Infection Control Update

Dental Branch
2006 Annual Clinic Update

Richard D. Bebermeyer, DDS

Restorative Dentistry & Biomaterials
UT Dental Branch Resources:
Staff Support in Central Sterilization &
Dispensaries
Appropriate Supplies
Clinic Manual:
– http://www.db.uth.tmc.edu/clinic-
pat/Documents/Clinic_Manual.pdf
Why Is Infection Control Important
in Dentistry?

Both patients and dental health care

personnel (DHCP) can be exposed to
pathogens
Contact with blood, oral and respiratory
secretions, and contaminated equipment
occurs
Proper procedures can prevent
transmission of infections among patients
and DHCP
Modes of Transmission
Direct contact with blood or body
fluids
Indirect contact with a contaminated
instrument or surface
Contact of mucosa of the eyes,
nose, or mouth with droplets or
spatter
Inhalation of airborne
microorganisms
Exposure To Blood and Body Fluids

Laceration

Needle stick

Puncture with dental bur

Splash of blood or saliva to mucus

membranes of mouth, nose or eyes
 Chain of Infection

Pathogen

Susceptible Host Source

Entry Mode
 Potential Routes of
Transmission of Bloodborne
Pathogens
Patient DHCP

DHCP Patient

Patient Patient
 Agencies That Impact Dental
Infection Control
Rules and regulations comply with
guidelines established by:
– Centers for Disease Control (CDC)
– Occupational Safety and Health
Administration (OSHA)
– American Dental Association (ADA)
– Texas Department of Health (TDH)
 Centers for Disease Control
(CDC)
Represented by a group of professionals
who make recommendations regarding
infection control, patient and worker safety
Guidelines for Infection Control in Dental
Health-Care Settings – 2003
Power Point Dental Infection Control
Presentation – 2005
http://www.cdc.gov/oralhealth/infectioncontrol
Occupational Safety and Health
Administration (OSHA)
True regulatory organization

Take the CDC recommendations and

develop regulations

Enforce the regulations

 American Dental Association
(ADA)
Provides many supportive services for
dental professionals

Recommendations for Dental Infection

Control
 Texas Department of Health
(TDH)
TNRCC –Texas Natural Resource
Conservation Commission - A component
of the TDH

Regulates the handling and disposal of

medical waste
 Exposure Control Plan
(Part II – Clinic Manual)
Written plan to eliminate exposure to blood
and body fluids

– Exposure determination

– Plan must be accessible

– Compliance
 Compliance - Standard
Precautions
Standard Precautions – A standard of care
designed to protect health care providers
and patients from pathogens that can
spread by blood and other body fluids.

ALL BLOOD AND BODY FLUIDS ARE

CONSIDERED TO BE INFECTIOUS.
 Compliance –Work Practice
Controls - PPE
Consider that all patients are infectious
Wear personal protective equipment
– Gowns
– Gloves
– Masks
– Protective Eyewear
 Clinic Gown

The official protective gown for

use in all Dental Branch clinics is
the Clinic Gown
–white for faculty
–blue for students
 Laboratory Gown
Working in a clinical
dental laboratory
laboratory (yellow)
gown should be
used.
 GLOVES

Vinyl, nitrile, or latex

examination gloves
must be worn when
treating nonsurgical
patients.
 Gloves

Sterile disposable
gloves must be
worn during all
surgical
procedures.
 Utility Gloves
•Each student must have a
pair of heavy-duty utility
gloves for break down after
patient treatment

•Must be washed with

antimicrobial soap,
rinsed and dried

•Stored in plastic bag in

locker
 MASKS

Masks must be worn to protect:

–Face

–Oral and nasal mucosa

 Masks

Masks must be changed if they

become damp.
The mask must be changed for
each new patient, except for short
exams
If a face shield is worn it must be
worn at the same time as a
surgical mask.
 Using Masks in Other
Situations.
A laser plume
face mask must
be worn during
a laser or
electro surgery
procedure.
 PROTECTIVE EYEWEAR
Must be worn to protect from aerosol
and spatter
Regular eyewear must have side
shields
Side shields must be securely
attached to the eyewear frame
abutting the lenses and free of vents
or openings
 Compliance – Work Practice
Controls – Sharps
Used needles,
blades, burs and
anesthetic
cartridges are to
be discarded in
sharps
containers
 Compliance – Work Practice
Controls – Sharps
Recap
anesthetic
needles by
using the
needle
recapper
 Compliance – Work Practice
Controls
Use the one
handed scoop
technique to
recap if a
recapper is not
available.
 Compliance – Work Practice
Controls - Sharps
USE OF SHARP INSTRUMENTS
– To prevent accidental exposure injuries
related to trimming wax with a red handled
lab knife at chair-side, DISINFECT when
possible and
– BE EXTREMELY CAREFUL WHEN USING
THE RED HANDLED LAB KNIFE
– Policy 2.39
 SHARPS
Handle carefully
Do not recap with
two hands
Discard in Sharps
container
Do not bend or
break needles
Report injuries
 Compliance - Work Practice
Controls – Food and Drinks
Eating and
drinking
prohibited in all
clinical areas
 Compliance – Work Practice
Controls
Hand Hygiene

Jewelry

Hair
 Hand Washing

15 second handwash
–Include the thumbs, fingertips
and areas between fingers and
around the fingernails
 Fingernails
Fingernails must be short in order to
prevent collections of microbes and
tears in gloves.
Colored nail polish is prohibited
– may obscure soil under the nails.
False fingernails are prohibited.
 HAIR

Hair should be short and well-

managed.
Long hair should be pulled back or
completely covered with a surgical cap
to minimize the possibility of
contamination.
Beards, mustaches, or other facial hair
must be neatly trimmed to fit under the
mask.
Compliance - Housekeeping
Housekeeping
– Worksite must be maintained in a clean and
sanitary condition
– Equipment and work surfaces must be
cleaned and decontaminated after contact
with blood and other infectious materials
– Protective coverings used to cover equipment
and work surfaces
Housekeeping Surfaces
 Compliance - Cleaning Clinical
Contact Surfaces
Risk of transmitting infections
greater than for housekeeping
surfaces

Clean and disinfect surfaces

Apply barriers
Clinical Contact Surfaces
 Surface Covers

Handles,
handpieces or
similar surfaces that
may be
contaminated by
blood or saliva must
be wrapped with
clear plastic wrap.
Compliance – Regulated Waste
Contaminated waste
disposal

Sharps disposal

In compliance with
OSHA and TDH
 Disposal of Contaminated
Waste
Blood or saliva
saturated items must
be placed in small
plastic biohazard bags
at chairside.
Small biohazard bags
must be disposed of
at the dispensary.
 Compliance – Training
Requirements
All health care workers with potential for
exposure to blood and body fluids must
receive training
– At time of initial assignment
– Annually
 Compliance – Hepatitis B
Vaccination
All health care workers must have
vaccination

Available at no cost to employees

Employees can decline vaccination, but

must sign a declination statement
Compliance – Exposure Incident
REMEMBER!

If you have received a puncture or

laceration injury from a contaminated
needle or instrument

REMOVE ANESTHETIC SYRINGE OR

INSTRUMENT FROM TRAY – DO NOT
REUSE INSTRUMENT
Compliance – Exposure Incident
REMEMBER!

STOP THE PROCEDURE

DO NOT DISMISS THE PATIENT

REPORT THE INCIDENT TO THE

NEAREST DISPENSARY
DO NOT DISMISS THE PATIENT
Compliance – Exposure Incidents
Confidential medical evaluation and follow-up

– Confidential medical evaluation and follow up

– UT Student or Employee Health

– Testing of source patient for STDs HIV and

Hepatitis infectivity
Compliance – Record Keeping
Medical records related to exposure
incidents must be retained for duration of
employment plus 30 years.

Training records must be maintained for

three years
 Tuberculosis
The bacteria are carried in
airborne infective droplets
Generated when persons
with pulmonary TB sneeze,
cough, speak or sing
Infective particles can stay
suspended in the air for hours
 Assessing Patient Risk for
Tuberculosis
Routinely ask all patients

– whether they have a history of TB disease

– whether they have symptoms suggestive of

TB
 Symptoms of Tuberculosis
Cough
Chest pain
Coughing up blood
Weakness
Fever and/or night sweats
Weight loss
Patients With History or Symptoms
of Undiagnosed TB
Should be referred promptly for medical
evaluation of possible infection

Should not remain in the dental facility any

longer than required to arrange a referral

Should wear surgical mask while in the

dental facility
 Patients With History of or
Symptoms of Undiagnosed TB
Should have elective dental treatment
deferred until a physician confirms that the
patient does not have infectious TB

If diagnosed as having active TB, elective

dental treatment should be deferred until
no longer infectious.
 Patient With Active TB

Should have urgent dental care

provided in areas that can provide TB
isolation.
 2005 Total Injuries = 49
2006 Total Injuries = 46
Total 2005 2006
Red Handled Lab Knife 26% 15%
Needlestick 19% 9%
Instrument 19% 26%
Bur 10% 15%
Splash to Eye 0% 4%
Falls 10% 13%
Suture Needle 2% 2%
Disc (laceration) 2% 0%
Miscellaneous 12% 15%
 2005 Exposure Injuries = 26
2006 Exposure Injuries = 15
TOTAL 2005 2006
Red Handled Lab Knife 23% 7%
Needlestick 30% 27%
Instrument 26% 47%
Bur 15% 13%
Splash to Eye 0% 0%
Falls 0% 0%
Suture Needle 4% 7%
Disc (Laceration) 0% 0%
Miscellaneous 0% 0%
PREVENTION OF INJURIES

Remove burs from handpiece

immediately after completion of dental
procedure

Recap anesthetic needles

 Prevention of Injuries
Restrict use of fingers in tissue
retraction or palpation during suturing
or administration of anesthesia

Avoid uncontrolled movements of

dental instruments. THINK BEFORE
MOVING AN INSTRUMENT.
Infection Control
Monitoring
Who Conducts I.C. Monitoring
Clinical Affairs Committee Members -
Undergraduate Clinical Bays (dental and
dental hygiene)
Clinical Staff - Undergraduate Clinics such
as Assessment, Urgent Care, Oral
Surgery, OMP and Radiology
Faculty and clinical staff - Graduate
Program Clinics
 Factors Monitored
Disinfection before and after treatment
Application and removal of barriers
Contaminated items in clean areas
Personal protective attire
Biohazard bag in place when applicable
Presence of food or drink
Extraneous items in operatory
Location of patient record.
 Monitoring Results
2005 and 2006
Total # Total # Total # Total #
Surveyed Infractions Surveyed Infractions
2005 2005 2006 2006

Pre
Doctoral 195 77 231 81

Dental
Hygiene 35 7 16 1

Post
Doctoral 95 23 117 25
Dental Unit Waterlines,
Biofilm,
and Water Quality
 Dental Unit Waterlines
and Biofilm
Microbial biofilms form
in small bore tubing of
dental units
Biofilms serve as a
microbial reservoir
Primary source of
microorganisms is
municipal water supply
 Dental Unit Water Quality

Using water of uncertain quality is

inconsistent with infection control
principles
Colony counts in water from untreated
systems can exceed 1,000,000
CFU/mL (CFU=colony forming unit)
Untreated dental units cannot reliably
produce water that meets drinking
water standards
 Dental Water Quality

For routine dental

treatment, meet regulatory
standards for drinking
water.
<500 CFU/mL of heterotrophic
water bacteria
Dental Unit Water Quality ICX
Available on gray
cabinets at the
back of the bays

Instructions
posted in each
cubicle.
Dental Unit Water Quality – ICX

Rinse empty water bottle with tap water

Prior to rinsing make sure the water from
tap has run for at least 30 seconds or until
clear
Add one tablet of ICX to empty water
bottle – avoid touching the tablet
Fill bottle with tap water
Wait 60 seconds for tablet to fully dissolve
Avian Flu
University has a
task force

TMC is putting
together a
pandemic flu plan
and all member
institutions will be
involved
Avian Flu: How to protect yourself
Wash hands frequently
Get vaccinated for seasonal flu
Avoid close contact with sick people
When sick keep distance from others
Cover mouth and nose when coughing
and sneezing
Properly dispose of used tissues
 Bioterrorism

In the event of an emergency or specific

threat,
– the institution will activate its Incident
Command Center
– a technical center designed to manage such
emergencies.
 Bioterrorism

What you should do:

Carry your UT-Houston identification
badge at all times.
If stopped by UT Police and asked for
identification, you must present your
badge.
 Bioterrorism
Check the UT-Houston Web page at
http://www.uthouston.edu/Media/ , for
updated information on security levels,
instructions and procedures.
 Bioterrorism
Continue to be aware of your surroundings
and report any suspicious activity,
packages, people or items immediately to
UTPD at (713) 500-HELP (4357).
Have a plan for communicating with key
individuals.
Take time to re-assess emergency plans
within your particular unit and for your
home.
 Bioterrorism
If you are at home during an event:
– http://www.uthouston.edu
– Click on “emergency information” link at the
bottom of the page
– to determine operational status and whether
you should come to work/school
 Bioterrorism
Or call:
– (713) 500-7999 — for employees with
offices in the Medical School, John Freeman
Building, Hermann Professional Building, or
Jesse Jones Library Building

– (713) 500-9996 – for other U.T. Houston

employees and students
Stay Safe!