Infection Control for Dental Professionals: The California Requirement _______________________________
• When your hands feel or look dirty • After contact with contaminated things or environments, such as charts • After handling used equipment or linen • After using the bathroom • Before contact with any portal of entry, your patient’s or your own • Before and after eating
blood. A central tenet of Standard Precautions is to consider all patients to be potentially infected with a bloodborne patho- gen. Saliva has always been considered a potentially infectious material in dental infection control; thus, no operational difference exists in clinical dental practice between Universal Precautions and Standard Precautions. For organisms other than bloodborne pathogens, early identification and prompt isolation are critical. As noted, Standard Precautions are the minimum infection prevention practices that apply to all patient care, regardless of health or dental care setting, and include [5]:
A number of conditions restrict DHCP from participating in direct patient care. These include weeping dermatitis, exuda- tive lesions, or any hand condition that increases the risk of disease transmission [9]. Good handwashing is difficult to practice, is rarely known or taught, and is one of the single most effective ways to prevent transmission of many diseases, including influenza. Everyone knows to wash their hands before eating and after using the restroom. However, few do little more than remove obvious dirt. Good handwashing involves removing the skin oils where organisms can remain even when the hands look clean. A quick pass under the water faucet and fast dry with a towel may remove visible dirt, but the oils and organisms remain. To effectively remove the oils and organisms, the process should take at least 20 seconds, or the amount of time it takes to sing “Twinkle, Twinkle Little Star.” The hands should be soaped and rubbed vigorously for 15 seconds to create a good lather and to assure that all parts of each hand are soaped and rubbed well. Then, the hands should be rinsed thoroughly and dried, preferably with a paper towel. The towel should be used to turn off the water faucet and then properly thrown away. However, 20 seconds is a long time in the busy life of a healthcare provider, and this 20 seconds has been identified as a major barrier to handwashing, particularly among those who consider themselves “too busy” to wash their hands. If there is no visible dirt or contamination, a waterless hand sani- tizer with at least 60% alcohol can be used between patients. However, nothing is as good as washing well with soap and water. Further, some organisms are not eliminated through the use of hand sanitizers alone (e.g., Clostridioides difficile spores). Hands should be thoroughly dried before donning gloves and washed again immediately after glove removal [9]. Some mistakenly think that hot water must be used to kill the organisms. Water hot enough to kill organisms would be too hot to touch. Warm water softens oils but mainly adds to comfort and encourages better washing technique (i.e., longer duration). Careful attention to handwashing and cleansing may result in chapped skin, so the dental professional must find effective lotions to care for his/her hands [14; 17]. Certain soaps contain stronger antiseptic compounds, such as chlorhexidine, and these soaps may be considered in cases in which exposure to potentially infectious material is likely. Antiseptic soaps or surgical preparation liquids have been found more effective than plain soap in removing bacteria
• Utilization of effective hand hygiene • Use of PPE (e.g., gloves, masks, eyewear) • Respiratory hygiene, including cough/sneeze etiquette • Sharps safety (engineering and work practice controls) • Safe injection practices (aseptic technique) • Cleaning, sterilization, and disinfection of instruments and devices • Cleaning and disinfection of environmental surfaces
HAND HYGIENE Despite the simplicity and effectiveness of hand hygiene in preventing the spread of infectious disease, adherence to hand hygiene practice remains low. Adherence varies among profes- sional categories of healthcare workers but is usually estimated at less than 50%. Healthcare providers may be required to clean their hands as many as 100 times in a 12-hour shift, depending on the number of patients and intensity of care [14; 17]. For dental healthcare workers, strict adherence to proper hand hygiene is the most important prevention strategy to protect both the patient and the worker. In one study, adherence rates to hand hygiene among postgraduate-year dentists found that overall handwashing compliance rate was 34.7%, with higher rates of compliance noted in oral surgery services (92.8%) than during work in general clinical practice (34.2%) [13]. The World Health Organization has designed the guidelines 5 Moments for Hand Hygiene as a reminder of when proper hand hygiene should be completed [11]: 1. Before touching a patient 2. Before a procedure 3. After a procedure or exposure to body fluids 4. After touching a patient 5. After touching a patient’s surroundings In general, perform hand hygiene [14]: • After contact with any bodily fluids, including your own • Before any non-invasive or invasive procedure • Each time you remove your gloves
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