Infection Control for Dental Professionals: The California Requirement _______________________________
lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure. Food and drink should not be kept in refrigerators, freezers, shelves, or cabinets or on countertops where blood or OPIM is present. A new, sterile syringe and needle should be used to draw up medications while preventing contact between the injection materials and the nonsterile environment. Practice proper hand hygiene before handling medications, and discard medi- cation vials upon expiration or any time there are concerns regarding the sterility of the medication [5]. Never leave a needle or other device inserted into a vial or bottle for multiple uses. This provides a direct route for micro-organisms to enter the vial and contaminate the fluid. Medications should never be combined between vials or administered from the same syringe to more than one patient, even if the needle is changed. Multidose vials should be used on a single patient whenever possible and should never enter the immediate patient treatment area [5]. Dental personnel should follow proper technique when using and handling needles, cannulae, and syringes. Whenever pos- sible, use sharps with engineered sharps injury protections (e.g., non-needle or needle devices with built-in safety features or mechanisms that effectively reduce the risk of an exposure incident). Do not disable or circumvent the safety feature on devices [5]. Cases of bloodborne pathogen transmission as a result of improper injection practices have common themes. Often, aseptic technique and Standard Precautions were not care- fully followed. Infection control programs may be lacking or responsibilities unclear. In several instances, failure to recognize an infection control breach has led to prolonged transmission and a growing number of infected patients. In all cases, investigations were time-consuming and costly and required the notification, testing, and counseling of hundreds and sometimes thousands of patients [5; 16].
Decontamination reduces the number of pathogenic micro- organisms on objects, usually with a 0.5% chlorine solution [21]. Thorough cleaning and decontamination are essential before high-level disinfection and sterilization because inor- ganic and organic materials that remain on the surfaces of instruments interfere with the effectiveness of these processes. Disinfection is a process that eliminates many or all patho- genic micro-organisms, except bacterial spores, on inanimate objects. In healthcare settings, objects are usually disinfected using liquid chemicals or wet pasteurization (i.e., the use of hot water to destroy micro-organisms). There are three levels of disinfection [9; 10]: • High-level disinfection: Used to disinfect patient- care equipment that touches mucous membranes or blood. • Intermediate-level disinfection: Used mainly to disinfect items that have contact with intact skin, but is appropriate for certain semicritical items (e.g., chair arms). • Low-level disinfection: Used to disinfect the healthcare environment or items that touch intact skin. Surface disinfection is an important part of environmental cleaning. Most bacteria and mycobacteria (e.g., TB) survive for several months on dry surfaces [20]. Respiratory viruses, such as coxsackie or influenza, can persist on surfaces for a few days. Hepatitis viruses and HIV can persist for more than one week, and herpes viruses have been shown to persist from only a few hours up to seven days [20]. All surfaces in patient care areas should be cleaned then disinfected according to the manufacturer’s instructions and allowed to dry completely. Sterilization is a process that destroys or eliminates all forms of microbial life and is carried out in healthcare facilities by physi- cal or chemical methods. Sterile and nonsterile are absolute concepts. If a sterile item is touched by anything nonsterile, the formerly sterile item is contaminated. The sterilization area should be separate from any patient care or staff break areas. The sterilization section of the processing area should include the sterilizers and related supplies, with adequate space for loading, unloading, and cool down [10]. The area can also include incubators for analyzing spore tests and enclosed storage for sterile items and single-use items. Manu- facturer and local building code specifications will determine placement and room ventilation requirements. According to the CDC guideline, heat-tolerant dental instru- ments usually are sterilized by steam under pressure (auto- claving), dry heat, or unsaturated chemical vapor [10]. All sterilization should be performed by using medical sterilization equipment cleared by the FDA. The sterilization times, tem- peratures, and other operating parameters recommended by the manufacturer of the equipment used, as well as instructions
STERILIZATION AND DISINFECTION OF PATIENT-CARE ITEMS AND DEVICES
Application of accepted infection control principles helps maintain a safe environment for both patients and dental care workers. This includes proper use of Standard Precautions and application of approved techniques for cleaning, disin- fection, sterilization, and reprocessing of dental equipment. Healthcare policies must identify—primarily on the basis of an item’s intended use—whether cleaning and disinfection or sterilization is indicated ( Table 2 ) [9; 10; 21]. Cleaning is defined as the removal of visible soil (organic and inorganic material) debris and OPIM from objects and surfaces; normally, it is accomplished manually or mechanically using water with detergents or enzymatic products [9]. Cleaning must precede any disinfection or sterilization process.
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