________________________________________________________ Infection Control for Dental Professionals
TUBERCULOSIS PREVENTION To prevent the transmission of Mycobacterium tuberculosis in dental care settings, infection-control policies should be developed based on the community TB risk assessment and reviewed annually. The policies should include appropriate screening for latent or active TB disease in dental care pro- viders, education about the risk for TB transmission, and provisions for detection and management of patients who have suspected or confirmed TB disease. The CDC recommends that all dental care providers be screened for TB upon hire, using either a tuberculin skin test or blood test [10]. Patients with symptoms of TB should be identified by screen- ing; dental treatment should be deferred until active TB has been ruled out or the patient is no longer infectious follow- ing treatment. The potentially active TB patient should be promptly referred to an appropriate medical setting for evalu- ation of possible infectiousness and should be kept in the dental care setting only long enough to arrange for referral. Standard Precautions are not sufficient to prevent transmis- sion of active TB [24]. A diagnosis of active respiratory TB should be considered for
If a sharps injury occurs, wash the exposed area with soap and water. Do not “milk” or squeeze the wound. There is no evidence that using antiseptics will reduce the risk of trans- mission for any bloodborne pathogens; however, the use of antiseptics is not contraindicated. In the event that the wound needs suturing, emergency treatment should be obtained. The risk of contracting HIV from this type of exposure is extremely rare. There are no documented cases of a dental healthcare professional contracting HIV from an occupational exposure. OSHA requires dental employers of an individual with an occupational exposure to a bloodborne pathogen to arrange a confidential medical evaluation and follow-up for any employee reporting an exposure incident [3]. An exposure incident is any eye, mouth, mucous membrane, nonintact skin, or other parenteral contact with blood or OPIM. Saliva in dental pro- cedures is treated as potentially infectious material. Following an exposure, the dental employer must refer the exposed employee to a licensed healthcare professional who can provide information and counseling and discuss how to prevent further spread of a potential infection. The exposed employee is entitled to appropriate follow-up and evaluation of any reported illness to determine if the symptoms may be related to HIV or hepatitis B or C infection [27]. Prompt response is necessary whenever an occupational expo- sure occurs. If possible, the patient should be interviewed to determine if any risk factors or bloodborne pathogens not previously disclosed are present. The patient may be tested along with the employee, if he or she agrees, in order to obtain the most information possible. Testing and postexposure pro- phylaxis may be conducted at an occupational injury clinic. All events leading up to and after the exposure should be documented in a written report [27]. Postexposure Prophylaxis Postexposure prophylaxis (PEP) involves the provision of medications to someone who has had a substantial exposure, usually to blood, in order to reduce the likelihood of infection. PEP is available for HIV and hepatitis B virus. Although there is no PEP recommended for hepatitis C virus, limited data indicate that antiviral therapy might be beneficial when started early in the course of infection [28]. For employees who have not received the hepatitis B vaccine series, the vaccine (and in some circumstances hepatitis B immunoglobulin) should be offered as soon as possible (within seven days) after the expo- sure incident. The effectiveness of hepatitis B immunoglobulin administered more than seven days after exposure is unknown. PEP has been the standard of care for healthcare providers with substantial occupational exposures since 1996 and must be provided in accordance with the recommendations of the U.S. Public Health Service [28].
any patient with the following symptoms: • Coughing for more than three weeks • Loss of appetite • Unexplained weight loss • Night sweats • Bloody sputum or hemoptysis • Hoarseness • Fever • Fatigue • Chest pain
A person with latent TB (positive skin test and no symptoms) can be treated in a dental office using standard infection control precautions [26]. This person has no symptoms and cannot transmit TB to others as there are no spores in his or her sputum. The American Dental Association recommends that all patients be asked about any history of TB or exposure to TB, including signs and symptoms and medical conditions that increase their risk for TB disease. The Health History Form, developed by the U.S. Department of Health and Human Services, can be used to ask these questions. If a patient with suspected or confirmed infectious TB disease requires urgent dental care, that care should be provided in a setting that meets the requirements for state, local, and employee standards for airborne infection isolation. Respi- ratory protection (with a fitted N95 disposable respirator) should be used while performing procedures on such patients. Standard surgical masks are not designed to protect against TB transmission [4; 26].
27
EliteLearning.com/Dental
Powered by FlippingBook