________________________________________________________ Infection Control for Dental Professionals
FOMITE TRANSMISSION Devices can transmit pathogens if they are contaminated with blood or bodily fluids or are shared without cleaning, disinfect- ing, and sterilizing between patients; these are classified as fomi- tes. Surgical instruments that are inadequately cleaned between patients or that have manufacturing defects that interfere with the effectiveness of reprocessing may transmit bacterial, fungal, and viral pathogens. Clothing, uniforms, laboratory coats, or gowns used as PPE may become contaminated with potential pathogens after care of a patient colonized or infected with an infectious agent [5; 6; 10]. WATER TRANSMISSION Dental water units and dental unit waterlines are both poten- tial sources of transmission and potential reservoirs. Routine cleaning and sterilization and adherence to the CDC’s rec- ommended procedures for treating dental unit waterlines have been shown to be effective in eliminating transmission of infectious organisms via these devices. Infections known to be caused by dental-related water transmission include Pseudomonas aeruginosa , Mycobacterium avium , and Legionella pneumophila [5; 7]. STANDARD PRECAUTIONS Since the 1980s, regulatory and legislative activity has focused on implementing a hierarchy of prevention and control mea- sures to improve infection control in healthcare settings. The gradual acceptance of various infection prevention standards has changed the way we work in the provision of dental care. The use of Standard Precautions reduces the risk of infection to staff and patients and ensures that the right precautions are used with both known and unknown carriers of diseases due to bloodborne pathogens. Standard Precautions apply to contact with blood, intact or nonintact skin, mucous membranes, and all bodily fluids, secretions, and excretions (except sweat), regardless of whether they contain blood. A central tenet of Standard Precautions is to consider all patients to be potentially infected with a bloodborne pathogen. Saliva has always been considered a potentially infectious material in dental infection control; thus, no operational difference exists in clinical dental practice between Universal Precautions and Standard Precau- tions. For organisms other than bloodborne pathogens, early identification and prompt isolation are critical. As noted, Standard Precautions are the minimum infection prevention practices that apply to all patient care, regardless of health or dental care setting, and include [5]:
• Safe injection practices (aseptic technique) • Cleaning, sterilization, and disinfection of instruments and devices • Cleaning and disinfection of environmental surfaces HAND HYGIENE Despite the simplicity and effectiveness of hand hygiene in preventing the spread of infectious disease, adherence to hand hygiene practice remains low. Adherence varies among profes- sional categories of healthcare workers but is usually estimated at less than 50%. Healthcare providers may be required to clean their hands as many as 100 times in a 12-hour shift, depending on the number of patients and intensity of care [14; 17]. For dental healthcare workers, strict adherence to proper hand hygiene is the most important prevention strategy to protect both the patient and the worker. In one study, adherence rates to hand hygiene among postgraduate-year dentists found that overall handwashing compliance rate was 34.7%, with higher rates of compliance noted in oral surgery services (92.8%) than during work in general clinical practice (34.2%) [13]. The World Health Organization has designed the guidelines 5 Moments for Hand Hygiene as a reminder of when proper hand hygiene should be completed [11]: 1. Before touching a patient 2. Before a procedure 3. After a procedure or exposure to body fluids 4. After touching a patient 5. After touching a patient’s surroundings In general, perform hand hygiene [14]: • After contact with any bodily fluids, including your own • Before any non-invasive or invasive procedure • Each time you remove your gloves • When your hands feel or look dirty • After contact with contaminated things or environments, such as charts • After handling used equipment or linen • After using the bathroom • Before contact with any portal of entry, your patient’s or your own • Before and after eating A number of conditions restrict dental healthcare professionals from participating in direct patient care. These include weep- ing dermatitis, exudative lesions, or any hand condition that increases the risk of disease transmission [9]. Good handwashing is difficult to practice, is rarely known or taught, and is one of the single most effective ways to prevent transmission of many diseases, including influenza. Everyone knows to wash their hands before eating and after using the
• Utilization of effective hand hygiene • Use of PPE (e.g., gloves, masks, eyewear)
• Respiratory hygiene, including cough/sneeze etiquette • Sharps safety (engineering and work practice controls)
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