Memberikan pemahaman tentang pencegahandan pengendalian infeksi yang harus diterapkandi Unit Gigi

Klinik Gigi

Percent

DocumentedPossibleDental Worker.. 0 6 *Nurse 24 35Lab Tech, clinical. 16 17Physician, nonsurgical 6 12Lab Tech, nonclinical.. 3 Other. 8 69Total57139CDC Database as of December 2002

Penularan HIV dari drg yang terinfeksi ke PasienDi laporkan hanya ada 1 kasus HIV dari drg ke pasien Dari penyelidikan 63 petugas kesehatan yang terinfeksi HIV tidak ada laporan terjadi penularan ( termasuk 33 drg atau mahasiswa kedokteran)

Resiko pekerjaan dari penularan Hep C diantara petugas kesehatan :Secara tidak sengaja tertular melalui paparan saat bekerja.Dilaporkan ada 3 kasus terjadi penularan melalui : percikan darah ke dalam mata Terjadi penularan secara terus menerus dari kuman HIV & HCV setelah terpapar pada kulit yang tidak intak( luka )

Concentration of HBV in Body Fluids High Moderate Low/Not Detectable

Blood Semen Urine Serum Vaginal Fluid Feces Wound exudates Saliva Sweat Tears Breast Milk

Infeksi HCV di Area Kesehatan Gigi Angka kejadian infeksi HCV diantara para dr Gigi hampir sama dengan populasi umum (~ 1%-2%) Tidak ada laporan mengenai penularan HCV dari petugas yang terinfeksi ke pasien/dari pasien ke pasien Risiko untuk tertular HCV tampaknya sangat kecil sekali

Faktor Risiko dari penularan HIV setelah terjadi paparan tertusuk jarum ( CDC Case-Control Study ) Kedalaman luka tusukJumlah darah yang ada pada peralatanArea insersi ( arteri atau Vena )Derajat /Tingkat penyakit dari (sumber) pasienya

Source: Cardo, et al., N England J Medicine 1997;337:1485-90.

MEKANISME PENULARAN :

Kontak langsung dengan : Darah, Cairan TubuhKontak langsung dengan Instrumen / Alat / PermukaanKontak dengan mukosa mata,hidung / mulut melalui tetesan/percikanInhalasi ( lewat mikroorganisme di udara)

Resiko rata rata penularan virus setelah tertusuk jarum

SumberRisikoHBVHBsAg+ and HBeAg+ 22.0%-31.0% hepatitis scr klinis ; 37%-62% serological evidence of HBV infectionHBsAg+ and HBeAg-1.0%-6.0% Hepatitis scr klinis; 23%-37% serological evidence of HBV infectionHCV1.8% (0%-7% range)HIV0.3% (0.2%-0.5% range)

Pelaksanaan hand HygieneGunakan lotion untuk mencegah kulit kering Pertimbangkan penggunaan produk yang cocok dg sarung tanganKuku jari harus pendekHindari kuku palsu Hindari assesoris tangan dapatmerobek sarung tangan

Buang sarung tangan Jika robek/ rusakTidak direkomendasikan ( Reuse ) sarung tangan dengan cara : desinfeksi,cuci,sterilkanGloves are not a substiitute for Handhygiene !!

Sterilisasi dan Disinfeksi peralatan pasien

Examples include surgical instruments, scalpel blades, periodontal scalers, and surgical dental bursSemi-critical InstrumentsHeat sterilized orsingle-use disposableExamples: Dental mouth mirrors, amalgam condensers, and dental handpiecesHeat sterilized orsingle-use disposableNoncritical Instruments and DevicesExamples: X-ray heads, facebows, pulse oximeter, blood pressure cuff

Automated Cleaning Instrument washerUltrasonic cleanerWasher-disinfector

Pembersiham secara manualCuci hingga bersih dan siap untuk di gunakan kembaliGunakan APD : sarung tangan,masker,gaun,kaca mata

Penyimpanan alat bersih dan steril Tempat bersih,tertutup dan kering ( tidak lembab) Bila steril pack lembab,cuci kembali, bungkus dan lakukan sterilisasi ulang.

Clinical Contact Surfaces

Medical WasteMedical Waste: Not considered infectious, thus can be discarded in regular trashRegulated Medical Waste: Poses a potential risk of infection during handling and disposal

Gunakan Alat Pelindung Diri (e.g., heavy-duty utility gloves, masks, protective eyewear) Pembersihan area dari mikroorganisme sangatlah penting dalam proses disinfeksiBaca literatur produk untuk disinfektan Rumah SakitJangan gunakan bahan steril atau disinfektan dosis untuk pembersihan permukaan

Rekomendasi pembersihan area lingkungan Resiko permukaan kontak lebih tinggi infeksi dari pada permukaan rumah tanggaPelindung permukaan dapat di pakai / diganti setiap pasien ORBersihkan kemudian atau disinfeksi menggunakan cairan deinfektan Rumah Sakit ke dosis ( untuk Hiv / HBV) ke dosis yang sedang ( untuk TBC)

Routinely clean with soap and water or an EPA-registered detergent/hospital disinfectant routinelyClean mops and cloths and allow to dry thoroughly before re-usingPrepare fresh cleaning and disinfecting solutions daily and per manufacturer recommendations

Kualitas AirGunakan sesuai standar air minum.**

Gunakan air steril untuk irigasi

Use sterile saline or sterile water as a coolant/irrigator when performing surgical procedures

Use devices designed for the delivery of sterile irrigating fluids

Kewaspadaan terhadap obat perenteralGunakan tubing IV, bags, jarum, dan syringes disposable sekali pakai . Vial Single dose .Jangan menggunakan obat multi dose kepada beberapa pasien meskipun jarum diganti.

Transmission of Mycobacterium tuberculosisMenyebar melalui percikanSistem kekebalan bisa lebih kuat mencegah penularanKuman TB dapat bertahan hidup di dalam paru untuk waktu yang lama (latent TB infection)

Pencegahan Penularan TB pada Alat Kes GigiTanyakan Riwayat pasien ( TB ?)Menunda tindakan elektifJika pasien memerlukan tindakan :Petugas harus menggunakan masker Pisahkan pasien dari yang lainRujuk pasien ke tempat fasilitas dengan pencegahan TB yang lebih baik.

Kesimpulan :

1.Pencegahan dan pengendalian infeksi di unit gigi perlu perlu mendapatkan perhatian dengan cara melaksanakan dan meningkatkan kewaspadaan standar 2.Melakukan surveilan secara aktif disemua tatanan pelayanan rawat inap dan rawat jalan

*BWaluyo/IX/06*Apa keuntungan memakai airborne ?Proses desinfeksi maksimal tidak ada sudut di dalam ruangan yang luput dari proses desinfeksi karena di mana udara dapat masuk maka cairan airborne akan masuk mendesinfeksi.Proses desinfeksi cepat.Cairan airborne tidak toksik (beracun) dan tidak korosif (merusak ) benda yang terkena cairan airborne.

**This slide shows some examples of clinical contact surfaces, including a light handle, countertop, bracket tray, dental chair, and door handle (shown by arrows).

Photo credit: Lt. Col. Jennifer Harte, U.S.A.F. Dental Investigation Service, Great Lakes, IL.

*Use appropriate protective barriers such as heavy-duty utility gloves, masks, and protective eyewear when cleaning and disinfecting surfaces.In general, cleaning and removal of microorganisms is as important as the disinfection process itself. Blood or other patient materials left on surfaces can interfere with the disinfecting process. Follow the manufacturers instructions for proper storage, dilution, and use of hospital disinfectants.Because of their toxic nature, the use of sterilants or high-level disinfectants on environmental surfaces is NOT recommended.

**For this reason, CDC recommends that water used for routine dental treatment meet regulatory standards for drinking water (fewer than 500 CFU/mL of heterotrophic water bacteria).

*During oral surgical procedures, microorganisms may enter the bloodstream and other normally sterile areas of the oral cavity (e.g., bone or subcutaneous tissue). For this reason, sterile solutions (e.g., sterile saline or sterile water) should be used as a coolant/irrigator when performing surgical procedures. Because the tubing cannot be reliably sterilized, conventional dental units cannot reliably deliver sterile water even when equipped with independent water reservoirs. Sterile water delivery devices, such as sterile irrigating syringes, shown here, or bulb syringes should be used to deliver sterile water. Sterile water systems, such as those used with surgical handpieces, bypass the dental unit and use sterile disposable or autoclavable tubing.

Photo credit, top: Lt. Col. Jennifer Harte, U.S.A.F. Dental Investigation Service, Great Lakes, IL.Photo credit, bottom: Eve Cuny, University of the Pacific School of Dentistry, San Francisco, CA.*Precautions to prevent disease transmission associated with the use of parenteral medications include:Treat fluid infusion and administration sets, including IV tubings, bags, connections, needles, and syringes as single-patient, disposable.Regarding single-dose vials:Do not administer to multiple patients even if the needle on the syringe is changed.Use single-dose instead of multi-dose vials whenever possible.Do not combine leftover contents for later use.

Photo credit: Lt. Col. Jennifer Harte, U.S.A.F. Dental Investigation Service, Great Lakes, IL.*Mycobacterium tuberculosis (TB) is spread from person to person through the air. When a person with pulmonary or laryngeal TB coughs or sneezes, tiny particles, known as droplet nuclei, are expelled into the air. The particles are an estimated 1-5 m in size, and normal air currents can keep them airborne for prolonged periods of time and spread them throughout a room or building. Infection may occur when a person inhales droplet nuclei containing TB organisms. During the first few weeks after infection, organisms can spread from the initial location in the lungs to the lymph nodes in the center of the chest and then to other parts of the body by way of the bloodstream. Within 2 to 12 weeks, the body's immune system usually prevents further multiplication and spread, although they can remain alive in the lungs for years. This condition is referred to as latent TB infection.Photo credit: Centers for Disease Control and Prevention, Atlanta, GA.

*Periodic updates of medical histories should include questions concerning history of TB exposure, infection or (current or past) treatment for active TB, and symptoms consistent with TB. Elective dental treatment should be deferred for any patient suspected or known to have active TB until they have been evaluated by medical personnel.DHCP should wear a face mask (surgical) or N-95 respirator for all patient contact. Any patient with suspected or possible infectious TB should be separated from other patients or DHCP, given a surgical mask to wear, and provided with tissues for coughing or sneezing. Refer the patient to a facility with proper TB infection control precautions for medical evaluation or urgent dental treatment.If you are in an office or facility that will provide dental treatment for patients with TB, additional precautions are necessary. Refer to CDC Guidelines for Preventing the Transmission of MTB in Health-care Facilities. MMWR 1994;43(No. RR-13)Photo credit: Centers for Disease Control and Prevention.

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