All DHCP must wear surgical face masks with either chin- length plastic face shields or protective eyewear whenever there is potential for aerosol spray, splashing, or spattering of droplet nuclei, blood, chemical or germicidal agents, or OPIM. Masks must be changed and disposed of after each patient. However, if a face mask becomes contaminated or wet, it should be changed during treatment. Following each patient treatment, face shields and protective eyewear shall be cleaned, disinfected, or disposed of (California Code of Regulations, 2011). Hands must be protected by wearing single-use (nonwashable), disposable, medical examination gloves whenever there is contact with mucous membranes, blood, or OPIM and during all pre-clinical, clinical, post-clinical, and laboratory procedures. Medical exam gloves must be discarded (a) when torn or punctured, (b) upon completion of treatment, and (c) before leaving laboratories or areas of patient care activities. All DHCP are required to perform hand hygiene procedures before donning gloves and after removing and discarding gloves. Gloves must not be washed before or after use (California Code of Regulations, 2011). Additionally, DHCP must wear heavy-duty utility gloves to prevent puncture wounds when processing contaminated sharp instruments, needles, and devices.
Regulations, 2011). Also included are “any unfixed tissue or organ (other than intact skin) from a human (living or dead),” as well as any cell, tissue, or organ cultures from humans or experimental animals; blood, organs, or other tissues from experimental animals; or culture medium or other solutions, that are known or reasonably likely to contain or be infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) (California Code of Regulations, 2011). The California Minimum Standards for Infection Control, Section 1005, stipulate that in order to protect their skin and clothing from blood and OPIM, “all DHCP shall wear reusable or disposable protective attire whenever there is a potential for aerosol spray, splashing or spattering of blood, OPIM, or chemicals and germicidal agents. Protective attire must be changed daily or between patients if they should become moist or visibly soiled” (California Code of Regulations, 2011). Protective attire used during patient care must be removed prior to leaving laboratories or areas of patient care activities. Reusable gowns must be laundered according to Cal/OSHA Bloodborne Pathogens Standard (California Code of Regulations, 2015). Protective attire must also be worn for disinfection, sterilization, and housekeeping procedures involving the use of germicides or handling contaminated items (California Code of Regulations, 2011).
HAND HYGIENE
care and from handling patient care equipment until the condition resolves (California Code of Regulations, 2011). Hand hygiene methods, agents, duration, and indicators include the following: 1. For routine wash : Use water and plain soap for 15 seconds before and after each patient. 2. For antiseptic wash : Use water and antiseptic soap for 15 seconds before and after each patient. 3. For antiseptic hand rub : Use alcohol-based hand rub and agitate hands until dry. Antiseptic hand rub is not to be used if the hands are visibly soiled. 4. For surgical asepsis : Use water and antimicrobial soap for 2 to 6 minutes, or water and non-antimicrobial soap for 2 to 6 minutes, followed by alcohol rub (CDC, 2016a)
At the beginning and end of each workday, DHCP must thoroughly wash their hands with soap and water. DHCP must also perform hand hygiene and don new gloves before treating each patient. Between patients, if hands are not visibly soiled or contaminated, an alcohol- based hand rub may be used for hand hygiene as an alternative to soap and water. Hands must be thoroughly dried before donning gloves to prevent promotion of bacterial growth, and hand hygiene must be performed again immediately after glove removal. DHCP must refrain from providing direct patient care if hand conditions are present that may render DHCP or patients more susceptible to opportunistic infection or exposure. All DHCP who have exudative lesions or weeping dermatitis of the hand must refrain from all direct patient Table 2: Hand Hygiene Methods and Indications Method Agent Purpose
Duration (Minimum)
Indication
Routine handwash
Water and nonantimicrobial soap.
Remove soil and transient microorganisms. Remove or destroy transient
15 seconds.
Before and after treating each patient. After barehanded touching of inanimate objects likely to be contaminated by blood or saliva. Before leaving the dental operatory or the dental laboratory. When visibly soiled. Before regloving after removing gloves that are torn, cut, or punctured.
Antiseptic handwash
Water and antimicrobial soap.
15 seconds.
microorganisms and reduce resident flora.
Antiseptic hand run
Alcohol-based hand rub.
Remove or destroy transient
Rub hands until the agent is dry.
microorganisms and reduce resident flora. Remove or destroy transient microorganisms and reduce resident flora (persistent effect).
Surgical antisepsis
2-6 minutes. Follow manufacturer instructions for surgical hand-scrub product.
Before donning sterile surgeon’s gloves for surgical procedures.
Water and antimicrobial soap OR water and non- antimicrobial soap, followed by an alcohol- based surgical hand-scrub product with persistent activity.
Note . Adapted from Table 2 in “Guidelines for Infection Control in Dental Health-Care Settings – 2003,” by W. G. Kohn, A. S. Collins, J. L. Cleveland, J. A. Harte, K. J. Eklund, and D. M. Malvitz, MMWR Recommendations and Reports, 52 (RR-17), pp. 1-61.
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