Myths and Realities: Infection Control under the Microscope

Transcription

1 Myths and Realities: Infection Control under the Microscope Chain of infection Presence of a pathogen Source/reservoir Patient Healthcare professional Inanimate object Mode of transmission Direct contact with blood and body fluids Indirect contact with contaminated instruments or surfaces Contact of nasal, oral and or ocular mucosa with droplets or spatter Inhalation of airborne microorganisms Route of entry Mucous membranes Broken skin Percutaneous injury Susceptible host Dental setting modes of transmission: Droplet Bloodborne Contact Airborne Bloodborne pathogens Human Immunodeficiency Virus Hepatitis B Virus Hepatitis C Virus Myths and realites: Transmission

2 HIV Prevalence and incidence, mortality HIV/AIDS and healthcare workers Risk of cross-infection Myths and realities in pathogens and regulations HBV Prevalence and incidence, clinical outcomes HBV and healthcare workers Risk of cross-infection Hepatitis C Prevalence and incidence, clinical oucomes Hep C and healthcare workers Risk of cross-infection Organizations: Centers for Disease Control: Universal precautions and standard precautions Role of CDC Role of EPA, OSHA, FDA< State and federal regulations, State Board Myths and realities: organizations and regulations Reemerging disease and concerns for infection control in the dental office setting and DHCP Immunizations and dental healthcare professionals Employees Recommended immunizations Declination Hand hygiene The #1 factor in preventing infection: Hand hygiene Myths and realities in hand hygiene Myths and realities for hand hygiene

3 Hand hygiene 88% of disease is spread through hand contact Mode of transmission recognized in 1800s, first by Semmelweis MRSA: Percentage who carry this microorganism on their skin MRSA and prevention Main goal of hand hygiene: Remove flora that can transmit disease CDC Guidelines When and how to perform hand hygiene Options for, and differences between, hand hygiene for surgical and non-surgical procedures o Definition of persistent activity o When to use antimicrobial soap with persistent activity o Effective handwashing o Alcohol-based hand rubs effective use and recommendations Advantages State of Nevada campaign Hand hygiene demonstration Compliance and noncompliance with hand hygiene Time/ workload Convenience Gloving Skin irritations Solutions Gloving and gloves Myths and realities in gloving Mandatory for all patient care Utility gloves for clean-up and instrument processing

4 OSHA and CDC: must wear new single-use protective gloves for patient care; whenever the hands might be contaminated with body fluids, or will be in contact with contaminated instruments/ devices CDC/OSHA: DHCP must wear sterile gloves whenever invasive surgical procedures are performed Choosing gloves considerations: o Size and fit o Allergies and sensitivity o Materials latex, vinyl, nitrile If you have latex gloves, also stock non-latex gloves o Ambidextrous vs. hand specific o Shelf life Latex allergy and contact dermatitis Gloves were introduced to the medical profession in 1889 Medical grade gloves: o Are considered a medical device o Regulated by the FDA1 o In harmony with the consensus standards of the International Organization for Standardization (ISO) and the American Society for Medical Testing (ASMT) The FDA makes sure the manufacturers meet performance criteria such as leak resistance, tear resistance, etc. Myths and realities about nails and jewelry Nail care and artificial nails

5 o The CDC RECOMMENDS that medical personnel not wear artificial nails when in direct contact with high-risk patients; not known if artificial nails result in cross-infection in the dental office setting o The World Health Organization RECOMMEND that artificial nails should not be worn Which jewelry needs to be removed? Masks, protective eyewear and masks Must wear protective eyewear that covers the eyes during dental procedures whenever splashes, sprays or spatter of blood, saliva, other body fluids, or water contaminated with blood, saliva or other body fluids may be produced (OSHA/CDC) Wear a surgical mask and eye protection with solid side shields, or a face shield to protect mucous membranes of the eyes, nose, and mouth Mask facts and selection: Choose a mask that fits face well, is comfortable, fits snugly and results in a light seal over face and nose Physical classification o Flat o Procedural o Surgical o With Visor o Specialty o Molded (Cone) Selection based on the level of protection required (based on procedure), then breathability, fit and comfort

6 Filtration classification o According to ASTM-2100 Low/moderate/high barrier Change masks between patients Clean reusable face protection when soiled, disinfect between patients Remove all personal protective barriers, including gloves, masks, eyewear, and gowns, before leaving work areas Never wear PPE to the breakroom, restroom, or out of the dental practice setting Myths and realities for PPE Fomites Clinical contact surfaces Range of survivability of microorganisms on surfaces: e.g., TB for several months; HSV for hours Treatment: Barrier Protection Protects surfaces, including harder-to-access areas

7 Reduces the amount of time required for cleaning and disinfecting Reduces need for chemicals If compromised, underlying surfaces must be cleaned and disinfected together with all other clinical contact surfaces Limit spread of contamination Set up operatory before starting treatment ; unit dose supplies Cover surfaces that could be contaminated Minimize splash and splatter Properly dispose of all waste Disposables Need for Disposable Air/Water Syringes Saliva ejectors Unit doses Bib holders Wax and supplies Carps Single-use dental instruments or devices that are labeled by the manufacturer as single-use must not be reused on any other patient (CDC) Nevada: One time campaign Myths and realities: Going Green What does Going Green Really Mean? Right equipment for the right job Do no harm Infection Prevention Engineering controls

8 Work practice controls Administrative controls Examples: Needle cappers and sharps containers Limited handling of instruments Instrument cassettes and tubs Disposable sharps must be removed and disposed of in an appropriate puncture-resistant sharps container at the point of use, or immediately after being taken to the reprocessing area Manage exposure to body fluids Waste and Medical Regulated Waste Properly labeled containment to prevent injuries and leakage Medical wastes are treated in accordance with state and local EPA regulations Clinical contact surfaces between patients Carefully remove barriers Clean and disinfect contaminated surfaces Cover area again with barrier protection At the end of the day remove all barriers and clean and disinfect all surfaces Myths and realities on clinical contact and housekeeping surfaces Use of low level and intermediate level disinfectants Surface disinfection: Use a low(hbv/hiv kill) to intermediate(tuberculocidal) disinfectant Low for general cleaning, not visibly contaminate

9 Intermediate level if blood involved Make sure correct and fresh Follow label directions Proper PPE Housekeeping surfaces: Routinely clean with soap and water or an EPA-registered detergent/hospital disinfectant Prepare fresh cleaning and disinfecting solutions daily and per manufacturer recommendations Instrument sterilization and disinfection: New Guidelines for Disinfection and Sterilization in Healthcare Facilities Several steps in processing: o Remove from treatment area o Clean, package and label o Sterilize o Storage and distribution o Monitor sterilizer and technique o Performed correctly EVERYTIME o Utility gloves, mask, goggles EVERYTIME Myths and realities in instrument processing Patient care items: o Critical Items o Semi critical items o Non-critical items Sort, soak and clean?

10 Packaging and sterilization Use only FDA-cleared materials Material for selected method of sterilization Use of indicators and documentation