Post-exposure management Post-exposure management is an essential component of a complete infection control program. Written post-exposure policies should describe the types of contact with blood or other potentially infectious materials that can place a DHCP at risk for infection and the procedures for promptly reporting and evaluating exposures, and identify a healthcare professional who is qualified to provide counseling and perform all medical evaluations and procedures including post-exposure prophylaxis when indicated. An exposure incident results when blood or other potentially infectious material contacts non-intact skin, tissue (through Program evaluation Routine evaluation of the infection prevention program, including evaluation of adherence to the infection prevention practices of all dental healthcare personnel, is recommended. The success of a program depends upon developing standard
parenteral contact), or the eye, mouth, or other mucous membrane. If an exposure incident occurs, first aid should first be administered as necessary. The incident should be reported to the infection control coordinator, who should document the incident on appropriate forms and then refer the exposed DHCP to a qualified healthcare professional for immediate and appropriate care. Details of the occupational exposure should be reported in compliance with OSHA Bloodborne Pathogens Standard and evaluated individually, and the risk for infection and need for follow-up care should be evaluated. Confidentiality of the exposed person must be ensured.
operating procedures, evaluating practices, and providing feedback to dental personnel, documenting adverse outcomes (occupational exposures, etc.), and monitoring healthcare- associated infections in patients.
STANDARD PRECAUTIONS
Standard Precautions are the minimum infection control practices that apply to all patient care regardless of the suspected or confirmed infection status of the patient in any healthcare setting (CDC, 2016). Standard precautions are designed to protect the dental hygienist (and other dental personnel) and prevent the spread of infections among patients. The elements of Standard Precautions include the following: 1. Hand hygiene. Hand hygiene Routine hand hygiene is considered the single most effective measure for reducing the risk of transmitting infections to patients and DHCPs. Noncompliance with standard hand hygiene procedures is strongly linked to the increased risk of healthcare-associated infections, spread of resistant organisms, and outbreaks of infectious diseases (ADA Center for Professional Success, 2020b). Throughout the workday, dental hygienists and other personnel typically visit several rooms within the dental office. If proper hand hygiene is not performed, hands become a mode of transmission for infection. Newly washed hands are not a substitute for gloves, and it is not sufficient to wash hands only when they are visibly soiled. All clinical dental health personnel should perform hand hygiene procedures at the following times: ● When first arriving to work in the morning. ● When hands are visibly soiled. ● After barehanded touching of contaminated objects or surfaces. ● Before and after treating each patient. ● After glove removal. After the DHCP removes gloves that have been torn, cut, or punctured and prior to regloving, the DHCP may use one of several available hand hygiene agents, depending on the circumstances. The indications for the use of plain soap, antimicrobial soap, alcohol hand rubs, and surgical hand scrub, or soap products are described below: ● Use plain soap: ○ If hands are not visibly soiled. ○ Before donning gloves and after glove removal. ○ Before eating. ○ After bathroom use. ● Use antimicrobial soap: ○ If hands are visibly soiled or contaminated with blood or other body fluids. ○ Before donning gloves and after glove removal. ○ Before eating. ○ After bathroom use.
2. Use of personal protective equipment. 3. Respiratory hygiene/cough etiquette.*
4. Sharps safety (engineering and work practice controls). 5. Safe injection practices (i.e., aseptic technique for parenteral medications).* 6. The delivery of sterile instruments and devices. 7. Clean and disinfected environmental surfaces. *Note : These elements of Standard Precautions are new since the publication of the 2003 Guidelines . ○ If hands are not visibly soiled. ○ Before donning gloves, and after glove removal. ● Use a surgical hand scrub or soap antisepsis: ○ Before surgical procedures. Although proper hand-washing techniques may appear to be simply “common sense,” specific steps are required for hand washing in the healthcare setting: 1. Wet hands thoroughly with warm water. Avoid temperature extremes; repeated exposure to hot or cold water may increase the risk of dermatitis. 2. Rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. 3. Rinse hands completely. 4. Dry hands thoroughly with a disposable towel. 5. Use the towel to turn off the faucet (if it is manual) to prevent recontaminating the hands. ● Use an alcohol hand rub: Proper alcohol hand rub technique requires these steps: 1. Use alcohol products that are U.S. Food and Drug Administration (FDA) cleared for use in healthcare settings. 2. Apply hand rub to dry hands in the correct amount specified by the manufacturer. 3. Rub the hands together, covering all surfaces of the hands and fingers, for at least 20 seconds until the hands are dry. (If the hands are dry after 10 to 15 seconds of usage, it is likely that too little product was used.) Several common practices that can potentially reduce the effectiveness of hand hygiene include the length of the individual’s fingernails, presence of jewelry, and use of certain products. Artificial and long nails make donning and removing gloves more difficult. They also make glove tears more likely. Additionally, bacterial counts are higher on hands with long or artificial nails and nails with chipped polish (Wann, 2017). Thus, it is recommended to keep fingernails unpolished and short with rounded, filed edges. Rings may also compromise the fit and integrity of gloves and increase bacterial counts on hands. Thus, wearing hand and arm jewelry while providing routine
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