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Géza T. Terézhalmy, D.D.S.,M.A. Géza T. Terézhalmy, D.D.S.,M.A. Professor and Dean Emeritus Professor and Dean Emeritus School of Dental Medicine School of Dental Medicine Case Western Reserve University Case Western Reserve University Cleveland, Ohio Cleveland, Ohio [email protected] [email protected]

PRACTICAL INFECTION CONTROL-1

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PRACTICAL INFECTION CONTROL-1. Géza T. Terézhalmy, D.D.S.,M.A. Professor and Dean Emeritus School of Dental Medicine Case Western Reserve University Cleveland, Ohio [email protected]. Practical Infection Control. Practical Infection Control. Practical Infection Control. - PowerPoint PPT Presentation

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Géza T. Terézhalmy, D.D.S.,M.A.Géza T. Terézhalmy, D.D.S.,M.A.

Professor and Dean EmeritusProfessor and Dean Emeritus

School of Dental MedicineSchool of Dental Medicine

Case Western Reserve UniversityCase Western Reserve University

Cleveland, OhioCleveland, Ohio

[email protected]@case.edu

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The transmission of pathogenic organisms in the oral healthcare

setting is RARE, yet cross-infection does present a POTENTIAL HAZARD

to OHCWs and patients alike.

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OHCWs’ primary obligation and ultimate responsibility is the delivery

of quality care in the privacy of a comfortable and SAFE

ENVIRONMENT

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To prevent or minimize cross-infection, it is MANDATED that oral healthcare facilities develop a written infection control/exposure control protocol.

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QUALITY OF INFECTION CONROL QUALITY OF INFECTION CONROL PRACTICESPRACTICES

Protocol should be appropriate for Protocol should be appropriate for settingsetting

▼▼Add quality at the production stage

▼Factors that affect quality are structure, process,

and outcome

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Structure Material resources

Example: sterilization area and equipment Human resources

Example: number and qualification of personnel

Organizational resources Example: timely availability of post-exposure

evaluation and follow-up

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Process Criteria, i.e., standards

Based on evidence derived from well-conducted trials or extensive, controlled observations

In the absence of such data, reflect the best-informed or most authoritative opinion available

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Process (cont’d) Execution

Development and implementation of activities to meet the criteria

Assessment Continuous monitoring of compliance and

outcome Response

Activities to resolve issues related to non-compliance and adverse outcome

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Outcome Impact of infection control/exposure

control strategies Enhanced knowledge Changed behavior Improved health of both OHCWs and

patients

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Office infection-control coordinator Responsibilities

Development and overall management of the protocol Provides both access and explanation of its content

upon request

Monitors effectiveness of the program on a day-to-day basis, and over time Ensures that the criteria a relevant, the procedures

are efficient, and the practices are successful

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EDUCATION AND TRAININGEDUCATION AND TRAININGCompliance is significantly improved Compliance is significantly improved

when personnel understand the rationale when personnel understand the rationale for infection control policies and practicesfor infection control policies and practices

▼▼Mandatory prior to initial occupational exposure to

blood and other potentially infectious material(and annually thereafter)

▼Training record maintained for the most recent 3-year

period

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The fabric of an educational and training program

Standard precautions A hierarchy of preventive strategies

Occupational risks in oral healthcare settings Immunizations Personal protective equipment (PPE) Engineering and work-practice controls Environmental infection control Post-exposure management Transmission-based precautions Administrative controls (policies)

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Occupational risks in oral healthcare settings Infection

Invasion and multiplication of microorganisms in body tissues resulting in local cellular injury Principles of the “chain of infection”

Adequate number of pathogenic organisms Sufficient virulence of pathogenic organisms A mode of transmission A portal of entry A susceptible host

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Modes of transmission Direct contact with blood and other

potentially infectious material (OPIM) Contact with objects contaminated with

blood and OPIM Exposure to splash and spatter containing

blood and OPIM Inhalation of airborne microorganisms

suspended in aerosols, i.e., droplets and droplet nuclei

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Pathogenic organisms of concern HBV

Mode of transmission Contact with blood and OPIM

Major risk of occupational exposure in the oral healthcare setting

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HCV Mode of transmission

Contact with blood and OPIM The risk of occupational exposure in the oral

healthcare setting is remote

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HIV Mode of transmission

Contact with blood and OPIM The risk of occupational exposure in the oral

healthcare setting is remote

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Measles (Rubeola) Mode of transmission

Inhalation of airborne droplets Direct contact with nasopharyngeal secretions Contact with freshly contaminated articles

The risk of occupational exposure in the oral healthcare setting is remote

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Mumps (Infectious parotitis) Mode of transmission

Inhalation of airborne droplets Direct contact with saliva Contact with freshly contaminated articles

The risk of occupational exposure in the oral healthcare setting is remote

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Rubella (German measles) Mode of transmission

Inhalation of airborne droplets Direct contact with nasopharyngeal secretions Contact with freshly contaminated articles

The risk of occupational exposure in the oral healthcare setting is remote

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Herpes simplex Mode of transmission

Direct contact with vesicular fluid Direct contact with infected skin and mucous

membranes Contact with freshly contaminated articles

Herpetic whitlow and herpetic keratoconjunctivitis occur commonly in the oral healthcare setting when standard precautions are not followed

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Varicella (chicken pox) and varicella zoster (shingles) Mode of transmission

Inhalation of airborne droplets Direct contact with vesicular fluid Direct contact with infected skin and mucous

membranes Contact with freshly contaminated articles

The risk of occupational exposure in the oral healthcare setting is remote

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Influenza and respiratory syncytial viruses Mode of transmission

Inhalation of airborne droplets Direct contact with nasopharyngeal secretions Contact with freshly contaminated articles

Upper respiratory tract infections occur commonly in the oral healthcare setting when standard precautions are not followed

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Mycobacterium tuberculosis Mode of Transmission

Inhalation of droplet nuclei Direct contact with contaminated sputum Contact with freshly contaminated articles

The risk of occupational exposure in the oral healthcare setting is remote

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Vaccinations Reduce the risk

of vaccine-preventable diseases Hepatitis B

vaccine Mandated for all

healthcare workers Mandatory

Hepatitis B Vaccination Declination Form

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Post-vaccination confirmation of anti-HBs titer 1-2 months after the 1st series

Anti-HBs titer of >10 mlU/mL is considered adequate

If anti-HBs titer is <10 mlU/mL A second series is recommended 1-2 months after 2nd series retest for anti-HBs

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If no antibody response occurs, test for HBsAg HBsAg-negative personnel

Shall be counseled about precautions to prevent HBV infection

AND Shall be provided HBIG prophylaxis for any known

or probable parenteral exposure to HBsAg-positive blood

HBsAg-positive personnel Shall obtain appropriate medical consultation

AND Shall be counseled about the prevent of HBV

transmission to others

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Influenza, MMR, varicella, zoster, Td/Tdap, and HPV vaccines Highly

recommended for all healthcare workers

Pneumococcal, hepatitis A, and meningococcal vaccines Highly

recommended for some healthcare workers

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Personal Protective Equipment Under normal conditions of use, PPE will

not permit blood or OPIM to pass through to and reach Street clothes Undergarments Skin Mucous membranes

Eyes, nose, and mouth

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Protective clothing Gowns or lab coats with long sleeves

Changed at least daily Anytime it becomes visibly soiled As soon as possible when penetrated by blood or

OPIM Removed before leaving work area Dirty clothing is placed in designated areas for

disposal or washing

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Task-specific gloves Non-surgical and surgical gloves are single-

use items When torn or punctured, change gloves as soon as

possible Gloves may not be washed

Wicking (penetration of liquids through undetectable holes in the gloves)

Double gloving is acceptable for certain extensive surgical procedures

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Heavy-duty utility gloves Worn for all instrument, equipment, and

environmental surface cleaning and disinfection

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Surgical masks Must cover both the nose and the mouth for

procedures likely to generate splash, spatter, and aerosols

Those provided for routine use shall have a >95% filtration efficiency (particle >3 m in diameter)

Should be changed, as soon as possible, when they become wet (between patients or even during patient treatment)

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When treating patients with suspected or confirmed infectious TB disease National Institute for Occupational Safety and

Health (NIOSH)-certified particulate-filter respirator shall be provided A >95% filtration efficiency when challenged with

particle 0.3 m in diameter

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Protective eyewear With solid side

shields or a face shied shall be worn by all OHCWs For procedures

likely to generate splash, spatter, and aerosols

Protective eyewear with solid side shield is also provided to patients

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Engineering and work-practice controls Engineering controls

Take advantage of available technology to eliminate, minimize, or isolate biohazards

Work-practice controls Promote safer behavior

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Hand hygiene Wearing gloves

does not eliminate the need for hand hygiene

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Natural or artificial fingernails shall be kept short to Facilitates through cleaning Prevents glove tears

All jewelry and ornaments shall be removed from the hands and wrists Interfere with glove use

Sinks with electronic, foot, or knee action faucet control Promote asepsis and ease of function

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Perform appropriate hand hygiene At the beginning of each work day Before gloving, after degloving, and before

regloving Before and after going to lunch, taking a

break, using the bathroom Anytime the hands are contaminated with

blood or OPIM

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Routine handwash Plain soap and

water Removes soil and

transient microorganisms

Acceptable method prior to performing Physical

examinations Nonsurgical

procedures

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Antiseptic handwash Antimicrobial soap

(i.e., iodophors) and water

Removes or destroys transient microorganisms and reduces resident flora

Acceptable method prior to performing Physical

examinations Nonsurgical

procedures

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Antiseptic hand rub Alcohol-based (i.e.,

60 to 95% ethanol) To be used only

when no visible soil on hands

Removes or destroys transient microorganisms and reduces resident flora

Acceptable method prior to performing Physical

examinations Nonsurgical

procedures

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Surgical antisepsis Antimicrobial soap (i.e., iodophors) and water OR Plain soap and water followed by antiseptic hand-

rub (i.e., 60 to 95% ethanol) Removes or destroys transient microorganisms and

reduces resident flora Persistent effect

Acceptable method prior to performing Surgical procedures

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