Infection Control for Dental Professionals ________________________________________________________
Most surgical masks are not National Institute for Occupa- tional Safety and Health (NIOSH)-certified as respirators, do not protect the user adequately from exposure to TB, and do not satisfy OSHA requirements for respiratory protection. However, certain surgical masks (i.e., N95 respirators) do meet the requirements and are certified by NIOSH. The level of protection a respirator provides is determined by the efficiency of the filter material for incoming air (e.g., 95% for N95) and how well the face piece fits or seals to the face. N95 respirators are required to be labeled as such on the device. Respirators are used when treating patients with diseases requiring Airborne Precautions and should be used in the context of a complete respiratory protection program. This program should include training and fit testing to ensure an adequate seal between the edges of the respirator and the wearer’s face. Goggles with side shields provide barrier protection for the eyes and should fit snugly over and around the eyes or personal prescription lenses. Personal prescription lenses do not provide optimal eye protection and should not be used as a substitute for goggles. If goggles or face shields are reusable, they must be placed in a designated receptacle for subsequent reprocessing. If they are not reusable, they may be discarded in a designated waste receptacle. Face shields extending from chin to crown provide better face and eye protection from splashes and sprays than goggles. Shields that wrap around the sides may reduce splashes around the edge. Removal of a face shield, goggles, and mask can be performed safely after gloves have been removed and hand hygiene performed. The ties, ear pieces, or headband used to secure the equipment to the head are considered clean and therefore safe to touch with bare hands. The front of the face shield is considered contaminated [10; 18]. RESPIRATORY HYGIENE If dental clinics and offices comply with state regulations for screening of patients with ATDs, they are not required to comply with the new standards for prevention of transmis- sion of ATDs [4]. However, because no screening process is universally effective, dental personnel should be aware of the potential dangers associated with transmission of pathogens via the airborne and droplet routes. Respiratory droplets can transmit infection when they travel directly from the respiratory tract of the infected individual to the mucosal surfaces of the recipient, generally over short distances (i.e., 6 feet or less). Airborne transmission occurs with only a few organisms that can survive the drying of respiratory droplets. When the droplets evaporate, they leave behind drop- let nuclei, which are so small they remain suspended in the air and can travel over longer distances. Respiratory droplets and droplet nuclei are generated when an infected person coughs, sneezes, or talks during procedures. Facial masks or shields generally provide direct protection from droplet transmission. Some pathogens transmitted via the airborne route (e.g., TB)
require the use of an N95 respirator or better (e.g., N99, N100) due to the small particle size [5]. Measures to contain respiratory secretions in symptomatic patients and accompanying adults may include [5; 18]: • Post signs to instruct patients with known or suspected respiratory infection to cover mouth and nose when sneezing or coughing, use and properly dispose of tissues, and wash hands after sneezing or coughing. • Provide tissues and no-touch receptacles. • Have handwashing stations or hand sanitizer available in waiting areas. • Offer masks to patients and accompanying adults. • Provide ample space in waiting areas, or consider placing symptomatic patients in a separate waiting area. ENGINEERING AND WORK PRACTICE CONTROLS (SHARPS SAFETY) Most percutaneous injuries among dental professionals involve scalers, burs, needles, wires, and sharp instruments. In 2000, the Federal Needlestick Safety and Prevention Act authorized OSHA to revise its Bloodborne Pathogens Standard to require the use of safety-engineered sharp devices in healthcare settings [2; 3; 16]. Guidelines on the design, implementation, and evaluation of a sharps injury prevention program have been developed by the CDC, and outline engineering controls and work practice controls as primary methods to prevent such occurrences. Engineering controls, such as sharps disposal containers, self-sheathing needles, and safer medical devices (e.g., sharps with engineered sharps injury protections and needleless systems) isolate or remove the bloodborne pathogens hazard from the workplace. On the other hand, work practice controls reduce the likelihood of exposure by specifying the manner in which a task is performed (e.g., prohibiting recap- ping of needles by a two-handed technique). Engineering and work practice controls are intended to work synergistically to eliminate or minimize employee exposure. These controls must be examined and maintained or replaced on a regular basis to ensure their effectiveness. To maintain a safe workplace, employers must provide handwashing facilities that are readily accessible to employees. Contaminated needles and other contaminated sharps should not be bent, recapped, or removed unless the employer can demonstrate that there is no alternative or that such action is required by a specific procedure. Necessary bending, recap- ping, or needle removal must be accomplished through the use of a mechanical device or a one-handed scoop technique. Shearing or breaking of contaminated needles is prohibited. Immediately, or as soon as possible after use, contaminated reusable sharps (e.g., scalpels, dental knives) must be placed in appropriate containers until properly reprocessed. These containers must be [9; 10]:
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