Safety Standards and Infection Control for Dental Hygienists

337 Pages·2001·4.138 MB·English

by  Ellen Dietz-Bourguignon, Raula Badavinac

Safety Standards
and
Infection Control
for
Dental Hygienists
Ellen Dietz, CDA, AAS, BS
Raula Badavinac, RDH, BAS
Australia Canada Mexico Singapore Spain United Kingdom United States
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Safety Standards and Infection Control for Dental Hygienists
7 by Ellen Dietz, CDA, AAS, BS
8 Raula Badavinac, RDH, BAS
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10 Health Care Publishing Director: Executive Marketing Manager:
William Brottmiller Dawn F. Gerrain
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Executive Editor: Channel Manager:
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Cathy L. Esperti Jennifer McAvey
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Developmental Editor: Production Editor:
16 Marah E. Bellegarde Mary Colleen Liburdi
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18 Editorial Assistant: Cover Design:
19 Matthew Thouin William Finnerty
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21 COPYRIGHT © 2002 by Delmar, ALL RIGHTS RESERVED.No part of Library of Congress Cataloging-in-
22 a division of Thomson Learning, Inc. this work covered by the copyright Publication Data
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used herein under license any form or by any means—graphic,
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38 in connection with any of the product information contained herein. Publisher does not assume, and expressly dis-
39 claims, any obligation to obtain and include information other than that provided to it by the manufacturer.
40
The reader is expressly warned to consider and adopt all safety precautions that might be indicated by the activities
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herein and to avoid all potential hazards. By following the instructions contained herein, the reader willingly
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assumes all risks in connection with such instructions.
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The Publisher makes no representation or warranties of any kind, including but not limited to, the warranties of
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Contents 8
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Foreword xv 18
Preface xvii 19
20
About the Authors xix
21
Acknowledgments xxi 22
23
SECTION I Microbiology and Disease Prevention 24
Specific to Dentistry 1 25
26
27
CHAPTER 1 Introduction to Microbiology . . . . . . . . . . . . . . . . . . . . 3
28
The Importance of Infection Control in the Dental Office . . . . . . . . . . . . . 4
29
Maintaining Aseptic Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
30
Members of the Dental Team Responsible for Infection Control . . . . . . 4
31
The Six Components in the Chain of Infection Control . . . . . . . . . . . . . . . 4
32
Infectious Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
33
Reservoir. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
34
Portal of Exit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
35
Means of Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
36
Portal of Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
37
Susceptible Host. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
38
Types of Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
39
Endogenous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
40
Exogenous. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
41
Nosocomial. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
42
Opportunistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
43
The Five Stages of Infectious Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
44
Incubation Stage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
45
Prodromal Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
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iv Contents
1 Acute Stage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2 Declining Stage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3 Convalescent Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4 The Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
5 Immunization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
6 Diseases of Concern to the Dental Hygienist . . . . . . . . . . . . . . . . . . . . . . 17
7 Hepatitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
8 Tuberculosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
9 Herpesvirus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
10 HIV Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
11 AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
12
13
CHAPTER 2 Disease Prevention in the Dental Office . . . . . . . . . . 25
14
15 Infection Control in Dentistry:Goals for Reducing
16 Cross-Contamination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
17 Ten Basic Principles of Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . 27
18 Patient Screening. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
19 Universal Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
20 Training of Employees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
21 Aseptic Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
22 Personal Protection:Hepatitis B Vaccine,Barriers,and
23 Personal Protective Equipment (PPE). . . . . . . . . . . . . . . . . . . . . . 28
24 Instrument and Handpiece Sterilization. . . . . . . . . . . . . . . . . . . . . . . . 29
25 Disinfection Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
26 Equipment Asepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
27 Dental Laboratory Asepsis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
28 Waste Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
29 Handwashing:The First Line of Defense in Disease Prevention . . . . . . . . 31
30 OSHA’s Handwashing Requirements . . . . . . . . . . . . . . . . . . . . . . . . . 32
31 Procedure Into Practice:Handwashing. . . . . . . . . . . . . . . . . . . . . . . . . . . 33
32 General Handwashing Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
33 Risk Reduction at Chairside . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
34 Preprocedural Antiseptic Mouthrinses. . . . . . . . . . . . . . . . . . . . . . . . . 36
35 Disposables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
36 Dental Dam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
37 High-Volume Evacuation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
38
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CHAPTER 3 Patient Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
40
Function and Importance of a Medical/Dental History. . . . . . . . . . . . . . . 42
41
Updating the Medical History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
42
Filing Lab Test Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
43
Latex Sensitivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
44
Methods to Combat Allergic Responses to Latex. . . . . . . . . . . . . . . . . 44
45
Screening Patients for Latex Allergy. . . . . . . . . . . . . . . . . . . . . . . . . . . 45
46
Completing Medical/Dental History Forms . . . . . . . . . . . . . . . . . . . . . . . 45
47
Interacting with the Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
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Contents v
Managing Difficult Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 1
Managing Sensitive Topics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 2
Related Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3
Clinical Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 4
Financial Responsibility and Insurance . . . . . . . . . . . . . . . . . . . . . . . . 49 5
Informed Consent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 6
7
8
CHAPTER 4 Legal and Ethical Considerations of
9
Infection Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
10
Legal and Ethical Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 11
Dental Jurisprudence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 12
Dental Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 13
Professional Standards of the Dental Hygienist. . . . . . . . . . . . . . . . . . . . . 54 14
Malpractice Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 15
Vicarious Liability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 16
Dental Hygiene Code of Ethics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 17
Maintaining Confidentiality of Patients’Records. . . . . . . . . . . . . . . . . . . . 58 18
Patient Confidentiality and the Fax Machine. . . . . . . . . . . . . . . . . . . . 58 19
Informed Consent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 20
Privileged Communications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 21
Treating High-Risk Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 22
Office Policy Statement on Treating Patients with HIV/AIDS. . . . . . . . 61 23
Observe Applicable Laws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 24
The Americans with Disabilities Act. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 25
Implications for the Dental Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 26
Necessary Office Renovations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 27
Risk Management and Quality Assurance Strategies to Prevent 28
Malpractice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 29
Negligence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 30
Standard of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 31
Abandonment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 32
Burden of Proof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 33
Elements of Malpractice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 34
Causes of Malpractice Suits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 35
Steps to Prevent Malpractice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 36
When an Accident Happens or a Patient Complains . . . . . . . . . . . . . . 69 37
When a Patient Declines or Discontinues Treatment . . . . . . . . . . . . . . 69 38
39
SECTION II National Guidelines, Recommendations, 40
and Regulations Affecting Dental Practice 75 41
42
43
CHAPTER 5 Regulatory Government Agencies and
44
Professional Associations. . . . . . . . . . . . . . . . . . . . . . 77
45
The Role of Government Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
46
Complying with Local,State,and Federal Regulations . . . . . . . . . . . . . . . 78
47
Differences and Distinctions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
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vi Contents
1 Centers for Disease Control and Prevention . . . . . . . . . . . . . . . . . . . . 78
2 Occupational Safety and Health Administration. . . . . . . . . . . . . . . . . . 79
3 Environmental Protection Agency . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
4 Food and Drug Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
5 Organization for Safety and Asepsis Procedures. . . . . . . . . . . . . . . . . . 80
6 American Dental Association. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
7 American Dental Hygienists’Association. . . . . . . . . . . . . . . . . . . . . . . 81
8
9
CHAPTER 6 The Dental Office Safety Supervisor . . . . . . . . . . . . . 85
10
11 Role of the Office Safety Trainer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
12 Training Organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
13 Record Keeping of Training Sessions. . . . . . . . . . . . . . . . . . . . . . . . . . 87
14 Twelve Tasks of the Office Safety Supervisor. . . . . . . . . . . . . . . . . . . . . . . 87
15 Train Newly Hired Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
16 Retrain All Personnel at Least Annually. . . . . . . . . . . . . . . . . . . . . . . . 87
17 Schedule Review Meetings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
18 Train Janitorial Service Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
19 Maintain Records Files . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
20 Perform Hands-on Daily Functions. . . . . . . . . . . . . . . . . . . . . . . . . . . 89
21 Perform Inventory Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
22 Supervise Staff Quality Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
23 Supervisor Handling and Treatment of Contaminated Laundry. . . . . . 90
24 Conduct Monthly Compliance Inspections . . . . . . . . . . . . . . . . . . . . . 90
25 Monitor Infection Control Publications. . . . . . . . . . . . . . . . . . . . . . . . 90
26 Prepare Patient Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
27
28 SECTION III Infection Control Techniques in the
29 Dental Office 95
30
31
CHAPTER 7 Personal Safety and Barrier Protection. . . . . . . . . . . 97
32
Hepatitis B and Other Recommended Vaccinations. . . . . . . . . . . . . . . . . . 98
33
Identifying Employees at Risk:Exposure Determination by
34
Categories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
35
Task Categorization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
36
Category I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
37
Category II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
38
Category III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
39
Universal Precautions:Gloves,Masks,Eyewear,and Outer
40
Protective Clothing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
41
Types of Gloves Used in Dentistry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
42
Disposable (Nonsterile) Examination Gloves. . . . . . . . . . . . . . . . . . . 101
43
Overgloves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
44
Sterile Gloves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
45
Nitrile Utility Gloves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
46
Nonallergenic Gloves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
47
Proper Use of Gloves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
48
Contents vii
Gloving Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 1
Glove Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 2
Latex Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 3
Masks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 4
Eyewear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 5
Scrubs or Protective Outer Garments. . . . . . . . . . . . . . . . . . . . . . . . . . . 106 6
Laundering of Reusable PPE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 7
Guidelines for Putting On and Removing PPE . . . . . . . . . . . . . . . . . . . . 108 8
Procedure Into Practice:Donning PPE. . . . . . . . . . . . . . . . . . . . . . . . . . 108 9
Procedure Into Practice:Removing PPE. . . . . . . . . . . . . . . . . . . . . . . . . 109 10
Eyewash Stations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 11
Sharps Management and Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 12
Procedure Into Practice:Emergency Eyewash Procedure . . . . . . . . . . . . 112 13
Recapping Contaminated Needles. . . . . . . . . . . . . . . . . . . . . . . . . . . 113 14
Procedure Into Practice:Minimizing Personal Injury from 15
Contaminated Sharps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 16
Updated Safety Needle Management Regulations . . . . . . . . . . . . . . . 114 17
Handling an Accidental Exposure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 18
Procedure Into Practice:What the Dental Hygienist Must Do 19
in the Event of an Accidental Exposure. . . . . . . . . . . . . . . . . . . . 117 20
Procedure Into Practice:What the Dentist/Employer Must Do 21
in the Event of an Accidental Exposure. . . . . . . . . . . . . . . . . . . . 117 22
23
24
CHAPTER 8 Instrument Recirculation. . . . . . . . . . . . . . . . . . . . . . 121
25
Introduction to Instrument Recirculation . . . . . . . . . . . . . . . . . . . . . . . . 122 26
Critical,Semicritical,and Noncritical Classifications. . . . . . . . . . . . . . . . 122 27
Critical Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 28
Semicritical Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 29
Noncritical Items. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 30
Processing Contaminated Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . 123 31
After Completion of a Chairside Procedure. . . . . . . . . . . . . . . . . . . . . . . 123 32
Procedure Into Practice:Processing Contaminated Instruments . . . . . . . 124 33
Instrument Precleaning/Soaking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 34
Instrument Scrubbing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 35
Manual Instrument Scrubbing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 36
Procedure Into Practice:Manual Instrument Scrubbing . . . . . . . . . . . . . 126 37
Ultrasonic Tips and Air Abrasive Tips . . . . . . . . . . . . . . . . . . . . . . . . 127 38
Ultrasonic Instrument Cleaning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 39
Procedure Into Practice:Ultrasonically Scrubbing Instruments. . . . . . . . 128 40
Monitoring the Ultrasonic Instrument Cleaner . . . . . . . . . . . . . . . . . 129 41
Disinfection versus Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 42
Chemical Disinfection of Instruments . . . . . . . . . . . . . . . . . . . . . . . . 129 43
Procedure Into Practice:Chemical Disinfection of Instruments 44
That Cannot Be Heat Sterilized . . . . . . . . . . . . . . . . . . . . . . . . . 130 45
Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 46
Accepted Methods of Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 47
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viii Contents
1 Liquid Chemical Sterilants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
2 Ethylene Oxide Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
3 Dry Heat Sterilization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
4 Steam under Pressure (Autoclaving) . . . . . . . . . . . . . . . . . . . . . . . . . 134
5 Procedure Into Practice:Instructions for Operating the Autoclave. . . . . . 136
6 Flash “Priority”Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
7 Chemical Vapor Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
8 Processing High-Speed Dental Handpieces. . . . . . . . . . . . . . . . . . . . . . . 138
9 Procedure Into Practice:Handpiece Sterilization Steps. . . . . . . . . . . . . . 139
10 Processing Fiber-Optic Handpieces. . . . . . . . . . . . . . . . . . . . . . . . . . 140
11 Procedure Into Practice:Packaging Instruments and Loading
12 the Sterilizer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
13 Sterilizer Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
14 Biological Monitors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
15 Procedure Into Practice:Maintaining a Sterilization Monitoring Log . . . 142
16 Process Indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
17 Storage of Sterilized Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
18 Most Common Reasons for Instrument Sterilization Failure. . . . . . . . . . 145
19 Autoclave Sterilization Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
20 Unsaturated Chemical Vapor Sterilization Errors. . . . . . . . . . . . . . . . 145
21 Dry Heat Sterilization Errors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
22
23
CHAPTER 9 Environmental Surface and Equipment Asepsis. . 149
24
25 The Need for Surface Disinfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
26 Classification of Environmental Surfaces. . . . . . . . . . . . . . . . . . . . . . 150
27 Decontamination of Environmental Surfaces. . . . . . . . . . . . . . . . . . . 150
28 Chemical Disinfectants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
29 Chlorine Dioxide Compounds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
30 Glutaraldehydes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
31 Iodophors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
32 Sodium Hypochlorite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
33 Phenolics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
34 Isopropyl Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
35 Spray-Wipe-Spray Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
36 Procedure Into Practice:Guidelines for Mixing,Handling,
37 and Discarding Chemical Sterilants and Disinfectants. . . . . . . . . 154
38 Placement of Protective Barriers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
39 Procedure Into Practice:Guidelines for the Spray-Wipe-Spray
40 Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
41 Custom Barriers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
42 Front Office Barriers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
43 Procedure Into Practice:Guidelines for Placing and Removing
44 Environmental Surface Barriers. . . . . . . . . . . . . . . . . . . . . . . . . . 157
45
46
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Contents ix
CHAPTER 10 Dental Laboratory Asepsis . . . . . . . . . . . . . . . . . . . . 161 1
The Importance of Infection Control Procedures in the Dental 2
Office Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 3
Communication with the Commercial Dental Lab. . . . . . . . . . . . . . . 162 4
Logging and Tracking Lab Cases. . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 5
Management of Outgoing Lab Cases. . . . . . . . . . . . . . . . . . . . . . . . . 163 6
Management of Incoming Lab Cases. . . . . . . . . . . . . . . . . . . . . . . . . 163 7
Asepsis in the Shipping/Receiving Areas of the Office. . . . . . . . . . . . . 165 8
Appropriate PPE in the Lab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 9
Disinfection of Lab Counters and Work Surfaces. . . . . . . . . . . . . . . . 165 10
Disinfection of Removable Prosthetics and Orthodontic Appliances. . 166 11
Procedure Into Practice:Disinfection of a Dental Prosthesis or 12
Orthodontic Appliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 13
Disinfection of Dental Impressions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 14
Elastomeric Impressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 15
Alginate (Irreversible Hydrocolloid) Impressions. . . . . . . . . . . . . . . . 168 16
Hydrocolloid (Reversible) Impressions . . . . . . . . . . . . . . . . . . . . . . . 168 17
Disinfection of Related Dental Laboratory Items . . . . . . . . . . . . . . . . . . 169 18
Wax Rims and Wax Bites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 19
Bite Registrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 20
Custom Acrylic Impression Trays,Bleaching Trays,and 21
Mouth Protectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 22
Dental Casts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 23
Miscellaneous Chairside Lab Items. . . . . . . . . . . . . . . . . . . . . . . . . . 170 24
Rubber Bowls and Mixing Spatulas. . . . . . . . . . . . . . . . . . . . . . . . . . 170 25
Stock Impression Trays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 26
Asepsis in the Dental Office Lab. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 27
Pumice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 28
Brush Wheels and Rag Wheels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 29
Disposal of Laboratory Waste Materials . . . . . . . . . . . . . . . . . . . . . . . . . 172 30
31
32
CHAPTER 11 Infection Control in Dental Radiography . . . . . . . . 175 33
Infection Control Awareness in Dental Radiography. . . . . . . . . . . . . . . . 176 34
Prior to Exposing Radiographs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 35
Protective Barriers in the Radiographic Area . . . . . . . . . . . . . . . . . . . 176 36
ADA Infection Control Recommendations for X-Ray Equipment 37
and Films . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 38
Procedure Into Practice:Placing and Removing Protective Surface 39
Barriers in the Radiographic Operatory . . . . . . . . . . . . . . . . . . . 177 40
Procedure Into Practice:Infection Control Procedures for the 41
Radiography Operatory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 42
Handling the X-ray Film Packet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 43
Handling Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 44
Barrier Protection Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 45
Two-Wipe Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 46
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