Figure 3: Eye Exposures
Is this an acceptable method? The OSHA Regulations state “a mechanism for flushing the eyes must be available to operators.” ● It’s hard to control the forces of the water with this method.
● Eyewash stations or sterile water in flush bottles are safer options. ● Irrigate the mucous membranes with sterile normal saline or water. Treat occupational exposures as a medical emergency. Note . Adapted from “Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C: Emergency Needlestick Information,” by the National Institute for Occupational Safety and Health, 2014. Retrieved from http://www.cdc.gov/niosh/topics/bbp/emergnedl.html STERILIZATION AND DISINFECTION
washer/disinfector. Cycles on ultrasonic and instrument washers should not be interrupted. If it is necessary to interrupt a cycle or add an item after a cycle has been initiated, the entire process should be restarted. Heavy- duty utility gloves should always be worn when working with contaminated instruments. After removal from the ultrasonic solution, instruments are rinsed, inspected (any additional debris may be removed at this point), lubricated, and packaged or wrapped for sterilization. Section 1005 states that sterilization “is a validated process used to render a product free of all forms of viable microorganisms” (California Code of Regulations, 2011). The limiting requirement is the inactivation of high numbers of bacterial and mycotic endospores (often simply referred to as spores), which are produced asexually and tougher than ordinary spores (Cornell College of Agriculture and Life Sciences, 2022; Yoo, 2018). of the disinfection process. These packages or containers shall remain sealed and shall be stored in a manner so as to prevent contamination, and shall be labeled with the date of sterilization and the specific sterilizer used if more than one sterilizer is utilized in the facility. If a sterile instrument package is torn, wet, or is otherwise damaged, the instrument should not be used and should be reprocessed and presterilized prior to use (California Code of Regulations, 2011). All high-speed dental handpieces, low-speed handpieces, rotary components, and dental unit attachments such as reusable air/water syringe tips and ultrasonic scaler tips shall be packaged, labeled, and heat-sterilized in a manner consistent with the same sterilization practices as a semi- critical item. Non-critical surfaces and patient-care items must be cleaned and disinfected with a Cal/EPA-registered hospital low-level disinfectant that is labeled effective against HBV and HIV. When the item is visibly contaminated with blood or OPIM, a Cal/EPA-registered hospital intermediate-level disinfectant with a tuberculocidal claim must be used (California Code of Regulations, 2011). Cleaning with a suitable product should always precede disinfection. Many disinfectants contain surfactants, making them suitable for both cleaning and disinfection. Always refer to the manufacturer's instructions to determine if the product can be used as a cleaner, the correct contact time, necessary PPE, disposal, and any other important information. Single-use disposable items such as prophylaxis angles, prophylaxis cups and brushes, tips for high-speed evacuators, saliva ejectors, air/water syringe tips, and gloves shall be used for one patient only and discarded. Special dental protocols exist for surgical procedures involving bone or soft tissues; in these instances, Section 1005 stipulates that sterile coolants/irritants must be used and must be delivered using a sterile delivery system
At the completion of the dental procedure, operators must safely process their reusable instruments and devices. Cleaning must precede any disinfection or sterilization process. Products and devices used to clean items or surfaces prior to disinfection or sterilization must be used in accordance with the manufacturer’s instructions. Follow the manufacturer’s instructions for cleaning solutions safe to use with the device, cycle times, and frequency of changing solutions. Contaminated instruments should not be wiped by hand prior to mechanical cleaning unless the item cannot be immersed, as is the case with a handpiece. Items that would be damaged by mechanical cleaning should be carefully cleaned by hand, wearing heavy-duty utility gloves, eye protection, and other appropriate PPE. Contaminated instruments should be thoroughly cleaned prior to sterilization, preferably using a mechanical device intended for that purpose, such as an ultrasonic cleaner or instrument Critical and semi-critical instruments Instruments, items, and devices are categorized as critical, semi-critical, and non-critical. Critical items are all instruments, devices, and other items used to penetrate soft tissue or bone. Semi-critical items do not penetrate bone or soft tissue, but contact oral mucous membranes, nonintact skin, or OPIM. Non-critical items are instruments, devices, equipment, and surfaces that come in contact with soil, debris, saliva, blood, OPIM, and intact skin, but not oral mucous membranes (California Code of Regulations, 2011). Examples of non-critical items include stethoscopes and blood pressure cuffs. Critical items confer a high risk for infection if they are contaminated by any microorganism. Section 1005 states that critical instruments, items, and devices shall be discarded or pre-cleaned, packaged or wrapped, and sterilized after each use. Methods of sterilization shall include steam under pressure (autoclaving), chemical vapor, and dry heat. If a critical item is heat-sensitive, it shall, at minimum, be processed with high-level disinfection and packaged or wrapped upon completion of the disinfection process. These instruments, items, and devices shall remain sealed and stored in a manner so as to prevent contamination and shall be labeled with the date of sterilization and the specific sterilizer used if more than one sterilizer is utilized in the facility (California Code of Regulations, 2011). Ink used to label packages should be non-toxic and markings should be on the non-porous side of plastic and paper pouches or written on indicator tape placed on the pouch (AAMI, 2017). Section 1005 states that semi-critical instruments, items, and devices shall be pre-cleaned, packaged or wrapped, and sterilized after each use. Methods of sterilization include steam under pressure (autoclaving), chemical vapor, and dry heat. If a semi-critical item is heat sensitive, it shall, at minimum, be processed with high-level disinfection and packaged or wrapped upon completion
EliteLearning.com/Dental
Page 31
Powered by FlippingBook