INFECTION CONTROL AND MANAGEMENT OF

HAZARDOUS MATERIAL

Infection control has become an integral part of dental practiceInfections may be transmitted from the patient to the dental staff or vice versaUpper respiratory tract infections, herpes simplex , tuberculosis ,hepatitis B etc…being transmitted during dental treatment

INTRODUCTION

current attention focused on acquired immunodeficiency syndrome,hepatitis B and other potentially life threatening diseases,infection control has become an important step during all treatment procedures.

Based on the CDC recommendation for infection control, the document delineates specific recommendation related to vaccination of dental health care workers (DHCWs),

protective attire and barrier techniques, hand washing and care of hands, The use and care of sharp instruments and needles;

sterilization or disinfection of instruments; cleaning and disinfection of the dental unit and environmental surfaces;

Use and care of handpieces ; antiretraction valves; and other intraoral dental devices attached to air and water lines of dental units;

Use of extracted teeth in dental educational settings Disposal of waste materials

BLOOD BORNE PATHOGENS STANDARD(BBP)

BBP standard is designed to protect employees against occupational exposure to blood borne pathogens such as hepatitis B

and HIV. Because all infected patients cannot be

identified by medical history, physical examinations or laboratory tests, CDC recommends that blood and body fluids precautions be used consistently for all patients.

This extension of blood and body fluid precautions ; referred to as UNIVERSAL PRECAUTIONS.

UNIVERSAL PRECAUTIONS

The term universal precautions means that all human blood and body fluids are to be treated as if known to be infectious with hepatitis B virus or HIV.

The rationale behind this concept is that,is not possible to identify those individuals who are infectious,so infection precautions are used for all health care personal and their patients.

VACCINES FOR DENTAL HEALTH-CARE WORKERS

Although HBV infection is uncommon amoung adult in uncommon among adults in united states serological survey has indicated that 10%-30% of health care of dental care or dental workers show evidence of past or present HBV infection

OSHA blood borne pathogens final rule requires that employers make hepatitis B vaccinations available without cost to their employees who may be exposed to blood or other infectious material

DHCWs also are at risk of exposure to and possible transmission of other vaccine preventable diseases.

Vaccination against influenza , mumps, rubella and tetanus may be appropriate for DHCWs.

HAND WASHING AND HAND CARE

Hand must be washed each time before gloves are put on and immediately after gloves are removed, and after inadvertent touching of contaminated objects or surface while bare handed.

It is important to dry hands well before wearing glove

Keep nails short and clean Dental personnel with open sore or

weeping dermatitis must avoid activities involving direct patient contact and handling contaminated instruments or equipment until the condition is resolved

For examinations and non surgical procedure,handwashing with plain soap is adequate.Antimicrobial soap help to reduce microbes on the skin and should be used before surgical procedures

PERSONAL PROTECTIVE EQUIPMENT

Dental heath care workers must wear personal protective equipment (PPE) such as protective clothing,surgicalmask,eyewear or a chin length face shield and disposible gloves when performing procedures capable of causing splash or splatter or those involving contact with body fluids,mucous membrane or both.

PPE must also be worn when other clinical activities are performed that require handling items contaminated with patient secretions.

PROTECTIVE CLOTHING

Protective clothing is used to protect the skin and underclothing of the worker from exposure to contaminated materials.

Protective clothing can include slacks laboratory coats , and surgical scrubs.

The type of protective clothing to be worn is based on the degree of anticipated exposure to contaminated aerosols when the high speed hand piece is being used during a cavity preparation.

GUIDLINE FOR WEARING PROCTECTIVE CLOTHING

Protective clothing should not be worn out of the office for any reason because it can spread contamination.

Protective clothing should be changed atleast daily,or sooner it becomes visibly soiled.

Protective clothing must never be worn on the staff lounge area or when co-worker are eating or consuming beverage.

PROTECTIVE MASKS

A mask is worn over the nose and mouth to protect the wearer from inhaling possible infectious organism spread by aerosols spray of hand piece or air water syringe and accidental splashes.

GUIDELINE FOR USING PROTECTIVE MASKS Change mask for every patient or more often ,

particularly if heavy splatter is generated during treatment or if the mask become damp

Handle the mask only by touching the side edges.

Confirm the mask well to your face.

Change your mask about once each hour , if it is long procedure.

Remember , a face shield is not a substitute for a mask because it provides no protection from aerosols.

PROTECTIVE EYE WEAR Protective eye wear is worn to protect

against the potential danger of eye damage resulting from aerosolized pathogens and from debris such as flying scrap amalgam or tooth fragments.

Protective eye wear also prevents spattered solutions or chemicals from injuring the eyes and may lead to blindness.

Protective eye wear should have shield on the sides and bottom.

FACE SHIELD A chin length plastic face

shield may be worn as an alternative to protective eye wear.

A face shield may be worn in addition to mask to protect from splashing or splattering of blood or other body fluid during procedure

GLOVES Gloves must be worn by dentist

assistant and hygienist during in all patient treatment in which there is a possibility of contact with the patients blood saliva or mucous membrane.

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GLOVES DAMAGED DURING TREATMENT

Gloves are effective only when they are intact.

If gloves are damaged they must be changed immediately . The procedure for regloving are Excuse yourself and leave the

chair side Remove and discard the

damage glove

Wash hand thoroughly. If you leave the chair for any reason

during the treatment, over gloves should be used.

STERILE SURGICAL GLOVES Sterile gloves which is used in hospital

operating rooms ,should be used for invasive procedures involving the cutting of bone or significant amounts of blood or saliva , such as in oral surgery or periodontal treatment

CHEMICAL WASTE MANAGEMENT

Hazardous chemicals

Hazardous chemicals is defined as any chemicals that can cause either a physical or health hazard.

A chemical is considered hazardous can ignite Can react when mixed with other substance Corrosive toxic

Exposure to chemicals Three method of chemical exposure are

inhalation,skin contact,and injestion. Inhalation of gases,vapours or dusts of

chemical can cause direct damage to the lungs

Injestion is another way in which chemicals can enter the body.

ACUTE AND CHEMICAL TOXICITY

The potential for a chemical to cause harm and the extent of harm depend on the amount of dose and the direction of exposure to chemical

The victim of acute toxicity feels the effectsimmediately.diziness,fainting,hea-dache,nausea and vomiting are symptom of acute over exposure to chemicals.

CONTROL OF CHEMICAL SPILS Mercury spill kits should be available in all

dental office in which amalgam is used.Exposure to even small amount of mercury is very hazardous to the health to dental personnel

PRECAUTIONS WHEN WORKING WITHMERCURY Work in well ventilated space Avoid direct skin contact with mercury Avoid inhaling mercury vapours Store mercury in unbreakable sealed

container away from heat

When preparing amalgam for restorations use preloaded capsules.

Left over srap amalgam is stored dry in tightly closed container

Reassemble amalgam capsule immediately after depending the amalgam mass

Ventilation Good ventilation is necessary when dealing with

any type of chemical Many dental office are equipped with special

exhaust system for fumes and dust in the laboratory,sterilization and dark room areas.

General precautions for storing

chemicals All dental materials contain chemicals

and the chemical component and some are more hazardous. The careful use and storage of dental material are important to ensure that these preparations retain their effectiveness.

DENTAL OFFICE WASTE MANAGEMENT

Dental office use certain substances that may be regulated federal, state or local environmental regulations.

Dental assistant should understand the type of dental waste, how to imply the regulations, and way to minimize the cost for disposal

Classification of waste

OSHA regulations apply to the handling of waste in the dental office for the protection of employers.

All dental waste should be classified according to EPA,guidelines as regulated or nonregulated.

DENTAL OFFICE WASTE

contaminated waste

Toxic wasteGeneral waste

Regulated wastes includes; sharps , disposible needles , scalpel needles , contaminated broken glass , disposible dental bur and endodontic files.

Other regulated wastes include blood, blood soaked items.

Non regulated waste include contaminated waste materials as well as saliva soaked gauge, used patient bibs and surface barriers.

color coding of waste disposal container

Normal waste Black, white or green containers are used for

normal waste, which is waste that has not been contaminated with blood or blood contaminated body fluids.

Clinical or infectious waste Yellow containers are used for clinical

waste.yellow rigid wall containers are usedf for sharps.both of this container should be labelled with the clinical waste symbol

Cytotoxic waste Purple containers with the cytotoxic

waste symbol are used for cytotoxic waste

Radio active waste Red containers with the radiation symbol

are used for radio active waste

Extracted teeth Extracted teeth are considered to be

potentially infectious material and thus are regulated waste if they are not disinfected.

Many states allow the dental office to sterilize the extracted teeth

Teeth that do not contain amalgam and are going to be used for educational purpose must be heat sterilized first

Sharps OSHA,CDC and the EPA classify sharps as

infectious waste According to OSHA regulations

dispossible sharps must be place in a leak proof puncture resistant container immediate after use.

The container must be labeled with the biohazard symbol and color coded for ready identification

Scrap amalgam Scrap dental amalgam should be collected

and stored in designated, dry, airtight container.

Scrap amalgam that is not recycled must be managed as hazardous waste

The container of scrap amalgam that is recycled must be labeled with the name, address, and telephone number of the dental office and date on which you first started collecting materials on the container

Disinfectant Small quantities of germicidal

solutions containing 2% or less gluteraldehyde may usually be poured down the drain

Germicidal solutions with greater than 2% gluteraldehyde may need to be managed as a hazardous waste.

check with the local authorities in disposal methods for these chemicals.

OSHA (Occupational safety and health act -1970)

The OSHA rule derives from the orginal occupational safety and health act passed by US congress in 1970.

This act identified employers obligations to protect employers from occupational risk

According to the act,each employers must furnish employees with a place and conditions of employment free from recognised hazards that presently cause,or likely to cause,death a serious harm to employers.

The created the occupational safety and health agency in US department of labour