Chapter 1 of 430% of exam
Infection Control
Infection control protects patients and the dental team by breaking the chain that lets microorganisms move from one host to another. This chapter covers standard precautions, personal protective equipment, instrument processing, sterilization monitoring, and the federal bloodborne pathogen rules that govern a dental office.
Chain of Infection and Standard Precautions
Disease transmission requires six linked elements: an infectious agent, a reservoir where it lives, a portal of exit, a mode of transmission, a portal of entry, and a susceptible host. Infection control works by removing any single link. Because a patient's infectious status is often unknown, the dental team treats every person and every body fluid as potentially infectious.
Six links
Agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host must all be present for infection to spread, so breaking one link stops transmission.
CDC Guidelines for Infection Control in Dental Health-Care SettingsStandard precautions
Apply the same protective measures to every patient and treat blood, saliva, and all other body fluids except sweat as infectious regardless of diagnosis.
CDC Guidelines for Infection Control in Dental Health-Care SettingsTransmission routes in dentistry
Expect direct contact with blood or saliva, indirect contact through contaminated instruments and surfaces, droplet spatter to the eyes, nose, or mouth, and inhalation of aerosols generated by handpieces and ultrasonic scalers.
Written exposure control plan
Every dental practice must keep a written exposure control plan, review and update it at least once a year, and make it available to employees.
OSHA 29 CFR 1910.1030Hand Hygiene and Personal Protective Equipment
Hand hygiene is the single most effective way to prevent transmission in a clinical setting. Personal protective equipment adds a barrier between the assistant and infectious material, and the order in which it is put on and taken off determines whether contamination reaches the skin or clothing.
When to wash
Perform hand hygiene before and after every patient, before donning and after removing gloves, and any time hands become visibly soiled.
CDC Guideline for Hand Hygiene in Health-Care SettingsSoap versus alcohol rub
Wash with soap and water when hands are visibly soiled or contaminated with blood; otherwise an alcohol-based hand rub is acceptable and generally reduces bacterial counts more effectively.
CDC Guideline for Hand Hygiene in Health-Care SettingsSurgical hand antisepsis
Before an oral surgical procedure, scrub with an antimicrobial soap or use an alcohol product with persistent activity, cleaning both hands and forearms.
CDC Guidelines for Infection Control in Dental Health-Care SettingsDonning sequence
Put on protective clothing first, then the mask, then eyewear or face shield, and gloves last so that the gloves cover the gown cuffs.
CDC Sequence for Donning and Removing PPERemoval sequence
Remove gloves first, then eyewear, then the gown, then the mask, and perform hand hygiene immediately; the mask comes off last because its ties are considered clean.
CDC Sequence for Donning and Removing PPEEmployer pays
The employer must provide, launder, repair, replace, and dispose of all required personal protective equipment at no cost to the employee, and contaminated clothing may never be taken home.
OSHA 29 CFR 1910.1030Instrument Processing Workflow
Contaminated instruments move through the sterilization area in one direction, from dirty to clean, so processed items are never re-contaminated. The workflow is holding, cleaning, packaging, sterilization, and storage, and each step has its own safety requirements. Heavy-duty utility gloves, a mask, eyewear, and a gown are worn for every step through packaging.
Step 1: holding
Place instruments in a holding solution or covered container of detergent or enzymatic cleaner when they cannot be cleaned right away, which keeps debris from drying onto the surfaces.
Step 2: cleaning
Remove all bioburden with an ultrasonic cleaner or instrument washer rather than hand scrubbing, because hand scrubbing sharply increases the risk of a puncture injury.
CDC Guidelines for Infection Control in Dental Health-Care SettingsStep 3: packaging
Dry, inspect, and wrap or pouch instruments in packaging cleared for the sterilizer being used, and place an external process indicator on each package.
Step 4: sterilization
Load packages loosely so steam or vapor reaches every surface, run the full cycle at the manufacturer's stated time, temperature, and pressure, and let packages dry before handling.
Step 5: storage
Store sterilized packages in a clean, dry, closed cabinet away from sinks and traffic; a package stays sterile until it is opened, torn, wet, or dropped.
One-way flow
Divide the processing area into contaminated receiving, preparation and packaging, sterilization, and clean storage sections, and always work from the contaminated end toward the clean end.
CDC Guidelines for Infection Control in Dental Health-Care SettingsSterilization Methods and Monitoring
Heat sterilization destroys all microorganisms, including bacterial spores, and is required for any instrument that penetrates soft tissue or bone or that contacts the oral cavity. Monitoring proves the process actually worked, and only a biological test confirms that spores were killed.
Steam autoclave
The most common dental method; typical cycles run about 121 degrees Celsius at 15 psi for 15 to 30 minutes, or about 132 degrees Celsius at higher pressure for a shorter cycle, and it can dull or rust items that are not stainless steel.
Chemical vapor and dry heat
Chemical vapor sterilizers heat an alcohol and formaldehyde solution under pressure and do not rust instruments but require ventilation, while dry heat runs at higher temperatures for longer times and is gentle on sharp cutting edges.
Critical, semicritical, noncritical
Critical items that penetrate tissue and semicritical items that touch mucous membranes must be heat sterilized, while noncritical items that touch only intact skin need intermediate or low-level disinfection.
Spaulding ClassificationMechanical and chemical monitoring
Check the sterilizer gauges or printout every cycle and use chemical indicators inside and outside packages; these confirm that conditions were reached but do not prove sterility.
Weekly biological monitoring
Run a spore test with bacterial spores at least once a week, and with every load containing an implantable device, because it is the only method that verifies spores were killed.
CDC Guidelines for Infection Control in Dental Health-Care SettingsFailed spore test
Take the sterilizer out of service, recall and reprocess items back to the last negative test, find and correct the cause, and do not use the unit again until it passes.
Surfaces, Waterlines, Sharps, and Exposures
Environmental surfaces, dental unit water, and contaminated sharp items each carry their own risks and their own rules. An exposure incident is a medical urgency for the employee and must be reported and evaluated immediately.
Barriers and disinfection levels
Cover clinical contact surfaces with barriers, or between patients clean them first to remove bioburden and then apply an EPA-registered hospital disinfectant for the full contact time on the label, choosing an intermediate-level product with a tuberculocidal claim when blood is present and a low-level product otherwise.
EPA Antimicrobial RegistrationDental unit waterlines
Keep water used for nonsurgical dental procedures at or below 500 colony-forming units per milliliter, treat and monitor the lines per the manufacturer, flush after each patient, and use sterile solution for surgical procedures.
CDC Guidelines for Infection Control in Dental Health-Care SettingsSharps handling
Never recap a needle with two hands and never bend, shear, or break contaminated needles; use a one-handed scoop or a recapping device and place sharps in a closable, puncture-resistant, leak-proof container labeled with the biohazard symbol.
OSHA 29 CFR 1910.1030Regulated waste
Items saturated or caked with blood, extracted teeth, and contaminated sharps are regulated waste and must go into labeled or color-coded containers, separate from ordinary trash.
OSHA 29 CFR 1910.1030Hepatitis B vaccination
The employer must offer the hepatitis B vaccine series at no cost within ten working days of assignment to a job with occupational exposure, and an employee who declines signs a written declination and may accept the vaccine later.
OSHA 29 CFR 1910.1030Exposure incident protocol
Wash the area immediately, report the incident to the employer at once, and obtain a confidential medical evaluation with source-patient testing, baseline blood testing, post-exposure prophylaxis as indicated, and follow-up, all at the employer's expense.
OSHA 29 CFR 1910.1030Test your knowledge
Practice questions on Infection Control