A dental office has several different types of tools on site. Therefore, keeping them sanitized and cleaned on a daily basis will protect both the patient and the dental office staff. This module will look at specific cleaning techniques and how to protect yourself and your patients from serious illnesses.
During procedures that could generate splashes or sprays of blood or body fluids, dental workers must wear a surgical mask that covers both the nose and mouth and protective eyewear with solid side shields or a face shield. Protective eyewear for patients also shields their eyes from debris generated during dental procedures.
When a surgical mask becomes wet from exhaled moist air; the resistance to airflow through the mask increases. This causes more airflow to pass around edges of the mask.
If the mask becomes wet, it should be changed between patients or even during patient treatment, when possible.
In addition, employees should:
In dental health care settings, all instrument cleaning, disinfecting, and sterilizing should occur in a designated central processing area in order to more easily control quality and ensure safety.
The instrument processing area should be physically divided into the following sections:
This division is designed to contain contaminated items in an area designed specifically for cleaning, therefore preventing contamination of the clean areas where packaging, sterilization, and storage of sterile items occurs. Reusable contaminated instruments and devices are received, sorted, and cleaned in the cleaning area. The packaging area is for inspecting, assembling, and packaging clean instruments in preparation for final processing. The sterilization and storage areas contain the sterilizers and related supplies, as well as incubators for analyzing spore tests, and can contain enclosed storage for sterile items and disposable items.
When it is not possible to have physical separation of these areas, clearly labeling each area might be satisfactory if the personnel who process the instruments are trained in work practices to prevent contamination of clean areas.
Cleaning should precede all disinfection and sterilization processes in dental instruments. The necessary cleaning involves the removal of debris (organic or inorganic) from an instrument or device. If visible debris is not removed, it will interfere with microbial inactivation and can compromise the disinfection or sterilization process.
Debris can be removed from an instrument either by scrubbing the instrument manually with a surfactant or detergent and water or by using automated equipment (ultrasonic cleaner or washer-disinfector) and chemical agents. After cleaning, instruments should be rinsed with water to remove chemical or detergent residue. Splashing should be minimized during rinsing and cleaning.
Considerations in selecting cleaning methods and equipment include their effectiveness, their compatibility with the items to be cleaned, and the occupational health and exposure risks they pose. Because instruments cleaned with automated cleaning equipment do not need to be presoaked or scrubbed, the use of automated equipment can increase productivity, improve cleaning effectiveness, and decrease worker exposure to blood and body fluids. Therefore, using automated equipment can be more efficient and safer than manually cleaning contaminated instruments.
If manual cleaning is not performed immediately, instruments should be placed into a container and soaked with a detergent, a disinfectant/detergent, or an enzymatic cleaner to prevent drying of patient material and make manual cleaning easier and less time consuming. The Centers for Disease Control (CDC) also recommends using long-handled brushes to keep the hand as far away as possible from sharp instruments.
Instruments should be handled as though contaminated until processed through the sterilization cycle. This needs to be done unless the instrument has been processed with a thermal washer/disinfector that has a high-level disinfection cycle.
To avoid injury from sharp instruments, personnel should wear puncture-resistant, heavy-duty utility gloves when handling or manually cleaning contaminated instruments and devices. Because splashing is likely to occur, they should also wear a facemask, eye protection or face shield, and gown or jacket.
Employees should not reach into trays or containers holding sharp instruments that cannot be seen. To reduce their risk of injury, they should instead remove instruments using forceps or empty them onto a towel.
Evidence does not support that housekeeping surfaces (floors, walls, and sinks) pose a risk for disease transmission in dental health-care settings. Actual, physical removal of microorganisms and soil by wiping or scrubbing is probably as critical, if not more so, than any antimicrobial effect provided by the agent used. The majority of housekeeping surfaces need to be cleaned only with a detergent and water or an EPA-registered hospital disinfectant/detergent, depending on the nature of the surface and the type and degree of contamination.
Schedules and methods vary according to the area (dental operatory, laboratory, bathrooms, or reception rooms), surface, and amount and type of contamination.
The majority of blood contamination events in dentistry result from spatter during dental procedures using rotary or ultrasonic instrumentation. Although there is no evidence supporting Hepatitis B, Hepatitis C, or HIV have been transmitted from a housekeeping surface, prompt removal and surface disinfection of an area contaminated by either blood or other bloodborne pathogens are appropriate infection-control practices and required by OSHA.
Strategies for decontaminating spills of blood and other body fluids differ by setting and volume of the spill. Blood spills on either clinical contact or housekeeping surfaces should be contained and managed as quickly as possible to reduce the risk of contact by patients and dental workers. The person assigned to clean the spill should wear gloves and other PPE as needed. Visible organic material should be removed with absorbent material, such as disposable paper towels discarded in a leak-proof, appropriately labeled container. Nonporous surfaces should be cleaned and then decontaminated with either an EPA-registered hospital disinfectant effective against HBV and HIV or an EPA-registered hospital disinfectant.
Studies show dental unit waterlines (narrow-bore plastic tubing that carries water to the high-speed handpiece, air/water syringe, and ultrasonic scaler) can become colonized with microorganisms, including bacteria, fungi, and protozoa. These microorganisms colonize and replicate on the interior surfaces of the waterline tubing and form a biofilm, which serves as a reservoir. The reservoir can increase the number of free-floating (i.e., planktonic) microorganisms in water used for dental treatment.
Extracted teeth that are being discarded are subject to the labeling provisions of the OSHA Bloodborne Pathogen Standard. OSHA considers extracted teeth to be potentially infectious material that should be disposed into medical waste containers. Extracted teeth containing amalgam should not be placed in a medical waste container that uses an incinerator for final disposal. State and local regulations should be consulted regarding disposal of amalgam.
Many metal recycling companies will accept extracted teeth with amalgam. Contact a recycler and ask about their policies and any specific handling instructions they may have. Extracted teeth may be returned to the patients upon request and are not subject to the provisions of the OSHA Bloodborne Pathogens Standard.
Hand hygiene is a general term that applies to routine hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis.
Hand hygiene substantially reduces potential pathogens on the hands and is considered a primary measure for reducing the risk of transmitting organisms to patients and health care personnel (HCP). Hospital-based studies have shown noncompliance with hand hygiene practices is associated with health care-associated infections and the spread of multi-resistant organisms. Studies also have shown that the prevalence of health care-associated infections decreased as hand hygiene measures improved.
Indications for hand hygiene include the following:
Also, for oral surgical procedures, perform surgical hand antisepsis before donning sterile surgical gloves.
Hand care products, including plain (non-antimicrobial) soap and antiseptic products, can become contaminated or support the growth of microorganisms. Liquid products should be stored in closed containers and dispensed from either disposable containers or containers that are washed and dried thoroughly before refilling. Soap should not be added to a partially empty dispenser, because this practice of "topping off" might lead to bacterial contamination of soap and negate the beneficial effect of hand cleaning and disinfection. Store and dispense products according to manufacturer's instructions.
Petroleum-based lotion formulations can weaken latex gloves and increase permeability. However, lotions are often recommended to ease the dryness resulting from frequent hand washing and more recently to prevent dermatitis resulting from glove use. The primary defense against infection and transmission of pathogens is healthy unbroken skin.
Frequent hand washing with soaps and antiseptic agents can cause chronic irritant contact dermatitis among dental health care personnel. The potential of detergents to cause skin irritation can vary considerably, but can be reduced by adding emollients. Lotions that contain petroleum or other oil emollients should only be used at the end of the workday. If using lotions during the workday, select a water-based product. At the time of product selection, information should be obtained from the manufacturer regarding interaction between gloves, lotions, dental materials, and antimicrobial products.
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