________________________________________________________ Infection Control for Dental Professionals
Medical Waste Management Federal, state, and local guidelines and regulations specify the categories of medical waste subject to regulation and outline the requirements associated with treatment and disposal.
Regarding irrigation, if a surgical procedure involves soft tissue or bone, the use of sterile coolants or irrigants should be used, delivered using a sterile delivery system [9; 10]. An example of the importance of water quality maintenance is the 2016 outbreak of mycobacterial infection from a South- ern California dental clinic that led to the hospitalization of more than 60 children, the cause of which was determined to be bacteria introduced through water during pulpotomies [29]. In response, in 2019, California introduced an infection control standard that requires that water or other methods for irrigation must be sterile or contain recognized disinfecting or antibacterial properties when performing procedures on exposed dental pulp; chlorhexidine, BioPure MTAD, and sodium hypochlorite are considered appropriate oral irrigants in this standard [29]. Dental professionals should refer to their state, local, and employer policies regarding dental unit waterlines and irrigation standards.
Regulated medical waste is defined as [10]: • Liquid or semi-liquid blood or OPIM
• Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed • Items that are caked with dried blood or OPIM capable of releasing these materials during handling • Contaminated sharps (e.g., needles, burs, scalpel blades, endodontic files) • Pathologic and microbiologic wastes containing blood or OPIM Regulated medical waste accounts for only 9% to 15% of total waste in hospitals and 1% to 2% of total waste in dental offices [10]. Examples of regulated waste found in dental practice set- tings are solid waste soaked or saturated with blood or saliva (e.g., gauze saturated with blood after surgery), extracted teeth, surgically removed hard and soft tissues, and contaminated sharp items, such as needles, scalpel blades, and wires [10]. General medical waste, including used gloves, masks, gowns, and lightly soiled gauze or cotton rolls, may be disposed of with ordinary waste. Regulated medical waste requires careful disposal and con- tainment before collection and consolidation for treatment. A single, leak-resistant biohazard bag is usually adequate for containment of regulated medical wastes, provided the bag is sturdy and the waste can be discarded without contaminat- ing the bag’s exterior. Contamination or puncturing of the bag requires placement into a second biohazard bag. All bags should be securely closed for disposal. Medical waste requiring storage should be kept in labeled, leak-proof, puncture-resistant containers under conditions that minimize or prevent foul odors. The storage area should be well-ventilated and inaccessible to pests. Any facility that generates regulated medical waste should have a regulated medical waste management plan to ensure health and envi- ronmental safety in accordance with federal, state, and local regulations [10; 21]. TRANSMISSION-BASED PRECAUTIONS As discussed, Transmission-Based Precautions are used in addition to Standard Precautions for patients that require additional precautions to prevent infection transmission. The three categories of Transmission-Based Precautions are Con- tact, Droplet, and Airborne Precautions; these categories may overlap, and more than one category may be used at a time [25].
CLEANING AND DISINFECTION OF ENVIRONMENTAL SURFACES
As discussed, contaminated surfaces and objects can serve as the means of transmission for potential pathogens. The trans- fer of a micro-organism from an environmental surface to a patient is largely via hand contact with the surface. Although hand hygiene is important to minimize the impact of this transfer, cleaning and disinfecting environmental surfaces is fundamental in reducing their potential contribution to the incidence of infections [10]. All work areas, including contact surfaces and barriers, must be maintained in a clean and sanitary condition. Employers are required to determine and implement a written schedule for cleaning and disinfection based on the location, type of surface to be cleaned, type of soil present, and tasks or pro- cedures being performed. All equipment and environmental and working surfaces must be properly cleaned and disinfected after contact with blood or OPIM. If non-critical items or surfaces likely to be contaminated are manufactured in a manner preventing cleaning and disinfec- tion, they should be protected with disposable impervious barriers. Disposable barriers should be changed when vis- ibly soiled or damaged and between patients. Products used to clean items or surfaces prior to disinfection procedures should be clearly labeled and follow all material safety data sheet (MSDS) handling and storage instructions. Clean and disinfect all clinical contact surfaces that are not protected by impervious barriers using an EPA-registered, hospital grade low- to intermediate-level disinfectant after each patient. The low-level disinfectants used must be labeled effective against hepatitis B virus and HIV. Use disinfectants in accordance with the manufacturer’s instructions. Clean all housekeeping surfaces (e.g., floors, walls, sinks) with a detergent and water or an EPA-registered, hospital-grade disinfectant. Chemical- resistant utility gloves should be worn when handling hazard- ous chemicals [9; 10].
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