________________________________________________________ Infection Control for Dental Professionals
(e.g., non-needle or needle devices with built-in safety features or mechanisms that effectively reduce the risk of an exposure incident). Do not disable or circumvent the safety feature on devices [5]. Cases of bloodborne pathogen transmission as a result of improper injection practices have common themes. Often, aseptic technique and Standard Precautions were not care- fully followed. Infection control programs may be lacking or responsibilities unclear. In several instances, failure to recognize an infection control breach has led to prolonged transmission and a growing number of infected patients. In all cases, investigations were time-consuming and costly and required the notification, testing, and counseling of hundreds and sometimes thousands of patients [5; 16]. STERILIZATION AND DISINFECTION OF PATIENT- CARE ITEMS AND DEVICES Application of accepted infection control principles helps maintain a safe environment for both patients and dental care workers. This includes proper use of Standard Precautions and application of approved techniques for cleaning, disin- fection, sterilization, and reprocessing of dental equipment. Healthcare policies must identify—primarily on the basis of an item’s intended use—whether cleaning and disinfection or sterilization is indicated ( Table 2 ) [9; 10; 21]. Cleaning is defined as the removal of visible soil (organic and inorganic material) debris and OPIM from objects and surfaces; normally, it is accomplished manually or mechanically using water with detergents or enzymatic products [9]. Cleaning must precede any disinfection or sterilization process. Decontamination reduces the number of pathogenic micro- organisms on objects, usually with a 0.5% chlorine solution [21]. Thorough cleaning and decontamination are essential before high-level disinfection and sterilization because inor- ganic and organic materials that remain on the surfaces of instruments interfere with the effectiveness of these processes. Disinfection is a process that eliminates many or all patho- genic micro-organisms, except bacterial spores, on inanimate objects. In healthcare settings, objects are usually disinfected using liquid chemicals or wet pasteurization (i.e., the use of hot water to destroy micro-organisms). There are three levels of disinfection [9; 10]: • High-level disinfection: Used to disinfect patient-care equipment that touches mucous membranes or blood. • Intermediate-level disinfection: Used mainly to disinfect items that have contact with intact skin, but is appropriate for certain semicritical items (e.g., chair arms). • Low-level disinfection: Used to disinfect the healthcare environment or items that touch intact skin.
• Puncture resistant • Labeled or color-coded • Leak-proof on the sides and bottom • Maintained in accordance with OSHA requirements for reusable sharps • Designed so personnel are not required to reach by hand into the container • Located as close as possible to the point of use
SAFE INJECTION PRACTICES (ASEPTIC TECHNIQUE)
Safe injection practices are designed to prevent disease trans- mission within the healthcare setting. The absence of visible blood or other signs of contamination in a used syringe does not mean the item is free from potentially infectious agents. Bacteria and other microbes can be present without any visible evidence of contamination. All used injection supplies and materials should be considered potentially contaminated and should be discarded. To ensure safe injection practices, use aseptic technique throughout all aspects of injection preparation and admin- istration. Aseptic technique involves the handling, prepara- tion, and storage of medications in a manner that prevents microbial contamination. It also applies to the handling of all supplies used for injections and infusions. To avoid contami- nation, medications should be drawn in a clean medication preparation area. Any item that may have come in contact with blood or OPIM should be kept separate from medications. In addition, eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure. Food and drink should not be kept in refrigerators, freezers, shelves, or cabinets or on countertops where blood or OPIM is present. A new, sterile syringe and needle should be used to draw up medications while preventing contact between the injection materials and the nonsterile environment. Practice proper hand hygiene before handling medications, and discard medi- cation vials upon expiration or any time there are concerns regarding the sterility of the medication [5]. Never leave a needle or other device inserted into a vial or bottle for multiple uses. This provides a direct route for micro-organisms to enter the vial and contaminate the fluid. Medications should never be combined between vials or administered from the same syringe to more than one patient, even if the needle is changed. Multidose vials should be used on a single patient whenever possible and should never enter the immediate patient treatment area [5]. Dental professionals should follow proper technique when using and handling needles, cannulae, and syringes. Whenever possible, use sharps with engineered sharps injury protections
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