_______________________________ Infection Control for Dental Professionals: The California Requirement
engineered sharps injury protections and needleless systems) isolate or remove the bloodborne pathogens hazard from the workplace. On the other hand, work practice controls reduce the likelihood of exposure by specifying the manner in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique). Engineering and work practice controls are intended to work synergistically to eliminate or minimize employee exposure. These controls must be examined and maintained or replaced on a regular basis to ensure their effectiveness. To maintain a safe workplace, employers must provide handwashing facilities that are readily accessible to employees. Contaminated needles and other contaminated sharps should not be bent, recapped, or removed unless the employer can demonstrate that there is no alternative or that such action is required by a specific procedure. Necessary bending, recap- ping, or needle removal must be accomplished through the use of a mechanical device or a one-handed scoop technique. Shearing or breaking of contaminated needles is prohibited. Immediately, or as soon as possible after use, contaminated reusable sharps (e.g., scalpels, dental knives) must be placed in appropriate containers until properly reprocessed. These containers must be [9; 10]: • Puncture resistant • Labeled or color-coded • Leak-proof on the sides and bottom • Maintained in accordance with OSHA requirements for reusable sharps • Designed so personnel are not required to reach by hand into the container • Located as close as possible to the point of use
therefore safe to touch with bare hands. The front of the face shield is considered contaminated [10; 18]. RESPIRATORY HYGIENE If dental clinics and offices comply with state regulations for screening of patients with ATDs, they are not required to comply with the new standards for prevention of transmis- sion of ATDs [4]. However, because no screening process is universally effective, dental personnel should be aware of the potential dangers associated with transmission of pathogens via the airborne and droplet routes. Respiratory droplets can transmit infection when they travel directly from the respiratory tract of the infected individual to the mucosal surfaces of the recipient, generally over short distances (i.e., 6 feet or less). Airborne transmission occurs with only a few organisms that can survive the drying of respiratory droplets. When the droplets evaporate, they leave behind drop- let nuclei, which are so small they remain suspended in the air and can travel over longer distances. Respiratory droplets and droplet nuclei are generated when an infected person coughs, sneezes, or talks during procedures. Facial masks or shields generally provide direct protection from droplet transmission. Some pathogens transmitted via the airborne route (e.g., TB) require the use of an N95 respirator or better (e.g., N99, N100) due to the small particle size [5]. Measures to contain respiratory secretions in symptomatic patients and accompanying adults may include [5; 18]: • Post signs to instruct patients with known or suspected respiratory infection to cover mouth and nose when sneezing or coughing, use and properly dispose of tissues, and wash hands after sneezing or coughing. • Provide tissues and no-touch receptacles. • Have handwashing stations or hand sanitizer available in waiting areas. • Offer masks to patients and accompanying adults. • Provide ample space in waiting areas, or consider placing symptomatic patients in a separate waiting area. ENGINEERING AND WORK PRACTICE CONTROLS (SHARPS SAFETY) Most percutaneous injuries among DHCP involve scalers, burs, needles, wires, and sharp instruments. In 2000, the Federal Needlestick Safety and Prevention Act authorized OSHA to revise its Bloodborne Pathogens Standard to require the use of safety-engineered sharp devices in healthcare settings [2; 3; 16]. Guidelines on the design, implementation, and evaluation of a sharps injury prevention program have been developed by the CDC, and outline engineering controls and work practice controls as primary methods to prevent such occurrences. Engineering controls, such as sharps disposal containers, self- sheathing needles, and safer medical devices (e.g., sharps with
SAFE INJECTION PRACTICES (ASEPTIC TECHNIQUE)
Safe injection practices are designed to prevent disease trans- mission within the healthcare setting. The absence of visible blood or other signs of contamination in a used syringe does not mean the item is free from potentially infectious agents. Bacteria and other microbes can be present without any visible evidence of contamination. All used injection supplies and materials should be considered potentially contaminated and should be discarded. To ensure safe injection practices, use aseptic technique throughout all aspects of injection preparation and admin- istration. Aseptic technique involves the handling, prepara- tion, and storage of medications in a manner that prevents microbial contamination. It also applies to the handling of all supplies used for injections and infusions. To avoid contami- nation, medications should be drawn in a clean medication preparation area. Any item that may have come in contact with blood or OPIM should be kept separate from medications. In addition, eating, drinking, smoking, applying cosmetics or
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