_______________________________ Infection Control for Dental Professionals: The California Requirement
• The descriptor “through the air transmission” should be used to characterize any transmission that involves a pathogen moving through the air or being suspended in the air. Two further descriptors can be used: ‒ Airborne transmission or inhalation: IRPs are expelled into the air and inhaled by another person. This can occur at short or long distances, dependent on various factors (e.g., airflow, humidity, temperature, ventilation). ‒ Direct deposition: IRPs are expelled into the air and directly deposited on the exposed mouth, nose, or eyes of another person. Due to the existing research and recommendations primarily using the terms and definitions of “aerosol” and “droplet,” these terms will continue to be used throughout this course, unless otherwise noted. The American Dental Association recommends that in addi- tion to using Universal and Standard Precautions, such as masks, gloves, and eye protection, Transmission-Based Precau- tions, including the proper sterilization of instruments and treatment of dental unit waterlines is necessary to reduce or eliminate this source of potentially contaminated dental aero- sols. Preprocedural rinsing with an antimicrobial mouthwash such as chlorhexidine is also recommended, although it is only effective for oral bacteria found in saliva and those adhering to mucous membranes. It does not penetrate subgingivally and likely has no effect on bacteria in the nasopharynx [5; 6]. Diseases known to spread by aerosols or droplet include: • TB • Pneumonic Yersinia pestis infection (plague) • Influenza • Legionellosis (Legionnaires disease) • Measles • Chickenpox • Disseminated shingles • Severe acute respiratory syndrome and coronavirus (SARS and COVID) Procedures or equipment aimed at eliminating the means of transmission include [5; 6]: • Universal preprocedural rinses • Dental dams for certain procedures • High-volume evacuator (HVE) at the treatment site (An HVE can only remove airborne contamination if it removes a large volume of air. A saliva ejector does not remove enough air to be classified as an HVE.) • High-efficiency particulate arresting and ultraviolet filters in the ventilation system
• Disposable PPE discarded after each patient (e.g., gloves, masks, gowns) • Cleaning, disinfection, and sterilization of equipment used by more than one patient • Environmental cleaning and disinfection, especially of high-touch surfaces
FOMITE TRANSMISSION Devices can transmit pathogens if they are contaminated with blood or bodily fluids or are shared without cleaning, disinfect- ing, and sterilizing between patients; these are classified as fomi- tes. Surgical instruments that are inadequately cleaned between patients or that have manufacturing defects that interfere with the effectiveness of reprocessing may transmit bacterial, fungal, and viral pathogens. Clothing, uniforms, laboratory coats, or gowns used as PPE may become contaminated with potential pathogens after care of a patient colonized or infected with an infectious agent [5; 6; 10]. WATER TRANSMISSION Dental water units and dental unit waterlines are both poten- tial sources of transmission and potential reservoirs. Routine cleaning and sterilization and adherence to the CDC’s rec- ommended procedures for treating dental unit waterlines have been shown to be effective in eliminating transmission of infectious organisms via these devices. Infections known to be caused by dental-related water transmission include Pseudomonas aeruginosa , Mycobacterium avium , and Legionella pneumophila [5; 7]. STANDARD PRECAUTIONS In 1986, California became the first state to pass a comprehen- sive bloodborne pathogen standard. The California standard provided a model for federal legislation, and in 1991, OSHA published its Bloodborne Pathogens Standard [3; 30]. Since then, regulatory and legislative activity has focused on imple- menting a hierarchy of prevention and control measures to improve infection control in healthcare settings. The gradual acceptance of various infection prevention stan- dards has changed the way we work in the provision of dental care. The DBC defines Standard Precautions as “a group of infection prevention practices that apply to all patients, regard- less of suspected or confirmed infection status, in any setting in which healthcare is delivered” [9]. The DBC mandates that Standard Precautions must be practiced in the care of all patients, and all body fluids, except sweat, are considered poten- tially infectious [9]. The use of Standard Precautions reduces the risk of infection to staff and patients and ensures that the right precautions are used with both known and unknown carriers of diseases due to bloodborne pathogens. Standard Precautions apply to contact with blood, intact or nonintact skin, mucous membranes, and all bodily fluids, secretions, and excretions (except sweat), regardless of whether they contain
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