The rates of seroconversions for bloodborne diseases following exposures is very low. On average, the risk after a percutaneous injury involving blood from a person infected with a bloodborne disease is 0.03% for HIV, 1.8% for HCV, and between 6% and 30% for HBV if the worker is unvaccinated (CDC, 2017). When new clinical employees are hired, they should receive training regarding the transmission of bloodborne pathogens, the wearing of PPE as protection, the tasks that place them at risk, and information on how to manage an occupational exposure. All training should be documented in the written protocol. Because HBV is the most easily transmitted of all the bloodborne pathogens (CDC, 2017; NIOSH, 2016), employees with occupational exposure to blood or OPIM should be offered HBV vaccination (Kuhar, et al., 2014).
Figure 2: Post-Exposure Management, Part 2
Note . Adapted from “Guidelines for Infection Control in Dental Settings – 2003,” by the Centers for Disease Control and Prevention, 2003, MMWR Recommendations and Reports, 52(RR-17), 1-68; and “Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis,” by D. T. Kuhar, D. K. Henderson, K. A. Struble, W. Heneine, V. Thomas, L. W. Cheever, … A. L. Panlilio, 2014, Infection Control and Hospital Epidemiology, 34 (9), 875-892.
Figure 3: Eye Exposures
Is this an acceptable method? The OSHA Regulations state “a mechanism for flushing the eyes must be available to operators.” ● It’s hard to control the forces of the water with this method.
● Eyewash stations or sterile water in flush bottles are safer options. ● Irrigate the mucous membranes with sterile normal saline or water. Treat occupational exposures as a medical emergency. Note . Adapted from “Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C: Emergency Needlestick Information,” by the National Institute for Occupational Safety and Health, 2014. Retrieved from http://www.cdc.gov/niosh/topics/bbp/emergnedl.html STERILIZATION AND DISINFECTION
At the completion of the dental procedure, operators must safely process their reusable instruments and devices. Cleaning must precede any disinfection or sterilization process. Products and devices used to clean items or surfaces prior to disinfection or sterilization must be used in accordance with the manufacturer’s instructions. Follow the manufacturer’s instructions for cleaning solutions safe to use with the device, cycle times, and frequency of changing solutions. Contaminated instruments should not be wiped by hand prior to mechanical cleaning unless the item cannot be immersed, as is the case with a handpiece. Items that would be damaged by mechanical cleaning should be carefully cleaned by hand, wearing heavy-duty utility gloves, eye protection, and other appropriate PPE. Contaminated instruments should be thoroughly cleaned prior to sterilization, preferably using a mechanical device intended for that purpose, such as an ultrasonic cleaner or instrument washer/disinfector. Critical and semi-critical instruments Instruments, items, and devices are categorized as critical, semi-critical, and non-critical. Critical items are all instruments, devices, and other items used to penetrate soft tissue or bone. Semi-critical items do not penetrate bone or soft tissue, but contact oral mucous membranes, nonintact skin, or OPIM. Non- critical items are instruments, devices, equipment, and surfaces that come in contact with soil, debris, saliva, blood, OPIM, and intact skin, but not oral mucous membranes (California Code of Regulations, 2011). Examples of non-critical items include stethoscopes and blood pressure cuffs.
Cycles on ultrasonic and instrument washers should not be interrupted. If it is necessary to interrupt a cycle or add an item after a cycle has been initiated, the entire process should be restarted. Heavy-duty utility gloves should always be worn when working with contaminated instruments. After removal from the ultrasonic solution, instruments are rinsed, inspected (any additional debris may be removed at this point), lubricated, and packaged or wrapped for sterilization. Section 1005 states that sterilization “is a validated process used to render a product free of all forms of viable microorganisms” (California Code of Regulations, 2011). The limiting requirement is the inactivation of high numbers of bacterial and mycotic endospores (often simply referred to as spores), which are produced asexually and tougher than ordinary spores (Cornell College of Agriculture and Life Sciences, 2022; Yoo, 2018). Critical items confer a high risk for infection if they are contaminated by any microorganism. Section 1005 states that critical instruments, items, and devices shall be discarded or pre-cleaned, packaged or wrapped, and sterilized after each use. Methods of sterilization shall include steam under pressure (autoclaving), chemical vapor, and dry heat. If a critical item is heat-sensitive, it shall, at minimum, be processed with high-level disinfection and packaged or wrapped upon completion of the disinfection process. These instruments, items, and devices shall remain sealed and stored in a manner so as to prevent contamination and shall be labeled with the date of sterilization and the specific sterilizer used if more than one sterilizer is
Page 28
EliteLearning.com/Dental
Powered by FlippingBook