) use of sterile instruments.gloves, and (5) use of sterile instruments.


Dental Office–to–Community Dental Office–to–Community TransmissionTransmission

Microorganisms can leave the dental office and enter Microorganisms can leave the dental office and enter the community in a variety of ways.the community in a variety of ways. Contaminated impressions sent to the dental laboratoryContaminated impressions sent to the dental laboratory Contaminated equipment sent out for repairContaminated equipment sent out for repair In theory, transportation of microorganisms out of the office In theory, transportation of microorganisms out of the office

on the dental team’s clothing or hairon the dental team’s clothing or hair The following measures can prevent this type of The following measures can prevent this type of

disease transmission:disease transmission: HandwashingHandwashing Changing clothes before leaving the officeChanging clothes before leaving the office Disinfecting impressions and contaminated equipment Disinfecting impressions and contaminated equipment

before such items leave the the officebefore such items leave the the office


Community–to–Dental Office–to–Community–to–Dental Office–to–Patient TransmissionPatient Transmission

Microorganisms enter the dental office Microorganisms enter the dental office through the municipal water that supplies the through the municipal water that supplies the dental unit.dental unit. Waterborne organisms colonize the inside of the Waterborne organisms colonize the inside of the

dental unit waterlines and form biofilm.dental unit waterlines and form biofilm. As water flows through the handpiece, air-water As water flows through the handpiece, air-water

syringe, and ultrasonic scaler, a patient could syringe, and ultrasonic scaler, a patient could swallow contaminated water.swallow contaminated water.


Roles and Responsibilities of CDC Roles and Responsibilities of CDC and OSHA in Infection Controland OSHA in Infection Control

The Centers for Disease Control and Prevention (CDC) and The Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) the Occupational Safety and Health Administration (OSHA) are federal agencies that play very important roles in are federal agencies that play very important roles in infection control for dentistry. infection control for dentistry.

The CDC is not a regulatory agency. Its role is to issue The CDC is not a regulatory agency. Its role is to issue specific recommendations based on sound scientific specific recommendations based on sound scientific evidence on health-related matters.evidence on health-related matters.

CDC’s recommendations are not law, but they do establish CDC’s recommendations are not law, but they do establish a standard of care for the dental profession.a standard of care for the dental profession.

OSHA is a regulatory agency. Its role is to issue specific OSHA is a regulatory agency. Its role is to issue specific standards to protect the health of employees in the U.S. standards to protect the health of employees in the U.S.

In 1991, based on the CDC guidelines, OSHA issued the In 1991, based on the CDC guidelines, OSHA issued the Bloodborne Pathogens Standard (BBP).Bloodborne Pathogens Standard (BBP).


CDC Guidelines for Infection Control CDC Guidelines for Infection Control in Dental Health-Care Settingsin Dental Health-Care Settings

In December of 2003, the CDC released the In December of 2003, the CDC released the Guidelines for Infection Control in Dental Health Care Guidelines for Infection Control in Dental Health Care Settings-2003. Settings-2003. The new guidelines have expanded upon the existing OSHA The new guidelines have expanded upon the existing OSHA

Bloodborne Pathogens Standard, and have included some Bloodborne Pathogens Standard, and have included some areas that were not already covered.areas that were not already covered.

The guidelines are based on scientific evidence and are The guidelines are based on scientific evidence and are categorized on the basis of existing scientific data, categorized on the basis of existing scientific data, theoretical rationale, and applicability.theoretical rationale, and applicability.

The guidelines apply to all paid or unpaid dental health The guidelines apply to all paid or unpaid dental health professionals who might be occupationally exposed to blood professionals who might be occupationally exposed to blood and body fluids by direct contact or through contact with and body fluids by direct contact or through contact with contaminated environmental surfaces, water, or air.contaminated environmental surfaces, water, or air.


OSHA Bloodborne Pathogens OSHA Bloodborne Pathogens StandardStandard

The bloodborne pathogens standard (BBP) is the The bloodborne pathogens standard (BBP) is the most important infection control law in dentistry.most important infection control law in dentistry. It is designed to protect employees against It is designed to protect employees against

occupational exposure to bloodborne pathogens, such occupational exposure to bloodborne pathogens, such as hepatitis B, hepatitis C, and human as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV).immunodeficiency virus (HIV).

Employers are required to protect their employees Employers are required to protect their employees from exposure to blood and other potentially infectious from exposure to blood and other potentially infectious materials (OPIM) in the workplace and to provide materials (OPIM) in the workplace and to provide proper care to the employee if an exposure should proper care to the employee if an exposure should occur.occur.



OSHA Bloodborne Pathogens OSHA Bloodborne Pathogens StandardStandard


The BBP applies to any type of facility in which The BBP applies to any type of facility in which employees might be exposed to blood and/or employees might be exposed to blood and/or other body fluids, which include:other body fluids, which include: Dental and medical officesDental and medical offices HospitalsHospitals Funeral homesFuneral homes Emergency medical servicesEmergency medical services Nursing homesNursing homes

OSHA requires that a copy of the BBP be OSHA requires that a copy of the BBP be present in every dental office and clinic. present in every dental office and clinic.


Requirements of the StandardRequirements of the Standard

Exposure control plan clearly describes how the office complies with the Exposure control plan clearly describes how the office complies with the standard.standard.

The term Universal Precautions is referred to in the OSHA Bloodborne The term Universal Precautions is referred to in the OSHA Bloodborne Pathogens Standard. Pathogens Standard. Universal precautions is based on the concept that all human blood and Universal precautions is based on the concept that all human blood and

body fluids (including saliva) are to be treated as if known to be infected body fluids (including saliva) are to be treated as if known to be infected with the bloodborne disease, HBV, HCV, or HIV. with the bloodborne disease, HBV, HCV, or HIV.

The CDC expanded the concept and changed the term to Standard The CDC expanded the concept and changed the term to Standard Precautions.Precautions.

Standard Precautions integrate and expand the elements of universal Standard Precautions integrate and expand the elements of universal precautions into a standard of care designed to protect healthcare precautions into a standard of care designed to protect healthcare providers from pathogens that can be spread by blood or any other providers from pathogens that can be spread by blood or any other body fluid, excretion, or secretion. body fluid, excretion, or secretion.

It is not possible to identify those individuals who are infectious, so It is not possible to identify those individuals who are infectious, so infection precautions are used for all healthcare personnel and their infection precautions are used for all healthcare personnel and their patients.patients.


Table 19-1 Occupational Exposure DeterminationTable 19-1 Occupational Exposure Determination


Postexposure ManagementPostexposure Management

Accidents happen! Accidents happen! Before an accident occurs, the BBP requires Before an accident occurs, the BBP requires

the employer to have a written plan. the employer to have a written plan. This plan explains exactly what steps the This plan explains exactly what steps the

employee must follow after the exposure employee must follow after the exposure incident occurs and the type of medical incident occurs and the type of medical follow-up that will be provided to the follow-up that will be provided to the employee at no charge.employee at no charge.


Follow-up Measures for Follow-up Measures for Exposed Worker*Exposed Worker*


Hepatitis B ImmunizationHepatitis B Immunization

OSHA requires the dentist to offer the hepatitis B virus OSHA requires the dentist to offer the hepatitis B virus (HBV) vaccination series to all employees whose jobs (HBV) vaccination series to all employees whose jobs include category I and II tasks. include category I and II tasks.

Vaccine must be offered within 10 days of employment. Vaccine must be offered within 10 days of employment. The dentist/employer must obtain proof from the The dentist/employer must obtain proof from the

physician who administered the vaccination. physician who administered the vaccination. The employee has the right to refuse the HBV vaccine; The employee has the right to refuse the HBV vaccine;

however, the employee must sign an informed refusal however, the employee must sign an informed refusal form that is kept on file in the dental office. form that is kept on file in the dental office.

The employee always has the right to change his or her The employee always has the right to change his or her mind and receive the vaccine at a later date at no mind and receive the vaccine at a later date at no charge.charge.


Hepatitis B VaccineHepatitis B Vaccine

The vaccine is administered in a series of three The vaccine is administered in a series of three injections. The most common vaccination schedule is 0, injections. The most common vaccination schedule is 0, 1, and 6 months. 1, and 6 months.

The preferred injection site is in the deltoid muscle (on The preferred injection site is in the deltoid muscle (on the arm). the arm). The seroconversion rate (development of immunity) is higher The seroconversion rate (development of immunity) is higher

than when the vaccine is administered in the buttocks.than when the vaccine is administered in the buttocks. The Centers for Disease Control and Prevention (CDC) The Centers for Disease Control and Prevention (CDC)

states that pregnancy should not be considered a states that pregnancy should not be considered a contraindication to the HBV vaccine; however, the contraindication to the HBV vaccine; however, the woman’s obstetrician should be consulted.woman’s obstetrician should be consulted.


Post-vaccine Testing as Post-vaccine Testing as Recommended by the CDCRecommended by the CDC

Between 1 to 2 months after the series has been Between 1 to 2 months after the series has been completed, a blood test should be performed to completed, a blood test should be performed to ensure that the individual has developed immunity. ensure that the individual has developed immunity.

Individuals who have not developed immunity should Individuals who have not developed immunity should be evaluated by their physician to determine the need be evaluated by their physician to determine the need for an additional dose of HBV vaccine.for an additional dose of HBV vaccine.

Individuals who do not respond to the second 3-dose Individuals who do not respond to the second 3-dose series of the vaccine should be counseled regarding series of the vaccine should be counseled regarding their susceptibility to HBV infection and precautions their susceptibility to HBV infection and precautions to take.to take.


Need for a BoosterNeed for a Booster

Routine booster doses of the HBV vaccine are Routine booster doses of the HBV vaccine are not recommended by the CDC.not recommended by the CDC.

The CDC does not recommend routine blood The CDC does not recommend routine blood testing (after the initial testing to determine initial testing (after the initial testing to determine initial immunity) to monitor the HBV antibody level in immunity) to monitor the HBV antibody level in individuals who have already had the vaccine. individuals who have already had the vaccine.

The exception to this recommendation is if an The exception to this recommendation is if an immunized individual has a documented immunized individual has a documented exposure incident and the attending physician exposure incident and the attending physician orders the administration of a booster dose.orders the administration of a booster dose.


Employee Medical RecordsEmployee Medical Records

The dentist/employer must keep a The dentist/employer must keep a confidential medical record for each confidential medical record for each employee.employee.

These records are confidential and must be These records are confidential and must be stored in a locked file. stored in a locked file.

The employer must keep these records for 30 The employer must keep these records for 30 years.years.


Managing Contaminated SharpsManaging Contaminated Sharps

Contaminated needles and other disposable sharps, Contaminated needles and other disposable sharps, such as scalpel blades, orthodontic wires, and broken such as scalpel blades, orthodontic wires, and broken glass, must be placed into a sharps container. glass, must be placed into a sharps container.

The sharps container must be puncture-resistant, The sharps container must be puncture-resistant, closable, leak-proof, and color-coded or labeled with closable, leak-proof, and color-coded or labeled with the biohazard symbol. the biohazard symbol.

Sharps containers must be located as close as possible Sharps containers must be located as close as possible to the place of immediate disposal.to the place of immediate disposal.

Do not cut, bend, or break the needles before disposal. Do not cut, bend, or break the needles before disposal. Never attempt to remove a needle from a disposable Never attempt to remove a needle from a disposable

syringe.syringe.


Fig. 19-4 A puncture-resistant sharps disposal container should be located Fig. 19-4 A puncture-resistant sharps disposal container should be located as close as possible to the area where the disposal of sharps takes place.as close as possible to the area where the disposal of sharps takes place.


Preventing Needlesticks Preventing Needlesticks as Recommended by the CDCas Recommended by the CDC

Never recap used needles by using both Never recap used needles by using both hands or any other technique that involves hands or any other technique that involves directing the point of a needle toward any part directing the point of a needle toward any part of the body. of the body.






Explain the importance of hand care for dental Explain the importance of hand care for dental assistants.assistants.

Explain proper hand hygiene for dental assistants.Explain proper hand hygiene for dental assistants. Explain the advantages of alcohol-based hand rubs.Explain the advantages of alcohol-based hand rubs. Discuss the types of personal protective equipment Discuss the types of personal protective equipment

(PPE) needed for dental assistants.(PPE) needed for dental assistants. Demonstrate the proper sequence for donning and Demonstrate the proper sequence for donning and

removing PPE.removing PPE. Discuss the various types of gloves used in a dental Discuss the various types of gloves used in a dental

office.office.


Hand HygieneHand Hygiene

Wash your hands each time before you put on gloves Wash your hands each time before you put on gloves and immediately after you remove gloves.and immediately after you remove gloves.

Wash your hands when you inadvertently touch Wash your hands when you inadvertently touch contaminated objects or surfaces while barehanded.contaminated objects or surfaces while barehanded.

Always use liquid soap during handwashing. Bar soap Always use liquid soap during handwashing. Bar soap should never be used because it may transmit should never be used because it may transmit contamination. contamination.

For most routine dental procedures, such as For most routine dental procedures, such as examinations and nonsurgical procedures, an examinations and nonsurgical procedures, an antimicrobial soap can be used. antimicrobial soap can be used.

For surgical procedures, you should use a germicidal For surgical procedures, you should use a germicidal surgical scrub product.surgical scrub product.


Fig. 19-7 Areas of the hand not thoroughly washed Fig. 19-7 Areas of the hand not thoroughly washed because of poor handwashing technique.because of poor handwashing technique.

(From Samaranayake LP, (From Samaranayake LP, Essential microbiology for dentistryEssential microbiology for dentistry, ed. 2, New York, 2002, Churchill Livingstone.), ed. 2, New York, 2002, Churchill Livingstone.)


Hand CareHand Care

Dry hands well before donning gloves.Dry hands well before donning gloves. Keep nails short and well manicured; rings (except Keep nails short and well manicured; rings (except

for wedding rings), fingernail polish, and artificial nails for wedding rings), fingernail polish, and artificial nails are not to be worn at work. are not to be worn at work.

Microorganisms thrive around rough cuticles and can Microorganisms thrive around rough cuticles and can enter the body through any break in the skin.enter the body through any break in the skin.

Dental personnel with open sores or weeping Dental personnel with open sores or weeping dermatitis must avoid activities involving direct patient dermatitis must avoid activities involving direct patient contact and handling contaminated instruments or contact and handling contaminated instruments or equipment until the condition on the hands is healed.equipment until the condition on the hands is healed.


Alcohol-Based Hand RubsAlcohol-Based Hand Rubs

Waterless antiseptic agents are alcohol-based products that Waterless antiseptic agents are alcohol-based products that are available in gels, foams, or rinses. are available in gels, foams, or rinses.

They do not require the use of water. The product is simply They do not require the use of water. The product is simply applied to the hands, which are then rubbed together to cover applied to the hands, which are then rubbed together to cover all surfaces.all surfaces.

These products are more effective at reducing microbial flora These products are more effective at reducing microbial flora than a plain soap, or even an antimicrobial hand wash.than a plain soap, or even an antimicrobial hand wash.

Concentrations of 60% to 95% are the most effective. Higher Concentrations of 60% to 95% are the most effective. Higher concentrations are actually less effective.concentrations are actually less effective.

They contain emollients that reduce the incidence of chapping, They contain emollients that reduce the incidence of chapping, irritation, and drying of the skin.irritation, and drying of the skin.

These products are very “dose sensitive.” This means that you These products are very “dose sensitive.” This means that you must use the amount that is recommended.must use the amount that is recommended.


CDC Recommendations for Hand CDC Recommendations for Hand CareCare

For most routine dental procedures, such as For most routine dental procedures, such as examinations and nonsurgical procedures, wash your examinations and nonsurgical procedures, wash your hands with either a nonantimicrobial or antimicrobial hands with either a nonantimicrobial or antimicrobial soap and water.soap and water.

If your hands are not visibly soiled, you may use an If your hands are not visibly soiled, you may use an waterless alcohol-based hand rub. waterless alcohol-based hand rub.

For surgical procedures, you should perform a For surgical procedures, you should perform a surgical scrub using either a nonantimicrobial or surgical scrub using either a nonantimicrobial or antimicrobial soap and water, dry your hands, and antimicrobial soap and water, dry your hands, and apply an alcohol-based surgical hand rub.apply an alcohol-based surgical hand rub.


Fig. 19-10 Hand lotions must be compatible with Fig. 19-10 Hand lotions must be compatible with glove material.glove material.

(Courtesy of Crosstex.)(Courtesy of Crosstex.)


Personal Protective EquipmentPersonal Protective Equipment

OSHA requires the employer to provide OSHA requires the employer to provide employees with the appropriate personal employees with the appropriate personal protective equipment (PPE) without charge to the protective equipment (PPE) without charge to the employee. employee.

Examples of PPEExamples of PPE Protective clothingProtective clothing Surgical masksSurgical masks Face shieldsFace shields Protective eyewearProtective eyewear Disposable patient-treatment glovesDisposable patient-treatment gloves Heavy-duty utility glovesHeavy-duty utility gloves


Protective ClothingProtective Clothing

Types of protective clothing include smocks, Types of protective clothing include smocks, slacks, skirts, laboratory coats, surgical scrubs slacks, skirts, laboratory coats, surgical scrubs (hospital operating room clothing), scrub (surgical) (hospital operating room clothing), scrub (surgical) hats, pants, and shoe covers.hats, pants, and shoe covers.

The type of protective clothing you should wear is The type of protective clothing you should wear is based on the degree of anticipated exposure to based on the degree of anticipated exposure to infectious materials.infectious materials.

The BBP prohibits the employee from taking The BBP prohibits the employee from taking protective clothing home to be laundered. protective clothing home to be laundered.

Laundering of contaminated protective clothing is Laundering of contaminated protective clothing is the responsibility of the employer. the responsibility of the employer.


Protective Clothing RequirementsProtective Clothing Requirements

Protective clothing should be made of fluid-resistant Protective clothing should be made of fluid-resistant material. material.

As a means of minimizing the amount of uncovered skin, As a means of minimizing the amount of uncovered skin, clothing should have long sleeves and a high neckline. clothing should have long sleeves and a high neckline. Note: The type and characteristics of protective clothing Note: The type and characteristics of protective clothing depend on the anticipated degree of exposure.depend on the anticipated degree of exposure.

The design of the sleeve should allow the cuff to be The design of the sleeve should allow the cuff to be tucked inside the band of the glove.tucked inside the band of the glove.

During high-risk procedures, protective clothing must During high-risk procedures, protective clothing must cover dental personnel at least to the knees when seated.cover dental personnel at least to the knees when seated.

Buttons, trim, zippers, and other ornamentation should be Buttons, trim, zippers, and other ornamentation should be kept to a minimum.kept to a minimum.


Fig. 19-11 Appropriate clinical attire consists of Fig. 19-11 Appropriate clinical attire consists of long-sleeved gowns, gloves, and eyewearlong-sleeved gowns, gloves, and eyewear..


Protective MasksProtective Masks

A mask is worn over the nose and mouth to A mask is worn over the nose and mouth to protect you from inhaling possible infectious protect you from inhaling possible infectious organisms spread by the aerosol spray of the organisms spread by the aerosol spray of the handpiece or air-water syringe and accidental handpiece or air-water syringe and accidental splashes. splashes.

A mask with at least 95% filtration efficiency A mask with at least 95% filtration efficiency for particles 3 to 5 mm in diameter should be for particles 3 to 5 mm in diameter should be worn whenever splash or spatter is likely.worn whenever splash or spatter is likely.

The two most commonly used types of masks The two most commonly used types of masks are dome-shaped and flat. are dome-shaped and flat.


Guidelines for the Use of MasksGuidelines for the Use of Masks

Masks should be changed for every patient or Masks should be changed for every patient or more often (CDC guideline).more often (CDC guideline).

To handle a mask, touch the side edges only; To handle a mask, touch the side edges only; avoid contact with the more heavily contaminated avoid contact with the more heavily contaminated body of the mask.body of the mask.

The mask should conform well to the face.The mask should conform well to the face. The mask should not make contact with the The mask should not make contact with the

mouth while being worn because the moisture mouth while being worn because the moisture that is generated will decrease filtration efficiency. that is generated will decrease filtration efficiency.

A damp or wet mask is not an effective mask.A damp or wet mask is not an effective mask.


Protective EyewearProtective Eyewear

Eyewear is worn to protect eyes against the danger of Eyewear is worn to protect eyes against the danger of damage caused by aerosolized pathogens.damage caused by aerosolized pathogens.

Protective eyewear also prevents spattered solutions or Protective eyewear also prevents spattered solutions or caustic chemicals from injuring the eyes.caustic chemicals from injuring the eyes.

OSHA requires the use of eyewear with both front and OSHA requires the use of eyewear with both front and side protection (solid side shields) during exposure-prone side protection (solid side shields) during exposure-prone procedures.procedures.

If you wear contact lenses, you must wear protective If you wear contact lenses, you must wear protective eyewear with side shields or a face shield.eyewear with side shields or a face shield.

After each treatment or patient visit, clean and After each treatment or patient visit, clean and decontaminate your protective eyewear in accordance decontaminate your protective eyewear in accordance with the manufacturer's instructions (CDC guideline).with the manufacturer's instructions (CDC guideline).


Face ShieldsFace Shields

A chin-length plastic face shield may be worn A chin-length plastic face shield may be worn as an alternative to protective eyewear.as an alternative to protective eyewear.

A shield cannot be substituted for a face A shield cannot be substituted for a face mask because it does not protect against mask because it does not protect against inhalation of contaminated aerosols.inhalation of contaminated aerosols.

When splashing or spattering of blood or When splashing or spattering of blood or other body fluids is likely during a procedure other body fluids is likely during a procedure (such as surgery), a face shield is often worn (such as surgery), a face shield is often worn in addition to a protective mask.in addition to a protective mask.


Fig. 19-18 Face shields provide adequate eye protection, but a face Fig. 19-18 Face shields provide adequate eye protection, but a face mask is still required during assistance with mask is still required during assistance with

aerosol-generating procedures.aerosol-generating procedures.


Protective Eyewear for PatientsProtective Eyewear for Patients

Patients should be provided with protective Patients should be provided with protective eyewear because they also may be subject to eyewear because they also may be subject to eye damage during the procedure. eye damage during the procedure.

This may result from:This may result from: Handpiece spatterHandpiece spatter Spilled or splashed dental materials, including Spilled or splashed dental materials, including

caustic chemical agentscaustic chemical agents Airborne bits of acrylic or tooth fragmentsAirborne bits of acrylic or tooth fragments


Fig. 19-19 Patients should be provided with Fig. 19-19 Patients should be provided with protective eyewear.protective eyewear.


GlovesGloves

Because dental personnel are most likely to come Because dental personnel are most likely to come into contact blood or contaminated items with their into contact blood or contaminated items with their hands, gloves may be the most critical PPE. hands, gloves may be the most critical PPE.

You must wear a new pair of gloves for each patient, You must wear a new pair of gloves for each patient, remove them promptly after use, and wash your remove them promptly after use, and wash your hands immediately to avoid the transfer of hands immediately to avoid the transfer of microorganisms to other patients or the environment microorganisms to other patients or the environment (CDC guideline).(CDC guideline).

Consult with the glove manufacturer regarding the Consult with the glove manufacturer regarding the chemical compatibility of the glove material and the chemical compatibility of the glove material and the dental materials you use (CDC guideline).dental materials you use (CDC guideline).


Fig. 19-21 Nonsterile exam gloves.Fig. 19-21 Nonsterile exam gloves. (Courtesy of Crosstex.)(Courtesy of Crosstex.)


Guidelines for the Use of GlovesGuidelines for the Use of Gloves

All gloves used in patient care must be discarded All gloves used in patient care must be discarded after a single use. after a single use.

These gloves may not be washed, disinfected, or These gloves may not be washed, disinfected, or sterilized; however, they may be rinsed with water sterilized; however, they may be rinsed with water to remove excess powder.to remove excess powder.

Latex, vinyl, or other disposable medical-quality Latex, vinyl, or other disposable medical-quality gloves may be used for patient examinations and gloves may be used for patient examinations and dental procedures.dental procedures.

Torn or damaged gloves must be replaced Torn or damaged gloves must be replaced immediately.immediately.



Guidelines for the Use of GlovesGuidelines for the Use of Gloves


Do not wear jewelry under gloves. (Rings harbor Do not wear jewelry under gloves. (Rings harbor pathogens and may tear gloves.)pathogens and may tear gloves.)

Change gloves frequently. (If the procedure is Change gloves frequently. (If the procedure is long, change gloves about once each hour.)long, change gloves about once each hour.)

Remove contaminated gloves before leaving the Remove contaminated gloves before leaving the chairside during patient care and replace them chairside during patient care and replace them with new gloves before returning to patient care. with new gloves before returning to patient care.

Hands must be washed after glove removal and Hands must be washed after glove removal and before regloving.before regloving.


Gloves Damaged During TreatmentGloves Damaged During Treatment

Gloves are effective only when they are intact Gloves are effective only when they are intact

(not damaged, torn, ripped, or punctured).(not damaged, torn, ripped, or punctured). If gloves are damaged during treatment, they If gloves are damaged during treatment, they

must be changed immediately. The procedure must be changed immediately. The procedure for regloving is:for regloving is: Excuse yourself and leave the chairside.Excuse yourself and leave the chairside. Remove and discard the damaged gloves.Remove and discard the damaged gloves. Wash hands thoroughly.Wash hands thoroughly. Reglove before returning to the dental procedure.Reglove before returning to the dental procedure.


OverglovesOvergloves

Overgloves, which also are known as “food Overgloves, which also are known as “food handler” gloves, are made of lightweight, handler” gloves, are made of lightweight, inexpensive clear plastic. inexpensive clear plastic.

These may be worn over contaminated These may be worn over contaminated treatment gloves (overgloving) to prevent the treatment gloves (overgloving) to prevent the contamination of clean objects handled contamination of clean objects handled during treatment. during treatment.


Guidelines for the Use of OverglovesGuidelines for the Use of Overgloves

Overgloves are not acceptable alone as a Overgloves are not acceptable alone as a hand barrier or for intraoral procedures.hand barrier or for intraoral procedures.

Overgloves must be worn carefully to avoid Overgloves must be worn carefully to avoid contamination during handling with contamination during handling with contaminated procedure gloves.contaminated procedure gloves.

Overgloves are donned before the secondary Overgloves are donned before the secondary procedure is performed and removed before procedure is performed and removed before the patient treatment that was in progress is the patient treatment that was in progress is resumed.resumed.

Overgloves are discarded after a single use.Overgloves are discarded after a single use.


Sterile Surgical GlovesSterile Surgical Gloves

Sterile gloves should be worn for invasive Sterile gloves should be worn for invasive procedures involving the cutting of bone or procedures involving the cutting of bone or significant amounts of blood or saliva, such significant amounts of blood or saliva, such as oral surgery or periodontal treatment.as oral surgery or periodontal treatment.

Sterile gloves are supplied in prepackaged Sterile gloves are supplied in prepackaged units to maintain their sterility before use. units to maintain their sterility before use.

They are provided in specific sizes and are They are provided in specific sizes and are fitted to the left or right hand. fitted to the left or right hand.


Utility GlovesUtility Gloves

Utility gloves are not used for direct patient care.Utility gloves are not used for direct patient care. Utility gloves must be worn: Utility gloves must be worn:

When the treatment room is being cleaned and disinfected When the treatment room is being cleaned and disinfected between patients.between patients.

While contaminated instruments are being cleaned or While contaminated instruments are being cleaned or handled.handled.

For surface cleaning and disinfection.For surface cleaning and disinfection. Utility gloves may be washed, disinfected, or Utility gloves may be washed, disinfected, or

sterilized and reused. sterilized and reused. Used utility gloves must be considered contaminated Used utility gloves must be considered contaminated

and handled appropriately until they have been and handled appropriately until they have been properly disinfected or sterilized.properly disinfected or sterilized.


Fig. 19-22 Utility gloves are used in preparing Fig. 19-22 Utility gloves are used in preparing instruments for sterilization.instruments for sterilization.


Maintaining Infection Control While Maintaining Infection Control While GlovedGloved

During a dental procedure, it may be During a dental procedure, it may be necessary to touch surfaces or objects such necessary to touch surfaces or objects such as drawer handles as drawer handles and material containers.and material containers.

If you touch these objects with a gloved hand, If you touch these objects with a gloved hand, both the surface and glove become both the surface and glove become contaminated. contaminated.

To minimize the possibility of cross-To minimize the possibility of cross-contamination, use an overglove when it is contamination, use an overglove when it is necessary to touch a surface.necessary to touch a surface.


Non–Latex-Containing GlovesNon–Latex-Containing Gloves

Healthcare providers or patients may Healthcare providers or patients may experience serious allergic reactions to latex. experience serious allergic reactions to latex.

For the person who is sensitive to latex, there For the person who is sensitive to latex, there are gloves made from vinyl, nitrile, and other are gloves made from vinyl, nitrile, and other nonlatex-containing materials.nonlatex-containing materials.


Glove CautionGlove Caution

Chemicals such as glutaraldehyde and Chemicals such as glutaraldehyde and acrylates readily permeate (pass through) acrylates readily permeate (pass through) latex gloves and can irritate the skin.latex gloves and can irritate the skin. Note that irritation can be mistaken for an allergic Note that irritation can be mistaken for an allergic

reaction to the chemicals in the latex glove. reaction to the chemicals in the latex glove. This is why latex gloves should never be worn This is why latex gloves should never be worn

for the handling of chemicals.for the handling of chemicals.






Explain the types and symptoms of latex reactions.Explain the types and symptoms of latex reactions. Describe the proper handling and disposal methods for each Describe the proper handling and disposal methods for each

type of waste generated in dentistry.type of waste generated in dentistry. Describe the roles of the CDC and OSHA in infection control.Describe the roles of the CDC and OSHA in infection control. Explain the CDC recommendations regarding the use of a saliva Explain the CDC recommendations regarding the use of a saliva

ejector.ejector. Explain the precautions necessary when treating a patient with Explain the precautions necessary when treating a patient with

active tuberculosis.active tuberculosis. Describe the rationale of CDC recommendations regarding Describe the rationale of CDC recommendations regarding

Creutzfeldt-Jakob disease and other prion-related diseases.Creutzfeldt-Jakob disease and other prion-related diseases. Describe the rationale of CDC recommendations regarding Describe the rationale of CDC recommendations regarding

laser plumes.laser plumes.


Latex AllergiesLatex Allergies

The use of natural-rubber latex gloves has The use of natural-rubber latex gloves has proved one of the most effective means of proved one of the most effective means of protecting the dental worker and the patient protecting the dental worker and the patient from the transmission of disease. from the transmission of disease.

The number of healthcare workers and patients The number of healthcare workers and patients who have become hypersensitive to latex has who have become hypersensitive to latex has increased dramatically.increased dramatically.

The CDC Guidelines include recommendations The CDC Guidelines include recommendations for contact dermatitis and latex hypersensitivity.for contact dermatitis and latex hypersensitivity.





There are three common types of allergic There are three common types of allergic reactions to latex.reactions to latex.

Two types involve an immune reaction and one Two types involve an immune reaction and one type involves only surface irritation.type involves only surface irritation. Irritant dermatitis, a nonimmunologic process (does not Irritant dermatitis, a nonimmunologic process (does not

involve the body’s immune system), is caused by involve the body’s immune system), is caused by contact with a substance that produces chemical contact with a substance that produces chemical irritation of the skin.irritation of the skin.• The skin becomes reddened, dry, irritated, and, in severe The skin becomes reddened, dry, irritated, and, in severe

cases, cracked. Irritant dermatitis can be reversed by cases, cracked. Irritant dermatitis can be reversed by identifying and correcting the cause of the problem.identifying and correcting the cause of the problem.



Fig. 19-24 Irritant dermatitisFig. 19-24 Irritant dermatitis..




Type IV sensitivityType IV sensitivity The most common type of latex allergy, type IV The most common type of latex allergy, type IV

sensitivity, is a delayed contact reaction, and it sensitivity, is a delayed contact reaction, and it involves the immune system.involves the immune system.• It may take as long as 48 or 72 hours for the red, itchy It may take as long as 48 or 72 hours for the red, itchy

rash to appear. rash to appear.

• Reactions are limited to the areas of contact and Reactions are limited to the areas of contact and do not involve the entire body.do not involve the entire body.

• An immune response is produced by the chemicals that An immune response is produced by the chemicals that are used to process the latex used in manufacturing the are used to process the latex used in manufacturing the gloves, not by the proteins in the latex. gloves, not by the proteins in the latex.





Type I allergic reaction Type I allergic reaction This is the most dangerous type of latex allergy, This is the most dangerous type of latex allergy,

and it can result in death.and it can result in death.• The reaction comes in response to the latex protein in The reaction comes in response to the latex protein in

the glove (in contrast to the reaction to chemical the glove (in contrast to the reaction to chemical additives in type IV reactions). additives in type IV reactions).

• A severe immunologic (immune system) response A severe immunologic (immune system) response usually occurs 2 to 3 minutes after the latex allergens usually occurs 2 to 3 minutes after the latex allergens make contact with the skin or mucous membranes.make contact with the skin or mucous membranes.


Treatment of Latex AllergiesTreatment of Latex Allergies

There is no specific cure for latex allergy. There is no specific cure for latex allergy. The only options are prevention, avoidance of latex-The only options are prevention, avoidance of latex-

containing products, and treatment of the symptoms. containing products, and treatment of the symptoms. Anyone who suspects that he or she has an allergy to Anyone who suspects that he or she has an allergy to

latex should see a qualified healthcare provider to latex should see a qualified healthcare provider to have a test to confirm the allergy.have a test to confirm the allergy.

Once a latex allergy has been diagnosed, the Once a latex allergy has been diagnosed, the affected person should practice latex avoidance in all affected person should practice latex avoidance in all aspects of his or her personal and professional lives. aspects of his or her personal and professional lives.


Remember…Remember…

When a latex allergy has been diagnosed in When a latex allergy has been diagnosed in one employee in the dental office, all staff one employee in the dental office, all staff members should use practices to minimize members should use practices to minimize the use of latex-containing products. These the use of latex-containing products. These practices include the wearing of powder-free practices include the wearing of powder-free gloves by all dental staff members to gloves by all dental staff members to minimize the risk of airborne latex particles.minimize the risk of airborne latex particles.


Latex-Sensitive PatientsLatex-Sensitive Patients

In the healthcare setting, patients with latex In the healthcare setting, patients with latex allergies should be treated with the use of allergies should be treated with the use of alternatives to latex.alternatives to latex.

Vinyl gloves and nonlatex rubber dams Vinyl gloves and nonlatex rubber dams should be available in all dental offices.should be available in all dental offices.


Waste Management in the Dental Waste Management in the Dental OfficeOffice

Dental practices are subject to a wide variety of Dental practices are subject to a wide variety of federal, state, and local regulations concerning waste federal, state, and local regulations concerning waste management issues. management issues.

The Environmental Protection Agency (EPA) and The Environmental Protection Agency (EPA) and most state and local regulations do not categorize most state and local regulations do not categorize saliva or saliva-soaked items as infectious waste.saliva or saliva-soaked items as infectious waste.

Because of the high probability that blood may be Because of the high probability that blood may be carried in saliva during dental procedures, CDC carried in saliva during dental procedures, CDC guidelines and OSHA regulations consider saliva in guidelines and OSHA regulations consider saliva in dentistry a potentially infectious body fluid. dentistry a potentially infectious body fluid.


Classifications of WasteClassifications of Waste

General waste: All nonhazardous, nonregulated waste General waste: All nonhazardous, nonregulated waste should be discarded in covered containers. should be discarded in covered containers. Examples include disposable paper towels, paper mixing pads, Examples include disposable paper towels, paper mixing pads,

and empty food containers.and empty food containers. Contaminated waste is waste that has had contact with Contaminated waste is waste that has had contact with

blood or other body fluids. blood or other body fluids. Examples include used barriers and patient napkins.Examples include used barriers and patient napkins.

Hazardous waste poses a risk to human beings and the Hazardous waste poses a risk to human beings and the environment. Toxic chemicals and materials are environment. Toxic chemicals and materials are hazardous waste. hazardous waste. Examples include scrap amalgam, spent fixer solution, Examples include scrap amalgam, spent fixer solution,

and lead foil from x-ray film packets.and lead foil from x-ray film packets.(Cont’d)(Cont’d)


Classifications of WasteClassifications of Waste


Some items, such as extracted teeth with Some items, such as extracted teeth with amalgam restorations, may be both hazardous amalgam restorations, may be both hazardous waste (because of the amalgam) and infectious waste (because of the amalgam) and infectious waste (because of the blood). waste (because of the blood).

Infectious or regulated waste (biohazard) is Infectious or regulated waste (biohazard) is contaminated waste that is capable of contaminated waste that is capable of transmitting an infectious disease. transmitting an infectious disease. Blood and blood-soaked materialsBlood and blood-soaked materials Pathologic waste Pathologic waste Sharps Sharps


Handling Dental Office WasteHandling Dental Office Waste

Contaminated waste: Items that may contain the Contaminated waste: Items that may contain the body fluids of patients, such as gloves and patient body fluids of patients, such as gloves and patient napkins, should be placed in a lined trash receptacle. napkins, should be placed in a lined trash receptacle.

Medical waste is any solid waste that is generated in Medical waste is any solid waste that is generated in the diagnosis, treatment, or immunization of human the diagnosis, treatment, or immunization of human beings or animals in research.beings or animals in research.

Infectious waste is a subset of medical waste. Only a Infectious waste is a subset of medical waste. Only a small percentage of medical waste is infectious and small percentage of medical waste is infectious and needs to be regulated.needs to be regulated. Must be labeled with the universal biohazard symbolMust be labeled with the universal biohazard symbol


CDC Guidelines for Handling CDC Guidelines for Handling Extracted Teeth Extracted Teeth

Dispose of extracted teeth as regulated medical Dispose of extracted teeth as regulated medical waste unless they are being returned to the patient. waste unless they are being returned to the patient. When teeth are returned to the patient, the provisions When teeth are returned to the patient, the provisions of the standard no longer apply.of the standard no longer apply.

Do not dispose of extracted teeth containing Do not dispose of extracted teeth containing amalgam in regulated medical waste that will be amalgam in regulated medical waste that will be incinerated.incinerated.

Note: Because of the mercury in amalgam fillings, Note: Because of the mercury in amalgam fillings, you should check with state and local authorities for you should check with state and local authorities for regulations regarding disposal of teeth containing regulations regarding disposal of teeth containing amalgam.amalgam.


Handling Contaminated WasteHandling Contaminated Waste

Contaminated items that may contain the body fluids Contaminated items that may contain the body fluids of patients, such as gloves and patient napkins, of patients, such as gloves and patient napkins, should be placed in a lined trash receptacle.should be placed in a lined trash receptacle.

A receptacle for contaminated waste should be A receptacle for contaminated waste should be covered with a properly fitted lid that can be opened covered with a properly fitted lid that can be opened with a foot pedal.with a foot pedal.

Keeping the lid closed prevents air movement and Keeping the lid closed prevents air movement and the spreading of contaminants.the spreading of contaminants.

Red bags or containers should not be used for Red bags or containers should not be used for unregulated waste. Check the specific requirements unregulated waste. Check the specific requirements of your local state or county health department.of your local state or county health department.


Fig. 19-25 Waste is separated into clearly marked containers. Fig. 19-25 Waste is separated into clearly marked containers. Left, unregulated waste. Right, regulated waste.Left, unregulated waste. Right, regulated waste.


Handling of Medical WasteHandling of Medical Waste

Medical waste is any solid waste generated in the diagnosis, Medical waste is any solid waste generated in the diagnosis, treatment, or immunization of human beings or animals in treatment, or immunization of human beings or animals in research.research.

Infectious waste is a subset of medical waste. Only a small Infectious waste is a subset of medical waste. Only a small percentage of medical waste is infectious and needs to be percentage of medical waste is infectious and needs to be regulated.regulated.

Containers of infectious waste (regulated waste) must be Containers of infectious waste (regulated waste) must be labeled with the universal biohazard symbol, identified in labeled with the universal biohazard symbol, identified in compliance with local regulations, or both. compliance with local regulations, or both.

Containers used for holding contaminated items must be Containers used for holding contaminated items must be labeled. Examples of such containers include contaminated labeled. Examples of such containers include contaminated sharps containers, pans or trays used to hold contaminated sharps containers, pans or trays used to hold contaminated instruments, bags of contaminated laundry, specimen instruments, bags of contaminated laundry, specimen containers, and storage containers. containers, and storage containers.


Disposal of Medical Waste Disposal of Medical Waste

Once contaminated waste leaves the office, it is Once contaminated waste leaves the office, it is regulated by the EPA and by state and local laws. regulated by the EPA and by state and local laws.

Under most regulations, the manner of disposal is Under most regulations, the manner of disposal is determined by the amount (weight) of infectious determined by the amount (weight) of infectious materials requiring disposal.materials requiring disposal.

The average dental practice is categorized as a “small The average dental practice is categorized as a “small producer” of infectious waste, and disposal is regulated producer” of infectious waste, and disposal is regulated accordingly. accordingly.

The law requires the dentist to maintain records of the The law requires the dentist to maintain records of the final disposal of this medical waste, including final disposal of this medical waste, including documentation of how, when, and where it was documentation of how, when, and where it was disposed of.disposed of.


Additional Infection Control PracticesAdditional Infection Control Practices

Never eat, drink, smoke, apply cosmetics or lip balm, Never eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in any area of the dental or handle contact lenses in any area of the dental office where contamination is possible, such as the office where contamination is possible, such as the dental treatment rooms, dental laboratory, sterilization dental treatment rooms, dental laboratory, sterilization area, or the area for the processing of x-rays. area, or the area for the processing of x-rays.

Never store food or drink in a refrigerator that contains Never store food or drink in a refrigerator that contains any potentially contaminated items. any potentially contaminated items.

You can minimize the amount of splash and spatter You can minimize the amount of splash and spatter contamination produced during dental procedures with contamination produced during dental procedures with the skillful use of a dental dam and high-volume the skillful use of a dental dam and high-volume evacuation.evacuation.


CDC Guidelines Special Considerations:CDC Guidelines Special Considerations:Saliva Ejectors Saliva Ejectors

Do not advise patients to close their lips tightly Do not advise patients to close their lips tightly around the tip of the saliva ejector to evacuate around the tip of the saliva ejector to evacuate oral fluids.oral fluids. Rationale: Backflow from low-volume saliva ejectors Rationale: Backflow from low-volume saliva ejectors

occurs when the pressure in the patient’s mouth is occurs when the pressure in the patient’s mouth is less than that in the evacuator. This backflow can less than that in the evacuator. This backflow can be be a source of cross-contamination between patients. a source of cross-contamination between patients. Although no adverse health effects associated with Although no adverse health effects associated with the saliva ejector have been reported, you should the saliva ejector have been reported, you should be aware that in certain situations backflow could be aware that in certain situations backflow could occur with the use of a saliva ejector.occur with the use of a saliva ejector.


CDC Guidelines Special Considerations:CDC Guidelines Special Considerations:Dental LaboratoriesDental Laboratories

Use PPE when handling items in the laboratory until they have been Use PPE when handling items in the laboratory until they have been decontaminated.decontaminated.

Clean, disinfect, and rinse all dental prostheses and prosthodontic Clean, disinfect, and rinse all dental prostheses and prosthodontic materials (e.g., impressions, bite registrations, occlusal rims, and materials (e.g., impressions, bite registrations, occlusal rims, and extracted teeth).extracted teeth).

Consult with manufacturers regarding the stability of specific materials Consult with manufacturers regarding the stability of specific materials (e.g., impression materials) relative to disinfection procedures.(e.g., impression materials) relative to disinfection procedures.

Clean and heat-sterilize heat-tolerant items used in the mouth Clean and heat-sterilize heat-tolerant items used in the mouth (e.g., metal impression trays and face-bow forks).(e.g., metal impression trays and face-bow forks).

Follow manufacturers' instructions for cleaning, sterilizing, or disinfecting Follow manufacturers' instructions for cleaning, sterilizing, or disinfecting items that become contaminated but do not normally come into contact items that become contaminated but do not normally come into contact with the patient (e.g., burs, polishing points, rag wheels, articulators, with the patient (e.g., burs, polishing points, rag wheels, articulators, case pans, and lathes.) If manufacturer instructions are unavailable, case pans, and lathes.) If manufacturer instructions are unavailable, clean and sterilize heat-stable items and disinfect them. clean and sterilize heat-stable items and disinfect them.


CDC Guidelines Special Considerations:CDC Guidelines Special Considerations:Preprocedural Mouth RinsesPreprocedural Mouth Rinses

Preprocedural mouth rinses are intended to reduce the Preprocedural mouth rinses are intended to reduce the number of microorganisms released in the form of number of microorganisms released in the form of aerosol or spatter. aerosol or spatter.

Preprocedural mouth rinsing can decrease the number Preprocedural mouth rinsing can decrease the number of microorganisms introduced into the patient’s of microorganisms introduced into the patient’s bloodstream during invasive dental procedures.bloodstream during invasive dental procedures.

Scientific evidence that preprocedural mouth rinsing Scientific evidence that preprocedural mouth rinsing prevents clinical infections among dental health prevents clinical infections among dental health professionals or patients is inconclusive .professionals or patients is inconclusive .

This is an unresolved issue, and no recommendation This is an unresolved issue, and no recommendation has been made.has been made.


CDC Guidelines Special Considerations:CDC Guidelines Special Considerations:Creutzfeldt-Jakob Disease and Other Creutzfeldt-Jakob Disease and Other

Prion Diseases Prion Diseases Creutzfeldt-Jakob Disease (CJD) belongs to a group of rapidly Creutzfeldt-Jakob Disease (CJD) belongs to a group of rapidly

progressive and invariably fatal degenerative neurologic progressive and invariably fatal degenerative neurologic disorders. disorders.

They affect both human beings and animals and are thought to They affect both human beings and animals and are thought to be caused by infection with prions. be caused by infection with prions.

Prion diseases have an incubation period of years but are Prion diseases have an incubation period of years but are usually fatal within 1 year of diagnosis.usually fatal within 1 year of diagnosis.

The infectivity of oral tissues in CJD patients is an unresolved The infectivity of oral tissues in CJD patients is an unresolved issue. Scientific data indicate that the risk, if any, of sporadic issue. Scientific data indicate that the risk, if any, of sporadic CJD transmission during dental and oral surgical procedures is CJD transmission during dental and oral surgical procedures is low to nil.low to nil.

No recommendation is offered regarding the use of special No recommendation is offered regarding the use of special precautions in addition to standard precautions in the treatment precautions in addition to standard precautions in the treatment of patients with known CJD (unresolved issue).of patients with known CJD (unresolved issue).


CDC Guidelines Special Considerations:CDC Guidelines Special Considerations:Laser/Electrosurgery Plumes or Surgical Laser/Electrosurgery Plumes or Surgical

SmokeSmoke In surgical procedures involving the use of a laser or In surgical procedures involving the use of a laser or

electrosurgical unit, a smoke byproduct is created during the electrosurgical unit, a smoke byproduct is created during the thermal destruction of the tissue. thermal destruction of the tissue.

Laser plumes and surgical smoke pose a risk to dental Laser plumes and surgical smoke pose a risk to dental healthcare professionals.healthcare professionals.

One concern is that the aerosolized infectious material in the One concern is that the aerosolized infectious material in the laser plume may reach the nasal mucosa of the operator or laser plume may reach the nasal mucosa of the operator or other members of the dental team. However, airborne exposure other members of the dental team. However, airborne exposure to an infectious agent in a laser plume might not be enough to to an infectious agent in a laser plume might not be enough to cause disease.cause disease.

The effect of the exposure (e.g., disease transmission or The effect of the exposure (e.g., disease transmission or adverse respiratory effects) on dental healthcare professionals adverse respiratory effects) on dental healthcare professionals resulting from the use of lasers in dentistry has not been resulting from the use of lasers in dentistry has not been adequately evaluated (unresolved issue).adequately evaluated (unresolved issue).


Documents

Ch. 19 - Disease Transmission