Policies and Procedures: Asepsis, Infection control and Hazardous control protocol. Preclinical/Laboratory/Clinical Infection Control

Orange Coast College

Dental Assisting Program

Rationale: The risk of cross-infection between the dentist, dental auxiliaries and patient is significant in a dental office setting. Since the dentist and auxiliaries are working with fluid, such as blood and saliva, there is the possibility that infectious microorganisms can be present in the patient, dentist or dental auxiliary. Protected methods must be utilized to stop the transferring of infectious microorganisms from one person to another person to object to person. The transmission can be either direct or indirect.

The Dental Assisting Program at Orange Coast College uses the principles of Standard Precautions which states all human blood and specific human body fluids are treated as if known to be infectious with the HIV virus, Hepatitis B virus and other bloodborne pathogens.

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Methods to Prevent the Transmission of Infectious Disease

All infection control programs utilize the principles of universal/standard precautions, in which, all human blood and specific human body fluids are treated as if known to be infected with the HIVvirus, Hepatitis B virus and other bloodborne pathogens. Components of this program will be discussed by describing the minimum standards for infection control recommended by the CDC (Center for Disease Control).

1. Personal Protective Equipment (PPE)

1. Gloves

(1) When there is a chance of coming into contact with blood, blood contaminated saliva, or other fluids found in the gingival sulcus and mucous, medical gloves are to be worn at all times.

(2) After contact with patient, glove must be removed, hands washed and then, before treating another patient, re-gloved.

(3) Types of gloves and their use are as follows:

a. Examination gloves (latex) are non-sterile and may be used for non-surgical procedures; one patient use glove.

b. Sterile gloves are used during surgical procedures; one patient use glove.

c. Rubber utility gloves, thicker and not easily penetrated; used for cleaning, disinfecting, and sterilization procedures. They should be sterilized or disinfected after use.

(4) Latex sensitivity may cause mild localized coughing, sneezing or dermatitis (irritation to skin) and anaphylaxis. When allergies exist, synthetic polymer gloves can be used instead.

2. Protective Clothing

(1) A lab coat, gown, or uniform must be worn when clothing is likely to be contaminated with blood and/or other oral fluids.

(2) Protective clothing should be removed prior to leaving the work area and placed in an appropriate container to prepare for decontamination, disinfecting, or disposal.

(3) When visible soiled or at least once per day, protective clothing should be changed.

3. Protective Masks

(1) For procedures that may produce splatter of blood, other oral fluids or when exposed to a potentially infectious mist from hand-piece, a face mask is always worn.

(2) The mask protects the patient, when an operator or assistant has a potentially infectious disease (cold in its primary stages). If the patient has a potentially infectious disease, the same is true, as the mask acts to block the transference process.

(3) Surgical face masks should be changed between each patient and/or when moist (wet).

4. Face shields or Protective eyewear

(1) Eye protection must be large enough to protect the eye from infected blood, fluid or particles.

(2) Even if a face shield is used, a face mask must still be worn.

(3) Face shield/Eyewear must be cleaned and disinfected after each patient or when visibly soiled.

(4) Side shields should be added when wearing prescription eyewear.

2. Hand Washing
1. Hand washing should be performed as follows:

(1) Upon arriving at the Dental office; it reduces microorganism from being brought into the office.

(2) After touching objects (barehanded) that perhaps is contaminated with either blood or oral fluids.

(3) Before or after treating each patient.

(4) Before and after wearing utility gloves; decontaminating the dental operatory.

(5) Upon leaving the Dental office; it reduces the spread of microorganisms outside of the office.

2. Characteristics of Hand Washing

(1) Wash hands with liquid antimicrobial soap and water for 15-30 seconds. Rinse hands with cool water. Dry hands before gloving.

(2) Avoid touching sink, handle, etc.

3. Other Protective Practices
1. Protecting Environmental Surfaces

(1) The following listed are environmental surfaces that should be covered with a barrier (e.g. foil, clear plastic wrap, or bags) as they are difficult, perhaps impossible to clean and disinfect. The barriers should be removed at the end of the dental appointment with utility gloves.

a. Light switch and handles

b. Air/water syringe handles and hoses

c. X-ray cone and tube

d. X-ray timer buttons

e. Oral evacuation hoses

f. Hand-piece hoses

g. Dental chair

h. Any surface that is touched in the operatory during a clinical procedure.

2. Aerosols

(1) In the dental laboratory, a splash shield should be used.

(2) Aerosol splatter that is created by either the air/water syringe or the high speed hand-piece can be reduced by using a high velocity evacuation system and/or rubber dam.

3. Resuscitation equipment

(1) Disposable mouth pieces should be used for CPR, ventilating devices or resuscitation bags.

4. Daylight Loader Processors

(1) Cross contamination easily occurs when using a daylight loader.

(2) The utilization of barrier protecting x-ray film packets minimizes the risk and can be used. (see procedure in radiology infection control policy for use in dental assisting program)

5. Employee practices

(1) In areas where they may be exposed to blood and/or oral fluids, employees must not eat, drink, smoke, apply cosmetics or handle contact lenses.

(2) Plastic over gloves should be worn over the examination gloves, when a gloved health professional leaves the patient, while handling the patient’s chart, x-rays, dental materials, etc.

4. Use and Care of Sharps

One of the largest problems in a dental office is cross-contamination by misuse of anesthetic needles or other sharps.

Never bend or break a needle after use. Hand to hand resheathing of needles should never be done! Syringe needles may be recapped using one of the following methods:

Place the sheath covering on the tray. After the injection, with one hand scoop, place the needle back into the sheath covering.

OR

Place a needle guard on the sheath (propped upon table); using one hand, slide needle into sheath.

A. Classification of Sharps

1. All sharps must be placed in an appropriate puncture-resistant red biohazard (sharps) container that is easily accessible.

2. Anesthetic syringe needles, anesthetic carpules, scalpel blades, orthodontic wires, and broken glass slabs are considered sharps.

B. Proper disposal of filled sharps containers.

1. Regulations may require that a professional disposal service pick up the filled sharps’ containers.

2. EPA regulates how sharps’ containers must be handled. Sharps’ containers are classified as infectious waste.

3. Many sharps’ containers are autoclavable; after proper sterilization the contents are no longer considered infectious waste.