nfection Prevention for Dental Practice

Transcription

1 nfection Prevention for Dental Practice

2 What is the problem? Risk to patients Risk to staff

3 Why update? Protect Patients CQC Regulations. Health and Safety Legislation HTM 01-05

4 Infections develop when a series of circumstances occur. This process is often called the Chain of Infection. Learning how the chain works can help you to; Find ways to prevent infection Assess the risks of infection spreading

5 The chain of infection?

6 Infectious agent Bacteria Viruses Prion Fungus The next few slides use BBV s (Blood Born Viruses) as an example of the chain of infection.

7 Be knowledgeable about the three most common blood borne pathogens encountered as a healthcare worker: Hepatitis B Hepatitis C HIV

8 Hepatitis B Hepatitis B is a blood borne and sexually transmitted virus which causes inflammation of the liver; Many infected people have no symptoms, but others have a flu like illness with nausea and jaundice; Hepatitis B becomes a chronic infection when the symptoms persists longer than 6 months; Hepatitis B vaccine can prevent hepatitis infection.

9 Hepatitis C Hepatitis is a blood borne virus which causes inflammation of the liver; Many people who are infected have no symptoms and are unaware that they are carrying the virus; Chronic infection is defined as infection lasting longer than 6 months and to 80 percent of infected people do go on to chronic infection; People with chronic Hepatitis C infection are at long term risk of developing Cirrhosis and liver cancer; There is no vaccine to prevent Hepatitis C infection.

10 HIV and AIDS HIV ( Human Immune-deficiency) is the infection through which progressive destruction of specific immune cells (CD4cells) leads to AIDS. HIV is a sexually transmitted and blood borne virus ( BBV). This means it can be transmitted by unprotected sexual intercourse or by shared needle use by injecting drug users, needle stick injuries in health care workers or mother to child transmission before, during or after the birth of the child (via breast milk from an infected mother). There is no effective vaccine,anti-retroviral therapy has changed the patterns of survival so patients need to continue on therapy.

11 Reservoirs BBV s are present in Blood Urine Saliva Any other bodily fluids

12 Portal of exit All body fluids MUST be treated as potentially infectious, therefore, safe working practices must be followed at all times. Micro organisms cannot walk, jump or run, they must hitchhike from one place to another. (Caddow 1989)

13 Means of transmission Innoculation Safe handling of sharps! Regular decontamination of all medical devices, instruments and worktops is essential.

14 Portal of entry Broken skin Mucus membrane Wearing single use PPE (personal protective equipment), for each patient and new gloves for each individual procedure is best practice.

15 Susceptible host Anyone who is not vaccinated adequately (Hep B)

16 Risk assessment What have I just done? What am I about to do? What type of preventative or control measures need to be implemented? What products or equipment should I use. What records do I need to keep? How susceptible is the person? Am I at risk?

17 Hand hygiene

18 Many staff don t realise they have bacteria on their hands do YOU? A culture plate 24 hours after an unwashed hand was placed on it.

19 The Personal Protective Equipment at Work Regulations (HSE,1992) Personal protective equipment is to be supplied and used at work wherever there are risks to health and safety that cannot be adequately controlled in other ways The regulations also require that PPE: Is properly assessed before use to ensure it is suitable; Is maintained and stored properly; Is provided with instructions on how to use it safely; Is used correctly by employees.

20 Protective clothing Risk Assessment Tool Assess risk of task No blood/bodily fluids Blood/body fluids Low risk of splashing Blood/bodily fluids High risk of splashing No protective clothing Latex gloves Plastic aprons Latex gloves Plastic aprons Eye Protection Face mask

21 PPE Why do staff wear PPE? Examples of PPE opposite When should staff remove PPE? On removing gloves how should staff clean their hands?

22 Gloves When should we wear gloves? When should we not wear gloves?

23 YES When there is a risk or any bodily fluid exposure When examining patients teeth When performing treatment NO General patient contact When getting equipment Ready When using the computer key board

24 A few notes on gloves and aprons Remove gloves and aprons immediately after patient contacts and before using the computer key board Do not wear the same gloves and apron between different patients. Remove gloves before touching any equipment ( X-ray, computer keyboard, over head lamp) and wear new gloves for following procedure. NEVER try to re-use gloves by washing them or using alcohol gel on them Dispose of used gloves in clinical waste bag. Vinyl gloves are only suitable for cleaning. Check allergy to latex gloves --- latex free.

25 Single-use items Are for single-use only and should never be re-used

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27 Hand hygiene Do you use Hand Sanitizer to decontaminate your hands? If yes, do you know when to use alcohol gel? Or, when you would wash your hands under running water and soap and dry with a paper towel.

28 Hand sanitizer Yes When hands are visibly clean In-between general patient and equipment contact No If hands a visibly dirty If contact with any bodily fluids After taking off gloves

29 Why is something so simple so complex?

30 Ayliffe technique

31 How would you feel if a patient asked if you had washed your hands? It s OK for the patient to ask you! They have the right to Clean Safe Care How can you improve and remedy any problems so that you can always clean your hands at the right time? Hand hygiene is EVERYBODY S responsibility!

32 Your five moments for hand hygiene at the point of care* *Adapted from the WHO Alliance for Patient Safety 2006

33 Respiratory hygiene

34 Sharps safety

35 Sharps safety rules Never re-sheath needles Never pass sharps to another person Never leave sharps lying around Take the sharps box to the sharp not vice versa Use the right size sharps box for the job All sharps boxes in use have to be correctly labelled When not in use a sharps box should always be partially closed Store safely (best wall mounted)

36 Sharps injury Encourage bleeding Wash area thoroughly Cover with a waterproof dressing Report incident and document (accident book) Contact supervisor Don t ignore near misses

37 Waste management is heavily regulated The Health and Safety at Work Act 1974 The Environmental Protection Act 1990 The Environment Act 1995 The Control of Substances Hazardous to Health Regulations 2002 Health Service Advisory Committee, Safe Disposal of Clinical Waste The Waste Management Regulations 1994 and all associate legislation The Hazardous Waste Regulations 2005 HTM 07-01

38 Handling waste safely Never remove items from waste containers. Handle waste containers with care and avoid contamination. Report leakage or spillage. After handling waste dispose of PPE properly. Wash hands after handling waste. Keep waste containers clean.

39 Suitable waste bin

40 Decontamination of Equipment HTM It is important to follow procedures correctly to achieve safe standards of infection prevention and control. Every practice should be capable of meeting the essential quality as per HTM regulations. Practices should have in place a detailed plan on how provision of decontamination services will move towards best practice. How compliant is YOUR surgery with the HTM regulations? Did you complete the Audit?

41 Cleaning and decontamination All equipment to be cleaned between each use. Areas / surfaces keep clutter free. Use general purpose detergent and water (or refer to manufacturers instructions).any fluid used for cleaning must be discarded after the cleaning session. Spillages soak up excess fluid using paper towel-clean surface with warm water and detergent.

42 Does your Dental Practice have a bare below the elbow policy? Does everyone adhere to this policy/ If not WHY NOT?

43 Uniforms Work uniforms should not be worn outside your dental surgery. Good practice is to remove uniform before leaving duty. Uniform should be washed separately (if washed at home) from the household laundry - at as hot a wash as the fabric can take then tumble dried and hot ironed, to kill any bacteria present. Shower at the end of your shift and uniform should be changed at least once a day.

44 Useful websites illypct/informationforprofessionals/infectionprevention/inf ectionhomeprof.aspx