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Introduction to DH environment

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Margit Strobl

on 17 October 2018

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Transcript of Introduction to DH environment

Introduction to the DH environment/Infection Control
Infection Control
CDHBC Practice Standards:
"Infection prevention and control is an important part of safe patient care. Concerns about the
possible spread of blood-borne diseases, and the impact of emerging, highly contagious respiratory and other illnesses, require practitioners to establish, evaluate, continually update and monitor their infection prevention and control strategies and protocols (CDHBC, 2012)."

3 approved types- steam under pressure, dry heat & chemical vapor. selection of a sterilizer is dependent on the manufacturers specifications as all items cannot be treated the same
(review p 113 D&W and section C in clinic manual for details) An information sheet can be viewed on D2L
2. Define infection control and routine practices
The dental hygiene environment
Infection Control
Infection control refers to a comprehensive, systematic program that, when applied, prevents the transmission of infectious agents or microorganisms among persons who are in direct or indirect contact with the healthcare environment (Darby/Walsh, 2015)
Essential Features of Disease Transmission
A chain of events consisting of six links is required for the spread of an infectious agent:

1. an infectious agent- bacterium, virus, fungi, etc.
2. a reservoir where invading organisms live and multiply (soil, water, etc.)
3. a port of exit- can exit through various body systems such as blood, respiratory tract or skin lesions
4. mode of transmission- ex. direct person to person contact (coughing, etc.) or indirect by contaminated hands, etc
5. a port of entry- similar to the portal of exit (eyes, mucous membranes, repsiratory tract, etc)
6. a susceptible host- does not have immunity to invading organism
Operatory set up
Floor plan will vary with each setting (hospital vs college facility vs mobile facility) and private office but will include a patient chair, operator and assistant stools, delivery system with suction (high and low), water ( either a separate water bottle or a facility wide water system) cabinets, sinks and various equipment (x-ray, sterilization, ultrasonics, etc.)
5. Explain routes of disease transmission in oral health care settings
11. Explain post exposure protocols related to oral health care with a particular emphasis on Camosun College protocols
1. Describe best practice standards in oral health care
12. Explore the Dental Hygiene Care Environment
The physical space that contains equipment and instruments where the dental hygienist delivers professional oral care
Compare your dentist's office and the image on the next frame to visualize differences in set up
read relevant sections about the dental unit on pages 91- 95 in Darby & Walsh for more details
To prevent healthcare associated infections among clients and injuries and illnesses in dental healthcare personnel
Routine practices:
a set of infection control guidelines used consistently, regardless of the health of the client, to ensure a safe environment to deliver oral healthcare

Transmission-based precautions
are used in addition to standard precautions to prevent the potential spread of certain diseases that are airborne or spread by droplets or contact. These precautions are utilized when the routes of transmission are not interrupted completely using routine practices alone
Reducing the Risk

1. Risk assessment: involves considering the client's health, client characteristics/level of cooperativeness, the dental hygiene environment and the dental hygienist's immunity. Procedures involving no anticipated exposure requires less precautions and vice versa
2. hand hygiene: this is the single most effective measure to prevent the transmission of microorganisms. Consists of hand washing with soap and water or alcohol based rub.
See the CDHBC guidelines for when hand hygiene should be performed
3. Use of PPE: shields the dental hygienist from exposure and protects clients by preventing the dental hygienist from becoming a vehicle to spread infectious agents. PPE includes, masks, gloves, glasses, drapes)
4. Safe handling and disposal of sharps and contaminated waste: Clients must be protected from sharp objects. Sharp objects must be kept out of reach of clients and disposed of in a clearly labelled container
Disinfecting agents:
used in different forms- surface, immersion, and hand antimicrobials. Categorized by their biocidal activity ( high, intermediate and low level)
(review p 114 D&W and clinic manual for details)
Post exposure protocols at Camosun:
section B, emergency protocol in your Clinic manual for more information
Look in your clinic manual in the infection control section for more information specific to the DH program- we will also discuss some of the pages in class
1. Darby M, Walsh M. Dental Hygiene Theory and Practice. 4th Ed. St. Louis Missouri: Saunders; 2015.
3. Camosun College Dental Hygiene Clinic Manual, 2016/2017 Ed.
2. College of Dental Hygienists of British Columbia [Internet]. British Columbia: CDHBC. Infection Prevention and Control Guidelines, 2012. Available from http://www.cdhbc.com/Documents/Infection-Prevention.aspx
def of sterilization:
destruction of all living organisms
Class Activities
Read Ch 9 D&W for more information
a more detailed introduction to the operatory/unit will be given in clinic
def of disinfection:
destruction of most but not all microorganisms
Instrument classification:
critical, semi-critical and non-critical
(review p 113 D&W and clinic manual for details)
(As identified in CDHBC guidelines- these guidelines are similar to the CDC guidelines outlined in the next slide)
Pathogens transmissible via the oral cavity
Epstein Barr
Measles, mumps, rubella
Candida albicans
Factors influencing the development of infection
# of organisms and duration of exposure: larger numbers of organism as well as a longer exposure time will increase the potential for infection
virulence- ability of infectious agent to produce disease
immune status of host: if the host has a compromised immune system, the potential for the development of infection increases
general health and nutritional status: obviously if an individual is in good health and is getting enough vitamins and minerals from what he/she is eating, the potential for infection development decreases
Factors that alter normal defenses
Abnormal physical conditions- defective heart valve
Systemic diseases- diabetes, alcoholism, leukemia
Drug therapy- steriods, chemotherapy
Prostheses &/or Transplants- may require antibiotic premedication
image retrieved fromhttps://www.google.ca/search?hl=en&site=imghp&tbm=isch&source=hp&biw=1301&bih=561&q=dental+operatory&oq=dental+oper&gs_l=img.1.0.0l10.1171.3777.0.6868.
4. Terra Nova films [Internet]. Youtube; [reviewed 2015 Sept 2]. [Video], Chain of Infection; 2012 Jul 6 [reviewed 2015 Sept 6]; [2 min 50 sec].
3. Explain when transmission based precautions would be utilized in a health care setting
4. Explain the essential features for a disease to be transmissible
7. Describe the four principles of infection control which reduce the risk of transmission
8. Describe various sterilization techniques including the advantages and disadvantages
9. Relate the minimum level of infection control management between clients
10. Explain ways in which to ensure the effectiveness of sterilization
Routine Practices (Health Canada) or Standard precautions (CDC) is a blend of universal precautions ( designed to reduce the risk of transmissible pathogens that are blood borne) and body substance precautions (designed to reduce the risk of transmitting pathogens from moist body substance). It applies to contact with blood, all body fluids, secretions, excretions (except sweat), nonintact skin and mucous membranes
The CDHBC Registrants Handbook provides current guidelines or best practice to ensure each clinician is implementing a comprehensive infection control program. Best practices are guidelines based on current industry standards and scientific evidence and it is the responsibility of every oral health professional to maintain current knowledge of best practices in infection prevention and control
routes of transmission in oral health care
movement can set dust in motion and it can settle on instruments, other objects or people
contaminants that occur in solid or liquid form, are invisible and may remain suspended in the air for long periods
larger particles that do not remain suspended for long periods of time because of size and weight. They drop on people, objects and the floor
Direct transmission:
direct physical contact with blood, oral fluids or other materials
Indirect transmission:
contact with an intermediate contaminated object such as a dental instrument
contact of oral, nasal or conjunctival (lining of the eyes) mucosa from coughing, sneezing or talking

Four principles of infection control (CDC guidelines)
Take action to stay healthy:
Everyone should take steps to maintain their own health. This can be done through good hand hygiene, education and training, immunization, managing post-exposures
Avoid contact with blood and other infectious body substances
: Use safe work practices and a comprehensive infection control program ( ex. CDHBC infection control guidelines). Use personal protective equipment (PPE) such as gloves, safety glasses, face masks, etc and handle sharp instruments safely
Make client care items safe for use:
use appropriate infection control measures to prevent the spread of infectious agents by cleaning, sterilizing and disinfecting items
Limit the spread of blood and other infectious body substances:
protect the oral health care environment by using protective barriers, clean and disinfect surfaces and effectively manage waste (including hazardous waste) and sharp instruments

Breaking any one of the links will prevent the spread of infectious agents
5. Additional precautions: these are additional measures taken when Standard precautions are not enough to interrupt the transmission or microorganisms. These precautions are typically utilized in institutional settings or a dental office where a client is known/suspected of having an infection that can be transmitted by large respiratory droplets
6. Relate basic knowledge of a variety of infectious diseases common to the oral health environment
see D2L for an information sheet with specific information about some of the diseases listed above
Steam under pressure:
can be used for all materials except oils/waxes and items that cannot be subjected to high temperatures. Must have space between items in order for steam to access
all microorganisms are destroyed
- a wide variety of materials can be sterilized
- most economical method of sterilization
can corrode carbon steel if precautions are not taken
Dry Heat:
for items that cannot be sterilized using steam under pressure
well suited for sharp instruments
- no corrosion
Long exposure time as heat penetration is slow and uneven
- high temperature is critical for certain materials

Chemical vapor:
uses formaldehyde and alcohol. Packaging cannot be heavy, tightly wrapped or sealed as vapor will not penetrate
no corrosion for carbon steel instruments
- sterilizes in relatively short amount of time
- easy to operate
adequate ventilation needed so cannot use in a small room
- slight odor
Disinfecting agents
High level
: inactivate spores and all forms of bacteria, fungi and viruses. Can be either a disinfectant or a sterilant
Intermediate level
: inactivates all forms of microorganisms but does not destroy spores
low level
: inactivate vegetative bacteria and certain lipid-type viruses but do not destroy spores, tubercle, bacilli or nonlipid viruses
instrument classification
instruments that penetrate tissue or bone. Must be sterilized or disposed. Ex. needles, curets, explorers, probes, surgical instruments
Instruments not intended to penetrate tissue or bone but touch mucous membrane and contact oral fluids. Must be sterilized or can use high level disinfection. Ex. ultrasonic handpiece, mouth mirrors, radiographic bite blocks
come into contact with intact skin only. do no touch mucous membranes, only unbroken epithelium. Must use intermediate level disinfection. Ex. light handles, safety eyewear, x-ray head/cone
come into contact with intact skin only. Must use low to intermediate level disinfection. Ex. countertops, equipment surfaces
Ensuring sterilization occurs

Three tests available to ensure all forms of life are destroyed: external, internal and biological.

External chemical indicator:
changes color to indicate that the steam under pressure or heat has been reached. should be used on every package. This indicator is not an indication that the sterilization process has occurred as other factors can interfere with sterilization

Internal chemical indicator:
color change assesses instrument exposure to temperature and steam for the required time

Biologic Monitor:
tests that the sterilizer is functioning properly. the highest level of verification that sterilization has occurred. Placed in the sterilizer with a load of instruments
Minimum level of infection control between clients
It is likely that you will see more than one client during a scheduled clinic session in the dental hygiene program. In a private practice setting, the number of clients in a day will vary. The minimum level of infection control between clients is as follows:
- a modified version of opening the unit is utilized
- dirty instruments are transported to the IN window with the use of utility gloves
- all objects which are touched during dental procedures must be decontaminated before the next client is seen.
- surfaces should be wiped with disinfectant and barriers replaced

see section C in the clinic manual
5. Wilkins E. Clinical Practice of the Dental Hygienist. 12th Ed.Philadelphia: Wolters Kluwer; 2017.
The risk of infection as a result of a dental procedure is extremely low but it is still an important client safety consideration
Why should oral health care professionals worry about transmissible diseases?
The "world" we work in as oral healthcare professionals is full of pathogens that increase the risk of transmission to both the dental hygienist and client from one another or by instruments, equipment, etc.
Implementing and following an infection prevention and control system allows the oral health care professional to develop strategies to interrupt transmission of infectious agents
The Code of Ethics from the CDHBC Registrants Handbook states, "Hold paramount the health and welfare of those served professionally". That means we must take every precaution in order to keep the clients safe
Answer the following questions:
1. What could you teach your client to look for in a dental care facility?
2. It is not a good idea for clients to close their lips around the saliva ejector. Why? p 93-94
3. What does "standard of care" mean with respect to infection control? p 102
4. Why do you think infection control is so important in dentistry?
5. Why is hand hygiene emphasized? p 110
6. How does a history of the client's health affect the oral healthcare professional's ability to maintain good infection control? p 108
7. Transmission of infectious agents can occur inadvertently because of inappropriate work practices. What are some inappropriate work practices?
A break in the chain of disease transmission is required to stop the spread of an infectious agent. Above are some examples of standard precautions and the dental hygienist's role in the interruption
Scenarios- work in small groups to determine the best option according to current best practices ( you can use any resources you need to complete this activity)
There is a nice table on page 113 (table 9-4) of Darby/Walsh that indicates the management of instruments based on their classification
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