| The first link in the chain of infection | – infectious agent: virulence strength or degree of pathogenicity |
| Links of infection | –infectious agent
–resevoir
–portal of exit
–transmission
–entry
–susceptible host
Virulence
-Numbers
-Susceptible host
-Portal of entry |
| Bioburden | blood saliva and other body fluids |
| Acute infection | an infection of short duration that is often severe |
| chronic infection | an infection of long duration |
| percutaneous | through the skin such as needles stick cut or human bite |
| direct transmission | when someone comes into direct contact with the infectious lesion or infected body fluids
–person–to–person contact |
| Mist–like aerosols | –has the finest droplets
–can remain suspended in the air for extended periods of time
–can only spread resp. infections not HIV and HBV inhaled |
| Bloodborne | –BB pathogens are organisms transferred through contact with bodily fluids. EX. blood
–common BBP of concern are HCV, HBV, HIV |
| know all the different types of immunity | –Active natural: contact with the disease and produce memory cells
– Passive natural: receive maternal antibodies through the placenta or breast milk
–Active artificial: vaccination to produce memory cells
–Passive artificial: receive antiserum with antibodies from another host |
| Know all the different types of transmission of diseases and the most common route in the dental office | – airborne transmission: the spread of disease through droplets of moisture containing bacteria or viruses
–Parenteral transmission: needlestick injuries, human bites, etc.
– Bloodborne transmission: direct or indirect contact with blood and other body fluids |
| Know all the different types of transmission of diseases and the most common route in the dental office PART 2 | – Food and water transmission: contaminated food is consumes
– Fecal oral transmission: improper hygiene and handwashing and a person ingests fecal material
– most common route is through direct contact with patients blood or saliva |
| Role of CDC | – Federal agency
–Not regulatory
– issues specific recommendations based on scientific evidence |
| Role of OSHA | – Federal agency
–Not regulatory
– Issues specific standards to protect the health of employees |
| Purpose of the BBP and how often it needs to be updated | BBP standard is designed to protect employees against occupational exposure to BBP |
| Standard precautions | all human blood, body fluids, nonintact skin, and mucous membranes are to be treated as if they are infectious |
| Protocol if there is an exposure incident | –Has to be a written plan
–explains exactly what steps the employee must follow after the exposure incident occurs and the type of medical follow up that will be provided to the employee at no charge
– counseling, HIV test series 0,6,12 weeks and 6 months, a tanus booster, HEP B, documentation |
| What is recommended by CDC after HBV vaccine | – Dentist must offer vaccine within days of employment
– Dentist must obtain proof\n– An employee can refuse by signing an informed refusal form
– 3 series dosses 0,1, and 6 months in the deltoid muscle
–blood test should be performed to ensure immunity after 1–2 months
– if immunity isn't there talk to the doctor
–after the second round of 3–dose series don't take another, must be given counseling |
| Sequence of PPE's | – protective clothing
–surgical mask
– protective eyewear
– gloves |
| What should the employer supply | all appropriate PPE's
–protective clothing
–surgical masks
– face shields
– eyewear
–disposable gloves
– heavy duty utility gloves |
| Latex allergy | No cure
– if one person in the office is allergic no one can wear latex
–3 types:
– irritant dermatitis
–Type IV allergic reaction
– Type I allergic reaction |
| Irritant Dermatitis | non immunologic
–contact with a substance that produces chemical irratation |
| Type IV allergic reaction | most common–
–delayed contact reaction, can take 48–72 hrs for rash to appear
–involves the immune system
–immune response is produced by the chemicals used to process latex |
| Type I allergic reaction | most dangerous
– severe immunologic response, takes 2–3 mins to react
– the reaction is in response to the latex protein in the gloves |
| General Waste | – non–hazardous, non–regulated should be discarded in covered containers
-EX. paper towels, empty food containers |
| contaminated waste | has made contact with blood or other body fluids
-EX. used barriers and patient napkins |
| hazardous waste | risk to humans and environment, toxic chemicals
–EX. amalgam, x–ray film, fixer solution |
| infectious or regulated waste(biohazard) | contaminated capable or transmitting disease
– some items like extracted teeth might be both hazardous(amalgum) and infectious
–extracted teeth are regulated waste unless they contain amalgam |
| Creutzfeld–Jakob disease | –rapidly progressive and invariably fatal degenerative neurologic disorder
– can affect humans and animals, caused by prions
–can incubate for years but are usually fatal within 1 year of diagnosis
–probably low infection rate |
| Cleaning surfaces | –touch
–transfer
–splash, spatter and droplet surface
–housekeeping |
| Touch surfaces | – directly touched and contaminated during treatments
–EX. Light handles, dental unit controls, chair switches, computers |
| Transfer surfaces | –not directly touched but often are touched by contaminated instruments
–EX. instrument trays and handpiece holders |
| Splash, spatter and droplet surfaces | – does not come in contact with personnel or contaminated instruments
–Ex. countertop |
| Housekeeping surfaces | – no evidence these pose a risk for transission
– can be cleaned with a low–level disinfectant
-EX. floors, walls and sinks |
| disinfectants | – intended to kill disease–producing microorganisms that remain on the surface after precleaning
– spores are not killed |
| sterilization | all forms of life are killed |
| Antiseptics | are antimicrobial agents that are applied to living tissue |
| antimicrobials | more effective at reducing microbial flora
–concentrations of 60% to 95% are more effective |
| Iodophors | –EPA registered
–intermediate–level hospital disinfectant
–tuboricidal action
– contain iodine turns metals red or yellow |
| Synthetic phenol compounds | –EPA registered intermediate–level hospital disinfectant
– broad–spectrum disinfecting action
– phenols leave a residual film
–prepare daily |
| Sodium Hypochlorite | –bleach
–fast, cheap, broad–spectrum intermediate–level disinfectant
–1:100
–unstable, prepared daily, corrosive
–causes plastic covers to crack |
| Alcohol | –not effective in precense of blood and saliva
–evaporates ad damages plastics and vinyl
– ADA and CDC and OSHA donot recomend |
| Immersion disinfectants | –can range from 6–30 hrs to sterilize
–used on heat–sensitive instruments |
| chlorine dioxide immersion disinfectant | – effective, fast, surface disinfectant (3 min)
–Chemical sterilant (6hrs)
–does not penetrate organic debris
–prepared daily, fumes, corrosive to aluminum |
| glutaraldehyde immersion disinfectant | –high level
–very toxic
–thoroughly rinse after us
– prolonged contact can lead to discoloration and corrosion of surfaces and cutting edges |
| Ortho–phthalaldehyde immersion disinfectant | –high level (12 min)
–more expensive than gluta.
–low odor does not require activation or mixing
–cant be used for a long time
–may stain
–plastics turn blue–green
– requires more than 3 hrs to secure sterilization |
| patient care items | critical
– semi–critical
–non– critical |
| critical | –penetrate soft tissue or bone
–greatest risk for transmission
–must be heat sterilized
–Ex. scalpels, bone chisels, scalers |
| semi–critical | – touch mucous membranes
–lower risk of transmission
–must be sterilized by heat if heat resistant or high level disinfection if not heat resistant
– Ex. plastic handled brushes, high–volume evacuator tips |
| Non– critical items | –least risk of transmission
– only contact with intact skin
–cleaned with EPA registered intermediat- level or low–level disinfectant
– Ex. lead apron, curing light |
| High–level | the process that kills some but not all bacterial endospores and inactivates m. tuberculosis |
| intermediate level | inactivates m. tuberculosis |
| low–level | –ineffective against m. tuberculosis and should be used only for house keeping |
| precleaning | reducing the number of microorganisms that are present by physically removing debris |
| sterilization | process that inactivates all microbial life including bacterial spores, viruses, bacteria and fungi |
| disinfection | process that kills disease causing microorganism, but not all microbial life |
| – PPEs required | utility gloves, mask, eyewear, protective clothing |
| – The ideal instrument processing area | o Centrally located
o Dedicated only to instrument processing
o Physically separated from the operatories and dental laboratory
o Not be a part of a common walkway
o No windows open to the outside |
| Thedifferent methods of precleaning | – hand scrubing
–ultrasonic
– instrument washing machine |
| Handscrubbing | least desired method, because it requires direct hand contact with contaminated instrument |
| o Ultrasonic | used to loosen and remove debris. Reduce risk of punctures |
| o Instrument washing machine | similar to dishwasher, combination of hot circulating water and detergents to remove organic mater (thermal disinfector) |
| – Flow | entrance–> contaminated area–> packaging area–>sterilization/storage |
| – Reasons for bagging instruments: | o Protect instruments from becoming contaminated after sterilization
o Can be grouped into special setups for convenience later |
| Ultrasonic | produces sound waves that travel throughcontainers and form bubbles, they implode. 5–15 minutes until visibly clean.Use appropriate ultrasonic cleaning solution, change solution 2 times a day |
| Thedifferent sterilizers | – steam autoclave
– flash
–unsaturated chem. vapor
–dry heat
– static air sterilizers
–forced air
–ethylene oxide
–chemical liquid |
| o Steam autoclave sterilization | o steam a moist heat rapidly kills microorganism.
–As steam fills the chamber the cooler air is pushed from an escape valve.
–It isthe heat not the pressure that kills–disadvantage: rust
-that kills
–disadvantage: rust
–Usually operates on four cycles: heat up,sterilizing, depressurization, drying§ Packaging materials may be fabric, but arecommonly film and paper pouches, nylon tubing,
–temp: 250–273
–time 3–30 |
| Flashsterilization | rapidheat transfer, steam and unsaturated chemical vapor. Can be used only oninstruments that are placed in the chamber unwrapped. These instruments shouldbe used immediately after sterilization. Compromises sterility |
| oUnsaturated Chem. Vapor sterilization | –similarto autoclave, except chemicals (alcohol, formaldehyde, ketone, acetone andwater) are used instead of water.
– OSHA requires MSDS because of chemicaltoxicity.
–Does not rust or corrode instruments, wide range of things can besterilized, short cycle time.
– Disadvantage: needs ventilation because of fumesor formaldehyde and methyl alcohol are released. Unpleasant odor
–Pressure: 20 psi
–temp: 270
– time: 20–40 min |
| unsaurated chem. vapor steriliation part 2 | Pressure: 20 psi Temperature: 131*c o(270*f)
Time: 20–40 minutes |
| Dryheat sterilization | –Hot air on instruments, this requires highertemperatures than steam or chemical vapor sterilization.
–Two types: static airand forced air
–Temperature: 160*–190*c (320*–375*f)
–advantage: instruments don’t rust |
| Staticair sterilizers | – similar to an oven, heating coils are at thebottom and the heat travels up.
–Takes 1–2 hrs for heat to transfer ontoinstruments
–Disadvantages: time consuming and may not be aseffective if operator calculates the wrong amount of time
–Wrapping materials must be heat resistant Ex.Aluminum foil, glass containers |
| ForcedAir sterilizers | –rapid heat transfer, circulates hot air fast.
–Transfer of heat happens quickly
– Time: after the correct temp has been reached, 6min for unpackaged items. 12 mins for packaged items |
| Ethyleneoxide sterilization | –low temperature
–Disadvantage: 4–12 hours and at least 16 hoursof post–sterilization aeration to remove gas molecules attached to plastics.
–Itis ineffective on wet items, and toxicity is possible mishandled
–These are often used in large clinics orhospitals rarely in private dental offices |
| Chemicalliquid sterilant | –for heat–sensitive items.
–Glutaraldehyde: 10 hours of contact time forsterilization
–Must have MSDS for the employees |
| Howto monitor the sterilization process | –physical
–chemical
–biologic |
| Physical monitoring | Lookat all the gauges/ readings and record the temp, pressure, and exposure time.(this only shows the temp inside the chamber, if there is crowding the gaugeswont detect that) |
| Chemical monitoring | –external and internal, heat sensitive chemicalthat changes color are used.
–Two types of chemical indicators are processindicators and process integrators both don’t indicate sterility
–Process indicators: placed outside instrumentpackages (ex. Autoclave tape) only identify if they have been exposed tocertain temperatures
– Process integrators: place inside the packages,they respond to |
| Biologic monitoring | –spore testing, the only way to determine ifsterilization has occurred properly.
–Must be done weekly
–Vials or strips containing bacteria spores. 2are placed inside the packs and 1 is the control
–Afterwards all of them are cultured if positivethe sanitation has failed. |
| Howto prevent rusting | –This occurs during steam sterilization
–Rust inhibitors such as sodium nitrate (spray ordip)
–Dry the instrument with dry heat or unsaturatedchemical vapor sterilization |
| Bestmethod for hand pieces | –Steam and chemical vapor sterilizers arerecommended because sterilization of HP should not exceed 275*f (135*c)
–Should be packaged packaged
–Never run a handpiece hot our out thesterilizer, no rapid cooldowns
–Only rapid cooldown allowed is air fan |
| Handpiece debris removal process | –flushing:
–Attach a pressurized handpiece cleaner to intaketube
–Flush the head of the handpiece to remove debris
–Blow out the handpiece using compressed air toremove debris before sterilization
–Running coolant water is insufficient |
| ADAA | oldestand largest group representing dental assistants |
| OSAP | not for profit, resource for infection control,injury prevention, and occupational health issues |
| Chemicalhandling | –hand protection
– eye protection
– protective clothing
–inhalation protection |
| Handprotection | –utility gloves made of chemical
–resistantmaterials like rubber, neoprene, or industrial–grade nitrile. Regular gloves arenot enough, they degrade and allow chemicals to come in contact with skin. |
| Eyeprotection | Protectseyes from fumes and splashes wile pouring chemicals. Ideally googles with softvinyl flanges (rims) at the top and bottom, snugly fitted to the face. |
| Protectiveclothing | when caustic or staining chemicals are used userubber or neoprene aprons. The MSDS provides |
